My journey and learnings in the field of De-addiction – Final part

Let me share with you my learnings now.

  1. Stay focused on here and now. Give your best. And the dream will unfold.

This is a valuable lesson. As a junior most resident in Psychiatry, I did not know that this work will get institutionalized into a ISO approved and President’s Gold Medal winning organization. But I tried to give my best by being genuine, innovative and hard working. Even today in my monthly visits to Muktangan my role is ‘Value addition’ by ‘generating ideas and alternatives’.

  1. The dream if shared by many is more likely to come in reality.

Had the dream of working in this field been accepted and owned by Sunanda,  Anil, Mukta and all my colleagues in Muktangan it would not have persisted for three decades now. I should not have ‘exclusive rights’ over any dream. When multiple people contribute it gets evolved…….and gets evolved in a better design.

  1. Its not only therapies but relationships help in the recovery of addicts.

There are hundreds and thousands of examples of this. As I am writing, one of my recovered patients, has won a prestigious prize in a technical area of film making. He mailed me the news and his photograph. It’s a story of an emotional turmoil for him and his family during his active days of addiction, and then the efforts for recovery. I have been with them in all those days also as a family friend, not only as a professional. I have actually never ever counted these relationships but each has been extremely special for me. The relationship spans across three or even four generations in a family. These bonds have been my forte in all these years of helping addicts.

  1. Right help at the Right time gives stable recovery.

Definition of ‘Right time’ is the internal unconditional genuine wish of a person to get out of addiction. The person/s who is/are helping have hardly any control over it but by giving non-judgmental support they can be helpful. ‘Right Help’ is the factor within control for the helping person. But the ability to walk that extra mile with the patient and family is important. There are countless incidents when I have crossed all limits as a ‘professional’ and helped such persons and families with whatever I could.

Just today I met one of my ex-addict patients of gambling. He shared with me his ‘Right moment to change’ when almost thirty years back I had confronted him with his reality. Deep in financial debts and defiant as a determined hawk he challenged my plan of treatment, by as asking me, “If I don’t agree and follow what you are saying . . . what else you can tell me?”

“Go up the terrace of this building, jump from it and end this game . . .” I had told him with a cold look and flat tone. But by this time I had walked that extra yard with him and his family so he knew that my intention was to see him recover . . . And so is he for thirty years now!

  1. Leaving the addictive substance is the first step towards recovery. Becoming a better human being is the essence of recovery.

I learnt this from many of my patients but most remarkably from a colleague and close guide of mine. His name is Stany Sequera. Uncle Stan who is no more resides in my conscience along with Sunanda and my father. He was an alcoholic. He lost his job in a company called Larsen and Toubro Ltd. He recovered with the help of AA. He started reemployment with the same company as a addiction counsellor and retired after mentoring numerous patients. From the deck of AA he was instrumental in guiding hundreds of recoveries. I met him first as a senior AA member and then as a senior colleague and guide in the formative years of IPH (Institute for Psychological Health). I plan to write about his impact on me separately some day but he was one person I saw who had changed himself immensely and had become not only more evolved but enlightened.

I have seen my colleagues in Muktangan, evolve like this. As I am writing this, the government of Maharashtra has conferred the Vyasanmukti Seva Puraskar of this year to Prasad Dhawale, our senior staff member at Muktangan. He is one of the chief architects of our follow-up programme across the state. His work is so exhaustive that for our follow-up meetings in South Maharashtra sometimes out active workers have to engage Theatres with huge sitting capacities. Very humble in demeanor but determined in his resolve to help; Tatya (we call him fondly) is a unique worker who was admitted in Muktangan many years back as a patient. Similarly Datta Shrikhande another colleague has become a ‘body builder’ in the age group of ‘Above Fifty’ and also a contestant amongst top fifty in TV show ‘Master chef.’

