The dim yellow lights in the room masked the circles around Roy D’souza’s* eyes. Twenty-nine-year-old Roy's hands shook as he lit up a cigarette. The two-week stay at a de-addiction centre located in the outskirts of Bengaluru had left him sleepless for over a month. “I am scared to fall asleep because I know I will dream about them locking me in a dark room,” Roy recounts. In that dark room, he remembers his hands being tied to the bed and screaming until his throat was sore. “Sometimes, I wish I never went to Delhi. That I never did cocaine on an impulse. I never knew I could get addicted,” he says. Roy, a native of Bengaluru, moved to the country’s capital in 2016 with big dreams of becoming a top criminal defense lawyer. Two years into working a job with long hours and with a few friends in a new city, Roy says he felt isolated. It was during his time in New Delhi that Roy became acquainted with a new crowd and his weekends were filled with parties, free-flowing alcohol and cocaine. “It was easy to get pulled into it. The euphoria and chasing that feeling became the most important thing for me at one point. I didn't even realise that I was addicted to coke (cocaine). By the time I realised what I got myself into, I was already dependent on it. I couldn’t go without snorting at least line or two every day,” Roy says. In March 2019, Roy’s mother paid him a visit to Delhi. Although she sensed something was different about him, Roy’s mother could not understand why her son was behaving erratically on some days, while perfectly happy on others. On March 19, 2019, Esther found cocaine in his bedroom. “That was the end. She brought me back to Bengaluru the next day and said that I had to get better,” he says. “They took away my phone, my debit cards and all the money I had. My parents just stopped trusting me overnight.” Roy’s parents were desperate for their son to recover. Though they attended counselling sessions and visited NIMHANS (National Institute of Mental Health and Neuro-Sciences), his mother Esther* says, there were no signs of change. “He stole from his father to buy drugs. We had to do something,” Esther says. In October 2019, Roy’s parents took him to a private ‘de-addiction centre’ located in the outskirts of Bengaluru. Although, he consented to treatment, Roy says that he never expected the physical and emotional torture he experienced there. “I don’t know if anyone there was an actual doctor. Some of them wore white coats but that was it. Before getting admitted, I had researched about the kind of treatment that is permissible. But that’s not what happened here. They would lock us up in separate dark rooms and expect us to go through the withdrawal period,” Roy alleges. Two weeks after being locked up in a dark room, Roy was weak and vomiting due to the withdrawal. With no visits allowed, Roy had to wait for his turn to call his parents and inform them about his condition. A day later, Esther got him released him from the centre and he has since been visiting a counsellor in Bengaluru ever since. While Roy’s family has been trying to support him through his recovery, he says that their constant monitoring and the lack of trust demotivates him. Roy says that his mother asks for his bank statement once every two weeks and asks him about his expenses. “She also calls my friends regularly and asks them about personal things. She does this to verify what I have told her. She thinks I lie all the time. It does not help but I am trying to understand why she does it. I think she doesn’t mean harm but it still hurts that she doesn't trust me anymore,” he says. The private ‘de-addiction centres’ in Karnataka Data obtained from the Karnataka State Mental Health Authority (KSMHA) says that there are 80 licensed private psychiatric facilities. The KSMHA says that 60 of the 80 facilities cater to substance use disorder, which includes Ayurvedic and naturopathic centres. There are also 34 centres that are funded by the government of India to run programmes for substance use disorder and these are monitored by the Department of Disability Affairs. Speaking to TNM, Dr Chandrashekar, who heads the Karnataka State Mental Health Authority, states that several private centres that claim to treat substance use disorder indulge in human rights violations. According to the Mental Health Act 2017, centres treating patients with substance use disorders, must have a psychiatrist, psychologists, trained nurses, one full-time counsellor for every 30 beds in the centre, social workers and vocational trainers, in case the centre provides long-term rehabilitation. Dr Chandrashekar says that most of the de-addiction centres in the outskirts of Bengaluru and in parts of north and central Karnataka are known to violate these norms. “These places do not follow regulations at all. They are supposed to have an OPD (out-patient department), a proper room for the patients to stay in if it is long-term rehabilitation, that is, if the patient is staying for a month or more. The centres must have a psychiatrist, psychologists, and trained nurses and there are so many regulations that these centres must follow, which they don’t,” Dr Chandrashekar says. Prior to the Mental Health Act, 2017, Deputy Commissioners of every district headed the committees monitoring mental health, and a psychiatrist with the district Health Department was in-charge of monitoring these de-addiction centres. “The monitoring was not rigid. Hence, a lot of these Ayurveda and naturopathy centres, which also claimed to treat substance use disorder, would use banned practices to treat patients,” he alleges. “They beat patients in many cases. They also have something called ‘new light’ treatment. Patients are kept in a dark room for days and when they are let out, they are told that they will see new light at the end of the darkness and that their addiction to whatever substance will be cured. This is mental and physical abuse,” Dr Chandrashekar says. In Roy’s case, the “dark room” he refers to was a “withdrawal” room, where patients were denied meals if they screamed in pain or yelled for help throughout the