|Year : 2014 | Volume
| Issue : 1 | Page : 29-31
Use of alcohol among treatment seeking illicit drug users in India
Hem Sethi, Sonali Jhanjee
Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||3-Nov-2014|
Dr. Sonali Jhanjee
Department of Psychiatry (NDDTC), Room No. 4080, Teaching Block, Ansari Nagar, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
Introduction: Concomitant multiple substance use by clients in drug abuse treatment settings has been recognized as an important treatment issue for many years, and remains under-researched in Indian context. Aim: To examine the patterns and prevalence of concomitant alcohol and illicit drug use among the patients seeking treatment for illicit drug use. Materials and Methods: A total of 110 patients attending the National drug dependence treatment centre having multiple drug use were included for the present study. Data was collected by face-to-face structured interview on a semi-structured proforma. Results: It was observed that overall 38.2% of the illicit drug users had concomitant alcohol use. Concomitant use of alcohol was found to be 37.1%, 45.5% and 44.4% among heroin, cannabis users and Doda (opium) users respectively. The maximum quantity of alcohol consumption was reported by patients who used opium (Doda) (mean = 703.13 ml/day). A multinomial logistic regression analysis showed that middle aged males and those with lower educational levels, were at greater risk for concomitant exposure to alcohol and illicit drugs. Conclusion: Many people use alcohol in combination with illicit drugs. Clinicians should warn every patient about alcohol-drug interactions, especially those at high risk for concomitant exposure. These findings have implications for prevention, as well as clinical risk for adverse consequences of concomitant alcohol and illicit drug consumption.
Keywords: Alcohol, illicit drug use, polydrug use
|How to cite this article:|
Sethi H, Jhanjee S. Use of alcohol among treatment seeking illicit drug users in India. J Mental Health Hum Behav 2014;19:29-31
|How to cite this URL:|
Sethi H, Jhanjee S. Use of alcohol among treatment seeking illicit drug users in India. J Mental Health Hum Behav [serial online] 2014 [cited 2020 Aug 11];19:29-31. Available from: http://www.jmhhb.org/text.asp?2014/19/1/29/143887
| Introduction|| |
A combination of population and substance-specific approaches has defined the monitoring of illicit drugs use during the last decades but most drug monitoring information remains substance-specific.  In contrast, the understanding of polydrug use in various drug using population subgroups has been more limited.  Polysubstance use by clients in drug abuse treatment settings has been recognized as an important treatment issue for many years, ,, as interactive or additive effects of multiple substance use may have more serious consequences than the use of single substance. Among many combinations are possible, use of alcohol and other drugs are the most common patterns.  This clearly indicates the importance of treatment programs to assess as well as treat both illegal drug and alcohol abuse.
The present study investigates the patterns and prevalence of concomitant alcohol and illicit drug use among the patients seeking treatment for illicit drug use.
| Materials and Method|| |
A total of 110 male patients were selected from outpatients visiting the National Drug Dependence Treatment Centre (NDDTC), AIIMS, India. All the patients were current polydrug users and were seeking treatment for their primary drug use namely heroin, opium and cannabis. Current use was defined as use in last 30 days. Data was collected by face-to-face structured interview on a semi-structured proforma. This proforma included assessment of socio-demographic profile and the assessment of both drug and alcohol use. Dependence upon different substances was according to clinical diagnosis by DSM-IV, which can be used to assess dependence upon a range of substances. The data was analyzed using a Statistical Package for Social Sciences (SPSS). Logistic regression was used to analyze the binary criterion variables.
| Results|| |
Illicit drug and concomitant alcohol use, by socio-demographics [Table 1]
All subjects were male ranging between the ages of 17 and 70 years with a mean age of 36.5 + 11.5 years. No statistically significant difference between the two groups was noted in the sociodemographic profile. However, a higher percentage of illicit drug users with concomitant alcohol use belonged to middle age group (31-50 years) (61.9%), were married (78.6%) and were Hindus (78.6%) when compared to those without concomitant use of alcohol.
|Table 1: Sociodemographics of the sample by the concomitant use of alcohol|
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Illicit drug with concomitant alcohol use, by type of illicit drug
Among the Illicit drug users, the concomitant alcohol use was reported by 38.2% of the total sample. The illicit drugs with which the alcohol was most frequently used reported to be cannabis (45.5%), opium (Doda) (44.4%) followed by Heroin (37.1%) [Figure 1].
|Figure 1: Percentage of concomitant use of alcohol among different type of illicit drug users|
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Concurrent illicit drug use and level of alcohol use
Among past month illicit drug users having concomitant alcohol use, most users (42.9%) consumed up to one quarter of the bottle (180 ml) of country liquor daily along with the other illicit drugs [Figure 2].
Mean alcohol consumption by type of illicit drug use
The median consumption of alcohol among the illicit drug users was found to be 337.5 ml. The Patients who used Doda had the maximum consumption of alcohol (mean = 703.13/day) while the heroin users drink on an average 235.2 ml/day a lesser amount than the other illicit drug users [Figure 3].
|Figure 3: Mean quantity of alcohol consumed (ml)/day by the type of illicit drug use|
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A logistic regression analysis was also carried out to find out the important variables related to the concomitant use of Alcohol among the illicit drug users. The results demonstrated that the males in the middle age group (30 to 50 years) who were using illicit
drugs were two times more likely to be concomitant alcohol users compared to other age groups (OR = 2.168, 95% CI = 1.031, 4.559). Further, the odds of having concomitant use of alcohol among illiterate illicit drug users were more than among the educated users (OR = 1.345, 500, 3.622).
| Discussion|| |
Literature suggests that individuals with concurrent abuse or dependence of alcohol and illicit drugs may differ from those with alcohol abuse or dependence alone. Overall, about 38% of current illicit drug users used alcohol concurrently in the present study. This behavior was more prevalent among certain groups - namely middle aged males aged between 30 and 50 years and illiterates reflecting differentials in rates of use of alcohol overall. Present study results also show that one fifth of the illicit drug users were heavy drinkers consuming one or even more than one bottle of country made liquor per day.
