Multiple dimensions of drug abuse Part-III: Biological and Medical Dimensions

We need to fully understand the neurobiology behind drug abuse as well as its types, signs and symptoms, risk factors, health hazards and treatments in order to manage it well

After having discussed some of the psycho-social and religious dimensions in the previous two parts of this article series, it is time to discuss important biological and medical factors governing drug abuse. 

Biological Dimensions 

In order to understand the neurobiology behind drug abuse we need to understand the role of chemical substances released inside our brain called neurotransmitters namely Dopamine and Serotonin. They are the chemical substances or neurotransmitters synthesized and released in the basal ganglia and limbic system of our brain that are responsible for regulating our pain and pleasure pathways. Every time these chemical substances are released by the nerve cells almost 80 percent of the substance released is reabsorbed back by the same neuron that releases it and only 20 percent interacts with the receptors and elicits a biological response. After interacting with their receptors these neurotransmitters are metabolized or degraded by enzymes. However, drugs like Cocaine and Heroine inhibit this reabsorption by blocking the neuronal transport system and constantly maintain a high concentration of Dopamine and Serotonin at the nerve junction called synapse whereas they should have been ideally stored back in their neuronal storage vesicles inside the neuron. This explains the neurobiology behind a constant craving for the drug because the moment drug intake is stopped by the abusers, brain feels deprived of the pleasure due to falling levels of dopamine or serotonin at the synapse and evokes a withdrawal syndrome that is manifested by a host of physical and psychological symptoms like body ache, shivering, muscle cramps, lethargy, sweating, vomiting, diarrhoea, palpitations, restlessness and immense discomfort. That is how these substances of abuse hijack the dopaminergic and serotonergic neurotransmission system by triggering a vicious cycle of drug intake-pleasure-drug deprivation-craving-motivation to take more drug-reward after intake in terms of pleasure and repetitive reinforcement of the cycle. This is what causes enslavement of abusers to these drugs who can’t live without consuming them and can go to any extent to procure and use them, leading to rise in criminal activities and anti-social behaviour of drug abusers. Therefore, there is need to make our budding generation aware about this brain hijacking process triggered by substances of abuse so that they remain aloof from them and do not fall prey to their slavery and dependence. And those who have already been entrapped and enslaved by them need to break their shackles of slavery and set themselves free from this scourge. 

Our youth need to know that there are better and smarter ways of pleasure seeking other than drugs and substances of abuse. Several research studies have suggested that protein-rich diet, exercise, sleep and sunlight have a direct impact on the structure and functioning of human brain and on the maintenance of sound mental health. Some of the foods like chicken, eggs, fish, soy products, soy milk, dairy products, nuts, seeds, pineapple etc increase serotonin levels in our brain and thereby promote mental health and improve our mood and behaviour. They also boost our immune system and keep us stress free. Serotonin is a feel-good neurotransmitter produced by nerve cells made from the essential amino-acid tryptophan. Tryptophan itself is important for brain function and plays an important role in sound sleep. We cannot synthesize tryptophan in our bodies, so we need to obtain it from our diet. However, tryptophan is found in many foods whereas serotonin is not. Therefore, eating a balanced diet rich in tryptophan is an essential way to support mental as well as physical health with positive benefits on energy levels, mood, behaviour and sleep. Sufficient secretion of serotonin inside our brain is a vital element for sound physical and mental health because the neurotransmitter has a significant impact on emotional well-being, mood stabilization and physical coordination. It is also important for good bone health, reduction of anxiety and depression, faster healing of wounds, healthy bowel habits and restful, rejuvenating sleep. Therefore, by opting for physical exercise, sound sleep of adequate duration, exposure to sunlight, intake of arginine rich protein diet like eggs, honey, nuts, bananas, spinach, seeds etc and meditation we can maintain our mental balance, stay calm and relieve ourselves of all sorts of stress, worries and anxieties. 

