Imphal Review of Arts and Politics

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Dr. R.K. Lenin on juvenile mental health
Dr. R.K. Lenin. (Picture courtesy DDK Imphal)

Drugs Menace is a Chicken and Egg Problem, if There are no Users There will be no Sellers, and Vice Versa: Dr. Lenin

Illicit drug use or substance abuse has paralyzed the citizens of Manipur. The victims of substance abuse are not only the users but their families too. Some people are greedy and selfish and that is why they sell these substances but on the other hand, there are others who are working tirelessly and sincerely to combat this war. One of them is Professor R.K Lenin Singh, the head of Department of Clinical Psychology at the Regional Institute of Medical Sciences (RIMS), Lamphelpat, Imphal, Manipur.

FPSJ Review obtained an interview with Dr. Lenin. Excerpt:

FPSJ Review: Sir, can you tell us how many cases of drug addiction/substance abuse come for treatment daily?

Dr. R. K Lenin: RIMS is not the only one with the substance abuse data however, at RIMS, daily we have two clinics, one is called DTC (Drug Treatment Clinic) and another one is MMT (Methadone Maintenance Treatment).In our OPD, along with other mentally ill patients, many drug abuse patients also come.

‘Drug abuse’ is a loose term so it would be more appropriate to use the term ‘substance use disorder’ since there is alcohol abuse also. Daily, we receive about 20-30 Substance Use Disorder patients in our OPD. Among these cases, half of them are alcoholic patients and half of them are related with other drugs cases such as Heroine, WY, SP, Marijuana etc. We do not get many cases of tobacco users because it is known as a socially sanctioned drug even though it is the most used substance in Manipur.

Substance users come to the Drug Treatment Clinic and the extreme addicts who find it very hard to give the substances up who have repeatedly been in rehabs but who cannot quit are treated at the Methadone Maintenance Treatment. They are given some substitution for the opioid drugs that they use such as SP, WY, Heroin etc. We give them a liquid drinking solution depending on how severe their cases are, every day, and the patients come daily to drink these doses in 5ml, 10ml etc. so that they can go about in a day without problems. We have 40 beds inside our Psychiatry ward here at RIMS. Among these, 20 beds are occupied by alcohol abusers and heroine abusers. Before we used to get only male patients but now, we get women patients also. Some of them are admitted also.

FPSJ Review: What kind of illicit drugs and substances are most hard to recover from and please tell us why?

Dr. R.K Lenin: Firstly, in a layman’s term, ‘drug addiction’ doesn’t mean a person who has been drinking alcohol for 10 years who drinks only one peg a week but someone who drinks every day and someone who does not want to quit but increase his doses every time, someone who does not have tolerance.

Secondly, when a person suddenly quits whatever he has been taking then he suffers from severe withdrawals, and this we call as ‘withdrawal syndrome’. Thirdly, there is a certain thing called ‘craving’-this is happens when there is a gap of intake of substance by a person, that person craves for the substance when it is not in their blood stream which can be severe.

In Heroine abuse patients, we see that even to their bones, there is aches and pains when they go through the withdrawal syndrome phase. They also have tears in the eyes, nose and mouth will be watery, they will not be able to sleep, they will get angry, they will not feel hungry during the withdrawal syndrome phase. That’s why the substance abusers go back to using by hook or by crook in order not to go through the withdrawal syndrome phase.

These three points are very important. The substance abusers cannot think of socializing and being social, they will keep thinking about the drugs and the alcohol once they are into it.

Lastly, they will evade being responsible as a family man, they will not feel like studying if they are students and they will not feel like working if they are in a job. The most addiction prone drug is Heroin. If one consumes alcohol for two years, addiction does not necessarily happen. But one-time or two-time Heroine usage is enough for people to get hooked to it. All substances are hard to recover from once someone is addicted to them. However, it depends on someone’s personality and will power also. If someone does not have a strong willpower, it will be very hard for them. Family support is a must in over-coming drug addiction and one of the main things is availability of the substances everywhere in Manipur. This is one of the major causes of drug addiction.

FPSJ Review: Please talk to us about how illicit drug use affects someone’s mental health?

Dr. R.K Lenin: Substance abuse changes a person’s life in the long term gradually, their lifestyles etc. Perhaps, the users would be someone who was soft-spoken, responsible, someone who cared about his family and his community would become someone who would be very negative- with a negative behavior, a negative attitude because  of the negative thing that he is doing.

