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Indian Journal for the Practising Doctor

A Study on Substance Abuse among Women from an Urban Locality of Delhi

Author(s): Khokhar A

Vol. 5, No. 5 (2008-11 - 2008-12)

ISSN: 0973-516X

Khokhar A

Dr Anita Khokhar, MD, Associate Professor, Department of Community Medicine, V.M.M.C. and Safdarjang Hospital, Delhi
Correspondence: Dr Anita Khokhar, 374-A, Pocket-2, Mayur Vihar, Phase-1, Delhi-110091

Abstract

Background: Indian society is in transition. Changing roles, increased stress and alterations in life style bring with them newer problems. Although the problem of drug abuse is now being increasingly recognized, female substance abuse statistics is difficult to find in official statistics.
Objective: To find the prevalence and pattern of substance abuse amongst women from an urban locality of Delhi.
Study design: Cross- sectional, descriptive study. Setting: Urban field practice area, Pillangi Gaon adopted by the Dept of Community Medicine, V.M.M.C and Safdarjang Hospital, Delhi Participants: Women residents of Pillangi area. Statistical analysis: Percentages, chi square test.
Results: Among the 400 women studied the prevalence of substance abuse was 36 % (144 women) 336 (84%) were Hindus and rest Muslims. 332(82%) were married,44(11%) single and 24(6%) divorced. 180 (45%) were illiterate and rest literate. More of the literate women were substance abusers; the difference between literates and illiterates was statistically significant (p<0.05). Medicines without prescription were the most common substances abused. Medicines were most commonly abused by women over 40 years as compared to those below 40; the difference between the two was statistically significant.(p<0.05). Majority of the Bidi smokers smoked less than 5 bidis a day. Major reasons cited for continuation of substance abuse were withdrawal symptoms amongst 42(95.45%) of the bidi users; for khaini, 20(60.6%) mentioned withdrawal symptoms and 14(42.2%) as addiction to it; 17(47.2%) of paan users cited withdrawal, 11(30.5%) addiction, 89(22.1%) boredom or time pass and 4(11.1%) relief. 27(50%) used medicines because they provided them relief and 12(22.2%) relief from withdrawal symptoms. 11(20.3%) did not have the will power to give up the medicines they were taking and 2(3.7%) abused them whenever they felt bored. For 2 (66.7%) of the naswar users, the reason cited for continuation was withdrawal symptoms and for 1(33.3%) it was addiction to it. For Hookah, withdrawal symptoms 2(50), addiction 1(25) and feeling bored 1(25%) were the reasons mentioned for continuation.
98% of the study population agreed that substance abuse was harmful. 95% of the study population was well aware of at least one disease caused by substance abuse. 67% of the abusers wanted to give up the substance abuse.

Key words: Substance abuse, women, Urban Delhi

Introduction

Drug abuse among women is a hidden and unrecognized problem. Data from Asia is scanty and where available limited in focus. It remains difficult to interview women users because of additional stigma and perceived consequences attached to the phenomenon. Caregivers do not recognize the problem thereby limiting treatment seeking.1,2 Women in India face greater problems from drug abuse than men do, although these differences do not clearly show up in official statistics.3,4 The present study was conducted against this background to find the prevalence and pattern of substance abuse among women and to assess their knowledge regarding the health impact of substance abuse.

Materials and Methods: It was a cross-sectional study conducted among women residents of Pillanji area – the field practice area of the Department of Community Medicine, V.M.M.C. and Safdarjang Hospital, Delhi. All the women above the age of 10 years were considered eligible to participate in the study. A systematic random sample was chosen, and data collected in two months time. A total of 400 women were interviewed using a pre-tested and pre-structured oral questionnaire.

The pre-structured questionnaire was first pretested on 25 women, and the requisite alterations and additions were made. Every second household was chosen and one woman from that household was interviewed. In families where more than one eligible woman was found, a number was assigned to each one of them and then chit method was applied to choose the woman to be interviewed. Interviews were conducted by the medical interns in Hindi and questionnaires were filled by the interviewer. Before starting the interview, the women were informed regarding the type of questions they would be asked, and assured of confidentiality. At the end of each interview the participant was thanked for her cooperation.