  1. Recovery from addiction requires ‘Network’ of support.

Over the years, Muktangan has evolved its much acclaimed model of comprehensive treatment with extensive web-work of regular follow-up centres. It runs regular training programmes for our ex-patient turned activists across the state to empower them. There is a similar network of Sahachari group (wives of alcoholics) across the state and a special occupational rehabilitation unit for them at Muktangan. We have marriage counseling programme titled ‘Sahajeevan.’ For children of alcoholics we have support group called ‘Ankur’. We have regular events and get-togethers at all major cities. When Baba, Mukta or me visit a city a follow-up meeting is organized there for us. At all ‘slippary days’ such as 31st December every year, hundreds of our recovering addicts come and stay at Muktangan for two to three days. We publish a trimonthly, magazine titled ‘Anandyatri’ that reaches homes of our patients. Now there are numerous Whatsapp groups of our patients and counselors. All of us are called with a Relationship . . . Anil is Baba, I am Anand kaka, Mukta is Tai, Prasad is Tatya, Prafulla Mohite our coordinator for woman-addicts programme is Phula atya. This is unique. In the days when interventions are becoming more impersonal (called professional) we have been able to integrate the therapeutic interventions with optimum transference.

  1. From Black holes of human fallibility to the blessed light of human development.

My journey in the field of De-addiction had consolidated my belief in human goodness. From the ashes of dark destruction the life-force can resurge with such a sustained and consistent way . . . really amazing. Baba says, “Miracles is an everyday affair at Muktangan.” I have experienced this so many times. Not only my trust in human goodness stands firmly reiterated, this journey makes me humble. My contributions at most times, timely and significant, are a drop in the ocean of the gravity of this problem. Yet when you see, it makes some difference, you feel satisfied. The journey made me think deeply about association of different themes such as REBT, AA recovery program, Spirituality, Neurosciences and gave me many fundamental insights about human nature and recovery from addictions.

The area of de-addiction in mental health is supposed to be extremely tough for a therapist . . . Yes, by all means, it is . . . But the happiness and satisfaction it gives you is so unique that you start really believing what Sunanda used to say, “There is no hopeless case in addictions.”

My journey and learnings in the field of De-addiction – III

I still vividly recall that day when Sunanda (Dr. Anita Avachat) passed away . . . And the morning after that when myself and Mukta were on way to Muktangan to talk to our patients and staff team. Sunanda had put her sweat and blood to evolve this unique de-addiction centre. She was a mother to all her patients and team members. More than eighty percent of our staff that time comprised of recovered patients from Muktangan whom we call ‘Muktangan Graduates’ Anil i.e. Baba was in deep grief; gallantly coping with a loss of a relationship that was extraordinary in so many ways.

On that day twenty years back, we all pledged that we will continue Sunanda’s vision and make her mission as meaningful as possible. The mantle of leadership now fell upon Mukta, daughter of Anil and Sunanda, a qualified Clinical Psychologist with great academic distinction. She was being inducted in the team at that time. She nurtured the dream of achieving a Doctorate by doing research on patients with addiction. Reality however threw a much bigger challenge in front of her; to stear an entire organization through a crisis of leadership.

Mukta and my team of senior counselors admirably rose to the occasion to make Muktangan what it is today, a ISO accredited organization that won president of India’s honour as a centre of excellence in the field of de-addiction.

At any given time there are close to two hundred inmates in Muktangan with a staff of over seventy workers. There is a separate ‘Nishigandh’ centre for rehabilitation of women addicts that has completed a decade. We run the Regional Research and training centre for the department of social justice, Govt. of India for the entire western region of the country.

We constituted a unique award in Sunanda’s memory, titled ‘Sangharsh Sanman Puraskar’. This award salutes the spirit of constructive developmental struggle in the domain of individual health and social field; two inseparable parts of Sunanda’s journey. For two decades, I have been compering this function and have interviewed forty personalities that resonate Sunanda’s spirit in their life stories.

In the year 2001, I published my book ‘Muktipatre’ on recovery from addiction. This book is written in the format of letters exchanged between a psychiatrist and a recovering alcoholic. Now close to double digit edition this book has been selling (sailing as well) silently without any reviews in the media. Patients across the state have given me feedback how they ‘identify’ with the protagonist Prateek, the name itself means ‘significant symbol.’ Some years back AIR (All India Radio) converted the book into a Audio-drama and was broadcast from its Pune station in a serial manner. By now it has been repeatedly aired by all AIR centres across the state. The book is now available in English as well with the tittle, ‘Dialogues to wellness’, splendidly translated by my friend Mr. Satish Bapat.

