Substance abuse

Most drugs affect the brain's "reward circuit" by flooding it with the chemical messenger dopamine

Substance abuse─ including drugs─ adversely impacts individuals, families and communities. Preventing and treating substance use disorders and related problems in children, adolescents and young adults are critical to Bangladesh’s behavioral and physical health. Substance abuse—involving drugs, alcohol, or both—is associated with a range of destructive social conditions, including family disruptions, financial problems, lost productivity, failure in school, domestic violence, child abuse, and crime. Moreover, both social attitudes and legal responses to the consumption of alcohol and illicit drugs make substance abuse one of the most complex public health issues.
What is drug addiction? Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person’s self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a "relapsing" disease—people in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug.
Why do people take drugs? In general, people begin taking drugs for a variety of reasons: (1) To feel good: Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction;       

(2) To feel better: Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction (3) To do better: Some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids (4) Curiosity and "because others are doing it": In this respect adolescents are particularly vulnerable because of the strong influence of peer pressure. Teens are more likely than adults to engage in risky or daring behaviors to impress their friends and express their independence from parental and social rules.

What environmental factors increase the risk of addiction? (1) Home and Family: The influence of the home environment, especially during childhood, is a very important factor. Parents or older family members who abuse alcohol or drugs, or who engage in criminal behavior, can increase children’s risks of developing their own drug problems; and (2) Peer and School: Friends and acquaintances can have an increasingly strong influence during adolescence. Drug-using peers can sway even those without risk factors to try drugs for the first time. Academic failure or poor social skills can put a child at further risk for using or becoming addicted to drugs.

What happens to the brain when a person takes drugs? Most drugs affect the brain's "reward circuit" by flooding it with the chemical messenger dopamine. This reward system controls the body's ability to feel pleasure and motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. This overstimulation of the reward circuit causes the intensely pleasurable "high" that can lead people to take a drug again and again.

Health impact of substance abuse: Substance abuse contributes to a number of negative health outcomes and public health problems, including: (1) Cardiovascular conditions (2) Pregnancy complications (3) Teenage pregnancy (4) Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (5) Sexually transmitted diseases (STDs) (6) Domestic violence (7) Child abuse (8) Motor vehicle crashes (9) Homicide; and (10) Suicide

Can drug addiction be cured or prevented? More good news is that drug use and addiction are preventable. In Bangladesh community, it is frequently seen that persons using drugs are socially traumatized and fail to be a part of mainstream social activities. According to a report by the World Health Organization (WHO), most drug users in Bangladesh range from 18 to 30 years old and are predominantly men. The exact number of drug users, however, is hard to pin down, but it is estimated that there are over 6 million people in the country who abuse and/or are dependent upon illicit drugs (Cannabis, Phensedyl, Yaba, Heroin, Pethidine/Morphine/TDJessic, Opium, Cocaine, Barbiturates/ Tranquilizers, Alcohol; etc.).

The Narcotics Control Act, 1990 was passed in 1990 by repealing all previous laws for control of narcotics, treatment and rehabilitation of drug addicts. For achieving the objectives of this law, a high-powered committee styled 'National Narcotics Control Board' was formed in the same year. The committee is headed by the Home Minister with the Director General of the Department of Narcotics Control acting as the Member-Secretary. According to the Department of Narcotics Control (DNC), heroin is the deadliest of drugs abused in the country, but cough syrup with codeine is the most widely abused, due to its availability and low price. In recent years, Yaba (a type of methamphetamine) has become quite ‘fashionable’ despite the very addictive qualities and dangerous properties.

The poverty stricken areas of Bangladesh encourage drug abuse as a way of coping with life on the streets, and a study conducted by the Journal of Health, Population and Nutrition (JHPN) found that 56.1% of all drug users are either students or unemployed. Other reasons for taking drugs include peer pressure, emotional stress due to issues with lovers or family members, and of course mental illness.

But while it is clear that addiction does run wild in Bangladesh, appropriate treatment facilities are much harder to find. There are several hospitals that offer detoxification and outpatient services, but a full-time residential program is hard to come by. The government has seven Drug Addict Treatment Center throughout the country with bed capacities of 265 only; and the government has no further plan to establish new treatment facilities for drug abusers. There are a few treatment facilities run privately and by NGOs but not adequate and quality of service at the mark.

How do the best treatment programs help patients recover from the pervasive effects of addiction? Gaining the ability to stop abusing drugs is just one part of a long and complex recovery process. When people enter treatment for a substance use disorder, addiction has often taken over their lives. The compulsion to get drugs, take drugs, and experience the effects of drugs has dominated their every waking moment, and abusing drugs has taken the place of all the things they used to enjoy doing. It has disrupted how they function in their family lives, at work, and in the community, and has made them more likely to suffer from other serious illnesses. Because addiction can affect so many aspects of a person’s life, treatment must address the needs of the whole person to be successful. This is why the best programs incorporate a variety of rehabilitative services into their comprehensive treatment regimens. Treatment counselors may select from a menu of services for meeting the specific medical, psychological, social, vocational, and legal needs of their patients to foster their recovery from addiction.

