Addiction and Substance Use

Stories, signs to notice and what to do

The Glass After Dinner

Raghav, fifty-one, runs a hardware shop in Nashik. He never drank in the mornings, he told himself, and he never missed a delivery. But the one glass after dinner had become three, then the bottle he kept behind the paint tins. Lately his hands shook until the first drink, and he had missed his daughter's school function twice.

His wife Meena found the bottles and wept. Raghav promised to stop on Monday. By Wednesday he was sweating, restless, and could not sleep, so he drank again, and felt ashamed all evening. The shame sent him straight back to the bottle.

One night he told Meena the truth. He said he did not even enjoy it any more. He just could not bear the feeling when he did not have it. Meena, instead of shouting, said she was frightened and wanted to take him to the family doctor together. The doctor listened without a lecture, said stopping suddenly at home could be dangerous, and arranged supervised care.

Months later, Raghav still goes to the clinic every fortnight. He had one bad week, a lapse, and told Meena the same day instead of hiding it. She did not panic. The doctor said a lapse is data, not a verdict, and adjusted the plan. Raghav now spends evenings teaching his daughter to repair bicycles, and says the quiet is still strange but no longer frightening.

How to recognise it

• Drinking more than intended, and promises to cut down that keep failing.
• Shaking, sweating or poor sleep when the drink is missing, which signals withdrawal.
• Hiding bottles, missing family events, and drinking despite clear problems.
• Needing more for the same effect.
• Shame and secrecy that follow each episode and feed the next one.

What this story explains

This story shows wanting without liking and the cue, use, relief, shame loop. It also shows why stopping dependent drinking alone at home can be medically dangerous.

Probable root causes

• A brain that has learned the drink predicts relief, so the craving itself becomes the hunger.
• Untreated stress, low mood or anxiety that the drink was quietly holding down.
• Easy access and a social culture where drinking is normal.
• Shame and secrecy that cut the person off from help.

What to do

1. Speak privately, when the person is sober and calm, and name what you have seen.
2. Do not suggest stopping suddenly at home; ask a doctor first because withdrawal can cause seizures.
3. Offer to go with them to a family doctor and to arrange medically supervised withdrawal if needed.
4. Ask the clinician to look for anxiety, depression or trauma underneath.
5. Keep the home safe and calm, and plan what to do if withdrawal symptoms appear.
6. If someone has a seizure, confusion or severe shaking, call the local emergency number or go to the nearest hospital.

Whom to consult

• Family doctor first, as soon as drinking is out of control or withdrawal signs appear.
• A psychiatrist or de-addiction clinic for supervised withdrawal and longer treatment.
• A counsellor or clinical psychologist for therapy and relapse prevention once safe.
• Emergency services or nearest hospital for seizures, confusion or severe shaking.

Do and don’t

How to behave and communicate

• Use a quiet tone: "I am not angry. I am scared, and I want to help."
• Describe what you saw, not what they are: "You missed Ria's function and I saw how sad you were."
• Listen without interrupting, and let silences sit.
• Offer a next step: "Shall we see Dr Joshi together this week?"
• Refuse the lie kindly: "I will not call your supplier with an excuse, but I will sit with you."

The Cigarette Behind the Hostel

Aisha, nineteen, started vaping at a friend's party in her first year of college in Pune. It looked harmless and tasted of mango. Within months she was stepping out of lectures every hour, and she felt irritable and unable to concentrate if she waited.

She tried to stop twice. Each time her head ached, she snapped at her roommate, and the craving felt like a hook behind her ribs. The third day she bought another one and felt relief wash over her. Then she felt weak and annoyed with herself.

Her roommate Neha noticed the pattern and asked gently, without judgement, whether it was bothering her. Aisha admitted she wanted to stop but could not. Neha helped her book an appointment at the campus health centre. The doctor explained that nicotine trains the brain to expect quick relief, that this is not a character fault, and that there are medically supported ways to quit and counselling that helps with cues like exam stress.

Three months on, Aisha is not perfect. She had a bad week during exams and used again, then told Neha instead of hiding it. They looked at what had set it off and planned a walk and a call home for those moments. Her cravings come less often now, and she says she can finally sit through a lecture without counting minutes.

How to recognise it

• Using more often than planned, and leaving class or work to use.
• Irritability, headaches or poor focus when use stops.
• Failed attempts to cut down.
• Use tied to stress, boredom or particular places and people.
• Rising cost, hidden use, and giving up activities to use.

What this story explains

This story shows that tobacco and nicotine are real dependence, not a habit of weak will, and that the cue-relief loop works even for a legal, mild-seeming product.

