Global and Indian Insights: Key Facts About Substance Abuse

Substance abuse is no longer a fringe issue confined to certain communities or age groups. It is a worldwide public health emergency that affects nearly 300 million people directly and millions more through families, workplaces, and healthcare systems. The numbers from international bodies like the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO), along with India’s own large-scale national survey, paint a clear picture of where the crisis is heading and who it hurts the most.

The global landscape of substance abuse 🔗

The scale of substance use worldwide has grown sharply in the past decade. According to the UNODC World Drug Report 2024, an estimated 292 million people used drugs in 2022, which marks a 20 per cent increase over the previous ten years. Cannabis remains the most widely used substance globally with around 228 million users, followed by opioids with about 60 million, amphetamines with 30 million, cocaine with 23 million, and ecstasy with 20 million.

The harms are not evenly distributed. New synthetic opioids such as nitazenes, which can be more potent than fentanyl, have triggered overdose deaths in several high-income countries. Cocaine production has reached record levels, and methamphetamine trafficking is expanding into South-West Asia and South-Eastern Europe. The report also notes that drug use disorders, which describe a condition where substance use causes significant health or social problems, continue to rise faster than treatment access.

Alcohol and the global death toll 🔗

While illicit drugs grab headlines, alcohol remains the deadliest psychoactive substance worldwide. The WHO Global Status Report on Alcohol and Health 2024 reported that 2.6 million deaths per year were attributable to alcohol consumption, accounting for 4.7 per cent of all deaths globally. Another 0.6 million deaths were linked to psychoactive drug use. Of these alcohol-related deaths, around 2 million were among men.

The report also estimated that around 400 million people lived with alcohol and drug use disorders globally, of whom 209 million had alcohol dependence. Of the alcohol-attributable deaths in 2019, 1.6 million came from noncommunicable diseases such as cancers and cardiovascular conditions, 700,000 from injuries including road crashes and suicides, and 300,000 from communicable diseases like HIV and tuberculosis where alcohol acted as a risk multiplier.

[Image: Infographic comparing global users of cannabis, opioids, amphetamines, cocaine, and ecstasy based on UNODC 2022 estimates]

Early initiation: a worrying global trend 🔗

One of the most disturbing findings concerns young people. The WHO reported that 23.5 per cent of all 15-19 year olds worldwide were current drinkers in 2019. In the European region, this figure rose to 45.9 per cent, followed by the Americas at 43.9 per cent. The highest proportion of alcohol-attributable deaths, at 13 per cent, was among young people aged 20 to 39. Adolescence is also recognised by the UNODC as a peak period for initiating substance use, which is why prevention programmes targeted at children and teenagers carry such importance.

Substance abuse in India: the national picture 🔗

The most authoritative data on substance use in the country comes from the National Survey on Extent and Pattern of Substance Use in India, published in 2019 by the National Drug Dependence Treatment Centre at AIIMS New Delhi for the Ministry of Social Justice and Empowerment. This survey covered 473,569 individuals aged 10 to 75 across 186 districts and remains the benchmark reference for substance use prevalence in the country.

Alcohol: the most widely used psychoactive substance 🔗

The survey found that alcohol is the most commonly used psychoactive substance in India. About 14.6 per cent of the population aged 10 to 75 years, roughly 16 crore people, currently consume alcohol. The gender gap is striking: prevalence among men is around 27.3 per cent compared to just 1.6 per cent among women. States with the highest prevalence of alcohol use include Chhattisgarh, Tripura, Punjab, Arunachal Pradesh, and Goa. Country liquor and Indian Made Foreign Liquor each account for roughly 30 per cent of total consumption, reflecting how access cuts across both rural and urban settings.

The more alarming figure is dependence. About 5.7 crore people, or close to one in every five adult drinkers, were estimated to suffer from harmful or dependent alcohol use, yet only a tiny fraction receive treatment.

Cannabis and opioids 🔗

The survey reported that around 2.8 per cent of Indians use cannabis products, comprising bhang (2 per cent) and ganja or charas (1.2 per cent). About 72 lakh people need help for cannabis-related problems. Uttar Pradesh, Punjab, Sikkim, Chhattisgarh, and Delhi report higher than national prevalence rates.

India also has a notably high opioid burden. About 2.1 per cent of the population, or roughly 2.26 crore people, use opioids. Heroin emerged as the most commonly used opioid (1.14 per cent current use), followed by pharmaceutical opioids (0.96 per cent) and opium (0.52 per cent). The survey also estimated that around 8.5 lakh people inject drugs, which carries serious risks of HIV and hepatitis C transmission. Inhalants, sedatives, cocaine, and amphetamine-type stimulants make up the remainder of the substance use profile, with inhalants being a particular concern among children.

