AMITY UNIVERSITY, UTTAR PRADESH

AMITY INSTITUTE OF PSYCHOLOGY AND ALLIED SCIENCES

BA (Hons) – Applied Psychology 1st Year

(2009-2012)

DRUG ABUSE: A REVIEW

By Kritika Doval

Submitted by:

Mrs Anurakti Mathur

Lecturer

AIPS
 Acknowledgement

I would like to thank all people who have helped and inspired me during my term paper
study.

I especially want to thank my subject teacher, Pooja Srivastav, for her guidance during my
term paper research and study at Amity University. Her perpetual energy and enthusiasm in
research had motivated me. In addition, she was always accessible and willing to help her
students with their research. As a result, the present work became smooth and rewarding for
me.

I was delighted to interact with Mrs Anurakti, my mentor by seeking her help and guidance
from time to time and for giving me useful suggestions and pointing out weaknesses in
organization which helped me to refine my project work.

I also thank Mr Librarian at Amity University who directed me to a wide range of resources
on the web and in the library stacks. He answered all of my questions as well as asked me
questions that helped me to narrow my search. He gave me this help during and after class
time.

All my class buddies at the AIPS made it a convivial place to work. In particular, I would
like to thank Jigyasa for her friendship and help from time to time. All other folks, including
Surbhi had inspired me in research and life through our interactions during the long hours in
the classroom. Thanks.

My deepest gratitude goes to my family for their unflagging love and support throughout my
life; this paper is simply impossible without them. I am indebted to my father, Satish Doval,
for his care and love and especially for editing my work helping me out with the internet. He
pointed me to various web sites that helped me acquire in depth knowledge about the drug
menace which helped me to complete this project.

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 Certificate

This is to certify that the term paper titled ‘Drug Abuse: A Review’ by Kritika Doval was
conducted under my supervision and it constitutes of her original work.

Signature

(Pooja Srivastava)

Lecturer

AIPS

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4
Index

Contents

• 1) Introduction .........................................................................................................5

• A)Facts of drug abuse...............................................................................................8

• B)Causes of drug addiction....................................................................................10

• C)Drug abuse statistics...........................................................................................14

• D)Medical Treatment..............................................................................................17

• E)Drug rehabilitation..............................................................................................23

• 2)Review Research..................................................................................................28

• 3)Key Learning........................................................................................................44

• 4)Conclusion............................................................................................................46

• 5) Critical Analysis...................................................................................................47

• 6)References............................................................................................................48

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 1) Introduction

The rising worldwide phenomenon of drug abuse among youth, and in particular among
students, in an epidemic form has been causing great concern. It has already engulfed the
vulnerable sections of societies in different parts of the globe. Of late, the illegal production,
consumption and illicit trafficking of hard drugs have increased phenomenally. No society or
nation can any longer claim to be free from this problem as the culture of drug abuse and
trafficking have assumed a transnational form and character. The situation created by the
crisis in the world is threatening to tear apart the very fabric of society and dehumanizing the
people. The production, consumption and trafficking of drugs have already become an
organised billion dollar business enterprise. Many powerful people and syndicates are now
involved in these illegal activities all over the world.

Millions of drug addicts, all over the world, are leading miserable lives, between life and
death. India too is caught in this vicious circle of drug abuse, and the numbers of drug addicts
are increasing day by day. According to a UN report, One million heroin addicts are
registered in India, and unofficially there are as many as five million. What started off as
casual use among a minuscule population of high-income group youth in the metro has
permeated to all sections of society. Inhalation of heroin alone has given way to intravenous
drug use, that too in combination with other sedatives and painkillers. This has increased the
intensity of the effect, hastened the process of addiction and complicated the process of
recovery. Cannabis, heroin, and Indian-produced pharmaceutical drugs are the most
frequently abused drugs in India. Cannabis products, often called charas, bhang, or ganja, are
abused throughout the country because it has attained some amount of religious sanctity
because of its association with some Hindu deities. The International Narcotics Control
Board in its 2002 report released in Vienna pointed out that in India persons addicted to
opiates are shifting their drug of choice from opium to heroin. The pharmaceutical products
containing narcotic drugs are also increasingly being abused. The intravenous injections of
analgesics like dextropropoxphene etc are also reported from many states, as it is easily
available at 1/10th the cost of heroin. The codeine-based cough syrups continue to be
diverted from the domestic market for abuse.

Drug abuse is a complex phenomenon, which has various social, cultural, biological,
geographical, historical and economic aspects. The disintegration of the old joint family
system, absence of parental love and care in modern families where both parents are working,
decline of old religious and moral values etc lead to a rise in the number of drug addicts who
take drugs to escape hard realities of life. Drug use, misuse or abuse is also primarily due to
the nature of the drug abused, the personality of the individual and the addict's immediate
environment. The processes of industrialization, urbanization and migration have led to
loosening of the traditional methods of social control rendering an individual vulnerable to
the stresses and strains of modern life. The fast changing social milieu, among other factors,
is mainly contributing to the proliferation of drug abuse, both of traditional and of new

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psychoactive substances. The introduction of synthetic drugs and intravenous drug use
leading to HIV/AIDS has added a new dimension to the problem, especially in the Northeast
states of the country.

Drug abuse has led to a detrimental impact on the society. It has led to increase in the crime
rate. Addicts resort to crime to pay for their drugs. Drugs remove inhibition and impair
judgment egging one on to commit offences. Incidence of eve- teasing, group clashes,
assault and impulsive murders increase with drug abuse. Apart from affecting the financial
stability, addiction increases conflicts and causes untold emotional pain for every member of
the family. With most drug users being in the productive age group of 18-35 years, the loss in
terms of human potential is incalculable. The damage to the physical, psychological, moral
and intellectual growth of the youth is very high. Adolescent drug abuse is one of the major
areas of concern in adolescent and young people's behaviour. It is estimated that, in India, by
the time most boys reach the ninth grade, about 50 percent of them have tried at least one of
the gateway drugs. However, there is a wide regional variation across states in term of the
incidence of the substance abuse. For example, a larger proportion of teens in West Bengal
and Andhra Pradesh use gateway drugs (about 60 percent in both the states) than Uttar
Pradesh or Haryana (around 35 percent). Increase in incidences of HIV, hepatitis B and C and
tuberculosis due to addiction adds the reservoir of infection in the community burdening the
health care system further. Women in India face greater problems from drug abuse. The
consequences include domestic violence and infection with HIV, as well as the financial
burden. Eighty seven per cent of addicts being treated in a de-addiction centre run by the
Delhi police acknowledged being violent with family members. Most of the domestic
violence is directed against women and occurs in the context of demands for money to buy
drugs. At the national level, drug abuse is intrinsically linked with racketeering, conspiracy,
corruption, illegal money transfers, terrorism and violence threatening the very stability of
governments.

India has braced itself to face the menace of drug trafficking both at the national and
international levels. Several measures involving innovative changes in enforcement, legal and
judicial systems have been brought into effect. The introduction of death penalty for drug-
related offences has been a major deterrent. The Narcotic Drugs and Psychotropic Substances
Act, 1985, were enacted with stringent provisions to curb this menace. The Act envisages a
minimum term of 10 years imprisonment extendable to 20 years and fine of Rs. 1 lakh
extendable up to Rs. 2 lakhs for the offenders. The Act has been further amended by making
provisions for the forfeiture of properties derived from illicit drugs trafficking.
Comprehensive strategy involving specific programmes to bring about an overall reduction in
use of drugs has been evolved by the various government agencies and NGOs and is further
supplemented by measures like education, counselling, treatment and rehabilitation
programmes. India has bilateral agreements on drug trafficking with 13 countries, including
Pakistan and Burma. Prior to 1999, extradition between India and the United States occurred
under the auspices of a 1931 treaty signed by the United States and the United Kingdom,
which was made applicable to India in 1942. However, a new extradition treaty between
India and the United States entered into force in July 1999. A Mutual Legal Assistance Treaty
7
was signed by India and the United States in October 2001. India also is signatory to the
following treaties and conventions:

• 1961 U.N. Convention on Narcotic Drugs

• 1971 U.N. Convention on Psychotropic Substances
• 1988 U.N. Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic
Substances
• 2000 Transnational Crime Convention

The spread and entrenchment of drug abuse needs to be prevented, as the cost to the people,
environment and economy will be colossal. The unseemly spectacle of unkempt drug abusers
dotting lanes and by lanes, cinema halls and other public places should be enough to goad the
authorities to act fast to remove the scourge of this social evil. Moreover, the spread of such
reprehensible habits among the relatively young segment of society ought to be arrested at all
cost. There is a need for the government enforcement agencies, the non-governmental
philanthropic agencies, and others to collaborate and supplement each other's efforts for a
solution to the problem of drug addiction through education and legal actions.

