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1 EXTENT OF THE PROBLEM

Extent of Drug and Tobacco Addiction and Alcoholism in India, Myths Associated with Them,
Health Hazards Associated with them and How they have become silent killers

3.1.0 Objectives
3.1.1 Introduction
3.1.2 Definition & Important Concepts
3.1.2.1 What is Drug?
3.1.2.2 Drug Abuse
3.1.2.3 Alcoholism
3.1.2.4. Drug Addiction and facts related to Narcotic drugs
3.1.3 The Process of Addiction
3.1.3.1. Addiction to Alcohol
3.1.3.2. Addiction to Drugs
3.1.4. Causes of Alcoholism and Drugs Addiction
3.1.4.1. Physiological Causes
3.1.4.2. Individual or Psychological Causes
3.1.4.3. Sociocultural /Environmental Causes
3.1.5. Extent of Drug and Tobacco Addiction and Alcoholism in India
3.1.5.1 Extent of substance abuse in India
3.1.5.2 Harmful and Dependent Use
3.1.5.3 The Way Forward
3.1.6. Myths related to Drugs and Alcohol Usage
3.1.7. Health Hazards Associated with them and how they have become silent killers
3.1.7.1 Health Consequences of Drug Abuse
3.1.7.2 Health Hazards Related to Alcohol Consumption
3.1.7.3 Alcohol, Drug Use and HIV/AIDS
3.1.8. Let us sum up
3.1.9. Key Words
3.1.10. Check Your Learning
3.1.11. Suggested Readings

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3.1.0 Objectives
Addiction to drugs and alcohol is today a worldwide crisis. The demand for and supply of
pharmaceuticals made in laboratories and naturally are both rising. The number of addicts is
rising and affecting nations all over the world, including India. As a result, the nation's
productivity has decreased. The majority of the countries are now starting to take the issue
seriously and acting to reduce it. The issue of alcoholism and drug addiction is covered in this
unit. After studying this lesson, you will be able to:
 Give an overview of the situation of drug and alcohol abuse and addiction in India;
 Describe the types of drugs and the causes as well as process of addiction; and
 Discuss the relationship between drugs addiction and alcoholism with health hazards and
crime
3.1.1 Introduction
Alcoholism and drug addiction are a worldwide menace at present. This is widespread
among adolescents, young adults and others. This substance abuse, like an epidemic, has taken
thousands of lives and threatens millions of lives worldwide. Besides, this also leads to various
biological and psychological problems for the individual indulging in their use. This worldwide
phenomenon has affected several nations, including India. National production has suffered as a
result all over the world. Most countries are now beginning to take the issue seriously and are
taking action to lessen it.
The Report of United Nations Office on Drugs and Crimes find that around 275 million
people were drug users worldwide in 2020, while over 36 million people suffered from drug use
disorders. A recent report (2022) suggests that around 284 million people aged between 15-64
use drugs worldwide, which is a 26 per cent increase over the previous decade. The same report
makes an observation that the rate of substance use is phenomenally high among the young aged
between 18 and 25. In Africa and Latin America, people aged under 35 represent the majority of
people being treated for drug use disorders. This substance abuse, like an epidemic, has taken
thousands of lives and threatens millions of lives worldwide. Besides, this also leads to various
biological and psychological problems for the individual indulging in substance abuse. This
worldwide phenomenon has affected several nations, including India. As a result, national
production has suffered all over the world. Women abusers in South Asian countries are on the
increase. They account for 17 percent of lifetime abusers. Reports show that a substantial
percentage of women drug addicts are divorced, separated, and widowed (India and Sri Lanka).

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The drug market today is the most profitable market attracting an increasing number of
customers. It is a supply-driven market that makes people, particularly the young, fall an easy
prey to substance use. Unknowingly, thousands of teenagers, adolescents and youth are
becoming victims of substance use today. Most countries are now beginning to take the issue
seriously and taking action to resolve it.

3.1.2 Definition and Important Concepts

In the following subsections, we will discuss the definitions of some of the important
concepts related to alcoholism and drug addictions such as drug use and abuse, addiction,
tolerance, dependence, alcoholism and so on.
3.1.2.1 What is Drug?
Drug is a chemical substance which is given to people in order to treat an illness or
disease or to prevent illness or disease. Drugs are chemicals that, when ingested by humans, can
alter both their physiological and cognitive functions. A doctor may recommend these chemicals
as medicine to treat minor illnesses or difficulties, such as difficulty in sleeping, headaches,
tension, etc. Most of the time, using these medicines is lawful. When drug are used for non-
medical purposes, it is an abuse.
Drugs may occasionally have non-medical purposes. Their usage is prohibited, as with
heroin and brown sugar. Alcohol use is permitted, although it might be dangerous if consumed
frequently or in large amounts. Other substances that fall under the category of socially
acceptable legal drugs include cigarettes, coffee, tea, and others. But they are not thought to be
hazardous. Some drugs, including alcohol, brown sugar, etc., can be addictive and deadly. It is
these drugs that will be discussed in the next subsection.
3.1.2.2 Drug Abuse
Drug "usage" can refer to the use of drugs to treat, prevent illness, or improve health.
Drug abuse is defined as the use of drugs (medical or non-medical) in a quantity, strength,
frequency, or way that impairs an individual's physical or mental functioning. This indicates that
even using medications in excess, too frequently, over an extended period of time, for the
incorrect reasons, or in the incorrect combination constitutes drug abuse.
In other words, ‘Drug Abuse’ is defined as self-administration of a drug for non-medical
reasons, in quantities and frequencies, which may impair an individual's ability to function
effectively and result in social, physical or emotional harm. Such drugs produce psychological

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 and physiological dependence. That is to say that the individual feels a false sense of well-being
and cannot function mentally and physically when they take drugs.

Do you know?
There are over 190 million drug users around the world. These users are now identified as
drug abusers. Drug abuse is a mounting problem showing an alarming increase rate. This
is a growing syndrome among young adults under 30. Drug abuse damages the body. Drug
addicts often use needles to inject drugs. They risk contracting HIV and hepatitis B and C
infections. Drugs of abuse are usually psychoactive drugs that are used by people for
various reasons, which include:

 Curiosity and peer pressure, especially among school children and young adults
 The use of prescription drugs that were originally intended to cause pain relief often
turns into recreational use.
 Addictive chemicals are taking the place of traditional alcohols and are used as part
of religious practices or rituals for recreational purposes.

