Studies on 300 Indian drug addicts with special reference to psychosociological aspects, etiology and treatment

Sections

Contents
I. Introduction
II. Statistical data
III. Etiological factors
IV. Comparison of drug addiction in the East and West
V. Medical profession and drug addiction
VI. Treatment
VII. Results of treatment
VIII. Summary and conclusions

Details

Author: G. S. CHOPRA, Paramjeet Singh CHOPRA
Pages: 1 to 9
Creation Date: 1965/01/01

Studies on 300 Indian drug addicts with special reference to psychosociological aspects, etiology and treatment

M.D. G. S. CHOPRA Drug Addiction Clinic, Hastings, Calcutta
M.D. Paramjeet Singh CHOPRA AssistentKing's County Hospital, Brooklyn, N.Y.

Contents

I. Introduction

II. Statistical data:

  1. Drugs of addiction

  2. Average daily doses

  3. Average age of addicts

  4. Duration of addiction

III. Etiological factors

  1. Group A: Association, contagion, curiosity, euphoria, personality problems.

  2. Group B: To alleviate symptoms of disease

  3. Group C: To overcome fatigue and stress

IV. Comparison of drug addiction in the East and West

V. Medical profession and drug addiction

VI. Treatment

  1. Preparation of the patient

  2. Withdrawal of the drug:

    1. Sudden withdrawal

    2. Withdrawal through substitutes

    3. Gradual withdrawal

  3. Adjustment to normalcy

  4. Rehabilitation

VII. Results of treatment

VIII. Summary and conclusions

IX. References

I. Introduction

During the past decade drug addiction has become a major world-wide problem, despite increasing efforts of local, national and international police, governmental and United Nations agencies. In part, this is due to the inadequacy of treatment and to the lack of a proper psychological and sociological approach.

For over twenty-five years, the writer has been interested in the drug addiction problem. In the course of investigations carried out by him in various parts of India and extensive travelling in the United States and other countries, he came across only a few specialists, physicians and psychiatrists who presented a sound knowledge of drug addiction. The medical profession appears to have resigned itself to the precept, "Once a drug addict, always a drug addict ".

Drug addiction must be approached from several angles at the same time, viz: medical, psychological, sociological and economic. Imprisonment of addicts for short or long terms is not the answer, and neither are general and most mental hospitals a satisfactory alternative. The solution lies in educating public opinion, a change in the addict's attitude towards life, research to provide non-addictive analgesics, extension of policing facilities, and improved treatment methods to deal with the economic and sociological factors conducive to drug addiction: an attempt will be made to review these aspects of the drug addiction problem.

In this paper are recorded observations on the etiology and treatment of 300 drug addicts in Calcutta in the writer's drug addiction out-patient clinic, since 1958. For sudden withdrawal and severe symptoms during abstinence, a small number were to be admitted to nursing homes, where all the facilities like those available in hospitals, were assured. The patients were asked to report daily during the rehabilitation stage for the first two weeks, and then weekly and fortnightly for a period of six weeks. The near relatives and friends were asked to keep a careful watch on them and they were not allowed to associate with their fellow addicts and contacts, who had been voluntarily or involuntarily responsible for initiating them to the drug habit.

II. Statistical data

In table I below are given the drugs of addiction, average daily dose, average age and average duration of addiction in a series of 300 addicts treated.

TABLE I

Sl No.
Drugs of addiction
Average daily dose
Number of cases treated
Percentage
Average age
Duration
1.
Opium
0.5 g 225 75 48 16
2.
Morphine, heroin
0.25 g 30 10 30 7
3.
Cannabis drugs
2 g 15 5 35 15
4.
Pethidine
300 mg 10 3.3 35 5
5.
New psychotropic drugs like meprobamate
1.6 g 5 1.6 39 2
6.
Barbiturates
500 mg 5 1.6 32 2
7.
More than one drug of the above series
  10 3.3 29 12

(i) Drugs of addiction

It would be seen that 225 persons (75 per cent) were addicted to opium, 30 persons (10 per cent) to morphine and heroin and 10 persons (3.3 per cent) to pethidine. There were five cases each of addiction to barbiturates and new psychotropic drugs like meprobamate and the amphetamines; 10 persons (3.3 per cent) took more than one drug. Although cannabis drug use is common in India, there were only 15 persons (5 per cent) in this series. This is because there are little or no withdrawal symptoms; thus making it easy for the users to give up the habit by themselves.

