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Proposal to the Indian Psychiatric Society for adopting a specialty

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Indian Journal of
Psychiatry OFFICIAL PUBLICATION OF THE INDIAN PSYCHIATRIC SOCIETY Volume 49, No. 4, October-December 2007

CONTENTS

EDITOR SPEAKS
They also serve who stand and wait.…: G. Swaminath 227

EDITORIAL
You can lead a horse to the water: G. Swaminath 228

GUEST EDITORIAL
Criminal behavior: A dispassionate look at parental disciplinary practices: T. S. Sathyanarayana Rao 231

AWARD PAPERS
Acute and transient psychosis: A paradigmatic approach: Savita Malhotra 233
Schizophrenia is a disorder of aberrant neurodevelopment: A synthesis of evidence from clinical and structural,
functional and neurochemical brain imaging studies: Ganesan Venkatasubramanian 244

ORIGINAL ARTICLES
A 5-year course of predominantly obsessive vs. mixed subtypes of obsessivecompulsive
disorder: S. B. Math, Jaideep Thoduguli, Y. C. Janardhan Reddy, P. N. Manoj, A. Zutshi, R. P. Rajkumar,
A. M. Adarsh 250
Cannabis-related psychosis: Presentation and effect of abstinence: Vani Kulhalli, Mohan Isaac, Pratima Murthy 256
Pesticide poisoning in non-fatal deliberate self-harm: A public health issue: Study from Sundarban delta, India:
A. N. Chowdhury, Sohini Banerjee, Arabinda Brahma, M. K. Biswas 262

BRIEF COMMUNICATION
Repetitive love proposing: A case report and review of phenomenology of impulsivity and compulsivity:
Narayana Manjunatha, Devvarta Kumar, Haque S. Nizamie 267

REVIEW ARTICLE
Clozapine: Current perspective: Ram K. Solanki, Paramjeet Singh, Mukesh K. Swami 271

COMMENTARY
Proposal to the Indian Psychiatric Society for adopting a specialty section on addiction medicine (alcohol and other
substance abuse): Vivek Benegal, Alok Bajpai, Debasish Basu, Neelam Bohra, Sudipto Chatterji, RB Galgali,
DS Goel, Mohan K Isaac, Venugopal Jhanwar, Rajkumar Lenin, PM Madhavan, AK Mittal, E Mohandas,
Thyloth Murali, Pratima Murthy, Rajesh Nagpal, S Nambi, C Ram Subramaniam, Shubhangi Parkar,
Prasad Rao, MS Reddy, Alok Sarin, TP Sudhakar, BM Tripathi, Matthew Varghese 277

VIEW POINT
Clinical practice guidelines for psychiatrists: Indian Psychiatric Society guidelines vs. international guidelines:
A critical appraisal: Dishanter Goel, Jitendra Kumar Trivedi 283

CASE REPORTS
A case of neuroleptic malignant syndrome induced by olanzapine in postpartum period: Mehmet Üstündağ,
Murat Orak, Cahfer Güloğlu, Mustafa Burak Sayhan, Mahmut Taş 287

Indian J Psychiatry 49(4), Oct-Dec 2007 303

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Mania as an unique life event: Manu Arora, Piyali Mukherjee, Samir Kumar Praharaj, Vinod Kumar Sinha 290
A case presented with ‘‘as if’’ phenomenon: Soumitra Ghosh, Kushal K. Tamuli, Sabita Dihingia 292

LITERARY PSYCHIATRY
Compulsive gambling in ancient Indian texts: Ajit V. Bhide 294

LETTERS TO EDITOR
Rejoinder in reply to critical appraisal on ‘‘factitious schizophrenia’’: Rajnish Raj, Balwant Singh Sidhu 296
More on responsibility of psychiatrists in Indian setting: Prakash Gangdev 298
A rare case of head (scalp) trauma with foreign body: Gurvinder Pal Singh 299

