Drug Abuse and Mental Health Situation in India and Netherlands
Introduction
Drug Abuse and Mental Health are two major topics which have gained increasing importance in terms of public welfare, human resource upliftment and also in the psychological context of well-being, self-esteem, self-confidence and an overall personality development of the individual. The relationship between these two concepts is of essential importance for the basic understanding of the ill-effects of drug/substance abuse/addiction. Once one realizes the basic knowledge about drug/substance abuse and its harmful consequences on one’s physical well-being, then they must venture into the aspect of mental health and delve into the consequences of it being hampered and disrupted when one creates a condition of drug overdose.
So, in order to better understand drug/substance abuse and mental health situations in the countries of Netherlands and India, we must first understand what is actually meant by drug abuse and mental health. According to the National Institute on Drug Abuse, “drug addiction is defined as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences. It is considered a brain disorder, because it involves functional changes to the brain circuits involved in reward, stress and self-control.” Now that we have understood drug abuse as a chronic disorder in which one seeks drugs and that too in intense quantities despite of knowing about its adverse consequences, we must now understand what is meant by mental health and how does it engage in a direct relationship with drug abuse.
According to Mental Health.Gov “Mental Health refers to our emotional, social and psychological well-being. It affects how we think, feel and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.” So, now that we have understood the definitions of both mental health and drug abuse, we must understand that how in a systematic manner drug abuse and that too in cases of overdose can hamper the neurological functioning of the brain and affect the reasoning power, decision-making skills, memory power, and differentiating abilities of the brain.
A typical drug addict who is observed to be consuming huge amounts of drugs such as cocaine, marijuana, ganja, LSD, ecstasy, tobacco, cigarettes and alcohol, etc experiences intensive panic attacks when someone attempts to suddenly discard all the present drug products in their homes and they commonly experience something termed as ‘withdrawal symptoms’ from drug consumption and it basically attributes towards a feeling of separation from one’s support system (drugs in this case) and subsequently an experience of loss of motivation, hope and basic survival instinct as they attribute their ‘aliveness’ with the consumption of drugs and since that life-giving agent has disappeared suddenly, so now they lose all willpower and confidence of staying alive. They do not become stable until and unless they are given the drugs in the same amount as much they used to take earlier and thus the body has developed a certain level of ‘tolerance’ for that much amount of drugs inside it.
Drug Abuse and Addiction Situation of Netherlands compared to India
According to the reports of 2019 by the European Monitoring Centre for Drugs and Drug Addiction, Cannabis is one of the most prominently consumed drugs by the Dutch Adult general population of Netherlands generally aged between 15-64 years of age, followed by consumption of MDMA/ecstasy and cocaine. There has been a widespread gender gap between males and females in terms of consuming cannabis, as the adult male population of Netherlands consumes twice as much the amount of cannabis consumed by the adult female population.
There had been rising trends observed in the consumption of ecstasy by young adults of age group 15-34 years till the year of 2015. After the commencement of the year 2015, there was a drastic downfall in the consumption of ecstasy by young adults till the year of 2017. At the same time, with a decrease in consumption of ecstasy, there was an increase in consumption observed for cocaine and amphetamine among young adults. It has been observed that the use of illicit drugs such as cocaine and ecstasy has been more prominent in recreational settings such as clubs and in festivals. It has also been observed that the use of new psycho-active substances such as 4-fluoroamphetamine (4-FA) has gained more importance than other drugs.
According to the European School Survey Project on Alcohol and Other Drugs (ESPAD), “The lifetime usage of cocaine and cannabis among school students aged 15-16 years was nearly null from the period of 1999-2015. But, from the year of 2015 onwards, the lifetime use of these drugs increased and was reported to be higher than the ESPAD average of 35 countries.
The average concentration of THC in the cannabis sold in coffeeshops has increased from 9% in 1998 to 18% in 2005. This means that less plant material has to be consumed to achieve the same effect. One of the reasons is plant breeding and use of greenhouse technology for illegal growing of cannabis in Netherlands.