(ii) Average daily doses

The average daily dose for opium was 0.5 g, morphine and heroin 250 mg, cannabis drugs 2 g, pethidine 300 mg, new psychotropic drugs like meprobamate 1,6 g and barbiturates 500 mg. There was a significant reduction in the average daily dose in the case of opium as compared with the writer's previous series of 1949 (a series of 8,000 cases treated in Assam), when it was 0.75 g amongst the opium addicts treated. This is due to restriction in sale, strict governmental control, education and improvement in the general standard of living.

(iii) Average age of addicts

The highest average age, viz: 48 years, was observed in the case of opium addicts. The explanation lies in that in developing countries like India, where medical facilities, especially in the rural areas, are inadequate, individuals, after reaching the age of 40 are subjected to severe physical strain, accompanied by emotional and mental pressure - to escape from which they may seek the aid of a narcotic. The use of cannabis was common amongst younger persons and the average age was 35 years. Morphine and heroin addicts had a still lower average age; viz: 30 years, the reason being that younger and juvenile persons fall prey to the habit on account of evil associations and for the new sensations which these drugs produce. Addicts who took more than one drug belonged to the youngest age group of 20 years. Barbiturate addiction predominated during the third decade of life, when responsibilities and worries presented themselves to the hitherto carefree youngsters, particularly amongst the educated classes.

(iv) Duration of addiction

A study of the average duration of addiction to the various narcotic drugs in this series, may be of interest. Opium and cannabis addicts displayed the longest duration of 16 and 15 years, respectively. This may be attributed to the alleged medical use and the quasimedical uses of these drugs. Although most of these addicts disliked the habitual use of opium, they were physically unable to resist due to their illness and their belief in the curative effects of these drugs. Next in order of duration came persons who took more than one drug, with an average age of 12 years. This again is easily explained, as one of these drugs was opium. An average duration of seven years was seen amongst morphine and heroin addicts. On account of the rapid deterioration of mental and physical health caused by these two drugs, and of the high cost, the average Indian addicts either died early or were unable to afford the expense of continuation. Pethidine addicts showed a duration of 5 years of addiction. This short duration is due to the scarcity of the drug in the open market - on account of excise control - and to its recent introduction on the market. The lowest duration of 2 years was observed in addicts to barbiturates and new psychotropic drugs, the reason being that the initial use was under medical advice but was continued in the pur suance of relief even after cure. Since these drugs had very mild withdrawal symptoms, stronger individuals dropped the habit to lead a normal life, whereas the weaker ones resorted to "stronger" narcotics and began a journey downhill. Some of them appeared in the series of addicts consuming more than one drug.

III. Etiological factors

At the time of the addict's first visit, he was questioned regarding his personal history and the vexing problems he faced in his day-to-day life. Environmental, professional, financial and other factors likely to have bearing on his drug habit were also recorded. Those suffering from intense addiction were subjected to thorough psychological screening. This process sometimes took several weeks. On the basis of the data collected from these studies, Indian addicts could be divided into three broad categories, as follows:

TABLE II

Group A
   
Association, contagion, curiosity, euphoria, personality problems
160 53.35
Group B
   
To alleviate symptoms of disease
90 30
Group C
   
To overcome fatigue and stress
50 16.65

A general analysis of these groups reveals very interesting information having a bearing on the sociological, psychological and therapeutic aspects of the problem, likely to be of use to the student of drug addiction.

