Yasir Arafat Zahgeer works as project coordinator at the Society for the Promotion of Youth and Masses to combat rising drug abuse in Kashmir.
SRINAGAR, INDIAN-ADMINISTERED KASHMIR – A 27-year-old former opioid addict from Srinagar, Kashmir’s summer capital, looks feeble and fragile.
He has obtained treatment for drug use since December 2012 at the Society for the Promotion of Youth and Masses, a national nonprofit agency with a daytime drop-in center in Srinagar for substance addicts.
Requesting anonymity to avoid social stigma attached to drug use, he says he started using brown sugar, also called “smack,” which is an adulterated form of heroin, 11 years ago. He was 16 and working in New Delhi, the national capital, in the tourism industry.
“As I worked in New Delhi, I got acquainted with a European tourist, who used to take brown sugar,” he says in Kashmiri. “I, too, took it once or twice in his company and later got addicted to it.”
He used a major portion of his earnings and borrowed money from friends to buy drugs.
“If I left taking drugs for a brief period, I felt pain in my entire body,” he says.
He started growing weak in 2012 and could not take as much brown sugar as he used to, he says. When his mother caught him taking drugs during a visit to Srinagar in 2012, she insisted that he quit.
He moved back to Srinagar from New Delhi and began daily treatment at the Society for the Promotion of Youth and Masses.
“Initially, it was difficult, as I felt pain and sleeplessness for [a] few days after I quit,” he says. “But I didn’t give it up and kept going to the center, followed their guidance, counseling and medication.”
He says nothing can stop anyone from recovering from addiction if they have a firm will to do so.
“I wish to get well and ask others to avoid drugs,” he says.
Illicit drug use is increasing in Kashmir, with some psychiatrists saying it has reached “epidemic proportions.” Health experts attribute the rise to various factors, including easy access to drugs, outside influence from tourism, and individual and societal strains from the ongoing conflict in Kashmir. Social stigma and a lack of preventative education reduce the likelihood that addicts will seek treatment. But there is also a lack of local de-addiction and rehabilitation centers and governmental policies offering services. Health experts call for an increase in the number of these centers in Kashmir and encourage drug users to seek help.
There are no known figures regarding drug addiction in Kashmir, says Dr. Arshid Hussain, a psychiatrist at the Government Psychiatric Diseases Hospital in Srinagar.
The most recent data he could cite was a 2001 survey conducted in southern Kashmir by the Government Psychiatric Diseases Hospital, local nongovernmental organizations and university students. In the survey, 17 percent of males ages 18 to 30 admitted to taking illicit substances.
“Which is actually very high,” Hussain says.
It is more than 6.5 times higher than the national average. Of Indian males ages 19 to 30, 2.6 percent reported using cannabis and 0.7 percent reporting using opiates in the 2004 survey “The Extent, Pattern and Trends of Drug Abuse in India.”
This is the first national survey of its kind, published by India’s Ministry of Social Justice and Empowerment and the United Nations Office on Drugs and Crime. The survey states that the lack of resources and the country’s size have hampered research on the magnitude and dynamics of drug abuse at the national level.
But health experts assure that drug use in Kashmir is increasing, especially of opioids and cannabis, which are illegal. Opioids are narcotics that possess characteristics similar to opiates but are not derived from opium.
Yasir Arafat Zahgeer, the project coordinator at the Society for the Promotion of Youth and Masses, says that he can tell from his field experience that drug abuse is rising in Kashmir. He has worked in drug prevention for 12 years.
Hussain says he detected a trend a few years ago of young people using cannabis because they can obtain it more easily than opioids.
But Zahgeer says that opioids are still a menace and have long caused dangerous addiction problems in Kashmir.
“The problem here is more about opioids,” says Zahgeer, who decided to work in the field when he was 15 when his friend died from drug abuse.
Substance abuse causes fatalities and mental health problems in youth adults, Hussain says.
“There are a lot of fatalities,” he says. “Young people die of substance abuse, young people die of accidents because of substance abuse, and young people die of mental health because of substance abuse.”
Substance abuse is common in Kashmir and is causing medical, social and health problems for the entire community, Hussain says.
“It is not only a disease of [a] person who is afflicted, but it is the disease of family, neighborhood and society,” he says. “It involves all. This is a huge problem, which is already in epidemic proportions.”
Although drug use occurs all over Kashmir, it is more of a problem in tourist and drug-cultivation areas, says Dr. Gh Ahmad Wani, assistant director and mental health officer at the Directorate of Health Services in Kashmir under the state Department of Health.
“It is more in Srinagar and Anantnag districts due to the fact that cannabis is cultivated in Anantnag district and due to tourism in Srinagar district,” Wani says.
Health experts say drug abuse is rising because of easy access to drugs, outside influence from tourism, and various repercussions of the ongoing conflict in Kashmir. Separatist violence has racked Kashmir for more than two decades.
Strong communities act as a buffer against drug use, Hussain says. But Kashmir’s weak societal infrastructure – caused in part by ongoing conflict – perpetuates illicit substance use among a large number of people.
Once society began to realize the extent of illicit drug use in Kashmir, it was already a large problem, Hussain says.