3.1.2.3 Alcoholism
One of the first substances used by humans was alcohol. It has long been a staple of
international cuisines and a common element of events ranging from weddings to funerals.
However, there have always been some who could not control their alcohol consumption and as
a result, experienced terrible repercussions. In layman's terms, these people are frequently
referred to as "alcoholics." This is related to the term "alcoholism," which refers to a behavioral
disease characterized by recurrent and unchecked excessive alcohol consumption. Alcoholism is
best understood in relation to the concept of "addiction." The body of the drinker suffers
functional and structural harm as a result of this addiction or habit. There are many types of
alcohol. Only one can be consumed, viz. ethyl alcohol (which is used in beer, wine, toddy,
whisky, brandy, rum and arrack or locally prepared liquor).

3.1.2.4. Drug Addiction and facts related to Narcotic drugs

Drug ‘abuse’ leads to addiction, i.e. inability to lead a regular life in the absence of the
drug/alcohol. The term addiction usually conjures up images of alcoholics and other drug addicts

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who manifest physical and/or psychological need for chemical substances. Such individuals rely
on substances to function or feel good (psychological dependence). When their bodies reach a
state of biological adjustment to the chronic presence of a chemical substance (physical
dependence), they require increasing amounts to achieve the desired effect (tolerance). When
denied access to their chemical elixirs, their bodies experience adverse effects (withdrawal),
typically the opposite bodily effects as those sought.
Drugs first alter feelings, thoughts, or behavior as a result of chemical changes in the
brain. In that regard, alcohol is similarly a drug. Drugs can be ingested, smoked, inhaled, sniffed,
drank, or administered intravenously. Aside from alcohol, drugs can be categorized as
stimulants- which increase brain activity, depressants- which decrease brain activity,
hallucinogens- which alter perceptions of sight, sound, and touch; cannabis- which includes
drugs like ganja and bhang made from hemp, and opiates- which are substances derived from
opium or synthetic alternatives that have effects similar to those of opium. Three of the most
common opiate kinds include morphine, heroin, and opium. The most harmful and widely used
laboratory derivative of morphine is heroin. Heroin purest is pricey. As a result, its unprocessed
form, often known as "brown sugar," "smack," etc. had gained a lot of popularity. It is currently
the substance that is most abused in India.

3.1.3 The Process of Addiction

It is generally recognized today that addiction is a disease and not simply a sign of moral
weakness or of a lack of will power. In this section, the process of addiction to alcohol and drugs
are examined separately, though the general path is similar.
3.1.3.1. Addiction to Alcohol
Alcoholism has been described as a disease by itself and not just a symptom of a
psychological problem. The disease itself causes psychological and physical problems, which
can be handled, only if the alcoholism itself is treated. It is a progressive disease, i.e. in the
absence of treatment, it worsens.
As a progressive disease, it goes through three different phases. In the Early Phase,
addict preoccupied with the drinks as well as needs for more alcohol for the same effects and
prone to forgetting all that one did under the influence of alcohol.
In the Middle Phase alcohol addict experience loss of control over the quantity, time and
place of consumption. Giving excuses for one’s drinking to others and self. Behave aggressively

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through words and action. Temporarily give up drink and change the type, the time/place of
drinking, etc. At times, the alcoholic may seek help for alcoholism at this stage.
Finally, in the Chronic Phase the alcohol addict experience decreased tolerance i.e. now
get ‘drunk’ even with a very small quantity, physical complaints, need continuous drinking for
days together, shows criminal behavior to get alcohol and unable to live up to social values,
experience paranoia or suspicious feelings that everybody is against him/her, encounter lack of
motor coordination and hallucinations. If alcohol is discontinued, severe physical discomfort and
pain follows. Either death or mental illness, mark the final stage.

Do you Know?

 Alcohol consumption contributes to 3 million deaths each year.

 While 28% of these deaths are due to injuries from traffic crashes, self-harm and violence,
21% are due to digestive disorders, 19% due to cardiovascular diseases .
 Overall, the harmful use of alcohol is responsible for 5.1% of the global burden of disease.
 Alcohol kills around 6,000 people every day across the world.
 Alcohol kills 2.6 lakh Indians every year either by causing liver cirrhosis, cancer, or leading to
road accidents caused by drunk driving.
 Odisha has the dubious distinction of being the second Indian state for alcohol induced
accident deaths. There were 735 and 900 accident deaths in 2017 and 2018 respectively due
to drunk driving.

3.1.3.2. Addiction to Drugs

Addiction to drugs is similar to alcohol addiction, in terms of its characteristics. The
addiction to drugs is also identical and experienced by the addict in three phases. In the Early
Phase, the addict increases the amount of drug and the number of times. The person begins to
spend more time and money on drugs and less on other activities in life. Thoughts about drugs
and the need to have them become important. In the Middle Phase, the person needs the drug in
larger quantity than before to feel well; experiences loss of control over drug use in spite of
repeated efforts and decisions to stop or reduce the taking of drug; begins to hide drug supplies.;

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encounters problems in all areas of life, e.g. educational, work, family, neglect of personal
hygiene, staying away from friends and earlier interests and change in personality, etc.
Finally, in the Chronic Phase, the addict experiences total loss of control over drug use
and almost constantly remains under the influence of drugs needs help of other people to attend
to own needs, e.g. eating and remains only with other drug taking persons. There is every
possibility of early death of an addict. Drug addiction thus leads to changes and deteriorations in
behavior, social life, and mental faculties like judgment, thinking and emotions.

