Awareness Is Key In The Fight Against Drug Abuse

If you visit any part of Punjab, urban or rural, you are bound to meet people complaining about rampant drug abuse in their area. There is no reliable data to support the exact epidemiology, however, it can be fairly stated that drug abuse has become one of the major, if not the biggest challenge to society in this part of the country. A 2015 study by Society for Promotion of Youth & Masses (SPYM), in collaboration with National Drug Dependence Treatment Centre, AIIMS, puts the number of opioid-dependent people in Punjab at 2,32,856 or 1% of the population. An affidavit submitted by the Department of Social Security & Women and Child Development, Punjab government, says “over 16% of the population is addicted to hard drugs”. A United Nations Office on Drugs and Crime (UNODC) report in 2004 put out that, at 56%, Punjab was home to the highest number of opium users in India. It's hard to quantify with any accuracy.

And then there are the human stories behind these statistics. Addiction has been universally accepted as a mental health issue, which should be managed by a team of psychiatrists and psychologists. Every person who drinks or uses a drug is not dependent or nachheri. For example, millions of people drink occasionally. They may be abusing alcohol but are not dependent on it. There is an established criterion for determining who is dependent on a drug or alcohol as per the ICD & DSM systems of classification of disorders. Broadly speaking, the label of drug dependence is used when a person just cannot do without taking the substance he is hooked to (for at least a year), neglects other sources of pleasure, does not stop abusing the substance even though its health ill-effects are very apparent, finds that with time more and more is needed for the same ‘kick' and also starts spending more time in procuring the addictive substance.

So, every single person who abuses alcohol or drugs does not become dependent on it. Have you ever wondered why? There are multiple factors - genetic, social, the environment. Numerous studies have shown genetic linkages so you could have multiple addicts within one family. It could also be peer pressure, easy availability, thrill-seeking behaviour or even just a feeling of novelty. But this is for sure, there is a science to addiction. There are neurochemical changes in the brain, leading to a loss of control over how much & how frequently substance abuse happens.

The most common substances of abuse are alcohol, opioids, cannabis (bhang) and nicotine. Society has evidently stamped its seal of approval on alcohol and nicotine. No party seems to be complete without a drink or a smoke. Cannabis was once looked upon as a very cheap drug but unfortunately, it has now become a fad to smoke pot, owing to its easy availability. Most abusers justify it by calling it a recreational drug and dismissing it as non-addictive. Nothing could be further from the truth. Cannabis addiction is, in fact, the most difficult to give up and has the most devastating effects on the brain, which can last a lifetime.

But then, our society is currently worried only about Opioids. Opioids are a category of drugs which are chemically similar to opium, like raw opium (afeem), poppy husk (phukki), poppy buds (doda), synthetic drugs like morphine, Buprenorphine (a double-edged sword, as it is a great treatment option as well), heroin (chitta), smack, cough syrup with Codeine in it, and painkillers like Tramadol, Tapentadol, and Spasmo-Proxyvon. In rural Punjab, there is the false impression that raw opium or poppy husk is natural, and therefore good for the health. I often hear patients, and their family members, say things like, ‘Hunn afeem vich milawat aundee hai tahin mundey heroin lain lag gaye' (the quality of raw opium available these days is not good, and that is why our youngsters have resorted to taking heroin). All of them are equally notorious. All of them causing just as much damage. There are also other myths around opium – stop taking it and you are at high risk for paralysis after a few months, or that opium helps treat diabetes. There is no truth in this. These seem to be rumours spread by people who just want to keep you hooked on opium.

Heroin or chitta is a huge focus of attention given the massive number of young people who are now addicted to it. It is the kind of drug that one can get hooked on to within a week of abuse, which is not the same with opium or poppy husk. Chitta is sniffed, chased on an aluminium foil or injected. In general, addicts are a close-knit community, who help each other procure the drugs as well. Practically every morning brings the news of one more young life lost to this dreaded drug. Many families report the death as heart failure or suicide or some other illness. Very few have the courage to openly accept that death was actually because of drugs.

How do we make out if our loved one is suffering from an addiction? If you notice any changes in behaviour - like staying aloof, or spending too much time in the toilet, or having new friends who never come inside the house, or suddenly asking for more pocket money, or money going missing from home on a regular basis, school/college authorities summoning you, or then a marked change in dietary habits – all of this may be an indication that something is wrong. You need to increase surveillance. You need to ask questions.

As per senior psychiatrist Dr. Hardeep Singh, who also runs one of the few certified de-addiction centres in the region, the results of treatment depend on many things. The awareness of addiction as a mental illness is the most important. Other factors include family support, social support, peer influence, and critically, the willingness of the patient. Will power is a dynamic process, and quite unreliable. There are treatment centres where the poor addicts are tagged as badmash, and doled out barbaric treatment, or confinement lasting anywhere from six months to a year, or even more. Usually, hospital-based treatment options are the best solution, as drug addiction is a disease just like any other albeit with major social ramifications. I often relate this to diabetes and tell my patients and their families that just like diabetes is a chronic illness that demands lifestyle and eating restrictions, the treatment of addiction is a lengthy process. One must allow for relapses as well, and there is a need to understand that one can easily substitute one drug with another. Don't we hear of people overdoing the alcohol to help them cope with reducing their opium intake?

When the patient is finally ready to be treated and knows where to seek that treatment, the next step is explaining the need for detoxification, which means cleansing the body of all effects of the drug. This usually takes 7-10 days. There are two methods - a conventional method that uses Clonidine, and the other using medicines like Buprenorphine, Tramadol, Tapentadol, which are chemically similar to opium & morphine, and need to be gradually tapered off. Trained psychologists also use Motivation Enhancement Therapy (MET) to enable the addict to stay off drugs in the long run.

There are only a few private psychiatry hospitals or de-addiction centres that keep psychiatrists and psychologists on their staff, and which run as per laid down norms. So, addicts have limited places to turn to. Even government facilities have limited numbers of psychiatrists, who are stretched to their limits in providing that much-needed support.

In addition to treating addicts, there is just as much need to treat their families. Without family counselling, the job is never successful. Very often we find families fighting among themselves or being negative in their approach towards the patient. They must unite as one. Anything less than complete unity, and the patient could end up sliding backwards despite making positive gains. Cutting the purse strings can bring even the strongest nations to their knees, and so families need to stop funding drug abuse. Family members invariably facilitate drug procurement. There is a need to recognise when their ward is blackmailing them emotionally when it is time to call the bluff. But families never do so. Instead, every addict's promise to give up is taken at face value swanky cars, bikes & money being handed out as a means of appeasement. In an attempt to hush up the situation, families end up doing the opposite of what is needed. Where families are clear and spell out in no uncertain terms what they expect from the patient. there is usually a greater willingness to get treatment. The problem arises when families are scared, family dynamics are skewed, the patient asserts his authority and does not consent to treatment. Families end up blaming each other rather than grabbing the bull by the horn. It needs to be understood that the addict needs treatment and for that, you need complete clarity as a family.

Let us pledge today, that we must spread awareness about addiction. Let the security agencies do their jobs. Let policymakers do theirs. With love and compassion, we can help many. Being taken to the right person, at the right time, can make a huge difference. Find, and consult, your nearest psychiatrist. There is no stigma, only good health.

Disclaimer: The opinions expressed in this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.