De-addiction and Rehabilitation

There is a growing concern around addiction to various substances due to the kind of impact it has on one’s mental and physical health concerns it can cause. It not only affects the health but also the our day to day function, relationships and profession. It can affect any ant gender and any background 

Addiction is characterised by the presence of the following symptoms:

1. Individual requiring or wanting to use the substance 

2. Developing tolerance, over time one starts to experience the need to consume increased amount of the substance in order to experience the same level of effect 

3. Experiencing emotional and physical symptoms of withdrawal when and if reducing or stopping the substance  

4. One might experience a complete loss of control over substance

5. Ignoring or disregarding any complications arising from the use of substance 

6. Individual starts neglecting their relationships and even their own self 

There are various substances including medications which can potentially cause addiction.

The common substance which can cause addiction are:

• Alcohol 

• Tobacco 

• Caffeine 

• Cannabis

• Opioids

• Cocaine 

• Sedatives 

The presence of the above mentioned symptoms in combination arising from the use of any of the psychoactive substances for most part of the year would amount to addiction.

There are a number of causes for an individual to develop addiction. Often it the interplay of multiple factors which leads to the onset of addiction in an individual:

• It is related to the changes in reward system of the brain which includes certain neurotransmitters like dopamine.

1. Genetics: Research shows an increased vulnerability to develop a addiction if you have an affected first degree relative. Number of neurotransmitters are studied to be responsible for addiction, the most important of them being dopamine and reward system. 

2. Mental health conditions: There is a strong bidirectional link between addiction and other mental health conditions has been established. Most common disorders to be associated with addiction are depression, post-traumatic stress disorder and bipolar disorder.  

3. Environmental factors: Negative childhood experiences play a role in development of addiction/ substance use disorder in an individual.

SUBSTANCE SPECIFIC INTOXICATION AND WITHDRAWAL AND MEDICAL AND PSYCHIATRIC CO MORBIDITIES
Alcohol

1. Intoxication: Symptoms progress proportionately to blood alcohol content (BAC). Actual levels required to cause the symptoms vary with tolerance, but the common symptoms which can occur in an individual are mild drowsiness, impaired judgment, slurred speech, behavioural disinhibitions, memory disturbances and decrease in motor coordination.

2. Withdrawal: A continuum of signs and symptoms can occur during alcohol withdrawal ranging from:

   1. Mild alcohol withdrawal which would include includes tremors, weakness, headache, sweating, and gastrointestinal symptoms. Heart rate above 100 beats per minute may be present and blood pressure can be slightly elevated.

   2. Alcohol withdrawal seizures can occur within 6-48 hours of cessation of alcohol

   3. Delirium tremens usually occurs between 48-72 hours post cessation of alcohol and it is characterised by confusion, disturbed sleep pattern and hallucinatory experiences which can be wither auditory or even visual. 

3. Associated mental health concerns: Alcohol addiction commonly has been associated with depression, anxiety, post-traumatic stress disorder and bipolar disorder.

4. Associated physical health concerns: Alcohol directly affects the cardiac, hepatic, and thyroid tissue. Continued heavy intake also commonly causes the following:

   1. Gastritis

   2. Pancreatitis

   3. Cardiomyopathy, often accompanied by arrhythmias and hypertension

   4. Peripheral neuropathy

   5. Brain damage, including Wernicke encephalopathy, Korsakoff psychosis and alcohol-related dementia

   6. Certain cancers (eg, liver, head and neck, esophageal), especially when drinking is combined with smoking

   7. Indirect long-term effects include undernutrition, particularly vitamin deficiencies
      

• Tobacco/ Nicotine

1. Withdrawal: Withdrawal from nicotine includes both mental and physical symptoms. Smoking cessation can cause intense symptoms, including strong cravings for nicotine in cigarettes and vapes, anxiety, depressed mood, difficulty in concentration, irritability, restlessness, insomnia, hunger, headaches, gastrointestinal disturbances, and sleep disturbances. The symptoms are most severe the first 3 days and usually lasts for 2 to 4 weeks for most individuals with nicotine addiction, but some symptoms, such as craving can continue for months. Weight gain is a common problem which individuals face while quitting smoking and gain and average of 4 to 5 kgs. 

2. Associated mental health conditions: Some common mental health conditions seen to be associated with nicotine addiction are anxiety disorders, attention deficit hyperactivity disorder and depression.

3. Associated physical health conditions: It is a known fact that physical health is affected with increased use of nicotine. The common conditions associated are cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes emphysema and chronic bronchitis.

• Caffeine 

1. Intoxication: Intoxication of caffeine is usually seen to be associated with higher dosages of caffeine. There can be increased sense of well-being, energy and alertness and also restlessness, anxiety, jitteriness which one can experience during intoxication phase.

2. Withdrawal: Withdrawal from caffeine usually occurs when stops caffeine after prolonged daily use. The withdrawal syndrome here consists of one experiencing headcahe, fatigue, difficulty in concentration and dysphoric/ low mood. 

