Young Punjab in rehab: A story of unequal cure, unlicensed centres and a few good men
Young Punjab is checking into rehabilitation centres to treat drug and alcohol addiction. The bad news is that many are getting stuck there. A story of unequal cure, unlicensed centres and a few good men.
Around five kilometres from the bazaars and bustle of Patiala, the road to Saifdipur gets bumpy but the scenery is still one of promise. The fields soak up the sun; water tanks and granaries appear on either side of our passing car; pigeons break flight and land on a terrace... These days, they are making fewer movies on the Punjabi NRI with his heart in the Punjabi countryside, you think, as the gate of a private drug rehabilitation centre cranks open to insistent honking. All of that was the Nineties. In Punjab, it is now the time of King-Ku.
King-Ku is the post-notoriety name of former wrestler-cop and Arjuna awardee Jagdish Bhola. In 2014, his arrest in the Rs 6,000-crore synthetic drug scam turned the spotlight, for the first time, on a major drug kingpin. It also underlined the deep roots of the state's addiction problem that, unofficial surveys say, has the youth in its grip. Jangveer Singh, media advisor to the state's Deputy Chief Minister Sukhbir Badal says that no survey has yet measured the scale of the crisis. What he does have, are numbers of "model centres (five) with 50 beds each" and "crackdown" figures.
"Punjab's jails house 28,000 inmates in drug-related cases against a capacity of 18,000," he says. Bhola is not the only king of the jungle, and drugs are not the only things being pushed in the state. With Punjab topping the state-wise NCRB data, 2012, with 10,220 drug-related cases, a business opportunity, locals say, is being sensed with a cure-and commerce model. The Narcotic Drugs and Psychotropic Substances Act gives addicts who volunteer for treatment immunity from prosecution. So it is the fear of jail on which the rehab economy runs.
The prescription in rehab centres of opioid medicines such as Buprenorphine to fight opioid (such as heroin, smack, poppy husk) dependence is another controversy that has lately hit the government's addiction-control drive. While some doctors believe these medicines are needed to control withdrawal symptoms, others feel they are being prescribed too easily.
Guddu*, 22, a car rallyist and a former patient at a private clinic (He is now being treated at Rajindra Hospital, Patiala) says "private clinics are more interested in the sales of drugs. Here, doctors don't even tell me the name of my medicine in case I get hooked on it." Government-run de-addiction centres are, however, cash-strapped. The sewerage system at Rajindra is malfunctioning and the dormitories stink. Patients said officials have to rely on "personal contacts with local grocers" to get them an adequate supply of milk.
Veteran psychiatrist PD Garg, who, by his own admission, has "turned drug specialist" over the past years because of the rise of addiction cases (50% patients in his de-addiction centre at the Guru Nanak Dev Hospital, Amritsar, are young heroin addicts), says he is not sure of the guidelines on who can run private rehab centres. Tarn Taran farmer Preet Brar * has been admitting addicts from his district into his de-addiction centre in Amritsar. He pays Rs 50,000 a month in bribes to health department officers even though the centre has a license. He doesn't mind.
Guddu,* a car rallyist and former medical student says private clinics push the sale of drugs. (Photo: Raj K Raj/HT)
"A hotel wouldn't have this much occupancy. Never a lean day in this business," he says. With each private centre housing around 40 patients and charging Rs 25,000-50,000/month, the revenue per centre is approximately Rs 10-20 lakh a month, a sum that could roll out new business ventures or create jobs in the rehab sector in a state where unemployment among youth is on the rise due to dwindling income from agriculture, its mainstay. The number of people getting themselves admitted is indeed rising.
According to Punjabi University researcher Madhu Bala's ongoing study (2009-12) on de-addiction and rehab centres in six districts of Malwa (Punjab's drug capital) in 2009, 12,994 patients were admitted in the 18 rehab centres surveyed. In 2012, the number increased to 18,770. Dr Garg makes a startling point. "The motive for rehab centres is financial. Supervised medication during detoxification with follow-up is enough. There are good rehab places, but check into a bad one and your legs are thrashed if you develop withdrawal symptoms."
It is one such complaint that brings us to the door of the private clinic in Saifdipur that's owned by a former liquor businessman-turned-social activist. And Tarsem Kumar, 34, has the perfect pedigree to be the man in charge. A textiles salesman and former smack addict, he checked into the centre he now manages as a patient five years ago. Farmer Gurminder, 32, now a patient with a Indian Red Cross-run de-addiction centre, says he was beaten at the Saifdipur centre for not doing his chores properly. "When I got admitted, they said, 'Here we treat you free', but started charging Rs 8,000 per month. I was made to cook and grow vegetables. Yes, we had medical checkups, but you'd better agree with what the doctor identified as your problem. If I did a task badly, I had to roll on the ground." Kumar says he knows nothing about this.
Daljit*, 25, a former kabbadi player and heroin addict, is produced for a counter narrative. Daljit is so at home here, he pays "flying visits" to his parents. "My treatment is complete but I am staying on to improve my will power," he says. Bhupinder Singh, who has an electronics business, is another success story who doesn't intend to leave any time soon. Now a self-appointed 'driver' at the centre, Singh frames his endorsement of the place in rather mysterious terms: "What I have seen or experienced here, I haven't seen in 45 years. This is my Canada," he says.
State of denial
Most young drug addicts who have decided to undergo the rehab drill usually have their ducks in a row. Their stories often begin with excessive neglect or attention at home, then move on to their finding a new community among friends, and end with accounts of full-blown bacchanalia. There are plenty of stories here. Twenty-year-olds reveal that they have drunk full bottles of vodka at a go and spent Rs 5,000 a day on synthetic pills. They talk of injecting themselves with heroin after believing the myth that it guarantees sexual intercourse for 30 minutes.
