How you can be a helping hand to people with addiction
Substance Abuse in India
India has seen an alarming epidemic of substance abuse amongst the young generation which can be attributed moderately to changing cultural values, dwindling supportive bonds, increasing economic stress, and unaddressed mental distress that has been the experience of this generation. In addition to this, the processes of urbanization, migration, and industrialization have led to a weakening of the traditional social sanctions of control over individuals, leading them to be vulnerable to addiction as a new mode of life.
Cannabis, heroin, and Indian-produced pharmaceutical drugs are found to be the most prominently abused drugs in India. India has unofficially about five million heroin addicts with one million registered ones, according to a UN report. Cannabis products, often referred to as ganja, bhang, or charas, having attained some amount of religious sanctity as a result of their association with some Hindu deities, are abused throughout the country. Due to the convenient availability of pharmaceutical products containing narcotics at 1/10th the cost of heroin, they continue to be increasingly abused.
https://www.pravara.com/pmr/pmr-1-4-2.pdf
Out of 3.1 crore Indians using drugs, 72 lakh are drug addicts of which only one in 20 gets treatment in a hospital.
However, of all the psychoactive substances, alcohol is the most commonly used with 16 crore Indian consumers, of whom every third tippler requires help for alcoholism. Of people reporting for alcohol dependence, only one in 38 receive any treatment and only one in 180 people get hospitalized to address their addiction.
https://www.thequint.com/voices/blogs/alcoholism-rising-menace-which-india-needs-address#read-more
Most drug users have been reported to be in the productive age group of 18-35 years, which implies severe loss of human potential for the country, given the high damage caused by drugs to the physical, psychological, intellectual, and moral growth of the youth. When it comes to adolescent drug use, it is found that most boys by the time they have reached the ninth grade have tried at least one of the substances.
https://www.pravara.com/pmr/pmr-1-4-2.pdf
Various studies have found alcohol use in India to be prevalent in both rural and urban areas, with prevalence rates of 23-74% in males, and although it is not that common in females, with prevalence rates of 24-48% in females belonging to certain sections and communities.
https://www.nhp.gov.in/healthlyliving/alcohol-use-disorder
Mental Health and Substance Abuse
When someone has a substance abuse problem along with mental health issues such as depression, anxiety, or bipolar disorder, it is termed a co-occurring disorder or a dual diagnosis. Together, they negatively affect one’s ability to function at work or school, maintain healthy relationships, handle life’s difficulties, and maintain a stable home life. These co-occurring disorders also impact each other such that when there is an untreated mental health problem, the substance abuse gets worse; and when the substance abuse increases, the mental health issues usually increase as well.
Although one doesn’t necessarily cause the other, mental health issues and drug and alcohol abuse can be interlinked in the following ways:
Alcohol and drugs are often used to soothe mental health distress.
For many people, alcohol and drugs serve as their attempts at self-medicating to ease the distress caused by an undiagnosed mental disorder, to change their mood temporarily, or to cope with difficult emotions. However, in the long term alcohol and drugs end up worsening the very symptoms they initially helped to soothe.
Alcohol and drugs can enhance the risk of mental health disorders. Although substance abuse has not been evidenced to directly cause a mental health disorder, if a person already is susceptible to developing a mental health disorder, using alcohol and drugs can serve as a catalyst towards its development. For instance, abusing opioid painkillers and cannabis have been linked to a greater risk for depression and schizophrenia respectively.
Alcohol and drugs can worsen the symptoms of a mental health problem. Substance abuse can sharply increase the severity of an already existing mental health problem in a person. It can also decrease the effectiveness of medications such as antidepressants, mood stabilizers, and anxiety medications, thus prolonging the recovery period.
Even in the absence of a clinically diagnosable mental health disorder, substance abuse can muddle with one’s emotional self-regulation skills as a result of the substance in the body taking precedence over one’s rational thinking and awareness of thoughts and feelings, thus leading to an inability to process and change emotional states to more positive ones.
