Alcohol & Drug Demand Reduction and Preventive Policies

Drug Demand Reduction and Preventive Policies: Government of India's Approach - A Synopsis

• Introduction - Natural vulnerability to drug abuse
• The Scenario - Need for state intervention
• Studies / Reports - Reported trends in drug addiction
• Constitutional and Legal Framework
• Demand Reduction Strategy - a welfare approach
• Treatment and Rehabilitation of Addicts - Government - NGO Collaboration
• Awareness and Preventive Education
• Training and Manpower Development - Development of service providers
• Inter-Sectoral Collaboration
• International Cooperation - an enrichment process
• Areas of Strength - success stories
• Area which Need to be Highlighted in Future - possibilities of future collaboration
• Conclusion

Introduction - Natural Vulnerability to Drug Abuse

India with a population of over 1 billion people, spread over an area of 3.28 million sq. kms. (3214 km. from North to South and 2933 km. from East to West), has about 3 million (about 0.3 per cent of total population) estimated victims of different kinds of drug usages, excluding alcohol dependents. Such population comes from diverse socio-economic, cultural, religious and linguistic backgrounds. The use of dependence-producing substances, in some form or the other, has been a universal phenomenon. In India also, the abuse of alcohol, opium and cannabis had not been entirely unknown.

India is the biggest supplier of licit demand for opium required primarily for medicinal purposes. Besides this, India is located close to the major poppy growing areas of the world, with "Golden Crescent" on the Northwest and "Golden Triangle" on the North-East. These make India vulnerable to drug abuse particularly in poppy growing areas and along the transit/trafficking routes

The Scenario - Need for State Intervention

Over the years, drug addiction is becoming an area of concern as traditional moorings, effective social taboos, emphasis on self-restraint and pervasive control and discipline of the joint family and community are eroding.

The processes of industrialization, urbanization and migration have led to loosening of the traditional methods of social control rendering an individual vulnerable to the stresses and strains of modern life. The fast changing social milieu, among other factors, is mainly contributing to the proliferation of drug abuse, both of traditional and of new psychoactive substances.

The introduction of synthetic drugs and intravenous drug use leading to HIV/AIDS has added a new dimension to the problem, especially in the Northeast states of the country.

Studies/Reports - Reported Trends in Drug Addiction

The rough estimation i.e. about 3 million population dependent on drugs (0.3% of the population), excluding those dependent on alcohol, has been the basis for various interventions. A long felt need to have an authentic profile of drug addicts and accurate data about the extent, pattern and trends of drug abuse has been accomplished through a survey undertaken in collaboration with the UN0DC and ILO (Project D-83). This project has three major components viz. National Household Survey, Rapid Assessment Survey and Drug Abuse Monitoring System with sub-studies on drug abuse among rural population, prison population, women, and in border areas. The data emerging out of this survey and the studies undertaken through professional agencies would be used for future planning to address the multi-faceted problem of drug abuse.

The survey and studies indicate a high concentration of drug addiction in certain social segments and high-risk groups, such as, commercial sex workers, transportation workers, and street children and in the northeastern states/border areas and opium growing regions of the country.

The situation in northeast states has been little aggravated due to high incidence of Intravenous Drug Use (IDU), especially in the state of Manipur, leading to HIV/AIDS. The sero-positivity amongst them is about 70%.

Constitutional and Legal Framework

Article 47 of the Constitution of India directs the State to regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties, and, in particular, to endeavour to bring about prohibition of consumption, except for medicinal purposes, of intoxicating drinks and drugs which are injurious to health.

Section 71 of the Narcotic Drugs and Psychotropic Substances Act, 1985 (as amended) provides as under:

"Power of Government to establish centres for identification, treatment, etc., of addicts and for supply of narcotic drugs and psychotropic substances -

1. The Government may, in its discretion, establish as many centres as it thinks fit for identification, treatment, education, after-care, rehabilitation, social re-integration of addicts ....."
2. The Government may make rules consistent with this Act providing for the establishment, appointment, maintenance, management and superintendence of ..... the centres referred to in sub-section (1) and for the appointment, training, powers, duties and persons employed in such centres."

Demand Reduction Strategy - A Welfare Approach

The issues relating to drugs are tackled by the Government of India through its two-pronged strategy viz. supply reduction and demand reduction. Whereas the supply reduction is under the purview of the enforcement agencies with the Department of Revenue as the nodal agency, the demand reduction strategy is under the domain of social sector and the Ministry of Social Justice & Empowerment in Government of India is responsible for implementation of demand reduction strategy in the country.

Over the years it was realized that the drug abuse is not only a problem arising out of the availability of such intoxicating drinks and drugs but it has a great deal to do with the social conditions which create the demand for or the need for consumption of such substances. The vulnerability of the modern society plays a catalytic role in promoting the consumption and abuse of narcotic and psychotropic drugs.