(i) Group A: Association, contagion, curiosity, euphoria, personality problems

160 (53.35 per cent) cases in this series attributed their addiction to evil association, euphoria, etc. Persons under this group were comparatively younger than those in the other two. Influence of evil associates and unhealthy environments were the principal causes for the development of the habit amongst this class of drug addicts. Backward masses readily accept suggestions and yield to the custom of taking drugs like opium or cannabis, symbolic of good fellowship in eastern countries. Narcotic addicts tend to exchange advice and sympathy so agreeable to the self-centred and introspective mentality. It is common observation that juvenile addicts take pleasure in acquainting themselves with narcotics, initially out of curiosity, and eventually fall victims. The habit is often a superimposed condition on some preexisting nervous or mental conditions such as mal-adjust- ment to life, inferiority complex, narcissism and parental neglect. Psychopaths, feeble-minded and mentally defective individuals with nervous diathesis predominated in this group. Narcotics produced a sense of well-being and a feeling of self-confidence, enabling them to overcome inhibition from which they suffered. There were several addicts, especially those using cannabis, who became victims of the drug habit due to religious belief. The cannabis plant, commonly known as "Shiv Bootey ", which means the plant of the god "Shiva" of the Hindus, is believed to impart supernatural powers to the addict. Sometimes the drug habit was a pre-requisite for joining or participating in the activities of anti-social gangs. Cannabis is a commonly used drug for this purpose.

Table III gives a detailed analysis on the basis of factors in Group A with a total of 160 addicts.

TABLE III

Sl. No.
Factors under Group A
Number of cases
Percentage in accordance with total series
1.
Association or contagion
61 20.33
2.
Euphoria, thrill, search for new sensations etc
39 13.00
3.
Personality problems
15 5.00
4.
Pathological character structure
6 2.00
5.
Immature character
6 2.00
6.
Inferiority complex
3 1.00
7.
Desire to live only in the present
11 3.60
8.
Narcissism
6 2.00
9.
Parental neglect
4 1.30
10.
Delinquency
9 3.00

It will be seen from table III that association and contagion account for 61 (20.33 per cent) cases in this Group. Euphoria 39 (13.00 per cent). The remaining were various nervous and pathological factors which served as predisposing cause in this group.

(ii) Group B: To alleviate symptoms of diseases

This Group was composed of 90 (30 per cent) individuals who started the habit on account of disease or as a cure for certain ailments. Most of the addicts in Group B were above 40 years of age, had started the habit due to some disability, and were sticking to small or moderate doses of opium. Euphoria or narcotic effects had little or no attraction for them. These addicts were generally aware of the disastrous effects of increased dosage. Most of them were manual labourers, artisans and men engaged in other strenuous vocations. Slight indisposition and inadequate medical aid were the common reasons expressed by these addicts for initial introduction to narcotics, especially opium. Some of these addicts had been taking opium for over 20 years without apparent ill-effects or interference with their vocations. It was believed that the use of opium in small doses kept their disabilities and diseases under control. Attempts to withdraw the drug led to recurrence of various disabilities which necessitated medical care and often rendered them invalid. Treatment was sought by those addicts who had increased their doses and were unable to afford its high cost, or were suffering from toxic reactions. Table IV gives a detailed analysis of the causes due to etiological factors under Group B.

TABLE IV

Sl. No.
Etiological factors under Group B
Number of cases
Percentage in accordance with total series
1.
Painful conditions, neuritis, arthropathy, biliary colic
25 8.33
2.
Respiratory affections, cough, pneumonia, tuberculosis (pulmonary), haemoptysis, asthma, etc
30 10.00
3.
Diseases of cardio-vascular system
11 3.66
4.
Rheumatic conditions
10 3.33
5.
Bowel diseases, diarrhoea, intestinal colics, dysentery, etc
6 2.00
6.
Insomnia
5 1.66
7.
Spermatorrhoea and diseases of genitourinary systems
3 1.00

It will be seen from table VI that painful conditions, neuritis, arthropathy, etc. accounted for 25 (8.33 per cent); respiratory diseases for 30 (10 per cent); diseases of cardio-vascular system for 11 (3.66 per cent); rheumatic conditions for 10 (3.33 per cent) persons of the total series. The remaining 13 (4.66 per cent) started the habit due to other ailments.

