Alcohol and Drug Addictions

What are alcohol and substance related problems?

Alcohol or substance related disorders are the conditions arising from the misuse or excessive use of alcohol, psychoactive drugs and other chemicals including charas, ganja, heroin, cocaine, etc.

When to call someone suffering from alcohol or substance related problems?

The continuous use of different types of drugs or alcohol gives rise to various problems in physical health as well as social and occupational life of a person. a person is diagnosed as having alcohol or substance related problems when:

ü  Person gets a strong desire to take alcohol or other drugs. The desire is so strong that a person feels compelled to take it,

ü  Person cannot control himself from taking drugs or as he losses the sense of when to stop taking it, or when he get completely intoxicated and need to curtail the intake,

ü  Person experiences extreme discomfort, restlessness, dizzy, body ache, disturbed sleep, tremors, nausea or other symptoms when tries to stop taking or reduces the amount of drug or substance,

ü  Person requires larger amount of alcohol or drug to get the same level of effect. The effect that he used to feel from small amount is not achieved with same amount of drug after some time,

ü  Person starts neglecting other interests and activities because he invests more time in obtaining the drug,

ü  Person continues to take drug or substance even after knowing clear, harmful consequences as accidents, physical problems or death.

What all things can cause such problems?

Most of those chemical or natural products that affect our central nervous system (Brain and other related system) have some capability of causing these problems. Such as:

1. Alcohol , “Desi sharab”, “Taadi”, Wine, Bear, Vodka, Gin, “Mahua”, “Hadia” etc;
2. Tobacco, “Khaini”, “Gul”, Ciggarette, “Bidi”, etc;
3. Opioids, “Brown sugar”, “Chase”, Opium, Heroine, “Charas”, “Cough Syrups”, “Spasmodic pain reliever”  etc;
4. Cannabis, “Bhang”, “Rocket”, “Ganja”, “Hukka”, etc;
5. Volatile solvents, “Thinner”, “Whitener”, “Paint”, “Petrol”,     
6. Steroids,
7. Hallucinogens,
8. Sedatives, Tranquillizers

What is the harm in taking such drugs?

These drugs may lead to following consequences:-

Immediate consequences-

1. Loss of control over body movements
2. Nausea,
3. Vomiting,
4. Restlessness,
5. Tremors,
6. Dry mouth,
7. Increase heart beats,
8. Sweating,
9. Irregular breathing,
10. Irritability etc.

Long term consequences-      

1. Damage to brain leading to psychiatric problems,
2. Deficiency of protein and vitamin B from the body,
3. Liver damage,
4. Increase susceptibility to infections,
5. Gastritis,
6. Peptic ulcers,
7. Acute or chronic pancreatitis,
8. Hepatitis,
9. Cirrhoris,
10. Hepatoma,
11. Death, etc

Psychological consequences-

1. Anxiety,
2. Depression,
3. Memory problems,
4. Sleep disturbance,
5. Lack of interest in work, etc.

Social Consequences-

1. Marital disruptions,
2. Loss of social status,
3. Familial discords,
4. Problems at work place,
5. Financial loss, etc.

What are the causes of alcohol related illnesses?

The causes of alcohol and drug related illnesses are divided in three major categories:

Biological Causes:

ü  Heredity or genetic causes: In person who has family members who had similar problem, have more chances of acquiring tolerance and vulnerability to take alcohol as compared to the other with no such background,

ü  Presence of any other psychiatric illness specially anxiety related,

ü  Presence of physical illnesses causing intense discomfort and pain,

ü  Experience of “high” and elevated, cheerful mood due to intake,

ü  Bodily discomforts, pains, tremors, disturbed breathing and disturbed heart beat when alcohol, drug is not taken, etc.

Psychological Causes:

ü  Curiosity, sensation seeking behavior,

ü  Social rebelliousness,

ü  Poor stress management,

ü  To get over with fatigue or boredom,

ü  Poor self-control,

ü  Trauma or recent loss, etc.

Social Causes-

ü  Pressure from friends,

ü  Imitation of actors or elders who take alcohol,

ü  Easy availability,

ü  Poor family bonding and support,

ü  Religious reason,

ü  Faulty concept of modernization, etc.

Is it habit, bad character, or something else?

Addiction, alcohol abuse, drug abuse are not simply habits or are part of bad character but it is an ILLNESS or PSYCHOLOGICAL DISORDER, which has some identified biological and other causes, and which is TREATABLE.

 

What can family do to help this illness?

