Book an Appointment

Drug Abuse & Addiction

Bloog-big

Drug use is a fairly common problem in adolescents and young adults. This age group is predisposed to trying various categories of drugs owing to multiple individual and social predispositions. Availability of the substance at home or in the community, peer pressure, curiosity, desire to fit in and exert independence are factors that often lead to first exposure.

Lack of proper knowledge and information along with risk-taking and impulsive behaviour, inability to regulate emotions and poor social skills can contribute to continued use of drugs.

Often there is shame and stigma around drug use which prevents helpful conversations or help-seeking behaviour. Tobacco, Opioids (heroin, morphine, tramadol), Cannabinoids (ganja, bhang, weed, hash, hashish) Cocaine, LSD, Barbiturates, Amphetamines, Alcohol, Benzodiazepine (Diazepam, Clonazepam, Zolpidem, Alprazolam) and Ketamine are commonly used drugs of abuse.

Recently there has been a rise in several children and adults using vaping as there is a misconception that it is relatively safer than smoking cigarettes and bidis. Vaping culture is alarmingly rising in schools and colleges even though vapes are banned in India.

Stages: Abuse to Addiction (The impulsive use to compulsive use cycle):

Impulsive/ recreational use      Occasional use      harmful use or abuse      dependence or addiction (compulsive use)      withdrawal, negative emotions in the absence of substance      continued use and dependence.

Factors leading to the start and continuation of an addictive substance. Often it starts with the following things:

Continuation can be due to:

It is important to know about the biology of addiction.

In the addictive brain, substances take up the normal learning pathways and activate reward circuits in response to drug-associated cues, which leads to cravings and compulsive drug-seeking behavior, despite harmful consequences.

The reward circuit is from an area in the brain called the ventral tegmental area to the nucleus accumbens, mediated by a chemical called dopamine. The clinical significance of these brain changes is that addiction, once established, becomes a chronic illness with relapses and remissions. The idea that people voluntarily choose to use drugs of addiction doesn’t make the addiction any less of a biological disease.

Usually, the reward pathway is stimulated by food, sex, exercise etc. Dopamine gets released in a higher amount with addictive substances. After continued exposure to an addictive substance, the dopamine receptors in the reward pathway get used to that and are always regulated in a way to ask for more dopamine, that is, more substance. With repeated exposure to the same reward, dopamine cells also fire in an anticipatory response to the conditioned stimuli (“cues”) that predict the delivery of the reward. Through the action of serotonin, the substance also affects the learning and memory of a person.

Psychological and cognitive changes in young adults suffering from a substance addiction:

  • Anxiety.
  • Depression.
  • Irritability.
  • Poor scholastic performance.
  • Overall decline of the cognitive faculty including attention, concentration, memory and learning.
  • Coping with stress by escape and avoidance.
  • Poor social life.
  • Intolerance to personal and professional stress.
  • Psychosis (often seen in alcohol withdrawal/ cannabis use).
  • Amotivation.
  • Slowing of performance – physical and mental.
  • Decreased sexual performance.
  • Fragmented sleep, unrefreshing sleep.

Behavioral Signs of Addiction in Young Adults:

  • Poor class attendance.
  • Sudden/ gradual decline in academic performance.
  • Restlessness.
  • Change in physical appearance – red eyes, slowed activity level, cluelessness, vague stares, inattention, trembling of hands/ body, restlessness etc.
  • Reduced social activity.
  • Desperate means of procuring money/ asking for more money from home in the recent past.
  • Frequent use of handkerchief (often a mode of inhalant abuse).
  • Declined communication skills.

Screening & assessment of the level of addiction (There are screening tools to assess the presence of abuse/ addiction and to assess the severity). A few are enumerated below:

  • Alcohol Use Disorder Identification Test/ AUDIT.
  • Fagerstrom Test for Nicotine Dependence.
  • Drug abuse screening test (DST): for other substances.

There are other specific tests for cannabis/ opioid screening. There are laboratory tests available that look for the presence or absence of specific drugs in urine, blood, or hair samples. These tests do not diagnose a substance use disorder but can tell whether a person has recently taken the drugs being tested. Approach to help a substance user:

  • Assessment.
  • Giving personalized feedback to the person (about the problem and its consequences and the ways to manage it).
  • Rapport establishment.
  • Advice and negotiation – discussing alternatives.
  • Motivating the person for change.
  • Expressing empathy.
  • Supporting self-efficacy, that is the power to change and betterment lies within the person himself/ herself.
  • Mobilizing social support with the consent of the user.
  • Monitoring.

When to seek professional help:

  • A brief intervention is not helpful.
  • Significant dependence, not amenable to brief counselling.
  • Frequent episodes of intoxication.
  • Evidence of physical/ psychological problems due to substance use – blackout, falls, depression, anxiety, liver problems, seizures, delirium, frequent infections, unexplained weight loss, unexplained fever, persistent anger issues etc.
  • Inability to eat/ sleep.
  • Risk of harm to self and others.

Proper assessment and treatment make a drastic difference in outcomes for drug abuse and addiction patients. The detailed assessment includes a detailed drug use history, an evaluation of reasons for continued drug use, assessing psycho-social support, and assessing family dynamics and stressors by a qualified psychiatrist/psychologist. After getting a detailed assessment a comprehensive treatment plan is formulated to assist the patient in detoxification for the short term to help with drug withdrawal symptoms and other medical issues under the supervision of a psychiatrist. A long term treatment support involves rehabilitation by a rehabilitation counsellor, constant counselling and therapy support by a qualified psychologist, and regular treatment by a psychiatrist to manage craving and sleep problems. Usually, patients struggling with drug and alcohol abuse require long-term support by the mental health team to maintain abstinence.