C HAPTER VI

National Drug
Demand Reduction
Programmes
R. Ray

VI : National Drug Demand Reduction Programmes 91

CHAPTER VI
NATIONAL DRUG DEMAND REDUCTION PROGRAMMES
R. Ray
In order to combat and minimize the problem of drug
addiction, a nation requires strategies and programmes for
both the control of supply and reduction of demand for
drugs. Supply reduction measures connote law
enforcement activities. On the other hand, demand
reduction activities include primary prevention, treatment
and social reintegration. In recent times, greater emphasis
has been placed upon demand reduction activities. This
chapter reviews and summarizes the various steps and
measures adopted by respective governments towards
demand reduction. International agreements provide the
basic guidelines and the core legislative framework is
developed based upon the country’s status as signatory of
various international conventions and treaties. Obligations
to these conventions require appropriate legal provisions
towards control of drug abuse for the nation (UNDCP,
1997).
First and foremost, any plan would require an assessment of
the current situation and resources available. National bodies
would need to examine several issues. These include :
l Need for such a programme
l Objectives
l Principles involved
l Policy formulation
l Formulation of strategy
l Identification of various components and drawing up
an action plan
l Programme administration including inter-sectoral co-
ordination and role delineation
l Setting priorities
l Phasing and time scaling of various activities
l Outputs expected
l Resources required/available
l Monitoring and evaluation.
Further, national policies and programmes are influenced
by economic and political stability and the existing nature
of legal and judicial systems of the country (details in the
next chapter). Specific objectives and activities are
determined by visibility, population sub-group most
affected and the magnitude of threat perception by the
community (UNDCP, 1997).
A national plan is expected to examine these issues and
propose various activities and programmes. Precise
estimates of the nature and extent of drug abuse are difficult
92 VI : National Drug Demand Reduction Programmes
to make in any country including the ones in this region.
This is because drug abuse is often a hidden phenomenon.
However, some approximation and estimates are possible.
These have been reviewed in chapter II. Based upon these,
a nation prepares itself and develops national policies and
programmes. The plan of action is not uniform as different
countries attempt different measures due to cultural
diversity, and differences in philosophy, strengths and
weaknesses. Supply reduction activities, i.e. suppression
of trafficking is a cross-border issue, while treatment and
prevention are specific to a country and can also vary in
different regions within it. Thus, these cannot be easily
transferred to or be applicable in another country. The
differences may be more obvious than similarities. For
example, a country with “zero tolerance” would attempt
exclusively abstinence oriented programmes. A country
with a higher degree of tolerance would adopt “harm
minimization” as one of the major objectives of the national
effort.
Successful planning requires considerable investment/
inputs from academicians, technical experts, policy
planners and administrators. Sensitization of key persons,
advocacy, and public and media pressure to initiate a
programme are also important. Political and administrative
will are absolutely crucial. International agencies like
UNDCP, WHO, SAARC (for this region), etc. can play very
decisive roles as catalysts and facilitators. (The role of
UNDCP will become clear in the following pages.) These
efforts and initiatives must be reinforced by strengthening
national institutions and organizations. For a programme
to be successful, support must come from all three bodies,
i.e. the government, non-government sector and private
sector. Often, health and law enforcement objectives can
be contradictory. Successful drug policies are a balance
between enforcement and persuasion, i.e. between
sanctions and incentives (UNDCP, 1997). Efforts, initiatives
and measures adopted by various countries are discussed
subsequently.
It can be seen from the earlier chapters that in this region,
Bhutan and Maldives are the least affected countries as
regards drug abuse. Bangladesh, India, Nepal and Sri Lanka
have varying degrees of drug problems. However, certain
commonalities also emerge. In all these countries, policy
formulations refer to both supply and demand reduction
activities. By and large, the emphasis has been on supply
reduction. Of late, the importance of demand reduction Youth and Sports : Various training centres are
activities has been realized. involved in educating youth on
hazards of drug abuse.
Besides the government, in most of these countries there Education : National Curriculum and Text
are a number of active NGOs who participate in policy Book Board is mandated to
formulation as well. This is most obvious from policies include chapters on drugs and
and programmes in Sri Lanka. Finally, in some countries drug abuse in text books for
(viz. India) even law enforcement authorities are involved students from class VI to X.
in demand reduction activities. This has led to integrated INFEP : The Integrated Non-Formal
drug control strategies. Specific projects and activities on Education Programme is involved
demand reduction activities are further elaborated in in imparting knowledge to
chapters VIII, IX, X and the related box items. persons outside the formal
education system.
Women’s Affairs : Is expected to provide training to
BANGLADESH women on drug abuse.
NGO Affairs Bureau : Supports NGOs.
Essential information is available from the National Master Information : National TV and radio to carry
Plan (1991), National Drug Demand Strategy (1995) and mass awareness programmes for
Five Year Strategic Plan (1995). The Government of prevention.
Bangladesh is yet to formulate a policy on drug control,
but sufficient information is available from the above three
documents.

The focal point for activities is the Department of Narcotics

Control (DNC), Ministry of Home Affairs. The DNC was
established in 1990, under the Narcotics Control Act, is
headed by a Minister, and has members from several ministries
and eminent public persons. It is responsible for all the
activities to control drug abuse in Bangladesh including
preventive education, treatment, rehabilitation and research.

BANGLADESH: NAT I O N A L D RUG CONTROL

ACTIVITIES
Workshop on review of National Drug Demand Reduction Strategy,
Bangladesh
Significant Events
Narcotics Control Act - 1990
Creation of DNC - 1990
National Master Plan - 1991 BANGLADESH: DEMAND REDUCTION ACTIVITIES
Sector Plan, Demand Reduction - 1993
Five Year Strategic Plan - 1995 Ministries/Departments involved :
l Health l INFEP
l Social Welfare l Women’s Affairs
For demand reduction activities the following ministries/ l Youth and Sports l NGO Affairs
departments are involved : l Education l Information

Health : To provide treatment through

government treatment centres in
medical colleges.
Social Welfare : To provide some degree of care
and counselling to affected
individuals and their families.
Financial assistance is provided
by the government.
The National Master Plan (1991) provides the framework
and basis of development of various programmes. Its
implementation has required a high level of resources and
efforts from UNDCP (UNDCP-ROSA, 1997), in a five year
joint project between the Government of Bangladesh and
UNDCP. The proposed activities for demand reduction are

VI : National Drug Demand Reduction Programmes 93

categorized as sector plans for:
l preventive education and information
l treatment and rehabilitation.
The long term objectives are containing and reducing the
effects of drugs on individuals, families and the community.
The immediate objectives are to establish centres for
treatment and rehabilitation and initiate preventive
education.
Following the development of the National Master Plan, a
Five Year Strategic Plan has been developed (1995). Several
workshops and widespread consultations were held to
formulate this plan. It was envisaged that drug abuse control
should have a judicious combination of both demand and
supply reduction activities. Several goals were identified
for demand reduction in the areas of treatment; relapse
prevention, work place intervention, reduction of sale of
pharmaceutical products, community support and
involvement of NGOs were suggested.
Specific strategies for preventive action viz. restructuring
of the DNC, development of a preventive package, training
for several groups of persons, development of media and
advertising policy, health warnings for pharmaceutical
products, sector based programmes and work place
intervention have been proposed.
Specific strategies for treatment and rehabilitation include
development of a client monitoring system (CMS), treatment
strategies including harm minimization, development of
community based care and rehabilitation services, human
resource development, co-ordination mechanism between
government and NGOs, and promotion of research,
monitoring and evaluation. Special emphasis was laid on
public health campaigns against HIV/AIDS and drug abuse.
Though the country does not have any surveillance system
for HIV/AIDS as yet, the National AIDS Committee under
the department of health has been identified for such
activities. A detailed monitoring mechanism has also been
proposed. As most programmes are funded by external donor
agencies, it has become obligatory to monitor various
activities closely. Formation of various committees such as
technical committees, zonal committees and community
coordination committees have been proposed.
Currently, four government funded treatment centres are
functional in four cities. Further, eight medical college
hospitals and one mental hospital are mandated to provide
beds for detoxification. About 20 NGOs are actively involved
in drug demand reduction. Some of these (six in Dhaka)
provide residential treatment facilities. Some are active
mostly for public education and awareness building activities
(National Drug Demand Reduction Strategy, 1995).
94 VI : National Drug Demand Reduction Programmes
The Drug Demand Reduction Programme (UNDCP assisted)
was evaluated in early 1997. The two components —
preventive education and treatment and rehabilitation —
were reviewed. It was noted by the review team that demand
reduction activities had not received adequate attention. The
two components were not integrated and were being viewed
independently. It was further noted that even though the
current drug use prevalence rate was low, drug abuse was
increasing, particularly the use of injectible buprenorphine.
Thus the risk of spread of communicable diseases like HIV/
AIDS and hepatitis could increase. The sector plans were
well conceived, though there was a delay in implementation,
and the actual operations began in mid-1994.
Public Awareness Programme at Grassroot Level
ACHIEVEMENTS
Preventive Education
Demand reduction training materials have been developed
and are in use. A drug education curriculum for school
grades six to ten is ready. Education through print and
electronic media have been carried out. Finally, a National
Resource Centre on drugs has been established.
BANGLADESH: DEMAND REDUCTION
PROGRAMME
Achievements in Preventive Education:
l Training materials developed
l Drug education curriculum for schools developed
l Education through media
l National Resource Centre Established
Treatment and Rehabilitation
The review team noted that most of the outputs had been
achieved. Excellent training materials were available and
several training workshops had been held. The Client
Monitoring System was operational.