In this term paper study I have tried to define drug abuse, its implications on society in
general, how it affects the brain bringing about psychological changes and affecting social
behaviour, the various research programmes aimed to understand its prevalence and the
depths to which it has penetrated and corrective measures undertaken by various
organisations and societies worldwide. In the end I have tried to pinpoint the key learning
points from the various studies conducted on this subject.

A. Facts of drug abuse

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• Drug abuse is a common problem that plagues all ethnic groups and social classes
worldwide

• Different people will be affected by drugs in different ways. Some people are more
prone to addiction than others.

• Drug abuse and dependence is a disease and not a character defect. A person being
treated for this condition requires the same respect as a person with any other medical
condition.

• A person who abuses drugs may not realize that he or she has a problem. Family
members often bring the abuse to the attention of a health care provider. Unfortunately, some
people who abuse drugs only realize they have a problem after they have been arrested for a
drug-related problem.

• A wide variety of substances can be abused. These take the form of illegal drugs (such
as phencyclidine known as PCP and heroin), plant products (such as marijuana or
hallucinogenic mushrooms), chemicals (the inhalation of gasoline, for example), or
prescription medications (see table below). Substances can be taken into the body in several
ways: Oral ingestion (swallowing), Inhalation (breathing in) or smoking, Injection into the
veins (shooting up) and depositing onto the mucosa (moist skin) of the mouth or nose
(snorting).

Anthony JC, Warner LA, Kessler RC. "Comparative Epidemiology of Dependence on

Tobacco, Alcohol, Controlled Substances, and Inhalants: Basic Findings from the National
Co morbidity Survey". Experimental and Clinical Psychopharmacology. 1994;2:244-68.
o In addition to health care costs from drug abuse, society pays a huge price for this
disease, like monetary costs from theft by abusers to support their drug habits, additional tax
money to pay for law enforcement agencies and loss to society of the potential contributions
the drug abuser would have made to his or her community had he or she remained sober and
productive.

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 As reported by licit exporting countries to the United Nations, except Communist
China ESTIMATED WORLD OPIUM PRODUCTION (In metric tons)
Others includes mainly North
Producing Country Africa
Licit and the NearIllicit
Production East Production Total Production
Source: BNDD Intelligence Staff, 750
India The World Opium Situation,
175-200unpublished paper,
925-950
October
Turkey 120 100 220
1970,
Russia p. 10 115 - 115
Pakistan negligible 175-200 175-200
Japan negligible - negligible
China 75-100 Unknown 75-100
Afghanistan - 100-125 100-125
Myanmar - 400 400
Thailand - 200 200
Laos - 100-150 100-150
Mexico - 5-10 5-10
Other - 5-10 5-10
TOTALS 1060-1085 1260-1395 2320-2480

What is drug addiction?

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and
use despite harmful consequences to the individual who is addicted and to those around them.
Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure
and function of the brain. Although it is true that for most people the initial decision to take
drugs is voluntary, over time the changes in the brain caused by repeated drug abuse can
affect a person’s self control and ability to make sound decisions, and at the same time send
intense impulses to take drugs.

Many people do not understand why individuals become addicted to drugs or how drugs
change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and
addiction as strictly a social problem and may characterize those who take drugs as morally
weak. One very common belief is that drug abusers should be able to just stop taking drugs if
they are only willing to change their behaviour. What people often underestimate is the
complexity of drug addiction—that it is a disease that impacts the brain and because of that,
stopping drug abuse is not simply a matter of willpower. Through scientific advances we now
know much more about how exactly drugs work in the brain, and we also know that drug
addiction can be successfully treated to help people stop abusing drugs and resume their
productive lives.

B. Causes of drug addiction

Drug addiction can be found in many forms. A person can be addicted to alcohol, prescription
drugs, inhalants, or other street drugs (cocaine, heroin, methamphetamines, etc.).
Understanding the reasons people are initially attracted to drug use can help stop future users
from becoming addicts.

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Experimentation and curiosity are the first factors that draw many to even try drugs. They
want to feel that "high", the sense of euphoria that comes with drug use. While this may lead
to recreational use of drugs (using only in certain situations), it rarely leads to actual
addiction unless other factors are present. However, some drugs (like heroin) have are more
likely to cause addiction than others, resulting in an addiction from simple experimentation
alone.

Prescription drugs can turn people into addicts because they have conditions in which they
need to take drugs in order to get relief. A person becomes hooked on prescription drugs
when they take more than the recommended dosage, take it more frequently than
recommended, and continue using the drug after their initial medical condition clears up.

The trend of prescription drug abuse is increasing in India, and is estimated to have grown
three folds in the last five years.

Elite athletes are susceptible to using drugs. They use them for performance enhancing
abilities. Steroids can make muscles bigger, while amphetamines help reduce or numb pain,
allowing persons to play injured. Recently, major league baseball has come under fire for
drug abuse. Though not as prominent, high school and college athletes have also been known
to use drugs to enhance their performance.

Others turn to drug use to cope with problems in their real lives. Whether it is past abuse
(physical or sexual), school problems, work problems, or relationship issues, drug use can
help a person temporarily escape the realities of his/her life.

Being around drugs and being exposed to addicts can also lead to drug addiction. If a family
member or close friend uses or is addicted to drugs, it becomes acceptable for other members
to engage in similar behaviour. It becomes a tolerated activity.

Peer pressure is also a factor in turning people into drug addicts. Contrary to popular belief,
peer pressure can happen at any age. Adults fall prey to peer pressure to fit into new social
classes, new workplaces, and new neighbourhoods. Teenagers fight peer pressure on
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everything from looks to alcohol to sex to drugs. In fact, crystal meth is becoming a way for
many teenage girls to fight the pressure that comes with needing to be thin and attractive.
Teenagers can also fall prey to the rebellious attitude that they need to do anything their
parents or those in authority say is bad.

Easy accessibility to drugs and new, lower prices are other causes of drug addiction. Drugs
can be found anywhere if a person simply asks. Street corners and alleyways are no longer
the only place to find drugs. Schools, workplaces, and even the family next door might be
new places to find drugs. With more drugs being produced, the price has also been driven
down.

Another one of the causes of drug addiction is using drugs to mask other mental problems.
For example, depressed people frequently use drugs to escape their sad feelings.
Schizophrenics find that some street drugs can control their hallucinations. Denial and hiding
the problem just lead to more problems in the long run.

How Drugs affect the brain

Let’s start with any person who is not using any drugs. All of the neuro function of the brain
is normal and there is no foreign substance in the bloodstream to interfere or influence this
function. Now we introduce cocaine and the drug circulates in the bloodstream.

The user experiences euphoria, a very pleasurable experience. Human nature will cause a
person to want more. They like the feeling and want to repeat the experience. Remember that
blood-brain barrier? It allows the cocaine to filter through and the neurons gather and
transmit the information. Let’s fast forward now as our person repeats this experience over
and over. The drug’s unintended consequences now come into play.

