Addiction:Break The Chain: T2 (The Telegraph) article dated 28th Oct'2018

The urge to escape, the longing to transcend themselves, if only for a few minutes, is and always has been one of the principal appetites for the soul.— Aldous Huxley

We may or may not agree with Aldous Huxley, but in our day-to-day life, we cannot deny the temptation to escape our reality. We all want a quick fix to our problems and miseries. Reality sometimes is overwhelming and our minds seek comfort and pleasure in not facing it. Some of us would rather drug ourselves, or get into a new obsession, or come up with various reasons to stay numb than actively take charge and find a solution to our problems. No wonder, substance addiction is on the rise.
People of all age groups are now susceptible to alcohol or drug addiction, with teenagers and young adults being the most vulnerable. The reasons? Isolation, loneliness, or/ and dysfunctional coping mechanism. The common reasons we give ourselves to use addictive substances are to feel a “high”, to counter boredom, to seek and repeat pleasure, as a form of self-medication for anxiety and insomnia or to escape the emotional turmoil. At times, we con ourselves to believe that we need a chemical crutch to not get disturbed by surroundings and even to be productive.
No matter what be our reason, any kind of addiction — whether a real substance addiction or a compulsive attachment to video games, phone, sex, food, make-up, shopping — is really just a distraction from the real world. It may help us to look away from our problems but doesn’t solve anything. Even legal addictive substances, like tobacco or caffeine, are quite a bit of a health hazard if consumed indiscriminately.
Addiction is a big concern like any other serious disease. If one adds up the risk of injury and damage from chronic alcoholism and substance addiction along with the risk of overdosing and poisoning, addiction definitely is a serious issue.
It destroys one’s physical and mental well-being alongside having severe negative effects on one’s family, employment and society as a whole. The risk of damage depends on the substance used, the dosage and route of administration but, at a varying degree, it involves acute substance toxicity or poisoning, risk-prone behaviour, secondary and chronic medical problems like cirrhosis of the liver in case of alcoholism, secondary psychiatric problem, risk of persistent cognitive impairment, risk of dependency, and other social/occupational negative consequences.

DEPENDENCY SYNDROME

Dependency on a chemical does not happen overnight. It starts at will, with controlled exposure. Nobody starts taking drugs or alcohol to be dependent. However, slowly the body becomes used to the chemical and the substance becomes essential to retain normal functionality.
Dependency Syndrome initially was described (Edward G. and Gross MM 1976: ‘Alcohol dependence: Provisional description of a clinical syndrome’) as provisional alcohol dependency but it is increasingly being applied to describe other drug dependencies as well.
It features a few categories to identify the problem and the extent of it. It might help us to identify where we stand.

• 1. Primacy of drug-seeking behaviour: In this, the substance user’s is always focused on the substance (alcohol or drug) and ways to procure it, which takes priority over everything else. Substance use becomes more important than one’s job, relationships or health. 
• 2. Narrowing of the drug-taking repertoire: The user restricts themselves to a single drug rather than experimenting with many. The route of administration, setting and company become familiar and stereotyped. This means, the user is well past experimentation or trial phase and is slowly becoming dependent on a particular chemical substance.
• 3. Increased tolerance to the effect of drug: The user feels the need to increase the dosage to get the same effect. They might try to use a different route of administration (oral to IV) to get better or faster results.
• 4. Loss of control over consumption: The user feels that they are not able to restrict the quantity of the substance they further consume once they have taken the first dose.
• 5. Withdrawal symptoms: At this stage, even a gap of a few hours of consumption gives rise to withdrawal symptoms, often more evident in the morning. 
• 6. Taking substance to prevent withdrawal: The user knows and anticipates withdrawal symptoms and in order to prevent it, they take measures to have substance handy.
• 7. Continued substance use despite severe negative consequences: Even when threatened by severe consequences, like a marital breakup, job loss or bankruptcy, they continue to use the substance.
• 8. Rapid reinstatement of the previous pattern of drug use after abstinence: Characteristically, when the previously-dependent user relapses after a period of abstinence and rehabilitation, it takes lesser time to again become dependent than the time initially taken. 

Once they are dependent, a user is usually very defensive about their substance misuse. It takes a lot of self-motivation and a strong drive to overcome dependency. Following are the stages one goes through on the path to recovery. It is not unusual to skip one or two stages, but the general progression remains the same unless the movement is halted.

