National Drug Dependence Treatment Centre Research Articles

INTRAVENTRICULAR HAEMMORHAGE IN A CHRONIC CANNABIS USER- A CASE REPORT.

Cannabis is one of the commonly abused psychoactive recreational drugs, the popularity of which has exponentially increased in the recent times due to the notion that it has minimal side effects [1-3]. But of late, many studies have showed that chronic use of cannabis has cerebrovascular as well as cardio vascular complications [4,5]. As per the report of National Drug Dependence Treatment Centre (NDDTC) of the All India Institute of Medical Sciences (AIIMS), New Delhi, 2.83% of Indians aged 10–75 years (or 31 million people) were current users of cannabis products [6]. A 22-year-old, apparently healthy male student, staying alone in a rented apartment with history of chronic cannabis use was found in an unconscious state with multiple packets of cannabis (Ganja/ Marijuana). During the PME, about 250-300 grams of intraventricular hematoma was present in the lateral ventricles of the brain. Diffuse haemorrhage was present over bilateral cerebellar hemispheres. No antemortem injuries were present on the body

A cost analysis study to estimate the cost spent by the National Drug Dependence Treatment Centre, Ghaziabad, for treatment of substance use disorders for a defined study population

A cost analysis study to estimate the cost spent by the National Drug Dependence Treatment Centre, Ghaziabad, for treatment of substance use disorders for a defined study population

Symposium

Opioid use disorders are one of the most serious global health problems. According to the latest national survey, current use of any opioid was 2.1% and an estimated 8.5 Lakh people who inject drugs (PWID) are in India. Opioid Agonist Treatment (OAT) is the most effective evidence-based strategy for management of opioid use disorders. In India, OAT is provided in government hospitals and through community-based OAT clinics. The covid-19 pandemic and nation-wide lockdown have adversely impacted OAT services delivery in the country.The National Drug Dependence Treatment Centre (NDDTC) runs a community drug treatment clinic in an urban impoverished area of East Delhi and provides low-threshold, free-of-cost OAT services for patients residing in the clinic’s vicinity. The clinic responded to the COVID-19 pandemic challenge and continued OAT throughout the pandemic by making substantial changes in its operations.This symposium shares the experience of NDDTC in running community-based OAT services using Clinical Workflow Automation based digital platform, teleconsultations, and various strategies adapted to deliver uninterrupted services during this unprecedented time.The feasibility, perceived satisfaction and retention rates of the patients receiving the tele medication assisted treatment offered is assessed among 100 patients will also be discussed. The various operational challenges faced and lessons learned during delivery of OAT services would also be discussed.

Partially empty sella with generalized epileptiform discharges presented as manic episode in an elderly female: A case with diagnostic dilemma - Causation or coincidence?

Partially empty sella with generalized epileptiform discharges presented as manic episode in an elderly female: A case with diagnostic dilemma - Causation or coincidence?

Improving Treatment of Substance Use Disorders through Community Drug Treatment Clinics: An Experiential Account.

India has a huge burden of substance use disorder (SUD). The national response to the problem of SUD has been to support addiction treatment centers either in government hospitals or in nongovernmental settings. The existing number of addiction treatment facilities is less compared to the burden of substance use in India. The existing models of treatment in India place undue emphasis on inpatient treatment of SUD. Community-based treatment aims to bring the treatment of SUD closer to the patients in their community. Community-based treatment of SUD utilizes existing services available in the community by establishing an integrated network of community-based services. There have been different models of community-based care for the management of SUD in India. Most of them, however, address short-term withdrawals and do not provide long-term treatment in community. National Drug Dependence Treatment Centre, AIIMS, New Delhi, has been providing community-based treatment for SUD since the 1990s. Two of the three community drug treatment clinics (CDTCs) are in operation for more than 5 years now and cater to the population residing within a defined catchment area. The CDTCs use infrastructure available in the community to operate the clinics. The clinics are run daily by a team of nursing staff, while the doctor is available only twice a week. A menu of options, ranging from short-term treatment to long-term agonist maintenance treatment is provided in the clinic. Both pharmacotherapy and psychosocial interventions are provided. Each clinic caters to hundreds of patients through these facilities. There is a need to expand CDTCs in India considering their cost-effectiveness, acceptability, and overall effectiveness, especially in urban colonies with higher substance-related problems.

