Addiction in Adolescents ---- A Current Trend

Dr.Anil Batta

A R T I C L E I N F O A B S T R A C T

Keywords:

Short Report

OpiumAbstinenceTranquilizersAlcoholRelapse

1. Introduction

A lot many factors are available which contribute to this

avoidable adventure. Out of these few which are highly relevant

have been lineated as follows.

Familial : This could be an important cause as individuals from

families with a history of any kind of addiction are more likely to

develop addiction.. The family scenario is again a driving force e.g.

history of alcoholism in the parents may become an important

cause.

Surroundings: Again as the Children are brought up by

alcoholic or drug addicted parents gets family environment

becomes a causative factor. Individuals from countries where use

of a certain substance is not imposed as an illegal sanction have

higher role to play as the causative factor.

Exploitation: Individuals who experienced sexual,

psychological, emotional or physical exploitation are more likely to

become addicts. The addiction becomes a coping mechanism in

them.

High Emotions: Emotional disorders such as anxiety,

depression, bipolar disorder or post-traumatic stress disorder

often increase the risk of substance abuse. In them the insecurity

feeling flares up the urge to use to drugs.

Action of drug: Certain substances are more addictive than

others, and risk of full-blown addiction is higher for drugs such as

opioids, alcohol & tranquilizer because of their ability to create

dependence after just a quick time.

Low Frustration Tolerance: One common factor found

amongst addicts of all types is a low frustration tolerance. Addicts

are highly susceptible to the negative effects of stress, having a low

threshold of facing the disturbances. They become easily upset

over everyday stress factors, creating a need for escape. They find

this escape in their addiction.

Absentism at school: Frequently missing classes or missing

school, a sudden disinterest in school or school activities, and a

drop in grades may be indicators of drug use.

Weak All of a Sudden : Lack of energy and motivation may

indicate that child is using certain drugs.

Listless appearance: Adolescents are generally concerned

about how they look. A lack of interest in clothing, grooming or

looks may be a warning sign of drug use.

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International Journal of Current Biomedical and Pharmaceutical Research

Int J Cur Biomed Phar Res. 2011; 1(3): 130 -133

CurrentSciDirectPublication

*Dep't of Medical Biochemistry, Baba Farid Univ. of Health Sciences, INDIA

* Corresponding Author : Dr.Anil BATTA

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Addiction is a condition that results when a person regularly consumes substances like alcohol, opioids or tranquilizers or engages in an activity like womanizing ,using internet, watching television & gambling which give him pleasure in increasingly high quantity so that finally it becomes an imperative compulsion and deviates him from carrying out normal duties User is not aware of this fact that continuity in increasing amount is creating problem to himself and to society. For all practical purposes it is uniinhibitng outcome of all these factors. . Its consequences are social, emotional and psychological. Pattern of substances of use is notorious as it can change from time to time. But this is for sure that the substances of abuse whether legal or illegal can cause havoc at national and even international levels. The nature of these though may be significant but the regional variation can vary from time to time. Substance of use among adolescents & children are a cause of deep concern. Keeping in view this thing in mind a study in northern belt was carried out.in 85 patients of age group of 14 to 19 years in age.Resuts were devastating and unimaginable. Important point is that this menace has to be tackled at social level.

Dep't of Medical BiochemistryBaba Farid Univ. of Health SciencesINDIAE.mail: akbattafarid@yahoo.co.in

Changes in behavior : Teenagers enjoy privacy, but

exaggerated efforts to bar family members from entering their

rooms or knowing where they go with their friends might indicate

drug use. Also, drastic changes in behavior and in relationships

with family and friends may be linked to drug use.

Sudden Expenditure: Sudden requests for money without a

reasonable explanation for its use may be a sign of drug use. You

may also discover money stolen from previously safe places at

home. Items may disappear from your home all of a sudden. Most

of these are costly items which are not of frequent daily use but

disappear suddenly.

Keeping all the things in mind a study was conducted in

adolescent subjects presenting to a Drug de-addiction OPD of

Dep't of Psychiatry PGIMER, CHD. Data on demographic and

clinical features were made available in adolescent patients who

presented to the centre during 1978-1992.

