ADDICTION

ARE YOU SUFFERING FROM ADDICTION?
Are you or a loved one repeatedly engaging in substances such as alcohol, tobacco,or cocaine without being able to stop?

Are you or your loved one ignoring work and other responsibilities to engage in such activities?

At Mumbai Psychiatrics Clinics, we have set up a De-addiction Clinic in Mumbai to help people from all over India find relief from their addictions. We are attached to the best De-addiction Centre in Mumbai if someone requires to get admitted for de-addiction purpose

What If There Was A Way Out?

Read on to understand what is happening and how you can help yourself…

It started with an occasional beer or a smoke here and there. Before you know it, you were drinking or smoking more and more every day. This habit slowly took over your life. Now, you cannot focus on work or at home. Your relationships are suffering, and so are you. You want to stop, but you do not know how. Sounds familiar? It is possible that you are suffering from an ADDICTIVE DISORDER.

The following symptoms are found in those suffering from a Substance Use Disorder. If you seem to feel that some or several of them apply to you, speak to the doctor! A formal evaluation encompassing assessments related to developmental, educational, psychological, as well as medical aspects of your history could help in identifying steps to reclaim your life!

Symptoms:

• Increasingly indulging in substance to experience the same amount of ‘high’
• Constantly wanting to cut down, but finding it impossible to do so
• Preoccupation with using the substanceor acquiring it
• Inability to function optimally, as a lot of your activities now revolve around the substance
• Intense craving, especially when in situations where you have previously consumed the substance
• Failing to do your tasks at school, work or home
• Inability to stop despite problems in your interpersonal relationships
• Losing interest or lack of participation in familial, social or work related activities
• Using the substance, even when it may be hazardous (e.g., drinking before driving)
• Being aware of physical or psychological problems caused by it, but being unable to stop
• Experiencing severe withdrawal when abstaining from the substance or activity
• Becoming agitated or angry if asked to do cut down

What Is Addiction?

Substances such as alcohol, tobacco, marijuana, opioid, inhalants and so on, change mood or behaviour, or both. These substances are often consumed occasionally for social or recreational purposes. However, at times, the use of such substances becomes excessive, leading to substantial impairment in personal, professional, and social life. In such a case, an individual is said to have become dependent on such substances. Similarly, behaviours such as gambling, exploring the internet, shopping or internet gaming can become addictive if they lead to significant interference in a person’s ability to function optimally. If the indulgence is associated with the above-mentioned symptoms, a person is said to have a “Substance Use Disorder” or an “Addictive Disorder”. Such disorders often begin in early adolescence, with extremely high prevalence in individuals aged 18-24 years.

The types of addictive substances include, but are not limited to alcohol, caffeine, marijuana, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants (cocaine and amphetamine related substances) and tobacco.

Causes:
Changes in the structure and chemistry of the brain are associated with a transformation from drug use to drug dependence. When a person ingests a drug, the drug interacts with the limbic system of the brain, which is asso-ciated with emotions as well as rewards. Thus, a drug directly affects the re-ward-pathway in the brainto produce feelings of pleasure or alleviation of dis-turbed emotion.

The process of using a drug is often accompanied with positive expectations of the desired effects. When the use of drug produces these desired positive effects, the individual receives a reinforcement to repeat this behaviour in the future. In addition, if such behaviour results in approval from friends and peers, it is more likely that the behaviour will re-occur in the future. Thus, this behaviour is learnt.

Genetic factors also play an important role in the development of drug de-pendence. Scientific research suggests a higher risk of development of sub-stance use disorders amongst those with family history of substance use.

In addition, environmental factors, such as ease of availability of drug, use amongst peers, culturally sanctioned use, and so on contribute to an in-creased risk of dependence.

The specific disorder associated with each substance is described below.

