CASE STUDY OF TWO DE-ADDICTION CUM REHABILITATION CENTRES IN
THE STATES OF UTTAR PRADESH AND UTTRANCHAL
By
S S Dhapola*
founder
Nirvan Hospital
MOB-9411107536
Abstract
An attempt has been made to study the substance abuses of two De-addiction cum rehabilitation centres, being run by NIRVAN, in the states of Uttar Pradesh and Uttranchal. Though the comprehensive data is still being collated, yet the preliminary statistics available clearly points towards some glaring areas, which need urgent attention and have a bearing on policy development and programme planning.
Introduction
Substance abuse is a grave problem affecting all parts of country. Due to its proximity to HIV/AIDS and Hepatitis, it is much more important that efforts are invigorated to deal with this menace. The problem cuts across all the socio-economic strata of the society and strikes the most productive age group. The Ministry of Social Justice and Empowerment, Governmental organizations to establish and run De-addiction cum rehabilitation centers all over the country, to undertake awareness creation and preventive education, treatment, after care, follow up and rehabilitation of recovering addicts. Experience has shown that much still desires to be done to attain and sustain the adopted minimum standards for the services being provided through these De-addiction cum rehabilitation centers.
An attempt here has been made to understand the problem in two states of the country, namely Uttar Pradesh and Uttranchal, which come in the way of having effective services in this area. This is being done through a case study of two De-addiction cum rehabilitation centers’, one each in Uttar Pradesh (Lucknow) and Uttranchal (Haldwani) been established by NIRVAN, a non – governmental organization. Though the comprehensive data with regard to these centers’ is yet being collated, the available statistics bring to the fore certain areas of concern which require urgent attention and have considerable bearing on policy development and programme planning.
The Status
As stated, the two De-addiction cum rehabilitation centers’, whose data is being studied, are located in the states of Uttar Pradesh and Uttranchal. The state of Uttar Pradesh has an area of 2.43 Lakh Sq. km., with a density of 828 km2. Out of a population of 19.9 crore, 15.51 crore live in rural area and 590.03 Lakhs are below the poverty line. The literacy rate is 69.72%. The state of Uttranchal is the twenty seventh state of the country. It has an area of 53483 sq. km. with a density of 189 km2 and its population is 1.01 Crore. With the present rate of Annual increase of population it is expected that in forty years the population would have doubled. The rural population is 7 Lakhs and 35.96 lakhs population is below the poverty line the literacy rate is 79.63%. Both the states are mainly Hindi speaking.
* . S S Dhapola, Director, NIRVAN Neuro Psychiatric & Drug Addiction Rehabilitation
NIRVAN
Nirvan is registered (1991) social welfare organization. It has established a 105 bed Neuro – Psychiatric and drug addiction rehabilitation centre at Lucknow. It has a staff of about 50 people, including psychiatrists, clinical psychologist, psychologist, counselor, social workers and other para medical staff. The centre at Haldwani was established in March 1993 and has a staff of 25 people. The Bareilly Centre was established in March 2000 and has a staff of 12. The de-addiction and rehabilitation centre at Lucknow and Haldwani have full occupancy, while the one at Bareilly is picking up. Besides drug de-addiction and rehabilitation facilities, these centers’ also provide other mental health services.
Findings
The following data has been made available by the de-addiction cum rehabilitation centre at Lucknow:
Table 1
Table showing the number of place of residence of addicts treated at the de-addiction cum rehabilitation centre at Lucknow from 1991 to 2001
| S.No. | Place | Number |
| 1 | Lucknow | 4342 |
| 2 | Barabanki | 2132 |
| 3 | Hamirpur | 32 |
| 4 | Gonda | 105 |
| 5 | Jaunpur | 72 |
| 6 | Bahraich | 121 |
| 7 | Unnao | 25 |
| 8 | Rai Bareli | 39 |
| 9 | Udham Singh Nagar | 05 |
| 10 | Faizabad | 32 |
| 11 | Sitapur | 39 |
| 12 | Meerut | 04 |
| 13 | Allahabad | 72 |
| 14 | Gorakhpur | 09 |
| 15 | Azamgarh | 12 |
| 16 | Balrampur | 32 |
| 17 | Basti | 12 |
| 18 | Banda | 09 |
| 19 | Jalaun | 19 |
| 20 | Deoria | 07 |
| 21 | Ambedkar Nagar | 11 |
| 22 | Lakhimpur Kheri | 12 |
| 23 | Muzaffarnagar | 02 |
| 24 | Amethi | 17 |
| 25 | Hardoi | 21 |
| 26 | Varanasi | 27 |
| 27 | Sultanpur | 13 |
| 28 | Pratapgarh | 07 |
| 29 | Kanpur | 29 |
| 30 | Tanda | 32 |
Others: Delhi (9) and Nepal (37)
Table 2
Table showing the year wise distribution of addicts at the de addiction cum rehabilitation centre at Haldwani as well as their place of residence.
