What addiction really is, how alcohol, tobacco, ganja, smack, tablets and whitener differ, why withdrawal can be dangerous, what modern treatment looks like, and how families can help without losing themselves.
In this article 15
- "He's a good man, Doctor. He just can't stop."
- The four Cs of addiction
- The picture in India
- The substances we see most: profile cards
- Why stopping suddenly can be dangerous
- Change happens in stages, and families can help at each one
- What modern de-addiction treatment actually looks like
- Medicines by substance: what the evidence supports
- Talking treatments and support
- Relapse is not failure: it is what chronic illnesses do
- What happened to Pankaj
- Choosing a safe de-addiction centre: questions to ask
- Frequently Asked Questions
- References
- About this article
Meaning
"He's a good man, Doctor. He just can't stop."
Sunita came to my clinic alone. Her husband Pankaj, forty-one, ran a small transport business from Begusarai. It had started as "a drink with drivers after work". Now he drank every day, hid bottles in the truck, had been in two accidents, and had promised to stop more times than she could count. Once, when he tried to quit on his own, he had shaken so badly by the third day that he had a fit. "He loves the children. He cries when he's sober. Why can't he just stop?"
Composite illustration · for education only · not a real person
Details are blended and altered so that no individual can be identified.
Her question is the question at the heart of addiction. Addiction (doctors now prefer the term substance use disorder) is a long-term condition in which a person keeps using a substance despite clear harm, because the brain's systems for reward, motivation and self-control have changed.2 It is not a lack of love or willpower. De-addiction is the medical and psychological process of helping someone stop or reduce use safely, repair the damage, and stay well.
The four Cs of addiction
Craving
A strong, often physical urge to use, triggered by places, people, stress or even a time of day.
Compulsion
Using more often or more than intended; much of the day goes into getting, using or recovering.
Control lost
Repeated failed attempts to cut down; promises made sincerely and broken.
Consequences ignored
Continuing despite harm to health, money, work, family or the law.
The picture in India
~16 croreIndians aged 10 to 75 use alcoholMSUI 2019
5.7 croreare affected by harmful or dependent drinking, about one in three drinkersMSUI 2019
~2.3 croreuse opioids; heroin ("smack") is now the most commonMSUI 2019
1 in 38people with alcohol dependence report getting any treatmentMSUI 2019
Types
The substances we see most: profile cards
Each substance affects the brain differently, has different warning signs, and needs a different approach to treatment. These cards cover what families in Bihar most often bring to us.
Alcohol
daru, desi, IMFL, home-brewed
Signs: Smell, morning drinking, hidden bottles, shaking hands in the morning, missed work, anger
Harms: Liver disease, accidents, violence, memory damage, depression, financial ruin
Withdrawal: Can be dangerous: fits and delirium possible
Tobacco
cigarette, bidi, khaini, gutkha
Signs: Constant use, mouth stains, irritability without it
Harms: Mouth and lung cancer, heart disease, stroke: the largest preventable cause of death
Withdrawal: Irritable and restless but not dangerous; quitting is very treatable
Cannabis
ganja, charas, bhang
Signs: Red eyes, sweet smoky smell, falling marks, low motivation, staying up all night
Harms: Memory and study problems; higher risk of psychosis, especially in teenagers and with strong use
Withdrawal: Irritability, poor sleep, low appetite for one to two weeks
Opioids
smack/brown sugar, heroin, painkiller tablets, cough syrups
Signs: Pinpoint pupils, drowsy "nodding", money and valuables missing, foil or injection marks
Harms: Overdose deaths; HIV and hepatitis from shared needles; crime and debt
Withdrawal: Very uncomfortable (aches, diarrhoea, yawning) and rarely dangerous itself, but overdose risk afterwards is high
Sedative tablets
"neend ki goli", anxiety tablets
Signs: Taking more than prescribed, buying without prescription, drowsiness, slurred speech
Harms: Falls, memory problems, dangerous breathing with alcohol or opioids
Withdrawal: Can be dangerous: fits possible; must be tapered under a doctor
Inhalants
whitener, "solution", petrol, glue
Signs: Chemical smell, stained hands or clothes, rag or bags hidden; mainly children and teenagers
Harms: Sudden death from heart rhythm problems even on first use; brain and nerve damage
Help: Urgent family support, schooling and counselling; Childline 1098 for children at risk
Heroin, smack and painkiller dependence in this region are discussed in more depth in opioid use disorder in India, with a focus on Bihar.