day. Once the patient was deemed to have completed their “withdrawal period,” they were moved to other wards. “Sometimes, I wanted to die and make it all end. When I screamed for hours, my throat was sore. My hands were tied up to the bed. This was not written in their brochures or the way they spoke about treatment. I was not allowed access to a phone for two weeks. I just wanted it to be over so I could call my parents and get out of the place,” Roy recounts. Though Roy considered taking his experience to the police, he wasn’t sure if he could cope with a long, drawn-out legal dispute. “I didn’t know if going to the police would help my mental health. I am in a bad place and I don’t have the strength to fight court battles now. I did think about going to the police many times but I need to get better,” he says. Since 2016, Dr Chandrashekar says that 28 licensed centres that broke regulations and committed human rights violations have been shut down by the Karnataka government. VM Shashi Kumar, an official at the Regional Resource and Training Centre, Drug Control Division, says that the state government began cracking down on private de-addiction centres after a horrifying case came to light in 2016. “This was in Bengaluru, where a man was beaten up so badly. There was a police case and all Deputy Commissioners in the state were pulled up for negligence in monitoring these centres. In the last two years, seven centres have lost their licenses,” he says. Ostracised and stigmatised Unlike Roy, 18-year-old Aadi*’s father Rao forced him into one such de-addiction centre located near Mangaluru in November 2019. Aadi had become dependent on the use of MDMA (Methylenedioxymethamphetamine) or ecstasy. MDMA or ecstasy is a psychoactive drug that produces feelings of increased energy, pleasure and distorted sensory and time perception. Aadi’s father found out about his drug use and decided to stop him from going to college. “For one week, he kept taking me to different doctors and asking them for solutions. Finally, one uncle told him about this Ayurvedic centre near Mangaluru and he decided to put me there. I come from an orthodox family and giving me a choice is not something that my father even considered,” Aadi says. When Aadi’s sisters found out about the incident, they got him back to Bengaluru and it was only a week after his return that they learned of the beatings he had received at the centre. “They would tie us up if we screamed. Sometimes, they had a bamboo cane and we were beaten with that,” Aadi says. The stigma surrounding patients with substance use disorder is not a disputed reality, but experts say the stigma really begins when the patients’ own families and relatives begin to view the patients through a negative lens. “Stigma from family leads to self-stigmatisation. This induces a deep sense of shame in the patients. Since families of patients view it as a bad habit and not an illness that can be treated, they do not have any qualms in sending them away to these deaddiction centres and some families even encourage beatings,” says Dr Vishal, who runs a rehabilitation centre in Telangana. “It’s always – what will society say or think if they find out my son or daughter is a drug addict? This is the common perception. Parents are ashamed of their children and vice versa if they become dependent on a drug. This makes them believe it’s OK for the patients to suffer for a week or two or even a month if it means they will be rid of the addiction and hence some families have no qualms about putting these patients in these centres where human rights violations happen,” he added. Even for Roy, who says he has not touched cocaine for months, the trauma hasn’t entirely ended. The lack of trust he feels from his parents, and most importantly, his two older brothers, who he was once very close to, has taken a toll on him. “Every time I go out for lunch or dinner, my mother wants to know if I am consuming drugs,” Roy says. Dr Divya Nallur, who is a psychiatrist at the Marga People Tree Hospital, says that the perception of people suffering from substance use disorder has to change and the first step is support from families and caregivers. “When parents force their children into it, or when spouses or caregivers force patients into detoxification centres, they in fact encourage beatings. They only want their relative to be cured of drug use. This mentality has to change. Relatives and caregivers need to be more sensitive and try to negotiate with the patients and motivate them, rather than become suspicious of their behavior and take away their right to choose what happens to their bodies,” she says. The process of recovery While Roy has suffered relapse twice, Aadi has gone back to substance use once after his stint at the ayurvedic centre. Dr Vishal notes, “Substance use disorder has to be treated with care. The detoxification process must be supervised by a psychiatrist. There are certain medications that are given to reduce the pain during withdrawal. Counselling and motivational therapy, group therapy and awareness and patient education are all steps in the process of recovery. Treating this cannot be done by any centre. In order for a patient to go through all this, he or she has to feel they are in control. When parents or people at the rehabilitation centre take away that control, then they are very likely to relapse.” Dr Divya maintains that in 50% of the cases she has treated, the patients have relapsed and this is not alarming as recovery is a slow process. She says that relatives and caregivers of those affected need to be patient as there is no ‘one size fits all’ approach to recovery. “It all depends on the patient’s mental state and whether they are in a frame of mind to let it go. When relapse happens, doctors at rehab centres and most importantly relatives must be patient. It is OK to relapse but in most cases, parents and relatives say they are fed up of the patient going back to consuming the drug again and again. There is so much stigma surrounding substance use and when family members show disdain and distrust, it does not help,” she says.
