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India Needs To Start Looking at Addiction as a Psycho-Social Problem

India Needs To Start Looking at Addiction as a Psycho-Social Problem

Photo: Toa Heftiba/Unsplash

  • Drug addiction is as much a problem of supply as it is of demand, yet the mere availability of addictive substances doesn’t produce an epidemic of addiction.
  • The policy approach to deaddiction has focused thus far on eliminating supply and to help the ‘inferior’ brains of addicts cope with the loss.
  • But research in the last few decades has revealed insights into the psychology of addiction that suggest getting addicts to voluntarily reject illicit drugs may be more helpful.
  • India’s case is particularly poor: its laws and institutions criminalise and shame addicts, and its healthcare system often imagines addiction as a ‘lifestyle disease’.

Drug addiction is as much a problem of supply as it is of demand. The mere availability of addictive narcotics does not produce an epidemic of addiction. Yet public perception and official policy in India have been skewed towards curbing the supply of narcotics, through alcohol prohibition or criminalising the possession and use of drugs.

Drug addiction is a complex bio-psycho-social problem whose roots don’t lie in morality or simple biology. Contemporary scientific research has shown that more than in the addict, we need to seek answers to addiction in the social environments that create crises of identity, alienation and economic precarity, often coupled with comorbidities such as depression.

A problem of will

The figure of the drug addict as it emerged in the 19th century was entwined with the moral question of ‘free will’. Christian temperance movements became a public force in the 1850s in the US and Britain. The narratives of Protestant temperance preachers fashioned the addict as a figure of civilisational collapse.

China’s defeat in the Opium Wars led to the complete capture of its foreign trade policy and ports by European powers, who then stoked fear: This is an example of what can happen when narcotic substances become available to a morally susceptible race!

Colonialists blamed Chinese migrants for bringing the ‘vice’ of opium to the West. The smoker was reviled as an emaciated man who had subjugated his own autonomy to a drug. Charles Dickens, in his story the Mystery of Edwin Drood, popularised the image of the opium den as a dingy hole of slow destruction.

But there is more to this story. In their historical account of narcotics in China, Frank Dikotter, Lars Laaman and Zhou Xun have noted that addiction was not the cause of the ‘Opium Wars’. The Qing court was concerned about the outflow of silver to pay for opium, the resulting inflation and the growing political influence of European traders in southern China. Opium use was extensive but there was no epidemic of ‘wasted’ or ‘emaciated’ addicts. Addiction became widespread well after the wars, with the collapse of the Chinese economy as a result of an imperialist stranglehold.

The mid-19th century then marked the origin of two ideas about drug addiction that have stayed with us to this day. The first is that drug addiction is a moral problem of free will – that those who are addicted are understood as being given to the vice anyway. The second is that drug addiction is an issue of supply: Cut the supply and kill all addiction.

This approach manifested in modern times within neurobiology and medicine as an influential group of scientists that has, since the 1980s, defined addiction as an ailment of the brain. The attempt here was to locate the precise brain chemistry that predisposes some users to getting addicted.

Since this time, the dominant mode of deaddiction treatment has been medicalised therapies such as drug replacements for opioid users or the 12-step program for alcoholics, both focused on the individual addict. The emphasis here is on ‘curing’ addiction by remapping the brain and its compulsive desires. The addicted brain is seen to be inferior to the ‘normal’ brain and thus being unable to prevent harm to its body.

But even this model of addiction has come to be challenged, with a host of neuroscientists, psychologists and anthropologists providing alternative explanations.

The socio-ecological model

In the 1970s, the psychologist Bruce Alexander conducted the ‘rat park experiments’ that compared two sets of rats. In the first group, rats were individually isolated and given the option of drinking from two water sources – one normal and the other laced with morphine. In this group, the rats repeatedly drank the morphine water until they all overdosed and died. In the second group, rats were kept together in a chamber and allowed to socialise freely. Here, the rats partook of the morphine water on occasion but never obsessively. Not one rat overdosed.