WATCH: Punjab's reeling battle with drug addiction
Brothers have introduced their sisters to the habit (and vice versa); addicts have got their partners hooked. All to feel happy and successful or to experience that sense of animation missing from their lives. But there could be a story here that no one is telling. The state's conflicted socio-political history has perhaps led to the slow unravelling of the Punjabi family and in turn, led to rampant drug addiction. The state's psychiatrists, the keepers of those secrets, think it is time to talk about all this.
The first sign of this, they say, is the parents' self-sabotage through drugs and alcohol, followed by that of the next generation. This leads to a cycle of denial and blame until the more vulnerable young are eventually locked up in distant rehab centres. Parents have even employed bouncers to ensure their children leave home for rehab, says Dr Sidhu, head of the de-addiction centre at Rajindra Hospital. Good rehab centres are now trying to keep it real while saying all this in a language that is sanitised and non-stress-inducing.
"What can treatments ultimately do if society is ill and suffering?" says a doctor on condition of anonymity. "I have a patient who is the son of a drug don. How do I tell him to his face that his father is responsible? So I pretend I don't know his background. I try to teach him skills to keep him safe when he goes back into that environment." A "seething neutrality" - an attitude of 'taking it', rather than 'facing it' - which is how writer Karan Mahajan describes the Punjabis' defence mechanism in the face of crisis, may have become their bane.
In his article, India's Forgotten Epic in the New Yorker on novelist Yashpal's book, 'This Is Not That Dawn' a classic of Partition literature, he says: "My grandmother, a refugee from Pakistan, would announce the deaths of relatives in a similar way: 'He had gone to the railway station. There, he was finished'… no prologue, no pity - just a statement that packed in centuries of Punjabi existentialism."
Out of earshot of their patients, doctors admit that Partition, Khalistan, Operation Blue Star, riots, migration and the failure of NRI marriages along with rampant consumerism and easy access to drugs have taken a cumulative toll. Some prefer not to call traumas by their name. Dr JPS Bhatia, who runs The Hermitage, a well-regarded private de-addiction centre in Amritsar, says his method is to keep patients focused on their recovery and work therapy, and keep off excitable subjects like "religion, politics, drugs". This could perhaps be one way to make rehab work.
Clockwise from L: Tarsem Kumar, a former smack addict, is a manager of a private rehab centre near Patiala; Dr JPS Bhatia runs a private rehab clinic in Amritsar; Nitin (former alchohol addict and stockbroker) and Namrata Gupta checked into Dr Bhatia’s rehab centre. They are now the centre’s family counsellors. (Photos: Raj K Raj/HT)
In group meetings, a young advocate, a cricketer who has played under-19 with Virat Kohli, a DJ, a doctor who lost a patient on the operating table, and a judge who was letting his stenographer pass the verdict, all refer to their past addiction obliquely and talk of the life ahead outside the care-home. At The Hermitage, patients are called Students; at Saifdipur, patients are taught to take their titles such as Expirator (patients who oversee new patients) or Ramrod (in charge of dirty nails), seriously.
The rehab paradox
An unforeseen fallout of this mix of cushioning and disciplining at rehab centres - most use either one or both of these strategies - is that it has produced, in some cases, a new set of insecurities. In this new collective of former or near-cure addicts, patients often see a certain safety which they would like to make permanent. They seem to feel unsure of adjusting to a life without a guide. The rehab may have taught them skills to re-negotiate the world; but what if they fail?
Vishal, an engineer, who is now The Hermitage's scientific advisor says he has not moved out of the centre because he is "an example for others". He believes addiction has been a blessing for him. "I have everything here, I have a better society around me," he says. Nitin, a former patient, and his wife Namrata are family councillors at their centre. Their son is being brought up by Nitin's mother. Namrata has embraced the term 'co-addict' for herself.
"The germ or triggers of addiction are present in the family. So as partner, I stay involved in the programme. What if there's a relapse?" she says. Punjabi families have suffered because they have lived with various issues, and denied them, she feels." Good rehabs, say former addicts, guarantee "500% chance of recovery if you make an effort".
The mood in Punjab is, however, fatalistic. Professionals employed in the government's rehabilitation effort, talk, in the same breath, of the new training programmes, on the one hand, and the availability of drugs in jail on the other. Dr Rana Ranbir of the de-addiction centre at the district hospital, Tarn Taran, (according to the National Aids Control Organisation, HIV prevalence among people who inject drugs, is more than 20% in Tarn Taran and more than 30% in Amritsar, that's three times more than the national average) says, legalised 'heroin rooms' where addicts check in to inject themselves under supervision is the way to go. "It's not treatment, it's not cure, it's harm reduction, the way Switzerland did in the 1990s." Great ideas and enterprises have come out of Punjab. But this might not be one of them.
* In 2009, the Punjab Health and Family Welfare department commissioned a study on drug abuse in the border belt of Amritsar, Tarn Taran, Gurdaspur and Ferozepur. Majority of drug abusers belonged to the 16-35 age group.
* The crackdown on street drug peddling led to 9,305 FIRs from April-November 2013. Over 3.19 lakh injections and 3.1 crore pharmacaeutical drugs (that can be misused) were recovered. Punjab's jails house 28,000 inmates in drug-related cases against a capacity of 18,000.
* Buprenorphine is used to treat addiction to heroin and narcotic painkillers. Since 2015, it has been made available only in government-run de-addiction centres and only for indoor patients.
(*Names changed on request)/ Inputs: Vishal Rambani