by Dr Imran Khan
Despite expanding treatment facilities, stigma, poverty, demographics and substance-specific factors continue to prevent many Kashmiris with addiction from seeking care.
Substance use disorder, commonly known as drug addiction, is a serious public health challenge confronting Kashmir. National estimates and localised clinical studies indicate that approximately 13.5 to 14 lakh individuals in the region use psychoactive substances. What is even more worrying is that the use of certain substances, such as opioids, inhalants and sedatives, is substantially higher than the national average.
Despite the negative consequences of substance abuse, surprisingly, not many individuals seek treatment and rehabilitation. Global data also confirm that only 8.1% of individuals with drug use disorders receive professional treatment. While treatment facilities have expanded over the years, a significant proportion of individuals struggling with addiction remain outside the healthcare system. This question lies at the heart of my recent research conducted among substance users in Kashmir.
Our findings point to a complex web of sociodemographic and substance-specific factors that act as invisible barriers to treatment-seeking, indicating that addiction is not merely a brain disease but is deeply influenced by social, economic and psychological factors. Recovery, therefore, cannot depend only on medicines or the establishment of rehabilitation centres. It also requires removing the barriers that prevent people from utilising those services.
Our study highlighted that a high proportion of students do not seek treatment, which could possibly be explained by limited risk-assessment skills at a young age, the initial stages of drug dependence, and the experience of early euphoria without severe withdrawal symptoms. Unfortunately, addiction often progresses silently before individuals recognise the seriousness of their condition. Conversely, individuals in the business category were much more likely to seek care, which can be explained by greater psychosocial maturity and independent financial resources.
Financial circumstances also appear to play an important role. Individuals from lower-income families were found to be less likely to seek treatment. Although government services are available, financial pressures, such as the cost of medicines, loss of income, prolonged rehabilitation and family responsibilities, can discourage treatment. Thus, for economically vulnerable families, addiction becomes not only a health crisis but also a financial burden.
Another important observation concerns stigma. In our society, substance dependence is viewed as a moral weakness rather than a health condition. Families often hide the problem until it reaches a crisis point. Many individuals fear social rejection and damage to the family’s reputation, thereby avoiding treatment.
Our study also highlighted that a significant number of substance users who did not seek treatment were from urban areas, potentially due to greater drug availability and localised environmental triggers. Furthermore, a very high percentage of those who avoided professional care were unmarried, indicating that marriage can act as a protective factor against drug use.
The study also showed that the type of drug used and the level of dependence influenced treatment-seeking. Individuals with severe opioid and sedative dependence were more likely to seek treatment, possibly because these substances rapidly produce serious physical, psychological and social consequences.
In contrast, many individuals with severe alcohol and tobacco dependence continued to avoid professional help. For tobacco, this can be explained by its high cultural acceptance, low risk perception, and a lack of specialised nicotine cessation clinics. For alcohol, the barrier may be socio-religious. Within the traditional religious fabric of Kashmiri society, alcohol use carries immense moral condemnation. Thus, such social and religious factors may act as barriers to open discussion or treatment-seeking. These findings remind us that addiction is influenced by society’s differing perceptions of various substances.
The implications of our findings are clear. To dismantle the treatment gap, policies and public health interventions developed to address substance use must be tailored to demographic and substance-specific patterns of severity. Making rehabilitation financially accessible to low-income families, establishing anonymous and confidential intervention pathways to counter socio-religious stigma, creating targeted early intervention programmes within educational institutions, and developing substance-specific intervention strategies can make a significant difference. Only by addressing these underlying demographic and substance-specific determinants can we convert invisible barriers into pathways to recovery.
(The author holds an PhD. in Psychology. He earlier worked as a Counselling Psychologist with the Jammu Kashmir Police Drug De-addiction Services and with Médecins Sans Frontières (MSF). Ideas are personal.)