Alexander extended this research to argue that at the heart of addiction is a ‘poverty of the spirit’, or a pervasive sense of dislocation and meaninglessness. He contended that a drug user is always making a choice about using recreational drugs when other sources of emotional support and social stability are absent or unreliable. Similarly, anthropologist Joshua Burraway found that addiction among the homeless population of London was most often a conscious attempt to induce a state of numbness against the uncertainties of life on the street.

The neuroscientist Marc Lewis extended this approach to hypothesise that addiction in individuals is determined by their social biographies. Men and women who deal with traumatic memories and suffer economic hardships and violence use drugs as a way to shield the psyche from further trauma.

But most rehabilitative approaches focus instead on enhancing the ‘will’ of the addict to overcome temptation, and attempt to wean the brain off by providing less-addictive narcotic substitutes.

These approaches, Lewis argued, have a high rate of relapse. The suppression of desire leads to an ego-fatigue or a deep-seated tiredness that causes the person to give in. Instead, he has called for a socio-ecological approach that will help the person develop meaning and purpose in their life. This would mean focusing on the person as well as the communities, neighbourhoods and families to which the person belongs.

The goal is to create safe living spaces, secure livelihoods and educate, and thus empower the person to voluntarily reject addictive substances.

In light of these developments, how does India’s approach to drug addiction measure? Poorly, as it turns out.

India’s approach

The public trials of Aryan Khan and Rhea Chakraborty may have been a decoy from other important news, but they also highlighted India’s misguided approach to ‘solving’ addiction. Stalling the supply of drugs and preventing drug money from financing crime are important – but they’re only part of the picture.

The Narcotics Drugs and Psychotropic Substances Act 1985 is the cornerstone of India’s anti-drug policy, and it has long been used to criminalise recreational users. The possession of illicit drugs in all quantities is punishable, plus it doesn’t clearly define who is an ‘addict’.

A user of drugs can receive probation from punishment and be sent to rehabilitation clinics, but these provisions are rarely used. The criminalisation of drug addicts is an extension of the moral view of addiction. Thus, the public outrage against Chakraborty and Khan wasn’t just against their use of drugs but for their “shameful” lifestyles, including partying, drinking and socialising with the opposite sex.

But a glaring lacuna here is the absence of a comprehensive policy for addiction treatment. This lack starts with data: there are no year-on-year numbers for harmful addiction and its outcomes in the country. The All India Institute of Medical Sciences, New Delhi, and the Union social justice ministry conduct a ‘Magnitude of Substance Use in India’ survey, but it has been erratic: its data is available for only three years since 2000. It also doesn’t not collect data on the social background, biographies and reasons narrated by victims of substance abuse.

What it does reveal is a shocking absence of investment in addiction rehabilitation. Of those who reported being addicted to alcohol in the survey, only 25% received any treatment. And more than 30% of those who did received religiously oriented therapy. Three-fourths of those using illicit drugs and also attempting to quit received no treatment at all.

The Centre’s policies on addiction treatment are the responsibility of both the ministries of health and social justice – but this creates a lack of focus in government efforts. Health is a state subject, so state governments create their own regulations for deaddiction centres. Thus, there is an absence of a national standard as well as an audit mechanism for the various state standards. (This is why there have been media reports of illegal deaddiction centres using torturous methods on the people admitted there.)

There is also no central database of deaddiction centres across the country, much less information on their therapeutic approach.

So as such, India is operating in a policy black hole as far as substance abuse is concerned. We need a comprehensive policy and data collection infrastructure to shed light on the ecological background of drug abuse post-haste. And instead of institutions and laws to criminalise and shame those seeking help, we need curative institutions that can provide emotional, economic and medical support.

Anirudh Raghavan is an independent researcher working on issues of medicine and public health in India. He is trained in medical anthropology and sociology from the Delhi School of Economics.

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