EVENTS AND HAPPENINGS 297

AUTHOR INDEX - 2007 300

TITLE INDEX - 2007 302

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304 Indian J Psychiatry 49(4), Oct-Dec 2007

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COMMENTARY
Proposal to the Indian Psychiatric Society for adopting a specialty section
on addiction medicine (alcohol and other substance abuse)
Vivek Benegal, Alok Bajpai, Debasish Basu, Neelam Bohra, Sudipto Chatterji, RB Galgali, DS Goel, Mohan
K Isaac, Venugopal Jhanwar, Rajkumar Lenin, PM Madhavan, AK Mittal, E Mohandas, Thyloth Murali,
Pratima Murthy, Rajesh Nagpal, S Nambi, C Ram Subramaniam, Shubhangi Parkar, Prasad Rao, MS Reddy,
Alok Sarin, TP Sudhakar, BM Tripathi, Matthew Varghese
Members, Indian Psychiatric Society
The Indian Psychiatric Society, laudably, has a few special
subsections catering to the advance and development of
certain areas of mental-health care. These are devoted to
areas or disciplines which are special to the health of the
people of India but for historical reasons have not received
the attention they deserve and therefore require affirmative
action and special nurturing.
This document outlines the need to adopt a similar approach
to persons with alcohol- and drug-related problems in India
and to create a specialty section on Addiction Medicine,
under the purview of the Indian Psychiatric Society.
BACKGROUND
Alcohol, tobacco and other substance abuse affects a
disproportionately large section of people in India
The current prevalence rates among male adults (i.e.,
subjects who had used within the last 1 month) according
to the NHS are as follows: alcohol 21.4% [62.5 million];
cannabis 3.0% [8.7 million]; opiates 0.7% [2 million]; any illicit
drug 3.6% [10.5 million]. These numbers, when applied to
the total Indian population of 102.7 crores in 2001, provide
prevalence rates of 60/1000, 8/1000 and 2/1000 population
respectively.[1]
Around 25% of current users were ‘dependent’ users.
Dependent users as a proportion of current users were
17% for alcohol, 26% for cannabis and 22% for opiates. A
meta-analysis by Reddy and Chandrashekar[2] revealed an
Correspondence: Dr. Vivek Benegal,
Dept. of Psychiatry, National of Institute of Mental Health and
Neuro Science, Bangalore - 560029, India.
E-mail: vbenegal@gmail.com
How to cite this article: Benegal V, Bajpai A, Basu D,
Bohra N, Chatterji S, Galgali RB, et al. Proposal to the
Indian Psychiatric Society for adopting a specialty section on
addiction medicine (alcohol and other substance abuse). .
Indian J Psychiatry 2007;49:277-82.
Indian J Psychiatry 49(4), Oct-Dec 2007
overall prevalence of alcohol dependence to be 6.9/1000 for
India, with urban and rural rates of 5.8/1000 and 7.3/1000
population. The rates among men and women were 11.9
and 1.7 respectively. It is also well recognized that the
prevalence rates are not uniform and vary widely within
the country. The prevalence rates for alcohol- and other
substance-use disorders are much higher – for example,
in some of the northeastern states (prevalence of alcohol
use was above 65% among men and above 50% in Arunachal
Pradesh).[1]
The figures for prevalence of substance use may at first
appear deceptively small, especially the figures for alcohol
use, when compared to global estimates; but the absolute
numbers are huge. Also, it is increasingly apparent that
the health burden, as well as the social cost attributable
to alcohol misuse, is due in greater measure to persons
with hazardous use than to persons with dependent use.
Hazardous use has been estimated at over 80 and 55% of all
male and female users respectively.[3]
There is no such comfort of ‘low prevalence’ as far as
tobacco use is concerned. There are currently about 240
million tobacco users aged 15 years and above (195 million
male users and 45 million female users) in India.[4]
Prescription drug abuse, especially of sedatives/ hypnotics
[0.3 million as per the NHSDAA, 2003], is a growing problem,
which has gone largely unrecognized in India. Media reports
suggest rising abuse of stimulants by students as awakening
pills (for exams, etc.) or as recreational agents in ‘rave’
parties. Then there is the largely unstudied phenomenon
of inhalant abuse, which is widely prevalent among ‘hidden
populations’ such as street children.
The prevalence is more than that of all severe mental
disorders combined
The gravity of the problem of substance-use disorders can
be highlighted by comparing their prevalence with that of
other psychiatric disorders. Recent studies have generated
277
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Benegal, et al.: Speciality section on addiction medicine