(iii) Group C: To overcome fatigue and stress

Fatigue and stress are the common causes of opium addiction in the cases of individuals of 40 years of age and above. There were 50 (16.65 per cent) who attributed their addiction to fatigue, strain and stress. Small doses of opium or alcohol, or a few whiffs of" ganja" smoke remove the feeling of hunger and fatigue for a while, and give a feeling of self-satisfaction and forgetfulness to a person, who generally takes them towards the evening, after a day's hard work. He becomes content, and relaxes into an easy mood. As the effects of a single dose last only for a few hours, a desire to repeat it at frequent intervals becomes irresistible and the next dose is only foregone if its acquisition is beyond his means. Opium is believed to stimulate physical energy. The living and working conditions of labourers in tea gardens, rice and wheat fields are often hard, and opium is sometimes used to mitigate the exhaustion due to the work and the heat. Thus addiction in India is mostly prevalent amongst the lower working classes. The incidence of such use in some of the labour population is as high as five per cent. A large number of tea garden and forest workers in Assam and in the coal field areas of West Bengal and Bihar, are addicts to ganja and opium. Prevalence of opium addiction amongst the lower classes is due to hard work, fatigue and insanitary and unhygienic conditions of life. In large cities like Calcutta, 3 per cent of the motor and bus drivers are using opium and cannabis in order to keep them fit for the arduous duty of driving for prolonged hours.

IV. Comparison of drug addiction in the East and West

A comparison of etiological factors, drugs of addiction and the types of addicts in the East and West would be of interest for a better understanding of the problem. In India, opium and cannabis are the principal drugs of addiction. They are taken in crude form which in itself limits their consumption and the effects produced are milder than those of the manufactured narcotic drugs. In "western" countries such drugs are more commonly used than opium or cannabis. They are taken by injections which produce a rapid and intense effect of short duration. Thus, there is a desire for frequent repetition of a dose, which is uncommon in the case of Indian addicts, who are usually content with a single dose for 24 hours. The very high cost and frequent repetition of the dose results in early physical and moral ruin in the Western addicts, as compared to Indian addicts. In India, the addiction is mainly a problem of middle and advanced age, while in the West it affects the younger generation, including teenagers. Environments, unhygienic conditions, lack of proper education, and recreation facilities, longer hours of work, fatigue, stress and strain, and inadequate medical facilities are the main contributory causes in the case of Indian addicts. The Indian addicts are, on the whole, moderate and docile individuals who do little or no harm to society, as compared to the western addicts who indulge in excesses of various kinds and are inclined to criminal acts. Indiscriminate use of barbiturates, tranquillizers and other dangerous drugs is an increasing menace in the West. Intense forms of addiction, as seen in the West, are rarely met with in India. Drug addiction is mostly confined to rural and industrial areas. Also, incidence of addiction to manufactured drugs like morphine, heroin and pethidine is much lower than in the West. The problem in the West affects mainly urban areas, especially the large cities.

V. Medical profession and drug addiction

The use of narcotics and analgesics is of unquestionable value for the medical profession, and the development of narcotic addiction during the course of illness can be considered a therapeutic hazard. The use of narcotics should be the last resort when normal therapeutic measures fail to alleviate severe pain associated with certain diseases and the physician feels it would be cruel to withhold narcotics from the patient. Therefore, narcotics should not be withdrawn from the medically addicted patients as long as the underlying illness has not been cured, and more so when the patient cannot bear the extra strain and shock of withdrawal. In certain painful illnesses of chronic type, the life-long continuance of narcotics may be the only therapeutic choice. In day-to-day practice narcotic drugs should not, as a rule, be used prior to the establishment of the diagnosis of the disease and trial of normal therapeutic measures, except if non-habit forming substitutes are unavailable. Such a use should also be discontinued when relief is obtained and the patient shows signs of craving and tolerance for the drug. In such cases, normal therapeutic doses of narcotics will be found inadequate to relieve pain and distressing symptoms, as in the early stages. This should be regarded as an early sign of establishment of addiction and the narcotics stopped through physiotherapeutic or substitution therapy. Some patients are addiction prone, and in such cases the use of narcotics should be avoided. The use of narcotics should only be resorted to when all other measures to relieve distress have been tried but failed. A careful watch should be kept on the behaviour of such individuals.

Through a combination with non-narcotic analgesics or tranquillizers it may be possible to reduce the dose of narcotic drugs.

Law does not restrict the physician from prescribing narcotics. When in good faith he believes the ailment to be other than narcotic addiction and to require such treatment, he should prescribe narcotics in such quantities and for such length of time as is reasonably necessary.

VI. Treatment

While treating drug addicts it should be borne in mind that the greatest difficulty comes from the personality problems that cause a person to become an addict. Therefore, if personality problems are tactfully handled, then the withdrawal pains are likely to be the lowest as the drugs are completely withdrawn. Human temperament and behaviour differ widely from person to person, and it is not possible to lay out any set rules in respect of the sociological and psychological treatment of drug addicts. Each addict presents a study by himself and has to be dealt with on his own merits.

