Strategy for the management of substance use disorders in the State of Punjab: Developing a structural model of state-level de-addiction services in the health sector (the “Punjab model”)

BACKGROUND: Substance use disorders are believed to have become rampant in the State of Punjab, causing substantive loss to the person, the family, the society, and the state. The situation is likely to worsen further if a structured, government-level, state-wide de-addiction service is not put into place. AIMS: The aim was to describe a comprehensive structural model of de-addiction service in the State of Punjab (the “Pyramid model” or “Punjab model”), which is primarily concerned with demand reduction, particularly that part which is concerned with identification, treatment, and aftercare of substance users. MATERIALS AND METHODS: At the behest of the Punjab Government, this model was developed by the authors after a detailed study of the current scenario, critical and exhaustive look at the existing guidelines, policies, books, web resources, government documents, and the like in this area, a check of the ground reality in terms of existing infrastructural and manpower resources, and keeping pragmatism and practicability in mind. Several rounds of meetings with the government officials and other important stakeholders helped to refine the model further. RESULTS: Our model envisages structural innovation and renovations within the existing state healthcare infrastructure. We formulated a “Pyramid model,” later renamed as “Punjab model,” where there is a broad community base for early identification and outpatient level treatment at the primary care level, both outpatient and inpatient care at the secondary care level, and comprehensive management for more difficult cases at the tertiary care level. A separate de-addiction system for the prisons was also developed. Each of these structural elements was described and refined in details, with the aim of uniform, standardized, and easily accessible care across the state. CONCLUSIONS: If the “Punjab model” succeeds, it can provide useful models for other states or even at the national level.