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Festivals in Sikkim and recovering addicts; “Causes and preventions to relapse”: Experts explain

Festival and holiday season are on us, as Dusshera (Dasain) has already passed, paving way for a plethora of all kinds of festivals to come. However, there are dark clouds that surround recovering addicts in these joyous of times.

In Sikkim चाडपर्व or festivals are synonymous with जाँड-रक्सी (alcohol), as the majority of the demography in the state have a significant use of alcohol, expert studies have found. In addition to the studies, the general public also resonate with the fact that there is an abundant use of alcohol, not just as beverages that are served in all types of festivals and celebrations but also as worship essentials/materials.

“Alcohol use could be correlated with the climatic and geographical location of Sikkim. Pattern of alcohol drinking among parents, sibling and friends found to be important risk factors. Nepali being the dominant community outnumbered others. Wide availability of alcohol in Sikkim is one among important factors for increased number abusers. Outreach in the society for recognizing treatment seekers is one important thing to look upon and extensive study is required focusing on treatment aspect of abusers,” the study by socio-economic experts Sunil Kumar Pandey, Debranjan Datta, Sanjiba Dutta, Yogesh Verma, and Amit Chakrabarti said.

The said study had the following results:

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Sociodemographic and economic characteristics of patients participating in the study (n=241)
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Pattern of alcohol and substance (drug) use among the participants and their family members
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Treatment characteristics of participants
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Sociodemographic significant differences between male and female

The study shows that there is a clear, if not substantial, infestation of alcohol abuse, which then leads to addiction. It is not just alcohol that leads the line in what are the most common addictions in Sikkim, other substances such as oipioids, brown sugar, pills, etc, have also drastically plagued the state.

However, this article isn’t a critical analysis of substance abuse and addiction in Sikkim, as it is a well known fact that Sikkim is plagued with substance abuse and addiction, and what is more alarming is that atleast 40-60% of the people who are suffering from the disease called ‘addiction’ have never even reached for help.

Now, before getting to Sikkimese festivals and Relapses, one should know about what “addiction” and “relapses” are:

To discuss this, Sikkim Chronicle spoke with a leading addiction psychiatrist and addiction medicine specialist, Dr Satish Rasailly, Addiction Medicine Specialist and Convener of NDPS Act Task Force, Indian Psychiatric Society.

Dr Rasaily talking about the World Health Organisation(WHO)’s definition of addiction said that it is a non-communicable chronic disease, just like diabetes, hypertension, etc. He further explained that it is a “disease” and “is caused by chemical imbalances in one’s brain”.

“Addiction is a treatable, chronic medical disease involving complex interactions among brain
circuits, genetics, the environment, and an individual’s life experiences. People with
addiction use substances or engage in behaviors that become compulsive and often continue
despite harmful consequences.” : American Society of Addiction Medicine defines.

Dr Rasaily explains why a hundred percent recovery for addicts is almost an implausible task. He says:

“Relapse rates for individuals who enter recovery from a drug or alcohol addiction are quite high.  Studies reflect that about 40-60% of individuals relapse within 30 days of leaving an inpatient drug and alcohol treatment center, and up to 85% relapse within the first year.”

“Look at recovery as a spectrum, where one end is relapse and the other is a thoughtful program full of self-care, selflessness and growth-oriented activities. The concept and process of relapse, then, becomes a little easier to imagine: it’s not a binary where someone is either sober or relapsing, but instead a series of continual movements in either direction as a person reacts gracefully to recovery’s blessings and challenges, or partakes in increasingly dysfunctional thoughts and behaviors.

Relapse is total dysfunction, where a person has continually engaged in a pattern of thoughts or behaviors that destabilizes recovery and makes the use of alcohol or other drugs appealing. To this person, a return to addiction makes sense because they’ve been internalizing, listening to and agreeing with the logic of addiction.”- Hazelden Betty Ford Foundation

So, it is important for individuals who struggle with an alcohol dependence or other substance dependence to acknowledge the high risk for relapse, have an awareness of what their own personal triggers are, and learn to cope with their triggers and emotions in a healthy way.  Through an understanding of common risks for addiction relapse, individuals can be better equipped and better able to maintain their recovery. 

“We have been fortunate that after 2000s there have been extensive studies and research that specifically tell us what addiction is and how the disease affects the brain and the chemicals in it,” Dr Rasaily says.

