By Akshaya Ashokan

The Indian subcontinent, a region of immense cultural, linguistic, and religious diversity, has a long and complex history with psychoactive substances. From ancient rituals involving intoxicants to the modern-day challenges of widespread substance abuse, the story of this region is intertwined with the use and misuse of various substances. This paper delves into the historical trajectory of alcohol and substance use in the Indian subcontinent, examines the current state of substance abuse, analyses the socio-cultural and economic factors contributing to this issue, and explores potential strategies for prevention and intervention.

I. Historical Overview: From Antiquity to the Colonial Era

A. Ancient India: Rituals, Medicine, and Social Practices

The earliest evidence of psychoactive substance use in the Indian subcontinent can be traced back to the Vedic period (c. 1500-500 BCE). The Rigveda, one of the oldest sacred texts, mentions Soma, a ritual drink believed to have psychoactive properties. While the exact identity of Soma remains debated, it is thought to have been derived from a plant or a combination of plants, possibly containing ephedra or psychedelic mushrooms. Soma was central to Vedic rituals and ceremonies, symbolizing divine inspiration and connection with the gods.

Apart from ritualistic use, substances like cannabis (bhang) and opium (afim) were also known in ancient India. Cannabis was used for medicinal purposes, as documented in the Atharvaveda, and also had social and recreational uses. Opium, while primarily used for medicinal purposes, may have also been used recreationally in some contexts.

B. Medieval Period: Influence of Islamic and Mughal Cultures

The arrival of Islamic rulers in the medieval period brought new cultural influences to the Indian subcontinent, including attitudes towards alcohol. While Islam generally prohibits alcohol consumption, some rulers and members of the elite indulged in wine and other intoxicants. The Mughal era (16th-19th centuries) saw the flourishing of a sophisticated court culture where wine and other substances were sometimes consumed, although public displays of intoxication were generally frowned upon.

Cannabis and opium continued to be used during this period, with opium gaining popularity, particularly in certain regions. The cultivation of opium poppy expanded under Mughal rule, and opium became an important trade commodity.

C. Colonial Era: Commercialization and Increased Availability

The British colonial period (18th-20th centuries) marked a significant turning point in the history of substance use in the Indian subcontinent. The British East India Company established a monopoly over opium production and trade, leading to a massive increase in opium cultivation and export, particularly to China. This period witnessed the infamous Opium Wars, which had devastating consequences for both China and India.

The British also introduced Western-style alcohol production and distribution, leading to increased availability and consumption of alcohol in India. The colonial government generated substantial revenue from the sale of alcohol, further incentivizing its promotion. This period saw the emergence of a more commercialized and widespread use of alcohol and other substances, laying the foundation for many of the challenges faced today.

II. Current State of Alcohol and Substance Abuse

A. Prevalence and Patterns of Substance Use

According to the “Magnitude of Substance Use in India” report (2019), conducted by the Ministry of Social Justice and Empowerment, alcohol is the most commonly used psychoactive substance in India, followed by cannabis and opioids. The report estimated that approximately 14.6% of the population aged 10-75 years uses alcohol.

• Alcohol: Alcohol use is more prevalent among men than women, with significant variations across states and regions. Some states, particularly in the northeast and south, have higher rates of alcohol consumption.
• Cannabis: Cannabis use, including ganja (marijuana) and charas (hashish), is also widespread, particularly among certain vulnerable populations.
• Opioids: Opioid use, including heroin and opium, is a significant concern in certain regions, particularly along drug trafficking routes.
• Other Substances: Other substances of abuse include inhalants, particularly among street children and adolescents, and pharmaceutical opioids and other prescription drugs.

B. Socio-Demographic Correlates of Substance Abuse

Substance abuse is associated with various socio-demographic factors:

• Gender: Men are significantly more likely to use and abuse substances than women.
• Age: Substance use often begins in adolescence or young adulthood.
• Socioeconomic Status: Substance abuse is prevalent across all socioeconomic strata, but certain substances, like inhalants, are more commonly used among lower socioeconomic groups.
• Occupation: Certain occupations, such as those involving manual labor or high stress, may be associated with increased substance use.
• Geographic Location: Substance use patterns vary across states and regions, with some areas having higher prevalence rates.

C. Health and Social Consequences of Substance Abuse

Substance abuse has far-reaching health and social consequences:

• Physical Health: Substance abuse can lead to various physical health problems, including liver disease, cardiovascular disease, respiratory problems, and infectious diseases like HIV/AIDS and hepatitis.
• Mental Health: Substance abuse is often associated with mental health disorders such as depression, anxiety, and psychosis.
• Social Problems: Substance abuse can lead to family problems, domestic violence, unemployment, crime, and social isolation.
• Economic Burden: Substance abuse imposes a significant economic burden on individuals, families, and society as a whole, due to healthcare costs, lost productivity, and law enforcement expenses.

III. Contributing Factors to Substance Abuse

A. Socio-Cultural Factors

• Cultural Norms and Traditions: Certain cultural practices and traditions may involve the use of psychoactive substances, which can normalize their use and increase the risk of abuse.
• Social Acceptance: In some communities, substance use, particularly alcohol consumption among men, may be socially accepted or even encouraged.
• Peer Pressure: Peer pressure, particularly during adolescence, can play a significant role in initiating and maintaining substance use.
• Stigma: The stigma associated with substance abuse can prevent individuals from seeking help and perpetuate the cycle of addiction.