For effective treatment, the addicts were categorised into four groups according to the etiology and intensity of addiction from which they suffered - determined by factors such as drug of addiction, age, daily dose, duration of addiction, general health and environment.

Group I

This group consisted of 150 persons (50 per cent), most of whom were above 40 years of age and were taking drugs in moderate doses. The average duration of addiction was shorter than in the other groups. Most of them belonged to the diseased category or had been initiated to the drug habit due to some mental strain arising out of illness. They were otherwise normal individuals with hardly any personality problems and reacted well to treatment. The original condition for which they had started the habit had either disappeared prior to seeking treatment or was treated before the actual withdrawal.

Group II

Persons suffering from intense forms of addiction predominated in this group of 30 persons (10 per cent). Most of these presented psychopathological and personality problems, and were difficult to treat since they were not keen to give up the habit. A few of them had little or no aim in life and were devoted to drugs to escape from reality, as they could not face the normal pressure of life to which all individuals are subjected. Here a sociopsychological approach prior to the actual withdrawal of the drug was considered necessary. An attempt was made to analyse the problems connected with different episodes of their lives and allay such disturbing factors as anxiety, frustration, maladjustment, parental and family relations, inferiority or superiority complex, etc. Those requiring psychological treatment were referred to psychiatrists and advised to adjust to normalcy prior to the actual withdrawal of the drug, which was not difficult after a reasonable adjustment of the personality was attained.

Group III

The third group comprised 100 addicts (33.33 per cent) who had taken to the drug habit to overcome fatigue, stress and Strain. These addicts were mostly in normal health and could be easily persuaded to give up the habit. The average dose of the drug in this group was the lowest and the results of treatment were very encouraging.

Group IV

The rest of the series, viz. 20 addicts (6.66 per cent) were suffering from an intense form of addiction, superimposed on some incurable disease like cancer, pulmonary tuberculosis, arthropathy, painful and permanent disabilities. In this group the prognosis and results of the treatment were not encouraging and it was only possible to reduce the dose.

Treatment was carried out in the following four stages, viz: (i) Preparation of the patient; (ii) Withdrawal of the drug; (iii) Adjustment to normalcy; and (iv) Rehabilitation.

(i) Preparation of the patient

The main problem in treating drug addiction is not readjusting the addict's body to a drugless state, but in helping his mind to overcome the desire to flee from the realities of life by taking drugs. If the underlying causes of addiction are not cleared, the addict is likely to return to the habit even if he has been without drugs for a long period. Keeping this in view, each patient was prepared for the withdrawal of the drug. During the preparatory stage, the addicts were treated for the initial disabilities or disease for which the drug habit was started, and for any intercurrent ailment. They were told that there might be a certain amount of discomfort for a day or two during the withdrawal period; co-operation on their part was very important and the outcome depended on them. Close associates, relatives and friends were asked to keep a careful watch on them. Their co-operation was sought to help them in solving their personal problems and maladjustments and to build confidence, assuring them that with a little courage and forebearance, they would be able to withstand and overcome the discomfort of withdrawal. Those suffering from an intense form of addiction, with nervous and psychological problems, were advised appropriately and efforts were made to analyse the problems dominating their minds. Disturbing factors, such as a sense of anxiety, frustration, different complexes and inhibitions were also attended to through reference to psychiatrists and by psychotherapeutic means. The addict's amenability to treatment was assessed; depending upon his reaction and behaviour during this stage, he was subjected to sudden or gradual withdrawal in the next stage, with or without the help of substitutes, according to his health and intensity of addiction.

(ii) Withdrawal of the drug

The aim was to withdraw the drug with as little danger and discomfort to the patient as possible. All the three well known methods of detoxication were employed, viz: ( a) Sudden withdrawal of the drug without the help of substitutes; ( b) Withdrawal through substitutes of drugs and other supportive measures; and ( c) Gradual withdrawal.

