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HJ^ACEMBKT
OP , DRUG „ ADDICTION
CASE
STUDIES
Iff
ISD]^
10 PSYCHIATRIC
DR. KUROTILLA,
assisted by
S.I.Siasn.
SOClETv ^Tromohon of area resource centres
K.D.
PRACTICE
PREPACB
Drug abuse in India has of late assumed new dinensions.
Psychiatrists in India have played an inportant role in the
treatment and rehabilitation of habituated patients. Sone of then
have nado seminal contribution in epidemiological research in the
field; sone have actively campaigned against drugs and have
mobilized public opinion for effective intervention in the field
of drug abuse.
Dr. Kuruvilla presents in these pages a set of case studies
of patients of drug abuse.
These case studies can be used
in training programmes, and group discussion
They present different
types of drugs abused; varied backgrounds of patients; organiza
tional parameters within which therapy was given; the recognized/
articulated causes of drug-use; intervention; outcome and some
reflections on the limits of the possible.
SPARC records its gratitude to the Ministry of Welfare,
G.O.I., for the financial support to the proje-ot on the Manage
ment of Drug Abuse in India under which this brief report has
been produced.
Bombay.
4.4.1987.
Gabriel A.A. Britto
National Coordinator
Addiction Research!SPARC
SUBJECT ; A :
1 A' , 52 year old physician, sought treatment after having
been addicted, to Fortwin (eight months), Morphine (three years) and
Amphetamines (nine years).
He had stopped the use of drugs a week
before admission and was going through acute withdrawal - restlessness,
irritability, pain, insomnia.
Ho also had a history of an epilepsy -
like problem for the last two years, which could be related to drug
abuse.
A post-graduate diploma holder, he was employed in a
public limited concern.
He was married and had one child.
Questioning revealed no psychiatric abnormality.
Conflict in marital
life had led to frustration and drugs.
With co-operation from his wife and sustained by his
motivation he underwent detoxification, and was treated for his
Aversion therapy was employed.
seizures.
He was subsequently
discharged and it is not known if he gave up his habit for he did
not return for follow-up.
One important factor that this case reveals is that follow
up is almost as important as detoxification.
Abstaining from drug
abuse is relatively easy in the controlled atmosphere of a treatment
centre.
The real test comes during rehabilitation when the patient
is back in familiar surroundings, facing peer group pressure and
temptation.
Regular follow-up would provide the support and
encouragement required to combat the situation.
Therefore, a great
deal of attention needs to bo paid to easily accessible, properly
staffed follow up facilities whore the patient can receive further
counselling and the therapist can keep track of his progress.
This
could help to reduce the number of relapse cases.
In this instance, the subject being a doctor, has easy
access to some types of drugs.
Intervention needs to cover linkages
of one's occupation with addiction.
SUBJECT : B ;
'B' , a 24 year old teacher, belonging to a big town came for
treatment with a three year history of using multiple drugs like
Mandrax & Morphine.
For the last eight months he had suffered from
fits, probably related to his addiction.
He had started with ganja
but found that heroine (morphine powder as he called it) gave him a
better high and he switched over to the use of that.
He had been more
or less continuously using the drug and did not abstain even when he
began to get fits.
When he tried to stop he suffered from acute
withdrawal symptoms like irritability, running nose, hiccups, loss of
appetite etc.,
He complained of having become negligent
about his work.
This addict sought no real treatment, asking solely for
advice which could.not be of great value to him unless he underwent
proper detoxification.
can-be made. -
He requires counselling before further
Very often, addicts are not even aware of the stages of
treatment required - from detoxification to follow-up.
They even
hold the mistaken view that their hahit is a disease that can be cured
with a course of medicines administered on an out-patient basis.
Public education through the media is a must to remove such misconcep
tions .
•
'
i
SUBJECT ; C :
*C', a 24 year old, was admitted with a history of
multiple-drug-abuse
for eight years.
