A
multi-dimensional approach needs to be adopted to counter the menace of
substance abuse that should include a slew of measures towards prevention and
control as well as towards treatment and rehabilitation in addition to strategies
needed to simultaneously reduce their supply, demand and harm in the community
Substance abuse is rapidly assuming
epidemic proportions in our society engulfing a significant population of our
youth who are otherwise meant to be our nation-builders. Statistics regarding
magnitude of the menace of substance abuse in our society emerging from various
de-addiction centres of J&K are quite worrisome and alarming and therefore call
for a systematic and scientific approach for countering the problem. Such an
approach may include a slew of measures described as under.
Generate
credible evidence through research
First step towards fighting the menace of substance
abuse in our society has to be the generation of credible, scientific evidence
about the incidence, prevalence, epidemiology, mortality and morbidity related
to this problem through context-specific and need-based research. We need to
have accurate statistics for chalking out our combat strategies and planning
our prevention, de-addiction and rehabilitation programmes well. Figures that
are often quoted about the magnitude of involvement of our youth in drug abuse
are usually found to be obsolete and redundant. We need to have latest facts, figures
and scientific analysis of not only the incidence and prevalence data but its
socio-economic and health impact too.
Convert evidence into a policy framework
Evidence generated through well-designed scientific
studies need to be translated into a robust policy framework for action.
Already we have a drug de-addiction policy notified by the Govt. of J&K on
January 11, 2019 that may be revisited and reviewed in light of the latest data
emerging from the epidemiological studies. A meticulous procedure for
persistent monitoring and evaluation laid out in the policy document per se needs
to be utilized for its periodic review. Need for a revision and review of the
policy after just two and a half years of its execution arises from the fact
that over a period of just three years between 2016 and 2019 a startling 945 percent
rise in the number of addicts has been reported at just one hospital and a radical
shift from abuse of prescription medicines like sleeping pills to narcotic drugs
like heroin has also been reported during this period in a pilot study
conducted by the Institute of Mental Health and Neurosciences (IMHANS). This
study revealed that 1.9 percent population in the twin districts of Srinagar
and Anantnag is abusing substances of various kinds that translates into 17,000
people, out of whom 87.3 percent were found to abuse opioids and heroin was the
most widely used opioid drug (GK dt. June, 26, 2020).
Translate policy into action
A sad fact of our part of the globe is
that mostly our policies remain confined to paper and are not fully implemented
well in time as was the case with our premier drug policy that was devised,
approved and promulgated in 2012 by the J&K govt. Even if they are
implemented the pace is often sluggish. Unless policies translate into action
on ground, they are worth the piece of paper on which they are written.
Timelines and roadmap for implementation of the policy in a systematic and
well-organized manner must be laid out in the policy document itself which does
not unfortunately happen quite often. Take for instance NEP-2020, there is no
clear roadmap laid out for its time-bound implementation in the policy document
itself. An online, real-time dashboard showing progress made in the
implementation of various policy provisions must be made mandatory for every notified
policy. Role and responsibilities of each and every stakeholder in its timely
implementation must also be specified in clear and unambiguous terms. Furthermore,
a step-wise approach needs to be adopted for policy implementation on the basis
of well-designed algorithms that includes measures like agenda setting, policy
formulation, adoption and implementation, organizational reform, capacity
building, monitoring and evaluation, periodic review and re-implementation in
the next cycle.
Supply reduction strategies
Supply reduction includes a broad range of
strategies and actions that are required to stop or minimize the production,
manufacture, sale and distribution of illicit drugs. Vulnerability of the
entire country in general and J&K in particular in serving as a transit
route and consequent hotspot of narcotics and illicit drugs becomes evident
from the fact that India is sandwiched between the golden crescent countries
like Iran, Pakistan and Afghanistan and golden triangle countries like Myanmar,
Thailand and Vietnam, that have historically been the hubs of opium cultivation
since hundreds of years. Somehow till recent times India had remained untouched
by this scourge but not so any more. This menace is assuming dangerous and
alarming proportions in the entire country now particularly in states/UT like
Punjab, Haryana, Rajasthan and now J&K. Notwithstanding the fact that only
a multi-dimensional approach can be effective towards curbing the menace of
drug abuse and evolving a drug-free society, it needs to be emphasized that stringent
law enforcement is without any doubt the most important and crucial step
required for the same. Though attempts to treat and prevent drug abuse through
tough penal sanctions alone for drug users have historically failed, unless trafficking
and supply of substances of abuse is not reduced to a very large extent, no
amount of hard work on the demand front is going to yield good results.