At the same time, we must be equally aware of the drug abuse and addiction situation in India as well so that we can perform a comparative study of the overall drug abuse and addiction situation and mental health problems in both the countries and understand the vulnerability of the Indian and Dutch populations in terms of their surrender ship to hard and soft drugs and the extent to which the drug abuse control and prevention laws have been effective and are being implemented in both the countries and also how has been the mental health situation of regular drug addicts in both the countries.
India is one such country which comprises of a large population of varied ethnic and socio-cultural communities and all these populations are tightly knitted in its relatively smaller density for settlements. So, it is essential to understand the prevalence of drug abuse and addiction amongst its varied communities and then compile it as a whole and present it henceforth.
According to a report by the United Nations, one million heroin addicts are registered in India, and unofficially there are as many as five million. Heroin abuse in India had begun as a practice of the high-income group populations residing in the metropolitan cities of Delhi, Mumbai, Kolkata and Chennai, but now not a single section of the Indian Society has been able to escape free from the menace of drug abuse. Gradually, along with heroin inhalation, addicts have now initiated a combined use of sedatives and painkillers , so in such cases the addiction process has been hastened and recovery has become even more difficult since as and when one increases the consumption amount and mixes it with other addictive substances, it quite easily develops a ‘tolerance’ level to it.
Cannabis, heroin, and Indian-produced pharmaceutical drugs are the most frequently abused drugs in India. Cannabis products, often called charas, bhang, or ganja, are abused throughout the country because it has attained some amount of religious sanctity because of its association with some Hindu deities. The International Narcotics Control Board in its 2002 report released in Vienna, stated that in India people addicted to opiates are shifting their drug choices from opium to heroin. Apart from heroin, adolescents have also used injections of analgesics like dextropropoxphene in huge quantities as substitutes of heroin as they are available at one-tenth the cost of heroin. Drug abuse among adolescents has been one major concern among the Indian population. It is observed that 50 per cent of the adolescent boys have tried consuming at least one of the addictive substances by the time they reach the age group of 15-16 years. The most commonly consumed drug in India is Alcohol followed by Cannabis.
Epidemiological surveys also reveal that 20-40% of subjects above 15 years are current users of alcohol and 10% of them are regular or excessive users. In a rural population of Uttar Pradesh alcohol was found to be the most common substance abused (82.5%) followed by cannabis (16.1%). The rates of current use of alcohol in Punjab were 45.9% in Jalandhar and 27.7% in Chandigarh whereas it was 28.1% in rural areas of Punjab. Most of the people who abuse or have an addiction to drugs in India are between the ages of 18 and 35. The majority of them are males, but there are a small percentage of women in India who abuse them; the number of women is slowly rising each year.
According to UNODC, India accounts for 10 percent of the total pharmaceuticals produced in the world. In its report, it noted that the law required all drugs with “abuse potential” to be sold only on prescription, but that there was “significant diversion” from this.
So, by systematically analyzing both the countries in terms of their surrender ship to the drug abuse and addiction, it is observed that while in India, adolescents engage in drug abuse in an age as early as 15-16 years and on the contrary, in Netherlands, instances of intensive drug abuse are reported after the age of 18 years. Women of the working population in Netherlands, have been supposedly consuming illicit drugs such as ecstasy, LSD, amphetamine, cocaine in a higher ratio as compared to Indian women. Women in India do not engage in drug abuse considering the fact that their families might be accused and blamed for their habit and also since most of the Indian population is middle class section of the society, where if by any case, their hard earned money is expended on addictive substances, then it is only the men who consume them. Whilst Ecstasy, cannabis and opium are commonly abused drugs in Netherlands, Heroin and analgesic dextropropoxphene injections and alcohol are commonly abused substances in India.
Mental Health Situation in Netherlands compared to India
In this section, we would analyze the situation of Netherlands as a nation in terms of the mental health situation of drug addicts in the nation and briefly analyze some of the laws imposed by the government for rehabilitation and de-addiction from drug abuse and the extent to which they are implemented after imposing.
