The National CME (Continuing Medical Education), on ‘Addiction Psychiatry: Facing the Reality and the Challenges’ was organised this week at the Postgraduate Institute of Medical Education and Research (PGIMER) by the Drug De-Addiction and Treatment Centre (DDTC), Department of Psychiatry.
Among public health concerns, the burden of the disease, which is associated with alcohol, illicit and prescription drug problems, is substantial. Substance use disorders are increasing in society and the use among special populations (children and adolescents, women, old age etc) is also being reported.
As part of the conference, a point of discussion was that earlier there was a stereotyped profile of addicts – mostly male, young adults for drugs and middle-aged adults for alcohol, the poor class for cheap drugs, and the upper sections for club drugs. However, now there is a change in scenario. Substance use has broken all barriers – gender, age, class, occupation, and personal choices. Children, women, elderly, prisoners, homeless, LGBTQ+ community are all affected by addiction problems, and doctors underscored that there are not enough chatter about these sections.
Substance use in vulnerable populations, discussed experts at the CME, is associated with higher rates of specific negative outcomes such as violence, legal problems, medication non-compliance, relapse and re-hospitalisation, incarceration, depression and suicide, severe financial problems from poor money management, unstable housing and homelessness, family burden, high rates of sexually transmitted diseases and higher treatment costs. In the CME, speakers who were working in this area from different parts of the country talked about various aspects of substance use in vulnerable populations.
Professor Pratima Murthy, Director, National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru, who has been working for the last three to four decades with women who use substances, here at the conference, talked about the epidemiology and risk factors in these women.
“In the last two decades, there has been a marked increase in the number of women indulging in substance use, with increased availability, accessibility, economic improvement, stress, and relationship issues, which are some of the many causes of the increase of substance use. We also see its initiation with partners and family. Women, apart from alcohol, also use sedatives and tranquillisers, and evidence clearly shows that substance and alcohol use in pregnancy can cause a high rate of foetal intellectual and physical disability. Also, women drug users have high suicide rates, and where both partners are users, there is no parenting,” reflected Murthy.
Murthy also talked at length about the social aspects of the issue, and how in this society, which is unequal, women are stigmatised. Many women find it hard to talk about their addictions and seek treatment, and also, do not feel comfortable in health facilities where there are no special provisions for women, and health professionals are also not trained to be sensitive towards their needs, which according to the de-addiction expert, is why women tend to drop out of treatment.
“In the government sector, apart from NIMHANS, there are no separate wards for women, and as a society, we need to have a change in perceptions, more support and new policies. Also, in drug de-addiction centres, where there are no exclusive OPDs for women, many are intimidated by being there among men, and may turn to the private sector for treatment, and not everyone can afford that. That’s why, we have a small number of women seeking help, going through the complete treatment and coming for regular follow-ups. There is a need for better facilities and more trained and sensitised health professionals in these centres. The perception is that alcohol is the main substance women use, but that’s not true, opioids, injectables, stimulants, we have seen a rise of these among women, and it is more in the age group of 30 to 40,” Murthy explained.
Professor Subodh B N, Additional Professor, Department of Psychiatry, PGIMER, Chandigarh, agreed that the number of patients in the institute’s DDTC has grown over the years, with the centre consulting around 4,000 new cases annually, including vulnerable populations of women, adolescents, geriatrics.
“Ten years ago, 80 per cent of the (addiction) cases were of alcohol dependency, but now the percentage is 50, as the use of opioids, and cannabis has increased. Yes, we need a separate space for women, and right now the DDTC has an in-patient strength of 20 operational beds. The plan is to expand and add more beds, and increase to 50 so that we have space that can cater to women patients so they feel comfortable and accepted. The expansion is on the cards. However, we need more staff, faculty, nurses, support staff, and space,” Subodh said.
“The effort will also be to train health professionals to be gender sensitive and to tailor treatment protocols to the needs of these patients. There is also a plan of expansion of the OPD so that we can have new treatment facilities, and do more group activities,” Subodh concluded.
Substance use in vulnerable populations, discussed experts at the CME, is associated with higher rates of specific negative outcomes such as violence, legal problems, medication non-compliance, relapse and re-hospitalisation, incarceration, depression and suicide, severe financial problems. (Representational photo/wikimedia) 
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