BANGLADESH: DEMAND REDUCTION
PROGRAMME
Achievements in Treatment and Rehabilitation:
l Training workshops held
l Training materials available
l Client Monitoring System operational
l Treatment centres established
Further, it was seen that capacity building did receive priority
over direct service delivery. This was a healthy move. The
team had several recommendations. These included
suggestions for improvement regarding management,
organizing study tours, conducting training workshops,
offering incentive remuneration, monitoring and evaluation.
Upgrading and strengthening of the National Resource
Centre were also suggested. Summarizing, the evaluation
team felt that the likelihood of the majority outputs and
objectives being achieved was high. However, in order to
make it sustainable, a suggestion was made to involve more
people, and bring more experts into the fold.
INDIA
In India, the Narcotic Drugs and Psychotropic Substances
(NDPS) Act (1985) provides the current framework for drug
abuse control in the country. It replaced earlier legislations
on the subject. Essentially, the Act deals with supply
reduction activities. However, certain provisions for health
care for drug dependent individuals exist. It authorizes the
Central Government (Government Of India) to take
necessary measures for identification, treatment, aftercare,
rehabilitation of addicts and preventive education. It gives
the Central Government the power to establish, maintain
and regulate treatment centres. The Act permits supply of
“drugs” to registered addicts, and use of these substances
for medicinal and scientific purposes. It would be important
to note that bhang (cannabis leaves only, herbal cannabis)
does not come within the purview of the NDPS Act.
There is no provision for compulsory treatment of addicts
under this Act. However, the personal option of an
individual is recognized. The law provides light penalty
for possession of “small quantity” (defined for various drugs
as per Government’s notification) or for personal
consumption. In such a situation the person may be
directed by the court to undergo treatment in recognized
treatment centres.
The focal points for demand reduction activities are the
Ministry of Health and Family Welfare, and the Ministry of
Welfare. Other ministries involved are Ministry of Human
Resource Development (Department of Youth Affairs,
Education) and Information and Broadcasting. However,
India being a federal state, a large number of responsibilities
lie with the State governments.
INITIATIVES SO FAR
Soon after this Act was passed, the Ministry of Health
and Family Welfare appointed an Expert Committee in
1986 to suggest various activities. In the opinion of the
Committee, the NDPS Act was considered the single most
important social legislation after independence with a far
reaching impact. It has been mentioned earlier (chapter
III) that even before the formation of this Expert
Committee, the Government of India had formed an
earlier Committee in 1977, to initiate various demand
reduction activities. Activities were initiated in some
health institutions. However, due to a lack of resources
no major programmes could be launched.
The Expert Committee (1986) noted that India not only
had a large number of raw opium, cannabis and alcohol
users, but also a sizeable youth who could be inducted
into abuse of other substances including heroin which was
clearly visible. The Committee recommended several
measures:
l Development of a National Centre under the Ministry
of Health and equivalent centres in various States.
l Development of these centres should take precedence
over development of treatment centres (designated
centres).
l Human resource development should receive high
priority.
l Existing general hospitals should be strengthened to
provide treatment.
l Treatment of subjects with drug dependence should
be the responsibility of the health ministry at the
centre and State health departments.
l Several treatment modalities both short term and long
term were suggested. Of particular interest was the
suggestion of a maintenance programme for treatment
of heroin dependece. The Committee provided guide-
lines for such a programme including qualifying crite-
ria for patients. At that point of time raw opium/tinc-
ture opium was suggested for maintenance.
l Monitoring of patients’ profiles from treatment centres
was suggested through the development of a Drug
Abuse Monitoring System (DAMS).
VI : National Drug Demand Reduction Programmes 95
l As regards policy, the Committee suggested drug and
alcohol dependence should have a separate visibility
in the National Health Policy.
l It was also noted that abuse of psychotropics might
increase soon. Thus in due course, prescription
monitoring should be established. Rational use of
psychotropics should be promoted through national/
state level workshops.
l For effective programme implementation, it was noted
that inter-sectoral integration and linkages with other
programmes (viz. Integrated Child Development
Schemes, National Rural Employment Programmes,
etc.) should be promoted. Involvement of the Ministry
of Welfare, and social scientists besides the health
experts, was considered crucial.
An action plan for service augmentation was proposed.
Several measures were initiated following the submission
of this report.
ADMINISTRATIVE MECHANISMS FOR
IMPLEMENTATION
As a follow up to the Act, the Government of India created
the Narcotics Control Bureau (NCB) in March 1986 and
empowered it to coordinate all activities for administration
and enforcement of the Act. For demand reduction activities
NCB was required only to coordinate action taken by the
Ministries of Health and Family Welfare, Welfare and the
concerned departments. As per the assigning of roles, the
responsibility for educational and social welfare aspects
of drug addiction was assigned to the Ministry of Welfare.
Surprisingly in 1986, medical and health care aspects of
drug abuse were not separately earmarked! Inspite of this,
the Ministry of Health and Family Welfare initiated several
measures along with the Ministry of Welfare. It was stated
earlier that in India’s federal system, public health care is
a responsibility of the States. Thus the central health
ministry assumed the role of coordinator and of providing
partial assistance to the programme. Over the years, the
Ministry of Health and Family Welfare became involved
with treatment and the Ministry of Welfare with counselling
and rehabilitation.
Under the NDPS Act, an advisory committee called the
Narcotic Drugs and Psychotropic Substances Consultative
Committee was constituted in February 1988 to formulate
a national policy towards drug abuse control measures.
The Committee (20 members) was broad based and
included members of parliament, professional experts,
social scientists, and secretaries of all concerned central
government ministries. A National Fund for Control of Drug
Abuse was established. Several other measures followed.
96 VI : National Drug Demand Reduction Programmes
The central government constituted a Cabinet Sub-
Committee in April 1988 and in August 1993, another
high level committee with members of parliament, experts
and senior level officers was constituted. Further, in order
to have effective coordination a committee of secretaries
(Narcotics Coordination Committee of Secretaries) was
constituted in March, 1994. The members are the
Secretaries of the Ministries of Health and Family Welfare,
Welfare, Department of Revenue (Finance), Home Affairs
and the Director General (DG), Narcotics Control Bureau.
INDIA: NATIONAL DRUG CONTROL ACTIVITIES
Significant events:
l NDPS Act - 1985
l Creation of NCB - 1986
l Formation of Expert Committee
(Ministry of Health & Family Welfare) - 1986
l Consultative Committee - 1988
l Cabinet Sub-Committee - 1988
l Committee of Secretaries - 1994
INDIA: DEMAND REDUCTION ACTIVITIES
Nodal points of activity:
l Ministry of Welfare
l Ministry of Health and Family Welfare
Others:
l University Grants Commission
l State health departments
l Ministry of Human Resource Development
l NGOs
On the basis of recommendations made by the Expert
Committee (1986) and the Cabinet Sub-Committee (1988),
five centres were established with central government
(Ministry of Health) assistance. In July 1988, specific
programme documents were developed on drug demand
reduction as a collaborative activity between UNFDAC
(now UNDCP) and Government of India. This project,
“Development of Drug Abuse Prevention, Treatment,
Rehabilitation and Control Measures”, for the years 1988-
93 had sub-projects on prevention, treatment and
rehabilitation. Programme A was to be implemented by
the University Grants Commission, programme B by the
Ministry of Health and Family Welfare and programme C
by the Ministry of Welfare and NGOs. A detailed workplan
listing objectives, outputs, activities, budget and
mechanism of implementation was worked out jointly.
There was rapid development of projects followed by a
slow down from 1990 and these were initiated again in
1992. The activities were reviewed by a team (national
and international experts) in February 1994 (discussed
below). In March 1994, a National Master Plan for drug
abuse control in India was submitted.
INDIA: DEMAND REDUCTION ACTIVITIES
Important events
Project on Development of Drug Abuse Prevention,
Treatment, Rehabilitation and Control Measures.
Joint activity between UNFDAC (UNDCP) and
Government of India - 1988 onwards.
A. Drug Abuse Prevention - University Grants Commission
B. Drug Dependence Prevention and Treatment - Ministry
of Health
C. Rehabilitation and Social Integration - Ministry of
Welfare
Detailed Workplan Developed
Ministry of Health and Family Welfare
On the basis of recommendations made by the Expert
Committee in 1986 and the Cabinet Sub-Committee in
1988, five centres were established by the central
government. Further, with assistance from UNFDAC
(UNDCP), two regional centres were also established.
These seven centres carried out several activities:
l Treatment, with special emphasis on community based
treatment
l Development of health educational material
l Training of numerous medical and para-medical staff.
One of the centres served as a National Apex Centre and
was involved in carrying out several activities including
research. In October 1989, the assistance from UNDCP
stopped. An interim workplan for 1990 was implemented,
pending approval of the revised plan of activities
(Government of India and UNDCP). Another national
consultant submitted its report of a work plan in March
1990. Implementation of this report was also postponed.
Meanwhile, between mid- 1992 and March 1994, the
Ministry of Health and Family Welfare (hereafter,
Ministry of Health), with assistance from UNDCP, started
providing construction grants to various State
governments (Depts. of Health) to establish treatment
centres. Some centres did receive token recurring grants
as well. By 1994, 27 centres in various States received
assistance. Thus a total of 34 centres in various settings
(medical colleges, district hospitals and prison hospitals)
were established in various States. Most of these were
functional in 1994, though not fully.
Eighteen of these institutions carried out several training
programmes for health personnel with assistance from
UNDCP. During this period 32 courses were carried out
and about 1000 doctors were trained, based on a formal
curriculum. Central observers were also present during
these training courses. Between 1988 and mid-1994, 34
centres were established.
MINISTRY OF HEALTH, GOVERNMENT OF INDIA
Treatment centres
Establishment of 5 centres - 1988
by central government
Regional Centres (2) - 1988
State Centres (medical colleges,
district hospitals) (27) - by 1994
In August 1994, a Training Master Plan was formulated.
As a part of support services and with UNDCP assistance,
6 treatment centres received laboratory instruments to
detect drugs of abuse in body fluids. Thus clinical service
received additional support to monitor treatment progress.
Additionally, 21 centres received ECG machines and
vehicles to carry out community based activities.
MINISTRY OF HEALTH, GOVERNMENT OF INDIA
Activities
l Treatment
l Community based treatment
l Health educational activity
l Human resource development
Ministry of Welfare
The Ministry had encouraged establishment of counselling
and de-addiction centres by funding several NGOs across
the country. Further, public awareness campaigns, media
publicity and community based action for identification,
treatment and rehabilitation were carried out. For
awareness building, the following activities were
