Q1: Substance abuse has emerged as a serious public health concern in Jammu and Kashmir. From a psychiatric perspective, how does medicine define drug addiction, and why should it be understood as a medical and social disorder rather than merely a habit or moral failing?

Ans: Drug addiction is a complex disorder with far-reaching medical, psychological, social, economic and legal consequences. In Jammu and Kashmir, where many young people are affected, it also has serious academic implications. Addiction is better understood as a syndrome involving multiple interrelated factors rather than a single isolated disease. It is not merely an individual problem; it affects families, communities and society and contributes to the broader public health burden.

Clinically, addiction is diagnosed using internationally recognised classifications such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11).

In simple terms, addiction occurs when a person uses a substance not medically indicated or consumes it beyond recommended dosage. Over time, the body develops tolerance, meaning higher doses are needed for the same effect. Some individuals use substances to experience euphoria, while others use them to cope with physical or psychological distress.

This process is closely linked to the brain’s dopamine reward system, often referred to as the “happy hormone.” Normally, dopamine is released during positive life events such as success, celebration or achievement. Drugs artificially stimulate this system, creating exaggerated pleasure and gradually leading to dependence and escalating use.

Another defining feature is withdrawal syndrome. When the substance is reduced or stopped, individuals may experience irritability, insomnia, tremors, palpitations or gastrointestinal discomfort, which often drives them back to substance use.

Addiction also disrupts daily functioning and relationships. Individuals may spend significant time procuring and consuming substances and recovering from their effects, leading to deterioration in academic performance, professional responsibilities and family relationships. In many cases it also results in legal consequences, including offences under the NDPS Act.

A particularly worrying trend in Kashmir today is intravenous drug use, where individuals inject substances and sometimes share syringes, greatly increasing the risk of Hepatitis B, Hepatitis C and HIV.

Having worked in this field since 2002, I can say substance abuse has become one of the most serious public health challenges in Jammu and Kashmir, particularly over the past decade, affecting countless young lives and devastating families.

Q2: Many families in Kashmir still view addiction as a moral weakness. From your clinical experience and research over the past three decades, how has the pattern of substance abuse evolved in the region, and why is the “moral failure” narrative a dangerous misconception?

Ans: The most dangerous myth is the belief that addiction is simply moral failure or degradation. In reality, addiction is influenced by environmental factors, availability of substances, peer pressure and sometimes genetic vulnerability. If addiction were purely about morality, all siblings in a family would develop it, which clearly does not happen.

Another misconception is that substance abuse affects only economically weaker groups. In clinical practice we see patients from all social backgrounds, including students from reputed schools and financially stable families.

Over the past three decades the pattern of substance use in Kashmir has changed significantly. In the 1990s, research by Professor Mushtaq Ahmad Margoob showed cannabis (charas) was the most commonly used substance.

Later, in a study I conducted between 2002 and 2005 involving around 300 patients, the trend shifted toward medicinal substances of abuse such as injectable opioids used for pain relief, benzodiazepines (sleeping pills), cough syrups and other prescription medications.

Around 2013–14, a study by Dr. Yasir Hassan Rather found inhalants becoming increasingly common among students, including correction fluids, adhesives, paints and thinners that were inexpensive and easily available.

A major turning point occurred around 2016–17 when heroin began entering the region in significant quantities. Earlier it existed but was rare. In my 2002–2005 study only about 10–15 of 300 patients used heroin, while most used cannabis, benzodiazepines or alcohol.

Today the situation has changed drastically. Nearly 95–98 percent of patients seeking treatment are dependent on opioids, particularly heroin, because it produces a rapid dopamine surge and intense euphoria.

This shift was also reflected in the National Drug Use Survey conducted by the Ministry of Social Justice and Empowerment in collaboration with AIIMS New Delhi, where the Department of Psychiatry at SKIMS Medical College served as a regional technical agency for Jammu and Kashmir and Ladakh. The findings showed opioids had become the dominant substance of abuse.

By 2019, Jammu and Kashmir ranked among the top five regions in India for opioid use. Our 2017–18 study estimated about 1.5 percent of the population used opioids, while research by IMHANS in 2021–22 suggested the figure had risen to nearly 2.5 percent, translating to approximately 2.5 lakh individuals.

Another disturbing development is increasing intravenous heroin use, which carries serious risks of Hepatitis B, Hepatitis C and HIV transmission.

In response, the government established addiction treatment facilities, and the centre at SKIMS Bemina was among the first in Jammu and Kashmir, supported by the Ministry of Social Justice.

Despite these efforts, the scale of the problem remains deeply concerning. Having worked in this field for over two decades, I find the situation troubling not only as a mental health professional but also as a parent and member of society.

Q3: Drug use is increasingly being reported among school-going youth. What early warning signs should parents and teachers watch for?