“Drug and Alcohol abusers (in some countries) used to be incarcerated and in some cases, killed, but even with those kinds of extreme punishment the problem didn’t seem to eradicate. After a study was conducted that looked at the brains of tobacco users and non users, drugs users and non users, and alcohol users and non users, a fascinating result was found out that there was a striking difference between the users and non-users.”

“It was found out that the regions of the brain that covered the reward centres like amygdala, hippocampus, hypothalamus, etc., saw brain activities that were either extremely active or extremely dormant in comparison to the normal brains, so it was the period in time when it was declared that addiction was a disease that contorted the brain, and that long exposers to substance abuse changes the brain chemistry,” Dr Rasaily adds.

Now, it is mostly common knowledge and all the above data and facts mostly cover general situations that are common all around the world, but what of Sikkim, where families still deal in deaths caused due to excess alcohol consumption, drug overdoses and substance abuse?

Dr Rasaily says that there has been “a decent amount of awareness in Sikkim in recent years, and what we have realised in the 15 years in this (de-addiction and addiction medicine) field is that relapses are frequent and plentiful.”

So there have to be markers, signs, and the dos and dont’s that come into play so relapsing, specially in festival times are less:

Here are a list of 10 common triggers that contribute to addiction relapse, according to Dr Rasaily and studies by different national and international addiction medicine specialists:

1.  Withdrawal

Many individuals relapse within the first week of stopping their substance use in order to avoid withdrawal symptoms, or thereafter due to post-acute withdrawal symptoms which can last for up to 6 to 18 months.  Individuals with an alcohol or drug addiction will experience varying degrees of withdrawal symptoms when they stop using their substance of choice. 

2.  Mental Health

Alcoholism and drug addiction are a problem in and of itself, but there is also a problem underlying the substance dependence.  Without addressing the underlying issues and simply stopping substance use, it is like putting a band aid on severed limb. Understanding the mental health aspects to the addiction is incumbent.

3.  People

Individuals with an alcohol or drug addiction often surround themselves with likeminded individuals who also enjoy drinking or drugging.  Being around the same people who are engaging in substance use while one is in recovery can trigger a relapse. 

4.  Environments/Places

Bars, liquor stores, wineries, strip clubs, casinos, and parties are some obvious places that individuals in recovery from alcohol or drug addiction may want to avoid, but there are many others.  The place will be dependent on the individual. 

5.  Things

Addiction impacts the brain as noted above, and how miniscule things can trigger a relapse, ones that may not even enter our conscious mind.  For example, glasses clinking, bottles popping, or cans opening may trigger an alcoholic to think of alcohol.  Credit cards or straws may trigger a cocaine addict or other drug addict to think of their drug of choice, as might a pill bottle or syringe.  Anything that one associates with one’s addiction is a thing to be mindful of.

6.  Poor Self-Care

Self-care is an important part of addiction recovery.  Proper self-care will make one feel better about themself, and will be sending a message to themself that they care about their wellbeing.  Conversely, poor self-care sends messages to themself that they don’t care about their wellbeing and can trigger a relapse.  For example, eating a diet that is unhealthy, low in nutrients, and/or high in sugar may result in poor physiological and neurological health that can lead to low mood and cause alcohol or drug cravings. 

7.  Relationships and Intimacy

If an individual is not in an intimate relationship when they enter recovery, it is often encouraged to stay out of one for several months or even a year, until they are more stable in their recovery.  This is because individuals who are newly sober may try to fill their void with an intimate partner.  Dating and intimacy often involves alcohol, and a newly sober individual may not know how to navigate the dating scene without alcohol or drug use.

8.  Pride and Overconfidence

Sometimes individuals who are new to sobriety experience a pink cloud, or have notions that they will never use alcohol or drugs ever again no matter what.  They have such bad memories of their substance use, and are enjoying their recovery journey.  Sure, it is a great feeling when one is confident in ones recovery, but keep in mind that everyone is eligible for relapse. Being overconfident that one can ‘take a sip’ and stop is a dangerous mindset and will cause relapse.

9.  Boredom and Isolation

Boredom and isolation could easily be listed as the number one reason for relapse by many individuals in early recovery.  Any and all down time prior to recovery was usually used getting their substance, using their substance, and recovering from their substance. 