The study was conducted at the Drug De-addiction and

Treatment Centre of PGIMER CHD, with incident area in north

India. Most patients either came of their own or were referred by

big Hospitals The De addiction services include outpatient,

inpatient, laboratory, aftercare, various agencies and self-help

groups. The cohort for this study consisted of all child and

adolescent patients (age less than or equal to 18 yr at the time of

registration) registered at the DDTC between September 1978

and December 1992. Substance dependence was diagnosed as per

ICD-9. by a consultant psychiatrist after direct interview with the

patient and her relatives. Following detailed evaluation, the

treatment consisted of detoxification, symptomatic treatment,

treatment of medical complications, if any, and psychotherapy of

patients and their families. Monthly follow-ups were done by a

psychiatrist when patient's drug use profile, social and

occupational functioning and physical and psychological

problems were monitored. The study was therefore limited to

these 85 subjects as that number was available.

2.Material and Methods

3.Results

2.1.Socio-demographic profile

3.1.Clinical profile

2.2.Clinical and substance use profile

substance intake. Lapses were defined as using the substance less

than that for relapse. Relapse was defined as re-mergence of

substance dependence as per the ICD- 9 or 10. Duration of follow-

up was calculated in number of months from first visit to the last

visit to the hospital.

Adolescents from nuclear families were 63.8%.out of these

76.9& were from urban population. School absentees comprised >

50%. In general they presented or were forced to present by

parents at the age of 15—18 years. Opioids were used by > 75%

and the commonest used opioid was morphine. Nicotine was also

found to be common by more than 52.9%. More than 76% used

these for curiosity for the first time. More than 20% were found to

be indulged in all types of multiple sex users. Nearly half of the

subjects had positive family history of either drug dependence

(40.2%) or psychiatric disorder (5.5%). Alcohol, tobacco and

tranquillizers along with analgesics are the common substances of

abuse.

The mean age at first use of the primary substance was 14

years (range 5-17.5 yr), while the mean age at clinic presentation

was 17 years . Almost all the subjects were single (96.4%) at

presentation; majority of them belonged to Hindu nuclear families

(63.5%).Out of these 83.5% were from urban background (More

than half of the subjects were school dropouts and nearly one third

(35%) of the subjects were going irregularly to school at the time

of presentation. Most of the subjects, who were not studying, were

unemployed (32.9%). An interesting finding was that nearly

three-fourth (72%) of the subjects who presented to our clinic had

studied, or had been studying, in government schools. It was also

observed that, two third (65.9%) of subjects were brought to the

OPD by a relative and only one fifth (21.2%) sought help on their

own and rest were referred by physician/surgeons. Most of the

subjects (97.6%) had good social support.

The mean duration of dependence on the primary substance

till clinic attendance was 20 years. The average duration to

develop dependence (from first use) was 6 month. Almost all

(97.6%) the subjects were dependent on at least one substance at

the time of presentation.

The commonest used primary class of substance was opioids

(76.2%) and the commonest used opioid was morphine (36.5%).

More than half of the subjects (54.2%) were also tranquilizers

dependent at the time of presentation.

Most of the subjects started using the substance either out of

curiosity (78.8%) or under peer pressure (16.5%). Nearly half of

the subjects had positive family history of either drug dependence

(40.2%) or psychiatric disorder (5.5%). About one-fifth (21.2%)

of the subjects indulged in high-risk behavior such as having

sexual intercourse with multiple sexual partners. Only a few

subjects (9%) reported physical co morbidity in the form of

A semi-structured proforma was used to record sex, age,

marital status, educational level, occupation, income, family type,

religion and locality.

This included type of predominantly used substance,

duration of dependence, relapses, treatments and hospitalizations

in the past (before the index treatment episode), detailed physical

and psychiatric co morbidity, and other substances being used.

The information about the physical and psychiatric co morbidity

was inferred from the history, and clinical and laboratory

evaluation and monitoring of the patient throughout the contact

period. Abstinence, lapse, or relapse was considered as the

primary outcome measures. Abstinence was defined as no

Anil Batta / Int J Cur Biomed Phar Res. 2011; 1(3): 130 -133 131

seizure disorder (4.7%), thyrotoxicosis (1.2%) and pancreatitis

(2.4%). A substantial minority (25.6%) of the subjects had co

morbid psychiatric disorder, most common being conduct disorder.More than half (57.6%) of the subjects were treated on outpatient

basis and about one third of the subjects (32.9%) were admitted

once only, during the period of contact. At the time of first contact,

more than two-third (68.2%) of the subjects had poor to superficial

motivation for treatment (0-1 as rated on a 0-4 scale), most being

brought by parents (65.9%).