all-India prevalence rates for all severe mental disorders of
58/1000[2] to 73/1000.[5]
The health burden attributable to substance misuse is
inordinately high
The impact of a health problem should not be gauged merely
by its prevalence but by the health burden and social cost
that it wreaks on society. Unfortunately, the focus of the
professional community, as well as public scrutiny, has been
primarily on the phenomenon of dependence or ‘addiction’
in the individual client. In this context, the excessive and
problematic use of a drug that is hard for the individual
to control becomes the target. The problems caused by,
and associated with, substance use are far broader. They
include problems partly or wholly caused by intoxication,
such as injuries and some acute illnesses; long-term effects
on health of a pattern of substance use that does not
otherwise disrupt social functioning; acute and chronic
health problems caused by unsafe ways of using drugs
otherwise unrelated to pharmacological effects (e.g., using
dirty needles); impacts on other people (e.g., secondhand
smoke); and impacts of the criminal justice system on
people engaging in illegal behavior.
Alcohol- and tobacco-related problems in India
Hospital admission rates due to the adverse effects of
alcohol consumption are disproportionately high. Several
studies indicate that nearly 20–30% of admissions/
consultations are due to alcohol-related problems (direct
or indirect) in different health-care settings but are
under-recognized by primary-care physicians.[6,7] Alcohol
misuse has been implicated in over 20% of traumatic brain
injuries[8]and 60% of all injuries reporting to emergency
rooms.[9] It has a disproportionately high association
with deliberate self-harm,[10] high-risk sexual behavior,[11]
HIV infection, tuberculosis,[12] esophageal cancer,[13] liver
disease[14] and duodenal ulcer.[15] A recent estimate from
surveillance of major noncommunicable diseases in India
placed the burden due to alcohol as the numero uno among
all noncommunicable disorders.[16]
There are 700,000 deaths per year due to smoking and
800,000 to 900,000 per year due to all forms of tobacco
use/ exposure in India. For the next 20 years, there will be a
faster trajectory of rise in tobacco-related deaths. Many of
the deaths (>50%) will occur below 70 years of age.[17]
The social cost due to alcohol- and tobacco-related problems
is prohibitively high.
Alcohol misuse wreaks a high social cost. In addition to the
health costs, there are indirect costs linked to a wide variety
of social implications (family disruption, marital disharmony,
impact on development of children, deprivation of the family,
absenteeism and industrial loss, crime and violence, etc.).[18–
20]
The social cost attributable to alcohol use, extrapolated
278
to the entire country, was estimated at Rs. 244 billion
for the year 2003–04; whereas the total excise revenues
generated from alcohol manufacture and sales was Rs. 216
billion.[20] An earlier study from Karnataka estimated that
monetizable direct and indirect costs attributable to people
with alcohol dependence alone were more than three times
the profits from alcohol taxation and several times more
than the annual health budget of that state.[21]
The cost of tobacco-attributable burden of just three groups
of diseases – cancer, heart disease and lung disease – was
estimated at Rs. 308.33 billion in 2002-2003.[17]
Alcohol and substance dependence/ abuse is very
often comorbid with other communicable and
noncommunicable disorders
Axis 1 psychiatric disorders (psychosis, mood disorders,
anxiety disorders) and substance abuse co-occur more
frequently than can be explained by chance alone. Patients
with schizophrenia are 4.6 times more likely to have
substance-use disorders than persons without mental
illness (3 times higher for alcohol, 6 times higher for other
illicit drugs).[22] While it has been previously commonly held
that substance-use comorbidity in schizophrenia represents
self-medication, an attempt by patients to alleviate adverse
positive and negative symptoms, cognitive impairment
or medication side effects; recent advances suggest that
increased vulnerability to addictive behavior may reflect
the impact of the neuropathology of schizophrenia on the
neural circuitry mediating drug reward and reinforcement.
Thus, schizophrenic patients may have a predilection for
addictive behavior as a primary disease symptom in parallel
to, and in many cases independent from, their other
symptoms. There is also early evidence that the pathology
in the neurobiological substrates that underlie mood and
anxiety disorders also subserves the predisposition to