  1. Sudden withdrawal

    Sudden withdrawal of narcotics, as described by Bonheffer, has been recognized scientifically as the best method of treatment. In this series, the narcotics were suddenly withdrawn in 210 cases. The writer has tried this method in a mass campaign in Assam on a series of over 10,000 opium addicts (Chopra and Chopra, 1949) with success.

    The patients were kept in the writer's clinic for five to seven days and those not willing to stay in the clinic were allowed to remain in their homes and withdrawal was undertaken under the careful supervision of their friends. The patients were visited twice in 24 hours by the writer or his assistants, to record the observations and treat acute withdrawal symptoms which the patient could not overcome by himself. In addition to lecithine (20 to 100 grains) by mouth, 25 cc or 25 per cent of glucose solution were injected intravenously. Drug therapy was only resorted to when the symptoms such as restlessness, insomnia, anxiety, sense of apprehension and cardiovascular disturbances were severe and could not be controlled through glucose injections. Liquid extract of rauwolfia, serpentina, Serpasil and bromides were used to overcome these symptoms. For nervous symptoms of severe degree, stronger psychotropic drugs such as Largactil, reserpine, Doriden, Equanil, Librium, and Phenergan were used. These drugs are not repeated for more than a week at a time and the maximum period was three weeks in the case of meprobamate, as the patient showed signs of habituation and development of tolerance. Little or no withdrawal symptoms were met with after sudden discontinuation of these drugs, and only a few cases showed depression and insomnia. The discomfort felt was milder than during the withdrawal of the parent drug of addiction.

  2. Withdrawal through substitutes

    Methadone Treatment

    Withdrawal of drugs like morphine and heroin through the use of methadone is very popular in the United States of America. The writer found it being widely employed by various hospitals in the States for treatment of drug addicts. Methadone is a synthetic drug with similar action to morphine. It was developed during World War II by Germans who had no opium to produce morphine. It has since been used as an analgesic in Europe and in the States. The drug is believed to help in painful withdrawal of narcotics and is considered more suitable for this purpose as it can be administered orally in small and controlled doses for short periods to wean the addicts from addiction to opium and opiates. Withdrawal of methadone is believed to cause comparatively milder suffering than that in the case of opiates. The American Medical Association has also endorsed the use of methadone for withdrawal treatment.

    Phenazocine, a new drug, has been developed by May, Nathan and Eddy of N.I.H. of the United States of America recently. It is considered to entail less risk than methadone. There are few advocates of this drug and it requires further trial.

    Neither of these two substitute narcotics was used by the writer in his present series. The Indian addicts seldom required substitution therapy by way of methadone and phenazocine. They reacted favourably to milder psychic drugs to allay nervous symptoms. Being synthetic drugs, methadone and phenazocine are not easily available in India.

  3. Gradual withdrawal

    In this series, 90 addicts were subjected to gradual withdrawal. The withdrawal was in most cases voluntary, and was undertaken at the addict's home under the care of his relatives and friends. The withdrawal symptoms which could not be controlled by the patients themselves were treated through administration of lecithine and glucose intravenously, as in the case of sudden withdrawal. In rare cases, the use of psychotropic and stimulant drugs was felt to be necessary. The patients were asked to visit the clinic for a period of 15 days, when they were declared free of drugs.

(iii) Adjustment to normalcy

Attempts were made to regain the state of normalcy in the addicts after withdrawal through adjustment of social, environmental behaviour. Efforts were made through diversional therapy to prevent relapses. Apart from the help of relatives and associates of addicts, co-operation of religious and social organisations was sought, with a view to helping in the moral rebuilding of the unfortunate individuals through a sympathetic attitude towards their problems. It was thus possible to relieve some of them of old troublesome complexes, worries and other apparent factors, which had led to the drug habit and excesses of various kinds. The addicts were also trained to live a hygienic life within their means. The importance of personal cleanliness, self-respect and the adoption of a rational and balanced attitude to life was also explained. The stage of adjustment to normalcy generally lasted for 4 to 6 weeks, depending upon the original personality of the addict, duration of addiction, dosage of drugs, and the addict's financial status. Out of the total series treated successfully for withdrawal of drugs, 51 persons (17 per cent) of the original series relapsed to their original drug habit during this stage. The relapses occurred mostly in the case of addicts suffering from an intense form of addiction with lack of a positive mental attitude towards life, without a definite purpose, self-discipline and co-operation and harmony. The addicts were also advised professional and recreational therapy, taking into consideration their general education, standard of living and environment.

