Read this report from Frontline newspaper -

A centre of hope
VINITA VISWANATHAN.
"Trapped in a black hole,
Desperately trying to crush my soul,
My body is weak, my mind weaker,
As the hole encompasses me, I fall deeper
It's not my fault, I am not to blame,
For all this grief, pain and shame."

- Rahul, recovering alcoholic and drug addict in the US.

RAHUL is a friend one almost lost to drugs and alcohol. He was in the United States during the worst of his times. While visiting Rahul at a de-addiction centre in the U.S., one wondered about the kind of facilities available in India to help those in si milar circumstances. The answer came during a visit to Chennai. One realised that people like Shanthi Ranganathan, the Founding Director and Honorary Secretary of the Chennai-based T.T. Ranganathan Clinical Research Foundation (T.T.K. Hospital) were ther e to provide care and hope for the Rahuls in India.

The T.T.K. Hospital, a pioneer in the field of rehabilitation, is one among the over 300 non-governmental organisations (NGOs) in the country working on anti-substance abuse programmes. The T.T.K. Hospital, which was established in 1980, was recently in the limelight: Shanthi Ranganathan received the first United Nations Vienna Civil Society Award for her "outstanding contributions in the fight against drug-abuse and crime" from United Nations Secretary-General Kofi Annan on July 19 (Frontline, A ugust 13).

Shanthi Ranganathan started the specialised institution for rehabilitating alcoholics and drug addicts after she lost her husband to "the disease" (alcoholism) in 1979. "I did not know that alcoholism was a disease until my husband was taken to the U.S. for treatment," she said. After his death, Shanthi Ranganathan, who had a post-graduate degree in social service administration, besides experience in running a blood bank for five years, went to the U.S. and trained at the Hazeldon Institute in Minneapo lis with the aim of setting up a similar de-addiction centre in India. "The common sentiment here (in India) is that alcoholism is one's own doing and is incurable," she said. "But that is not so. It is a dreadful disease that has a cure and requires tim e, patience, understanding and cooperation from close associates of the victim, particularly the family."

The T.T.K. Hospital made a shift from the traditional "isolated psychiatric approach" to a more group-oriented form of treatment, and has, since its inception, treated about 11,000 patients, one-fifth of them free of cost. According to Shanthi Ranganatha n, group activities enable the patients to realise that they are not alone in their battle. B. Mala, a psychologist at the de-addiction centre at the Voluntary Health Services (VHS), Chennai, shares this view. "Group therapy is definitely successful as t he addicts share their experiences and are motivated by each other. Initially they have inhibitions but they gradually get over these," she said.

The T.T.K. Hospital, which started out as a small out-patient centre in Santhome, is now a 65-bed in-patient centre, located in a 41,000-sq ft premises in a calm and serene part of the city at Adyar. Initially the centre dealt with victims of alcoholism and in 1985 extended its services to drug-dependent persons. Patients are required to spend a month at the centre. Chronic addicts have the option of staying for an extended period of three months at the After Care Centre (ACC) that was established in 19 89.

The centre was set up with a donation of Rs.1.1 crores from the T.T.K. group of industries. ACC has got funds also from the European Commission, the TVS group of companies and Birla Charities. The centre has a corpus fund of Rs.50 lakhs created by the T .T.K. group. It keeps increasing, with donations regularly pouring in from industries, individuals and organisations. Every year, the centre incurs an expenditure of Rs.60 lakhs. Treatment, which includes counselling, accommodation at the centre (excludi ng food) and medicines, costs about Rs.5,000 a patient.

The first week of treatment comprises detoxification. Patients experience severe withdrawal symptoms during this period as they are required to abstain from consuming alcohol or drugs. The withdrawal symptoms can range from loss of appetite and insomnia to delirium tremens, a condition in which patients suffer bouts of disorientation, tremors and hallucinations. The patients are treated for these symptoms.

After detoxification, patients undergo a psychological therapy. Trained professionals conduct this programme, with a strong emphasis on improving the quality of life. According to Shanthi Ranganathan, "The basic idea underlying the psychological therapy programme is to allow the patients to return to normalcy and a routine."

