Illicit drug use is a growing concern in India, with a treatment gap of 73%. Explanatory models can offer valuable insights into patients’ understanding of their condition and inform help-seeking and treatment strategies. This study aims to develop an explanatory model to identify barriers and facilitators for help-seeking, desired resources, and treatment strategies among adolescents struggling with illicit substance misuse. Semi-structured interviews were conducted with 23 adolescents seeking treatment for drug use and 25 healthcare providers across three Indian sites. Thematic analysis revealed barriers to help-seeking, such as stigma, lack of awareness, and financial constraints. Family awareness was crucial for recovery, and adolescents sought personalized, comprehensive treatment. Healthcare providers emphasized the need for more government funding and flexible treatment options. These findings provide valuable insights into help-seeking behaviors and treatment preferences, which could enhance treatment engagement and outcomes for adolescents with drug use disorders.
All India Institute of Medical Sciences. (2019). National survey on extent and pattern of substance use in India. In Nuds.
2.
BallonB.KirstM.SmithP. (2004). Youth help-seeking expectancies and their relation to help-seeking behaviours for substance use problems. Addiction Research and Theory, 12(3), 241–260. https://doi.org/10.1080/16066350942000193202
3.
BanerjeeT. J.BanerjeeG. (1995). Determinants of help-seeking behaviour in cases of epilepsy attending a teaching hospital in India: An indigenous explanatory model. International Journal of Social Psychiatry, 41(3), 217–230. https://doi.org/10.1177/002076409504100306
4.
BhuiK.BhugraD. (2002). Explanatory models for mental distress: Implications for clinical practice and research. British Journal of Psychiatry, 181(1), 6–7. https://doi.org/10.1192/bjp.181.1.6
CallakY.OnatM. B.YilmazG.YilmazB. N. K.AkgürS. A. (2022). Family-based prevention in youth’s substance misuse in low- and middle-income countries: A review from Turkey and cultural adaptation of family based interventions. Journal of Ethnicity in Substance Abuse, 23(4), 641–659. https://doi.org/10.1080/15332640.2022.2149655
DegenhardtL.StockingsE.PattonG.HallW. D.LynskeyM. (2016). The increasing global health priority of substance use in young people. In The increasing global health priority of substance use in young people (Vol. 3, pp. 251–264). Elsevier Ltd. https://doi.org/10.1016/S2215-0366(15)00508-8
9.
DhawanA.ChopraA.AmbekarA.RayR. (2015). Treatment seeking behavior of inhalant using street children: Are we prepared to meet their treatment needs. Indian Journal of Psychological Medicine, 37(3), 282–287. https://doi.org/10.4103/0253-7176.162918
10.
DhawanA.PattanayakR.ChopraA.TikooV.KumarR. (2016). Injection drug use among children and adolescents in India: Ringing the alarm bells. Indian Journal of Psychiatry, 58(4), 387–393. https://doi.org/10.4103/0019-5545.196701
11.
DhawanA.RaoR.AmbekarA.PuspA.RayR. (2017). 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 Journal of Psychiatry, 59(3), 380–384. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_19_17
12.
DinosS.AscoliM.OwitiJ. A.BhuiK. (2017). Assessing explanatory models and health beliefs: An essential but overlooked competency for clinicians. BJPsych Advances, 23(2), 106–114. https://doi.org/10.1192/apt.bp.114.013680
13.
ErdalK.SinghN. S.TardifA. (2011). Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway. Journal of Affective Disorders, 133(3), 481–488. https://doi.org/10.1016/j.jad.2011.04.038
14.
GrayK. M.SquegliaL. M. (2018). Research Review: What have we learned about adolescent substance use?Journal of Child Psychology and Psychiatry, 59(6), 618–627. https://doi.org/10.1111/jcpp.12783
15.
HagmayerY.EngelmannN. (2014). Causal beliefs about depression in different cultural groups-what do cognitive psychological theories of causal learning and reasoning predict?Frontiers in Psychology, 5, 1303. https://doi.org/10.3389/fpsyg.2014.01303
16.
