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 Table of Contents  
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 1-3

Managing Illicit Drug Use and Gambling Cases in Poor Countries: Fixing Accountabilities and Finding Solutions

1 Independent Public Health Researcher, Dehradun, Uttarakhand, India
2 Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India

Date of Submission17-Nov-2020
Date of Decision07-Dec-2020
Date of Acceptance07-Dec-2020
Date of Web Publication23-Mar-2021

Correspondence Address:
Dr. Sudip Bhattacharya
Jollygrant, Dehradun, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jascp.jascp_4_20

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How to cite this article:
Bhattacharya S, Singh A. Managing Illicit Drug Use and Gambling Cases in Poor Countries: Fixing Accountabilities and Finding Solutions. J Appl Sci Clin Pract 2021;2:1-3

How to cite this URL:
Bhattacharya S, Singh A. Managing Illicit Drug Use and Gambling Cases in Poor Countries: Fixing Accountabilities and Finding Solutions. J Appl Sci Clin Pract [serial online] 2021 [cited 2023 Mar 29];2:1-3. Available from: http://www.jascp.org/text.asp?2021/2/1/1/311763

Illicit drug use and gambling are global public health problem. Its management is difficult if physicians only relied upon the bio-physical models for treatment as it is commonly observed in psychiatry outpatient departments in the resource-constraint poor countries. Putting emphasis on cultural and social aspects is nearly missing during the training periods in most of the medical schools. It is especially important for the medical students to learn the socio-economic and cultural reality regarding the management of illicit drug and gambling cases in the community as well as in hospital settings.

  Illicit Drug Use is a Global Problem and is One of the Contributors to the Poverty Top

“Illicit drugs are those whose nonmedical use has been prohibited under international drug control treaties. These include the plant-based drugs heroin, cocaine, and cannabis; synthetic drugs such as amphetamines; and pharmaceutical drugs such as opioids and benzodiazepines.”[1]

Countries with the highest rate of DALYs (>650 DALYs per 100,000 population) include the USA, the UK, Russia, and Australia where the problem of illicit drugs has been stabilized to a large extent.[1] In contrast, many developing countries still struggle with illicit drug use, where there has been a sharp increase in intravenous drug use.[1],[2]

Few studies have been conducted in developing and lower middle-income countries on the social and environmental factors affecting illicit drug dependence and gambling. However, it is evident, from various studies and reports, that urbanization, poverty, migration, technological change, educational deficits, and unemployment are aggravating factors on illicit drug dependence and gambling.[3]

According to a National Survey Report by the United Nations Office on Drugs and Crime and the Indian Ministry of Social Justice and Empowerment data, 10.7 million people in India use illicit drugs, including 8.7 million who use cannabis and 2 million who use opioids.[4]

It is recognized that societal disruption and illicit drug use follows a bidirectional vicious cycle.[3]

  The Illicit Drug Users and Gamblers Display Early Warning Signs, but Quite Often we Fail to Detect these Top

There are some possible early warning signs for the detection of illicit drug use cases by the family members,[5],[6] these are:

Problems at school or work

Initially, the victim begins to miss school occasionally, leading to a decrease in school performance. They display gradually increasing disinterest in school activities and his work.

Physical health issues

Lack of energy and motivation, weight loss, and red eyes are often observed.

Neglect of appearance

After sometime, however, victim does not bother with his clothing, grooming, or general appearance.

Changes in behavior

Family members can observe drastic changes in his behavior such as abusing his mother and wife.

Monetary issues

The patient may ask for money with, or without, a reasonable excuse, and over time their need increase to the point that they start stealing things.

  A Huge Gap is Present in between the Theoretical and Applied Aspects for the Treatment of Illicit Drug Users Top

Illicit drug use is linked to social stigma, there are multiple barriers are present in the service provider level and receiver level. Patient level barriers include-low health literacy, false beliefs, high cost for the treatment, unwilling to go to the de-addiction centres and many more. Whereas the system levels barriers include-lack of trained health care workers,long distances, low collaboration between care sites, and little or no availability of health care services. [1,6-8]

  Inter Sectoral Involvement for Handling Illicit Drug Use and Gambling is Clearly Missing Top

Treating illicit drug use cases need inter-sectoral collaboration i.e., self-control by the drug users, and emotional support from the family and friends, sympathetic attitude from the healthcare system, adequate social support, and strict law enforcement.[7],[9],[10]

Additionally, if we discuss about the various models of drug dependence, the biopsychosocial model has also documented drug dependence as a complex problem, and the solution it outlines requires the expertise of multiple sectors. Previously, drug dependence and gambling were considered as a single entity, namely as a social problem, a pharmacological problem, an educational issue, spiritual issue, or as an immoral behavior requiring punishment. However, scientific evidence has revealed the role of a complex, multi-factorial interaction between repeated exposure to drugs, along with biological and environmental factors. It is now acknowledged by experts that this problem cannot be solved through interventions aimed at only a single factor. It requires multiple interventions at various levels. For example, the law enforcement sector cannot handle the neurological alterations that occur in the brain, which are linked with the motivation pathways involved in drug dependence and gambling.[6],[7],[10],[11],[12],[13],[14],[15]

