Dr Deepika Khakha presented on drug abuse and illicit trafficking among children in India. She summarized a nationwide study from 2013 that found children began using substances like tobacco at 12 years old on average. Peer pressure and lack of treatment were common factors. During COVID-19, existing mental health issues in children may be exacerbated by school closures. Health care professionals can help by reducing risk factors through family and school programs, as well as treatment including detoxification, counseling, and relapse prevention. Collaboration across sectors is needed to address this issue.

1. Dr DEEPIKA C KHAKHA
MA(Psych),MSN,PhD
Fogarty fellow, New York University, USA
Advanced AITRP fellow,Unv of California Los Angeles, USA
Associate Professor
AIIMS, New Delhi
Role of Health Care workers against Drug abuse &
Illicit trafficking among children

2. Assessment of pattern and profile of children
using substance- Nationwide study, 2013
Substance-using children could be easily recruited from
multiple settings (school, out-of-school, street) from sites
across 100 cities in all states of India.
The average age at the initiation
Tobacco use - 12.3 years
Inhalants- 12.4 years
Cannabis- 13.4 years
Alcohol use- 13.6 years
Opioids and pharmaceutical drugs - 14–15 years
Dhawan A et al., 2017

3. Continued..
• Peers using substances were common (>80%) and peer
pressure was reported by 40% as the reason for
continuing drug use.
• Around 70% had never sought any treatment or had
contact with any non-governmental organization (NGO).
• Only a small proportion (7.7%) of children were in daily
contact with an NGO.
Dhawan A et al., 2017

4. Outline
Support group available for illicit drug abuse and
trafficking
Battle against drug abuse and Illicit drug trafficking in
Children:- Role of Health care professionals
Caregiver support during covid-19 lock down period

5. Prevention and Treatment of Child
Substance Use – GOI Concerned
authorities
•Ministry of Social Justice and Empowerment
•Ministry of Health, Women and Child Development
•Ministry of Human Resource Development
•Ministry of Youth Affairs and Sports
•Ministry of Labour and Employment
•Department of AIDS Control (DAC)

6. Support groups - NGO
•Federation of Indian NGOs for Drug Abuse
Prevention (FINGODAP)
•Society for Transformation, Inclusion and
Recognition through Sports (STAIRS)
•Nada India Foundation
•Al-Anon Family for Teens
•Many more..

7. Battle against drug abuse and Illicit drug
trafficking in Children
Role of Health care professionals
•Efforts to reverse or reduce risk factors
•Risk factors are:
•Lack of mutual attachment and nurturing by
parents or caregivers
•Ineffective parenting
• A chaotic home environment
• Lack of a significant relationship with a caring
adult
•A caregiver who abuses substances, suffers
from mental illness, or engages in criminal
behaviour.
Preventive aspects

8. Battle against drug abuse and Illicit drug trafficking
in Children:-
Role of Health care professionals…
• Preventive aspects
• Family programs
• Should enhance family bonding and relationships and
improve parenting skills
• Family bonding is the bedrock of the relationship
between parents and children.
• Parental monitoring and supervision are critical for
drug abuse prevention.
• Moderate, consistent discipline is essential

9. Battle against drug abuse and Illicit drug
trafficking in Children:-
Role of Health care professionals…
•Preventive aspects
School programs
• Preschool Level
• Early intervene and address risk factors such as
aggressive behaviour, poor social skills, and
academic difficulties
• Elementary school children
• Early intervene and address risk factors such as
aggression academic failure, and school dropout.
• Focus on self-control; emotional awareness;
academic support, especially in reading.

10. Battle against drug abuse and Illicit drug
trafficking in Children:-
Role of Health care professionals…
Preventive aspects
School programs
•Middle or High school students
• Improve the following skills
•Study habits and academic support
•Peer relationships
•Self-efficacy and assertiveness
•Drug resistance skills against experimentation
•Strengthening of personal commitments
against drug abuse.