undertaken:
l Audio-visual publicity
l Development of print materials
l Press advertisements
l Out-door publicity
l Distribution of materials
l Publicity through traditional media
Till end-December 1992, 145 counselling centres, 86 de-
addiction centres and 14 aftercare centres were supported
VI : National Drug Demand Reduction Programmes 97
by the Ministry in 32 States and union territories of the
country.
In 1991-92, 3,24,437 persons registered and were helped
through these centres; the numbers dropped slightly in
1992-93 and 1,32,073 addicts were registered. However,
these figures do not suggest the actual number of persons
seeking help as more than one centre reported the same
individual for three kinds of activities, namely counselling,
de-addiction and aftercare.
MINISTRY OF WELFARE, GOVERNMENT OF INDIA
Centres established till December 1992
Counselling Centres - 145
De-addiction Centres - 86
Aftercare Centres - 14
In 1991-92 - 3,24,437
addicts were registered
Monitoring of the programme was carried out on a monthly/
quarterly basis. On the basis of experience gained, steps
were taken to reformulate the plan for subsequent years
(1992-97).
In 1989, the Ministry had sponsored a study covering 33
cities to assess the drug abuse situation in the country. The
report was made available in 1992 and the findings have
been reported in chapter II. However, in the absence of a
central coordinating executive organization, the
capabilities were under utilized.
MINISTRY OF WELFARE, GOVERNMENT OF INDIA
Activities
l Awareness building
l Community based action for identification, treatment
and rehabilitation
l Human resource development in drug abuse prevention
NATIONAL MASTER PLAN (1994)
The team responsible for the development of the National
Master Plan (NMP) reviewed the current (1994) drug abuse
situation, available facilities, existing legal and
administrative arrangements and measures initiated by the
Ministries of Welfare and of Health and Family Welfare.
The team proposed a comprehensive plan, sector-wise, for
the years 1994-2000 for both demand and supply reduction
activities.
98 VI : National Drug Demand Reduction Programmes
The team noted that the proposed 7-year period of the
NMP overlaps with the time period of two national
developmental plans covering the years 1992-97 (8th Plan)
and 1997-2002 (9th Plan). The allocations for health and
social welfare activities for the 8th Five Year Plan were
examined.
The team made several recommendations. These
included developing an appropriate administrative
mechanism for the National Drug Abuse Control
Programme in the Ministry of Health and the creation
of a coordinator for voluntary activities of drug abuse
control in the Ministry of Welfare. It suggested activities
for these ministries.
Ministry of Health:
l establishment of national and State apex centres
l establishment of Drug Abuse Monitoring System
l establishment of treatment centres
l development of several levels of treatment modalities
(brief to intensive)
l establishment of maintenance programme for opiate
dependent subjects
l human resource development
l establishment of laboratory services (drug abuse
screening)
l development of health educational material
l surveillance of supply and use of psychotropics
Ministry of Welfare:
l establishment of national centre for drug abuse
prevention
l development of comprehensive awareness scheme
l preventive education for several population sub-groups
l development of treatment centres in the NGO sector
l providing treatment facilities in prisons
l development of pilot projects on rehabilitation of drug
abusers
l training of personnel in drug abuse prevention
It is obvious that there is some degree of overlap regarding
the proposed roles and activities of the two ministries.
Estimated expenditure, and phasing the mechanism of
monitoring and evaluation were also suggested. Plans for
the health sector contained a State-wise framework,
keeping in mind the role of State health departments and
local problems that are unique to a given State. This plan
is at the draft stage and yet to be formally adopted by the
government. However, it has been examined by the
concerned ministries and departments and several activities
have been strengthened and new initiatives undertaken,
on the basis of this draft version.
The activities on demand reduction have been reviewed
by several committees, both formally and informally. A
formal evaluation in 1994 revealed that :
l Overall, budgetary utilization was low.
l There was slow pace of implementation due to several
factors, namely inadequate monitoring and review, and
frequent change of staff in key ministries.
l The quality and range of services were limited. It was
felt that low cost intervention strategies should have
been tried and the activities should aim to target both
dependent and non-dependent individuals.
l Primary prevention activities needed to be broadened.
At that time it was mostly “warning” young people to
prevent initiation. A shift to promoting a drug free,
healthy lifestyle was suggested.
Recommendations were made to:
l establish a national resource centre
l emphasize the building of technical capacities
l promote research.
Inspite of these views, the evaluation team felt that some
very useful steps had been initiated by 1994. UNDCP’s role
as a catalyst had resulted in the initiation of several measures
by both the central and State governments. As a matter of
fact, it was noted that quite a few activities initiated could
function without the support of any external agency. Hence
these gains were sustainable and the programmes did receive
some priority both in the health and welfare sectors. These
achievements are enumerated below.
INDIA: NATIONAL MASTER PLAN, 1994
l Proposals for both supply and demand reduction
activities, 1994-2002
l Overlapping responsibilities for Ministry of Health
and Ministry of Welfare for demand reduction
ACHIEVEMENTS
Achievements and progress made can be seen from several
documents and the terminal report prepared in October
1996.
Ministry of Health and Family Welfare
(see table 15)
1. An office of the Project Manager for programme
planning, coordination, implementation, review and
monitoring was established in 1993. It was initially
funded by the UNDCP. From 1995 it has been funded
by the Government of India. This cell has 3 dedicated
staff (full-time), the most senior rank equal to that of a
deputy secretary.
2. A course curriculum for:
a) general duty medical officers was developed in October
1988 and several institutions have carried out training
programmes (3 weeks duration each). These are still
continuing with the Government of India’s initiatives. A
manual for doctors has been developed and is in press.
b) nursing personnel was developed in October 1995,
and till date two such programmes (3 weeks duration)
have been carried. One of them was for master trainers.
c) laboratory personnel for detecting drugs of abuse in
body fluids was developed in March 1992. Two such
programmes have been held. A manual for laboratory
technicians has been developed and is in press. A
curriculum for training persons from both health and
welfare ministries was developed in August 1994 as
the Training Master Plan. This plan has been further
examined and suitably modified to build national
technical capacities. Currently, this is being examined
by UNDCP and the ministries for implementation.
3. A total of 72 centres in various States were established
till March 1997. These are at various sites: medical
colleges, district hospitals and civil hospitals. These
offer clinical services and varying degrees of
interventions, acute and long term care with out-patient
follow up. The therapeutic approach consists of
judicious use of short term/long term pharmacotherapy
and psychosocial interventions.
4. Four centres in the country (medical colleges) are
equipped to carry out both qualitative and quantitative
estimation of drugs of abuse in body fluids. They are
fully functional. Another six centres have received
support from UNDCP to start laboratory services,
though these are not yet operational.
5. Several health educational materials have been
developed by individual institutions. These are
booklets, leaflets, pamphlets, and several TV and radio
programmes have been carried out (see Box Item-37
in chapter XI).
An important project in this regard was carried out
jointly by All India Radio, Indian Council of Medical
Research, and De-Addiction Centre, All India Institute
of Medical Sciences. This programme, Radio-DATE
(Drug, Alcohol, and Tobacco Education), had 28
episodes and was aired at prime time. These were
simultaneously broadcast in 16 regional languages and
had registered listeners (14,000) who received printed
material before airing.
6. A suitable data collection system, Drug Abuse
Monitoring System (DAMS) has been developed and
VI : National Drug Demand Reduction Programmes 99
TABLE 15: Ministry of Health and Family Welfare, India
Activities and Achievements
1 Establishment of office of the Project Manager
2 Human Resource Development
a) Training of Medical Doctors: Uniform Curriculum,
Review of Curriculum (1996), Manual - in press (1997)
b) Training of Nurses
c) Training of Laboratory Technicians: Manual - in press (1997)
3 Treatment centres established in various States (upto March, 1997)
4 Laboratory for drug abuse
a) Screening centres
b) Additional, expected to be functional soon
5 Development of Health Educational Materials
6 Establishment of data collection system (DAMS)
7 Several research studies
8 National/regional workshops (upto 1996)
9 District level rapid assessment surveys
10 Community based pilot projects
Source: Terminal Report, 1996; Ministry of Health and Family Welfare, 1997
has been pilot-tested in three cities over three years
(see data provided in chapter II). Efforts are now on to
develop it as a national activity and use the National
Informatics Centre (NIC) of the government, utilizing
its satellite network.
7. A number of research studies have been carried out on
a) epidemiology
b) treatment and outcome
c) biological studies
d) other clinical issues.
These have been funded by national and local research
bodies and are discussed in various chapters (II, VIII,
IX and XV).
8. Several national/regional workshops have been held
to strengthen delivery of service facilities. Special
emphasis was laid on activities needed in N.E. States,
and strategies for harm reduction. These have focussed
on development and review of course curriculum and
training programmes, demand reduction with emphasis
on harm minimization, abuse potential of
buprenorphine, rational use of psychotropics, cannabis
health damage and therapeutic usefulness.
9. New initiatives
a) Over the last two years, as a part of innovative
approaches, community based pilot projects have been
initiated in three districts. Two of the districts are licit
poppy growing areas of the country. These projects
100 VI : National Drug Demand Reduction Programmes
1993
1988
1995
1992
72
4
6
16
6
3
aim at providing comprehensive services at the
community level, involving government medical
institutions/health infrastructure, NGOs, local self-
government bodies (Panchayat, Zila Parishad), office
of the district administration, District Magistrate (DM),
Sub-Divisional Officer (SDO), Block Development
Offices (BDO), Community Development Officer
(CDO) and others, office of the district police
administration (Superintendent of Police), office of the
Deputy Narcotics Commissioner (DNC). In other
words, the project is an integrated approach involving
officials from both demand and supply reduction
activities at the district level. One of the premier
medical institutions and the Ministry of Health act as
agencies for execution, advice and monitoring. The
actual implementation is being done by the district
bodies. Each district has a local coordination committee
to carry out various activities. By and large, the district
committees are headed by District Magistrates. The
various activities being carried out are: survey to assess
the magnitude of the problem; delivery of treatment
and aftercare services; community awareness building;
health education; integration with other parallel
programmes of the government; and integration with
supply reduction activities. The actual activities began
in February 1996. Another unique aspect of the project
is that the action plan/programme activities are
suggested by the local coordination committee and a
top-down approach is not followed. As has been
suggested by local bodies, technical capacity building
 has been given priority. As a result, training of several