“There was already an epidemic going on,” he says.
Other reasons include the easy availability of drugs, the presence of conflict, and the absence of recreation and enjoyment, Hussain says. Peer pressure is also a major factor.
“It is the only mental health problem which is contagious,” he says. “If one student in the school is a drug addict, all others are at risk.”
Drug abuse is increasing because of unemployment, domestic problems, and mental and physical stress after decades of conflict, Zahgeer says.
Family drug use is also a large influence, Zahgeer says. He used to see just one family member as a patient at de-addiction centers, but now centers treat two or three people from the same family.
At the same time, social stigma and a lack of drug-abuse education prevent people from attaining timely treatment.
Some drug addicts do not approach doctors until they develop physical or mental health complications, Hussain says.
“Thirty percent of them are institutionalized in psychiatrist hospital, and most of them have a history of substance abuse,” he says. “With time, they end up with medical or psychiatric emergencies and stay in hospital for life or die in accidents.”
Society still lacks understanding of drug users, Zahgeer says.
“Either they are considered as thieves or liars,” Zahgeer says. “But this is a multidimensional disease and can be prevented.”
Stigma is the biggest hindrance when drug users seek help, Wani says. It is important to generate awareness about drug addiction.
Mudasir Ahmad, the community mobilizer at the Society for the Promotion of Youth and Masses, says that workers go door-to-door in high-risk areas to generate awareness about drug addiction and to identify drug addicts, as most of them do not approach centers.
“Then, we talk to the affected persons,” Ahmad says in Urdu. “Many a times, they are reluctant to share the information, but we keep trying. At times, they themselves approach us or the center.”
As more people receive drug education, more people seek help before they develop serious health problems, Hussain says.
But there is a lack of government aid and de-addiction and rehabilitation centers in Kashmir for those who do seek help for drug use, Wani says.
Substance treatment comprises four steps: motivation, detoxification, maintenance and rehabilitation, Hussain says.
There are six government de-addiction centers in Kashmir, Wani says. Kashmir has a few private de-addiction centers, but the number is unknown.
Kashmir needs more de-addiction centers because the few that exist are not enough to help all the people who come to these locations for help, Zahgeer says. De-addiction centers provide daytime care and facilities to detoxify patients.
“There are certain centers here taking care of [the] addicted population suffering from substance abuse,” he says. “But there should be de-addiction centers in every district in Kashmir.”
There must also be more rehabilitation centers, which are vital to prevent relapses because they offer counseling and 24-hour care, Zahgeer says. These centers detoxify patients before enrolling them for weeks or months in a rehabilitation program.
There is usually a high chance of recurrence after treatment if patients do not go through rehabilitation, Hussain says. But these services are not available.
“No one is working on rehabilitation,” he says.
Of the de-addiction centers in Kashmir, only one includes a rehabilitation program: the drug de-addiction center at the Police Control Room in Srinagar, Wani says.
The only government-funded policy in place for public hospitals to give free care to substance abusers is through a mental health program. District hospitals can admit drug addicts with mental health concerns under the District Mental Health Programme started in Kashmir in 2008, Wani says. Since then, the mental health program has treated 120,000 patients in Kashmir.
“Out of which, 8 percent have been diagnosed with substance abuse,” he says.
The Ministry of Social Justice and Empowerment also provides grants to private de-addiction centers that meet the criteria of the Scheme for Prevention of Alcoholism and Substance (Drugs) Abuse, according to information on the ministry’s website.
The Society for the Promotion of Youth and Masses does not receive funding from this scheme but is applying for a grant this year, Zahgeer says. Still, there is no comprehensive governmental policy in place to rehabilitate drug addicts.
Creating more de-addiction and rehabilitation centers can reduce drug use in Kashmir, Hussain says.
The Directorate of Health Services in Kashmir has sent a project implementation plan to the Indian government with a request for 260,000 Indian rupees ($4,780) for each of Kashmir’s districts to create de-addiction centers, Wani says. The government is currently reviewing this plan.
“Funds and man power are required,” Wani says. “Perhaps, this year, funds are coming, and we’ll be recruiting people and starting small de-addiction centers in every district and subdistrict hospital.”
Zahgeer says the Society for the Promotion of Youth and Masses is planning to start a 24-hour rehabilitation center soon. It also aims to focus on community outreach programs in both rural and urban areas. This will supplement its existing programs, which includes counseling sessions, art classes, English lessons, and games such as badminton, chess and carrom.
But successful change occurs only when people who use drugs want to quit, Zahgeer says.
“Otherwise, people come to us and say they’ve promised their mother or wife to quit, and that is why they are there,” Zahgeer says. “This doesn’t really help them to quit until there is also their own will to quit. If they are themselves motivated and convinced, things get easy.”
Zahgeer says that when he first met the 27-year-old obtaining treatment at the agency’s drop-in center, he was skeptical that he could fully recover from his opioid addiction.
“He had taken brown sugar that morning when he approached us,” Zahgeer says. “But he got motivated to quit and has been regularly following the center since then. He wanted to quit, and that is what is required.”
Interviews were conducted in English, Urdu and Kashmiri.
