UNVEILING DRUG ABUSE AND THE ROLE OF SERVICE PROVIDERS IN SIKKIM

Drug abuse has become a global concern, with its prevalence steadily rising across the world. The Indian Government adopts a comprehensive, multifaceted strategy to combat the escalating issue of drug abuse by focusing on three key pillars: Supply Reduction, Demand Reduction, and Harm Reduction:

• Supply Reduction involves the creation and enforcement of specific drug laws and policies aimed at limiting the availability of illegal substances. This responsibility is primarily handled by the Narcotics Control Bureau (NCB) under the Ministry of Home Affairs, with coordination from various central and state-level agencies. 
• Harm Reduction focuses on minimising health risks, particularly the prevention of Human Immunodeficiency Virus (HIV) transmission among Intravenous Drug Users (IDUs). This is implemented through a range of health-oriented initiatives overseen by the National AIDS Control Organisation (NACO), which operates under the Ministry of Health and Family Welfare (MoH&FW). 
• Lastly, Demand Reduction addresses the need to lower the desire and dependency on drugs through prevention, treatment, and rehabilitation programmes. This domain is managed by the Ministry of Social Justice and Empowerment (MoSJE). Together, these coordinated efforts reflect the government’s structured and holistic response to tackling drug abuse in the country (Dhawan et. al, 2017). 

The NCB identified the states of Manipur, West Bengal, Bihar, Jharkhand, Gujarat, Uttarakhand and Jammu and Kashmir as major traffickers of opium (NCB, 2020). The Magnitude of Substance Abuse Report (2019) highlights that approximately 1.18 crore individuals in India use sedatives and inhalants. The states of Arunachal Pradesh, Chhattisgarh, Goa, Punjab and Tripura have the highest prevalence of alcohol use, while Chhattisgarh, Delhi, Punjab, Sikkim and Uttar Pradesh have the highest prevalence of cannabis use. Arunachal Pradesh, Nagaland, Manipur, Mizoram and Sikkim also reported the highest opioid and sedative use. Sikkim, the 22nd state of India, has been actively participating in the Nasha Mukt Bharat Abhiyan (NMBA) - a nationwide initiative launched in 2020 by the Ministry of Social Justice and Empowerment (MoSJE), Government of India. Currently in its second phase, the programme has identified all six districts of Sikkim as highly vulnerable to drug abuse. In response, the Social Welfare Department, Government of Sikkim, formally launched the Nasha Mukt Sikkim campaign on 2nd July 2024, aiming to build a drug-free society within the state. This campaign acknowledges the rising misuse of drugs in Sikkim and focuses on addressing the root causes through a demand reduction approach, emphasising prevention, awareness, and rehabilitation as key strategies in the fight against substance abuse.

By placing greater emphasis on rehabilitation and reintegration, the amendment seeks not just to reduce drug-related harm, but also to help individuals rebuild their lives and rejoin society as contributing members.

The Sikkim Anti-Drugs Act (SADA), enacted in 2006 by the Government of Sikkim, was introduced to bridge critical gaps in addressing the misuse of prescription drugs and other substances not covered under the central Narcotic Drugs & Psychotropic Substances (NDPS) Act. This state-specific legislation empowers the government to regulate the manufacture, sale, distribution, and possession of such substances, while also laying down provisions for enforcement, penalties, and rehabilitation. A significant turning point came in 2017, when the Act was amended to draw a clear distinction between a ‘peddler’, someone caught with a large quantity of drugs, and a ‘consumer’, who possesses smaller amounts. This shift in legal perspective marked a more compassionate and rehabilitative approach towards individuals struggling with substance use. By placing greater emphasis on rehabilitation and reintegration, the amendment seeks not just to reduce drug-related harm, but also to help individuals rebuild their lives and rejoin society as contributing members. As a result of this progressive approach, the last decade has witnessed a rapid growth in De-addiction, Detoxification and Rehabilitation Centres (DDRCs) across Sikkim, reflecting the state’s commitment to a more humane and effective response to drug abuse.