Age and demographic factors 🔗

Adolescence and young adulthood are the highest-risk periods for both initiating substance use and progressing to dependence. A nationwide survey of school-going adolescents published in The National Medical Journal of India found that the average age of initiation for any substance was 12.9 years. The age was even lower for inhalants at 11.3 years, followed by heroin at 12.3 years and unprescribed pharmaceutical opioids at 12.5 years. Overall, 15.1 per cent of students reported lifetime use of psychoactive substances, and 10.3 per cent reported past-year use.

Why adolescence is a critical window 🔗

The teenage brain is still developing, particularly in areas controlling judgement, impulse control, and reward processing. Early exposure to alcohol, tobacco, or other substances during this window can rewire these systems and dramatically increase the risk of lifelong dependence. A multi-state primary health centre study published in peer-reviewed research found that among young people who used substances, 75.5 per cent began before completing adolescence, and more than 80 per cent had moderate or high substance involvement.

The gender dimension 🔗

Men consistently account for the vast majority of substance users across categories in India. The male-to-female ratio for alcohol use sits at roughly 17:1. Globally, men also account for about 77 per cent of alcohol-attributable deaths. However, women face unique risks. Lower body water content, hormonal differences, and the social stigma around women seeking treatment mean that female substance users often suffer faster physical harm and have much lower access to care.

Implications of the data 🔗

The numbers translate into a heavy socio-economic and public health burden. Substance abuse contributes to road traffic accidents, domestic violence, lost productivity, intergenerational poverty, and pressure on already stretched healthcare systems.

Public health and disease burden 🔗

Alcohol alone plays a causal role in over 200 diseases, injuries, and other health conditions, including liver disease, several cancers, cardiovascular disease, and mental health disorders. It also increases the risk of HIV transmission and tuberculosis mortality. Opioid use disorder, particularly among injecting drug users, drives outbreaks of HIV and hepatitis C in pockets of Punjab, Manipur, Mizoram, and Nagaland.

Treatment gap 🔗

The treatment gap is one of the most damning aspects of this crisis. WHO data shows that the proportion of people with substance use disorders in contact with treatment services ranges from less than 1 per cent to no more than 35 per cent across countries that reported data. In India, only a fraction of those with dependence on alcohol or opioids ever reach a hospital or rehabilitation centre. Stigma, lack of insurance coverage for addiction care, and limited specialist manpower all play a role.

Economic and social costs 🔗

The costs ripple outward. Families bear the burden through lost income, medical bills, and emotional trauma. Children of dependent parents face higher risks of malnutrition, school dropout, and exposure to violence. Workplaces lose productive hours. Governments lose tax revenue to the illicit market and spend more on policing, healthcare, and welfare. The UNODC has emphasised that drug production and trafficking continue to drive instability, inequality, and environmental damage, particularly in source and transit regions.

What the data tells us about prevention 🔗

The combined evidence from UNODC, WHO, and the Indian national survey points to a few clear priorities. Prevention programmes must reach children before age 12, since that is when initiation often begins. Screening and brief interventions must be integrated into primary healthcare. Treatment infrastructure needs to expand beyond metros into smaller towns where dependence rates are sometimes higher. And alcohol policy, including taxation and regulation of marketing, must be strengthened, particularly because alcohol causes more harm than any single illicit drug.

What do you think? Given that the average age of substance use initiation in Indian schools is now around 13 years, what role should families and schools play in prevention before this critical window closes? And should alcohol, which causes the largest share of substance-related deaths, receive the same policy attention as illegal drugs in public conversations about addiction?

References

1. https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2024.html
2. https://news.un.org/en/story/2024/06/1151446
3. https://www.who.int/news/item/25-06-2024-over-3-million-annual-deaths-due-to-alcohol-and-drug-use-majority-among-men
4. https://www.who.int/news-room/fact-sheets/detail/alcohol
5. https://www.vitalstrategies.org/new-who-report-detailing-alcohols-devastating-toll-on-global-health-reinforces-urgent-need-for-governments-to-act/
6. https://socialjustice.gov.in/writereaddata/UploadFile/Survey%20Report.pdf
7. https://www.pib.gov.in/Pressreleaseshare.aspx?PRID=1565001
8. https://nams-annals.in/nams-task-force-report-alcohol-substance-use-disorders-and-behavioral-addictions-in-india/
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC7197827/
10. https://nmji.in/substance-use-among-school-going-adolescents-in-india-results-from-a-nationwide-survey/
11. https://pmc.ncbi.nlm.nih.gov/articles/PMC10988150/