Man has long used psychoactive drugs not only to enhance pleasure and relieve discomfort but also facilitate the achievement of social and religious aims. Accounts of use of psychoactive substances including alcohol, cocoa leaves, opium and cannabis are as old as civilization and dependence on drugs where described by Greek, Roman and Biblical authors.
In our society use of certain substances to modify mood or behavior under certain circumstances is generally regarded as normal and appropriate. Such use includes the use of caffeine as a stimulant in the form of coffee. There are also sub cultural variations. In some groups even the recreational use of alcohol is allowed while in other groups the use of various illegal substances for recreational use is well accepted.
A psychoactive drug is one that is capable of altering the mental functioning. There are four important patterns of substance use disorders which overlap with each other.
According to ICD-10 acute intoxication is transient condition following the administration of a psychoactive substance resulting in disturbances in level of consciousness, cognition, perception, affect or behavior.
It is characterized by a cluster of symptoms often specific to the drug used which develop on total or partial withdrawal of a drug usually after repeated use.
is characterized by:
A strong desire to take the substance
Difficulty in controlling the substance taking behavior
Evidence of tolerance where increased doses of the substance are required to achieve effects originally produced by lower doses
Progressive neglect of alternative pleasures or interests
Harmful use is continued use despite awareness of medical or social effect of the drug.
The major dependence producing drugs are
Whether or not a given person will develop dependence on a particular drug will depend on the interaction of three factors:
Personal characteristics and experiences of the individual:
The personality factors which correlate with drug abuse are low self esteem, depressive feelings, sensational seeking curiosity, low frustration tolerance, need for immediate gratification, low religiosity, presence of various psychiatric disorders like depression, mania, anxiety, phobia, schizophrenia, etc.
Immediate socio-cultural milieu:
The socio-cultural precursors which facilitate the initiation or perpetuation of drug abuse are problems within the family (like break up, divorce, violence, lack of communication, drug abuse in parents), peer pressure, unemployment, low income, poor social support, rapid urbanization.
The characteristics of the drug used:
The pharmaco-dynamic characteristics (mood elevators are preferred to depressants), amount and frequency (the drugs which are to be taken less frequency and lesser doses are abused more), roots of administration (drugs which can be smoked or inhaled preferred to inject able drugs), easy availability and cost (easily available and cheaper drugs are misused maximally), the public acceptance of the drug (socially acceptable drug in take like tobacco, alcohol in some groups, etc.).
Long absence from home
Quarrels and violence
Neglect of family
Marital discord and divorce
Misbehavior with others
Loss of position
Selling personal articles
Selling household articles
Selling immovable property
Spending money over drug instead of family
Suspension from job
Loss of job
Frequent changes in job
Loss of skills
Loss of work habit
Thefts and crimes
Driving under influence
Violation of rules
Arrests and court cases
GIT problems like fatty liver
CNS problems like delirium, hallucinations, head injury and fracture
Respiratory like bronchitis, lung cancer
Infections like HIV, septicemia
Treating the drug addict:
It includes hospitalization, withdrawal of drug, detoxification with various agents depending on drug of abuse, administration of vitamins, pain killer, supportive psychotherapy, counseling and psycho education of the person and family
After discharge factors like craving, peer pressure, maintenance treatment, treatment of co morbid disorder, regular follow up and rehabilitation in family, society are important.
Role of parent:
If the parents find that their child is on the drug then accept the truth take immediate remedial steps
Do not thrash or ill treat the child
Treat the child with love and understanding
Do not stop his pocket money in the hope that this may curtail his resources to buy the next dose. It will lead to theft and crime
Do consult your doctor
About 80% of addicts resume their habit within 6 months. The main causes of relapse are present of co morbid illness, poor rehabilitation services, easy availability of the drug, continuous peer pressure, and OPD method of treatment except opoid substitution therapy where relapse rate is very low.
It can be done at different levels:
Provide the child with secure, stable home environment
Give him or her love and time
Keep the child occupied, provide opportunities for sports, hobbies, other, useful activities
Keep the child informed of the hazards of drug addiction
Seminars about hazards of drug addiction in schools, colleges, etc.
Media should play its role
Friday preachers and Muhalla committees should play their role
Do not over burden the kids
Government and legal control
Law enforcement agents at all levels like police, judiciary should be vigilant
There should be strict drug control
Do not give drug without doctor's prescription
Stop quacks not doctors for practising
Establishment of de-addiction centers at all tertiary hospitals as well as district hospitals
Department of psychiatry, GMC Srinagar is running de-addiction facility round the clock at SMHS as well as Psychiatry Hospital, Srinagar. Various colleges and schools are coming to the department and they are being educated about the hazards of drug addiction. Our Deptt. ran a Deaddiction campaign among university, college and higher secondary students from 15th to 26th June 2015 at Community psychiatry centre (Deaddiction centre) SMHS in which they were educated by our doctors about various aspects of Drug addiction.
The Author is HoD, Psychiatry, GMC, Srinagar