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Addiction in Adolescents ---- A Current Trend
Dr.Anil Batta
A R T I C L E I N F O A B S T R A C T
Keywords:
Short Report
OpiumAbstinenceTranquilizersAlcoholRelapse
1. Introduction
A lot many factors are available which contribute to this
avoidable adventure. Out of these few which are highly relevant
have been lineated as follows.
Familial : This could be an important cause as individuals from
families with a history of any kind of addiction are more likely to
develop addiction.. The family scenario is again a driving force e.g.
history of alcoholism in the parents may become an important
cause.
Surroundings: Again as the Children are brought up by
alcoholic or drug addicted parents gets family environment
becomes a causative factor. Individuals from countries where use
of a certain substance is not imposed as an illegal sanction have
higher role to play as the causative factor.
Exploitation: Individuals who experienced sexual,
psychological, emotional or physical exploitation are more likely to
become addicts. The addiction becomes a coping mechanism in
them.
High Emotions: Emotional disorders such as anxiety,
depression, bipolar disorder or post-traumatic stress disorder
often increase the risk of substance abuse. In them the insecurity
feeling flares up the urge to use to drugs.
Action of drug: Certain substances are more addictive than
others, and risk of full-blown addiction is higher for drugs such as
opioids, alcohol & tranquilizer because of their ability to create
dependence after just a quick time.
Low Frustration Tolerance: One common factor found
amongst addicts of all types is a low frustration tolerance. Addicts
are highly susceptible to the negative effects of stress, having a low
threshold of facing the disturbances. They become easily upset
over everyday stress factors, creating a need for escape. They find
this escape in their addiction.
Absentism at school: Frequently missing classes or missing
school, a sudden disinterest in school or school activities, and a
drop in grades may be indicators of drug use.
Weak All of a Sudden : Lack of energy and motivation may
indicate that child is using certain drugs.
Listless appearance: Adolescents are generally concerned
about how they look. A lack of interest in clothing, grooming or
looks may be a warning sign of drug use.
Copyright 2011. CurrentSciDirect Publications. IJCBPR - All rights reserved.c
Contents lists available at CurrentSciDirect Publications
Journal homepage: www.currentscidirect.com
International Journal of Current Biomedical and Pharmaceutical Research
Int J Cur Biomed Phar Res. 2011; 1(3): 130 -133
CurrentSciDirectPublication
*Dep't of Medical Biochemistry, Baba Farid Univ. of Health Sciences, INDIA
* Corresponding Author : Dr.Anil BATTA
Copyright 2011. CurrentSciDirect Publications. - All rights reserved. IJCBPRc
Addiction is a condition that results when a person regularly consumes substances like alcohol, opioids or tranquilizers or engages in an activity like womanizing ,using internet, watching television & gambling which give him pleasure in increasingly high quantity so that finally it becomes an imperative compulsion and deviates him from carrying out normal duties User is not aware of this fact that continuity in increasing amount is creating problem to himself and to society. For all practical purposes it is uniinhibitng outcome of all these factors. . Its consequences are social, emotional and psychological. Pattern of substances of use is notorious as it can change from time to time. But this is for sure that the substances of abuse whether legal or illegal can cause havoc at national and even international levels. The nature of these though may be significant but the regional variation can vary from time to time. Substance of use among adolescents & children are a cause of deep concern. Keeping in view this thing in mind a study in northern belt was carried out.in 85 patients of age group of 14 to 19 years in age.Resuts were devastating and unimaginable. Important point is that this menace has to be tackled at social level.
Dep't of Medical BiochemistryBaba Farid Univ. of Health SciencesINDIAE.mail: akbattafarid@yahoo.co.in
Changes in behavior : Teenagers enjoy privacy, but
exaggerated efforts to bar family members from entering their
rooms or knowing where they go with their friends might indicate
drug use. Also, drastic changes in behavior and in relationships
with family and friends may be linked to drug use.
Sudden Expenditure: Sudden requests for money without a
reasonable explanation for its use may be a sign of drug use. You
may also discover money stolen from previously safe places at
home. Items may disappear from your home all of a sudden. Most
of these are costly items which are not of frequent daily use but
disappear suddenly.
Keeping all the things in mind a study was conducted in
adolescent subjects presenting to a Drug de-addiction OPD of
Dep't of Psychiatry PGIMER, CHD. Data on demographic and
clinical features were made available in adolescent patients who
presented to the centre during 1978-1992.
