By the time Sandra Mutoni was in Senior Four, she was drinking heavily, barely eating and struggling with severe insomnia.

Behind the changes was emotional distress she had kept to herself, including an attempted sexual assault by her father when she was younger. Around the same period, a friend introduced her to cannabis, telling her it would help her sleep.

"I started smoking marijuana and drinking alcohol a lot. I wasn’t eating and I lost a massive amount of weight,” Mutoni recalls.

By late 2015, when she was 17 and in Senior Five at a private school in Kigali, her substance use had become a serious problem.

What began with alcohol and cannabis would later progress to heroin, repeated rehabilitation and relapse before she eventually began rebuilding her life.

Her experience reflects a wider concern among mental health professionals: people who begin using alcohol and drugs at a young age may face a greater risk of developing dependence later in life.

As Rwanda steps up efforts to curb alcohol and drug abuse, experts say prevention and early intervention among young people remain particularly important.

Dr Dynamo Ndacyayisenga, Director General of Kigali Mental Health Referral Centre, says substance abuse can begin as early as 11, although people commonly affected are between 16 and 35 years old.

Starting young, he says, can reinforce the use of alcohol or drugs as a way of coping with stress, difficult experiences or the pressure to fit in with peers.

"Starting to abuse alcohol or drugs at a young age is associated with a greater risk of developing dependence later in life,” Ndacyayisenga says.

"Early exposure to alcohol and other substances can become a repeated way of coping with stress or fitting in with peers.”

Mutoni’s journey through addiction

Mutoni traces some of her struggles to what was happening in her family.

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Her father, a retired soldier, had been affected by trauma related to the 1994 Genocide against the Tutsi, she says. He became heavily dependent on alcohol, later smoked cigarettes heavily and eventually lost his job.

Mutoni, the only girl among boys in the family, had been particularly close to him. Watching him change was devastating.

Her mother, a nurse, became the family’s breadwinner and often spent much of the week away from home because of work.

It was during this period, Mutoni says, that her father entered her bedroom while she was sleeping and attempted to rape her. She was in Senior Two.

He did not proceed, but she says the experience left her deeply affected. She never told anyone, including her mother.

"I used to confide in him about everything,” Mutoni says. "It destroyed me to learn that my own father had attempted to sexually abuse me.”

She kept the experience to herself for years.

By Senior Four, her emotional distress had become overwhelming. She was drinking heavily, barely eating, struggling to sleep and had attempted suicide.

Around the same time, a friend introduced her to cannabis.

When her mother noticed the dramatic changes in her daughter, she sought professional help. Mutoni was admitted to Icyizere Psychotherapeutic Center in 2015.

There, she met other young people struggling with substance use, including some who were using heroin and other drugs.

After leaving the centre, she became friends with people addicted to harder drugs. One later encouraged her to try heroin, telling her it would improve her appetite and make her feel good.

Despite her difficulties, Mutoni returned to school, completed secondary education with good grades and obtained a government scholarship.

But after finishing school, she tried heroin.

She says she did not understand how powerful the drug was. Her appetite disappeared, she became extremely thin, withdrew from those around her and stopped taking proper care of herself.

"I literally forgot all about myself and my sanity,” she says.

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Why early intervention matters

Elvis Benimana, Community Health Advisor and Programme Manager for Community Health and Harm Reduction at Health Development Initiative, says young people may start using substances because of peer pressure, curiosity, experimentation and their surrounding environment.

"Young people are usually influenced by peer pressure and the environment around them. Curiosity and the desire to experiment can also lead some young people to start using substances,” he says.

"If they receive professional intervention and treatment early, they are more likely to quit and become sober.”

Ndacyayisenga says young people may also have protective factors that can support recovery, including family support, access to education, fewer responsibilities and legal protections.

These factors can make it easier for families and professionals to intervene before substance use becomes deeply established.

However, he cautions against treating the age at which someone first uses alcohol or drugs as a definitive predictor of whether they will recover.

"An early start does not mean that a person is unable to quit, and starting later does not guarantee an easy recovery,” he says.

The difficulty of stopping depends on several factors, including the substance involved, how frequently and for how long it has been used, a person’s mental health and the support available.

Mutoni’s own recovery involved several attempts at rehabilitation.

Her mother later took her to Huye Isange Rehabilitation Center, where she met a therapist and began another attempt at recovery.

During treatment, Mutoni says she received medication to manage severe withdrawal symptoms. She credits medication, counselling, therapy and other rehabilitation support with helping her through the process.

"I was really tired of the relapses. I hated myself, but going to the rehabilitation centres really helped me,” she says.

Substance abuse later in life

People who begin abusing alcohol or drugs later in life can also face significant barriers to recovery.

Benimana says substance use among adults may be linked to trauma, family and workplace pressure, stress and difficulties coping with painful experiences.

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Someone who develops a substance use problem at 35, 40 or 45, for example, may already have accumulated years of difficult experiences before beginning to rely on alcohol or drugs.