B. Economic Factors

• Poverty and Unemployment: Poverty and unemployment can contribute to substance abuse as individuals may turn to substances as a coping mechanism for stress and hardship.
• Availability and Affordability: The easy availability and affordability of certain substances can increase their use and abuse.
• Economic Liberalization: Economic liberalization and globalization have led to increased marketing and availability of alcohol and other substances, contributing to their consumption.

C. Psychological Factors

• Stress and Trauma: Stressful life events, trauma, and mental health disorders can increase vulnerability to substance abuse as individuals may use substances to cope with negative emotions.
• Genetic Predisposition: Genetic factors can play a role in increasing susceptibility to addiction.
• Personality Traits: Certain personality traits, such as impulsivity and sensation-seeking, may be associated with increased risk of substance abuse.

D. Policy and Regulatory Framework

• Enforcement of Laws: Inadequate enforcement of existing laws related to substance production, distribution, and consumption can contribute to their misuse.
• Lack of Comprehensive Policies: The absence of comprehensive national policies addressing substance abuse can hinder prevention and intervention efforts.
• Limited Access to Treatment: Limited access to affordable and effective treatment services for substance abuse can perpetuate the problem.

IV. Prevention and Intervention Strategies

A. Public Health Approaches

• Health Education and Awareness Campaigns: Public health campaigns can raise awareness about the risks and consequences of substance abuse and promote healthy lifestyles.
• School-Based Prevention Programs: School-based programs can educate young people about substance abuse and equip them with skills to resist peer pressure and make informed choices.
• Community-Based Interventions: Community-based programs can engage local communities in preventing and addressing substance abuse through various activities and initiatives.

B. Treatment and Rehabilitation

• Detoxification: Detoxification programs can help individuals safely withdraw from substances under medical supervision.
• Therapy and Counselling: Various forms of therapy and counselling, such as cognitive behavioural therapy (CBT) and motivational interviewing, can help individuals address the underlying causes of their addiction and develop coping mechanisms.
• Medication-Assisted Treatment: Medication-assisted treatment (MAT) can be effective for certain types of substance abuse, such as opioid addiction.
• Rehabilitation Centres: Rehabilitation centres can provide structured environments and support for individuals recovering from addiction.

C. Policy and Regulatory Measures

• Strengthening Law Enforcement: Strengthening law enforcement efforts to curb the production, distribution, and trafficking of illegal substances is crucial.
• Implementing Effective Regulations: Implementing stricter regulations on the marketing and sale of alcohol and other substances can help reduce their availability and consumption.
• Increasing Access to Treatment: Increasing access to affordable and effective treatment services for substance abuse is essential.
• Developing Comprehensive National Policies: Developing comprehensive national policies addressing substance abuse, encompassing prevention, treatment, and rehabilitation, is vital.

D. Addressing Social and Economic Determinants

• Poverty Reduction Programs: Implementing poverty reduction programs can address the underlying economic factors that contribute to substance abuse.
• Employment Generation Initiatives: Creating employment opportunities can provide individuals with alternatives to substance use and improve their economic well-being.
• Social Support Programs: Strengthening social support programs can provide individuals with resources and assistance to cope with stress and hardship.

V. Conclusion: A Call for Multi-pronged Action

Substance abuse in the Indian subcontinent is a complex and multifaceted problem with deep historical roots and far-reaching consequences. Addressing this issue requires a multi-pronged approach that tackles the various contributing factors at the individual, social, economic, and policy levels.

Key areas for future action include:

• Further Research: More research is needed to understand the specific patterns and trends of substance use in different regions and among various populations.
• Data Collection and Monitoring: Improved data collection and monitoring systems are necessary to track the prevalence and consequences of substance abuse and evaluate the effectiveness of interventions.
• Collaboration and Coordination: Enhanced collaboration and coordination among government agencies, NGOs, healthcare providers, and community organizations are essential for effective prevention and intervention efforts.
• Community Involvement: Engaging local communities in addressing substance abuse is crucial for developing culturally appropriate and sustainable solutions.
• Addressing Stigma: Efforts to reduce the stigma associated with substance abuse are necessary to encourage individuals to seek help and support.

By adopting a comprehensive and collaborative approach, the Indian subcontinent can make significant strides in preventing and addressing substance abuse, improving the health and well-being of its population, and building a healthier and more prosperous future.

References

• Ambekar, A., et al. (2019). Magnitude of Substance Use in India. Ministry of Social Justice and Empowerment, Government of India.
• Room, R., et al. (2005). Alcohol in Developing Societies: A Global Review. Finnish Foundation for Alcohol Studies.
• Chopra, I. C., & Chopra, R. N. (1965). The Use of Cannabis Drugs in India. United Nations Office on Drugs and Crime.
• Ray, R. (2004). The Extent, Pattern and Trends of Drug Abuse in India. United Nations Office on Drugs and Crime.
• The National Mental Health Survey of India (2015-16). National Institute of Mental Health and Neurosciences (NIMHANS).
• Kumar, R. (2019). Drug Abuse in India: A Sociological Study. Concept Publishing Company.
• Various articles and papers available on PubMed, Google Scholar, and other academic databases related to substance use in India.
• Historical texts like the Rigveda, Atharvaveda, and accounts from Mughal era travellers.