substance-use problems.[23]
Substance abuse, especially of alcohol and tobacco, and a
spectrum of high-risk behaviors , which often go together,
are common risk factors for most of the noncommunicable
disorders (like hypertension, diabetes, heart disease,
cancer), which are assuming increasingly larger proportions
of the health burden on the Indian society.[3]
Drug abuse and addiction also have tremendous implications
for the health of the public, since drug use, directly or
indirectly, is now seen as a major vector for the transmission
of many serious infectious diseases, particularly HIV/ AIDS,
hepatitis and tuberculosis; and is instrumental in one of the
largest sources of mortality and morbidity in India, namely,
road traffic accidents and violence.[20]
Substance use disorders, especially involving alcohol and
tobacco, are grave public health problems
It obviously follows from the above statements that
Indian J Psychiatry 49(4), Oct-Dec 2007
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Benegal, et al.: Speciality section on addiction medicine
substance-use disorders need to be recognized as public
health problems and that there is urgency for psychiatrists
to liaise with other medical specialties, the public health
delivery system, as well as organizations working in the
area of development. As specialists in bio-behavioral
disorders, psychiatrists are in an ideal position to do so, and
the problem requires the involvement of diverse medical
professionals.
Here, one needs to exercise caution and steer clear of
the ‘me-too’ syndrome, wherein one creates a specialized
discipline which clamors for an independent share of
limited health-care resources. It would be prudent for
the psychiatrist community to work in tandem with, and
to juxtapose its strength and skill-sets with, the existing
networks and delivery systems for communicable and
noncommunicable disorders.
Addiction medication is an area where the psychiatrist can
fruitfully work in tandem with other medical specialists, and
in some ways this will be a good medium to get psychiatry
into the mainstream. So the advantage can be mutual.
Alcohol and tobacco use are also strongly affected by the
economic and political compulsions of the day. One needs
to only look at the recent imbroglio over the issue of scary
pictures of consequences of tobacco use on cigarette packs
and the subsequent backtracking by the Ministry of Health
in the face of pressure from the tobacco lobby.[24] Similarly,
the pursuit of a rational alcohol policy has been vitiated by
economic compulsions of the states and the misdirected
coercion of market economics. Thus, there is very little
debate on the recent active moves of the grape-growers’
lobby to have the Finance Ministry re-designate wine as an
agricultural product.
Macro-level interventions in these domains are likely to
be more effective and cost-effective. Intensive advocacy at
several levels should therefore be a part of any endeavor in
this area. The Framework Convention on Tobacco Control
(FCTC) is a classic example and could provide the template
for such initiatives at the national/ international level. The
negative economics of addictions (e.g., the social costs
of alcohol and tobacco overshadowing tax revenues from
these commodities) must be carefully articulated as these
are potent advocacy tools. It is also necessary to examine
and publicize the cost-effectiveness of interventions to
control substance abuse . The role of the industry and its
vested interests (e.g., the powerful liquor and tobacco
lobbies), as well as the complicity of medical professionals
and pharmacists (as in benzodiazepine and other over-the-
counter–medication misuse), should also be a focus of any
remedial strategies.
The psychiatric community is specially equipped to provide
leadership to such activities and bring to bear the valuable
Indian J Psychiatry 49(4), Oct-Dec 2007
experiences gained from the successes and mistakes of the
community psychiatry movement in India.
Substance-use disorders constitute a large proportion
of the clinical load in both private and public-health
psychiatric practice
Substance-use disorders already form more than 20% of the
case load of psychiatric practitioners, often, as noted above,
inextricably associated with mood, anxiety and psychotic
disorders. However, as a recent piquant exchange on a
popular Indian psychiatrists’ bulletin board revealed, many
psychiatrists are loath to take on clients with substance-
use disorders, preferring to refer them on to a very short
list of colleagues who will see them. This is often related
to a feeling of helplessness and frustration faced with the
