The road to perdition

Dealing with drug-dependent youth needs a community approach

Several recent high-profile cases of alleged use of drugs by celebrities have put the spotlight back on drug abuse by young people in India. As often happens, the narrative has expectedly become the tedious binary of those speaking for the celebrities or against, often drawn on political lines. What is missed is the enormity of the problem that these cases symbolise, and the urgency of a community-wide response to what is an impending epidemic affecting large numbers of adolescents and young adults across the country.

The National Survey on the magnitude of substance abuse in India undertaken by the Ministry of Social Justice and Empowerment in 2019 was a noteworthy effort to assess the extent and pattern of substance use. To achieve this objective, a combination of two data collection approaches was employed. A Household Sample Survey (HHS) was conducted among a representative sample of the 10-75 age group population in the country. During the HHS, over 200,000 households were surveyed in 186 districts and close to 500,000 individuals were interviewed. In addition, a Respondent Driven Sampling (RDS) survey was conducted covering 135 districts and over 70,000 people suffering from dependence on illicit drugs.

The scientific estimates generated by the survey should serve as a wake-up call. Cannabis and opioids are the most commonly abused substances in India, with over 30 million individuals estimated to have used them in the 12 months prior to the survey. Over 22.5 million individuals use opioids that include opium, heroin, and a variety of pharmaceutical opioids. The non-medical, non-prescription abuse of sedatives and inhalants, the survey estimated, was by over 11.8 million people, with their use being much higher among adolescents and children than amongst adults. What should be of deep concern and must trigger urgent community-wide action is the alarming fact that the prevalence of opioid use in India is three times the global average.

While the proportion of harmful or dependent users varies across different substances, what was clear from the survey was that a significant population needs help; but sadly, less than 25% of such people dependent on illicit drugs receive medical treatment or social counselling, and less than 5% of people that are drug-dependent receive in-patient treatment.

What might be the way forward to trigger urgent action?

First, scientific evidence-based treatment needs to be made available at scale for people with substance use disorders. However, the reach of the national programmes for the treatment of substance use disorders is grossly inadequate. Assessment of substance abuse often fails to recognise age-appropriate symptoms and the treatment centres on clinical settings, medication, and therapy.

Teenage vulnerabilities arise from multiple causes. There is, therefore, a need to shift the response paradigm from a clinical setting to a community-based setting that can help adolescents and young adults understand this better; teachers and parents to recognise their limitations; and enable non-specialist preventive care grounded in the principles of safety, trust, voice, and empowerment; to restore the locus of control to the youth that are at risk.

Adolescents in poor and marginalised communities face economic deprivation and social exclusion; childhood abuse, gender violence, and discrimination, early in life. They need help, but have little access or the means to seek help. In this resource-poor setting, a community-wide effort will help reinforce positivity, inculcate problem-solving skills, enable early detection of behavioural difficulties, encourage seeking help, and help prevent the onset of drug abuse. Scaling up non-clinical community-based treatment services will require large-scale capacity building and a coordinated multi-stakeholder response.

Second, a multi-pronged policy environment to protect young people from the drug abuse problem is central to a coordinated response. Often, prevention of drug use is seen – erroneously, I might add -- as synonymous with spreading awareness of the dangers of drug abuse among young people. Evidence on the effectiveness of awareness programmes is rather weak.

Research suggests that the best prevention strategies are those that involve working with families, schools, and communities. Such a coherent policy response and coordinated action must work at three levels: at home to influence parenting practices; at school to encourage problem-solving, healthy social environment, and providing counselling; and with the adolescent, to foster progressive attitudes, engaging in and addressing issues that concern young people, including dealing with peer-group pressures and external influences.

The theory of change that circumscribes the policy to combat the drug abuse menace must recognise the growing psychological stress faced by adolescents arising from the gap in aspirations and attainment regarding education, employment and sexuality. The strength of such an approach is that it provides a stepped care model with psycho-social interventions.

Finally, supply reduction approaches aimed at curbing and monitoring the availability of drugs must receive greater enforcement attention and legal action. Though several agencies are mandated to enforce strict drug control laws and bring violators to criminal justice, a wide variety of controlled substances are finding their way into the illicit market.

More importantly, while the law is enforced to control the availability of all the controlled substances, there is a pattern in terms of the demand for and supply of certain kinds of substances. Enforcement must therefore be guided by data to uncover these patterns. The time has come to leverage the power of data science and machine learning techniques to infuse greater scientificity in enforcement. More than conventional policing, the application of data analytics and computational game theory to draw insights will yield optimal results and help the enforcement agencies stay ahead of the drug smugglers. Every piece of data must serve to incrementally inform evidence-based enforcement.

The drivers of teenage vulnerabilities are intrinsic to adolescence -- minds that are passionate, irascible and impulsive as Aristotle observed hundreds of years ago -- triggering increased risk-taking behaviour. The crisis of widespread drug abuse threatens to take India’s youth on the road to perdition. We need to reinvigorate our moral compass to once again make adolescence and youth the wonder years.

Else, we will fail our children.

(The writer is Director, Public Affairs Centre)