categories of persons has been carried out. It is hoped
that the activities will be carried out with Government
of India assistance for 5 years. Subsequently the State
governments or local bodies should be able to fund
the activities; only then is the project sustainable and
viable. Periodic reviews are carried out by field visits
with formal mechanisms, i.e. proforma/schedules to
document change of perception of community leaders,
progress and outcome following treatment. An interim
evaluation report for the period upto July 1997 is
available with the Ministry.
b) Over the last six months, another project is in progress
in three other districts of eastern and north eastern India
with the assistance of WHO. This project has two
components:
l Survey to assess magnitude of the problem.
l Ethnographic observations by interviewing selected
number of drug users (mostly heroin addicts). The
proposed plan of action is to record various factors
responsible for initiation, and maintenance of drug
use, societal perception and cultural factors related
to drug use. Projects to interview some “ex-addicts”
to understand the factors responsible in achieving
drug free status are also planned.
Ministry of Welfare (see table 16)
During the seventh Five Year Plan (1987-92), the Ministry
of Welfare was promoting a community based approach
towards drug abuse prevention. In October 1994, during
the eighth Five Year Plan (1992-97), certain changes were
brought about. The de-addiction and aftercare centres were
amalgamated into de-addiction cum rehabilitation centres,
while counselling centres were converted into drug
awareness, counselling and assistance centres. Industrial
workers and intervention at worksites (see Box Item-29)
were also initiated. NGO forums in each city were
proposed. Under this scheme, financial assistance was
TABLE 16: Ministry of Welfare, India
Activities and Achievements
1 Establishment of Bureau of Drug Abuse Prevention (under NISD)
2 Total number of centres established (till March 1997)
a) Drug Awareness Centres
b) De-addiction cum Rehabilitation Centres
3 Several Radio/TV programmes
4 Anti-Narcotic Pantomime Plays
5 Comprehensive demand reduction activities in one centre (Rajasthan)
6 Training courses carried out (1988-96)
7 Umbrella Equipment Project (no. of Centres)
available to these centres. Additional activities pursued
were de-addiction camps, preventive education and
manpower development.
1. The National Institute of Social Defence (NISD), an
institute directly under the Ministry of Welfare,
established a Bureau of Drug Abuse Prevention. The
Bureau, with its small staff, was responsible for assisting
the Ministry in policy formulation, programme
development and human resource development. A
Training Master Plan (1994) has also been developed.
This has been further modified to enhance national
technical capacity building.
2. By March, 1997, the total number of centres
established were 341. Out of these, 218 were drug
awareness centres and 123 were de-addiction cum
rehabilitation centres. During the year 1996-97 about
0.3 million subjects were registered and about 0.1
million were detoxified. The expenditure from the
government increased to Rs. 110 million (1995-96)
from Rs. 80 million (1992-93).
3. Several radio and TV programmes were carried out. A
number of films were produced and several NGOs
were given grants to undertake preventive education
among specific target populations. These included
radio spots, phone-in-programmes, telefilms (3), docu-
dramas, slogans/messages on railway tickets, postal
stationery, posters and comic books.
4. One of the NGOs carried out several anti-narcotic
pantomime plays using mobile teams.
5. In Rajasthan (western India - traditional opium use area)
one of the NGOs carried out surveys, de-addiction
camps, and awareness building activities. The attempt
was to develop a drug free community.
341
218
123
255
140
VI : National Drug Demand Reduction Programmes 101
6. NISD conducted several training courses of variable
duration (between three days to two months). A total
of 255 courses of the above types were held between
1988 and 1996. Majority (53 per cent) of these were
of one week duration.
7. Under the “Umbrella Equipment Project”, the Ministry
recommended the names of 95 counselling centres
and 45 de-addiction centres for receiving various
medical and other equipment. These items included
X-ray machines, ECGs, VCRs, refrigerators, music
systems, typewriters and laboratory equipment.
However, laboratory equipment were provided only
to six NGOs. Mobile exhibition vans were supplied
to seven NGOs.
Summarizing, from the activities undertaken by the two
Ministries on demand reduction activities, the team
responsible for preparation of the Terminal Report (period:
upto September, 1996) concluded that:
l There has been a significant upgradation in the
capabilities of the concerned departments.
l The achievements were visible and assistance from and
involvement of UNDCP acted as a vital catalytic factor.
Drug abuse control including demand reduction
activities did receive higher priority and created greater
awareness in the government.
l A number of institutions had come into existence both
in the government and NGO sectors. These centres
are functional in different regions of the country.
l Human resource development (training of several
categories of staff) took place through established
infrastructure of high quality. There is now a vast
pool of trained manpower to undertake various
activities.
l The policy and programmes for future development
were clearly formulated and clearly stated in the draft
National Master Plan.
l The Ministries (Health and Welfare) had developed
their own programmes with budgetary allocations from
internal resources. Thus external assistance
supplemented these endeavours.
Several shortfalls in outputs were also noticed:
l The activities under the project “Prevention of Drug
Abuse through Education” were not carried out, though
both ministries, of health and welfare, carried out
several community based preventive and health
education activities for the general population.
102 VI : National Drug Demand Reduction Programmes
l The funds for activities on “Drug Dependence
Prevention and Treatment” in the health sector were
generally underutilized and only 13 per cent of the
total budget (UNDCP) was used. However, the most
healthy sign was that the Ministry of Health spent
approximately Rs. 125 million from 1992 onwards
even though the proposed allocation was Rs. 48 million.
It was stated earlier that most of the activities related to
delivery of health care come under the preview of State
health departments; thus the role of the central health
ministry is restricted to policy formulation, acting as a
facilitator and providing suggestions, guidance and
assistance, mostly non-recurring. There were other
competing national programmes and most often
communicable disease received priority. Inspite of this,
resources were generated internally. However, the
treatment centres in the States had an acute shortage of
staff, paucity of funds and the activities did not receive
adequate priority in State health departments.
l About, 64 per cent of the funds (UNDCP) allocated for
the project “Rehabilitation and Social Integration” were
utilized. Here too, the Ministry of Welfare spent
approximately Rs. 424 million between 1992-96, as
against the proposed Rs. 67.5 million.
l Postponement of funding led to delays and non-
utilization.
l Though other activities for demand reduction did
receive some priority, it was still not optimal. Thus
sustained and high profile activities were not visible.
TERMINAL REPORT: UNDCP FUNDED
PROJECTS, INDIA (1996)
Demand Reduction Activities
Shortfalls:
l Project on prevention through education not carried
out
l Prevention activities carried out as part of other
activities
l Overlapping functions in the two ministries
l Underutilization of funds (UNDCP)
l Low level of priority by central/State governments
NEPAL
It was stated in chapter II that currently major drugs of abuse
in the country are heroin, cannabis and psychotropic
substances. Since the emergence of escalating heroin use
in the late 1970s, Nepal has initiated several important steps
to control and prevent drug abuse. The Narcotic Drugs
Control Act was framed in 1976 and amended in 1981 and
1987. The Act is comprehensive and covers both supply
and demand reduction activities, aiming towards overall
health and economic well being of the people.
The Ministry of Home Affairs is the focal agency for all
activities related to drug abuse control. The National Co-
ordination Committee for Drug Abuse is the highest body
in the country and is chaired by the Hon’ble Minister for
Home Affairs. This Committee is responsible for formulating
national policy. An executive committee under the above
Committee is entrusted with the responsibility of execution
of the approved policy. The Chief Narcotic Drug Control
Officer is the head of this executive committee.
NEPAL: NARCOTIC DRUGS CONTRO L ACT,
1976 (Amended 1981,1986)
Focal Agency - Ministry of Home Affairs
National Coordination Committee
Chief Narcotic Drug Control Officer
National Master Plan for Drug Abuse Control, 1992
With regard to demand reduction activities, the plan,
programmes and strategies are outlined in these documents:
l National Master Plan for Drug Abuse Control - 1992
l Sector Plan for Treatment, Rehabilitation and other
Demand Reduction Activities - 1992
l National Drug Control Policy - 1995
l National Drug Demand Strategy - 1996-99.
NEPAL: DEMAND REDUCTION A CTIVITIES
Sector Plan for Treatment, Rehabilitation and Preventive
Education - 1992
National Master Plan, approved and implemented - 1995
Drug Abuse Demand Reduction Project
Project Steering Committee
Most demand reduction activities carried out by NGOs
The National Master Plan was jointly developed by the
HMG/N (His Majesty’s Government, Nepal) and UNDCP
in 1992 and has been approved and implemented since
January, 1995. Following this, Drug Abuse Demand
Reduction Project (DADRP) was launched and now has
an office at the Teaching Hospital, Tribhuvan University.
The National Master Plan proposed that all demand
reduction would be implemented by the Ministry of Home
Affairs in cooperation with the Ministry of Education, and
NGOs involved in providing treatment. A Project Steering
Committee was to implement the various proposed
activities under the overall supervision of the National
Executive Committee. The Master Plan addressed the
following issues :
l Objectives - developmental, immediate
l Expected end-of-project situation
l Target beneficiaries
l Project strategies and implementation arrangements
l Outputs
l Budgetary requirements
Various activities for treatment and rehabilitation,
preventive education and information were outlined. The
need for consultants for the above two broad activities was
proposed.
POLICY CHANGES (see table 17)
Initially, subjects with drug dependence were treated in
police custody with short term interim measures. The
National Drug Demand Strategy (1996-99) proposed to
abolish these custodial services and replace them with
treatment facilities within the existing health care delivery
system. However, because of paucity of resources and
infrastructure, the government delegated most of the
responsibilities related to demand reduction activities to
the NGOs. These include detoxification, rehabilitation and
aftercare service, though the NGOs did not receive much
moral or financial support from the government.
NGO Response
A number of NGOs are providing detoxification and other
treatment services. Till date, 5 NGOs are providing
treatment though there are 81 registered NGOs, and most
are not active. Between these 5 NGOs, 102 beds are
available. Additionally, 12 beds are available in one
treatment centre in the Teaching Mental Hospital
(government centre). Many of these centres have developed
programmes complementary to each other and carry out
low cost intervention strategy.
Of special interest would be treatment facilities for methadone
maintenance and needle exchange programmes. These
are discussed in the chapter on treatment (chapter VIII).
Preventive Education and Information
The National Master Plan recommended that it was
necessary to formulate a coherent policy towards
preventive education. The Ministry of Education was
expected to develop curriculum for schools, and audio-
visual aids as preventive packages. Training programmes
VI : National Drug Demand Reduction Programmes 103
TABLE 17: National Drug Demand Strategy (1996 - 99), Nepal
Objectives

