By Gayatri Kotbagi and Rucha Satoor
“It’s been five days since I have run out of maal (weed). I am having a hard time falling asleep. Usually, I would smoke a joint with my friends on the katta and come home and crash. I just don’t know how I am going to survive for the next few weeks without my daily joint before bed.”
As a clinical psychology researcher, it’s not alarming that I get to hear these words often. But with the COVID-19 lockdown, what is alarming is the frequency with which I get to hear this amongst my clients. In India, the announcement by Prime Minister Narendra Modi of a 21-days national lockdown due to COVID-19 has shut liquor and tobacco shops in most parts of the country. We’ve read reports about 30 deaths so far in the country as a consequence of people struggling with their addictions.
Addiction is not simply a ‘bad habit’, ‘a deplorable behaviour’ or a ‘sin’ but a neuropsychiatric disorder. Addiction is losing control over the consumption of a substance or a behaviour, despite harmful consequences. This loss of control leads to deprivation of liberty and an increase in the signs of withdrawal.
Addiction also leads to an obsession with ‘the quest’: ‘Where do I get my weed?’ ‘Where will I be able to consume this drink?’ ‘How long before I can get back to my video game?’ these thoughts form an obsessive, recurring pattern. For the person who is addicted, a lot of effort can go into feeding the habit.
In the times of COVID 19, just because individuals are confined to their homes, the pathology of addiction is not going to stop. On the contrary boredom, promiscuity, sense of helplessness, and insecurity are likely to weaken individuals and amplify their craving for the substance or the addictive behaviour.
Therefore, a lockdown is a paradox for an addict: you want to consume more to reduce your stress, but you’re less likely to get your bottle or joint.
Unfortunately, yes. The lockdown increases the risk of consumption both for people with an addiction problem but also for those who were only recreational users before. The latter are people who are not a priori addicted, but who perhaps due to increased anxiety, stress or boredom start using more of the substance, especially alcohol. At the same time, those who are at risk of getting addicted may tend to weigh the effects of alcohol withdrawal symptoms against the likely risk of getting COVID-19.
These individuals may very well reason that the consumption of alcohol is likely to be less harmful than getting COVID-19. People’s decisions of resorting to substances depend a lot on the context of their lives. However, experts predict that risk-taking behaviours are likely to increase during the lockdown and fear that the complete closure of alcohol /tobacco shops may not be the right solution.
Along with increased addictions, we will also be witnessing a rise in withdrawal behaviours as people remain confined at home. Some broad symptoms of withdrawal can be anxiety, fatigue, sweating, vomiting, depression, and seizures. Having a person living with symptoms of withdrawal at home can be a challenge for those who live around them. Experiencing emotional and physical violence, frequent altercations and depressive episodes of people you love and care for can take a toll on one’s mental health.
“I have to take care that I don’t run out of stock. So, I have reduced my consumption until there is some sort of solution to this lockdown.”
Of course, I believe that quarantine doesn’t just have negative consequences. Confinement can certainly be an opportunity to reflect on our behaviours, understand our motivations behind our relationship with substances. I had a client, a man in his fifties, tell me over the phone about how prudent he has become with his alcohol consumption. He now gets to spend time with his children, helps his wife at home and works from home whenever he can. All this has certainly reduced his craving for a late-night drink. But like I said, it heavily depends on the socio-economic context of the individual.
Yes. COVID-19 is a severe acute respiratory syndrome coronavirus. For people with a mild version of the virus will have symptoms of upper respiratory tract infection, those with a more severe version may end up with life-threatening pneumonia. So smokers (tobacco or marijuana) are more vulnerable to COVID-19 and may end up with worse lung conditions.
Apart from the poorest in society, we are hyper-connected these days given the circumstances. People forced to be inside due to the lockdown may end up with increased screen time- playing more online games, constantly taking in news related to the pandemic, binge-watching on OTT platforms. However, people must not be criticized or shamed for their problematic relationship with screens or the internet. They just need to be cautioned and offered help to deal with their internet addiction.
Set or agree on a goal (it need not be a big goal) defined in terms of the behaviour to be achieved. Identify specific triggers (e.g. altercation with a family member, watching alcohol and other substances being consumed on television or the internet, anxiety, etc) that generate the urge/want/need to drink. Develop strategies for avoiding these triggers or have a plan for what you would do to manage your negative emotions if you were exposed to such triggers, that motivate drinking or smoking.
Have an action plan: a list of meditations that work for you, physical activity, or make a list of friends and family you can reach out to who will help you stick to your goals. For example, I sign a behavioural contract with my therapist (this can also be a friend) that I won’t smoke for a week. Use words and phrases such as “I will”, “highly committed”, “strongly”, etc more frequently. The use of affirmative and re-affirmative phrases increases our self-efficacy and helps motivate us towards our goals.
Monitor your behaviour as well as the outcome of your behaviour. Are you washing your hands frequently because of COVID-19, what is the outcome of that? Have you had to drink another glass of alcohol or smoke another joint? What was the outcome of that?
Despite all the physical distancing, identify family and friends you can rely on. Their support can support you by hearing out your anxieties and keeping away the triggers
Having access to online support groups are ideal during these times. Find local or national Facebook groups, twitter handles or WhatsApp groups to be able to talk and connect with.
Many people are told what needs to be done and what should not be done. However, we are seldom told how to do it. Seek help to know how to keep a diary, how to stick to the plan you have made for yourself, what to do in case the plan fails. Learn how you can restructure your physical and social environment to achieve your goal. A mental health professional can help you to learn these skills.
Achieving the desired change in one’s behaviour may be an example to others. Therefore, making healthy choices for yourself may help those around you to do the same. You can also work on your incompatible beliefs by drawing attention to discrepancies between the current or past behaviour and self-image and understand how it creates discomfort. You may also write about your strengths (make a small rating scale for yourself with emojis on the two ends). You as well as those around you may help you change your identity by addressing you as an ex-smoker for example. You can successfully achieve the wanted behaviour, arguing against self-doubts and asserting that you can and will succeed.
Links to online Alcoholics Anonymous and Narcotics Anonymous meetings:
For psychosocial support you may contact:
NIMHANS toll-free no: 080-46110007.
MPowerMinds toll-free number: 1800-120- 82050
Fortis Stress Helpline: +918376804102
ASSOCIATION OF PSYCHIATRIC SOCIAL WORK PROFESSIONALS: http://apswp.org/wp-content/uploads/2020/03/Online-psychosocial-support-mental-health-services-COVID-19-APSWP.pdf
COVID CARE: https://covidav.com/
List of Mental Health Practitioners for Young Adults at Nominal Fee/Sliding Rates or Free created by Mahima Kukreja
Rucha Satoor is a part-time writer, part-time development professional who works in the areas of child rights, gender, caste, and sexuality.
Dr Gayatri Kotbagi is a clinical psychology researcher and faculty at Symbiosis School of Liberal Arts, Pune and Bournemouth University, UK