3.1.4. Causes of Alcoholism and Drugs Addiction

Research shows that the complex phenomena of addiction is more likely to result from a
combination of causes than from a single one. Previously, it was thought that particular types of
people—namely, deviants—were more susceptible to develop addictions. There is no one
personality type that is predisposed to addiction. While others may make it more difficult to stop
using, some elements may produce an environment conducive to addiction development. These
are looked at in the following sub-sections.
3.1.4.1. Physiological Causes
It has been discovered that a child has a higher risk of getting addiction if both parents
are addicts. While this does not imply that all addicts' offspring will develop addictions, it does
raise the likelihood. The tendency for alcoholism in particular to run in families raises the
possibility that being predisposed to addiction may be inherited. The amount and frequency of
drug use, the route of intake (injected drugs are more addictive), the availability, access, and cost
of the drug, as well as other environmental influences outside of the family, may all have an
impact on the problem's growth. Other physiological elements, such as alcoholism, nutritional
deficiencies, and dysfunction of various body systems, such as the endocrine system, are thought
to play a role in the development of addiction. But none of these has received definite proof.
3.1.4.2. Individual or Psychological Causes
Addiction has long been considered a psychiatric disorder brought on by personal issues.
According to studies, addicts are insecure people. Many addicts report experiencing minor to
severe mental disturbances as their symptoms. However, it is unclear if addiction creates mental
disorders or whether mental problems induce addiction. Whatever the connection, there is
enough proof to show that addicts struggle with severe personality disorders, feelings of

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inadequacy, dependency, powerlessness, isolation, and low self-respect. Addicts have been
shown to have problems related to their childhood as well as current stresses prior to the onset of
addiction. Addiction is seen to be the outcome of learning, as well. Initial drug use results in a
pleasurable sensation or experience. This serves as a reward and could cause the intake to keep
rising. Thus, even a positive initial encounter could result in addiction. But the widely accepted
idea holds that certain personalities are more predisposed to addiction than others.

3.1.4.3. Sociocultural and Environmental Causes

There are several views out there today that say addiction has social roots. People are
more prone to consume drugs and/or alcohol heavily in communities where doing so is seen as
acceptable and when drugs are readily and affordably available. Alcohol use is a feature of
religious events and rituals in several indigenous tribes. Some people may develop an addiction
as a result of such frequent intake. This does not imply that addiction is exclusively encouraged
by availability and acceptability. Some persons who experience normlessness turn to drugs or
alcohol in societies where this intake is not recognised. Teenagers frequently use drugs to rebel
against the standards and ideals of adults. According to the cultural defiance theory, these
emotional and social links to an unconventional group contribute to the development of drug
addiction.
The fact that alcohol and other less-addictive drugs are socially acceptable in some
spheres of society is another element that contributes to this. On some religious and social
occasions, including as weddings, funerals, and festivities, custom in India has long permitted
the use of wine, bhang, and marijuana. This is especially true among several sociocultural
groups. In today's society, drinking is seen as a symbol of social standing and is increasingly
consumed socially across all sociocultural groups. In several Western nations, drinking alcohol is
considered socially acceptable, and taking medications to ease pain or enhance performance is a
common practice.
Another crucial aspect of determining the prevalence of addiction is the substance's legal
standing. It is also thought that the degree of addiction in a culture is closely tied to whether drug
use is sanctioned or penalized in that society. Therefore, it is thought that legalization of drugs as
well as cultural acceptance of them both raise the rate of addiction. The number of people
addicted to "hard" drugs will decrease if milder types of narcotics are legalized. Such people
believe that grouping all drugs into one broad category has hurt efforts to avoid addiction.

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 Since ability to tolerate alcohol is equated with one’s manhood, boys often begin to
consume alcohol and at times drugs at a young age, due to peer pressure. Persons in jobs that
create stress-physical and/or mental are known to become addicted. Those prone to addiction
thus include persons in conservancy jobs, morticians and morgue workers and rag pickers, etc.
Even those performing excessively exhausting, monotonous, laborious work e.g. load-carriers
and porters, drivers, etc. are prone to alcoholism. Young boys imitate if the family has an adult
addict. Besides aggravating of stress by the family at periods of transition, e.g. adolescence, the
absence of reasonable parental control, and a disunited and dysfunctional family.
Sociological theorists offer other explanations as well. The theory of strain holds that
people turn to drugs and alcohol because social conditions in their environment do not provide
them adequate opportunity for achievement. This is particularly so for lower socio-economic
groups and other socially disadvantaged groups.
It is also believed that people, because of their consumption of alcohol and other drugs
and life-style become labeled as “deviants”, tend to become dependent on drugs and/or alcohol,
as these become the most important aspects of their lives.
Therefore, it is evident that a number of sociocultural, psychological, and physical
factors, including curiosity, stressful environments, early drinking, mental health issues, drinking
while taking medication, genetic issues, a lack of family supervision, large and dysfunctional
families, wealth and weakening of parent-child ties, disregard for social values and a common
human goal, changing socio-cultural norms and values, lack of community control, absence of
interpersonal relationships, and others, contribute to this epidemic.
3.1.5 Extent of Drug and Tobacco Addiction and Alcoholism in India
In the above section we have deliberated upon various conceptual aspect of drug and
alcohol additions. In the subsequent paragraphs we will discuss the extant of the drug and
alcohol addiction in India at the present time.
Although the use of various psychoactive substances such as alcohol, cannabis and
opioids has been observed in India for centuries, the current dimension of the extent and pattern
of psychoactive substance use and the problems associated with their use are not well
documented.
According to data on the global situation, the three most commonly misused substances
are alcohol, opium, and cannabis. More men than women are addicted to them. Particularly in
recent years, heroin addiction has seen a sharp increase. By injecting drugs, a person runs a
significant danger of contracting additional diseases and health issues, such as AIDS (Acquired

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Immune Deficiency Syndrome), as well as death from some of these issues and from taking an
overdose.
Earlier, addiction was simply a problem for a select few people, but today's users come in
all shapes and sizes. In reality, it is becoming more common to use multiple drugs at once, such
as mixing alcohol and narcotics. Alcohol and other substances are being experimented with at
younger ages than in the past. Due to rising prosperity, contemporary life's stressors, widening
economic and social disparities, and a growing sense of discontentment with one's life, the issue
is slowly getting worse in India, affecting both urban and rural communities.
3.1.5.1. Extent of substance abuse in India
Recently published report “Magnitude of Substance Use in India 2019” presents the
major findings of the National Survey on Extent and Pattern of Substance Use in India
commissioned by the Ministry of Social Justice and Empowerment, Government of India in
collaboration with the National Drug Dependence Treatment Centre (NDDTC), All India
Institute of Medical Sciences, (AIIMS), New Delhi, in terms of proportion of Indian population
affected by substance use.
The survey finds that there is widespread substance use among all demographic
categories in India, although adult men are disproportionately affected by substance use
problems. This survey also shows that there are significant differences in the extent and
prevalence of use across states and among different substances.
Indians most frequently use alcohol as a psychedelic substance (among those included in
this survey). Between 10 and 75 years old, 14.6% of the population nationwide uses alcohol. In
terms of absolute numbers, the country has roughly 16 crore alcohol consumers. Men use alcohol
at a rate that is significantly greater than women (27.3%). (1.6 percent). There are 17 alcohol-
using men for every woman who drinks alcohol. Spirits or Indian Made Foreign Liquor
(approximately 30 percent) and country liquor, sometimes known as "desi sharab," are the most
popular alcoholic beverages among drinkers. The states with the highest rates of alcohol use
include Goa, Punjab, Arunachal Pradesh, Tripura, and Chhattisgarh.