My friend and theatre director Chandrakant Kulkarni saw a play in this book. He along with playwriter Prashant Dalvi had serial discussions with me for adapting the book into a play. They visited Muktangan with me and experienced the therapeutic environment there. The play titled ‘Get well soon’ was successfully staged with lead-star Swapnil Joshi. For Marathi commercial theatre, this was an unique experience to produce a play on recovery from alcoholism. This play won numerous awards but what was more important was influenced many to take treatment and sensitized many to introspect not only on addictions in particular but coping with life in general.

With the hundredth show of the play, eight edition of the book was published. It was a moment of great satisfaction for me. In fact watching the characters come alive is always a treat for any writer. It is interesting that the script of the play is also published now in a separate book.

In my monthly visit to Muktangan I regularly take group sessions with my patients, a thirty five year young habit now. But each group still is a fresh event of introspection for me with a variety of questions and problems asked by them and responded by me. I take group meetings with the staff team to plan forthcoming activities and events. I sometimes take a learning session on any topic pertaining to addiction. Some of my favourite themes are how to integrate principles of REBT (Rational Emotive Behavioral Therapy) with principles of AA that is Alcoholic Anonymous; or how to integrate REBT with spirituality. Sometimes I give inputs on counseling skills, sometimes on the topic of dealing with personality disorders. It is a very refreshing experience.

I also interact personally with patients as well as team members. Muktangan’s strength lies not only at the therapy centre but also in over twenty follow-up centres spread across the entire state of Maharashtra. Whenever I travel to anyone of these cities I conduct follow-up meetings of recovering patients organized by our local recovered patients and counselors from Muktangan who are allotted the co-ordination of different centres. Sometimes the follow-up meetings require specious auditorium. The people who turn up for follow-up are in multiples of hundreds. We do get alarmed by people turning to addictions in large numbers. It’s a redeeming truth that if determined and focused many can come out of this disorder of dependence.

For professionals working in this field I have developed learning programmes on ‘Counseling an Addict and his/her family’ based on principles of REBT. I have also developed a module on ‘How to take Therapy groups in the field of Mental Health.’ Both these are two-three day long workshops where I try to share with others what I have gained from my experiences.

What is very fascinating is the multitude of ways in which I have been able to deal with the theme of addictive behavior . . . From Individual to Organizational, Scientific to Creative, Psychiatric to Social and from Biological to Cultural. . . And the integrated picture that has evolved during this journey.

My major learnings and lessons, I will share with you in the concluding part of this series.

(Contd. Part IV …)

निषेधाचे नवे मार्ग

डॉक्टरांनी ‘संप’ केल्याने नेमके  काय साध्य होणार आहे?

प्रश्न आहे वैदयकीय व्यावसायिकांच्या सुरक्षेचा. तो महत्वपूर्ण आहे आणि त्यासाठी डॉक्टरांनी निषेधाचे सर्व कायदेशीर आणि नैतिक मार्ग वापरायला हवेत. त्यामध्ये  मोर्चा,उपोषण, निवेदने, कायदेशीर पावले, लोकप्रतिनिधी पातळीवरची जागृती अशा अनेक उपायांचा समावेश करता येईल.

परंतु समाजामध्ये आज आपल्या व्यवसायाची विश्वासार्हता कमी होत असताना, सदभावना कमी होत असताना आपण रुग्णांना सेवा देणे बंद करावे हे मला योग्य वाटत नाही.

हे वागणे असे दाखवते की वैद्यकीय व्यवसाय अन्य व्यवसायांसारखाच आहे. त्याला नैतिकतेचा आधारच नाही. ‘सामान्य’ कामगारांप्रमाणेच वागताहेत हे डॉक्टर. असे आरोप सामान्य माणसे जास्त प्रमाणात करणार. सदभावना वाढणार की कमी होणार?

निषेध हे आपले नजीकच्या पल्ल्याचे ध्येय आहे पण विश्वासार्हता पुन्हा स्थापित करणे हे व्यावसायिकांचे लांब पल्ल्याचे ध्येय असायला नको का?

