Exploring Addiction Part I Substance use and other battles

Last year, while some of us found the lockdown a necessary break from the hustle and bustle of the city life, “it’s been a mixed bag for people with addiction along with mental health issues that are exacerbated by health concerns, financial worries, isolation and disruption in our daily rhythms,” as said by Anna Lembke, a Stanford Psychiatrist. From a government report, a third of Indian men, ranging from the ages 10 and 75, drink alcohol. “14% Indians are binge drinkers”, says WHO in comparison to the global average of 16%.

With such severity, the aggressive lockdown in India further worsened the Alcohol Withdrawal Syndrome (AWS) and social isolation, resulting in people replacing the lack of alcohol with other toxic substances such as benzodiazepines, an increase in the sale at the grey market for Charayam (or other local substances), consistent online searches on DIY Alcohol methods, violence, and deaths by suicide. Not to mention, 15% of those that are symptomatic of AWS develop epileptic seizures and delirium tremens. These harsher symptoms are life-threatening, with a mortality rate of 20%. Thankfully, these can be managed, only when detected early, reducing it to 1%.  It is safe to say, lockdown could have stolen a primary mode of coping and a space to practice personal choice.

The book titled “Never Enough” by Judith Grisel does a magnificent job of talking about the neuroscience of addiction. She uses her journey and combines it with neuroscience to bring to light the differences in the brains of those addicted and the role drugs play in all our lives, emphasizing that in the end the cure will be found in the way we interact with our communities. A biological explanation for addiction can often provide a sense of comfort for struggling individuals. It helps them realize they aren’t alone and that someone understands their lived experiences.

Another TED talk by Michael Botticelli titled: Addiction is a disease. We should treat it like one, draw important parallels between addiction and diseases, and implore, therefore, to address the issue like any other disease in exchange for moralizing addiction. He then goes on to say, “stigma is one of the reasons I could come out as a gay man in 2015 but not about my history with addiction.” 

He further concluded by stressing the importance of changing our collective gaze on those that are enduring struggles or have a history around addiction to bring about durable changes in public opinion and thereby, influence public policy. Like anything else, mainstream digital media also focuses on bringing about varied aspects of Addiction and those that are casualties of the disorder. Popular shows such as Grey’s Anatomy and This Is Us have both portrayed this push and pull quite accurately; While one narrates a multi-generational story, the other tells the story of coping with substances amidst stressors, eventually causing harm to more than one person. 

American Psychological Association,  further accentuates, “Substance Use Disorder (SUD) is a complex condition in which there is the uncontrolled use of a substance despite harmful consequences. People with SUD have an intense focus on using a certain substance(s) such as alcohol, tobacco, or illicit drugs, to the point where the person’s ability to function in day-to-day life becomes impaired. People keep using the substance even when they know it is causing or will cause problems. The most severe SUDs are sometimes called addictions.” The development of a substance use disorder can be due to a range of factors. While there is a definitive involvement of genetics, environmental factors play a huge role too. Various research studies ranging from twin to adoption studies have all consistently found that  “approximately 50-60% of the variation in risk for alcoholism is accounted for by genetic factors.” (Prescott et al, 2016) Additionally, various environmental factors pose a risk to the development of the disorder. These factors include- peer pressure, growing up around adults who are addicts themselves, availability of substances around, poverty, and other triggers such as people, places, or activities. 

The complexities of the disorder warrant professional help since these can involve multiple diagnoses. More often than not, individuals diagnosed with a substance use disorder are also diagnosed with Depression, Anxiety, PTSD, and other mental health disorders. Sometimes, individuals struggling with depression or anxiety develop substance use disorders as a result of using substances as a coping mechanism. Other times, individuals diagnosed with a substance use disorder develop depression or anxiety ergo the substance use. While addiction may be one of the most prevalent mental health issues around the world, the stigma around it continues to be one of the biggest obstacles to overcome. The common feelings of shame and guilt around addiction can worsen one’s experiences with the disorder. It can prevent one from seeking support whether that be from a loved one or a professional.  