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 (Source: Ambekar A, et.al, Magnitude of Substance Use in India. New, 2019)
Cannabis and opioids are the second most popular drugs in India after alcohol. A total of
3.1 crore people, or about 2.8 percent of the population, report using cannabis products in the 12
months prior. The authorized form of cannabis (bhang) and other illicit cannabis products were
further distinguished in terms of cannabis consumption (ganja and charas). About 2.2 crore
people (or about 2 percent) were found to use bhang, and about 1.3 crore people (or about 1.2
percent) were found to use illegal cannabis products like ganja and charas. Uttar Pradesh,
Punjab, Sikkim, Chhattisgarh, and Delhi are the states with the highest rates of cannabis
consumption.

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 (Source: Ambekar A, et.al, Magnitude of Substance Use in India. New, 2019)
Opioids, such as Opium (or its derivatives such poppy husk known as doda/phukki),
Heroin (or its impure form, smack or brown sugar), and a range of pharmaceutical opioids, are
used by about 2.1 percent of the population of the country (2.26 crore people). Heroin (1.14%),
prescription opioids (0.96%), and opium are the most often used opioids in the country (0.52
percent ). With regard to overall opioid use, Sikkim, Arunachal Pradesh, Nagaland, Manipur, and
Mizoram have the highest rates (more than 10 percent ).

(Source: Ambekar A, et.al, Magnitude of Substance Use in India. New, 2019)

According to the report, a sizable percentage of people take sedatives and inhalants.
Approximately 1.18 crore Indians aged 10 to 75 (or 1.08 percent) currently take sedatives (non-
medical, non-prescription use). The highest rates of contemporary sedative use are seen in the
states of Sikkim, Nagaland, Manipur, and Mizoram. However, the top five states with the highest
sedative use rates are Uttar Pradesh, Maharashtra, Punjab, Andhra Pradesh, and Gujarat.

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 (Source: Ambekar A, et.al, Magnitude of Substance Use in India. New, 2019)
Inhalants (overall prevalence 0.7%) are the only category of substances for which the
prevalence of current use among children and adolescents is higher (1.17%) than adults (0.58%).
Other categories of drugs such as, Cocaine (0.10%) Amphetamine Type Stimulants (0.18%) and
Hallucinogens (0.12%) are used by a small proportion of country’s population.

Every year on June 26th, the International Day Against Drug Misuse and Illicit Trafficking
is commemorated with the goal of raising awareness about the problem of drug abuse and
addiction, as well as its consequences, among individuals and communities.

Drug Abuse Figures of India

 In India, 19 metropolitan cities are at a high risk of drug abuse. Mumbai reported
the highest number of cases under the Narcotic Drugs and Psychotropic Substances
(NDPS) Act.
 Among states, Uttar Pradesh reports the highest number of drug addicts, the
number being 10,852. Uttar Pradesh is followed by Punjab and Tamil Nadu in
terms of the number of drug abusers, the cases being 6,909 and 5,403 respectively.
 Kerala reported 4,968 cases and took the fourth place while Maharashtra filed
4,714 cases and came in the fifth place.
 Mumbai reported 3,509 cases under the NDPS Act.
 Bengaluru records a total number of 2,766 cases and Indore, 998 cases.
 Punjab recorded 6,909 cases and Tamil Nadu, 5,403 cases.

3.1.5.2. Harmful and Dependent Use

A small percentage of most drugs and substances users reach the threshold for "harmful
use" and "dependence." But the percentage of risky or dependent users varied according on the
substance (indicating the differential propensity of various substances to develop problem use).
For the health and social welfare sectors, the total of the estimates of harmful and dependent use
represents the "quantum of work" (i.e., the percentage of the population that requires assistance).
At the national level, as many as 19% of current users of alcohol consume alcohol in a
dependent pattern. According to estimates, 2.7 percent, or 2.9 crore people, of the general
population (10-75 years old), consume alcohol in a dependent manner. A further 2.7 crore people
(or 2.5 percent of the population) in the nation engage in problematic alcohol use. In other
words, more than 5.7 crore people, or around 5.2 percent of the population, are impacted by
hazardous or dependent alcohol consumption and require assistance. One in five drinkers have
alcohol dependence and require immediate treatment. The following states have high rates of

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alcohol use disorders (greater than 10% prevalence): Tripura, Andhra Pradesh, Punjab,
Chhattisgarh, and Arunachal Pradesh.

(Source: Ambekar A, et.al, Magnitude of Substance Use in India. New, 2019)

The percentage of people who use cannabis problematically (i.e., in a hazardous or
dependent manner) is rather low. One in eleven cannabis users (or 0.25 percent) in the country
has a cannabis dependence problem. But when it comes to dependent use, bhang and
ganja/charas differ significantly. While just roughly one in sixteen bhang users were cannabis
dependent, this number was one in seven for ganja/charas users.

(Source: Ambekar A, et.al, Magnitude of Substance Use in India. New, 2019)

When compared to consumers of other opioids like opium and pharmaceutical opioids,
heroin users are much more likely to be addicted to opioids. According to estimates, 77 lakh
Indians, or around 0.70 percent of the population, struggle with opiate consumption. Only a few
states—Uttar Pradesh, Punjab, Haryana, Delhi, Maharashtra, Rajasthan, Andhra Pradesh, and
Gujarat—contribute more than half of the country's estimated 77 lakh individuals with opioid use
disorders (harmful or dependent pattern). The top states in the nation, however, in terms of the

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percentage of the population afflicted, are those in the north-east (Mizoram, Nagaland,
Arunachal Pradesh, Sikkim, Manipur), along with Punjab, Haryana, and Delhi.
Numerous other drug users, including those who use sedatives and inhalants, also require
support. About 0.20 percent of Indians in general need assistance with their sedative usage
issues. According to estimates, 4.6 lakh children and 18 lakh adults in the country require
assistance due to their dangerous usage or dependence of inhalants. The states with the highest
percentage of kids seeking assistance for inhalant usage in terms of absolute numbers are Uttar
Pradesh, Madhya Pradesh, Maharashtra, Delhi, and Haryana. Compared to the size of the
country's population, the number of cocaine, stimulant, and hallucinogen users is incredibly low.