DDRCs in Sikkim play a pivotal role as key stakeholders in this critical effort. Drug rehabilitation and detoxification refers to psychotherapeutic treatment for dependency on drugs in order to reintegrate people with Substance Use Disorders (SUDs) back into the social realm. In 2023, Sikkim had 2 IRCAs, 1 Drug Treatment Centre (DTC), 1 De-Addiction cum Rehabilitation Centre, and 1 ATF (Lhasungpa & Gurung, 2024). In the same year, the state had 15 functional DDRCs with nearly 60 per cent of the centres falling under the category of private not-for-profit organisations, and 20 per cent operating as private-for-profit entities (ibid). DDRCs in Sikkim offer intake, assessment, and/or referral services, as well as detoxification and substance abuse treatment. Alcohol addiction accounts for the majority of treatment cases in Sikkim, with drug abuse following closely behind. The service providers in these DDRCs play a crucial role in supporting recovery, preventing relapse, and contributing to broader collaborative efforts to address substance abuse. Interestingly, a significant number of these providers are individuals who have personally battled addiction themselves, far outnumbering those without a history of substance use. 

“Drugs were never the problem. It was the solution to address the problem. I used to take drugs whenever I needed to express happiness, sadness, or anger” – Ex-user.

This powerful quote offers an alternative perspective, shared by an ex-user who now serves as a service provider. It underscores the importance of understanding the underlying emotional and psychological reasons behind substance abuse. The statement highlights that no one begins using drugs with the intention of becoming an addict, rather, drug use often emerges as a coping mechanism for unresolved issues or emotional distress. For many, completing their treatment becomes just the beginning of a deeper journey. An active service provider in Pakyong says  “Centre aunu sajilo cha, niskeyra jaanu saaro cha” (It is easy to come to the centre, but very difficult to exit). NGO-operated centres often become a safe haven, where former patients return, not just to stay connected to a supportive environment, but also to give back by volunteering. In doing so, they reinforce their own recovery while helping others through theirs. This creates a powerful, symbiotic relationship. The centres benefit from the lived experience and empathy these individuals bring, while the ex-patients gain an extended support system and a sense of purpose. With formal outpatient 'after-care' systems still limited in Sikkim, this peer-led model of support fills a critical gap, allowing recovering individuals to form strong communities, share accountability, and maintain sobriety together over the long term. 

Most service providers at the DDRCs live and work on-site, offering round-the-clock residential care, often going above and beyond their duties while receiving only a modest salary. Many of them are young, in their most productive years, and typically unmarried, coming from nuclear family backgrounds. Their educational journeys vary, most have studied up to the senior secondary level, with a smaller group holding graduate degrees. Only a handful have pursued technical education or earned diplomas, and a few had only reached middle school before stepping into this role. Despite their diverse academic backgrounds, what unites them is a deep, personal commitment to helping others walk the path they once walked themselves. Individuals with lived experiences of addiction often form the most powerful connection with the public, as their personal stories resonate deeply with others facing similar struggles. As a respondent from Samaritan, Pakyong poignantly put it, “Kati ley suneyra bujh cha, kati ley bhaneyra bujh cha, haami ley cheteyra bujheyko ho” (Some understand by listening, some by speaking, but we have understood by living it).  

Challenges of Service Providers

“Bhanayko jasto service provide garnu paako chaina” (unable to provide the service as expected/desire) – Service provider, Jeewan Marg II, Jorethang.

Service providers face numerous challenges in the course of their work. Many individuals felt that a heavy sense of stigma and discrimination stems from the misconception and stereotypical understanding of substance abuse and addiction. A respondent stated, “rehabs are seen as second jail” or even “it is better to send patients to jail than to a rehab” hinting that entering a rehab taints the reputation of a person even after they manage to stay sober. Often, patients are admitted to rehabilitation centres against their will, leading to feelings of resentment and resistance towards the staff. This can manifest as violent outbursts, anger issues, and in some cases, self-harming behaviour, making the recovery process even more difficult to manage. Mr. K. C. Nima, founder, Freedom Facility Centre, shared that one of the biggest difficulties for patients is the sudden loss of personal freedom. Being in a controlled environment, away from familiar surroundings and routines, can be mentally exhausting and emotionally overwhelming for many. This initial phase of treatment often becomes a significant hurdle, as patients struggle to adjust to structure, rules, and the internal battle of withdrawal and self-reflection. Adding to this, many family members lack a clear understanding of the role and limitations of rehabilitation centres, which creates further tension. While some families do cooperate, many expect the patients to make a full recovery and pinpoint the inefficiency of the treatment centres if expected outcomes were unmet. In such situations, when a patient’s behaviour poses a risk to themselves or others, centres are sometimes left with no option but to discharge the individual and return them to their families, prioritising the safety and well-being of all involved. 