The family has a major role in the treatment of this condition,

ü  For identification and evaluation of the problem,

ü  For leading and motivating patient,

ü  For arranging treatment facilities for patient,

ü  For supporting and expressing faith in the patient,

ü  And for boosting self-esteem and self-efficacy of the patient.

What is the treatment of this condition?

The treatment of this condition is divided into two parts

Biological:

ü  It includes detoxification, which is helping the patient to stop the consumption of drug/alcohol and manage the physical discomforts that a person may experience due to sudden cessation of drug intake. This process takes only a few weeks.

ü  It also includes helping the patient in reducing the intense desire or craving sensation for drug.

ü  The patient can also be helped by giving certain components which if take regularly cause highly distressing reacting to intake of alcohol and thus prevents person from taking it.

Psycho-Social:

ü  It includes improving persons’ motivation to quit drug/alcohol,

ü  Helping patient to develop skills to control his behavior,

ü  Helping patient to prevent further relapses (restarting drug),

ü  Bringing about changes in person’s life style, stress management, etc,

ü  Involving family members to get support and care,

ü  Helping patient to regain self-esteem, self-efficacy, and self-respect.

Is it curable?

Substance related conditions can be cured with effective treatment but what required is personal motivation to help oneself, good support of family, and professional consultation.

Attention Deficit Hyperactive Disorder (ADHD)

What is Attention deficit hyperactive disorder (ADHD)?

ADHD is a kind of psychiatric illness having its manifestation during the early years of life. This is a developmental disorder it is called so as the symptoms of ADHD appear clearly by the age of five years and are more prominent during the early years of life. Only in some cases the symptoms persist with same severity in the adulthood.

How to identify ADHD?

There are certain differences which make children having ADHD different from other children:-

ü  Difficulty concentrating for long on any task,

ü  Leaving the task incomplete to take up a new task,

ü  Inability to prolong interest even on otherwise liked things,

ü  Disliking for tasks that require involvement and thinking,

ü  Excessive activity, inability to sit at a place for long,

ü  Running around as if being run by motor,

ü  Continuously moving hand, legs even when sitting,

ü  Very easily distractible,

ü  Making strange voices,

ü  Inability to wait for their turn,

ü  Blurting out the answer before the question is completed,

ü  Keep losing the things,

ü  Makes careless mistakes,

ü  Looses temper easily.

Any of the above mentioned symptoms when appear for long time and interfere with child’s education or other learning and development should be given adequate attention.

Does is mean child has poor intelligence?

In some cases the child having ADHD may have associated condition such as mental retardation, learning disorder, language disorders, conduct disorder (dissocial behavior) etc. but in cases where child does not have any other associated condition the poor performance of the child might only be because of his inability to pay attention to the task given to him rather than poor intelligence.

What causes ADHD?

There is no one cause of having ADHD but a combination of factors might be responsible for this.

1. Due to any neurotransmitter (Chemical) imbalance in the brain,
2. Due to various structural abnormalities in brain,
3. Lack of normal development in child before birth,
4. Effect of dangerous environment (lead exposure, trauma, poison, drug, alcohol, etc) to the child before or immediately after birth, etc.

What is the treatment of ADHD?

The children having ADHD can get help through medication prescribed by a trained psychiatrist as these medicine help reducing increased activity to some extent.

For other behavioral problems child require help from Clinical Psychologist and Special Educator.

How to control increased activity?

For controlling increased activity follow certain things given below:

ü  Let the child be involved into activities requiring high energy level such as racing, cycling, dancing for long time before asking him to sit at  a place for some work,

ü  Let the child do some extra exercise in morning,

ü  Encourage him to sit at a place for small duration and gradually increase the time, give child something that he likes when successfully does so,

ü  Establish contract with the child in which the goal and tasks are determined and the privileges that will be given for doing any task are mentioned. This contract is made with child and is followed by both the parties (i.e. child and caretaker), etc.

What to do to increase his attention?

ü  Allow the child to do task in part rather than whole at one time and encourage him with something that he likes (such as sweet, toy, allowing TV for 10 minutes etc.) for doing each part,

ü  Allow him to do tasks for small duration and gradually increase the duration, remember start with activities that child likes to do,

ü  Give small and clear instructions (i.e. get me the bottle, rather than get me the bottle which is kept over the table and pour the water in glass),

ü  Hold the shoulders of the child and look straight into his eyes while giving him instruction,

ü  Ask him to follow simple mazes, computer game etc,

ü  Remove extra distractions from the room where the child is to be taught something,

ü  Try to use as many sensory modalities as possible while teaching (i.e. make him see, touch, speak, hear a word while teaching rather than simply either see from book, or listen from teacher), etc.