A study of pathways to care among opioid dependent individuals seeking treatment at a community de-addiction clinic in India

Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18–60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking.

Inpatient treatment outcomes of aged substance-using patients admitted to a tertiary care center

Background and Aims: Studies on aged substance users are few from the Indian subcontinent, though they are likely to represent a subgroup of patients with distinct clinical needs. This study aimed to present the inpatient treatment outcomes of such aged substance-using patients admitted to a tertiary care treatment facility in India. Methodology: This descriptive, retrospective chart-based study presents data of aged patients (age 50 years and above) admitted between January and December 2014 at the National Drug Dependence Treatment Centre, Ghaziabad. Results: A total of 72 aged patients were admitted during this period out of total 953 admissions (7.6% of the sample). All of them were male. Forty patients (55.6%) had a diagnosis of alcohol dependence and 32 (44.4%) had a diagnosis of opioid dependence. The mean duration of stay was 12.9 (±9.6) days. Of these 72 patients, treatment could be completed for 57 patients (79.2%), while seven patients left against medical advice, four were discharged on disciplinary grounds, three were shifted to another facility (two due to medical reasons), and one absconded. Treatment completion rate was least among aged patients with only opioid dependence (25.65%). Conclusion: Medical issues may be a consideration of premature discharge among aged patients admitted for the treatment of substance use disorders. Furthermore, treatment noncompletion is more among aged patients with opioid use disorder than among alcohol use disorder. Further studies are needed with prospective methodology for the assessment of various factors associated with treatment completion, which can help to address the treatment needs of aged patients with substance use disorders, which in turn can lead to better treatment outcomes for them.

34 - Evaluation of oxidative stress and toluene exposure among adolescent inhalant users at a tertiary care centre of North India

Background Inhalants are linked with numerous adverse health effects. Production of reactive oxygen species (ROS) could be one of the contributing factors. Literature suggests that intentional toluene inhalation causes a decrease in antioxidants and formation of ROS inducing oxidative stress. The present study evaluated the effect of oxidative stress among adolescent inhalant users seeking treatment at a tertiary care centre of India. Methods The study included individuals exposed to toluene (Group I) and healthy individuals with no history of drug use (Group II). Five ml of blood and thirty ml of urine was collected from each patient, meeting the inclusion criteria. Urinary Hippuric acid and serum concentrations of Malondialdehyde (MDA), Protein Carbonyls (PC), 8-hydroxydeoxyguanine (8-OHdG) Glutathione peroxidase (GPx) activity, Superoxide Dismutase (SOD) activity and Total Antioxidant capacity (TAC) were measured using Gas liquid chromatography, spectrophotometry and ELISA techniques. Statistical analysis was done using SPSS 22.0. Results A total of 134 male subjects (toluene exposed, n = 67 and unexposed, n = 67) were included. Mean Age for Group I and Group II were 14.8±2.12 and 14.7±2.02 years respectively. Mean hippuric acid concentration (mg/ml) in group I and II was found to be 1.6±1.8 and 0.3±0.3 (p Conclusion This indicates that toluene abuse is linked to oxidative stress. There is a need to create awareness among adolescent inhalant users about the adverse health effects of toluene use. Further studies with larger sample size are needed to clarify the biological significance of oxidative stress among inhalant users. Supported by National Drug Dependence Treatment Centre, AIIMS, New Delhi and University Grants Commission, Government of India.

Tramadol for maintenance in opioid dependence: A retrospective chart revie

Background and aims: Tramadol is an opioid agonist which can be potentially used for maintenance treatment of patients with opioid use disorders. This chart review presents the characteristics of individuals with an ICD 10 diagnosis of opioid dependence who were maintained on tramadol for a period of at least 6 months.Methods: Records of patients seeking treatment for opioid dependence from the outpatient clinic of the National Drug Dependence Treatment Centre, Ghaziabad, India were screened. One hundred consecutive patients who received tramadol for more than 6 months were included.Results: The sample comprised exclusively of males and had a mean age of 40.9 years. The median dose of tramadol at initiation and continuation was 300 mg/ day. Sixty-two patients achieved complete abstinence during the course of treatment. Greater age, longer duration of opioid use, and better follow-up adherence were associated with abstinent status. The rates of abstinence were higher among those presenting with natural opioid use as compared to others (prescription opioid use or heroin use).Conclusion: Tramadol can be an alternative medication for harm reduction in select group of patients with opioid dependence. Further research is required to strengthen the evidence base of rational use of tramadol for maintenance treatment of patients with opioid dependence.