Probable root causes

• Nicotine quickly teaches the brain to expect relief.
• Stress, exam pressure and loneliness in a new place.
• Friends who use, and attractive flavours and easy access.
• Using as a way to cope with anxiety or low mood.

What to do

1. Notice the cues: stress, breaks, social settings, and plan something else for those moments.
2. Tell one trusted person that you want to stop.
3. Ask a doctor about supported quitting options and counselling.
4. Expect cravings to come in waves and ride them with a walk, water, or a call to a friend.
5. If you slip, note what triggered it and restart the plan the next day.

Whom to consult

• Family doctor or campus health service for quitting support.
• A counsellor if stress or anxiety is driving the use.
• A pharmacist or clinician before using any quitting aid, and follow their advice only.

Do and don’t

How to behave and communicate

• Ask open questions: "Is this something you want to change?"
• Use warm honesty: "I have noticed you leave every hour. I am here if you want help."
• Listen to their reasons before offering advice.
• Normalise slips: "A lapse tells us what to plan for. It does not end the effort."

Night Games, Empty Mornings

Karan, fifteen, from Jaipur, once loved cricket and drawing. Over a year, an online game took over. He played until three in the morning, hid the phone under the blanket, and became furious when his mother asked him to stop.

His marks fell. He stopped seeing friends and skipped breakfast. When his father switched off the wifi, Karan shouted, kicked a door, then sat on the floor shaking and tearful. He said later that the game was the only place he felt good at anything.

His parents first tried punishment, which only made him hide more. Then a school counsellor called them in. She asked about Karan's loneliness, because a teasing episode the year before had left him anxious. His parents agreed to set up clear, shared rules with him: screens in the living room at night, set hours, and time for cricket again. They also arranged to see a child psychologist for the anxiety underneath.

It was slow. Some evenings Karan still argued, and his parents held the line calmly without shouting. The psychologist helped him talk about the teasing he had never mentioned. Within a few months he was back at the nets on Saturdays, sleeping better, and playing his game for an hour on weekends with his father sitting beside him, learning the rules.

How to recognise it

• More time online than planned, with failed attempts to cut down.
• Losing interest in earlier hobbies, friends and sleep.
• Strong irritability or distress when access is removed.
• Falling marks and missed responsibilities.
• Hiding use and playing to escape low mood.

What this story explains

This story shows that a behaviour loop such as gaming or phone use can share the cue, relief, shame pattern with substances, and that the underlying anxiety needs care too.

Probable root causes

• Games that reward constantly make the wanting stronger than the liking.
• Loneliness, bullying or anxiety that the game soothes.
• Easy, unlimited access and no screen-free structure.
• Not enough offline activities that give a sense of success.

What to do

1. Talk about it calmly before you remove anything, and ask what the game gives him.
2. Agree clear screen rules together, such as devices out of the bedroom at night.
3. Rebuild offline joys: sport, art, friends, family meals.
4. Keep sleep regular and protect it first.
5. Look underneath for bullying, anxiety or low mood and get help for it.
6. Stay consistent as parents, and model your own phone habits.

Whom to consult

• School counsellor for early support and a link to services.
• A child psychologist or psychiatrist if mood, anxiety or refusal is strong.
• Paediatrician or family doctor to check sleep and general health.

Do and don’t

How to behave and communicate

• Start with curiosity: "Tell me what you like about this game."
• Name the worry without blame: "I miss seeing you laugh at dinner."
• Offer choice inside limits: "Would you rather stop at nine or have a longer weekend slot?"
• Listen more than you speak, and avoid lectures.
• Stay calm when he is angry and return to the talk later.

Pills for Sleep, Pills for Nerves

Mrs Dorothy Pereira, sixty-eight, widowed in Goa, was given a sleeping tablet after her husband died. It helped at first. Over two years she kept asking for repeats, then asked a second doctor too. She noticed she needed more for the same sleep.

Her daughter Anita saw her unsteady on the stairs and confused in the afternoons. When Dorothy once ran out for two days, she became shaky, tearful and could not sleep at all. She was frightened and ashamed, and said she could not tell anyone because she was taking what a doctor gave her.

Anita took her to the family doctor and told the full story, including the second prescriber. The doctor said these medicines can lead to dependence, that stopping suddenly can be dangerous, and that a slow, supervised plan was needed. They also arranged grief counselling, because the sleeplessness had started with loss. Dorothy cried with relief at being understood.

