Drug Addiction and Recovery Dialogues: Stories & Insights – Part 2

Interview by Prabir Debbarma

June 26, 2024

Narrator*: Welcome back to “Drug Addiction and Recovery Dialogues: Stories & Insights,” brought to you by Yakhrai Production. In this second part of our series, we delve deeper into the medical perspective on addiction, exploring the complexities of substance abuse, it’s connection with HIV and the path to recovery.

Addiction is a multifaceted challenge, impacting not only the individual but also their families and communities. Understanding the medical and psychological underpinnings of this condition is crucial for effective treatment and long-term recovery.

Today, we have the privilege of speaking with Dr. Mahendra Debbarma, MBBS, MD (Medicine) from Agartala Medical College and Gobind Ballabh Pant Hospital. Dr. Debbarma brings years of expertise and compassion to the forefront of addiction issue.

Join us as we gain valuable insights into the medical aspects of addiction, its treatment, and the vital role of community and family support. This essential conversation sheds light on the journey from addiction to recovery, offering hope and guidance to those affected.

Interviewer: Hello Dr. Mahendra, welcome to the programme produced by Yakhrai Production. To start, can you explain what addiction is and how it is defined medically?

Dr. Mahendra: Addiction is a disease that affects the brain and body. When a person uses a substance, it can alter their physiology to the point where they feel compelled to continue using it, despite negative consequences. This compulsion defines addiction.

Interviewer: What are the main factors that contribute to the development of addiction?

Dr. Mahendra: Several factors contribute to addiction, but key ones include age, typically between 15-24 years, lifestyle, and environment. Social issues such as domestic violence, poor neighbourhood conditions, and lack of social hygiene can lead to depression and anxiety, pushing individuals towards substance abuse.

Interviewer: How does addiction differ from casual substance use?

Dr. Mahendra: The difference is significant. Casual substance use doesn’t typically lead to dependence. In addition, repeated use leads to physical and psychological dependence, where the person experiences pain and struggle without the substance. Tolerance also increases, requiring higher doses to achieve the same effect, which isn’t seen in casual use.

Interviewer: What are the stages of addiction, from initial use to dependence?

Dr. Mahendra: There are three main stages of addiction. The first is intoxication, where the person explores the effects of the drug. The second is withdrawal, where the person experiences discomfort without the drug. The final stage is preoccupation or anticipation, where the person constantly thinks about using the drug and sharing it with others, making it a very dangerous stage.

Interviewer: Can you explain the concept of tolerance in the context of addiction?

Dr. Mahendra: Tolerance occurs during the intoxication stage. As a person uses the substance, they explore different doses. Over time, their body adapts, and they need higher doses to achieve the same effect. This is because the initial dose no longer produces the desired effect.

Interviewer: What is withdrawal, and what symptoms might someone experience during withdrawal?

Dr. Mahendra: Withdrawal is a crucial stage where the person feels severe discomfort without the substance. Symptoms include pain, vomiting, stomach aches, diarrhoea, constipation, irritability, anger, and body tremors. These symptoms can be severe and require monitoring.

Interviewer: Can family members diagnose drug addiction based on withdrawal symptoms?

Dr. Mahendra: Yes, if these symptoms are observed and occur frequently, family members should closely monitor the person. If symptoms improve after taking the substance and worsen without it, it indicates withdrawal and addiction.

Interviewer: How does addiction impact the brain’s reward system?

Dr. Mahendra: Addiction affects the brain’s reward system by overstimulating it. The substance creates a strong feel-good signal, overwhelming the brain’s ability to inhibit this sensation, leading to a loss of control over drug use.

Interviewer: What role do genetics and environment play in the risk of developing addiction?

Dr. Mahendra: Genetics can predispose individuals to addiction, especially those prone to depression and anxiety. Certain genetic variations affect how the brain experiences pleasure and reward, increasing susceptibility to addiction. A family history of addiction also raises the risk due to inherited traits and learned behaviour.

