Journal of Mental Health and Human Behaviour

ORIGINAL ARTICLE
Year
: 2014  |  Volume : 19  |  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

Correspondence Address:
Dr. Sonali Jhanjee
Department of Psychiatry (NDDTC), Room No. 4080, Teaching Block, Ansari Nagar, All India Institute of Medical Sciences, New Delhi - 110 029
India

Abstract

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.



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 2021 Jan 15 ];19:29-31
Available from: https://www.jmhhb.org/text.asp?2014/19/1/29/143887


Full Text

 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. [1] In contrast, the understanding of polydrug use in various drug using population subgroups has been more limited. [1] Polysubstance use by clients in drug abuse treatment settings has been recognized as an important treatment issue for many years, [2],[3],[4] 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. [5] 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}

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}

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].{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}

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. [6],[7]

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. [8],[9],[10],[11],[12]

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. [13],[14],[15],[16],[17]

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.

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