Need for specialty addiction clinic services: Findings from a newly established addiction medicine clinic

INTRODUCTION

Substance use disorders (SUDs) pose a significant public health problem globally, which is also on the rise. The national survey on the magnitude of substance use in India highlights the spectrum of substance use in the country, with 14.6% of individuals aged 10-75 years being current alcohol users, while 2.8% and 2.1% are cannabis and opioid users, respectively.¹ Moreover, they are associated with a substantial mental health gap;¹ these findings are supported by the National Mental Health Survey of India conducted in 2015-2016.²

The first step in reducing the treatment gap would involve defining the extent of the problem. While the overall prevalence of substance use in India may appear lower than global averages, the prevalence rate for opioids is notably higher.³ Also, the extent and type of substance use vary region to region across the country. Despite certain states of India being declared as “dry” states, the problem of substance use continues to smolder, especially amongst the youth who are also experimenting with newer psychoactive substances. Community-based studies have revealed variations in the extent and magnitude of substance use problems within and between the states. For example, in Eastern Uttar Pradesh, the overall prevalence of substance abuse was found to be 36.9%.⁴

A meta-analysis in the United Kingdom revealed that approximately 1 in 5 hospital patients experience harmful alcohol use, and 1 in 10 suffer from alcohol dependence syndrome.⁵ Similarly, a cross-sectional study in an Indian multidisciplinary teaching medical institution found that 37.6% of inpatients reported lifetime use of any psychoactive substance, with tobacco (31.4%), alcohol (23.8%), and cannabis (4.1%) being the most common.⁶ These data may have an important role in planning treatment and allocating resources appropriately. Moreover, although addressing the overall problem of substance use requires a multi-disciplinary or intersectoral approach, one of the effective and viable approaches to intervention is to engage and treat substance users visiting health facilities.

Hence, it is important to generate more data and report findings from within different areas of the country. Such data may not only be helpful in understanding the sociodemographic correlates of SUDs at the regional level but also be helpful for policymakers to bring about pragmatic solutions to the burden of SUDs.

To effectively address the pervasive issue of SUDs, there is a clear need to shift treatment paradigms. Community clinics like community outreach clinics run by de-addiction and treatment center (DDTC) PGIMER, Chandigarh, and Community Drug Treatment Clinics by The National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi, offer a promising approach by moving from long-term inpatient care for a few to low-intensity outpatient treatment for many, thereby contributing to bridging the treatment gap and reducing mental health or SUDs-related stigma in India.⁷ However, Outpatient Clinics in various medical institutions still form the backbone of the treatment of SUDs in the country. Many hospitals and medical colleges are providing specialty addiction medicine services to cater to the special needs of people with SUDs. A specialty clinic provides an easier, approachable, and specialized care to the subgroup. Such a service may improve accessibility to services, motivate patients to seek treatment in a non-stigmatized manner, and help to reduce the treatment gap in SUDs.^8-10

This paper discusses findings from the patients attending the newly established Addiction Medicine Clinic (AMC) of a multispecialty clinic in Central India. Such findings may enrich the literature with the felt need for more such services in other regions.

MATERIAL AND METHODS

RESULTS

A total of 125 patients attended the specialty AMC over the period of four months. The mean age of the patients was 35.5 (SD = 11.6) years, with the age range varying from 18 to 69 years [Table 1]. As the institute conducts a separate child and adolescent psychiatry clinic on a different day, no patients below 18 years of age were seen in the AMC. There were 116 (92.8%) visits by male patients and about 9 (7.2%) visits by female patients.

Of the total 61 were new cases, while 64 were follow-up cases (including patients who had registered in the AMC during the four-month study period, as well as those registered earlier in other psychiatry outpatient services but who began follow-up in the AMC during this timeframe). In terms of geographic distribution, most were from Raebareli district (n = 118, 88.8%), where the institute is located. Smaller numbers, however, also hailed from Amethi (n = 4, 61 km), Fatehpur (n = 4, 60 km), and Pratapgarh (n = 3, 72 km). One patient each presented from Unnao (102 km), Lucknow (80 km), and from another state, Punjab (Moga, 970 km).

