INDIAN JOURNAL OF PSYCHIATRY, 2003, 45 (III), 189-192
ORIGINAL ARTICLE
A Study of Substance non-use
VASANTHAJAYARAM,ANANDARAM,T.S.J.,ANAND BALAN & BASHYAM.V.S.P
A B S T R A C T
120 persons belonging to the four different groups namely, students, unskilled workers,
skilled workers and professionals were interviewed using a semi-structured interview
schedule on subsunce non-use. Results were analysed using SPSS 7.5 version. 65%
of the sample used, at least, one of the substances during their lifetime. Alcohol
(55.8%) and nicotine (45%) were the commonly used substances and paan (21.7%)
was used to some extent. The non-users were questioned on the reasons for non-
use, with respect to each of the substances, namely, nicotine, alcohol, paan, cannabis,
sedatives, opioids and others. Familial values, disinterest, effects of the substance,
adverse effects due to substances, moral values, responsibilities and being a role
model were the commonly attributed reasons for substance non-use.
category included drivers, carpenters and
office clerks. The professional group
consisted of doctors, engineers and
managers. The student group comprised of
medical and non-medical students at die
graduate and post-graduate levels. Qualitative
interview using a semi- structured interview
schedule was conducted on non-usage of
substances, namely, nicotine, alcohol, paan,
cannabis, sedatives, opioids and others. A
person was considered not to have used a
substance if he or she had not used the
substance even once during their lifetime.
The non-user of a substance was questioned
on the reasons for non-use of the particular
substance using a check list and open-ended
questions. The responses to the open-ended
questions were similar to what was given in
the checklist. Statistical analysis was done
using SPSS 7.5 version.
Key words: Substance use, non-use, predictors
RESULTS
INTRODUCTION
Substance use is one of the major public
healdi problems facing the society and the
costs arising due to it, both direct and
indirect, are enormous. Nicotine is one of
the major causes of premature deadi and
smoking is said to be on the increase in
developing nations (Synopsis of Psychiatry,
8* Ed). Alcohol and illicit drugs are strongly
associated with medical and psychiatric
morbidity, accidents, violence, homicide,
suicide, occupational dysfunction and
reduction in life span. Nicotine ranks third,
alcohol fifth and illicit drugs ninth amongst
the ten major risk factors contributing to
die global burden of disease. Apart from
the above- mentioned substances, paan is
another substance used in India. It is a well-
known fact that paan use is associated widi
oral cancer.
Treatments for substance abuse disorders
are effective but patients require long- term
treatment. The treatment for these disorders
can be further improved by research focusing
on prevention (APA, 2000). For every one
dollar spent on drug prevention, communities
can save up to four to five dollars spent
on substance abuse treatment and counselling
(National Institute of Drug Abuse, U.S.A
2002). Risk and protective factors associated
with substance abuse have been studied
(NHSDA, SAMHSA 1997) and used in
preventive strategies.
Thus, a study focusing on factors
associated with substance non-use can
enhance our understanding of substance
use prevention. This would also help us to
evolve better strategies.
AIMS A N D OBJECTIVES
1) To study the factors associated with
substance non-use.
MATERIALS A N D METHODS
The study was done on 120 persons
belonging to the 4 major groups, namely,
unskilled workers, skilled workers,
professionals and students. The unskilled
workers consisted of labourers. The skilled
The sample consists of 120 persons.
The socio-demographic characterstics of
the sample is depicted in Table 1.
Of the 120 persons interviewed, 64.2%
had used some substance or the other at
least once in their lifetime and 35.8% had
never used even a single substance in dieir
lifetime. Amongst the substance users, the
pattern of use was as follows: alcohol-
55.8%, nicotine- 45%, paan- 21.7%,
cannabis- 7.5%, sedatives-3.3%, opioid-2.5%,
Others (antihistaminics)- 1(0.8%).
On questioning the non-users on reasons
for not using a substance or substances, the
reasons given were either common for all
substances or specific for substances. Forty
different reasons were given for substance
non-use.
The most frequendy reported reasons are
the reasons reported by more than 40% of
the sample. These reasons, which are
common to non-use of all the substances,
are as follows (Ref. Table-II):
Familial factors (disapproval, strict parents,
family members are non-users), disinterest
in substances, effects of substances, adverse
effects due to substances, substance usage
is against one's moral values, family
commitments and responsibilities and
wanting to be a good role model.