• Alcohol:Alcohol is a depressant that interferes with the functioning of several neurotransmitters in the brain.
  • Effects: Alcohol initially leads to reduction in inhibitions and feeling good about oneself. Since alcohol lowers the functions of inhibitory centres, as well as other centres of the brain, increased consumption leads to slurred speech, lowered motor activity, slow responsiveness, and impairments in judgement.Along with the symptoms mentioned at the beginning, those with alcohol use disorder continue drinking alcohol despite physical problems such as liver disease and recurrent blackouts; psychological problems such as depression; or interpersonal problems such as aggressiveness.
  • Withdrawal: The person may experience withdrawal beginning from 4 to 12 hours after consumption. Since it is undesirable, the individual may consume more alcohol to mitigate symptoms of withdrawal
  • Age of onset:Typically begins in late teens to early 20s. Rarely begins after the age of 40.
  • Gender differences: Males have a higher risk of drinking and related disorder than women.
  • Comorbidity: This disorder frequently occurs along with severe anxiety and depression, conduct problems, as well as antisocial behaviour.
  • Causes:
    • Environmental: Alcohol is widely, easily and legally available as compared to other substances. Additionally, consumption of alcohol to a certain extent is often culturally accepted. This results in greater consumption and hence higher risk of alcohol use disorder. Extreme stress, peer pressure, faulty ways of coping, overestimation of positive effects of alcohol also contribute largely.
    • Genetics: This condition has a threefold risk in those with close relatives suffering from this disorder, even when they are adopted into families with no history of the disorder.
• Caffeine: Caffeine is a stimulant, one of the most commonly ingested substances in the world. It is present in tea, coffee, sodas, energy drinks, analgesics and cold remedies, weight-loss aids, as well as in chocolate. This is considered to be the one of the least harmful psychoactive substance, with no long lasting effects.
  • Effects: In small amounts, caffeine elevates mood, and increase alertness. In extremely large doses, it could lead to restlessness, nervousness, excitement, insomnia, flushed face, diuresis, gastrointestinal disturbance, muscle twitching, quickeningof thoughts and flow of speech, increase, or decrease in heart rate, periods of inexhaustibility, andincreased bowel movement.
  • Withdrawal: Withdrawal from caffeine leads to headache, irritability, low mood, and difficulty in concentrating. Withdrawal could extend up to 9 days, with headaches up to a period of 3 weeks.
  • Age of onset: Individuals of almost all ages consume caffeine. The amount of caffeine intake increases up to the age of 30 and then plateaus off.
  • Comorbidity: Caffeine when used in excess has been linked to depressive disorder, bipolar disorder, eating disorders, psychotic disorders, and sleep disturbances.
    Individuals with anxiety are more likely to avoid caffeine, as it is likely to make them “on edge”
• Cannabis: Cannabis is known by several names all over the world. Other names include ganja, weed, pot, bhang, grass, mary jane, dagga and dope. Concentrated extraction
  of cannabis is called Hashish. Synthetic oral formulations of delta-9tetrahyrdrocannabinol are available by prescription for nausea and vomiting caused by chemotherapy,
  for anorexia and for weight-loss in individuals with AIDS. However, the effects of smoking cannabis are more rapid and intense. Disputes with the family are common with users of ganja.
  • Effects: Consumption of Cannabis leads to sensation of slowed time, euphoria, impaired motor coordination, anxiety, impaired social judgement, and increased appetite. Adverse effects may include dry mouth and increase in heart rate. Signs of acute and chronic usage are red eyes, yellowing of fingertips, chronic cough, burning of incense to hide the odour, exaggerated craving for specific foods, sometimes at unusual times of day or night.Smoking cannabis increases the likelihood of developing a respiratory illness. Accidents and injuries are often reported due to engagement in dangerous activities under the influence. Cannabis use has been linked to schizophrenia and other psychotic disorders.
  • Withdrawal: Withdrawal could vary depending on the use. It may cause irritability, depressed mood, anger or aggressive behaviour, anxiety, restlessness, sleep difficulty, decreased appetite or weight loss, tremor or chills, stomach pain and head ache.
  • Age of onset: Most commonly begins during adolescence or young adulthood. Medical marijuana may have contributed to increased age of onset in older adults. Cannabis use is generally seen in preteens, adolescents, and young adults with conduct disorders, as it is commonly one of the first substances tried by individuals. . It is perceived as less harmful because of less exaggerated behavioural changes in cannabis intoxication compared to alcohol intoxication.
