Addiction
25 year old Engineering drop out with addiction to Alcohol, Nicotine & Cannabis.
A 25-year-old male was brought to my clinic at Podiyadi, Thiruvalla by his parents. He had complaints of addiction to multiple substances including Alcohol, Nicotine & Cannabis.
My client started using substances after he joined for Mechanical Engineering at a prestigious institute in Kerala. During the ragging time seniors would ask him to drink Alcohol, which he obliged. Later he began to drink alcohol with friends on occasions. Slowly he began to drink more regularly about 300ml once in 3 days along with friends. From his 2nd year of engineering he began to drink on a daily basis alone. He would either go and buy it self or would ask his juniors to get it for him. He would drink about 500-1000ml brandy per day. He began to drink as soon as he got up from sleep. After a while at night he would wake up in between his sleep and would consume liquor. He began to lose interest in other activities like sports and studies. He began to have intense craving for drinking. All the time he was pre-occupied with how to get money to buy more alcohol. He began to tell his parents lies that he had exams, study tours and projects in order to get money for buying alcohol. A couple of times he stole money from his friends too. His friends began to counsel and advise him to stop drinking. Slowly he began to feel guilt and shame over his drinking. So, he tried to cut down on his drinking. But whenever he tried to reduce the amount of alcohol consumed, he had tremors of hands and sometimes whole body shaking; sleep was also disturbed. He began to experience anxiety, worries and had low mood.
Along with his alcohol use he also used to smoke cigarettes- nicotine and cannabis. Initially he would smoke about 2-3 cigarettes occasionally, but slowly after a year he was addicted to it and began to smoke about 15-20 cigarettes per day. He had intense craving for nicotine, more than that he had for alcohol. He also began to use cannabis initially along with friends for fun, but later on a regular basis alone. Whenever he smoked cannabis, he had this dreamy state where he could hear voices which nobody else could and see images which nobody else could. He was frightened and became paranoid. A couple of times he had fight with his friends accusing them of spying on him when he was high on weed. After smoking cannabis his eyes would become red and muddy and he would have high appetite and would become irritable and frequently quarrelled with his friends. He began to be suspicious of his girlfriend, whom he accused of having relationship with others. Once he beat his girl friend very badly that she had to be hospitalized. Once in a Bar, under the influence of alcohol he had a fight with locals and caused damage to the property. A legal case was filed against him. He was suspended from college and later became a college drop out.
His parents took him to a local psychiatrist and was admitted for 30 days in a de-addiction centre. Upon discharge he was given medications. But after discharge he again began to consume alcohol. So, the doctor gave the parents medicines to be given in his food without his knowledge. So, this time after he drank alcohol, he had severe vomiting and had to be hospitalized. There after they discontinued his medications and later, he again began drinking as before. So now they took him to another de-addiction centre where he was admitted for 21 days. There according to him, they gave him alcohol and after taking each sip, he was given electric shocks as an aversive conditioning method. This made him very angry and ‘mad’ and un-cooperative. He completed 21 days of hospital stay, but on the day of discharge itself he went away from his home to Bangalore and took a part time job in a hotel. There at Bangalore he began to drink heavily and also smoke cannabis. His parents gave police complaint and was found and brought back.
He became depressed, was sad over the fact that he could achieve nothing in life when his friends were now well placed. He had also lost his girlfriend. He was full of guilt and thought that he has become a burden to his family. He lost hope in himself and thought that it was better for him to die. He tried to commit suicide by wrist slash with a blade, but was seen on time and rescued. His father who was working in an MNC in gulf resigned and came home. His father searched online for a psychiatrist who does deaddiction treatment and found my name and called, took appointment and came to my clinic at Podiyadi, Thiruvalla.
On examination, my client was moderately built and nourished, fully conscious, fairly cooperative, rapport was difficult to establish in the beginning, with lots of denial. Psychomotor activity was decreased, Talk was slightly decreased in amount, tone & tempo, reaction time was increased, prosody was maintained, relevant & coherent. Examination of his Thought showed that he had depressive cognitions- ideas of helplessness, worthlessness and hopelessness. No active suicidal ideas although death wishes were present. Mood was anxious & depressed. Affect was decreased in range and reactivity, appropriate with no lability. No perceptual abnormalities like hallucinations were noted. Cognitive functions showed decreased attention and concentration with normal intelligence & memory. Abstractability and intact judgement were normal. Insight was moderate.
Neuropsychiatric assessment scales used:
- CAGE Questionnaire
- The Michigan Alcoholism Screening Test (MAST)
- Alcohol Use Disorders Identification Test (AUDIT)
- Hamilton Depression rating scale (HAM-D)
Diagnosis of – ADS (Alcohol Dependence Syndrome), CDS (Cannabis Dependence Syndrome), NDS (Nicotine Dependence Syndrome) and Substance induced Depressive disorder- moderate was made.
Patient and relative were psychoeducated regarding the disorder, a definitive management plan was worked out with the client and relative. Client was started on Psychotherapy (MET: Motivation Enhancement Therapy) along with detoxification phase with drugs. Slowly patient was motivated to stop substances. After detoxification phase, anti-craving medications were started along with CBT (Psychotherapy). He was also encouraged to get involved in Alcoholic Anonymous programmes (peer support group), which he did with great enthusiasm. After 4 weeks of treatment, he remained completely abstinent from alcohol and other substances, his depression got resolved and he was self-motivated in continuing to remain abstinent from substance use.
Self-Assessment