Drugs are chemicals that tap into the brain’s communication system and disrupt the way
nerve cells normally send, receive, and process information. There are at least two ways that
drugs are able to do this: (1) by imitating the brain’s natural chemical messengers, and/or (2)
by over stimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers,
called neurotransmitters, which are naturally produced by the brain. Neurotransmitters carry
information which allows us to experience pain, pleasure, etc. When a doctor administers an
anesthetic, that drug blocks the pain by blocking the perception of pain. In a sense, we are
fooled into thinking something doesn’t hurt because the vehicle for delivering that
information is blocked. The communication between neurons is key to understanding how we
react to a drug. The effect the drug has on us is what triggers addiction. When we go from
enjoying something, to craving it and losing control over our reasoning and our actions, that
is addiction. Because of this , these drugs are able to “fool” the brain’s receptors and activate
nerve cells to send abnormal messages.
Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release
abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of
these brain chemicals, which is needed to shut off the signal between neurons. This disruption
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produces a greatly amplified message that ultimately disrupts normal communication
patterns.

Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit
with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control
movement, emotion, motivation, and feelings of pleasure. The overstimulation of this system,
which normally responds to natural behaviours that are linked to survival (eating, spending
time with loved ones, etc.), produces euphoric effects in response to the drugs. This reaction
sets in motion a pattern that “teaches” people to repeat the behaviour of abusing drugs.

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in
dopamine by producing less dopamine or by reducing the number of dopamine receptors in
the reward circuit. As a result, dopamine’s impact on the reward circuit is lessened, reducing
the abuser’s ability to enjoy the drugs and the things that previously brought pleasure. This
decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring
their dopamine function back to normal. And, they may now require larger amounts of the
drug than they first did to achieve the dopamine high—an effect known as tolerance.

Long-term abuse causes changes in other brain chemical systems and circuits as well.
Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn.
When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to
compensate, which can impair cognitive function. Drugs of abuse facilitate non conscious
(conditioned) learning, which leads the user to experience uncontrollable cravings when they
see a place or person they associate with the drug experience, even when the drug itself is not
available. Brain imaging studies of drug-addicted individuals show changes in areas of the
brain that are critical to judgment, decision making, learning and memory, and behaviour
control. Together, these changes can drive an abuser to seek out and take drugs compulsively
despite adverse consequences—in other words, to become addicted to drugs.

Why do some people become addicted, while others do not?

No single factor can predict whether or not a person will become addicted to drugs. Risk for
addiction is influenced by a person’s biology, social environment, and age or stage of
development. The more risk factors an individual has, the greater the chance that taking drugs
can lead to addiction. For example:

• Biology. The genes that people are born with––in combination with environmental
influences––account for about half of their addiction vulnerability. Additionally, gender,
ethnicity, and the presence of other mental disorders may influence risk for drug abuse and
addiction.

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• Environment. A person’s environment includes many different influences––from
family and friends to socioeconomic status and quality of life in general. Factors such as peer
pressure, physical and sexual abuse, stress, and parental involvement can greatly influence
the course of drug abuse and addiction in a person’s life.

• Development. Genetic and environmental factors interact with critical developmental

stages in a person’s life to affect addiction vulnerability, and adolescents experience a double
challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use
begins, the more likely it is to progress to more serious abuse. And because adolescents’
brains are still developing in the areas that govern decision-making, judgment, and self-
control, they are especially prone to risk-taking behaviours, including trying drugs of abuse.

• While patients of all age groups and economic status are victims of drug abuse,
substance abuse is fairly common among teenagers and young adults below 25 years of age.

C. Drug abuse statistics

Drug abuse statistics effectively highlight the severity of the increasing seriousness of drug
dependency and addiction in today's society. These drug abuse statistics not only
demonstrate the relatively easy availability of drugs but the serious need for treatment and
substance abuse facilities. Of particular concern is the correlation of the drug abuse statistics
and the national trends in domestic violence and child abuse.

Startling drug abuse statistics for the year 2007 indicate that more than 7.5 million residents
of the U.S. required treatment for illegal drug use. In addition to the number of citizens
requiring treatment, drug abuse statistics further indicate that more than 6.2 million residents

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needed but did not receive treatment for illegal drug use. Approximately 70% of persons
using illegal drugs made no effort to receive treatment for their dependency or addiction.

Youth Drug Abuse Statistics

One of the more alarming drug abuse statistics involves the non-medical use of pain relievers,
tranquilizers, sedatives and stimulants which translate to approximately 2.5 million newly
dependent or addicted persons per year. The average age of persons illegally using these
psychotherapeutics was 21.8 years old. The average age of first-time cocaine users in 2007
was 20.2 years. Approximately 8.5 % of high school seniors reported use of cocaine. The
increasing vulnerability of the young is dramatically demonstrated by these drug abuse
statistics as shown in the diagram below:

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16
According to drug abuse statistics, approximately 50% of youths aged 12 and older reported
that it was "fairly easy" or "very easy" to procure marijuana. 14.1 % of this age bracket also
reported that it was easy to procure heroin while 24.5 % said it was "very easy" to obtain
cocaine. Even more alarming is a report that indicates that 22.3% of children aged 12-17 said
they had been in involved in a violent altercation or confrontation. A majority of these
confrontations were drug related.

As reported in 2007 drug abuse statistics, 3% of the total population aged 12 or older, or 7.5
million residents of the U.S. need treatment. Of these 1.3 received treatment at a specialty
centre. Conversely, according to 2007 drug abuse statistics, 6.2 million residents who needed
specialty treatment did not receive treatment. Drug abuse statistics do not reflect treatment
provided at emergency rooms.

Notes: Data are from persons aged 12 or older responding to the 2004 to 2006 National
Survey on Drug Use and Health who reported initiation of a substance 13 to 24 months prior
to the interview. Pain reliever, sedative, tranquilizer, and stimulant use refers to nonmedical
use of prescription-type drugs not prescribed for the respondent or used only for the
experience or feeling they caused. Percentages may not sum to 100 due to rounding.
Source: Substance Abuse and Mental health Services Administration, "Substance Use and
Dependence Following Initiation of Alcohol or Illicit Drug Use, “The NSDUH Report,
March 27, 2008. Available online at
http://www.oas.samhsa.gov/2k8/newUseDepend/newUseDepend.cfm.

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 D. Medical Treatment

Symptoms

The signs and symptoms displayed by a person depend on what substances the person has
abused. A person who has not abused drugs extensively may experience unpleasant
symptoms and may seek help from family members and friends. Chronic drug abusers
generally know what to expect from their drug use and rarely seek help for themselves.

• Most agents cause a change in level of consciousness—usually a decrease in

responsiveness. A person using drugs may be hard to awaken or may act bizarrely.

• Suppression of brain activity can be so severe that the person may stop breathing,
which can cause death.

• Alternatively, the person may be agitated, anxious, and unable to sleep. Hallucinations
are possible.

• Abnormal vital signs (temperature, pulse rate, respiratory rate, blood pressure) are
possible and can be life threatening. Vital sign readings can be increased, decreased, or absent
completely.

• Sleepiness, confusion, and coma are common. Because of this decline in alertness, the
drug abuser is at risk for assault or rape, robbery, and accidental death.

• Skin can be cool and sweaty, or hot and dry.

• Chest pain is possible and can be caused by heart or lung damage from drug abuse.

• Abdominal pain, nausea, vomiting, and diarrhea are possible. Vomiting blood, or
blood in bowel movements, can be life threatening.

• Withdrawal syndromes are variable depending on the agent but can be life
threatening.

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• Sharing IV needles among people can transmit infectious diseases, including HIV (the
virus that causes AIDS) and hepatitis types B and C.

• Many common household drugs and chemicals can be abused. Gasoline and other
hydrocarbons are frequently abused by adolescents and preadolescents. Over-the-counter
drugs, such as cold medications, are commonly taken in excessive doses by adolescents and
young adults to get high. Prescription medications are additional examples of drugs that
are abused and that can be obtained illegally (without a prescription).