Studies of concurrent drug use have demonstrated that the use of alcohol in combination with other drugs has been associated with more severe psychological and social consequences than alcohol abuse or dependence alone. ,
Concurrent alcohol use also varied depending upon the type of illicit drug used. The illicit drugs with which the alcohol was most frequently used were reported to be cannabis (45.5%) and opioid users (Doda [44.4%] and heroin [37.1%]) respectively. Among cannabis users 40% were drinking up to one quarter and an equal percentage of cannabis users were consuming 2 to 3 quarter of alcohol per day. General survey studies of incidence of drug use demonstrate that most cannabis users drink alcohol and those who use alcohol are much more likely than "teetotalers" to use cannabis. In addition, heavy users of cannabis tend to drink more alcohol than light or infrequent users. ,,,,
The maximum quantity of alcohol consumption was reported by patients who used opium (Doda) (mean = 703.13 ml/day). It was observed that 50% of the Doda users were consuming one bottle or more than that of alcohol. Use of opium with other substances that depress the central nervous system (CNS), such as alcohol, antihistamines, barbiturates, benzodiazepines, or general anesthetics, increases the risk of life-threatening respiratory depression. Nearly half (49%) of heroin users in the present study consumed alcohol concurrently up to 1 quarter of the bottle per day. Concomitant use of other drugs (polydrug use), particularly CNS depressants such as alcohol and benzodiazepines, appears to be a common practice among heroin users and use of alcohol and benzodiazepines in conjunction with opioids is a common characteristic of overdose incidents and is associated with greater risk. ,,,,
Ethanol and heroin act additively on the central nervous and respiratory systems, producing cardiopulmonary arrest that is more often fatal than that produced by heroin alone. Thus, treatment agencies should consider alcohol use as a risk factor in developing their opioid overdose prevention strategies.
Since no systematic prospective studies have been carried out in India, on this issue therefore more detailed intensive studies are recommended to find out the potential adverse health consequences of simultaneous alcohol and illicit drug use. Prevention and treatment providers should continue to emphasize the risks of using alcohol and illicit drugs together, with targeted messages for those groups at greatest risk for this behavior.
| References|| |
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). Polydrug Use: Patterns and Responses Luxembourg: Office for Official Publications of the European Communitie; 2009.
Weisner C. A comparison of alcohol and drug treatment clients: Are they from the same population? Am J Drug Alcohol Abuse 1992;18:429-44.
Gossop M, Marsden J, Stewart D. Dual dependence: Assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems. Addiction 2002;97:169-78.
Miller NS, Millman RB, Keskinen S. The diagnosis of alcohol, cocaine, and other drug dependence in an inpatient treatment population. J Subst Abuse Treat 1989;6:37-40.
Earleywine M, Newcomb MD. Concurrent versus simultaneous polydrug use: Prevalence, correlates, discriminant validity, and prospective effects on health outcomes. Exp Clin Psychopharmacol 1997;5:353-64.
Brady KT, Sonne S, Randall CL, Adinoff B, Malcolm R. Features of cocaine dependence with concurrent alcohol abuse. Drug Alcohol Depend 1995;39:69-71.
Hedden SL, Malcolm RJ, Latimer WW. Differences between adult non-drug users versus alcohol, cocaine and concurrent alcohol and cocaine problem users. Addict Behav 2009;34:323-6.
The Report of the Canadian Government Commission of Inquiry into the Non-Medical Use of Drugs - 1972-Cannabis Report, Schaffer Library of Drug Policy.
Manheimer DI, Mellinger GD, Balter MB. Marijuana use among urban adults. Science 1969;166:1544-5.
Russell J. Survey of Drug Use in Selected British Columbia Schools. Vancouver: Narcotic Addiction Foundation of British Columbia; 1970.
Soueif M. The use of cannabis in Egypt: A behavioural study. Bull Narc 1971;23:17-28.
Udell JG, Smith RS. Attitudes and the usage of other drugs among users and nonusers of marijuana in a high school population. Bureau Of Business Research and Service, Graduate School of Business, University of Wisconsin, Madison, Wis., October 1969.(Wisconsin Project Reports, 4, no. 4.)
Ruttenber AJ, Kalter HD, Santinga P. The role of ethanol abuse in the etiology of heroin-related death. J Forensic Sci 1990;35:891-900.
Sergeev B, Karpets A, Sarang A, Tikhonov M. Prevalence and circumstances of opiate overdose among injection drug users in the Russian Federation. J Urban Health 2003;80:212-9.
Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: I. Prevalence and correlates of non-fatal overdose. Addiction 1996;91:405-11.
McGregor C, Darke S, Ali R, Christie P. Experience of non-fatal overdose among heroin users in Adelaide, Australia: Circumstances and risk perceptions. Addiction 1998;93:701-11.
Seal KH, Kral AH, Gee L, Moore LD, Bluthenthal RN, Lorvick J, et al.
Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998-1999. Am J Public Health 2001;91:1842-6.
[Figure 1], [Figure 2], [Figure 3]