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By Sunil Mittal

October 2001

A look at the whys and hows of substance abuse, and how during addiction can be dealt with and overcome

Drugs have been used down the ages for pleasure, to alter the state of consciousness, or for relief from pain and anguish. Added to these are inquisitiveness, curiosity and the need for change and experimentation.

The initial use of a drug for pleasure leads to repeated use and reinforcement. Soon, addiction develops and withdrawal symptoms appear on not taking the drug. Then follows continuous use to experience the pleasure or to avoid the pain of withdrawal.

IS THERE AN ADDICTIVE PERSONALITY?

If exposed to drugs, many of us would be susceptible to becoming dependent on them. One’s psychological state either initiates one to use drug, or helps perpetuate drug-using behavior. There is then no question of will power. The cause for addiction is a combination of genes and psychosocial experiences. No drug addict sets out to become one. They believe in their invulnerability, ‘will power’ and omnipotence and use a drug initially to experience the ‘kick’ or the ‘high’. But before they know it, they are ‘hooked’.

INITIATION INTO ADDICTION

The psychological and social reasons for substance abuse are many, such as adverse experiences during childhood, mental illness, discord, neglect, violence, stressful family life, changing social values, breakdown of traditional role models, identity crisis and identity diffusion. Or it might just be a desire to relieve monotony, pain, tension or stress. Easy availability of drugs, peer pressure and sensation seeking behavior result in experimentation with drugs.

Research has revealed the mode of action of drugs and alcohol in the body to be through the brain’s neuro-chemicals. Endogenous morphine-like substances (endorphins are chemicals that resemble morphine) and specific receptor binding sites for different drug molecules have been identified in the nervous system. This means that our bodies react to drugs because we are biologically so predisposed.

SYMPTOMS OF ADDICTION

A drug abuser or an addict is a person who manifests ‘physiological, behavioral and cognitive phenomena in which the use of a drug or a class of substances takes priority over other behaviors that once had greater value’.

A drug addict experiences at least three of the following symptoms at some point or the other:

• Craving for the drug
• Difficulty in controlling the onset, termination or level of use
• Experiencing a withdrawal on not taking the drug
• Increase in the quantity used
• Neglect of other activities
• Continued use of the drug despite clear evidence of harmful consequences
THE DRUG SUB-CULTURE

With increasing use of a drug, the abuser is sucked into a sub-culture that has its own set of values, practices and rituals that are followed to the exclusion of everyday life experiences. These are often in conflict with socially acceptable norms. Reinforcement and rationalization follow because of opposition from the social mainstream that results in further adherence to this drug sub-culture. Drug sub-cultures have existed in India for quite some time, for example the hippies of the 1960s and ’70s and the elite ‘party crowd’ that ‘freebases’ on cocaine or pops ‘Ecstasy’ when ‘stretching a party’.

TYPES OF DRUGS

Drugs may be classified as legal (like alcohol) or illegal, prescription or non-prescription, socially sanctioned or taboo, organic or synthetic and also include substances that were never meant for human consumption (such as glue, solvents like thinner or even petrol, which are all ‘sniffed’).

Opiates: Includes opium that is obtained from the poppy plant and all its derivatives (morphine, codeine, thebaine); drugs like heroin (brown or white sugar, smack) manufactured from opium and synthetic opiates like methadone. These substances are highly addictive and a single use can lead to addiction. Opiates work through endorphin receptors in the brain that give a powerful kick. Cannabis: Derivatives and preparations of the cannabis plant (Indian hemp) include bhang, ganja also called grass, marijuana and charas or hashish. Cannabis is widely used in India and the plant grows wild almost everywhere. It also finds use during certain religious rituals and in some ayurvedic preparations. Dependence can develop, though a few remain occasional recreational users.

Cocaine: Derived from the coca plant whose leaves were traditionally chewed in parts of South America, cocaine is a powerful ‘upper’ that produces elation, diminishes anxiety and increases alertness. Overuse causes hallucinations and paranoia reducing the person to a nervous wreck. Its effect lasts for about eight to twelve hours, after which the person feels ‘crashed’ out and depressed, leading to more cocaine use to ‘ride’ the high again.

Cocaine works through dopamine, which is also a ‘feel-good’ brain neurotransmitter. Over-stimulation of dopaminergic pathways causes psychotic behavior and paranoia.

Amphetamine type stimulants (ATS): Other stimulants are amphetamines (popularly known as speed and dixies) that have been used by students to stay awake while studying, or related chemicals like Ecstasy that produce a ‘wide-eyed euphoria’. Users pop them frequently and become addicted. Overuse can cause psychotic episodes and paranoia.

Hallucinogens: These include LSD (acid), mescaline, dhatura, phencyclidine (angel dust or angel mist). Sedatives and tranquilizers: These include all prescription and non-prescription tranquilizers like benzopdiazepines (such as Calmpose), barbiturates, methaqualone (Mandrax). Dependence may occur inadvertently when a prescription for these is over-used or used without medical supervision.

TREATING ADDICTION

Quitting is always difficult because the addict invariably denies being addicted and usually insists that he or she can quit any day. Only those who have some sort of ‘inner realization’ are able to quit drugs on their own. Most need help to quit, and more importantly, to stay drug-free.

Treatment involves a long process that extends to a lifetime of accepting one’s proneness to addiction. The first step is to motivate the addict to leave drugs, which may be done by friends, family, or by professional counselors or ex-addicts. The subsequent stages of treatment are:

Detoxification: This is done in a specialized set-up equipped to handle drug-withdrawal by appropriate medication, prevent complications of sudden withdrawal (such as seizures, dehydration, delirium, severe insomnia), and to treat other disorders caused by drugs (liver cirrhosis, respiratory problems, infections). The duration is two to three weeks.

Psychotherapy and counseling: Aimed at altering addictive behavior, this includes individual therapy and family therapy to help family members of recovering addicts learn new strategies to cope, resolve conflicts and prevent relapse. Also included is group therapy with other recovering addicts, craving control, relaxation techniques, leisure time planning and lifestyle review.

Rehabilitation: Psychosocial rehabilitation is required to bring the ex-addict back to the mainstream of life. Carried out in specialized settings, a person may be required to stay admitted for a period of time.

Anti-craving or antagonist medicines: Certain medicines that reduce drug craving (naltrexone in alcoholism and opiates), or block the high of a drug, or those that produce an adverse effect by reacting with the drug (disulfiram with alcohol), or mimics the action of the drug (methadone in opiates) may be used to ‘buy’ time to effectively rehabilitate the addict.

Relapse prevention: As relapsing into an addiction is fairly common, effective aftercare and relapse prevention programs have to be followed. These require follow-up at treatment centers for about one to two years. These programs aim at addressing outstanding issues, reducing stress, reviewing treatment gains, taking up new responsibilities and producing lifestyle changes that help a person grow.

The road to recovery does not end here, as it is a continuous journey. Though the risk of relapse decreases with the passage of time, nevertheless it can still occur. The treatment enhances the client’s capacity to cope and progress on a drug free life.