After the initial detoxification, 37.6% agreed to take

pharmacoprophylaxis with naltrexone. Only one fifth of the

subjects, however, continued to take pharmacoprophylaxis beyond

one month, with mean duration of prophylaxis being 156 month

(range 2-730; SD 181.14). Among the 28 subjects who were

prescribed naltrexone, 20 were noted to be abstinent at the last

follow-up.

The mean duration of follow-up was 11.2 month (SD 21.90,

range 0-122). The mean number of follow-up at hospital visits was

6.62 (SD 5.42, range 1-31). While 51.8% subjects reported

abstinence at the last follow up, 36 subjects (42.4%) were noted to

be continuing substance use or had relapsed after an initial period

of abstinence.

The current study was a retrospective chart review with the

aim of studying the sociodemographic and clinical profile of

adolescents presenting to a de-addiction centre of a tertiary care

hospital. The profile of treatment seekers can help the treatment

agencies to prepare themselves in managing such cases. More than

half of the subjects were school dropouts and nearly one third of the

subjects were going irregularly to school at the time of presentation.

This probably reflects the effect of drug use on the educational

functioning of the subjects. Mean age at first use of the primary

substance was nearly 15 year, which suggests that various drugs are

easily available. The mean duration required to develop

dependence was nearly 6 months. This was probably highly

influenced by the predominant substance of dependence, i.e.,

opioids, which are known for their high drug dependence potential.

Almost all the subjects were dependent on at least one substance at

the time of presentation. This was probably due to more frequent

use of high dependence potential drugs. The commonest used

primary class of substance was opioids and the commonest used

opioid was morphine. This finding is different from studies

conducted among school students from other centers in the country,

where alcohol & tranquilizer is the commonest drug of use, followed

by tobacco. This probably reflects the availability of substances

across various regions of the country. Also, a tertiary-care centre

such as ours is likely to attract more dependents on harder drugs

like heroin.

More than half of the subjects (54.2%) were also nicotine

dependent at the time of presentation. This probably suggests that

nicotine use/dependence acts as a gateway for starting other hard

drugs. Most of the subjects started using the substance either out of

curiosity or under peer pressure. Previous studies have also

4. Discussion

5. Conclusion

6. References

reported starting of substance on experimental basis and later on

becoming dependent on it. Co morbidity was reported in very few

subjects and could be attributable to the selection procedure.

Nearly half of the subjects had positive family history of either drug

dependence or psychiatric disorder, which is in similar lines with

other studies, which have implicated environmental and genetic

factors in development of drug dependence.

Within the limits of generalizability, this study provides a

glimpse into the profile of clinic-attending adolescent substance

abusers. The major strength of the study derives from the fact that it

has collected data from clinic-attending patients over a span of a

quarter of a century. Patients came from nuclear urban set-up and

were predominantly opioid-dependent. There was evidence for

both genetic as well as socio-environmental factors as correlates of

drug use. Efforts should be made to collect similar data from other

addiction clinics in the country so that a more composite picture of

the clinical situation can emerge nationwide.

The results suggest that the development of substance

dependence in children and adolescents is a combination of familial

and social vulnerability factors, including the drug culture of the

social milieu. A rise in opiate use was reported in school children.

Indian data on the profile of young population with substance abuse

in organized form is lacking. For planning effectively and to provide

efficient services catering to the special needs of this sensitive and

vulnerable population, there is a need to understand the substance

use profile, associated problems, as well as the special needs of

adolescents. Hence, the current study was designed to be familiar

with the socio-demographic and clinical profile of the adolescent

population seeking treatment for de-addiction.. All the probable

causes of the abuse should be nullified to bring a feeling of

responsibility in the young ones who will decide the future of the

country. If adolescents are themselves the victims then any

unpleasant thing is on cards. Multiple addiction is the ultimate that

can be expected.

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132Anil Batta / Int J Cur Biomed Phar Res. 2011; 1(3): 130 -133

Copyright 2011. CurrentSciDirect Publications. IJCBPR - All rights reserved.c

133

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