Rebecca Ejifoma writes that one of the preventive measures against drug and substance addictions, as well as mental health disorder among youths, is robust parent and child interaction. Corroborating,
CEO and Medical Director of Hakron Specialist Care Centre in Lagos, Dr Akeem Akinloye, said mental health disorder is a medical condition that has snowballed into a public health concern, adding that family members play crucial roles in its treatment
Mental health disorder is a medical condition that has snowballed into a public health concern. Medical experts have said it has the potential of crippling a nation- society, families, loved ones and friends, as well as the addicts themselves. Over time, studies have also backed up their anxieties about addiction and mental health disorder, which activates emotional, physical, psychological, and productive imbalance.
Sadly in 2018, the United Nations Office on Drugs and Crime (UNODC) reported that one in seven persons, aged 15 and 64 in Nigeria, had used a drug in the past year. The Global Burden of disease study in 2017 had it that globally 585,000 persons died from drug use.
Consequently, this has called for more concerns among psychiatrists like the CEO and Medical Director of Hakron Specialist Care Centre in Lagos, Dr Akeem Akinloye.
Defining Drug Addiction
During a virtual interview with Akinloye, he described drug addiction as a situation where a psychoactive drug enslaves a person. "This person that is usually seen on the street as an addict can hardly do anything and complete it successfully because he or she uses all the time available to him to search for the drug he is addicted to.
"It is a complex phenomenon, as it has medical, social, and psychological implications on the individual affected; although the affectation on the family of the patient is mainly social and psychological. We consider drug addiction as a family disorder in our centre since causes, manifestation of the disease, and its treatment usually involves both the patient and close relatives that live with them."
Signs of Drug Addiction
As a psychiatrist, with about 17 years experience, Akinloye hinted at some signs of addiction to look out for. Among them are: change in behaviour, which comprises change in attitude, change in the activities of daily living, irritability, sneaking out of home at night.
He emphasised: "In these people, especially when the drug use is transforming to addiction (drug dependence), one begins to notice behaviours that suggest poor judgement. Irritability is very common among them; little things that ordinarily should not result in anger, tip them off. Hence, that person starts looking his parents in the face, eyeball to eyeball when there is an argument on a trivial issue.
"They usually sneak out of the house early in the morning to seek drugs; they usually come to the house late at night. The key thing to note is that all their activities during the day when they are awake is progressively narrowing to drug seeking behaviour which is the reason they start failing in school, at work and any other endeavour that they engage in."
Biological Causes Of Drug Use
While outlining the causes of addiction, the medical director termed them as many and interwoven. He classified them as social, biological or psychological. "By social, I mean modelling - 'my brother whom I admire so much for his maturity is doing so, I want to do too'. Biologically an important cause under this category is genetics, which implies that the use of psychoactive substances can run in the family. The causes could be psychological because some can use it to suppress some feelings like unhappiness, lack of confidence, feeling of inadequacy and the rest."
However, Akinloye noted that the most useful classification, especially in psychological treatment, is the one that groups these causes into predisposing causes, precipitating causes and perpetrating causes. The predisposing factor, which mostly arises due to genetic or poor interaction between the parents and the child, sets the child into abnormal feelings such as lack of confidence, inadequacy, and ambivalence.
According to the psychiatrist, it has been proposed that strong support and compact interaction between children and their parents allows encephalin (brain hormones) to bathe the brain of infants during the first two years of life and also during the other part of their lives.
Psychoactive Drugs Prescribed in Hospitals
At this point, the expert expressed worries about some addictive medications prescribed in hospitals in the country. "This is where precipitants come in. This could be a friend, an associate, a sibling who eventually introduces the addict to the drugs. A would-be addict could actually present his or her feelings problems to this person who then tells them to be using street drugs for coping."
He, however, lamented the prescription of psychoactive drugs in hospitals. According to Akinloye, drugs like Benzodiazepines, Pentazocine, Tramadol, Rohypnol, and Diazepam among others used in the hospital can turn a predisposed person to an addict.
