A presentation on social case work in De-Addiction Center. Addiction is a psychological and physical inability to stop consuming a chemical, drug, activity, or substance, even though it is causing psychological and physical harm.

2. Addiction is a psychological and physical inability to stop consuming a
chemical, drug, activity, or substance, even though it is causing
psychological and physical harm.
Addictions pose serious public health concerns.
• Substance abuse is the most common disorder encountered by physicians.
30% to 50% of all psychiatric emergencies.
• An estimated 60% hospitalizations are related to chemical abuse.
• The regular consumer of alcohol will have at least one medical or legal
complication.
• Half of all murders are under the influence of drugs.
• Average treatment age is 12 to 17 years.
• A quarter of the people who commit suicide were alcoholics.
• Majority of the child abuse or rape takes place with the influence of
addictions.

3. An addict is one whose drinking / drug use
causes continuing problems in any area of his
life (family relationships, job, financial status,
etc.) and despite this, he continues using it
because he has developed physical and
psychological dependence on it.

4. He becomes physically dependent on the drug. That is, his
body becomes so accustomed to the presence of the drug
over a period of time, that when he stops using it, he
experiences withdrawal symptoms. These symptoms range
from tremors, sleep disturbances and nervousness to
convulsions, disorientation and hallucinations. He also
constantly struggles with thoughts of how, when and where
he can have the next drink / drug. His entire thinking
revolves only around the drug. This condition is called
psychological dependence.

5.  The most commonly abused drugs are alcohol and nicotine.
Brown sugar and cannabis(ganja)are other drugs of abuse.
 Prescription drugs such as painkillers, sleeping tablets,
muscle relaxants, cough syrups, antihistamines (prescribed for
allergies), anti-depressants and anti-psychotics can also be
addictive and are abused.
 Glue and solvents like varnish, eraser fluids, petrol are also
abused.
 Speed, Ecstasy, and Ketamine, known as 'party drugs' are
abused.

6. It is an addictive, depressant drug which
slows down the activity of the brain. It
affects all parts of the body including the
brain, liver, heart, stomach and
pancreas. Out of the 10 people who start
drinking alcohol, one / two become
addicted to it.
BROWN SUGAR
It is a highly addictive drug. It is an inferior
quality of the drug called 'heroin'. Within a very
short time, the person who uses 'brown sugar'
becomes physically and psychologically dependent
on it. That is, when he stops using it, he
experiences withdrawal symptoms such as
running nose, vomiting, diarrhea, severe stomach
cramps and goose flesh or 'cold turkey'.

7. Contrary to the widespread
belief, ganja is a potent drug
which can trigger off psychiatric
problems, It produces strong
psychological dependence. The
user finds himself thinking only
about the drug and if he stops
using it, he experiences
restlessness, agitation
sleeplessness/ nightmares and
depression.

8. Nicotine is a harmful chemical, present in products
containing tobacco. It is abused either by smoking or
chewing. Smoking has been connected to emphysema, heart
disease, stroke and cancer. Individuals who chew tobacco
have a high risk of developing lung and oral cancer. On
cessation of tobacco use, the person experiences problems
like restlessness, irritability, lack of concentration, fatigue,
constipation or diarrhea, sleep disturbances and depression.

9.  These turn a bright, talented, lively person into a withdrawn wreck, taking away
his zest for life, ruin his career, destroy his social standing and family life.
 Excessive use of alcohol leads to physical problems like gastritis, jaundice,
cirrhosis and cardiac problems.
 Drugs including alcohol lead to permanent damage of the brain cells. Ability to
analyze, power of understanding, memory and concentration are affected by their
use.
 Under their influence, the user is not able to perceive clearly, judge properly and
react swiftly. As a result, he meets with accidents at the workplace and elsewhere.
 Use of unsterile needles leads to Hepatitis B & C, HIV infections
 Alcohol and other drugs are known to cause sterility and impotence, and in a
young person, the damage may become permanent.
 They trigger off psychiatric problems
 Death due to overdose is an ever present possibility
 Possession of illegal drugs is prohibited and therefore he faces the threat of
prosecution and imprisonment.

