Drug Abuse & Dependence: A Cultural Catastrophe



LIFE throws up innumerable situations, which we greet with both negative and positive emotions such as excitement, frustration, fear, happiness, anger, sadness, joy et al. All human beings are not equipped to take on changes or difficult situations in life, naturally. Out of them, many don’t adapt to those situations. The result normally is— those situations and accompanying stress overwhelm people. The mind-boggling changes in every sphere of life—culture, profession, modes of transportation and rapid lifestyle changes put pressure on men to adjust with equal speed. Stress begins to wear them out and there is a loss of resiliency against adverse situations of life. Consequently, they begin to pull away from others and give in to depression.It is said that life acts and you react. Our attitude is our reaction to what life hands out to us. A significant amount of stress symptoms can be avoided or aroused by the way we relate to stressors. Stress is created by what we think rather than by what has actually happened. For instance, handling adopted children, adolescents, academic failures, retirements or sudden loss of money needs a relaxed attitude, focused will and preparedness to face the quirks of life positively. Otherwise one tends to feel stressed and reacts in anger and frustration. Children of stressed out parents are more likely to be ill equipped to handle stressors positively. They may suffer from emotional disturbances, depression, aggressive behaviour or confusion besides chances of weak physical constitutions, which again can be a source of anxiety. With a better control of attention one can feel that the world is a more congenial place to live in. A right attitude can make a resilient person out of us in the face of stressful situations.
Substance abuse: People abuse substances such as drugs, alcohol, and tobacco for varied and complicated reasons, but it is clear that our society pays a significant cost. 
 76.5 million Persons with alcohol use disorders worldwide. At least 15.3 million persons who have drug use disorders. Injecting drug use reported in 136 countries, of which 93 report HIV infection among this population. For every dollar invested in drug treatment, 7 dollars are saved in health and social costs. More than half the economic cost of alcohol and drugs is due to crime. A substance abuser is 18 times more likely to be involved in criminal activity than someone in the general population. Many violent crimes have been linked to the mind-altering effects of drugs. Substance abusers often commit thefts to support their drug habits. Drugs and alcohol have been linked to domestic violence and sexual assault. Most abused substances have harmful health effects. For some substances, such as tobacco, effects are caused by long-term use. For other drugs, a single use can cause significant disease. In addition to their direct effects on health, drugs produce other indirect effects. Many drugs lessen inhibitions and increase the likelihood that a person will participate in risky behavior. Studies show that the use of alcohol and drugs among teenagers increases chances for teen pregnancy and contracting HIV/AIDS or other sexually transmitted diseases. Any injected drug is associated with contracting HIV/AIDS and hepatitis B and C. Up to 75% of injured people treated at emergency departments test positive for illicit or prescription drugs. Alcohol is strongly associated with both intentional and unintentional injury. Drug use also puts people at risk of violence. Nearly half of assault victims are cocaine users.
The global burden: Psychoactive substance use poses a significant threat to the health, social and economic fabric of families, communities and nations. The extent of worldwide psychoactive substance use is estimated at 2 billion alcohol users, 1.3 billion smokers and 185 million drug users. Disability Adjusted Life Years (DALY) are calculated by adding the years of life lost due to premature mortality and the years of life lost due to living with disability. The years of life lost due to disability are determined from morbidity, where each disease has been given a certain disability weight, which is multiplied with the time spent with that disease, to arrive at the years of life lost due to disability. In an initial estimate of factors responsible for the global burden of disease, tobacco, alcohol and illicit drugs contributed together 12.4% of all deaths worldwide in the year 2000. Looking at the percentage of total years of life lost due to these substances, it has been estimated that they account for 8.9%. The level of economic development in countries also plays an important role. The burden from psychoactive substance use is higher in the developed countries than especially in the high mortality developing countries. The sex ratio for the attributable deaths of psychoactive substance use varies from 80% male for tobacco and illicit drug use and 90% for alcohol. With regard to DALYs it is between 77 and 85% for all substances. The largest proportion of DALYs is on males in the developed countries, where psychoactive substance use accounts for 33.4% of all DALYs. Many substances can bring on withdrawal-an effect caused by cessation or reduction in the amount of the substance used. Withdrawal can range from mild anxiety to seizures and hallucinations. Drug overdose may also cause death. Nearly all these drugs also can produce a phenomenon known as tolerance where you must use a larger amount of the drug to produce the same level of intoxication.
Tobacco: Tobacco continues to be the substance causing the maximum health damage globally. According to WHO estimates, there are around 1.1 thousand million smokers in the world, about one-third of the global population aged 15 and over. While consumption is levelling off and even decreasing in some countries, worldwide more people are smoking, and smokers are smoking more cigarettes. Substantially fewer cigarettes are smoked per day per smoker in developing countries than in developed countries. However, this gap is fast narrowing and unless effective tobacco control measures take place, daily cigarette consumption in developing countries is expected to increase as economic development results in increased real disposable income.  People cite many reasons for using tobacco, including pleasure, improved performance and vigilance, relief of depression, curbing hunger, and weight control. The primary addicting substance in cigarettes is nicotine. But cigarette smoke contains thousands of other chemicals that also damage health. Hazards include heart disease, lung cancer and emphysema, peptic ulcer disease, and stroke. Withdrawal symptoms of smoking include anxiety, hunger, sleep disturbances, and depression. Smoking is responsible for nearly a half million deaths each year. 