usual picture of recidivism that typifies the natural history
of persons with alcohol and drug disorders.
Practitioners have an attitude of therapeutic nihilism
towards addiction medicine and the addicted patient
These experiences translate into an attitude of therapeutic
nihilism, which unfortunately is widely prevalent across the
medical community. There are several factors which appear
to contribute to this way of thinking:
Lack of education about alcohol and substance abuse: Only a
very small portion of the undergraduate medical syllabus,
and even the postgraduate psychiatry syllabus, is devoted to
this area, and it is limited only to the medical complications
of alcoholism.
Negative attitudes about alcoholism: Physicians and
psychiatrists in training often see late-stage alcoholics, who
often evoke feelings of aversion, hostility and helplessness.
Some physicians tend to see alcoholics and drug addicts as
bad or morally weak.
Discomfort with related social issues: Since alcoholism involves
not just medical issues but significant psycho-social issues
also, many physicians are uncomfortable dealing with it.
Pessimism about treatment: There are many physicians who
feel that addiction is not treatable. Part of the helplessness
and pessimism occurs because of the experience with
late-stage problem drinkers, where the treatment is not
always successful. The physician must remember that
early detection of, and intervention to resolve, alcohol-,
tobacco- and other substance-related problems offers the
best results.
It is not surprising, then, that the field of addiction psychiatry
currently suffers the same pariah status that psychiatry was
once ‘favored’ with among other medical professionals. The
drug rehabilitation centers of the early 21st century often
serve the same function that the leprosaria and asylums of
the early 20th century did: seclusion and restraint!
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Benegal, et al.: Speciality section on addiction medicine
Leadership in the field of advocacy and policy making or
legislation has been ceded to nonmedical, nonpsychiatric
bodies
To a large extent, this pessimism also arises from the fact
that till lately, there have not been too many effective
treatments. Here one must invoke the late Abraham Maslow,
who famously said: “If your only tool is a hammer, all your
problems look like nails!” For far too long, treatment
strategies have been limited by a single-hammer model
dominated by an abstinence paradigm and equipped with
limited behavioral-change strategies.
Unconscionably, physicians in frustration have attempted to
curb the uncontrollable behaviors of persons with drug and
alcohol problems with antipsychotics and electroconvulsive
therapies. This has only served to alienate them from this
client group. One has only to attend a survivors’ group
meeting to realize the hostility that psychiatrists in general
are viewed with.
Not surprisingly, the onus of treating these clients has
shifted either to survivor groups like the Alcoholics
Anonymous and Narcotics Anonymous; or to nonmedical,
nonpsychiatric rehabilitation agencies. Unsurprisingly, the
leadership in the field of advocacy and policy making or
legislation in the area has also been ceded to nonmedical,
nonpsychiatric bodies.
One needs to mention here that the standards of treatment
of clients with addictive disorders are variable, at best.
The various agencies involved differ widely in the methods
they utilize and in a mostly unregulated field; there are
numerous instances of clients being subjected to practices
which are questionable, at best, and often highly unethical
and dangerous.
It is incumbent upon the members of the society to use
their collective influence to bring some regulation and
standardization of procedures into the field, being guided by
evidence . A good point to start from is the documentation
on treatment protocols that the society has previously
generated, as well as the guidelines generated by the
ministries of Health and Social Justice and Welfare.
Addictive disorders are bio-behavioral disorders which
are strongly impacted by economic and political
influences
However, one needs to assert here that psychiatrists,
because of their training as bio-behavioral specialists, are
best positioned to coordinate the management of this array
of problems. Increasingly, these recurrent and relapsing
illnesses are being recognized to be a resultant of the
unfortunate pairing of substance use with a neurobiological
diathesis modulated by environmental influences. Recent
studies have demonstrated that susceptible individuals
have smaller volumes in brain areas critical for attention,
