Relapse, Craving, and Reinstatement

Drug abuse is a relapsing disorder. In fact, most drug abusers and

addicts have stopped or tried to stop taking drugs, only to eventually

relapse. So at any given time, most drug abusers are in fact relapsers.

Therefore, it is important to study relapse itself, and this is nicely

done in a variant of the self-administration model, as mentioned pre-

viously. It works by allowing the animal to learn to self-administer a

drug, such as cocaine, until the lever pressing is stable. Then, the

drug is withdrawn, and, as expected, the animal gradually tires of

lever pressing without a reward and the lever pressing behavior is

extinguished. This animal is now an experienced drug user, much like

most humans who have used drugs but have stopped. A human in this

condition likely thinks about the drug, and when stressed or

reminded of the drug, perhaps by some cue, craves the drug and per-

haps starts looking for a drug. The cue can be the sight of friends who

use drugs, the crack house, or even some white powder that reminds

him or her of the drug. Cues and their effects are very interesting and

currently studied. For example, Drs. Leslie Lundahl and Chris-Ellyn

Johanson recently found that drug-related cues set off cravings in

marijuana-dependent subjects.5 Getting even a small amount of the

drug (which is a cue) might set off a binge of drug taking. So, as you

can see, certain events can trigger craving, drug seeking, and relapse.

Now, let’s return to the animal that has experienced a drug but is

currently without it. If stress, such as a foot shock, is present or if the

drug is injected, the animal remarkably starts to press the lever that

previously resulted in a drug injection. The animal does this even if

no drug is given by the lever press (see Figure 2-4). Previous drug use

has conditioned the animal to look for the drug in situations that elicit

cravings in humans.

Lucky that we are not prey to drugs

 Some of us are lucky and we either have no interest in drugs or

can walk away from them at any time. Everybody’s brains are differ-

ent, at least to some degree, and have different vulnerabilities to drug

use. Surprisingly, women and men respond differently to drugs, and

so do adolescents and adults. Teens are a special concern because of

their youth and increased sensitivity to drugs. Many studies have

revealed why this is so and why some of us are more likely to get into

trouble with drugs than others. Stress, involved in so many health

problems, also feeds the demons of drug abuse. Our genetics also

play a role, but not an overwhelming one; we can still fight back.

Drug abuse and addiction are costly, not the least because of the

misery they bring. Because of this cost, society has invested in science

to combat drug use. It is paying off. We have found the demons, and

we can fight. But if you are new to the war itself, because of the

addiction of a loved one, a patient, or yourself, then prepare to arm

yourself to fight.

Unhealthy Beliefs

 

Beliefs that are unhealthy have, at their core, explicit or implicit, rigid, powerful demands, usually expressed as MUSTs, SHOULDs, HAVE TOs, GOT TOs, e.g. I absolutely must not be rejected. Unhealthy demands are not based on reality.

Rigid demands have three powerful unhealthy derivative beliefs:

1. Awfulising – an unrealistic assessment of badness where negative events are viewed or defined as ‘end of the world bad’ or 100% or more bad.

Example: ‘It would be awful if I’m rejected’, ‘It would be the end of the world if I am rejected and therefore I must not be rejected.’

2. Low Frustration Tolerance (LFT) – the perceived inability to tolerate frustration or difficulty even though we do tolerate it. We do not spontaneously combust and die in the face of frustration and difficulty.

Example: ‘Rejection is unbearable’, ‘I can’t stand it’, ‘It’s intolerable, therefore I must not be rejected.’

3. Total Damning of Self or Other – rating the self, another or the world in a totally negative way, based on a condition.

Example: ‘Rejection proves I’m a failure or worthless or unlovable as a person, therefore I must not be rejected.’

These beliefs are unhealthy because they generate emotional disturbance or unhealthy negative emotions like anxiety and depression. They are unrealistic, do not make sense and are unhelpful to you. They sabotage the achievement of your goals

‘People are disturbed not by things but by their view of things’

 ‘People are disturbed not by things but by their view of things’

This often quoted phrase of Epictetus (Stoic philosopher) is at the heart of the Ellis model. 

The intent behind Ellis’s work and his theory was to:

• Help people clarify their emotions, behaviour and goals.

• Identify the unhealthy beliefs that are at the heart of their emotional problems and 

that sabotage their goals.

• Dispute them and replace them with their healthier version in order to get better 

through consistent and constructive action.

• Finally, to generalise the change to other areas of life.

Epictetus’s quote can be conceptualised by the ABC diagram which follows.

It is not the event, but the belief or view you hold about the event, which is at the heart of 

emotional states. Emotions, thoughts and behaviours can be healthy and functional, or unhealthy and dysfunctional. The event can be something that has happened in the past, 

something that is happening now or something that could happen in the future. It can also 

be real, imaginary, internal or external. Internal events can be thoughts, images, memories, 

physical sensations or emotions.

National Anti-Drug Addiction Day

 Substance Abuse, an Enigma a Hidden Epidemic

National Anti-Drug Addiction Day is observed every year on 2nd October. The aim of the day is to make India free from drug and to preserve the talent. Father of the nation Mahatma Gandhi condemned the use of drugs. Drug addiction leads to chronic brain diseases. 

