Substance abuse and tuberculosis in Pakistan

Pakistan ranks sixth amongst the 22 tuberculosis high-burden countries in the world, accounting for one of the major health problems in Pakistan.

Substance abuse is the most commonly reported behavioral risk factor among tuberculosis patients. The study was done at the Indus Hospital TB program Karachi. Rationale of the study was to find out the frequent use of substances among patients.

Cigarette smoking (up to pack/day) as a most common addiction was seen particularly among male patients as compared to females, who were found to be addicted to pan and ghutka. Moreover, niswar, chewable tobacco, alcohol and hashish were also reported by males.

Counseling setup in the Indus Hospital TB program provided special counseling to these patients about adverse reactions of substances in TB treatment and general health to ensure treatment compliance.

RISK FACTORS

Anyone can contract tuberculosis, but there are a few dynamics which may increase risk of the disease. A number of diseases like HIV, diabetes, cancers and other factors such as poverty, malnutrition, living and working in crowded and unhealthy regions and also an addiction to different substances weaken the immune system and make it more vulnerable to tuberculosis.

DIFFERENT PERSPECTIVE FROM DIFFERENT PATIENTS

Interesting responses were collected from the patients interviewed for the study. The following questions were asked:

Do you use any substance or not?

At what age did you start?

Why did you start?

The majority of patients started using substances at the age of 14 due to the peer pressure and to try out a new experience which seems adventurous, fascinating to them, whereas for some patients, they learned to do so by observing their parents and other elders living in close contact.

For many patients substances, predominantly smoking, serve as a relaxant and an approach of coping with stress like economic, personal and social problems. On the other hand, truck and bus drivers smoke because this keeps their minds alert and they remain awake during driving for hours. Some have tried to quit, but returned to cigarettes due to withdrawal symptoms.

Some patients also use smoking as a treatment for their gastrointestinal problems; in particular for digestion, they take it immediately after meals.

PREVENTION IS BETTER THAN CURE

Addiction is a habit that is difficult to break; hospitals and substance abuse programs need to work hand-in-hand since substance abuse is associated with negative treatment outcomes. Effective interventions and referral mechanism need to be developed by hospitals to address the need of patients who abuse substances.

About the author: Zainab Barry is a clinical psychologist at The Indus Hospital and consultant clinical psychologist at the Life Care Consultant Clinic.