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jAYARAM et ml
TABLE I : Socio-Demography of the Sample (n = 120)
Serial No. Socio-dcmographic
Variables
Distribution
% (n * 120)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Age : Mean
Sex : Males
Females
Education : Mean
Marital status
Married
Unmarried
Occupation
Unskilled
Skilled
Student
Professionals
Socio-economic status
Lower
Middle
Upper
Religion
Hindus
Christians
Muslims
Residence
Uran
Rural
Living with
Family
Alone
Hostel
Type of Family
Joint
Nuclear
Extended
32.85+10.63 yrs
77.5 (93)
22.5 (27)
13.76 + 4.57 yrs.
61.7 (74)
38.3 (46)
22.5 (27)
30 (36)
21.7 (26)
25.8 (31)
15.8 (19)
63.3 (76)
20.8 (25)
87.5 (105)
4.2 (5)
8.3 (10)
82.5 (99)
17.5 (21)
90.8 (109)
6.7 (8)
2.5 (3)
25 (30)
62.5 (75)
12.5 (15)
TABLE II : REASONS MOST FREQUENTLY GIVEN FOR NON-USE ( IN
%) & ALSO COMMON TO ALL SUBSTANCES
S. No.
1
2
3
4
5
6
7
8
Reasons
Familial
Disinterest
Effects
Physical Harm
Adverse effects
Moral values
Responsibilities
Role model
Distribi
Nic
61
58
53
50
43
47
41
41
ution
Ale
65
56
56
47
40
52
45
41
with respect to non-use <
Paan
54
51
52
51
50
44
44
42
Cann
52
57
55
55
54
50
47
40
Sed
51
55
53
57
51
47
45
41
of substances (in %)
Opioid
54
56
54
54
53
50
48
40
Others
39
32
15
19
16
29
26
29
(nic-nicotinc, ale-alcohol, cann-cannabis, sed-sedatives )
There were other most frequendy
reported reasons, which were not common
to non-use of all substances, but were
found to be associated with one or more
substances (Ref. Table-Ill). Identification
with a non-user, social stigma, cultural
values and real life experiences associated
with adverse effects of the substance were
the reasons attributed to non-use of alcohol.
Social stigma was associated with non-use
of cannabis. Fear of addiction, followed by,
fear of psychological harm, were the most
frequendy attributed reasons for non-usage
of cannabis, sedatives and opioids.
There was no specific reason reported
for non-usage of nicotine and paan.
There were reasons that were least
associated with substance non-use. These
reasons, with respect to each of the
substances, were reported by less than 30%
of the sample. They are as follows (Ref.
Table-IV):
Religion, holding a respectable job, peers
influencing against using substances, presence
of a physical disorder, presence of a
psychiatric disorder, availability, accessibility
and cost of substances.
85% of the sample was aware about
these substances. 95% of the non-users
were definite that they would continue to
abstain in the future.
DISCUSSION
It is quite interesting to note that 64%
of the sample had used some substance or
the other, at least, once in their lifetime,
though substance use is considered as a
taboo in our culture. Alcohol (67%) and
nicotine (54%) were the commonly used
substances. This can be explained by the
fact these two substances are more socio-
culturally acceptable than others in India
(Basu et al 1995). Paan ranks third amongst
the substances used and this is not surprising,
as paan chewing is a cultural habit in India.
Cannabis is used to a much lesser extent
(7.5%) in our sample, though, it is considered
as one of the gateway drugs in the west.
Nobody reported to have used cocaine,
which again is dissimilar to western statistics
available in text books of psychiatry.
Reasons for non-use of substances (Ref.
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A STUDY OF SUBSTANCE NON-USE
TABLE III REASONS MOST FREQUENTLY GIVEN FOR NON-USE ( IN
% ) BUT NOT COMMON TO ALL SUBSTANCES
S. No. Reasons Distribution with respect to non-use of substances (in %)
Nic Ale Paan Cann Sed Opioid Others
1
2
3
4
5
6
Addiction
Psychological
Identification
Culture
Social Stigma
harm
Real life experience
31
29
33
38
38
32
32
32
46
44
46
43
33
35
36
29
36
34
45
43
34
29
37
34
40
46
32
28
36
35
44
45
32
29
40
37
16
16
19
39
32
10
( nic-nicotine, ale-alcohol, cann-cannabis, sed-sedatives )
TABLE IV : REASONS LEAST FREQUENTLY GIVEN FOR NON-USE ( IN%)
s.
