- Pre contemplative (Addict? Who-me?)
- Contemplative (maybe I have a problem)
- Action (I do have a problem / I should do something about it)
- Maintenance (Abstinence is the best option for me; then I can really change my life).
Cannabis/alcohol/ ATS / Cocaine are notorious. Anxiety, panic, depression, Delirium, Alcohol/drug induced psychosis, Alcohol hallucinations, Alcohol/drug induced delusional disorder, Schizophrenia and Amotivational syndrome. Acute intoxication phenomena may include mania and at times even uncontrollable aggression, rape and homicidal behaviour (detailed descriptions are beyond the scope of this article).Co-Morbidity:
Accidents & injuries, Cardio-vascular complications, Gastro-Intestinal complication, Haematopoietic complications, Hepatic complications, Neuro-muscular complications, Pulmonary complications, Reproductive system complications, Risk Behaviour related infections, Skin complications, Special Senses complications and Sexual dysfunctions.Treatment:
The core consideration in management of addiction is abstinence from the chemical, followed by rehabilitation programmes. This programme of care would optimally contain the following component, Outreach, Awareness and intake: Community level activity to identify, motivate and induct users into treatment.
Detoxification short duration abstinence in a quasi- controlled environment or hospital setting (5-7 days), with medicines and other support to minimize withdrawal phenomena.
Deaddiction-care in a quasi- controlled environment with counselling and psychological / medical support and group activities, to educate and sustain motivation for rehabilitation intentions, in the recent relatively unstable mental state due to the absence of the regularly used psycho-active substance. This may last 3-4 weeks and include contact / discussions with significant others who themselves would be included in the programme.
Rehabilitation- longer duration of a quasi- controlled environment and structured programme that allows the individual to introspect, learn and practice issues related to social relationships, responsibilities, identification and managing potential stressors and other circumstances that could lead to a relapse in addictive behaviour. The programme duration may last 1-3 months.
Whole Person Recovery would include reintegration into society and sustaining a drug free life while efforts continue towards personal growth. Self Help Groups (such as alcoholics Anonymous, Narcotics Anonymous, Al-Anon for Family Members) are extremely useful in providing support. There isways a need for a continuum of care within the community to facilitate change in community to address issues of stigma and discrimination as well as early identification of relapse and provision of care for it.
The following ‘Continuum of Care’ model would be extremely useful method.