The writer is Former Head, Department of Medical Sociology,
Institute of Epidemiology, Disease Control & Research (IEDCR)
Dhaka, Bangladesh
E-mail: [email protected]

 

Substance abuse

Most drugs affect the brains reward circuit by flooding it with the chemical messenger dopamine

Substance abuse─ including drugs─ adversely impacts individuals, families and communities. Preventing and treating substance use disorders and related problems in children, adolescents and young adults are critical to Bangladeshs behavioral and physical health. Substance abuseinvolving drugs, alcohol, or bothis associated with a range of destructive social conditions, including family disruptions, financial problems, lost productivity, failure in school, domestic violence, child abuse, and crime. Moreover, both social attitudes and legal responses to the consumption of alcohol and illicit drugs make substance abuse one of the most complex public health issues. What is drug addiction? Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted persons self-control and interfere with their ability to resist intense urges to take drugs. These brain changes can be persistent, which is why drug addiction is considered a relapsing diseasepeople in recovery from drug use disorders are at increased risk for returning to drug use even after years of not taking the drug. Why do people take drugs? In general, people begin taking drugs for a variety of reasons: (1) To feel good: Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the high is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates such as heroin is followed by feelings of relaxation and satisfaction; (2) To feel better: Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction (3) To do better: Some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids (4) Curiosity and because others are doing it: In this respect adolescents are particularly vulnerable because of the strong influence of peer pressure. Teens are more likely than adults to engage in risky or daring behaviors to impress their friends and express their independence from parental and social rules. What environmental factors increase the risk of addiction? (1) Home and Family: The influence of the home environment, especially during childhood, is a very important factor. Parents or older family members who abuse alcohol or drugs, or who engage in criminal behavior, can increase childrens risks of developing their own drug problems; and (2) Peer and School: Friends and acquaintances can have an increasingly strong influence during adolescence. Drug-using peers can sway even those without risk factors to try drugs for the first time. Academic failure or poor social skills can put a child at further risk for using or becoming addicted to drugs. What happens to the brain when a person takes drugs? Most drugs affect the brains reward circuit by flooding it with the chemical messenger dopamine. This reward system controls the bodys ability to feel pleasure and motivates a person to repeat behaviors needed to thrive, such as eating and spending time with loved ones. This overstimulation of the reward circuit causes the intensely pleasurable high that can lead people to take a drug again and again. Health impact of substance abuse: Substance abuse contributes to a number of negative health outcomes and public health problems, including: (1) Cardiovascular conditions (2) Pregnancy complications (3) Teenage pregnancy (4) Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (5) Sexually transmitted diseases (STDs) (6) Domestic violence (7) Child abuse (8) Motor vehicle crashes (9) Homicide; and (10) Suicide Can drug addiction be cured or prevented? More good news is that drug use and addiction are preventable. In Bangladesh community, it is frequently seen that persons using drugs are socially traumatized and fail to be a part of mainstream social activities. According to a report by the World Health Organization (WHO), most drug users in Bangladesh range from 18 to 30 years old and are predominantly men. The exact number of drug users, however, is hard to pin down, but it is estimated that there are over 6 million people in the country who abuse and/or are dependent upon illicit drugs (Cannabis, Phensedyl, Yaba, Heroin, Pethidine/Morphine/TDJessic, Opium, Cocaine, Barbiturates/ Tranquilizers, Alcohol; etc.). The Narcotics Control Act, 1990 was passed in 1990 by repealing all previous laws for control of narcotics, treatment and rehabilitation of drug addicts. For achieving the objectives of this law, a high-powered committee styled National Narcotics Control Board was formed in the same year. The committee is headed by the Home Minister with the Director General of the Department of Narcotics Control acting as the Member-Secretary. According to the Department of Narcotics Control (DNC), heroin is the deadliest of drugs abused in the country, but cough syrup with codeine is the most widely abused, due to its availability and low price. In recent years, Yaba (a type of methamphetamine) has become quite fashionable despite the very addictive qualities and dangerous properties. The poverty stricken areas of Bangladesh encourage drug abuse as a way of coping with life on the streets, and a study conducted by the Journal of Health, Population and Nutrition (JHPN) found that 56.1% of all drug users are either students or unemployed. Other reasons for taking drugs include peer pressure, emotional stress due to issues with lovers or family members, and of course mental illness. But while it is clear that addiction does run wild in Bangladesh, appropriate treatment facilities are much harder to find. There are several hospitals that offer detoxification and outpatient services, but a full-time residential program is hard to come by. The government has seven Drug Addict Treatment Center throughout the country with bed capacities of 265 only; and the government has no further plan to establish new treatment facilities for drug abusers. There are a few treatment facilities run privately and by NGOs but not adequate and quality of service at the mark. How do the best treatment programs help patients recover from the pervasive effects of addiction? Gaining the ability to stop abusing drugs is just one part of a long and complex recovery process. When people enter treatment for a substance use disorder, addiction has often taken over their lives. The compulsion to get drugs, take drugs, and experience the effects of drugs has dominated their every waking moment, and abusing drugs has taken the place of all the things they used to enjoy doing. It has disrupted how they function in their family lives, at work, and in the community, and has made them more likely to suffer from other serious illnesses. Because addiction can affect so many aspects of a persons life, treatment must address the needs of the whole person to be successful. This is why the best programs incorporate a variety of rehabilitative services into their comprehensive treatment regimens. Treatment counselors may select from a menu of services for meeting the specific medical, psychological, social, vocational, and legal needs of their patients to foster their recovery from addiction. The writer is Former Head, Department of Medical Sociology, Institute of Epidemiology, Disease Control Research (IEDCR) Dhaka, Bangladesh E-mail: [email protected]