Breaking The Habit

Families coping with Drug Abuse

Dr. Abdel Nasser Omar talks to Cairo East Magazine about breaking the habit.

By Hilary Diack

Chances are you have recently been around someone living with an addiction. Surprised? Don’t be. According to Prof. Dr. Abdel Nasser Omar, CEO of Al Mashfa Hospital, the figures are startling. Out of 100 people, around 16 will try drugs, with 4 going on to become regular users, and 1 becoming an addict. Cairo East Magazine spent an informative couple of hours with Dr. Omar, learning more about who is most at risk, and how we can help.

CEM: Is addiction actually a disease?

AO: Yes, it is. Unfortunately the common perception is that addiction is a sign of undisciplined or anti-social behaviour, rather than something that needs expert help and the understanding of the patient’s family and circle of friends. The most vulnerable are the approximately 50% of addicts with a genetic predisposition, meaning that they are predisposed through inherited DNA to a susceptibility to drug addiction. The condition may be dormant until a stress-diathesis occurs, where genetic or biological factors interact with environmental stress, which results in the patient turning to drugs. An individual’s biological vulnerabilities, or predispositions, to particular psychological disorders can be triggered by stressful life events. If the individual is resilient or has low biological vulnerability for a particular disorder, it would take extremely high levels of stress to trigger symptoms of that disorder. On the other hand, if the individual has high biological vulnerability to the disorder, then it would take lower levels of stress for symptoms to be exhibited.

Are there certain personality patterns that occur in people suffering from addiction?

Those at the highest risk are with borderline personality disorder (BPD), with a pattern of instability in interpersonal relationships, self-image and emotions. People with borderline personality disorder are also usually very impulsive. This disorder occurs in most by early adulthood. We also see histrionic and narcissistic personalities, manifesting in anti-social tendencies. With narcissism the patient feels that he is superior to those around him and lacks empathy, when a histrionic personality is in place everything is over-dramatized and the subject has extreme emotional reactions. An addictive personality can often indulge in binge-eating, escapism, and stimulants like coffee and chocolate that elevate serotonin and dopamine levels in the body. Addicts actually often have a lower than normal level of these to start with, which can lead to a depressive state, so the drugs they take are used to get a boost in mood.

What are the signs to watch out for if one thinks that a friend or family member may have become involved with drugs?

The early signs are behavioural changes such as mood shifts, increased aggression with outbursts of anger, suspicion and over-sensitivity. The person’s sleep patterns may change, they may ignore responsibilities as they set up their lifestyle to seek drugs. Academic and social deterioration of young family members are important warning signs that should grasp attention.

How can we help when we think a family member might be getting involved with drugs?

The family dynamic is very important, we often see a person escaping into drug use if they belong to a high Emotional Expression family where communication is typically critical and hostile. Equally, a strictly controlled or overly protective environment can be as much of a problem. Through creating a healthier, balanced and supportive family interaction and avoiding vilification of the person it will form a stronger base. We must remember that addiction is an illness, not bad behaviour by choice.

What are the most commonly used drugs?

The most commonly used are marijuana and hashish, both with the active component, tetrahydrocannabinol (THC). The more affluent sectors of the community tend to use hashish, while marijuana, known colloquially as “weed” or “bango”, use is more prolific in rural and lower-income areas. It should be noted that most smokers of cannabis start with cigarette smoking, often at an early age. Recently there has been an increase of freebase cocaine, which is widely available and decreasing in price, making it more attractive to users. Cocaine is a stimulant and appetite suppressant with highly addictive components. There is also widespread use of synthetic opiates like Tramadol which produce a sense of wellbeing, euphoria and increased energy that can be addictive to some people. Under correct medical supervision opiates are legitimately used for treating pain, but when the medical need has passed many people continue by self-medicating and develop tolerance, meaning they need more and more to get the same effect. With relatively easy access to these synthetic opiates it is not uncommon for people go on to develop an addiction. Another drug group, benzodiazepines, includes Diazepam, which is medically prescribed for treatment of anxiety disorders, seizures, muscle spasms, and alcohol withdrawal. Xanax is another medication used to treat anxiety and panic disorders, and again should only be used under medical supervision. Benzodiazepines, in some patients, create a rapid tolerance in the body, after as few as three or four weeks a higher dosage might be required to get the initial effect.

This is just the tip of the iceberg; many other substances and drugs circulate in Egypt, including sniffing sprays, “skulls” (MDMA) amphetamine tablets, and a synthetic cannabis extract named “spice”, all peddled in schools to young children. Self-medication is becoming a serious issue, and the ready availability of these items does not help. Alcohol abuse is on the rise again, as a real problem amongst the youth of Egypt.

Going back to marijuana, it has become de-criminalized and even legalized in several locations recently, in addition to being authorized for medical use. What is your perspective on this?

Cannabis has definite dangers, although it may be considered a “soft” drug in some cultures. It affects the neuro-transmitters and has addictive qualities. It stays in the system for anything from 30 to 45 days, hence the lack of obvious withdrawal symptoms. Studies have shown that frequent use can lead to paranoia and anti-social behaviour. Some countries that have semi-legalised cannabis use may be implementing “damage control”, by allowing freer access to a less dangerous option, in the hope that people will then avoid turning to heavier substances like cocaine and heroin. Unfortunately this is not always the case, cannabis is the most common gateway drug to many of the more addictive and lethal drugs out there. It must also be noted that the form of cannabis administered medically, mainly as pain relief for sufferers of cancer, is not in smoking form and is an orally consumed derivative prescribed by a doctor.

Are addicts generally addicted to just one drug?

Some people are, they have a specific drug of choice, while others will take whatever is on offer. It is important to understand some points when a person undergoes a withdrawal programme, one addiction can lead to other addictions, and one drug can make a person relapse with another drug. For example, if you want to stop using cocaine then you have to stop using all addictive drugs. Recovery requires total abstinence.

What is involved in a recovery programme?

We use a 12 step programme, designed to help individuals create new life that does not involve drugs. We use a community based treatment along with physical withdrawal, with the patient under the care of psychiatrists and psychologists. An essential factor is creating a total change of environment and reduction of stress. A change of lifestyle is implemented, with distancing from any peer group that encouraged drug use.

How long does treatment take, and what is the rate of relapse?

The risk of relapse is high; it takes a lot of patience and persistence from the addict and his or her family, as well as the medical and psychiatric support team, to maintain abstinence. It is important to enable a productive lifestyle, with the right sort of pleasure-giving and stimulating activities, to avoid the patient slipping back into depression and boredom. The patient remains at risk for a long time, there are many situations that could trigger a relapse, but the longer they can stay “clean” the much better the prospects. Again, it cannot be stressed enough, the support and understanding of family, friends, and community around them is a vital component in enabling a return to a drug-free and productive lifestyle.