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Dealing with Drug Abuse

Post by on Saturday, August 7, 2021

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Drugs? Medicines? The two terms are synonymous, when we are referring to therapeutic drugs i.e., those used for treatment of various illnesses. But the term drugs also has a specific connotation in public mind, the drugs of abuse, which come under the category of psychoactive drugs. In current medical terminology, the group is also referred to as psychoactive substances. The group includes a wide range of drugs or substances including nicotine (tobacco), alcohol, cannabis (Marijuana) products, opioids (morphine, heroin and related drugs), cocaine, hallucinogens like MDMA, and many others. When a person starts using a drug, the person develops dependence over it after a short period. Dependence or addiction is characterized by craving to take the drug, withdrawal symptoms whenever the effect of drug is over and tolerance, i.e. need to take increasing amounts of the drug to control the withdrawal symptoms.
Broadly drugs of abuse can be categorized in two groups: licit drugs like alcohol and tobacco products, which are not legally banned and illicit drugs like cannabis products, opioids, cocaine, hallucinogens and many others, which come under the law enforcement and whose production, sale and use is not permitted by the law of land. Drug use (abuse) and dependence is very common. A recent countrywide survey conducted by the National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi has estimated that India 14.6% of the population use alcohol, 2.1% use opioids and 2.8% use cannabis products.  Global Adult Tobacco Survey has estimated that 29% of India's population uses tobacco in different forms.
Why people use drugs is important to know. Drug use often starts in early childhood or adolescence. There could be a number of reasons for initiation of drugs.  Curiosity, peer pressure, misconception that drugs relieve stress and role models (seeing elders using drugs) and surrogate advertisements are often in the background of initiation of drug use. Tobacco in front of cigarettes or smokeless tobacco and inhalants are often called entry drugs.
All drugs including tobacco, alcohol, opioids and others are associated with a range of adverse health consequences. Tobacco use is associated with cancer of the mouth and lungs and heart disease. Alcohol affects the liver, heart and brain. Drug dependence is recognized as an illness with biological, familial and psychosocial causes. There are effective treatments available for drug dependence. Unfortunately, there are a number of misconceptions associated with drugs. Drug dependence is often considered as a bad habit and not an illness. Infact, drug dependence or addiction is an illness like tuberculosis or hypertension and needs treatment. Many times, there are different kinds of misconceptions in society about drugs. Alcohol is also considered a part of many festivities. Both alcohol and tobacco are often used in socializing. The misconceptions are responsible for persons with drug dependence not seeking treatment. It has been observed that nearly 90% of the persons with drug related problems don’t seek treatment.
Drug dependence is a public health problem of grave concern. One of the most important approaches is raising public awareness about the ill effects of drugs and that the persons using drugs can be helped. Children starting from school need to be sensitized about it and especially How to Say No to Drugs? Media also needs to take responsibility by not showing surrogate advertisements. The Government has also created facilities for treatment of drug dependence in most hospitals. It is important to know that treatment for drug problems is to be taken atleast for a few months. There are both medicines and counselling used in treatment. The person using drugs needs affection and support from the family and should not be criticized. It is possible to help a person with drug dependence and bring him or her back to a drug free state.
Helping a person dealing with drug problems
Drug use has existed in society since ages. In earlier eras, it used to be part of festivities. In rural India, Hookah (a device to smoke tobacco) has been a part of social customs. Raw opium has been used by different names like Doda in the farm sector. Use of cannabis in the form of bhang is common in many rural belts. Brewing of alcohol in different parts of rural India has been quite common. Thus, in India also drug use behaviour is deeply ingrained in the society. The last few decades have seen a larger emergence of synthetic drugs like hashish and other cannabinoids, heroin, cocaine, cathinones. Synthetic opioids like heroin and increasing availability of the Indian made foreign liquor at affordable price. Smokeless tobacco industry has also proliferated so widely in the last two decades with multiple colorful surrogate advertisements in the media, though cigarette smoking has declined during this period.  
Kashmir with a long international border with Pakistan has seen a meteoric rise in opioid use. The state probably acts as a transit point for smuggling of drugs. There have been reports of Kashmiri youth getting addicted to heroin, which is further evidenced by the increasing number of the affected people accessing treatment at various treatment facilities in the state. The National Survey of Magnitude of Substance Use in India found more than 2% of the population of Jammu and Kashmir current users of cannabis or opioids. Percentage is expected to be much higher in the youth.
Thus, when helping a person with a drug use problem, one needs to correct all associated myths and misconceptions. The most important strategy would always be prevention followed by early identification and treatment, and rehabilitation back into society.  Creating awareness about harmful effects of drugs in the community, especially in the younger population, is an important preventive strategy. The awareness programmes could be organized in educational institutions, which should start at an early age, and continue throughout childhood and adolescence. The children and adolescents should be equipped with a skill ‘how to refuse, when offered a substance’, and refusal should be perceived as a sign of strength. Teachers need to be equipped with skills at early identification of the problem in the students and refer to school counsellor. Parents also need to be sensitized about the problem and should be aware of how and with whom they spend time. Community resources like religious institutions, spiritual organizations, community clubs, health clubs, workplace settings, Panchayats and resident welfare organizations can also be involved in raising awareness about the problem.
The drug user and the family, and the society in general needs to know from what kind of help is available; and where they can access it. The person using drugs has often poor motivation, which needs to be built up, both at the level of family and the sufferer. The family always plays an important role in treatment and should be supportive rather than critical. The person and the family members are further sensitized about the ill effects of the drug and benefits of leaving it. The treatment consists of a phase of detoxification lasting about 2-3 weeks, in which focus is on controlling the withdrawal symptoms as well as educating the person about harms of drugs and how to prevent a relapse. In this phase, the person may need to be hospitalized. Detoxification is followed by a maintenance phase of treatment in which counselling sessions can be taken with the drug user and their families individually or in groups. Focus is on rehabilitation back to the society as well as relapse prevention.
It is important to emphasize here again that drug use is not a habit or a social problem, though it has social consequences. The person using drugs needs medical treatment. As happens with physical illnesses, treatment failures can occur in drug use disorders also and the person may relapse. It is frustrating for the family, but relapses can be effectively treated. Certain patents with opioid addiction need long term maintenance treatment. This is also called opioid substitution therapy. It helps the person in rehabilitating back into society.
Facilities for treatment of drug dependence are available in psychiatry departments in most big hospitals. The Government has also opened deaddiction clinics at many places. Many psychiatrists and non-government organizations also run such facilities.

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