280
learning, judgment, reward and motivation (possibly due to
a maturational lag affecting myelination). This may result in
a trait of central nervous system hyperexcitability, usually
manifest as a spectrum of externalizing behaviors marked
by compromised impulse control, high novelty-seeking or
sensation-seeking behavior, increased response to reward,
a tendency to pay more attention to immediate rewards
and neglect long-term outcomes when making decisions,
reduced response to punishment and a disregard for social
norms. This is associated with heightened reinforcement
from alcohol and drugs coupled with impaired early warning
of intoxication. A significant portion of this research has
come out of India! In effect then, drug dependence, in
large part, may be the epiphenomenon of, or a variable
expression of, a generalized disinhibitory complex, which
has been hypothesized to predispose to mood disorder,
anxiety disorder and perhaps schizophrenia! Susceptible
individuals may be self-medicating themselves and initially
even successfully reversing, or compensating for, their low
motivational responses to normal rewards.[25]
This is important to assert; because, for far too long,
despite the lip service paid to the medical and bio-psycho-
social model of alcohol and other substance dependence,
practitioners have rarely been able to distance themselves
from the prevalent social discourse which regards drug users
through the lenses of the moral model as ‘losers – who are
too weak to stop and who deserve what they get!’
Also, the growing literature on the long-lasting neuro-
adaptations consequent to prolonged exposure to substances
of abuse is beginning to delineate the neuropathology that
gives rise to the characteristic behavioral changes which
account for the recurring and relapsing nature of the illness.
Slowly, these advances from the laboratory benches are being
translated into changes in behavioral and pharmacological
strategies for more efficacious treatment. There are recent
reports on the efficacy of newer pharmacological agents
and audits of individual and population-level interventions
which are more efficacious than earlier remedies.[26–28]
A special and concerted effort is required to test and
document these interventions and make them broad based,
while at the same time bringing them into public notice.
And the community of psychiatrists is well positioned
to spearhead these efforts at advancing the study of the
bio-behavioral determinants of this array of disorders and
incorporating the opportunities derived from research into
day-to-day practice.
Addiction medicine is a prominent and active subsection
in most international psychiatric bodies
It is instructive to look at the status of addiction medicine,
within the structure of other international psychiatric bodies.
In the USA, for example, doctors focusing on addiction
medicine are medical specialists who focus on addictive
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Benegal, et al.: Speciality section on addiction medicine
disease and have had special study and training focusing on
the prevention and treatment of such diseases. There are
two routes to specialization in the addiction field: one via
a psychiatric pathway and the other outside of psychiatry.
The American Society of Addiction Medicine notes that
approximately 40% of its members are psychiatrists, while
the remainder has received medical training in other fields.
The facts stated above underline the urgent need for the
Indian Psychiatric Society to constitute a specialty section
(with appropriate regional representation) devoted to
Addiction Medicine, within its ambit.
AIMS AND OBJECTIVES
The specialty section on Addiction Medicine will be
required to:
• Promote and advance the bio-psycho-social contributions
to the science and practice of Addiction Medicine in all
its different manifestations;
• Promote a] the improvement of the health of persons
directly or indirectly impacted by alcohol- and other
substance-related problems and b] prevention, control,
treatment and relief of all alcohol- and other substance-
related problems, as well as conditions which constitute
high risk for potential drug- and alcohol-related problems.
This involves encouraging and enabling members of the
society to explore, extend and pursue ‘evidence-based’
treatment strategies and prevention methods. This
includes liaison with other stakeholders, including, but
not limited to, a] governmental agencies overseeing
health, social justice and welfare, finance and human
development; b] nongovernmental agencies involved in
direct care of persons with substance abuse, as well as
