DRUG ABUSE

 De - addiction centres

Drug is a chemical compound which, when taken into the body, changes the body's metabolismDrug abuse is a widespread problem that affects people from all socioeconomic levels. Drug abuse occurs when a person feels the need to use a drug repeatedly for various reasons. Drug addiction is said to be present when a person continues to abuse a drug after serious problems related to the drug use have occurred. Drugs lessen the person's  ability to cope with life's difficulties. 

 The symptoms of abuse and addiction differ slightly based upon the drug being taken. Drug abuse and addiction cause many health-related and social problems. Be unable to cut down on drug use when he or she wants to continue to use the drug despite the problems it causes  Develop tolerance for the drug, so that increased amounts are needed to get the same effect  

Physical symptoms vary depending on the drug being abused and the extent of the drug use. Long-term use may result in changes in brain function that last long after the person stops using drugs.

 If a person has any symptoms of drug abuse, it is a good idea to seek help. The earlier the treatment, the better the results. Effective treatment may include behavioral therapy, medicines, or some combination of these. The best drug abuse programs will provide a combination of therapies and services. Counseling and behavioral therapies should be included in the treatment plan.  Medicines may be needed along with counseling.  

Effect of  drugs on the body

. But obviously not everyone who takes drugs is an addict. The inherent overpowering nature of the drug per se, was that no person could resist the pull of the drugs: the one-shot-and-you-are-gone-syndrome. After the 1940's (especially in the USA) this biological disease concept was revised. The old addiction-in-the-drug model considered the source of addiction as being in the drug itself. The new theory of addiction being mooted is that the tendency to addiction is inherent in people who were susceptible to addiction to drugs because of (unknown) factors in their personality.

That addiction is not an inherent characteristic of drugs or people, but of person's response to a particular type of experience. The main problem with most past and continuing research on addiction, is that it locates the source of addiction in the wrong place. Addiction does not come from a drug; it begins with the person, his or her situation and that person's search for a given experience.

This is a much broader and more unified understanding of addiction

Addiction as a very personal, subjective response to a given experience; a result of behaviour, not necessarily inherent in any person or substance. But the main question we still have to solve is: what exactly is the mechanism causing the tendency to increase the dose, resulting in repeated consumption of drugs? Initially, taking the drug is pleasant experience, giving one the feeling of being relieved from anxiety, when in actual fact those things  in life which cause anxiety grow more severe. It is here that the vicious circle of drug addiction starts, with the dialectic of relief and slavery as its driving force. This is certainly more complex than mere physical dependence.

The key to diagnosis of addictive disease is in the observation that the patient persists in using drugs in spite of the consequences.  It also means that taking away the drug would not solve the problem of drug addiction.

Typical progression in the drug life of an addict

The reconstruction of drug addicts' life stories gives the following picture:

1. Addiction starts as a pleasant experience, chasing pleasant feelings and running away from the unpleasant. It becomes an addiction when the experience is no longer pleasant, but the person continues to risk everything by compulsively attempting to repeat and even intensify the pleasant experience previously produced by drugs.

2. Addiction becomes a lifestyle: predictable, habitual, and repetitive.  Drug-addicted people doubt both their ability to set themselves realistic goals and their ability to bring about the results they want. Because they do not believe their efforts will be rewarded, they give up trying. For the addict, the reward becomes the drug of his / her choice.

3. Because of the lifestyle maintained by drug addict (using mostly illegal and very expensive drugs) his or her behaviour starts to infringe on the rest of society (criminal activities, prostitution, etc.)

4. These kinds of activities go against the set of values with which the addict has been raised. this produces strong feelings of guilt and self-hate associated with the addiction which cause the addict to rely more heavily on his or her drug. The vicious circle keeps rolling.

To sum up, addiction means an over-dependency which has become habitual, obsessive and compulsive, governing.

