(Ms. Afsana Rashid, 32, was born and raised in Srinagar and attended the Minto Circle High School. She graduated from the Government College for Women with a Bachelor's degree in science, and completed her post-graduation degree from the University of Kashmir, obtaining her Master's Degree in Mass Communication and Journalism. She has received numerous world-wide recognition and awards for covering economic depravation and gender sensitive issues in Kashmiri journals, which include Sanjoy Ghose Humanitarian Award, Bhorukha Trust Media Award 2007, and the 2006-07 UNFPA-Ladli Media Award. Her work on "Impact of conflict on subsistence livelihood of marginalised communities in Kashmir and Alternatives", was recognized by Action Aid India in 2005-06. She has travelled abroad attending a workshop on "conflict Reporting" by Thomson Foundation, Cardiff, UK, and a seminar for women in conflict areas by IKV Pax Christi, Netherlands. In February, 2008, she compiled a book, "Waiting for Justice: Widows and Half-widows." She has been a valley based correspondent for various local and national journals.)
Drug Abuse - a Challenge to Society
Drug abuse in Kashmir is a glaring socio-cultural, religious and medical problemconfronting the contemporary society. It is a growing concern that needs immediate attention by one and all. “Substance abuse, emerging as medical, social and health problems of immense consequences is very common in Kashmir. Because it is not only a disease of person who is afflicted, but it is a disease of family, disease of neighborhood and disease of society. It involves all. This is a huge problem which is already in epidemic proportions,” says Dr. Arshid Hussain, valley’s renowned psychiatrist at Government Psychiatric Disease Hospital, Kashmir.
He said there is more of cannabis use again. “Cannabis is again taking a centre-stage, though for a long time opioids took a centre-stage. Medicinal opioids are continuously being used. Alcohol is also increasing.”
The psychiatrist states that the trend world over is that substance abuse is more common in urban areas and underprivileged and is hugely associated with other mental health issues, whereas in Kashmir, the trend is different. “It is common not only among this population but in rural population as well.”
Dr. Hussain, who also works as Assistant Professor, department of Psychiatry, Government Medical College Srinagar,points out multiple reasons that lead to drug-addiction. He said influence by peer-group is one of the major contributing factors for the menace.
“Substance use spreads by sheer peer pressure. It is the only mental health problem, which is contagious. If one student in the school is a drug-addict, all others are at risk.” He adds there was absolutely no education available to children that it is harmful.
Explaining further, the psychiatrist says absence of other modes of recreation and enjoyment, conflict and its easy availability are other contributing factors that lead to drug-addiction. “I seriously believe sports as well as outdoor activities can play a major role in curbing drug-addiction among youth whereas its easy availability plays a major role in its spread.”
Dr. Hussain admits that statistics about drug-addicts during conflict in Kashmir can’t be traced. “We just can’t trace it and can’t say what would have happened in absence of conflict.” He however, adds with decline in traditional Kashmiri society, culture that acted as buffer against many such things, started breaking and number of people started abusing substances.
“When we woke up to substance abuse, we were caught unawares and there was already an epidemic going on,” says the psychiatrist, while referring to a survey conducted in south Kashmir in 2001-2002. He said the survey observed that drug-addiction was common among the age-group 18-30 and 17 percent of males had responded ‘yes’ to have taken to substances, “which is actually very high.”
He further stated that drug-addicts didn’t approach doctors till they were forced to as they end up with certain health complications. He recollects that he first saw such a patient in ward number 6 of Shri Maharaja Hari Singh (SMHS) hospital in 2000 and the patient had reported seizures, multiple times. Ultimately, he was found abusing substances.”
He shared “though such patients were already there but they didn’t easily come to doctors. The trend has changed a bit; still there are a lot of fatalities. Young people die of substance abuse, young people die of accidents because of substances and young people die of mental health because of substance abuse. 30 percent of them are institutionalized in psychiatric hospital and most of them have a history of substance abuse.”
Dr. Hussain adds, “With time they end up with medical or psychiatric emergencies and stay in hospital for life or die in accidents.”
Social taboo and stigma and lack of education prevent people from attaining timely treatment. “Due to lack of education among people, they don’t come forward for early treatment. Less percentage of population considers it as a medical problem. It has all dimensions – socio-cultural, religious and medical dimension,” he says, adding “Once we medicate it, we de-stigmatize it a bit.”
Currently, there are two functional de-addiction centres – one is police de-addiction centre and other is with Psychiatric diseases hospital. “There was a time when we had none, now we’ve two. Atleast we’ve some hope, now. Still these are in need of more facilities.”
The psychiatrist says families do cooperate as they’ve no other choice. “No comprehensive policy is in place to rehabilitate them.”