आपल्याला आपल्या रुग्णांमधला विवेक जागृत करायचा असेल आणि आपला व्यवसाय खऱ्या अर्थाने मानवतावादी आहे असे दाखवायचे असेल तर राज्यभरच्या व्यावसायिकांनी एक आठवडा (किमान एक दिवस) आपल्या सर्वांच्या सर्व सेवा निःशुल्क द्याव्यात. मी जर हॉस्पिटलात काम करणारा विशेषज्ञ् डॉक्टर असेन तर मी माझे शुल्क न घेता उपचार द्यावे, शल्यक्रिया करावी. प्रत्येक रुग्णाला असेल सांगावे की तू म्हणजे माझ्यासाठी समाजाचा प्रतिनिधी आहेस. तुझा विवेक जागृत करण्यासाठी मी ही सेवा निःशुल्क देत आहे. असेही डॉक्टर आहेत असे तू किमान दहा लोकांना आजच्या दिवसात सांग.

आपण असे समजू की संपूर्ण महाराष्ट्रात, IMA ने ‘Medical camp’ घोषित केला आहे. एक रविवार असा ठरवावा  ज्या दिवशी शहरातल्या डॉक्टरांचे गट करून त्यांनी आपापल्या विभागामध्ये खास ‘Medical camp’ घ्यावे. त्या दिवशी वैदयकीय शंकासमाधानाचे कार्यक्रम आयोजित करावे. अशी सेवा घेण्यासाठी येणाऱ्या प्रत्येकाला व्यवसायिकांवरच्या हल्ल्यांचा आणि हिंसेचा निषेध करणारे पत्रक द्यावे; त्या रुग्णांच्या त्यावर सह्या घ्याव्यात. असे करताना व्यावसायिकाला आत्मशुद्धीचे समाधानही लाभेल. माझ्या व्यवसायातील अपप्रवृतींचा मी निषेध करतो हे सुद्धा  ह्या निमित्ताने सर्व व्यावसायिकांनी सांगितले पाहिजे. डॉक्टरांवर होणारे हल्ले सर्वसाधारणपणे कोणती व्यावसायिक मूल्ये पाळणाऱ्या किंवा पायदळी तुडवणाऱ्या व्यावसायिकांवर होतात त्याची पहाणीही व्हायला हवी.

रुग्णाला सेवा न देणे हे नकारात्मक आहे आणि ते प्रतिक्रियावादी (Retaliatory, Reactive) पाऊल आहे. निःशुल्क सेवा देऊन आपले मत समाजाला पटवणे हे सकारात्मक आणि proactive पाऊल आहे.

आपण आपापल्या समाधानी रुग्णांनाही आवाहन करायला हवे की ऐन आणीबाणीच्या वेळी वैद्यकीय व्यावसायिक त्यांच्या मदतीला कसे आले त्याचे अनुभव त्यांनी सलग आठवडाभर आपापल्या समाजमाध्यम गटांमध्ये पसरावे. सर्व प्रसार माध्यमांना आपण आवाहन करावे की त्यांनी ‘मी आणि आमचे डॉक्टर’ किंवा ‘कुटुंबाचे डॉक्टरकाका’ अशा विषयांवर वृत्तकहाण्या (Newsfeatures) आणि संवादसत्रे (Talkshow) घडवून आणावेत. काही जमावांनी दुःख आणि राग आततायीपणे व्यक्त केला म्हणून तो मार्ग सर्वांनी घ्यायचा का हा choice आहे.

समाजमाध्यमांमध्ये प्रस्तूत करण्यात आलेल्या IMA पत्रकानुसार गावागावांमध्ये डॉक्टर्स सेवाबंदी करत आहेत की नाहीत हे पहाण्यासाठी विशेष पथके तयार करण्याची सूचना आहे. तसेच ह्या कामबंद निषेधामध्ये सहभागी न होणाऱ्यांसाठी असहकाराची गर्भित धमकीसुद्धा आहे. संघटनेच्या पदाधिकाऱ्यांनी इतके भावनिक व्हावे आणि विवेकाला तिलांजली द्यावी हे खूप दुःखदायक आहे.

