2. PREVALENCE OF DRUG ABUSE  20 LAKH PEOPLE ARE REGULAR DRUG USERS IN PUNJAB ONLY  66% OF SCHOOL GOING CHILDREN ARE ABUSING GUTKA  7 OUT OF 10 COLLEGE STUDENTS HAVE ABUSED ONE OR OTHER DRUG  3 OUT OF 10 GIRLS HAVE ABUSED ONE OR OTHER DRUGS  HOSTLERS MORE PRONE TO ADDICTION

3. MENACE OF DRUG ABUSE  PER HEAD CONSUMPTION OF ALCOHOL IS HIGHEST IN PUNJAB  GOVT. OF INDIA SPENDS RS 27000 CRORE ON TOBACCO RELATED PROBLEMS WHILE EARNS RS6000 CRORE FROM TOBACCO INDUSTRY  GOVT.HAS TO SPEND RS I20 ON HEALTH PROBLEMS CAUSED BY EVERY PACK OF CIGARETTES

5. CAUSES OF ADDICTION  OUT OF CURIOSITY  FOR PLEASURE KICK  LACK OF PARENTAL CONTROL  TOO MUCH POCKET MONEY  PRESSURE FROM FRIENDS  TO GAIN ACCEPTANCE IN GROUP  DEFIANT GESTURE AGAINST AUTHORITY  PREY TO PPEDDLERS OF DRUGS

6. CAUSES  ESCAPE FROM TENSIONS EMOTIONAL FRUSTRATION HIGH EXPECTATIONS OF PARENTS ADDICT PARENTS NEGATIVE ROLE MODEL FOR CHILDREN SOCIAL AND ECONOMIC FRUSTRATION

7. PEDDLERS

9. CURIOSITY

10. TRAP OF DRUGS

11. POTENTIAL ADDICTS  LOW SELF ESTEEM  LACK OF AMBITION FOR FUTURE  NON PARTICIPATION IN SPORTS, EXTRA CURICULAR ACTIVITIES  INVOLVEMENT IN POLITICAL MOVEMENTS  SIBLING USE OF DRUGS,ALCOHOL  DRUG USE IN FRIENDS

12. Potential drug users  BROKEN FAMILIES  UNHAPPY FAMILY  NOT PRACTISING ANY RELIGION  PARENTAL USE OF CIGARETTES  EXCESSIVE ALCOHOL USE BY PARENTS  POOR ACADEMIC ACHIEVEMENTS

13. CHILDREN OF ADDICTS

14. RECOGNISING AN ADDICT  AVOIDING PEOPLE  SPENDING LONG HOURS IN BATHROOM  PREFER TO BE ALONE  DROPP ING OLD FRIENDS  SUDDEN NEW FRINDS CIRCLE  LOSS OF INTERST IN GAMES,EXTRACURICULAR ACTIVITIES

15. KEEP EYES OPEN FOR THESE CHANGES  STEALING,BORROWING MONEY  EXCESSIVE SPENDING OF MONEY  ERRATIC BEHAVIOUR,CONFUSED THOUGHTS  SUDDEN UNEXPLAINED TEMPER TANTRUMS  LAZINES,APATHY,IRRITABILITY  EMOTIONAL INSTABILITY

16. PHYSICAL CHANGES  REDNESS OF EYES  PUFFINESS UNDER EYES  SLURRING OF SPEECH  UNSTEADY GAIT  LOSS OF APPETITE  FRESH\NUMEROUS INJECTION SITES  PECULIAR SMELL FROM BREATH  SHABBILY DRESSED

18. THREE STAGES OF ADDICTION Stage I Experimental and social use Frequency of use Occasional / usually on weekends Source of drugs / alcohol Friends / peers at parties

19. REASONS  Curiosity / risk taking and seeking thrill  For pleasurable feelings / relief from boredom  Peer pressure / to be sociable  To obtain social acceptance  To appear grown up / to defy parental limits

20. EFFECTS  Experiences euphoria and returns to normal state after using  Small amount may cause intoxication  Feelings sought - fun, excitement, thrill, belonging and control

21. BEHAVIOURAL INDICATORS  Little noticeable change  Experiences moderate hangovers  Occasional evidence of use such as beer can or marijuana joint

22. Stage II - Abuse Frequency of use  Regular / several times per week  Some times during the day  Prefers to use alone Source of drug / alcohol  Friends  Buys for himself  May borrow / steal / peddle drugs to maintain supply

23. REASONS  To manipulate emotions – experience pleasure, cope with stress and uncomfortable feelings and to overcome feelings of inadequacy  To stay high or at least to maintain normal feelings

24. EFFECTS  May experience discomfort in the absence of drugs  Intoxication becomes regular  Feelings sought - pleasure, relief from negative emotions and stress reduction  May feel guilty, ashamed and afraid  Has suicidal ideation / may attempt suicide  Tries to control use but fails

25. BEHAVIOURAL INDICATORS  Mood swings  Changes in personality  Lying and stealing  Change in friendships ……..  Decline in work performance

26. BEHAVIOURAL INDICATORS (contd..)  Decrease in extra curricular activities  Begins adopting drug culture (clothing, hairstyle) ……..

