PROJECT -ISR
JUDITH LEWIS
ADMISSION NO. HPGD/JL14/0769
SOCIAL CAUSE: WORKING AMONG PEOPLE AFFLICTED
WITH CHEMICAL DEPENDENCY
NAME OF THE NGO: “KRIPA FOUNDATION”
PRIN. L. N. WELINGKAR INSTITUTE OF MANAGEMENT DEVELOPMENT
& RESEARCH
YEAR OF SUBMISSION: NOVEMBER 2015
DECLARATION
I, Ms. Judith Lewis student of Prin. L. N. Welingkar Institute of Management Development &Research with admission no. HPGD/JL14/0769 hereby declare that I have completed this project on ISR – Working among people affected with chemical dependency and HIV infection, NGO – KRIPA FOUNDATION in the academic year 2015.
Both chemical dependency and HIV/AIDS study is vast. Hence, I have limited to one aspect and concentrated on chemical dependency subject dealt by the NGO, KRIPA FOUNDATION and pleased to project my work accordingly, since I feel individuals if educated about alcohol consumption, tobacco intake, drug abuse and rehabilitated then many families can be saved and also, crimes can be reduced this leading to happier families, society and country at large.
The information submitted by me is true and original to the best of my knowledge.
Signature of the Student
(Judith Lewis)
ACKNOWLEDGEMENT
I hereby take this opportunity to express my heartfelt gratitude to thank Mrs. Susan Samson – Project Director Baroda Centre for her support and providing insights of the activities and organization of Kripa Foundation.
I would also like to express my indebtness to my family members, especially my nephew, Mr. Reewan Olivera, my friends and well-wishers for their constant support ensuring the completion of my project.
SR. NO. / PARTICULARS / PAGE NO.PART A
1 / Introduction / 7
2 / Nature of Drug Problem
Type of Substance Abuse: Alcohol, Tobacco, Drugs(Licit, Illicit) / 8 to 17
3. / The Social Impact of Substance Abuse and its Consequences
- Individual, Friends, Family, Society
- Health
24 to 33
4. / Combating and Preventing Drug and Substance Abuse
- Education
- Crime Reduction
- Work & Employment
35,36
36 to 38
5. / Economic Impact
Economic Cost to Society
Productivity Losses, Burden on Public Assistance & Social Service
Traffic Crashes
Criminal Justice and Protective Services
Health Care, Drug & Development / 39 to 42
6. / Global Turmoil, Marginalisation / 43
7. / Future Challenges / 44
8. / Some Common What, Why Questions on Substance Abuse and How it is Dealt / 45,46
8. / Statistics of Rehabilitation Centres in India
Minimum Standards of Care at National & International Levels
Minimum Standards of Care –NGO sector
Screening & Case finding
Diagnosis & Assessment
Promoting Engagement in Treatment for Substance Use Illness
Withdrawal Management
Psychological Interventions / 47
48
49
9. / Current problem -Prospective wise
Extent of problem
General Considerations
Drugs of Abuse and Addiction
Classifying the Psychoactive drugs
Common drugs of abuse
Legality in India
Some important definitions
Health providers should look for the following indications of substance use problems
The Addicts State of Mind
Co-Morbidity
Psychiatric
Medical
Treatment / 50 to 57
6.1 / Current problem - neurology basis
The Neurological basis of Addiction
Natural Rewards:
The neurological reward pathway
Dopamine Pathways
Is There Recovery?