However, addiction being a tangled web, the government of India (GOI) has undertaken various measures to make rehabilitation and care for those that are addicted to substances as accessible as possible. The scheme, Assistance to Voluntary Organizations for Prevention of Alcoholism and Substance (Drugs) Abuse and Social Defence Services headed by the Department of Social Justice & Empowerment provides organizations that focus on rehabilitation, expenditures needed, and certifications on setting up Integrated Rehabilitation Centre for Addicts (IRCA), Regional Resource and Training Centres (RRTCs) and more. Further, these agencies are free to provide outpatient care, as opposed to the notion of isolating patients from their familiar social setting. Under this service, the patients are free to stay up to 30 days or more if they wish to do so. This also aids in accommodating as many people needing care, rather than an accumulation of in-patients. Unfortunately, the pandemic has constricted outpatient service provision as well.

Interning at an IRCA rehab center I got the privilege to sit as a co-counselor (with the consent of the client) in the sessions, they were kind enough to let a stranger be a part of their vulnerability. A few things that perplexed me was that the sessions focused:

1. On using external sources as the primary incentive to stop the addiction, E.g. “To be an honorable man of the society, you ought to fulfill *Xyz roles*.” 
2. The other measures focused solely on attaching morals to the act of addiction, thus valorizing or demonizing the individual engaged in the act. 
3. In addition, I was also troubled at the unavailability of skill-building provisions or championing an individual’s potential to instill in them maximum agency. 
4. A deprivation of a healthy routine focusing on rebuilding an individual’s injured nervous system and interpersonal elements, since the individual is in isolation and unfamiliar territory. 

Some of these transported me to a rigid system of high-moralistic values, often anti-humanistic and farther from reality. Although I do understand the intent, considering the heightened level of addiction the individual is at, nonetheless, I find these external facets to help rehabilitate; inconclusive. 

Andrius Banelis

From my limited experience of working at the rehab center and hearing common stories around other centers, it seems that a reformed holistic approach to understanding and nursing addiction in its varied forms could be the need of the hour. This is primarily because systems catering to the physical, emotional, spiritual, cultural, and social parts of an individual can positively impact their psychological wellbeing, further catering to a sustainable outcome at the end of their rehabilitative journey. In the current condition, spiritual and cultural parts are the only bits focused to resurrect them, whereas physical (physical movements), emotional (humanistic therapeutic interventions, prioritizing the individual and aiding in making their inner-world honorable as is), and social (strengthening interpersonal know-hows) parts of the individual aren’t given the significance it deserves. Something that sticks out a mile is the incorporating of the aforesaid elements since it further aids in managing underlying triggers of SUD such as loneliness, social isolation, anxiety, static ideals of the self, precarious of their inner world, the anonymity of the self, strenuous effort in practicing healthy self-control, etc. Therefore, banning a functional coping tool and focusing simply on banishing the compulsion to rely on the external source (substances) of comfort is highly reductionistic to an overly complex issue. 

Prior to starting my internship as an addiction counselor, I had my assumptions and biases about substance use disorders. I assumed that only homeless people, men, and people without a stable income, suffered from addiction. The experience of facilitating and co-facilitating groups from women to codependency groups, helped me discern that anyone regardless of gender, age, race, social, or financial status, could suffer from addiction. This exposure was both eye-opening and life-changing for me as a mental health professional. 

As a collective, it is pertinent to recognize that durable change can come into a pass, if the paternalistic trait of relating to the other would be kept aside, employing a certain kind of trust in the autonomy of the individual over their behavioral decisions. Although safer to curb the virus, evidently the lockdown has medical, ethical, and social implications on those that consume alcohol and other substances alike. From this, we should know that neither going cold turkey like the imposition of the lockdown nor underestimating that our problems are a piece of cake, will serve us in the long run; Both undermine the complex creatures we are, ignore the biochemical changes in our body and the dualities our self-inflicting vices can morph into. Confessing we have a problem that needs emotional and rational care is key to being compassionate individuals to ourselves and our social environment. 

The total shutdown of everyday life has also conceived ruminating thoughts, death anxiety, and exhaustion, triggering relapses and converting, either a social drinker to someone who’d need that glass before bed or has set ablaze addictive behaviors in the rest of us.

