Abstract
Changing Landscape of Drug Use in India
There has been a differential evolution in the landscape of drug use in India over the last two decades, when one compares the two national surveys on drug use in India conducted 18 years apart (in 2001, followed by 2019). The 2001 survey reported the prevalence of cannabis use among adolescents (12–18 years of age) as 3%, which had reduced to around 0.9% in the 2019 survey (10–17 years of age). Correspondingly, opioid use experienced a significant increase from 0.1% in the 2001 survey to 1.8% in the 2019 survey.1–3 On examining the legal drugs—tobacco has shown a declining trend among the youth in India from 2003 (16.9%) to 2019 (8.5%), according to the Global Youth Tobacco Survey-4 India factsheet. 4 For alcohol, although there had been no nationwide survey for its use amongst adolescents in the past, the recent national survey found the prevalence of alcohol use to be around 1.3% among adolescents. 2 However, a very recent study that assessed the global burden due to substance use disorders among adolescents in different countries across the world found a reduction in the same in the South Asian region, including India. 5 In fact, most of these studies suggest an overall declining trend of drug use among adolescents, except for opioids. While reduction in drug use is laudable, the drastic increase in use of opioids among adolescents is definitely a cause for concern, given the long-term negative impacts opioid use disorder can cause on the various domains of a person’s life. Regarding patterns across a vast and culturally and geographically variable country like India, it is important to note that the changes in drug use patterns are not uniform across all the states, and there are significant regional variations. 2
A Snapshot on Drug Use Among Adolescents in Different Regions of India
Recently, a government survey conducted by the Kerala Excise Department amongst 600 adolescents (10–19 years of age) getting treatment from de-addiction services under Vimukthi Mission of Kerala found that 70% of respondents started taking drugs between 10 and 15 years of age, and 9% started taking drugs between 5 and 10 years of age. 6 Also, while tobacco, followed by alcohol, were the most common psychoactive substances initiated by the respondents, the majority of treatment seekers were also taking cannabis. Interestingly, opioid use among adolescents in this survey was very less (0.24%). While national survey has indicated higher prevalence of opioids among adolescents in our country, the low prevalence found in this survey could be due to various reasons—stigma related to seeking help for opioid use, lack of awareness about availability of treatment, or low prevalence of opioid use in the state of Kerala for general population overall (including adolescents and adults).
Another cross-sectional study conducted among 400 adolescents and young adults (11–30 years of age) in rural areas of Punjab found that nearly two-thirds of the study population had been using drugs (65.5%), with alcohol being the most common (41.8%). Also, more than one-fifth of the study population reported using heroin (20.8%). 7 A qualitative study among young people with substance use disorders found different themes for initiation of drug use at an early age, namely—peer pressure, lack of parental monitoring, experimentation or curiosity, and availability of substances. 8 A recent online survey among 6927 students from classes 9th-12th found poor knowledge about the harms related to drug use, as well as treatment available for drug use disorders. 9
A recent study of school-going tribal children in the North-Eastern states of India found significant regional variations across states, with more than one-fourth of students in Arunachal Pradesh reporting alcohol use, and more than one-fourth of students from Meghalaya reporting use of illegal drugs like cannabis and cocaine (28.04%). 10 Also, the age of initiation into injection drug use was found to be very early, around 20 years, in a study from Manipur and Nagaland. The study also found that the majority of the time, injection drug use initiation was done in the presence of drug-using peers. 11
As can be seen from the above snapshot of drug use in three different regions (South, North, East) of India, there is heterogeneity in the prevalence and pattern of drug use among children and adolescents across different parts of the country (though alcohol seems to be a favored substance). But, a common thing that is striking and concerning is that drug use in this age group
Neurodevelopmental Theory of Addiction
Impact of Drug Use During Adolescence
Substance use during adolescence negatively impacts not only the brain development, but also various other key aspects of the child’s life—physical health, psychological health, relations with family and friends, academic performance, etc. It can also increase the risk of interface with law due to various reasons—use of certain drugs per se is illegal as per Narcotic Drugs and Psychotropic Substances Act, drugs can alter the behavior of the person when he/she is under its influence (e.g., disinhibition under the influence of drugs), the person can indulge in illegal activities like stealing to obtain money for purchase of the drugs. For example, an adolescent addicted to drugs, who does not earn or have money to buy drugs, has a higher risk of resorting to illegal activities like stealing to obtain money for the same. Recently, there have also been reports of adolescents killing others or their own family members for confronting them regarding their drug use, or in anger for not providing money for drugs. 13 The double stigma caused by drug use, as well as the legal entanglement, can negatively affect the mental health, as well as the societal and occupational opportunities for the adolescent.