agencies whose developmental programs are impacted
unfavorably by substance-abuse problems directly or
indirectly, affecting their beneficiaries; and c] other
medical specialties and primary health-care providers.
This also requires sharing the expertise of members of
the society and other professionals involved in diverse
fields such as school mental health, community-based
rehabilitation, epidemiology, drug trials, maintaining
disease registries, to name just a few;
• Actively engage in advocacy in order to influence policy
making and legislation, keeping in mind that substance-
use disorders and their consequences constitute a grave
public health disorder which imposes an unacceptably
severe burden on the health and well-being of the
people of India. This, above all, requires consistent
accumulation and dissemination of data on the
economic, social and health costs of substance abuse to
the Indian society; and on the evidence of cost-efficacy of
appropriate intervention. There is emerging conviction
that the risk factors and consequences of substance-
Indian J Psychiatry 49(4), Oct-Dec 2007
use disorders are often common to, and frequently
complicate, the development and outcome of a whole
host of medical disorders and social ills. Synergizing
with other stakeholders mentioned above, in sharing
of methodologies, will strengthen each other’s effort to
mutually benefit both in terms of intervention impact
as well as the collective bargaining power to advocate
change. Such co-action will also reduce the competing
and conflicting ‘me-too’ demands stemming from parallel
agencies working towards similar ends, which overwhelm
limited resources of finance and manpower and weaken
the effectiveness of the discourse for change;
• Formulate and recommend standards of treatment and
rehabilitation of persons or populations affected directly
or indirectly by substance-use disorders. In addition, it
will be necessary to obtain recommendations for syllabi
and commission resources for the education and training
of medical and nonmedical personnel involved in the
field;
• Safeguard the interest of psychiatrists and fellow
professionals engaged in the practice of Addiction
Medicine in India and promote ethical standards in the
practice of Addiction Medicine in India; and
• Promote research in the field of addiction science
with a focus on translating the benefits of research to
the bedside and propagate the use of evidence-based
interventions in the daily delivery of mental-health care.
SUGGESTED ACTIVITIES
1. A web portal, linked to the web page of the Indian
Psychiatric Society, which will initially host information
of relevance to the practice of Addiction Medicine in
India, with direct and indirect links to published or
unpublished scientific papers, databases, treatment
protocols, available treatment agencies, online resources,
etc.; and later, e-learning sites for online education and
training.
2. Coordinating Continuing Medical Education (CME)
pertaining to the aspect of the science and practice
of Addiction Medicine, with special emphasis on
underserved areas like the northeastern states, Andaman
and Nicobar Islands, etc.
3. Enabling and commissioning position papers on the
impact of substance abuse in India, with a view to
influence public policy.
4. Engaging with relevant organizations to promote
demand-reduction strategies, such as the police to
prevent drinking and driving, primary health providers
and emergency rooms for early detection and brief
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Benegal, et al.: Speciality section on addiction medicine
intervention.
5. Pursuing the aim of working to safeguard vulnerable
populations, e.g., inoculating children and adolescents
through skills training ; sensitizing physicians and
pharmacists to prevent over-the-counter drug abuse,
especially for the elderly.
6. Examining the possibility of creating a national registry,
using standardized data-entry protocols.
The proposal to constitute a specialty section on Addiction
Medicine was first mooted by Dr. Varghese Punoose at the
IPS South Zone CME program at Kodaikanal in 2007. It was
seconded by Dr. M. S. Reddy and received enthusiastically
by the IPS President, Dr. I. R. S. Reddy. This document is
in continuation of that process; and we urge the Society
to place the document before the appropriate body, to
initiate the necessary processes so that the Society may
further debate and hopefully set in motion the steps to give
substance to this proposal.
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Source of Support: Nil, Conflict of Interest: None declared
Indian J Psychiatry 49(4), Oct-Dec 2007