  • Gender differences:
    • Comorbidity: It is often associated with other substance use disorders such as alcohol, cocaine, and opioid. Commonly co-occurs with depression, anxiety disorders, bipolar disorder, conduct disorder, antisocial, obsessive compulsive, paranoid personality disorders. It is also associated with in increased risk of suicide.
      It is associated with several medical conditions, such as impaired cardiovascular, respiratory, immune, neuromuscular, and reproductive functioning.
  • Risk Factors:
    • Early cannabis use (prior to age 15) is connected to the development of cannabis use disorder as well as other mental health problems.
    • Temperament: Those with problems in conduct or with antisocial personality disorder are more prone to developing this disorder. Disinhibition in
      behaviour from an early age is associated with many substance use disorders, including cannabis.
    • Environmental: Individuals with backgrounds of academic failure, unstable families, tobacco smoking, are at a greater risk.
      In addition, family history of substance use disorder or use of cannabis amongst family members, low socioeconomic status, and ease of availability also increase the risk.
  • Diagnosis: Use of cannabis can be detected by laboratory testing, as it stays in the body for long period.
• Phencyclidine: (PCP, Angel Dust): Commonly smoked or taken orally, but can also be snorted or injected
  • Effects: In small amounts, Phencyclidine can result in feelings of dissociation of mind and body.
    Psychoactive effects of Phencyclinde last for a few hours typically, but in vulnerable individuals, the hallucinogenic effects may persist for weeks,
    precipitating a persistent psychotic episode. In extremely high doses, it could lead to stupor and even induce a coma. Symptoms associated may also include
    hypertension, and violent behaviour as individuals may believe they are being attacked.
  • Age of onset: Individuals as young as 12 have been reported to use phencyclidine, with 16-23 being the ages associated with highest use.
  • Gender differences: Males have higher emergency room admissions, about 75%.
  • Diagnosis: Laboratory tests could help identify use of PCP, as it may be present for up to 8 days after ingestion.
• Hallucinogens other than Phencyclidine:3-4-Methylenedioxymethamphetamine (MDMA or Ecstasy), Lysergic acid diethylamide (LSD), Dimethyltryptamine (DMT). These substances are usally taken orally. Some forms may be smoked or, very sparingly, injected (ecstasy). They are differentiated from most other substances in that most hallucinogens do not cause withdrawal symptoms
  • Effects: Some hallucinogens, like LSD and Ecstasy are hard hitting. They often cause users to spend days using or recovering. On the other hand, those
    like DMT have an effect of up to a few hours. Tolerance to hallucinogens has been reported, along with psychological as well as autonomic dependence. Unlike other hallucinogens,
    Ecstasy has been reported to have withdrawal symptoms.Long-term use of ecstasy has been linked to damage to neurons, impairment in memory,
    sleep disturbances, and impairment in neuro-endocrine function.
  • Age of onset:18-29 years
  • Comorbidity:Other substance disorders, particularly alcohol and cannabis are often present in individuals with this disorder.
    In addition, Major Depressive Disorder is also known to co-exist.
  • Diagnosis: Phencyclidine users may present with disorientation, confusion without hallucinations, hallucinations or delusions, catatonic like state or coma of varying severity.
    Prolonged use may produce extensive cardiovascular and neurological toxicity ( seizures, hypothermia or hyperthermia and so on)
  • Risk Factors:In adolescents, other substance use disorders and major depressive disorder are associated with higher use of hallucinogens. Higher novelty seeking behaviours as well
    as high use amongst peers increases risk. Studies suggest a contribution of the genetic component to some degree.
• Inhalants: These include volatile hydrocarbons in fuels, glue, toxic paints, shoe polish and so on. Like hallucinogens, sudden cessation of inhalants use does not lead to withdrawal symptoms.
  • Effects: Could lead to euphoria, dizziness, slurred speech, unsteady gait, lethargy, slowed down reflexes, blurred vision, , generalised muscle weakness, stupor and even coma.
    Adverse effects: Could lead to sudden “sniff-death” due to irregular heartbeat, even in the first dose of an inhalant. These substances can cause cardiovascular, gastrointestinal, pulmonary, as well as neurological problems. Increased risk of depression, anxiety, HIV, sexually transmitted diseases. Deaths due to accident or injury, asphyxiation, arrhythmia and so on may occur.