With respect to substances used [Table 2], tobacco (58.4%, n = 73) and alcohol (51.2%, n = 64) were the most common, followed by opioids (40.8%, n = 51), cannabis (16%, n = 20), and inhalants (0.8%, n=1). Regarding patterns of multiple substance use, the most frequent categories was combined alcohol and tobacco users (31.2%, n = 39). Other combinations included alcohol, tobacco, and cannabis (12%, n = 15); opioid and tobacco (9.6%, n = 12); and cannabis and tobacco (3.2%, n = 4). A single patient (0.8%) reported use of all four substances (alcohol, tobacco, cannabis, and opioids), and one patient reported exclusive inhalant use. Among single-substance users, opioids were the most common (31.2%, n = 39), followed by alcohol (8%, n = 10) and tobacco (3.2%, n = 4).

Age-wise distribution [Table 3] showed that alcohol and tobacco use were most prevalent among adults (alcohol: 45.6%, n = 57; tobacco: 52%, n = 65). Smaller proportions were noted among older adolescents (alcohol: 3.2%, n = 4; tobacco: 4%, n = 5) and young adults (both alcohol and tobacco: 2.4%, n = 3). No cases of alcohol or tobacco use were recorded among older adults (>60 years).

For opioid use, the majority were adults (33.6%, n = 42), followed by older adults (5.6%, n = 7) and young adults (1.6%, n = 2); no adolescent opioid users were observed. Cannabis use was predominantly reported among adults (10.4%, n = 13), followed by older adolescents (4%, n = 5) and young adults (1.6%, n = 2). The single inhalant user belonged to the adult age group.

DISCUSSION

The analysis of the AMC during its initial four months of operation (April–July 2025) provides important insights into the demographic and substance-use characteristics of individuals seeking care in a newly established specialty clinic within a tertiary-care setting in North India.

The mean age of patients presenting to the AMC was 35.5 years (SD = 11.6). This finding is consistent with existing literature.^12-14 For instance, in a national survey by Avasthi et al.¹² on epidemiology of substance use in India, the mean age of participants was 36.3 years. Another study in Gujarat, India, reported that about 67% of patients with SUDs seeking de-addiction services were in the age range of 25-45 years.¹⁴ Similarly, the present findings highlight that adults, particularly those in middle adulthood, constitute most treatment seekers. This pattern is in line with both national and global trends, as reflected in the National Survey on Extent and Pattern of Substance Use in India (2019).⁴

Of the total patients (n=125) who attended the clinic during the study period, there was an almost equal distribution of new (48.8%) and follow-up (51.2%) cases. This pattern suggests consistent patient retention even within the short operational span of the AMC. The relatively high proportion of follow-up cases may be explained by referrals from other psychiatry outpatient services to the AMC for specialized care. Additionally, individuals previously engaged in treatment at the ATF and were coming for follow-up on general OPD days, which have been operational six days a week in the same department since 2021, may have opted to visit on AMC days instead of general OPD days due to easier accessibility and reduced patient load compared to general outpatient days.

A separate clinic day appears to attract patients from general OPD days to the specialty AMC day, likely due to reduced footfall, lesser stigma, and the availability of more specialized care, in addition to the ATF services that operate six days a week. One possible mechanism for stigma reduction is that patients with substance use may avoid psychiatric OPDs, perceiving them as meant only for those with severe mental illness, or often loosely termed mad people in that region. A dedicated day and clinical team make patients with SUDs more comfortable attending a specialized clinic, while also enabling the institute to highlight available services and allocate resources for addiction treatment in the region. For example, awareness programs showcasing the institute’s specialty clinic may attract more patients to seek treatment for SUDs. This integrated service model may also have contributed to improved patient retention in follow-up. However, a formal assessment of stigma reduction was not conducted in the present study and may be a topic for future investigation.