| S.NO | CITY | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | NUMBER |
| 1 | ALMORA | 107 | 23 | 24 | 11 | 96 | 38 | 108 | 78 | 43 | 24 | 552 |
| 2 | AGRA | - | - | 1 | - | - | 2 | - | - | - | - | 3 |
| 3 | ALLAHBAD | - | - | 1 | - | - | - | - | - | - | - | 1 |
| 4 | ALIGARH | - | - | 1 | 3 | 1 | - | - | - | - | - | 5 |
| 5 | BADAUN | 30 | 5 | 9 | 17 | 1 | 10 | - | 1 | 7 | - | 80 |
| 6 | BIHAR | --- | - | - | - | 1 | - | - | - | 1 | - | 2 |
| 7 | BAGESHWAR | 27 | 21 | 19 | 34 | 21 | 18 | 98 | 36 | 33 | 21 | 328 |
| 8 | BARIELLY | 97 | 105 | 84 | 95 | 83 | 35 | 89 | 33 | 46 | 12 | 679 |
| 9 | BIJNOR | 17 | 4 | 6 | 33 | 23 | 28 | 25 | 7 | 7 | 2 | 152 |
| 10 | BULANDSHAHAR | -- | - | 1 | - | - | - | - | - | - | - | 1 |
| 11 | CHAMPWAT | - | 2 | 7 | 28 | 7 | 18 | 19 | 10 | 10 | 7 | 108 |
| 12 | DELHI | - | 9 | 1 | 3 | 1 | 7 | 2 | 7 | 1 | 5 | 36 |
| 13 | DEHRADUN | - | 1 | 9 | 4 | 1 | 2 | - | - | 1 | 1 | 19 |
| 14 | ETA | - | - | 10 | 2 | 1 | 3 | - | - | 5 | - | 21 |
| 15 | FARUKHABAD | 8 | 6 | 5 | 7 | 3 | 21 | - | 1 | 3 | 3 | 57 |
| 16 | Ganganagar |
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| 1 |
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| 1 |
| 17 | GAZIPUR | - |
| 2 | - | - | 8 | - | 1 | - | - | 11 |
| 19 | HARIDWAR | - | - | - |
| 2 | - | 2 | 1 | 1 | - | 6 |
| | | | | | | | | | | | |
| 20 | HALDWANI | 187 | 143 | 176 | 156 | 183 | 180 | 194 | 173 | 167 | 98 | 1657 |
| 21 | HARYANA | - | 1 | - | - | - | - | - | - | - | - | 1 |
| 22 | HARDOI | - | - | 1 | - | - | 2 | - | - | - | - | 3 |
| 23 | J.P.NAGAR | 3 | 7 | 2 | 12 | 4 | 15 | 2 | 5 | 8 | 3 | 61 |
| 24 | HATERUSH | - | - | - | - | - | - | - | - | 1 | - | 1 |
| 25 | KANPUR | - | 1 | 2 | - | 1 | - | 1 | 1 | 1 | - | 7 |
| 26 | KASGANJ | - | - | 3 | - | - | - | - | 1 | - | - | 4 |
| 27 | KHERI | - | - | 2 | - | - | - | - | - | - | - | 2 |
| 28 | LAKHINPUR | - | - | - | - | - | 2 | 1 |
| 1 | - | 4 |
| 29 | LUCKNOW | - | - | 1 | - |
| 6 | 1 | 3 | - | - | 11 |
| 30 | MAINPURI | - | - | 2 | 13 | 6 | 10 | - | 2 | - | - | 33 |
| 31 | MATHURA | - | - | 2 | - | - | - | - | - | - | - | 2 |
| 32 | MEERATH | - | - | 3 | 1 | 1 | - | 1 | 1 | - | 2 | 9 |
| 33 | MUJAFFAR NAGAR | - | - | 1 | - | - | - | - | - | - | - | 1 |
| 34 | MUMBAI | - | - | 1 | - | - | - | - | - | - | - | 1 |
| 35 | MORADABAD | 31 | 38 | 77 | 96 | 80 | 75 | 43 | 24 | 26 | 9 | 499 |
| 36 | NEPAL | 7 | 19 | 13 | 7 | 5 | 13 | 8 | 2 | 18 | 2 | 94 |
| 37 | NAINITAL | 94 | 57 | 77 | 87 | 31 | 94 | 34 | 77 | 50 | 33 | 634 |
| 38 | PUNJAB | 2 | 2 | 10 | 4 | 1 | 8 | 5 | 3 | 1 | - | 36 |