The Importance of Raising Awareness
Given the statistics above that point to a high percentage of people in India, especially the youth between 18-35 years of age, using and abusing alcohol and drugs, with or without the knowledge of their harmful consequences on their physical, emotional, and mental health, it is a no-brainer that raising awareness against drug and alcohol addiction in India has become a necessity. Also, it has been found that about 10-15% of alcohol abusers commit suicide. Moreover, it stands to reason that the receiving of early treatment by this population can save a significant number of lives. Thus, by raising awareness and understanding the requirement of treatment, we are collectively preventing the loss of human potential and lives. The first step towards this goal achievement, however, would be very small – that of educating yourself first.
https://www.nhp.gov.in/healthlyliving/alcohol-use-disorder
How You Can Help a Person with Addiction
Helping a person with addiction can be challenging, especially since a lot of reasons can come in the way of their seeking or accepting help such as them –
o not agree they have a problem,
o using substances as a means to avoid dealing with other mental health issues,
o not wanting to change their addiction behaviour,
o feeling embarrassed or uncomfortable discussing their addiction with you or anyone else,
o feeling uncomfortable or awkward discussing their personal issues with a professional such as an addiction counsellor or a doctor.
Moreover, there are various aspects that one needs to be intentional about when approaching a friend or loved one about their addiction:
Establish Trust – Establishing trust with them can be the first step that can lead an individual with addiction towards confiding in you and considering the idea of change. For this, it is important to avoid trust-destroying behaviours such as – nagging, complaining, criticizing, name-calling, yelling, exaggerating, and lecturing the addicted individual. Engaging in addictive behaviours yourself, even if it is in moderation, might make them think of you as a hypocrite. This is because they might think that you are not ‘walking your talk’ by engaging in the addictive behaviour yourself, and therefore you are not in an influential position to tell them that they should stop the behaviour when you yourself are unable to.
https://www.verywellmind.com/how-to-help-addicts-22238
Also, trust is a two-way street – not only should the addicted person feel like they can confide in you about their addiction without any fear of judgement or criticism, but you should also be able to develop trust in their ability and willingness to change their addiction pattern in the long term – even if they do not seem willing at the moment. Your positive or negative expectation about them affects the way you talk to them (which reflects in your choice of words and non-verbal behaviour) and thus can positively or negatively influence their receptivity to change.
Help Yourself First. Having a close one with an addiction can be difficult for you as well as them. It is important not to diminish the negative impact that this can have on your mental health and seek support. You can learn stress management techniques such as meditation, mindful walking, practicing yoga, breathwork, etc., go for counselling yourself, and/or join a support group meant for people who have to deal with an addicted close one.
Communicate. It can be tempting to let your loved one know the negative consequences that you and others may have to face as a result of their addiction and thus ask them to urgently consider changing their behaviour. It is important to not let the decision to change feel ‘forced’ or ‘manipulative’ to them, as in the end, it has to be their choice to go about changing their behaviour. A person with addiction is more likely to think about changing if the problem is communicated to them honestly and without threat. Also, if it is their choice, they will be more likely to stick through the process of change which can feel difficult in the face of relapse.
Consider Professional Treatment Options. Addiction is not like any other ‘bad habit’ that can be changed easily with discipline or threats. It is a serious problem with roots in the person’s physiology and neurology, thus, taking professional help becomes a necessary method of treatment. You can approach a Counsellor who specializes or deals with addicted individuals or an addiction rehabilitation that has counsellors, psychiatrists, and clinical psychologists, where your loved one will have access to continuous care and support to treat their addiction. You can also consider local support groups such as Alcoholics Anonymous (AA) or Narcotics Anonymous (NA). http://www.aagsoindia.org/ is a good website that will provide you information about Alcoholics Anonymous group meetings in India near you in your city. https://naindia.in/ is a similar website for Narcotics Anonymous meetings in India. However, if your loved one chooses to be in treatment privately, it might be helpful to:
o Respect their privacy in daily life. You can do this by not informing their friends, colleagues, family members, or others that they are in treatment, if your loved one may feel exposed and if it might hinder them from taking treatment.
o Respect their privacy in counselling. If they do not want to share the details of their addiction or treatment with you, do not push them to.
o Practice patience regarding the change. Change is not an overnight process, and neither is it a linear process. There will be times when your loved one might seem to have let go of their addiction and may relapse. Be gentle with them and allow them to take their time to eventually overcome their addiction.
https://www.verywellmind.com/how-to-help-addicts-22238
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=2255
The Start to Breaking the Habit
The importance of talking to an individual with addiction about their problem behavior is often undermined. Logic says addiction being a problematic behavior is an alert enough for the addict to start seeking ways to reduce it. However, more often than not, the addicted individual can be in ‘denial’ about having a problem and may rationalize that their alcohol or drug usage is ‘under control’ and in moderation. They may also be oblivious to the financial, physical, or psychological consequences that they may inflict on their family or close ones. This is why talking to a person with addiction can be a necessary start towards their breaking of the habit. However, it is important that this be done in a non-confrontational attitude only after having established trust and expressed genuine concern for the person’s well-being.