Preventive Education Treatment and Rehabilitation

Funding for NGOs (DAPAN)

School based programmes Cost-effective treatment
Programmes for non-student youth Treatment in prison and other settings
Prevention at worksite Mandatory treatment
Human resource development Drug substitution programmes
Research Harm reduction strategies
Human resource development
Research
Source: National Drug Demand Strategy, HMG/N and UNDCP, 1996

for parents, teachers, community leaders, police officials
and other key functionaries were proposed.
Several TV spots (Nepal TV), jingles (Radio Nepal) and
telefilms have been developed. Various social groups and
the Nepal Medical Association have participated in these
activities. School based programmes, and training of
community leaders have also been carried out.
Resource Scarcity
Nepal is faced with a number of severe constraints
regarding its social and economic development. Despite a
series of concerted efforts, very little impact has been made
in terms of raising the living standards of a great majority
of people. Thus government resources for demand
reduction activities are scarce. It will therefore be necessary
to obtain support from the private sector and increase
external assistance for control of drug abuse.
ACHIEVEMENTS (see table 18)
The National Master Plan led to the development of the
National Drug Demand Reduction Strategy for the years
1996-99. This strategy document was developed by a group
of experts representing people working on drug abuse
prevention, health care professionals, teachers, trainers,
media persons, youth and drug dependent persons in
October/November 1995. Objectives, activities, time
frames and earmarking of responsibilities were proposed.
Separating the two major demand reduction activities; a)
preventive education, and information, and b) treatment
and rehabilitation was proposed (table 17). Under the sub-
project on preventive education, provision of school based
programmes and those for non-student youth, prevention
and intervention at work site, human resource development
and regular research activities were proposed. Under the
sub-project on treatment, cost-effective treatment and
rehabilitation services in various settings including prisons
were proposed. Additionally, mandatory treatment, drug
substitution programmes and other harm reduction
measures, human resource development and ongoing
research were also proposed.
Both formal and informal evaluations were carried out at
various stages. An evaluation carried out in 1996 revealed
that several treatment centres were operational. These
included a therapeutic community in a jail, a community
recovery centre, drop-in centre and a detoxification centre
at the Tribhuvan University Teaching Hospital, a zonal
hospital. NGOs (Drug Abuse Prevention Association Nepal
- DAPAN) had received financial assistance from the
government. A number of surveys (RAS, study of women
drug abusers) were carried out and enhanced the knowledge
of the current drug abuse situation. A project involving low
cost technology for treatment and rehabilitation has been
carried out and was found to be successful. Various activities
in this project were women’s literacy classes, workshops,
vocational training and production of telefilms.
As regards preventive education, a National Drug Control
Policy has been approved by the Cabinet and this would
provide the framework for drug control policy in the
country’s 9th National Plan (1997-2002). A wide range of
educational materials for both formal and non-formal
systems of education have been developed. Several training
programmes (1-5 day) for teachers, trainers, and voluntary
workers have been carried out.
Additionally, the climate and quality of relationships
between various administrative offices has been very
cordial. It was further seen that most of the achievements
took place between mid-1995 and end-1996; the progress
before this period was slow. Overall, the project made a
significant contribution. However, in order for it to be
sustainable UNDCP’s presence and continued assistance
was thought to be very crucial.

