Sikkim’s drug crisis, a societal problem

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“Here, I have some cool s***…you wanna do some?”

Words that started a six-year-long rehabilitation programme for Kesang*, 21 whose dependency on brown sugar, an opiate drug, left him walking in and out of Jiwan Mark De-addiction Society in Luing. 

“I was a pretty quiet person but once I started, everything went from bad to worse. My choice of chemical was brown sugar and it used to give me a lot of body pain. Between friends, we used to call those phases ‘being sick’. So if anyone used that phrase, it was understood that we were having that body ache. Once that happens, it doesn’t matter how, whether we lie at home or however we can, we have to take it. I used to buy for 500 a day. I even got mugged when buying it once”. 

When you observe him, he does not fit society’s standard assumption of how people with drug addiction looks like. He speaks in a crisp manner, smiling politely and recounting how his addiction affected his relationship with his family. “It was my third treatment. It was not like before. I did not reach rock bottom with my family but I’m still in the process of building the trust.”

Still, he narrates how his fascination for drugs grew watching his older brother do the same. “I saw my brother do those things and I thought it was cool – but later, he was the one who dragged me to the centre because he said that it was his fault that I was in the condition and it was his responsibility to find a solution. He has been a member of NA for almost nine years now.” 

Kesang’s story isn’t a lone case of young people falling prey to social influences and the need to ‘try cool stuff’. There are many others, in his age group and above, who resort to using drugs as a way to cope with issues that vary from childhood trauma to learned behavioural patterns. 

When I ask Kesang what he aims to be, he pauses before answering. “It was all messed up then – now, whatever comes, it is fine. I just don’t want to go through that time…you become emotionally bankrupt. You know, we can blame our families and give in to self-pity, saying – why am I like this? Why only me? That is the main reason why people like us relapse. People are depressed because they are emotionally bankrupt, but now I’ve stopped calling myself bichara”. 

The State Government’s Plan:

Sikkim’s decision to decriminalize addiction has been important in starting a discourse on the topic of drug abuse. There are many deaddiction and detoxification centres in Sikkim, but not much is known about them. Even if they are, there is a wrong picture or atleast one that isn’t clear enough. 

Rohini Pradhan, Joint Secretary of the Social Justice and Welfare Department mentions that the government is working on a State Action Plan for Reducing Demand for Drugs, where sustainable solutions are given priority. Under this, there are three important points of focus – awareness generation, capacity building and specific intervention/social outreach. 

“We are trying to build a system where everyone can participate. A more holistic approach is needed, instead of punitive action, a more therapy based course of action must be taken. There is a lack of special educators and medical professionals in the state,” she says. “Full-time clinical psychiatrists are needed in a rehab centre, not only therapists because they cannot prescribe medication. The solution has to be a state initiative”.

She informs me about Khichudumra in South Sikkim, where a de-addiction cum rehabilitation centre has been built, with the new addition of a livelihood school. “We want to make it a model rehab centre, where the patients are taught life skills because what’s next for them after their treatment? Sometimes age-related factors can’t help them get jobs so we have to think of ways to help them all”.

One of our society’s problems is hiding illness and Uday Chandra Rai, Founder of Serenity Homes explains how it is only detrimental to the people who need help. “Families here are afraid of their loved ones or ashamed of seeing them to a rehabilitation centre. We cannot hide this sickness and the only way it dies is at the exposure of light. We need to think about their survival rather than the drugs they consume. 

“Solving the drug crisis is like a puzzle – various departments have to align but for now, we have to give credit where credit is due”. 

The way our society sees drug addiction is that it could only be because of exposure to certain media but we forget that we’re a young state. It is not an individual’s problem. Sure, certain psychological stressors could lead to people using drugs as a means of escape, but when one rehabilitation centre has around 70 people being treated for the same issues, does that not strike us as being a problem that is bigger than one person’s? 

Our generation is more frustrated than ever – the Internet shows greener pastures while also being the only space they can be themselves or the version of them that makes getting up every day worthwhile, the constant conversations following government jobs or lack thereof have lulled our dreams into a coma, relationships with family have become strained because the older generation does not understand why we aren’t working at 22 or 23 like them – there is an overconsumption of media and we don’t understand why the world is suddenly changing at such a quick rate. 