Homeless people’s substance use has been characterized as the main mental health problem for homeless people in the Netherlands. A review among homeless populations in Western countries reported that alcohol dependence ranges from 8% to 59% and drug dependence from 5 to 54%. Most studies evaluate the relationship between substance use and longer durations of homelessness. Due to factors such as the wide variation in prevalence rates of substance use among homeless populations and differences in drug markets and drug policy, these studies have limited generalizability to European countries. For example, while non-European studies report a relatively high prevalence of crack cocaine use and even an increase in crack cocaine use among the homeless over recent decades, cocaine use is now less prevalent among Dutch homeless people. So, hereby we can understand that one major contributing factor towards drug abuse and further leading to drug abuse problems is homelessness and a feeling of being left out and a lack of basic resources such as housing, clothing and food due to poverty.
A study by the European Journal of Public Health reveals that “most of the people involved in Drug Abuse in the Netherlands are from the population of 15-16 years and most of them being males in this population.” A pattern tends to be formed whenever a teenager is reported to being engaged in drug abuse, which is whenever they feel that they aren’t receiving the emotional support, love and affection and most importantly that bond of trust isn’t formed due to increased tensions within the family, marks a sense of loneliness and a lack of hope and motivation and they tend to lose all self-esteem, confidence and intrinsic happiness once they are considered distant from their families.
So, they significantly attribute everything as an after effect of their doings and that it is their behavior and actions which are drifting them apart from their family members and friends and so they resort to extreme drug abuse. They engage in drug abuse as an alternative of busting stress by discussing about their problems and issues they have been facing with their family members and also tend to increase their intake amount as soon as they get habituated to daily consumption. The immediate effects of drug abuse can be observed as reduced memory abilities, interrupted attention and focus, reduced decision-making skills, low level of creativity and an even reduced reasoning power of the brain.
Teenagers in the Netherlands are commonly observed abusing drugs in clubs and bars and they also resort to such tactics due to peer pressure and creating a ‘cool’ impression in front of their adolescent friends. They are afraid of portraying themselves as ‘deviants’ or ‘opposers’ of what their entire group is doing and so they resort to drug abuse under peer pressure. Many teenagers are also observed running businesses of drug distribution illegally by borrowing drugs from smugglers.
India also hasn’t been able to escape from the menace of drug abuse, smuggling and illegal trading and subsequently ruining one’s mental health and physical health. In India, one can find the highest population of middle- class people. This middle- class population experiences immense stress as a result of the competitiveness with other people and to achieve peaks of success and enter the population of the upper class or the ‘privileged’ class. They persistently stress over their financial condition, marriages of their daughters as to how they would afford the entire expenditure involved, they have minimal savings as most of them are utilized in daily expenses of groceries, medicines, dairy products, etc. As a result of extreme stress and anxiety, they adopt the path of drug abuse and spend most of their money in purchasing illicit drugs such as ganja, cocaine, ecstasy and most of them also regularly visit bars to have their regular dose of alcohol. The condition of such drug addicts usually is that they never prepare themselves of confronting a stressful situation and easily resort to drug abuse whenever they feel that they cannot handle the pressure. The mental health issues being faced by an individual aren’t quite known in India, the key reason being a lack of awareness of mental health problems and their adversity if left unattended. But, still one consequence of drug abuse on people’s behavior is that the husbands subject their wives to extreme domestic violence and verbal abuses. They do not have a control on their bodily impulses and so they unknowingly cause harm to their wives and children. Domestic violence rates in India are rising in India due to drug abuse and it also hastened the rate of divorce rates significantly. Most of the mental health disorders due to drug abuse go unrecognized in India due to sectional discrimination in the society.
