Kamal Sonavane knew she’d pass out if she chewed smokeless tobacco one more time. It was a scorching April afternoon in the middle of another of India’s brutal heat waves, and with no job to go to, the farmworker had already chewed tobacco five times that day. “Even an addicted person avoids doing this in extreme heat because there’s a risk of fainting,” she says.
Yet Sonavane repeated the familiar ritual: adding the slaked lime to the tobacco leaves, then putting the mixture in her mouth. “I would have anyway collapsed, either because of the heat waves or the mounting stress,” she says, sitting in her two-room brick house in Bhadole in the Indian state of Maharashtra. Anxious about money, her lack of work, and the extreme heat, she turned to the tobacco once again.
Climate change is making farming in Maharashtra harder. This in turn impacts day laborers, who are hired when agricultural help is needed. “Every few months, farmers report losses caused by heat waves or floods,” says community health worker Shubhangi Patil, who serves the Kolhapur district where Sonavane lives. When crops fail, earnings become more precarious, and farm laborers “resort to substance use to forget their problems,” says Patil. It’s a prevailing issue across the region, Patil says.
It’s also a phenomenon that isn’t limited to India—or to countries with predominantly low- and middle-income wages. Research from other regions has found groups responding to the pressures of climate change by increasing their consumption of alcohol and other substances, with potentially deleterious effects on their health.
A landless farmworker in her mid-60s, Sonavane has been toiling in the fields of Kolhapur for over 25 years. A decade earlier, she says, she didn’t chew smokeless tobacco. “I despised it,” she says. “Today I can’t stay even a few hours without it.”
The weather, she says, started to get bad in western Maharashtra in 2019. “This region has seen two floods, unbearable heat, incessant rainfall, hail storms, and a drought,” all in the past three years, Sonavane says. Farmers have faced tremendous losses: 36 million hectares of sugarcane, onions, rice, and other crops lost over the past five years, according to Maharashtra’s department of agriculture. Farm workers are currently finding it difficult to get even eight days of work a month because crop damage is so common, Sonavane says.
With no resources for dealing with the stress of being out of work, Sonavane stumbled across the solution of soothing her anxiety with smokeless tobacco, which costs just 10 rupees ($0.12) a packet. Like cigarettes and vapes, chewing tobacco contains nicotine, a central nervous system stimulant. Users say it elevates their mood; improves concentration; and relieves anger, tension, and stress. “They desensitize grief, sadness, and negativity for a while,” says Kolhapur-based clinical psychologist Shalmali Ranmale Kakade, referring to tobacco and other commonly abused substances, such as alcohol.
But nicotine is also highly addictive, and in heavy tobacco users, those positive effects may simply be the consequences of staving off withdrawal. Repeatedly chewing tobacco also causes many types of cancer—including those of the mouth, oesophagus, stomach, and bladder.
Sonavane has become so accustomed to using tobacco that she now has fixed times in the day for taking it. But if she’s particularly stressed, she’ll chew it more frequently. “After trying it out a few times, people start associating liquor, tobacco, or any form of abuse as relief, which eventually becomes a loop,” says Ranmale Kakade. Health worker Patil says she’s witnessed people using substances to manage climate stress in at least 200 villages across her district.
The climate crisis has multiple ways of pushing people toward using mood-altering substances. Research published in the journal Perspectives on Psychological Science notes that people may worry about climate change itself, or feel anxious about the destabilizing effect it can have economically and socially. Changes to the weather—in particular, more days of extreme heat—can also impact people’s physical and mental health, driving them to self-medicate with substances that they can access. A shifting climate also has the power to alter people’s established behavior patterns, which might allow the formation of new, unhealthy habits.
And India is not the only country where this is taking place. In 2019 and 2020, Australia experienced severe bushfires that burned 19 million hectares of land and over 3,000 homes, killing more than 56,000 livestock animals. A paper published earlier this year, which assessed the mental health of 746 Australians aged 16-25, found “greater presentations of depression, anxiety, stress, adjustment disorder symptoms, substance abuse, and climate change distress and concern,” even among participants who weren’t directly exposed to the fires.
