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

MENACE OF DRUG ABUSE  PER HEAD CONSUMPTION OF ALCOHOL IS HIGHEST IN PUNJAB  GOVT. OF INDIA SPENDS RS 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

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

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

PEDDLERS

CURIOSITY

TRAP OF DRUGS

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

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

CHILDREN OF ADDICTS

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 ……..

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

TREATMENT CENTRE

DRUGS

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

TREA T MENT

Methods  Medical and nursing care  Assessment  Supportive counseling

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

DRUGS FREE ZONE

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

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

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

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

FOLLOW-UP  Essential part of case management

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

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

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

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

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

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

CHOICE

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

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