Tramadol for maintenance in opioid dependence: A retrospective chart review.

Tramadol is an opioid agonist which can be potentially used for maintenance treatment of patients with opioid use disorders. This chart review presents the characteristics of individuals with an ICD 10 diagnosis of opioid dependence who were maintained on tramadol for a period of at least 6 months. Records of patients seeking treatment for opioid dependence from the outpatient clinic of the National Drug Dependence Treatment Centre, Ghaziabad, India were screened. One hundred consecutive patients who received tramadol for more than 6 months were included. The sample comprised exclusively of males and had a mean age of 40.9 years. The median dose of tramadol at initiation and continuation was 300 mg/day. Sixty-two patients achieved complete abstinence during the course of treatment. Greater age, longer duration of opioid use, and better follow-up adherence were associated with abstinent status. The rates of abstinence were higher among those presenting with natural opioid use as compared to others (prescription opioid use or heroin use). Tramadol can be an alternative medication for harm reduction in select group of patients with opioid dependence. Further research is required to strengthen the evidence base of rational use of tramadol for maintenance treatment of patients with opioid dependence.

Maintainence Treatment of Opioid Dependence with Tramadol

Background:Although tramadol has been used in the management of acute withdrawal in patients with opioid dependence, its use for maintenance treatment as a harm reduction approach has not been assessed systematically. This case series describes patients with opioid dependence who were treated with tramadol for long-term maintenance.Methods:Patients with opioid dependence who received treatment at the National Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, were included in the study. Patients who received at least 6 months of tramadol and had follow-up adherence of more than 80% were included in the case series.Results:A total of 25 cases were included, all of whom were males. The types of opioids being taken at the time of initiation of tramadol were natural opiates (poppy husk and raw opium), followed by heroin. The median dose of tramadol at initiation and maintenance was 300 mg/day. Nineteen patients were able to achieve complete abstinence to other opiates on tramadol.Conclusion:Tramadol may be an effective option in the long-term management of patients with opioid dependence. Further studies are required for establishing the efficacy of tramadol for agonist management of patients with opioid dependence.

Profile of women substance users seeking treatment at tertiary care treatment center in India: A retrospective chart review study

ABSTRACTIntroduction: Among substance users, women represent a small, unique subpopulation. Studying their socio-demographic and substance-use profile helps us understand their concerns and formulate management strategies. Materials and Methods: In this retrospective chart review, all the available records of outpatient treatment seekers at National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), Ghaziabad, from 1 January 2011 to 31 December 2015 were screened. Data from the women substance users were entered into a specially designed MS Excel format and analyzed. Results: In these 5 years, 217 women (mean age 36.75 ± 11.84 years) sought treatment. Majority were married (75.6%), housewife (53.5%), educated (59.4%), from an urban background (70.0%). Most common primary substance used was opioid (61.3%), including heroin (30.0%) and pentazocine (16.1%). About 20.3% reported injectable opioid use. The mean duration of opioid use was 5.44 ± 4.68 years. History of prior treatment seeking was reported by 4.6% and no prior significant abstinence attempts by 77.4%. Discussion and Conclusion: Majority of female treatment seekers, are young, married urban women and seek treatment for opioid use, particularly heroin (as opposed to pentazocine, suggested by previous studies). Prior treatment seeking and abstinence rates are low. Data indicates the need of specialized services for this population.

