Chemical dependency is often accompanied by certain psychiatric disturbances the most common ones being major depression, paranoid disorders, anxiety disorders, schizophrenia and psychopathic personality disorders. This co-occurrence of drug abuse with psychiatric problems is referred to as dual disorder and the situation demands an integrated treatment approach. Both the problems should be treated simultaneously failing which the untreated disorder will increase the chances of relapsing to the other disorder. Apart from continued counseling and group therapy, such clients should be given medicines as prescribed by the psychiatrist.

Certain problems are more common within dual diagnosed clients compared to those with single disorder. Such people may suffer due to psycho-social chaos which may be caused by certain inter-related factors such as loss of job, legal problems, family conflict, homelessness, indebtedness, and others. It is beneficial to prioritize the treatment goals in such situations. Involving the family members and strengthening the support and networking with other agencies to mobilize resources are extremely essential.

Many substances like Methamphetamines, when abused overtime, may lead to brain damage which in many cases could be irreversible. This damage may limit the addict’s ability to understand issues, comprehend, remember and apply them in his journey of recovery. The counselor should be extremely patient in dealing such cases. The messages should be given in clear and simple language using concrete examples.

Traumatic past experiences of the recovering addict also complicate his recovery. Specialized help may be sought to deal with Post Traumatic Stress Disorders.

Lack of family support also cause complications and delay the recovery process.

In sleep apnea the muscle tone in the throat becomes excessively relaxed resulting in blockage of the airway. The person struggles to breathe and this happens several times during his period of sleep often leaving 10 seconds or more within breaths. The sleeper actually fails to notice this until the next day when he might experience daytime drowsiness, headaches, irritability – all of which result from sleep apnea. Apnea might also lead to driving accidents, cognitive problems, stroke and heart disease.

The researchers monitored the sleep of 71 ecstasy users who had used it at least for 30 times but had not used it or any other illicit drugs within the previous fifteen days. 62 people who never used ecstasy served as the control group. The age of the volunteers ranged from 18 to 46 years with an average age of 24 years. None of them reported of having any sleep disturbances in the past.

Based on the number of breath stoppages per hour, the researchers rated sleep apnea as mild, moderate and severe. One of the ecstasy users had severe apnea while 8 had moderate apnea. The mild rate was more or less same within the two groups (27% between non-users and 21% within users). Longer the period of use greater the number of sleep apnea episodes.

Dr. McCarn said, “Our findings may be explained by how ecstasy damages neurons related to serotonin, a chemical in the brain that is involved in sleep regulation and breathing, among other important functions.”

The participation and encouragement of the family members has a crucial role to play in the treatment of an addict. But an essential fact is that the family members are also often extremely distressed and confused. They often face innumerable problems ranging from violence, separation, divorce, inappropriate role models and extreme financial crisis. The problem of addiction creeps in silently until it is finally detected and it is perhaps only then faced by the family. However, by that time it has left a mark on each family member. Thus initially even the family members require a lot of assistance and encouragement to enable them to support the person in treatment.

Drug addiction is not a condition which can be completely cured once it is treated. It is a chronic, relapsing condition and the chances of reverting to the same situation is quite high if the individual along with his family members do not take adequate precautions. Treating addiction thus involves more than just getting the dependent to stop using drugs. It also involves counseling the family members thus improving the family relationships and functioning.

The family members have an important role to play in helping the recovering drug user adapting to the substance-free lifestyle. Extra money can always lead to a relapse. Thus the family should guide the person in managing finance in a better way by making use of some of the options like clearing his previous debts, budgeting current expenses or investing for the future.

Time management is one of the most important tasks of a recovering drug user and the family can play a critical role in this area by helping the individual schedule activities, engaging him in some activities of his interest.

Re-integration with the family is foundation of any treatment approach. The understanding, support and co-operation of the family members can help these hapless individuals come back to the mainstream of life.

The family of an addicted person plays a pivotal role which could be either detrimental or beneficial for his recovery. Family members may be closely involved with several aspects of addiction: their response to addiction, their response to the dependent person and influence on the course of addiction and their role in the individual’s treatment and aftercare, which may either aid or precipitate relapse.