  • Age of onset: Use of inhalants is seen in 12-17 year olds; typically using glue, shoe polish, toluene, spray-paints and so on. Usage drops drastically among those in their 20s.
  • Comorbidity: Antisocial personality disorder as well as other substance use disorder. High prevalence of suicidal ideation is often seen.
  • Gender differences: Inhalant use disorder is nearly equally prevalent among adolescent males and females, but very low in adult females.
  • Diagnosis: Urine, breath, or saliva samples can be used to test in laboratory.
  • Diagnosis: Factors helping with diagnosis include recurrent intoxication with clear standard drug screens, peri-oral or peri-nasal rash (glue sniffer’s rash). It is associated with past suicide attempts particularly in those who previously reported loss of pleasure or low mood
  • Risk factors:
    • Environment: Inhalants are widely available legally and are also found in common household items. Childhood maltreatment is associated with conversion from inhalant use in children to inhalant use disorder in youth.
    • Genetic: As mentioned earlier, behavioural disinhibition is related to early onset substance use disorder (including inhalants), multiple substance use, and early conduct problems.
• OPIOIDS: Opioids include substances such as heroin, morphine, codeine and propoxyphene that relieve pain. Our body produces naturally occurring opioids, which are targeted by the substances. Individuals with opioid substance disorders compulsively self-administered opioid for despite lack of legitimate medical reasons or in excess of required dosage. Opioids are usually obtained illegally or from physicians by misrepresenting medical problems or taking medication from several physicians at the same time.
  • Effects: Opioids are used to induce euphoria, drowsiness as well as slow down breathing. Develop a conditioned response to a drug related stimulus. (this occurs with most drugs: intense psychological response that is difficult to extinguish, thus contributing to relapse)
  • Withdrawals: Symptoms such as excessive yawning, muscle weakness, diarrhoea , nausea, vomiting, chills and insomnia are commonly associated with withdrawal of opioids.
  • Onset: Can begin at any age, but generally comes to notice in the late teens or early 20s. Increased age is linked to less use, possibly owing to early deaths and absence of symptoms post age of 40
  • Gender differences: Use of an opioid is generally more common in males, especially with reference to heroin. Relapse following abstinence is common.
  • Risk factors:Impulsivity and novelty seeking behaviours are linked to higher opiate usage. Peer usage as well as family and social environment also influences. High risk for accidental as well as intentional suicides due to intense withdrawal symptoms
  • Diagnosis:Urine tests show presence for 12-36 hours. Other opiates need to be specifically tested for, and can be present in the body for up to a week. There is an increased risk of Hepatitis A, B and C as well as HIV due to intravenous intake by opiate users. Mildly elevated liver function tests are also common. Drug related crimes like possession or distribution, robbery, forgery. Marital disturbances, unemployment, and irregular employment are also linked.
• Sedative, Anxiolytic or Hypnotic Use Disorder: These substances include benzodiazepines, benzodiazepine-like drugs (e.g. zolpidem), Carbamates, barbiturates, and barbiturate-like hypnotics. These substances induce sleep and are prescribed as antianxiety medications. These are available illegally as well as by prescription by exaggeration of medical symptoms. Intense craving is a characteristic feature of these substances.
  • Effect: The effect of these substances is similar to that of alcohol in terms of disinhibited behaviour and slurred speech. Euphoria and other desired effects result from activation in the brain stem. These may result in slight drop in pulse, blood pressure, as well as respiratory rate.Adverse effects include ignorance of responsibilities at home and work, thus leading to repeated absences for long periods. In some cases, respiratory depression and hypotension developed suddenly may prove fatal. These substances can be particularly lethal when mixed with alcohol.
  • Withdrawal:
  • Onset: The occurrence of this disorder is highest amongst the age group of 18-29years. Between the ages of 12-17, females have a higher prevalence than males. This phenomenon occurs in reverse for adult populations.
  • Comorbidity: Other substance use such as cannabis, opioid, and alcohol is often associated with this disorder. Intravenous consumption leads to an increased risk of HIV and Hepatitis. Co-occurrence of disorders such as antisocial personalitydisorder, depression, bipolar, anxiety, and bipolar disorders is common.