104 VI : National Drug Demand Reduction Programmes

TABLE 18: National Demand Reduction Activities, Nepal
Achievements
Preventive Education
Development of National Drug Control Policy
Policy paper on preventive education
Development of educational materials
(formal and non-formal education)
Development of curricula
Several training programmes conducted
SHORT FALLS
During evaluations some cause for concern was noted.
Even though an office of the Programme Coordinator
(DADRP) of the project has been created, staffing level is
low. Thus effective coordination was lacking. Monitoring,
support and clarity of roles between HMG/N and NGOs
and HMG/N and UNDCP needed improvement. The
Project Office needed upgradation, including basic
hardware. The evaluation team suggested several measures
for effective functioning. These included:
l Continued support from UNDCP
l A new sector plan for demand reduction was required,
as the current project was likely to be completed before
the scheduled time and activities should be expanded.
l The Social Welfare Council, and health and education
ministries need to be more involved.
l Resources for training and infrastructure development
should be extended by the government.
l NGOs required more support.
l The curriculum developed should be incorporated into
textbooks at the earliest.
Nepal in a span of two years (1995 and 1996) has made
significant progress towards demand reduction. Several
projects have been launched and are ongoing both on
treatment and rehabilitation, and preventive education.
The adoption of a work plan clearly indicates the
commitment of the government to address drug problems.
As a matter of fact, as per the plan, demand reduction
activities may be completed ahead of time and a new
sector plan is needed. However, without the support of
external agencies, notably UNDCP, these initiatives are
still not sustainable. Increased involvement of the HMG/
N and higher resource allocation would be needed for
Treatment and Rehabilitation
Establishment of treatment centres
Therapeutic Community
Drop-in centre; methadone maintenance
Needle exchange programme
Detoxification centre
Low cost intervention strategy
Development of support systems for NGOs
effective implementation and to achieve the targeted
objectives of the National Drug Control Policy and the
National Drug Demand Strategy.
SRI LANKA
The Government of Sri Lanka became concerned about
growing drug problems as early as the 1970s. For effective
control, a National Narcotics Advisory Board was
established in 1973, to advise on various drug control
measures. In the early 1980s, the problem of drug abuse
grew and the government initiated the process of
formulating a comprehensive national policy to control
drug abuse. As a result, in April 1984, the Parliament
enacted the National Dangerous Drugs Control Board Act
and created the National Dangerous Drugs Control Board
(NDDCB) under the Ministry of Defence. Since then, the
NDDCB has been the focal point of all activities related to
drug abuse control. The Board is a multi-member body
and has representation from the departments of education,
health, police, customs, as well as government analysts
and experts on the ayurvedic system of medicine.
SRI LANKA: NATIONAL DRUG ABUSE
CONTROL PROGRAMME
Important events
National Dangerous Drugs
Control Board Act - 1984
National Dangerous Drugs
Control Board (NDDCB),
Ministry of Defence - April, 1984
National Policy formulated - 1990
NDDCB the focal point of all activities
A National Policy was formulated by the NDDCB, and its
other activities included enforcement, preventive
VI : National Drug Demand Reduction Programmes 105
education, public awareness, treatment and rehabilitation,
aftercare, research, training, drug abuse testing and
international and regional cooperation. The above activities
are carried out by various divisions of the Board. As regards
demand reduction, preventive education and treatment are
the identified activities. In 1985, the Board set up various
sub-committees for assistance. The role of NGOs was
appreciated very early on and was encouraged for
involvement in demand reduction activities. As a result,
in January 1986, the Federation of Non-Government
Organizations Against Drug Abuse (FONGOADA) was
born. The Federation, an umbrella organization, is a legal
body, and is mandated to contribute to the following:
1. Establishment and development of a working
relationship with GOs and NGOs.
2. Collection, collation and dissemination of information
on drug abuse, treatment and prevention modalities.
3. Coordinate activities of NGOs, national and
international organizations.
4. Suggest policies and strategies to achieve a drug free
nation.
5. Assist in the development of effective treatment and
prevention strategies.
6. Raise funds to carry out various activities.
FONGOADA has eight full-time agencies as its members
for anti-drug activity and another 14 service centres. The
Federation has grown over the years and has a very fruitful
partnership with NDDCB.
SRI LANKA: DEMAND REDUCTION ACTIVITIES
FONGOADA - established January, 1986
l Umbrella organization of NGOs
l Legal body
l Preventive education and awareness
l Involvement of other government bodies
FONGOADA is a member of the International Federation
of NGOs against Drug Abuse (IFNGO) and brings together
both GOs and NGOs to participate in demand reduction
activities. However, there are a few non-FONDOADA
organizations who also carry out demand reduction
activities.
In the government sector, the ministries of health, labour
and vocational training, social services, education and
106 VI : National Drug Demand Reduction Programmes
cultural affairs and information are involved in a major
effort to carry out various activities.
PREVENTIVE EDUCATION AND PUBLIC AWARENESS
For these activities, NDDCB, ministries of education,
cultural affairs and information, labour, social welfare,
public administration, youth affairs and sports, and NGOs
are the implementing agencies. The strategies involve
education through mass media, prevention through formal
educational institutions, work place prevention, vocational
skill training and promotion of leisure time activities.
TREATMENT, REHABILITATION AND AFTERCARE
The team involved in the preparation of the National Master
Plan (NMP) noted that till the late 1980s, treatment
modalities were highly medically oriented, beds available
were limited, no serious effort was made towards
rehabilitation, and services in the NGO sector were not
organized. During the early 1990s NGOs began a highly
systematic programme consisting of counselling, treatment
and rehabilitation. The camp approach was quite popular.
In 1993, there were five NGOs offering treatment/
rehabilitation at 120 sites. NDDCB was directly involved
in offering services through four centres. Additionally, the
prison department was involved in providing care to drug
dependent individuals through an “open-prison”
programme.
NATIONAL MASTER PLAN , SRI L ANKA
The Sri Lanka National Master Plan (1993) is an effort to
develop an action plan to implement the already
formulated National Policy for the prevention and control
of drug abuse. The Master Plan proposed implementation
in four phases. Phase 1 would consist of linking problems
and needs, phase 2 would secure broad political
commitment, phase 3 would strengthen administrative
machinery, and phase 4 would carry out selected (demand
reduction) activities. A policy and plan for control of
tobacco and alcohol consumption in addition to illicit
drugs were also stated. For all programmes including
demand reduction, specific objectives, activities,
implementation, resource requirements, monitoring and
evaluation were proposed. FONGOADA and other NGOs
have been identified primarily for preventive education,
and NDDCB, GOs and NGOs are responsible for
treatment and rehabilitation.
Various activities and strategies proposed for prevention
are educational programmes using mass media to impart
relevant knowledge, foster a positive attitude and improve
coping skills, particularly directed towards youth. It was
proposed that preventive education should be attempted
through both formal and non-formal education systems.