Disharmony between his parents had led him to seek escape
from unhappiness in drugs.
Now unemployed and unmarried, he had
progressed from ganja and hash to the more potent drugs available.
Social contact was limited to fellow addicts.
Coming from a well-to-do
family he could well afford to support his own habit without difficulty
and he,probably even supported his friends' as well.
Despite his
addiction,he managed to complete his graduation, but found it difficult
to hold a job.
Health slowly deteriorated.
His relationships with
his father and his brothers worsened considerably, especially when
having been forcibly admitted for treatment twice, he returned to his
habit immediately on release.
A course of treatment at a private
rehab centre was no help either and on being caught taking drugs
while under treatment, he was asked to leave.
Ultimately, he underwent detoxification under strict
surveillance from his mother and was brought for counselling.
found that he was an adventurous and sociable person.
It was
Though he had
had some behavioral and adjustment problems in school, there was no
real underlying psychiatric problem.
He was under emotional turmoil
resulting from a feeling of insecurity which stemmed from the
knowledge that if he did not mend his ways he would be ostracised
by his family and left to his own resources.
And he was conscious
that while still an addict he could not hope to support himself.
In fact, it was this very knowledge that motivated him to undergo
treatment.
In this case, disharmony among parents distressed the
friendly, outgoing child to the extent that he found solace in drugs.
Once they were aware of his addiction, both parents, despite their
desire to help him, probably blamed each other for his addiction
and that only made it worse.
The realization.that now he was a
cause of dispute undermined the effect of any encouragement and help
each parent could provide.
and family counselling.
What is required here is both individual
The addict must find a release for his
emotions in some other healthy activity - he could perhaps join
a club or take up a hobby.
1'hc parents must cease their squabbling
so that the environment at home is harmonious, supportive and loving.
The habit could then be broken.
Parents must rcalizo the importance of their harmonious
and contented partnership to their children.
parents constitutes an ideal world.
The life of their
They feel insecure when
fights are frequent and sometimes they may even have to take sides.
This insecurity could lead a sensitive child to drug abuse.
SUBJECT ; D ;
A JO year old labourer was a regular user of ganja.
He
belonged to-the low socio-economic strata, earning only Rs.200/~ a
month.
Educated upto the eighth standard, he had been carried for
4 years, was childless and was suffering from a sexually transmitted
disease.
In addition to ganja abuse, a habit of 12 years standing,
he was suffering from acute depression and was occasionally suicidal.
His addiction led
to
'
sleeplessness, burning sensations all over
his body and other associated problems.
After symptomatic treatment
he was required to undergo psychotherapy to alleviate his depression.
Two months later he was conceivably better but since follow-up was
poor, it is not known whether he was completely cured of his addiction.
Such a case is typical of the labour class, earning a
paltry sun, barely able to keep body and soul together and seeking
some sort of temporary escape from the bitter grind of- poverty through
the 'high1 the drug provides.
the solution.
Psycho therapy would not always provide
The answer lies in alleviation of the misery of the poor
and improvement of their lot.
SUBJECT t E ; '
Subject 'E' was a 35 year old businessman belonging to the
upper middle-class, Married and living in e. small town, ho had been
used to a joint family all his life, whore
decisions..
the elders took the
When the family split up into smaller units, the
responsibility for his wife and children camo upon his inexperienced
shoulders and unable to face what was to him, an enormous task,he
found comfort in alcohol, sedatives and tranquillizers.
a number of physical ailments began to appear.
disturbances made him seek treatment.
After 6 years,
Body ache and sleep
Once detoxification was over, ho underwent psyche thox-ew
in order to build in him the confidence and maturity required to face
the pressures of his responsibilities and deal with the.stresses of
life.
However, once his aches and pains disappeared after discharge
he did not return for follow-up.
Once again misinformation is one of the contributory factors.