He shares usually there are high chances of recurrence, as per literature, but “here in Kashmir, recurrence rate is definitely much lesser than what is written in literature. It takes not only weeks or months but years for their treatment. Leaving one part unattended usually leads to recurrence.”
He observes there is no idea of rehabilitation. “Basically, treatment of substance user is done in four steps. Motivation where counselor, religious leaders and family has a role; followed by de-toxification process wherein de-addiction centres play their role; followed by maintenance wherein community, health system and society has a role followed by rehabilitation. We’ve done little bit in everything except rehabilitation.”
Dr. Hussain stresses drug-addiction among females is low. “As it makes good news, so we talk about it. But, actually, it is at a very low level. I am not denying that the problem is not there, but its proportion compared to males is low. Culture and religion are the reasons responsible.”
He shares till date he has seen 10 female drug-addicts compared to 7000 males. He recollects most of these drug-addicts approached him, unmotivated or when they had a serious psychiatric issue or any other complication.
“Cannabis that is grown so widely here can be abused and that is where the problem starts. Here government can play its role. But for rehabilitation purpose, non-government organizations should step-in. These are the areas where they need to pitch in.”
He adds former drug-addicts, who have been de-addicted can help to fight this menace. “It has been observed worldwide that such groups have been effective in fighting the menace. Those can be of real use here as well but there is no one yet. Besides, we need good place and human resources in de-addiction centres and need more de-addiction centres. Helplines too can be advantageous. Probably, there is one helpline. We require more and it can be useful for motivation and education, especially when they are reluctant to come over.”
Dr. Ghulam Ahmad Wani, Assistant Director, Health Kashmir and in charge Mental health, Directorate of Health Services, Kashmir says stigma is the biggest problem and is found more in urban population. “Awareness, especially what would be its complications and impact on children is important. Things are improving and patients are coming forward.”
Dr. Wani states “We are running National Mental Health Programme, which has two components - District Mental Health Programme that is carried out in district hospitals of health department and National Mental Health Programme, which is a component of Government Medical College and is related to upgradation of mental hospitals of the college.”
He informs about 30 crore rupees have been sanctioned under the programme, out of which 10 to 15 crore rupees have already been spent. He further informs the programme is being run since July 2008 and 1,20,000 patients have been treated, so far. “Out of which, eight percent have been diagnosed with substance abuse.” Dr. Wani adds there can be single or multiple substance abusers.
“About 5623 patients were treated with substance abuse in 2012 and the sub-types of substance abuse included Nicotine was found in 49 percent of patients, cannabis in 35 percent, Benzodizapines in 54 percent, alcohol in 5 percent, cocaine in 2.4 percent, pain killers in 3.3 percent, kerosene oil in 0.2 percent, ink erasers in 0.4 percent and boot polish in 0.3 percent.” He adds generally, they’ve found multiple substance abuse like nicotine, cannabis and others being done by a single person, which is known as multiple substance abuse and is found in 71 percent.
Collective data of all these years (2008 to 2012) shows that the percentage is almost same and it is infact, going up, he further adds.
Drug de-addiction centres of Directorate of Health Services are at sub-district hospital Sopore, district hospital Baramulla, sub-district hospital Khan sahib in Budgam and in district hospital Anantnag, says Dr. Wani, adding there is 30-bed de-addiction centre at Shri Maharaja Hari Singh hospital and 10-bedded de-addiction and rehabilitation centre, PCR and 15-bed Rahaat centre, Khanyar in the private sector. “There are no rehabilitation centres; they are all drug de-addiction centres except PCR.”
He observed that there should be de-addiction centre in every district and sub-district hospital. “Funds and manpower are required. Perhaps this year funds are coming and we might be recruiting people. We have sent PIP to Government of India (GOI), according to which about 26 lakh are required per district.”
Meanwhile, according to a report about drug de-addiction centre PCR, Kashmir from March 01, 2008 to December 31, 2012 total number of patient visits/follow ups is 6000, total number of patient registrations 921, total number of patients admitted/treated 416, total number of patients treated on OPD basis 505, minimum stay of an indoor patient is 21 days and maximum stay of an indoor patient is 45 days or more.
The report, while providing district wise data of patients reported to drug de-addiction centre PCR Kashmir from March 01, 2008 to February 29, 2012 says 351 patients were reported from district Srinagar during this period, followed by 105 in district Baramulla, 45 in Budgam, 41 in Anantnag, 37 in Pulwama, 24 in Jammu/outside state, 20 in Kupwara, 17 in Bandipora, Ganderbal and Kulgam, each, 16 in Shopian, 14 in Tral and one in Leh.
About occupation wise data of patients from March 01, 2008 to February 29, 2012 the report further quotes 163 were businessmen followed by 162 unemployed, 148 students, 81 drivers, 77 government employees, 37 police personals, 14 were street vendors and doctors/health workers, each and nine belonged to private jobs.