With this the need arose for implementing strategies for prevention of drug abuse, educating the people about its ill effects and rehabilitation of the addicts. The recent UN documents have also stated Demand Reduction as the pillar of drug control strategies and have urged upon all the Members States to take immediate steps so as to make significant achievement by the end of year 2003 in controlling the demand for consumption of illicit drugs.

The findings of studies/reports indicate to the relationship of drug abuse with the socio-economic conditions or the social dynamics of the population. Therefore, the approach is to recognize drug abuse as a psycho-socio medical problem, which can be best, handled through community based interventions.

Keeping the aforesaid approach in view, the Govt. of India has a three-pronged strategy for demand reduction consisting of:

Building awareness and educating people about ill effects of drug abuse Building awareness and educating people about ill effects of drug abuse

Dealing with the addicts through programme of motivational counselling, treatment, follow-up and social-reintegration of recovered addicts.

To impart drug abuse prevention/rehabilitation training to volunteers with a view to build up an educated cadre of service providers.

The objective of the entire strategy is to empower the society and the community to deal with the problem of drug abuse.

Treatment and Rehabilitation of Addicts - Govt - NGO Collaboration

The Ministry of Social Justice & Empowerment, as the focal point for drug demand reduction programmes in the country, has been implementing the Scheme for Prohibition and Drug Abuse Prevention since the year 1985-86. As implementation of programmes for deaddiction and rehabilitation of drug addicts require sustained and committed/involved effort with a great degree of flexibility and innovation, a State-community (voluntary) partnership appears to be particularly strong mechanism for service delivery. Accordingly, under the Scheme, while major portion of the cost of services is borne by the Government, the voluntary organisations provide actual services through the Counselling and Awareness Centres; Deaddiction cum Rehabilitation Centres, Deaddiction Camps, and Awareness Programmes.

Under this Scheme, the Ministry is assisting 361 voluntary organisations for maintaining 376 De-addiction-cum-Rehabilitation Centres and 68 Counselling and Awareness Centres all over the country. Average annual allocation for this programme has been around US $ 5 million.

The basic objective in creating facilities for treatment, at Centres run through voluntary organisations, is to ensure that the support of the family and the community is mobilized to the maximum. These Centres adopt a wide variety of approaches, systems and methodologies for treatment and rehabilitation of the addicts suitable and adaptable to the social customs, traditions and culture. However this do not in any way undermine adoption of scientific, modern and established systems of treatment.

The rehabilitation and social reintegration of an addict is the mainstay of any such initiative. Therefore all programmes for treatment of addicts must compulsorily integrate into delivery system, programmes for psychosocial counselling of the addict and his family/peer groups; programmes for vocational training/rehabilitation and comprehensive programme for after-care and follow-up.

To attain these objectives, all Centres are equipped with a cadre of experts from various fields including doctors, counsellors, community workers, social workers etc. Thus, it is a multi-disciplinary approach being applied according to the needs of individual cases. They work in coordination with the community resources as well infrastructure and services available under other related agencies.

To facilitate the medical treatment of hard-core addicts who require intensive long-term medical attention, 100 Deaddiction Centres are being run in Government hospitals/Primary Health Centres, etc.

Awareness and Preventive Education

The Counselling and Awareness Centers are engaged in a wide range of awareness generation programme in varied community settings including village panchayats, schools etc. Besides these Centers, the Ministry has been actively utilizing the various media channels, print as well as audio-visual for educating the people on the ill effects of drug abuse and also disseminating information on the service delivery.

The overall approach is based on the need to comprehensively address the widespread ignorance and lack of information on the ill- effects of drug abuse prevention/rehabilitation services and to build up a climate of abstinence from drugs through sensitising the community at large.

In this perspective, the strategy for public awareness about the damage consequences of drug abuse takes into account the culture-specific aspects of the problem. A differential approach has been adopted towards educating the public vis-à-vis groups at risk.

Training and Manpower Development - Development of Service Providers

The Government has established a National Centre for Drug Abuse Prevention (NC-DAP) under the aegis of the National Institute of Social Defence, New Delhi, to serve as the apex body in the country in the field of training, research and documentation in the field of drug abuse prevention.

To meet the growing demand of rehabilitation professionals in the country, the Centre has been conducting three months' Certificate Course on Deaddiction Counselling and Rehabilitation of Drug Abusers. The Centre has been conducting advocacy programmes, seminars, conferences and training courses all over the country in collaboration with the State Govt. Institutions and NGOs for sensitisation, awareness generation and training.

The NC-DAP is mandated to serve as a Centre of Excellence in the region with an in-house team of experts as faculty, being complemented and supported by eminent experts and professionals as guest faculty.

Inter-Sectoral Collaboration

The problem of alcoholism and drug abuse is a social malaise and is dealt holistically by targeting all spheres of human activity. The Government of India has been following an integrated approach involving all concerned Ministries and Departments who could complement and supplement the initiatives being taken by each other. The initiatives being taken include imparting education on drugs and positive alternative to the youth through appropriate modification in school curriculum and sensitisation of school environment. Programmes are being developed for the sensitisation of the teachers, parents and the peer groups in a school environment through the participation of the Non-Government Organisations. The cooperation of the media and various youth organisations has also been solicited for dissemination of information on ill effects of alcohol/drugs and in engaging the community in positive/healthy alternatives.