(Source: Ambekar A, et.al, Magnitude of Substance Use in India. New, 2019)

Around 8.5 lakh drug injectors are thought to be present nationwide. The opioid family of
medicines is primarily injected by People Who Inject Drugs PWID (heroin – 46 percent and
pharmaceutical opioids – 46 percent). Many PWID report using dangerous injection techniques.
According to estimates, the states of Uttar Pradesh, Punjab, Delhi, Andhra Pradesh, Telangana,
Haryana, Karnataka, Maharashtra, Manipur, and Nagaland have high PWID rates.
The majority of those suffering from substance use problems do not have access to
treatment programmes. Only one in thirty-eight alcohol-dependent individuals report receiving
any kind of treatment or assistance for their drinking issues. One in four people who use illegal
substances and are addicted to them have ever sought therapy. Even fewer people with alcohol
and drug issues seek hospitalization or inpatient treatment. About one in 180 people who
struggle with alcoholism and one in 20 people who struggle with illicit drug addiction report
receiving inpatient care.
The prevalence of alcohol usage appears to have remained consistent with previous
studies of a similar nature, however a sizable percentage of Indians (more than 5%) experience

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alcohol use disorders. While cannabis usage is less common than the global average, opioid use
is three times more common in India than it is elsewhere, according to statistics on illegal drug
use. Opium was the most common opioid used by men in India in 2004. According to this
survey, not only is total opioid use higher than it was in 2004, but heroin use has surpassed
opium use as the most popular opioid.
3.1.5.3 The Way Forward
India requires significant investments to improve the treatment options due to the
country's large treatment gap (difference between demand and availability of treatment services).
This report referred above demonstrates that a significant portion of the Indian population suffers
from substance use disorders and requires immediate assistance. The governmental programmes
for the treatment of substance use disorders, however, fall woefully short in terms of their reach.
Protecting the youth of the nation is of paramount importance. Very often, drug use
prevention is seen (erroneously) as synonymous with spreading awareness about dangers of drug
use among young people. Evidence for effectiveness of awareness generations as the
predominant preventive strategy, is very weak. Prevention programmes must address the risk and
protective factors aimed at not just preventing substance use but ensuring that young people
grow and stay healthy into adulthood, enabling them to realize their potential and become
productive members of their community and society.
Findings indicate that despite the existence of strict drug control laws and a multitude of
agencies working towards drug supply control, a wide variety of the controlled drugs are being
used and a sizeable number of Indians suffer from addiction to these drugs. Results also indicate
a shift in demand for psychoactive substances, from traditional, low-potency, plant-based
products (e.g. opium) to more potent and processed products (e.g. heroin). Thus, there may be
elements of drug supply control which influence the pattern of demand. The non-medical,
recreational use of controlled pharmaceutical products remains a concern. There needs to be an
efficient coordination between the drug supply control sector as well as the entities involved in
drug demand reduction and harm reduction.
Besides, proper regulation for production and distribution control of drugs and alcohol is
necessary in order to combat the issue. Along with regulations proper preventive education
programmes, public awareness programmes by both governmental and non-governmental
agencies for prevention of addiction is highly required. Alcohol continues to be a major income-
earner for many countries. Alcoholism affects a larger section of society than drug addiction and

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affects all socio-economic sections. Today there is a strong demand to view alcoholism as a
serious social problem along with drug addiction.

3.1.6. Myths related to Drugs and Alcohol Usage

Myths are what is popularly believed but in fact are false. The general public has not
properly understood drugs and their effects. Many people become addicts due to false notions
related to drugs. Let us discuss some of those myths prevalent in Indian society here:
Only weak individuals become addicts: In actuality, the opposite is true: Addicts develop
into frail people. Nobody uses drugs with the intention of becoming addicted. As we just
observed, there are various reasons why people start abusing drugs. Even at that point, a drug
addict has a strong will to obtain their drug supply. An addict will do anything to keep using
drugs. Aside from that, motivation affects how strong a person's will is. Priority affects
motivation. Chemicals are the addict's top priority since they offer him a quick fix for all of his
issues. As a result, the addict selects to obtain the chemicals over any other form of gratification.
Drugs give mental and physical strength: Drugs can alter a person's capacity for
reasoning. As a result, he will be prepared to perform tasks that he was previously unable to
complete because of drug use. Second, gaining strength is simply a temporary solution. Drugs
can also make someone appear brave by assisting them in overcoming inhibitions and fears.
Recreational use of drugs is not harmful: All illegal drugs are harmful. They cause
physical and psychological changes in the user. Prolonged drug use leads to addiction. Besides
all drugs are expensive. They make the user poor physically and financially. It also encourages
drug trafficking.
Everybody is taking drugs: The truth is that persons who take drugs often use this
defence to justify their actions. Despite the fact that there are many drug users, the majority of
individuals do not use drugs. It is challenging to deal with peer pressure, and it takes more
fortitude and stamina to defend the moral high ground and to abstain from drugs. Drug use is not
widespread.
Drugs help to forget failures and painful events of life: The truth is that it merely aids in
forgetting for the one to three hours that the chemical's effect lasts. It only functions in the short
term. Burying issues alive is akin to a ghost that will one day return to haunt you.
Drugs help to keep peer group status: The fact is that the peer group has no status all
those who drink are drinking because they cannot stop drinking. They want to stop but cannot.
The status the peer group pretends to have is unreal and unhealthy.

