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Substance Abuse: Patterns and Prevention.

  • Trends

  • Contributing Factors

  • Risk Groups

  • Social Aspects

  • Treatment

  • Does " Treatment Work"?

  • Reduction in Supply and Demand

  • Some Parental Safeguards.

  • India is one of the big suppliers of licit demand for opium required primarily for medicinal purposes. Besides this, India is located close to the major poppy growing areas of the world, with “Golden Crescent” on the Northwest and “Golden Triangle” on the North–East. These make India vulnerable to drug abuse particularly in poppy growing areas and along the transit/trafficking routes.

    As per documents released by the United Nations Office on Drugs and Crime, there has been decreased production of opium in India but increased production in Afghanistan. Drug production and trafficking from Afghanistan in the west and Myanmar on the east has always been a problem for India.

    The theme for International Day against Drug Abuse and Illicit Trafficking 2004 is “ Treatment Works.” Dr Anita Rao, who has been with a TTRCRF, a committed Deaddiction Centre, for nearly two decades discusses the issues regarding substance abuse. Ms Aditi Ghanekar, counsellor, also provided inputs.

    What are the recent trends in substance abuse?

    Dr Anita Rao: We find that there is an increase in drug abuse and addiction.

    • There is an increased abuse of pharmaceutical drugs. Some of the categories of these drugs are:

      • Narcotic analgesics like: Buprenorphine, Morphine, Pethedine, Pentazocine, Codeine.

      • Depressants like: Diazepam, Lorazepam, Alprazolam

      • Cough syrups like Codeine, Anti histamines like Avil.

    • Combinations of these drugs are also tried

    • Inhalants are being used in a big way, especially by labourers, street children and vagrants.

    Aditi Ghanekar: HIV is another major recent facet of the problem. Apart from poor hygiene and sharing of needles, many substance abusers visit sex workers. For one thing the bars that supply narcotic substances themselves make sex workers easily available. For another, there seems to be an urge among substance abusers to have sex. ( Though performance will be nothing to talk about!)

    What are the contributing factors to increase in abuse? Documenting agencies seem to imply that there is a decrease in indigenous cultivation of narcotics..?

    Availability and Attitude are the two governing factors I can point to.

    When the Drug Control Agencies like NCB are tightening the screws, brown sugar might be difficult to get. Then pharma drugs abuse goes up. Analgesics like buprenorphine (Tidigesic) and depressants like Alprazolam are abused. Typewriting correction fluid can be inhaled. Petrol and derivatives available at pumps can be inhaled. These are cheap and available.

    We are actually more open to substance abuse than we are willing to admit. I feel one substance is bad as the other, if it is going to bring dependence: we are okay with tobacco abuse in various forms. We have the highest incidence of oral cancer in the world and that does not seem to disturb us. When there is prevalent abuse of one type of substance, moving on to others happens.

    What are the individual factors that may contribute to addiction/ Is there a risk group?

    There are no definable groups. But we do observe that some factors keep cropping up quite often. Many addicts

    • At a personal level, are with psychological problems/without coping skills for the environment they have to deal with.

    • At the family level, may come from troubled families. A parent might be an alcoholic. Family might be dysfunctional due to various reasons.

    • At a social level, the immediate clique they are interacting with may be into some kind of substance abuse.

    Other observable trends are:
    • All drug abuse activity starts as peer activity. College hostels continue to be initiation points for a high percentage of addicts.

    • The vulnerable age is still 16 -25.

    Is there a social factor that is playing a part? Are we a more thrill seeking, more angry society?

    I think we have become a more selfish society. It is “ I, me, myself” now. In a nuclear family there were tasks for each according to capacity and needs. If one member in the family was dysfunctional, there were aunts, uncles and cousins whom we could relate to.

    Now all those buffers are gone. We have become very competitive. From LKG parents want children to come first in class. We are paying less attention to emotional quotient and social skills. The stress this builds up cannot be handled by all.

    At the lower strata, violence continues to be a part of people’s lives. TV and film violence desensitises our society to violence. Addicts are prone to violent outbursts and experience a change in values ( they can rob, lie and cheat without compunction), but these are accepted as a part of life. This in itself becomes a kind of permissibility.

    What are the treatment programmes you offer?

    We have a holistic approach. The residential programme is for about a month.

    The first five days involve detoxification.

    All related health problems ( including probable HIV infection are attended to).

    The rest of the stay, patients are given psychotherapy; this involves individual counselling, group therapy and family counselling. Apart from this ”classes” are taken on various aspects as per requirement. This could include anything from social skills to financial advice.

    Following this will be a three month after care period.

    For those who may need it we give some vocational training to help them pick up skills that will help employment.

    Addiction is a chronically relapsing condition. We do not look at relapse as failure. It is a part of recovery! So long term follow up is advised.

    We also have a harm minimisation centre. For labourers and economically weaker sections, who cannot afford to miss a day’s labour/wages, we give medical attention day to day on a planned programme.

    We conduct health camps, awareness and prevention programmes.

    International Day against Drug Abuse and Illicit Trafficking 2004 is “Treatment Works” what has been your experience?

    At the outset let me tell you, about fifty percent of the addicts we treat recover. They may have an occasional relapse, but they beat the habit. That also means fifty percent of the people we treat are not able to quit fully. Of this fifty percent about thirty percent use us like some revolving door to a better life. They come in and go out , relapse and then come back again. But they cope at some level. The other twenty percent we lose track of and I am afraid they all probably relapse.

    But yes, treatment works. Especially holistic treatment. For one thing, the addict has a fifty percent good chance of quitting. For another even if the addict has not quit effectively and completely abstained, the family learns to put things in perspective. To a large extent the rest of the family is protected from the fallout of one person’s addiction. So in that sense, the problem is contained.

    So I would advise care givers and abusers themselves to stop believing in non medical nonsense like astrology, marriage or mumbo jumbo as cure and focus on clinical treatment and counseling. It helps everyone.

    Aditi: Addiction is a disease. After a point it has nothing to do with will power or self control. But addiction is a treatable disease. Get help and get better.

    Government policy calls for a reduction in supply and a reduction in demand. How do you think this can be achieved?

    Reduction in supply is directly related to government controls. Enforcement agencies have do their bit.

    Reduction in demand is the call the entire community has to take. We have to promote awareness, provide support, change our attitudes

    As part of the preventive mechanism can you give us some safeguards that we as parents and members of society can apply to prevent substance abuse.

    I wish we had a foolproof agenda for this. Unfortunately, this is not possible.

    But parents and caregivers can do the following to minimise risk.

    • Keep the communication channel with your kids open. Communication does not mean talking; it means plenty of listening.

    • Refrain from abuse yourself: stop smoking, drinking, using violence- verbal and physical.

    • Remember authoritarian parental figures inhibit intimacy with children.

    • Don’t force your goals on your children. Do not expect them to come first in everything, or all the time

    • Use your intelligence and resources in helping them realise their potential in what they are gifted.

    • Spend a lot of time with them. Expensive gifts or other material sops are not a substitute for your presence.

    • Know your kids. AND KNOW THEIR FRIENDS. If your child is staying over with some friend, you should know quite a bit about this friend. Especially his or her lifestyle. This is not to say you should nag them or spy on them. Have the friends over. Acquaint yourself. Be alert to their habits.

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