|Year : 2015 | Volume
| Issue : 2 | Page : 151-155
Socioeconomic characteristics of alcohol and other substance users, seeking treatment in Sikkim, North East India
Sunil Kumar Pandey1, Debranjan Datta1, Sanjiba Dutta2, Yogesh Verma3, Amit Chakrabarti4
1 Department of Pharmacology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
2 Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
3 Department of Pathology, Medical Superintendent, STNM Hospital, Government of Sikkim, Gangtok, Sikkim, India
4 Division of Toxicology, Regional Occupational Health Centre (Eastern), National Institute of Occupational Health, Indian Council of Medical Research, Kolkata, West Bengal, India
|Date of Submission||01-Apr-2014|
|Date of Decision||10-Aug-2014|
|Date of Acceptance||23-Sep-2014|
|Date of Web Publication||1-Apr-2015|
Sunil Kumar Pandey
Department of Pharmacology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: The present study was conducted to generate information for better understanding of socioeconomic and CAGE characteristics of alcohol and other substance users who were undergoing treatment in Sikkim. Subjects and Methods: Socioeconomic and CAGE questionnaire was administered to alcohol and other substance abusers of Sikkim (n = 241) who were undergoing treatment in different treatment centers of Sikkim. Information was collected on printed instrument after taking participant's consent and data was statistically analyzed. Results: Male participants (93.8%) outnumbered female (6.2%). Majority of the sample were either in the school dropout group or school completed (36.1%) group. Most of the samples were occupationally unemployed, urban residents, Nepali by ethnicity, single, and Hindu (48.5%) by religion. Minimum age for starting of alcohol and drug was 5 years and 7 years respectively. Knowledge about AIDS and its transmission was satisfactory. All the four CAGE characteristics were present in majority of samples. Conclusions: Climate, geographical location, wide and easy availability of alcohol in Sikkim make this state vulnerable for alcohol abuse. Alcohol drinking among parents, sibling and friends found to be important risk factor. Outreach to the community for better acceptability of treatment is an important area to fill the gap of treatment demand and treatment supply.
Keywords: Abuse, alcohol, treatment, Sikkim, socioeconomic
|How to cite this article:|
Pandey SK, Datta D, Dutta S, Verma Y, Chakrabarti A. Socioeconomic characteristics of alcohol and other substance users, seeking treatment in Sikkim, North East India. J Pharm Bioall Sci 2015;7:151-5
|How to cite this URL:|
Pandey SK, Datta D, Dutta S, Verma Y, Chakrabarti A. Socioeconomic characteristics of alcohol and other substance users, seeking treatment in Sikkim, North East India. J Pharm Bioall Sci [serial online] 2015 [cited 2021 Mar 9];7:151-5. Available from: https://www.jpbsonline.org/text.asp?2015/7/2/151/148778
Consumption of alcohol and other substance (drugs), are major public health concern around the globe. The World Health Organization has noted, alcohol and drug use disorders as one of the three behavioral diseases as the leading cause of disability (mental illness and Alzheimer's disease/dementia are the other two). ,
Consumption has direct relation with production and trafficking. Illicit cultivation of cannabis and opium poppy in India has been reported in many studies. International Narcotic Control Board reported that in India, around 7,500 ha area is being used in the cultivation of Opium poppy. United Nation Office on Drug and Crime, has estimated that out of 40 tons of total heroin available in South Asia in 2009, 15 tons of it had been illicitly manufactured in India.  Around 95 ha of cannabis has already been eradicated in the first half of 2011. India is one of the source country of ketamine, benzodiazepines, cannabis, heroin, precursor chemical for MDMA [3,4-Methylenedioxy-methamphetamine (ecstasy)]. 
Cannabis remains the most widely used illicit substance globally, with an estimated annual prevalence in 2010 of 2.6-5.0% of the adult population aged between 15 and 64 years. India, was ranked the third largest source country of cannabis resin in 2010.  For around a decade (2002-2010), India was one among other illicit opium poppy cultivating country.  There is dearth of correct information in regard to use of Cocaine and illicit substance use in India.
A study revealed an overall substance use prevalence of 6.9/1000 for India with urban and rural rates of 5.8 and 7.3/1000 population. The gender based difference in rates among men and women were 11.9 and 1.7% respectively. ,
The National Household Survey (NHS) of Drug Use in India  is the first large systematic survey to document the nation-wide prevalence of drug use in India. The study had shown that the primary substance used (except tobacco) was alcohol (21.4%) followed by cannabis (3.0%) and opioid (0.7%). Seventeen to 26% of alcohol users qualified for International Classification of Diseases (ICD) 10 diagnosis of dependence, translating to an average prevalence of about 4%. The Drug Abuse Monitoring System,  which evaluated the primary substance of abuse in inpatient treatment centers found that the major substances were alcohol (43.9%), opioids (26%) and cannabis (11.6%). 
