In recent years Drug Addiction has significantly increased in Bangladesh. This agent of human devastation has spread its tentacles worldwide and also in our country. Every intelligent and humane person in the world society and international organisations such as the UN and WHO are alarmed by the present rate of addiction. In our country the regular seizures of stocks of heroin and other hard drugs by the police and narcotics department gives us an indication of the extent of addiction in our country. Nowadays nearly ten per cent of outpatients in our hospitals are cases of drug addiction involving heroin, ganja and phensidyl. These are generally youths and young men between 15-30 years of age and come from all strata of the society. But there are adolescents below 15 years of age and men and women over 30. Hospital surveys show that average age of drug addicts is 22. The addicts are students, professionals, businessmen, laborers, rickshawallahs and from other professions. Students are most affected and drugs have caused deterioration in standards of education and students have also given up going to schools and colleges. These addicts are turning to various criminal activities, in order to procure drugs.

What are Drugs ?

Generally speaking drugs are substances that affect the physical and mental condition of persons significantly and adversely Any substance that can lead to addiction, misuse and dependence is a drug. Addiction level of drugs increase with each day of use. If drugs are not available, the patient shows critical withdrawal symptoms when immediate medical care is needed to prevent physical and mental deterioration, even death.

Drug Addiction Symptoms:

1. The addict develops a craving for the drug, and he spends all his efforts procuring it.
2. Drug tolerance in users leads to increased dosage of drugs needed to provide the same degree of enjoyment and kick.
3. Without drugs the addict loses his mental and physical abilities to work and enjoy life which is termed as psychological dependence and physical dependence.

Reasons for Drug Addiction

In brief the reasons determined through research, include :

1. Curiosity and excitement through use
2. Despair and frustration among the youth
3. Some patients are addicts because they try to follow the western culture of drugs and enjoyment of life.
4. All drug addicts in our country are afraid of social stigma more than the threat from the law.

The Dangers and Destruction Caused by Drugs

Drug addiction beings on rapid erosion of educational and cultural, moral and family values. The addicts lose their professional and educational capabilities, self-dignity, and get involved in serious or petty criminal activities. The sole aim in life of an addict becomes the procurement and use of drugs. Other aims and objectives in life are thrown by the roadside. Besides, dread diseases such as Hepatitis, HIV/AIDS can easily attack drug addicts through use of injectible drugs.

In our country, heroin is mostly smoked within aluminum foil or cigarette paper, but in other countries this is injected. Intravenous injection of pethidine/ morphine and now tadigesic brand of riknomar penic. These are extremely dangerous drugs and increases addiction manifold. Injections through infected needles can cause diseases of the liver, brain, heart, lungs and spinal cord. Normal medication also interacts with heroin and cause many complications, which many addicts do now know about. Such interactions may also cause e death.

Heroin addiction lowers mental enthusiasm and efforts and physical ability The addict loses contact with normal society and becomes self and drug-centered. He engages in all types of activities to obtain money to buy drugs. A Heroin addict may need about Taka 500 worth of the drug a day. He neglects the needs of the family, and those are non-earning may sell off family assets. They also go out on the streets for mugging and dacoity

Words of Caution for the Parents

Children are the beloved of the parents. Suspicions of one's child engaged in immoral and criminal activities are a source of the utmost heartache for the parents. Yet for this very reason, children must be kept under close observation. Behavioral and emotional changes are common in the adolescent and young men. But long-standing changes and rapid shifts in mood needs specialist doctor's attention and investigation. Heroin addicts live in a dream world, unconnected with realism and the environment around them. They lose concentration, live alone, and are irritated by interference and contact with non-addicts or other addicts. They rub their eyes and legs, and lose appetite rapidly.

If you come to know that your son or daughter is a heroin addict, do not lose calm and temper. Try to take stock of the situation and seek medical attention immediately, without trying to forcibly rid your children of the habit.

Symptoms of Heroin Addiction

• Your shy child may become aggressive about money. Keep your son/daughter under observation.
• If you suspect anything, examine their rooms in their absence. Burnt paper, empty cigarette packets, oily scraps of paper are some signs.
• Rapid weight loss of your child . Avoidance of any reply to your queries about weight loss . Get answers from them and keep under observation
• Uncertain temper, loss of appetite, lack of sleep, hand tremors.
• Regular onset of fever at a fixed time. Watery eyes.

