Substance abuse: How patriarchy is stopping women from getting help

A study by the same ministry titled ‘Magnitude of Substance Use in India 2019’, says one in 16 women who consume alcohol are dependent on it. The dependence is higher among men, with one in five being dependent on alcohol. The report noted that the use of cannabis among women was at 0.6 per cent, opioids at 0.2 per cent and inhalants at 0.07 per cent.

While lower rates have resulted in fewer centres across the country, leaving even those women who want to seek help in a lurch, the lack of support from family and society make the de-addiction journey all the more impossible.

Not just a problem of the rich

Medical practitioners say contrary to popular belief, addictions are not just restricted to high income groups.

“I see them in my private practice too. There are young college-going women from affluent families who seek help for fighting addictions like cannabis. And in pockets of the city, you will see older women consuming liquor every night. Near my house, I have tried to persuade a group of flower sellers who are visibly addicted to alcohol, to seek help for their problem. But, they simply laugh it off and go on with their drunken banter,” says Dr P Poorna Chandrika, director of Indian Institute of Mental Health (IMH).

She, however, admits that the institute is yet to open a separate de-addiction ward for women and that patients like Latha are usually admitted in the general psychiatry ward for women.

“I just hope we don’t reach a point when we have to open a ward specifically for them. However, the lifestyle of women has changed and a higher rate of alcohol consumption has been seen among pub hoppers. In many cases of addiction, women are initiated into it by their partners,” she adds.

Also read: Are de-addiction centres the solution to drug problems?

The report on the magnitude of substance abuse has not covered the nuances of addiction among women, even as the study shows women entering the statistics and being outnumbered by men, points out Dr Pratima Murthy, professor and head of psychiatry department, National Institute of Mental Health and Neurosciences (NIMHANS).

“There are higher levels of addiction among women in certain occupations and in certain socio-economic strata. These are yet to be ascertained. We for long thought that foetal alcohol syndrome (a condition in a child that results from exposure to alcohol during the mother’s pregnancy) was not present in India, but there is evidence that there are cases here as well,” she says.

Societal, logistical hiccups

Meena*, a 60-year-old woman and a small-time actress had several reasons to hit the bottle. A tumultuous life fraught with struggles from a young age, an unsuccessful marriage and now the death of a son – she is never short of reasons to drink, Meena admits.

Over a period of time, Meena began severing ties with family members, one by one, to escape attention. “They will be shocked to know that I drink. And it will be worse if they find that I am an addict. Who will support an ageing woman who drinks every day?” she wonders.

While it is commonplace to see families rallying behind a man with addiction, the same addiction in women invites reproach and denial by family.

So it is no wonder that Navkiran, a de-addiction centre in Punjab’s Kapurthala, which the state government opened in June 2018, exclusively for women and children, has found a few takers.

Dr Sandeep Bhola, psychiatrist at the centre, says women in most cases show willingness to seek treatment only if they are supported by their partners or spouses.

“The women come forward for treatment when their partners, also addicts, show a willingness to be treated. The women rarely come for help on their own,” he explains.

The centre has seen women working as sex workers and bar dancers reaching out for treatment. “They view addiction as a solution to their problems. They say being high on drugs like heroin or cannabis makes it easier for them to be with multiple men on the same day,” he adds.

Till a few years ago, Sahaj Sambhav, a centre in Delhi, began encountering nagging problems while trying to rehabilitate women addicts. “They were being treated and were ready to be sent back home. But in many cases, the families would refuse to take them home and the women had to stay back for a longer time. So, we decided to only provide counselling to women addicts as outpatients,” says Rekha Jhingan, founder of the centre.

Experts also say that women addicts often find it difficult to continue when centres are not sensitive enough to gender-related issues. “Hospital-based treatment gets difficult for many women. First, many of these women may have other illnesses which may not be treated by the de-addiction centres they are admitted in. Secondly, many women are reluctant to get admitted, thinking who will take care of their family when they are in the hospital,” Dr Pratima adds.

Also read: Where do mental health professionals go when they need help?

The TTK Hospital in Chennai has in the last decade seen just one woman among every 100 people getting admitted for addiction, and like Navkiran’s clients, the women were comfortable only when the spouse sought help as well.

Dr Anita Rao, former medical director, TTK Hospital, says, “The older couples often get admitted for alcohol addiction and younger couples for drug problem. Another concern for the hospital authorities is the safety of women patients at the rehab centres.”

A lesson to learn from Mizoram  

Family and social support make a lot of difference in the recovery of an addict, as seen in the northeastern state of Mizoram. In the region, addiction is rampant due to the circulation and usage of heroin, opium and pharmaceutical opioids, as revealed by the government report. In a majority of cases, it is a combination of opioids and alcohol addictions.

Thutak Nunpuitu Team (TNT), an NGO has been running a de-addiction centre, in the capital city of Aizawl since 1991. The centre at the moment has 65 women inmates in the age group of 18- 40 years. The strength at times touches 100. The inmates are mostly from the state, or the nearby states of Assam, Meghalaya and Nagaland.

R Malsawmtluanga, general secretary of TNT, attributes the rise in drug addiction to the increasing popularity of rock music culture in the region. “It is also the in thing to do, as there is immense peer pressure on these people to experiment with drugs and alcohol under the influence of rock music culture,” he adds.

He, however, says that among such youth, there is also an openness to seek treatment, unlike the shyness towards it in other parts of the country. That’s precisely why families in the region have often tales of substance abuse and good riddance.

Alcohol and abuse go hand in hand

SM Venkatesh, a social worker based in Chennai, rescues at least 10 destitute and homeless women from the streets every three months. Of such women found outside hospitals, railway stations and busy terminals, at least a third are alcohol addicts, he says.

“They are from lower middle income families and in many cases, when they open up about their stories, it is an evident case of families abandoning them. They begin wandering to find ways to access alcohol, and the families just want them to leave the neighbourhood. When we try to reunite them, their families refuse to take them back,” Venkatesh says.

From younger women in their 20s, to middle aged to those above 60, Venkatesh discusses the sordid tales of abuse the women face. “I once found a 60-year-old woman outside a TASMAC outlet and later found that she was being sexually abused by several men in the locality during night time. I immediately arranged for her to be moved to a home for treatment,” he adds.

Dr Ranjana Kumari, director, Centre for Social Research, New Delhi, says that the abuse of addicted women is often not talked about. “The extent of abuse has not been studied and only a few NGOs have been focusing on protecting the women addicts. It is time the government takes up the problem,” she says.

Rates set to soar

Dr Poorna Chandrika says the rates are definitely going to be higher among women in the coming years. “The cases we are seeing is just the tip of the iceberg,” she says.

Opening rehab centres alone cannot solve the issue when no one wants to acknowledge the problem, says Dr Anita.

“It may take a 100 years for the taboo (addiction among women) to become acceptable. It is unfair on the women and the rates of addiction are probably more than what we think. Today, youngsters think that using cannabis is okay and the consumption of medical marijuana in the West has spiralled the interest. Studies may never reflect the actual levels of addiction because families will never say they have a woman with an addiction in their homes,” she says.

The factors triggering addiction among women too are multiple and complex in nature. “In our study of women addicts, we found that there were genetic factors or history of addiction in the family, like in the case of men. Moreover, we also found that a difficult childhood or women who have faced abuse in their childhood were likely to have an addiction. A family atmosphere that normalises alcohol or drug consumption along with genetics are also factors,” adds Dr Anita.

(* names have been changed)