The corona outbreak is by far the biggest crisis of its kind in our living memory. To check the spread of the pandemic, the Indian government responded promptly and announced a 21 days nationwide lockdown, from 24 March 2020.  Amongst many precautionary measures, it seems that the government did not adequately consider the health and psychiatric consequences of sudden non-availability of alcohol, toddy and tobacco (cigarettes, beedi, gutka, etc.) on those addicted to these substances.

Remember, nicotine in tobacco is one of the most addictive substance known to man, and alcohol is one the most toxic one, causing nearly 60 diseases, including psychiatric ailments like anxiety, depression and suicide. Remember both were sold legally, everywhere (up until lockdown), despite significant adverse health impact on its regular users.

Unsurprisingly, there is a sudden spurt in enquiries about coping with nicotine and alcohol withdrawal symptoms. Pre-emptive few stocked up before lockdown. Others are desperately seeking fresh supply, rather than taking advantage of this restriction and the opportunity to consider options to come clean of their habit and effect a much-needed change.

Unfortunately, the southern Indian state of Kerala has reported nine deaths not due to the infection but because of the non-availability of alcohol. These include seven cases of suicide, one cardiac arrest, and one who died after consuming aftershave lotion.

Why is addiction undesirable?

Dependency on anything is never a good idea. Feeling helpless and not being in control is generally contrary to human instincts. And when the dependency is driven by a sense of compulsion and craving for the desired substance (or behaviour) with underlying helplessness and loss of control over initiation or containment of said behaviour, then it constitutes an addiction. Of course, there are other diagnostic criteria such as preference of consumption over other pressing activities, and continuation despite adverse consequences on health, wellbeing, work, relations and obligations.

Addicts often live in denial of their habit, overshadowed by a misplaced belief that puffing and regular drinking will not affect their health as it does to others, or if you are fit and well, then the ill effect will be mitigated. Many have avoided making an effort to quit, for fear of withdrawals and inability to tolerate them. Some can’t be bothered to disrupt the comfort zone of their habit or attempt change. Others have only realized their deep dependence on alcohol or nicotine when they couldn’t procure it. The current lockdown has created that situation, and invariably many are suffering.

Are the withdrawals dangerous?

Nicotine being a highly addictive component of tobacco causes unpleasant physical withdrawals upon abrupt discontinuation. These features include anxiety, restlessness, irritability, insomnia and intense craving. These symptoms are discomforting but not dangerous or life-threatening and may last for weeks or months if not substituted with nicotine replacement and other medicinal options.

But withdrawal features of alcohol, especially for those who are excessive daily drinker, can vary from trembling, restlessness, insomnia, and anxiety in mild cases to risk of convulsions in moderate cases, and confusional state, delirium & psychosis (losing touch with reality) in severe cases. Therefore, sudden discontinuation after regular excessive and heavy drinking can be dangerous and life-threatening.

What are the options?

For those with milder habit and minimal withdrawals, home remedies may help while you consider professional intervention. They typically include a healthy diet, hydration, regular exercise, yoga, meditation. Rest and relax with music and reading. One can engage in board games or other mind engaging family activities to overcome mental anguish or guilt of developing the habit. Remember, you are not alone, and this is as good as time to rid yourself of the chemical dependency.

I think professional help and guidance from a psychiatrist or de-addiction specialist is the definitive way forward. A formal assessment will establish the degree of addiction and intensity of withdrawals followed by necessary medicinal treatment & motivational therapy for sustained change. While one2one consultation would be preferred at least initially, but given the current scenario, I think video consultation or eConsult is a safer and more convenient option.

For nicotine addiction:
Consider nicotine substitutes like a patch or chewing gums. They are both available over the counter but ideally taken under professional guidance and support. You do not want to substitute one habit for another. Research suggests that majority who try to quit without specialist advice and replacements, relapse to smoking or tobacco chewing soon afterwards.

Besides, there is medication to reduce craving and associated anxiety. These require a formal script from a practicing physician or a psychiatrist.

For alcohol addiction:
A specialist can address your difficulties and consider all treatment options, including harm minimization or abstinence-based programme.

Harm minimization programme may be a starting point for some who are not keen or ready for change. Herein, one is educated about their habit and encouraged to gradually cut down the said behaviour or habit (including reducing intake of the substance) while adopting a healthier lifestyle. Besides, motivational sessions will emphasize the process of change by tapping into intrinsic motivation within the client and help transform to a state of being content and in control. Harm minimization programme can offer new learning and a taste of healthier living and eventually lead to abstinence.

On the other hand, in an abstinence-based programme, an abrupt and complete discontinuation of alcohol is advised. And where necessary, detoxification & anti-craving medicines with thiamine supplements are given to reduce or avoid withdrawal symptoms & medical complication. Both programme can be delivered at hospital outpatient setting or via online video consultation.

Those who have severe withdrawals and have underlying psychiatric and medical conditions (like hypertension, diabetes, epilepsy) are at higher health risk and require hospitalization for short medical detoxification treatment followed by ongoing psychosocial therapy. Before the initiation of any treatment, all individuals will require some baseline blood tests and ECG to ascertain their physical health status.

The Indian government’s District Mental Health Programme (DMHP) has issued a set of guidelines for medical officers and district psychiatrists to assess and treat persons seeking help withdrawals. But I think they should also publish advisory for individuals on ways to cope with these addictions during the lockdown and encourage seeking treatment at specialist centres (both public and private sector). The Kerala government suggestion of ‘issuing alcohol on doctor’s prescription’ is not just odd but unethical. Instead, they should issue guidelines for treatment.

In the meantime, individuals should suffer no more and seek professional help. I think this lockdown has provided a unique opportunity for many who wanted a change but feared to address it. Now are left with no choice but to move towards nicotine and alcohol-free healthier lifestyle.

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Suggested reading:
For other practical tips and advice do read my previous MindBlog on smoking cessation titled – ‘Kick the Butt’ and gutka addiction titled ‘Gutka or smokeless tobacco, a pinch of poison.’