SRI LANKA: PREVENTIVE EDUCATION
Suggested Activities, NMP (1993)
Educational programmes through mass media
Improve coping skills
Promotion of leisure time activities
Formal and non-formal education
Target group: youth, work force
For treatment and rehabilitation, it was proposed that
detoxification and other modalities of treatment should be
integrated with rehabilitation and aftercare. These should
be supported by counselling and other psychosocial
interventions. Specific objectives, activities, implementation
and a monitoring mechanism were suggested. NDDCB, GO
and NGO treatment centres would be responsible for
carrying out these activities. NDDCB has already initiated
treatment and rehabilitation centres in three major cities
in Sri Lanka. It was proposed that a comprehensive
treatment programme should be developed and
implemented by the health sector. Community support and
mobilization would be essential for follow-up and
rehabilitation. Till date, four government treatment centres
with a total capacity of 143 beds and seven counselling /
rehabilitation centres with 30 beds have been established.
These are centres dedicated for de-addiction. Further, there
are three training institutions for training on various demand
reduction activities.
SRI LANKA: TREATMENT AND REHABILITATION
Suggested Activities, NMP (1993)
Strengthen NDDCB
Collate information
Promote awareness
Establish criteria for funding NGOs
Establish national training centre
Specific projects, mechanisms for strengthening awareness
requirements, were also proposed. Special emphasis was
placed on delivery of care through non-medical persons,
training of health care staff, establishing a drug abuse
monitoring system and sensitization of key employees as
regards vocational rehabilitation of recovering addicts.
BHUTAN AND MALDIVES
It has been stated earlier that as of now Bhutan and
Maldives are the least affected countries in the sub-region.
Cannabis products are the only drugs which have been
reported most often. Both these countries are party to the
SAARC Drug Control Convention and have participated
in previously held workshops on drug abuse control in
1995 and 1996. In a recent workshop on relapse prevention
(SAARC meeting, New Delhi, September, 1997) the country
report from Maldives showed that the Ministry of Health
has proposed a comprehensive plan for counselling,
treatment, education of general population and a school
based preventive education programme. Government
hospitals have been recommended for treatment, and the
responsibility of preventive education falls on NGOs. A
single NGO is currently active. In the coming year it is
proposed to expand these as community based activities.
Further details on treatment and delivery of care in Maldives
are discussed in chapter VIII.
REGIONAL DEVELOPMENT AND
COOPERATION
It is evident from the review of national drug demand
reduction programmes that even in the absence of precise
information on the extent of the problem, most countries in
this region have initiated several steps to control drug abuse.
Significant advances have been made, and quite a few things
have been achieved. Master Plans have been formulated by
Bangladesh, India, Nepal and Sri Lanka and have been
adopted by their governments. India, however, is yet to
formally adopt it own plan, though several measures have
been initiated on the basis of the draft. National Master Plans
provide the basic framework to develop strategies and
programmes. In Nepal and Sri Lanka, national policies on
drug abuse control have also been drawn up. Following
this, strategy plans have been formulated (in Bangladesh,
Nepal). Development and implementation of the National
Master Plans and strategy plans have required a high level
of involvement and resources from UNDCP. National
governments have also mobilized varied internal resources.
However, in most countries, enhancement of literacy, general
welfare programmes, control of infectious diseases, maternal
and child health care, family welfare (population control)
programmes receive higher priority, and understandably so.
Therefore, drug abuse programmes have received low
priority; this is particularly evident in comparison with the
health sector programmes.
In relation to drug abuse control programmes, supply
reduction activities have received higher resource
allocation, though in recent times the importance of
demand reduction measures have been realized. However,
these two activities are often seen as separate and distinct.
Only recently have some steps been initiated (viz. in India)
to integrate the two. It has been observed that with harsh
VI : National Drug Demand Reduction Programmes 107
penal measures for illicit compounds, people have started
abusing pharmaceutical preparations. Thus, abuse of a
whole range of new products has emerged. These
compounds have medicinal value and cannot be banned.
With strict control, genuine patients have often suffered;
this was observed in the case of phenobarbitone in India.
With stricter enforcement a few years back, availability
became scarce and patients with epilepsy suffered the most
as it was their prescription drug (cheap and effective).
In the sphere of demand reduction, it is seen that preventive
education, and treatment and rehabilitation run parallel,
with different agencies responsible for implementation. It
is encouraging to see that preventive education is currently
receiving greater attention. Most countries have felt that a
hospital based “cure”oriented approach has led to the
development of services for urban populations, resulting
in the neglect of preventive and promotive aspects of care,
including health care. Involvement of community based
organizations and voluntary workers is very necessary for
carrying out effective preventive strategies. The role of
NGOs has been realized; most are encouraged and many
are very active regionally and have formed associations in
their respective countries. Sri Lanka has achieved the most
towards organizing and motivating the NGOs, and bringing
them together. In Nepal, most of the demand reduction
activities are carried out by NGOs. However, the
relationship between GOs and NGOs is yet to be
streamlined in these countries. In some countries NGOs
receive substantial support (e.g. India). These are then
extensions of government centres, as regards their financial
support. Very few have mobilized resources on their own.
In some countries, the support, both moral and financial,
is minimal (viz. Nepal). Efforts by NGOs are discussed in
chapter X and Box Items 30-35.
Many of these countries already have a vast network of
public health bodies for treatment through government
centres. The national programmes have attempted to
integrate drug demand reduction activities with them by
creating treatment facilities. A few dedicated centres have
also been established.
In all four countries (Bangladesh, India, Nepal and Sri
Lanka), a nodal agency for overall drug abuse control has
been created. These are alligned with the Ministry of Home/
Defence/Finance. Some have created nodal agencies or
national resource centres for demand reduction activities
as well.
The Master Plans reflect the sensibility that control of drug
abuse would have to be seen in the context of overall
human development which includes measures like
improved literacy, poverty alleviation, economic
108 VI : National Drug Demand Reduction Programmes
development, availability of safe drinking water, good
sanitation and better quality of life. Drug addicts are often
people of lower socio-economic status. Poverty,
unemployment, poor educational achievements and lack
of gainful employment are critical factors for initiation and
continuation of drug abuse. Thus measures should be
initiated to address these issues. Demand reduction
activities in isolation are unlikely to show results. Finally,
it is not out of place to reiterate that without the requisite
political will, drug abuse control activities will not receive
higher priority. Such political commitment would naturally
lead to policy formulation.
In this region, religion, culture and strong family ties are
assets in drug abuse control. There are several protective
factors against drug use. These need to be identified and
strengthened to prevent drug use. For far too long we have
asked the question “Why do people take drugs”, and have
continued with the “scare technique”. We also need to
ask why many people do not take drugs. There is enough
research data to suggest that education alone or the above
approach of instilling fear does not help. We need to
formulate newer programmes for drug abuse prevention
by promoting healthy lifestyles, alternate motivating factors
and strengthening traditional, cultural, and family values.
Regional and sub-regional cooperation is based on the
recognition that certain problems related to drug abuse can
be addressed in a collaborative way by countries who have
common borders, particular vulnerabilities or shared cultural
ties. Thus specific responses may not be identical to global
ones. Such a move has already been made. Together with
UNDCP, a sub-regional drug control cooperation
programme for Central Asia (1996-99) has been signed.
MOUs have been signed in other regions as well (UNDCP,
1997). In this region all these countries are also members of
SAARC and have adopted the SAARC Convention on
Narcotic Drugs and Psychotropic Substances. These ties have
further been strengthened by the joint endeavours of SAARC
and UNDCP in May, 1995. These two organizations can
jointly help in formulating a regional action plan. In this
regard, institutional strengthening and human resource
development should receive the highest priority. Applied
research along with information sharing between identified
institutions would lead to the refinement of policy
formulations and improved strategies for drug demand
reduction. These are further elaborated in Box Item-16.
RESOURCE DOCUMENTS
BANGLADESH
1. National Master Plan, Vol. 1 (1991).
2. National Drug Demand Reduction Strategy (1995).
3. Five Year Strategic Plan (1995).
4. ‘Mid-term evaluation of UNDCP-Bangladesh Drug
Demand Reduction Programme’ (1997).
INDIA
5. Ministry of Health and Family Welfare, Govt. of India
(1983): National Health Policy.
6. Ministry of Health and Family Welfare, Govt. of India
(1986): ‘Expert Committee—Report on Drug
Dependence Services’.
7. National Master Plan for Drug Abuse Control (1994).
8. ‘Mid-term evaluation of UNDCP-India Country Project
on Development of Drug Abuse Prevention, Treatment,
Rehabilitation and Control Measures’ (1994).
9. Ministry of Health and Family Welfare, Govt. of India
(1995): Drug Abuse - Consequence and Responses.
India Country Report.