• Amphetamines and cocaine cause impotence in men. Sildenafil (Viagra) has been
used by cocaine and amphetamine users to counteract impotence. Because Viagra is generally
prescribed for middle-aged and older men, a younger person must be questioned as to why he
has a need for Viagra.

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When to Seek Medical Care

Someone who wishes to receive treatment for drug abuse or dependence should see a doctor.
Family members should accompany the person with a drug abuse problem to the doctor's
appointment to discuss the issue.

A person with an acute drug overdose should be brought to a hospital's emergency

department immediately. The emergency department is a frequent place for people who suffer
from drug dependence to seek medical care. People who are behaviour problems may come
to the attention of the Emergency Medical Services system or police. These public service
professionals can assist in bringing the person to the hospital.

• Anyone with an alteration of consciousness needs immediate medical evaluation.

Such a person may not recognize how ill he or she is, or may be a danger to himself or herself
or to others. A hallucinating person, for example, may think he can fly and jump off a
building killing himself, as well as a person below. Violent behaviour is also possible.

• Anyone with abnormal vital signs, severe pain, or any severe or sudden onset of
problems needs immediate care.

Exams and Tests

The doctor will determine what substances have been abused and will ask what symptoms
prompted the person to seek care. The doctor will then perform a physical examination to
evaluate for possible organ damage.

• Laboratory studies are directed to evaluate for specific organ damage.

• Drug screening tests are readily available for some agents. Other substances can be
detected with specialized tests at only a few laboratories in the country. Some agents cannot
be detected by laboratory evaluation. There may be little benefit from drug testing.

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Drug Treatment Programs

• Drug addiction is a preventable disease. Results from NIDA-funded research have

shown that prevention programs that involve families, schools, communities, and the media
are effective in reducing drug abuse. Although many events and cultural factors affect drug
abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. It is
necessary, therefore, to help youth and the general public to understand the risks of drug
abuse, and for teachers, parents, and healthcare professionals to keep sending the message
that drug addiction can be prevented if a person never abuses drugs.

The key to treatment is stopping the abuse of the drugs or substances.

• Agitated or violent people need physical restraint and may need sedating medications
in the emergency department until the effects of the drugs wear off. This can be disturbing for
the person to experience and for family members to witness. Medical professionals go to
great lengths to use as little force and as few medications as possible. It is important to
remember that whatever the medical staff does, it is to protect the person.

• Very few antidotes are available for drug intoxications. In most cases, the only way to
eliminate a drug is for the body to metabolize it—in other words, let it run its course. In some
acute intoxications, the doctor may administer certain agents to help prevent absorption in the
stomach or to help speed metabolism of the drug.

• The dose of some agents (for example, benzodiazepines and barbiturates) must be
reduced slowly to prevent withdrawal. Withdrawal from some drugs can cause significant
problems, and stopping these drugs should only be done under the supervision of an
appropriate health care provider. Withdrawal from other agents, such as narcotics, is
21
uncomfortable but generally not harmful, and unpleasant effects can be lessened with
prescription medications. These prescriptions must be combined with a specific plan for
stopping drug abuse. The use of the prescription medication combined with continued drug
abuse may cause life-threatening complications.

• People who are acutely intoxicated may need hospitalization for detoxification. Some
cities have detoxification centres for sobering from drug and alcohol intoxication.

• Counselling programs may be suggested. Programs similar to Alcoholics Anonymous

are helpful for some people.
No single treatment plan is appropriate for everyone.
“Matching treatment settings, interventions, and services to an individual's particular
problems and needs is critical to his or her ultimate success in returning to productive
functioning in the family, workplace, and society.”

• Treatment needs to be readily available.

“Potential patients can be lost if treatment is not immediately available or readily accessible.
As with other chronic diseases, the earlier treatment is offered in the disease process, the
greater the likelihood of positive outcomes.”

• Remaining in treatment for an adequate period of time is critical.

“Research indicates that most addicted individuals need at least 3 months in treatment to
significantly reduce or stop their drug use and that the best outcomes occur with longer
durations of treatment. Recovery from drug addiction is a long-term process and frequently
requires multiple episodes of treatment.”

• Medications are an important element of treatment for many patients, especially when
combined with counselling and other behavioural therapies.
“For example, methadone and buprenorphine are effective in helping individuals addicted to
heroin or other opioids stabilize their lives and reduce their illicit drug use. Naltrexone is also
an effective medication for some opioid-addicted individuals and some patients with alcohol
dependence. Other medications for alcohol dependence include acamprosate, disulfiram, and
topiramate.”

• Many drug-addicted individuals also have other mental disorders. Treatment programs
should assess patients for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and
other infectious diseases as well as provide targeted risk-reduction counselling to help
patients modify or change behaviours that place them at risk of contracting or spreading
infectious diseases.
“Typically, drug abuse treatment addresses some of the drug-related behaviours that put
people at risk of infectious diseases. Targeted counselling specifically focused on reducing
infectious disease risk can help patients further reduce or avoid substance-related and other
high-risk behaviours.”

Follow-up

22
The initial evaluation by a doctor is just the first step in battling drug abuse. Follow-through
in drug avoidance is essential to successful treatment.

• It will generally be necessary to discharge the person from the emergency department
into the care of a sober adult. Activities that require skill and judgment, such as driving, high-
speed activities (bicycling, skateboarding), operating machinery, and swimming (even
bathtub use) should not be undertaken until all the effects of the drug have worn off.

• Joining support groups like Alcoholics Anonymous or Narcotics Anonymous can be

intimidating, but such groups are very helpful for some people. A social worker at the
hospital can advise on local resources available.

• Prevention is the Key

E. Drug rehabilitation

23
Drug rehabilitation (often drug rehab or just rehab) is an umbrella term for the processes of
medical and/or psychotherapeutic treatment, for dependency on psychoactive substances such
as alcohol, prescription drugs, and so-called street drugs such as cocaine, heroin or
amphetamines. The general intent is to enable the patient to cease substance abuse, in order to
avoid the psychological, legal, financial, social, and physical consequences that can be
caused, especially by extreme abuse.

Two-fold nature

Drug rehabilitation tends to address a stated twofold nature of drug dependency: physical and
psychological dependency. Physical dependency involves a detoxification process to cope
with withdrawal symptoms from regular use of a drug. With regular use of many drugs, legal
or otherwise, the brain gradually adapts to the presence of the drug so the desired effect is
minimal. Apparently normal functioning of the user may be observed, despite being under the
influence of the drug. This is how physical tolerance develops to drugs such as heroin,
amphetamines, cocaine, nicotine or alcohol. It also explains why more of the drug is needed
to get the same effect with regular use. The abrupt cessation of taking a drug can lead to
withdrawal symptoms where the body may take weeks or months (depending on the drug
involved) to return to normal.

Psychological dependency is addressed in many drug rehabilitation programs by attempting

to teach the patient new methods of interacting in a drug-free environment. In particular,
patients are generally encouraged or required not to associate with friends who still use the
addictive substance. Twelve-step programs encourage addicts not only to stop using alcohol
or other drugs, but to examine and change habits related to their addictions. Many programs
emphasize that recovery is a permanent process without culmination. For legal drugs such as
alcohol, complete abstention—rather than attempts at moderation, which may lead to relapse
—is also emphasized ("One is too many, and a thousand is never enough.") Whether
moderation is achievable by those with a history of abuse remains a controversial point but is
generally considered unsustainable.

Types of treatment

Various types of programs offer help in drug rehabilitation, including: residential treatment
(in-patient), out-patient, local support groups, extended care centres, and recovery or sober
houses. Newer rehab centres offer age and gender specific programs.