The Centres:

Mahindra Tamang, person-in-charge of Sikkim Rehabilitation & Detoxification Society at 32 Mile, one of the oldest facilities in Gangtok, is a recovered addict himself. Well-articulated and open to discussing his own past, we discuss the need for de-stigmatization of people who go to rehabilitation centres for treatment for alcoholism and de-addiction and how the centres are funded.

Before we began, I had to address a rumour I heard from the villagers who live around the centre of the recent tuberculosis outbreak having originated from the patients at the centre. I ask him if they have patients who might be infected but he assures me that they don’t. “We never keep patients who have communicable diseases. We live near a river, so it gets cold in the mornings and evenings. We have fields but do you see anything being planted? None, because the people here are lazy and we have a poor health system. Most people take lunch at around 1 or 2 o’clock so they are vulnerable to airborne diseases when on an empty stomach.”

He tells me the story behind the outbreak. “So, we have a lot of migrant workers that come and live here, one family had members who were infected with MDR and stayed nearby in a rented house. They did not reveal their condition so that’s how the outbreak started. But I’ve heard weird theories of apparently the air circulation being different here and that’s why tuberculosis has spread to even places like Nimtar!”

He continues. “At the time of admission, we tell people only drug addiction and alcoholism is treated here. The guardians have to take care of the patient in case of serious ailments. We do keep HIV positive patients but not people who have tuberculosis or such”.

Gathering funds seem like a priority to those running the places. Mahindra elucidates their problem with funds. “Yearly, we get a sum of two lakhs by the government. We charge a patient 35,000 for the entire treatment, which comes to approximately Rs 297 per day for food, 24/7 monitoring and counselling and psychiatric counselling. You might not believe it, but only 20 people right now are paying the full amount! Most of them ask for charity, even rich people who can afford to pay the full amount ask for charity sometimes.”

There are around 76 men in the centre and the most common problem is alcoholism, especially with older people. The substance that is gaining more notoriety is brown sugar, while some from other Northeastern states are addicted to heroin. Migrant workers who have jobs in Dubai or Hong Kong also come to get treated while on a break. 

He isn’t complaining, but because of the tight budget things like affording psychiatrists every week is not fulfilled. “We are tied up with Manipal but now a psychiatrist comes only twice a month. Previously, a doctor used to come voluntarily but he no longer does unless it is for special cases. We still get a few interns under him”.

“Currently, we have four counsellors. We need a psychologist and a good doctor but we can’t afford it; centrally funded rehabs have honorariums of 12,000m – who wants to work 24/7 for that amount of money? Especially students who have major degrees…we have to give extra money to our staff to counsel the patients.”

Despite the financial restraints, he perseveres because he believes it is important to get to the root cause of this issue and understand the psychology behind why people find the need to consume drugs. “We need to understand that substance is not the problem but the psychology behind why they take it, is. The substance actually comes as a boon to the patients when their mind is obsessive, physically they are impulsive and emotionally, they have a self-centred attitude.”

The Jiwan Mark Society at Luing has a 144-day treatment program where they focus on 15-day detoxification programmes which have a similar pattern of activities like most other rehabilitation centres, where Group Discussions, psychiatric counselling, meditation, yoga, indoor games, music are all encouraged. People from Darjeeling and West Bengal who are addicted to brown sugar also come for treatment, along with a few cases of schizophrenics triggered by overconsumption of cannabis. For people who have relapsed, they have a 105 days programme. 

Then there is Drishya Foundation, a multifunctional facility that not only imparts treatment to those suffering from addiction but also deals with issues of family separation and domestic abuse. Additionally, they have a child care institute and a domestic helpline number. They are annually funded with 1.70 lakhs by the state government and they narrate a similar story as SRDS, where they are in need of psychiatrists, nurses and counsellors. 

Pempa Rabgyal, the in-charge at Drishya, explains why people relapse and the reason isn’t what most people expect to hear. “The ratio of people who have fully recovered and relapse is 60:40. See, families have high expectations of the patients once discharged from the rehab. The people who have just gotten a break after being in a rehabilitation centre for months want to be a little lax, but the family members begin to nag even if they wake up a little late or something as small as that. After a while, the recovered ones begin to get frustrated seeing the little trust in them and might resort to taking drugs again – that’s how you relapse.”

He also adds that substance abuse is compulsive behaviour. “Earlier, young people would take prescription drugs but now that is outdated so they take high-quality ones. But, the most common reason why young people are in these facilities is because of peer pressure.”