The slow plan took months, guided by the doctor, and some nights were hard. Anita stayed close, and a neighbour began to walk with Dorothy in the evening. In the grief group Dorothy met other widows and found that talking tired her out in a good way. She now sleeps without fear of running out, and keeps one doctor in charge of her medicines.

How to recognise it

• Needing more of a sedative for the same effect, or running out early.
• Getting prescriptions from more than one doctor.
• Daytime drowsiness, confusion, unsteadiness or falls.
• Shaking, anxiety or insomnia when doses are missed.
• Shame about taking a medicine that was legitimately prescribed.

What this story explains

This story shows that prescription sedatives are among the substances in the chapter and can cause tolerance and withdrawal, and that stopping needs medical supervision while the cause is treated.

Probable root causes

• Untreated grief, anxiety or insomnia that the pills were covering.
• Long-term use without regular review.
• Tolerance, where the body needs more for the same effect.
• Loneliness, and shame that stops people asking for help.

What to do

1. Go with the person to the doctor and give the full picture, including all medicines and prescribers.
2. Never stop the medicine suddenly; ask the doctor for a supervised plan.
3. Treat the reason sleep or nerves went wrong, such as grief or anxiety.
4. Build sleep habits: fixed times, daylight, a quiet evening, no late screens.
5. Reduce fall risks at home while confusion and drowsiness continue.
6. If there is a seizure or severe confusion, call the local emergency number or go to the nearest hospital.

Whom to consult

• Family doctor to review all medicines and plan any change.
• A psychiatrist for dependence and for anxiety, depression or grief.
• A grief counsellor or psychologist for talking support.
• Emergency services or nearest hospital for seizures or severe confusion.

Do and don’t

How to behave and communicate

• Reassure first: "You did nothing wrong by taking what you were given."
• Be concrete: "Let us go to the doctor together and tell her everything."
• Listen to the grief behind the sleeplessness.
• Use slow, simple words and check understanding.

The Brother Nobody Mentions

Tomas, twenty-six, lived in Lisbon with his parents and his younger sister Inês. His older brother Rui used heroin, and the family had spent years in a cycle of pleas, anger and secrecy. Their mother paid his debts, hid the evidence from relatives, and phoned his employer with excuses.

Inês stopped inviting friends home. Their father stopped speaking about Rui at all. Tomas found himself lying awake, checking his phone for news that might be terrible.

A family doctor suggested the parents join a family support group instead of fighting alone. They learned the difference between enabling and support. They stopped paying the fines and stopped telling lies for him, but they kept the door open, offered Rui a ride to a clinic, and spoke openly about the danger. Rui eventually went for treatment with medical support. He had a lapse months later, and his family treated it as information, not the end.

Inês, the youngest, was invited to speak at the family group too. She said she had felt invisible for years. Tomas said he had felt guilty for sleeping well on the nights Rui was away. Hearing that other families had the same feelings loosened something in all of them. They learnt that caring for the whole family was part of helping Rui, not a betrayal of him.

How to recognise it

• Family members cover up, pay fines or lie to employers.
• Secrecy, shame and avoided visitors.
• Brothers, sisters or parents sleeping badly and living in constant alarm.
• Cycles of anger, then rescue, then silence.
• Risk of overdose when use is heavier or mixed with other substances.

What this story explains

This story shows family support without enabling and why stigma and secrecy delay care. It also touches harm reduction and treatment with medicines as care.

Probable root causes

• Opioid dependence with strong tolerance and withdrawal.
• Untreated pain, trauma or low mood that the drug softened.
• Family secrecy and stigma that delay treatment.
• Easy access to supply.

What to do

1. Learn about the loop and about treatment, including medication-assisted treatment as a real medical option.
2. Stop enabling: refuse to pay fines, hide the evidence, or make excuses to others.
3. Offer practical support: a ride to a clinic, a meal, a safe room.
4. Keep the home safer by learning what overdose looks like and having a plan; if it happens, call the local emergency number at once.
5. Look after the rest of the family, including siblings, who are affected too.
6. Join a family support group so you are not alone.

Whom to consult

• Family doctor for guidance and referral to a de-addiction service.
• A psychiatrist or addiction clinic for treatment, including medicine when a clinician chooses it.
• A family counsellor or support group for the people living around the problem.
• Emergency services right away for suspected overdose.

Do and don’t

How to behave and communicate

• Say it plainly: "I love you and I will not lie for you."
• Offer help that is not money: "I can drive you to the clinic on Monday."
• Stay steady, not dramatic, and talk when everyone is calm.
• Listen to their fear and shame without a lecture.
• After a lapse: "That was hard. Let us work out what happened and what we try next."

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.