Alcohol and Substance Use: When It Becomes a Problem, and What Helps

Alcohol or drug use may be becoming a problem if you need more than before, cannot cut down or use it simply to feel normal. It may also begin affecting your health, work, money or relationships.

These changes can be difficult to notice, especially when the substance first helped with stress, pain or sleep. This guide explains the signs of addiction, how to stop safely and the treatment options available in India.

What Is Addiction?

Addiction, also called a substance use disorder, means finding it difficult to control alcohol or drug use even when it is causing harm [1].

These patterns exist on a spectrum. The important question is not which label fits, but whether substance use is affecting your health, work, finances or relationships.

What Are the Signs of Addiction?

Possible signs include:

• Needing more to get the same effect
• Using more or for longer than you planned
• Trying to cut down but being unable to
• Spending a lot of time using, finding or recovering from the substance
• Continuing despite problems with health, money, work or relationships
• Feeling shaky, anxious or unwell when you stop
• Using it to sleep, cope or feel normal
• Losing interest in other activities

You do not need to experience every sign before speaking to a professional.

Which Substances Can Cause Addiction?

Different substances have different risks and treatments.

• Alcohol: India’s national survey found that about 14.6% of people aged 10–75 used alcohol. Around 5.7 crore people were affected by harmful or dependent alcohol use [2]. Read more about alcohol use disorder.
• Tobacco and nicotine: This includes cigarettes, bidis, gutka and chewing tobacco. Read about quitting smoking and nicotine.
• Cannabis: This includes bhang and other cannabis products. Around 2.8% of people surveyed in India had used cannabis during the previous year [2]. Read about cannabis dependence.
• Opioids: Around 2.1% of people surveyed used opioids, including opium, heroin and pharmaceutical opioids [2]. These substances can cause dependence and overdose.
• Prescription medicines: Some sleeping pills, pain medicines and anti-anxiety medicines can cause dependence when used without proper medical supervision. Learn more about how psychiatric medicines work.

Is It Safe to Stop Drinking Suddenly?

Do not suddenly stop drinking without medical advice if you drink heavily every day.

Alcohol withdrawal can be dangerous. Symptoms may begin within hours and include:

• Shaking and sweating
• Anxiety or agitation
• Confusion
• Hallucinations
• Seizures

A severe form of withdrawal called delirium tremens may develop several days after the last drink [3].

Some families try to manage alcohol withdrawal at home because they fear hospital admission or a “de-addiction centre.” However, severe withdrawal needs medical care. A doctor can decide whether you require hospital treatment or can stop safely through outpatient care.

Nicotine and cannabis withdrawal may be uncomfortable, but they are not usually dangerous in the same way as severe alcohol withdrawal.

I understand why families try to handle withdrawal at home, the fear of a hospital or a de-addiction centre is real in our society. But severe withdrawal is a medical situation, not something willpower or home care can safely manage. Please don't take that risk alone.

Why Does Addiction Happen?

Addiction usually develops because of several factors:

• Family history and genetics
• Stress or trauma
• Family or social environment
• Easy access to alcohol, tobacco or drugs
• Physical pain
• Sleep problems
• Anxiety, depression or other mental health concerns
• Using a substance to cope with difficult feelings

In India, work pressure, financial stress, family difficulties and easy access to alcohol, tobacco, gutka or some medicines may also affect substance use.

Some people use alcohol or drugs to manage another problem. For example, they may drink to sleep or use a substance to avoid painful memories. Treatment works better when these underlying concerns are also addressed.

Read more about generalised anxiety disorder, depression, PTSD and trauma, and insomnia and sleep disorders.

How Is Addiction Diagnosed?

There is no single blood test for addiction. A doctor or mental health professional may ask:

• What substances you use
• How much and how often you use them
• Whether your use has increased
• What happens when you stop
• How it affects your health and daily life
• Whether you have other physical or mental health concerns

Tell the professional about everything you use, including alcohol, tobacco, cannabis, prescription medicines and locally available substances. This information helps them plan safe treatment.

The conversation is meant to understand your situation, not judge you. Speaking to a professional does not mean you must agree to stop that day.

How Is Addiction Treated?

Treatment depends on the substance, your health and the support you need. It does not always mean staying in a rehabilitation centre.

Medical Support

A doctor may help you manage withdrawal safely. For some substances, medicines may reduce cravings or lower the chance of returning to use.

Depending on your needs, treatment may happen through clinic visits, online consultations, a short hospital stay or residential rehabilitation.

Learn more about medicines used to treat addiction.

Therapy

Therapy can help you:

• Understand what triggers your substance use
• Manage stress and difficult emotions
• Find healthier ways to cope
• Plan for situations where you may feel tempted to use
• Treat related anxiety, depression or trauma

Read about what to expect in psychotherapy.

Support Groups and Relationships

Support may come from family, trusted friends, healthcare professionals or peer groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Meetings may be available in person or online.

Family support can help, but relatives may also need guidance. Repeatedly hiding, managing or solving the consequences of someone’s substance use can affect the whole family.

If substance use is affecting your family, read our guide to supporting a loved one.

Help After a Relapse

Using alcohol or drugs again does not mean that recovery has failed. It may show that your treatment plan, support or coping strategies need to change.

Tell your doctor or therapist what happened so you can decide the next step together.

When Should You Get Help?

Consider speaking to a professional if:

• You have tried to reduce or stop but could not
• You need more of the substance than before
• You use it to sleep, cope or feel normal
• It is affecting your health, work, money or relationships
• People close to you have repeatedly expressed concern
• You feel unwell when you stop

Only around 1 in 38 people with alcohol dependence in India receives treatment [2]. Shame, fear of judgement and concerns about family reputation can delay care.

You can speak to a professional even if you are not ready to stop completely.

When Is Emergency Help Needed?

Get urgent help if someone:

• Becomes confused, severely shaky or has a seizure after stopping alcohol
• Cannot be woken after drinking or using drugs
• Is breathing very slowly, irregularly or not at all
• Has thoughts of suicide or cannot stay safe

Call 112 or go to the nearest hospital emergency department. Do not leave the person alone.

Visit our crisis support and helplines page for more immediate support options.

Can Addiction Be Treated?

Yes. Recovery is possible, although it may take time and more than one attempt. Treatment can help you stop safely, reduce substance use and manage the reasons behind it.

If you are concerned about yourself or someone close to you, consider speaking confidentially with a qualified professional. You do not need to wait for a crisis before asking for help.