On a typical day at the centre, patients wake up at 6-30 a.m., wash themselves, listen to a lecture and reflect on it, take part in group discussions, undergo individual counselling peppered with recreational activities and have meals. The day ends with a meeting of the Alcoholics Anonymous (A.A.) or the Narcotics Anonymous (N.A.).

The A.A. and the N.A., which have chapters all over the world, are based on a non-sectarian spiritual programme; their central idea is that by helping others you help yourself. Past members of the group speak at these meetings and inspire patients to rec over. Shanthi Ranganathan said: "Patients celebrate each year of sobriety as a new year of their life and continue to attend these meetings even after their stay at the centre ends."

Despite the excellent programme and efforts undertaken by the centre approximately 45 per cent of the patients end up in relapse. Dr. Anita Rao, Director of Medical Services at the centre said, "There is no single reason as to why a patient goes into rel apse. A number of factors contribute to this phenomenon."

Raj has been seeking treatment from the centre for the past five years. His attempts at staying sober have been inconsistent. Raj attributed this primarily to "stress and frustrations at not being able to meet goals." Rachel George, a counsellor at the c entre, said that a relapse does not occur overnight. It shows itself at first as craving. If help is sought, it can be prevented. Otherwise, it manifests itself as behavioural change. According to Rachel George, overconfidence, interaction with old drink ing friends, refusal to change, grandiose, impulsive behaviour and workaholism are symptoms that can trigger a relapse.

After patients complete their treatment, they are asked to visit the centre on a regular basis. The number of visits come down as time passes. According to Dr. Anita Rao, "one of the steps taken to combat relapse is to prescribe a dose of disulfiram for recovering alcoholics and naltrexone for recovering drug addicts. These are medications that react violently with alcohol and drugs and cause adverse effects such as seizures and vomiting of blood, and serve as a deterrent to the consumption of alcohol o r drugs."

N. BALAJI
The T.T.K. Hospital, in Chennai has played a pioneering role in anti-substance abuse programmes.

In addition to the medication, the centre has a community support programme that involves a third party (other than the patient's immediate family) which alerts the centre in the event of a patient's relapse.

The centre is also a pioneer in Family Therapy Programme. Shanthi Ranganathan said: "While it appears as though the patient is the only affected person, one must remember that the family undergoes a similar, if not greater, trauma." The centre is strict in its insistence that the family of every patient takes part in the programme.

V. Thirumagal, Director of Quality Control and Patient Care, said: "The main focus of this programme is for family members to realise that their husband/son requires their complete support and understanding to recover, and for the family to maintain a no rmal routine." They are taught how to deal with an alcoholic and what to do when he goes into a relapse. The family members also meet with Al-Anon, a group that functions along similar lines of the A.A., but counsels family members and close associates o f alcoholics.

Patients who approach the centre are first screened by the in-take counsellor. Thirumagal said: "If the patient has a severe medical condition that we are not equipped to handle then we refer him to another hospital. We take him after the condition has b een brought under control." The centre admits about 900 patients a year. The patients are mostly men. The average age of alcoholics is around 35 years and that of drug addicts, between 25 and 35. The centre has also treated the odd female patient.

Shanthi Ranganathan said: "While patients are brought here by their relatives or someone who has their best interests in mind, we don't accept anyone who comes here against his will." As is the case with almost all problems, the stepping stone to recover y is acceptance of the problem, she added.

Anand was a social drinker in college; gradually, his dependence on alcohol grew to unimaginable proportions. "I never thought I had a problem and always blamed external elements for my condition," he said. His job performance was at an ebb and he plung ed into marriage in the hope that it would solve his problems. "After 22 years of addiction and four other centres, I came here in 1990. Today I have a new life and I repent for the pain I have caused to all those around me," he said.

Regret, remorse and a strong desire to make amends prevail among most patients at the centre. However, despite seeing some light at the end of the tunnel, they do not know how to get there. Keeping this in mind, the centre has a number of counsellors wh o provide individual attention to the patients and their families. All the counsellors hold post-graduate degrees in psychology and/or social work and devote themselves to the challenge of restoring stability to the shattered lives of families and patien ts.

The centre has, since 1986, conducted over 250 training programmes, 300 lectures and about 100 exhibitions for industries, medical staff and social workers throughout India. Among the industries and institutions that benefited from the programme are Tata Iron and Steel Company Ltd., Jamshedpur; Wheels India Ltd., Chennai; social workers and medical officers in Mumbai and Chennai; and the staff of the safety department of Southern Railway.

