Understanding the mental health status and social support systems of individuals engaged in drug use is crucial for effective intervention strategies and support services. Drug use often intertwines with complex psychological and social dynamics, which can significantly impact an individual's well-being and recovery journey. Consequently, determining the mental health status and assessing the level of social support available to drug users becomes paramount in developing holistic approaches to address their needs.

This study aimed to delve into the methodologies and considerations involved in evaluating the mental health status and social support structures of individuals grappling with drug use. By examining these aspects, we can gain insights into the multifaceted challenges they face and devise targeted interventions to facilitate their rehabilitation and reintegration into society.

Through a comprehensive exploration of various assessment tools, frameworks, and research findings, this study seeks to shed light on the intricate interplay between mental health, social support, and drug use. By doing so, it endeavours to contribute to the development of evidence-based practices that prioritize the holistic well-being of individuals navigating substance misuse disorders.

Study setting and duration

The study was conducted within Aizawl Municipal Area (AMC), Mizoram, India, from 1st March, 2023 to 28th February 2025., a period of two years.

De-addiction centres, Hospital, Camping centres, Drop-in centres, Client’s home and Hotspots for IDUs within the area of AMC were visited during field work for both qualitative and quantitative studies.

Inclusion criteria: Any female or male adult individual abusing drugs were the respondent for the study and only those who gave consent formed the sample.

Exclusion criteria: Under aged individuals; male or female.

Study Design

The study used an exploratory research design.

Data Collection

A semi-structured interview schedule was used as the tool for data collection to collect information with regards to the objectives of the study. Qualitative data were also collected with the help of case studies and key informant interviews.

A standardized questionnaire based on Warwick-Edinburgh Mental Well-being Scale (WEMWBS) developed by a group of researchers at the Universities of Edinburgh and Warwick in the year, 2007 to support the development of an evidence base relating to public health which encompasses the promotion of well-being, the prevention of mental illness and recovery from mental illness[3]. It has the ability to capture both eudaimonic and hedonic perspectives on wellbeing (people's functioning, social relationships, sense of purpose, and personal development) (e.g. feelings of happiness, optimism, cheerfulness, relaxation).

To find out the social support received by members of drug users, a 5 point structured scale was constructed to measure 3 items each such as the availability, quality and adequacy of social support across various dimensions of social support viz. basic needs support, emotional support, physical health support, mental health support, support in life skills and instrumental support. [4],[5],[6]

For the purpose of the present study we conducted case studies, KII, FGD and questionnaires among IDU’s within AMC area, Aizawl. The data analysis report features the demography, mental health status and social support available for the client’s to identify current status of the question at hand and also to suggest measures to improve that status.

Statistical analysis

All data gathered from standardized questionnaire were entered and analysed using Statistical Package for the Social Sciences (SPSS) version 21. Additional analysis were performed by the technical officer and social worker based on the report and findings gathered from the qualitative studies such as; Case study, FGD and KII.

Socio Demographic Profile

Data from 620 drug users (2023–2025) shows that majority are aged between 18-39 years (88.2%), more than two third are male drug users and most of them earn Rs. 10,000-30,000. (Table-1)

Source: Computed                 Figures in parenthesis indicates percentages

Mental Health

Mental health status, measured using WEMWBS, showed 49.35% had medium, 46.77% had low, and only 3.87% had high mental health. (Table 2)

Source: Computed                 Figures in parenthesis indicates percentages

Social Support

The overall social support across the six dimensions from the primary, secondary and tertiary supporters is medium with regards to the availability, quality and adequacy. (Table 3).