The purity of heroin can vary greatly. Heroin can be mixed with powdered milk, sugar, baking soda, procaine and lidocaine (local anaesthetics) or even laundry detergent, talc, starch, curries powder, Ajax cleaner or strychnine. All of these "additives" are dangerous if they are injected into to bloodstream. Heroin is smoked or inhaled as a powder or it can be mixed with water, heated and then injected. Heroin crosses through the blood-brain barrier 100 times faster than morphine since it is highly soluble in lipids.

Injecting heroin into a vein (intravenous use) produces effects in 7 to 8 seconds. Injecting heroin into a muscle (intramuscular use) or under the skin (subcutaneous use) can produce effects in 5 to 8 minutes. Addicts sometimes inject them upto four time in one day.

Heroin is an illegal opiate drug made from the seeds of the opium poppy, Papaver somniferum. The opium poppy is a plant found in the Middle East, Southeast Asia and parts of Central and South America. To harvest opium, the seed pad of the poppy is cut and a juice flows out. The main ingredient that is extracted from raw opium is morphine. Morphine is easily converted to heroin by a chemical process.

Effects of heroin

The overall effect of heroin is a depression of the central nervous system.

Short term effects

• Analgesia (reduced pain).

• Brief euphoria (the "rush" or feeling of well being).

• Nausea.

• Sedation, drowsiness.

• Reduced anxiety.

• Hypothermia.

• Reduced respiration; breathing difficulties.

• Reduced coughing.

• Death due to overdose - often the exact purity and content of the drug.

• Is not known to the user. An overdose can cause respiration problems and coma.

Long term effects

Tolerance: more and more drug is needed to produce the euphoria. In addition, other effects on behaviour.

Addiction: psychological and physiological need for heroin. People are driven to get more heroin and feel bad if they do not get it. People begin to crave heroin 4 to 6 hours after their last injection.

Withdrawal : About 8-12 hours after their last heroin dose, addicts' eyes tear, they yawn and feel anxious and irritable. Excessive sweating, fever, stomach and muscle cramps, diarrhoea and chills can follow for several hours later. These withdrawal symptoms Can continue for 1 to 3 days after the last dose and can last 7 to 10 days. In some cases, full recovery can take even longer.

Other effects

In addiction to the direct dangers of heroin, this powerful drug also carries the risk of :

• HIV / AIDS - due to sharing of needles.

• Poisoning - from the addiction of toxin to the drug.

• Hepatitis - liver damage.

• Skin infections - from repeated intravenous injections.

• Other bacterial and viral infections.

• Increased risk of stroke.

• Collapsed veins.

• Lung infections.

How heroin affects the brain

Not all of the mechanisms by which heroin and other opiates affect the brain are known. Likewise, the exact brain mechanisms that cause tolerance and addiction are not completely understood. Opiates stimulate a "pleasure system" in the brain. This system involves neurons in the midbrain that use a neurotransmitter called "dopamine." These midbrain dopamine neurones projects to another structure called the nucleus accumbens which then projects cerebral cortex. This system is responsible for the pleasurable effects of heroin and for the addictive power of the drug. Other neurotransmitter systems, such as those related to endorphins are also likely to be involve

Effects of cocaine on the nervous system

A dose of between 25 to 150 mg of cocaine is taken when it is inhaled. Within a few seconds to a few minutes after it is taken, cocaine can cause:

• A feeling of euphoria.

• Excitement.

• Reduced hunger.

• A feeling of strength.

After this "high" which lasts about one hour, users of cocaine then "crash" into a period of depression. This causes cocaine users to seek more cocaine to get out of this depression and results in addiction. Withdrawal from cocaine can cause the addict to feel depressed, anxious and paranoid. Then the addict goes into a period of exhaustion and they may sleep for a very long time.

Various doses of cocaine can also produce other neurological and behavioural problems like

• Dizziness.

• Headache.

• Movement problems.

• Anxiety.

• Insomnia.

• Depression.

• Hallucinations.

Death caused by too much cocaine (an overdose) is not uncommon. Cocaine can cause large increases in blood pressure that may result in bleeding within the brain. Constriction of brain blood vessels can also cause a stroke. An overdose of cocaine can cause  breathing and heart problems that could result in death.

