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Drugs Grimy, sunken eyed, teenagers are seen huddled together on platforms, railway bridges, and on pavements, sharing anything from cigarettes to petrol cans. They stare at passersby and get doses of wrinkled noses and hurt sensibilities. But have we ever thought as to what pushes them into this state? It is probably less from working in garbage and filth than from the societal negligence. These teenagers seem unable to elicit a response from the denizens of this desensitised megalopolis.

It is not only street children who are caught in a sinister net of addictions. Addictions seem to have affected all classes of society, and there are no age barriers either. Although history is witness to the use of a variety of drugs, drug addiction seems to have become a threat of great proportions to society only recently.

The increase in drug addictions can be attributed to changing value systems, changing fashions and the increased pressure of competition, compounded by peer pressures. To cope with all this, youth turn to drugs and alcohol.

The use of psychoactive drugs dates back to prehistoric times. Opium was used in ancient Egypt to alleviate pain. Morphine, its chief constituent, still remains a favoured drug for pain relief. Alcohol was a part of religious ceremonies in early civilizations of the Near and Middle East. Coca leaf has been chewed by Andean Indians to lessen fatigue. In India `bhang' (normally consumed during the `Holi' festival) was used. Tobacco and `madira' (alcohol) have been used from ancient times.

Therefore, drug use, and abuse, has to be studied in the existing social context. Fads affect drug taking, like they do almost all other things. For example, drug use may be the `in-thing' for a couple of years. Then suddenly the society decides it is bad, and drug use becomes a cause for concern. This typifies the society's response to drug abuse.

Even religion plays an important role. Islam prevents drinking alcohol. Among the Christians "drinking of healths" is a common and a very accepted custom. However, drug use seems to have grown into a problem of alarming dimensions only in the recent past.

Most of the psychoactive drugs synthesized or extracted in the recent times were developed for medicinal purposes -- mainly to help in relieving psychological distress and other mental illnesses. But regular usage led to addiction. There are problems like withdrawal symptoms while terminating long term usage of tranquilliser and sleeping pills, even when taken under medical supervision.

As the older drugs like opium and heroin became more stringently guarded by the drug control laws, newer drugs were discovered. Among these were the LSDs, inhalants and tranquillizers. Use of Ly-sergic Diethylamide (LSD), also known as `acid', was encouraged by Dr.Leary, one of the original synthesizers of LSD. He even gave the slogan, "Turn on, Tune in, and Drop Out". The most common type of acute LSD toxicity is the "bad trip", or "bummer" as it is frequently called. Shortly after taking the drug, the users feel that they have lost control over their thoughts, perceptions and behaviour and "want out" immediately. This usually leads to panic followed by confusion, and in some cases, psychological depression.

Inhalants are substances that are sniffed in order to produce mind-altering effects. In one case of solvent abuse, a young German girl was attracted to the smell of "trichlorothylene", a common organic cleaning agent. She frequently sniffed the solvent. Several months later she died after inhaling a lethal amount of the solvent. Although death due to solvent abuse is not uncommon, excessive solvent use more often leads to a psychotic - like episode.

Besides hard drugs like opium, heroin, LSD's, etc., substances like cigarettes, alcohol, sleeping pills are all psychoactive, and also commonly used among a majority of population. Cigarette smoking is a common fad; it has crossed both age and gender barriers of drug use. There is a misconception that cigarette smoking enhances memory and increases alertness. It will not be wrong to assert that smoking is sometimes the first step in the direction to drug abuse.

Another major attraction with youth these days is alcohol. Alcohol consumption has increased for various reasons. One of the main reasons is probably that young people are constantly exposed to their elders using it and are tempted to try it out. Even parents do not seem to object to their wards using alcohol with any degree of seriousness. In fact some of them hold a liberal view about it. Some youth try it for `the pleasure', probably of just trying something new! They are later `hooked' to it. But the most important cause could be the changing value systems in society. This has led to a change in the very definition of `the good, bad, acceptable and evil'.

Another seemingly innocuous addiction is consumption of sleeping pills. In India, where there are scant restrictions to their availability, their use has increased, and with it the number of cases of deaths due to overdose of sleeping pills.

Whether it is the rich, bored kids without any directions or the street children trying to survive their shattered dreams - drugs seem to them a plausible solution rather than a persistent problem.

Many institutions put the number of street children anywhere between 30,000 and 3,00,000, and age range of 15-25 years. Gabriel Britto of NARC says that nearly 80% to 90% of the street kids are into hard drugs.

Have we ever wondered why so many youngsters want to escape the reality of this world? Why have we given them a world they don't want? Can we make it better? Let's try.

Dr Harish Shetty is a psycho-therapist and a psychiatrist actively involved in helping de-addiction. He firmly believes that healthy minds are as important as healthy bodies. Problems of addiction, especially alcohol consumption among young college going students, worry him. It is very important to cultivate good friends in whom you can confide, and it is equally important to be a friend in need to others.

Y. First and foremost, doc, please define drugs and also give us an idea of drugs which are currently used by Mumbaiites.
B. A drug can be defined as a substance which causes euphoria or a change in mood, promotes a sense of well being, and stoppage of which causes severe withdrawal symptoms.
According to me Alcoholism is a greater problem than drug addiction these days. If I rate the drugs then the order would be --
  • Alcohol
  • Cannabis i.e. charas (exudate), ganja (flowering tops), and bhang (leaves)
  • Opioids i.e. opium, heroin, brown sugar, pure white heroin and buplemorphine
  • Sleeping pills, and lastly,
  • Cough mixtures.