Most of the family members suffer from tension, anxiety, depression, insomnia and other such symptoms. They may also have serious social and psychological problems. Strong senses of anger, guilt as well as a desire for vengeance are not uncommon. Denial of the existing problem by the family members worsens the situation. Denial is an unconscious process of blocking out reality. The problem of denial is manifested in different ways like failure to see the problem entirely, recognizing the extent or severity of the problem, realizing the connection between drug use and the problems it has caused and above all understanding the fact that the drug dependent needs help in dealing with the problem.

The family members try their best to cover up the misdeeds of the addicted person, completing his unfinished work, paying the bills that he did not pay and rescuing him from various kinds of problems like legal problems. They usually take up the responsibilities which the addict has abandoned. Denial allows everyone to pretend that there is no problem. The longer the denial goes on, the longer it takes before the drug user changes his behavior.

A significant family member can thus be either supportive or inductive. The former category can greatly reduce damage and can be extremely useful in treatment. But the inducer shows extremely unsupportive behavior which actually induces the individual to continue drug use. He constantly rebukes him, imposes excessive surveillance, restriction and threats all of which actually worsen the situation and induces drug use.

Recently a study on drug abuse had been conducted at Kalindini and Mombasa districts. The study, sponsored by National AIDS Control Council and carried out by DARAT, an organization based in Mombasa, indicated that a sample of 120 narcotic users including injecting drug users showed an exceptionally high rate of Hepatitis C and HIV positive cases. The drug users were all residents of Mombasa and Kalindini.

Dr. Timothy Mugusia, who was involved in the study said, “Over 70 per cent of them were found to be infected with hepatitis C while half of them were HIV positive.” He also said, “An abnormally high rate of HIV and hepatitis among injecting drug users at the Kenyan coast points to ‘flashing blood’ among local users.”

The practice was first reported in Dar es Salaam two years ago. Sheryl McUrdy of the University of Texas and Paul Kilonzo of the University of Dar es Salaam first reported the incidents of flash blood in a study published in the African Journal of Drug and Alcohol studies in 2006.

Dr. Mugusia estimated that there are around 6,000 drug injectors in Mombasa and Kalindini and most of the users are in their early 20s. The women in Mombasa have threatened to strip publicly if the government fails to take any immediate steps to check drug use in this part of the city since it is eroding the productivity of the youth.

The risk of relapse remains for most drug abusers throughout their life. Several factors might trigger relapse, crisis being one of them. Crisis is a painful event or situation that can disturb the normal functioning and emotional state of the individual. A crisis in an abstinent person’s life can push him back into the nasty cycle of drug addiction. But, every problem is not a crisis. The individual, in his course of recovery, learns to solve several problems on his own. But there are situations that cannot be solved with just his usual problem solving resources. It is during such situations that a professional help is required to deal with the situation and help the person continue with his recovery.

For a recovering drug user crisis may emerge from any of the following situations –

Family situations like lack of family support, separation, physical illness in the family, death of a close family member can give rise to crises for the abstinent user.

Interpersonal problems arising from difficulties in relationships within and outside the family can lead to crises. Positive emotions like a promotion, marriage, birth of a child could also act as crisis situations.

Personal and social situations involving problems resulting from the person’s previous drug use like legal action for some criminal action done before, ostracism from the community due to previous behavior are also potential causes of crisis.

Economic situations like losing a job, failure to repay debt, failure to find a job could also spark off a crisis.

Following a crisis, the person feels anxious, hurt, upset or angry. He might try to deal with the problem on his own or with the family members. But if he fails then the emotional problems might worsen and he might run the risk of relapse. This possibility usually lasts for 4 to 6 weeks and it is a critical period when he needs help to stay on his path of recovery.

The disease of addiction entails a lot of complexities which affect every sphere of the addict’s life as well as that of his family members. Addiction, like any other chronic disease, is treatable. Treatment of addiction has several components which aims at making the victim drug free and rehabilitating him into the mainstream of life. It covers detoxification and management of medical problems, providing individual, family and group counseling and extending follow-up care.

Treatment of addiction is primarily based on certain guiding principles, the salient one being that recovery from addiction is possible though there is a probability of relapse and recovery is usually a long process. The treatment procedure must focus on various needs of the recovering person – physical, psychological, legal, vocational, spiritual and others. Counseling forms an integral part of the treatment and this should continue for an adequate period of time. Regular monitoring of the individual’s needs, problems and his progress is essential.