| 39 | PITHORAGARH | - | 24 | 27 | 33 | 18 | 38 | 18 | 34 | 44 | 23 | 259 |
| 40 | PILIBHIT | - | 32 | 27 | 37 | 48 | 40 | 13 | 30 | 21 | 8 | 256 |
| 41 | RAMPUR | 45 | 60 | 76 | 17 | 26 | 41 | 12 | 27 | 22 | 13 | 339 |
| 42 | RAJASTHAN | 2 | - | - | - | - | - | - | - | - | - | 2 |
| RANIKHAT | 15 | 2 | 26 | 16 | 1 | 14 | 4 | 10 | 5 | 3 | 96 |
| 43 | GAZROLA | - | - | - | - | - | - | - | 1 | 1 | - | 2 |
| 44 | SHARANPUR | - | - | 3 | - | - | - | - | - | - | - | 3 |
| 45 | GARWAL | - | 4 | 4 | 3 | 1 | - | 1 | 3 | 1 | - | 17 |
| 47 | (U.K) |
| 48 | SHAHJAHANPUR | 15 | 22 | - | 19 | 16 | 5 | 6 | 6 | 6 | - | 95 |
| 49 | UDHAM SINGH NAGAR | 87 | 126 | 169 | 48 | 139 | 377 | 103 | 156 | 233 | 64 | 1502 |
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| TOTAL | 774 | 714 | 885 | 786 | 802 | 1110 | 790 | 735 | 764 | 333 | 7693 |
Table 3
Table showing the year wise number of addicts and their drug use at the centre at Haldwani
| S.NO | Type of Drug | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | TOTAL |
| 1 | ALCOHOL | 220 | 225 | 317 | 206 | 242 | 468 | 231 | 245 | 224 | 130 | 2508 |
| 2 | CHARAS | 123 | 96 | 187 | 163 | 145 | 235 | 251 | 282 | 274 | 99 | 1855 |
| 3 | COUGH SYRUP | 10 | 3 | 5 | 9 | 14 | 18 | 5 | 5 | 2 | 4 | 75 |
| 4 | HEROIN | - | 1 | 1 | - | 2 | - | - | - | - | - | 4 |
| 5 | IDU’S | 65 | 42 | 61 | 63 | 58 | 87 | 32 | 30 | 105 | 12 | 555 |
| 6 | MULTI DRUGS | 97 | 20 | 59 | 67 | 72 | 44 | 69 | 62 | 38 | 28 | 556 |
| 7 | CAPSULS | 30 | 26 | 59 | 79 | 82 | 53 | 62 | 44 | 56 | 23 | 514 |
| 8 | BROW SUGER | 157 | 263 | 112 | 176 | 137 | 165 | 94 | 51 | 46 | 18 | 1219 |
| 9 | INHALANTS | 5 | 6 | 36 | 9 | 21 | 20 | 7 | 11 | 13 | 9 | 137 |
| 10 | TABLETS | 62 | 18 | 33 | 14 | 23 | 20 | 39 | 4 | 5 | 7 | 225 |
| 11 | OPIUM | - |
| 1 | - | - | - | - | - | 1 | 2 | 4 |
| 12 | AFEEM | 2 | 8 | 6 | - | 4 | - | - | 1 | - | 1 | 22 |
| 13 | DODA | 3 | 6 | 8 | - | 2 | - | - | - | - | - | 19 |
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| TOTAL | 774 | 714 | 885 | 786 | 802 | 1110 | 790 | 735 | 764 | 333 | 7693 |
The picture which emerges from the above tables reveals that:
Most of the De-addiction and rehabilitation centre’s in the two states still follow the medical model albeit with some modifications. These modifications depend upon the awareness, knowledge, competence and training of the NGOs running the centre. However, as they cater to a large number of addicts who come from long distance obviously, aftercare, follow-up and rehabilitation is weak and in many cases non-existent. Thus, rehabilitation as such is still a far cry.