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 Drugs improve your concentration: Drugs can improve mental function, but they can
damage brain cells over time. Drugs are used by students and anyone who need longer periods to
work or study. However, many people become addicted to drugs, and over time, they die early.
Brilliant poet Byron passed away in his 20s due to alcoholism. As a result, it's important to
respond carefully to any conversations that are had about using drugs.
Consuming alcohol is normal, common, healthy and very responsible: Supporter of
Alcohol presents "regular" drinkers as outgoing people at the center of a thriving social life.
They claim that drinking alcohol is linked to good health, fortune, prosperity, tradition, and
manners. Alcohol is almost usually associated with good health, sports, physical attractiveness,
romance, friendships, and leisure activities in advertisements. Contrary to these myths, the reality
is that regular drinkers contribute significantly to social costs of alcohol harm, consume more
than the "recommended" number of units, and are linked to a variety of negative outcomes such
as unemployment, productivity loss, violence, suicide, child abuse, NCDs, poverty, and other
drug use.
Darker drinks are healthier: There is a misconception that alcohol with deeper hues is
healthier. However, the truth is that while dark alcoholic beverages like bourbon and whiskey
may have more compounds that are healthy for the body, they also include more harmful
substances that worsen hangovers. Since flavonoids have a strong anti-inflammatory effect on
the body, dark beers actually contain more of them than light beer. Red wine contains higher
polyphenols than white wine; these compounds function as blood antioxidants in preventing
heart disease, cancer, and other potential ailments. However, darker liquids also contain larger
concentrations of congeners, harmful substances produced by fermentation. Although they are
not fatal, they might worsen a hangover, so you might feel like you're going to die. In fact, a
study compared the reported symptoms of hangover in individuals who drank the same amounts
of dark bourbon and vodka. Bourbon drinkers complained of more severe hangover symptoms.
Drinking is a Good Way to Take the Edge Off Chronic Pain: Alcohol is occasionally
used by people with long-term (chronic) pain to lessen their suffering. There are a number of
reasons why this might not be the best option. Painkillers and alcohol should not be combined.
The chance of developing liver issues, stomach bleeding, or other issues may rise when alcohol
is consumed alongside painkillers. It makes alcoholism more likely to develop. Most people
require more than a moderate amount of alcohol to feel better. Additionally, as one builds up a
tolerance to alcohol, they will need to consume more to have the same level of pain alleviation.
Drinking that much raises the possibility of developing alcohol use disorders. Chronic (long-

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term) alcohol use can make pain worse. Alcoholics experiencing alcohol withdrawal symptoms
may experience increased sensitivity to pain. Additionally, prolonged heavy drinking might
really result in a specific sort of nerve discomfort.
Alcohol Gives You Warmth: Alcohol can make you feel warm, but it doesn't actually
warm your body up. Your blood vessels may widen as a result of drinking, boosting the blood
flow. More blood starts to flow to your skin as a result, giving you the sensation of a warm hug.
However, when you drink, your body actually loses heat more quickly, making you feel cooler.
Alcohol is also a diuretic. As a result, your body will lose more water, which could make you
feel dehydrated. Therefore, exercise caution when drinking outside in the cold and refrain from
mistaking a glass of whisky for a warm blanket.
Beer is good for your hair: Have you noticed the countless banners hawking beer
shampoos and other hair care items that claim to have more alcohol than your drinks? Do you
find it surprising that there is no proof, according to science, that beer makes hair better? While
beer is a great beverage to enjoy with friends while sharing stories and conversations, it should
not be used as a shampoo or self-care product. Applying or ingesting it has no clinical benefit for
your skin and hair.
God and sages used to drink so we can drink: Some people say in the Vedic times, gods
used to drink Soma drink which was an intoxicating drink. Hence, there is no problem with
drinking alcohol. It is a fact that there are references in ancient literature regarding consumption
of liquor. But at the same time, they also speak against the alcohol consumption. Drinking the
spirituous liquor called Sura is considered as a mortal sin (mahapataka)”. There are many other
scriptures like Brahmanas and Sutras that condemn the consumption of liquor as well as allow on
some occasions. The Chandogya Upanishad clearly states that drinking alcohol is one of the five
biggest sins. Therefore, we can say that consumption of alcohol is prohibited in Hinduism.
Whatever it may be we are living in modern scientific age. We understand the medical problem
associated with alcohol. Hence, it is necessary to debunk traditional myths and protect our own
health.
As drug use has spread throughout the world, myths have grown and facts have been
distorted and subjected to ridicule. Wrong information about drugs as well as alcohols and their
effects is common among the public. Governments, scientists, experts, and others have only
limited success communicating accurate information. Individuals often begin taking drugs as an
experiment, with the belief that the substances are not dangerous. If the drug gives the effect that
the individual is seeking then the user’s lack of knowledge about the health consequences

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permits continued use. By the time the dangers are fully realized, it is too late for that person to
stop taking drugs or to reverse the damage.

3.1.7 Health Hazards Associated with them and how they have become silent killers
Abusing substances harms a person's physical, psychological, and emotional health. His
or her social connections deteriorate and their financial situation deteriorates. A individual starts
using drugs to try to overcome his issues. They don't decrease; they just keep becoming bigger.
Drugs harm the body's essential organs, including the liver, brain, heart, kidneys, etc. In this
state, he cannot support himself and requires a large sum of money to keep getting narcotics.
Addiction to drugs and alcohol has major health consequences in addition to social and economic
risks.
3.1.7.1 Health Consequences of Drug Abuse
Alcohol and drug consumption has been identified as an important risk factor for illness,
disability, and mortality. They are health damaging. The extent, degree and the type of health
damage related to alcohol and drug use depend upon the drug type, period of use, route of use,
amount of consumption, adulterants in street samples, and other high risk behaviors.
According to World Drug Report, 2021 published by the United Nation Office on Drugs
and Crime (UNODC) in 2019 approximately half a million (5,00,000) deaths occur worldwide
due to drug abuse. Further the report reveals that in 2019, 18 million healthy life were lost owing
to drug use disorders. More than half of the deaths were due to liver cancer, cirrhosis and other
chronic liver diseases resulting from hepatitis C, but the increase reflects, in part, the rise in
overdose deaths attributed to use of opioids such as fentanyl. Deaths related to drug use disorders
have nearly doubled over the past decade, far outstripping any increase in the number of users,
suggesting that drug use has become more harmful. The official rates quoted are much lower.
Most of the countries do not have adequate reporting facilities for reporting damages caused by
drug abuse.
Drugs like heroin can cause death due to overdose. Alcohol overdose does not lead to
death. Long-term period of drug use is a health hazard. Most of the addicts who use narcotics
and stimulants die prematurely. Alcohol and cannabis users take a long time to get addicted, so
health problems occur late in life. Drugs that are orally taken have less chance of leading to
overdose. In case of an overdose, the person vomits, and thus the toxic reaction is slowed down.
Adulteration of drugs has caused severe health problems. Often drugs are adulterated with very