Further, since addiction is not an easy habit to break, it is important to not undermine the role of the addicted person’s friends and family members in providing support, caregiving, and a hand-to-hold, which can speed up the recovery process as well as help sustain change.
Role of Family Members
Help them follow all treatment recommendations. Regardless of the choice of treatment method, whether it is medications, individual or group therapy, rehabilitation facilities, family therapy, or a combination of these, your loved one may feel demoralized, unmotivated, sceptical about the value of treatment services, deny their problem, or have difficulty keeping track of appointments – which may make following treatment recommendations difficult for them. You can support them by –
o keeping track of their appointments,
o helping them remember to take all the prescribed medications,
o listening to their concerns about medications or treatment facilities and addressing them,
o keeping in touch with the treatment team to be informed about more ways in which you can act as a support.
Support total abstinence. The nature of addiction is such that it is not easy to limit one’s alcohol or drug usage, thus making “controlled” use impossible. Thus, the most effective way of promoting recovery is total abstinence. You can encourage this by –
o expressing the belief that abstinence helps recovery,
o helping them avoid social situations or places that can expose them to substances,
o helping them find and participate in sober, recreational activities,
o helping them develop their social network consisting only of sober people who support abstinence.
Provide social support. When it comes to people with co-occurring disorders, having stress in the family can act as a relapse factor for the substance use disorder, the mental health disorder, or both. Providing social support, in contrast, can reduce stress and thus facilitate coping. You can do this by –
o developing good communication skills that foster constructive support and minimize conflict,
o expressing your care for them,
o being resourceful and flexible when faced with a problem,
o spending rewarding, positive time together.
Learn about the signs of relapse. Both mental health disorders and addiction disorders are prone to relapses, therefore it can be quite useful to know about the early signs of relapse and prepare for them. You can –
o know their early signs of relapse and be observant of them,
o develop a family plan along with them in advance about how to deal with actual or signs of relapse,
o involve treatment providers and other important people in devising a relapse prevention plan.
Promote hope. Even a person with co-occurring disorders is capable of living a successful, rewarding, and worthwhile life. Family members’ support can act as a powerful medicine for this person when they show their firm belief in their recovery and ability to create and live the life of their dreams. This can act as a boost to the person’s motivation and determination to follow through with the treatment and thus take control of their life again.
References
Alcohol Use Disorder. (2015, August 3). NHP India. https://www.nhp.gov.in/healthlyliving/alcohol-use-disorder
Gaur, P. (2019, April 16). Are We, as a Nation and a Society, Failing Our Alcohol Addicts? [Blog post]. Retrieved from https://www.thequint.com/voices/blogs/alcoholism-rising-menace-which-india-needs-address
Hartney, E. (2020, June 3). How to Help an Addicted Friend or Relative [Blog post]. Retrieved from https://www.verywellmind.com/how-to-help-addicts-22238
Nadeem, A., Rubeena, B., Agarwal, V. K., & Piyush, K. (2009). Substance abuse in India. Pravara Med Rev, 4(1), 4-6.
Nine Strategies for Families Helping a Loved One in Recovery. (n.d.). Behavioral Health Evolution. https://www.bhevolution.org/public/family_support.page
Robinson, L., Smith, M., & Segal, J. (2021, July). Dual Diagnosis: Substance Abuse and Mental Health. HelpGuide. https://www.helpguide.org/articles/addictions/substance-abuse-and-mental-health.htm#
Tripathi, K. (2019, February 18). 16 crore people consume alcohol in India; here’s how many need urgent medical help [Blog post]. Retrieved from https://www.financialexpress.com/india-news/india-has-six-crore-alcohol-addicts-72-lakh-people-addicted-to-cannabis-ganja-charas-heroin-other-drugs/1491108/
Watson, L. R., Fraser, M., & Ballas, P. (Eds.). (n.d.). Helping a Friend with an Addiction. In Health Encyclopedia. University of Rochester Medical Center. Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=1&contentid=2255