Definitions Used

DSM-IV5, issued by the American Psychiatric Association, defines substance abuse as follows:

  1. maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
    1. Recurrent substance use resulting in a failure to fulfill major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; neglect of children or household)
    2. Recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
    3. Recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct
    4. Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, physical fights)
  2. The symptoms have never met the criteria for Substance Dependence for this class of substance.

Working Definition:

In our study we have included the following substances- bidi, khaini, paan, hukkah, nasvaar, gutkha, alcohol, medicines, charas, ganja, I/v drugs etc.

Abusers were considered those who used to take the substance daily and in case of medicines, without the prescription of the doctor.

Results

Of the 400 women studied, 44 (11%) were 10-20 years, 152 (38%) 20-40 years, 124(31%) 40 to 60 years and 80 (20%) were more than 60 years of age. 336(84%) were Hindus and rest Muslims. 332 (82%) were married, 44(11%) single and 24(6%) divorced. 180(45%) were illiterate and rest literate.

36 ( n=144) of the studied sample were abusing some or the other substance. More of the literate women were abusing substance; the difference between substance abuse amongst literates and illiterates was statistically significant (p<0.05). 232(58) of the studied women belonged to the upper middle socioeconomic group according to Gupta et al categorization; 96(24%) belonged to the lower middle, and 36(9%) each to upper and upper lower class.

Medicines without prescription were the most common substance abused as evident (Table 1), and were more commonly abused by women over 40 years of age than those less than 40 years; the difference between the two was statistically significant. (p<0.05).

Major reasons cited for continuation of substance abuse were withdrawal symptoms amongst 42 (95.45%) of bidi users. For khaini 20(60.6%) mentioned withdrawal symptoms and 14(42.2%) as addiction to it. Among Paan chewers 17(47.2%) cited withdrawal, 11(30.5%) addiction, 89(22.1%) boredom or time pass and 4(11.1%) relief as reasons for continuing with the habit. 27(50%) used medicines for relief from some discomfort, 12(22.2%) relief from withdrawal symptoms, 11(20.3%) did not have the will power to give up the medicines they were taking and 2( 3.7%)n abused them whenever they felt bored. In case of naswar, 2 (66.7%) feared withdrawal symptoms on discontinuation and 1(33.3%) was addiction to it. For Hookah, withdrawal symptoms were given by 2(50), addiction by 1(25) and feeling bored by 1(25%)

Knowledge

98% of the study population agreed that substance abuse was harmful. 95% of the was well aware of at least one disorder/disease caused by substance abuse. Ironically, 67% of the abusers wanted to leave the substance abuse.

Discussion

Prevalence of substance abuse in this study was 36% which is higher than what was reported by key informants in a Mumbai study in which only 5–10% of women were shown to be using drugs.6 In Jodhpur Drug De-addiction Centre only 1-3% treatment seekers were females.7 Till now not much of insight has been provided into patterns of drug use in Indian women. National multi-centred studies in 1956, the late 1970s and in 1989 reported negligible drug use among women. Four large epidemiological studies undertaken in 1990s covering North, West, South and North-east India showed 92-94% women had never taken drugs in their lifetime.6 In the present study, medicines (cough syrup, pain killers) were abused by many i.e. 37.5% followed by bidis (30-55%). This is in agreement with reports from north India where the commonest abused drug was opioids (by 60% of the abusers).7 In our study bidi and khaini were used to lessen mental and physical stress which compares well with the UNDCP report. 13% of the women from Mumbai reported initiation of drug use on account of humiliation, shame, anger and powerlessness as a response to their situation.8

Acknowledgement: I thank all the women who participated in this study. Also I acknowledge the efforts put in by the interns and the field staff.