Pharmacotherapies

Certain opioid medications such as methadone and more recently buprenorphine are widely
used to treat addiction and dependence on other opioids such as heroin, morphine or
oxycodone. Methadone and buprenorphine are maintenance therapies used with an intent of
stabilizing an abnormal opioid system and used for long durations of time though both may
be used to withdraw patients from narcotics over short term periods as well. Ibogaine is an
experimental medication proposed to interrupt both physical dependence and psychological
craving to a broad range or drugs including narcotics, stimulants, alcohol and nicotine. Some
24
antidepressants also show use in moderating drug use, particularly to nicotine, and it has
become common for researchers to re-examine already approved drugs for new uses in drug
rehabilitation.

Counselling

Traditional addiction treatment is based primarily on counselling. However, recent

discoveries have shown those suffering from addiction often have chemical imbalances that
make the recovery process more difficult.

Historical Approaches to Substance Abuse Treatment

Disease Model and Twelve-Step Programs

The disease model of addiction has long contended the maladaptive patterns of alcohol and
substance use displayed by addicted individuals are the result of a lifelong disease that is
biological in origin and exacerbated by environmental contingencies. This conceptualization
renders the individual essentially powerless over his or her problematic behaviours and
unable to remain sober by himself or herself, much as individuals with a terminal illness are
unable to fight the disease by themselves without medication. Behavioural treatment,
therefore, necessarily requires individuals to admit their addiction, renounce their former
lifestyle, and seek a supportive social network who can help them remain sober. Such
approaches are the quintessential features of Twelve-step programs, originally published in
the book Alcoholics Anonymous in 1939 . These approaches have met considerable amounts
of criticism, coming from opponents who disapprove of the spiritual-religious orientation on
both psychological and legal grounds. Nonetheless, despite this criticism, outcome studies
have revealed that affiliation with twelve-step programs predicts abstinence success at 1-year
follow-up .

Client-Cantered Approaches

In his influential book, Client-Cantered Therapy, in which he presented the client-cantered

approach to therapeutic change, psychologist Carl Rogers proposed there are three necessary
and sufficient conditions for personal change: unconditional positive regard, accurate
empathy, and genuineness. Rogers believed the presence of these three items in the
therapeutic relationship could help an individual overcome any troublesome issue, including
alcohol abuse. To this end, a 1957 study compared the relative effectiveness of three different
psychotherapies in treating alcoholics who had been committed to a state hospital for sixty
days: a therapy based on two-factor learning theory, client-cantered therapy, and
psychoanalytic therapy. Though the authors expected the two-factor theory to be the most
effective, it actually proved to be deleterious in outcome. Surprisingly, client-cantered
therapy proved most effective. It has been argued, however, these findings may be
attributable to the profound difference in therapist outlook between the two-factor and client-
cantered approaches, rather than to client-cantered techniques per se . The authors note two-

25
factor theory involves stark disapproval of the clients’ “irrational behaviour” this notably
negative outlook could explain the results. as in some other cases

Psychoanalytic Approaches

Psychoanalysis, a psychotherapeutic approach to behaviour change developed by Sigmund

Freud and modified by his followers, has also offered an explanation of substance abuse. This
orientation suggests the main cause of the addiction syndrome is the unconscious need to
entertain and to enact various kinds of homosexual and perverse fantasies, and at the same
time to avoid taking responsibility for this. It is hypothesised specific drugs facilitate specific
fantasies and using drugs is considered to be a displacement from, and a concomitant of, the
compulsion to masturbate while entertaining homosexual and perverse fantasies. The
addiction syndrome is also hypothesised to be associated with life trajectories that have
occurred within the context of traumatogenic processes, the phases of which include social,
cultural and political factors, encapsulation, traumatophilia, and masturbation as a form of
self-soothing. Such an approach lies in stark contrast to the approaches of social cognitive
theory to addiction—and indeed, to behaviour in general—which holds human beings
regulate and control their own environmental and cognitive environments, and are not merely
driven by internal, driving impulses. Additionally, homosexual content is not implicated as a
necessary feature in addiction.

Cognitive Models of Addiction Recovery

Relapse Prevention

An influential cognitive-behavioural approach to addiction recovery and therapy has been

Alan Marlatt’s (1985) Relapse Prevention approach. Marlatt describes four psychosocial
processes relevant to the addiction and relapse processes: self-efficacy, outcome
expectancies, attributions of causality, and decision-making processes. Self-efficacy refers to
one’s ability to deal competently and effectively with high-risk, relapse-provoking situations.
Outcome expectancies refer to an individual’s expectations about the psychoactive effects of
an addictive substance. Attributions of causality refer to an individual’s pattern of beliefs
relapse to drug use is a result of internal, or rather external, transient causes. Finally,
decision-making processes are implicated in the relapse process as well. Substance use is the
result of multiple decisions whose collective effects result in consumption of the intoxicant.
Furthermore, Marlatt stresses some decisions—referred to as apparently irrelevant decisions
—may seem inconsequential to relapse, but may actually have downstream implications that
place the user in a high-risk situation.

26
Drug addiction treatment trends.

A recovering alcoholic may decide one afternoon to exit the highway and travel on side
roads. This will result in the creation of a high-risk situation when he realizes he is
inadvertently driving by his old favourite bar. If this individual is able to employ successful
coping strategies, such as distracting himself from his cravings by turning on his favourite
music, then he will avoid the relapse risk (PATH 1) and heighten his efficacy for future
abstinence. If, however, he lacks coping mechanisms—for instance, he may begin ruminating
on his cravings (PATH 2)—then his efficacy for abstinence will decrease, his expectations of
positive outcomes will increase, and he may experience a lapse—an isolated return to
substance intoxication. So doing results in what Marlatt refers to as the Abstinence Violation
Effect, characterized by guilt for having gotten intoxicated and low efficacy for future
abstinence in similar tempting situations. This is a dangerous pathway, Marlatt proposes, to
full-blown relapse.

Cognitive Therapy of Substance Abuse

An additional cognitively-based model of substance abuse recovery has been offered by

Aaron Beck, the father of cognitive therapy and championed in his 1993 book, Cognitive
Therapy of Substance Abuse. This therapy rests upon the assumption addicted individuals
possess core beliefs, often not accessible to immediate consciousness (unless the patient is
also depressed). These core beliefs, such as “I am undesirable,” activate a system of addictive
beliefs that result in imagined anticipatory benefits of substance use and, consequentially,
craving. Once craving has been activated, permissive beliefs (“I can handle getting high just
this one more time”) are facilitated. Once a permissive set of beliefs have been activated, then
the individual will activate drug-seeking and drug-ingesting behaviours. The cognitive
therapist’s job is to uncover this underlying system of beliefs, analyze it with the patient, and
27
thereby demonstrate its dysfunctionality. As with any cognitive-behavioural therapy,
homework assignments and behavioural exercises serve to solidify what is learned and
discussed during treatment.

Emotion Regulation, Mindfulness, and Substance Abuse

A growing literature is demonstrating the importance of emotion regulation in the treatment

of substance abuse. For the sake of conceptual uniformity, this section uses the tobacco
cessation as the chief example; however, since nicotine and other psychoactive substances
such as cocaine activate similar psychopharmacological pathways, an emotion regulation
approach may be similarly applicable to a wider array of substances of abuse. Proposed
models of affect-driven tobacco use have focused on negative reinforcement as the primary
driving force for addiction; according to such theories, tobacco is used because it helps one
escape from the undesirable effects of nicotine withdrawal or other negative moods.
Currently, research is being conducted to determine the efficacy of mindfulness based
approaches to smoking cessation, in which patients are encouraged to identify and recognize
their negative emotional states and prevent the maladaptive, impulsive/compulsive responses
they have developed to deal with them (such as cigarette smoking or other substance use).

