Drugs are chemicals that have a profound impact on the neurochemical balance in the brain which directly affects how you feel and act. People who are suffering emotionally use drugs, not so much for the rush, but to escape from their problems. They are trying to self-medicate themselves out of loneliness, low self-esteem, unhappy relationships, or stress. This is a pattern that too often leads to drug abuse and addiction.
Identified as a disease in 1956 by the World Health Organisation (WHO) and the American Psychiatric Association, drug abuse is the illicit consumption of any naturally occurring or pharmaceutical substance for the purpose of changing the way in which a person feels, thinks or behaves, without understanding or taking into consideration the damaging physical and mental side-effects that are caused.
Grim Scenario in Indian Subcontinent
The news for India and the subcontinent on narcotic drugs is not encouraging. India has since long been precariously flanked by Asia’s two biggest drug producing regions –- the Golden Triangle comprising Myanmar, Laos and Thailand, and the Golden Crescent comprising Afghanistan, Pakistan and Iran.
A recently released report prepared by the Inter-national Narcotics Control Board (INCB) has painted a grim picture for the region. First, there is an increase in the trafficking of amphetamine-type stimulants or ATS and their precursor chemicals throughout South Asia.
This is important because ATS are abused by more people than cocaine and heroin combined. Mani-pulating pleasure centres of the brain, these synthetic drugs, which include ‘speed’ and ‘ecstasy’, are easy to produce, cheap to buy and hard to control.
UN Report
A recent report prepared by the UN office on Drugs and Crime states that ATS alone affect approximately 25 million worldwide with most abuse taking place in East and South-East Asia. It has not so far been ascertained whether the Indian subcontinent is becoming a recipient or is merely serving as a transit area between manufacturing hubs in East Asia and the rapidly growing illicit markets on the Arabian peninsula.
Second, the HIV transmission rate in the subcontinent is still high among persons who abuse drugs by injection and this has only been rising in the subcontinent. The INCB report observes that in India the prevalence of HIV infection among such drug abusers in 2006 was estimated at a national average of 8.71 per cent.
In Bangladesh, HIV prevalence among such drug abusers in the region of Dhaka alone rose from 1.4 per cent to 7 per cent in 2006. In Nepal, HIV prevalence among such drug abusers in Kathmandu was the highest in this region at 34 per cent.
According to the report, apart from alcohol (62.46 million users), cannabis (8.75 million users), opiates such as heroin, opium, buprenorphine and propoxyphene (2.04 million users), and sedatives (0.29 million users) are the drugs most abused. Between 17 per cent and 20 per cent of current drug users were classified as dependent users (addicts). The users were mostly male; the Rapid Assessment Survey found only eight per cent of drug users to be women. By and large, young, underemployed males and marginalised populations were prone to drug abuse.
Drug abuse causes a range of health complications—from weakness, loss of body weight and respiratory disorders. Often, under the influence of drugs, addicts also indulge in high-risk behaviours such as unsafe sex and needle sharing, which has contributed to the spread of infectious diseases such as HIV/AIDS and Hepatitis C. One of the most important effects of drug abuse is impaired judgment and a lack of rational thinking. Addicts develop psychological problems such as depression, anxiety and irritability, apart from personality problems.
The Reasons
People start on drugs for a number of reasons, from curiosity and recreation to the need to cope with stress. What begins as abuse can often lead to dependence. Physically, the body develops tolerance for it, and more of the drug is needed to experience the same effect. This leads to increases in consumption, which eventually leads to physical dependence. At that stage, lack of the drug causes severe withdrawal symptoms, which disappear if the drug is taken again; this ensures that abusers remain hooked.
Users are almost always young, initiated into drug use with alcohol and then with cannabis and its derivatives. Often, they graduate to other, more potent, drugs such as narcotic analgesics, stimulants, depressants, hallucinogens and volatile solvents. Most abusers consume multiple drugs. According to a psychiatrist, who has been treating patients with drug dependence problems for several years, the easy availability of drugs, curiosity, peer approval and thrill-seeking are the most common reasons for drug abuse among the youth.
The incidence of drug abuse is also high among people with untreated psychiatric or emotional problems, who often resort to taking drugs as a coping mechanism. Thus drug abuse may be primary or secondary to an existing emotional problem. Deeper emotional issues caused by dysfunctional families, feelings of self-hate, low self-esteem, and physical or mental abuse are some issues that need to be addressed during the identification and treatment of the problem.
Treatment and Recovery
As in all diseases, timely treatment is essential. But unfortunately warning signs often go unheeded, especially among the youth. There is almost always deterioration in the normal daily functioning. Sleeping late, mood changes, deterioration in academic performance, behaviour problems such as aggression, rebelliousness and hyperactivity, lack of concentration and so on, are often ignored by family members as signs of adolescence rather than symptoms of addiction. To sustain their habit, with which they become obsessively preoccupied, addicts often lie, steal and manipulate family members.
