Pattern of Substance Abuse among Children in Slum Areas of India

1. Introduction

Substance abuse is a social problem from eternity.World Health Organization (WHO) mentions substance abuse as the harmful or hazardous use of psychoactive substances, such as alcohol and illegal drugs. Substance abuse is “persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice” [1]. Substance abuse among the youngsters and adolescents is the rising social problem all over world [2].

Alcohol addiction is the leading problem for death and disability all over the world.it is observed that 75 million people are alcohol addicts and 3 million are opioid abusers in India [3]. Due to tobacco addiction nearly 13,000 deaths per day occurs all over It has been predicted by the According to World Health Organization (WHO) that tobacco consumption will lead more than 500 million mortality people by 2030 and it will be the commonest cause of death [4, 5]. Many studies has shown that smokers became habituated at adolescent period. It is unfortunate that consumption of alcohol is getting social acceptance and has become status symbol.

All hard drugs like opioids and other became the easily available which is the important cause of substance abuse in adolescents. Alcohol and opioid addiction is common in children. According to National institute on drug abuse (NIDA), in adolescence marijuana use consumption is common. Many studies had shown that common age group of substance abuse ranges from 12 to 20 years [6].

The United Nations has designed 17 Sustainable Development Goals (SDGs) and 169 targets. They expected that by 2030 all states will succeed to achieve all goals. From above all Sustainable Development Goals, important Goal-3 having Target-5 stresses on Strengthening the prevention of substance abuse and its proper treatment especially of narcotic drug and alcohol abuse. Many researches has confirmed that antisocial activities in childhood leads to alcohol abuse in adolescent. Adolescents is the most important stage of human life but unfortunately this group is most misunderstood and neglected by the society [7].

Substance addiction (drug addiction) and Non-substance addiction (behavioral addiction) are two different disorders. Substance addiction or drug addiction is a neuropsychiatric disorder categorized by a periodic craving for the consumption drug despite of having knowledge about harmful effects. Non substance abuse includes pathological food obsession, internet craving, and mobile phone compulsion [8].

Men are always under stress and for relief of it used many parameters one of it is drug abuse. This problem has risen at all levels in the society in various forms. Drug trafficking is one of the most profitable trades along with petroleum and weapons trade. Every country has and is facing this problem in its own way. Newer forms of drug abuse patterns like solvents are on the rise probably due to strict regulations on other recognized forms of abuse.

Street children in India constitute a group of marginalized population in most urban centers of the country. They constitute children living in streets permanently, who are detached from their families and live on the streets temporarily, children who belong to poor families and spend most of their time on the streets, children living with their families on the streets etc [9].

These children have to put up with a variety of physical and mental abuse and hence are a concern for a wide range of social issues. Poly substance abuse is common among these children and often solvents are the first psychoactive substance they attempt to try. Not much is known as to why children adopt such abusive behavior. Solvents are freely available in the market without any regulations in India. Though a lot of global awareness is reached about this form of abuse it is yet to be recognized by the political circle in the country [10].

We have been facing a shocking rise of substance abuse among the youngsters. Recent times have witnessed a steady increase in drug abuse among younger population, with more children starting substance use from an early age. Further, the delinquent is seen across all socioeconomic groups, from cities to small towns and rural areas, with new and multiple substance use also being recognized [11, 12].

Speedy industrial development with changing lifestyles have left the youth harassed for their survival; compelling many to seek defense in the dark world of substance abuse. India too, is fronting a similar condition that has been paying attention of policy makers and researchers [13, 14, 15].

Not only the child, but the family and society as a whole are likely to be disturbed as a result of early onset substance use. Thus, this matter is of nationwide interest and significance. This phase of life is characterized by growth and maturation of brain and body, which potentially affects responses to drugs and treatment [16, 17, 18, 19].

World Health Organization (WHO) estimates that globally 25 to 90% of children and adolescents have consumed at least one substance of abuse [1, 19, 20]. In India approximately 5500 children and adolescents start using tobacco products daily, some as young as 10 years old. A large number of them have used tobacco prior to the age of 18 years [21, 22, 23].

Dependence is defined by World Health Organization and American Psychiatric Association, as a syndrome of physiological, behavioral and cognitive phenomena, which lead to loss of control over use. DSM-5, cancels the term ‘dependence ‘and substitutes it with ‘use disorder’ [24].

Research on substance abuse among children and adolescents presents its own distinctive challenges. But the main question is that why the Indian society is facing such a quandary where more of the teenagers and youths are indulging in immoral and unproductive activities like substance abuse. The present study has the aim of analyzing the biosocial profile and pattern of substance abusers. The study is indicative for the need of fostering a supportive environment comprising of both parents and teachers so that adolescents can adopt and sustain with the right choices for a healthy life.