An Association Study of the COMT and GABA Gene Variants with Alcohol Dependence

Alcohol dependence (AD), associated with high mortality and morbidity is caused due to involvement of both environmental and genetic factors. Behavioral effects of alcohol including cognitive impairment, motor incoordination, tolerance and dependence are likely due to its effect on the multiple brain proteins including neurotransmitters. Dysfunction in these neurotransmitter systems may be at the level of enzymes involved in metabolic degradation, or receptors involved in neurotransmission like dopamine, Gamma-amino butyric acid (GABA), serotonin etc. Genetic polymorphisms in these neurotransmitter systems are implicated in conferring susceptibility to AD. Aim: To identify association of single nucleotide polymorphisms (SNPs) in COMT (rs4680 and rs2075507) and GABAA receptor genes (rs13172914 and rs211014) with AD. Method: A total of 100 AD patients diagnosed on the basis of DSM IV criteria from the outpatient clinic of the National Drug Dependence Treatment Centre (NDDTC) of All India Institute of Medical Sciences (AIIMS), and 100 healthy individuals from the general population were recruited. A detailed history including pattern of drug use and demographic details with pedigree information was noted. Genomic DNA from peripheral blood samples was processed for PCR amplification followed by restriction digestion to screen for the presence of polymorphisms. Genotype and allele frequencies were evaluated and correlated with alcohol use parameters including duration of alcohol use, age at onset of alcohol use, quantity of alcohol consumed (gms/day) and WHO ASSIST score and levels of liver function enzymes (SGPT and SGOT). Statistical analysis was performed using SPSS v21.0. Results: Genetic analysis of the study group revealed COMT rs4680 to be significantly associated with AD (p=0.03), while the other COMT SNP rs2075507 showed an association with increased levels of SGPT in the patients. GABAA receptor gene polymorphisms showed no association with AD. Conclusion: The study suggests a role of COMT gene polymorphism rs4680 in conferring susceptibility to AD.

Assessment of abuse liability of Tramadol among experienced drug users: Double-blind crossover randomized controlled trial

Tramadol is a widely used opioid analgesic. Different preclinical, clinical, and postmarketing surveillance studies show conflicting results regarding abuse potential of this drug. A randomized double-blind complete crossover study was conducted at National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. Total subjects were 10, comprising total 120 observations (each subject assessed at baseline, 5, 45, and 240 minutes). Subjects with history of substance abuse were included after detoxification and informed consent. Assessment was done using modified single dose opiate questionnaire, morphine benzedrine group (MBG), pentobarbital chlorpromazine alcohol group (PCAG), and two bipolar visual analogue scales (VAS) after administration of three drugs-Tramadol (100 mg), Buprenorphine (0.6 mg), and Placebo (Normal Saline) intramuscularly, at 5-day interval. In intra-group analysis, there was statistically significant increase in scores of all four scales from baseline to all three time points after Tramadol and Buprenorphine administration. In inter-group analysis, statistically higher scores were seen for Buprenorphine in comparison to Tramadol at 5, 45, and 240 minutes for MBG scale; the score was significantly higher for Buprenorphine in VAS for pleasurable effect at 45 and 240 minutes, but not at baseline and 5 minutes. There was no significant difference in score at any point of time between Tramadol and Buprenorphine in PCAG scale and VAS for sedative/alertness effect. The scores were statistically insignificant in case of Placebo. All the subjects liked Buprenorphine most and then Tramadol followed by Placebo. Tramadol has abuse potential (even in therapeutic doses) more than Placebo but less than or comparable to Buprenorphine.

Who Seeks Treatment for Dual Disorders? Observations from a Dual Disorder Clinic at the National Drug Dependence Treatment Centre in India Over a 12 Year Period

Background: There is limited literature available on the diagnosis and treatment of dual disorders in non-western settings. Objectives: The present study aims to describe the profile of patients diagnosed at a dual disorders clinic over a period of 12 years. Patients and Methods: This retrospective study analyzed the case records of patients registered in the dual diagnosis clinic of the national drug dependence treatment centre (NDDTC) in Ghaziabad. Information relating to the demographics of the sample, substance use disorders, and psychiatric disorders were extracted from the case records. The association between the use of specific substances and psychiatric illnesses was assessed. Results: The study included 492 patients, the majority of whom were male, married, and employed. Psychotic disorders were the largest category among the comorbid psychiatric disorders (38.7%), followed by depressive disorders (27.5%), and bipolar disorders (20.0%). Among the patients with primarily psychotic disorders, 40.8% were deemed to have substance-induced psychosis. Cannabis use had greater odds of being associated with psychotic disorders, opiates and benzodiazepines with depressive disorders, and alcohol with anxiety disorders. Conclusions: The establishment of a dual diagnosis clinic offers an opportunity to gain further insights into the characteristics of patients diagnosed with dual disorders. It may also offer opportunities for training health-care personnel, evaluating specific treatment approaches, and providing comprehensive services customized to the patients’ needs.