Cocaine is highly "reinforcing" when it is given to animals, they will give it to themselves. In fact, if animals are given the choice, they will put up with electrical shocks and give up food and water if they can get cocaine.

Cocaine acts by blocking the re-uptake of the neurotransmitters -- dopamine, norepinephrine and serotonin in the brain. Therefore, these neurotransmitters stay in the synaptic cleft for a longer time. Research has also shown that cocaine can also cause the release of dopamine from neurons in the brain.

Cocaine can also affect the peripheral nervous system. These effects include constriction of blood vessels dilation of the pupil and irregular heart beat.

We at Muktangan subscribe to the theory that addiction is a disease which affects a person at many levels. It effects every aspect of the afflicted person's life; at the physical and mental level, in all the person's relationships, and even causes the person to loose all sense of morality.The disease has a way of recurring and we feel that only a total change in attitudes brings any meaningful recovery. To bring about this whole person recovery we adopt a multi-dimensional approach.

Recovery

• Minimum of medication required to relieve the patient of the intense withdrawals is administered . The psychiatrist prescribes medication to handle behavioral problems.

• The patient's validated history is collected. We lay a lot of emphasis on clinical observation and ward observation. The patient's history is considered validated after input from numerous sources.

• More importantly the patient is subtly guided towards self discovery, through group therapy and individual counseling sessions. The session use the methods to achieve therapeutic goals.

• Narcotics Anonymous and Alcoholics Anonymous meetings are conducted regularly in our premises.

• We have a regular monthly therapy group for marriage counseling titled 'Sahajeevan'. Children of addicts meets regularly under the banner of 'Ankur' group. Wives of addicts try to learn from each other experiences in 'Sahachari' group.

• If required, our clinical psychologists put the patients through numerous psychological tests and note the findings on the case file, so that the social workers handling the case get an idea about the patient's personality and coping up patterns.

• We are convinced of the immense value of peers helping each other consciously and unknowingly. Our centre functions like a therapeutic community. All the work, including maintenance and kitchen is shared by all the members. Our counselling staff includes a substantial number of recovered addicts whom we fondly call 'Muktangan Graduates'. There is a strong family atmosphere and everyone is strongly encouraged to develop a sense of responsibility and belonging.

• We work towards helping patients regain their self esteem and confidence. There is a routine to be followed. Patients are encouraged to cultivate interests and regain physical and mental health. Facilities like a well equipped gymnasium , a well stocked library with books in different languages, musical instruments, art material, equipment to play different indoor and outdoor games etc. are provided. Patients are encouraged to contribute in an in-house monthly magazine. Yoga and meditation is taught to all patients. In short every effort is made to fill up the vacuum which is left after leaving addiction. Thus the patient is guided towards a new way of living and thinking.

• The patient is taught vocational skills and helped in being assimilated into society. Some of our patients come and work at the Centre which staying at home (Day Care) and some patients who are working in the city make Muktangan their 'half-way home ' before getting absorbed in the social mainstream.

• An effective treatment for cleansing oneself. We at MDC carried out a study. It has been observed that a patient, if trained to do Waman Dhauti properly responds to psychotherapy and acquires self confidence and sociability.

  It is clinically proven that Waman Dhauti is very useful tool for inducing patients for psychotherapy. 'Psychotherapy' is a process of change in emoting, thinking and behaving.

  MDC's experience is that for last 10 years Yoga Therapy is rated as most adored therapy as admitted by 97 percent patients. 79 percent of the recovered addicts, admit that Yoga has helped them to be aware of themselves and as such they have been sober. 68 percent patients feel that they should spend at least 30  minutes for yoga postures after they are discharged from MDC. Most of the patients feel that they feel more relaxed after Waman Dhauti.

  They also feels like talking more openly. Change in emotion / thinking happens if one is able to receive things told by the therapist. Waman Dhauti enables the patient to think openly and thus respond to new thoughts. Realisation dawns that just as one consumes drugs, he can get away from the it whenever he desires so.