Drugs are any chemical substance used in the treatment, cure, prevention, or diagnosis of diseases or used to otherwise enhance physical or mental well-being

Drugs of Abuse can be any chemical/drug, natural/synthetic, which actson the brain and influence either thinking/ perception, feelings/emotions, behaviors individually or coordination of all these functions”. They are also called as ‘Psychoactive Substances’

The drug use pattern in any individual/community can be as follows:

1. Abstinent: A large number of the general population do not take any drug of abuse. They remain abstinent
2. Social use: This includes casual drinking/ drug use in a social setting without an intent to get drunk/ intoxicated. Culture and societal values also determine the definition of social use. For example: In our country, in some communities, alcohol is served as a beverage in their marriage and other celebrations. But in certain communities alcohol use is strictly prohibited.
3. Hazardous use: Hazardous use is a pattern of substance use that increases the risk of harmful consequences for the user. Some would limit the consequences to physical and mental health (as in harmful use); some would also include social consequences. In contrast to harmful use, hazardous use refers to patterns of use that are of public health significance despite the absence of any current disorder The drug use pattern in any individual/community can be as follows: in the individual user. This is not a commonly used terminology.
4. Harmful use: This is a pattern of psychoactive substance use that is causing damage to health. The damage maybe
   • physical (e.g. hepatitis following injection of drugs) or
   • mental (e.g. depressive episodes secondary to heavy alcohol intake).
   • Harmful use commonly has adverse social consequences

   This pattern of drug/ alcohol use can be of a significant public health concern as it may harm the individuals, their significant others and their community at large.

5. Dependence/ Addiction: This pattern is the most severe form of drug abuse. It includes a cluster of behavioural, psychological and physiological symptoms and signs that may develop after repeated substance/drug use. There will be significant dysfunction in most of the dimensions (personal, family, social and occupational) of the person’s life due to the drug use related behaviours.

Although any person who uses drugs may evolve over from social use to addiction, it needs to be kept in mind that not all those who have social use will develop an addiction.

According to International Classification of Diseases (ICD)-10 a definite diagnosis of dependence should usually be made only if 3 or more of the following symptoms/ signs have been present together at some time during the previous year:

• a strong desire or sense of compulsion to take the substance.
• difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use.
• a physiological withdrawal state when substance use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for the specific drug or substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms.
• evidence of tolerance, such that increased doses of the drug/substances are required in order to achieve effects originally produced by lower doses
• progressive neglect of alternative pleasures or interests because of drug/ substance use, increased amount of time necessary to obtain or take the substance or to recover from its effect.
• persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning.

Alcohol is the most common psychoactive substance used by Indians. Nationally, about 14.6% of the population (between 10 and 75 year of age) uses alcohol. In terms of absolute numbers, there are about 16 crore persons who consume alcohol in the country.

The prevalence of dependent patterns of alcohol use in the general population (10—75 years) is estimated to be 2.7%, or 2.9 crore individuals.

No. Only a certain subset of the users become addicted to it.

The following are some examples of people who are at risk of developing addiction

1. Those who start drugs / substances under 19 years of age have a higher chance of getting addicted
2. Persons with history of mental illness
3. Persons with family history of addiction or mental illness
4. Those children who undergo significant stress in the form of poverty, violence in family and neighbourhood, poor nutrition, physical/emotional/sexual abuse, poor parenting, etc during the development years.
5. Those who are with poor impulse control/ disturbed emotional regulations/ high thrill seeking behaviour/ low perception of dangers in drug use

Some of the following are probable indicators in a person for drug/substance abuse:

Sudden change in behaviour and mannerism, frequent change of friends – who family doesn’t know/ approve, unnecessary anger, unsatisfactory explanation, withdrawn behaviour (especially with family), disinhibition, depression, mood instability, and apathy, suddenly beginning to come home late, unusual and violent behaviour following trivial arguments or simple requests, sense of vulnerability and emotional instability, lack of motivation to any necessary activity, slurred speech/ communication difficulty, multiple thefts or missing personal items., neglect of personal hygiene and appearance and adoption of unusual dress habits.

Motivation is a dynamic phenomenon. Same person who resists quitting drugs of abuse once might be willing to quit later. The different stages of motivation are as follows

• Pre-contemplation: Person is not ready to consider a change or unaware of the need to change; sometimes demoralised
• Contemplation: Ambivalent; Person both considers and rejects change.
• Preparation: Person is open to change and preparing for change
• Action: Person is engaging in actions with the intention of bringing about change.
• Maintenance: Person is maintaining a change that has already been made