He advised that people can only take the medications on doctor's prescription. "Those drugs are on prescription. This means that a doctor must write on prescription before anyone takes it," explaining further that doctors know the dose at which they are safe to evade addictions.
Effects of Addiction
Once addicted, the expert said there would be disruption of family life, failure here and there, inability to progress in any endeavour which makes it impossible for the patient to face life and focus, whenever they are sober, they are not happy, so they need to get back to their intoxication state. "These factors in addition to withdrawal symptoms make the drugs use a vicious cycle to continue," he cautioned.
Explaining to THISDAY factors that trigger addictions today, Akinloye acknowledged that the human brain is growing in volume, creating more and more complex pathways. He suggested that the only way this can be measured more accurately is the speed at which the world is transforming. "More knowledge and information are pouring out; youth are the ones bringing innovation and no one wants to stay out of competition. The time and energy available during the day are no more enough for the curiosity life is presenting."
Reasons for Drug Use
He, however, blamed misinformation, early marriages, inter-ethnic annexation and admixture, nationalisation as well as globalisartion are more or less in the mid stage as other contributing factors. All these, the expert bemoaned, have made family ethos, and cultural values wane. "Support systems are going down too.
"Negative emotions like disappointment, sadness, lack of confidence, and losses among others are abound everywhere creating predisposition for drug use," And, he chipped in, I think we must know that youthful brains, especially those from 16 to 24 are highly flexible. This makes it very easy for psychoactive drugs to reshape and create new pathways in their cerebrum, which leads to continued usage."
Commonly abused drugs/substances
Some of the commonly used substances and drugs responsible for these addictions are: Cannabis (weeds, Indian hemps), "Loud", "Arizona" which is known as a stimulant at a higher dose, Amphetamine Cocaine too is a stimulant.
"But when they say depressant (the calmers) - opposite effect as stimulants; we talk of Opiate like Heroin, Codeine, Morpine, Folatile liquid like - remember that they can also be used in combination for example "Monkey tail" which is combination of Alcohol and cannabis. Alcohol itself is a psychoactive substance although not classified as drugs," he explained.
Addiction in Females Difficult To Treat
With more female addicts being admitted at psychiatric facilities in the country, the MD disclosed that while males are more prone to addiction than females, addiction in females tends to be worse and far more difficult to treat.
Statistics of Addicts
On how frequent addicts are brought in, the doctor mourned, "Regularly, and on a daily basis, although not all of them are financially buoyant to stay and complete their rehabilitation programme."
Akinloye, whose facility at 24 Oyetola, Mafoluku at Oshodi is known for rehabilitating and enlightening addicts, described some cases as worse. He recalled, "One case that comes to mind is a young man who is a citizen of both Nigeria and the United States but resides in the state with his wife and two kids. This young man who is a retired marine soldier in America ran away to Lagos after he was admitted about three times in the US. He refused to stop using Cocaine. Three major public rehab centres in Lagos managed him before our facility, Hakron, was contacted."
This particular patient, he continued, was consecutively readmitted in our facility five times before he was finally able to achieve sobriety. "I meant five times of admission," he emphasised "When a reasonable number of the family members gave their support and completely cooperated with our therapists. This is completely unusual in our centre where results used to happen."
Legally Forcing Addicts for Treatment
Speaking further, Akinloye said the decision of family members always depends on whether the addiction is complicated with psychosis and poor judgement and lack of insight or not. "An addict with any of the three listed above may not be able to have capacity to make a reasonable decision about their healthcare. More so, they may be a threat to their own life or to others around them.
"This kind of a patient will need to be legally coerced for treatment until he is capable of making decisions for his care when he is no longer a threat to the society. His decision for treatment is reviewed whether he wants to continue in rehabilitation or not. However, in an addiction case without complication as I mentioned above, the mental health bills which are yet to be passed into law in Nigeria does not allow anybody to force such a person into treatment."
