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Table of Content Volume 13 Issue 1 - January 2020
Women, Culture and Substance abuse
Sharanabasavaraj Devarmani1, Anil Gumaste2*
1Senior Resident, 2Assistant Professor, Department of Psychiatry, RIMS, Raichur, Karnataka, INDIA. Email: gumasteanil@gmail.com
Abstract Objective: To study the socio-demographic profile, cultural aspects and pattern of abuse of Chloral hydrate, among women in Raichur. Material and methods: The study included women attending RIMS Psychiatry OPD and IPD, from Jan 2018 to June 2018 with ICD-10 diagnosis of Sedative (Chloral hydrate) Dependence Syndrome with withdrawal state. Socio-demographic profile was evaluated using modified Kuppuswamy scale. A semi structured questionnaire was designed to evaluate the pattern and cultural aspects of use. Conclusion: Women belonging to the lower socio-economic class use Chloral hydrate, initially it is culturally sanctioned and used during religious ceremonies, Jatras, marriages, and deaths. Subsequently majority of the women started using it on regular basis and later on developed Sedative (Chloral hydrate) Dependence Syndrome with withdrawal state. Key Word: culture, women.
INTRODUCTION Culture shapes not only our beliefs, attitudes, behaviour but also addiction. Over many centuries humans have used many substances for recreation. Mankind’s quest for hedonism has resulted in development of plethora of substances which have addiction potential. Almost all cultures have used psycho-active drugs to facilitate social interaction, to alter consciousness, to heal1. The ICD-10 and DSM-5 have classified these substances in 9 groups, which roughly cover everything under the sun. Chloral hydrate is an old sedative first synthesized by Justin Liebig in 1832, andthen widely used from the end of the 19th century until around 1950 2. Chloral hydrate is a non-barbiturate sedative that slows down the central nervous system and brain activity, causing extreme drowsiness and deep sleep within an hour, depending on the dosage3 Alcoholics typically used it to get to sleep, and it was extremely popular in Victorian England in literary and aristocratic circles 4. Once considered safe and easy to use, chloral hydrate is now recognized addictive, carcinogenic, and dangerous, especially when used on children5. Chloral hydrate is a sedative that was developed in 1831 for the purpose of hypnosis and sedation. The use of Chloral hydrate even medically has come down, with availability of better drugs. But the evils of any such sedative drugs remain. We report a pattern of Chloral hydrate use which is quite rampant in and around Raichur. Here Chloral hydrate powder is mixed with water and served in one litre bottles with one litre costing around 15-20 rupees. As such there have been individual reports of abuse of Chloral hydrate and mass use has so far been unreported. But it is surprising to report that a significant number of patients particularly women who avail the services of Psychiatry Department for Substance abuse problems in RIMS are addicted to Chloral hydrate. Substance abuse has traditionally been considered a disease of men. Women were believed to have some kind of immunity in terms of “social inoculation”5. However it is now being seen that women are also susceptible to substance use and related problems. In India, traditional use of various substances by women during religious festivals is not unknown. Chewing tobacco is a common practice among many women across the country. Cultural use of alcohol has been known in some tribal populations. National multi-centred studies in early 80’s reported negligible drug use rates among women6. Further it is been noted that there is acceptance of substance abuse by the family members. This prompted us to study this unique confluence of women, substance abuse and culture.
MATERIAL AND METHOD Female patients diagnosed with Chloral Hydrate dependence at RIMS Raichur, during January 2018 to June 2018, meeting the dependence criteria were approached to participate. Fifty Five women patients during the study period with inclusion criteria were approached to participate, fifty two patients agreed to participate. A semi-structured questionnaire was used to assess the socio demographic profile. Since Chloral hydrate is a sedative, patients were diagnosed using ICD 10 as having Sedative Dependence. They also met the criteria of Sedative Withdrawal State. Patients who had significant medical problems were excluded from the study. A questionnaire was used to interview one accompanying family member to assess cultural attitudes of the family towards the problem. The family member identified was husband, son, and daughter in law or brother of the patient. Inclusion criteria
Exclusion criteria
Sample size: Fifty Five women patients attending psychiatry OPD during the study period with inclusion criteria were approached to participate in the study. Fifty two patients agreed to participate.