India is a country with high rates of alcohol production as well as consumption. India contributes to almost 65% alcohol produced in South East Asia. , When translated in absolute numbers, the data of National household survey shows that there are 62.5 million alcohol users and 10 million alcohol dependents in India. ,
The result of National Family Health Survey-3 (NFHS-3)  reflect an increase in alcohol use among males since the NFHS-2, and an increase in tobacco use among women.  There is a marked variation in alcohol use prevalence in different states of India (a low of 7% in the western state of Gujarat (officially under Prohibition) to 75% in the North-Eastern state of Arunachal Pradesh. 
From unofficial estimates, alcohol use has traditionally been prevalent among population of Sikkim. There is rampant drug abuse in Sikkim-even inadvertently; student starts as early as from the age of 9 to 10 years, when they start using dendrite, alcohol and tobacco. 
Sikkim, a hilly state in Northeast India is located in the foothills of the Himalayas and shares international borders with Nepal, Bhutan and Tibet.  Sikkim has an approximate population of 540,768,  a literacy rate of 70% and a landscape varying from 300-8585 meters in altitude.  NFHS-3, Government of India, has also highlighted a significant prevalence of alcohol use in Sikkim - 45.4% and 19.1% among above 15-49 years of age in males and females, respectively. 
There is a dearth of information on socioeconomic status and pattern of alcohol and other substance users of Sikkim who are undergoing any kind of treatment. So, this study is an effort to bring out those information. This may add information on prevalence and pattern of abusers in Sikkim and may help in achieving the target of making the state a drug free society by 2015. 
Specific objectives were:
- To describe sociodemographic and economic characteristic using sociodemographic instrument
- To describe CAGE characteristics using CAGE- Cut-down, Annoyed, Guilt, Eye-opener questionnaire.
| Subjects and Methods|| |
This single, cross sectional, baseline situation assessment of socioeconomic and CAGE characteristics was carried out in seven treatment centers of Sikkim (one each of private and public hospital of east Sikkim and five rehabilitation [two in South Sikkim and three in East Sikkim] centers). The assessment was carried out on regular visit as per the convenience and suitability of the center and the investigator, from March 2011 to December 2012.
This baseline situation assessment encompassed collection of primary data on the sociodemographic and economic status along with CAGE characteristics. The chosen treatment centers are the major centers, for the treatment of abuse and addiction and are also easily accessible. The study was designed as a target population based survey, which involved voluntary participation of: Any type of drug (except nicotine), alcohol dependents who were already going under treatment or rehabilitation. Treatment centers, were visited and due permission was taken from the concerned administrators of respective centers for interviewing the participants. Repeated visit was made to enroll maximum possible participants. The participants were not preinformed about the survey and participant selection was done immediately prior to interviewing.
As this was an exploratory assessment, the initial target was set to enroll at least n = 220 participants altogether but, by the end of the study there were n = 241 participants.
Two instruments were used in the study; the first was the 29-item sociodemographic questionnaire  and the second questionnaire was 4-item CAGE questionnaire  (4 items).
The sociodemographic questionnaire was broadly based on:
- Demographic, family background and social status variables
- Familial and social environment variables
- High risk behavior-related variables
- Previous treatment history variables.
The CAGE questionnaire  was used for alcohol users and comprised of following questions:
- Have you felt you needed to cut down on your drinking?
- Have you felt annoyed by criticism of your drinking?
- Have you felt guilty about drinking?
- Have you felt you needed a drink first thing in the morning [eye-opener]?
Standardization, and validation of instruments was carried out by expert analysis method.
Data collection was based on personal interviews with the participants. Before interview, the participants were explained about the nature and objective of the study and the nature of questions involved. Confidentiality was ensured and it was also mentioned that they have the freedom of refraining from any response. The respondents were also briefed about the need of their honest answers in order to get correct information. The interview was initiated only after the participant understood, voluntarily agreed and signed (or left thumb impression) the informed consent form. The informed consent form was originally made in English language and then was translated to Hindi and Nepali language for better understanding of participants. They were given a copy of signed informed consent. The interview was conducted in private. During interview local Nepali language, Hindi or English was used as per the convenience of the participant. All responses were recorded on the printed paper questionnaire form. Participants were not given any monetary or other compensation in lieu of participation in the study.
The study protocol and questionnaires were approved by the Research Protocol Evaluation Committee and Institutional Ethical Committee.