Withdrawal symptoms vary with patients according to dosage and the patient's personality. Withdrawal symptoms start four hours after the last dosage of heroin. Eight hours later the patients yawns, sweats, with watery eyes and nose. 6 hours later his muscles start aching. No appetite at all. Within 24 to 36 hours the patient may have fever. No sleep and rise in blood pressure and pulse count results. Between 36 to 48 hours the patient may vomit with diarrhoea. Some also ejaculate. The symptoms slowly disappear. After one week the patient feels better. But normalcy returns after two to four weeks.

Treatment : The main points in the treatment of drug addiction is to reduce use of substances, to increase public awareness and social resistance and treatment and rehabilitation of the drug addict in specialized institutions.

Resistance to Drug Use

• Dissemination of Information: The target group has to be made aware and fully informed about drugs, its misuse and horrifying consequences. Educational institution, student and youth organizations should be involved in group discussion and meetings, with advocacy and awareness programmes through posters, slogans, radio and TV programme and various mass communication agenda, including the print media. Community leaders, politicians, sport and movie personalities can take active part in the campaign against drug addiction. Organizations to resist drug addiction must be built up by the students and youths
• Alternative Programmes: The inherent strengths of the youth in society have to be put to constructive work. Monotony, idleness, unemployment cause despair and frustration in the patient, and to seek solace elsewhere the target group look to drugs for comfort and to forget the trouble and tension of everyday life. Monotony and frustration may be eliminated through sports and games, physical training and competitive games, social work which make the youth adjust to the environment. Student life exposes the youth to many social pressures which leads to despair and tensions and the need for drugs to forget the stresses of modern life. Counseling of students on mental and physical health and tackling of various problem at school and college is required. Medical care is extremely and urgently necessary for the addicts. Withdrawal symptoms hinder the giving up of the habit. The first step in treatment is to stop drugs and treat for the withdrawal symptoms. Various physical symptoms of withdrawal have to be treated at this stage. Stopping the taking of heroin has to be under the supervision of a specialist. To get the patient to agree to treatment for addiction is the first step in the treatment. The patient will try to make excuses to avoid treatment. Sometime the patient stops taking requisite medication. The giving up of heroin without specialist advice is a waste of time, energy and money.

The patient should be treated in a hospital or clinic under supervision of doctors and nurses. The patient’s history has to be known and understood in detail by the health professionals and then medication and course of treatment may be prescribed. The patient's personality and mental make-up has to be understood by the doctor along with the patient’s physical and mental disabilities.

Once the heroin is removed from the human body, the patient and his/her family has to cooperate in a courses of long-term treatment prescribed by the specialist which include considerations of the patient's depression, social environment, recreation and other aspects. The preferred treatment mode is psychotherapy. The patient and his family must be convinced of the fact that giving up heroin is not the end of the treatment course, but just the end of the beginning of the treatment. Long-term follow-up treatment is the only cure to this terrifying problem. The patients who cannot or do not undergo follow-up treatment, may again revert to addiction.

The Role of Religious Values

Many addicts can become re-addicted. Many of their religious and moral values are not strong enough. Drug treatment and rehabilitation centers may be attached to mosques and other places of worship. Induction of religious values is a significant part of the treatment. The whole course of treatment of drug addiction revolves around the restoration of social, community and religious values in the patient. Addicts are many a time found to be oblivious about religious imperatives and rituals.

Conclusion:

The main elements in combating Drug addiction include measures to control availability and use of drugs, treatment of withdrawal symptoms, and restoration of social moral and religious values. To prevent re-addiction in patients, innovative treatment containing medical, social and religious aspects have to be put in place. Easy availability of treatment will ensure the elimination of this socially and physically dreaded disease.

Treatment of addiction in our country is still not in a hopeful stage. Some unqualified and unscrupulous people are engaged in making money out of this affliction with mushrooming organizations and signboards, which confuse the patients. Such institutions do not have doctors. Others falsely advertise the availability of services and doctors form abroad. Such doctors even if available cannot be very effective, unless they are truly knowledgeable about our social, cultural and economic environment.

Its is time that experienced and qualified doctors and health professionals come to the aid of the addict in our society, and give genuine and prolonged treatment and care.

The author is a psychiatrist and specialist in treatment
of drug abuse (The original article in Bangla was
translated by Mahbub Husain Khan).