A Retrospective Chart Review of Treatment Completers Versus Noncompleters Among In-patients at a Tertiary Care Drug Dependence Treatment Centre in India.

Background and Aims:Engagement into treatment is crucial for improving outcomes among patients with substance use disorders. This study aimed to find the rates and characteristics of treatment noncompletion in patients who were admitted to a drug dependence treatment center in north India.Methods:This retrospective record review analyzed data from consecutive patients admitted between January 1, 2014, and December 31, 2014, at the National Drug Dependence Treatment Centre, Ghaziabad, India. The type of discharge was discerned from the records, along with selected demographic and clinical characteristics of the patient.Results:A total of 942 in-patients were included in the analysis, 936 (99.4%) of whom were males. The mean duration of ward stay was 12.7 (±8.1) days. Of the 942 patients, 779 (82.7%) completed the inpatient treatment while 163 (17.3%) did not complete (n = 95, 10.1% were discharged against medical advice; n = 44, 4.7% were discharged on disciplinary grounds and n = 24, 2.5% absconded or left without intimation). The inpatient treatment noncompleters had a shorter duration of ward stay (8.3 ± 6.9 days vs. 13.6 ± 8.0 days, P < 0.001), were of a greater average age (33.1 ± 10.0 years vs. 30.5 ± 9.4 years, P = 0.002), were more likely to be dependent on opioids (71.2% vs. 59.1%, P = 0.004) and less likely to be dependent on alcohol (30.1% vs. 42.9%, P = 0.002) than treatment completers.Conclusion:Understanding the characteristics of patients with substance use disorders who do not complete inpatient treatment may help in identifying those at-risk of having poor outcomes. Efforts are required to address their concerns so that the overall patient outcomes can be improved.

Injection drug use among children and adolescents in India: Ringing the alarm bells.

Introduction:Injection drug use (IDU) is intricately linked to preventive aspects for human immunodeficiency virus from a public health perspective. No large-scale data are yet available for injectable drug use among children and adolescents in India, apart from few anecdotal reports.Aims and Methods:The present paper reports on the profile and substance use pattern of 509 child IDU users, among a total sample of over 4000 children using substances across 100 sites from 27 states and 2 UTs in India. It was undertaken in 2012–2013 by the National Commission of Protection for Child Rights in collaboration with the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. For inclusion, participants had to be 18 years or less, should have used at least one other substance besides tobacco in the last 1 year, and should be living at home/street, in or out of school. Data were gathered using a 95-item semi-structured questionnaire.Results:A large proportion of ever users of IDU also reported use in the past year (96.5%) and past month (92.7%). Apart from IDU, tobacco, alcohol, cannabis, and pharmaceutical opioids were the most common substances of abuse in order of frequency. There was an interval of about 3 years from the initiation of tobacco to the initiation of IDU. Average age of onset for IDU was a year lesser in males than female users. The street children initiated IDU earlier than out-of-school and schoolgoing children. No quit attempt was made by more than half of the children. More than 40% had frequent familial conflicts, more than half had a familial history of substance use, and three-fourths had drug-using peers.Conclusion:The paper highlights the profile and pattern of children and adolescents using IDU across many parts of India, dispelling the myth that IDU is largely an adult phenomenon in India. There is a clear need to promote different harm reduction and preventive strategies across the “hard-to-reach” younger age groups using injecting drugs.

Profile of female patients seeking in-patient treatment for prescription opioid abuse from a tertiary care drug dependence treatment centre from India.

