Dealing with Drug Problems

Preventing and Treating Drug Abuse

Drug abuse can be a painful experience – for the person who has the problem, and for family and friends who may feel helpless in the face of the disease. However, there are things you can do if you know or suspect that someone close to you has a drug problem.

Certain drugs can change the structure and inner workings of the brain. With repeated use, they affect a person's self-control and interfere with the ability to resist the urge to take the drug. Not being able to stop taking a drug even though you know it's harmful is the hallmark of addiction.

A drug doesn't have to be illegal to cause this effect. People can become addicted to alcohol, nicotine or even prescription drugs when they use them in ways other than prescribed or use someone else's prescription.

People are particularly vulnerable to using drugs when going through major life transitions. For adults, this might mean during a divorce or after losing a job. For children and teens, this can mean changing schools or other major upheavals in their lives.

Kids may experiment with drug use for many different reasons. 'It could be a greater availability of drugs in a school with older students, or it could be that social activities are changing, or that they are trying to deal with stress', says Dr. Bethany Deeds, an expert on drug abuse prevention. Parents may need to pay more attention to their children during these periods.

The teenage years are a critical time to prevent drug use. Trying drugs as a teenager increases your chance of developing substance use disorders. The earlier the age of first use, the higher the risk of later addiction. However, addiction also happens to adults. Adults are at increased risk of addiction when they encounter prescription pain-relieving drugs after a surgery or because of a chronic pain problem. People with a history of addiction should be particularly careful with opioid pain relievers, and make sure to tell their doctors about past drug use.

There are many signs that may indicate a loved one is having a problem with drugs. They might lose interest in things that they used to enjoy or start to isolate themselves. Teens' grades may drop. They may start skipping classes.

'They may violate curfew or appear irritable, sedated or dishevelled', says child psychiatrist Dr. Geetha Subramaniam, an expert on substance use. Parents may also come across drug paraphernalia, such as water pipes or needles, or notice a strange smell. 'Once drug use progresses, it becomes less of a social thing and more of a compulsive thing – which means the person spends a lot of time using drugs', Subramaniam says.¹

If a loved one is using drugs, encourage them to talk to their primary care doctor. It can be easier to have this conversation with a doctor than a family member. Not all drug treatment requires long stays in residential treatment centres. For someone in the early stages of a substance use problem, a conversation with a doctor or another professional may be enough to get them the help they need. Doctors can help the person think about their drug use, understand the risk for addiction and come up with a plan for change.

Substance use disorder can often be treated on an outpatient basis, but that doesn't mean it's easy to treat. Substance use disorder is a complicated disease. Drugs can cause changes in the brain that make it extremely difficult to quit without medical help.

For certain substances, it can be dangerous to stop the drug without medical intervention. Some people may need to be in a hospital for a short time for detoxification, when the drug leaves their body. This can help keep them as safe and comfortable as possible. Patients should talk with their doctors about medications that treat addiction to alcohol or opioids, such as heroin and prescription pain relievers.

Recovering from a substance use disorder requires retraining the brain. A person who's been addicted to drugs will have to relearn all sorts of things, from what to do when they're bored to whom to hang out with. It can help if they identify and learn to avoid their triggers, the things that make them feel like using drugs.

'You have to learn ways to deal with triggers, learn about negative peers, learn about relapse [and] learn coping skills', Subramaniam says.

Scientists are studying ways to stop addiction long before it starts – in childhood. Dr. Daniel Shaw at the University of Pittsburgh is looking at whether teaching healthy caregiving strategies to parents can help promote self-regulation skills in children and prevent substance abuse later on.

Starting when children are two years old, Shaw's study enrols families at risk of substance use problems in a programme called the Family Check-Up. During the programme, a parenting consultant visits the home to observe the parents' relationship with their child. Parents complete several questionnaires about their own and their family's wellbeing. This includes any behaviour problems they are experiencing with their child. Parents learn which of their children's problem behaviours might lead to more serious issues, such as substance abuse, down the road. The consultant also talks with the parents about possible ways to change how they interact with their child. Many parents then meet with the consultants for follow-up sessions about how to improve their parenting skills.

Children whose parents are in the programme have fewer behavioural problems and do better when they get to school. Shaw and his colleagues are now following these children through their teenage years to see how the programme affects their chances of developing a substance abuse problem.³

Even if their teen has already started using drugs, parents can still step in. They can keep closer tabs on who their children's friends are and what they're doing. Parents can also help by finding new activities that will introduce their children to new friends and fill up the after-school hours – prime time for getting into trouble. 'They don't like it at first', Shaw says. However, finding other teens with similar interests can help teens form new habits and put them on a healthier path.

A substance use problem is a chronic disease that requires lifestyle adjustments and long-term treatment, like diabetes or high blood pressure. Even relapse can be a normal part of the process – not a sign of failure, but a sign that the treatment needs to be adjusted. With good care, people who have substance use disorders can live healthy, productive lives.

Questions to Ask Your Doctor

Here are some important questions to ask when choosing a treatment programme:

• Does the programme use treatments backed by scientific evidence? Effective programmes usually combine medical and behavioural treatments.
• Does the programme tailor treatment to the needs of each patient? No single treatment is right for everyone.
• Does the programme adapt treatment as the patient's needs change? A person in treatment may need different services at different times.
• Is the length of treatment sufficient? Most addicted people need at least three months in treatment.

Wise Choices: Signs to Look for

People with drug problems may act differently than they used to. They might

• Spend a lot of time alone
• Lose interest in their favourite things
• Get messy – for instance, not bathe, change clothes or brush their teeth
• Be really tired and sad
• Be very energetic, talk fast or say things that don't make sense
• Be nervous or cranky (in a bad mood)
• Quickly change between feeling bad and feeling good
• Sleep at strange hours
• Miss important appointments
• Have problems at work
• Eat a lot more or a lot less than usual

Reference:
Wein, H. (Ed.). (2017, June). Dealing with drug problems: Preventing and treating drug abuse. NIH News in Health. Bethesda, MD: U.S. National Institutes of Health (NIH). Retrieved 15 August 2019 from https://newsinhealth.nih.gov

Subramaniam, G.A. & Volkow, N.D. (2014). Substance misuse among adolescents: To screen or not to screen? Journal of the American Medical Association (JAMA) Pediatrics, 168(9), 798–799. doi:10.1001/jamapediatrics.2014.958

Dishion, T.J., Brennan, L.M., Shaw, D.S., McEachern, A.D., Wilson, M.N. & Jo, B. (2014). Prevention of problem behavior through annual family check-ups in early childhood: Intervention effects from home to early elementary school. Journal of Abnormal Child Psychology, 42(3), 343–354. doi:10.1007/s10802-013-9768-2

Brennan, L.M., Shelleby, E.C., Shaw, D.S., Gardner, F., Dishion, T.J. & Wilson, M. (2013). Indirect effects of the family check-up on school-age academic achievement through improvements in parenting in early childhood. Journal of Educational Psychology, 105(3), 10.1037/a0032096. doi: 10.1037/a0032096