A Day in the Life: 

Now you must be wondering, what is a day in the life of a patient at a deaddiction centre? Growing up in a small town, I was exposed to a certain demonization of rehabilitation centres – they were seen as places no respectable person would want to see themselves or their friends or children, instead of a place of recovery and recuperation. The following account is a quick run-through of the day at SRDS.

They wake up at 5:45 am, have their tea at 6 am and then go for a walk or meditation (twice a week) or yoga since the centre keeps changing sessions so as the patients don’t get bored by a repetitive routine. Around 8:15 am, they begin Therapeutic Duty Assignment (TDA) where they take care of maintenance and cleaning, after which they go for breakfast and take their medications. On all days except Sunday, there is an input session from 9:30-10:30 am where the counsellors talk about addiction as a disorder of the brain; they explain that it is all about self-discipline and that it is an impulse control disorder, for which they get therapy.

Then, a reading session of the 12 step program begins, where they go through it chapter-wise and discuss, following which is a writing session where workbooks that talk about character defects, questions of morals and ethics and questions that ask them to acknowledge their mistakes and shortcomings are given to them to use. Then, it is time for lunch and a siesta as the eating part is done. 

Why the siesta? Mahindra explains that because their brains are used to being driven by chemicals, it is always in a run motion; basically the idea is to rewire the brain to believe it needs rest. “Their brains demand the substance they were addicted to and so it keeps running. We are training the brain to rest so that in four months, the brain automatically wants to sleep as soon as it is noon.” 

Then AA meetings where they can share various issues. After this, they have a recreational time where the patients are asked to physically engage in games and activities. Usually, around 6:30 pm, we put on music or sing and chat with each other before one of their last sessions at 7 pm, before dinner. “It is called inventory. They journal what they did the whole day, where they don’t write their routines but the thought patterns they had. They review how and what they felt and have a bit of spiritual reflection too”.

Once they are done with dinner, at 8:15 pm, the last session, called postmortem takes place, where the patients sit and talk about their emotions, both good and bad, chaired by the counsellors. It was introduced with the idea that if one could take out unwanted emotions, before retiring to bed, one could sleep soundly. 

A Societal Problem: 

One of the ignorant actions our society is initiating children to alcohol at a very young age. I believe most of us have had the occasional taste of spirits from our parents or relative’s glass, which was either viewed as funny or was quite strangely justified as “building up a tolerance,” as if that made any sense. What nobody seems to understand is that it stops brain development in children. 

“This is a disease of ignorance – who does not know drugs are bad and affects the lives of many? It is a complex issue which cannot be solved by just one conversation alone,” says Mahindra. 

I met Anil*, a 25-year-old recovering addict being treated at Drishya Foundation, at the Inter Rehab Football Match at Paljor Stadium, the latter which is an initiative of the Social Justice and Welfare Department to engage both recovering and recovered drug addicts in something that is separate from their treatment. 

He confesses that he started abusing drugs with no reason. “I began taking prescription pills at 18. I had chances to rectify myself but didn’t; began to have trust issues and irritation with others. I gave in because of peer pressure.” But again, contrary to the idea that “oh, drug addicts cannot do anything/they are wasted” that majorly prevails in the hills, he has completed B.A. Hons in English from Geyzing and music remains one of his passions. He is as ordinary as the rest of us, who likes to sing and talk about his life. The only difference is that he made a mistake, acknowledged it and took the steps to fix it. We talk a bit more before he gets up to play for his team at the match. 

It is because of all these interactions with both patients, officials and in-charges of rehab centres that I’m awed by how much hearsay has twisted the image of rehabilitation in Sikkim. A third person who has never been to a centre or heard the story of recovery and relapse will never understand how much willpower it takes to even acknowledge the existence of a problem, yet there are people out there doing it daily, despite knowing people will talk in prejudiced tones and met out judgement without knowing the facts of the matter. 

Our state pushes its people to be aware of drugs, but the efforts are wasted when no conclusive change occurs in the minds of citizens. There is no way that the solution should be so unilateral – we are part of the problem and also the solution. Changing our attitudes to this drug crisis is a responsibility we have to take up seriously, for ourselves, for our state. The rest have already found their way to recovery.

*Names changed to protect identity.

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