Environmental factors are equally important. Supportive family relationships can protect against addiction, while conflict or neglect can increase vulnerability. Peer pressure, especially in adolescence, often leads to experimentation with drugs.

Additionally, stressful neighbourhood conditions and exposure to crime can push individuals towards substance use as an escape. Conversely, strong social support, educational opportunities, and safe recreational spaces can deter substance abuse.

Interviewer: What is the difference between substance abuse and substance dependence?

Dr. Mahendra: Substance abuse involves using a substance to achieve a desired effect, while substance dependence is characterized by an increasing need for the substance and an inability to function without it. Dependence is an advanced stage of substance abuse.

Interviewer: What is the link between drug abuse and HIV?

Dr. Mahendra: There is a significant link between drug abuse and HIV, particularly with intravenous drug use. When people inject drugs, they often share needles, which can spread HIV if even one person in the group is infected. The virus is transmitted through blood, making needle sharing a high-risk activity.

Additionally, drug use can lead to impaired judgment and risky behaviours, including unsafe sexual practices. Individuals under the influence of drugs are less likely to use condoms or may engage in sex with multiple partners, both of which increase the risk of HIV transmission. This risk is present in both heterosexual and homosexual relationships.

The combination of needle sharing and unsafe sex practices creates a dangerous environment where HIV can spread rapidly. In communities with high rates of drug abuse, this dual risk significantly contributes to the prevalence of HIV.

Addressing drug abuse through education, harm reduction programs, and accessible treatment can help mitigate this public health issue.

Interviewer: Why is addiction considered a chronic disease?

Dr. Mahendra: Addiction is considered a chronic disease because it persists over an extended period and involves recurring cycles. It typically begins with the initial exploration of the substance, where the individual experiences its effects and may continue to use it for the pleasurable sensations it provides. Over time, this progresses to the withdrawal stage, where the person feels physical and psychological discomfort without the substance, leading to repeated use to alleviate these symptoms.

As addiction develops, it affects the brain’s structure and function, particularly the areas responsible for reward, motivation, and memory. These changes can make it extremely difficult for the individual to stop using the substance, even when they want to or when it causes harm.

The repeated cycles of intoxication and withdrawal reinforce the addictive behaviour, making it a long-term issue. Furthermore, addiction impacts overall health, leading to a range of physical and mental health problems. Chronic use can result in organ damage, mental health disorders like anxiety and depression, and a decline in social and occupational functioning. Because of these persistent and recurring patterns, addiction is classified as a chronic condition, much like diabetes or hypertension, requiring ongoing management and treatment.

Interviewer: How does addiction affect a person’s daily life and functioning?

Dr. Mahendra: Addiction has far-reaching effects on individuals, their relationships, and society as a whole. For the individual, the consequences can be severe and life-threatening. High doses of substances can lead to overdose and death. Addiction often brings about significant changes in behaviour, including increased irritability, aggression, and unpredictable moods. This can make it difficult for the individual to maintain healthy relationships and perform daily tasks. At the relational level, addiction strains relationships with family, friends, and colleagues.

Trust is often broken, and communication deteriorates, leading to conflicts and a sense of isolation for both the individual and their loved ones. As addiction progresses, the person may prioritize substance use over their responsibilities and relationships, causing further damage to their social support network. In the context of society, addiction can lead to criminal behaviour as individuals may resort to theft, fraud, or other illegal activities to obtain money for drugs. This criminal behaviour not only harms the individual but also affects the safety and well-being of the community.

Increased crime rates can lead to a sense of insecurity and fear among community members, further isolating the individual with addiction. Moreover, the social costs of addiction are substantial, including healthcare expenses, law enforcement resources, and lost productivity. The ripple effect of addiction impacts everyone, from immediate family members to the broader community, highlighting the need for comprehensive support and intervention strategies to address and mitigate these widespread consequences.