According to the report, apart from alcohol (62.46 million users), cannabis (8.75 million users), opiates such as heroin, opium, buprenorphine and propoxyphene (2.04 million users), and sedatives (0.29 million users) are the drugs most abused. Between 17 per cent and 20 per cent of current drug users were classified as dependent users (addicts). The users were mostly male; the Rapid Assessment Survey found only eight per cent of drug users to be women. By and large, young, underemployed males and marginalised populations were prone to drug abuse.
Drug abuse causes a range of health complications—from weakness, loss of body weight and respiratory disorders. Often, under the influence of drugs, addicts also indulge in high-risk behaviours such as unsafe sex and needle sharing, which has contributed to the spread of infectious diseases such as HIV/AIDS and Hepatitis C. One of the most important effects of drug abuse is impaired judgment and a lack of rational thinking. Addicts develop psychological problems such as depression, anxiety and irritability, apart from personality problems.
The Reasons
People start on drugs for a number of reasons, from curiosity and recreation to the need to cope with stress. What begins as abuse can often lead to dependence. Physically, the body develops tolerance for it, and more of the drug is needed to experience the same effect. This leads to increases in consumption, which eventually leads to physical dependence. At that stage, lack of the drug causes severe withdrawal symptoms, which disappear if the drug is taken again; this ensures that abusers remain hooked.
Users are almost always young, initiated into drug use with alcohol and then with cannabis and its derivatives. Often, they graduate to other, more potent, drugs such as narcotic analgesics, stimulants, depressants, hallucinogens and volatile solvents. Most abusers consume multiple drugs. According to a psychiatrist, who has been treating patients with drug dependence problems for several years, the easy availability of drugs, curiosity, peer approval and thrill-seeking are the most common reasons for drug abuse among the youth.
The incidence of drug abuse is also high among people with untreated psychiatric or emotional problems, who often resort to taking drugs as a coping mechanism. Thus drug abuse may be primary or secondary to an existing emotional problem. Deeper emotional issues caused by dysfunctional families, feelings of self-hate, low self-esteem, and physical or mental abuse are some issues that need to be addressed during the identification and treatment of the problem.
Treatment and Recovery
As in all diseases, timely treatment is essential. But unfortunately warning signs often go unheeded, especially among the youth. There is almost always deterioration in the normal daily functioning. Sleeping late, mood changes, deterioration in academic performance, behaviour problems such as aggression, rebelliousness and hyperactivity, lack of concentration and so on, are often ignored by family members as signs of adolescence rather than symptoms of addiction. To sustain their habit, with which they become obsessively preoccupied, addicts often lie, steal and manipulate family members.
A patient’s recovery process thus involves not only abstinence but also lifestyle changes. Detoxification, the first phase in treatment, involves medical management to make the withdrawal process safe and comfortable. For effective care and full recovery, psychological support is necessary and coexisting psychiatric problems have to be identified and treated simultaneously with the addiction.
In fact, according to the various components of the National Survey, hardly a third of drug-dependants reported having taken treatment (it was as low as two per cent in one of the components). There was also a significant time lag between the onset of dependence and the seeking of treatment, largely owing to a lack of knowledge about the need for treatment and rehabilitation and access to treatment facilities.
There is a general perception that “will power” alone is enough to stop taking drugs. While personal motivation is indeed crucial to recovery, it is important that patients and their families know that drug abuse is a disease that can be treated with appropriate and timely medical and psychological help.
Relapse prevention is also an important part of the recovery process. Isolating recovering addicts from friends who use drugs is essential. Support groups such as Narcotics Anonymous (NA) (an international brotherhood where recovering addicts help and motivate each other to abstain from drug abuse) are of enormous help in preventing a relapse.
Tough Challenge
The challenges to the international drug control system are as daunting today as they were a century ago and perhaps more complex. Of considerable concern is the impact of globalisation that has been facilitated by the advances in information and communication technologies.
Another challenging fallout of the communication revolution is the emergence of ‘rogue’ pharmacies that are encouraging drug abuse among vulnerable groups. For example, the report observes that in the US, where the abuse of prescription drugs by young adults has been rising sharply since 2002, 34 illegal Internet pharmacies dispensed more than 98 million dosage units of hydrocodone products during 2006.
At the lower end of the spectrum of those vulnerable are a rising number of educated unemployed graduates. Rural people, another vulnerable group, are dominant opium abusers. According to the National Survey, between 51 per cent and 76 per cent of drug users were from rural areas, and between 16 and 49 per cent were illiterate.
In fact, focused interventions are needed to prevent the initiation of new users and the progression of occasional and casual users to dependent users, and for the treatment, aftercare and rehabilitation of established dependent users. The prevention programmes based only on information dissemination were rarely successful, especially if the approach depicted exaggerated risks associated with drug use in order to frighten people into abstinence. A less sensational, scientific approach, which presents accurate information of facts and risks, would be highly effective.
Given the large and rising number of drug abusers and the complex nature of the problem, it is important that the issue is brought into the domain of public health care and related to such other issues as crime prevention, health care, lifestyle changes and education. It should become part of a larger public discourse, rather than a problem to be dealt with after it reaches a chronic stage.
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