2.1 What is Substance Addiction?

OVERVIEW:

Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication. Substances such as alcohol, marijuana and nicotine also are considered drugs. When you're addicted, you may continue using the drug despite the harm it causes. Substance Addiction is a psychological dependence and habit-forming of a person to particular substance which will not be under voluntary control. Impact of Substance abuse can affect almost all organs in the human body; Substance use can weaken the immune system, increasing susceptibility to infections.

Drug addiction can start with experimental use of a recreational drug in social situations, and, for some people, the drug use becomes more frequent. For others, particularly with opioids, drug addiction begins with exposure to prescribed medications, or receiving medications from a friend or relative who has been prescribed the medication.

The risk of addiction and how fast you become addicted varies by drug. Some drugs, such as opioid painkillers, have a higher risk and cause addiction more quickly than others.

As time passes, you may need larger doses of the drug to get high. Soon you may need the drug just to feel good. As your drug use increases, you may find that it's increasingly difficult to go without the drug. Attempts to stop drug use may cause intense cravings and make you feel physically ill (withdrawal symptoms).

You may need help from your doctor, family, friends, support groups or an organized treatment program to overcome your drug addiction and stay drug-free.

figure 2.1 (a) introduction to substance addiction

VIEW OF THE DISORDER:

Recognizing unhealthy drug use in family members

Sometimes it's difficult to distinguish normal teenage moodiness or angst from signs of drug use. Possible indications that your teenager or other family member is using drugs include: Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes Neglected appearance — lack of interest in clothing, grooming or looks Changes in behavior — exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

SUBSTANCE ADDICTION

LEGAL CONSEQUENCES

MENTAL HEALTH PROBLEMS/ PTSD

figure 2.1 (b) addiction and its consequences

SOCIAL STIGMA

Substance abuse carries both social stigma and the potential for negative legal consequences for the addict. Thus, substance abuse is often underreported.

SYMPTOMS:

Drug addiction symptoms or behaviors include, among others: •Feeling that you have to use the drug regularly — daily or even several times a day •Having intense urges for the drug that block out any other thoughts •Over time, needing more of the drug to get the same effect •Taking larger amounts of the drug over a longer period of time than you intended •Making certain that you maintain a supply of the drug •Spending money on the drug, even though you can't afford it •Not meeting obligations and work responsibilities, or cutting back on social or recreational activities because of drug use •Continuing to use the drug, even though you know it's causing problems in your life or causing you physical or psychological harm •Doing things to get the drug that you normally wouldn't do, such as stealing •Driving or doing other risky activities when you're under the influence of the drug •Spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug •Failing in your attempts to stop using the drug •Experiencing withdrawal symptoms when you attempt to stop taking the drug [1].

•Changes in personality traits

•Mental illness like depression or anxiety

•Paranoid, fearful or obsessive thoughts

•Negative self-image

•Dismal outlook on or attitude toward life

•Withdrawing emotionally from loved ones

•Lack of motivation

•Feelings of apathy or disinterest

SYMPTOMS V/S SOLUTION

STILLNESS, FOCUS

CALM

DISTRACTION

POSITIVE ENVIORNMENT

ENGAGING ACTIVITY

FEELING OF BELONGING

A PROPER ROUTINE

HEALTHY INTERACTION

figure 2.1 (c)

figure 2.1 (c) transforming negativity to positivity

DRUG ABUSE IN INDIA:

The epidemic of substance abuse in young generation has assumed alarming dimensions in India. Changing cultural values, increasing economic stress and dwindling supportive bonds are leading to initiation into substance use. According to the World Health Organization (WHO) substance abuse is persistent or sporadic drug use inconsistent with or unrelated to acceptable medical practice. The picture is grim if the world statistics on the drugs scenario is taken into account. With a turnover of around $500 billions, it is the third largest business in the world, next to petroleum and arms trade. About 190 million people all over the world consume one drug or the other.

According to a UN report, 1million heroin addicts are registered in India, and unofficially there are as many as five million. What started off as casual use among a minuscule population of high-income group youth in the metro has permeated to all sections of society. Inhalation of heroin alone has given way to intravenous drug use, that too in combination with other sedatives and painkillers. This has increased the intensity of the effect, hastened the process of addiction and complicated the process of recovery. Cannabis, heroin, and Indian-produced pharmaceutical drugs are the most frequently abused drugs in India. Cannabis products, often called charas, bhang, or ganja, are abused throughout the country because it has attained some amount of religious sanctity because of its association with some Hindu deities. The International Narcotics Control Board in its 2002 report released in Vienna pointed out that in India persons addicted to opiates are shifting their drug of choice from opium to heroin. The Important finding of these studies is that alcohol was the commonest substance used (60-98%) followed by cannabis use (4-20%). Epidemiological surveys also revealed that 20-40% of subjects above 15 years are current users of alcohol and 10% of them are regular or excessive users. In a rural population of Uttar Pradesh alcohol was found to be the commonest substance abused (82.5%) followed by cannabis (16.1%).It was found that rates of current use of alcohol in Punjab were 45.9% in Jalandhar and 27.7% in Chandigarh whereas it was 28.1% in rural areas of Punjab . It was reported that 38.3% of the rural population in Uttar Pradesh was habitual substance users. In a study conducted in rural community in Bihar prevalence of alcohol/drug use was found to be 28.8% of the study population.[2]

