By Cosmas Omegoh
Is your child or spouse doing drugs? Here are red flags to see. Dr Charles Umeh, a consultant clinical psychologist at University of Lagos Teaching Hospital (LUTH), Idi-Araba, Lagos, in an encounter with Sunday Sun gives a blow by blow account of what to look out for. Excerpts:
What are drugs?
Essentially, drugs are chemical substances capable of influencing one or two functions of the body when they are ingested. Essentially, we use drugs to deal with health issues so as to bring about the normal functioning of the body. However, a lot of people have issues relating with the common drugs we use. Some drugs are capable of affecting us negatively. They can influence the way we think, feel and react. Not every drug does that. We call drugs that do that psychoactive substances. There are different categories of psychoactive drugs depending on the action they exact on the body. We call those that slow down the body functions depressants. Some drugs stimulate mental alertness; we call them stimulants. Then we have the hallucinogens. And we also have the inhalants too. One thing that is common among drugs is that they have the good and the bad, including the ones we buy over the counter. However, here, we are focusing on the psychoactive substances that affect and influence the way we behave. One big other thing such drugs bring which makes them attractive to people is that it is capable of making the consumer feel euphoric. That is why most people look out for them.
So, how do drug use habit develop?
A lot of people go through all manner of things and oftentimes want to escape from them. They don’t want to deal with such problems the way they are. So, they seek for a way out. Indeed, psychoactive substances can give momentary relief from whatever problem one is going through; they make people believe that everything is cool; they make people feel good. But when the effects of such drug wear out, they will know that they have really done nothing than to destroy them.
Now, psychoactive substances are pretty dangerous because they have addictive tendencies that will lure people to a journey of no return.
Young people are lured to drugs first because they look up to certain people; they love them and the way they behave; they want to be like them. So, they start nosing around to see how to be like such individual. That is one of the attractions. Next, they stumble on what those people do. At that initial time, the kind of information they get is one that will make drugs attractive to them. But no one tells them about the drugs’ side effects. Once they try them and feel good, the tendency is that they want to try and try until they get hooked. When they get hooked, they discover that they have entered into a problem they cannot deal with. Some will regret the action that lead them into substance use, but cannot get out; they cannot help themselves. Now, one thing is certain: one can never be hooked on any drug without first using it. The sequence of drug-habit development is: first, there must be use. This use might be legit or illegit. When we say it can be legit, we mean that it can be through prescription drugs that one gets used to it. Here, of course, the quantity one can take is regulated. But that is not what we are talking about. A drug like Pentazocine is used in pain management of sickle cell patients. But one of the side effects is that the user feels euphoric. Later, some of them might begin to look for it even when the doctor has stopped prescribing it. They can go for it and then get hooked. Other drugs like tramadol can relieve pain. When a doctor prescribes a drug and people use it, there is a tendency for them to go back to it again without doctor’s prescription. We call this misuse. Sometimes, the user wants to go higher without the doctor’s prescription: because they want to get that feeling they initially had in the beginning. When this drug is being misused, it is not for the purpose it was prescribed, but for the side effect it gives. Those side effects now have no dose regulation anymore; the abuser keeps taking the drug to get high. When one is misusing such drug, it means they are no longer using it for the purpose it was prescribed. Now, there is a way the body reacts to drugs – including common substances like alcohol. That is what we call tolerance. When one is given the first dose, and they feel high, the next time they are using the same substance, that same doze will not offer the same degree of euphoria anymore because of what we call enzyme induction. This time round, the user is having more enzymes to break down the substance. The first time, the drug was strange to the body. When next they take it, the body has got the enzymes that can break it down immediately. So the active ingredients get broken down immediately. Now, what they get is not enough to give them the same effect as before; so they need to get more to have the same effect the first one gave. That is why most times when you take a glass of alcohol, you feel tipsy. Subsequently, you have to take more glasses to feel tipsy. That is the biological process of drug tolerance. That is why drug users keep asking for more to get the same effect. Next time, the body begins to react when the substance is not in the system. The user starts having withdrawal symptoms. So, they start craving for more. When they don’t have it in the system, the body feels something is missing and begins to make demands. At that point, if the user doesn’t have money, they can steal to ensure that they buy the drug because the body needs it. When they satisfy the craving, they feel good again.
What are signs one is abusing drugs?
