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drug is withdrawn, and, as expected, the animal gradually tires of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

Suicide A New outlook! Being Certain in times of Uncertainties

Is life so tough that we cannot survive?

There’s no doubt about it: life is hard. It’s a given. Life is so hard we don’t even realize how often we walk around complaining about how hard life is anymore.  It’s kind of trending, in fact.

But there’s no doubt that life is also amazing and wondering, and with the bad stuff always comes some form of goodness, even if it doesn’t feel that way at the time. If you’ve ever found yourself crying into your hands wondering why life is so hard, you are definitely not alone.

But humanity is slowly, albeit painfully slowly, starting to realize that a lot of the bad things that happen to us do not actually happen to us, they are just things that happen.  It’s our negative attitude or disposition that turns neutral circumstances into something full of despair and anger, confusion and frustration.

You got it: emotions, thoughts, and feelings. They are what make life so damn hard. But there are other things too. Here are four reasons why life continues to be so hard for you.

As if life has no value?

We could live life — perhaps as animals do — without judging whether it is good or bad, meaningful or meaningless, or worthwhile or not. However, we do not. We make judgements about the value of life, concluding that life has no value or great value, and then may attempt to convince each other that we have placed the proper value on life.

It is not just philosophers who perform these evaluations. Many people, whether they realize it or not, compare their own lives, or life in general, to their expectations or desires, and then render a judgement about whether life, as they have experienced and view it, measures up to the standard they have adopted to judge it. There is a wide range of sophistication with these evaluations and judgements. At one extreme are simple, commonly uttered statements such as «life is good» or life is terrible, where it may be unclear how the person reached the conclusion they did.

Why we are succumbing to pressure and stress?

Be careful not to confuse pressure with stress – they are quite different. Pressure can be a very positive quality. Experiencing it, yet feeling calm and in control, can spur people on to achieve great things. It’s only when it keeps building and that sense of calm and order is replaced by a feeling of being out of control that stress happens, and has a wholly negative effect.

Whether you can’t stop snapping at people, can’t stop drinking, or can’t stop thinking stupid thoughts, feeling out of control can be frustrating. Sometimes it’s scary, and sometimes it’s exciting… until we wake up the next day and realize what we’ve done.

It’s normal to feel out of control every once in a while. We all make mistakes and do things we regret. But if you find yourself losing control all the time, there’s probably more going on.

Logical decisions take more brain power than emotional ones. The more distracted we are, the harder it is to think logically. Here are just a few things that can make it harder to control your behaviors:

Why worry about things you can’t control when you can keep yourself busy controlling the things that depend on you?”

 Transform your stress in to challenge?

You constantly hear how bad stress is for you: it’s damaging your health, jeopardizing your relationships, and hurting your performance. While these risks are real, recent research is showing that work strain, when managed correctly, can actually have a positive impact on productivity and performance. So how can you take the stress you thought was killing you and make it constructive?

Stress is unavoidable. “We live in a world of ongoing worry, change, and uncertainty. You have to get used to it,” says experts. “Stress is an inevitable part of work and life, but the effect of stress upon us is far from inevitable, Stress can be good or bad depending on how you use it,” they say.

Experts advise the following five ways to manage the stress…

Recognize worry for what it is

Then, reframe the stress

Focus on what you can control

Create a network of support

Get some stress-handling experience

Think of stress as an indicator that you care about something, rather than a cause for panic then Focus on the task, rather than the emotion and finally Build relationships so that you have people to turn to in times of stress.  At the same time don’t assume your stress is going to last forever, don’t worry about things that are out of your control and finally don’t spend time with people .who are negative

Challenging suicidal thoughts are very important:?

Whatever is going on for you that has led to how you’re feeling right now is unique to you – but having suicidal thoughts is not. You are not alone, lots of people have thought about killing themselves and have found a way through. Having suicidal thoughts can be overwhelming and frightening. It can be very difficult to know what to do and how to cope. You may feel very depressed or anxious or you may just feel really bad and not know what the feelings are.