Conclusively, we can say that the Indian government is undoubtedly working a lot towards mental health awareness and is promoting it in schools, universities and organizations, but it needs to achieve equality in provision of counselling services and rehabilitation to the most impoverished sections of the society. Mental health is still considered a ‘taboo’ in many parts of India and it still remains a ‘privilege’ for the backward sections of the society. The rates of rehabilitation and counselling should be minimal/subsidized or even free of cost for some sections of the society so that they do not end up becoming victims of mental disorders such as depression, stress and panic disorders, anxiety disorders or suicidal tendencies. On the other hand, mental health awareness is prevalent in the Netherlands and it is not a myth or taboo there, yet there is an extreme gap between recovered drug addicts who enrolled themselves in rehabilitation and drug addicts who ignored their symptoms and didn’t work towards solving their drug abusing tendencies. Both the governments need to address specifically the symptoms one faces once they abuse an addictive substance and assign them specific treatments accordingly. Not much is known regarding the mental health problems faced specifically by drug addicts in both the nations. Though in Netherlands, the government and the esteemed institutions do address mental health issues seriously and have set up de-addiction centers, rehabilitation centers, counselling services for all facing mental health issues, but it needs sincere effort towards addressing mental health issues due to drug abuse and identify people at risk at an initial phase to avoid disastrous situations.
Laws formulated in Netherlands related to Drug Abuse Control and Prevention and Mental Health compared to India
This section largely covers the laws formulated by the nations of Netherlands and India in terms of Drug Abuse Control and Prevention and Mental Health issues related to it and suggests some amendments or significant changes which can be made in the existing laws for better implementation and administration.
Drug use prevention in the Netherlands is embedded in a broader perspective of a national prevention program for 2014-16, which was renewed in May 2017. The Dutch drug use prevention policy particularly aims to discourage drug use and reduce the risks for drug addicts themselves, for their families and for the society as a whole. The national drug use prevention policy has been shaped along five objectives. In recent years, emphasis has been laid to counteracting the normalization of recreational drug use in nightlife settings.
Prevention activities are coordinated and funded mainly by the Ministry of Health, Welfare and Sport. Local municipalities are responsible for administering the prevention interventions and policies in close cooperation with schools, municipal care services, neighborhood centers and other organizations involved in substance use prevention.
Environmental and universal strategies target entire populations, selective prevention targets vulnerable groups that may be at greater risk of developing substance use problems and indicated prevention focuses on at-risk individuals.
In the Netherlands, environmental prevention activities are mainly concerned with regulating and controlling the availability of alcohol and tobacco. The enforcement of these measures is appointed to municipalities.
Drug prevention is carried out in schools through the Healthy School and Drugs program. This program targets students from elementary school level to vocational education, as well as parents and teachers. It was revised to increase its skill-focused components and provide more intensive interventions on social norms, self-regulation and impulse control, and professional training for educational staff. Outside school settings, the project Alcohol and Drug Prevention at Clubs and Pubs aims to create a healthy and safe nightlife environment. Electronic media and new applications are increasingly used to provide information and counselling on drug-related issues.
The Dutch government tolerates the sale of soft drugs in ‘coffee shops’. A coffee shop is an establishment where cannabis may be sold subject to certain strict conditions, but no alcoholic drinks may be sold or consumed. The Dutch government does not prosecute members of the public for possession or use of small quantities of soft drugs. However, in the Netherlands as elsewhere, drugs cause nuisance and crime. The government is responding by imposing tougher rules on coffee shops and acting to curb trafficking in hard drugs and dismantling cannabis-growing operations. Addiction care is available for those who are addicted to drugs. Also, the Dutch government has differentiated amongst drugs by defining them as hard drugs and soft drugs or in technical terms one can define them as licit drugs and illicit drugs. Licit drugs refer to drugs such as drugs which tend to have less adverse effects on mental health and physical health of an individual and their addictive property is generally for a short period of 7-8 hours as compared to illicit drugs which can easily make a person an addict upon single consumption and begin affecting the brain and body at the very first consumption event and their effects tend to continue upto an entire day, depending on the body metabolism of an individual the period differs from 12-15 hours to an entire day. Common licit drugs include alcohol, cigarettes, tobacco and cannabis and common illicit drugs include cocaine, LSD, ecstasy and marijuana.
