A Multi-Faceted Treatment Approach with The Happy Tree
Our weekly webinars talk about various industry scenarios and challenges of rehabs across the country and the de-addiction and mental health challenges the mental health community faces and people in general.
In the second webinar of a new 2021 series, we invited Dr Anuneet Sambharwal – Founder of The Happy Tree. The webinar was hosted by Ms Akansha – Project Manager of RehabPath, India, who was assisted by Ms Rajnandini – Editor at RehabPath, India and a professional psychologist.
In the webinar, Dr Sabharwal shared his views on opening India’s finest De-addiction and mental health hospital along with a multi-faceted treatment approach.
You can read the summary of the webinar below or you can watch it online here.
Ms Rajnandini: Please tell us about you.
Dr Anuneet Sabharwal: I have been associated with the de-addiction and mental health community for almost a decade now. I have been working predominantly on an OPD-based setup for the last five years before I decided to open my facility. The Happy Tree is 5-6 years old but the in-patient facility was only started over a year ago. I also actively engage with the media in all forms like radio, print, and online. I also engage with colleges and universities for training, sometimes including corporate setup. Since my area of interest is de-addiction, so The Happy Tree was born.
Ms Rajnandini: Please tell us about The Happy Tree and how it is different from other facilities.
Dr Anuneet Sabharwal: The Happy Tree came into existence in 2016 after finishing my education. Then, I came back to Delhi to pursue SR (Senior Residency) at GB Pant Hospital. The process of starting my OPD came during those days. The basic idea was to bring cutting-edge neuromodulation techniques and technologies to India that are not given much emphasis. I also wanted to introduce an IPD where importance is also given to psychotherapy and medication besides treatment processes.
Many facilities don’t stress much on medication, psychotherapy or neuromodulation. The usual setup has someone who has had an addiction in the past or a psycho-social worker, only sometimes does a trained psychologist talk to the patients of substance use addiction. There is a lack of trained professionals for addiction and comorbidity management, including psychiatric comorbidities that are often ignored.
All of this creates a big gap in addiction management. I wanted to have a diagnosis centre where everything is amalgamated into a system that an average person can afford and get quality treatment.
Rajnandini: How does having both psychiatric and rehabilitation facilities under one roof benefits the patients?
Dr Sabharwal: Data states that 40-45% of people with addiction also have psychiatric problems. While managing one, you are likely to miss the other problem at hand. You may have depression that might lead to addiction and vice-versa. These things are often ignored during addiction treatments. It is why I wanted to have a facility where both the issues are adequately addressed.
During treatments, a psychiatrist’s access is also not frequent. I wanted to have both the facilities should the patients need a change of medicine or referral for psychotherapy or if they need a neuromodulation procedure.
Traditionally, the patient goes to a hospital for medical detox for ten days from where they are referred to another substitute centre. In such cases, almost 90% of the patients do not visit the substitute centre. The moment you are out of the hospital, you are out of supervision. That is where abstinence or relapse happens.
Alternatively, the patients may directly reach the centre expecting them to also provide detoxification. Initial 10-15 days can even threaten their lives if the centre does not have a medical detox facility.
The facilities in our hospital can be considered as essentials and not luxuries.
Rajnandini: How does a typical day at The Happy Tree look like?
Dr Sabharwal: In a substitute centre, there’s a typical schedule that everyone follows. Because we are not a substitute centre, we function more like a hospital in terms of activities.
Let us say, you want to have breakfast. It will come to your room but it’s not expected of you to eat it right away. Since it is a hospital, you are free to choose. We do not force schedules upon our patients. We encourage them to engage with others and enjoy their time. We offer many indoor games and activities like board games. The hospital has only one television so that patients are not confined to their rooms.
Throughout the day, psychotherapy sessions, neuromodulation procedures, and other things go as per the routine. Individual therapy sessions occur every week at no extra cost. Investigation of the addiction happens in the first week of the patient wherein the physician visits and collects information to assess their current situations.
