A cross-sectional study was conducted at 10 DDCs in Punjab. A total of 15 DDCs are being run by the Indian Red Cross Society [4]. There are multiple private DDCs which are being run by private registered societies. As has been shown in the tables, Seven Indian Red Cross DDCs and three private DDCs were studied. Those centres that were functional for more than a year were included. Necessary permission was taken and data was collected by using a pre-tested questionnaire. Only those patients (n=120) who were admitted to the DDCs on the day of the scheduled visits were interviewed. The interviews were conducted in person, after taking informed consents of the patients and giving an explanation about the purpose of the study. Strict confidentiality of the information which was provided was ensured. The data which was collected was then statistically analyzed by using Microsoft Excel and application of the Chi-square test.

A majority of the DDCs (7 out of 10) were urban. The private DDCs were not receiving any type of financial aid [Table/Fig-1].

In the year 2010, the total Outpatients Department (OPD) patients were 12,548, including 17 females (OPD only), and 2,305 in patients (all males). Here, OPD patients were those who had either reported to out-reach camps which were organized by the DDCs and had taken treatment from the camp sites, and those who had reported directly to the OPDs of the DDCs. Indoor patients were those who had been admitted to the DDCs for any respective duration of time.

The major drugs which were abused were Propoxyphene, Alcohol, Bhukki, Opium, Cannabis and Buprenorphine, in descending order of abuse [Table/Fig-2].

The major routes of drug abuse were oral (86.2%), inhalation (4.3%) and intravenous (3%). The sources of referrals of the patients to the DDCs were family members (35.3%), social workers (29.8%), self (13.6%), friends (9.3%), ex-clients or their family members (6.7%) and counselling and awareness centres (4.1%).

A majority of the patients were married (72.5%), and 18.1% were unmarried. About 9.4% patients were separated/divorced due to drug abuse.

About 36.3% of the patients were educated up to higher secondary level, 18.43% were middle passed, 13.53% had only primary education, 11.8% were literate (read and write), 10.9% patients were illiterate, 5.64% were graduates and 3.4% were post graduates.

About 43.5% of the patients stayed at the DDCs for a period which was less than the recommended duration of 1 month. At the private DDCs, all patients stayed for more than 60 days [Table/Fig-3].

A majority of the patients left the treatment which was provided by the DDCs due to personal reasons (40.9%) and lack of family support (37.5%) [Table/Fig-4].

Out of the 82 patients who required additional treatment, the reasons for it were the following: Hepatitis B (n=24), Hepatitis C (n=10), TB (n=17), HIV (n=7), and Syphilis (n=2).

Out of the 2415 patients whose records were available, 58.5% were treated, 24.2% had relapsed and 17.2% had dropped out [Table/Fig-5].

Home visits were conducted by the counsellors at the homes of patients discharged from the Red Cross DDCs, but not at the homes of the patients who were discharged from the private DDCs.

All the centres organized out-reach camps in urban areas and villages for preventive education, spreading of awareness, registration of addicts, counselling, and detoxification/de-addiction treatment. No vocational rehabilitation was given at any of the DDCs.

On comparison, more patients were found to be satisfied by the services which were provided by the Indian Red Cross DDCs [Table/Fig-6].

The number of private DDCs is increasing in the rural areas of Punjab,India. The probable reason behind this is providing for the larger existing rural population.

According to the scheme for prevention of alcoholism and substance (drugs) abuse, DDCs should ordinarily have 15 bedded or 30 bedded facilities with specified staff, as per the norms. The centres receive financial assistance, with up to 90% of the approved expenditure. The project directors of the private DDCs were made aware of the fact that they could apply for a grant-in-aid after running the centre successfully for one year and fulfilling the requirements which were laid down by the MSJE [3,4].

DDCs at Kharar, Nawan Shahar, Faridkot, and Bathinda had more beds than were sanctioned, due to an increase in the number of patients and requests made by families of the patients to admit their family members at the DDCs by any possible means.

Separate wards for females were present at the Patiala and Ludhiana centres, but there was no indoor stay facility for female patients. Drug addiction in females was reported in the OPDs, but due to social stigma, they were not admitted.

A majority of the patients were referred to the DDCs by family members and social workers. Families play an important role in the motivation of addicts in getting treatment. Social workers can go and talk to the addicts and their families and motivate them to get treatment.

A majority (36.3%) of the patients at all the centres were educated up to higher secondary level, and this was followed by 18.43% patients, who were educated up to middle standard. Similarly, in Uttar Pradesh Singh et al., found that most of the drug abusers were educated up to primary and secondary levels (40.13% and 41.10% respectively). It was also found that those that fell into drug abuse habit at early ages produced an increased amount of school dropouts [6].

In the present study, 54.4% patients were employed in some form or the other. On the other hand, Singh et al., found 81.36% of the drug abusers were employed as drivers, labourers and rickshaw pullers. This difference probably occurred due to different socio-economic profiles of the people from the two states [7].

In a different study done on the long-term outcomes of in-patients who were suffering from substance use disorders in Chandigarh, Singh et al., found that patients who were followed-up had a significantly longer durations before relapse [8]. Thus, DDCs should stress on keeping patients on follow-ups, in order to achieve better outcomes.

A very small number of the staff had received training of any kind, which was probably the reason behind the patients being not satisfied by counselling and staff services.

A high rate of dissatisfaction was seen at the private DDCs. Various reasons given by the patients included verbal abuse, physical abuse and even torture by the DDC staff, especially when they didn’t obey the orders of the staff. Medical services were mostly irregular as well. Many patients were forced to sleep on the ground. The treatment duration was 6 months.

A statistically significant finding was that most of the patients felt a positive change and that they were willing to recommend the Red Cross DDCs (p<0.05) to other people, probably due to their better services [Table/Fig-7].

No statistically significant difference was found (p>0.05) with respect to the difference in incidents of harassment from staff of both types of DDCs. Patients were interviewed in separate rooms, with a maintenance of full confidentiality, but 70% of patients at the Red Cross DDCs and 56.7% of patients at the private DDCs denied this [Table/Fig-8]. It could be due to the fact that the patients were afraid of the consequences of reporting, or that they may have been given a warning of being thrown out from the DDCs.

There is an urgent need for filling all vacant posts and improving the services and facilities which are provided to patients by DDCs. Private DDCs should be guided, supported and promoted by the government, so that these centres can be run more efficiently, in order to provide more beneficial facilities. All DDCs must be strictly checked and regulated by the concerned higher authorities for any human rights violations. It is highly recommended that these services should be provided free of cost to the poor.

A vocational rehabilitation program that provides training in tailoring, carpentry or computer courses must be financed and supported at all DDCs, in order to reintegrate the de-addicted persons into the social mainstream. Project directors must ideally be retired from the medical profession or from an allied subject, so that they can direct the centres in a more knowledgeable way.