By Anne Bagenda
Addiction has been described as the continued obsession with using a substance despite its negative consequences on the individual.
Most people are not aware that drug and alcohol addiction is now described as ‘substance use disorder’ – people are no longer using the term ‘addict’. This is the appropriate clinical terminology that aligns with the diagnostic criteria used in the Diagnostics and Statistical Manual.
This use of patient-centred language where the patient is not blamed for the addiction is encouraged. Substance use disorder is managed as a chronic disease that can be treated just like diabetes. People with substance use disorder do not seek treatment for fear of being labelled drug abusers or ‘not clean’. One of the predictors for developing substance use disorder is being excluded from a social group and so labelling users as abusers may actually lead them to seek substance use more or prohibit them from receiving treatment.
Other predictors for substance use disorder include higher doses of opioid prescriptions, introduction to drugs by a friend, preexisting mental disorders like anxiety, depression, eating disorder, post-traumatic stress disorder, and higher rates of chronic pain. Genetic predisposition makes someone four times more likely to experience substance use disorder versus someone without the genetic predisposition according, to experts. Substance use disorder has a negative effect on the individual because they develop a negative image of themselves, there is stigma from family members and colleagues, which stigma could lead to failure in seeking treatment. This illness leaves the person feeling defeated and overwhelmed by what seems like the lack of control over their behaviour. On the other hand, the family members are affected by the numerous lies told by the sick person in order to get money to support their habit of substance use, there is theft of money and other articles that are traded by the person in order to get money to support their habit. The user may even abandon their family and this can lead to conflicts within the family.
The use of substance affects a person’s ability to function in a way that contributes positively to their financial needs, impacting their safety as well as their nutritional needs and physical wellbeing. The addiction may also affect their personal relationships, eroding and destroying trust with their friends, family and the community.
Families have lost loved ones to this illness. Therefore, we need to apply public health tools to incentivise people to move towards health and social services that provide treatment. Moreover, getting them help might address the criminality issues they are involved in. There is need to provide safe spaces where patients can talk freely about their condition and care providers are encouraged to apply the motivational interviews where patients are motivated to change their behavior through an interview with the care provider about their motivation to use the substance. Complementary medicine approaches like massages, teas, natural oils, physical therapy and acupuncture have been tried and found to be useful for some people.
Non-medication treatments include sober living coaches, mutual help organisations like Alcoholics Anonymous and Narcotics Anonymous, mindfulness based treatment, cognitive behavioural therapy and contingency management where rewards (cash or gifts like television) are provided for people who stop using. Medication treatment for substance use disorder in Uganda is provided only in hospital settings and not at home. The recovery process from use disorder is usually long-term and someone in recovery needs to work daily to maintain recovery. Our communities can help in the isolation and despair people feel when dealing with the consequences of their actions. Mutual help groups like Alcoholics Anonymous and Narcotics Anonymous can provide some respect and friendship needed in rebuilding their lives and in learning from past experiences.
Ms Bagenda is a public health practitioner.