Coffee shops in Netherlands are only permitted to sell soft drugs and not more than five grams of cannabis per person per day. Coffee shops are governed by strict laws that control the amount of permitted soft drugs, and the conditions in which it is sold and used and are further not allowed to advertise drugs. Persons under the age of 18 are prohibited from buying drugs and are barred access to coffee shops.
According to the European Monitoring Center for Drugs and Drug Addiction, the Netherlands Opium Act is the basis for the current drug legislation. It defines drug trafficking, cultivation and production and dealing in and possession of drugs as criminal acts. The Act and its amendments confirm the distinction between Schedule I drugs (e.g. heroin, cocaine, MDMA/ecstasy, amphetamines) and Schedule II drugs (e.g. cannabis, hallucinogenic mushrooms). The Opium Act is implemented by the national Opium Act Directive to prosecutors, which is frequently revised; for example, since 2018, prosecutors have been asked, under appropriate circumstances, to consider (partially) replacing community service and prison sentences with a fine. New psychoactive substances are regulated through amendments to relevant schedules of the Opium Act. Drug abuse is prohibited in public settings such as schools and public transport in order to protect public health and those practicing burglary, theft, illegal trafficking and selling and manufacturing of drugs can be sentenced to imprisonment under the law.
The Dutch mental health care system is relatively rich and to a considerable extent still hospital-based. In the 1980s a mental health care system was developed in the Netherlands, which is known as ‘transmural care’: a term, which alludes to the concept that care continues beyond the walls of the institutions. This system, a flexible combination of outreach, outpatient departments, day treatment and hospital services with continuity of treatment and care, has become an important standard in the Netherlands. Twenty-four-hours-a day, 7-days-a-week crisis services have been organized in every region.
Responsibility for the organization, implementation and coordination of addiction care in the Netherlands has been delegated to regional and local authorities and is part of the broader mental health care agenda. Drug treatment is provided by specialized addiction care organizations. Municipal public health services, general psychiatric hospitals, several religious organizations and some private clinics also offer care for people with substance use problems. Since the reorganization of mental health care in 2014, drug treatment has been provided in a three-step approach: frontline support from a general practitioner or a general practice mental health worker, followed by generalist primary mental health care and specialized mental health care. Some treatment providers deliver inpatient treatment programs.
In general, funding for drug treatment is provided by health insurance, while the public budget for social support at the national and local levels funds specific programs, such as heroin-assisted treatment and supported living.
The options for drug treatment interventions in the Netherlands are diverse. Opioid substitution treatment (OST), complemented by psychosocial treatment, is the treatment of choice for opioid dependence, and OST with methadone has been available since 1968. Heroin-assisted treatment (HAT) is provided at 17 outpatient treatment units in 16 cities (668 treatment slots), while methadone-based treatment is available from various treatment providers, including office-based practitioners and mobile units. In case of gamma-hydroxybutyrate (GHB) dependence, treatment with medical GHB is available, and research is being done into relapse prevention by means of baclofen.
Available psychosocial treatments in drug treatment centers include motivational interviewing, relapse prevention techniques, cognitive-behavioral therapies, and family, community and home-based therapies. New treatment options have been introduced for young cannabis users, people with multiple (dependencies and mental health) problems, crack cocaine users and GHB users. In addition, new treatment settings for homeless drug users in several municipalities have been developed.
The Narcotic Drugs and Psychotropic Substances Bill, 1985 was introduced in the Lok Sabha in India on 23 August 1985. It was passed by both the Houses of Parliament and it was assented by the President on 16 September 1985. It came into force on 14 November 1985 as THE NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES ACT, 1985 (shortened to NDPS Act). Under the NDPS Act, it is illegal for a person to produce/manufacture/cultivate, possess, sell, purchase, transport, store, and/or consume any narcotic drug or psychotropic substance.
