It is important to understand the correct situation of drugs and alcohol problem in our country in order to formulate effective control mechanisms and to provide adequate treatment and rehabilitation services to the affected.
Bhutan’s drugs abuse problem is less compared with that of other countries. It is estimated that less than 7 percent of youth abuse drugs on a daily basis. The types of drugs abused are mainly pharmaceutical such as pain medicines like Spasmoproxyvon (SP+), sedatives likes Nitrazepam (N10), marijuana and cannabis, inhalants and solvents like dendrite, paint thinners, and correcting fluid.
However, we cannot afford to remain complacent. The negative impact of drugs on individuals and their families is overwhelming. Addiction is considered a medical disorder. But, unlike other types of illnesses, addiction affects youth in their prime age and permeates into all aspects of their lives. Drugs can interfere with learning, whether it is academic or vocational due to the damage it causes to the brain and body. It affects their social learning and relationships. It affects their functioning and finances. Addicts have high risk of coming in conflict with the law due to their vulnerability to frauds and violence. Many youth affected by drugs have lost their lives due to overdose.
The problem is magnified in the Bhutanese context due to low level of awareness and capacity to deal effectively with the addicts. Lack of adequate facilities and trained professionals to treat and rehabilitate them compound their problem. Restrictive laws that are more punitive than reformative add to the burden of care. For example, the amended Narcotic Drugs, Psychotropic Substances and Substance Abuse (NDPSSA) Act of Bhutan 2018 mentions that an individual caught with 21 capsules of SP+ will be convicted as felony of fourth degree crime with mandatory jail sentence of 3 to 5 years. By this narrow definition of a drug trafficker, most addicts in Bhutan if caught in possession with drugs can be convicted as a criminal as majority of them would take 20 – 30 capsules of SP+ in a day if available. The situation is aggravated by lack of rehabilitation services in the jails and risk these incarcerated youth becoming hardcore criminals in the future.
But on the other hand, the problem of alcohol abuse in the country is by far the biggest public health issue that necessitates urgent action. Alcohol has been the biggest killer and burden on health care services for the past several decades. Majority of alcoholic patients die in their prime age due to cirrhosis. Death due to alcohol surpasses that of combined AIDs, TB, and Malaria. Yet, we do not even have a dedicated public health control programme to address the problem. One government official observed recently: “We spend millions of Ngultrums to refer and treat late stages of cancer outside Bhutan but spend less on preventable diseases like cirrhosis.” Alcohol not only affects the individual’s health, functioning and finances, but also affects the family, their relationships and well-being. Alcohol is also highly correlated with domestic violence, motor vehicle accidents and suicide in Bhutan. Alcohol is a multi-faceted problem and requires multi-stakeholder approach. Just leaving it to the Health Ministry is not solving the issue.
Health ministry has established detoxification and treatment services in all hospitals and BHUs in the country. Health workers are trained on detoxification and provided with basic essential medicines. The treatment is fairly simple and cost-effective. However, treatment records show very small numbers receiving treatment. This shows that either the addicts are not coming for treatment or the health workers are not proactively offering the treatment. If we can increase the detoxification of alcoholics, the rate of cirrhosis due to alcohol can be reduced and deaths prevented. Services are already available. All we need is to create more awareness and upscale the treatment.
What is lacking today is rehabilitation beds. Addiction is a lifelong disorder. Detoxification and treatment is only the beginning of the treatment where an addict is helped to overcome withdrawal symptoms with use of substitute drugs and screened for co-occurring physical and mental disorders. The next phase of treatment is rehabilitation where an addict learns some essential skills to stay sober after discharge and is given time in a safe environment to stabilize his physical and mental state.
After discharge from rehab, an addict has to be vigilant and use the skills he learnt to stay away from drugs and alcohol. He or she has to attend self-help groups like AA/NA to build a support system when in risk of relapse. Many have lost their families. They may not have a place to stay after discharge from rehab programmes. For this group of people, halfway homes or temporary shelters may be needed before they can find a permanent home. That an addict can become sober on his own without professional and family support is a myth. Families need to create the space and support to sustain drug/alcohol free life. As of now, there are only three rehab centres in the country with potential for 25 beds each. These centres can provide rehab and treatment for only 300 individuals in a year. Many addicts are compelled to go abroad for rehab. Therefore, there is urgent need to establish at least 75 more rehab beds in the country.
Just as a person does not become an addict in few months or years, it takes that many years or even longer for some to recover. The most challenging task for an addict is to reintegrate to mainstream society after rehabilitation due to lack of education, life and vocational skills, damage to physical and mental health. Recovering addicts need understanding, compassion and support from families and community to get jobs and to lead independent lives. In recent years, RCSC has been proactively helping alcohol-affected civil servants to seek treatment and rehabilitation rather than punishing them. Likewise, schools are showing more compassion to drug-affected youth by sending them for treatment and accepting them back to school.
Our society needs to rethink our whole approach to treatment of addicts and pursue these positive leads. Criminalizing drug-affected behavior and incarcerating young people by imposing punitive laws without reformative services in jails will only make them hard core criminals in the long run, accruing huge costs to the government for their upkeep and security. Not only do we need to relook and make appropriate changes in our NDPSSA Act of Bhutan 2018 before it is too late, we also need to establish reformative, rehabilitation and vocational training services in our jails.
Every member of our society has responsibility to remove the burden of addiction in our country. Let us not leave this problem to be solved only by the government, NGOs, individuals or their families. Only a concerted effort from all sectors of our society will be able to address this multi-faceted problem.
Contributed By Dr.Chencho Dorji,
Sr. Consultant Psychiatrist, JDWNRH, Thimphu