Getting to the bottom of substance abuse among children

When he was in Class 5, watching movie stars like Mahesh Babu or Shankar Nag smoking cigarettes fascinated Vinay (name changed) no end. He would watch the curls of smoke go up in the air, awestruck. One day out of curiosity he tried smoking a half-burnt cigarette thrown away by his friend’s father. This was his initiation into tobacco use.

He turned towards alcohol when he was in Class 7 after someone told him that drinking beer makes people put on weight. He recollects visiting bars along with a friend and sharing a pint of beer, then available for Rs 23. By Class 9, he had started smoking weed (ganja). In the first year of college, he was caught with drugs in his pocket. That was when his family came to know of his addictions.

Nineteen-year-old Ranga (name changed) too started early. “In 7th and 8th it was cigarettes, and in 9th alcohol.” He would walk directly into a bar along with friends and order for it. “I used to get ready for school, wearing an extra dress underneath the school uniform, and leave home for school. Then I used to remove the uniform, leave the school bag somewhere and roam along with friends, play cricket, drink, watch films, fight with unknown persons and relax. By 3 pm, I came back, picked up the bag, combed my hair and got ready and went  home – this used to be my routine.”

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Ranga dropped out of school. After many years of addiction, he went into a de-addiction programme. However, after a relapse, he went back to a rehabilitation centre for the second time.

Both their stories are fairly typical of how addiction starts and progresses in children.

According to Dr Arun Kandaswamy, who works closely with addicts at the Centre for Addiction (CAM) Medicine at the National Institute of Mental Health and Neurosciences or Nimhans, alcohol and cannabis are the main addictive substances abused by minors. About 60% of adults who become addicts start drug abuse when they are minors, and 40% become dependent before they become 19, he says. “Earlier the onset of use, higher are the chances of getting addicted.”

Not all of them might be addicts though, as most of them are in different stages of experimentation.

He says most cases that come to CAM are about children or teens in schools or colleges caught using drugs or alcohol, and seeking medical certification that they are fit to attend the classes. This group, which is still experimenting and exploring drugs, does not seek treatment.

Vinay, who now works as a counsellor at a rehab centre, says children with addiction tendencies can be identified at the school level itself. They don’t mingle with peers easily and are drawn towards the company of older children or adults, who sometimes might already be alcohol or drug users.

“The real tendency may not be known until they join colleges and get more freedom, mobility, money and the easing of parental and school restrictions. That’s when they become full-blown addicts, due to better access to alcohol or drugs and due to better networking and money,” says Vinay.

This is also when generally they are placed in rehab centres, at the age of 17 and beyond.

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Addictive substances used by younger children

Children with a tendency to get addicted might get started with easily available substances like glues, pain balms, whiteners or petrol. Then it graduates to serious forms of addiction.

Painkillers and sleeping tablets are some of the addictive drugs used by children and adolescents. These fall under the Schedule H category, to be sold only on a doctor’s prescription. However, many medical shops sell them over-the-counter.

Underage kids and alcohol

A group of female students from a famous school in Bengaluru reportedly purchased alcohol from a shop in a mall that did not ask for any identity proof; sat in a coffee outlet, mixed it with water in a bottle and drank it. No one cared to check what was going on.

The Karnataka Excise Act, 1965 prohibits the selling of liquor to adolescents under 18. However, the rules under the general conditions of license approvals say that liquor cannot be served to those under the age of 21.

While confusion about age limit prevails, this does not deter young explorers-turned-violators. Underage kids figure out ways to procure alcohol – buying it directly, ordering online, buying it through adults or simply using the stock at home.

Of the three liquor shops visited by DH in Rajajinagar, two claimed that they asked for age proof while selling liquor. But there are ways to bypass the law. “If an adult labourer is paid 50 rupees and asked to buy liquor, who in the shop will know whom he is buying it for?” asked the cashier in one of the shops visited.

Addiction is only a symptom

While addiction was viewed as a problem in itself earlier, doctors now see it as a pointer to deeper issues faced by the child. “The current understanding is that addiction is a manifestation of an underlying issue which makes them vulnerable and is not the cause itself,” says Dr Kandaswamy. He explains that in the under-19 age group of those suffering from addictions, almost 60% have psychological issues.

“The cause and treatment are both biological and psychological. Those who seek refuge in intoxicants might be suffering from other psychological issues, such as anxiety, depression, bipolar disorder, Attention Deficit Hyperactive Disorder (ADHD), which make them unable to deal with life in a normal manner,” he says.

Biological vulnerability to substance abuse – in the form of a family history of substance abuse or mental health issues – may also combine with environmental factors. The latter include poverty, malnutrition, lack of a safe environment, poor parenting, non-availability of parents, and abuses and traumas faced in childhood.

He notes that drug abuse is just one of the manifestations of distress among children, and cautions about other tendencies like suicidal behaviour, running away from home, juvenile crimes, adolescent pregnancies and more.

Where the law fails children

While biological and environmental factors play their part in pushing kids into addiction, there is also a social dimension to it. “In India, no rules are followed, so it is very easy to get anything,” says Dr Gopal Dabade, Co-ordinator, All-India Drug Action Network. Cough syrups containing codeine, banned by the government, are still brazenly sold in pharmacies. Underage kids find a way to procure alcohol. The police may turn a blind eye when they spot violations. According to Sandeep (name changed), a 20-year-old youth who is in rehabilitation now, kids strike deals with the police in order to be saved from the law.

“If there was someone who stopped me, if police or elders questioned me at that point, fear would have kept me away from bars,” he says, adding that there is zero oversight.

“Addiction among kids and teens is directly proportional to corruption in society and systems,” sums up Vinay.