If they are professionals, our policy also allows them to bring gadgets and work as and when they require with some restrictions. If a person has gambling issues or shares their gadgets with someone else in the hospital, gadgets are forfeited in such cases.
We might revise this policy in future but these activities occupy patients the entire day. Furthermore, some patients often end up being friends with the staff. We also have Yoga between 6 – 9 AM and 4 – 6 PM, which patients can choose to attend as per their convenience.
Rajnandini: Could you tell us about the basic treatment structure being followed at The Happy Tree?
Dr Sabharwal: It is a combination of three things.
First is a psychiatric intervention where I come in. My job is to prescribe medication and advise neuromodulation procedures as and when required. I must also rule out psychiatric issues, if any, and initiate medication for the same. The biggest benefit of having a psychiatrist 24*7 in the facility is that I can make decisions regarding a patient’s increase or decrease of the medicinal dose. Let us say, a person has behavioural addiction like sex or porn addiction, they might need intense psychotherapy that can be done at any time of the day or night.
The second and most important aspect of the treatment is psychotherapy. We usually do two psychotherapy sessions in a week for most individuals. One session is individual while the other is a group session. If the patient has been in the facility for more than three weeks and has already done 6-7 sessions, they can also decide to skip one or two sessions.
The third aspect is the neuromodulation procedures that separate us from others. We carry out many neuromodulation procedures through different devices that may or may not have been seen in India before. These are cutting-edge devices that help an individual manage intense cravings. In addition, we also do Ketamine Infusion Psychotherapy that no one might be following in India right now. The US also approved it last year. We are one of the only two facilities in India that have a Ketamine Infusion method.
We are also looking forward to the legal approval of the use of psychedelics that can be available in the US in the next five years (similar timeline for India). My focus has always been on the latest cutting-edge technologies for our aid. However, I believe psychotherapy is the most important factor for an individual’s recovery.
Most programs have a duration of 1-3 months because our patients are mostly professionals who may not want to lose their jobs or suffer business losses. However, we are a licensed psychiatric facility that allows us to remove this timeline. We can make the patients stay as long as we want.
We generally encourage people to visit us for a month, take the treatment, and discuss further courses of action. Should they choose to move out after a month or two, we support their decisions.
Another thing that separates us is Naltrexone Implantation. In most facilities, patients are advised and referred to other facilities or hospitals to take this treatment. Here we have a mini operation theatre where the surgeon can come and implant Naltrexone into the patient. We have one of the lowest rates for all treatments in India.
Rajnandini: As you mentioned dual-diagnosis, please tell us more about it and how you deal with it at The Happy Tree.
Dr Sabharwal: Dual-diagnosis means diagnosis other than substance use. A pure diagnosis would be a person having substance use problems without depression, anxiety, and other psychiatric problems. But it does not happen in the real world.
In most cases, people consume substances to self-medicate or feel better and vice-versa. Stats say there is almost a 50% overlap of the psychiatric and substance use issues. This needs to be addressed at par with each other.
Rajnandini: The Happy Tree features a range of non-invasive treatment procedures. How do these assist the recovery process?
Dr Sabharwal: There has been evidence for these treatment procedures. For instance, we have Transcranial Pulsed Electromagnetic Field (TPEMF), Cranial Electrotherapy Stimulation (CES), Photo Bio-Modulation, and many other devices. Their role is to indirectly manage cravings by controlling psychiatric symptoms that come along with addiction. For instance, if you are craving a substance, you are likely to have anxiety or palpitations. It is where neuromodulation techniques come into the picture.
Some of the techniques help stimulate a specific part of the brain, some may help release neurochemicals that help you feel better and relaxed, and others may help in the overall wellness of your brain. Some techniques may help become flexible or become indifferent to old memories. These procedures help along with the medications and psychotherapy to get the patient better.
Rajnandini: How is a holistic treatment approach helpful for people?