Available Government infrastructure and services have been integrated with the services offered by the NGO sector for dealing with associated health problems such as TB, HIV/AIDS, Hepatitis etc. Efforts are also being made to provide the medical professionals in the health sector with the knowledge on rehabilitation and after-care of alcohol and drug dependents. Simultaneously, steps have been initiated for providing training to the NGO professionals on various medical inputs for providing effective service to the clients. One of the successful initiatives towards inter-sectoral collaboration has been the integration of HIV/AIDS prevention programme into the substance abuse programme of 100 NGO run Deaddiction Centres supported by the Ministry of Social Justice and Empowerment.

International Cooperation - An Enrichment Process

The Ministry of Social Justice & Empowerment, in collaboration with the International Labour Organization and UNODC, implemented a project on "Developing Community Drug Rehabilitation and Workplace Prevention Programmes", to sensitise and train the voluntary organisations and workplace settings on prevention of alcoholism and substance abuse in workplace. It is viewed that the work environment of an individual is the most important area of preventive intervention for a potential addict as he still enjoys economic security. The loss of a job further aggravates the addictive behaviour. This aspect was not getting its due importance under the on-going programme. With the sincere efforts made under the project, a number of corporate institutions have also volunteered their involvement in the project.

This was followed up with two community-based interventions in collaboration with UNODC and ILO, namely:

1. Community Wide Demand Reduction in India
2. Community Wide Demand Reduction in North-Eastern States of India

These initiatives were primarily addressed towards strengthening the delivery of services through capacity building of the service providers, developing infrastructure for decentralization of programme monitoring at the regional levels, developing networking and linkages amongst the NGOs, the concerned agencies and the Government as well as sister UN organisations drawing upon the experience gained in the earlier project. The project for the Northeast was specifically designed keeping in mind the local customs, cultural traditions, community bonding as well as infrastructural inadequacies. The projects have adopted a comprehensive approach to the development of the target communities of these States.

Areas of Strength - Success Stories

Quality Assurance and Minimum Standards: The sheer size of population and geographical expanse of the country with cultural diversity makes it a real challenge to ensure delivery of quality services across the country. The quality assurance has, however, been ensured by developing a Manual of Minimum Standards of Services with adequate flexibility for adaptations to suit regional requirements, and by making institutional arrangements for professional training of service providers.

Professional Manpower Development: The assurance of quality in delivery of the services being the benchmark, creation of infrastructure of professionally trained service providers has been in the centre stage of Government agenda. National Centre for Drug Abuse Prevention (NCDAP) has come up as an apex institution with the mandate for training, research and development in the drug sector. Training requires regional and local variations. Further to ensure that training is imparted indigenously, eight non-government organisations (NGOs) have been established as Regional Resource and Training Centres (RRTCs). These objectives have been realized under the collaborative projects of the Ministry of Social Justice and Empowerment, UNODC and ILO, popularly known as E40 and E41.

Networking of Service Providers: The uniform delivery of services across the vast country with basic minimum standards is considered paramount in drug prevention programme. FINGODAP (Federation for Indian NGOs in Drug Abuse Prevention) is a movement to facilitate networking amongst member NGOs (essentially those funded by the Government of India) so as to gain from each other's experience, and also to ensure self-restraint towards implementation of minimum standard of services.

Focused Interventions for Vulnerable Targets: The work places prone to drug addiction among the employees have warranted focused interventions to check the prevalence of drug abuse at these places. The Workplace Prevention Programme (WPP), a collaborative effort of the Government, ILO, NGOs and corporate sector has come up as a result. This collaboration has led to the formation of an effective group of various stakeholders, known as ARMADA, the Association of Resource Managers against Alcohol and Drug Abuse.

Inter-sectoral Convergence: Since drug demand prevention has to be addressed at the level of individuals, families and communities, India has adopted a holistic approach by way of convergence of advocacy, prevention and rehabilitation programmes of all relevant Government departments as also of other non-government activities. This convergence has been concretised by way of dovetailing the drug issues in the curriculum of schools/colleges, educational and informative programmes of media, activities of youth and sports organisations and health programmes.

Areas which need to be Highlighted in Future - Possibilities of Future Collaboration

• Information linkage
• Better & personalised data management
• Research on usage of indigenous methods of treatment both in medicinal & therapeutic
• Accelerated awareness campaign

Conclusion

While all round efforts are being made for prevention and containment of drug abuse in our society, a long journey is yet to be covered before we can draw some satisfaction. The problem having transnational causes and implications shall require Herculean efforts on the part of all the institutions. The empowerment of society through sensitisation and awareness is the only solution to support the efforts of enforcement agencies in containing the proliferation of drug trafficking and drug abuse.