Welcome to this week’s “Mental Health Chat Room”, this is a chat room where we discuss the basics of our mental health in order to understand and have a full grasp of the rudiments of mental health and mental well-being. 

This is an essential component of our mental health advocacy activities aimed at promoting our wholesome wellness, prevent mental illness, improve our awareness of mental illness, understand that effective, qualitative and modern (technology based) mental health care services are available in Nigeria and globally to enhance quality living, harmonious interpersonal relationships and peaceful coexistence within our communities.

A recap of our last conversation where we discussed the urgent need to decriminalize attempted suicide and “tame suicide tragedy” as a continuation of our chat on attempted suicide and suicide.

We stated that it is quite obvious that suicide has become more prevalent in recent years, and is now reported regularly in the news. We noted that there is increasing awareness of the challenge of suicide and attempted suicide; partly as a result of increase in social media use, suicidal behavior has become public health issue in Nigeria and the rest of the world. The provisions criminalizing attempted suicide in Nigeria should, as a matter of urgency be repealed, this move might go a long way in reducing the stigma attached with suicides. People will not any longer feel the need to hide their suicidal thoughts and would be encouraged to talk about it with others and subsequently to seek professional help. Cultural and religious factors preventing people from reporting and stigmatizing suicide should also be addressed through public enlightenment campaigns.

The time is ripe for Nigeria to repeal the obnoxious, archaic and inhuman 1916 “lunacy act” which does not speak nor understand modern mental health language, it places emphasis on only custodial care and does not have mental health promotion, mental illness prevention, treatment and rehabilitation in its entire content.

Today, our topic for discussion is “Drug Addiction: A Treatable Mental Disorder”. Sunday 26th June 2022 was a day set aside as the international day against drug abuse and illicit trafficking otherwise referred to as “World Drug Day”! The day, celebrated every year on 26th of June was established by the United Nations General Assembly in 1987. 

It serves as a reminder of the goals agreed to by Member States of creating an international society free of drug abuse; we are therefore contributing to this reminder with this publication. I will be taking you through the journey to the destination called “addiction”! In doing so, I will use the story of Mr. Femi to illustrate drug addiction as a slippery journey to hell on earth. Please, read on:

Femi is a 40 years old man, he is presently divorced after two failed marriages; he is unemployed (he lost his job in the bank five years ago due constant absenteeism and involvement in fraud, twice his father bailed him out but finally he was dismissed). 

He has two children from his first marriage. He got married to his first wife who is a daughter of a politician (his father’s friend), she was his girlfriend, they smoked, used alcohol and attended parties together. Their marriage lasted six years. His second marriage lasted for 14 months!

Femi’s father is a Politician/retired Banker, a socialite who smokes cigarette, drinks alcohol and attends parties with his wife (Femi’s mother).  Femi’s mother is a university Teacher who has been treated for depression at a private mental health facility and she recovered completely. 

Femi is the first among three children of his parents. His maternal uncle also had drug problem and was at one time diagnosed bipolar affective disorder. He received treatments at spiritual homes and herbalists home and finally at the psychiatric hospital.

Femi left primary school from class 5 at nine years old, he was enrolled into a private high brow secondary school but was expelled in SS1 because of the use of drugs. He moved to another secondary school where he spent only two years before gaining admission into the university to read Business Administration. 

At the university, he maintained his drug behavior, met new friends through partying and escalated his drug use both in “hierarchy” of drugs and quantity. He graduated with a third class degree after spending six years for a four-year degree program. 

He was able to graduate, principally due to his father’s influence than his hard work! He was able to perform the mandatory one National Youth Service Corps (NYSC) scheme in the bank and he secured employment within the same bank. However, the use of psychoactive substances took its toll on him, he couldn’t cope with the demands of the work, he frequently got involved in fraudulent activities (shortfalls in cash/advance fee activities) which earned him queries, warnings and finally dismissal!

