The academics of substance addiction is full of definitions and statistics. The World Health Organization defines substance abuse as “persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice”. Hours have been spent on understanding the patterns. Yet, when you put a face to the problem and ask them to describe it – it very simply is about losing control.

“You know it harms you. Yet you feel so helpless to fight the urge. That loss of control is possibly the hardest thing when you battle addiction.” remembers Sahana (name changed). She should know. The 38 year-old professional who battles alcohol addiction has been in and out of rehab twice already.

“I’d have a couple of drinks with work colleagues on a weekend and before I knew it, I couldn’t go without have a drink even when I was home by myself. I couldn’t sleep without a drink.” she says. Her addiction with alcohol ended her three-year marriage, alienated her from her parents and cost her her job. It was only when her sister stepped in and admitted her into a private rehab that she recognized she had a problem.

Urban India grappling with the problem

The problem of substance abuse – which includes alcohol, tobacco, narcotics, prescription medicine among others – is growing to be a large problem in the country. The National Institute of Mental Health and Neuro Sciences (NIMHANS) conducted a study across 12 states and found that almost 22.4% of the 18+ population in these states suffered from Substance Abuse Disorders (SUDs), including alcohol and tobacco etc.

But those who work in the field also say that there has been an increasing number of youngsters who are brought in to fight addiction. Dr Jayant Mahadevan, Senior Resident, Centre for Addiction Medicine told Citizen Matters “There is a map we have noticed with the kind of substance abuse in the 13 states where this survey was done – in the North Indian belt of Haryana, Punjab and surrounding areas narcotics abuse is dominant, while in the south, it is more of opioid addiction that we see. Alcohol and tobacco are still the highest agents of substance addiction in the country.”

Dr Mahadevan also draws attention to the increasing incidence among younger people who come with addiction problems. “We have had children as young as 15 come to us with substance abuse issues. This problem cuts across the social and economic strata and affects kids from all walks of life,” he says.

In the 2013 edition of the journal Indian Pediatrics, a sample survey of just three schools in Bengaluru threw up alarming figures. Smoking started as early as 15 and cocaine came in at 12 years in the average!

Tobacco and alcohol are still most prevalent addictions in India – at 20.9% and 4.6% respectively according to the survey by NIMHANS, though the sample size was above the age of 18. With substance abuse (unlike behavioral addiction), the physiological ramifications of disease etc., along with the mental problems of depression and the like, make it more complex.

In Sahana’s case, her gender also became a factor. “My time in rehab was even more difficult because I was a woman. There is more demanded of us in the social structure – as daughters, wives, mothers. So when we fail, the backlash is greater. I sometimes wonder if my parents would have cut me off as easily as they did if I were a son. I will never know” says Sahana.

What could you do?

What leads to substance addiction? “It is usually considered a way to deal with stress and peer pressure (it is the case with both adolescents and adults),” says Dr Mahadevan. So how does one deal with an addiction or an addict in the family? He lists a few steps.

If you are addicted

• Recognising that you have an addiction is the first important step. Addiction of any kind will begin to affect your professional performance and interpersonal relations. The constant need to reach for a cigarette or a drink (or even your phone) and an absolute loss of control to stop yourself from doing that is a strong indicator of an addiction.
• There is a fine line of distinction between dependence (addicts) and regular, frequent usage (potential addicts) when we talk of substance abuse. Reaching out for help at the earliest is very important. The stronger the addiction, the more time it will take for you to get out of it.
• The first point of contact can be your general physician or any hospital with a psychiatry wing which is trained to act as first point of contact.
• Recovery does not follow a similar graph for everybody – both as a timeline and intensity. Reach out and create a support system of family and friends to help you through it.

If you have an addict amidst you

• The first step is not always about recognising the addiction. Family members (especially in the case of minors) and friends should watch out for mood swings and erratic behaviour. With children, parents need to watch out for thieving as an indicator. Dilated pupils/spaced out responses are also indicative of substance abuse.
• Since children are legally wards of their parents, they are usually brought to hospital even in the absence of consent. Try to convince them instead. The therapy is a lot more effective when the addict is a willing participant.
• Be a constant support system, but do not spy on their lives. Allow them the confidence of dealing with the problem by themselves as well.

Another golden rule Dr Mahadevan lists is to allow oneself to have a realistic approach during post therapy care. “While abstinence is ideal to deal with an addiction, do know that there will be lapses. You will reach out for that one drink or a cigarette. The point you have to work on is to ensure that the lapse does not become a relapse. Discipline is the key to one’s recovery. Realign your brain to understand pleasure sources. Pick up a new hobby. It can be done.”

Sahana agrees. “I fell off the wagon again after I stayed sober for two years. I wasn’t able to hold my job and it caused a relapse. But this time, I went back to rehab myself and that was a great feeling too. The key is to believe that you can do it.”