27. BEHAVIOURAL INDICATORS (contd..)  Conflict with family members  Becomes more rebellious  Interest focused on procuring and using drugs / alcohol

28. Stage III Dependency / addiction Frequency of use  Daily use / continuous Source of drugs / alcohol  Uses any means to get alcohol / drugs  May engage in criminal activities to get money for drugs

29. REASONS  Has no control over his behaviour  To avoid pain and depression  To escape from realities of daily living

30. EFFECTS  Normal state is pain and discomfort  Unlikely to experience euphoria  Experiences suicidal thoughts / may attempt suicide ……..

31. EFFECTS (contd..)  Guilt, shame and remorse  Repeated blackouts  Changing emotions such as depression, irritation and apathy Experiences

32. BEHAVIOURAL INDICATORS  Physical deterioration including weight loss, health problems  Memory loss, flash back, paranoia, volatile mood swings and other psychiatric problems  Likely to dropout or get expelled from college or lose jobs ……..

33. BEHAVIOURAL INDICATORS  Away from home most of the time  Possible overdoses  Not concerned about being caught  Focuses only on procuring and using drugs

34. TREATMENT CENTRE

35. DRUGS

36. TREATMENT  ADDICTION IS AN ILLNESS  IT IS A CURABLE DISEASE  SIGN OF MORAL WEAKNESS  RECOGNITION OF PROBLEM IS HALF THE BATTLE WON  SEEKING PROFESSIONAL HELP IS  ROLE OF FAMILY IS VERY IMPORTANT

37. TREA T MENT

38. Methods  Medical and nursing care  Assessment  Supportive counseling

39. MEDICAL TREATMENT  DETOXIFICATION OF DRUGS UNDER MEDICAL SUPERVISION  WITHDRAWL OF ADDICTION  CONTROL OF WITHDRAWL SYMPTOMS  ENGAGING IN OTHER SOCIAL ACTIVITIES  MAKING NONAVAILIBILITY OF DRUGS

40. DRUGS FREE ZONE

42. MEDICAL TREATMENT Medical care to deal with withdrawal symptoms, co-existing medical / psychiatric problems

43. Methods v Counseling v Involving family and significant others v Making appropriate referrals

44. COUNSELLING  MOTIVATING THE PATIENT FOR TREATMENT  REALISATION OF PROBLEM OF ADDICTION BY ADDICT  FAMILY PLAYS A BIG ROLE  ROLE OF SOCIAL WORKERS  RELIGIOUS GROUPS

47. REHABILITATION  BEHAVIOURAL THERAPY  CHANGE IN PEER GROUP  IMPROVE FAMILY ATMOSPHERE  SUPPORT,EMOTIONAL SECURITY FROM FAMILY  PSYCHOLOGICAL BUILDING UP OF ADDICT

49. FOLLOW-UP  Essential part of case management

50. FREQUENCY OF FOLLOW-UP  Very regular in the initial phase of recovery - Once every 10 days for 3 months and then monthly visits until one year  Quarterly visits after 1 year for at least four more years

51. WHAT HAPPENS IN A FOLLOW-UP?  Drug free status  Health condition  Family relationships  Social relationships  Occupational status  Financial status  Leisure time activities Review about the client in the following areas

52. STRENGTHENING FAMILY RELATIONSHIPS  Interaction with spouse,children and other family members  Efforts taken to patch up strained relationships  Assuming responsibilities at home  Quality time spent with family members

53. RENEWING SOCIAL RELATIONSHIPS  Participating in family functions  Socializing – making new friends

54. OCCUPATIONAL STATUS  Regularity and punctuality at work  Adaptability to work with colleagues  Improvement in efficiency and concentration  If unemployed, efforts taken to get a job

55. RECREATIONAL SCHEDULE  Reviving old hobbies  Getting involved in new activities  Physical exercises / games  Yoga and meditation

56. CHOICE

57. WHO CAN BE A SUPPORT PERSON A support person is  Genuinely interested in the client’s well-being  Not using alcohol / drugs  A person whom the client respects and holds in high regard  Someone who can constantly be in touch with the client

58. SOCIAL SUPPORT PROGRAMME Patient OccupationFriendsHealthFamily Religion Managers Supervisors At work In society Family physician / medical officers at work place Parents In- laws Siblings Clergymen Religious heads