Dr Sabharwal: Nutrition, medication, and other treatment procedures must be in sync for a holistic approach. Nutritional psychiatry is one of the newest fields in psychiatry. We’re now beginning to discover the better your diet, the better your mental health. You are going to eat probably the same as your ancestors. We try to keep the food as vegan as possible. During the treatment, we also administer nutritional supplements that are known to aid the overall recovery of the organs.
Rajnandini: Do you see stigma in your area of practice?
Dr Sabharwal: Not only in my work but also colleagues from other fields also have this sub-conscious stigma towards mental health. Nobody wants to acknowledge or talk about it unless someone in their family faces the issue. But the best part of living in young India is that our youth has taken charge of fighting the stigma with us.
Maybe in my generation, the problem persists. When I see young people who come here for help, I’m happy to see because they are taking help at the right time. Some of them take the treatment and become completely fine or off-medication in a couple of months. If I would have started this facility 10 years ago, we would have come across more stigma than today.
Rajnandini: Many people do not recognise the illness until it worsens.
Dr Sabharwal: It majorly happens with addiction. If a patient consults me today, they are very likely to get admission a year after. It still happens with addiction.
Rajnandini: Do you see stigma affecting the patient’s recovery process?
Dr Sabharwal: Absolutely. In India, nobody wants to be called a ‘Sharabi’ or alcoholic. Since nobody wants to be labelled, they stay in denial and continue drinking to death. Of course, it affects their recovery process. If you have cancer or heart disease, everyone sympathises with you. But if you have an addiction, the same people blame you for it. This part of addiction is tragic because it is an illness like any other. I believe it must be given its importance as there are reasons responsible for it beyond psychological aspects.
Rajnandini: People often try to attach shame to it and expect the person to just stop drinking. But that’s not how it works since it is an illness. How do you deal with such a stigma, especially if within families?
Dr Sabharwal: Our job is to counsel and tell them to not let it worsen because it becomes irreversible after a certain point. Following this, some people can have severe medical conditions like cancer or liver damage.
If you come at an early stage, it is the best time to take treatment. However, the patients can take the treatment at any time and live a little longer.
Rajnandini: It only needs awareness and some psychoeducation to remove the stigma. Moving on to our next question, how affordable are the treatment plans at The Happy Tree?
Dr Sabharwal: They are very affordable. We opened our doors to the patients in the middle of this pandemic but the response has been extraordinary. I’d put it this way – if you can use alcohol every day, you can afford our facility for treatment. This is by far the most affordable facility in the segment in India. The rates are low because of the pandemic and our recent inauguration of the facility. However, the rates will be revised in the future.
Rajnandini: In the deaddiction segment, what are the things lacking in India compared to the western countries?
Dr Sabharwal: In my opinion, psychoeducation at large and debunking stigma are two major things lacking here. I have many international clients who are in tune with their mental health and have supportive families. In India, it is shoved under the carpet and assumed to magically disappear.
We have good facilities and psychiatrists who run individual centres but there is no standardisation for building the infrastructure and providing services. In western countries, there is a chain of such facilities and SOPs.
I have visited at least 15-20 facilities in India run by psychiatrists that are doing a great job and I see progress in the overall infrastructure and patient’s health. If the spouse was an alcoholic 20 years ago, people used to resign on their betterment thinking they would eventually die. It has changed today. People are making efforts for themselves or their loved ones to get better.
Our relapse rate is 80% but we still have a 20% chance of improving.
Rajnandini (Question from participant): How important is nutrition in the recovery process and what an ideal meal should look like?
Dr Sabharwal: Nutrition is essential for everything. An ideal meal includes everything that you can cook or get at home like vegetables, lentils, chapati, rice, curd and salads. When people consume substances (especially cannabis users), they binge eat a lot. Many of our obese patients lose weight during their stay in the facility because of a proper diet.
With light and healthy meals, they feel better, lightheaded, become active and focussed. I’ve to mention here that we make our pickles.
Rajnandini (Question from participant): Can someone take a 100% holistic approach to treatment and if it is possible?