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poisonous substance to increase their quantity and potency. Rat poison, DDT and other
poisonous ingredients are reported to be found in the drugs sold in the street.
Abuse of drugs encourages dangerous behavior. A person who uses hallucinogens may
experience a misleading sense of time, space, and sound. The usage of hallucinogens results in a
lot of accidents. It is a proven fact that drug usage lowers one's resistance to illness. The ability
to fight infectious diseases, such as bacterial, viral, or parasite infections, can be lowered by
drinking and medication usage. The following facts have been discovered after extensive study
in the fields of immunity and drug abuse for many years: Drug misuse decreases the body's
resistance to disease, decreases the creation of antibodies that fight disease, slows the immune
system's response time, and decreases the body's capacity to successfully fight disease.

3.1.7.2. Health Hazards Related to Alcohol Consumption

More than 30 conditions listed in the WHO’s International Classification of Diseases,
10th Edition (ICD–10) (WHO 2007) include the term “alcohol” in their name or definition,
indicating that alcohol consumption is a necessary cause underlying these conditions. This
group's most important disease conditions are alcohol use disorders (AUDs), which include
alcohol dependence and harmful use or alcohol abuse. Disease and injury conditions for which
alcohol consumption is a component cause contribute more to the global burden of disease than
do alcohol specific conditions. Overall, the following are the main disease and injury categories
impacted by alcohol consumption (listed in the order of their ICD–10 codes).
Infectious Diseases: Alcohol consumption has a detrimental impact on key infectious
diseases such as tuberculosis, infection with the human immune-deficiency virus (HIV) and
pneumonia.
Cancer: The Monograph Working Group of the International Agency for Research on
Cancer concluded that there was sufficient evidence for the alcoholic beverages as carcinogenic
to humans. Now it an established fact chronic alcohol consumption is a strong risk factor for
cancer in the oral cavity, pharynx, hypo pharynx, larynx and esophagus and is also a major
etiological factor in hepato carcinogenesis. Alcohol also increases the risk for cancer of the
colorectal and the breast.
Diabetes: Higher consumption of alcohol is associated with an increased risk of diabetes.
Detrimental effect of diabetes has been found starting at about four standard drinks (50 to 60
grams of pure alcohol) per day.

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 Neuropsychiatric Disorders: With respect to neuropsychiatric disorders, alcohol
consumption has by far the greatest impact on risk for alcohol dependence. However, alcohol
also has been associated with basically all mental disorders. The relationship between alcohol
and epilepsy is much clearer. There is substantial evidence that alcohol consumption can cause
unprovoked seizures. Most of the relevant studies found that a high percentage of heavy alcohol
users with epilepsy meet the criteria of alcohol dependence.
Cardiovascular Disease: The overall effect of alcohol consumption on the global
cardiovascular disease burden is detrimental. The effects of alcohol on the cardiovascular system
are well documented and range from the protective effects of light drinking for ischemic stroke
and coronary disease through to the increased risk from heavy drinking for hemorrhagic stroke,
cardiomyopathy, hypertension and cardiac arrhythmias. Alcohol consumption mainly has
harmful effects on the risk for hemorrhagic stroke, which are mediated at least in part by
alcohol’s impact on hypertension.
Diseases of the Liver and Pancreas: Alcohol consumption has marked and specific
effects on the liver and pancreas, as evidenced by the existence of disease categories such as
alcoholic liver disease, alcoholic liver cirrhosis, and alcohol induced acute or chronic
pancreatitis. Worldwide alcohol is one of the most important reasons for an end-stage liver
disorder. Alcoholic fatty liver is generally asymptomatic and may produce no changes in liver
function tests other than those related to the direct effect of the alcohol on liver function in the
early stages. It may, however, present with right abdominal pain, nausea and vomiting, which
resolve on abstinence. Alcoholic hepatitis and cirrhosis result from chronic alcohol abuse.
Alcoholic hepatitis produces liver cell necrosis and inflammation. Cirrhosis involves a
permanent loss of liver cells, which are replaced by fibrosis with loss of the normal liver
architecture. The clinical presentation is with jaundice, pyrexia, right abdominal pain, ascites and
possible encephalopathy. In patients with poor liver function and a prothrombin time prolonged
to a degree which precludes liver biopsy, the prognosis is poor, with a third of patients dying in
the acute episode. Acute and chronic pancreatitis and gastritis and peptic ulcer are other
gastrointestinal consequences of alcohol abuse.
Unintentional Injuries: The link between alcohol and almost all kinds of unintentional
injuries has long been established. The acute effects of alcohol consumption on injury risk are
mediated by how regularly the individual drinks. People who drink less frequently are more
likely to be injured or to injure others. There also is a clear link between alcohol consumption
and aggression, including, but not limited to, homicides.

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 Reproductive disorders: In premenopausal female alcoholics, there is an increase in the
frequency of menstrual disturbances, abortions and miscarriages and infertility. Regular
consumption of alcohol during pregnancy may affect the foetus. The abnormalities range from
growth retardation to Fetal Alcohol Syndrome (FAS). Children with FAS have reduced body
weight and height, are hyperactive and have subnormal intelligence. Their faces may be
recognized by short palpebral fissures, short upturned noses, mid facial hypoplasia, low nasal
bridge and a thin upper lip. Studies of male alcoholics have reported that alcohol consumption
may affect spermatogenesis and spermatogenesis and cause reduced sperm counts.