11. Continued..
•Community programs
•Prevention programs should address all forms of
drug abuse, alone or in combination
•Legal drugs (e.g., tobacco or alcohol)
•Illegal drugs (e.g., marijuana or heroin)
•Inappropriate use of legally obtained substances
(e.g., inhalants)

12. Treatment Aspects
DETOXIFICATION
INTERVENTION
REHABILITATION
CORE COMPONENTS
•Maximize motivation for abstinence
•Restructure their lives without alcohol / drugs
•Minimize relapse

13. Psychological interventions
•Brief Intervention
•Motivation enhancement
therapy
•Relapse prevention
counselling
•Group therapy
Counselling
 Social skills training
(saying no).
 Problem-solving
skills.
 Relaxation training.
 Anger management.
 Cognitive
restructuring.

14. Relapse Prevention
•Identifies situations in which the risk for relapse is high.
•Help to identify modes of coping to be used when craving
increases
•Remind about the appropriate attitude.
•Rebuild relationships
•Supportive family therapy

15. Mental health concerns children
during COVID-19 lock down period
• Existing mental illness among children and adolescents
may be exacerbated by the pandemic, and with school
closures, problems of accessing to mental health services
• Additional care should taken against suicide and substance
abuse among adolescents
• Special care against excessive use of internet and related
consequences at home

16. Caregiver support during
Covid-19 lock down period
Recognize the specific sign of psychological distress
•Difficulty in eating, sleeping
•Being sad, withdrawn, fearful
•Night mares
•Decreased interest in routine
works

17. Continued..

18. Managing children during
lockdown
•Keep them busy
•Allow them to help in household chores
•Make them feel responsible
•Help them acquire new skills
•Cultivate new hobbies

21. Recommendation
•Training manpower and capacity building can
be enhanced through short-term training, long-
term training and skill-based workshops
•Cost-effective, culturally relevant interventions
should be developed separately for children in
school, at home or on the streets

22. Recommendation..
•Child welfare systems need to be strengthened,
especially for homeless children, children with
history of abuse in family, etc. as these should be
effective safe spaces for children.
•Effective counselling services could reduce the risk
of substance use and approach should be child-
sensitive

23. The average age of initiation to alcohol in India which
was 19 years in1986 has come down to 14 years in
2006.
( Source: Rekha , The Lancet, 2009)Current trends

24. Conclusion
•Drug abuse and Illicit drug trafficking among children has
received attention only recently in India and much work needs
to be done to address the issue.
•A collaborative efforts and multifaceted approach with equal
focus on prevention as well as treatment efforts can only
address this emerging problem.

26. References
Dhawan A, Pattanayak RD, Chopra A, Tikoo VK, Kumar
R. Pattern and profile of children using substances in
India: Insights and recommendations. The National
Medical Journal of India. 2017 Jul 1;30(4):224.
Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal
SK, Chadda RK on behalf of the group of investigators for
the National Survey on Extent and Pattern of Substance
Use in India (2019).Magnitude of Substance Use in India.
New Delhi: Ministry of Social Justice and Empowerment,
Government of India

27. References
Psychosocial Support for Children during COVID-19
Available
https://www.unicef.org/india/media/3401/file/PSS-
COVID19-Manual-ChildLine.pdf Accessed 23/06/2020
Golberstein E, Wen H, Miller BF. Coronavirus disease
2019 (COVID-19) and mental health for children and
adolescents. JAMA pediatrics. 2020 Apr 14.
Coronavirus disease 2019 - World Health Organization
COVID-19 : Resources for Adolescents and Youth
Available
https://www.who.int/maternal_child_adolescent/links/covi
d-19-mncah-resources-adolescents-and-youth/en/
Accessed 23/06/2020

28. References
Preventing drug use among children and
adolescents-NIDA
https://www.drugabuse.gov/sites/default/files/preventi
ngdruguse_2.pdf Accessed 23/06/2020
Protection of Children From Abuse and Neglect in
India:Available
https://www.med.or.jp/english/journal/pdf/2013_05/29
2_297.pdf Accessed 23/06/2020

29. Acknowledgement
Jaison Joseph, Ph.D. Scholar, Lecturer (Jr),
College of Nursing, PGIMS, Rohtak, Haryana