Under one of the provisions of the act, the Narcotics Control Bureau was set up with effect from March 1986. The Act is designed to fulfill India’s treaty obligations under the Single Convention on Narcotic Drugs, Convention on Psychotropic Substances, and United Nations Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances. The Act has been amended three times – in 1988, 2001, and most recently in 2014.
The 2014 Amendment recognizes the need for pain relief as an important obligation of the government. It creates a class of medicines called Essential Narcotic Drugs (ENDs). Power for legislation on ENDs has been shifted from the state governments to the central governments so that the whole country now can have a uniform law covering these medicines which are needed for pain relief.
Subsequently, NDPS rules which would be applicable to all states and union territories has been announced by the government of India in May 2015. It also has included 6 drugs namely Morphine, Fentanyl, Methadone, Oxycodone, Codeine and Hydrocodone. According to these rules, there is a single agency – the state drug controller – who can approve recognized medical institutions (RMI) for stocking and dispensing ENDs, without the need for any other license.
The Act extends to the whole of India and it applies also to all Indian citizens outside India and to all persons on ships and aircraft registered in India.
The Prevention of Illicit Trafficking in Narcotic Drugs and Psychotropic Substances Act is a drug control law passed in 1988 by the Parliament of India. It was established to enable the full implementation and enforcement of the Narcotic Drugs and Psychotropic Substances Act of 1985.
Anyone who contravenes the NDPS Act will face punishment based on the quantity of
where the contravention involves small quantity (<1 kg), with rigorous imprisonment for a term which may extend to 6 months, or with fine which may extend to ₹10,000 or with both;
- where the contravention involves quantity lesser than commercial quantity but greater than small quantity, with rigorous imprisonment for a term which may extend to 10 years and with fine which may extend to ₹1 lakh;
- where the contravention involves commercial quantity, with rigorous imprisonment for a term which shall not be less than 10 years but which may extend to 20 years and shall also be liable to fine which shall not be less than ₹1 lakh but which may extend to ₹2 lakh.
The Mental Healthcare Act (MHCA), 2017, is enacted with an aim to promote and protect the rights of and improve the care and treatment for people affected by mental illness in India. The Act purportedly includes substance use disorder (SUD) specifically in the definition of mental illness itself. However, some of the phrases used in the definition such as “abuse” are not clear, as the current classificatory systems of mental illnesses do not have any diagnostic category termed “abuse.” The Mental Healthcare Act (MHCA), 2017, is enacted with an aim to promote and protect the rights of and improve the care and treatment for people affected by mental illness in India. The Act purportedly includes substance use disorder (SUD) specifically in the definition of mental illness itself. However, some of the phrases used in the definition such as “abuse” are not clear, as the current classificatory systems of mental illnesses do not have any diagnostic category termed “abuse.”
Section 89 of the MHCA allows a person with mental illness to be admitted and treated without his consent, but with request from a nominated representative. The Act stipulates that an individual with mental illness can be admitted without his consent if he has “……tried or threatening to harm himself or has behaved violently or is causing another person to fear bodily harm from the person with mental illness, or has shown/is showing inability to care for himself to a degree that places the individual at risk of harm to himself” (emphasis added).
Based on this information, we can infer that both the nations have significantly addressed the issues of mental health and drug abuse control and prevention and delved into the specifics of mental health disorders due to substance abuse and curated de-addiction and rehabilitation treatments for individuals based on their symptoms and also specified punishments and time period of imprisonment, also specified substances which can be legally consumed and the quantity which can be procured by individuals and coffee shop owners (in Netherlands) and also paid heed to illegal trafficking, manufacturing and distribution of drugs. Both of the nations have significantly achieved progress in terms of the laws formulated, but the aspect of trafficking and illegal manufacturing and impose more stringent actions such as lifetime imprisonment or death penalties upon discovery of smuggling hotspots and practices in the nation.
