Addiction Psychiatry

Addiction is a medical condition involving changes to the brain's reward system — not a character flaw. Assessment uses validated tools, like AUDIT for alcohol, so treatment is based on an actual severity assessment rather than a moral judgment about how much someone drinks or uses.

Where opioid dependence is involved, Dr. Tiwari's role is assessment and appropriate referral — dispensing of opioid substitution medication legally requires a government-authorised de-addiction centre in India, and referral into that pathway is part of the care provided here.

Alcohol Use Disorder — far more common than the silence suggests

AUD doesn't always look like the extreme version portrayed in popular imagination — many people maintain jobs, families, and social lives while the condition progresses quietly underneath. This is sometimes called high-functioning dependence, and it's precisely why an objective screening tool matters more than a personal impression of "I'm not that bad."

Behavioural Addictions — real, and rarely brought up first

This category also includes pornography addiction, an area that carries particular stigma and is rarely brought up directly in a first conversation, though it's a legitimate and treatable clinical concern — one example of the broader silence around mental health stigma in India that keeps people from seeking help.

Families often develop patterns meant to help that can unintentionally make the problem easier to sustain — covering for missed work, paying off debts quietly, minimising the issue to relatives. This is called enabling, and it comes from love and exhaustion in roughly equal measure. Family sessions, separate from or alongside the patient's own care, are part of what's offered here.

Addiction is generally treated as a chronic, relapsing condition — closer in shape to diabetes or hypertension than to a one-time fix. A relapse is data, not a verdict — it usually points to something specific that needs adjusting, and coming back after one is treated exactly like that: coming back, not confessing.

Assistant Professor, Department of Psychiatry, NIIMS, Greater Noida, and consultant psychiatrist at Sowaka Care. MD Psychiatry, People's University, with residency training at AIIMS Raipur.