डॉक्टर्स आणि समाज ह्यातील कटुता कमी करणे हे आपले ध्येय असायला हवे. गढूळ झालेले समाजमन अधिक गढूळ करायचे आणि आपल्या व्यवसायाबद्दलच्या नाराजीला अधिकच खतपाणी घालायचे ह्यामुळे आपली विश्वासार्हता पुन्हा येणार आहे का? उलट निःशुल्क सेवा दिल्याने आपण प्रतीकात्मकपणे पण थेट कृतीतून समाजाला हे दाखवू की आमच्यासाठी ‘आर्थिक लाभ’ हा एकमेव हेतू असणार नाही तसेच आम्ही आमच्या ‘सेवाव्रताशी’ प्रतारणा करू इच्छित नाही. माझ्या व्यवसायावर झालेल्या शारीरिक हिंसेची प्रतिक्रिया मी जर अप्रत्यक्षपणे हिंसा करूनच करणार असेन तर मी माझ्या व्यवसायाला उन्नत आणि परिपक्व असा व्रत-व्यवसाय का म्हणावे? माझा व्यवसाय हा सामाजिक विवेकाचा मापदंड असावा अशी माझी इच्छा आहे आणि ती मला माझ्या कृतीतूनच ठामपणे व्यक्त करायला हवी.

  • डॉ. आनंद नाडकर्णी


आज सकाळपासून मी ‘Walk the talk’ ह्या न्यायाने तीसहून अधिक रुग्णांना विनाशुल्क तपासले. प्रत्येकाला माझ्या वागण्याचे कारण सांगितले. माझे विचार समजून सांगणारे निवेदन दिले. ह्या सर्वाचा Feedback विलक्षण सकारात्मक होता. सर्वच रुग्णांनी मला सांगितले की तुमचा अभिनव मार्ग भावला. काही जणांनी माझ्यासोबत फोटो काढला, काही जण पाया पडले आणि प्रत्येकाने हा अनुभव त्यांच्या जवळच्या प्रत्येकासोबत share करण्याचे आश्वासन दिले. माझा निषेधाचा आवाज अनेकांपर्यंत प्रभावीपणे पोहोचला. रात्रीपर्यंत मी अजून तीस रुग्ण आणि त्यांच्या कुटुंबीयांपर्यंत पोहोचेन. काम थांबवले असते तर माझ्या व्यवसायाबद्दलची सदभावना तर मी साठ कुटुंबांपर्यंत पोहोचवली नसतीच पण माझ्याबरोबर ह्या सर्वांच्या डॉक्टरांसंदर्भातल्या गप्पाही झाल्या नसत्या.

My journey and learnings in the field of De-addiction – II

Ignorance is indeed bliss sometimes . . . I did not know the enormity of the challenge of Narcotic Drug Addiction. I took it as my responsibility to respond. . . . Society at large did not know about this condition . . . so let me start spreading awareness . . . It was that simple. I had nice relationship with the official photographer of KEM Hospital. I requested him to shoot some slides for me. I prepared script of a slide show on drug addiction. I had around eighty slides in all. By changing sequence of the slides and adding-deleting some, I could create almost seven variations of my talk that would cater to different audiences. So, with same visuals I could address students, adults, addict, Medias, police, teachers . . . with different contents and sequence. Mrs. Prabha Apte a close friend of mine donated a slide projector and a screen. I started visiting wherever I was invited . . . Over next three years I must have given over 600 presentations across Mumbai . . . There  were chawls, bastis, schools, Ganesh festivals, community lecture halls. . . . Many social organizations, political parties, trade unions started calling me. I did not say No to anyone.

Just before I started this individual crusade of mine, I had passed my MD examination and was approaching the end of my three years residency. Dr. G.B.Parulekar, Dean of KEM knew and supported my work. So did Prof. Dr. L.P.Shah . . . Before my residency ended a new post called ‘Lecturer-in charge De-addiction’ was actually created in Municipal Corporation. I applied for it. I was called for interview. There were few other candidates. But everyone knew the result. I had no ‘pull or push’ or ‘political clout.’ It was sheer volume of work by an individual . . . By this time I had organized probably the first community detoxification camp in Maharashtra at sweeper’s colony opposite Mahalaxmi Racecourse. I had started separate group therapy for addicts. I was training law enforcement officials.