Summary / 58 to 61
6.2 / Kripa Continuum of Care / 62
7. / Scheme for Prevention of Substance Abuse / 63,64
PART B
NGO – KRIPA FOUNDATION
1. / Organisation / 65, 66
2. / Vision, Mission, Goal, Objectives / 67
3. / Board of Trustees / 68
4. / Head of Department / 69
5. / Activity List / 70 to 73
6. / Liaison Networking / 75 to 76
7. / Treatment Module / 77
8. / Twelve Traditions of Alcoholic Anonymous / 78
9. / Inpatient Program / 79, 80
10. / Extended Care / 81
11. / Holistic Rehabilitation / 82 to 90
12. / About Rev. Fr. Joe H. Pereira, Founder Managing Trustee / 91 to 93
13. / Kripa Centres / 94
14. / Liaison Networking / 95,96
15. / News Article / 97
PART C
1. / Bibliography
Key Readings / 98
INTRODUCTION
Addiction is a global socio-cultural problem at all ages and involves both sexes of human populations. While the origins of substance use practices lies in antiquity, the world is faced today with a bewildering range of modern day variability in substance practices associated with socioeconomic inequalities and an increasingly hedonistic lifestyle. The impact of substance abuse is almost never a ‘single person’ issue and is often the cause of breakdown in family systems and economic integrity.
All countries make efforts through suitable legislation for the control and management of drug production, medicinal and sanctioned use and also prevention and control of illicit production, sale and trafficking.
The Government of a country in collaborating with NGOs can help in organising resources in creating facilities for treatment, at Centers run through voluntary organizations, to ensure that the support of the family and the community is mobilized to the maximum. These NGOs adopt a wide variety of approaches, systems and methodologies for treatment and rehabilitation of the addicts suitable and adaptable to the social customs, traditions and culture.
[7]
NATURE OF DRUG PROBLEM
Type of Substance Abuse:
The abuse of alcohol, cannabis and raw opium has been traditionally known. The abuse of synthetic narcotic drugs and psychotropic substances is comparatively new. Substance abuse has infiltrated all socio-cultural and economic strata causing loss of productivity. Family stress, lack of coping skills, peer pressure, personality disorder, co morbid psychiatric illnesses, social stress and market forces act as risk factors. Survey shows that around 20–30% of adult males and 5% of adult females use alcohol while 57% of the male and 10.8% of the female drug users consume opiates in some form or other. Rapid assessment survey on substance abuse shows that the primary abused drugs are heroin (36%), other opiates (29%) and cannabis (22%); 75% of addicts start drug abuse before 20 years of age; in urban areas heroin abuse is more while in other sites cannabis abuse is more.
Alcohol
Alcohol Use and Abuse: What You Should Know
Drinking alcoholic beverages is often seen as a way to relax, socialize or celebrate, but drinking too much or drinking as a way of dealing with feelings of anxiety or depression has negative consequences.
[8]
How much is “a drink”?
The amount of liquid that is considered “a drink” depends on the type of alcohol being consumed. The National Institute on Alcohol Abuse and Alcoholism defines the following as one standard drink:
It is advised that men consume no more than 4 drinks in a single day and no more than 14 drinks total in a week. Because women’s bodies process alcohol differently, they should consume no more than 3 drinks in a single day or 7 drinks total in a week.2 These are only rough guidelines. Pregnant women, people under the age of 21 or people with health conditions or medications that interact with alcohol should not drink alcohol.
Effects of Alcohol
Alcohol has many widely known short and long term effects. In the short term, after changes in mood and decreased inhibition have passed, one may experience a hangover. Hangovers often include feelings of dehydration, a sense of mental fogginess, headache and nausea. In the long term, heavy alcohol use can lead to serious organ damage and memory problems. Here are some other effects of alcohol that you may not be as familiar with.
While alcohol may cause some people to be able to fall asleep more quickly, it decreases the quality of sleep by interfering with REM.3 REM (rapid eye movement) is a part of the sleep cycle when dreams occur, and is thought to be the most restorative stage of sleep. If REM sleep is disrupted you may feel tired and unable to concentrate the next day.
[9]
Alcohol alters serotonin levels in the brain.4 Serotonin is a neurotransmitter, or chemical, used by the brain to regulate mood, and imbalances in serotonin are thought to cause mental health conditions like depression, anxiety and obsessive compulsive disorder.
