How to end addiction
A30-year-old aviation professional had been married for less than a year when she discovered that her 34-year-old husband, a marketing executive, was addicted to alcohol. There were days when he would find it hard to leave the bed, sometimes soiling the sheets, alternating between violent and remorseful behaviour. The aviation professional sought counselling and eventually got her husband enrolled in a de-addiction programme.
According to Prevalence Of Drug Abuse In India Through A National Household Survey, a study published in 2015 in the International Journal Of Current Science, substance abuse (which includes alcohol, tobacco, drugs and dependence on any addictive substance) was acknowledged as one of the foremost public health problems in India, responsible for many deaths that could have been prevented.
In Substance Use And Addiction Research In India, published in the Indian Journal Of Psychiatry in January 2010, tobacco abuse was identified as highest among males in the age group of 41-50. Alcohol was the second most widely abused substance, followed by cannabis and opioids.
These days, of course, addictive behaviour can extend beyond these well-known vices. In addition to gambling, the use of inhalants and porn addiction, the internet too can be a threat, with recent reports of internet de-addiction centres cropping up in Delhi and Bengaluru.
“Alcohol, cannabis still form the bulk of our cases,” says Rohann Bokdawala, consultant neuro-psychiatrist at the Masina Hospital in Mumbai. “However, nowadays, dependence on newer designer drugs like MDMA, MCAT is common. Basically, consumption of anything in excess which disrupts daily routine and causes social and occupational impairment is addictive behaviour.”
“It is critical to understand what fuels addiction,” says M. Suresh Kumar, director and consultant psychiatrist at Psymed Hospital and senior consultant psychiatrist, department of neurosciences, Voluntary Health Services, Chennai. “Addiction is a brain disorder and not a personality flaw. However, besides the addict, addictive behaviour causes great pain to family members.” In the Indian context, the problem increases manifold since addictions tend to be stigmatized, with addicts being seen as morally flawed and lacking in willpower. “Many ‘rehabilitation’ centres in India are dehumanizing, merely locking up patients instead of treating the root cause of addiction in a scientific way,” says Dr Kumar.
The root cause, experts say, is the irresistible urge to indulge in behaviour or abuse a substance that triggers the release of dopamine, the neurochemical that is associated with intense pleasure and reward, in our brains. “Once this pattern of behaviour (trigger and reward) is established, it is hard to stop. More abuse creates critical changes in neural pathways,” says R. Dheep, a consultant psychiatrist at Apollo Specialty Hospitals, Madurai, de-addiction specialist and founder of the Madurai-based TOPKIDS counselling and personality development centre.
Such behaviour, in fact, could well be genetic. “It is 10-40% genetic in nature and the rest depends on environment and circumstances,” says Dr Bokdawala. “Addicts know fully well the damage they are doing to themselves, and yet procuring the substance becomes the main focal point of their existence. Over a period of time, they develop a tolerance to the substances they abuse.” Higher quantities of the substance are then required to attain the same level of euphoria.
For years, abstinence (whether it worked or not) was considered the only treatment for addictive behaviour. But treatments are now evolving.
Chemical detoxification involves the use of prescribed medication to keep substance abuse at bay. In the 1920s, chronic alcoholics were first given Disulfiram, a medication that produced extreme sensitivity to ethanol, the key intoxicating agent found in all liquor. “This worked because it produced, almost immediately, the extreme effects of a hangover whenever the patient consumed alcohol after taking the medication,” says Dr Dheep.
The drug would induce severe headaches, nausea and purging, dizziness, even lead to loss of consciousness if the patient drank after taking it. So alcoholics were often given cards that would identify them as Disulfiram users to hospital staff. “Initially, when Disulfiram was used, it was in doses that were much higher than what we see today,” says Dr Dheep.
“It was employed as a deterrent against drinking but the risk of collapse made doctors cautious about prescribing it. Eventually it was tapered down, but today, there are far more sophisticated neurological drugs that act on the brain. These minimize cravings that fuel all addictive behaviour. However, because Disulfiram is an inexpensive therapy, it is still in use in many government hospitals across the country,” he says.
Medication should, however, be seen at best as a short-term solution, given the side effects involved. For a lasting cure, psychiatrists are now turning their attention to habits that foster the addiction in the first place.
Identifying key triggers, changing habits
Habits play a key role in addictive behaviour. Sometimes, then, all it takes to end addiction is a change in long-term habits, some of which a person may not even be aware of. “For instance, if you’re an alcoholic and you pass a liquor shop on your route to work or go to parties that are overflowing with cocktails, there will be a moment when you won’t be able to resist temptation. We analyse a patient’s personal habits, so we can see how we can help eliminate these triggers that would be feeding their addiction,” says Dr Dheep.
An analysis of habits works best for alcohol and tobacco addictions, which are triggered by repetitive/cyclical behavioural patterns.
Opioids are drugs that act on the nervous system to relieve pain. “When treating a person addicted to opioids, psychological distress is a common issue, and it needs to be addressed,” says Dr Kumar. “In many cases, they use (and abuse) these drugs to manage chronic pain and relapse is very commonly seen in this group. In fact, 95% of the patients will relapse even after prolonged treatment and this can cause great trauma for families.
“In cases like this, abstinence is not recommended, as we would for alcohol or tobacco. We replace illicit drugs with certain prescription medication that has the same effects but which, over time, can be tapered and are not as addictive,” he adds. This treatment is called substitution therapy.
Family counselling and rehabilitation
“A very important aspect in dealing with de-addiction is to involve the family as much as possible and teach them how to handle the patient,” says Dr Bokdawala. The burden on the caregiver, when dealing with any kind of addiction can be immense, especially since relapse is so common.
“Evidence over the past five decades shows that nearly 80% of patients worldwide relapse in the first year. This may sound very disheartening but the numbers are improving.” Dr Bokdawala.
“If you have a family history of addiction, it helps to take precautions,” says Dr Kumar. This is because most addictive behaviour starts young, before the age of 18. “Exposing the brain to substance abuse at a very young age destroys the protective myelin sheath in the nerves and makes one vulnerable to neurological disorders.”
A holistic approach is needed, say experts. “Finding better, positive ways to manage stress right from a young age is critical,” says Dr Dheep. “Encourage children to spend more time engaged in activity outdoors—a bicycle ride, swimming, trekking. Teach them to embrace the simple joys of living to seek relief instead.”
■ New Delhi
SPYM De-Addiction Centre, Sector B-4, Vasant Kunj
Call: 26893872, 26136249
National Addiction Research Centre
Bhardawadi Municipality Building, Andheri (West)
National Institute of Mental Health and Neurosciences
Hosur Road, Wilson Garden
TTK Hospital (TT Ranganathan Clinical Research Foundation)
17, IV Main Road, Indira Nagar
Call: 24912949, 24426193