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Helping Persons With Addiction Booklet
Helping Persons With Addiction Booklet
2009
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Front inner cover
Title: Alcohol, Drug Misuse and other Addictions: What to know and how to get help.
Illustrations:
Vivek Benegal, Additional Professor of Psychiatry
*Some of the illustrations have been downloaded from the internet.
Our hearfelt thanks to all our nursing staff who have given valuable insights into
inpatient care, to our patients, many of whom have provided a feedback for the draft
versions of this booklet and to Ms Geeta Krishnan for secretarial assistance.
We gratefully acknowledge the support of Dr D Nagaraja, Director and Vice-
Chancellor, NIMHANS.
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(back inner cover)
NIMHANS
A Short History
The De-addiction Centre at NIMHANS was established in 1991. In 1998, the NIMHANS
De-Addiction Centre was recognized as the Regional Centre for the Southern Region by
the Ministry of Health and Family Welfare, Government of India.
A separate building was commissioned in 2002.
It has now expanded into a 58 bedded centre.
Outreach services
We have provided services and models of care for NGOs and workplaces in evolving substance
use prevention programs
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Regular training on substance use management to medical and other health professionals
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Drugs of abuse: What are they?
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How do drugs cause problems?
By their behavioural effects
o intoxication
o removal of inhibition
o impairment of memory
o loss of control over one‘s action
o tendency to take risks under influence
By leading to addiction
What is addiction?
Addiction is a chronic, relapsing disease characterized by
compulsive drug seeking and abuse and by long-lasting chemical
changes in the brain
It is a state of being dependent on a substance, which is harmful
or dangerous for the physical and/or mental health of the person
and for his social and economic well-being
What environmental factors increase the risk of drug abuse and addiction?
Home and Family
Friends and School
Starting to use at young age
Method of use: Smoking a drug or injecting it into a vein increases its addictive
potential
Addiction is a developmental disease - it typically begins in childhood or adolescence
o Timely counseling and treatment help to arrest the progression of the disease
o It allows the person to have improved functioning and a good quality of life
o It helps to anticipate and effectively deal with lapses and prevent a lapse from
becoming a relapse
Treatment consists of
o Assessment
o Medications
o Individual Counseling
o Family Counseling
o Group Therapy
o After care
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ALCOHOL
o It is the most widely used substance in the world, and has been for thousands of years
o Alcohol is a potentially addictive substance.
Cirrhotic liver
Consequences of alcohol drinking
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Consequences of intoxication
o Motor vehicle crashes. Alcohol complicates diagnosis of trauma-related injury, may
mask or mimic the signs of a head injury and complicate treatment
o Workplace accidents
Withdrawal symptoms
Coarse tremors of hands, tongue or eyelids later
Nausea/ vomiting
Malaise/ weakness
Increased pulse
Sweating
Elevated blood pressure
Anxiety
Depressed/ irritable mood
Headache and sleeplessness
Social problems
o marital disharmony and domestic violence
o neglect of children
o criminal behaviour such as driving offences, breach of the peace, shoplifting
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o unsafe sex
o financial problems
Family problems
Occupational problems
o Poor work performance,
o Absenteeism
o Poor relationship with colleague
o Discipline problems
o Loss of job
o Industrial losses
o Losses to society
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Can one use without getting hooked?
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BEHAVIOURAL ADDICTION
Gambling
Sex addiction
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BENZODIAZEPINES
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o ―fits‖ if stopped suddenly
Medical problems on repeated use
o Sleep disturbance
o Seizures
o Toxicity with overdose of the drug
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CANNABIS
It is a common psychoactive substance used widely.
It is obtained from the plant cannabis sativa
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OPIOIDS
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What are signs of intoxication?
o A ("rush") accompanied by a warm flushing of the skin, a dry mouth, and heavy
extremities.
o Following this the user goes into an alternately wakeful and drowsy state.
o May become confused with higher doses.
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TOBACCO
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hat are the problems with tobacco?
Symptoms of nicotine withdrawal
o Irritability
o Impatience
o Hostility
o Anxiety
o Depressed mood
o Difficulty concentrating
o Restlessness
o Decreased heart rate
o Increased appetite or weight gain
Health impacts
Smoking effects most of the organs of our body
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Changes in lung due to smoking
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Smoking increases the risk of heart attacks
o A few people can stop smoking tobacco use themselves however most others need
professional help.
o Professional help includes:
o A detailed assessment
o Counselling
o Medication
o Some may require additional therapy
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VOLATILE SOLVENTS
Complications
o With successive inhalations,
o can suffer loss of consciousness and
death.
o After heavy use of inhalants, abusers may
feel drowsy for several hours
o experience a lingering headache.
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Complications of repeated and prolonged use
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TYPES OF TREATMENT
1. Pharmacological Treatment
Medications are given to control the withdrawal symptoms just after stopping drugs
Alcohol: Diazepam and lorazepam
Opioid: Buprenorphine or clonidine
Cannabis, inhalants: diazepam/ lorazepam
Detoxification
o Process by which an alcohol or drug dependent person is helped to stop the use of the
substance in a supervised manner
o withdrawal symptoms and the attendant risks are minimized.
o Detoxification is the first step towards the treatment .
Aim :
o establish a diagnosis of alcohol or drug dependence
o detect those at significant risk of developing a withdrawal syndrome
o determine if a patient can be managed in a particular setting
How is it Done?
o Non-medicated detoxification
o but it is often necessary to prescribe sedatives for few days
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1. Sedation (Or Substitution)
Appropriate sedation can prevent, abort or relieve withdrawal to a large extent.