figure 2.2 (a) statistical data

There has been a sudden spike in the drug smuggling cases in Gujarat that was noted after the second wave of Covid 19. The compiled cases in the reports showed that since June, both the local police and NCB have seized narcotics worth above Rs 6.6 crores in 21 cases and had arrested over 52 people in drug trafficking from different parts of the state. The police said that for cheap intoxicants like ganja and bhang, cannabis and hemp plantations are grown by local farmers in Gujarat. The Anand police in May busted a huge marijuana plantation and seized over 900 kgs of plants sown amongst the jowar crops. Talking about the addictions, Dr Alpa Vyas, a counsellor at the Naya Jeevan De-addiction Centre said that there are over 250 addicts that visited the center in the past year. While many leave abruptly, some complete their 30 days rehab period while some may return to the center after each relapse.[3]

figure 2.2 (b) excerpt from a news article

figure 2.2 (c) excerpt from a news article figure 2.2 (d) excerpt from a news article

figure 2.2 (e) excerpt from a news article figure 2.2 (f) excerpt from a news article

There is official prohibition in the state of Gujarat since its inception in 1960. However, this exists merely on paper. In reality, it is a different story. As anyone who has enjoyed a drink (or two or more) in Gujarat will tell you, alcohol is easily available. In fact, it is home-delivered like pizza. As expected, this has led to crime and tragedy. There are no proper rehabs in the state. Some hospitals provide detox services, but proper rehabilitation for alcoholics and addicts is not available in Gujarat. Hope Trust Rehab In Hyderabad has received a surprisingly large number of clients from Gujarat. This, despite prohibition! [4]

MAIN REASONS

• Easy availability of substance • Spike in cases after Covid-19 • Enhanced prosperity and peer pressure • No proper rehabs in Gujarat • People looking for rehabs often look for a rehab outside Gujarat

figure 2.2 (g) Ahmedabad iconography

Ahmedabad is the largest city of Gujarat. The former capital, administrative headquarters, and seat of the Gujarat high court. A search for de-addiction Ahmedabad rehabilitation does not return many results. For a city of more than a few million people, there should be more services available. [5] Dr Rajendra Anand. “On an average, I see a new patient of addiction every day in Ahmedabad and Gandhinagar,” he says.

HOW CAN ONE HELP ADDICTS?

CHOOSES HELP VOLUNTARILY

REHABILITATION

GROUP 1

figure 2.3 (a) group classification DOES NOT CHOOSE HELP VOLUNTARILY

AWARENESS

GROUP 2

GROUP 1 USER GROUP COMPARISION

GROUP 2

• Have identified their problem i.e.. are self aware • Can afford • Aren't quite worried about the stigma • Falls in educated and comfortable socio economic background

• Haven't identified their problem i.e. are unaware. • Mostly wont be able to afford. • Cares about the stigma • Falls in less educated and lowerlower middle socio economic background

SERVICES AVAILABLE

GROUP 1

• There are over 1500 rehab centers in India. The current scenario of rehabs in India may not be appropriate, as they might not suit the concept of rehabs. Dr.

Ashok Rao (CEO, trustee of freedom foundation) • The major problem is if the rehab if apt., it isn’t affordable to larger audience. e.g.. Alpha healing center,

Abhasa rehab center. • To create awareness against the menace of drug abuse and alcoholism among students, youths, general public especially slum dwellers, factory and mill workers who are totally exposed to alcohol and drugs. • The very first step to detox this user type is awareness. Many organizations are working on it door to door. e.g.. Naaya Jeevan IRCA,

Kalarav CPLI,Umang ODIC

GROUP 2

GROUP 1 SERVICES AVAILABLE

GROUP 2

figure 2.3 (b) Alpha Healing Center, Baroda, Gujarat

figure 2.3 (c) Veda Rehab Center, Ahmedabad, Gujarat

figure 2.3 (d) Mindcare De-addiction Center, Ahmedabad,Gujarat figure 2.3 (e) Naaya Jeevan IRCA

figure 2.3 (f) Kalarav CPLI

figure 2.3 (f) Umang ODIC

Rehabilitation is defined as “a set of interventions designed to optimize functioning and

reduce disability in individuals with health conditions in interaction with their environment”.