Another paper published this April in the Journal of Environment Management found a relationship between heat waves, declining mental health, and alcohol consumption in Chinese people aged 50 and above. Looking at a sample of China’s population, it concluded that extreme heat led to more frequent drinking, with people reducing positive behaviors, such as exercising. But the total extent of climate-related substance abuse worldwide is currently unknown, limited by the relatively small amount of research that’s been done on the topic.
Once a bad climate event has passed, people’s behaviors don’t necessarily revert to how they were before. “Exposure to climate-related stressors—such as storms, floods, wildfires, and droughts—can lead to physical and psychological distress that often persists for months after the event,” says Francis Vergunst, an associate professor of psychosocial difficulties at the University of Oslo and a coauthor of the Perspectives paper.
Vergunst notes that in most cases, people’s new habits won’t tend to meet the diagnostic criteria for a substance-use disorder. However, the substance-use behaviors will still be harmful to the individual, their family, or the community.
Balaso Thorwat, who is in his mid-70s, lives in Khochi, a village in Kolhapur. It has flooded frequently in recent years. After losing vegetables worth $350 to flooding in 2019 and 40,000 kilograms of sugarcane worth over $1,400 in 2021, Thorwat was extremely stressed. “I was unable to sleep because of the mounting losses,” he says.
Thorwat went to the nearby public doctor, who offered him only the most basic advice: “Don’t stress.” With no one to talk to about his problems, it was easier for him to turn to country liquor—a type of locally made alcohol sold informally, often made from fermented sugarcane molasses, which is then distilled. “Whenever I feel stressed, I drink liquor. At least I can sleep peacefully after that,” he says. When I asked him how often he gets stressed, he replied: “Daily.” When alcohol didn’t help, he started chewing smokeless tobacco as well.
“Even teenagers are now seen resorting to substance abuse,” says Shubhangi Kamble, a health care worker from Arjunwad, another flood-affected village in Kolhapur, noting that in her observations, the issue has become much more prominent in the past three years. After speaking to over a hundred people from drought- and flood-affected villages, Kamble found a pattern: “There’s a lot of stress because people aren’t able to understand how the climate will keep changing.”
During the first nine months of 2022, India faced climate disasters on nine out of 10 days. And research released in April this year found that more than 90 percent of India’s population—over 1 billion people—are now vulnerable to the adverse effects of heat waves. But while the impact of climate disasters is large and growing, the country’s capacity to help those driven toward addiction is insufficient. A 2019 government report acknowledged that the “reach of the national programs for the treatment of substance-use disorders is grossly inadequate.”
India also doesn’t have enough mental health professionals. For the 833 million people who live in rural areas, the country has just 1,224 subdistrict hospitals and 764 district hospitals. The latest World Health Organization statistics show that per million people, India has only three psychiatrists working in the mental health sector, and fewer than one psychologist. When Sonavane was feeling the acute stress of the heat wave back in April, she says she wasn’t able to get any help or counseling. This was the same for many other farmworkers affected by the heat wave, say the health workers WIRED spoke to.
To be treated and prevented, climate-related substance abuse needs to be better recognized, and for that, clear evidence of the existence and size of the problem is required. In India and elsewhere, there’s a lack of data to establish a direct link between climate change and substance abuse—but this could be fixed. “Examine hospital admissions data for substance use-related problems before, during, and after a severe weather event,” suggests Vergunst. “Another option is to use survey data to track substance-use patterns alongside climate-related stressors such as heat waves or floods.”
Until these efforts are made, climate-related substance abuse will continue as an underreported and undertreated health problem. Sonavane and Thorwat know the health risks of heavy use of substances like alcohol and tobacco. But the stress they are dealing with outweighs these concerns. “I’ve spent my entire life working in the soil,” says Sonavane. “The stress will only go away after I die finding work in this soil.”