As the literacy rate in these states in quite low and the number in the rural areas and those under the poverty line are more, the advocacy of a bio-psycho-socio-cultural approach to the problem appears not to cut ice with the general masses and as such most of the NGOs prefer to provide the services under a medical coverage, which gives them easy accessibility to the patient client / relatives. However, it appears that as there still exists a misconception that the problem of alcohol/drug addiction is primarily a medical one, the other more vital and important aspects of the treatment are sadly neglected. One may criticize the approach, but the reality as exists cannot be overlooked.
This has obviously led to another problem. As these centre’s, by and large, follow the medical model they are being asked to seek license under Mental Health Act, 1987 under section 5 which reads “Establishment or maintenance of psychiatric hospital and psychiatric nursing homes – (1) The Central Government may, in any part of India, or the State Government may, within the limits of its Jurisdiction, establish or maintain psychiatric hospitals and psychiatric nursing homes for the admission, treatment and care of mentally ill persons at such places as it thinks fit; and separate psychiatric hospitals and psychiatric nursing homes may be established or maintained for –
those who are under age of sixteen years;
those who are above 60 years of age ;
those who are addicted to alcohol or other drugs which lead to behavioural changes in a person;
those who have been convicted of any offence; and
Those belonging to such other class or category of persons as may be prescribed.
The statistics pertaining to the Uttaranchal state indicates that there is a steady increase in the number of IDU’s from 7 in 1994 to 32 in 2001. This needs to be further probed into and steps initiated to link it with HIV/AIDS programme due to the known propensity of IDU’s towards HIV/AIDS.
In both the states, heroin and alcohol are the prominent drugs of addiction. This aspect would have to be further looked into to suggest strengthening of the legal and other control measures in this regard.
Almost all the staff in the centre’s, in these two states is Hindi speaking. They may have been exposed to basic / advanced training which is mostly in English. It is open to question as to how much they would have been able to understand, retain and utilize in their day to day work. Thus there is an urgent need of preparing relevant resource material in Hindi. In this regard, it may be stated that three ILO Manuals have been translated in Hindi and have been given to the National Institute of Social Defence for printing and distribution to the NGOs. It is more than a year now that they are lying with them. Their printing and subsequent distribution should be expedited without any further delay. They would also help in training the centre staff in Hindi, which is spoken in the states of Bihar, Jharkhand, Uttar Pradesh, Uttaranchal, Madhya Pradesh, Chattisgarh, Haryana and Himanchal Pradesh and it could be helpful in many parts of Maharashtra and Gujarat.
On other aspect which also needs to be looked into is the need to augment services to aftercare, follow up and rehabilitation. Established and well maintained de addiction cum rehabilitation centre’s attract patients from long distances. This may be due to the fact that the necessary services and facilities may not be available locally, or even if available may not have been able to establish heir credibility. It is also possible that many addicts may be going to for off treatment centre’s to maintain their anonymity so that they may not be loose face/status in their local social milieu. In either case, these better De-addiction cum rehabilitation centre’s tend to form a nucleus. If they are attached with such local centre’s which could be entrusted the task of (a) conducting outreach programmes; (b) identification and motivation of addicts; (c) referral of such addicts for proper and adequate treatment; (d) assistance in aftercare, follow-up vocational rehabilitation and mainstreaming of recovering addicts, the aforesaid services would be undoubtedly strengthened. Such local centre’s could also function as day care centre’s, if need be. There has been a lot of criticism of the erstwhile counseling centre’s. Perhaps, with a new mandate they could be to do this work. Such an approach could invigorate the much required and desired services for aftercare, follow-up and rehabilitation.
These aspects are not new, as they have been discussed at various regional and national forums. This paper is an effort to reiterate the obvious that if addiction rehabilitation has to be made efficacious, adequate resources material and training in the local language, monitoring and assistance in standard raising as well as linkage and networking of NGOs as well as the Ministry of Social Justice and Empowerment, Government of India, have to be further augmented.