Interviewer: What role does stress play in the development and continuation of addiction?

Dr. Mahendra: Stress is a significant factor in the development and continuation of addiction. Individuals often turn to substances as a way to escape from their problems and alleviate stress. This initial use of substances as a coping mechanism can quickly lead to dependence and addiction.

Continuous stress exacerbates addiction by creating a cycle where the individual increasingly relies on substances to manage their stress. The relief provided by substances is temporary, leading to repeated use and higher doses to achieve the same effect. This ongoing cycle not only deepens the addiction but also impairs the individual’s ability to cope with stress without substances. Chronic stress also affects the brain’s reward system, making it more vulnerable to addiction.

 The constant exposure to stress can alter the brain’s chemistry, increasing cravings for substances that provide temporary relief. Over time, the brain’s natural stress-regulation mechanisms weaken, further entrenching the addictive behaviour. Therefore, effective stress management is crucial for both preventing and treating addiction. This includes developing healthy coping strategies such as mindfulness, exercise, therapy, and building a strong support network.

By addressing the underlying stressors and learning to manage stress in healthier ways, individuals can reduce their reliance on substances and support their recovery journey.

Interviewer: How can one differentiate between helping someone with addiction and enabling their addiction?

Dr. Mahendra: Helping someone with an addiction involves actively observing their behaviour, recognizing the signs of substance abuse, and addressing the issue with care and concern. This means encouraging the individual to seek professional help, such as counselling or rehabilitation, and providing them with moral and emotional support throughout their recovery journey.

Effective helping also includes setting healthy boundaries and being consistent in your support, promoting positive changes, and being patient with the recovery process. Enabling, on the other hand, involves actions that indirectly support the individual’s addiction. This can include ignoring their problematic behaviour, making excuses for their substance use, or providing them with money or resources that allow them to continue their addiction.

Enabling behaviours may come from a place of love or a desire to avoid conflict, but they ultimately prevent the individual from facing the consequences of their actions and seeking the help they need. By enabling, you inadvertently contribute to the continuation of their addiction, rather than helping them move towards recovery.

Interviewer: Why is it important to view addiction as a medical condition rather than a moral failing?

Dr. Mahendra: Viewing addiction as a medical condition is crucial because it allows for the appropriate treatment and support that individuals need to recover. Addiction is a complex interplay of genetic, psychological, and environmental factors that affect brain chemistry and behaviour.

By recognizing it as a medical issue, we can address the underlying causes and provide comprehensive care, including medical treatment, counselling, and rehabilitation. Judging individuals with addiction as morally weak or flawed leads to isolation and discrimination. This stigma can prevent them from seeking help and can exacerbate feelings of shame and hopelessness, driving them further into substance abuse. When society views addiction through a moral lens, it often results in punitive measures rather than supportive ones, which can hinder recovery and reintegration. Treating addiction as a medical condition encourages a compassionate and evidence-based approach. It focuses on healing and rehabilitation, helping individuals to overcome their dependency and regain control of their lives.

This approach not only benefits the individual but also reduces the overall societal impact of addiction, promoting healthier communities and reducing the burden on healthcare and criminal justice systems. By providing the necessary support and understanding, we can help those struggling with addiction to recover and reintegrate into society as productive members.

Interviewer: Thank you, Dr. Mahendra, for sharing your expertise with us.

Dr. Mahendra: Thank you for having me on the program. Raising awareness about addiction is crucial, and we need to utilize various media platforms to spread this message effectively. It’s essential to understand and treat addiction as a medical condition rather than a moral failing. Providing access to counselling and rehabilitation services is vital for helping those affected to recover and rebuild their lives. I appreciate this opportunity to contribute to increasing public understanding and awareness about the realities of addiction and the importance of compassionate, evidence-based treatment approaches. Thank you once again.

*Narration was provided by Pankaj Debbarma

*The interview was conducted by Prabir Debbarma, who, when not conducting interviews, works in a public sector bank.