One day the hall where I was taking my groups got a consignment of 50 brand new foldable chairs . . . courtesy Mr. D.S. Soman, the then police commissioner of Mumbai. I received a handwritten letter by actress Smita Patil, who became a close friend thereafter . . .

One fallout of all these efforts was, patients coming to ‘see me’ even before I had passed my M.D. examination. The credit must be given to all my seniors, as they appreciated this fact. As such my ‘public relations’ with everyone working in KEM from ward boy to the Dean were excellent. Because of my activities in literature, dramatics, journalism, social fields and media; I had gathered a fairly large circle of friends and well-wishers around me in these ten years since I entered the medical college. It was hard to believe for my own self that a shy student, conscious of his middleclass, Marathi medium background was accepted so well by so many . . .

So, without a gap of a single working day I glided in the post of lectureship. (Incidentally I had topped my batch in MD examination). This gave me fresh impetus to reach out to more people. I had written a play on addiction . . . a musical which was staged by all AA members to celebrate fifty years of AA in India. It was a unique activity where a top class performance by all ex-alcoholics was presented in Mumbai. I wrote a script now on drug-addiction. A group of youngsters started staging it. The same group after two years produced ‘Ek Aakash Sampale’ first ever Marathi serial on drug addiction. At the end of each episode I used to come on screen and summarize the episode. I also developed a six part educational programme ‘Bhasmasur’ on Marathi DurDarshan.

During this time Anil Awachat (Senior Marathi writer and social activist) whom I call my Baba now, and his psychiatrist wife Dr. Sunanda came in my life. Only son of one of their family friends had got entangled in narcotic addiction. Both Anil and Sunanda were helping the family. They came to me to discuss my work. They were staying in Pune. Anil got so interested in my work that he stayed with me in my KEM quarters for a month. We visited many places in Mumbai associated with Narcotic addiction including my patient’s homes. He attended my group sessions in KEM, public lectures and sat with me in OPD. The result was a series of journalistic articles published in Maharashtra Times, a popular Marathi Daily. The articles were widely discussed in the entire state. Famous Marathi writer P.L. Deshpande and his wife Suneeta approached Anil-Sunanda and offered funds to start an exclusive treatment centre on addictions.

Sunanda was working in the Government Mental Hospital in Pune as a senior consultant. There was a specious building lying vacant in those premises. She and Anil managed to get permission to use it as a centre and Muktangan De-addiction centre started in August 1986. I anchored the opening ceremony (as I did on the 20th and 30th anniversary of Muktangan). Baba Amte, noted social worker was our chief guest. We got out first patient admitted right after the conclusion of the opening ceremony. Sunanda used to call him ‘Shakunacha Mahadev’ . . . meaning ‘The God Shankar of good omen.’ His name is Mahadev Ghare. He is sober from that day and attended our 30th anniversary as a special guest.

I decided to quit my lecturer’s post in late 1986 and soon started a day-care centre for alcoholics and drug addicts in Thane along with impatient facility. Dr. S.R. Kanbur and Dr. Suneeti Kanbur, prominent Gynecologist couple from Thane provided their hospital space for this and provided support for a decade without expecting any monetary returns. It was a great risk for their reputation as theirs was a Gynaec nursing home. But they believed in the mission of de-addiction.

At a time almost twenty recovering addicts used to be there at Shivneri (Name of the hospital) throughout the day. We started making greeting cards, Diwali lanterns and Christmas trees. We organized an awareness programme for all educational institutes in Thane titled ‘Drug Fight89.’ This brought me in close contact with a young police officer named Hemant Karkare. Our association turned into a very deep friendship till his untimely heroic death during the terror attack in Mumbai.

Around 1990, Sunanda had been diagnosed with breast cancer and was spearheading Muktangan and caring for hundreds of addicts. As her health started showing fluctuations I pledged to come regularly every month to Muktangan and contribute which is going on till todate.

Working with Sunanda was a fantastic experience. She gave me more respect than I deserved as her junior colleague. She used to mention my name as her teacher in de-addiction. This was more out of her humility. But we shared a deep bonding. She was my mother as well as a intensely close friend. I had become by this time an integral part of their family. Even today, a set of my clothes, towel, toiletry is at Baba’s home. Actually my elder brother stays in Pune and I do visit him but my ‘home’ in Pune is with Anil and Sunanda.