10.  Early Phase
 Middle Phase
 Chronic Phase

11. This is the first warning sign of the development of addiction. The
person needs more alcohol / drugs to get the same effect.
 Black out (seen only among alcoholics)
During a black-out, the alcoholic goes through man" activities,
without being able to remember even a trace of them later on. He
walks, talks, even drives a vehicle 'apparently normally', but has no
recollection of it afterwards.
 Preoccupation
Even when he is not using, he is preoccupied with the thoughts of
how, when and where to get the next supply.

12. Initially, there is loss of control over the amount of alcohol /drug
consumed. He is unable to reduce the quantity of intake even when
he wants to. Later on, he loses control over the time, place and
occasion of drinking/drug use. Loss of control is a clear cut sign of
addiction.
Justifying
He feels guilty and justifies his drinking /drug taking by giving
excuses like unhappy marital life, tension at the office or pressure
from friends.
Grandiose behavior
He talks 'big' about himself, makes 'huge' future plans and spends
much more than what he can afford.

13. Abstaining for a temporary period
At this stage, he would have developed a number of health
problems, problems at home and at the office. In order to
convince himself and others that he can give up drugs if only he
decides to, he abstains for some time - at times even for a month
or more - but after the specific period of time, he gets back to
excessive use all over again.
Changing the pattern
After trying to abstain, he changes the pattern of drinking /
drug use. For instance, he changes drinks / drugs - from arrack
to brandy, from whisky to beer, from brown sugar to ganja and
so on. He shifts the place and time of drug use. But whatever
changes he makes, he faces the same problems which haunted
him before.

14. This phase is characterized by noticeable physical, mental and social
deterioration. There is a total breakdown in the relationship with the family.
Binge
He drinks continuously for days together and quits for a period, going back to
drinking again, does not eat and does not involve himself in any other activity
during drinking period, At the end of each binge, he is left in a shaken,
frightened, guilt ridden condition.
Ethical breakdown
He starts telling lies, steals or borrows in order to maintain his supply of
alcohol/drugs. When he reaches this stage, two things may possibly happen to
him. He continues to drink or use drugs and becomes mentally ill or faces a
premature, painful death. The only solution to this problem is to stop drinking
/ taking drugs totally for life.

15.  Identification, Intervention and Referral
 Treatment and Rehabilitation
 Prevention Efforts
 Community Mobilization

16. Identifying an alcoholic or a drug dependent person is not always
easy. Only in a few cases the family members, employer or friend or
the abuser himself may approach you for help.
The stigma associated with drug use or excessive drinking, the guilt
and shame resulting from inappropriate use and the lack of
awareness about the part alcohol / drugs play in the problems they
face - all these lead to denial of the problem of addiction. In an
attempt to protect the dignity of the family, in most of the cases the
members also deny the existence of any serious problem.
Identification becomes possible if one is alert to the hidden as well.

17. Identification in the workplace
Deteriorating job performance is the first indicator of a person's problem with
addiction, This can be ensured through the person's repeated
 Absenteeism
 Poor quality and quantity of work output
 Involvement in accidents
 Frequent demand for loans
 Poor interpersonal relationships

18. Identification in the hospital settings
The addicted individual usually comes to the physician or health worker with
medical problems like gastritis, neuritis, liver disorder, abscesses, drug withdrawal
symptoms, sleep problems and psychiatric symptoms.
Identification through spouse's behavior
Addiction leaves its impact not merely on the abuser, but on each and every
member of his family. The following symptoms present themselves in the wife and
they can be viewed as indicators of husband's addiction.
 Withdrawn and depressed
 Suicidal attempts
 Poor care of self
 Bruises(due to domestic violence)
 Nature of living not in keeping with the income level

19. Identification through child's problems
Children are also victimized by their father's addiction. Constant exposure to a
dysfunctional environment leads to emotional problems and these present
themselves in varied forms like :
 Academic performance not in keeping with IQ level
 Lack of concentration
 Poor interpersonal relationships
 Behavior problems like rebelliousness and aggression
 Suicidal attempts

20. An ability to build a rapport with the potential patient at this level of
evaluation, can assist gaining more accurate information. However, he
may not readily admit that he has a problem with drugs or alcohol. You
have to be conscious of the fact that he may be experiencing severe
stress, arising out of fear of withdrawal, fear about the nature of
treatment and fear about others coming to know about his problem. It is
important that these inner barriers which prevent him from admitting
his need for help are recognized and discussed with empathy, taking
care not to appear judgmental, accusatory or apathetic.
The addicted individual generally comes for treatment only when he is
left to face some crisis all by himself- loss of job, marital dissolution or
legal threat. Make use of this crisis to motivate him to accept help.

