In Nepal, addiction is still spoken about in hushed tones. A man who drinks too much is said to lack self-control. A teenager glued to a phone is blamed for poor discipline. Someone who uses drugs is often seen as irresponsible, immoral, or beyond help. These explanations feel familiar because they are deeply cultural. But neuroscience tells us they are wrong. Addiction is not a failure of character. It is a disorder of the brain.
This is not a matter of opinion. Over the past several decades, research in neuroscience and public health has shown that addiction changes how the brain functions. It alters neural circuits responsible for reward, motivation, stress, learning, and self-control. When this science is ignored, society responds with shame instead of treatment. People suffer longer. They relapse more often. Many die quietly, without support or care. Nepal is now facing a growing addiction crisis that demands a science-based response.
The scale of addiction in Nepal
Government data show that substance use is not a marginal issue. The Nepal Drug Users Survey conducted by the Ministry of Home Affairs estimated more than 130,000 current drug users nationwide, with the number increasing each year. Most users are young, and the vast majority are men. This is not a hidden subculture. It is a public health challenge affecting families, workplaces, and entire communities.
Alcohol use is even more widespread. According to Nepal’s STEP wise Survey on Non-Communicable Disease Risk Factors, conducted with support from the World Health Organization (WHO), nearly one in four adults reported consuming alcohol in the past year. Rates were far higher among men. Tobacco use remains similarly common across the population.
Since alcohol and tobacco are legal and socially accepted, their harm is often underestimated. Yet research conducted within Nepal tells a more troubling story. A large study from central Nepal, published in an international mental health journal, found that nearly one in four male drinkers screened positive for alcohol use disorder. Harmful drinking was closely associated with depression, suicidal thoughts, reduced ability to function at work and home, and intense feelings of shame. The researchers did not describe alcohol misuse as a lifestyle choice. They described it as a condition deeply intertwined with mental health and stigma.
Drug use injections add another layer of risk. Studies published in journals such as PLOS ONE have documented high vulnerability to HIV and hepatitis C among people who inject drugs in Nepal. These studies also highlight how fear, discrimination, and criminalization discourage people from seeking healthcare until serious illness develops. When addiction goes untreated, it becomes a driver of infectious disease, disability, and premature death.
A new and growing addiction among Nepal’s youth
While Nepal continues to debate drugs and alcohol, another form of addiction is growing rapidly, especially among adolescents. Problematic internet and smartphone use is now widely reported among Nepali school and college students. A 2024 study of urban school adolescents found that excessive internet use was strongly associated with poor sleep, depression, and emotional distress. Another study published in PLOS ONE the same year reported that a substantial proportion of adolescents met criteria for internet addiction, and that physical inactivity and disrupted sleep patterns were common.
These findings matter because behavioral addictions are not less real than substance addictions. The brain does not distinguish between dopamine released by alcohol, gambling, or endless social media scrolling. What matters is repetition, intensity, and how powerfully a behavior trains the brain’s reward system.
Nepal’s youth are growing up in a digital environment that rewards constant engagement and rapid stimulation. Their brains are still developing, particularly the regions responsible for impulse control and decision-making. Neuroscience shows that early and excessive exposure to addictive patterns, whether chemical or digital, can shape brain development in ways that persist in adulthood.
What neuroscience tells us about addiction
Modern neuroscience has transformed how addiction is understood. Addictive substances and behaviors repeatedly overstimulate the brain’s reward system. Over time, the brain adapts. Everyday pleasures feel less satisfying. Stress and irritability increase. Cravings become automatic. The systems responsible for self-control struggle to regulate behavior. This is how addiction shifts from choice to compulsion.
WHO has consistently emphasized that addiction is a chronic brain disorder, not a moral failing. This is also why relapses are common. When someone returns to substance use, it does not mean treatment failed or that the person lacked willpower. It means the brain remains vulnerable and requires continued support. WHO’s recognition of gaming disorder in its international disease classification further reinforces this understanding. Compulsive behaviors that disrupt daily functioning are legitimate health conditions, not personal flaws.
A response shaped by stigma
Despite this growing body of evidence, Nepal’s response to addiction remains limited and fragmented. Addiction is often treated as a social nuisance rather than a health condition. Families hide the problem until it becomes severe. Individuals delay seeking help because they fear judgment. When treatment is accessed, it often relies heavily on institutional rehabilitation, with limited long-term follow-up or integration with mental health care.
Research conducted in Nepal shows that stigma itself worsens outcomes. People with alcohol use disorders frequently internalize shame, which is associated with poorer mental health and a lower likelihood of seeking help. Shame does not cure addiction. It fuels it. At the same time, Nepal’s mental health system is overstretched. The country has a limited number of trained addiction specialists, most of them concentrated in urban areas. Community level prevention and early intervention remain rare.
A global warning Nepal should not ignore
Globally, addiction is rising. The United Nations Office on Drugs and Crime reports that more than 300 million people worldwide used drugs in the past year, the highest number ever recorded. WHO estimates that alcohol alone contributes to more than two million deaths each year.
These are not failures of morality. They are failures of health systems that do not act early or compassionately enough. Countries that have adopted neuroscience informed approaches, including early screening, integrated mental health care, harm reduction, medication assisted treatment, and long-term support, have seen better outcomes. Those that rely on punishment and stigma do not.
What Nepal must do now
Nepal must recognize addiction as a health condition rooted in brain biology. This shift would change how families respond, how clinicians treat patients, and how policymakers allocate resources. Care for people with addiction must be integrated into primary healthcare. Screening for alcohol, tobacco, drugs, and problematic internet use should become routine. Training in addiction medicine and mental health must be expanded. Treatment should address depression, trauma, and anxiety alongside substance use, not as separate problems.
Harm reduction services for people who inject drugs must be strengthened, not stigmatized. Evidence from Nepal itself shows that community-based outreach saves lives and reduces disease transmission. Prevention must begin early. Schools should teach how the brain forms habits and how sleep, stress, substances, and screens affect mental health. Parents cannot fight addictive digital platforms alone.
A choice Nepal can no longer avoid
If addiction could be solved through shame, Nepal would have solved it generations ago. Addiction persists because it is not a moral problem. It is a brain problem shaped by biology, stress, trauma, and the environment. Neuroscience also shows that the brain can recover, but only when treatment replaces judgment, and understanding replaces silence. Nepal has begun to speak more openly about mental health. Addiction must be part of that conversation. Treating addiction as a brain disorder is not an excuse. It is the first step toward effective, compassionate, and evidence-based care. Silence has failed. Stigma has failed. Science has not.
The author is a PhD candidate in the Department of Neurosciences and Neurological Disorders at the University of Toledo College of Medicine and Life Sciences