2. Methodology

It’s a descriptive cross sectional study done in collaboration with NGO (Balbhavan Project) working in slum areas of Ahmednagar. They were evaluated according to pre designed questionnaire in given time frame with the help of NGO (Balbhavan project) working in that area. All the children satisfying the following inclusion and exclusion criteria were enrolled in the study.

2.8 Results

To know the present scenario of substance abuse, we conducted a descriptive cross sectional study, among 246 children of slum areas of Ahmednagar under the guidance of Snehalay balbhavan project. The result obtained at the end of the study was quit shocking. It was found that in slum areas 87% children were drug abusers, among which 83% were boys and 17% were girls. A high correlation of substance abuse was found with increasing age consisting of 6.1% drug abuser of age group 5–8 years, 15% drug abuser of age group 9–12 years and 78.9% drug abuser of age group 13–18 years. Most abused substance among them was Tobacco, Alcohol, Inhalants, Sedative and opium. When we inquired about the educational status of parents, it was found that 84.6% of mothers were illiterate and 60.2% of fathers were illiterate. A special emphasis was laid on education of children among which 52% were school going and remaining were engaged in unskilled labor like rag picking, hotel worker, street vending, dhabha and other work. About 77.6% of these children got addicted due to their friends and 17.3% from their family. At the end of our study only 46.3% of them were willing to quit. 50.9% of children were craving for the substances and 38.8% of children got addicted due to peer pressure (Tables 1-5 and Figures 1 and 2).

Sr. No.	Variable	Groups	No. of participants (N = 246)	Percentage (%)
1	Sex	Male	191	77.6
		Female	55	22.4
2	Age	5–8 years	15	6.1
		9–12 years	37	15.0
		13–18 years	194	78.9
3	Living arrangement	Home (With family)	191	77.6
		(with friends/ distant relatives)	55	22.4
4	Mothers literacy	Literate	38	15.4
		Illiterate	208	84.6
5	Fathers literacy	Literate	98	39.8
		Illiterate	148	60.2
6	Drug abuse by mother	Yes	197	80.1
		No	49	19.9
7	Drug abuse by father	Yes	207	84.1
		No	39	15.9
8	Work	Student	128	52.0
		Rag picker/ Kabadi	29	11.8
		Street level vending	9	3.7
		Dhaba/ Restaurant/ Waiter	5	2.0
		Unskilled worker/ Labourer	13	5.3
		Do not work	30	12.1
		Others	32	13.0

Table 1.

Demographic profile of participants.

Age Groups	Drug Abuse (%)	No Drug abuse (%)	Total	Chi-Square Value	P Value
5–8 years	6 (2.8)	9 (28.1)	15 (6.1)	41.517	0.000
9–12 years	27 (12.6)	10 (31.2)	37 (15.0)
13–18 years	181 (84.6)	13 (40.6)	194 (78.9)
Total	214 (100.0)	32 (100.0)	246 (100.0)

Table 2.

Association between age and drug abuse.

As p < 0.05, there is significant association between age and drug abuse. Children in the age of 13–18 years are more likely to get involved in drug abuse.

Drug abuse by mother	Drug Abuse by children (%)	No Drug abuse by children (%)	Total	Chi-Square Value	P Value
Yes	178 (90.4)	19 (9.6)	197 (100.0)	9.887	0.004
No	36 (73.5)	13 (26.5)	49 (100.0)
Total	214 (87.0)	32 (13.0)	246 (100.0)

Table 3.

Association between mothers involved in drug abuse and drug abuse by the children.

As p < 0.05, there is significant association between mother involved in drug abuse and drug abuse by the children. If the mother is using drugs, there are 90.4% chances of children getting involved in drug abuse.

Drug abuse by father	Drug Abuse by children (%)	No Drug abuse by children (%)	Total	Chi-Square Value	P Value
Yes	188 (90.8)	19 (9.2)	207 (100.0)	16.920	0.000
No	26 (66.7)	13 (33.3)	39 (100.0)
Total	214 (87.0)	32 (13.0)	246 (100.0)

Table 4.

Association between fathers involved in drug abuse and drug abuse by the children.

As p < 0.05, there is significant association between father involved in drug abuse and drug abuse by the children. If the father is using drugs, there are 90.8% chances of children getting involved in drug abuse.

Sr. No.	Variable	Groups	No. of participants (N = 246)	Percentage (%)
1	Substance abuse (N = 246)	Tobacco	140	56.9
		Alcohol	41	16.7
		Inhalant	23	9.3
		Sedative	6	2.4
		Opium	4	1.6
		No Substance abuse	32	13.0
2	Want to quit the habit (N = 214)	Yes	99	46.3
		No	115	53.7
3	Procurement of the drug (N = 214)	Friends	166	77.6
		Family	37	17.3
		Itself	11	5.1
4	Difficulty in quitting (N = 214)	Craving	109	50.9
		Peer pressure	83	38.8
		Easily available	17	7.9
		Withdrawal symptoms	5	2.4

Table 5.