Background & objectives:There has been a limited focus on prescription drug abuse among women in the country. Choice of psychoactive substance, reasons for initiation and co-occurring disorders have been found to be different among men and women. The current study was aimed at studying the profile of female patients seeking in-patient treatment for prescription drug use over a period of five years at a tertiary care drug dependence treatment centre in India.Methods:Case records of all female patients admitted with substance use disorder at a national level drug dependence treatment centre in north India across five years (between January 2008 and December 2012) were reviewed retrospectively to study their socio-demographic and clinical profile. The information was gathered using a semi-structured proforma and detailed case records. Abstinence, relapse and retention rates were calculated.Results:Over the five years, 31 female patients were admitted with prescription drug abuse. Of them, 12 (39%) used prescription opioids and 11 (36%) used prescription opioid along with benzodiazepines. Commonest prescription opioid was pentazocine used by 87 per cent of the women. Twenty two (71%) women were introduced to opioid by medical practitioners and commonest reason for introduction was pain (among 48%). Common co-occurring psychiatric diagnoses were depressive disorder (26%), cluster B traits/disorder (19%) and somatoform disorder (13%). Eight women did not complete treatment and left against medical advice. Thirteen women were advised maintenance treatment, and 70 per cent of them were retained for at least six months.Interpretation & conclusions:Our findings revealed a link between mental illness, pain and non-medical use of prescription opioids among women. Majority of these women received opioids as a legitimate prescription form physician. Therefore, these legitimate prescribers should be trained for pain management to facilitate proper treatment of pain and to prevent the subsequent misuse of these medicines. Female patients with frequent pain complaints should be assessed for psychopathology while prescribing opioids.

Brief Intervention with Adolescents Having Inhalant Use Disorder: a Case Series

Introduction The prevalence of substance use is among adolescents is on rise. In India, inhalant is one of the common drugs of use and acts as a gateway for illicit substance use. The mainstay of treatment for inhalant use among this population is psychosocial interventions. In India, we largely rely on western models to guide intervention programs, however, there is a need to develop and test the psychosocial interventions which are culturally relevant and effective. Objective The present study aims to highlight the culture specific psychopathological factors associated with inhalant use among adolescents. The paper aims at studying the effectiveness of a psychosocial intervention in reducing the frequency and quantity of inhalant use among adolescent clinic population. Methodology Four adolescents reporting to the Adolescent Clinic at the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi were recruited for the study. A single-case design was adopted. The pre-, and post- intervention assessment were carried out. Results and Discussion There was a significant reduction in frequency and quantity of inhalant use in the cases. The findings of the study are discussed in the light of available research work, implications, limitations of the study and suggestions for future research. The psychpathological factors and challenges to intervention are discussed.

SY03-2-4 * WHO-ISAM FELLOWSHIP BARRIERS OF TOBACCO CESSATION AMONG INDIAN BUPRENORPHINE-NALOXONE MAINTAINED PATIENTS

Introduction. Prevalence of smoking in opioid agonist treatment programme, leading to significant health hazards and high mortality. This study aims to examine the readiness to quit, perceived personal health and risk susceptibility associated with tobacco use and importance of intervention, among patients on opioid agonist treatment with buprenorphine-naloxone. Methods. Fifty-five males on buprenorphine-naloxone treatment at National Drug Dependence Treatment Centre, India, were assessed using Tobacco Use Characteristics, Fagerstrom test for nicotine dependence (smoker and smokeless tobacco user), Readiness to Change questionnaire (RCQ), Smoker's Perceived Health Risk Evaluation (SPHERE), Importance of Intervention scale and a semi-structured questionnaire. Results. 65.4% of the subjects were smokers, 9% were using smokeless tobacco only whereas 25.6% were using both. Mean FTND score of 5 ± 1.70 among smokers, denotes medium dependence. Only one-fifth of them reported prior quit attempts for tobacco. None of the attempts involved any assistance. 38.8% did not plan to quit in next 6 month. Perceived personal health and risk were poor. Only 61.62% considered intervention for smoking cessation important. Most common choice of intervention was advice and guidance only (49%). Conclusions. Higher severity of nicotine dependence, Poor willingness to quit highlights the need for on-site motivational treatment.