Though the addict did need counselling to build his confidence he was
unaware that he actually needed help for his addiction, and not merely
treatment for the symptoms of addiction.
Better follow-up facilities with properly trained staff
could perhaps improve the situation.
Such patients could be visited
at hone fcr further counselling that would make then aware of the
problem and its root cause.
Even their fanilitos could be included in
counselling sessions in order to enlist their help.
SUBJECT : F:
T’ , now 45 years ol
a medical student.
started taking drugs when he was still
He was happily marrie.L with two- children and all
relationships were satisfactory.
Ho was in Government service.
He
started with morphine for relief from regular migraines, then progressed
to
pethidin and had been using it f-_>r close to 20 years.
he had undergone treatment a few times but to no avail.
In between
Ho had even
undergone brain surgery on being told that it helped cure addiction but
that was no help.
relapse.
After abstaining for ?. year and a half, ho had a
Eventually, he admitted himself once again for treatment since
his addiction upset him
A physical ailment therefore, can often cause addiction •
if the sane drugs are used for long periods of tine.
in problems such as migraine which have no known cure.
More especially
The patient is
not consciously looking for a high, he is merely taking the.widely-
accepted treatment for pain.
The subject was probably aware of the
consequences of addition and would not really require counselling.
A complete cure could only be effected with the help of the patient's
own motivation and deep resolve.
SUBJECT ; Gr x
A 32 year old engineer, addicted to ganja for twelve years,
sought help when depression and lack of concentration sot in and work
began to suffer.
On being advised to get himself admitted, he promised
to return but did not.
Lack of information about treatment methods gives rise to
the belief that addiction can be treated with only medicines, on an
out-patient basis, just like any other disease.
On hearing that they
must be admitted and detoxified, most patients are put off by the
complexity of treatment and lack
motivation to take even
the first step.
SUBJECT : H :
’H’, now 25 years old and unemployed, took • to drugs while
still in school doing his 10*2.
Always a problem child, he had had
problems of adjustment and for the last two years had been conscious and
distrustful of people around him, imagining that all were out to harm
him.
He had been addicted to ganja for six years and had started talcing
Mandrax since the last three years.
MH-n-0 ~
Al G"}"
O HSs' lf-
Tests revealed that he was a schisophrenic, for which he
he had even been successful in
underwent and was greatly inproved,
avoiding drug abuse for two months.
Psychiatric and psychotic problems are sometimes the under
lying cause of addiction and need prolonged and careful treatment
after which chances of a cure are
bright,
Sometimes addiction leads to
psychosis preliminary screening of addicts for psychosis is necessary.
SUBJECT : I :
Mr. I, a 27 year old, began to take injections of Fortwin to
treat frequent head aches.
Initially he was advised an injection a
month under medical surveillance.
Then he learnt to inject himself and
gradually began to feel the need for it two or three times a day.
Consequently he became depressed and lost a great deal of weight.
He wa
conscious of being constantly restless and disturbed when he did not
take the injection.
He was a graduate and had continued studies but had changed
courses frequently and had ultimately not finished his post-graduation.
Married and a father of three children, he was a smoker and took alcohol
occasionally.
There was no real underlying psychiatric problem here.
Given adequate motivation (sone counselling may be required to boost it)
there are few grounds for a relapse.
It is a case of medical
treatment developing into addiction unknowingly. This case again
emphasises the need to orient G.P.s on addictive drugs,addiction fits
man ago me nt
SUBJECT ; J ;
Mr. J, is a 2J year old. farmer from Andhra, belonging to the
upper middle class, he was married recently.
He used to take alcohol
regularly while he was in college, then two years ago he had also
started taxing Morphine injections.
Since the last ciz months hoth
dosage and frequency of Morphine had greatly increased but he had
discontinued the use of alcohol.
He had also tried calmpose as a substitute for Morphine in
order to break his habit but in vain.
Now he complained of feeling
drowsy all day through if he abstained. He could not sleep and his
appetite was poor.