10.  Uncomfortable Emotions

In active addiction, emotional triggers play a substantial role in bringing about a relapse. If one used drugs while being emotionally distressed or elated, in recovery the same emotions might cause conditions for relapse.

Now reading the above statistics and knowing that relapses are more common than one would think of, one would have questions like:

How often do recovering addicts relapse?

According to the National Institute of Drug Abuse, “Relapse rates for addiction resemble those of other chronic diseases such as diabetes, hypertension, and asthma.” In numbers, the statistics indicate that anywhere from 40 to 60 percent of people with addiction will experience a relapse.

Some people may look at those numbers and ask, “Why bother with treatment or sobriety if nearly half of people in recovery will relapse at some point?” But that philosophy toward treatment and recovery completely misses the mark. The other half of people who don’t relapse have found long-term sobriety and the coincident health and happiness that come with it. And abstinence isn’t the only measure of success: those who do relapse still have the resources, support system and coping tools from treatment that will allow them to enter into recovery whenever they feel ready.

Looking at the above facts, one can easily get distraught but experts say that recovery is never an end product but a journey one must embark on.

Dr Rasaily says that there are two kinds of managements for people who might be under duress of their own brain chemistry while on their recovery journey: “one is lapse management, and other is relapse management therapy; now lapse is someone who is in recovery and restarts their (drug or alcohol) usage for a few days and relapse is when someone fully delves into their addiction.”

It is stated by the ASAM, that “the longer one is able to maintain their sobriety, the better chance they have at long-term recovery. As noted, up to 85% of individuals relapse within their first year of sobriety.”

However, the good news is that the longer one is able to maintain their recovery, the better chance they have at sustaining long-term sobriety. “Once an individual is able to maintain sobriety for their first year, their chances of maintaining their sobriety exponentially grows.” -AMAS

Dr Rasaily adds, “do not think that just because one has attended a rehab treatment program that they will be cured.”

“One should seek out therapy, relapse prevention and have additional support. It is also recommended for people to engage in holistic recovery related behaviours, like maintaining a routine, continuous check -ins at the de-addiction centers etc.,”

Talking in the sense of Sikkimese culture and relapses, Dr Rasaily says, “there are many factors that might cause a person to relapse, so what we tell our patients is that they rather learn to manage lapse than relapse before matters get worse.”

“We tell our patients that they rather come back after lapsing up till a week of lapsing, and we will congratulate them for seeking help before the lapse turns into relapse or medical, legal, and psychological issues, that way it will become easier to manage the lapse.” Dr Rasaily adds.

Dr Rasaily who also runs Center for Addiction Medicine (CAM), Sawney, Chuwatar, one of the best rehab and drug-de-addiction centres in Sikkim, says that “there isn’t a complete abstinence model (for Sikkim), and we will have a lot of patients come in during ‘dasai-tihar’ (festivals). We have also observed that 92-95% people lapse and relapse within a year of treatment.”

Talking about the ways how relapses and lapses can be managed Dr Rasaily pointed out the following strides:

  • “Families should be vigilant of the recoverers and then change the way they celebrate festivals etc”
  • “It is advisable that most of the celebrations (that are in the proximity of alcohol), should be done during the day time, since it is observed that relapses happen frequently during the night celebrations”
  • “Will power and confidence alone cannot be driving force behind sobriety”
  • “There should be constant therapy and medications”
  • “There are special contracts that we (CAM) have worked out so woking people specially don’t have to stay in a rehab for months. They can be counselled for few days and then can be worked with in their addiction recovery”
  • “Medication shouldn’t be seen as substitute for the substances addicts are abusing, medicines are just to control cravings, we have all kinds of de-addiction medicines for all kinds of substance addictions. People have a misconception that these medicines that cost only 100 Rs would substitute for tens of thousands worth of substances.”
  • “Recovering patients should avoid all triggers in this period.”
  • “In families that have had a bad history with alcohol, it is advisable that they altogether stop using alcohol in celebrations.”

Dr Rasaily adds, “In this festival period we get calls from recoverers who say that festivals have arrived and it is going to be very difficult for us so what should we do. So we say that patients can use anti craving medicines in this period of time to prevent relapse.”

It is evident that addiction a lifetime diagnosis, so patients have to carefully maintain their recovery using different coping skills, support networks and self-care routines, so by using those important techniques, people in recovery can use the tools in their arsenals to live about as freely and reduce the risk of relapsing.

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