28
 2) Review Research

Introduction

Attempts to understand the nature of illicit drug abuse and addiction can be traced back for
centuries, however, the search has always been limited by the scientific theories and social
attitudes available or dominant at any one time. Dr. Benjamin Rush, a founder of the first
medical school in the United States and a signer of the Declaration of Independence, was one
of the pioneers of U.S. drug abuse research. However, he had few scientific resources
available to attack the problem. The intricacies of cellular response to a drug could not be
understood until tools were developed to measure the response and to integrate this
knowledge with complex cellular biochemistry—a technology that has been developed only
in the past decade. One can compare this situation with that of pneumonia. A myriad of
treatments and partially effective remedies were used until the discovery of penicillin, when
the old treatments became a part of medical history. It is now possible, however, to be
optimistic that the tools needed to resolve the addiction problem are at hand.

Drug abuse research became a subject of sustained scientific interest by a small number of
investigators in the late nineteenth and early twentieth centuries. Despite their creative efforts
to understand drug abuse in terms of general advances in biomedical science, the medical
literature of the early twentieth century is littered with now-discarded theories of drug
dependence, such as autointoxication and antibody toxins, and with failed approaches to
treatment. Eventually, escalating social concern about the use of addictive drugs and the
emergence of the biobehavioral sciences during the post-World War II era led to a substantial
investment in drug abuse research by the federal government. That investment has yielded
substantial advances in scientific understanding about all facets of drug abuse and has also
resulted in important discoveries in basic neurobiology, psychiatry, pain research, and other
related fields of inquiry. In light of how little was understood about drug abuse such a short
time ago, the advances of the past 25 years represent a remarkable scientific accomplishment.
Yet there remains a disconnect between what is now known scientifically about drug abuse
and addiction, the public's understanding of and beliefs about abuse and addiction, and the
extent to which what is known is actually applied in public health settings.

During its brief history, drug abuse research has been supported mainly by the federal
government, with occasional investments by major private foundations. At the federal level,
the lead agency for drug abuse research is the National Institute on Drug Abuse (NIDA),
which supports 85 percent of the world's research on drug abuse and addiction. Other
29
sponsoring agencies include the National Institute of Mental Health (NIMH), the National
Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental
Health Services Administration (SAMHSA), all in the Department of Health and Human
Services; as well as the Office of Justice Programs (OJP) in the Department of Justice.
Throughout the federal government, the FY 1995 investment in drug abuse research and
development was $542.2 million, which represents 4 percent of the $13.3 billion spent by the
federal government on drug abuse (ONDCP, 1996). By comparison, $8.5 billion (64 percent
of the FY 1995 budget) was spent on criminal justice programs,1 $2.7 billion (20 percent) on
treatment of drug abuse, and $1.6 billion (12 percent) on prevention efforts.

ALCOHOL AND DRUG ABUSE RESEARCH CENTER

The Alcohol and Drug Abuse Research Centre (ADARC) conducts multidisciplinary research
on the behavioural and biological aspects of substance abuse. This approach is based on the
premise that substance abuse reflects a complex interaction between the individual, the
abused drugs and society. One goal of this research program is to improve understanding of
the multiple determinants of drug abuse and alcoholism and to develop more effective
treatment and prevention programs. A second goal is to evaluate the behavioural and
biological consequences of substance abuse and dependence in clinical studies, and in
preclinical models of drug abuse. A third goal is to train young scientists in research on the
determinants, consequences and treatment of substance abuse in parallel clinical and
preclinical studies. An important feature of the Alcohol and Drug Abuse Research Centre is
that all of its component laboratories are located in the same building to facilitate
communication and interaction between the scientists and postdoctoral trainees. Another
advantage of the Centre’s organizational structure is that parallel clinical and preclinical
studies can be conducted in several disciplines. The multidisciplinary research areas currently
being investigated by ADARC scientists are summarized in the diagram below.

30
Diagram of ADARC’s Multidisciplinary Work

MAJOR ACHIEVEMENTS IN DRUG ABUSE RESEARCH

There have been remarkable achievements in drug abuse research over the past quarter of a
century as researchers have learned more about the biological and psychosocial aspects of
drug use, abuse, and dependence. Behavioural researchers have developed animal and human
models of drug-seeking behaviour, that have, for example, yielded objective measures of
initiation and repeated administration of drugs, thereby providing the scientific foundation for
assessments of "abuse liability" (i.e., the potential for abuse) of specific drugs. This
information is an essential predicate for informed regulatory decisions under the Food, Drug
and Cosmetic Act and the Controlled Substances Act. Taking advantage of technological
advances in molecular biology, neuroscientists have identified receptors or receptor types in
the brain for opioids, cocaine, benzodiazepines, and marijuana and have described the ways
in which the brain adapts to, and changes after, exposure to drugs. Those alterations, which
may persist long after the termination of drug use, appear to involve changes in gene
expression. They may explain enhanced susceptibility to future drug exposure, thereby
shedding light on the enigmas of withdrawal and relapse at the molecular level.
Epidemiologists have designed and implemented epidemiological surveillance systems that
enable policymakers to monitor patterns of drug use in the population and that enable
researchers to investigate the causes and consequences of drug use and abuse. Paralleling
broader trends in health promotion and disease prevention in the past 20 years, the field of
drug abuse prevention has made significant progress in evaluating the effectiveness of

31
interventions implemented in a range of settings including communities, schools, and
families.

Marked gains have also been made in treatment research, including improvements in
diagnostic criteria; development of a wide range of treatment interventions and sophisticated
methods to assess treatment outcome; and development and approval of Leo-alpha-
acetylmethadol (LAAM), a medication for the treatment of opioid dependence.
Pharmacological and psychosocial treatments, alone or in combination, have been shown to
be effective for drug dependencies, and treatment has been shown to reduce drug use, HIV
(human immunodeficiency virus) infection rates, health care costs, and criminal activity.

Some drugs that are abused, most notably the opioid analgesics, have essential medical uses.
Since its founding, NIDA has been the major supporter of research into brain mechanisms of
pain and analgesia, analgesic tolerance, and analgesic pharmacology. The resulting
discoveries have led to an understanding of which brain circuits are required to generate pain
and pain relief (Wall and Melzack, 1994), have revolutionized the treatment of postoperative
and cancer pain (Folly and Interesse, 1986; Car et al., 1992; Jacob et al., 1994), and have led
to improved treatments for many other conditions that result in chronic pain.

32
What the research shows about play therapy.
By Bratton, Sue; Ray, Dee
International Journal of Play Therapy. Vol 9(1),2000, 47-88.
Abstract
The results of a comprehensive literature review of 82 play therapy research studies from
1942–2000 are summarized with an emphasis on the effectiveness of play therapy with
specific presenting issues and populations. Studies are organized by research topic in chart
form to allow play therapists to readily utilize the information to educate parents, schools,
judicial systems, managed care systems, other mental health professionals, and other
populations with whom they work. Although positive outcomes were noted with each of the
research areas, self-concept, behavioural adjustment, social skills, emotional adjustment,
intelligence, and anxiety/fear are topics demonstrating the most significance regarding the
efficacy of play therapy. Although not all outcomes have supported the use of play therapy as
viable intervention, the authors focus primarily on significant findings regarding play
therapy effectiveness. (PsycINFO Database Record (c) 2009 APA, all rights reserved)

IMPORTANCE OF DRUG ABUSE RESEARCH

The widespread prevalence of illicit drug use in the United States is well documented in
surveys of households, students, and prison and jail inmates. Based on the National
Household Survey on Drug Abuse (NHSDA), an annual survey presently sponsored by
SAMHSA, it was estimated that in 1994, 12.6 million people had used illicit drugs (primarily
marijuana) in the past month (SAMHSA, 1995). That figure represents 6 percent of the
population 12 years of age or older. The number of heavy drug users, using drugs at least
once a week, is difficult to determine. It has been estimated that in 1993 there were 2.1
million heavy cocaine users and 444,000-600,000 heavy heroin users (Rhodes et al., 1995).
This population represents a significant burden to society, not only in terms of federal
expenditures but also in terms of costs related to the multiple consequences of drug abuse.

