In 2010, Institute for Development and Communication (IDC), Chandigarh, released a report on drug abuse in Punjab’s border districts.
Of 1,500 addicts surveyed, 3% were between 6 and 10 years old. And 85.6% of respondents were matriculates — dispelling the notion that opioid dependence is a problem of the unschooled.
Here’s the thing: the scale of the problem in Punjab is not much worse than it is in the rest of the country.
Web Comic | Shobit was 13 when he started sniffing glue
In 2014, the National Drug Dependence Treatment Centre (NDDTC) at the All India Institute of Medical Sciences (AIIMS) conducted the first nationwide survey on drug abuse in children. Of 4,024 minors surveyed, 83.2% had used tobacco, 67.7% consumed alcohol, 35.4% used cannabis and 34.7% were sniffing inhalants such as glue and correction fluid.
The worst part? The study found that only 5% of adolescents received treatment for substance use, and even they got counselling, on average, about five years after they began their drug use.
It is a problem of putting the cart before the horse, says Dr Vivek Benegal, additional professor of psychiatry at the De-Addiction Centre of Bangalore’s National Institute of Mental Health and Neurosciences (NIMHANS). “Intervention tends to be focused on the drug rather than vulnerabilities that make children take such substances. Addiction is a form of self-medication and needs to be understood as such.”
The tendency to view drug addiction as more a crime than a psychological problem, he feels, leads to “therapeutic nihilism”, where minors and young adults flit in and out of rehab.
“It’s not surprising that many minors sent to juvenile detention centres for, say, marijuana use, come out as hardened criminals or end up using harder narcotics,” Dr Benegal says.
What do you do, then, when a child becomes an addict? The story of Shobit Gupta* above is a good example of what works. His parents responded quickly, sought counselling as a first step, and worked with the counsellor to frame a customised way forward that made sense for him.
“Drug abuse in children overwhelmingly starts off with illicit legal substances like tobacco and alcohol. But there’s almost always a delay in treatment because, between ignorance and denial, few come forward even when their children begin to skip school, indulge in theft, or start to withdraw from society,” says Dr Anju Dhawan, associate professor at NDDTC. “Still fewer visit government institutions because no one wants to be on the public records. Apart from this, India doesn’t have enough paediatric counsellors and psychiatrists, so access can be a problem too.”
The key — more than laws, awareness campaigns and even parental communication — doctors say, is quick reaction time.
Otherwise, there’s a chance that the child will end up like Bijoy Kalita*, whose case stands out in Dr Gorav Gupta’s mind, sadly, for all the wrong reasons.
“Of about 2,000 patients in my 22-year career, he’s the one I’ll never forget,” says Dr Gupta, a psychiatrist who heads the Delhi-based Tulasi Psychiatric & Rehabilitation Centre.
In 2014, Kalita was brought to Dr Gupta’s centre by his landlord, who found him passed out outside his flat. The 18-year-old had rashes around his mouth, dried blood under his nose and violent muscle tremors. He was also hallucinating.
It turned out Kalita had been huffing inhalants like glue and solvent since he was 13, weaned himself off them, got his act together, moved from Guwahati to Delhi to study and get his life started — and the stress of all the changes had led to a relapse.
“He had never seen a counsellor. He had fought this all on his own,” says Dr Gupta.
The day his landlord found him, he’d suffered an overdose that could have cost him his life (it’s called Sudden Sniffing Death Syndrome; technically, arrhythmia caused by inhalant overdose).
Far from home and all alone, Bijoy entered a cycle of rehab and relapses.
“He falls off the wagon, misses sessions and follow-ups. His parents back home work on tea plantations and can’t visit him to help,” Dr Gupta says. “If Bijoy had got the help he needed when he was younger itself, chances are he wouldn’t be suffering the way he is.”
Last month, the Supreme Court directed the Centre to create a national action plan to tackle alcohol and drug abuse among schoolchildren.
The Court was hearing a 2014 petition by Nobel laureate and child rights activist Kailash Satyarthi, founder of the Bachpan Bachao Andolan, who was asking that de-addiction centres be set up in each district, with special wings for children, and the dangers of drug use be included in the school syllabus.
Right now, some doctors feel the school can be more a problem than a solution when it comes to drug use.
“We need to counsel our school counsellors and include them in the fight against child drug abuse,” says Dr Alpesh Panchal, a psychiatrist and former consulting counsellor at Mumbai’s government-run Lokmanya Tilak hospital. “A lot of them are torn between maintaining confidentiality and alerting the principal or authorities about a student’s drug use. In the latter instance, the child is invariably thrown out of school, which never helps.”
The system certainly did more harm than help in the case of Shantanu Tawde*, a patient of Dr Panchal’s, on and off, in 2007-08 and again in 2013.
He’d begun using inhalants at 8 and his concerned mother, a domestic worker, had brought him to the government hospital for counselling.
“She was a single parent working multiple jobs and couldn’t keep our appointments. Shantanu soon stopped attending our sessions,” Dr Panchal remembers.
Four years ago, the mother brought him back. He was now 13, and addicted to marijuana. And the spiral had begun. Again, the sessions were sporadic, and just a month in, Shantanu and two friends tried to rob a bank and killed a man in the process. He was now in a juvenile home.
“Sometimes, juvenile centres are worse than the outside world,” says Dr Panchal. “Children don’t get the treatment they need. By the time his mother sought permission to consult me instead of the resident counsellor, Shantanu was already addicted to a cocktail of drugs: whiteners, cocaine, opioids, alcohol, you name it.”
Two weeks after he was released on probation in 2013, he ran away. Desperate, the mother went to the police, and they found her boy in Lucknow three weeks later — alone, starving, and in a fugue state. Tawde is now back in a remand home.
Contrast this with the case of Tausif Shaikh*, another of Dr Panchal’s patients. While counselling the 13-year-old for attention deficit hyperactivity disorder (ADHD) in 2011, the psychiatrist learnt from a concerned relative that not only was the teen a marijuana user, so was his father.
The two were counselled via individual and group therapy, didn’t miss a session, and have both been drug-free for three years.
“He never spiraled,” Dr Panchal says. “This is why the government must boost infrastructure and manpower. The more grassroots-level workers, activists and doctors we have, the more accessible treatment becomes to children and their families. Doctors in remand homes and government institutions are so overburdened, they sometimes see 2,000 patients a week, making it impossible for them to help.”
Dr Panchal is still haunted by the difference in the two case outcomes.
“Trends are intermittent, but the problem is not, because we shy away from talking about these things in the open,” he says. “Just like we shy away from talking about sexual abuse, and it remains rampant, and it is a major factor that pushes children to internalise trauma and use drugs to numb themselves. If parents and schools don’t start to talk to their kids, how will their kids cope?”