Ans: Among young people, peer influence is often critical. Many begin experimenting with substances during gatherings or celebrations. What begins as casual use can gradually evolve into habit, compulsion and addiction.

Availability also plays a role. Jammu and Kashmir lies close to the Golden Crescent, a major global narcotics source, and substances often enter through routes linked to Punjab or cross-border networks.

Parents and teachers should watch for sudden behavioural changes. A previously disciplined child may become aggressive, withdrawn or secretive. Declining academic performance, frequent absence from school or coaching classes and association with unfamiliar company are important indicators.

Lifestyle changes may include disturbed sleep patterns, irregular eating habits, withdrawal from family interaction or neglect of personal hygiene. Physical signs may include stained fingers or lips, nasal irritation from inhaled substances or injection marks on arms, wrists or ankles in intravenous use.

If parents strongly suspect substance use, they may consider a urine drug screening test (UDS kit), available at pharmacies and usable at home, though samples must be collected carefully as individuals may try to dilute them.

I often explain addiction with a simple analogy: drug addiction is like a house on fire. If a neighbour’s house burns and we ignore it, the fire may spread to ours. Similarly, ignoring addiction in our community eventually puts every family at risk.

Addressing this crisis requires a collective response from families, schools, healthcare systems, law enforcement, community organisations and religious leaders.

Q4: How do changing family structures and digital isolation affect vulnerability to addiction?

Ans: Family environment plays a crucial role. One major shift over recent decades has been the move from joint to nuclear families. Earlier children often grew up under the supervision of grandparents and extended relatives even when parents were busy. Today many families rely on caregivers or domestic helpers who cannot fully replace parental guidance and emotional attention.

Family conflict is another factor. Rising marital stress, frequent parental disputes and increasing divorce rates can create emotionally unstable environments. Children often absorb these tensions even if they do not express them.

There is also growing emotional disconnect within families. Members may be physically together but emotionally distant, absorbed in digital devices. The COVID-19 pandemic accelerated this through online classes and increased smartphone use, reducing family communication.

Young people increasingly express emotions through social media posts or emojis instead of real conversations. Yet virtual interactions cannot replace genuine emotional connection.

Another concern is the culture of online gaming and screen-based entertainment, which reduces outdoor activity and real-life interaction. As I often say, you cannot become Virat Kohli or Cristiano Ronaldo by playing on a mobile phone; you must step onto the field.

Biologically, the dopamine reward system involved in substance addiction also plays a role in behavioural addictions like excessive gaming or internet use. Digital addictions can therefore increase vulnerability to substance abuse.

Q5: Why do relapse rates remain high despite treatment facilities?

Ans: Jammu and Kashmir is among the few regions in India where nearly every district now has an addiction treatment facility. This reflects both the scale of the problem and government recognition of its seriousness. Yet what we address is still only the tip of the iceberg.

Stigma remains a major barrier. Many individuals and families hesitate to seek treatment because addiction is seen as moral failure rather than a medical condition. As a result cases often reach medical attention two or three years after substance use begins, when addiction is deeply entrenched.

Another misconception is that addiction affects only certain social groups. In reality anyone can be vulnerable, regardless of background, because young people study and socialise together.

Even after detoxification, patients often return to the same environment and peer groups that triggered substance use. With limited coping mechanisms, exposure to the same triggers makes relapse highly likely.

This leads to what clinicians call the “revolving door phenomenon,” where patients receive treatment, return home, relapse and come back again.

Another issue is limited rehabilitation infrastructure. Many centres focus mainly on detoxification and medication, but recovery requires rehabilitation, rebuilding routines, coping skills and social reintegration.

Drug supply networks and peddlers also target individuals already dependent on substances, making them vulnerable to relapse.

Current efforts include supply reduction through law enforcement and demand reduction through treatment initiatives such as Opioid Substitution Therapy supported by the Ministry of Social Justice and the National Drug Dependence Treatment Centre at AIIMS. However, much more needs to be done in rehabilitation and long-term recovery support.

Q6: What message would you give to young people who may be experimenting with drugs?

Ans: Addiction rarely begins as addiction. Most individuals say they started out of curiosity, peer influence or the belief they could control it. But substances like opioids quickly alter the brain’s reward system and create dependence before the person realises it.

Once this cycle begins, consequences extend beyond the individual, affecting health, education, family relationships and future opportunities. Many young people lose some of the most productive years of their lives.

Momentary excitement is not worth long-term suffering. When facing stress or emotional challenges, seeking support from family, teachers or professionals is always a better path than turning to substances.

At the same time society must create an environment where young people feel safe discussing their struggles without fear of judgement, because prevention begins with awareness, openness and timely guidance.

Arooj Bilal is a student at the Department of Media Studies, Amar Singh College, and is currently pursuing her academic assignment with the Centre for Interdisciplinary Studies on Ageing, Moul Mouj Foundation.

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