The study was conducted at the Drug De-addiction and
Treatment Centre of PGIMER CHD, with incident area in north
India. Most patients either came of their own or were referred by
big Hospitals The De addiction services include outpatient,
inpatient, laboratory, aftercare, various agencies and self-help
groups. The cohort for this study consisted of all child and
adolescent patients (age less than or equal to 18 yr at the time of
registration) registered at the DDTC between September 1978
and December 1992. Substance dependence was diagnosed as per
ICD-9. by a consultant psychiatrist after direct interview with the
patient and her relatives. Following detailed evaluation, the
treatment consisted of detoxification, symptomatic treatment,
treatment of medical complications, if any, and psychotherapy of
patients and their families. Monthly follow-ups were done by a
psychiatrist when patient's drug use profile, social and
occupational functioning and physical and psychological
problems were monitored. The study was therefore limited to
these 85 subjects as that number was available.
2.Material and Methods
3.Results
2.1.Socio-demographic profile
3.1.Clinical profile
2.2.Clinical and substance use profile
substance intake. Lapses were defined as using the substance less
than that for relapse. Relapse was defined as re-mergence of
substance dependence as per the ICD- 9 or 10. Duration of follow-
up was calculated in number of months from first visit to the last
visit to the hospital.
Adolescents from nuclear families were 63.8%.out of these
76.9& were from urban population. School absentees comprised >
50%. In general they presented or were forced to present by
parents at the age of 15—18 years. Opioids were used by > 75%
and the commonest used opioid was morphine. Nicotine was also
found to be common by more than 52.9%. More than 76% used
these for curiosity for the first time. More than 20% were found to
be indulged in all types of multiple sex users. Nearly half of the
subjects had positive family history of either drug dependence
(40.2%) or psychiatric disorder (5.5%). Alcohol, tobacco and
tranquillizers along with analgesics are the common substances of
abuse.
The mean age at first use of the primary substance was 14
years (range 5-17.5 yr), while the mean age at clinic presentation
was 17 years . Almost all the subjects were single (96.4%) at
presentation; majority of them belonged to Hindu nuclear families
(63.5%).Out of these 83.5% were from urban background (More
than half of the subjects were school dropouts and nearly one third
(35%) of the subjects were going irregularly to school at the time
of presentation. Most of the subjects, who were not studying, were
unemployed (32.9%). An interesting finding was that nearly
three-fourth (72%) of the subjects who presented to our clinic had
studied, or had been studying, in government schools. It was also
observed that, two third (65.9%) of subjects were brought to the
OPD by a relative and only one fifth (21.2%) sought help on their
own and rest were referred by physician/surgeons. Most of the
subjects (97.6%) had good social support.
The mean duration of dependence on the primary substance
till clinic attendance was 20 years. The average duration to
develop dependence (from first use) was 6 month. Almost all
(97.6%) the subjects were dependent on at least one substance at
the time of presentation.
The commonest used primary class of substance was opioids
(76.2%) and the commonest used opioid was morphine (36.5%).
More than half of the subjects (54.2%) were also tranquilizers
dependent at the time of presentation.
Most of the subjects started using the substance either out of
curiosity (78.8%) or under peer pressure (16.5%). Nearly half of
the subjects had positive family history of either drug dependence
(40.2%) or psychiatric disorder (5.5%). About one-fifth (21.2%)
of the subjects indulged in high-risk behavior such as having
sexual intercourse with multiple sexual partners. Only a few
subjects (9%) reported physical co morbidity in the form of
A semi-structured proforma was used to record sex, age,
marital status, educational level, occupation, income, family type,
religion and locality.
This included type of predominantly used substance,
duration of dependence, relapses, treatments and hospitalizations
in the past (before the index treatment episode), detailed physical
and psychiatric co morbidity, and other substances being used.