Drugs are one of the greatest evils for our society. It not only affects the individual but also the society. It causes loss of ability to make rational decisions and takes precedence over everything else – career, family, loved ones, friends and even civic sense. 

Going through the process of realization, People are trying hard to come out of this evil but Pandemic has thrown several challenges in their path ahead.

Drugs & India

More than 3.1 Crore Indians have reported using cannabis in 2018.  Among them 89% of drug addicts are Opioid dependents. Approximately 1.18 crore people use sedatives or non prescription purposes. This consumption highest in children and Adolescents India is home to six crore alcohol addicts, more than the population of 172 world nations including Italy. The prevalence of alcohol use is 4.6%, with male: female ratio being 17:1, followed by cannabis at 2.8% and opioids at 2.1%. Coming to harmful and dependent use, 19% of alcohol users use it in dependent pattern, whereas 0.25% of cannabis users use it in dependent pattern

Prevention better than cure

Today's youth face many risks, including drug abuse, violence, and HIV/AIDS. Responding to these risks before they become problems can be difficult. One of the goals of any drug prevention program must aim to help the public understand the causes of drug abuse and to prevent its onset. Drug abuse has serious consequences in our homes, schools, and communities. The use of all illicit drugs and the inappropriate use of licit drugs is considered drug abuse.

Prevention science has made great progress in recent years. Many interventions are being tested in "real-world" settings so they can be more easily adapted for community use. Scientists are studying a broader range of populations and topics. They have identified, for example, effective interventions with younger populations to help prevent risk behaviors before drug abuse occurs. 

Drug Abuse Prevention Starts with Parents

Drugs, including tobacco and alcohol, are easily available to children and adolescents. As a parent, you have a major impact on your child’s decision not to use drugs. Most likely, children in primary school have not begun to use alcohol, tobacco, or any other kind of drug. That is why primary level is a good time to start talking about the dangers of drug use. Prepare your child for a time when drugs may be offered.

Drug abuse prevention starts with parents learning how to talk with their children about difficult topics. Then, the programs offered by school, sports, and other groups can support what you have started. As a parent, you have a major impact on your child’s decision not to use tobacco, alcohol, and drugs.      Prevention starts when you start talking with, and listening to, your child.  Help your child make good choices and good friends.  Teach your child different ways to say “No!”

Wanted to Come Out

Knowingly and unknowingly people get trapped in Drug Addiction.  Most people start to take drugs for experiment, fun and curiosity while some succumb to peer-pressure.  Some come out early and some gets stuck.  Those stuck suffer more and more they are disparate they started even using some of life saving medicines as drugs.  When situation deteriorates from physical and psychological health aspects, then the person realizes how depth he went into this mud filled dirty world.

But when realization comes and the person tried to look for option that can bring him out, unfortunately only 1 in 20 drug addicts in India get treatment.

Treatment Options Available

There are many options that have been successful in treating drug addiction, including:

• behavioral counseling

• medication

• medical devices and applications used to treat withdrawal symptoms or deliver skills training

• evaluation and treatment for co-occurring mental health issues such as depression and anxiety

• long-term follow-up to prevent relapse

A range of care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed. Follow-up care may include community- or family-based recovery support systems.

Complications during Pandemic

The stress and isolation of the COVID-19 pandemic are presenting enormous challenges for these individuals, but ultimately the altered realities of healthcare may create opportunities to reach more people with services and possibly even increase the reach of recovery support systems.  Significant increases in many kinds of drug use have been recorded since March, when a national emergency was declared and our lives radically changed due to lockdown and the closure of businesses and schools.

The national drug de-addiction helpline witnessed a huge spike in calls in April when the lockdown was in full swing, receiving 4996 calls, the highest for a month since January. Even the total number of calls between April to June at over 9400 was higher compared to 8208 calls received from January to March.

In fact, there was a 200% rise in the initial days after the imposition of the lockdown from March 25. Compared to an average of 90 calls a day from 15th to 21st March normally, the helpline received 266 calls a day from March-end to April 5.

Overcoming Challenges 

The good news is that policy changes facilitating telehealth and expanding access to medications for opioid use disorder may compensate somewhat for these problems. People with opioid use disorders can now begin treatment without an initial in-person doctor visit, which used to be the rule. The stresses of the pandemic and the social isolation resulting from distancing measures may take an especially great toll on people trying to achieve or in recovery from an Substance use disorders. Three quarters of a recently conducted survey respondents reported emotional changes since the beginning of the pandemic, especially increased worry (62%), sadness (51%), fear (51%), and loneliness (42%). These emotions increase the risk for relapse, and unfortunately, circumstances since the pandemic have made peer support, for instance in 12-step meetings and similar groups, much more difficult.

While online recovery supports may not be an option for all and cannot fully capture the in-person experience, here, as in the realm of treatment, teleconferencing tools and smart phone apps are helping some people adapt to restrictions on physical gatherings.  

COVID-19 continues to be an uncertain, ever-evolving reality, and its impacts are particularly being felt among those with addiction and those in recovery from substance use disorders. At this point, there is very sparse data on how SUDs are affecting COVID-19 susceptibility and outcomes, although findings are emerging slowly. As we think about and support this community, this month and every month, we need to imagine and implement new ways of facilitating treatment delivery and needed recovery supports under these new circumstances.