Special issue with the Sunday Magazine
From the publishers of THE HINDU

ADDICTIONS: February 25,2001

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A dependence that destroys

V. Thirumagal

The writer is a counsellor at the T. T. Ranganathan Hospital, Chennai.

Addiction is truly a non-discriminatory disease - it can happen to anybody. Age, sex, intelligence, family background, social status, personality style - nothing seems to matter. Alcohol, the socially and legally sanctioned central nervous system (CNS) depressant drug, turns at least 15 per cent of the drinking population into alcoholics. When the physician's instructions are flouted, even medically used drugs like pain killers and sleeping pills can cause addiction. With illegal drugs like ganja and brown sugar, the very term drug use is a misnomer - to use the drug is to abuse it. And with abuse, addiction follows.

R.Prasanna Venkatesh/Wilderfile

What starts off as casual or experimental use slips into a routine. "Just a little after all,""once a week does not hurt," "daily but only after the work is completed." The justification seems perfectly logical. Addiction develops gradually, each stage merging into the other. Tolerance sets in and the usual quantity of alcohol/ drugs do not seem to give a high anymore. So, the imbiber simply increases his quantity.

Physical and psychological dependence gradually develop and he feels normal only if he drinks/ takes drugs. Attempts to cut down or skip his intake make him uncomfortable. Tremors, sleeplessness, restlessness, body pain, anxiety or strong craving for the chemical drives him back to the usual routine.

It is like a giant wheel ride that simply gets faster and faster. After a while, it is not fun anymore but the rider cannot get off. The guilt can be overwhelming and he attempts to stifle it with the next drink/ fix which does not help. The famous lines "I will quit tomorrow", are repeated endlessly.

The ability to resist drugs or refrain from alcohol is meaningful in the early period before addiction per se has developed. Once addiction has set in, the only way out is to give it up completely. Unable to accept his powerlessness he continues the abuse.

The changes are subtle initially but startling later on - yet pathetic and painful all the same. The "ace" worker who trail-blazed in his career does not show promise anymore. The genial, soft spoken gentleman is now irritable and touchy. The fitness freak is not concerned about his gaunt appearance.

Even in the face of such losses, he persists with the self-destructive behaviour. Sometimes a crisis helps. An accident, loss of job or marital separation can force him to seek help. More often, it is the intervention from people who care that motivates him to take up treatment.

Recovery is possible. With help, he can give up alcohol and drugs and live without it. But this process cannot be achieved without the active involvement of the patient. The honesty with which he works with issues and the need to do so are crucial factors that influence recovery. While family, friends or the workplace can make a world of a difference, it is the patient himself who is the key player. The process of recovery can be initiated and supported by others but it is his commitment that sustains it.

Recovery from addiction essentially moves through three phases. Accepting that he has lost control over alcohol/ drugs and that this has caused problems is often the first and most difficult step in recovery.

Following this, he recognises the need to change his behaviour. As controlled drinking/ drug taking is impossible, he understands that abstaining is the only way out. As addiction has an impact on all major life areas, a whole new way of life is needed. Making changes in his lifestyle and maintaining it is the third phase of the recovery.

Professional treatment procedures help the patient move through these phases.

Addiction treatment focuses on four key issues - medical help, psychological therapy, family therapy and follow-up care after completion of the active phase of treatment. While some centres like the T. T. Ranganathan Clinical Research Foundation/ TTK hospital in Chennai offer all of it in a comprehensive manner, many offer services based on their treatment philosophy.

G. Ramamurthy/Wilderfile

Medical treatment

Cessation of alcohol and drug use brings on withdrawal symptoms that can be mild or severe. Medications are used to ensure that this process is handled in a safe and comfortable manner. The patient may have medical problems like gastritis, neuritis or abscesses that are caused by drug or alcohol abuse. Owing to neglect, poorly handled diabetes and hypertension or problems due to malnutrition may also be present. Anxiety, depression, paranoia and other problems related to psychological well-being need to be treated at the initial phase of treatment as well as on a long-term basis. Help under the supervision of a competent physician is necessary to help him achieve an optimum level of physical and psychological well-being.

Deterrent drug therapy is also made available to help maintain abstinence. Disulfiram is generally prescribed for alcoholics, as this drug helps them resist alcohol. Narcotic drugs abusers on naltrexone cannot experience the drug effect as the drug blocks the receptors in the brain. The futility of using the drug dissuades them from trying the drug again.

Psychological therapy

The complexity of the disease demands that many objectives are met. This calls for the use of different techniques, with each therapy addressing the issue of recovery from different angles.

Lectures: Irrespective of their education, alcoholics and drug abusers can be surprisingly ignorant of the extent of the damage that addiction has wrought. As a patient says, "Until I came in for treatment I never realised the shame my children experienced due to my drinking. I could also understand that I had withdrawn from people and kept conversations to the minimum just to avoid uncomfortable questions. During the lectures I could understand changes I needed to make".

Group therapy: Verbalising his drug using history, expressing guilt and remorse, and other negative feelings of the past with other people who experience the same problems is cathartic. Sharing thoughts and feelings with others in a supportive environment invites him to be honest, look at himself more deeply and strengthen motivation to abstain from drug taking.

"Just talking about the past and hearing others do so was a great relief. For the first time, I found myself talking about the past and expressing hope about the future without fear of being judged or ridiculed", says a patient.

Counselling: "During counselling, I was able to understand my triggers, identify my high risk situations and plan appropriate coping strategies. By being listened to without criticism and with the counsellor providing appropriate suggestions, I was able to work through my problems", says one patient.

Manoj K. Jain

Self-help groups: The slogans and the 12 steps of the self help groups of Alcoholics Anonymous, Narcotics Anonymous and Gamblers Anonymous present time tested ideas that support recovery. Meeting others through these groups gives a lot of hope and support to those in the early part of the recovery. Introduction to the concept and facilitating attendance are part of the treatment centre's efforts.

Family therapy

Addiction affects not just the patient but the entire family. Helping the family to recover is as important as working with the patient. Helping the family understand the addiction process and their faulty coping mechanism helps them develop a healthier lifestyle.

In the absence of family therapy, the anger and resentment remains unaltered and the home environment is silent, hostile and tension filled. Or else, the family may expect him to return "shining and perfect." They need to understand that recovery is a process that takes time and learn to provide support and encouragement in an appropriate way.

Follow-up

Needless to say, a short-term treatment programme cannot simply modify a deeply learned destructive lifestyle that has been maintained for a few years. While recovery plans are made during the primary treatment programme, follow-up is an essential part that ensures that these plans materialise. Follow-up visits provide a lot of support for clients to handle difficult situations as well as craving as and when it happens. Patients opine that "meeting my counsellor and discussing my progress or lack of it helped me focus on my priorities. It also helped me handle setbacks and go through life in an optimistic frame of mind."

Relapses

Relapses after treatment do not mean failure. It rather indicates areas that the patient needs to fine tune and with some support he can reestablish sobriety.

Addiction is a painful illness and it can leave a mark on all areas of life. With recovery, a slow but happy transformation is possible. For many, treatment efforts mark the beginning of new lives and treatment centres can report many success stories with happy endings. But with many, the message is lost and the pain continues.