ACKNOWLEDEMENT

The success and final outcome of this project required a lot of guidance and
assistance from many people and I am extremely privileged to have got
this all along the completion of my project. All that I have done is only due
to such supervision and assistance and I would not forget to thank them.

I respect and thank Ms. Saumya Mahajan, for giving me all support and
guidance which made me complete the project duly. I am extremely
thankful to her for providing such a nice support and guidance, although
she had a busy schedule managing other affairs.

I would also like to express my special thanks of gratitude to my principal,

Ms. Deepti Dwivedi who gave me the golden opportunity to do this
wonderful project which also helped me in doing a lot of research work
and I came to know about so many new things.
 SUBSTANCE-ABUSE
DISORDER

What is Substance-Abuse?
Substance abuse refers to the harmful or hazardous of psychoactive
substances, including alcohol and illicit drugs. Most abused drugs produce
intense feelings of pleasure. This initial sensation of euphoria is followed
by other effects, which differ with the type of drug used. Some people who
suffer from social anxiety, stress-related disorders, and depression begin
abusing drugs in an attempt to lessen feelings of distress. People suffering
 from drug and alcohol addiction also have a higher risk of unintentional
injuries, accidents and domestic violence incidents. All drugs of abuse -
nicotine, cocaine, marijuana, and others - effect the brain's "reward" circuit,
which is part of the limbic system.

The Substance-Use Disorder

According to the DSM-5, a “substance use disorder describes a problematic
pattern of using alcohol or another substance that results in impairment in
daily life or noticeable distress.” As with most addiction problems, despite
any consequences a person who has a problem with either alcoholism or
drugs suffers, they will generally continue to use their drug of choice. They
may make half-hearted attempts to stop or cut back their use, usually to no
avail.

Substances for which a person can establish a substance use disorder:

 Alcohol
 Cannabis
 Phencyclidine
 Other Hallucinogen
 Inhalants
 Opioid
 Sedative, hypnotic, or anxiolytic
 Stimulant: Specify amphetamine or cocaine
 Tobacco
 Other (Unknown)

Symptoms
 Consuming more alcohol or other substance than originally planned
 Worrying about stopping or consistently failed efforts to control one’s use
 Spending a large amount of time using drugs/alcohol, or doing whatever
is needed to obtain them
 Use of the substance results in failure to “fulfill major role obligations”
such as at home, work, or school.
 “Craving” the substance (alcohol or drug)
 Continuing the use of a substance despite health problems caused or
worsened by it. This can be in the domain of mental health (psychological
problems may include depressed mood, sleep disturbance, anxiety, or
“blackouts”) or physical health.
 Continuing the use of a substance despite its having negative effects
on relationships with others (for example, using even though it leads to
fights or despite people’s objecting to it).
 Repeated use of the substance in a dangerous situation (for example, when
having to operate heavy machinery or when driving a car)
 Giving up or reducing activities in a person’s life because of the
drug/alcohol use
 Building up a tolerance to the alcohol or drug. Tolerance is defined by the
DSM-5 as “either needing to use noticeably larger amounts over time to get
the desired effect or noticing less of an effect over time after repeated use of
the same amount.”
 Experiencing withdrawal symptoms after stopping use. Withdrawal
symptoms typically include, according to the DSM-5: “anxiety, irritability,
fatigue, nausea/vomiting, hand tremor or seizure in the case of alcohol.”

Effects of Alcohol
Alcohol intoxication is indicated by behavioral and psychological
symptoms. This includes poor judgment and difficulty getting along with
other people. Alcohol affects the cerebral cortex. This makes it difficult to
inhibit impulsive urges. Impulsivity can lead to aggression and risky
sexual behavior. Alcohol intoxication causes observable symptoms. These
symptoms include slurred speech; unsteady gait; a lack of coordination;
impaired memory/attention; involuntary rapid eye movements
(nystagmus); and even coma. Heavy alcohol use can cause many health
problems. These problems often involve the gastrointestinal,
cardiovascular, and nervous systems. In addition, the interaction between
alcohol and other drugs can be fatal. This is especially true with other
drugs that depress the central nervous system such as sedatives, hypnotics,
and anxiolytics LINK.