In the present study, there was an overwhelming male predominance among attendees (92.8%), consistent with previous Indian studies, where cultural, social, and stigma-related barriers deter women from accessing addiction treatment services.^15,16 However, this gender disparity underscores the need to enhance access and reduce stigma for female substance users. It is important to understand the biological, psychological, and social differences between men and women, as these factors may influence the development, maintenance, and treatment of SUDs.¹⁷ Notably, one Indian study in eastern Uttar Pradesh reported a higher prevalence of tobacco use among females compared to males.⁴ Despite this, cultural restrictions, stigma associated with treatment seeking, and dependence on male family members for accessing services may contribute to lower treatment-seeking among women, despite the significant burden of substance use in this population

In terms of geographical distribution, most patients (88.8%) were from the Raebareli district. This finding reflects the importance of geographical proximity in determining healthcare access, particularly for chronic and stigmatized conditions such as SUDs. Attendance from neighboring districts was relatively low, further underscoring the role of location in accessing such services.

The prevalence of tobacco use (58.4%), alcohol use (51.2%), and opioid use (40.8%) in our study was particularly high, followed by cannabis (16%) and inhalants (0.8%). These patterns resonate with national surveys and other epidemiological studies from community-based settings for e.g. a study conducted by Rao et al.⁶ among 290 in-patients in a medical college in India, reported that 37.6% had lifetime use of any psychoactive substance, with tobacco being the most common (31.4%), followed by alcohol (23.8%) and cannabis (4.1%). These findings are comparable to our study, highlighting the dual burden of legal (tobacco, alcohol) and illicit (opioids, cannabis) substances in the community.

The relatively high prevalence of opioid use (40.8%) in our cohort may be explained by patients already enrolled in the ATF’s opioid substitution therapy (OST) program who also began attending the AMC on specialty days instead of general OPD days.

With respect to comorbid substance use, only 43.2% of individuals reported single-substance use, while the remainder engaged in multiple-substance use (≥ 2 substances). The most common combination was alcohol-tobacco (31.2%), followed by alcohol-tobacco-cannabis (12%). One individual reported use of all four substances (alcohol, tobacco, opioids, and cannabis), underscoring the complexity and severity of substance use problems. These findings highlight the necessity for clinicians to routinely screen for polysubstance use, which complicates treatment and adversely affects prognosis. These findings are consistent with worldwide data reported by Saha et al.¹⁸ among more than 36,000 patients, where 12-month alcohol use prevalence was 72.7%. Among alcohol users, 62.0% used alcohol alone, 21.6% used alcohol with nicotine, 8.1% used alcohol with other drugs, 4.6% used alcohol, nicotine, and cannabis, and 3.7% used alcohol and cannabis together.

Concerning the age distributions of the substance users for different substances, a multicenter cross-sectional study conducted across 15 Indian states among 1,630 young people (10–24 years) attending primary health centers reported a prevalence of substance use of 32.8%, with a median age of initiation at 18 years. Among users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%), and cannabis (9.5%) were the most consumed. In contrast, in our study, most users across substances were adults aged 25-59 years, although a small but concerning proportion of older adolescents (15-19 years) reported alcohol, tobacco, and cannabis use. It is important to note that the department operates a separate child and adolescent clinic on another weekday; hence, patients younger than 18 years may not have presented to the AMC. This likely accounts for the relatively small number of adolescents in our dataset. Notably, no opioid use was reported in the 15–19 years age group, whereas among adults aged 25-59 years, opioid use was 33.6%, and among older adults aged 60-99 years, it was 5.6%, raising concerns of both chronicity and late-onset use.¹⁹

This early dataset from a newly established AMC demonstrates that, even within a short period, there is both demand for and utilization of specialized addiction services in semi-urban settings. The presence of follow-up patients indicates early signs of engagement and possible treatment adherence.

CONCLUSION

The establishment of the AMC at the institute has the potential to address the crucial gap in addiction treatment within the region. Patient profiles indicate a complex pattern of substance use, predominantly among middle-aged males, with high rates of polysubstance use. These findings underscore the need for integrated interventions that are age- and gender-sensitive and tailored to address multiple substances. Collection of data over longer periods will provide a more comprehensive understanding of trends, treatment outcomes, and service needs, thereby informing service expansion and policy decisions.