DocGenie Blog

Written by Dr. Roshan Jain (MBBS JJMMC Karnataka, MRCP Psychiatry UK, MMedSc Univ of Nottingham,UK), one of the best psychiatrists in Bangalore.

The Covid outbreak is by far the biggest crisis of its kind in our living memory. To check the spread of the pandemic, the Indian government did a series of nationwide lockdowns since March 2020.  However, the government did not adequately consider the mental health consequences of the sudden non-availability of alcohol, toddy and tobacco (cigarettes, beedi, gutka, etc.) on those addicted to these substances. Coping with addiction is a real challenge to be addressed.

Nicotine in tobacco is one of the most addictive substances known to man. While alcohol can cause nearly 60 diseases, including psychiatric ailments like anxiety, depression and suicide. Remember both were sold legally, everywhere, despite their adverse health impact.

The lockdown resulted in a rise in enquiries about coping with addiction and about nicotine and alcohol withdrawal symptoms. Some people stocked up before lockdown. Others desperately sought fresh supply, rather than using this restriction as an opportunity to consider implementing a much-needed change.

For eg. the southern Indian state of Kerala reported nine deaths because of the non-availability of alcohol. These include seven cases of suicide, one cardiac arrest, and one who died after consuming aftershave lotion.

Why is addiction undesirable?

Dependency on anything is never a good idea. Feeling helpless and not being in control is generally contrary to human instincts. Addiction is caused when this dependency is driven by a compulsion and craving for the desired substance (or behaviour) with an underlying sense of helplessness and loss of control. Other diagnostic criteria include a continued preference for consumption, while neglecting other activities.

Addicts often live in denial of their habit and often erroneously believe that staying physically fit will mitigate the effects of addiction. Many have avoided making an effort to quit, due to fear of withdrawal. Some can’t be bothered to disrupt the comfort zone of their habit or attempt change. Others have only realised their deep dependence on alcohol or nicotine when they couldn’t procure it. The lockdown created that situation and invariably many are not coping with addiction.

Are withdrawals dangerous?

Nicotine causes unpleasant physical withdrawals upon abrupt discontinuation like anxiety, restlessness, irritability and insomnia. These symptoms are discomforting but not dangerous or life-threatening. They may last for weeks or months if not substituted with nicotine replacement and other medicinal options.

The withdrawal features of alcohol are wide-ranging, especially for those who are excessive daily drinkers. They can vary from trembling, restlessness, insomnia, and anxiety to risk of convulsions in moderate cases. In severe cases, it may cause a confusional state, delirium and psychosis (losing touch with reality). Therefore, sudden discontinuation after regular excessive and heavy drinking can be dangerous and life-threatening.

What are your options?

People with milder habits and minimal withdrawals can try home remedies. These typically include a healthy diet, hydration, regular exercise, yoga and meditation. Other activities which help include reading, listening to music and playing board games with family. Remember, you are not alone, and this is a good time to rid yourself of the chemical dependency.

I think professional help and guidance from a psychiatrist or de-addiction specialist is the definitive way forward. A formal assessment will establish the degree of addiction and intensity of withdrawals followed by necessary medicinal treatment & motivational therapy for sustained change. While a one to one consultation would be preferred, given the current scenario, I think video consultation With Physicians or online consult is a safer and more convenient option.

For nicotine addiction:

You should consider nicotine substitutes like a patch or chewing gums. They are both available over the counter but should be taken under professional guidance and support. You do not want to substitute one habit for another. Research suggests that majority who try to quit without specialist advice and replacements, relapse to smoking or tobacco chewing soon afterwards.

Besides, there is medication to reduce craving and associated anxiety. These require a formal prescription from a practicing physician or a psychiatrist.

For alcohol addiction:

A specialist can address your difficulties and consider all treatment options, including harm minimization or abstinence-based programme.

Harm minimization programme is a starting point for people who are not keen or ready for change. In this, a person is educated about their habit and encouraged to gradually cut down, while adopting a healthier lifestyle. In addition, motivational sessions will focus on the process of change by making them feel content and in control. Harm minimization programmes offer new learnings and a taste of healthier living to patients.

On the other hand, in an abstinence-based program, abrupt and complete discontinuation of alcohol is advised. And where necessary, detoxification & anti-craving medicines with thiamine supplements are given to reduce or avoid withdrawal symptoms & medical complications. Both programs can be delivered in a hospital outpatient setting or via online video consultation.

Those who have severe withdrawal symptoms and have underlying psychiatric and medical conditions (like hypertension, diabetes, epilepsy) are at higher health risk and require hospitalisation for short medical detoxification treatment followed by ongoing psychosocial therapy. Before the initiation of any treatment, all individuals will require some baseline blood tests and ECG to ascertain their physical health status.

The Indian government’s District Mental Health Programme (DMHP) has issued a set of guidelines for doctors to assess and treat persons dealing with addition. But I think they should also publish advisory for individuals on coping with addiction during the lockdown and encourage seeking treatment at specialist centres. The Kerala government’s suggestion of ‘issuing alcohol on doctor’s prescription’ is not just odd but unethical. Instead, they should issue guidelines for treatment.

Talk to a professional

In the meantime, individuals should suffer no more and seek professional help. I think this lockdown has provided a unique opportunity for many who wanted a change but feared to address it. Now are left with no choice but to move towards nicotine and alcohol-free healthier lifestyle.

About the author

Dr Roshan Jain is one of the best psychiatrists in Bangalore. He is a UK qualified specialist with extensive experience in psychiatry, addictions, psychotherapy, teaching and motivational work. Based in Bangalore (India), he offers in person-centred mental health evaluation and interventions. He has worked tirelessly in reducing the stigma associated with mental health problems through speaking events and mental health awareness education, workshops & publication.

DocGenie is an online telemedicine platform that provides you quality healthcare from the best doctors in the comfort of your own space. On DocGenie, you will find a select few, highly-qualified doctors, unlike other online platforms with thousands of doctors. So you can be assured of receiving excellent, honest, personalized care from the best professionals.