Godmen, Guilt, and Ghar Ki Izzat: A Review of Barriers to Clinical Help-Seeking for Substance Use Disorders in India

Abstract

Substance use disorders represent a growing public health concern in India, complicated by pervasive stigma at the social, internal, and structural levels, that deters treatment engagement. Cultural narratives attributing addiction to moral failings, karma, or supernatural causes often divert individuals toward spiritual or traditional healers, resulting in delayed access to evidence-based care and reinforcing reduced self-efficacy and hopelessness. Systemic challenges, such as inadequate mental health training among primary care providers, fragmented service delivery, and regulatory gaps, further hinder effective intervention. The objective of this paper is to critically examine the multifaceted psychological, cultural, and systemic barriers impeding access to effective clinical treatment for substance use disorders (SUDs) in India, and to explore culturally sensitive, integrative strategies that can enhance help-seeking and recovery outcomes. Emerging models emphasize community-based, culturally aligned approaches, that combine biomedical treatments with spiritual understanding, leveraging psychoeducation, family involvement, and lay health workers to bridge treatment gaps. Addressing these psychological and systemic barriers through culturally attuned, evidence-based strategies is critical for advancing SUD treatment outcomes in the Indian context.