HallW. D.PattonG.StockingsE.WeierM.LynskeyM.MorleyK. I.DegenhardtL. (2016) Why young people’s substance use matters for global health. In Why young people’s substance use matters for global health (Vol. 3, pp. 265–279). Elsevier Ltd. https://doi.org/10.1016/S2215-0366(16)00013-4
17.
HalladayJ.WoockR.El-KhechenH.MunnC.MacKillopJ.AmlungM.OgrodnikM.FavottoL.AryalK.NooriA.KiflenM.GeorgiadesK. (2020). Patterns of substance use among adolescents: A systematic review. Drug and Alcohol Dependence, 216, Article 108222. https://doi.org/10.1016/j.drugalcdep.2020.108222
18.
KirmayerL. J.BhugraD. (2009). Culture and mental illness: Social context and explanatory models (pp. 29–40). John Wiley & Sons, Ltd eBooks. https://doi.org/10.1002/9780470743485.ch3
19.
KirmayerL. J.SanthanamR. (2001). The anthropology of hysteria. In HalliganP.BassC. (Eds.), Contemporary approaches to the study of hysteria: Clinical and theoretical perspectives (pp. 251–270). Oxford University Press.
20.
KleinmanA. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry (Vol. 3). Univ of California Press.
21.
KleinmanA.LeonM. A.GoodB. (1978). Culture, illness, and care clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88(2), 251–258. https://doi.org/10.7326/0003-4819-88-2-251
22.
LubmanD. I.BerridgeB. J.BleeF.JormA. F.WilsonC. J.AllenN. B.McKay-BrownL.ProimosJ.CheethamA.WolfeR. (2016). A school-based health promotion programme to increase help-seeking for substance use and mental health problems: Study protocol for a randomised controlled trial. Trials, 17(1), 393. https://doi.org/10.1186/s13063-016-1510-2
23.
MandalP.ParmarA.AmbekarA.DhawanA. (2019). Substance use among treatment seeking Indian adolescent girls: Are they unique?Asian Journal of Psychiatry, 41, 17–19. https://doi.org/10.1016/j.ajp.2019.03.007
24.
MarkovaV.SandalG. M. (2016). Lay explanatory models of depression and preferred coping strategies among Somali refugees in Norway. A mixed-method study. Frontiers in Psychology, 7, 1435. https://doi.org/10.3389/fpsyg.2016.01435
MattooS. K.SarkarS.GuptaS.NebhinaniN.ParakhP.BasuD. (2015). Stigma towards substance use: Comparing treatment seeking alcohol and opioid dependent men. International Journal of Mental Health and Addiction, 13(1), 73–81. https://doi.org/10.1007/s11469-014-9514
27.
McCannT. V.LubmanD. I.BoardmanG.FloodM. (2017). Affected family members' experience of, and coping with, aggression and violence within the context of problematic substance use: A qualitative study. BMC Psychiatry, 17(1), 209. https://doi.org/10.1186/s12888-017-1374-3
28.
MurdockG. P. (1980). Theories of illness: A world survey. University of Pittsburgh Pre.
29.
MurthyP.ManjunathaN.SubodhB.ChandP.BenegalV. (2010). Substance use and addiction research in India. Indian Journal of Psychiatry, 52(Suppl 1), S189–S199. https://doi.org/10.4103/0019-5545.69232
30.
NadkarniA.DabholkarH.McCambridgeJ.BhatB.KumarS.MohanrajR.MurthyP.PatelV. (2013). The explanatory models and coping strategies for alcohol use disorders: An exploratory qualitative study from India. Asian Journal of Psychiatry, 6(6), 521–527. https://doi.org/10.1016/j.ajp.2013.06.010
31.
NebhinaniN.SarkarS.GhaiS.BasuD. (2012). Reasons for help-seeking and associated fears in subjects with substance dependence. Indian Journal of Psychological Medicine, 34(2), 153–158. https://doi.org/10.4103/0253-7176.101784
32.
