Many are the times I hear people, especially frustrated parents say, “Amerudi kwa tabia yake mbaya ya kuvuta bangi…nimechoka na yeye! Shauri yake!” (He’s gone back to his bad habit of smoking cannabis… I’m tired! It’s his fault!”

While initiation of alcohol or any other ‘drug’ use may be a result of peer pressure or bad company, some people may self-medicate with substances to find relief for an underlying mental illness. It could be an effort to lift their mood in a major depressive disorder (depression); to stabilize their mood in bipolar mood disorder; to calm themselves in anxiety disorder, to try and concentrate on a task in attention deficit hyperactivity disorder (ADHD); or perhaps to make the ‘voices’ disappear in schizophrenia.

According to the American Society of Addiction Medicine (ASAM), Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by the inability to consistently abstain, impairment in behavioral control, cravings, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.

Apart from drug addiction, people can develop addictions to other human behaviour or experiences such as food, sex, gambling, pornography, exercise, internet, television, shopping, role-playing games, among others. Addiction is commonly used interchangeably with the term ‘Substance Use Disorders’, which refers to a pattern of continued pathological use of a psychoactive substance that may cause serious physiological, behavioral and social consequences.

Diagnosis Of Substance Abuse

According to DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), a diagnosis of substance use disorder is made considering the following criteria:

  1. Taking the substance in larger amounts or for longer than you are meant to.

  2. Wanting to cut down or stop using the substance but being unable to.

  3. Spending a lot of time getting, using, or recovering from use of the substance.

  4. Cravings and urges to use the substance.

  5. Not managing to do what you should at work, home, or school because of substance use.

  6. Continuing to use, even when it causes relationship problems.

  7. Giving up important social, occupational, or recreational activities because of substance use.

  8. Using substances repeatedly, even when it puts you in danger.

  9. Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance.

  10. Needing more of the substance to get the effect you want.

  11. Development of withdrawal symptoms, which can only be relieved by taking more of the substance.

The severity of the disorder depends on the number of symptoms: mild shows 2 to 3 symptoms, moderate 4 to 5 symptoms and severe 6 or more symptoms. Addiction, like other chronic diseases often involves cycles of relapse and remission and without treatment or engagement in recovery activities; it is progressive and can result in disability or premature death.

The diagnosis can be made by a health professional on receiving a detailed history of one’s complaints and drug use, doing physical examination and laboratory investigations. Assessments using appropriate tools or tests can also help make a diagnosis.

Psychoactive substances

These work on the mind or on behavior by altering one’s mood thoughts and actions. They can be broadly categorized as depressants, hallucinogens and stimulants.

  • Depressants include alcohol, benzodiazepines, opiates/opioids, low dose cannabis and some inhalants/solvents slow down the respiratory and cardiac centers in the brain.

  • Hallucinogens distort the senses and produce hallucinations, which are experiences that depart from reality. Examples are high dose cannabis, ecstasy and ketamine.

  • Stimulants are either synthetic or plant derived substances that increase alertness and arousal by stimulating the central nervous system. They include nicotine, khat (miraa), cocaine, amphetamine and methamphetamine.

Some prescription drugs such as benzodiazepines like diazepam, alprazolam, bromazepam etc. and opioids like pethidine, morphine, codeine, fentanyl, methadone among others, have a high potential for addiction when used without medical supervision, in high doses or for longer durations than prescribed.

There has also been an emergence of new psychoactive substances (NPS) either in pure form or a preparation, which are sold even through the internet. Examples include ketamine, piperazines, pnenethylamines, synthetic cannabinoids, synthetic cathinones, plant based substances. There is also an increasing trend towards using more than one drug at a time, especially among the youth.

Management of Substance Use Disorder

Management is critical and is achieved by use of both medication and psychosocial interventions. Treatment can take various forms such as management of withdrawal symptoms also referred to as medical detoxification; management of intoxication and overdose; maintenance treatment as in the case of opioid use disorders. Some people may present with concurrent medical or psychiatric disorders which also require treatment.

Relapse prevention is a key component of treatment of substance use disorders. All these interventions can be done either in an outpatient or inpatient setting depending on the severity of the illness and the psychosocial needs of the person.

If anyone is concerned that they may be having a problem with substance abuse or addiction, it is important that they seek help immediately from the nearest health facility whereby they shall be directed to the appropriate health care providers.

Please remember that:

  • Addiction is a disease, not a choice

  • Addiction is progressive, chronic and can be fatal

  • Young brains especially adolescents are at highest risk due to its unique stage of development

  • Addiction is very treatable especially help is sought early

  • Early interventions, assessment and treatment are the keys to successful recovery from addiction

  • It is important to focus on addiction prevention

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