The way back

AN INTRAVENOUS DRUG user. As most drugs act on the nervous system, prolonged use results in dependence and addiction. - SHOVAN GANDHI

Getting off drugs is not easy for the addict, but help is round the corner for those who have had enough.

MOHAN still remembers the day he took the bus to the detoxification clinic way outside town more than a decade ago. When he walked out of the clinic 14 months later, he did not have a job, a house, or a plan. But what he did know was that he never wanted to go back to drugs.

Today, he has been clean for 11 years. Eleven years since "rock bottom". "Rock bottom is when you are finished physically, mentally, emotionally and financially," says Mohan. "It's when your veins are blocked but you are still injecting, when your marriage is on the rocks but there's nothing you can do. It is when you wake up every morning and promise yourself that you will never touch another drug again, but every night you find yourself fixing another `hit'."

Most addicts go through "rock bottom" when the heady rush of the drugs has finally worn down, and reality slowly sinks in - of years of abuse having left scars and abscesses, friends having drifted away, and relationships having broken down except for those with fellow addicts, and the drug of choice.

The first step towards getting clean is detoxification, or detox as it is commonly known. Detox is a medical process that seeks to reduce the body's physical dependence on drugs. As most drugs act on the nervous system (particularly neurotransmitters and receptors), prolonged use results in dependence and addiction.

Garima, aged 28, was on heroin for eight years before she finally quit. "Getting off drugs is not easy," she says. "Withdrawal symptoms kick in almost as soon as you skip a dose, and then it feels like your body is tearing itself apart." She was admitted to detoxification clinics more than once, before she finally managed to quit.

At present, the medical community is divided on how to wean the body of its drug dependence; while one group advocates drug substitution, the other advises "total abstinence".

The drug substitution method, as practised by support groups such as Sharan, consists of a 15-day residential programme in which addicts are prescribed progressively reducing doses of buprenorphin. They are also given small doses of sleeping pills, vitamins and treatment for other ailments, if any. Sharan, and Sahara, another support group for addicts and those recovering from addiction, also run harm-reduction programmes such as needle-exchange where drug-users who rely on injection can exchange used syringes for fresh ones.

Proponents of substitution and harm reduction explain that such approaches recognise the reality of addiction and attempt pragmatic interventions. Needle exchanges, for instance, acknowledge the fact that in spite of free recovery programmes, drug users are often not ready for detoxification and rehabilitation, and inject themselves using old, possibly infected syringes. Thus the programme offers them a safer and more hygienic way to continue their drug habit and protects them from diseases such as HIV/AIDS and hepatitis.

"We also understand that their biggest deterrent for quitting drugs is the agony of withdrawal," says a doctor speaking on conditions of anonymity. "The substitution programme aims at reducing withdrawal symptoms, making the process easier for the user."

However, most initiatives funded by the Central government, through the Ministry of Welfare and Social Justice, work on the total abstinence method. "We put our patients through a comprehensive six-month programme based on homoeopathy and naturopathy," says Dr. Vipin Chauhan of the Navjyoti Delhi Police Foundation. Dr. Chauhan opposes drug substitution techniques as he feels that users, once cured of their addictions, get hooked onto the substitutes instead. Detoxification is usually followed by a rehabilitation process, where recovering addicts are re-sensitised to the outside world.

"But then it is easy to get clean," goes the saying. "It is staying clean that really tests you." Every evening, across the country, members of an anonymous fellowship meet in sparsely furnished rooms to share their experiences with their particular drugs. Autorickshaw drivers, bankers, artistes, executives, all sit in for hour-long Narcotics Anonymous meetings, united in their belief that only one addict can truly understand another. As the name suggests, the fellowship is entirely anonymous - no attendance is marked at meetings, no member lists are drawn, no fees are collected. The only thing that unites them is their inability to fight drugs alone. The fellowship is premised on the belief that addiction is a disease that can be cured, or at least managed.

Some have been clean for years, while many others are just starting out on the painful process of recovery; each has a "sponsor", or guide, who guides them through the "twelve-step path" to recovery and helps them ward off the seductive lure of relapse.

A number of theories have been advanced to explain addiction. Addiction theories range from disease models which speak of addiction as a disease that must be treated, to physical dependency models which originate from the idea of withdrawal and hence impute that drugs create physical dependencies that must be satiated. Other models such as positive reinforcement models theorise that drugs act on dopamine receptors in the brain and thus generate positive responses which set up the demand for more drugs. This could help explain how addicts can often ignore bodily demands such as food and sleep.

Several persons who came out of addiction told Frontline that they did not know why exactly they took to drugs. While some said that drugs gave them a sense of belonging, others said it was prompted by the need to `fit in'. Many were not even sure why they tried. "No one ever offered me drugs," said Adil. "I walked up to a peddler, asked for a tola (10 gram) of marijuana, smoked my first joint with the peddler, and it felt great."