  • Gender differences: Females may be at a higher risk than males in the development of this disorder
  • Risk factors:
    • Temperament: Highly impulsive and sensation seeking behaviours are associated with development of this disorder.
    • Environmental factors: Factors such as availability, use in peer groups, those with pre-existing alcoholuse disorder, and so on influence the development of this disorder.
  • Diagnosis: Laboratory tests of blood and urine samples up to one week later can help find out if use is prominent.
• Stimulant Use Disorder:Substances such as amphetamine, dextroamphetamine and methamphetamine are usually consumed orally or intravenously. Very rarely, they are snorted. This disorder can be developed as rapidly as in a week. Sometimes, amphetamines are used for weight loss, as they reduce appetite.
  • Effect: At low doses, amphetamines can induce feelings of euphoria, confidence and increase in energy and can reduce fatigue. However, this ‘high’ is followed by a ‘crash’. Use of stimulants results in blunting (a lack of emotional expression), changes in sociability, interpersonal sensitivity, anxiety, tension, stereotyped behaviours, impaired judgment, and impairedsocial or occupational functioning. At very high doses, extreme aggressiveness, or violent behaviour, intense temporary anxiety as well as paranoid ideation is seen.
  • Withdrawal: Rambling speech, hallucinations, headache, anhedonia are common withdrawal symptoms. Depressive symptoms such as hypersomnia, increased appetite and dysphoria along with suicidal ideation are also experienced on cessation of use of stimulants.Increased risk for respiratory problems, HIV, myocardial infarction, seizures and preterm delivery could occur due to a very high dose of stimulants.
  • Onset: Age of onset may be as early as 12 years, with highest rates occurring between 18-29 year olds and lowest among 45 to 64 year olds.
  • Comorbidity: Conduct disorder, Bipolar disorder, antisocial personality disorder as well as schizophrenia are noteworthy co-morbid conditions.
  • Gender differences: In the adult population, prevalence in males and females is approximately equal. However, in 12-17 year olds, females have a greater prevalence.
  • Risk factors:
    • Temperament: Impulsive behaviours, other substance use disorders, childhood conduct disorder and adult antisocial disorder are associated with a higher risk of stimulant use disorder.
    • Environment: Prenatal and postnatal exposure to stimulants such as cocaine, family disturbances, psychiatric conditions as well as interactions with dealers are substantially high risk of stimulant use disorder.
  • Diagnosis: Laboratory testing may reveal cocaine use fro 1-3 days ago, sometimes up to even 7 days. Additionally elevated liver function tests also suggest use.
• Tobacco: Nicotine interacts with the pleasure pathway in the brain, thereby producing euphoria. Persistent use leads to a tolerance. This isis exemplified by intense effect from first intake in the morning, and disappearance of nausea and dizziness after persistent use. Individuals with this disorder report craving if they do not use for a few hours. They readily give up activities occurs when activities involve being in a no- tobacco zone. Does not lead to interference with work commonly, but can often lead to interpersonal problems with those who do not support tobacco use.
  • Withdrawal: Symptoms of withdrawal from tobacco include, but are not limited to: Irritability, difficulty concentrating, increased appetite, anxiety, depressed mood, insomnia, decrease in heart rate and increase in weight.
  • Onset: Most users would have had their first intake of tobacco by the age of 21. Repeated periods of abstinence and use are common among tobacco users.
  • Comorbidity: Commonly, disorders such as Attention deficit/hyperactivity disorder, depression, bipolar, anxiety, and personality disorders. High risk of lung and other cancers, cardiac and pulmonary heart disease, shortness of breath, miscarriage and so on. Those dependent on tobacco have significantly higher risk of developing disorders.
  • Risk Factors:
    • Temperamental: Children with externalising traits, with ADHD, or conduct disorders and adults with depressive, bipolar, anxiety, personality, psychotic are at heightened risk of tobacco use disorder.
    • Environment: Tobacco is readily and legally available. Low income and low education levels more likely to initiate and continue use.
    • Genetic: It is substantially inheritable, such that children of parents with tobacco use disorder could have close to a 50% chance of developing a substance use disorder.
  • Diagnosis: Blood, urine or saliva samples can suggest recent use of nicotine. Craving for sweets, decreased alertness