We were developing a treatment programme for de-addiction with our experiences and with a cultural ethos of this soil. There were group activities, patient get-togethers, individual counseling sessions. Sumitra Bhave and Sunil Sukhatankar directed a film ‘muki’ for Muktangan and I wrote its title song . . . I was enjoying the work as my personal work was slowly getting institutionalized . . . And then in 1996, Sunanda left us. Although we knew this was coming, it was tough to endure . . . Muktangan was at a tough cross-road.

(contd Part III) ……

My journey and learnings in the field of De-addiction

It has been over three and a half decades . . . Thirty five years as a psychiatrist in the field of de-addiction. Time to look back and take stock . . .

In the field of De-addiction there are some special terminologies. Like in internal medicine, the process of getting better is called ‘Recovery’ . . . The state of mere staying away from addictive substance is called ‘staying clean’. If along with it the person undergoes positive attitudinal change then it is called ‘sobriety’ (that is ‘being not only clean but sober). In contrast long-time ‘only clean’ state is called ‘DD’ meaning ‘Dry Drunk’ stage. Reverting to addiction after a remission is called ‘slip.’  A prolonged slip is called (like in cancer) a Relapse. Then there is this potent destructive word called ‘craving’ which means inability to control the demand for consumption of an addictive substance. What is remarkable is, these English words are used in many Indian languages where the sentence itself will be in Marathi, Gujarathi, Konkani or even Tamil . . . That is one reason why all addictions are supposed to create a ‘concurrent counterculture.’

My journey in this world of addicts started as a novice, which was quite understandable, as I was the juniormost resident in the Psychiatry unit Headed by Prof. Dr. L.P. Shah in Seth G.S. Medical Collage and K.E.M. Hospital, Mumbai. More interestingly, I had no aspiration or motivation to work in this field. It so happened on one fateful day in the middle of 1981; Dr.Shah summoned for me and told me look after the ‘Ward Ten’ patients. Alcoholics used to get admitted there and those beds were in proximity with Neurology and internal medicine wards. I started treating delirious withdrawals of tremulous individuals first with anxious preoccupation and then with a routine confidence. Most of my early patients luckily enough recovered from physical withdrawal and I started talking to them.

They were my very first teachers. The medical part of physical withdrawal, although difficult could be mastered by experience, reading textbooks and discussing with seniors. But I was a resident in Psychiatry . . . and still did not know a thing about ‘counseling’ addicts. The textbooks here were of limited help as they were theoretical and had a western context.

Mr. Jeet C. and Mr. Arun T. were my first teachers. Jeet, a robust Punjabi gentleman was quite rough when intoxicated but quite tough at that time in his resolve for recovery. Travelling on his two-wheeler I started attending AA (Alcoholic Anonymous) meetings across Mumbai. Arun T. was owner of a restaurant and came from a respectable Marathi Brahmin family where ‘alcohol’ was a taboo. He was more thoughtful and serious discussions with him many times left me in disbelief about he being a ‘relapsing alcoholic.’ I used to read about clinical states, symptoms and syndromes in the book and ask about it to these two . . . They used to parade before me at the meeting time people who had or were suffering from the same . . . I used to share my scientific explanations with diagrams regarding say ‘An Alcoholic Block out’, a state of temporary amnesia and they used to narrate their experiences over cups of tea in some obscure Irani restaurant in the heart of Mumbai . . . I got some outstanding clinical as well as human insights.

I started visiting with Jeet and Arun homes of recovering alcoholics to realize that the people involved came from stingy chawls of the mill dominated central Mumbai, plush buildings of Napeon Sea road or middle class housing colonies in Hindu Colony Dadar. A family member from a very prominent industrial house had turned into an AA member. By now I had started talking regularly at AA gatherings as I had started reading books on AA philosophy with active discussion with my patients, friends . . . so, this gentleman called me for a one on one meeting. I opted for tea, sitting in his office and he was gulping lemon juice. He was putting ice-cubes in the glass at regular intervals. We were sitting in a building that had his family’s name on its nameplate. “I don’t know why I like it this way….” He mused. “May be . . . you are trying to recreate an experience from which you haven’t still got detached . . .” I said almost in a murmur but straight looking at his eyes . . . He put the cube that he was holding back in the ice-box and smiled. We had a great chat thereafter.