What to do to control inability to wait (impulsivity)?

ü  Help the child understand that he will be given something if he delays his reaction to anything for some time and than gradually increase the time required to wait between a thing is given and the child to react to it,

ü  Teach the child to postpone the reaction only by a few seconds first and than increase the duration,

ü  React negatively if he blurts out before time, etc.

Can a child suffering from ADHD study in a regular school?

Yes, the child having ADHD can study in regular school, but he/she needs special attention and special training to cope with the problem

How can parent help the child?

The parents play a very important role for the treatment of such child as the training required for them has to be constant and structured for all the settings such as school, home, playground etc. for which the most concerned and constant trainer is parent.

OBSESSIVE COMPULSIVE DISORDER (OCD)

What is Obsessive-compulsive disorder?

OCD is an illness characterized of some constant worries and fears which appear illogical or irrational to the person who is having it. But even than the sufferer is unable to let go or remove these worries for long time, he is only able to remove these worries for brief periods of time that too only after doing something which again appears irrational and excessive.

What is an Obsession?

Obsessions are thoughts, images, or a sudden intense desire that keeps coming to the mind of sufferer even when the person may find them senseless or even “bad” and unpleasant.

What is a compulsion?

A compulsion is a action that a person feels compelled to repeat again and again, though he or she has no desire to do so. These actions can be of any type some of the frequently seen behaviors are

• Frequently washing hands for long duration, 
• Taking long time in cleaning things,
• Checking door locks, knobs, switches etc repeatedly even he remembers clearly that he has checked  it,
• Keeping things in a “specific” order and feeling of major discomfort if things are not kept in that specific order,
• Speaking some words or phrases silently,
• Doing some acts such as moving in-out, up-down, etc repeatedly, etc.

How to identify OCD?

Obsessions and compulsions have few things in common like:-

·         An idea, a desire, an image forces into the person’s mind which is not liked by person,

·         A feeling of “something bad will happen” is experienced by the person either to himself or to family members,

·         In order to reduce this feeling, the person had to perform certain actions against his will,

·         The cycle goes on and on…..

·         The person recognizes it as irrational and senseless and feels a strong desire to resist

·         But they feel that they are compelled to take action to reduce it.

What are the major types of such thought that may disturb a person?

OCD may have 4 major types of content of disturbing thought:

Contamination of dirt and germs: the person usually believes that the contamination is spread from object to object or person to person by even a slight contact.

Irrational doubts: the person always feels guilty or responsible about having forgotten or committing something wrong which may have dire consequences.

Forceful thoughts: repetitive thoughts of sexual or aggressive acts that the person “feels” that he might have committed.

Symmetry: the person feels the need for precision or perfection and therefore become slow in performing the activities.

Is it only me who has this problem?

In general population 2-3 out of every 100 people suffer from OCD. 

At what age it can occur to me?

Though OCD can occur at any age, time or to person of any gender, but for men the average age of starting OCD is about 20 years and for women the average age of starting OCD symptoms is 22 years. At times people may have the illness even at the age of 35 or late. In some cases symptoms were found to be occurring at age of as young as 2-3 years.

What are the causes of OCD?

There are many reasons which are found to have their share in developing OCD but which of these reason is working in a person is not known. It is believed that not any one but the combination of the below mentioned reasons might be responsible for it:

• Certain chemical (serotonin) disturbance/misbalance in the body,
• Heredity can also play an important role. It can run in family from one generation to other,
• Development of “faulty relationship” between a non-threatening thing with a fearful thing that produces fear, anxiety or discomfort,
• In order to reduce this anxiety and discomfit the person discovers that certain actions reduce anxiety and develop active avoidance strategies to control the anxiety and accordingly, it strengthens and become fixed as learned pattern of compulsive behavior. 

Who have high chances of developing OCD?

Any person of  any gender, class, religion, caste or culture can have OCD. The chances of having it increase if there are other family members who are either having OCD or any other psychiatric problem.

Dose it ever get cured?

About 20-30% of patients having OCD recover completely from there symptoms whereas 40-50% have major improvement but not complete recovery. The recovery is facilitated by good support from family members and the persons own efforts to follow instruction of the professional Psychiatrist and Clinical Psychologist.

What are the treatments available?

OCD can be very effectively treated with the help of medications along with psychotherapy.  The medications are safe, non habit forming should be taken under supervision.