Effective Ways to Manage Drug Use Disorder Among Adolescents
Management of drug use disorder usually follows the three-pronged approach of supply reduction, demand reduction and harm reduction. Supply reduction focuses on cutting down the availability and accessibility of drugs. Ban on sale of legal drugs to minors, restriction on the location of alcohol and tobacco shops near educational institutions, seizure of drugs and arrest of drug peddlers by law enforcement officials are part of this strategy. Demand reduction strategy usually focuses on raising awareness about the various harms related to drug use and providing treatment to people suffering from drug use disorder. Harm reduction focuses on reducing the harms associated with drug use and drug-use-related behaviors.
For any individual with drug use disorder, pharmacotherapy and psychosocial interventions go hand in hand during treatment. Provision of treatment to the adolescents addicted to drugs can help in reducing the “demand” for drugs. For adolescents with drug use disorder, family-based interventions, multicomponent approaches and cognitive behavior therapy have been found to be the most effective treatment strategies. 14 Adolescence is a period when the personality is still developing and the individual is learning various life skills. Providing proper treatment and appropriate rehabilitation, along with a focus on life skills training, can go a long way in improving the life of the individual. This will also potentially lead to a reduction in crimes in society related to drug use. Hence, family and community can play a major role in shaping the adolescent’s treatment as well as in shaping his personality in a healthy manner.
Prevention of Drug Use Among Adolescents
The majority of literature focusing on the prevention of drug use among adolescents has focused on school-based programs. These studies have found that simple drug awareness alone is not effective, 15 but basic social skills, problem-solving skills, healthy behaviors, health education, etc., are more effective in the prevention of drug use. 16 The Kerala survey also noticed that more than one-third of the adolescents reported taking drugs to relieve stress. More than three-fourths reported being introduced to drugs by friends and close acquaintances. These findings highlight an important aspect which policy makers should focus on. Stress management skills and skills to develop and maintain healthy relationships with peers an important aspects that need to be part of the school curriculum. 6
Also, prevention of substance use among adolescents, as well as management of substance use disorder among adolescents, can be effective only when there is a holistic approach to the same. It requires inter-ministerial coordination between various departments/ministries of the government—health and family welfare, social justice and empowerment, education department, excise department, national commission for protection of child rights, etc. It also requires the involvement of social welfare organizations that are dedicated to the welfare of children.
Specific Substance Use Disorder Management Models in India, with Focus on Adolescents
Kerala
The Kerala Government have introduced the “Vimukthi” Campaign, an initiative started in 2016 under the Excise department, a state-wide anti-narcotics mission aimed at eradicating drug, alcohol, and tobacco abuse, with a special emphasis on adolescents and youth. 17 The campaign aims to create public awareness as well as increase the treatment for youth suffering from drug use disorder. The program is implemented with the help of Student Police Cadets, Vimukthi Anti-Drug Clubs in Schools and Colleges, National Service Scheme, etc., at various levels—ward, panchayat and block levels. The scheme has established de-addiction and counselling centers in all 14 districts. The Kerala excise minister had also noted in the legislative assembly that the number of children taking treatment for addiction had increased drastically in 2024 from the previous year. While the government had considered this to be one of the markers for an increase in drug use in the state, it might actually turn out to be a good sign showing increased awareness amongst adolescents or their families about the availability of treatment for drug use, and they are actively seeking treatment for the same. Appropriate treatment for drug use disorder as early as possible can go a long way in stabilizing the life of the adolescent. While data shows an increase in the number of adolescents taking treatment for addiction in Kerala, there are still reports of state-run de-addiction centers being both inadequate and unfunded. It needs to be emphasized that it is vital to enhance the accessibility and availability of treatment. 18 Also, the treatment that is provided should be evidence-based for maximum benefit, and proper mechanisms should be in place to ensure the same. The Kerala government has also intensified drug seizures and arrests of drug peddlers through various campaigns like D-Hunt (started in 2024) and Clean Campus, Safe Campus (started in 2014). While this has increased the number of seizures and arrests, there are a few concerns—many adolescents are used as “carriers” to supply drugs to others in exchange for free drugs. The fact that many adolescents were introduced to drugs by their “friends” highlights the importance of focusing on this aspect too, while developing future refinements in the strategies for drug use prevention and treatment.