Alcohol: Although many people have a drink as a “pick me up,” alcohol actually depresses the brain. Alcohol lessens your inhibitions, slurs speech, and decreases muscle control and coordination, and may lead to alcoholism. Withdrawal from alcohol can cause anxiety, irregular heartbeat, tremor, seizures, and hallucinations. In its most severe form, withdrawal combined with malnutrition can lead to a life-threatening condition called delirium tremens. Alcohol is the most common cause of liver failure in the US. The drug can cause heart enlargement and cancer of the oesophagus, pancreas, and stomach. In addition to alcohol and nicotine, there are a number of psychotropic substances that are taken for their effects on mood and other mental functions. Other Drugs (substances) misused include Solvents, Amphetamines and related substances, Ecstasy, Cocaine, Hallucinogenic drugs, Cannabis, Tranquillizers and Opiates.
Substance Abuse Causes: Use and abuse of substances such as cigarettes, alcohol, and illegal drugs may begin in childhood or the teen years. Certain risk factors may increase someone’s likelihood to abuse substances. Factors within a family that influence a child’s early development have been shown to be related to increased risk of drug abuse: Chaotic home environment, Ineffective parenting and Lack of nurturing and parental attachment. Factors related to a child’s socialization outside the family may also increase risk of drug abuse: Inappropriately aggressive or shy behaviour in the classroom, Poor social coping skills, Poor school performance, Association with a deviant peer group, Perception of approval of drug use behaviour.
Substance Abuse Symptoms : Giving up past activities such as sports, homework, or hanging out with new friends, Declining grades, Aggressiveness and irritability, Forgetfulness, Disappearing money or valuables, Feeling rundown, hopeless, depressed, or even suicidal, Sounding selfish and not caring about others, Believing that in order to have fun you need to drink or use other drugs, Frequent hangovers, Taking risks, including sexual risks. Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. Many people do not realize that addiction is a brain disease. While the path to drug addiction begins with the act of taking drugs, over time a person’s ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behaviour results largely from the effects of prolonged drug exposure on brain functioning. Addiction affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behaviour. Some individuals are more vulnerable than others to becoming addicted, depending on genetic makeup, age of exposure to drugs, other environmental influences, and the interplay of all these factors.
Treatment: Long-term drug use alters brain function and strengthens compulsions to use drugs. This craving continues even after your drug use stops. The most important component of treatment is preventing relapse. Treating substance abuse depends on both the person and the substance being used. Behavioural treatment provides you with strategies to cope with your drug cravings and ways to avoid relapse. Often, a drug user has an underlying mental disorder, one that increases risk for substance abuse. Such disorders must be treated medically and through counseling along with the drug abuse. Addiction is a complex but treatable disease that affects brain function and behavior. No single treatment is appropriate for everyone. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. Treatment needs to be readily available.  People take drugs because they want to change something about their lives. They think drugs are a solution. But eventually, the drugs become the problem destroying and ruining millions of lives every year. Treatment varies depending on the type of drug and the characteristics of the patient.  There are a variety of evidence-based approaches to treating addiction. Drug treatment can include behavioural therapy (such as individual or group counseling, cognitive therapy, or contingency management), medications, or their combination. The best programs provide a combination of therapies and other services to meet an individual patient’s needs. Behavioural therapies can help motivate people to participate in drug treatment; offer strategies for coping with drug cravings; teach ways to avoid drugs and prevent relapse; and help individuals deal with relapse if it occurs. Behavioural therapies can also help people improve communication, relationship, and parenting skills, as well as family dynamics.
Prevention :  Prevention science has made great progress in recent years. Many interventions are being tested in “real-world” settings so they can be more easily adapted for community use. Prevention programs should enhance protective factors and reverse or reduce risk factors. Family-based prevention programs should enhance family bonding and relationships and include parenting skills; practice in developing, discussing, and enforcing family policies on substance abuse; and training in drug education and information. Family bonding is the bedrock of the relationship between parents and children. Bonding can be strengthened through skills training on parent supportiveness of children, parent-child communication, and parental involvement.
 Once this is done, we can expect better results. Such an approach can restore life the beauty it has lost to addiction.

 [Dr. Syed Amin Tabish (FRCP, FAMS, FACP, MD (AIIMS) is Medical Superintendent of Sher-i-Kashmir Institute of Medical Sciences, Srinagar]

Lastupdate on : Fri, 25 Jun 2010 21:30:00 Makkah time
Lastupdate on : Fri, 25 Jun 2010 18:30:00 GMT
Lastupdate on : Sat, 26 Jun 2010 00:00:00 IST

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