RESULTS The results showed that out of 52 patients in psychiatry OPD, 30 were admitted IPD. These patients had predominantly had sleep disturbance, most were unaware that Chloral hydrate (Henda) drinking was the reason for current problem or wanted help to quit it. The mean age was around 40 years, 57.7% were married, and majority 86% were illiterate, 78% were urban in residence, predominantly 92.3% were Hindus and belonging to BPL income. The money spent was usually 84.6% less than 20 rupees.
Most common withdrawal symptom was sleep disturbance, 19% had seizures and 14% had Delirium. Most common medical problem was Anaemia(67%), followed by Hypertension(9.6%) and Hypothyroidism(7.6%) Psychiatric disorder were noted like Somatoform disorder(9.6%), Depressive disorder(3.8%), GAD(5.7%), Panic disorders(3.8
Most of the women started using Chloral hydrate (Henda) 44(84.6%) 5-10 after marriage and had been using it more than 10 years(80.7%). Many were using (31)59.6% on daily basis In (18)34.6% families drinking was accepted and (44) 57.6% had problems on stopping it. 94.2%(49) had reported regular use on special occasion like marriage, festivals, jatras and other functions like death ceremonies
DISCUSSION This is perhaps the only study that has assessed mass consumption of Chloral hydrate. Even though supply of Chloral hydrate is not legal, but still it is rampantly abused in and around Raichur. Every geographic area has its own characteristics to which we can add locally available chemicals of addiction. Chloral hydrate a long forgotten sedative has become the cherished substance of abuse. It is cheap, sedative and effective anxiolytic makes it very attractive. It was noted that most of the women started drinking only after marriage and especially in some communities drinking by women during religious ceremonies is a norm. There was greater acceptance in this area. Widowed women with good financial freedom were found to be drinking more than one bottle per day7. There was greater acceptability in family unlike some studies found Alcohol use in women being linked with sexual misconduct, promiscuity, and neglect of children and significant others, a set of conditions that cause stigma and social discrimination8.However in our study there was no such aspects noted. Moreover, factors like poor education status, lack of job, young age at work, early marriage, and lack of social support increased vulnerability of such females This in keeping with other studies that have shown effect of caste and class dynamics on gender . Caste such as Rajput, a woman is considered as a good Rajput women and an adoring wife when she accepts the “Manwar” at wedding and rituals. “Manwar” is raising a toast by new married couples9. In Rajasthan Banchadda caste includes: Gujar, Mali, Karmawat, Singhawat etc. These all caste prefers taking alcohol, chew betel leaves and tobacco, smoke bidi and cigarettes. In our study Women taking all these substances are found common among them. Similarly 86.7% used tobacco in the of nashee a form of tobacco applied as a paste. The informant was usually the husband or son, and none of patients reported alone. This is unlike other which has the many were Key informant interviews in the women's study of the national survey revealed that 31% of the women across the sites were single, and 32% were separated or divorced. Low psychiatric morbidity in the form was where some studies noted higher coomorbidity11.However high rates of Anaemia was noted in patients Higher class women openly take the alcohol and some amount of opium and lighter drugs. They considered it as fashionable, sign of freedom and independence Whereas, middle class women are restricted and bound by norms of not consuming alcohol. Nevertheless, still it has been seen that many women do not want to label themselves as a spoil sport and they want to match and explore themselves with the other higher groups. So, they keep aside their fear of social taboo and hesitation and try to drink liquor at parties and pubs12. Our study showed that the women belonging to lower social economic had greater autonomy in their choices.
CONCLUCION Every area has its own peculiarities and in our study we report mass use of a almost ancient drug which has lost its utility. Chloral hydrate a sedative has become popular in around Raichur wherein a simple process of mixing with water and selling it in bottles not only makes it cheap but easily prepared and distributable. Further its use was found to be higher in women belonging to lowersocio economic class. There was greater acceptability in the family members who also consumed it. There was no such stigma associated with it. The use was usually associated with religious functions life marriages. death jathras. Relatively lesser psychiatric comorbidity was noted which can be due to probably eased social structure.
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