The involvement of family, community, workplace and support groups facilitate recovery. Co-morbidity is one of the most chief factors since most of the addicts do suffer from different types of physical or mental problems which, if left untreated, will take a more serious form in recovery and this might act as a trigger for relapse.

The initial step in treating an addict is assessment of the causes of addiction and identification of the most appropriate treatment modalities which could meet his needs.

Detoxification is the next step which deals with the abstinence syndrome caused by the cessation of the use of drugs. Detoxification can be done in a controlled environment such as at a detoxification center or on an outpatient basis.

The early detoxification phase is followed by counseling – individual or group. This enables the client to assess his problems and motivates him to develop coping skills.

An effective treatment procedure should have a component of aftercare since it is essential to sustain recovery.

The recovery process is a long and painful journey from dependence on drugs to a drug free healthy lifestyle. It is the process for making intrapersonal and interpersonal changes. It is the time for healing the damage caused by addiction by learning new skills and tasks to face the challenges of the drug free life.

The process of recovery begins when the addict sees that he can go no further accepting the fact that he is over-powered by drugs and there is actually no safe way of using it. Most of the time his family members and friends intervene to make him realize the fact.

Recovery from addiction is thus a dynamic and progressive process and it could be divided into certain stages on the basis of the developmental growth events experienced by the individual during his recovery journey.

The “Unfreezing Phase”/Ambivalence

This is the phase of emotional awakening when the person suddenly realizes the sorrowful condition of his existence, the things that he has lost, troubles he has caused, the innocent people he has hurt. After many false starts he accepts help, begins to trust a helping person, evaluates experiences and recognizes the damage and distress that drug has caused. He begins to feel hopeful and decides to accept directive help to learn to live without drugs.

The “Reshaping Phase”/Commitment

The recovering addict learns to live without drugs. Slowly he becomes adapted to the new routines of life and at the same time he develops better self-control and self-respect. He also develops an alliance with other recovering peers and practices the recovery skills together with them. The stronger the bondage the better the chances of recovery.

The “Refreezing Phase”/Integration
This is the final stage in which he makes progress in all aspects of life. The process of assimilation and validation occurs most naturally. He assumes responsibilities with confidence and adapts to recovery practices in everyday life to reduce drug craving and risk of relapse. He becomes a part of the mainstream community.

The underlying vulnerability is masked by the toughness and the burden of responsibilities and constant stress make them internally vulnerable and a physical or emotional disturbance might cause a turmoil triggering drug abuse leading to drug dependency.

Women drug abusers face serious challenges to their well-being during their lives. Researches show that a large number of them present a history of physical and sexual abuse. The condition worsens when such women get into flesh trade just to earn the money to sustain their drug taking habit. The result is obvious – sexually transmitted infections, HIV/AIDS.

Often it is found the initiation of the habit is through her male counterpart – spouse or boyfriend- who is also an addict. In such cases it becomes very difficult for the women to abstain from drugs since the lifestyle of the partner supports it.

Research indicates that women become more easily dependent on certain drugs like cocaine even after experimental or casual use. Thus by the time she seeks treatment she may be severely addicted.

A problem with female addicts is that most of the time they do not seek treatment due to fear of rejection from their family members, community. But treatment is an absolute necessity for them. A comprehensive treatment approach that takes care of the special needs of women together with support and encouragement from the family and community is essential to help them in refraining from addiction.

But relapse is preventable provided the recovering person as well as the significant people in his life is able to identify the relapse warning signs and take the necessary steps to cope with the situation. The changes take place at the following levels –

Changes in attitude

- No efforts/commitment towards sobriety.
- Becoming extremely pessimistic.
- Impatience.
- Tunnel vision – looking at life in fragments and not as a whole.
- Overconfidence.
- Open rejection of help.

Changes in thought

- Thoughts about substitute drugs.
- Denial and resistance to change.
- Thinks that he deserves drugs since he has been sober for quite some time.

Changes in feelings

- Increased moodiness and depression.
- Strong feelings of anger and resentment.
- Increased feelings of boredom and loneliness.

Changes in behavior

- Increased episodes of disagreement with people around.
- drug taking friends.
- support group meetings.
- Displaying visible signs of stress such as smoking more cigarettes.
- Talking repeatedly about pleasures associated with drug use.

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