Morphine also gave him a feeling of elation and
euphoria which he relished.
Past history revealed that though he was a B.Con., he had
been a poor student and hau been twice debarred from taking examinations
because he was caught cheating.
He also had some anti-social streaks
in his personality, given to picking quarrels and was currently facing
case of having been involved in a street fight.
a court
- He submitted to family pressure and sought treatment but
motivation was poor and during detoxification he ran away from the
hospital four times, each time going back to drug abuse.
Eventually,
when he was discharged after a month he was 'clean' but hot? long he
stayed that way is not known since motivation had been poor.
Ho also underwent individual and family therapy but he did. not ■
participate voluntarily’"and had to be persuaded.
Lack of adequate motivation such as in this case makes
relapse an almost foregone conclusion.
What is required is that the
addicts motivation be sufficiently b.osted to enable him to undergo
detoxification,
Later, his behavioural abnormalities can be treated
through proper therapy.
This patient would need to be shown an
alternative means to relieve his pent-up feelings so that ho did not
The root cause for his anti-social personality'
stray into quarrels.
could well still be undetected and perhaps would emerge with further
therapy and thereby determine the path his treatment should take.
SUBJECT : K ;
A boy from Madras, a student of TY B.Com. now almost 22
years old, had been smoking cannabis
ganja
regularly for
during the last year a friend offered to introduce
the last 15 years,
him to another drug which, he promised, would give him a better 'high'.
Finding that he preferred this'new stuff1 over all the others, he
switched to it on a regular basis and gradually increased the dosage
as his craving grew.
The 'new stuff was heroin.
His family disapproved of his habit and tried to persuade him
to dicontinue it.
He would/J1*-® to them saying he was no longer addicted.
One two occasions he tried to stop it by himself but developed severe
withdrawal symptoms like sneezing, runny nose, head ache and body ache
etc., 'and found relief from them only by taking the drug again.
Eventually, with some persuasion from his sister, a para-nodical trainee,
he sought treatment at a centre.
When he got himself admitted, he was
once again experiencing withdrawal since he had refrained from using
the drug for the last few days.
Farm Ty history showed no real psychiatric abnormalities.
He was quite spoilt by his parents and was used to getting his own way.
Frustration' tolerance was also found to be low, and some signs of
aggresion and stubbornness could bo a cause of problems in social and
family relationships.
Ho was to return for admission with his mother who would
stay to provide support.
But she decided that she would prefer him
being treated in their hone town and they did show up again.
Motivation in this patient was obviously not strong enough
and he had no other problems resulting from his addiction other than
withdrawal when he stopped.
flaws.
Even his personality showed no great
So there was no underlying reasons for his habit other than the
pleasure he derived from it.
Counselling would have to establish
adequate motivation.perhaps, by making him aware of the grin consequences
of drug abuse.
Then aversion therapy would be likely to be most
effective. Family constraints precludes certain options available for
the treatment of drug addicts.
■
Ofcourse, such a case also lays stress on the need for
imparting accurate and detailed information about drugs right from
school level onwards so that children can be discouraged right from the
start.
SUBJECT : L :
Mr. L, now 28 years old and hailing from Bangalore revealed
that he had had an unsatisfactory academic career since the age of 12.
He missed school regularly and spent his time wandering about claiming
that he was studying privately,
during these years he bagan to consume
alcohol in large quanties and in his 27th year, had also became a
multiple drug abuser.
Since he was unemployed, his mother, the only
earning member and widow, gave him regular pocket money.
She had
also financed several unsuccessful business ventures that he undertook.
A police problem was also mentioned but no details were made available.
Since passing his higher secondary he had made no attempts to pursue
further education, spending his energies in frequent sexual relationships.
However, he complained of personality disorder problems.
