Alcohol or drug addiction devastates a person's life leading to destitution from family, friends and finances, besides having a debilitating effect on one's health. Addiction is a major community problem not only in India but across the world. The personality of an addicted person can change beyond recognition making him or her out of sync with the rest of the world. WHO acknowledged alcoholism as a treatable illness in 1951, the American Psychiatric Association categorized alcoholism as a disease in 1965, followed by the American Medical Association in 1966.

In a national household survey conducted in India in 2000-2001 to estimate the extent of substance dependence for alcohol and opiates it was found that the prevalence of alcohol was 21.4%, Cannabis 3.0%, Heroin 0.2%, Opium 0.4% and other opiates 0.1%. An important finding of the survey indicated that 17-29% of the users of various substances were dependent users.

Medindia interviewed Padmashri Dr. Shanthi Ranganathan, Founder, Director of TTK Hospital, a non profit, pioneer voluntary organization involved for more than three decades in the holistic treatment and rehabilitation of persons addicted to alcohol, narcotic drugs and smoking.

Q. Given your long history of dealing with alcohol and other drug addicts what is your advice to medical professionals who come across patients with addictive disorders?

Denial is one of the many barriers to the effective diagnosis of addictive disorders. Telling the patient flatly that he has a problem will put him on the defensive and his denial of the problem can prove counter productive. I would encourage medical professionals to keep the communication channels open and express concern about the negative effects of addiction on the patient's physical, mental, economic and social well being. Judgmental attitude or pessimism about the patient’s recovery could hinder diagnosis and treatment, possibly driving away the patient to further doom. Adopt an understanding and empathetic approach that will encourage the patient to "open up."

If a patient needs specialized intensive treatment for addiction, medical professionals should refer them to an addiction treatment and rehabilitation center or introduce the person to self help groups such as Alcoholics Anonymous (AA) / Narcotics Anonymous (NA) that operate within the area.

Q. The treatment and rehabilitation offered at TT Ranganathan Clinical Research Foundation (aka TTK hospital) is known to be unique in the whole of Asia. Please tell us about the treatment process in your hospital for de-addiction?

Our hospital offers 4-6 weeks comprehensive in-patient treatment program that frees a person from the clutches of addiction in a phased manner. Treatment starts as soon as the patient comes in with an initial assessment by the intake counselor who confirms the addiction problem and gauges the patient’s motivational level to overcome addiction and the support provided by family or well wisher backing the patient.

Medical management or detoxification follows for 3-7 days to help the person overcome withdrawal symptoms like fits, sleeplessness and severe pain. The patient is also treated for associated physical problems such as gastritis, neuritis, depression and malnutrition. Once the patient stabilizes physically and his normal eating and sleeping patterns are restored, he is moved to the psychological therapy wing. This highly structured program includes individual counseling, group therapy, educative session and self help programs packaged for 21 days.

Each patient and the accompanying family member are assigned a counselor who helps them understand that addiction is a disease that seriously harms the wellbeing of an individual, his family and the society. The counselor is a supportive professional who helps them ‘open up’, face reality, take responsibility for their lives and face the future with dignity and confidence. Counselors are available to converse in English and in all leading Indian languages because we get patients from different states in India.

Group therapy is a vital part of this program where patients share their painful past experiences and come out of denial and accept they have a problem that needs to be rectified. In our Re-educative sessions we teach practical methods to make positive lifestyle changes and use the story telling technique for therapeutic changes in recovering patients. Our experts draw inspirational stories from mythology, fables, parables and real lives to enthuse the patients on the road to recovery. Sharing, by recovering alcoholics, members from Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) strengthens the self help group members to stay sober with the basic philosophy, "I can’t do it alone, but together we can."

Computer education and special programs such as tailoring and other arts and crafts to facilitate rehabilitation of families are also offered. The one-month residential primary care treatment has a Follow up support for 2 years to help patients sustain abstinence and to monitor the patient’s lifestyle improvement help resolve blocks in recovery.

Q. What is your success rate and if a patient suffers a relapse after he completes your treatment program, how do you help him?

We have a 65% success rate and more than 20,000 persons have been treated successfully in our hospital since its inception in 1980. Our After Care Center has a Relapse ward that offers an intensive, two month treatment for those who have suffered a relapse. This again includes detoxification, psychological therapy and a separate 5-day program for family members of relapsed patients.

Q. Please tell us about your Out Reach programs such as Village camps?

We observed frequent school dropouts from a village school at Manjakudi (managed by our Trust), especially during the harvest season. Our teachers found out that the kids’ fathers were alcohol addicts who never worked and turned violent if there was no food for them at home. The mothers sent their children as hired laborers to do petty jobs in the fields during the harvest season so that they would bring home at least a little rice to feed the starving homes. TTK Hospital felt the need to take de-addiction programs to villages where drinking is a serious problem and villagers lack the awareness to seek treatment is cities.

We decided on an innovative ‘Rural Camp’ that took addiction treatment and rehabilitation to rural homes. This Community Supported Recovery where the recovered persons in the village, empower others coming out of addiction and this transforms the entire village into a mighty force combating alcoholism. For the last 20 years we have been conducting 5-6 rural camps every year, each camp lasting for 15 days, treating 25-30 patients in each camp, while effectively using the resources available in the community. We have witnessed measurable success in the number of fathers giving up alcohol and going back to work in the fields, the number of dropouts resuming school and the daughters getting married in families of treated patients.

Following the success rate of these camps TTK hospital undertook a UNESCO backed project to educate rural women towards identifying community resources, for HIV counseling and testing, addiction treatment and vocational training. The project has effectively reached 30,000 micro-credit group women in the last five years. We have shared our knowledge and experience gained in this community module with other Asian countries that are successfully implementing such projects, especially in Sri Lanka and other Tsunami hit coastal areas.