Y. Please elaborate as to how sleeping pills and cough mixtures can be addictive.
B. Yes, sleeping pills and cough mixtures can be very addictive. There are several reasons for this.
  1. In our country there are not very strict rules for selling both these drugs over the counter.
  2. Since any ordinary general physician can write the prescription for both cough mixtures as well as sleeping pills, they can be obtained fairly easily.
  3. They are a lot less expensive than hard drugs and more easily available over the counter and anybody from the poor to the rich can go and buy these without arousing suspicions.
  4. Another reason for increase in the use of sleeping pills is poor awareness among the masses about the ill effects of the pills. These being relaxants, people continue with these pills long after the prescribed period. A person normally does not immediately develop addiction for these two. But with continuous usage over a period of time the body develops dependence. Then gradually the initial aount of dosage seems to have no effect. This is described as tolerance, and with this the person is "hooked on to" these things.
Y. Do you imply that a drug user may not be a drug addict?
B. Yes.
Y. Then when can a drug user be called a drug addict?
B. A drug user can be called a drug addict, when he becomes dysfunctional and when he on his own cannot stop taking the drugs.
Y. Which class of people is the most hard hit with the problem of addiction?
B. The poor. Though even the upper classes use drugs it is the poor which seem to be most hard hit. This can be attributed to the fact that there is no social acceptance of a poor drug addict but a rich drug addict is sympathised with by the society. If anything he is even accepted back into the fold.
Y. Are Amphetamines, LSDs used in India?
B. Not very extensively, but even if they are used it is by the rich because these are extremely expensive.
Y. Tell us doc, is multiple drug use common in India?
B. Well, it is hard to say that. But only hard core addicts are multiple drug users and they generally hail from the poorer sections of the society and commonest combination being alcohol with one hard drug.
Y. What are the effects of drugs on health?
B. The effects of drugs on health vary from one category to the other. Alcohol damages the liver causing liver cirrhosis, bleeding from stomach and oesophagus, loss of memory and unconsciousness. Apart from that even HIV+ve cases are high among alcoholics and drug addicts. Hard drugs like brown sugar and heroin can cause chest infections, TB, gastro intestinal tract infections, malnutrition, brain damage, sexual impotencies. Apart from that people suffer from reduced immunity which makes them susceptible to infections.
Y. What has led to increase in the consumption of drugs?
B. I would attribute the increase in the consumption of drugs to four things --
  1. Affluence,
  2. Changing value systems,
  3. As far as alcohol goes, it is more freely advertised and more often than not even parents encourage their children to have an occasional peg with them.
  4. Association of sports with alcohol is also a major reason why there is an increase in alcoholism.
Y. But why doesn't government put restrictions on alcohol usage?
B. Because it happens to be one of the major sources of excise revenue (around rupees 15,000 crores). The amount of alcohol sold in India in 1996-97 itself has been about Rs. 75,000 crores. No government could afford to lose so much in revenue. In Andhra Pradesh they banned liquor. But they had to reconsider their decision because they lost Rs. 5000 crores in revenue.
Y. Which organisations are actively involved in rehabilitation or drug de-addiction?
B. Apart from the government institutions, there are Narcotics Anonymous, Alcoholics Anonymous, DAIRRC (Drug Abuse Information Rehabilitation and Research Centre), Sevadham. Besides, Swadhyay and certain church groups are also involved.
Y. How far have these de-addiction programmes been successful?
B. Well, they have not been successful.
Y. What are the reasons for that?
B. There are many reasons, but most importantly,
a) De-addiction is a very expensive process; approximately costs anything from Rs. 2,000 to Rs. 10,000 per addict. Even after that, the abstinence rate is 12% - 15%.
b) The drug addicts who have been de-addicted are not socially accepted. Hence frustrated they revert back to drugs.
c) Drug addiction is also a symptom of poverty. There are a large number of drug addicts in the poorer sections.
d) Lastly, comprehensive care is required for these addicts because they have acquired a number of other infections due to reduced immunity. But these facilities are lacking in de-addiction centres as also is the problem of tight budget of the de-addiction centre.
Y. How do you think these de-addiction programmes can be made more practical or workable?
B. For these programmes to be successful, we have to start accepting this problem also like all other physical ailments and not shun these addicts. We have to learn to give mental hygiene as much importance as physical hygiene. Also, we should understand that the brain has not only cognitive functions but is also a seat of emotions.
And the most important of all is that instead of simply pointing out the causes we should try to treat or cure them.
Y. What are the common withdrawal symptoms?
B. Every drug has different withdrawal symptoms. Besides, it also depends upon the severity of the addiction.
For alcohol the withdrawal symptoms generally start within 24 hours to one week. Tremors, aggressive behaviour, insomnia, hallucinations. For brown sugar, it is watering of nose, pain, violent and aggressive behaviour, lack of sleep, abnormal behaviour, vomiting etc.
Y. Last question, doc, how far are college students affected by this problem?
B. The addiction is quite in control among college students, usually restricted to alcohol abuse and cigarettes but more widespread in the age group of 20-34 years i.e. freshly out of college people.
Y. Thank you, doctor, it has been one of our most enlightening and informative discussions on this topic.

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