Safety first
Why stopping suddenly can be dangerous
Families often lock someone in a room "to get it out of his system", or take him to a centre that offers no medical care. With some substances, that can be life-threatening. Withdrawal risk depends on what, how much and how long.
The hour-by-hour course of alcohol withdrawal, and the signs that mean an emergency, are explained in our alcohol withdrawal symptoms and timeline guide.
Emergency first aid: keep this page
Suspected opioid overdose (very sleepy, can't be woken, slow or no breathing, blue lips, pinpoint pupils):
- Call 108 or 112 immediately
- Lay the person on their side (recovery position), keep the airway open
- If trained, give rescue breaths; an overdose-reversal medicine, where available, can save a life
- Stay with them until help arrives
After drinking illicit or home-made liquor: blurred or lost vision, severe stomach pain, vomiting, breathlessness or confusion may mean methanol poisoning. Go to hospital at once; minutes matter.
Swallowed pesticide or tablets: do not try to make the person vomit; call 108 or 112 and take the container to hospital.
Overdose after a break: after detox, jail or hospital, tolerance falls quickly. Using the old amount can kill. This is one of the most dangerous moments in recovery.
A note for families in Bihar
Since 2016, the sale and consumption of alcohol have been prohibited in Bihar. In my clinic, I see three consequences families should know about. First, people who are dependent on alcohol do not stop needing help, but fear and shame make families hide the problem for longer. Second, illicit liquor of unknown origin carries a real risk of methanol poisoning. Third, some people switch to other substances: ganja, smack, tablets or cough syrups. Seeking medical treatment for addiction is a health matter, and what you share with your doctor is confidential under the Mental Healthcare Act, 2017.10
The road back
Change happens in stages, and families can help at each one
Psychologists James Prochaska and Carlo DiClemente showed that people rarely jump straight from "no problem" to "quit".4 They move through stages, often going back and forth. Knowing which stage your loved one is in tells you what to say, and what not to.
| Stage | Sounds like | Family can |
|---|---|---|
| 1 · Not ready precontemplation | "I can stop any time." "Everyone drinks." "It's not a problem." | Stay calm; share specific facts, not labels: "You missed Ravi's school meeting twice this month." Protect yourself and the children. |
| 2 · Thinking contemplation | "Maybe I drink a bit much... but it helps with stress." | Ask what they don't like about it. Listen more than you lecture. "What would be different if you cut down?" |
| 3 · Preparing preparation | "I want to stop. I don't know how." | Act quickly: book the appointment, offer to go along. "I'll come with you on Monday." |
| 4 · Action action | "Ten days without a drink." Irritable, tired, unsure. | Praise effort, not perfection. Remove alcohol from home. Support appointments and medicines. |
| 5 · Staying well maintenance | "I can handle a wedding now." Rebuilding trust and routine. | Help plan for risky situations; rebuild normal family life; watch for early warning signs. |
| Slip or relapse common, not the end | "I've ruined everything. What's the point?" | Respond with concern, not "I told you so". "Let's call the doctor today." A quick return to treatment matters most. |
Treatment
What modern de-addiction treatment actually looks like
- 1Safe withdrawal
Medically supervised detoxification over about 5 to 10 days, with medicines to prevent fits and ease discomfort, vitamins, and treatment of any physical problems. At home, as a day patient or in hospital, depending on risk.
- 2Relapse prevention
Medicines that reduce craving or block effects, plus counselling: understanding triggers, handling stress and cravings, repairing relationships, and building a life without the substance.
- 3Staying well
Regular follow-up for at least a year, support groups, treatment of depression or anxiety, work and family rebuilding, and a plan for slips.