21. Talk when the person has not been using drugs or alcohol
Avoid labeling the person an 'alcoholic' or 'addict'
Present disease concept
List specific incidents resulting from the person's drug or
alcohol problem (for example, "You recently met with an
accident under the influence of alcohol").
Be prepared for denial, resentment and rejection.
Instill hope and confidence

22. Once the problem of addiction is identified, the person needs to be
referred to a treatment center.
 Identify resources (Addiction treatment center would be ideal)
 In its absence, locate a center offering medical or out-patient
counselling help and make use of your skills to fill the gaps
 While referring, provide clear directions with appropriate details
 Provide help immediately without delay.
 Ensure regular follow up after referral
 Collect details about AA / NA meeting places and encourage
attendance

23. Treatment for the patient and his family
In any specialized addiction treatment center, psychiatrists, physicians, clinical
psychologists, social workers and recovering addicts work in consultation with one
another as a team to handle this multidimensional problem. If you are part of a
multidisciplinary team, you can play a key role in :
 Providing re-educative lectures
 Conducting group therapy sessions
 Offering individual, marital and family counselling
 Providing after care and rehabilitation services

24. Addiction leads to problems in several areas of a person's life. The
individual would usually have lost available support systems. These
systems have to be strengthened, without which his recovery is likely
to be poor or slow. You can provide effective services in the following
areas :
 Education - to get back to the school / college
 Occupation - to get reinstated in the old job or find a new job
 Family towards reconciliation with wife / other family members
 Health - to ensure visits to the health center, general physician and
the treatment center.

25. One of the reasons behind the alarming growth of the problem is lack of
correct information and lack of skills to resist / assert oneself . Neither the
family nor the schools are equipped to handle the issue. You can play a
key role in providing accurate information about alcohol and other drugs
to as many people as possible so that they can make sensible choices.
In order to effectively contribute,
 Learn facts about alcohol, drugs and addiction
 Have specific information about the kind of drugs abused and the myths
associated with them.
 Be familiar with the laws with regards to drinking and possession of
drugs.
 Be equipped to teach life skills to resist offer of alcohol/drugs.

26. SPECIFIC GROUP
 Parents
 Teachers
 Students
 Employer/ Employees
 Fellow professionals
 Community / General public
STRATEGIES
 Audio-visual presentations
 Street plays
 Role plays
 Group discussions
 Curriculum linked
programmes in Schools /
colleges
The programs have to be tailored to suit the needs of individual
target groups and modes of communication have to be employed.
Prevention efforts have to be planned and carried out on a long term
basis, since any social change takes time.

27. Addiction is not the problem of a single individual, What starts off as one
person's problem, spreads and becomes a social issue. Addiction leads to
violence, theft and insecurity and therefore, the entire community can be
involved in dealing with the issue. The empowered community has
infinite powers to reform itself, a power which no treatment center can
ever match.
 Sensitize the community about the consequences
 Strengthen personal commitment towards non drug use
 Strengthen advocacy groups. Make use of women victimized by their
husbands'/ son's addiction, youth groups and non users towards policy
changes
 Provide motivation to sustain the interest of the group.

28. NATURE OF SERVICE SKILLS NEEDED
IDENTIFICATION
• INTERVIEWING SKILLS
• HISTORY TAKING FROM PATIENTS AND SIGNIFICANT
OTHERS
• PSYCHOLOGICAL TESTING
INTERVENTION
• IDENTIFYING AND INTERVENING MAKING USE OF
INDIVIDUAL AND SOCIAL NETWORK
• MOTIVATION SKILLS
• MOBILIZATION OF AVAILABLE RESOURCES
• REFFERAL TO APPROPRIATE CENTERS
TREATMENT
• COUNSELLING
• DEALING WITH DENIAL
• COMMUNICATION SKILLS
PREVENTION
• PUBLIC SPEAKING
• OBJECTIVE EVALUATION
• CREATIVELY MAKING USE OF DIFFEERNT MODES OF
COMMUNICATION

29.  Rukmani, J. Dealing with addiction. T.T. Ranganathan Clinical Research
Foundation.