Drug abuse & related parameters.

3. Discussion

Substance abuse refers to the harmful or hazardous use of psychoactive substance including alcohol and illicit drugs. The present study reveals the prevalence of substance abuse among children to be 87%, which is higher than that reported by Lisa Sarangi et al. [2] where the prevalence was 43.4%.Jasani PK et al.in his study covered 600 adolescents and he found that substance abusers children were 30.17% [25]. Another study conducted at Andhra Pradesh by Benegal et al. Prashant et al. [11] revealed that about 32.7% children were abusers. Many research studies have found that, in India 50% children up to grade nine experiences the substance at least once [26, 27].

This research study revealed the major basic reason behind such high consumption of substance abuse is poverty, easy availability of substances and peer pressure. Jasani PK et al. found that most common cause of substance abuse was peer pressure, then experiencing thrill in life and academic stress [25]. Our results coincides with Benegal et al. Prashant et al. [11], in their study, they revealed most common reason was peer pressure (52.9%) then for pleasure (21.1%).But according to Jain et al. curiosity (68%)was the main reason for start of substance abuse [22], the reason behind it may be due to different culture and economic status. Another study by Barua et al. shown that academic stress comforting outcome and only for enjoyment were the common causes of consumption of alcohol [23].

This study also revealed that the most common substance being abused is the widely available Tobacco (56.9%) which is supporting, the findings of Dhirendra N. Sinha et al. [28]. Our findings are similar with Jasani PK et al., it showed most common substance is tobacco 25.83%, followed by liquor (2.17%), opioid/afin (1%) bhang (0.67%) [25].

Bihar based study by Sinha et al. showed that smoking is commonest substance abuse (19.4%)in school going children [14]. Kaur et al. from North India revealed 39.2% substance abusers consumes tobacco [15]. Another study from Uttar Pradesh by Dube and Handa et al. stated that alcohol is consumed by 22.8% abusers [16]. Similar findings 18.55% abusers are taking alcohol are also reported by Thacore [17], Shukla et al. described that 38.3% is substance abuse prevalence in the rural population in Uttar Pradesh [18]. Jena et al. also reported 28.8% rural people of Bihar consumes alcohol/drug [19]. Study conducted in most sensitive state, Punjab by Varma et al. revealed that 45.9% alcohol taking habit in urban population and 28.1% in rural population [20, 21].

It was found that in slum areas 87% children were drug abusers, among which 83% were boys and 17% were girls Prevalence of tobacco use was higher among boys than girls. Many research studies have found that, in India 50% children up to grade nine experiences the substance at least once [26, 27, 29]. Study by Majra et al. found that tobacco consumption is more among males (42.1%) as compared to females (17.0%) [13]. As boys are involved more in outdoor activities and are subjected to substance abuse. Adolescents reported using tobacco in multiple forms, chewing tobacco being the most popular.

A WHO study group on youth and drugs indicated that most of the experimentation and initiation of dependence producing drugs takes place during adolescence [30]. Though they had some knowledge about the harmful effects of substances, this was not sufficient to motivate them to quit, in our study only 46.3% were willing to quit. Craving (50.9%) was the most common cause to abstain substance abuse.

11 DSM-5 criteria implementation in clinics research purpose is easier than 11 DSM-IV criteria because one disorder is involved instead of two hierarchical disorders. A checklist helps for covering all criteria [31].

4. Conclusion

The study has emphasized the escalating incidence of substance abuse among slum children in Ahmednagar, pressing need of initiating programs for prevention and treatment in slum areas. The subject needs to be dealt in a comprehensive manner. There is need for availability of specialized treatment services for children who are using substances. These facilities should be available in government hospitals. The settings in which the facilities are delivered should be child sensitive and safe. Treatment programs must attempt to include the family in treatment and address the family issues as a part of the remedy. Rehabilitation of children should focus on skill building and vocational training. Substance abuse by children has detrimental impact on their physical, psychological, social and mental well-being hence needs immediate intervention. Rehabilitation of children abusing illicit substances is the necessity of the hour.

Acknowledgments

Firstly, I would like to express my sincere gratitude to my advisor Dr. Girish Kulkarni (Founder of Snehalaya) and Dr. Hanif for their great support. I am also thankful to all my students for their active participation in the project-Chhajed Neel A., Mehta Rahul J., Arve Rutvik N., Upadhyay Prabhakar I., Mustafa Saad.

Conflict of interest

The author declares no conflict of interest in the present study.

Source of funding

Not applicable.

Ethical clearance

Taken from institutional ethical committee.