Medicines by substance: what the evidence supports
| Substance | Medical treatment (classes) | What the evidence shows |
|---|---|---|
| Alcohol | Withdrawal medicines for detox; anti-craving medicines; a deterrent medicine in selected, supervised cases | A 2014 JAMA review of 120+ trials found anti-craving medicines reduce return to drinking.5 They are under-used in India. |
| Opioids | Opioid agonist (substitution) treatment: long-acting, prescribed and supervised; or a blocking medicine after detox in selected people | Large studies show agonist treatment roughly halves the risk of death and cuts crime and HIV risk.6 Available at government-supported centres and specialist clinics. |
| Tobacco | Nicotine replacement (gum, patch) and prescription stop-smoking medicines | Roughly doubles the chance of quitting compared with willpower alone; most effective with counselling. |
| Cannabis, inhalants | No approved medicines; treat sleep, mood and withdrawal symptoms | Psychological treatments are the main approach. |
Talking treatments and support
Motivational interviewing builds the person's own reasons to change. CBT and relapse prevention teach practical skills for cravings and high-risk situations; our explainer on how CBT works shows what the sessions involve. Contingency management (small rewards for verified abstinence) has some of the strongest evidence, especially for stimulants. Mutual-help groups such as Alcoholics Anonymous and Narcotics Anonymous help many people: a 2020 Cochrane review found AA and structured programmes linked to it led to higher rates of continuous abstinence than several other approaches.7 Family therapy is essential when the whole household has been affected.
Outpatient (OPD)
For mild to moderate problems with low withdrawal risk and good family support.
Day-care programme
Structured therapy during the day, home at night; keeps work and family ties intact.
Inpatient
For severe dependence, high withdrawal risk, serious medical or psychiatric illness, or repeated failed attempts.
At Healthy Minds India, assessment, detox planning and follow-up are offered through our de-addiction centre in Patna, and the day-care de-addiction programme in Patna provides structured therapy during the day while the person lives at home.
Relapse and the family
Relapse is not failure: it is what chronic illnesses do
In an influential 2000 paper in JAMA, Thomas McLellan and colleagues compared addiction with other long-term illnesses.3 Relapse rates for drug addiction were similar to those for diabetes, high blood pressure and asthma: conditions where returning symptoms lead to adjusting treatment, not giving up on the patient.
Addiction is a treatable, chronic condition. A slip after months of sobriety does not erase those months. What matters is how quickly the person returns to care.
For families: the CRAFT approach
Community Reinforcement and Family Training (CRAFT), developed by Robert Meyers and William Miller, teaches families how to encourage a loved one into treatment without confrontation. In trials it brought about two-thirds of reluctant loved ones into treatment, more than confrontational "interventions" or support groups alone.8 Its core ideas:
- Reward sober behaviour: spend warm time together when they're not using.
- Step back from rescuing: let natural consequences of use fall on the user, not on you.
- Communicate positively: "I" statements, no labels, no lectures when they're intoxicated.
- Choose your moment: suggest treatment when they are sober and showing regret.
- Protect your own safety: leave or call 112 if there is violence.
What happened to Pankaj
Sunita worked with us for three weeks before Pankaj agreed to come. He was admitted for a medically supported detox, this time without a fit, and started an anti-craving medicine. His triggers were clear: evenings with drivers and the stress of loans. He switched his evening routine to cricket with his son, joined a local AA group, and his liver tests improved. At four months he had one slip at a wedding; he called us the next morning. A year later he said, "The tablets helped my body. The meetings and my wife helped everything else."
Before you choose
Choosing a safe de-addiction centre: questions to ask
- Is there a qualified doctor (preferably a psychiatrist) who examines every patient?
- Is withdrawal managed with proper medical care and emergency back-up?
- Can family visit and speak to the patient freely?
- Are fees, length of stay and treatment plan explained in writing?
Warning signs
- Walk away from any place that uses beating, chaining, starving or locking people up "for discipline": this is illegal and harmful.
- Be wary of "guaranteed cure in 7 days" promises or secret medicines.
A family member can come for advice first, even before the person who drinks or uses is ready; you can book a consultation in Patna or online.
Your questions
Frequently Asked Questions
What is the meaning of de-addiction?
The medical and psychological treatment that helps a person stop or safely reduce substance use, manage withdrawal, prevent relapse and rebuild life. It is much more than "detox".
How do I get someone to accept treatment?
Confrontation rarely works. Approaches like CRAFT help families encourage treatment through calm, positive communication. You can see a doctor yourself first; you don't need to wait for them.
Is addiction a disease or a habit?
It is a medical condition involving lasting changes in brain reward and control systems, influenced by genes, environment and mental health. Choice matters, but so does treatment.
Can de-addiction be done at home?
