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It is estimated that there are about 62.5 million alcohol users, 8.7 million cannabis users and about 2million opiate users in our country. There are an estimated 250 million tobaccousers of age 10 and above.Serious public health problems result from alcohol and other drug consumption. Drug abuse and its impactamong women is now becoming more evident in India. Licit substances like tobaccoand alcohol are widelyprevalent, while abuse of illicit substances like cannabis, heroin, other opiates including opium andpropoxyphene is recognized throughout the country. The abuse of psychotropic substances and solvents isalso increasingly being recognized. Substance abuse (alcohol, tobacco and otherdrugs) is associated with arange of physical, psychological, social and occupational problems.Interventions for substance abuse are largely limited tospecialized de-addiction centers and limited to tertiaryintervention for those with established late stage problems. Itis well recognized that early problems related to substance abuserespond well to brief interventions. Physicians requiresensitization and training in recognizing substance abuse relatedproblems and offering intervention to such patients. A simple5-A strategy of Asking every patient about the use of substances(just as we ask for a history of diabetes or hypertension), Assessing

the pattern of use and resulting problems (establishing a linkbetween substance use and presenting problem), Advice (clearstrong advice to stop or cut down), Assisting (in the form of specific interventions) and Arranging (bymaking appropriate referrals when required) is recommended, especially for licitsubstance use (alcohol andtobacco). Illicit substance abuse is often not identified because it is not asked. This is also the case withpsychotropic drug abuse. A vigilant physician will make sure to incorporate history of substance use as partof routine history taking. This must be done as a part of health evaluation without attaching any stigma ormoral overtones to substance use.

Knowing what to do is especially important in order to be able to effectively intervene for substanceabuse and dependence (a pattern of regular use, development of tolerance to drugeffects, withdrawalsymptoms when the substance is discontinued, stereotyped pattern of use and continued use despite knowledgeCommon Drugs of Abuse in India (Males)Drug Type Current PrevalenceTobacco 55.8%Alcohol 21.4%Cannabis 3.0%Heroin 0.2%Opium 0.5%

Other Opiates 0.1%(National Household Survey 2002)* Pratima Murthy, MD, DPM, Professor of Psychiatry and Head, De-Addiction Centre, National Institute of Mental Health andNeuro Sciences, Bangalore.12Psychosocial Interventions for Persons with Substance Abuseof harm). There are well established psychosocial interventions, which if provided in an effective and timely

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