By FLORENCE AMAGIYA
Dr. Imafidon Agbonile   graduated from the University of Benin in 1995 with the MBBS degree. His interest in human behaviour and motivation drew him to the field of mental health.

In year 2000 after working as a medical officer in Abuja, Lagos and  Benin; he joined the services of one of the nation’s first generation psychiatric facilities, Federal Neuropsychiatric Hospital (FNPH)Uselu, Benin City.  He had his specialist training in Psychiatry at FNPH, Uselu and became a Fellow of the West African College of Physicians (FWACP). He was in charge of the Drug Dependence Unit of the hospital for many years and later moved to Child and Adolescent unit, as Consultant Psychiatrist.

His special interest area is Drug and Child/Adolescent Mental Health. Today, he is currently the Chairman of Uselu Unit and executive member of the Ugbowo Chapter of Nigerian Institute of Management, NIM, and a lecturer at Igbinedion University Okada; where he lectures on Mental Health in the College of Health Sciences. In this interview, he talks about hard drugs, abuse of drugs and drugs dependence. 

Excerpts.     

What is a Drug?

The term ‘Drug’ has several definitions depending on the professional background of the author. However, in the medical community, a drug can be regarded as a substance with the potential to prevent/diagnose and treat diseases or to enhance physical or mental well being. Drugs can be naturally occurring or synthetic.  A drug is ideally to be used for medicinal or licit purposes and not otherwise (or what is known as illicit use).

How can you describe hard drug?

Agbonile

A hard drug is a substance of abuse with a strong potential for inducing dependence (addiction) and is usually dangerous to the physical, mental and socio-economic health of the abuser. Examples of hard drugs are cocaine, heroin, marijuana, etc. Due to the fact that the term “Drug” is being used to refer to both medicinal and non medicinal use or abuse, drug dependence experts prefer to refer to drugs that are abused as “substances”.

This is to differentiate between the licit or medicinal use of drugs from the illicit or illegal use or abuse of drugs. Another reason for the use of the term “substance abuse” is that not all substances being abused fit into the traditional definition of “Drugs”.  For example, people abuse chemical substances like some house paints, some types of wood, gum/glue popularly called “evostic”. These substances are usually volatile solvents with a pungent smell. They are abused via inhalation and have psycho-active (mind altering) effects.

How can drugs be abused?

Drug abuse has been defined in many ways, but a very simplified definition is:  “The use of illegal drugs or the inappropriate use of legal drugs”.

What is the scope of problems in Nigeria from the usage of abused drugs?

There are widespread abuse of drugs across all age groups, gender and socio-economic class, but the worse cases are from adolescents and young people of 15-24 years old.  We also have more males abusing drugs than females, but the gap is narrowing as more females abuse drugs these days. We have more people in the urban areas  than in the rural areas abusing drugs.

The most frequently abused substance is alcohol. And the most frequently abused illicit substance is cannabis (marijuana). Some other substances commonly abused in Nigeria are: heroin, cocaine, amphetamine,  hypnosedatives  (especially valium, lexotan,  ativan ),  volatile solvents. A relatively common pattern of abuse is the use of pentazocin injection. This drug is a powerful but potentially additive analgesic which is used for severe pains resulting from conditions like sickle cell crisis, post surgical procedures, etc. Sicklers who “self medicate” are potential addicts to this drug.  A peculiar pattern of use of cannabis (marijuana) is in the form known locally as “monkeytey” or “monkeytail”.  This is simply a concoction derived by soaking cannabis (marijuana) in local gin called “ogogoro” over a period of time.

The alcohol acts as a solvent, thus extracting the active ingredients from the cannabis. This is a particularly dangerous way of abusing cannabis because the active ingredients tend to be more concentrated. “Monketail” is popular with abusers because they are spared the tell-tale smell of cannabis on their breath and clothing which smoking causes.  Lately, a trend among students is the abuse of codeine-based cough syrups. Abusers purchase large quantities of cough syrups from patent medicine stores claiming that they are afflicted with cough related conditions. They often swallow the content of a bottle of cough syrup in one go!

What are the effects or consequences of substance abuse?