Sometimes, for mild cases with low withdrawal risk and good supervision. Heavy daily drinkers and people on sedative tablets usually need closer medical care because withdrawal can cause fits.
How long does treatment take?
Detox takes about a week; real recovery takes months to years. We recommend at least a year of follow-up, with longer support for many people.
Are de-addiction medicines addictive?
Anti-craving medicines are not. Opioid substitution treatment is a prescribed, supervised medicine that stabilises the brain, like insulin for diabetes, not "swapping one drug for another".
Can a person ever drink "normally" again?
For people with dependence, stopping completely is usually safest. For milder problems, controlled reduction can be a goal agreed with a doctor.
What should we do after a relapse?
Stay calm, ensure safety, and contact the treatment team quickly. Remember: tolerance drops after a break, so the overdose risk is higher. Return to care, not to blame.
References
The studies, surveys and guidance named in the text, in order of first mention in the original edition.
- Ambekar A, Agrawal A, Rao R, Mishra AK, Khandelwal SK, Chadda RK, on behalf of the group of investigators. Magnitude of Substance Use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India; 2019.
- Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. New England Journal of Medicine. 2016;374(4):363-371.
- McLellan AT, Lewis DC, O'Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284(13):1689-1695.
- Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology. 1983;51(3):390-395.
- Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889-1900.
- Sordo L, Barrio G, Bravo MJ, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.
- Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews. 2020;3:CD012880.
- Miller WR, Meyers RJ, Tonigan JS. Engaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology. 1999;67(5):688-697.
- World Health Organization. ICD-11: Disorders due to substance use or addictive behaviours. Geneva: WHO; 2022.
- Government of India. The Mental Healthcare Act, 2017; Bihar Prohibition and Excise Act, 2016.
About this article
Written and medically reviewed by
- MD (Psychiatry) AIIMS New Delhi
- Associate Professor & HOD, Dept. of Psychiatry, RDJM Medical College, Muzaffarpur
- Ex-Assistant Professor, PMCH Patna
- Consultant, Healthy Minds India, Patna
- Published
- 14 October 2026
- Format
- Patient guide
- Focus
- De-addiction and family support
- Sources
- 10 references
- Dr. Saurabh Kumar worked for two years as a Senior Registrar at the National Drug Dependence Treatment Centre, AIIMS, and has treated people with alcohol and drug problems throughout his career.
- The Stages of Change model is from James Prochaska and Carlo DiClemente; motivational interviewing from William Miller and Stephen Rollnick; CRAFT from Robert Meyers and William Miller. The "four Cs" is a widely used teaching summary.
- Sunita and Pankaj's story is a composite; case details are illustrative only.
- Written for general education. It does not replace an individual assessment by a qualified clinician and does not diagnose any condition. Diagrams are original illustrations prepared for this article.
© 2026 Healthy Minds India, Patna · Blog edition 2.0, October 2026 (revised from the earlier web article)
If you or someone close to you needs help right now
Emergency: 112 · Ambulance: 108 · National drug de-addiction helpline (Government of India): 14446 · Tele-MANAS (free, 24×7, Government of India): 14416 or 1-800-891-4416 · Childline, for children in distress: 1098
If there is any immediate risk to life, do not wait for an appointment: call 112 or go to the nearest hospital emergency department.
Healthy Minds India, Patna
House No. 46/B, Sahdeo Mahto Marg, Near Sri Krishna Puri Park (Children's Park), Patna 800001
In person in Patna, online across India · Mon-Wed, Fri & Sun, 9 AM-7 PM (Thu & Sat closed)
Appointments
Non-emergency: 7050024223 / 9060484416 · book a consultation
Services: De-addiction OPD · Day-care de-addiction · Family counselling · Internet and gaming addiction · Psychiatric consultation
For general education; not a substitute for a personal consultation. If you or someone close to you is in distress, please speak to a qualified mental health professional.
Medically reviewed by Dr. Saurabh Kumar, Consultant Neuropsychiatrist, Healthy Minds India, Patna. This article is for general education and is not a substitute for a personal consultation. To discuss your situation, book an appointment or contact the clinic.
Disclaimer: all characters and events depicted in this blog are entirely fictional. Any resemblance to actual persons, living or dead, is purely coincidental. The content is intended for informational purposes only and should not be considered medical advice. Always consult a qualified healthcare professional for medical concerns.