The ultimate aim of the nation's investment in drug abuse research is to enable society to take
effective measures to prevent drug use, abuse, and dependence, and thereby reduce its
adverse individual and social consequences and associated costs. It now appears that
injection drug use is the leading risk factor for new HIV infection in the United States
(Holmberg, 1996). Most (80 percent) HIV-infected heterosexual men and women who do not
use injection drugs have been infected through sexual contact with HIV-infected injection
drug users (IUDs). Thus, it is not surprising that the geographic distribution of heterosexual
AIDS cases has been essentially the same as the distribution of male injection drug users'
AIDS cases (Holmberg, 1996) Further, the IUDs-associated HIV epidemic in men is reflected
in the heterosexual epidemic in women, which is reflected in HIV infection in children (CDC,
1995). Nearly all children who acquire HIV infection do so prenatal.

The extent of the impact of drug use and abuse on society is evidenced by its enormous
economic burden. As noted above, the federal government accounts for a large segment of the
33
societal expenditure on illicit drug abuse control- spending more than $13.3 billion in FY
1995 (ONDCP, 1996). About two-thirds were devoted to interdiction, intelligence,
incarceration, and other law enforcement activities. Research, however, accounts for only 4
percent of federal outlays, a percentage that has remained virtually unchanged since 1981
(ONDCP, 1996). Given the social costs of illicit drug abuse and the enormity of the federal
investment in prevention and control, research into the causes, consequences, treatment, and
prevention of drug abuse should have a higher priority. Enhanced support for drug abuse
research would be a socially sound investment, because scientific research can be expected to
generate new and improved treatments, as well as prevention and control strategies that can
help reduce the enormous social burden associated with drug abuse.

In the early 1980s, NIDA began to encourage research on comprehensive drug abuse
prevention programs that involve many components of a community. The theory behind this
approach is that children are more likely to pay attention to antidrug messages that are
repeated throughout the community than they are to heed messages from only one source,
such as in school or at home.

The program involved schools, mass media, parents, community, and health policymakers.
Sixth- and seventh-graders were taught in school how to resist social influences to use drugs.
This learning was reinforced through public service announcements and news stories. Parents
were encouraged to help their children on drug abuse prevention homework assignments and
to talk with their children about drugs. Volunteers from the community provided leadership,
developed community antidrug campaigns, and raised funds for related prevention activities.
Finally, the community established policies that discouraged the use of drugs, cigarettes, and
alcohol in schools, at work, and in public places.

Research findings indicated that students in the 107 participating schools in Kansas City and
Indianapolis used significantly less marijuana, cigarettes, alcohol, and cocaine than did
students whose schools did not participate. Substance abuse increased for both groups of
students as they got older, but the increase was substantially less for students in participating
schools.

Behavioural Research

Behavioural research has contributed to our understanding of many of the factors involved in
drug abuse, including initiation, maintenance, cessation, and relapse. Prior to the 1960s, the
general belief held by professionals and lay people was that drug abuse was caused by an
underlying psychopathology that could be studied only in humans. Behavioural researchers,
however, took advantage of the knowledge gained about the control of appetitive behaviours
and developed an animal model of drug abuse. Although early work on drug abuse and drug-
taking behaviours assumed that only those animals already physically dependent on opiates
could be induced to take them (Thompson and Schuster, 1964), it soon became clear that
when drugs were made available, drug-naive animals took them readily and to excess.

BEHAVIORAL MODELS

34
The major contribution of behavioural research to the study of drug abuse has been the
development of the self-administration model and the use of this model to test for abuse
liability and to expand our understanding of addiction. This basic model has been augmented
by other models based on the principles of learning and conditioning such as drug
classification (drug discrimination); the relationship between drug use and variables
controlling use (behavioural economics); the nature of transition states in drug abuse
(initiation, abstinence, withdrawal); motivational states (e.g., incentive motivation); and the
roles of tolerance and physical dependence in drug-seeking behaviour.

Drug Self-Administration Model

The drug self-administration model is based on the learning principle that behaviour is
maintained by its consequences, called reinforcers. Laboratory animals (humans and
nonhumans) will work to receive a range of different drugs administered orally,
intramuscularly, intravenously, by smoking, or by insufflation. In this model, the laboratory
animal performs some action, such as depressing a lever, to trigger the administration of a
drug (e.g., through an indwelling catheter or a solution to drink). In general, those drugs (e.g.,
cocaine, heroin, nicotine, alcohol) that maintain drug taking in nonhumans are also
commonly abused by humans, and those that are avoided by humans (e.g., antipsychotics) are
also avoided by nonhumans. These results are replicable in virtually every species tested with
the model and with different routes of administration. Such findings brought into question the
traditional explanations of the etiology of drug abuse, such as psychopathology or various
social deprivations.

This model also allows behavioural researchers to control past history and current
environmental conditions, thus demonstrating that it is the interaction of the drug's
pharmacological effects with past history and current environmental conditions (i.e., setting)
that determines whether sampling an abusable drug will proceed to persistent use or abuse
(e.g., Barrett and Witkin, 1986). This model points to the importance of a confluence of
variables in drug-taking behaviour and has broadened the clinician's understanding of the
various causal factors that might be involved in drug abuse.

Animal Models of Drug Dependence

Drug dependence has also been modelled in laboratory animals. Drug dependence (or
addiction) is characterized in both the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV; APA, 1994) and the International Classification of Diseases (ICD-10, WHO, 1992)
as drug-seeking behaviour involving compulsive use of high doses of one or more drugs, for
no clear medical indication. Dependence is usually accompanied by tolerance and
withdrawal; physicians often confuse the presence of a withdrawal syndrome (i.e., physical
dependence) with the compulsive drug taking that is a part of the behavioural dependence
syndrome. Models have been developed in which animals are maintained on specific drugs of
abuse (e.g., opiates) for some period of time, either via self-administered or experimenter-
administered drug, and then observed for the effects of abrupt cessation (e.g., Woods and
Schuster, 1968). Manipulations using animal models have provided information about the
relationship between repeated drug use and toxicity, as well as the likelihood that the drug
will be taken in the future.

35
Survey of Drug Abuse in India

There is evidence to show that in the age of Mahabharat and Ramayana, ‘Somras’ was drunk
by kings and their courtiers the virtue of which ancient epics refer to. It was used in the
worship of Lord Shiva. Certain preparation of cannabis like bhang, charas, and ganja have
long been used by priests and other religious personages as an aid to meditation in getting
free from stress, depression and tension.

Opium was first used in India in the ninth century by the Arab traders. The use of opium and
poppy pods increased during the Mughal period. Traditionally it was used in medicines and
as a sedative and pain killer. It was given in all kinds of ailments, like dysentery, diabetes,
cough etc. The use of cocaine for euphoric purposes, however, is not more than hundred years
old in India (Chopra, 1940, 1942).

Available literature on drug addiction in India is either cross-sectional or retrospective and

has generally been epidemiological and/or clinical in nature. Cities like Delhi, Mumbai,
Kolkata and Chennai have large number of addicts. Delhi alone is estimated to have more
than a hundred thousand drug addicts, although these numbers are at best intelligent guesses.

A nationwide survey on the prevalence of drug abuse has not yet been conducted but a
number of studies and surveys available have been identified which highlight on the
phenomenon (Adutyanjee, Mohan, and Saxena, 1984; Bannerjee, 1989; Khan, 1985, 1989).
In a study conducted by Chopra (1940) taking into account the total quantity of drug
consumed, it deduced that one percent of the total Indian population was addicted to
cannabis. Dube and Handa (1969) reported that 0.77% out of 29,468 in general population
habitually use alcohol. Thacore (1972) surveyed 497 families comprising a population of
2626. The results revealed that the rate of drug abuse was 18.55 / 1000 for taking alcohol,
cannabis, tranquilisers and stimulants.

