Drug and Alcohol Addiction

Drug and alcohol addiction are significant public health concerns in India, with large segments of the population affected by harmful patterns of substance use. According to the National Survey on Extent and Pattern of Substance Use in India (2019) commissioned by the Ministry of Social Justice & Empowerment:

• Approximately 16 crore Indians (≈14.6% of people between age 10–75) are current users of alcohol.
• Of these, about 2% meet criteria for alcohol dependence.
• Opioid use occurs in about 06% of the population, and nearly 0.7% of young people are inhalant users.
• Around 5 lakh (850,000) people inject drugs (people who inject drugs — PWID).
• Cannabis users are approximately 1 crore (31 million) with 0.66% suffering cannabis-related problems.
• Sedatives, inhalants, and other substances also contribute significantly to the burden of harmful use.

Other epidemiological work places substance use disorder (SUD) prevalence among adults at ~22.4% when including tobacco, alcohol, and other drugs.

What Is Drug and Alcohol Addiction?

Addiction is a chronic brain disease characterized by compulsive drug or alcohol use despite harmful consequences. It reflects dysregulation in neural circuits of reward, motivation, stress, and executive control in the brain — particularly within the mesocorticolimbic dopamine system and prefrontal networks responsible for decision-making and self-control.

With repeated use, the brain adapts to the presence of the substance, resulting in:

• Tolerance: needing more of the substance to achieve previous
• Dependence: severe physiological adaptations leading to withdrawal symptoms upon
• Craving: intense urges driven by conditioned cues and altered reward

Neural plasticity changes in glutamate, GABA, and neuromodulator systems reinforce compulsive seeking behavior. These mechanisms make quitting without structured support extremely difficult — even when the person wants to stop.

What Causes Addiction?

No single cause determines addiction risk. Proven contributory factors include:

• Genetics: heritable variation in risk for substance-induced reward sensitivity, impulsivity, and stress responses.
• Environment: exposure to substance-using peers, social stressors, trauma, and socio-economic disadvantage.
• Developmental: brain maturation, particularly in adolescence, confers high vulnerability to early initiation.
• Psychiatric comorbidity: depression, anxiety, PTSD, and other disorders often coexist with addiction.

Initiation typically reflects other factors — curiosity, societal norms, availability, and stress relief — not innate addiction. But repeated use remodels neural circuits, driving compulsivity.

Effects of Addiction

Substances of abuse (including alcohol) hijack the brain’s reward pathways:

• Dopamine surge produces euphoria, reinforcing
• Neuroadaptive changes reduce sensitivity to natural rewards and strengthen salience of substance-related cues.
• Behavioral disinhibition and cognitive impairments may undermine judgment and future planning.

Consequences include: impaired executive control, memory alterations, mood dysregulation, social dysfunction, violence, risk taking, medical complications, and elevated mortality.

Recognizing Addiction: Signs and Symptoms

Presence of one or more of the following may signal addiction — though clinical assessment is required for diagnosis:

• Loss of interest in previously meaningful activities (family, hobbies, work).
• Repeated unsuccessful attempts to cut down or control
• Persistent desire or craving for the
• Continued use despite interpersonal or legal
• Increasing amounts needed for the same effect (tolerance).
• Priority of substance use over responsibilities (education, employment).
• Withdrawal symptoms upon reduction or

Conclusion

Substance use and addiction in India are widespread, heterogeneous, and increasing, affecting tens of millions of individuals across ages and regions. Patterns range from risky use to full-blown dependence. Early recognition and evidence-based interventions (psychosocial therapies, pharmacotherapy where indicated, harm reduction) improve outcomes and reduce long-term neurological and social consequences. Delay in addressing the problem strengthens neurological adaptations that sustain compulsive use.

Need help? Contact Harmony Mind Clinic for assessment and treatment.

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About the Author

Dr. Sagar Bhalke is a consultant psychiatrist and addiction specialist based in Mumbai. He works with individuals and families affected by alcohol and substance use disorders, focusing on neuroscience-driven, evidence-based recovery.