The most common and effective therapies for OCD are:

·         Exposure and response prevention in which the patient is repeatedly exposed to fearful thing that produces obsession and compulsive behaviors and helped in a scientific manner to control the symptoms,

·         Desensitization,

·         Thought stopping,

·         Flooding,

·         Aversive conditioning,

·         Group therapy,

·         Family therapy

Always remember –

·         It is an illness and not bad character,

·         Just like any other physical illness which has some causes and treatment OCD also has a treatment,

Contacting a mental health professional (Psychiatrist, Clinical Psychologist) on seeing any such symptoms is a good idea because right consultation at right time can help the person the most.

Dementia: Early Identification for Early Intervention

What is dementia?

Dementia is a psychiatric condition characterized of certain major changes in a persons’ ability to remember things and other day to day behaviors.

What causes dementia?

Dementia is a common term used to indicate a group of conditions characterized of similar manifestations but having different etiologies in different people such as due to Alzheimer disease, vascular degeneration etc. The major cause behind the condition is the gradual degeneration (death) of brain cells, which are the building blocks of brain and are responsible for the regular day to day behaviors and abilities of a person.

What are the major changes in the behaviors of such patients?

Dementia is mainly characterized of following symptoms

·      Gradual loss of memory leading to inability to remember names, relations, faces, where things were kept,

·      The person may forget the way to home and may get lost at the place which was very familiar to him/her,

·       Person may get lost even in his own home or office,

·       Inability to dress-up oneself, shave oneself, tie shoelaces, bathe properly, combing etc,

·      Complete change in the personality such as increased jocularity, disinhibition,

·      Sudden anger outbursts, irritability, risk taking behavior,

·      Urinating in cloths or at inappropriate places,

·      Inability to recognize things of daily use,

·      Inability to understand commands or to express what they want to say,

·      Inability to coordinate the simple body movements (such as picking up cup, use knife)

Is it aging or illness?

Though after the age of 60 or above anyone may have some of gradual deterioration of memory functions but in cases where the problems increase rapidly and start having major problems in day to day life may require immediate psychiatric consultation.

What to do if some of your known person has any of the above mentioned symptoms?

If any of your known has any of the above mentioned problems you must seek consultation from a psychiatrist who may help the patient by prescribing the medications which may slow down the process of gradual death of brain cells and thus resulting in slowing down the process of behavioral problems.

“He forgets his way and gets lost” what to do for this?

To help the person who loses his way when gone out

·    Should not be allowed to travel very far alone, but he should be given freedom to move out for a small walk (if required under supervision)

·       When going out a paper slip/diary indicating the address, name, and the name of the person whom to contact in case of need should be kept in his pocket,

·        The person can be given a location guide or map which can help the person in case of confusion about directions, etc.

If the person gets lost even within the house

·        In such cases certain arrow marks towards toilet, bedroom etc can be placed,

·        Name of the place in bold letters can be written and pasted at different places,

·        In case the person leaves home as he sees the door a mirror can be placed over the door’s back so that the person gets distracted as he reaches the door.

·         A night bulb must be lit up in night.

·        There should be adequate lighting in the room of the patient, etc.

What can be done if he forgets names, dates, people etc?

·           Person should be shown his old photographs, letters, videos etc frequently,

·        Whenever anybody comes to meet him/her he should be introduced by name and relationship rather than asking patient to identify him (such as “Look your daughter Seema has come to meet you with her husband Amit, they have come after a week to see you would you like to meet them?”),

·           Keep large calendars, clock and pictures of family members in patient’s room,

·           Indicate in bold letters about what is kept here, such as “MEDICINE” over the cupboard where medicine is kept,

What if he gets angry or remains irritable unnecessarily?

·           Try to understand the patients confusion and avoid arguments with him,

·            Do not blame patient for his condition,

·            Try to keep the activities structured,

·             Keep less articles (distractions) in the room of patient,

·            Use audible but polite voice while interacting with him,

·            Allow him/her to walk around and engage in activities that he likes to do, etc.

What to do if he urinates in bed/clothes?

·             Try to track the time of the day when he urinated for a few days and then make it a habit to ask patient to use toilet before that identified time comes,

·              Patient can be reminded to use toilet even if does not feel the need after every two hours,

·              Give him a privilege if he remains dry for the whole night,

·      Train patient to hold the urine for longer duration gradually increasing time between liquid intake and elimination of urine, etc.

Can dementia be cured?

In some cases where the cause is not the degeneration there the condition can be reversed with right treatment. Mostly dementia is often a result of gradual degeneration of brain building blocks thus once it has been started it can only be slowed down but cannot be reversed. It puts a big onus on the caregivers, as it requires constant care.