1
2
3
4
5
6
7
8
No. Reasons
Religion
Occupation
Peer pressure
Physical disorder
Psychiatric disorder
Availability
Accessibility
Cost
Distribution with respect to non-use
Nic Ale Paan Cann Sed
24
21
9
8
5
6
2
2
32
20
15
6
6
4
2
4
20
27
12
6
4
4
2
2
18
26
15
6
6
6
5
4
17
25
15
6
3
7
5
4
of substances (in %)
Opioid Others
17
30
15
6
4
10
6
7
16
3
10
3
3
7
3
3
( nic-nicotine, ale-alcohol, cann-cannabis, sed-sedatives )
Tables II & III)
The reported reasons were either
associated with non-use of all the substances
or found to be associated with non-use of
some substances. The reported reasons for
non-use were the following: familial (family
values etc), substance -related (effects of
substances, adverse and harmful effects)
and individual-related (role model,
responsibilities etc).(Ref Table II).Our
findings are consistent with earlier reports
about the protective effects of familial
factors (Dieker 1997, Fountain et al 999).
They are also in concordance with earlier
studies, which cited disinterest and
unfavourable attitudes towards substance
use, as important factors in substance use
prevention (Basu et al 1998, Fountain et al
1999). These factors have been widely
researched with respect to alcoholism. They
are reported to be the factors associated
with alcohol non-use among Asian youths
in the U.S. (NHSDA 2001). In a follow-up
study of alcoholics, these factors have been
found to be associated with abstinence
(Desai 1997, Graham 1998).
In the case of alcohol (Ref Table-Ill),
social factors (stigma, culture) and individual
factors (identification with an abstinent
person, real life experience), in addition to
the earlier mentioned factors, have
contributed to non-use. On the other hand,
fear of addiction and mental harm were
found in association with non-use of
cannabis, sedatives and opioids (Ref Table-
Ill). This shows that the latter group is
considered to be more associated with
addiction, than alcohol, nicotine or paan. It
is not surprising to note that social stigma
is a contributory factor to non-use of
opioids (Ref Table-Ill), since, it is used to
a much lesser extent in the society. This
implies that preventive strategies, apart from
adopting a common approach towards all
substances, should also focus on specific
areas, depending on the substance.
Factors that had least influence on
substance non-use (Ref Table-IV) :
It is important to note that some factors
had hardly any influence on substance non-
use, as modification of these factors, would
not make an impact on substance use
prevention. Religion, occupation, and
presence of diseases have negligible influence
on substance non-use, as per our study. Peer
pressure is known to contribute to substance
use (Dieker et al 1997) but seems to have
hardly any influence with respect to
substance non-use in our study. Availability,
accessibility and cost of substances were
least associated with substance non-use in
our sample. This shows that the usually
adopted governmental measures, like raising
the cost or reducing the availability or access
to substances, really do not help in preventing
substance use. The utility of legal controls
in controlling or preventing substance abuse
has been widely debated. Probably, there is
even merit in the argument that legalizing
illicit drugs would help in reducing drug-
related consequences (Room 1999 et al).
Awareness of substances of abuse was
high (85%). Most of the non-users (95%)
were certain that they would continue to be
abstinent in future. Therefore, these factors
associated with substance non-use, can be
used in preventive strategies. Substance abuse
being a major health problem, certainly,
needs prevention programmes in the
community (Manickam 1997). Several reports
(SAMHSA 1997, NHSDA 2001) and studies
(Mathrobootham 1997) have emphasized
the importance of incorporating, the
protective factors against substance use, in
substance use prevention. Prevention
strategies focusing on adverse health
consequences of substance use have reduced
usage of nicotine and increased motivation
to seek treatment, amongst youth
probationers in Utah, USA (Harrison 1997).
It has been stated that, prevention
programmes incorporating individual
(disinterest), substance- related (effects of
substance) and familial factors, have reduced
consumption of gateway drugs in the
community (Hamburg 1997). These factors
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JAYARAM et al
have also been associated with abstinence
amongst alcoholics in a follow-up study
(Desai 1997).This goes to prove the
effectiveness of substance use prevention.
CONCLUSION
The factors associated with substance
non-use can be used in preventive strategies.
The prevention strategies should stress
the importance of familial factors, advocate
a healthy lifestyle to promote disinterest in
substance use and educate the community
on the harmful consequences of substances.
The factors contributing to non-use can also
be used to identify high-risk groups who
have the susceptibility to develop substance
abuse. The factors associated with substance
abuse are said to be common with factors
associated with other youth problem
behaviours (Harrison 1997). Thus, these
preventive strategies would also help to
prevent other high-risk behaviours of youth.
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*VASANTHA JAYARAM, D.P.M., D.N.B., Assistant Professor, T.S.J. ANANDARAM, M.D., Assistant Professor, ANAND BALAN, D.N.B., Assistant Professor,
V. S. P. BASHYAM, M.D., D.P.M., Professor & Head; Department of Psychiatry, Sri Ramachandra Medical College & Research Institute (Deemed University),
Chennai-6001 16.
* Correspondence
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