The substance users’ sleep patterns will change, eating patterns will change and they won’t feel like talking nicely to people, they would want to be isolated and they would want to stay alone, dreaming about something. They would only want to talk to other substance users because they will think that other people are not understanding them. The interpersonal relationships that the substance users have will deteriorate gradually, either it is with parents or siblings, they will always be in a negative space. So, substance abuse will affect relationships, attitudes, performance, behaviors negatively and all these lead to depression and ultimately leads to suicidal thoughts.

Most of the chronic alcoholics or chronic drug abusers who hardly have anyone, who don’t have job, whom the society looks down upon, tend to commit suicide. Most of them were normal before and because of their addiction, they are not trusted by people and this also hurts them, they become hopeless because despite trying a lot they are not able to overcome their addiction, they are heartbroken and all these factors lead to an end of a life. The regular usage of substances will bring a permanent neurobiological change in a person because they are affecting the users’ brains directly.

Along with this there will be psycho-social change and they will become a totally different personality because of the substance abuse. They also become mostly anti-social. Some of already mentally ill people such as people suffering from schizophrenia also tend to use substance to ease themselves because they are at war with their own brains. Therefore, people who use substance also develop ill mental health because of substance abuse and at the same time, people who are mentally ill also tend to use substance to ease their minds.

FPSJ Review: What do you have to say on the widely available drugs in Manipur?

Dr. R.K Lenin: People say that if there are no buyers then there won’t be any sellers, and vice-versa. Now, we are at the ‘who came first-the chicken or the egg?’ Kind of chase. However, what we must know is that ‘demand’ and ‘supply’ generate each other. Selling drugs is a very lucrative business. Because people are blinded with greed for money, they are unable to see the youths’ destruction and even if they can see this, the business of selling drugs have been perpetuating.

If we want to reduce this, we must be very honest. There is a lack of honestly in this state. On every level, that is, on the level of the administration, on the level of law enforcement, on the level of drug peddling, on the level of drug abusers- all of them need to be honest. We need to be compassionate towards our fellow humans as well. We must be able to think that if something is going to affect someone negatively from my actions, we must not do it. All people fighting against the drug war are not successful because of corruption and dishonesty. Three things, that is –

  1. Demand reduction
  2. Supply reduction
  3. Harm reduction

These three are very important. Demand reduction means what we are doing – that is, trying to treat people and to help them not want to take drugs. Supply reduction is what NAAP are trying to do- destroying poppy plants and such. Harm reduction is to provide substitute medicines for the extreme cases of substance abusers.

Illicit drugs are still available widely in Manipur and I doubt that it will reduce because there seems to be dishonesty at different levels.”

FPSJ Review: In your opinion, how can we combat and win this war against illicit drug use?

Dr. R.K Lenin: In today’s modern society, we have become very materialistic. With more development, we are seeking pleasures from the material world today. In my opinion, true happiness and peace cannot be derived from the material world. In search for happiness, because of our ignorance, we look for easy gratification. We want happiness instantly and that is why people just shoot up Heroine and that temporary pleasure they get out of it is thought of by them as true happiness which is nothing but an illusion.

Another thing is our present-day lifestyle has become fast, so we are usually stressed out, tensed and it has become very competitive. We are always stressed out and tensed. Because of these, our lives have become less peaceful. Because we are not at peace, we want instant gratification.

That is the first point, why we seem to be losing this war against illicit drug use and the second is also related to that, which is, wide availability of these illicit drugs. Therefore, we must have a short-term plan and a long term-plan, and we must instill in the young generation since they are children. In short-term plan, the proper utilization of fast tract courts is a good thing and in the long-term plan, a good value-system should be ingrained in our children today.

For example, we should teach the children to know that rather than obtaining extreme wealth and focusing on the material world, more value should be given to an honest person. Then, slowly, we can overcome demand reduction. The immediate solution is to catch the illicit drug sellers, treat the already existing illicit drug users and providing substitute medicines for the extreme cases of illicit drug users.

Lastly, the message I want to give is that illicit drug users are not only naughty kids, but we should know that it is also a disorder- Substance Use Disorder and we can treat this when they fall unfortunately. We should not discriminate against them because they need our help and support. We should not stigmatize the illicit drug users otherwise stigmatization will lead to marginalization. We should try to understand them and show compassion to them and treat them with dignity and try to cure them.”

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