3.1.7.3. Alcohol, Drug Use and HIV/AIDS

Alcohol dependency is a common phenomenon. In India we do not have reliable statistics
about the relationship between drug abuse and HIV/ AIDS. Yet the injecting drug users report
that drug and alcohol use precipitates risk behavior that leads to HIV transmission. It is true that
alcohol and drug use do not cause infection with HIV. Mood altering drugs may, however, be co-
factor. The biggest concerns that relate alcohol and drug use to HIV infection and the
development of AIDS are listed below:
1) People drunk or taking drugs are likely to engage in risky behavior that leads to HIV
infection.
2) Persons with lowered immunity due to their previous alcohol and drug use may be
more likely to become infected with HIV when exposed.
3) Persons already infected with HIV may continue to destroy their immune system
through drug and alcohol use.
4) Persons using alcohol or drugs may be more likely to participate in unsafe sexual
behavior, increasing the risk that they will be exposed to HIV-or if they are already exposed, that
they will increase the risk of transmitting HIV to others or becoming re-infected themselves.
Drug users share needles to push drugs. If one of the persons in the group is infected the
others in the group are sure to be infected by the needle they share. Some of the drug users are
likely to experiment with risky sexual behaviors with the same sex as well as the opposite sex.
This increases the risk of infection.

Addiction is the only disease that tells you that you don’t have a disease.” Jason Z. W. Powers

Alcohol and drugs are silent killer. Their consumption slowly damages internal organs of
human body without any apparent major signs or symptoms for early detection. Drugs and

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alcohol can affect every organ of the human body; however, some organs such as liver, heart,
pancreas and brain are more prone to severe damage. Hence, it is important not to ignore the
warning signs of alcoholism and drug abuse before it is too late to reverse the health condition.
Even when the ill-effects of alcoholism and consumption of deadly tobacco products are
very well evident in our society, citizens continue to reel under the menace of these silent killers.
Commercialism, it seems, has overtaken health interests. The lackadaisical attitude of the people
and the society in particular leaves no doubt that we are not serious about this menace which will
hit us in the long run if steps are not taken now. We are seeing more of the young addicted to
alcohol, drugs and tobacco. Usually, tobacco use is combined with alcoholism or recreational
drug abuse. Prevention is better than cure.” The need of the hour is to see that all the concerned
people should work together and be determined to get rid of these social evils, forever.

3.1.8. Let us sum up

This unit began with definitions and explanations of different concepts related to
alcoholism and drug abuse, such as the meaning of the term’s drugs, alcohol, drug abuse, and the
concept and causes of alcoholism and addiction. Then a brief description of the extant of the
menace of alcoholism and drugs abuse in India has been presented. Some myths favoring drugs
abuse and alcohol consumption as prevailing in the society are dealt with and debunked. The unit
ended with a discussion on health hazards associated with drugs and alcoholism and how they
are becoming a silent killer in human society. We have learnt that alcoholism and drug abuse are
complex social problems. It is a problem of society, family and the individual, and, therefore, it
requires joint efforts of the government institutions, which includes health education and social
welfare, voluntary organizations, legislative and political bodies, community at large, and the
affected families to find solutions to this problem.

3.1.9. Key Words

Addiction: Inability to lead a regular life in the absence to use of the chemical substance; is
defined as a disease.
Alcohol : A drug that is addictive and affects the way the body and mind works.
Alcoholism : A chronic illness involving excessive and repeated drinking beyond customary
use, such that it interferes with work, family, social and economic life of person.
Cannabis : Drugs produced from different parts of hemp plant.

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Dependence : The body cannot perform its normal functions without taking the drug (physical).
One constantly thinks about the drug, its use, how to get the drug and one is
unable to emotionally lead a normal life without taking the drug (psychological)
Depressants : Drugs that slow down the activity of the brain.
Drug : Any chemical substance which when put into the body affects the way the body
works and the mind thinks due to chemical reactions in the brain.
Drug Abuse: The use of chemical substances (medicinal and non-medicinal) in an amount,
strength, frequency or manner that damage the physical or mental functioning.
Hallucinogens: Drugs that change the way we see, hear and feel.
Opiates : Drugs obtained from opium or artificial substitutes that have opium-like effects.
Stimulants : Drugs that give a feeling of excitement as they increase the activity of the brain.
Tolerance : The need for more quantity of the drug and frequent use of the drug to produce
the same effect from the drug, as earlier.
Withdrawal Symptoms : Painful physical reactions ranging from physical discomfort to
severe vomiting and cramps, when the drug consumption is suddenly stopped, in
the case of an addict.

3.1.10. Check Your Learning

Q.1. Definitional Type
a) Addiction
b) Drug Abuse
c) Alcoholism
d) Drug Trafficking
e) Depressants
f) Drugs Tolerance
g) Tolerance
Q.2. Analytical Type
a) Define drug addiction as a disease.
b) What are the different types of drugs? Discuss with example.
c) What is denial? How does it promote addiction?
d) Discuss the socio-cultural and environmental causes responsible for addictions.
e) In what way Individual or Psychological Causes leads to addiction?
Q.3. Essay type

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 a) Discuss the different stages of drugs addiction and alcoholism.
b) Define drug addiction and alcoholism. Discuss the causes responsible for addiction of
drugs and alcohol.
c) Examine and debunked the myths associated with drug addiction and alcoholism in
India.
d) Discuss the health consequences of drugs and alcohols on human body and mind.
e) “Addiction is the only disease that tells you that you don’t have a disease” elaborate
the phrase with the idea that addiction of drugs and alcohol as a silent killer in human
society.

3.1.11. Suggested Readings

 Anil, Agarwal., Narcotic Drugs, National Book Trust, New Delhi, 1995.
 Larry, Siegel (ed), AIDS and Substance Abuse, Harrington Park press, New York, 1987.
 Singh, Gurmeet., “Alcoholism in India”, in Alan and D.A. DeSouza (ed.) Psychiatry in
India, Bhalani Book Depot, Bombay : pp.240-251, 1984.
 Ranganathan, T.T., Alcoholism and drug dependence, Clinical Research Foundation,
Chennai, 1989.
 UNDCP, Drug Abuse, United Nations Department of Public Information, Geneva, 1992.
 UNDCP Regional Office for South Asia., Drug Demand Reduction Report, New Delhi,
1999.
 Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal SK, Chadda RK on behalf of
the group of investigators for the National Survey on Extent and Pattern of Substance
Use in India, Magnitude of Substance Use in India. New Delhi: Ministry of Social Justice
and Empowerment, Government of India, 2019.
 Donovan, D.M. & Marlatt, G.A. (Eds.)., Assessment of Addictive Behaviors (2nd Ed.).
New York: Guilford Press, 2005.
 Arnold Washton & Donna Boundy., Will Power is Not Enough, Harper Perennial, New
York, 1989.
 Dennis E Poplin Scott., Social Problems, Foresman and Co, Illinois, USA, 1978.

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