Set forth plainly, restoration helps a kid, grown-up or more seasoned individual to be pretty much as free as conceivable in regular exercises and empowers support in schooling, work, diversion and significant life jobs like dealing with family. It does as such by tending to basic circumstances (like agony) and working on the way a singular capacities in regular day to day existence, supporting them to defeat hardships with thinking, seeing, hearing, conveying, eating or moving around.

Recovery is profoundly individual focused, implying that the mediations and approach chose for every individual relies upon their objectives and inclinations. Recovery can be given in various settings, from ongoing or short term clinic settings, to private facilities, or local area settings, for example, a singular's home.[6]

Helps in optimal degree of :

• Functionality • Personal Autonomy • Quality of life

figure 2.4 (a) illustration depicting restoration of mind

Restoration of an individual’s health, efficiency, and well-being.

DRUG REHABILITATION:

• Drug rehabilitation is the psychotherapeutic treatment given to drug addicts. It helps the patient to get rid of substance abuse as well as process abuse. The treatment mainly includes counselling by experts, medication for depression, making them to be spiritual.

Drug rehabilitation centers offer certain programs which include residential treatment, local support groups, extended care centers, recovery houses, and out-patient. • Principles of effective drug rehabilitation treatment are no single treatment is appropriate for all, Treatment needs to be readily available, Effective treatment attends to the multiple needs of the individual, Treatment plans must be assessed and modified to meet changing needs, Remaining in treatment for an adequate period of time is critical for treatment effectiveness. • Counseling and other behavioral therapies are critical elements of rehabilitation,

Medications are crucial element of treatment for many patients, and possible drug use during treatment must be monitored continuously Rehabilitation programs need to work close to the patient, offering a variety of options like local support groups and extended care supports. • Rehabilitation is one of the hardest thing that one addict has to accomplish. [7]

figure 2.4 (b) illustration depicting drug addiction

Addiction treatment centers provide people addicted to Substances or alcohol, additional care and assistance that they need.

REHAB CENTER:

Patients should expect to undergo the following steps when they enroll in a comprehensive drug rehab program: •Orientation. The first few days of treatment are focused on helping the patient to feel comfortable in the program and assisting the medical team in better understanding the needs of the individual patient. The doctors and therapists must be familiar with the patient’s drug history, mental health history, and medical history in order to create a personalized treatment plan that will be effective. •Detox. If the patient has physical dependence and/or withdrawal symptoms, detox is the first step after diagnostic evaluation. Patients may receive medication if warranted and begin the process of the psychotherapeutic care that will define the bulk of their rehab experience. •Counseling. Next, patients receive care through experiential, personal and group therapy sessions. This time is when patients begin the process of working on the trauma and mental health issues that may have pushed them toward addiction in the first place. •Aftercare. When patients return home after treatment, they pick up where they left off during the counseling process. Aftercare can consist of therapy, yoga, treatment services such as acupuncture and even a residential sober living program.[8]

figure 2.4 (c) how rehabilitation works

Substance and alcohol addictions are diseases, but they are treatable. Addiction treatment is offered at detox clinics, outpatient facilities and full-service rehab centers, but the quality of treatment can vary greatly among these facilities. These programs include:

• Medically assisted detox • Inpatient (residential) • Partial hospitalization • Intensive outpatient • Outpatient • Teletherapy or Online Rehab • Aftercare [11]

Long term therapy communities regularly incorporate clinical direction and management and reference to an assortment of step-down programs that you can change towards subsequent to finishing clinical detox. While getting long term treatment, you'll live nearby at a recovery office in a steady and managed climate. In the wake of completing ongoing recovery, you might keep recuperating in a private, fractional hospitalization, serious short term or short term treatment setting.

“An inpatient drug rehab offers the opportunity to express complex feelings, receive support from a compassionate community, and work through trauma in a safe environment with highly skilled and devoted professionals.”[10]

figure 2.5 (a) explanation of an inpatient rehab center

WHY IN-PATIENT REHAB CENTRE?

• HAVE TO STAY FOR ABOUT 30 DAYS • BREAKS YOUR EVERYDAY ROUTINE INVOLVING SUBSTANCE • NO ACCESS TO SUBSTANCE • HELPS IN DEVELOPING NEW HEALTHY HABITS • SUCCESS RATE • HAVING A COMMUNITY

IN-PATIENT REHAB DETOX PROGRAMS

•Comprehensive evaluation and treatment planning •24-hour nursing supervision •Medication management, if necessary •Meeting with a psychiatric provider one or more times a week •A community meeting group •Ongoing review of treatment goals •Individual therapy •Recreational therapy, such as meditation and yoga •Daily group therapy, including specialty groups and peer groups •Aftercare and discharge planning (a necessary component in this level of care) [11]

figure 2.5 (b) process of in-patient rehab program