• Pre-contemplation: The user doesn’t recognise the problem although friends and family have already begun to suspect that there is a problem. The user might brush it off or even be surprised if someone points out the possibility of a dependency. A careful non-judgemental chat, a friendly nudge without prodding, might help the user to go to the next stage.
• Contemplation: The user recognises and often acknowledges the problem in a non-judgemental, trusting environment. They might accept that there is a problem and be able to see the negative aspect of continued substance use. Recognising a problem genuinely is half the battle won if one can look for a solution and ask for help.
  As soon as the user recognises the problem, they need to reach out to people who can help. It is important to have a trusted, support group, which may comprise friends, professional caregivers and family members. It might be important to avoid friends who justify drinking and trivialise your insight, even if they are well-meaning.
• Decision: This is a vital and crucial point where the user decides whether to attempt change or continue using the substance. Many times, they might decide to continue until, one day, they change their mind about it. 
• Action: The point of motivation where the user attempts to change. At this turnaround point, it is important to keep the motivation up even if the attempt fails. One needs to be patient and gentle with themselves. Perseverance and determination are key. Family and friends can support a great deal by helping the user to remain goal-oriented, encouraging and celebrating successes and ignoring the ill effects of initial withdrawal symptoms.
• Maintenance: A stage of maintenance sounds easy as the physical dependency is tackled already. Although it’s time to maintain the gain made and focus on rebuilding a life, many times, if the motivation drops, one might relapse. Again, a support group can be a very good resource. It is also important to keep busy and have an active social life. Avoiding ‘risky’ groups who will encourage drinking is crucial. The user might have to rehearse what to say when offered a drink, to deal with awkwardness. 
• Relapse: A return to the previous behaviour doesn’t mean all is lost. There is always a possibility of gaining useful strategies to extend the maintenance period on the user’s next attempt. A relapse is also a stage on the path of recovery if one is aware and motivated. 

De-addiction is quite possible if the user chooses a healthy and safer lifestyle. Like any change, it requires determination, self-compassion and patience. Professional help from a psychiatrist and/or a therapist, to deal with withdrawal symptoms, may be needed on the path to recovery.

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-Dr Sangbarta Chattopadhyay and Dr Namita Bhuta

are medical practitioners and practising psychotherapists. They conduct individual and group therapy sessions

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Q n A: Teen Daze: T2 (The telegraph) Article dated 7th Oct'2018

Q. Of late my daughter, who is in Class VIII, has become a compulsive liar. She lies even about basic things, like what she had for lunch. Is this a psychological condition or a passing phase?

Ans:

When a child learns to lie it means they are learning to use their imagination to influence their reality. However, for a girl in Class VIII this is not normal. 

Communication is the key to solving problems, so sit her down and talk to her. Ask her about what’s going on in her life and why she is lying. There may be some stressors that she may have been facing, which is leading her to behave in this manner. Also, is she just lying to you or to everyone? If she is lying to you then you may need to change some aspects of your interaction with her. Explain clearly what is non-negotiable for you. Be firm. Angry outbursts often have a counter-productive effect on children with behavioural problems.

You may need to reiterate that lying is not acceptable. However, when you tell her that lying is not right, you have to be flexible to be able to deal with honesty. You need to be able to acknowledge and reward her each time she chooses to be honest instead of lying. If you think that the problem is getting out of hand, you can also take help of a counsellor. The counsellor should not only be able to help your daughter but will also be able to tell you what’s happening to her and help you interact better with her.

Q.I have a 17-year-old son who dropped out of college. He is now doing his graduation through distance learning. The problem is, he refuses to go out of the house and do anything. There are days when he doesn’t even get up from bed all day. He doesn’t like interacting with anyone. We have not been able to persuade him to see a counsellor. Please suggest what to do. 

Ans:

This indeed is a tricky situation. The whole interaction depends on your shared dynamics. First, what led him to drop out of college? Maybe that is still the reason he is behaving the way he is. Be open and ask him if there is something that is going on and he’d like to share. Explain to him that you are very concerned. 

