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)

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