Pubdate: Sun, 02 Jan 2005 Source: Star, The (Malaysia) Copyright: 2005 Star Publications (Malaysia) Bhd. Contact: http://www.thestar.com.my Details: http://www.mapinc.org/media/922 Bookmark: http://www.mapinc.org/rehab.htm (Treatment) IS DRUG DEPENDENCE A MEDICAL DISEASE? X WAS 16 years old when his parents divorced. It was a trying period prior to that as there were frequent arguments and uncertainty in the air. Because of his parental problems X had problems focusing in school and did poorly in his Form 3 exams. There were many things X wanted to tell his parents, but he hadn't the chance. They were too engrossed in their own problems. He resorted to talking to a friend in school whose parents were also divorced. Soon they spent more time together and since his new friend smoked, it wasn't long before X was coaxed to trying cigarettes. They had their secret place to smoke their cigarettes away from others until once they stumbled upon a group of senior students smoking cannabis. With their newfound friends they moved from cannabis to heroin. Heroin seemed to help them forget. There was no more pain, be it physical or psychological. At the age of 25, after being admitted to Pusat Serenti once and to lock-up three times, X heard of his friend's death from an overdose of heroin. X had wanted to stop his drug use for a long time but had tried several times on his own with no success. He was desperate as he was unemployed and had no family support. Drug dependence in our country is on the increase and every day official statistics suggest that there are close to 50 new cases detected. Drug dependence occurs during a phase of life when individuals are expected to develop new skills, build families and contribute to nation building. Its' effects, which can be devastating, are not only to the individual but to their families and the community at large. There are several models in approaching drug dependence. We are all familiar with the moral model where drug dependence is thought to be intentional and due to a lack of self-discipline. In this model drug dependents deserve to be punished. The socio-cultural model suggests that it is related to a defect in the socialisation process and the environmental influences initiate drug use. Recovery in this model is thought to be through a change in environment. This includes isolating drug dependents from their community. However, when they are released back into their community, their desire and craving for the substance re-emerges and thus leads to high levels of relapse. The medical modal suggests that drug dependence is a chronic and progressive disease. This is evidenced by neurochemical changes that are detected especially in an area of the brain called the mesolimbic dopamine system that is activated by a variety of drugs. Research suggests that there is some truth to all the models and thus an appropriate approach would be to look at drug dependence from a bio-psycho-social-spiritual model. Subsequently, treatment would need to be holistic, balanced, spiritual, with changing lifestyle and inculcating skills to prevent relapse. Drug dependence under the Diagnostic Statistical Manual -- version 4 -- is characterised by at least three of the following symptoms for a period of 12 months: 1. Substance often taken in larger amounts or longer periods than the person intended. 2. Persistent desire or unable to cut down use. 3. A great deal of time spent in activities necessary to get the substance. 4. Withdrawal symptoms when substance is stopped. 5. Other important activities given up or reduced because of substance use. 6. Continued use despite serious physical, social or psychological effects caused by the drug use. 7. Tolerance or the need to increase amounts used to get the same effect. Drug dependence often results from first experimental use that leads to social use and later regular use or abuse and finally leading to an addiction. There are numerous substances that are abused for their mind altering effects and the common types in Malaysia include heroin, codeine, cannabis, ecstasy, solvents and amphetamines. Most drug use starts in adolescence and is often in relation to peer influence and pressure. Peer pressure alone may not initiate drug use, but in combination with poor parenting skills, poor academic performance, underlying depression or anxiety, teenagers may be at the higher risk to try drugs. It has been suggested that drug use progresses from initial milder drug use to more dangerous use. This is coined as the gateway theory and proposes that adolescents start with licit drug use such as with tobacco and alcohol and gradually progress on to harder substances such as cannabis and heroin. Delaying the onset of licit drug use then reduces the chances of illicit drug use. Prevention tactics that have been shown to be effective include education on drugs and their ill effects done together with improving and developing skills in the young. These skills will include how to manage stress, problem solving, coping skills, being assertive and learning to say no to drugs. In some developed countries, these skills are taught as part of the curriculum in school and have been shown to reduce drug use as well as bullying, depression and early sexual experiences. Parents too play a pivotal role and need to equip themselves with parenting skills. Parenting in this day and age is more challenging than it was in yester years and parents cannot rely on their individual experiences alone to help in bringing up their children. Adolescents often resort to their peers if they do not have the opportunity to relate with their parents. In Malaysia there is a need for all agencies to come and work together, applying their knowledge and experience to develop more holistic approaches towards managing withdrawals from drug use as well as relapse prevention. Family support is essential and needs to be harnessed early in treatment. Often families resort to looking for help when they have become intolerant to the ways of the drug dependent family member. Drug dependence must be tackled at an early stage when the opportunity of recovery is better. X is presently on a substitution therapy programme combined with psychological and social treatments through group sessions with other recovering and recovered addicts. He is starting to get more stability in his life and has found himself a job. He is more confident about remaining drug free. * This article is contributed by members of MPA & Early Intervention Unit (EIU). For further information, e-mail If you think you or someone close to you, have some problems of mental illness, please contact the EIU voice-operated hotline 03-79585752 for further details on specific mental disorders. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star disclaims all liability for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. - --- MAP posted-by: Jo-D