Abstract
Abstract Background Polysubstance use is a major public health issue among marginalized Indigenous youths in Northeast India. Ukhrul District, Manipur, is a remote tribal area where the drug dependence burden is high and district-level epidemiological data remain scarce. Design A cross-sectional, quantitative study was carried out with 250 drug-dependent youth aged 15–29 years who were sampled through snowball sampling. Structured interview schedules, which included the Fagerström Test for Nicotine Dependence (FTND; [10]), socio-demographic data, and substance use histories, were used to gather data. Data were analysed using descriptive statistics and cross-tabulations in SPSS. Results A total of 207 participants were administered the FTND, of which 66.2% had clinically significant nicotine dependence (scores ≥ 3), most commonly among older participants (26–29 years). Tobacco was the most common substance (78% daily users; 56% reported it as their first substance used). Cross tabulations revealed co-occurrence of daily use with frequent alcohol use and current or prior heroin use. High unemployment (50.4%) and low educational level were characteristic of the sample. Conclusion Results highlight the importance of implementing Nicotine Replacement Therapy (NRT) and culturally appropriate tobacco cessation services in the current substance use disorder treatment programs in Ukhrul District. More socioeconomic interventions are required to tackle structural factors underpinning the tobacco-alcohol-heroin syndemic in this population.