HOMEOPATHY FOR SUBSTANCE USE DISORDERS OR DRUG ADDICTION

A drug is defined by WHO, as any substance that, when taken in to the living organism, may modify one or more of its functions. This definition conceptualizes ‘drug’ in a very broad way, including not only the medications but also the other pharmacologically active substances.

The words ‘drug addiction’ and ‘drug addict’ were dropped from scientific use due to their derogatory connotation. Instead ‘drug abuse’, ‘drug dependence’ , ‘harmful use’, ‘misuse’, and ‘psychoactive substance use disorders’ are the terms used in the current nomenclature. A psychoactive drug is one that is capable of altering the mental functioning.

There are four important patterns of substance use disorders, which may overlap with each other.

·       Acute intoxication

·       Withdrawal state

·       Dependence syndrome

·       Harmful use

Acute intoxication

According to the ICD-10, acute intoxication is a transient condition following the administration of alcohol or other psychoactive substance, resulting in disturbances in level of consciousness, cognition, perception, affect or behavior, or other psychophysiological functions and responses. This is usually associated with high blood levels of the drug.  

However, in certain cases where the threshold is low, due to a serious medical illness such as chronic renal failure or idiosyncratic sensitivity, even a low dose may lead to intoxication. The intensity of intoxication lessens with time, and effects eventually disappear in the absence of further use of the substance. The recovery is therefore complete, except where tissue damage or another complication has arisen.

The following codes may be used to indicate whether the acute intoxication was associated with any complications.

·       Uncomplicated (symptoms of varying severity, usually dose-dependent, particularly at high dose levels.

·       With trauma or other bodily injury

·       With other medical complications, such as hematemesis, inhalation of vomitus

·       With delirium

·       With perceptual distortions

·       With coma

·       With convulsions

·       Pathological intoxication, only for alcohol

Withdrawal state

A withdrawal state is characterized by a cluster of symptoms, often specific to the drug used, which develop on total or partial withdrawal of a drug, usually after repeated and/or high-dose use. This, too, is a short-lasting syndrome with usual duration of few hours to few days.

Typically, the patient reports that the withdrawal symptoms are relieved by further substance use.

The withdrawal state is further classified as:

·       Uncomplicated

·       With complications

·       With delirium

Dependence syndrome

According to the ICD-10, the dependence syndrome is a cluster of physiological, behavioral, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviors that once had greater value.

A central descriptive characteristic of the dependence syndrome is the desire (often strong and sometimes overpowering) to take psychoactive substances (which may or may not have been medically prescribed), alcohol, or tobacco. There may be evidence that return to substance use after a period of abstinence leads to a more rapid appearance of other features of the syndrome than occurs with non-dependent individuals.

A definite diagnosis of dependence should usually be made only if at least three of the following have been experienced or exhibited at sometime during the previous year.

·       A strong desire or sense of compulsion to take the substance.

·       Difficulties in controlling the substance-taking behavior in terms of its onset, termination or levels of use.

·       A physiological withdrawal state when the substance use has ceased or reduced, as evidenced by the characteristic withdrawal syndrome for the substance; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms.

·       Evidence of tolerance, such that increased doses of the psychoactive substance are required in order to achieve effects originally produced by lower doses (clear examples of this are found in the alcohol and opiate-dependent individuals who may take daily doses that are sufficient to incapacitate or kill non-tolerant users).

·       Progressive neglect of alternative pleasures or interests because of psychoactive substance use, increased amount of time necessary to obtain or take the substance or to recover from its effects.

·       Persisting with substance use despite clear evidence of overtly harmful consequences, such as harm to the liver through excessive drinking, depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

A narrowing of personal repertoire of patterns of psychoactive substance use has also been described as a characteristic feature of the dependence syndrome (e.g., a tendency to drink in the same way on weekdays and weekends, regardless of the social constraints that determine appropriate drinking behavior)

The dependence syndrome can be further coded as (ICD-10):

·       Currently abstinent.

·       Currently abstinent, but in a protected environment (e.g., in hospital, in a therapeutic community, in prison etc.).

·       Currently on a clinically supervised maintenance or replacement regime (controlled dependence, e.g., with methadone, nicotine gum or nicotine patch).

·       Currently abstinent, but receiving treatment with aversive or blocking drugs (e.g., naltrexone or disulfiram).

·       Currently using the substance (active dependence).

·       Continuous use.

·       Episodic use (dispsomania).

The dependence can be either psychic, or physical, or both.

Harmful use

Harmful use is characterized by:

·       Continued drug use, despite the awareness of harmful medical and/or social effect of the drug being used, and/or

·       A pattern of physically hazardous use of drug (e.g., driving during intoxication).

The diagnosis requires that the actual damage should have been caused to the mental or physical health of the user. Harmful use is not diagnosed, if a dependence syndrome is present.DSM-1V-TR uses the term substance abuse instead, with minor variations in description.

The other syndromes associated with the psychoactive substance use in ICD-10 include psychotic disorder, amnesic syndrome, and residual and late-onset (delayed onset) psychotic disorder.