Had I not encountered so many interesting people courtesy ward No Ten and AA, I would not have persisted in this field. I was finding my ease in the process of interacting with alcohol dependent people when Dr. L.P. Shah came out with a bright new idea. “Anand, why don’t we start a therapy group for alcoholics? . . .” Posed as a question, this was an elegant order. I nodded.

There was one lonely hall in the hospital’s main building which was used as ‘Child guidance clinic’ for six long hours per week. There was nothing there that any child would have loved barring an open space in front and a solitary tree. By then I had attended many AA meetings and thought that my meetings should be different. By that time Dr. Shah had given permission to Jeet, Arun and others to have a separate AA meeting in the same hall once in a week. So I thought of many formats. Interviews with senior recovering addicts, round table theme discussions, role plays, question answers on topics related to alcoholism, guest lecture by different medical specialists, communication and team building activities . . . I had told myself that I will never repeat a format. I did not know anything about conducting therapeutic groups. Mrs. Hema Shah, wife of Dr. L.P.Shah who was working in our PSM (Preventive and Social Medicine) Department used to be with me. Soon I started taking evening group meetings as well. Those were left to me. And after six months and forty-nine group meetings later, I started getting attendance of more than forty recovering alcoholics. They came from all over. . . . All were not my patients. Some attended in an already intoxicated state . . .  And later did come for admission in hospital.

When I left KEM six years later I was conducting six groups every week, two for alcoholics, two for drug addicts and two for family members. It was valuable training for me. Now in my monthly working day at Muktangan De-addiction Centre in Pune. I regularly conduct a group . . . off course I have lost the count or numbers in these thirty six years. But my energy and focus in every group is very rigorous, thanks to the early days training.

I remember, somewhere in 1988-89, the Indian Journal of Social Work, an indexed journal published by TISS (Tata Institute of Social Sciences) invited me to write an article on ‘Group Intervention with Recovering Addicts.’ I wrote exactly what I had done and what I had learnt. The article was duly published in a special issue on De-addiction. After almost an year I received a letter from National Institute of Alcoholism and Drug De-addiction from USA that my article was selected as one of the ten research papers adjudged as ‘original research in the field of De-addiction.’ That was hilarious in one way but quite apt as the contents of the paper were really ‘original’ without a long list of references and cross references. I did not realize that I was creating ‘Research paper.’ For me it was the thrill of doing something creative.

While I was gaining valuable experience in the field of De-addiction, I was doing all my other duties as a resident doctor and also a complete range of extracurricular activities including creative writing, dramatics, watching movies and having fun with friends. The AA groups in Mumbai used to organize ‘Night vigils’ a mix of continuous lectures and discussions that would start in the evening to end well after midnight . . . After delivering a lecture on one such occasion I was coming down from the dias when an elderly gentleman greeted me introducing himself as ‘member of this fellowship.’ I was stunned to note that he was a prominent senior psychiatrist himself. He praised me for my work and said, “I always tell my resident doctors to go and see your work.” This was a beginning of long friendship between this very competent clinician and me.

As my residency was proceeding I started preparing for my MD examination. And a series of events came up my way. In our Psychiatry outpatients department we started getting a new set of patients. These were young people consuming a new drug called variously as ‘Brown sugar,’ . . . ‘Gard’ . . .’Heroin.’

I went back to books to learn about this Narcotic derivative. Because of a curious mix of geopolitical factors, these narcotics started travelling through our country with obvious disastrous consequences to follow. Because of my ‘experience’ in dealing with alcoholics Dr.Shah instructed me to co-ordinate our response to treat these people.

As was my habbit I started chatting with the young addicts and their families. I realized most of the young men did not know the details of what they were consuming. With narcotics; physical dependence develops in no time. Then it becomes extremely difficult to leave it . . . I knew, I had to respond to this challenge . . . How? . . . I started exploring . . .

(contd… in part II)