The high road to despair

An AIIMS report on alcohol and drug taking is alarming

anushka

Anushka Dixit | March 5, 2019 | Delhi


#Magnitude of Substance Use in India   #survey   #government   #NDDTC   #cannabis   #opioid   #india   #alcohol   #drug use   #Ministry of Social Justice and Empowerment   #AIIMS  


India has 16 crore people who drink and 6.5 crore drug users, a survey by the All India Institute of Medical Sciences estimates. Of those who take alcohol, 5.7 crore have health or dependency problems. But only 2.6 percent of them report getting any treatment. Of the drug takers, only five percent have received hospital help. An alarming finding is that 4.6 lakh children are dependent on inhalants like petrol, thinners, and whiteners.

The survey was conducted by the National Drug Dependence Treatment Centre (NDDTC) of AIIMS, and sponsored by the ministry of social justice and empowerment. It sampled 5.4 lakh people between 10 and 75 years of age. About 2 lakh households were visited, from which 4.7 lakh responses were obtained. A respondent-driven sampling covered 70,293 individuals.
 
Substance categories studied in the report were: alcohol, cannabis (bhang and ganja/charas), opioids (opium, heroin and pharmaceutical opioids), cocaine, amphetamine type stimulants (ATS), sedatives, inhalants and hallucinogens.

 

 
 
Some questions
Let’s face it: it’s almost impossible to enumerate the number of any kind of subgroup (say, the number of people who smoke cigarettes or love chocolate) from a large population. Nor is it necessary, say statisticians. Random sampling, with an appropriately chosen sample size, will do the trick. From the results of a truly random sampling, an estimate can be made for the whole population. The trouble is that absolutely random sampling is an impossible ideal. There are further complications: large populations are usually stratified, that is, there are categories such as male/female, income slabs, regions and so forth, and these affect people’s choices. A sampling that is both truly random and adequately represents each of those categories and sub-categories becomes even more difficult to achieve. Statisticians adjust for these errors using elaborate methods of assigning weightages and arriving at confidence levels and margins of errors. Think of these values as the number of proverbial pinches of salt with which the survey results should be taken.
 
The AIIMS survey is certainly plausible. But there are questions that need to be asked, especially given the fact that the report mentions no confidence levels and margins of error.
 
Here are some questions Governance Now thinks should be asked of the survey:
  • Out of the total Indian population of 133.92 crore, the sample size was a meagre 5.4 lakh people or 0.0004 percent. The surveying exercise needs further attention in large-scale considerations. If not, it poses a validity threat to data reliability as well as quality and results on which national policy is framed.
  • There is no mention of Kerala in the report. Kerala, for a long time, was a state with high alcohol consumption, competing with Punjab on per capita annual consumption. With higher population density than Punjab, at one point it had the highest per capita alcohol consumption of any state in India, at over 8 litres per person per year. This was well above the national annual average alcohol consumption, which is 5.7 litres per person per year. But the report simply makes no mention of Kerala, which keen observers of the alcohol habit would have been interested in.
  • One of the problems in carrying out a drug abuse survey is that unlike users of alcohol, identifying substance dependance might not be easy as respondents are not forthcoming with information.
  • The Narcotic Drugs and Psychotropic Substances Act, 1985 (‘NDPS Act’) – India’s primary law to combat drug trafficking – has not performed as anticipated. There were on average 31,654 instances of crimes related to drugs in India annually between 2005 and 2014, reported under NDPS Act, according to reports by NCRB. 
  • The NDPS Act mentions rehabilitation but it does not give any guidelines or process on how this rehabilitation set-up would work. Rehabilitation is the second priority led by criminalisation and punishment. It was only in 2014, after Punjab acquired notoriety as a state where there was rampant drug abuse, the government set up 28 rehabilitation centres under a central scheme funded by the ministry of social justice.
  • According to data by the Open Government Data (OGD) platform India, the number of Integrated Rehabilitation Centres for Addicts (IRCAs), run by NGOs being supported under the scheme of assistance for prevention of alcoholism and substance (drugs) abuse, in India was 428 during April 2016. Although there are treatment centres dotted around the country, there is a gap between the number of centres and the prevalence of drug abuse. 
  • There is major ambiguity in the data available from government agencies about the number of rehabilitation centres as well as the number of beds available in the country at present; the number of children consuming illegal substances and number of drugs being consumed by the rural and urban population in unknown – which would call to question the relationship between socioeconomic status and substance use. 

anushka@governancenow.com 

(This article is published in the March 15, 2019 edition)

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