Effects of Sedatives and Sleeping Pills

Sedative, Hypnotic, or Anxiolytic Intoxication is characterized by

significant behavioral changes. These include aggression, mood swings,
and impaired judgment. The effects of these drugs is similar to alcohol.
This may contribute to social blunders, aggression, and even legal
problems. Physical signs involve slurred speech; nystagmus; a lack of
coordination; impaired memory; decreased blood pressure and pulse; and
possibly coma. Serious injuries (due to falls or accidents) and overdoses
(intentional or accidental) are not uncommon.
 Effects of Nicotine and Tobacco
Nicotine and tobacco are highly addictive. The ingestion of nicotine and
tobacco result in a discharge of epinephrine from the adrenal cortex,
causing a sudden release of glucose. Stimulation is followed by depression
and fatigue, leading the abuser to seek more nicotine.

In addition to nicotine, cigarette smoke is primarily composed of gases

(mainly carbon monoxide) and tar. The tar in a cigarette leads to a high risk
of emphysema, lung cancer, and bronchial disorders. The carbon monoxide
in the smoke increases the chance of cardiovascular diseases.

Warning Signs in Adolescents

 Changes in appetite or sleep patterns: This could be characterized by a
marked increase or decrease in either or both. For example, individuals
abusing amphetamines may show a diminished need for sleep and food.
Those abusing marijuana may sleep more and have an increased appetite.
These effects may vary depending upon the drug being abused. If you are
interested in the effects of specific drug use, you may want to conduct
some online research or call your local drug and alcohol commission or
mental health clinic for more specific information.
 Deterioration of physical appearance: Typical teenagers are very
concerned about the way they look to peers and friends and may be very
specific about clothing, makeup, and overall hygiene. Individuals abusing
substances often start to focus less on their physical appearance as their
substance use increases.

 Withdrawal from social or important activities: You may notice your teen

stops showing interest in things he or she once found pleasurable. For
example, they may start missing school or participate less in sporting
events or other social activities. They may also stop attending family
functions or gatherings such as church because their drug use has become
more important, or they may be embarrassed and try to hide their use from
others.

 Unexplained need for money or secretive about spending habits:

Individuals abusing drugs may begin asking for money without a clear
reason. Generally an abuser will not ask for very large amounts, but rather
small amounts over periods of time. They may also become more secretive
about spending habits. For example, he or she may claim to need more for
something than they actually need and pocket the extra money.

 Sudden change in friends or locations: The abuser’s friends or hangout

spots may change. For example, a teen may start hanging out with a
different crowd of friends. You may notice where they hang out may
change as well. They may suddenly think their old friends are no longer
“cool.” They also may start to break curfew or lie about where they are
hanging out.

 Increased interpersonal or legal problems: Individuals abusing substances

may start having more interpersonal problems, i.e., increased arguments
with parents, friends, or other authority figures. They may begin to get in
legal trouble for shoplifting or other crimes and cited for possession or
underage drinking.

 Change in personality or attitude: This one can be a little tricky. Given the

raging hormones of teenagers, personality and attitudes can change
 regularly. In someone abusing substances, this will look a little different.
The mood swings would be unlike typical teenage attitudes. Depending on
the substance being abused, you may begin to notice marked hyperactivity
or extreme happiness followed by a “crash” where the mood becomes just
the opposite. The individual may appear very lethargic or more irritable
than usual. Thinking and behaviors may become irrational and
unpredictable.

 Neglecting responsibilities: If the adolescent is normally very responsible

and there is a change in that behavior, this may be a sign. Substance abuse
often begins to take precedence over other things that were once deemed
important. As a result, responsibilities are often neglected and the teen
becomes more and more irresponsible over time.

 Using despite knowing it is dangerous: Most teens are very aware of the

negative effects and possible consequences of substance use. If the
adolescent is using despite this knowledge, this is a sign of abuse.
 CASE SUMMARY

The case that I shall be presenting now is of a regular, school going boy
Madhukar Tripathi, who reported addiction to alcohol and tobacco. He had
been consuming large amounts large amounts of alcohol and tobacco since
10th grade. He is weak, thin and appears sad and distressed most of the
time. He also reported loss of control- Madhukar tried several attempts at
controlling the amounts of tobacco he consumed, but those times when he
was able to abstain from tobacco use were when he substituted alcohol
and/or sedatives and sleeping pills. Whenever he tries to avoid consuming
tobacco, he feels burdened on the back of his head. He experiences lack of
concentration due to which his studies are getting affected severely. He
started consuming tobacco in class 10th when he failed in the final
examinations, and later engaged into drinking. When he consulted a
psychologist, he was diagnosed with Substance-Abuse. After the
application Of Guided-Self Change (GSC, a behavioural treatment)
combined with Cognitive Behavioural Therapy (CBT), there were
significant changes in Madhukar’s life and he could give up smoking and
drinking.
 IDENTIFICATION OF DATA