(iv) Rehabilitation

In India there are no facilities such as sanatoria and vocational therapy centers. So it was not possible to offer them such facilities. Therefore, the only way was to achieve the state of normalcy through prolonged observations and training, as described in the foregoing paragraphs. After reaching normalcy, addicts were entrusted to the care of their friends and employers. They were also suggested the type of work likely to be of interest to them and within their physical capacity. During the rehabilitation stage, the addicts were removed from their old environments which had been responsible for the addiction. The importance of controlling their minds and the nature of their thoughts away from their previous life was impressed. The addicts were also advised to concentrate their thoughts frequently on the idea that they had overcome the vice.

The importance of having an incentive to replace the desire to repeat the drug was also explained. The addicts were advised to develop an inner conviction that they would be better off in every way and be freed of craving for narcotics.

This suggestive treatment has been helpful in keeping the persons treated away from the use of narcotics, and some of them have developed social and co-operative attitudes and are now deeply interested in relieving their fellow addicts of their drug habit.

VII. Results of treatment

Comparative results of sudden and gradual withdrawal treatments are summarized in table V.

It would be seen that out of 225 opium addicts, 150 individuals were subjected to sudden withdrawal. 116 (or 77.3 per cent) were relieved of the drug, in 34 (or 23 per cent) the drug could not be withdrawn. There were 75 opium addicts in the series who were subjected to gradual withdrawal. Amongst them 40 (or 53.3 per cent) were relieved of the drug and for the remaining 35 (or 46.6 per cent) the treatment was not successful. Thus it appears from these results that sudden withdrawal is more suitable in the case of Indian opium addicts than the gradual withdrawal. The sudden withdrawal method was also more effective in the case of morphine and heroin where it was successful in the case of 10 persons (or 50 per cent) and failed in 10 (or 50 per cent); with gradual withdrawal, out of 10 cases, the treatment succeeded in 2 (or 20 per cent) and failed in 8 (or 80 per cent) of the cases.

TABLE V

 

Sudden withdrawal

Gradual withdrawal

 

Addiction

Successful

Failure

Successful

Failure

Total

Opium
116 34 40 35 225
 
(77.3%)
(23%)
(53.33%)
(46.6%)
 
Morphine and heroin
10 10 2 8 30
 
(50 %)
(50 %)
(20 %)
(80 %)
 
Hemp drugs
15
nil
nil
nil
15
 
(100%)
       
Pethidine
10
nil
nil
nil
10
 
(100%)
       
New drugs like mep-robamate
5
nil
nil
nil
5
 
(100 %)
       
Barbiturates
5
nil
nil
nil
5
 
(100%)
       
More than one drug
5
nil
5
nil
10
 
(100%)
 
(100%)
   

As regards pethidine, new psychotropic drugs, barbiturates and cannabis, the addicts were subjected to sudden withdrawal of the drugs and the treatment was successful in all cases. The reason for this appears to be that these drugs in the amounts here taken, rarely lead to an intense form of addiction, like opium, morphine and heroin. It would be considered a form of habituation with marked craving. These results are interesting from epidemiological and treatment points of view. Addictions like opium, morphine, heroin and cocaine produce a state of chronic intoxication with an overpowering desire to repeat the dose, consequent upon the development of tolerance, and increase of dose, leading to psychopathological changes in the individual, which is injurious to his character and detrimental to his behaviour towards society. The drugs of the latter series, viz: cannabis and amphetamines should not be classified as true drugs of addiction, although they lead to craving and their habitual use is attended with harmful physical and mental effects. These drugs are repeated for euphoric and pleasure-giving effects. The development of tolerance and increase in dose is less marked than in the case of opiates. Mental and physical effects, although discernible, are less pronounced. The difference between the effects of habitual use of the two types of drugs, i.e. habituation and addiction, should not be lost sight of while dealing with the subject of treatment and eradication of drug addiction.

VIII. Summary and conclusions

  1. The present study relates to a series of 300 Indian addicts, and covers a period of six years. 85 per cent of them were addicted to opium and cannabis and the rest to morphine, heroin, pethidine, barbiturates and new psychotropic drugs.