Femi sold his mother’s jewelries and one of her cars, and sold his father’s landed properties to finance his drug use. He also easily disposed his personal possessions whenever he was short of cash and the need for drug arises. He has encountered several legal issues, some were financial problems with bank customers of which his father always rescue him from serving prison term, he also had encounter with the law for being caught with illicit drugs.

Femi spent a total of 12 months in spiritual healing home at different times and another 14 months shackled in the herbalist treatment center! He recently attempted to commit suicide while under the influence of drugs for which he was hospitalized at a psychiatric hospital where he had detoxification, received treatment of comorbid depression and drug rehabilitation. 

He has been free of drugs and is mentally stable since discharged from the psychiatric hospital 2 years ago! He is presently working as a marketing manager in an insurance company.

Drug addiction (dependence) is a mental health disorder that is classified under mental and behavioral disorders due to psychoactive substance use in section F10-F19 of the international classification of diseases 10th edition (ICD 10), a publication of the World Health Organization (1992) and in the section on “substance related and addictive disorders” in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM V, 2013), a publication of American Psychiatric Association. Addiction is a treatable clinical condition that is characterized by inability to function normally in the absence of psychoactive substance (drug); this usually results from excessive or prolonged (or both) use of the psychoactive substance (drug). 

It is a chronic (long standing), relapsing disease of the brain that is involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. A central descriptive characteristic of drug addiction is the desire to use the drug that is quite strong and most times over powering (compulsive urge).

A Slippery Journey To Hell On Earth

The Road to Hell: Is a pattern of substance use behaviour characterised by insidious and progressive graduation of the use of substance from experimentation to casual use, to habitual use and finally to addiction.

 When we are embarking on a journey, there will be considerations for certain activities; planning and preparations, setting out and encounters on the journey and finally arrival at the destination! I would like us to take this trip together with these activities on our minds, using journey to demonstrate the evolution of drug addiction from adolescence to adulthood!.

Planning/Preparation: These are the factors that are related to the individual predisposition to addiction, they include genetics, early life experiences and dynamics of life. Studies have shown that drug addition is over represented in some families more than others (there is a higher risk of drug addiction among individual who have family member that has suffered from drug addition) but the direct link on how such genetic transmission takes place is yet to be elucidated. Studies have also shown that some mental disorders are also over represented in families and extended families of people that suffer from drug addiction; these conditions include mood disorders (depression and bipolar mood disorder). However, such genetic predisposition alone has not been able to account for the manifestation of addiction disorder.

Setting out and encounters: This marks the commencement of the journey and heading towards the destination, here we consider factors that are related to precipitation of the condition, stressors and challenges of life. 

The journey to addiction usually starts with “experimentation”. Young people either due to curiosity; peer influence or the urge to belong to certain groups may find themselves experimenting psychoactive substance (drug). Some may walk away from the drug after experimentation whereas some, due to genetic predisposition, stressors or social pressure (the urge to remain in the group) may graduate into “casual” (situational) drug user. At this stage, the drug use is becoming regular but the individual uses it only during particular event, situation, place or in company of peers. As the regularity of the use of the drug progresses, “habitual”  (more intense) use will set in, at this stage the use of the drug has become intense and individualized, the individual does not need the presence of peers or situation and the individual will rather create the occasion for the use of the drug rather than wait for the occasion to arrive! There will be evidence of assigning some level of priority to the drug at the expense of other activities and there will be likelihood of the drug taking some financial toll on the individual. Initial stressors, precipitants and challenges may no longer be present or responsible for the continuous use the drug.

Destination: Habitual use of drug leads to “drug addiction”, the destination is characterized by a cluster of cognitive, behavioral and physiological symptoms indicating that the individual continues using the drug despite significant drug-related problems. At this point, there is clearly underlying change in the brain circuitry; that is to say that the normal functioning of the brain has become altered, which may require a long term intervention to revert! Clearly, the individual will manifest poor sense of judgment (due to impaired control), risky use, social impairment and physiological problems like withdrawal symptoms (which could be potentially fatal). Due to the psychological pain, social embarrassment, physical problems and financial predicaments, the individual often express persistent desire to cut down or regulate or stop the use of the drug: and here lies the “hell”. In extreme of cases, individuals may experience other complications of drug addiction such as mood or psychotic disorder or suicidal behavior.