N. BALAJI
A group counselling session for family members of persons undergoing rehabilitation. The centre is keen that family members of every patient take active part in the rehabilitation programme.

The T.T.K. Hospital is now working with two Chennai-based establishments to make them drug- and alcohol-free. It collaborates with the International Labour Organisation (ILO), which, along with the United Nations Drug Control Programme, started the "Deve loping Community Drug Rehabilitation and Work Place Prevention Project" in India in 1995. The programme, which covers nine cities and 12 establishments in India, was formulated in response to the problem of the rising number of drug addicts in the countr y. For this programme, the ILO selected nine host organisations, one in each city. These organisations are trained to work with local establishments. The T.T.K. Hospital has been selected to work with two establishments in Chennai - Kasturi and Sons Ltd. and Hindustan Motors, two organisations that volunteered to be part of the programme.

Kasturi and Sons Ltd and Hindustan Motors had been making efforts to create awareness among their employees about the ill-effects of substance abuse even before the start of this programme. When they got the opportunity to join forces with an internation al agency, the managements extended complete cooperation. According to Mukthiar Singh, the National ILO Project Co-ordinator for India, "it was largely because of the enthusiasm shown by the managements of the two companies that they were selected for th e programme." The ILO's primary role in this programme is to "train the trainers", that is, local host organisations such as the T.T.K. Hospital. Among other things, the programme teaches volunteers to identify addicts, deal with them and to bring down a bsenteeism in the establishments. The T.T.K. Hospital conducts seminars, meetings and awareness programmes for the employees and the employers of the two establishments on a regular basis.

Malini Roberts, Medical Social Worker at The Hindu Employees' Health and Welfare Centre run by Kasturi and Sons Ltd, is satisfied with the programme and says, "the management's role is crucial for the success of the programme." Since 1983, even prior to the ILO programme, Kasturi and Sons Ltd was referring employees with substance abuse problems to the T.T.K. Hospital. The management of Kasturi and Sons Ltd shows its support to the recovering alcoholics by paying for the treatment and granting medical l eave for the period of treatment. Those undergoing rehabilitation are seen as victims, rather than as culprits. As part of the ILO programme Kasturi and Sons Ltd has laid down a policy on substance abuse at the workplace.

About 26 employees of Hindustan Motors underwent rehabilitation and all of them have remained sober since then. P.R. Santhanakrishnan, Divisional Manager, Industrial Relations, Hindustan Motors, says: "The collaboration with the ILO and the T.T.K. Hospit al has proved to be excellent. Instead of just concentrating on alcoholics requiring rehabilitation, we now pay heed to employees who are non-alcoholics, urging them to stay so." The stress is on the maxim 'Prevention is better than cure'. Since the impl ementation of the ILO programme, there have been no new cases of alcoholism in Hindustan Motors.

It is community service projects such as these that place the T.T.K. Hospital in a class of its own. "People need to be made aware that such de-addiction centres exist," said Shanthi Ranganathan, "and that it is possible to cure alcoholism and drug addic tion."

Apart from catering to individuals and industries, the T.T.K. Hospital has an extensive community project that involves conducting camps on alcoholism in villages. Currently, the centre has adopted six areas in Tamil Nadu and conducts camps on a regular basis. To date, about 60 camps have been conducted. The duration of each camp is 15 days, and includes a doctor, a nurse and counsellors.

Assisted by a host organisation (any organisation within the village that has earned the trust of the people, such as a school or a government agency) that acts as a medium, the centre interacts with the villagers.

The T.T.K. Hospital is waging a relentless war against drug and alcohol abuse. It has extended its activities to other States and even other countries. It has conducted over 1,000 training programmes for medical and social workers in India. It has also trained a number of health and social workers from Sweden, Myanmar, Sri Lanka, Bangladesh, Nepal and Mongolia. Shanthi Ranganathan said: "We cannot reach out to everyone who needs our help. This is why we train people from various countries, particularl y from the subcontinent." Shanthi Ranganathan and the T.T.K. Hospital are thus a great source of inspiration to other agencies and individuals all over the world in the battle against substance abuse.

Names of patients have been changed to maintain anonymity.

"A well wisher"