  2. As regards etiological factors, in 53 per cent of the cases the causes were association or contagion with personality problems, pathological character structure, various kinds of complexes and inability to face the realities of life. Disease and quasi-medical use of narcotics was responsible for the formation of addiction in 30 per cent of the cases. In the remaining 16.6 per cent of the cases, the drug habit was the outcome of environmental factors, poverty, strain and stress.

  3. Drug addiction in the East and West have been compared. Etiological factors appeared to influence the pattern of addiction in each case. In the East, poverty, unsanitary conditions of living, over-crowding, physical strain and fatigue and inadequate medical aid are the factors responsible for drug addiction. In the West, drug addiction is a product of strain and stress, leisure and laxity that go hand in hand with an age of technology and industrialisation. In the East crude drugs like opium are commonly used, while in the West, the use of more potent chemicals like morphine, heroin, pethidine and new psychotropic stimulants and depressant drugs is more common.

  4. Etiological factors have a bearing in determining the results of treatment. Persons exposed to accidental exhaustion, hunger, poverty and those who acquire the drug habit for social and cultural reasons are easily relieved of the habit. Good results were obtained in the case of addicts whose addiction was the result of some disease or illness of a physical or psychological nature, when the main motive for taking the drugs had disappeared. This may occur in cases of painful diseases or primary personality disorders.

    A small group had resorted to drug addiction in order to solve their deep-rooted personality problems. These persons had a pathological character structure, were frustrated individuals, and presented a serious therapeutic problem. With proper psychological care, a few of them became adjusted and amenable to treatment. It was then not difficult to withdraw the drug.

    Those suffering from incurable diseases like cancerous growth, arthropathy, advanced tuberculosis, etc. did not respond to treatment.

    The results of treatment were encouraging after the patients had been subjected to a thorough physical and psychological examination and treatment for intercurrent conditions or diseases during the preparatory stage. Sudden withdrawal of narcotics proved to be more successful than gradual withdrawal. Lecithine and glucose were helpful during the withdrawal period. The results of treatment were encouraging. The withdrawals of the drugs were successful in 213 (or 71 per cent) cases; of these, 166 (or 55.35 per cent) underwent sudden withdrawal and the remaining 47 (or 15.33 per cent) gradual withdrawal. There were 51 (or 17 per cent) relapses during the stage of normalcy, thus leaving 162 persons (or 54 per cent) who were completely relieved of their drug habit.

    All of them, except 10 who are not traceable, are living as useful citizens and leading a normal life.

  5. Relation between the medical profession and drug addiction has also been discussed.

IX. References

CHOPRA, R. N., and CHOPRA, G. S., Ind. Journ. Med. Res., 23, p. 359 (1935).

CHOPRA, R. N., and CHOPRA, G. S., (1937), Ind. Med. Gaz., 72, p. 255.

CHOPRA, R. N., and CHOPRA, G. S., (1938), Ind. Med. Gaz., 73, pp. 81, 132, 193.

CHOPRA, R. N., and CHOPRA, G. S., (1940a), Ind. Med. Gaz., 75, p. 388.

CHOPRA, R. N., and CHOPRA, G. S., (1940b), Ind. Jour. Med. Res., 38, p. 225.

CHOPRA, R. N. and GANGULY, S. C. (1939), Ind. Jour. Med. Res., 28, p. 699.

CHOPRA, R. N., MUKHERJEE, S. N. and CHOPRA, G. S.(1935), Ind. Jour. Med. Res., 22, p. 561.

CHOPRA, R. N., MUKHERJEE, S. N. and GUPTA, J. C. (1935), Ind. Jour. Med. Res., 23, p. 353.

CHOPRA, R. N. and ROY, A. C., Ind. Jour. Med. Res., 25, p. 205.

CHOPRA and CHOPRA (1949), Ind. Jour. Med. Res., 37, p. 205.

MA WEN CHAO (1932), China Med. ,Jour., 48, p. 806.

MOSK Stanley, Narcotic Prescribing for the Professions. The Narcotics Problem (A Brief Study).

Treatment of Drug Addicts (1960), World Health Organization.

Treatment of Drug Addicts (1962), World Health Organization.

LISTEN (May-June 1963), A journal of better living. LISTEN (July-August 1963), A journal of better living