A lot of people who suffer from drug addiction most often do not know or understand that they are ill, while some are in denial. Family members tend to play down and sometimes trivialize drug addiction, especially once it has become clear that it is a disorder of the brain. Stigma of mental illness further fuels denial by the individual and the family, and constitutes a major barrier to effective and quality care.

Drug addiction is a treatable mental disorder, the care is conducted by a multidisciplinary team of Doctor, Clinical Psychologist, Mental Health Social Worker, Occupational Therapist and other clinicians as indicated after assessment at a center designated for drug addiction care. 

The care involves a combination of medication, psychotherapy, hospitalization, support group/self help and any other form of intervention as indicated after proper assessment.

In conclusion, the road to hell in drug addiction describes pattern of substance use behaviour characterised by insidious and progressive graduation of the use of substance from experimentation to recreational use, graduating to casual (situational) use; to habitual (more intense) use and finally to addiction. 

This journey typically starts in adolecence period and become well established in young adult life. The complex interaction between the individual brain circuitry, genetic predisposition, early life experince, the environment and the drug leads to drug addiction. A central descriptive characteristic of drug addiction is the desire that is quite strong and most times over powering (compulsive urge) to use the drug. Denial of drug addiction, stigma and trivializing the condition are strong determinants of appropriate health-seeking behavior and they constitute a major barrier to quality and effective treatment of drug addiction. There is need for community engagement, drug addiction awareness campaign and advocacy on preventive strategies for drug addiction (and related disorders) and mental health promotion, mental illness prevention and treatment strategies in general.

I hope today’s conversation will improve our understanding that drug addiction is a treatable mental disorder.

Professor Taiwo Lateef Sheikh

[email protected]

Note:  If you have comments, questions and  contributions, please reach out to us on: +2348037004611 or email us at [email protected].

READERS’ COMMENT

Feeling low, should I see a therapist?

Dear Prof,

I feel quite low sometimes, even when I am in the midst of friends and loved ones. Should I see a therapist?

Seun, Ibadan

Prof says,

One of the most important things to do if you’re feeling down is to open up. 

Most people feel more comfortable confiding in a close friend or family member in the first instance. Often simply talking about it helps. If the problem continues and begins to interfere with everyday life, you can speak to your doctor, who can talk you through the support that’s available. A low mood often gets better on its own after a few days or weeks and you can improve a low mood by making small changes in your life. Resolve anything that’s bothering you or getting more sleep.

Seeing things, hearing sounds that don’t exist 

Dear Prof,

My husband has an odd habit of seeing things and hearing sounds that are non-existent. What can be the cause of this hallucination?

Kunle, Lagos

Prof says,

Hallucinations are where you hear, see, smell, taste or feel things that appear to be real but only exist in your mind. 

You may have hallucinations if you hear sounds or voices that nobody else hears or see things that are not there like objects, shapes, people or lights or even feel touch or movement in your body that is not real. 

Sometimes hallucinations can be temporary. They can happen if you have migraines, a high temperature or just as you wake up or fall asleep. Best to consult a qualified therapist.

I cannot express myself coherently in public

Dear Prof,

Anytime am trying to express myself, particularly in public. I notice incoherent in articulating my thought?

Diane, Awka

Prof says.

Thought disorder may be a symptom of a mental disorder. Many mental disorders such as schizophrenia are progressive and don’t improve without treatment. 

However, people with mental disorders are often unaware of their symptoms and need help from a family member or friend.

If you notice any other symptoms of schizophrenia in somebody you know, you may want to encourage them to see a doctor: