The Menace of Drug Addiction

Accounts of use of psychoactive substances including alcohol, cocoa leaves,
The Menace of Drug Addiction
Representational Photo

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.

Acute Intoxication

Withdrawal State

Dependence Syndrome

Harmful Use

Acute Intoxication:

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.

Withdrawal State:

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.

Dependence syndrome:

is characterized by:

A strong desire to take the substance

Difficulty in controlling the substance taking behavior

Withdrawal state

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:

Harmful use is continued use despite awareness of medical or social effect of the drug.

The major dependence producing drugs are

Opoids

Cannabis

Alcohol

Cocaine

Amphetamines

Hallucinogens

Sleeping pills

Solvents

Nicotine

Predisposing factors:

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.).

Complications:

(a) Familial:

Long absence from home

Quarrels and violence

Neglect of family

Marital discord and divorce

(b) Social:

Misbehavior with others

Arguments, fights

Social isolation

Loss of position

(c) Financial:

Exhausting savings

Selling personal articles

Selling household articles

Selling immovable property

Borrowing money

Spending money over drug instead of family

Financial bankruptcy

(d) Occupational:

Unpunctuality

Absenteeism

Getting warnings

Suspension from job

Loss of job

Frequent changes in job

Loss of skills

Loss of work habit

Fights, thefts

(e) Legal:

Thefts and crimes

Driving under influence

Violation of rules

Imprisonment

Drug trafficking

Arrests and court cases

(f) Medical:

GIT problems like fatty liver

CNS problems like delirium, hallucinations, head injury and fracture

Respiratory like bronchitis, lung cancer

Infections like HIV, septicemia

Management:

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

Relapse:

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.

Prevention:

It can be done at different levels:

Parents:

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

Community:

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

dardrmaqbool@gmail.com

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