Dr Sabharwal: We do not recommend it as it can be life-threatening, especially with severe withdrawal symptoms. Let us say, you are driving while having a withdrawal symptom, an accident can happen that could lead to fatalities. It can happen with a host of substances under drugs or alcohol. As a psychiatrist, I would not recommend taking a 100% holistic approach.
Rajnandini: It is like applying zandu balm on your fractured leg or arm.
Rajnandini (Question from participant): What are the requirements of patient admission to your centre w.r.t. COVID-19 protocols?
Dr Sabharwal: We run COVID-19 tests for all the patients taking admission in our centre. The RT-PCR test is done by the staff at the facility before admitting the patient.
We have an SRL collection centre in the hospital where we can run all the tests.
Rajnandini (Question from participant): Are there any virtual or online options at The Happy Tree in case the patient cannot admit themselves to the hospital?
Dr Sabharwal: You can certainly book an appointment with our counsellor and take psychotherapy sessions. As the main person in charge, I would always recommend in-person appointments because nothing can change the human element of interaction. We are seeing teletherapy or online psychotherapy getting popular but the response from the in-person appointment is different. However, we are still open online to help.
You can get in touch with us through the numbers mentioned on the website and book an appointment. We also ship medicines to our patients who travel anywhere within the country for jobs or any other purpose.
Rajnandini (Question from participant): Many organisations have now started using psychedelics for treatments of mental health issues, especially in the US, after much research. What is your take on this?
Dr Sabharwal: We are doing it through Ketamine Infusion aided psychotherapy. They are not yet available or legal in India. But the moment it becomes legal, we will become the first facility to use this treatment procedure. This aspect of psychotherapy fascinates me. To my knowledge, we are the only facility actively using Ketamine Infusion aided psychotherapy in India.
Rajnandini (Question from participant): Do you have any views on people locked in their homes for a long time?
Dr Sabharwal: If you are locked inside your home for long and face mental health challenges, we are here to help and take this further after our discussion. People dealing with issues other than addiction are also welcomed at The Happy Tree.
Rajnandini (Question from participant): In the last webinar, you predicted the addiction outbreak that did happen. How do you see the situation in the upcoming months?
Dr Sabharwal: Now that the pandemic has happened, I expect people will now take more help for diagnosis and treatment. There’s something I’d like to say that regularly happens. The moment a person’s withdrawal symptoms go away, they feel they have managed to overcome it.
At The Happy Tree, we aggressively manage the symptoms. Withdrawals symptoms usually last 3-4 days or 1 week at max, we try to manage it by the third or fourth day itself.
Some patients start thinking they have recovered since withdrawals are over and decide to go home. The actual treatment starts after the withdrawal symptoms have been managed. It does not start from your Day 1 of hospital admission. The entire treatment focuses on recovery and not only on detoxification.
If you are looking to treat yourself or your loved ones, you must not focus only on the withdrawal symptoms because it is a minor aspect of the recovery process. You must consider the time after completing the treatment where you must deal with real-life situations. Relapse can happen if the circumstances are not favourable. It is why substance use and recovery programs exist for a longer duration (than one week). It takes up to six months for recovery and a lifetime to maintain it.
We try neuromodulators to hasten the process but it does not happen in 3-4 days. Rewiring or rewriting a brain takes time. Give yourself at least one month and then decide if you want to continue and join a substance use program.
Akansha: Thank you Rajnandini and Dr Sabharwal for an insightful session today. If you have a message for us, Dr Sabharwal, please share.
Dr Sabharwal: If you are addicted or know someone who is, get help today because you do not want to regret it five years later when they are gone. Addiction claims many lives each year and it is not a happy place to be. Losing someone at the age of 35-40 is not easy but can be prevented with appropriate intervention.
Disclaimer: If you have any other substance abuse problems, get help as fast as you can. Go to your nearest psychiatrist or a rehab centre and get the help you need. All the rehabilitation centres are open.
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