Punjab
In Punjab, there have been reports of the state government taking several initiatives to manage drug use disorder. One such initiative is “The Punjab Substance Abuse Prevention (P-SAP) model,” a structured, multi-tiered approach operating at the village level, block level, district level and state level. The model is planned to be holistic with integration of prevention, treatment and rehabilitation services. The model envisages coordination amongst keyholders from different sectors—both health and non-health for effective implementation. The health sector will provide for treatment, capacity building, technical support and conducting research. Non-health sectors like: (a) police will focus on supply reduction, (b) Department of Education will focus on review of curriculum to include life skills and other effective prevention strategies, (c) Department of Sports and Youth Affairs will focus on IEC activities, (d) Religious and Spiritual organizations will also focus on raising awareness and support in drug use prevention and treatment, and (e) Department of Social Justice and Empowerment will focus on capacity building, social marketing, provision of resources, etc. Non-Governmental Organizations (NGOs) will also be involved in coordination and support. The model also includes the mandatory appointment of District Substance Abuse Prevention Officers (DSAPOs), who coordinate awareness campaigns, monitor de-addiction services, and ensure implementation of district action plans. At the school level, life skills education focusing on decision-making, peer resistance, and emotional regulation is imparted through trained teachers to prevent early initiation into substance use. The model also mandates data-driven planning, regular interdepartmental reviews, and active participation from other departments. Its outcomes have been envisaged to include increased community awareness, early identification of users, improved access to treatment, and a notable rise in treatment-seeking behavior. 19 The model appears very promising in that it shows the political commitment to reduce drug use in the state, and there is a presence of multi-sectoral involvement. The actual implementation and result of this model will help in refining of intervention, as well as providing a template for planning future models for other states in India.
Conclusion
The changing landscape of drug use in India, particularly among adolescents, highlights a complex mix of public health trends, neurodevelopmental vulnerability, and social influences. While national data show a decline in the use of substances like cannabis, tobacco, and alcohol among adolescents, the sharp rise in opioid use is of serious concern. Early age of onset (i.e., adolescence) of drug use reflects the seriousness of this problem in a rapidly developing nation like India.
Adolescence is a crucial window for intervention due to the brain’s heightened sensitivity to addiction and the lasting impact of substance use on combined mental, physical, and social development. It is important to remember that managing adolescent substance use requires a shift from punitive measures to supportive, holistic strategies. This includes strengthening family- and community-based interventions, improving service delivery, and fostering collaboration across health, education, and social sectors. A balanced approach combining supply reduction, demand reduction, and harm reduction—anchored in science and empathy—can help protect India’s youth. The way forward probably lies in compassion, awareness, and building systems that empower adolescents to make healthy, informed choices.
The models from two very different culturally, socially and geographically situated states—Kerala and Punjab, shows state government’s commitment to tackle drug menace in their respective state through a holistic approach, focusing not only on supply reduction, but also focusing on other important aspects—prevention, treatment and rehabilitation through awareness generation, multi-sectoral co-ordination and using evidence based strategies. In terms of local implementation, the Kerala model has started showing good response in the form of an increase in treatment seeking; it is envisaged that the Punjab model will show good response in reducing the prevalence of drug use, too.
The authors have tried to provide a snapshot of the problem of the use of drugs, which is afflicting society at large, especially one of the most vulnerable sections, that is, adolescents. The current generation of adolescents forms the building block of our future generations. To protect and help them, mental health professionals need to intervene effectively, through multi-level collaborative efforts, using the principles of availability, accessibility, and affordability!
Footnotes
Disclaimer
This editorial expresses the opinion exclusively of the authors, and not necessarily of the Journal.