Recovery from Opioid Dependence with Co-occurring Depression

Palwinder Singh, a 33-year-old male from Samrala, Ludhiana, was admitted to our Akal Drug De-Addiction Centre at Cheema in May 2026 being his first inpatient admission. He completed a 30 day stay and demonstrated significant improvement in his substance use, emotional well-being and overall functioning.

Background and Onset of Substance Use

Palwinder had an approximately 8 year history of opioid dependence (Raw opium for initial years to street heroin dependence since last 2 years), with heroin primarily used through the inhalational route. At the peak of his use, he was spending approximately Rs 2,000 per day on heroin.

Despite making multiple attempts to quit, he was unable to maintain abstinence and experienced repeated relapses. He had previously sought treatment from multiple centres and psychiatrists on an outpatient basis but was unable to achieve sustained recovery.

Psychosocial and Emotional Impact

During individual and group therapy sessions, it became evident that Palwinder had an underlying depressive component that had remained largely unaddressed. His presentation was characterised predominantly by irritability and agitation, along with reduced pleasure in day-to-day activities.

An important component of his treatment involved addressing his underlying depressive symptoms. Based on the clinical assessment and observations during individual and group therapy sessions, a dual diagnosis of opioid dependence and moderate depressive episode was considered and antidepressant treatment was initiated as part of his comprehensive management.

Treatment Course: A Biopsychosocial and Spiritual Approach

Palwinder's treatment was structured around a biopsychosocial model, addressing the biological, psychological, social and spiritual dimensions of recovery rather than focusing solely on abstinence from substances.

Spiritually, he became increasingly engaged with the spiritual environment of the centre. During his stay, he regularly visited Darbar Sahib in the centre three times a day, incorporating this practice into his daily routine. This spiritual engagement provided an additional source of structure, reflection and emotional grounding during his recovery.

Treatment Response and Progress

Over the course of his 30-day inpatient stay, Palwinder demonstrated significant improvement.

His withdrawal symptoms gradually subsided, while his sleep, appetite, mood, irritability and overall daily functioning improved. He became increasingly cooperative and engaged with the treatment process.

There was also a noticeable improvement in his emotional awareness and willingness to discuss his experiences during therapy sessions. Addressing the previously unrecognised depressive component allowed the treatment team to work not only on his substance dependence but also on the psychological vulnerabilities contributing to his relapses.

Conclusion

Palwinder's journey highlights the importance of looking beyond substance use itself and identifying the underlying emotional and psychiatric factors that may contribute to repeated relapse.

His case demonstrates how a biopsychosocial and spiritual approach, combining opioid substitution therapy, management of co-occurring depression, psychotherapy, relapse-prevention work, psychoeducation, social rehabilitation, family involvement and spiritual engagement, can provide a comprehensive framework for recovery.

From repeated unsuccessful attempts at quitting to sustained engagement with treatment and regular follow-up, Palwinder has made significant progress towards recovery.

His story reinforces an important message: recovery is not merely the absence of substance use; it is the gradual restoration of physical health, emotional well-being, relationships, purpose and functioning.