For some people affected by the 1994 Genocide against the Tutsi, he says, post-traumatic stress disorder and other trauma-related challenges may contribute to substance use as a coping mechanism.

Older adults may also have greater family and work responsibilities that make it difficult to seek treatment.

"What usually hinders older people are responsibilities at home and at work,” Benimana says. "Sometimes they live in denial because they do not think that what they are experiencing is a problem that requires treatment.”

Financial pressures can create another barrier, particularly for people who are the main providers for their families.

"If this person is the breadwinner of the family, it becomes difficult to seek treatment because the money is supposed to take care of the family’s needs,” he says.

Rwanda’s trauma context

Ndacyayisenga says Rwanda’s history also has to be considered when examining the relationship between trauma and substance abuse.

Some people struggling with alcohol or drugs may still be affected by trauma linked to the 1994 Genocide against the Tutsi, including psychological consequences, family dislocation and secondary trauma among children of survivors.

He also refers to what he describes as an "unprotected umbrella”, where survivors and their children can continue to experience the effects of trauma within families, particularly where relatives are still living with long-term psychological consequences.

Without timely treatment and appropriate support, he says, such circumstances can complicate efforts to stop substance use.

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Mutoni believes trauma within her family formed part of the environment in which her own substance use developed.

But her attempts at recovery were further complicated by stigma.

She says relatives and other people who knew about her addiction often judged her harshly. Even small mistakes were interpreted as proof that she had not recovered.

"They would say that I had never healed, that I was still on drugs or alcohol,” she recalls.

The stigma became another burden. She relapsed and returned to drug use, while suicidal thoughts resurfaced.

Her mother remained concerned and eventually helped her return to rehabilitation.

A turning point

In 2020, Mutoni became pregnant, a period she describes as one of the darkest of her life.

The father of her child was also struggling with drug addiction and was unable to support her. She felt increasingly isolated from her family, while some relatives viewed the pregnancy as another source of shame. Some advised her to terminate it.

"I almost did, but my mother was always by my side and really supported me through thick and thin,” she says.

Mutoni says she continued using heroin secretly during pregnancy, while suicidal thoughts persisted.

After giving birth, her family became deeply concerned. She continued experiencing severe withdrawal symptoms and using heroin, including while breastfeeding.

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Her drug use also left her struggling to care for her newborn.

When the baby was three months old, she returned to rehabilitation.

Leaving her child behind was painful, but Mutoni says she had come to understand that she needed treatment if she was going to become the mother her child needed.

"It was such a horrible situation for me, leaving my baby, but I knew I would not be able to love and take care of him if I wasn’t okay. I had to accept treatment.”

After she returned home, something her son later told her became a source of strength whenever she experienced cravings.

"Mum, I love you and you’re my best friend. You can always tell me anything. I’ll always hear you. I’ll always be your best friend and I love you so much,” she remembers him telling her.

The words stayed with her.

"They always rang in my head whenever I craved heroin. They gave me the courage to fight the urge,” she says.

Mutoni says she eventually made a conscious decision to fight for her life.

"I was extremely tired, but I chose not to die. I chose to do whatever it takes to fight for my life and become a good mother to my child.”

She committed to following her doctors’ instructions, continuing therapy and putting into practice what she had learned during rehabilitation.

She also changed her social environment.

She cut ties with friends associated with drug use, stopped going to places she previously frequented, deleted drug dealers’ contacts and distanced herself from people and environments connected to her past.

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For Mutoni, recovery became more than simply stopping drug use. It required building a different life.

"I promised myself that time I wasn’t going to go back to rehab, and that meant that I had to create a new identity for myself.”

Families urged to replace stigma with support

Mental health nurse and therapist Olive Mukase of Nyamata Hospital advises families dealing with substance use to avoid judgment and instead listen to their children.

She encourages parents to seek professional help when they notice major changes in a child’s behaviour, mood or school performance, saying early intervention can prevent problems from becoming more difficult to manage.

For people recovering from addiction, Mukase recommends continued counselling and support from family and peer networks.

She also cautions families against viewing relapse as proof that recovery has failed.

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Benimana similarly urges families to replace stigma with empathy and recognise addiction as a health condition requiring professional care.

"Families should be empathetic and treat addiction just like any other disease,” he says.

He encourages families to seek help promptly through rehabilitation centres, counselling and other professional services while remaining involved in the recovery process.

"It is important to seek professional help as soon as you identify that your family member is struggling with addiction,” Benimana says.

The experiences of people who begin using substances early, as well as those who develop problems later in life, underline why recovery cannot be reduced to age alone.

Early exposure may increase the risk of dependence, but recovery is also shaped by the substance involved, patterns and duration of use, mental health, traumatic experiences and the support available.

For Rwanda’s efforts to tackle alcohol and drug abuse, experts say preventing early substance use remains important. But for those already affected, access to professional treatment, counselling and supportive families and communities can be equally critical to recovery.