Medical Dimensions 

Medical dimensions of drug abuse include types and definitions of drugs, drug abuse, misuse, substances of abuse, dependence, addiction, epidemiology including incidence, prevalence, mortality and morbidity due to drug abuse, signs and symptoms, risk factors, diagnosis, treatment, prevention, complications, rehabilitation, individual and overall public health impact of drug abuse. It also includes aspects like access and affordability of drug de-addiction treatments and reintegration strategies including creation of livelihood generation opportunities for drug abuse victims. It goes without saying that the impact of drug abuse on the health and well-being of an individual is huge and can severely damage one’s lungs, liver, kidneys and cause acute cardiovascular, dermatological and gastrointestinal disorders besides badly affecting one’s immune system, orientation, memory, concentration and learning abilities. Withdrawal or abstinence syndrome, that is caused when the drug abuse is abruptly stopped by the victim makes things even worse and therefore needs immediate de-addiction treatment. Some of these damages are permanent that cannot be reversed by any means and some have a lasting impact upon one’s physique, mental health, persona and character. Therefore, resorting to drugs is as good as committing suicide or leading to self-harm and destruction. It amounts to disabling, crippling and converting oneself into a vegetable and thereby confining oneself into darkness of drugs for no logical reason whatsoever. When one can use the bounties of Almighty Allah like a sound mind and a sound heart in a sound body for creative, productive, fruitful, constructive and progressive activities, there is no tangible reason why one would make them subservient to the slavery of drugs and destroy his career, reputation, public impression and entire life. 

Socio-economic impact of drug abuse is even worse than its medical and health impact because it not only cripples a person physically but financially, intellectually and emotionally too. They become outcasts in the society and are looked down upon by everyone though that is not justified. They are abhorred, discredited and renounced within their family as well as friend circles. Therefore, drug abusers pay a huge price for their momentary pleasure and temporary excitement. Some of them lose their jobs and businesses, other fail in their crucial examinations and some get divorced too. Therefore, timely deaddiction treatment is a must for those who have fallen prey to this menace following which they can be rescued, rehabilitated and brought back into the mainstream. For this to happen government needs to establish drug de-addiction and rehabilitation centres in every district as envisaged in the drug de-addiction policy of the UT. De-addiction treatments need to be made readily available, affordable and accessible at these de-addiction centres and livelihood generation opportunities need to be made available to them for sustaining themselves and their dependents. Drug abuse detection kits need to be made available and used at schools, colleges, highways for timely detection and deterrence against drug abuse. 

Both parents and teachers need to be well aware about the signs and symptoms as well as about the risk elevating factors of drug abuse that include easy availability of drugs and money, peer group pressure, emotional distress, performance pressure, eccentric personality traits, social seclusion and other unfavourable circumstances. They need to be alert about the changing habits, attitudes, behaviours and daily routines of their children and may occasionally snoop into their rooms to make sure there is nothing like razor blades, aluminium foils, insulin syringes, cigarettes, sniffing straw etc lying around in their rooms and belongings. Teachers too need to be vigilant about any sudden or gradual changes in the performance, responsiveness, attitudes and behaviours of their students and can report the same to their seniors, parents or counsellors and arrange a counselling session for them. While parents need to be cautious about the pocket money given to and spent by their wards because abundant pocket money and easy availability of drugs in their vicinity could make their children potential candidates for drug abuse, teachers too need to keep the students engaged in creative and recreational activities like sports, cultural and community-based group activities so that their energies and curiosities get channelized in the right direction. Government in turn needs to create adequate avenue of recreation and sports activities like indoor and outdoor stadia, youth clubs, gymnasia, wellness centres, swimming pools etc for the proper orientation, utilization and promotion of youth energy and talent. Last but not the least sufficient number of adequately trained and well qualified psychiatrists and clinical psychologists needs to be made available in every district and sub-district hospital and educational institution. 

(Author teaches at the Department of Pharmaceutical Sciences, University of Kashmir and holds the additional charge of Director, Centre for Career Planning and Counselling of the University)