A respondent stated, “rehabs are seen as second jail” or even “it is better to send patients to jail than to a rehab” hinting that entering a rehab taints the reputation of a person even after they manage to stay sober.

While most centres primarily cater to male patients, a few centres have begun extending treatment services to women as well. Among them, the Niwasa Female Rehabilitation & Detoxification Society,  is the the only dedicated female rehabilitation centre in Sikkim. Run by sisters Rinzing Bhutia and Ongmu Bhutia, Niwasa started by serving mostly patients from Arunachal Pradesh, but has more recently begun seeing an increase in local women seeking help. The majority of these women come in for alcohol addiction treatment. Rinzing, a prominent female figure in the fight against drug addiction in Sikkim, has observed distinct patterns in the backgrounds of many female patients. She spoke candidly about the stigma and resistance she faced while trying to establish the all-female centre. When she set out to find a building for the centre, many people in the community were apprehensive, fearing the presence of a rehabilitation facility in their locality. This widespread hesitation and societal judgment meant it took her an entire year to secure a suitable space, with the centre finally opening its doors in February 2023. Even among patients, fear and misconceptions persist. Many women are hesitant to seek treatment, worried that entering such a treatment facility might subject them to mistreatment or physical assault. Compounding this is the lack of family support, which Rinzing identifies as a major barrier to successful and complete recovery. While she acknowledges the importance of awareness campaigns, she warns that in rural areas, such initiatives can sometimes backfire, unintentionally sparking curiosity about drugs rather than deterring their use. According to her, broken families, sexual abuse by relatives or family members, and domestic conflicts are among the leading causes driving women towards substance use. She believes that a holistic recovery programme must be tailored to each individual, emphasising that self-motivation is a critical factor in sustaining long-term recovery.

Alongside the efforts of DDRCs, two prominent organisations have emerged from this growing solidarity among recovering users: the Recovering Users Network (RUN) of Sikkim, and the Sikkim Drug Users Forum (SDUF). Both organisations have been playing a crucial role in amplifying the voices of people affected by SUDFs, bringing their concerns to the forefront. Additionally, civil society organisations and concerned citizens are also stepping up in the fight against drug abuse in Sikkim. The Drug Safai Abhiyan, popularly known as the Aama Party, from Majhigaon, Jorethang, is a remarkable grassroots initiative that emerged in response to the rising concerns of drug-related crimes, frequent fights, daytime thefts, and the growing presence of substance abuse in the locality. It is an all women-led initiative, showcasing a powerful assertion of agency, courage, and community leadership, highlighting a compelling example of how women’s collective action can drive meaningful and lasting impact in the fight against substance abuse. Similarly, the Anti-Drug Squad initiated in Melli Bazar stands out as another impactful community-driven response to the growing drug problem. Started by a panchayat member along with a group of concerned citizens, this initiative reflects a rising sense of local responsibility and civic engagement in addressing substance abuse at the grassroots level. 

An individual struggling with addiction is often an unfortunate victim of the deeper, pathological conditions within our society, and must be approached with empathy, understanding, and dignity.

An individual struggling with addiction is often an unfortunate victim of the deeper, pathological conditions within our society, and must be approached with empathy, understanding, and dignity. Effective intervention requires scientifically grounded, holistic approaches that not only treat the addiction but also address the underlying social, emotional, and psychological factors. There is an urgent need for sustained support and exploration of the tireless efforts being made by individuals and organisations working in this field. Whether it’s centre heads, civil society groups, or committed community members, many continue to dedicate themselves to this cause with hope and resilience. Their unwavering optimism reflects a shared belief that, over time, their efforts will lead to positive, transformative change in society, one recovery story at a time.

References:

Narcotics Control Bureau Annual Report, 2020.

Ambekar A., Agrawal A., Rao R., Mishra A.K., Khandelwal S.K., & Chadda R.K. [on behalf of the group of investigators for the National Survey on Extent and Pattern of Substance Use in India] (2019). Magnitude of Substance Use in India. New Delhi: Ministry of Social Justice and Empowerment, Government of India.

Lhasungpa, N. C. & V. Gurung (2024). Drug Abuse, Addiction and Rehabilitation in Sikkim: Report 2024. National Fund for Control of Drug Abuse. Department of Revenue. Ministry of Finance. Government of India.