10. Ministry of Welfare, Govt. of India (1995): Drug Abuse
- Consequences and Responses. India Country Report.
11. ‘Terminal Report on UNDCP Funded Projects’ (1996).
12. Ministry of Welfare, Govt. of India (1997): ‘Country
Profile—India’.
13. Ministry of Health and Family Welfare, Govt. of India
(1997): ‘Drug Abuse in India’.
NEPAL
14. National Master Plan, Vol.1 (1992).
15. Sector Plan, Demand Reduction, 1993-95.
16. National Drug Control Policy, (1995).
17. ‘Evaluation—National Master Plan’ (1996).
18. National Drug Demand Strategy, 1996-99.
19. ‘Country Report’. SAARC Workshop on Relapse
Prevention, 1997, New Delhi, India.
SRI L ANKA
20. National Dangerous Drugs Control Board (NDDCB)
(1991): Hand Book of Drug Abuse Information
1981-89.
21. National Master Plan (1993).
22. NDDCB (1996): Handbook of Drug Abuse Information,
1991-95.
23. NDDCB : ‘Sri Lanka National Policy for the Prevention
and Control of Drug Abuse’.
OTHERS
24. WHO, ‘Programme on Substance Abuse—Action to
Reduce Substance Abuse’, 1991,1992,1993.
25. UNDCP-ROSA: Annual Field Report, 1996.
26. UNDCP-ROSA: Annual Field Report, 1997.
27. UNDCP (1997): World Drug Report. Oxford University
Press, New York.
VI : National Drug Demand Reduction Programmes 109
BOX ITEM - 16
ROLE OF INTERNATIONAL ORGANIZATIONS IN SOUTH ASIA
Ravi Raj Thapa
DRUG ADVISORY PROGRAMME OF THE
COLOMBO P LAN
The member governments of the Colombo Plan noted that
drug abuse was posing a serious problem to the Asian
region, at the Colombo Plan’s 22nd Consultative
Committee Meeting held in New Delhi in 1972. It was
agreed to appoint a Drug Advisor to the Colombo Plan
Bureau who would consult with governments, assist in the
organization of seminars, workshops and similar activities,
and help develop cooperative programmes designed to
eliminate the causes and ameliorate the effects of drug
abuse. The United States government offered to meet the
expenses of this Advisor. The Drug Advisor assumed duties
in August 1973 and the programme of activities began.
While the United Nations and other international
organizations were working on a global scale, the Drug
Advisory Programme (DAP) of the Colombo Plan took on
a pioneering role directed towards the promotion of
effective national, regional and sub-regional efforts in
tackling local and international problems and identifying
areas in which bilateral and multilateral assistance and
cooperation would be required in the Asia-Pacific region.
To this end, the DAP established liaison (consultation and
coordination) with drug abuse/narcotics coordinating
bodies, prevention and control agencies of member
governments, and regional and international organizations.
Working arrangements and regular liaison/consultation was
established with the UN Commission on Narcotic Drugs
(UNCND), UN Division of Narcotic Drugs (UNDND), UN
Fund for Drug Abuse Control (UNFDAC), UN Sub-
Commission for Illicit Drug Traffic in the Near and Middle
East, International Narcotics Control Board (INCB), WHO,
ILO, FAO, UNESCO and other agencies.
Since it began, the DAP has organized, conducted,
sponsored, co-sponsored or supported 92 activities. These
include conferences, seminars, workshops, training
programmes and development of training manuals. In
addition, the organization has awarded study/training
fellowships, with the aim of enhancing skilled manpower
and developing human resources in the field of drug abuse
prevention and control of trafficking in narcotic drugs and
psychotropic substances (figure 8). More than 3200 officials
from member countries have been able to participate in
110 VI : National Drug Demand Reduction Programmes
these programmes and gain knowledge, skills and expertise.
The scope of activities covered under the two major areas,
i.e. demand reduction and supply reduction are shown in
table 19.
SOUTH A SIAN ASSOCIATION FOR R EGIONAL
COOPERATION (SAARC)
In pursuance of a decision taken by the heads of state of
SAARC member countries during their summit meeting
held in Dhaka in December 1985, a Study Group meeting
was held to examine the problem of drug trafficking and
abuse as it affects the region and to submit recommenda-
tions as to how best the member states could cooperate
among themselves to solve the problem. The meeting
agreed that cooperation between member states would be
essential for effective prevention, control and eventual
elimination of drug and illicit trafficking in South Asia.
NETWORKING OF BILATERAL/MULTILATERAL
AGENCIES
The Colombo Plan’s proposal to establish working relations
with the SAARC Secretariat (DAP Project 94-1; SAARC
Forum on the Role of NGOs in Drug Demand Reduction)
was approved by the SAARC’s Standing Committee at its
twentieth session (New Delhi, April, 1995) and by the
Council of Ministers at its fifteenth session (New Delhi,
May, 1995).
In recent years, the DAP has started organizing joint projects
and collaborating with the United Nations International
Drug Control Programme (UNDCP). DAP organized a
series of legal workshops jointly with UNDCP Vienna and
the Commonwealth Secretariat with the aim of assisting
the signatory countries in the region to implement the UN
Conventions. As an area of immediate concern, a workshop
on precursor regulation and control was held in Colombo
in August, 1997 for participants from the South Asian
countries, jointly organized by UNDCP-ROSA and DAP.
In early 1996, in conjunction with the French Government,
the DAP organized a training programme for the law
enforcement officers of Southeast Asian member countries.
The Australian Federal Police provided the expertise for a
Training of Trainers Course on Drug Intelligence Collection,
Analysis and Dissemination, organized by the DAP. This
TABLE 19: Scope of DAP’s Activities
DEMAND REDUCTION
I. Primary Prevention
Training and exposure via
a. Education/Awareness Programmes
b. Media Campaigns
c. Mobilization of NGOs against Drug Abuse
d. Women Counsellors
II. Secondary Prevention
1. Forums and Meetings of Policy Makers
2. Development of Training Guides & Manuals
3. Training and support through/to:
a. Treatment and Rehabilitation (T&R)
b. Trainers/Counsellors
c. National GO/NGO Projects
d. Management of T&R in Prisons/Correctional
Settings
e. T&R of Juveniles/Minors
f. Mobile Camps
III. Tertiary Prevention
1. Support to Follow-up & Aftercare Programmes
2. Training and Support in:
a. Relapse Prevention
b. Family Counselling
c. Re-entry & Aftercare
d. Formation of Ex-addict Support Groups
IV. Fellowships/Study Tours
training was done in two phases: the 1st phase for South Asia
in April, 1995, and the 2nd phase for Southeast Asian countries
in November, 1997. Even though a non-member country,
Brunei was given an opportunity for representatives to
undergo training free of charge during this project. This training
was found very useful by recipient countries. The European
Union (EU), with the funding assistance and cooperation of
DAP, conducted the Forum Consultation Meeting in Colombo
in November, 1996 for NGO participants in the South Asia
region, supported by the EU. Daytop International Inc., USA,
conducted several training programmes organized by DAP
in the area of treatment and rehabilitation, introducing the
therapeutic community approach.
As the countries of the South Asian region are covered by
the UNDCP Regional Office for South Asia in New Delhi,
SUPPLY REDUCTION
I. Organization and Conduct of International Conferences/
Seminars/Workshops/Training Programmes
1. Sponsorship of Participants
2. Conducting Training Programmes for:
a. Intelligence Collection, Analysis & Dissemination
by Experts of Australian Federal Police
b. Policy Development in the Administration &
Management of Juveniles/Minors
c. Law Enforcement Officers
II. Legal Workshops Organized Jointly with UNDCP &
Commonwealth Secretariat to Assist Countries Implement
the UN Conventions
III. Substance-specific Workshops and Trainings
Control & Regulation of
a. Amphetamines
b. Precursors
IV. Development of Manuals on Training of Trainers
V. Collaborative Efforts with Regional & International Law
Enforcement Agencies such as Interpol, World Customs & DEA
VI. Fellowships/Study Tours
and these countries are also members of both SAARC and
the Colombo Plan, coordination, networking and
collaboration between these regional/international bodies
would be highly beneficial to the member countries; will
enable the identification of specific needs; help develop
joint efforts for better and effective programmes; and
prevent wastage of resources.
In developing projects suited to the South Asian region,
DAP used to organize programmes on a sub-regional basis,
taking into consideration cultural, linguistic and
geographical constraints. However, since 1997, DAP has
introduced ‘in-country’ training programmes in secondary
and tertiary prevention areas, especially in treatment and
rehabilitation of drug addicts in correctional settings, and
facilitating the formation of ex-addict support group
VI : National Drug Demand Reduction Programmes 111
networks. The advantages of conducting training
programmes on an in-country basis are that (a) participants
from all relevant agencies within the country can be trained,
(b) they facilitate networking among the national agencies
and encourage them for closer contact and cooperation,
(c) by utilization of local resource persons and translators
along with outside expertise, they help participants
understand the contents better, (d) they encourage the host
country to play a role by being a co-sponsor and meeting
some of the local costs, (e) save on costly air fares, and (e)
effectively manage scarce financial resources. This
approach also helps to plan better and effective follow-up.
Drawn from a needs assessment of member countries
carried out by DAP in 1996, figure 8 shows the training
priorities of member countries with regard to Demand
FIGURE 8: Training Priorities of Member Countries, Colombo Plan
DR - Demand Reduction
SR - Supply Reduction
112 VI : National Drug Demand Reduction Programmes
Reduction (DR) and Supply Reduction (SR). This may give
some ideas in planning future programmes and joint
approaches for the South Asian region.
As the UNDCP can now specialize in designing and
organizing specific programmes in the supply reduction
area, such as regulation and control of precursors and
amphetamines in this region, the DAP is focussing its
attention on treatment and rehabilitation, follow-up,
aftercare and relapse prevention areas, and is in the process
of implementing projects in South Asian countries.
A joint approach and cooperation between the bilateral/
multilateral agencies and international bodies in the South
Asian region will have a greater impact, with enhanced
benefits for the recipient countries.