  Providing Health Care to Patients Trapped within the Poverty Culture is a Challenging Task Top

The “culture of poverty” concept includes the notion of a self-perpetuating cycle. It attracted academic and policy attention in the 1970s, survived underwent harsh academic criticism and made a comeback at the beginning of the 21st century. It offers an explanation as to why poverty exists despite anti-poverty programs.[3]

People who live within the poverty culture have an acute, urgent, and short-term focus.[3] They chronically live within a crisis-oriented mind-set where their prime objective in life is simply to get through the day. This culture is then reflected in their behavior; for example, health is always low on their priority list. As a result, a middle-class mentality cannot be expected from them. They perceive their future as miserable. It is highly unrealistic for them to think about things such as higher education, a good job, expensive cars, or a high professional status. Achieving the stereotypical macho image is the only hope for young men to gain status and self-esteem. As a result, they begin smoking, taking illicit drugs, gambling, drinking, and flirting with the women. Thus, illicit drug users become trapped because of poverty and have little hope for getting out of it.[3]

We must understand this behavior, and the reasons behind it, when considering the prevention and treatment of illicit drug use. It cannot be expected that these patients will keep to a follow-up appointment 1 month after their initial consultation. When treating such patients, we encounter many similarities in the disease cases. Continuously managing these conditions by clinicians can become quite frustrating due to the cultural and social complexities associated with them (that are an ingrained integral part of the poverty culture) being beyond our control. Their housing is second-rate, migration is quite frequent, education is below average, and survival (not health) is their priority. These circumstances must be managed and resolved within their context and through using the resources available by the community. Since we cannot change the culture, culture-specific treatment strategies must be developed. Moreover, poverty, gambling, and illicit drug use are often perpetuated in a bidirectional cycle that is difficult to break. As such, it requires interventions at multiple levels.[3]

  Conclusion Top

Illicit drug use and gambling are universal problem. However, its effects are more serious for people living in poverty. As a reciprocal factor, such addiction also adversely influences the socioeconomic status of the affected families. When an individual engages in illicit drug use and gambling, the entire family suffers extensive collateral damage in terms of physical, mental, and social consequences. To manage such cases, we must address the cultural and social complexities that are a part of the poverty subculture. Adequate involvement of multiple sectors, namely family, school, and hospitals, are needed. This will not only help the patients but will also prevent the inevitable disintegration of their families.

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Conflicts of interest

There are no conflicts of interest.

  References Top

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Erickson PG, Lettieri DJ, Sayers M, Pearson HW, Ludford JP. Theories on drug abuse: Selected contemporary perspectives. Contemp Sociol 1983;12:404.  Back to cited text no. 5
Ali S, Mouton CP, Jabeen S, Ofoemezie EK, Bailey RK, Shahid M, et al. Early detection of illicit drug use in teenagers. Innov Clin Neurosci 2011;8:24-8.  Back to cited text no. 6
Administration (US) SA and MHS, General (US) O of the S. Health Care Systems and Substance Use Disorders. US Department of Health and Human Services; 2016. Available from: https://www.ncbi.nlm.nih.gov/books/NBK424848/. [Last accessed on 2019 Jan 06].  Back to cited text no. 7
Barman R. Barriers to Treatment of Substance Abuse in a Rural Population of India. Open Addict J 2011;4:65-71.  Back to cited text no. 8
Anderson P, Berridge V, Conrod P, Dudley R, Hellman M, Lachenmeier D, et al. Reframing the science and policy of nicotine, illegal drugs and alcohol – Conclusions of the ALICE RAP Project. F1000Res 2017;6:289.  Back to cited text no. 9
Stothard B, Duke K, Bjerge B, Frank VA, Klein A. Stakeholder Influences on Drug and Alcohol Policy Processes. Drugs and Alcohol Today. 23 November, 2015. Available from: https://www.emeraldinsight.com/doi/full/10.1108/DAT-10-2015-0060. [Last accessed on 2018 Jun 18].  Back to cited text no. 10
Treloar C, National Drug Strategy (Australia), Australia, Department of Health and Ageing. Barriers and incentives to treatment for illicit drug users. Canberra: Australian Govt. Dept. of Health and Ageing; 2005.  Back to cited text no. 11
Dhawan A, Rao R, Ambekar A, Pusp A, Ray R. Treatment of substance use disorders through the government health facilities: Developments in the “Drug De-addiction Programme” of Ministry of Health and Family Welfare, Government of India. Indian J Psychiatry 2017;59:380-4.  Back to cited text no. 12
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Avasthi A, Basu D, Subodh BN, Gupta PK, Goyal BL, Sidhu BS, et al. Epidemiology of dependence on illicit substances, with a special focus on opioid dependence, in the state of Punjab, India: Results from two different yet complementary survey methods. Asian J Psychiatr 2019;39:70-9.  Back to cited text no. 13
Ghosh A, Basu D, Avasthi A. Buprenorphine-based opioid substitution therapy in india: A few observations, thoughts, and opinions. Indian J Psychiatry 2018;60:361-6.  Back to cited text no. 14
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