OkelloE. S.NeemaS. (2007). Explanatory models and help-seeking behavior: Pathways to psychiatric care among patients admitted for depression in mulago hospital, kampala, Uganda. Qualitative Health Research, 17(1), 14–25. https://doi.org/10.1177/1049732306296433
33.
PerumbillyS. A.Melendez-RhodesT.AndersonS. A. (2019). Facilitators and barriers in treatment seeking for substance use disorders: Indian clinical perspectives. Alcoholism Treatment Quarterly, 37(2), 240–256. https://doi.org/10.1080/07347324.2018.1530579
34.
QadriS.GoelR.SinghJ.AhluwaliaS.PathakR.BashirH. (2013). Prevalence and pattern of substance abuse among school childern in nothern India: A rapid assesment study. International Journal of Medical Science and Public Health, 2(2), 273. https://doi.org/10.5455/ijmsph.2013.2.271-280
35.
ReifS.BraudeL.LymanD. R.DoughertyR. H.DanielsA. S.GhoseS. S.SalimO.Delphin-RittmonM. E. (2014). Peer recovery support for individuals with substance use disorders: Assessing the evidence. Psychiatric Services, 65(7), 853–861. https://doi.org/10.1176/appi.ps.201400047
36.
RitterA.CameronJ. (2006). A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug and Alcohol Review, 25(6), 611–624. https://doi.org/10.1080/09595230600944529
37.
SarkarS.MajumderP.GuptaR.DasN.NarnoliS.BalharaY. P. S. (2021). Prevalence and socio-demographic correlates of law enforcement involvement among treatment-seeking adult males with opioid use disorder. International Journal of Law and Psychiatry, 74, Article 101653. https://doi.org/10.1016/j.ijlp.2020.101653
38.
SarkarS.TomA.MandalP. (2021). Barriers and facilitators to substance use disorder treatment in low-and middle-income countries: A qualitative review synthesis. Substance Use & Misuse, 56(7), 1062–1073. https://doi.org/10.1080/10826084.2021.1908359
39.
SatinskyE. N.KleinmanM. B.TralkaH. M.JackH. E.MyersB.MagidsonJ. F. (2021). Peer-delivered services for substance use in low- and middle-income countries: A systematic review. International Journal of Drug Policy, 95, Article 103252. https://doi.org/10.1016/j.drugpo.2021.103252
40.
SawyerS. M.AzzopardiP. S.WickremarathneD.PattonG. C. (2018). The age of adolescence. The Lancet Child and Adolescent Health, 2(3), 223–228. https://doi.org/10.1016/S2352-4642(18)30022-1
41.
SharmaB.AroraA.SinghK.SinghH.KaurP. (2017). Drug abuse: Uncovering the burden in rural Punjab. Journal of Family Medicine and Primary Care, 6(3), 558–562. https://doi.org/10.4103/2249-4863.222037
42.
ThomasR.PandianR. D.MurthyP. (2018). Treatment service related needs and concerns of women with substance use disorders: A qualitative study. International Journal of Culture and Mental Health, 11(2), 123–133. https://doi.org/10.1080/17542863.2017.1334076
43.
TseringD.PalR.DasguptaA. (2010). Licit and illicit substance use by adolescent students in eastern India: Prevalence and associated risk factors. Journal of Neurosciences in Rural Practice, 1(2), 76–81. https://doi.org/10.4103/0976-3147.71721
44.
VargheseM.BenegalV.PathakK. (2016). National mental health survey of India, 2015-16 prevalence, national family health survey 4 view project national family health survey 4. https://www.researchgate.net/publication/325128785
45.
WeissM. G. (1997). Explanatory model interview catalogue (EMIC): Framework for comparative study of illness. Transcultural Psychiatry, 34(2), 235–263. https://doi.org/10.1177/136346159703400204
46.
WisdomJ. P.ManuelJ. I. (2011). Prevalence of substance use in people with first-episode psychosis. Journal of Dual Diagnosis, 7(1–2), 39–49. https://doi.org/10.1080/15504263.2011.569876
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