3. Associated mental health conditions: The most common mental health conditions which are associated with caffeine addiction are sleep disturbances/ insomnia and anxiety disorders.  

4. Associated physical health conditions: The consumption of higher doses by vulnerable individuals can lead to increased risk for negative health consequences, including cardiovascular problems and perinatal complications including miscarriage, low birth weight etc.

• Cannabis

1. Intoxication: Within minutes, smoking cannabis produces a dreamy state of consciousness in which ideas seem disconnected, unanticipated, and free-flowing. Time, color, and spatial perceptions may be altered. Intoxication consists of a feeling of euphoria and relaxation commonly termed as “a high”. These effects last 4 to 6 hours after inhalation. Physical effects are mild in most individuals. Increased heart rate, redness of the eyes and dry mouth occur regularly. Concentration, sense of time, fine coordination, depth perception, tracking, and reaction time can be impaired for up to 24 hours. Appetite often increases. It can also precipitate psychotic episodes in individuals who are predisposed to them or even otherwise.

2. Withdrawal: Stopping use in cannabis dependent users can cause a mild withdrawal syndrome; the time of onset of withdrawal symptoms is variable but often begins about 12 hours after the last use. Symptoms consist of insomnia, irritability, depression, nausea, and significant decline in appetite. 

3. Associated mental health conditions: Mental health concerns associated with cannabis addiction are depression, can lead to an individual developing an acute psychotic episode to schizophrenia. 

4. Associated physical health conditions: The concerns seen to be various lung diseases including COPD, emphysema.

Opioids

1. Intoxication: Intoxication with opioids usually leads to a feeling of euphoria and drowsiness. There can be changes in the respiratory functioning leading to lowered respiratory rate and depth. Constriction of pupils, confusional stat, decreased heart rate, decreased body temperature and urinary retention can be seen when the level of opioids in the body reaches toxic levels.

2. Withdrawal: Withdrawal with opioids leads to central nervous system hyperactivity. Symptoms may appear as early as 4 hours after the last dose of heroin, peak within 48 to 72 hours, and subside after about a week. Anxiety and a craving for the drug are followed by increased breathing rate (> 16 breaths/minute), usually with excessive sweating, yawning, watering of eyes, dilation of pupil, and stomach cramps. One can experience tremors, muscle twitching, tachycardia, hypertension, fever and chills, anorexia, nausea, vomiting, and diarrhea. 

3. Associated medical health conditions: aThe associated mental health concerns which can occur with opioid addiction include social withdrawal, depression and sleep disturbances.

4. Associated physical health concerns: Opioid is known to affect the physical health when abused. The common physical health concerns are chronic constipation, excessive sweating, peripheral edema, drowsiness, and decreased libido. There can be cardiac (heart), pulmonary (lungs), and hepatic (liver) damage due to infections such as HIV infection and hepatitis B or C.

Cocaine

1. Intoxication: Intoxication effects are seen depending on the mode of use. When injected or smoked, cocaine causes alertness, euphoria, a sense of increased energy, and feelings of competence and power. These feeling are intense when cocaine is snorted.

2. Withdrawal: The withdrawal symptoms seen with either stopping or significant reduction in dosage of cocaine are depression, difficulty concentrating, and increased drowsiness. Appetite is increased. Withdrawal symptoms can last for several weeks to months. 

3. Associated mental health concerns: One can experience symptoms of paranoia, anxiety, mood changes, irritability etc  

4. Associated physical health concerns: abnormalities with the heart. Rarely, repeated snorting causes cocaine-induced nasal septal perforation. Cognitive impairment, including impaired attention and verbal memory, occurs in some heavy users. Users who inject cocaine are subject to the typical infectious complications. When adulterated cocaine is inhaled frequently, interstitial pneumonitis or pulmonary fibrosis may develop. 

Sedatives

1. Intoxication: Clinical feature of sedative intoxication are similar to alcohol intoxication. Under the intoxication of sedatives one can experience an array of symptoms ranging from excessive sleepiness, dizziness, difficulty with focusing or thinking, blurred vision and impaired depth perception and slowed reaction time and reflexes. Usually the effects of mild to moderate intoxication are self-limiting however, in case of severe intoxication when the symptoms seen are significant sedation, slurred speech, respiratory depression and even coma, there is a requirement of critical care and should consult a specialist.

2. Withdrawal: common symptoms of withdrawal from sedatives are shaking of hands (tremors), sleep disturbances, increased heat rate, rapid breathing, confusional state and seizures.  

3. Associated mental health concerns: One of the major concerns with use of sedative is the addictive potential with the same. If taken for longer durations without the supervision of the doctor it can lead one being dependent on it. 

4. Associated physical health concerns: Prolonged use of sedative or excessive use can lead to certain physical health related concerns. The common physical health concerns seen to be associated are liver related conditions and memory disturbances.