Diazepam is the usual drug prescribed for sedation in alcohol and benzodiazepine
withdrawal.
Diazepam is also helpful in detoxification for other drugs
Clonidine is prescribed for hospitalised patients undergoing opioid.
Some drugs as buprenorphine and methadone are being used for opioid with drawl.
Similarly, in tobacco cessation, nicotine substitution is used to relieve withdrawal.
2. Symptomatic Relief
They should be treated on an as required basis, according to the particular symptom
complex
It may be drugs as anti-diarrhoeal drugs, drugs against gastritis, multivitamins
3. Supportive Care and Environment
Noisy, uncomfortable, over-stimulating and/or threatening environments aggravate
withdrawal states.
4. Alcohol Detoxification
o Benzodiazepine class of drugs are main choice of drugs (eg. Diazepam,
chlordiazepoxide, lorazepam)
o The drugs are tapered gradually over 7-10 days.
o Lorazepam is used in those with suspected liver dysfunction, whereas in other cases
diazepam is commonly used
B. Supplements
o Thiamine and B-vitamin deficiency occurs in patients with alcohol dependence
o Thiamine 100-150 mg/day is given to all patients with alcohol dependence.
o Fluid and electrolyte balance is maintained
Tobacco Detoxification
o Initially chewing gums containing nicotine may be used if the withdrawal symptoms
are severe
o Also behavioral methods are also taught.
Opioid Detoxification
o Clonidine is used to suppress signs and symptoms of opioid withdrawal For heroin
withdrawal
o clonidine is started at a dose of 0.1 to 0.2 mg every four hours, which is tapered
starting after day 3, with treatment lasting a total of about 10 days.
o Sublingual buprenorphine provides an effective and comfortable withdrawal and it
appears to be superior to clonidine in this regard.
o Buprenorphine is usually started at 4 to 16 mg daily
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Benzodiazepine Detoxification
o The dosage of benzodiazepines must be reduced slowly. As rapid reduction can cause
unpleasant effects.
o Slow withdrawal means tapering dosage gradually, usually over a period of some
weeks or months.
o Initial few days substitution with long acting benzodiazepines as diazepam are used to
reduce the intensity of the withdrawal symptoms
Amphetamine Detoxification
o Sedation is provided in the first few days with diazepam usually. other drugs for
sedation have also been used
o For symptomatic relief of the aches and pains pain killers are prescribed for the initial
few days
o Supplementary vitamins are also prescribed
o Encouraged to maintain a good food intake
Cocaine Detoxification
o Initially used drugs help in controlling agitation of the patient. usually diazepam is used
in this phase.
o For supportive management pain killers and vitamin supplements are provided
Inhalants Detoxification
o There is no specific detoxification agent. Initial withdrawal symptoms are managed
with diazepam or other benzodiazepines
o Vitamin supplements
o supporting environment is provided
Cannabis detoxification
o Initial symptoms are usually managed with diazepam.
o In some cases antipsychotic drugs in low doses may be needed.
o Supportive caring environment is provided
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Common side effects of Drugs?
Disulfiram
o Disulfiram can cause severe reaction if person drinks alcohol seen as flushing, nausea,
dizziness, headache
o In severe reactions, there could be respiratory depression, heart problems and even death.
Naltrexone
o Nausea, vomiting and abdominal pain
o Headache and fatigue
o Liver problems
Acamprosate
o Diarrhea
o Headache
o Flatulence
o Nausea
o Vomiting
o Dyspepsia
Topiramate
o Dizziness
o Drowsiness
o Unstable gait
o Impaired concentration
o Confusion, fatigue
o Tingling sensation
o Speech difficulties
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Medications for Cannabis
o No specific agent is available
o Baclofen 20-60 mg/day has been used recently.
o It probably helps in the reduction of the urge to use the drug
Stimulants
o No specific agents available for stimulants
o Naltrexone has been tried
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PSYCHOSOCIAL TREATMENT
Relapse Prevention
What is Relapse?
o Who is getting treatment for drugs or alcohol problem slips back or starts using the
substance again .
o Relapse does not mean that you would not get well , it is a part of the getting well
process
What is lapse?
o Lapse is the first episode of drug use after one stops taking the drug.
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Giving in to temptations or urges.
Interpersonal Triggers
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Social pressure
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Relapse pathway
o ―Everyone else drinks so that makes it all right for me to drink too‖.
Use of substance to ―Test" if one can control or use once in a while; to ―Just try it once" to see
what happens; testing the effects of treatment or one‘s own ―Willpower".
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How to cope with Craving?
o Craving is like a wave it builds up reaches a peak and then comes down. The wave
may last from a few minutes to a few hours
o Recognize craving triggers and avoid them
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GROUP THERAPY
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o The behavior of the parents and problems at home can affect the children
psychologically
o Family counseling helps the family members to handle these problems effectively
o The aim is to help to be a ―Happy Family‖
Do I need admission ?
o May be done as inpatient or outpatient
o Depends from individual to individual and degree of problems
Home/Outpatient treatment:
Done if:
o not severely dependent on drugs
o no medical or psychiatric complications requiring close observation or treatment
o has a drug-free and supportive home environment and family members available to
support the patient
Hospital/Specialist Treatment:
Needs admission if
o Severely dependent
o Associated illness or injury
o Use of multiple drugs
o Poor family support
o Previously failed home treatment
Duration of stay
o The treatment at the center needs 21days stay at the hospital
o May require longer stay if there are severe problems
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Contact Address:
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