Data was feeded in Statistical Package for the Social Sciences, version 20, IBM Corp. Before analysis all entries were checked and cleaned. The frequency distribution analysis was done by running descriptive analysis and Chi-square was run for nonparametric data to show the significant difference, if any. Level of significance was set at P < 0.05.
| Results|| |
[Table 1] shows, the socio economic and demographic characteristics of all the participants (n = 241) of the study. The male participants (93.8%) outnumbered female (6.2%). The age range of male and female participants was between 17 and 63 years and between 21 and 60 years respectively. Predominant participants (86%) were in the age group of 15-44. Majority of the sample were either in the school dropout group (37%) or school completed (36.1%) group. Most of the samples were unemployed (31.1%), urban residents, Nepali by ethnicity, single, and Hindu by religion (48.5%). The annual income of most of the participant (74%) was below INR 10,000/month.
|Table 1: Sociodemographic and economic characteristics of patients participating in the study (n=241|
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[Table 2] shows, history and pattern of alcohol or substance use. Majority had used alcohol (68.4%) or other substance (77.4%) or both between past 21 and 30 days before initiation of the treatment. Predominant participants started consuming alcohol in the age group of 15-30 years (70.5%) and other substance (drug) in the age group of 16-25 years (54.4%). Minimum age for starting of alcohol was 5 years and 7 years for drugs. 52% samples had parental history of alcohol consumption when compared to parental history of drugs consumption (1.26%).
|Table 2: Pattern of alcohol and substance (drug) use among the participants and their family members|
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[Table 3] shows, the treatment characteristic of participants, the first treatment initiator for maximum participants were family members (63.1%) and the expenses was borne by parents (44%). According to most of the treatment undergoing participants (37.8%), the cost of treatment was between INR 12501-22500.
[Table 4] shows, the significant difference of socio-demographic characteristics between male and female. Significant difference was found between the literacy rate of male (92.03%) and female (53.33%) alcohol and/or drug abusers (χ2 = 30.08, df = 1, P < 0.0001). There was no significant difference in sex ratio of participants from urban and rural population. We found more of male belonged to, other than married group and female in married group.
|Table 4: Sociodemographic significant differences between male and female|
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[Table 5] shows, the four important characteristics (CAGE) of alcohol dependent/abusers. All the four characteristics were present in most samples. 46.6% sample had a total score of 4 in CAGE instrument.
|Table 5: CAGE characteristics of patients participating in the study (n=174)|
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[Table 6]. There was significant difference between urban and rural groups for the knowledge about AIDS (P = 0.020) and between two groups for the knowledge about AIDS transmission (P = 0.006).
|Table 6: Differences in knowledge of AIDS between urban and rural respondents|
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| Discussion|| |
When compared with the study of Goel et al., 2010, and study of home department, Government of Sikkim, the respondents were having lower literacy (Amit Goel et al., 2009-98%), marital status (Amit Goel et al., 2009-57.3%), more number of respondents were in school dropout group and majority of alcohol and/or drug abusers were Nepali (66.8%) by ethnicity , and in contrast, present study [Table 4] show literacy in men (NFHS-3-83%), higher and literacy of females (NFHS-3-72%), marital status of male (NFHS-3-55.33%) lower than NFHS-3 survey.  Parental status of alcohol use differ significantly between the sexes, the history of use of alcohol by fathers was more in case of males and by both the parents in case of females. The Drug Abuse Monitoring Survey conducted in 203 treatment centers in different states of India reflected that 42% have completed higher secondary education and above 70% were employed and 71.9% were married which is larger than our present study. 
Among the substance (drug) using population in this study, 54.4% respondent started in the age group of 16-25 years which is comparable to Goel et al. 2010 study (74.6%) and NHS (60%). For the alcohol using population 70.5% respondent had started taking alcohol in the age group of 15-30 years. Family history  and drug use by friends  were found to be important risk in this study too. Parental alcohol use was significantly higher than drug use and it was more in female (80%) and rural (63.1%) respondents. 79.67% and 59.8% respondents had more than one alcohol using friends and drugs using friends respectively. This highlights the importance and impact of use of alcohol and drugs by friends. Knowledge about AIDS and its transmission found to be appreciably good in both urban and rural respondents but significant difference was found in both the variables and between the groups.
Of all the alcohol dependent participants (n = 174), around 70% had misused alcohol in the past 1-month before the treatment initiation. The result of CAGE questionnaire show that 47% of respondents had a total score of 4 which reflects the severity of dependence and it matches with the NFHS-3 survey where it was found to be 45.4%. 
| Conclusions|| |
From the participant's responses it could be concluded that the number of male abusers were more than female. Alcohol use could be correlated with the climatic and geographical location of Sikkim. Pattern of alcohol drinking among parents, sibling and friends found to be important risk factors. Nepali being the dominant community outnumbered others. Wide availability of alcohol in Sikkim is one among important factors for increased number abusers. Knowledge about AIDS and its transmission among the patients undergoing treatment was sufficiently good but there is a scope of improvement. Outreach in the society for recognizing treatment seekers is one important thing to look upon and extensive study is required focusing on treatment aspect of abusers.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]