You may feel like you are useless and not wanted or needed by anyone. You may be feeling hopeless about the future or powerless, like nothing you do or say can change things. You may be blaming yourself for things that have happened in your life, and you might think it would be easier for others if you weren’t here. You may not even know why you feel suicidal, and think that you have no reason to want to kill yourself. Because of this, you may feel guilty and ashamed, and start feeling even worse.

It can feel much worse if no-one knows what you are going through or how bad you feel. You don’t need to be alone. There are people who are willing, able and available to help you.

Thinking positive in any circumstances can change you as person?:

Happiness and optimism were both linked to a lower risk of heart disease and stroke, with the most optimistic people having the greatest benefits. The study, published in the journal Psychological Bulletin, also found that optimistic and happy people tended to have healthier lifestyles. They exercised more, ate better, and slept more. In addition, they were less likely to have risk factors for heart disease and stroke, including high blood pressure, high cholesterol, and obesity. All of this is known to contribute to better heart health.

Does being happy or optimistic make the heart healthy, or does a positive attitude just encourage healthy behaviors? The study was not large enough to answer that question, but negative psychological factors—like stress and depression—have already been found to increase the risk of heart attacks.

Staying positive, then, may work the other way, such as by lowering blood pressure and cholesterol. Even if you aren’t upbeat all the time don’t let that get you down. Healthy eating and exercise are still an important part of lowering your risk of heart disease and stroke. There are also psychiatric interventions, like behavioral therapy, that can help you find a more positive outlook on life, even when confronted by your overly perky coworkers.

Being Proactive can help much?:

Positive thinking, or an optimistic attitude, is the practice of focusing on the good in any given situation. It can have a big impact on your physical and mental health.

That doesn’t mean you ignore reality or make light of problems. It simply means you approach the good and the bad in life with the expectation that things will go well.

Many studies have looked at the role of optimism and positive thinking in mental and physical health. It’s not always clear which comes first: the mindset or these benefits. But there is no downside to staying upbeat.

Smile more, reframing once situation, Positive hope on future, Focusing on Strengths keep one to be more positive.

 At the end, it is not your fight alone and you are not the only one fighting and facing such challenges is what ultimately brings back one from these dirty thoughts of suicide.  So nothing happens when you fight may be some time you may lose that’s it.

Be Positive and live with hope. Ultimately it is being certain during uncertainties will prevent one from taking these extreme steps.

This article is prepared for 10th September, World Suicide Prevention Day

Dr. Johnsey Thomas,

Lifestyle Psychologist and Strategist Health-Wellness

EAP Consultant Certified Cognitive Behavioral Therapist,

Aster Prime Hospital, Ameerpet, Hyderabad

 

AMEERPETASTER PRIME HOSPITALCOVID19

DR. JOHNSEY THOMASEAP CONSULTANT CERTIFIED COGNITIVE BEHAVIORAL THERAPISTHYDERABADLIFESTYLE PSYCHOLOGISTSTRATEGIST HEALTH-WELLNESS

Mental Health for All Greater Investment – Greater Access

Mental health is one of the most neglected areas of public health. Close to 1 billion people are living with a mental disorder, 3 million people die every year from the harmful use of alcohol and one person dies every 40 seconds by suicide. And now, billions of people around the world have been affected by the COVID-19 pandemic, which is having a further impact on people’s mental health.

Mental disorders comprise a broad range of problems, with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behaviour and relationships with others. Examples are schizophrenia, depression, intellectual disabilities and disorders due to drug abuse. Most of these disorders can be successfully treated.

Yet, relatively few people around the world have access to quality mental health services. In low- and middle-income countries, more than 75% of people with mental, neurological and substance use disorders receive no treatment for their condition at all. Furthermore, stigma, discrimination, punitive legislation and human rights abuses are still widespread.

COVID – 19 & Hampered Response

The limited access to quality, affordable mental health care in the world before the pandemic, and particularly in humanitarian emergencies and conflict settings, has been further diminished due to COVID-19 as the pandemic has disrupted health services around the world. Primary causes have been infection and the risk of infection in long-stay facilities such as care homes and psychiatric institutions; barriers to meeting people face-to-face; mental health staff being infected with the virus; and the closing of mental health facilities to convert them into care facilities for people with COVID-19.