Deterrent punishments and penalties need to be awarded by the courts to all the
convicts of drug abuse. Only when the region is cleared of all kinds of
substances of abuse on a sustained basis, can the demand side activities
mentioned below prove to be fruitful in countering this menace.
Demand reduction strategies
This includes a range of policies and
programs that seek to reduce the desire, demand, craving and preparedness to
obtain and use illicit drugs. It includes a host of measures aimed at informing
and educating the masses and enhancing awareness about the socio-economic,
medico-legal impact and harmful effects of drug abuse on health. It highlights
the adverse effects on the vulnerable populations including women and children
in particular. Emphasis is laid during demand reduction upon primordial and
primary prevention of drug abuse. Primordial prevention informs the community
about the potential risk factors and consequences of substance abuse as well as
the means to avoid those factors. It also seeks to improve over-all living and
working conditions of the people besides healthy and drug-free environment at
schools and work-places. It also aims to promote overall physical and mental well-being
in the community by adopting healthy lifestyles, hygienic and nutritious food intake
and regular exercise. Similarly primary prevention measures seek to embrace the
protective factors and reduce the impact of risk factors targeting the
populations at risk and focussing on decreasing their vulnerabilities. It also
aims at training the teachers and community health workers in identification,
risk reduction and timely medical help for the children and adolescents having traumatic
life experiences which makes them vulnerable to substance abuse. Awareness
about ill effects of drug abuse needs to be incorporated into the curricula at
all levels of education and the teachers too need to be acquainted well with
the signs and symptoms of potential substance abuse.
Harm reduction strategies
It includes policies and programmes that
focus directly on reducing the harm resulting from the use of illicit drugs,
both to the individual and the community at large. Harm reduction encompasses
measures that take the victims of substance abuse out of the quagmire through a
sustained de-addiction process that includes medical interventions like drug
treatment, psychotherapy, counselling and rehabilitation services. Psychotherapy
helps them break the vicious cycle of negative feelings, behaviours and actions
and trains them in adopting effective coping strategies against stress and
intriguing thoughts. Rehabilitation of drug abuse victims on the other hand is
of paramount importance as drug abuse is fraught with stigmatization and therefore
de-stigmatization needs to be achieved by bringing them back into the
mainstream of society and providing them ample opportunities to earn their own
livelihood. This will also include adequate education and counselling of their
families and communities to treat them well and help them in resuming their
normal life. Rehabilitation thus includes empowerment of the victims to stay
away from drugs and live a joyful life amidst their families and communities. Harm
reduction also includes secondary and tertiary prevention measures for those
who have already fallen prey to the menace of substance abuse and the focus is
now on reducing further harm and complications and salvaging the remnants of
their physical and mental health from the ill-effects of the disorder.
Conclusion
Based on the outlook that substance abuse
is a psycho-socio-medical problem and not necessarily a “self-acquired
affliction”, that can be handled through community-based interventions, a multi-dimensional approach needs to be adopted to counter
the menace that should include measures towards prevention and control as well
as towards treatment and rehabilitation. Strategies need to be devised that
simultaneously address supply, demand and harm reduction side of drug abuse control.
An effective partnership, coordination and collaboration between various
govt. agencies and multiple stake-holders needs to be fostered. Drug
de-addiction policy notified by the J&K government in the year 2019 must be
implemented in letter and spirit, constantly monitored for its effectiveness
and regularly reviewed and revised for making necessary amendments in the same
with a view to make it highly effective, focused, productive and goal-oriented
policy.
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