How Family Members Can Support
Family members play crucial roles in the treatment of such mental disorders. "In the first instance they usually initiate the treatment as the patient may neither know nor agree that there is a problem at all. The cooperation among themselves to annex support for the patient is very germane. They also need to work with the therapist in order for them to know the psychological needs of their ward. They also play the role of financing the treatment which is very very costly.
"They supervise the patient's medication after being discharged, they must make sure that recovery is for life and that relapse (going back to illness or drugs is very common), they have a lot of roles to play. Even their own individual emotional feelings affect the patient's stability and vice versa. "
Actualising a Drug-free Nation
For Akinloye, everyone who wishes to make Nigeria a drug-free country has to join politics. "If that is done, the National Drug and Law Enforcement Agency (NDLEA) capacity will be raised, mental health bills will be passed, and the attempt at pushing for legalisation of cannabis will be thwarted. Without this, achieving a drug free society in Nigeria is more or less a mirage."
Improving Understanding of the World Drug Problem
According to the Hakron medical expert, rapid globalisation and nationalisation is the answer, especially in terms of creating more professionals in drug addiction treatment and prevention. "This shall help in terms of further research in this area.
"The US has already started. They began with a gentle approach to train everyone that has interest in becoming Addiction Professional all over the world in their Colombo Plan Drug Advisory Programme (DAP). They have a model for prevention and treatment; the centre for Universal Treatment training is Yaba Neuropsychiatric Hospital while Global Initiative on Substance Abuse (GISA) is the body handling prevention training in Nigeria."
He outlined that people are already going for the training, a part-time programme for everyone to have an idea about drug addiction. "I think in the near future these programmes shall help everybody to make informed decisions about drug problems. However, it seems currently drug barons are winning the race. That is why you hear 'It is being legalised here and there'."
He further lamented that these drug traffickers are in high places, "Controlling politics! Once the knowledge spreads, research grows, the impact of the drugs on governance, health and security problems shall be reduced, if not totally exterminated".
Not satisfied with the level of performances from concerned agencies, Akinloye tasked the Nigerian government to strengthen the NDLEA in both supply and demand reduction sections. He added that the law needs to be very clear and enforced while noting that passage of Mental Health Bills which has been lingering for years is also important.
He suggested further, "More and standard drug rehabilitation centres like Hakron Specialist Care Centre that are devoid of stigma and have well articulated programmes are very essential. Good policies in the area of governance that will support good family lives. We need to do a lot in the area of our social welfare as a country. Our school curriculums need to contain subjects that educate on psychoactive substances (Drug of Abuse) from primary to tertiary institutions. This will alter the attitude to drugs in this country."
Solution for Addict is Rehabilitation not Arrest
"I don't think arrest is the solution for drug sellers. However, for the supply reduction among traffickers, arrest can be the starting point", pointing out he said, "But how many of them really get prosecuted at the end of the day? But for the users or the addicts, the only solution is rehabilitation because these people are chronically sick; the stage of wrong-right cannot hold again. There is no punishment that can bring them back."
Dedication to Rehab, Therapy
Founded about five years ago, Hakron is a mental health private hospital and rehabilitation home at Mafoluku just close to Murtala Muhammed International Airport. "Since it got off the ground, the rehabilitation centre has taken care of more than 200 clients' families. When I say family I'm referring to the patients and their family members," he stated.
He boldly maintained that the results have been wonderful; "as we used to tell the families that contacted us; it always depends on how much the family wants it; their readiness and ability to work with our therapists. Our mode of treatment is medical. We use pharmacotherapy, psychotherapy and social therapy in our inpatients, out patients as well as day care depending on what is suitable for the patient after comprehensive assessment. In terms of results, we are number one".
Family members play crucial roles in the treatment of such mental disorders. In the first instance they usually initiate the treatment as the patient may neither know nor agree that there is a problem at all. The cooperation among themselves to annex support for the patient is very germane
2) I don't think arrest is the solution for drug sellers. However, for the supply reduction among traffickers, arrest can be the starting point... . But for the users or the addicts, the only solution is rehabilitation because these people are chronically sick; the stage of wrong-right cannot hold again. There is no punishment that can bring them back