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by Ranga Chandrarathne

The principle difference in the management and treatment of drug addicts in a residential Rehabilitation Centre and in their homes, is that they are being treated in a real-life environment and the re-integration phase is much more easier in a home, under the care of parents or guardians than in a residential Rehabilitation Centre where the prevalent environment is not so natural.

However, when drug addicts are rehabilitated in a home, the parents and the close relations should have fare knowledge of the symptoms of a hardcore drug addict.

They should also knowledgeable of the basic medicine and be able to recognise the changing behavioral patterns. It is also important that drug addicts should be periodically tested on the progress achieved and identifies the weak traits.

Dos and Don'ts in managing drug addicts

Parents and relations and if possible the general public should exercise care in the treatment and in interaction with known drug addict. At all times the persons, specially, relatives and parent should give him/her the recognition and the care they showed him/her before the addiction. He/she should not be marginalised and branded as a drug addict.

It should also be borne in mind that in order to make social interaction smooth, persons concerned should by all means consider as normal addiction and the addiction to drugs should be considered as any other illness and not as a social menace. The addicted persons should not be hurt, lest it could lead to serious mental disorders and perhaps ends up in suicide.

However, considering the prevailing perception of drug addicts, parents must be careful enough not to let neighbours or relations know the condition of their son or daughter as it would adversely affect the future of drug addicts.

Periodical medical check-ups should also be conducted and should be followed by counselling sessions to ascertain the progress of the drug addict.

Improving the skills of social integration

As the saying goes " habits die hard", parents and guardians could cultivate good habits and skilful engagements and recreational activities in drug addicts while continuing drug treatment to gradual elimination of harmful behavioral patterns.

As the patterns of behaviour have played an important role in the everyday activities of any person, changes brought about in those pattern will also play a vital role in reducing withdrawal syndrome outside the course of medication and sessions of counselling. It is also important that drug addicts should be introduced to productive social groups such as youth of their own age but pursuing further studies or should be employed in gainful professions.

This positive exposure gives them an object lesson, more worth than infinite advice by elders. The positive exposure would help in the long term healing process and reintegration them (drug addicts) into society as well-behave productive citizens.

It is also advisable that parents and close relations should not expect positive results within a short period of time; instead, they should be patient and should understand the process of healing will take a considerable period of time, depending on the complexity of the addiction and the damage in terms of chemical changes that occur in the brain.

To restore the damaged brain would take a long time and these changes manifest themselves in drug addicts' ordinary behavioral patterns and should not be mistaken for an abnormality. These changes could occur during medication and parents and guardians may identify the symptoms and should continue the course of drugs prescribed by the doctor.

However, parents or guardians of drug addicts may consult a psychiatrist for further advice if changed behavioral patterns continue for a long period of time after the rehabilitation of them.

(to be continued next week)

Inquiries should be sent to [email protected]

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The neurobiology of drug addiction

Animals models have begun to provide insights into the neurobiological basis of reinforcement in drug addiction. The reinforcing effects of indirect sympathomimetics such as cocaine and amphetamine appear to depend on release of dopamine in the terminal fields of the mesocorticolimbic dopamine system. The acute reinforcing effects of opiates involve not only an activation of dopamine, but also dopamine- independent elements in the terminal regions of the mesocorticolimbic dopamine system.

Nicotine's reinforcing effects may involve both dopaminergic and opioid peptidergic systems. Ethanol's reinforcing effects may result from multiple neurotransmitter interactions including gamma-aminobutyric acid, glutamate, dopamine, opioid peptides, and serotonin.

Subtle changes in neurochemical function and signal transduction and transcription mechanisms in sensitive neuronal elements in the extended amygdala may be mediators of chronic drug action that lead to vulnerability to relapse and may provide exciting insight into the neuroadaptations associated with drug addiction.

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The Addiction Process

In the "Impaired Response Inhibition and Salience Attribution" (I-RISA) model, we have emphasized the interaction between inhibitory control (e.g., willed-control over automatic processes, interruption of ongoing behavior) and reward processing (e.g., the experience of pleasure, attribution of relative reward value) in drug addiction, implying that inhibitory control would be especially disturbed under conditions of high drug salience (Goldstein & Volkow, 2002). Preliminary fMRI BOLD results - money differentially activates the brain reward circuit as a function of drug addiction - support our hypothesis.

The brain circuits we target are the mesolimbic and mesocortical dopamine pathways encompassing the striatum (caudate, putamen, nucleus accumbens), hypothalamus, amygdala, anterior cingulate, insula, and orbitofrontal cortex. The behaviors that are at the core of drug addiction include drug intoxication/drug reinforcement, craving, bingeing, and withdrawal.

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The Patient-Physician Relationship

Patients recovering from substance use disorders are commonly seen in the primary care setting, and relapse is a serious long-term problem for these patients. Extrapolating from therapeutic strategies effective in specialty addiction treatment settings, this article outlines a practical approach to relapse prevention in the primary care setting.

Working within a supportive patient-physician relationship, the primary care physician can help recovering patients decrease their susceptibility to relapse, recognize and manage high-risk situations, and use available self-help, pharmacological, and specialty resources.

Drawing on the therapeutic relationship and skills they already possess, primary care physicians can have an important, productive, and satisfying role in the long-term management of patients in recovery from alcohol or other drug problems.

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