 Name: Madhukar Tripathi

 Age: 17 years
 Gender: Male
 School: Lucknow Public Collegiate
 Father’s Name: Mr. Ranaveer Tripathi
 Mother’s Name: Mrs. Pooja Tripathi
 Diagnosed Problem: Substance-Abuse Disorder
 Case duly referred
 CASE HISTORY

CONTEXT
Madhukar is a 17 year old boy studying in class XI in LPC School. He lives
in a nuclear family with his mother, father and a younger brother. He
belongs to affluent family with access to principal amenities. The family
holds a position of esteem in society. Madhukar had been an average
student till class 8th and managed to pass till class 9th. But a turning point
came in his life when he was in class 10th. He failed in the final examination
and had to repeat class 10th. He was bullied by other students of his school.
Unable to cope with the stress, he started smoking. And later, due to peer
pressure, he started drinking. He got addicted to tobacco and alcohol and
became completely dependent on it to feel relaxed.

His health and studies got severely affected. He passed class X but, failed
again in class XI as he could not concentrate on his studies because of his
addiction to tobacco and alcohol. He tried giving up tobacco but whenever
he tried to do so, he had to intake sedatives and sleeping pills for calming
his mind and sleeping. He felt drowsy and weak all the time.

He was not able to give up tobacco and hence, decided to consult a

psychologist. He expressed that even after trying so hard, he is not able to
give up his false habits, and that it is having profound effects on his life. He
reported that during stressful situations, such as, during exam time,
and/or the times when he is bullied, the urge to engage in smoking and
drinking increases and when he is unable to do so, he consumes sedatives
and sleeping pills.

The information was collected by the application of interview method and

a series of questionnaires were given to Madhukar.
A few sections of the questionnaire are attached on the following pages
for review and analysis.

The questionnaire was a highly standardized one with significant results.

The feedback report card is attached for perusal.

APPLICATION OF TREATMENT
After conducting a series of questionnaires based on The World Health
Organization Alcohol, Smoking and Substance Involvement Screening Test
(ASSIST), it was found that Madhukar was at moderate risk of health and
other problems from his current pattern if substance abuse , both now and
also in future if he continues the same pattern of use. Madhukar’s social
and cultural structures surrounding him and the problematic psychological
and behavioural patterns were targeted. Guided Self-Change (GSC), which
is an integrative treatment, combining CBT and Motivational Interviewing
was used.

Motivational Interviewing was used to leverage Madhukar’s motivation

for behaviour change. MI evoked his internal motivation for changing
problematic pattern in his life.

CBT involved self-monitoring i.e. tracking current substance abuse habits

and high-risk circumstances for use. With this increased awareness,
Madhukar with the help of his therapist, strategised ways to alter the faulty
thought patterns (I cope better with tobacco and alcohol).
 Early Experience

Father coping with alcohol- Daily alcohol and

tobacco abuse

Trigger/Situation
Core Beliefs
Internal Conflicts/
(I am not good enough, etc.) Peer
Pressure/Boredom
Negative Thoughts

(I cope better with

tobacco/alcohol, I feel
relaxed)

Reactions

Availability of drug results in continuous urges/cravings for

smoking and drinking
 CONCLUDING COMMENTS

After diagnosis of Substance-Use Disorder, treatment was started in the

light of CBT method. A total of twenty sessions were conducted. CBT and
GSC involved “self-monitoring” or tracking Madhukar’s current substance
use habits and “high-risk” circumstances for use. With this increased
awareness, he strategized ways through which he was able to alter
certain thoughts and behaviours that lead to problematic patterns.
Motivational Training (MI) was conducted with Madhukar where he was
evoked to change the problematic patterns in his life, while highlighting his
intrinsic strengths and resources.

Madhukar showed considerable improvement and was able to control the

urge to smoke and drink. Madhukar learned to deal with his problems and
identified his positive strengths and interests. Gradually, when he altered
his thoughts and behaviours, the cravings reduced and he was able to give
up smoking and drinking completely.

REFERENCES
 The World Health Organisation Alcohol, Smoking and Substance
Involvement Screening Test (ASSIST)

 Book on effects of Alcohol and Tobacco

 The Beck Youth Inventories

 Interview of Madhukar

 Psychology NCERT Textbook, Class XII