Types of Problem Drinking
Heavy Drinking: When someone consumes more than the daily or weekly guideline amounts for alcohol.2
Binge Drinking: When excessive amounts of alcohol are consumed in a short period of time, resulting in a spike in blood alcohol content (For example, a man who has 5 drinks in 2 hours, or a women who has 4 drinks during that time).5 People who binge drink are especially prone to “blackouts” or lapses in memory.
Alcoholism: Also known as alcohol dependence, is a disorder characterized by an uncontrollable urge to drink, inability to stop drinking once started, need to drink more and more to feel the effects (tolerance), and withdrawal symptoms if one does not consume alcohol.
Withdrawal symptoms can include anxiety, sweating, nausea or shakiness.
[10]
Tobacco
Tobacco is a leafy plant grown around the world, including in parts of the United States. There are many chemicals found in tobacco or created by burning it (as in cigarettes), but nicotine is the ingredient that can lead to addiction.
Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked.
[11]
Smoking is a practice in which a substance is burned and the resulting smoke breathed in to be tasted and absorbed into the bloodstream. Most commonly the substance is the dried leaves of the tobacco plant which have been rolled into a small square of rice paper to create a small, round cylinder called a "cigarette". Smoking is primarily practiced as a route of administration for recreational drug use because the combustion of the dried plant leaves vaporizes and delivers active substances into the lungs where they are rapidly absorbed into the bloodstream and reach bodily tissue. In the case of cigarette smoking these substances are contained in a mixture of aerosol particles and gasses and include the pharmacologically active alkaloid nicotine; the vaporization creates heated aerosol and gas to form that allows inhalation and deep penetration into the lungs where absorption into the bloodstream of the active substances occurs. In some cultures, smoking is also carried out as a part of various rituals, where participants use it to help induce trance-like states that, they believe, can lead them to "spiritual enlightenment".
Cigarettes are primarily industrially manufactured but also can be hand-rolled from loose tobacco and rolling paper. Other smoking implements include pipes, cigars, bidis, hookahs, vaporizers, and bongs. Smoking-related diseases have been shown to kill approximately half of long term smokers when compared to average mortality rates faced by non-smokers. A report states that, each year, about 4.9 million people worldwide die as a result of smoking.
Smoking is one of the most common forms of recreational drug use. Tobacco smoking is the most popular form, being practiced by over one billion people globally, of whom the majority are in the developing world. Less common drugs for smoking include cannabis and opium. Some of the substances are classified as hard narcotics, like heroin, but the use of these is very limited as they are usually not commercially available.
[12]
Illicit and Nonillicit Drug Use
[13]
Licit Drug
The war against illegal drug use has been going on for decades, but now it seems the “war on drugs” should have a new target… Legal drug addiction is taking lives in record numbers.
Legal drug addiction is tricky because it often starts out with a prescription obtained from a doctor. Many people find themselves addicted to painkillers before they even realize what’s happened, often after taking the drugs to recover from surgery or treat chronic back, or other, pain.
Three Factors That Might Increase Your Risk of Becoming Addicted to Painkillers
Painkillers work by interacting with receptors in your brain resulting in a decrease in the perception of pain. They are inherently addictive, as they also create a temporary feeling of euphoria, followed by dysphonia, which can easily lead to physical dependence and addiction. However, why certain people become addicted while others get by unfazed has remained a mystery.
It included those who:
- Used prescription painkillers more frequently
- Have a prior history of substance abuse (often unrelated to pain relief)
- Are less accepting of pain or less able to cope with pain
[14]
Painkiller Addiction Can Easily Lead to Death Painkillers (opioids) like morphine, codeine, oxycodone, hydrocodone, and fentanyl are one of the most commonly abused drug classes. These drugs are not only addictive, they can lead to slowed breathing and death if too much is taken, and the risks are compounded if you add alcohol to the equation. Many are not aware that pain-killing drugs like fentanyl are actually 100 times more potent than natural opioids like morphine, making the addictive potential and side effects associated with prescription drug use much higher. And it doesn’t always take extremely excessive use, or even very long-term use, to have a fatal overdose. Abuse of legally prescribed drugs is also increasing alarmingly.
