By Dr Mohammad Maqbool Dar
Man has long used psychoactive drugs not only to enhance pleasure and relieve discomfort but also to 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 civilisation and dependence on drugs where described by Greek, Roman and Biblical authors.
In Indian society, use of certain substances to modify mood or behaviour under certain circumstances is generally regarded normal and appropriate. It 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 accepted. A psychoactive drug is one that is capable of altering mental functioning. There are four important patterns of substance use disorders which overlap with each other.
Acute intoxication: According to ICD-10 acute intoxication is a transient condition following the administration of a psychoactive substance resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour.
Withdrawal state: It is characterised 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: it is characterised by a strong desire to take the substance; difficulty in controlling the substance taking behaviour; withdrawal state; evidence of tolerance where increased doses of the substance are required to achieve effects originally produced by lower doses, and progressive neglect of alternative pleasures or interests.
The major dependence producing drugs are: opioids, cannabis, alcohol, cocaine, amphetamines, hallucinogens, sleeping pills, solvents and nicotine. 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, curiosity, low tolerance, need for immediate gratification, limited 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 urbanisation.
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.).
Treating the drug addict
It includes hospitalisation, withdrawal of drug, detoxification with various agents depending on drug of abuse, administration of vitamins, painkiller, supportive psychotherapy, counselling and psycho education of the person and family
After discharge of the patient, factors like craving, peer pressure, maintenance treatment, treatment of co morbid disorder, regular follow-ups and rehabilitation in family, society are important.
Role of parents
If the parents find that their child is on drugs they must accept the truth and take immediate remedial steps. But do not thrash or ill treat the child; treat him 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. Consult your doctor
About 80 per cent of addicts resume their habit within six months. The main causes of relapse are presence of co-morbid illness, poor rehabilitation services, easy availability of the drug, continuous peer pressure, and OPD method of treatment except opioid substitution therapy where relapse rate is very low.
Parents should provide their wards with a stable home environment and give them time. Keep your child occupied with various activities; provide him opportunity to play and indulge him in his hobbies. Society should also come forward and disseminate awareness about drug abuse.
The department of psychiatry, GMC Srinagar is running a de-addiction facility round the clock at SMHS hospital as well as in the psychiatry hospital of Srinagar. Various colleges and schools are coming to the department and they are being educated about the hazards of drug addiction. Our department ran a de-addiction campaign among students of psychology from universities, college and higher secondary students from 15th to 26th June 2015, at community psychiatry centre, SMHS.
—The author is the head of the psychiatry department at GMC, Srinagar. Feedback:dardrmaqbool@gmail.