1. Association between Social Support and Mental Health

Table 4: Co-relation between mental health and different support system

Chi-square test of association showed that the characteristics from primary supporters namely, Quality of  basic need support, Adequacy of basic needs support, Availability of emotional support, Quality of emotional support, Adequacy of emotional support, Quality of emotional support, Adequacy of emotional support, Availability of Physical Health support, Quality of Physical Health support, Adequacy of Physical Health support, Availability of Mental Health support, Quality of Mental Health support, Adequacy of Mental  Health support, Availability of Life Skill support, Quality of Life Skill support, Adequacy of Life Skill  support, Availability of Instrumental support, Quality of Instrumental support, Adequacy of Instrumental support, from secondary supporters, characters namely- Availability of  basic needs support, Quality of  basic need support, Adequacy of basic needs support, Availability of emotional support, Quality of emotional support, Adequacy of emotional support, Availability of Physical Health support, Quality of Physical Health supportAdequacy of Physical Health support, Quality of Mental Health support, Adequacy of Mental  Health support, Availability of Life Skill support, Quality of Life Skill support, Adequacy of Life Skill  support, Availability of Instrumental support, Quality of Life Skill support, Adequacy of Instrumental support and from tertiary supporters, characters such as- Availability of Basic Needs support, Quality of  basic need support, Adequacy of basic needs support, Quality of emotional support, Availability of Physical Health support, Quality of Physical Health support, Adequacy of Physical Health support, Quality of Mental Health support,  Adequacy of Mental  Health support, Availability of Life Skill support, Quality of Life Skill support, Adequacy of Life Skill  support, Availability of Instrumental support, Quality of Instrumental support, Adequacy of Instrumental support have p value less than 0.05. Hence, statistically significant association was found between these characteristics and WEMWBS at 95% confidence level and 5% level of significance.

However, there was no statistical significant association between Availability of Mental Health support by Secondary Supporters (p=0.223), Availability of emotional support by Tertiary supporters (p=0.348) , Adequacy of emotional support  by Tertiary Supporters (p=0.152) and Availability of Mental Health support  by Tertiary Supporters (p=0.136) at 5% level of significance

Qualitative Study

A study of 80 cases found drug abusers often suffer from mental health issues, especially long-term users with health problems. De-addiction centers in Aizawl are ineffective, causing frequent relapses. Accessible treatment clinics are lacking, though OST programs are easier to reach. Lack of parental and social support increases the risk of drug abuse and relapse.

Addiction, mental health, and social support are deeply interconnected, playing a crucial role in both the onset and recovery from substance abuse. Poor mental health can often lead to drug use as a coping mechanism, while prolonged addiction further deteriorates psychological well-being, creating a vicious cycle. Social support, whether from family, friends, or community programs, acts as a protective factor, offering emotional stability, encouragement, and access to rehabilitation services[7]. Understanding the relationship between these factors helps in identifying gaps in support systems, determining the needs of drug users, and formulating effective intervention strategies.

The mental health scale, constructed using the Warwick Edinburgh Mental Well-Being Scale (WEMWBS), comprises fourteen (14) items designed to assess an individual's mental well-being and further divided to low, medium and high, it showed that almost half of the respondents have low mental health and only 3% are shown to have high mental health, which confirmed the comorbidity of mental-illness and Drug abuse. The study showed that self-determination is one of the most important factor that can help a person to recover from drug abuse but is not enough as drug addiction is a complex disease, and quitting takes more than good intentions or a strong will; because drugs change the brain in ways that foster compulsive drug abuse, and quitting is difficult, even for those who are ready to do so. Religious faith is also highly suggested by clients, based on the study, to help their mental health status and help them to recover from drug addiction [8]. Acquiring new hobbies and changing their habits; their day to day life and abandoning their old patterns might help as well[9].

The social support received by respondents from primary, secondary, and tertiary sources across various domains, encompassing basic needs, emotional support, physical health, mental well-being, life skills, and instrumental aid was assessed using a 5-point scale that gauged availability, quality, and adequacy within these dimensions[10],[11],[12]. From the study majority of the clients receives a relatively good social support from primary supporters but there are many broken families which have correlation with addiction. With regards to secondary supporters we find that there is an inadequate support received. The tertiary supporters which include the government do not provide much support individually or in groups as well. These indicated that there is a lack of treatment centres, de-addiction centres and rehabilitation centres within Aizawl to meet the demands for IDUs, their success rate is also shown very low as clients tend to relapsed right away, as Garmendia, et, al., (2008)[13] stated that lack of social support can be one of the influencing factors in recurrence of drug use after rehabilitation.

