WHAT IS DRUG ADDICTION?
According to the latest evidence from human and animal studies (yes, even animals can become addicted to drugs), addiction is a chronic disease, just like diabetes or hypertension. As in other chronic diseases, it too occurs in vulnerable individuals who have been exposed to risks of getting the disease.
In diabetes, individuals who are overweight, don’t exercise and have family members with diabetes are more likely to contract it. In addiction, those who abuse addictive substances have a high likelihood of becoming addicted to them. What surprises laypeople and medical personnel alike is the lack of insight addicts have into their own behaviour. They are in a constant state of denial of how miserable addiction is making their life. The addict says, “I am only taking this to get through the day. I can stop if I really want to.” But he never does for long.
Addictive substances such as heroin, alcohol, nicotine, methamphetamines (also called ice and syabu) and ecstasy pills cause drastic changes in people. The most recent research indicates these drugs act on the part of the brain called the reward pathway. Humans, as well as other organisms, engage in behaviours that are rewarding; the pleasurable feelings one has cause the behaviour to be repeated. There are natural rewards as well as artificial rewards, such as drugs. Natural rewards such as food, water, sex and nurturing allow the person to feel pleasure when eating, drinking, having sex and being nurtured or loved. Such pleasurable feelings reinforce the behaviour so that it will be repeated, thus ensuring the survival of the species.
The collection of nerve cells that is located towards the centre of the brain called the reward pathway is the part of us that controls these behaviours. When a person becomes addicted, his reward pathway is short-circuited. The feelings of pleasure that he gets from eating a durian or being praised is no match for the feelings of pleasure from taking heroin. This can be crudely illustrated by comparing the amount of endorphins (the natural opiates produced by the brain to give pleasure and to reduce pain) which act on the reward pathway to the torrent of opiates received, when he takes heroin.
Addicted persons have difficulty describing the “high” they feel because it is beyond normal people’s experience. What this causes is a permanent change to the brain chemistry, resulting in addiction. Addiction is a state in which a person engages in compulsive behaviour, even when faced with negative consequences (such as being caught by police, or losing the love of one’s family, or worsening health).
A major feature of addiction is the loss of control in limiting intake of the addictive substance, as was seen in Jamal’s spiralling use of heroin. The most recent research indicates that the reward pathway may be even more important in the craving for the substance, compared to the reward itself.
The abuse of illicit drugs remains a serious problem in Malaysia. Over the decade there has been a drastic increase in illegal drugs used. The National Drug Agency (ADK) has, through its efforts, registered more than 300,000 addicts in its drug fight. However, just like the iceberg, the numbers are only what is seen above the surface.
Some local studies have suggested there are an estimated three to four addicts who are not registered with the ADK for every one that is. Hence the potential numbers of addicts in Malaysia is quite staggering, a possible one million addicts in our country of 25 million, or 4% of the populace! In comparison, some statistics from the United States estimate that the number of addicts there is one in 3,000, or only 0.03% of their population.
The major substance of abuse here are:
- Marijuana (ganja)
- Opiates (heroin, morphine, candu)
- Hallucinogens (LSD, cocaine)
- Amphetamine (pep pills, ecstasy)
- Inhalants (glue and gum sniffing)
The opioids include both natural opiates – that is drugs the opium poppy (morphine, heroin) and opiate-related synthetic drugs, such as meperidine and methadone. The medical use of these drugs is mainly for their powerful analgesic actions (pain killer). They are abused for their euphoric effects. Heroin can be injected, smoked or inhaled. It has the ability to alter mood and reduce anxiety. Young people who sniff heroin report that they forget everything that troubles them. These drugs also produce respiratory depression, constipation, reduced appetite and low libido. The effects of a usual dose of morphine lasts three to four hours.
Psychological dependence exists when a drug is so central to a person’s thoughts, emotions, and activities that he needs to continue its use because he has a craving or compulsion.
Physical dependence, also called addition, is characterised by tolerance, that is with continued use, the individual must take more and more of the drug to achieve the same effect. Tolerance develops rapidly leading to increasing dosage.
Withdrawal symptoms will occur if use of the drug is reduced or stopped abruptly. Withdrawal from opiates may occur as early as a few hours after the last dose. Major withdrawal symptoms peak between 48 to 72 hours after the last dose and usually subside within a week.
THE WITHDRAWAL SYMPTOMS INCLUDE
- Intense craving for the drug
- Restlessness and insomnia
- Pain in the muscles and joints
- Running nose and eyes
- Abdominal cramps
- Vomiting and diarrhea
- Dilated pupils
- Raised pulse rate and
- Goose pimples / feeling cold
Thus, the motivation to continue using the drug stems from the need to avoid pain and discomfort which drives addicts to seek further supply to relieve withdrawal symptoms. Overdose of opiates drugs would lead to respiratory depression and urgent medical treatment is required.
Other hazards of opiate’s addiction are related to intravenous usage such as:
- Infection at the injection site and infection of distant organs e.g. heart (SBE)
- Hepatitis B, AIDS and HIV infection – associated with needle sharing among the drug users
- Fetal abnormality especially when drugs are abused in early pregnancy. In late pregnancy, the fetus may become dependent on opiates. After delivery the baby would develop serious withdrawal symptoms.
As the drug comes to play an increasingly salient part in the person’s life, he/she often experiences a number of distressing social consequences. The first impact is on his family. It would disrupt relationships as families would go through anguish and frustration with the struggle to stop the abuser from the habit. The abuser would break promises leading to disappointments which could lead to rejection by parents, spouse or children.
As the abuser becomes more tolerant to the drug he is taking, he would need to take more and more to get the same effect, which would lead to an even greater financial burden on the family. Abusers usually have poor work records and frequent absences from work as well as low productivity. All the above results in a decreased earning power and debts would accumulate. The abuser would then turn to crime like stealing to sustain his habits.
SUBSTANCE ABUSE AND THE LAW
In Malaysia any person confirmed as a substance user will be sent for treatment and rehabilitation under the law for two (2) years to a drug rehabilitation center (Pusat Serenti). A person may as well volunteer for rehabilitation.