According to the annual health bulletin 2017, incidence of alcohol liver disease is 46 per 10,000 people.

More than 3,508 alcohol liver disease cases were treated and around 1023 alcohol dependence syndrome cases were reported in the hospitals. This is excluding the cases of substance abuse and those who could not seek help from hospitals.

This according to senior Psychiatrist at Jigme Dorji Wangchuk National Referal Hospital, Dr Chencho Dorji, said that such cases could be prevented and reduced with well-developed detox centre, adequate rehabilitation and drop-in centres.

Dr Chencho Dorji said: “If we can detoxify them [patients] early, the risk of liver cirrhosis can be reduced. It is a good prevention programme in terms of reducing both mortality and morbidity rate. The number of incidences is on the rise.”

The psychiatry department of JDWNRH has a 10-bed ward. More than 350 patients were detoxified last year. It takes at least a week to detoxify a patient. Of the total patients who underwent detoxification treatment, only 160 was referred for rehabilitation.

Bhutan Vulnerability Baseline Assessment 2016 identified person using drugs and alcohol as a vulnerable group.

The assessment recommended more rehabilitation centres and to develop short-term activities and skills training that can be used to engage individuals who come for counselling and rehabilitation.

“The quality of rehabilitation and counselling services provided by the hospitals is also a cause of concern,” stated the report.

There are only two rehabilitation centres in the country today. A 60-bedded rehab was established recently in Tshaluna, Thimphu. It takes three months for a patent to complete the whole rehabilitation programme.

Dr Chencho Dorji said that there is a need of more rehabilitation centres in the country. “The rehab centre would be able to provide rehabilitation to 400 patients. A study has found that there are around 2,000 young people who are dependent on substance abuse. With the number of rehabilitation centres we have today, it might at least four years to treat them [patients].”

The psychiatry department has been training medical staff in the area of detoxification since 1999. Detoxification service was made available in the BHUs across the country since 2004.

“However, many do not seem to be aware of the availabil service,” said Dr Chencho Dorji.  He added that facilities and the treatment process should be complete and enough.

There are only six drop in centres in the country.

Peer counsellor Mellisa Milbert said that there is a need to fill service gaps, between rehabilitation and reintegration periods. “The level of the substance abuse and alcohol use situation has reached the alarming stage.”

She added that there is also lack of effort from parents and relatives. “Parents have limited ideas about the issue. The parenting skills are practiced differently here. On an average, seven to eight patents come for counselling service daily.”

Executive director of Chithuen Phendey Association, Tshewang Tenzing, said that ignorance and misconception about addiction is a serious cause of concern.

“We have to understand the issues of substance abuse and alcohol addiction. A traumatized child does not grow up to be addicted, but all addicts were traumatized children. This is where our parenting has gone wrong. The government had to spend millions of ngultrum in treating NCDs and there is not much investment made in the prevention.”

The baseline assessment recommended engaging those seeking counselling and rehabilitation support as peer counsellors or role models who can work in the community and help reduce the incidence of substance use.

It also recommended that Childcare and Protection Act of Bhutan 2011 be reviewed.