Though supported -'/-his mower, his relationship vn.cn ner
too was disturbed and storey an 1 in fact, when sho brought him for
treatment, he insisted that i.. was she who required it more than he
did.
despite being told that his sexual inadequacy was linked to his
habit of drug-abuse motivation was almost negligent and he was reluctant
to undergo any form of treatment, not even prepared to concede that his
addiction was a problem.
Also his mother was not in a position to stay
with^o provide encouragement ?nd support and later, to participate in
family therapy in order to resolve their problems.
Given the circumstances treatment of such a patient would be
greatly unsuccessful since he was not even willing to accept that he
needed -help or indeed, that he had a problem.
In such cases counselling
would help little unless the patient was more receptive and open-minded.
SUBJECT : M ;
t
Mr. M, hailed from Manipur.
children and employed as a
L.B. Clerk.
He was 28, married with two
Before marriage he used to drink
occasionally but later he took to drugs until eventually ho was a
multiple drug abuser addicted to morphine, heroin etc.,
He sought treatment for continual head-aches and abdominal
pain, probably ailments linked to his addiction.
No physical abnormali
ties were detected and he was moved on to the psychiatric department•
for psychological tests which showed that he was also suffering from
depression.
Though he was unaware of his depression, he gave his pains
as the reason for his drug abuse.
It was difficult to make him
understand that his pains were interlinked with his depression and
addiction and could not be cured unless the latter two problems were
treated.
Unfortunately for this addict, the climate of Vellore proved
unsuitable and besides, it was difficult to have all his relatives
travel the long distance for family therapy.
It was not viable
financially either, for treatment would take tine, so he returned
to Manipur,
It is possible that further tests would have revealed some
frustrations which arose after marriage for which he found comfort in
drugs.
Counselling would definitely have helped hin had time permitted.
What is really required is that treatment and rehabilitation
facilities are provided for in large numbers in every state so that
addicts can be treated locally as far as possible.
This would also
facilitate follow-up.
SUBJECT : N :
Mr. N, 2J years old and belonging to an upper middle class
family of Calcutta, was doing his Engineering in Bangalore,
talcing cannabis while in the 10th Standard in school.
He started
After 4-5 years
of this, he took to alcohol until finally he settled for heroin and had
been on it eight months when he sought treatment.
Though he was a user
only for the high or elation it gave him, he had noticed that away from
college, the craving was less.
When he abstained from drugs, he took
alcohol in large quantities, perhaps to compensate.
With no problems, psychiatric or otherwise, the patient had
became an addict merely to experience the 'high' it gave him.
caused painful withdrawal.
Abstinence
He would need counselling in order to make
him realize to what extent continued abuse could cause damage both
physically and mentally.
Once he was aware of the horrifying
consequences of his seemingly pleasurable habit, ho could be motivated
enough to try and break away iron his addiction.
For the sane reason
detailed and proper education on the use & abuse of drugs is a must
for school and college going children by whatever moans available.
Such a programme would be more effective and far reaching if it were
Government - sponsored and carried out through the media.
SUBJECT : 0 ;
An engineering student, married, sociable, of an out-going
and friendly temperament became an abuser.
Knowing full-well tho
physical consequences of drug addiction.
He had no psychiatric or
physical abnormality that led to his habit.
unaware that he had a problem.
In fact he was almost
He firmly believed that ho could give
up his pleasure-giving habit whenever he so desirod and that he
required, no special treatment for it.
Even a detailed resume of the
consequences could not induce him to undergo treatment.
In such cases counselling at such a stage can have no
foreseeable results.
Perhaps when physical and emotional problems
emerge due to the addiction, the patient can bo made to see reason
THE PROJECT AT A GLANCE
PATIENT
PROFILE
CITIES
EXISTING
FACILITIES
COUNSELLIN
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BOMBAY
DELHI
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MADRAS
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CALCUTTA
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GOA
psychiatric &
MED. PRACTICE
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IMPHAL
HYDERABAD
SRINAGAR
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