The qualitative study also further confirmed the inadequacies of social support as a whole, as one of the client who is a psychiatrist from KII stated that there is no “real rehabilitation centre” in Aizawl, which is true in a sense that all of the de-addiction centres in Aizawl usually does not provide complete services such as structured surroundings, expert medical and psychological care, personalised treatment programs, and more, with a specialized approached, they are mostly faith-based with some un-professional medical and incomplete psychological care[14], there are some relatively good centres that provided most of the mentioned services which are in high demand. Especially in recent years, with high prevalence of drug abuse, de-addiction centres are in high demands and could not keep up with the demands. Support from immediate family, based on the study, is relatively good as clients mostly reported that their family supported them if they show the willingness to comply, although there are a few clients with no family to turn to, and some even living on the streets, who reported that stigma against them from the society as a whole is unbearable, the most support they could get is to be admitted in TBC centre by the YMA without their consent, which is a de-addiction centre funded by the YMA and charity, and is notorious for their human rights violations, poor facilities and poor diet etc. nevertheless, facilities are upgraded in recent years as reported.  Harm reduction programs such as OST programs facilitated by drop-in centres are relatively easy to access for the clients, and also seem to show relatively satisfactory results, according to Singh et al (2017)[15], Drug addiction can be treated with medications and psychological treatment.

In qualitative studies, the clients are selected from de-addiction centres, Drop-in centres, home visits and even visiting Hotspots for IDUs. From analysing the reports gathered it has been discovered that most of the clients who are long term abusers have developed minor to medium physical pain and weakness of the body, they are also found to be less likely recovered. Clients who have not been abusing for a long time; injecting only for a year or two are shown to be more determined and found to be more likely recovered[16]. The mental health status of the long term and short term abusers are different although, mental illness like sociopathic behaviour; compulsive lying, willingness to break laws, are all found in clients to a certain degree in one way or another but another form such as anti-social behaviour, depression, anxiety even suicidal thoughts are seen more in long term abusers. This is also consistent with the findings of Barnard (2007)[17] where the effects of drugs caused the feelings of anger, sadness, anxiety, shame, and loss.

Limitations of the study

The main limitations and issues faced by the research are listed as follows.

1. Some NGOs may be uncooperative, making it challenging to obtain permission to freely interact with their clients for case studies and focus group discussions (FGDs), thereby limiting access to valuable data sources.
2. Tracking clients who are not staying in de-addiction centres for case follow-up can be difficult as they frequently change addresses, leading to potential loss of valuable data and insights.
3. Often there arise a need to visit hot spots for addicts to conduct case studies, which poses safety concerns and logistical challenges, impacting the efficiency of data collection efforts.
4. Privacy concerns may arise when conducting interviews or focus group discussions in public spaces, potentially compromising the confidentiality of participants and affecting their willingness to share sensitive information.
5. Resistance or reluctance from individuals with substance abuse issues to participate in research activities may lead to recruitment challenges and ultimately limit the sample size and diversity of perspectives represented in the study.

In conclusion, addressing the impact of mental health and social support on drug users is essential for effective intervention and long-term recovery. Strengthening mental health services, fostering supportive social environments, and enhancing access to rehabilitation can significantly improve the well-being of individuals struggling with addiction. A holistic approach that integrates awareness, early intervention, involvement of parents in their children’s life while growing up and sustained support can help break the cycle of substance abuse, ensuring that those affected receive the care they need. By recognizing the importance of mental health and social support, society can take meaningful steps toward reducing addiction rates and fostering a healthier, more inclusive community.

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