De-addiction center in Bangalore:

Higher power foundation – de-addiction

AA meetings in Bangalore

• 12TH STEP, Corporation Sports Club – 91-92069-14165 , 4th Square, Austin Town, Bangalore
• FOURTH DIMENSION , Jyothi School – 91-77607-52288, Lingarajapuram, Bangalore
• WISDOM, Govt.Primary School – 91-90663-49910 + 91-90664-26008 , HAL 3rd Stage, Next to Police Station , Jeevan Bhima Nagar, Bangalore
• GRATITUDE, Stacey’s Memorial High School – 91-97419-61891 , St. Marks Road, Bangalore
• PROMISES, St.Francis School – 91-82968-77350 , KrupaNidhi College, 3rd Block , Koramangala, Bangalore

*Disclaimer: This is a curated round-up but not foolproof. Please use your discretion and conduct necessary due diligence when seeking these support services.

Recommended reading:

1. In the realm of hungry ghosts – Gabor Mate
2. Guts – Kristen Johnston.
3. High on Arrival – Mackenzie Phillips
4. Never Enough –   Judith Grisel 

References

1. Anonymous. (2015, January 1st). Scheme List: Department of Social Justice and Empowerment—Government of India. http://socialjustice.nic.in/SchemeList/Send/42?mid=48565
2. Anonymous. (n.d). Helping struggling individuals with eating disorders find the strength to confront and overcome the root causes of their disease. Lindner Center of HOPE. https://lindnercenterofhope.org/addictive-disorders/
3. Anonymous. (2020, July 31). Coronavirus: 10 die drinking sanitizer after Indian state shuts liquor shops. BBC News. https://www.bbc.com/news/world-asia-india-53614343
4. Anonymous. (2020, January 20). What is a holistic approach?. NSW Government. https://www.health.nsw.gov.au/mentalhealth/psychosocial/principles/Pages/holistic.aspx 
5. Abramson .A. (2021, March 1). Substance use during the pandemic. American Psychological Association. https://www.apa.org/monitor/2021/03/substance-use-pandemic
6. Biswas .S. (2020, May 13). Dark truth behind India’s post-lockdown liquor lines. BBC News. https://www.bbc.com/news/world-asia-india-52640266
7. Cherry .K. (2020, April 19). How Holism Can Help Us Understand Behavior. Verywell Mind. https://www.verywellmind.com/what-is-holism-4685432
8. Costello, A. P. (2020, August 11). How the pandemic is affecting people struggling with addiction. Scope. https://scopeblog.stanford.edu/2020/08/11/how-the-pandemic-is-affecting-people-struggling-with-addiction/
9. Felman .A. (2021, April 23). Addiction: Definition, symptoms, withdrawal, and treatment. Medical News Today.  https://www.medicalnewstoday.com/articles/323465
10. Nadkarni, A., Kapoor, A., & Pathare, S. (2020). COVID-19 and forced alcohol abstinence in India: The dilemmas around ethics and rights. International Journal of Law and Psychiatry, 71, 101579. https://doi.org/10.1016/j.ijlp.2020.101579
11. Prescott, C. A., Khoddam, R., & Arpawong, T. E. (2016). Genetic risk for substance abuse and addiction: Family and twin studies. ELS, 1–11. https://doi.org/10.1002/9780470015902.a0005230.pub2
12. Sharma, N. C. (2020, January 14). To ease the burden on rehab centers, govt to give free OPD access to addicts. Mint. https://www.livemint.com/news/india/to-ease-burden-on-rehabilitation-centres-govt-to-give-free-opd-access-to-addict-11579026190500.html
13. Singh .S, Sharma .P & Balhara .S.P.Y. (2020, October 8th). The impact of nationwide alcohol ban during the COVID‐19 lockdown on alcohol use‐related internet searches and behavior in India: An infodemiology study. Wiley Online Library. https://onlinelibrary.wiley.com/doi/10.1111/dar.13187
14. TED. (2017, April 22). Addiction is a disease. We should treat it like one | Michael Botticelli. https://www.youtube.com/watch?v=7_RGn75JcZ8&ab_channel=TED 
15. TED. (2015, July 9). Everything you think you know about addiction is wrong | Johann Hari. https://www.youtube.com/watch?v=PY9DcIMGxMs&ab_channel=TED 
16. The Audiopedia. (2017). What Is ANTIHUMANISM? https://www.youtube.com/watch?v=Ifmt0jzZNvA&t=311s&ab_channel=TheAudiopedia.
17. Varadhan .S. (2020, July 31). With liquor shops locked down, 10 die in India drinking sanitizer. Reuters. https://www.reuters.com/article/us-health-coronavirus-india-idINKCN24W0MS