There are numerous effects of substance abuse, especially abuse of hard drugs such as cocaine and heroin.  Some substances can even change a person’s body and brain in ways that last long after the person has stopped taking them, maybe even permanently.

The impact of substance abuse  can be far-reaching, affecting almost every organ in the human body.  The complications vary depending on the drug of abuse. These effects may be classified into physical,  psychological and social.

What are the physical effects?

It includes bloodshot eyes especially with marijuana. Yellow eyes (jaundice) may result from prolonged abuse of alcohol due to liver damage or liver failure. Substance abuse can lead to abnormal heart rate and heart attacks. When one gets abused via injection; it can lead to collapsed veins and infection of the blood vessels and heart valves.  Abused substances can compromise the immune (defense) system of the body, leading to infections and diseases that would ordinarily not afflict the abuser. Substances like heroin can cause nausea, vomiting and abdominal pain.

What are other physical signs you can see on someone abusing a drug?

There may be seizures (convulsions) with various body injuries; stroke and widespread brain damage that can lead to memory loss.  Pregnant women may have premature delivery; “drunk baby” syndrome; birth defects in the new born baby and retarded children with poor academic performance. There can be deterioration of physical appearance, personal grooming habits, tremors, slurred speech, or impaired coordination.

Can there be any psychological effect?

Some of the psychological effects of the substances is on the brain, these include: craving for the substance, leading to tension and restlessness. There may be dependence (addiction) on the substance and paranoia (abuser may become inappropriately suspicious).

This may lead to aggression and even violence. Substances can lead to a state of delirium characterized by altered consciousness. It can lead to impaired judgment, impulsiveness and  loss of self-control; anxiety disorders and major depressive illness. Abusers may have hallucinations i.e. may see things others cannot see or hear voices others cannot hear. This may progress to full blown psychotic disorders.

Is there a socio-economic effect on someone abusing a drug?

There are increased tendency to commit crimes such as stealing, mugging, burglary, armed robbery and homicides under the influence of these substances;loss of job due to low productivity at work resulting from the pre-eminence of the use of the substance over normal duties and responsibilities; poor academic performance at school; dropouts/truancy by youths; expulsion by school authorities; broken relationships and marriages resulting from irrational behaviours such as wife battery; financial insolvency; repeated borrowing; sale of property; embezzlement and other vices. There are also destitution; street begging and prostitution; physical and sexual abuse of children by substance abusing parents.

What  would you say are the causes of drug abuse?

Peer pressure;  desire to experiment;  personality problems such as low self esteem; family exposure – use of drugs by other members of family; parental deprivation;  family discord; media advertizing; unemployment;  under-employment;  frustration,  rapid urbanization leading to breakdown of social and family support;  high risk jobs like working in breweries, Tobacco Company, bar attendants; drug availability and the so-called spillover effect of drug trafficking.

Is there a natural progression when it comes to the abuse of drugs?

There are usually four stages involved in developing drug dependence (addiction). The first stage is the stage of experimentation,  the second stage is called  the stage of more frequent use, the third stage is the stage of intense pre-occupation to experience the effects of the drug and the last but not the least is the stage of drug dependence (addiction).

How can you tell signs of drug abuse and drug dependence on someone?

There will be problems in relationships, such as fights with  partner or family members or the loss of old friends.

As for drug dependence; the patient develops drug tolerance; the need to use more of the drug to experience the same effects with smaller amounts; the need to take drugs to avoid or relieve withdrawal symptoms. If  he stays too long without drugs, the abuser experiences symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety.

The abuser  uses drugs more frequently than he planned or he uses more quantity than he planned. He may want to stop using, but feels powerless to do so. His life revolves around drug use. He or she spends a lot of time using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects. He abandons activities he used to enjoy, such as hobbies, sports, and socializing, because of the drug use.

He’ll continue to use drugs, despite knowing its harmful effects, that it’s causing major problems in his life but he continues its abuse.

Although different drugs have different physical effects, the symptoms of dependence are the same no matter the substance. Other signs and symptoms of drug abuse are: neglecting responsibilities at school, work, or home (e.g. flunking classes, skipping work and neglecting children) because of drug use.