With the disruption in health services, countries are finding innovative ways to provide mental health care, and initiatives to strengthen psychosocial support have sprung up. Yet, because of the scale of the problem, the vast majority of mental health needs remain unaddressed. The response is hampered by chronic under-investment in mental health promotion, prevention and care for many years before the pandemic.

Mental Health Infrastructure and Challenges Ahead in India

In India, 10 per cent of the population has common mental disorders and 1.9 per cent of the population suffers from severe mental disorders. Schizophrenia, bipolar affective disorder (BPAD), depression, anxiety disorders, psychoses, phobia, suicide, mood disorders, neurotic or stress related disorders, post-traumatic stress disorder, marital disharmony, sleep disorders, alcohol dependence and substance misuse and dementia are becoming common problems in the general population.

Mental illnesses are not only underreported in India but are not reported at all. Still whatever data is available; it clearly depicts the dreadful stage that we have reached in terms of our mental health. A total of 197.3 million people in India are estimated to be suffering from any mental disorder. In our case maximum load of mental illness is coming from Depression and Anxiety disorder with a striking 45.7 million and 44.9 million being prey to it respectively, whereas 7.5 million are suffering from Bipolar and 3.5 million from Schizophrenia. And we also need to understand that people having mild depression may report and seek help more easily than someone having Severe Mental illness.

In context of the present COVID-19 situation where there is likelihood of grave mental health problems in communities, with the given challenges it is going to be an uphill task for the nation. It is estimated that 10 to 20 persons out of 1000 population suffer from severe mental illness and 3 to 5 times more have emotional disorder. 

With such a horrific state of mental health, our counter mechanism to deal with it lacks significantly. Although the Government of India has taken a number of commendable measures, but unfortunately having Law codes and Policies on paper doesn’t really help much if the implementation at ground-level is not ensured by all the concerned actors, especially State level Government and Civil society need to work together with uniformity.

The major challenges faced by Indian mental health system are lack of knowledge about the mental illnesses as well as lack of adequate mental health services. The inadequacy exists in both areas, for example, infrastructure and human resources. India spends < 2 per cent of its annual health budget on mental health which is far less than many countries of the world. 

We have a dismal status in mental health care resources. With a population of more than 1.3 billion only around 9000 psychiatrists exist. A mere 0.75 Psychiatrists cater to about one lakh population in India whereas the desired number is above 3, in US and Europe there are 16 and 10 Psychiatrists to serve 100000 population respectively. US have almost 30 percent of World’s total Psychiatrists. At State level only Kerala has 1 psychiatrist per 1 lakh population.

World Mental Health Day: an opportunity to commit

The World Mental Health Day campaign will offer opportunities, primarily online given the continuing pandemic, for all of us to do something life-affirming: as individuals, to take concrete actions in support of our own mental health, and to support friends and family who are struggling; as employers, to take steps towards putting in place employee wellness programmes; as governments, to commit to establishing or scaling-up mental health services; and as journalists, to explain what more can and must be done to make mental health care a reality for everyone.

It is nearly 30 years since the first World Mental Health Day was launched by the World Federation for Mental Health.  Since then it is observed that an increasing openness to talk about mental health in many countries of the world.  But now turn these words into actions.  We need to see concerted efforts being made to build mental health systems that are appropriate and relevant for today’s – and tomorrow’s - world.  With so many people lacking access to good quality, appropriate mental health services, investment is needed now more than ever.

Countries spend on average only 2% of their health budgets on mental health. Despite some increases in recent years, international development assistance for mental health has never exceeded 1% of all development assistance for health. This is despite the fact that for every US$ 1 invested in scaled-up treatment for common mental disorders such as depression and anxiety, there is a return of US$ 5 in improved health and productivity.

Move for Mental Health: Let’s Invest

The world is already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching. During the past few months, the World Health Organization has issued, in collaboration with partners, guidance and advice on mental health for health workers and other frontline workers, managers of health facilities, and people of all ages whose lives have changed considerably as a result of the pandemic. 

That’s why, for this year’s World Mental Health Day, WHO, together with partner organizations, United for Global Mental Health and the World Federation for Mental Health, is calling for a massive scale-up in investment in mental health. To encourage public action around the world, a World Mental Health Day campaign, Move for mental health: let’s invest has been kicked off.