“…after just a few months of taking the pills, something starts to change in the body. The effectiveness wears off, and patients typically report getting only about 30% pain relief, compared with when they started. Even more concerning, a subgroup of these patients develop a condition known as hyperalgesia, an increased sensitivity to pain. As you might guess, all of this creates a situation where the person starts to take more and more pills. And even though they are no longer providing much pain relief, they can still diminish the body’s drive to breathe. If you are awake you may not notice it, but if you fall asleep with too many of these pills in your system, you never wake up. Add alcohol, and the problem is exponentially worse. People who take pain or sleeping pills and drink a couple glasses of wine are playing Russian roulette.” -
[15]
Illicit Drug
Illicit drug use includes the non-medical use of a variety of drugs that are prohibited by international law. These drugs include: amphetamine- type stimulants,3 cannabis,4 cocaine,5 heroin6 and other opioids,7 and MDMA (ecstasy)
Before and After Composite Portrait
[16]
Drug abuse causes acute and chronic physical, psychological and social effects in varying amounts along with serious social problems in the form of crime, unemployment, family dysfunction and disproportionate use of medical care. Science has not yet explained fully the physiological and psychological processes leading to drug abuse. Substance abuse affects above 50 million people worldwide. The annual worldwide drug revenues are now next only to arms trade.
[17]
THE SOCIAL IMPACT OF SUBSTANCE ABUSE AND ITS CONSEQUENCES
- Individual, Friends, Family, Society
The effects of substance abuse can be felt on many levels: on the individual, on friends and family, and on society.
On the Individual
[18]
People who use drugs experience a wide array of physical effects other than those expected. The excitement of a cocaine high, for instance, is followed by a "crash": a period of anxiety, fatigue, depression, and an acute desire for more cocaine to alleviate the feelings of the crash. Marijuana and alcohol interfere with motor control and are factors in many automobile accidents. Users of marijuana and hallucinogenic drugs may experience flashbacks, unwanted recurrences of the drug's effects weeks or months after use. Sudden abstinence from certain drugs results in withdrawal symptoms. For example, heroin withdrawal can cause vomiting, muscle cramps, convulsions, and delirium. With the continued use of a physically addictive drug, tolerance develops; i.e., constantly increasing amounts of the drug are needed to duplicate the initial effect. Sharing hypodermic needles used to inject some drugs dramatically increases the risk of contracting AIDS and some types of Hepatitis. In addition, increased sexual activity among drug users, both in prostitution and from the dis-inhibiting effect of some drugs, also puts them at a higher risk of AIDS and other sexually transmitted diseases. Because the purity and dosage of illegal drugs are uncontrolled, drug overdose is a constant risk. The substances most frequently involved are cocaine, heroin, and morphine, often combined with alcohol or other drugs. Many drug users engage in criminal activity, such as burglary and prostitution, to raise the money to buy drugs, and some drugs, especially alcohol, are associated with violent behaviour.
[19]
Effects on the Family
[20]
A family evolves with each individual change, both positive and negative, creating an ever ebbing and flowing system. The impact of substance abuse on the family system can be very complex and if not addressed can have a significant impact on all members of the family, throughout all stages of life and into the next generation. Evidence suggests family therapy provides the best outcomes for the substance abusers and the family.
Family rules, roles and relationships are established and organized around the alcohol and/or other substances…-Marni Low
The user's preoccupation with the substance, plus its effects on mood and performance, can lead to marital problems and poor work performance or dismissal. Drug use can disrupt family life and create destructive patterns of co-dependency, that is, the spouse or whole family, out of love or fear of consequences, inadvertently enables the user to continue using drugs by covering up, supplying money, or denying there is a problem. Pregnant drug users, because of the drugs themselves or poor self-care in general, bear a much higher rate of low birth-weight babies than the average. Many drugs (e.g., crack and heroin) cross the placental barrier, resulting in addicted babies who go through withdrawal soon after birth, and foetal alcohol syndrome can affect children of mothers who consume alcohol during pregnancy.