The information about the physical and psychiatric co morbidity
was inferred from the history, and clinical and laboratory
evaluation and monitoring of the patient throughout the contact
period. Abstinence, lapse, or relapse was considered as the
primary outcome measures. Abstinence was defined as no
Anil Batta / Int J Cur Biomed Phar Res. 2011; 1(3): 130 -133 131
seizure disorder (4.7%), thyrotoxicosis (1.2%) and pancreatitis
(2.4%). A substantial minority (25.6%) of the subjects had co
morbid psychiatric disorder, most common being conduct disorder.More than half (57.6%) of the subjects were treated on outpatient
basis and about one third of the subjects (32.9%) were admitted
once only, during the period of contact. At the time of first contact,
more than two-third (68.2%) of the subjects had poor to superficial
motivation for treatment (0-1 as rated on a 0-4 scale), most being
brought by parents (65.9%).
After the initial detoxification, 37.6% agreed to take
pharmacoprophylaxis with naltrexone. Only one fifth of the
subjects, however, continued to take pharmacoprophylaxis beyond
one month, with mean duration of prophylaxis being 156 month
(range 2-730; SD 181.14). Among the 28 subjects who were
prescribed naltrexone, 20 were noted to be abstinent at the last
follow-up.
The mean duration of follow-up was 11.2 month (SD 21.90,
range 0-122). The mean number of follow-up at hospital visits was
6.62 (SD 5.42, range 1-31). While 51.8% subjects reported
abstinence at the last follow up, 36 subjects (42.4%) were noted to
be continuing substance use or had relapsed after an initial period
of abstinence.
The current study was a retrospective chart review with the
aim of studying the sociodemographic and clinical profile of
adolescents presenting to a de-addiction centre of a tertiary care
hospital. The profile of treatment seekers can help the treatment
agencies to prepare themselves in managing such cases. More than
half of the subjects were school dropouts and nearly one third of the
subjects were going irregularly to school at the time of presentation.
This probably reflects the effect of drug use on the educational
functioning of the subjects. Mean age at first use of the primary
substance was nearly 15 year, which suggests that various drugs are
easily available. The mean duration required to develop
dependence was nearly 6 months. This was probably highly
influenced by the predominant substance of dependence, i.e.,
opioids, which are known for their high drug dependence potential.
Almost all the subjects were dependent on at least one substance at
the time of presentation. This was probably due to more frequent
use of high dependence potential drugs. The commonest used
primary class of substance was opioids and the commonest used
opioid was morphine. This finding is different from studies
conducted among school students from other centers in the country,
where alcohol & tranquilizer is the commonest drug of use, followed
by tobacco. This probably reflects the availability of substances
across various regions of the country. Also, a tertiary-care centre
such as ours is likely to attract more dependents on harder drugs
like heroin.
More than half of the subjects (54.2%) were also nicotine
dependent at the time of presentation. This probably suggests that
nicotine use/dependence acts as a gateway for starting other hard
drugs. Most of the subjects started using the substance either out of
curiosity or under peer pressure. Previous studies have also
4. Discussion
5. Conclusion
6. References
reported starting of substance on experimental basis and later on
becoming dependent on it. Co morbidity was reported in very few
subjects and could be attributable to the selection procedure.
Nearly half of the subjects had positive family history of either drug
dependence or psychiatric disorder, which is in similar lines with
other studies, which have implicated environmental and genetic
factors in development of drug dependence.
Within the limits of generalizability, this study provides a
glimpse into the profile of clinic-attending adolescent substance
abusers. The major strength of the study derives from the fact that it
has collected data from clinic-attending patients over a span of a
quarter of a century. Patients came from nuclear urban set-up and
were predominantly opioid-dependent. There was evidence for
both genetic as well as socio-environmental factors as correlates of
drug use. Efforts should be made to collect similar data from other
addiction clinics in the country so that a more composite picture of
the clinical situation can emerge nationwide.
The results suggest that the development of substance
dependence in children and adolescents is a combination of familial
and social vulnerability factors, including the drug culture of the
social milieu. A rise in opiate use was reported in school children.
Indian data on the profile of young population with substance abuse
in organized form is lacking. For planning effectively and to provide
efficient services catering to the special needs of this sensitive and
vulnerable population, there is a need to understand the substance
use profile, associated problems, as well as the special needs of
adolescents. Hence, the current study was designed to be familiar
with the socio-demographic and clinical profile of the adolescent
population seeking treatment for de-addiction.. All the probable
causes of the abuse should be nullified to bring a feeling of
responsibility in the young ones who will decide the future of the
country. If adolescents are themselves the victims then any
unpleasant thing is on cards. Multiple addiction is the ultimate that
can be expected.
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133
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