TREATMENT

Effective treatment involves addressing the many facets of dependence at our De-addiction Centre in Mumbai. Repeated use of a substance leads to an increased tolerance for the same. Thus, a person requires larger quantities of the drug to experience the same effect over a period. Additionally, psychological dependence often occurs because the individual begins to associate drug use with positive emotions. Hence a combination of pharmacotherapy and counselling works best.

Depending on the severity of the disorder, the treatment approaches vary. In more severe cases, admission into a rehabilitation centre is required. In other cases, an outpatient treatment, comprising of medication and therapy is required.

Pharmacotherapy: Given that the use of substances is associated with changes in brain chemistry, medication plays a vital role in the treatment of substance use disorders. The co-occurrence of several mental health problems with substance use disorders further underlines the importance of pharmacological intervention in treatment.Detoxification is the primary intervention in the treatment of a substance use disorder.

• Easing Withdrawal: Reduction or cessation of substance use initiates severe withdrawal symptoms, often leading to drug intake once again. This intervention aims at using medications to ease the withdrawal process, so as to facilitate detoxification and abstinence.
• Substitution:One approach is to substitute a safe drug with a similar molecular composition in place of the addictive drug. For example, methadone is prescribed in place of heroin. Similarly, nicotine-dependent individuals are given less harmful substitutes like nicotine patches or gums that do not have the carcinogens in cigarettes. Slowly, the quantity of nicotine administered is reduced and completely stopped.
• Aversive Treatment:In some cases, pharmacotherapy is used to create an aversion. For example, in cases of alcohol use disorder, Disulphigramis used to interfere with the breakdown of alcohol in the body, creating a sensation of nausea, vomiting and increase in heart rate. As such, consuming alcohol produces unpleasant feelings instead of the euphoria. The resultant negative feelings towards consumption of alcohol reduce the craving for alcohol.
• Antagonist treatment: In another approach, the desirable effects that the drugs produce through their interaction with the neurotransmitters in the brain are blocked.Naltrexone is prescribed as an opiate-antagonist.

The challenge in treatment of substance use disorders is to prevent relapse once a person has been able to abstain from the substance. Hence,psychological therapies are used in combination with medications to ensure that the individual does not relapse in face of stress or craving.

Psychological Therapy:

Depending on the severity of the disorder, the individual may need inpatient or outpatient set-ups. In in-patient set ups. In-patient or residential setups or rehabilitation centres are useful for those with severe substance use disorder. Such set-ups are highly structured, and use techniques such as supportive psychotherapy and token economy to bring about change.

Outpatient Therapy, such as those in a clinic, focusses on identifying trigger situations that possibly leads to substance use and developing strategies to deal with such situations. It helps to identify lifestyle patterns that may be maintaining the dependence and thereby preventing a healthy lifestyle, free of drugs. Cognitive Behaviour therapy: This therapy aims at identifying an individual’s self-defeating thoughts and behaviours that contribute to prolonged drug use. It also focusses on behavioural changes that could reduce dependence.

Family Therapy: Given that drug use disorders are highly prevalent in adolescents, family therapy is used to identify and address any familial pressures or patterns that may be contributing to the maintenance of the problem. It aims at improving overall family functioning.

Supportive groups: In addition to therapy, there are several support groups which help individuals suffering from specific disorders come together and discuss the challenges as well as accomplishments in dealing with substance dependence. Alcoholics Anonymous is one of the most popular groups for those suffering from alcohol dependence.

Behaviour Therapy: Behaviour therapy is another popular form of therapy used to treat substance use disorders. Techniques such as contingency management, behaviour modification and aversive techniques are used in behaviour therapy.

Thus, treatment involves a triad of goals: namely, stop substance use, prevention of relapse and reclaiming life. With the right help, it is possible to stop drug use and prevent relapse.

We at Mumbai Psychiatry Clinics have a dedicated team of counsellors and clinical psychologists who will help you with your problems, cite interventions and assess the progress on regular intervals. There are experienced psychiatrists who will be guiding you throughout your journey and our Multidisciplinary team will try to assure you with the best help possible.

Reference

Diagnostic and Statistical Manual of mental Disorders – 5th edition

Abnormal Psychology – Richard P. Halgin, Susan Krauss Whitbourne

Synopsis of Psychiatry – Benjamin J. Sadock, Virginia A. Sadock (10th edition)

Abnormal Psychology – David Barlow, V Mark Durand (7th edition).