Encourage him to talk to you without nagging or prodding him. If he trusts you enough, perhaps, he will open up to you eventually. When he does, do not try to tell him what he should do or should not do or offer solutions and advice immediately. Just listen to him and ask him what he would like to do, so that he does not go on feeling the way he is. 

Reaffirm that you want him to enjoy life, go out and socialise and if he doesn’t, it may not be healthy. If he denies there is anything wrong, then encourage him to join in activities with you. Go for walks or to the gym together. If his mood and behaviour stay the same, then take him to a psychiatrist or a psychotherapist saying that as one goes for a medical check-up this is also to be sure that everything is all right with him.  Be firm but don’t lose your cool. You need to be tender yet persuasive to get through his resistance. 

Q.My son is an extrovert, quite a popular child in school. He is 15. Recently I have observed that he is stammering, especially at social gatherings. He is becoming very conscious of it.

Ans:

Stammering can be due to psychological stress or sometimes due to a physical issue. However, since it has just started, it is more likely to have a psychological cause. Talk to him without making him feel judged or weird about himself. Try to find out if there is something that’s bothering him. Has he been anxious of late or has there been some incidence that is bothering him? You can take him to a counsellor if he is not opening up to you. 

At times, even after one deals with the psychological components, one needs to retrain their speech to overcome the impediment. Take him to a speech therapist, who, in this case, is the most qualified to help your son. Be sensitive to what is happening to him and do not keep correcting him when he is speaking.

Q.I’ve come across a stash of ganja in my 16-year-old son’s drawer. I can’t decide if I should confront him or let it be this time and keep an eye out in future? 

Ans:

Ignoring a problem may save you an uncomfortable confrontation but is not helpful in the long run. Letting it be doesn’t address the problem. If it is okay with you, we recommend that you tell him what you’ve found in the drawer and ask him why it was with him. Hear him out patiently. Once you hear what he has to say, let him know that this is not all right with you. However, when you communicate this, do not be overemotional or angry. Communicate with him in a calm but firm manner. 

Children, as part of growing up, will push the boundaries that you have set. They test our threshold and push our limits but as parents, it is our duty to keep defining this boundary. It’s not necessary that they agree with us or see eye to eye with us on every issue but it is important that they learn to respect the limits set by us.

Tell him that if it is the first time and an experiment, you understand but you wouldn’t want this to be repeated. If he tries to argue with logic about how good it is, don’t encourage the discussion. Tell him that it’s not acceptable and as long as he is under your care, this cannot continue. You may also say that you have enough reasons to believe that weed is not good for his physical or mental health and that this is not up for discussion. 

If he says that he’ll not do it again then trust him and give him a chance to follow through on what he is promising. Be aware that in the future he might repeat the same thing and you may have to repeat the same exercise in a firmer way. Setting a boundary is often a long repetitive process, till it becomes apparent and obvious. It is important that you keep an eye on your son.

Q. My 13-year-old daughter still wets her bed at times. She has already started menstruating. How can we help her?

Ans:

Bed-wetting can happen because of various physical and psychological issues. Some children bed-wet occasionally till they are around 12 or until they start menstruating. She is not very far off the normal bell curve as yet. Around the time of menarche, it is also not uncommon to have an uncomfortable feeling around the urinary tract, which can lead to bed-wetting. Sometimes an infection in the urinary tract can cause this type of episodes.

Take her to a paediatrician first and ensure that there is no physical cause for this. If physically she is fine, first, have a friendly chat with her. There can be a lot of anxiety and awkwardness regarding the menstrual cycle, and other pubertal changes. Make her feel normal and comfortable regarding these topics. 

Explore your relationship with her. Could this be a reflection of the anxiety and restlessness she’s feeling? Is she able to express herself and her feelings to either parent without fearing judgement and trivialisation? 

A few other practical things you can try out are as follows: Restrict her fluid intake after 7pm and, throughout the day, ensure she finishes 1.5 to 2 litres of water. Make sure she goes to the washroom just before retiring to bed. It might help to restrict exciting, adrenaline rush-causing films, like horror, suspense and thriller in the evenings. If you have a fairly good idea about which part of the night she is prone to bed-wet, you can wake her up prior to that and get her to go to the toilet, for a couple of months. It might also help her to have her own bed and eventually her own room if possible. A certain degree of autonomy helps them get better autonomy over their body.

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