n each of us there is another whom we do not know”

– Carl Jung (Swiss psychologist)

Dr A¹ is a graduate of a prestigious medical university in Pakistan. He was recently married and has a young child. His wife is a physician. Both are living in a Western country, building their medical careers. From afar, their lives are the fantasy that many Pakistanis dream of. But there is a problem: Dr A is addicted to alcohol, ‘hash’ and prescription anxiety medicine and is desperate because of his worsening addiction. If he does not get the help that he needs, his career, his marriage and his life are all at risk of exploding into nothingness.

Stories like this are commonplace in the work that I do. They are both infuriating and heartbreaking. It is infuriating because we seem unable to envision the monster about to swallow large chunks of our youth population whole: the menace of both street and prescription drugs. It is heartbreaking because the monster is eating the segments of our society we can least afford to lose: the young, school and college students, professionals, and able-bodied workers.

But first, some context: According to the United Nations Office on Drugs and Crime, Pakistan has an estimated 6.7 million drug users, a significant proportion being the youth. Approximately 78 per cent of drug users in Pakistan are under the age of 35. Males are more likely to use substances compared to females. However, the number of female users is also rising, often in urban areas and among educated segments of society. Substance abuse is more prevalent in urban areas due to the easier availability of drugs and greater social pressures. However, rural areas are not immune. Cannabis (hash, bhang, hashish, charas) is the most used illicit drug among the Pakistani youth. Around 4 million people use cannabis annually, a significant number are young people.

Pakistan also has one of the highest rates of heroin use in the world, thanks to our proximity to Afghanistan, which produces around 90 per cent of the world’s opium that is then funnelled to rich Western countries, with Pakistan being a significant part of the traffic. The UNODC estimates that there are about 860,000 heroin users in the country, many of them are young adults.

Of particular concern, especially given the increasing participation of women in the workforce, is the rising use of substances among young, educated women.

Ms B reached out to me through a common acquaintance for an appointment. It was immediately evident that her mood and anxiety problems, which were leading to significant social and work issues, were related to her heavy and pervasive alcohol use, a pattern stretching back years. She was highly educated, with an advanced degree from the US, and held a high-powered, well-paid consulting job. Although she had never married, she was coming off yet another toxic relationship that led to more binge drinking.

Even though she was young, in her mid-30s, she had fallen several times under the influence of alcohol, leading to significant injuries. Despite all this, her purported reason for consulting me was to help with her ‘mood and anxiety.’ My insistence that we needed to address her drinking problem went nowhere. She stubbornly maintained that she did not want to stop drinking alcohol ‘socially,’ a classic addict’s defence. This is sometimes phrased as, “XYZ substance is not a problem for me; I can quit whenever I want; you need to help me with... my mood, my anxiety, my sleep, etc.” As they say, “denial is not just a river in Egypt!”

The epidemic of substance use in Pakistan has many contributing factors. For youth, academic pressures and peer pressure are paramount. Lack of awareness about the dangers of even a single ‘hit’ of many drugs exacerbates the problem. Additionally, for youth from poor backgrounds, there is the ever-present spectre of poverty and unemployment. Factories in Pakistan are filled with (mainly) young men who are addicted to various types of drugs, ‘uppers’ and ‘downers,’ often provided by other drug users in the workplace to help them stay awake for long, backbreaking work shifts or to go to sleep afterwards. We treat young people like this all the time in our public hospitals and have nothing to offer them except temporary symptomatic relief.

This brings us to what needs to be done if we are to begin combating this menace. Initial ‘detoxification’ treatment involves getting a person with substance abuse issues off a drug and helping them combat the initial withdrawal symptoms during the first few weeks when the risk of relapse is very high. Once the initial detox period of a few weeks is completed with the help of medicines or perhaps a short stay in the hospital, the real work of recovery begins.

Much is already being done. The Government of Pakistan has launched several initiatives to combat drug abuse, including awareness campaigns, rehabilitation programs, and stricter enforcement of drug laws. Non-governmental organisations also play a crucial role in providing education, counselling, and rehabilitation services to young drug users. Schools and universities are increasingly implementing drug education programs to raise awareness among students, but much more needs to be done on our campuses.

What is still sorely lacking are community-based interventions, including support groups and outreach programs, which are essential in addressing the root causes of substance abuse and providing support to affected individuals. This is a crucial piece that needs attention since it will help former substance users stay sober for the long term.

My own children, now 23, 21, and almost 18, are almost through their fraught teen years, where the combination of hormonal turbulence, peer pressure and risk-taking behaviour peaks, resulting in poor decision-making in many spheres. Thankfully, we have been able to steer them through the storm without any major damage, but we are a family with ample economic and social resources to manage comfortably, even in Pakistan. We also have extended family close by to lend a hand if things get out of control. For millions of families in Pakistan who struggle daily with paying their bills and keeping a roof over their heads, it is a far more uphill struggle, and young people, by the tens of thousands, are falling by the wayside in the meantime. Once addiction takes hold, it can be a lifelong struggle to contain it. We must do more.

June 26 is the United Nations International day against drug abuse and illicit trafficking sometimes also called World Drug Day.

The writer is a psychiatrist and faculty member at King Edward Medical University. He is the author of Faiz Ahmed Faiz: A Biography, Sang-e Meel Publications, 2022. His X handle: @Ali_Madeeh

¹ Details have been changed to protect the privacy of those concerned.