Psychoactive substances

The major dependence producing drugs are:

·       Alcohol

·       Opioids, e.g., opium, heroin.

·       Cannabinoids, e.g., cannabis

·       Cocaine

·       Amphetamine and other sympathomimetics

·       Hallucinogens, e.g., LSD, phencyclidine (PCP)

·       Sedatives and hypnotics, e.g., barbiturates

·       Inhalants, e.g., volatile solvents

·       Nicotine

·       Other stimulants, e.g., caffeine

Causes

Aetiological factors in Substance use disorders:

A. Biological

·       Genetic vulnerability (family history of substance use disorder, e.g., in type 11 alcoholism)

·       Co-morbid psychiatric disorder or personality disorder

·       Co-morbid medical disorders

·       Reinforcing effects of drugs (explains continuation of drug use)

·       Withdrawal effects and craving (explains continuation of drug use)

·       Biochemical factors (e.g., role of dopamine and norepinephrine in cocaine, ethanol, and opioid dependence

B. Psychological factors

·       Curiosity; need for novelty seeking

·       General rebelliousness and social non-conformity

·       Early initiation of alcohol and tobacco

·       Poor impulse control

·       Sensation-seeking (high)

·       Low self-esteem

·       Concerns regarding personal autonomy

·       Poor stress management skills

·       Childhood trauma or loss

·       Relief from fatigue and/or boredom

·       Escape from reality

·       Lack of interest in conventional goals

·       Psychological distress

C. Social factors

·       Peer pressure (often more important than parental factors)

·       Modelling (imitating behavior of important others)

·       Ease of availability of alcohol and drugs

·       Strictness of drug law enforcement

·       Intrafamilial conflicts

·       Religious reasons

·       Poor social/familial support

·       ‘Perceived distance’ within the family

·       Permissive social attitudes

·       Rapid urbanization

HOMOEOPATHIC REMEDIES

Homoeopathy today is a growing system and is being practiced all over the world. Its strength lies in its evident effectiveness as it takes a holistic approach towards the sick individual through promotion of inner balance at mental, emotional, spiritual and physical levels. When substance use disorder is concerned there are many effective medicines are available in Homoeopathy, but the selection depends upon the individuality of the patient, considering the mental and physical symptoms.

AVENA SATIVA

Avena sativa is one of the best remedies for drug addiction. It is effective for the bad effects of morphine or heroin addiction. It is a good remedy for those addicted to cocaine, marijuana, nerviness, tranquilizers or sedatives. Insomnia due to drug s or alcohol. Sleeplessness with nervous exhaustion and weakness.

NUX VOMICA

Nux vomica is effective for the bad effects of alcohol, tobacco, opium, coffee, wine etc. The patient is nervous and highly irritable.  Headache and intoxicated feeling. Dyspepsia, nausea and vomiting, constipation are other leading symptoms.

MORPHINUM

Morphinum is used for the bad effects of over use of drugs. Mentally the patient is depressed and behaves in a dream-like state. Vertigo and dizziness on least movement of head. Face is dusky red or pallid lividity of face, lips, tongue, mouth, or throat. Violent throbbing in heart and carotids. Alternation of tachycardia and bradycardia.

COFFEA

Severe insomnia due to drug addiction. Hyperactivity of mind and body. Increases the sensibility of nerves, making them over excitable and over sensitive. Special senses become over acute, emotions especially joy and pleasurable surprise, produces dangerous symptoms. Now joyous, now gloomy. Coffea removes the bad effects of sleeping pills.

CANNABIS INDICA

Exaltation of spirits. Constant fear of becoming insane. Horror of darkness. Absent minded, forgetful. Emotions and sensations are exaggerated.

BELLADONNA

Fear of darkness and vision of ghosts as a result of drug addiction.  Desire to escape or hide himself. Acuteness of all senses.  Changeable moods. Hallucinations, sees monsters, hideous faces. Spit on faces of other persons. Easily angered.

HYOSYAMUS NIGER

Headache from narcotic addiction. Hallucinations most marked. Talks with imaginary persons to dead ones. Imagines things are animals. Inclined to laugh at everything. Does foolish things, behaves like mad. Laughs, sings, talks, babbles and quarrels.

SULPHUR

Sulphur antidotes the bad effects of Cannabis addiction. Sulphur patient express sadness and melancholy. They imagine himself a great man. Strong impulsive tendency to suicide by drowning or leaping from a window.

LACHESIS

Headache from narcotics addiction. The patient is highly talkative. Sensation of tension in various parts. Cannot bear anything tight anywhere. Sensation of constriction in throat, abdomen and head.

PULSATILLA NIGRICANS

Diarrhea from heroin addiction. Changeable stools, no two stools alike.

PASSIFLORA INCARNATA

Sleeplessness due to drug addiction.  Effective for morphine addiction. Give mother tincture doses.

OPIUM

Drowsiness and coma from drug addiction. The patient falls into a heavy deep sleep. Thinks he is not at home. Sees frightful visions of mice, scorpions. Perversion of all senses. Euphoric state, overexcitement and sleeplessness.

VIPERA

A remedy for drug addictions by injections.