There are very many signs that suggest that someone is experimenting with drugs. They vary depending on the age of the individual. Now, let’s look at the segment that is more inclined to drug use: adolescents and youths. We can have several emotional, physical and behavioural changes that might suggest that a certain fellow is experimenting with drugs or regularly using psychoactive substances. Now, let’s start with the behavioural changes. One, there will be changes in social groups. When one starts using drugs, former friends become archaic. They will start dropping them and migrate to new friends; the user starts identifying more with their new friends. That way, what members of the new group do will become more adorable – the way they dress for instance. Second is secretive behaviour. Anyone that is using any psychoactive substance tends to be a pathological liar. When kids who were hitherto not lying begin to lie, then know that something is happening; now, they want to conceal their drug behaviour because they know that the society frowns at drug use. So, they want to do everything to conceal the act to their parents. If a man is married, he starts becoming a bit more secretive with the things he does with the wife. That can come in form of concealing his activities, belongings, and whereabouts. He will no longer share information with trusted family members because he knows what that may lead to. As for kids, you start seeing declined in their school performance since they no longer pay attention to their studies. Rather, hanging out with their new friends becomes the in-thing. Those ones using cannabis are ill-motivated. They no longer do their homeworks; their assignments are not done. Class activities are postponed; they keep believing they will have time to sort out things. Yet that time never comes. That begins to show in their academic performance. Some might engage in risky behaviour. They start experimenting with new dangerous behaviour. Those who are of age will start driving dangerously. Some might not have money to manage their activities, so they start either selling or stealing things. Once they are having the craving for drugs, the only option is to quench it. In some cases, they engage in very risky sexual behaviour. They can do anything because they don’t care anymore. Their relationships with members of their family become strained. They start engaging in arguments more frequently either with their parents or family members. They don’t see things from the perspective of any family member anymore because they feel bolder and can do things better. They want to call the shots. They feel emboldened and want to be heard.
Now, there are some physical changes one might begin to notice, for instance, changes in their appearance, depending on the type of drugs they are using. Those using cannabis will start losing weight. They will start looking older than their real age. In some instances, their personal hygiene begins to drop. Their eyes become bloodshot. If you look critically at their pupils, they become dilated. Some of them wear disfigured appearance; they want to look tough. Some of them who use cocaine have frequent nose bleeding; there is deterioration in their health; they have stomach problems, fatigue and general illness. You do all the investigations and find nothing; they still feel the way they are feeling. In some other cases, they will be having unusual body ordour; those that use alcohol exude strong smell. Those that use marijuana would like to conceal their odour by using perfume because they don’t want you to smell anything. Some will even be eating sweets all the time. Now, we also have some emotional reactions or psychological changes that might come with drug use. We can have mood swings. Suddenly someone becomes highly irritable. Some other times, they become highly excited. You keep wondering what is causing all the euphoria. There could be depression at times and even anxiety. So, when you start noticing a sense of emotional instability in any adult or adolescent who has no underlying mental issues, that is a pointer to the fact that they are doing drugs.
Some other drugs can cause paranoid. The user starts hearing voices. That is hallucination, but not all the drugs do that. Hallucinogen and stimulants do that. Hallucinogen is something like cannabis. Any adult that uses them will show signs of paranoia hallucination. They will have distorted sense of reality. There could be increased anxiety or depression. That is a kind of sudden onset of a high level of depression or anxiety or hopelessness. When they feel so, the tendency is that they will go back to drug use to make them feel good again. We know that those who use substances can go into depression, and we know that those who are depressed can go into substances to elevate their mood. It is a two-way thing. So it becomes difficult to pinpoint which one is responsible for which.
Largely, the user experiences lack of motivation. They don’t do any meaningful thing anymore. Their whole attention is focused on the substances: cannabis is the number one that does that. That is why the user never does well in school except by miracle. We also have some cognitive and memory problems. Some might find it difficult remembering things or making decisions. There are also some typical signs you will see depending on the substances the individual is using. For instances, anyone using alcohol will have slur speech, impaired coordination, flushed skins; you will smell alcohol in their breath. That is why one way to test the alcohol level in someone is by breathing into a device and it tells you the level of alcohol in the system. You see those using marijuana or Loud on the streets with bloodshot eyes, dry mouths, poor coordination or relaxed demeanour and some sense of lethargy. Those using cocaine or Met, experience decreased inaction because cocaine is a stimulant. They also exhibit erratic behaviour, nose bleeding and dilated pupils.
What then can be done to help abuser?
First, they will be antagonistic to you because they are enjoying what they are doing. So, we encourage motivational intervention. They will not tell you the truth. So, what you use is a subtle way to win their trust so that they start talking. If they cannot communicate with you, there is nothing you can do. But when they start talking, that is when you begin to make arrangement for professional intervention. You cannot manage them by yourself unless when they are just beginning. That way, you can catch them and nip the problem in the bud. But if they have gone far, you seek professional help.
The most important thing is for them to open up. You cannot force anything on them. The first and most important thing is to win them over and let them tell what they are doing so that you can psycho-educate them.