In India, there have been many steps taken by various governmental and non-governmental
agencies in the area of prevention of substance abuse. A major achievement has been the
recent inclusion of information on substance abuse as an obligatory component of the school
curriculum. On the demand side, the Ministry of Health and Family Welfare has established
several de-addiction centres which are mostly based at the district hospital level: there are
about 130 such centres spread across the country now. A Narcotic Drugs and Psychotropic
Substances (NDPS) Act was passed in 1985 and amended in 1989. In 1999-2000, the
Ministry of Social Justice and Empowerment, along with the United Nations Office for Drugs
and Crime, undertook for the first time a major national study on the extent, patterns and
trends of substance abuse in the country, a major component of which was a national
household survey This seminal study has become the basis for planning of substance abuse
prevention and treatment strategies. An inter-ministerial collaborative effort has already been
initiated.

36
 3) Key Learning

Summing up the key learning points from the above study, I have enumerated the following
pertinent points from the study:
1. Drug or substance abuse is a worldwide phenomenon with increasing number of
people becoming drug addicts threatening the very fabric of society.
2. Most drug users are in the productive age group of 18-35 years.

37
3. Drug addiction is the most common form of addiction. People use certain drugs and
generally overuse will cause a physical and mental dependence. Addictive drugs such
as heroin and cocaine are very dangerous and may lead people to become damaging to
themselves and other around them.
4. The use of synthetic drugs and intravenous drug use is leading to an increase in
HIV/AIDS infections and has added a new dimension to the problem.
5. The spread and entrenchment of drug abuse needs to be prevented, as the cost to the
people, environment and economy will be colossal.
6. A wide variety of substances can be abused. These take the form of illegal drugs (such
as phencyclidine known as PCP and heroin), plant products (such as marijuana or
hallucinogenic mushrooms), chemicals (the inhalation of gasoline, for example), or
prescription medications (see table below). Substances can be taken into the body in
several ways: Oral ingestion (swallowing), Inhalation (breathing in) or smoking,
Injection into the veins (shooting up) and depositing onto the mucosa (moist skin) of
the mouth or nose (snorting).

7. Myanmar is the biggest producer of illicit opium in the world.

8. There are various causes why people become addicts – curiosity and experimentation,
prescription drug overuse, athletes using them to enhance performance, peer pressure,
easy accessibility etc.

9. The chemicals in drugs affect the brain’s communication system which plays havoc
with the way the nerve cells normally send, receive and process information.

10. Risk for addiction is influenced by a person’s biology, social environment and age or
shape of development.

11. Drug addiction is a disease and is preventable.

12. Prevention programmes need the involvement of families, schools, communities and
media.

13. Drug rehabilitation is twofold in nature – physical dependant and psychological

dependant.

14. Counselling is the key to drug addiction treatment. It may be client- centred or
psychoanalytical.

38
 15. Cognitive therapy of substance abuse is based on addicted individuals’ “core beliefs”.

16. Dr Benjamin Rush was one of the pioneers of US drug abuse research.

17. The lead agencies of drug abuse research in the US are: National Institute on Drug
Abuse (NIDA), which supports 85 percent of the world's research on drug abuse and
addiction. Other sponsoring agencies include the National Institute of Mental Health
(NIMH), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the
Substance Abuse and Mental Health Services Administration (SAMHSA), all in the
Department of Health and Human Services; as well as the Office of Justice Programs
(OJP) in the Department of Justice.

18. The major achievement of drug abuse research is the knowledge gained about
biological and psychosocial aspects of drug drug abuse and dependence.

19. The ultimate aim of research is to enable society to take timely effective measures to
prevent drug use, abuse and dependence in order to check the adverse consequences.

4) Conclusion

Research on drug abuse has been going on for many centuries. Dr Benjamin Rush was one of
the pioneers in this research and founder of the first medical school in the United States. In
the last 25 years there have been tremendous advances in this field with remarkable scientific
accomplishments.

Drug abuse research is mainly supported by the federal government with very few private
foundations taking up the cause. The main federal agencies involved are: National Institute
on Drug Abuse (NIDA), which supports 85 percent of the world's research on drug abuse and
addiction. Other sponsoring agencies include the National Institute of Mental Health
(NIMH), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the
39
Substance Abuse and Mental Health Services Administration (SAMHSA), all in the
Department of Health and Human Services; as well as the Office of Justice Programs (OJP)
in the Department of Justice.

There are many aspects of drug abuse research. The Alcohol & Drug abuse centre (ADARC)
conducts pre-clinical and clinical research based on behavioural science, brain imaging,
endocrinology, genetics, immunology, medicinal chemistry and pharmacology. Thus it is a
multi-disciplinary research. In the last 25 years major achievements have been reported
especially as researchers have learned more about biological and psychological aspects of
drug use, abuse and dependence. Following major advances in molecular biology,
neuroscientists have been able to decipher the effect of drug exposure on the brain. Their long
time effects have been studied. A NIDA-sponsored research was the driving force in the
identification of morphine-like substances that serve as neurotransmitters in specific neurons
located throughout the central and peripheral nervous systems.

The importance of drug abuse research lies in the ultimate aim of a nation’s investment in
drug abuse research enabling society to take effective measures to prevent drug use, abuse
and dependence thereby reducing its harmful consequences.

One of the first comprehensive prevention programs was the Midwestern Prevention Project
conducted by Dr. Mary Ann Pentz and her colleagues at the University of Southern California
in Los Angeles. The research program was first implemented in Kansas City, Kansas, and
Kansas City, Missouri, in 1984 and later replicated in Indianapolis, Indiana, starting in 1987.
The program involved schools, mass media, parents, community, and health policymakers.
Sixth- and seventh-graders were taught in school how to resist social influences to use drugs.

Behavioural research has contributed to our understanding of many of the factors involved in
drug abuse, including initiation, maintenance, cessation, and relapse. Behavioural models
include the basic self-adminstration model which has helped us to expand our understanding
of addiction. This model helped us to determine if a drug will proceed to persistent use or
abuse.

In India, a detailed survey of drug abuse has not been undertaken on a nationwide scale
although there have been many steps taken by various governmental and non-governmental
agencies which are involved in prevention of substance abuse. A major achievement has been
the inclusion of information on substance abuse in the school curriculum.

5) Critical Analysis

The research done on drug abuse and study of its effect is usually done on animals
through self-administering the drug. This leads to a theoretical approach that drug abuse is
simply a matter of "sufficient exposure" to a given drug. But these research models
overlook the fact that the human population of interest consumes drugs in highly variable
patterns, influenced by any number of factors. If the development of addiction is a result
of the "correct" repeated exposure to drug, this just does not explain why some individuals
end up exposing themselves according to the addiction protocol and some do not! It is my
belief that a more interesting way to move forward in understanding drug abuse would be
to concentrate our models on population outcomes that is based on human data more
closely.
40
The total funds spent on research is, according to me, not sufficient given the social costs
of illicit drug abuse and the enormity of the problem. The government should allot more
funds for this important research in order to prevent and control the menace. Research
should be conducted into the causes, consequences, treatment and public awareness
programmes and should be given a higher priority than it is at present.

A major area of concern is the illicit production of drugs like opium. I think stricter laws
and regulations need to be put in place and closer scrutiny conducted so as to eliminate
illicit production which is prevalent in only certain parts of the world.

Drug addicts support groups have proliferated over the past twenty-five years, and very
few studies have been done on these computer-mediated support groups. Preliminary
research dealing with on-line support groups suggests that they may offer a number of
advantages to their members compared to face-to-face drug rehabilitation groups, such as
twenty-four hour access to the group, anonymity, and an extended support network that
would be impossible to have in a face-to-face environment. However, disadvantages in the
form of increased anonymity, increased distance between support providers, and
asynchronous communication that typically occur within on-line support groups could
possibly negatively affect on-line group members' satisfaction with the support they
receive. No studies, however, have examined the relationship between satisfaction with
supportive relationships in on-line support groups and the types of coping strategies used
by on-line support group members.

41
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