Conclusion

Indian society is in transition. Changing roles and attendant stresses have brought problems with them which never existed before. Prevalence of drug abuse is on the rise amongst different strata of society. As a result of their subordinate position women are more likely to suffer from the consequences. We need to evolve alternate strategies to identify women with problems related to drug abuse. Most women abuse the drugs most readily available to them that is medicines. May be the health and welfare needs of the women require to be addressed in a more focused way so that they do not feel the need to take drugs.

References:

  1. Closer MH, Blow FC.Special population.Women, Ethnic minorities and the elderly. Psychiatry Clin N Am, 1993; 16:199-209
  2. Smith L.Help seeking in alcohol dependent females.Alchol, Alcohol, 1992; 27:3-9
  3. Sanjay Kumar. Drug misuse causes major problems for women in India .Br Med J 2002; 324:1118(11th May).
  4. Anupam Bhagria ‘Drug addiction on the rise among women’. Express India.Com, September 30, 2007
  5. Definition of substance abuse-Medicine net.com15th May, 2008, DSM-IV, Fourth Edition of the Diagnosis and Statistics Manual of Mental Disorder by American Psychiatric Association.
  6. Study on substance abuse among women:’ The women’s study’ book 23.12.02.pg65.
  7. Grover S, Irpati AS, Saluja BS, Mttoo SK and Basu D, Substance- dependent women attending a de-addiction center in North India: Sociodemographic and clinical profile., Ind J Med Sci, 2005; 59(7):283-91
  8. Women and Drug Abuse: The Problem in India, UNDCP Report, Ministry of Social justice and Empowerment, 2002.

Table 1: Pattern of substance abuse among women subjects (n=144)

Substance abused٭ Number Percentage
Medicines 54 37.5
Paan 44 25
Bidi 36 22.9
Khaini 33 2.7
HUkkah 4 2.08
Nasswar 3  

٭responses are not mutually exclusive

Table 2: Frequency of consumption of the various substances abused by women

Substance n %
Bidi n=44
<5times/d 28 (63.5)
5-10times/d 07 (15.9)
>10 times/d 9 (20.45)
Khaini n=33
<1 packet 27 (81.9)
1-2 packet 04 (12.12)
>2 packet 02 (6.76)
Paan n=36
1-2 24 (66.5)
3-5 08 (22.2)
>5 04 (11.11)
Hukkah n=4
1-3 times/day 3 (75)
4-6 times/day 1 (25)
Naswar n=3
1-2 times /day 2 (66.5)
3-5 times /day 1 (33.3)
Medicine n=54
Once a day 39 (72.2)
Twice /day 10 (18.51)
>2 times/day 05 (9.25)

Table 3: Reasons for substance abuse cited by the studied women

Substance
(multiple responses)
Mental stress Physical Stress Influence of
family /friends
Addiction Others
Bidi n=44 17(38.6) 11(25) 9 (20.45) 12(27.3) 2(4.5)
Khaini n=33 5(15.2) 12(36.3) 6(18.1) 10(30.3) 2(6.1)
Paan n=36 12(33.3) 10(27.7) 8(22.2) 18(50) 0
Hukkah n=4 2(50) 0 1(25) 2(50) 0
Nasvaar n=3 1(33.3) 0 2(66.6) 2(66.6) 0
Medicine n=54 11(20.3) 45(83.3) 0 10(18.5) 3(5.5)

٭Figures in brackets are percentages

Table4: Substance abuse according to time duration

Substance abused <5 yrs 5-10yrs 10-15yrs 15-20yrs >20yrs
Bidi(n=44) 12(27.3) 14(31.8) 16(36.4) 0 2 (4.5)
Khaini(n=33) 18(54.5) 6(18.18) 4(12.12) 0 5(15.15)
Paan(n=36) 5(13.9) 8(22.2) 13(36.11) 2(5.55) 8(22.2)
Hukkah(n=4) 0 0 1(25) 2(50) 1(25)
Nasvaar(n=3) 1(33.3) 0 0 1(33.3) 1(33.3)
Medicine(n=54) 51(94.4) 3(5.6) 0 0 0
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