Current Perspectives on Substance Use Disorder in Bhutan

Bhutan is a small landlocked nation in the Eastern Himalayas, and the country’s development philosophy is rooted in the concept of Gross National Happiness (GNH), which seeks to balance material and spiritual well-being. GNH guides Bhutan’s development strategy, aligning with the Sustainable Development Goals (SDGs). Despite significant strides in human development, Bhutan faces challenges such as economic diversification, income inequality, environmental conservation, and climate change adaptation. However, substance use among adolescents has emerged as a major challenge. Alcohol, the most used and abused substance in Bhutan, is associated with high rates of mortality, morbidity, suicide, and violence. The per capita consumption of pure alcohol among adults significantly exceeds global consumption, leading to alcoholic liver disease (ALD) being the primary cause of mortality among the male population in Bhutan. The country’s long and porous border with India poses challenges to law enforcement agencies due to the easy accessibility of substances. While “hard drugs” are not prevalent, teenagers often begin experimenting with volatile substances before progressing to cannabis. More harmful substances include pharmaceutical products containing opioids, which are available in India by prescription but are banned in Bhutan.