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Block 1 Problem of Substance Abuse

Unit 3 Substance Abuse among Special Population Groups: Women, Adolescents, Mentally Ill and Prisoners

1) What is the need for studying substance use disorders separately in women and adolescents?

Need for Separate Study of Substance Use in Women and Adolescents: 

The sources emphasize the importance of studying substance use disorders separately in women and adolescents due to distinct biological, psychological, and socio-cultural factors that influence the initiation, progression, and consequences of substance abuse in these populations.

1. Women: Experience unique physiological responses to substances, are at higher risk for specific health complications (e.g., reproductive issues), and face distinct social pressures and stigmas.
2. Adolescents: Are in a critical developmental stage, are more vulnerable to peer pressure and the effects of substance use on brain development, and are more likely to engage in risky behaviors.

2) What are the various health hazards faced by women who abuse alcohol/substances?

Health Hazards for Women who Abuse Substances: Women who abuse alcohol or other substances face numerous health hazards, including:

1. Reproductive Issues: These include menstrual irregularities, infertility, and complications during pregnancy and childbirth.
2. Foetal Alcohol Syndrome: Substance use during pregnancy can lead to foetal alcohol syndrome and other developmental issues in offspring.
3. Increased Risk of STIs and HIV: Due to high-risk sexual behaviours, including unprotected sex and sex work to fund drug use.
4. Higher Sensitivity to Substances: Women may experience more rapid progression of substance dependence and physical damage compared to men.
5. Physical Health Issues: Including damage to the liver, heart, stomach, and brain.
6. Mental Health Issues: Co-morbid psychiatric disorders such as anxiety, depression and eating disorders may arise due to substance use.
7. Increased risk of violence and abuse: Women with substance use disorders are at increased risk of physical and sexual abuse.

3) Describe how social factors can play the role of both risk as well as protective factors with respect to substance use in women?

Social Factors as Risk and Protective Factors for Substance Use in Women: Social factors can either increase or decrease the risk of substance use in women.

1. Risk Factors:
   • Lack of social support: Social isolation, unemployment, and early marriage increase vulnerability.
   • Substance using role models: Having family members or spouses who use substances increases the risk of initiation.
   • Stigma: Negative societal attitudes towards women who use substances can increase isolation and discourage seeking help.
   • Social disadvantage: Women may use drugs as a means of coping with social disadvantage and isolation.
2. Protective Factors:
   • Strong social support networks: Supportive families, friends, and communities can offer protection against substance use.
   • Positive role models: Having non-using role models can deter substance use.
   • Access to education and employment: Empowerment through education and employment can be protective.
   • Cultural norms: Traditional cultures with low tolerance for substance use among women may act as protective factors.

4) What are the special issues to be kept in mind before and during the assessment of a female substance user?

Special Issues in Assessing Female Substance Users: Assessment of female substance users requires sensitivity to the unique issues they face:

1. Building Rapport: Establishing trust and a non-judgmental environment is essential, especially when discussing sensitive topics like sexual abuse and high-risk behaviours.
2. Confidentiality: Ensuring confidentiality is critical due to stigma and fear of judgement.
3. Socio-demographic factors: It is important to gather information regarding the client's age, marital status, education and place of residence.
4. Drug Use Details: Enquire about substances used, mode of consumption, frequency and amount consumed and last instance of use.
5. Complications: Explore physical, psychological, occupational, familial, social and legal issues.
6. High Risk Behaviours: Explore high risk sexual and injecting behaviours.
7. Medical/Psychiatric History: Assess for co-occurring mental health conditions, and reproductive and sexual health history.
8. Family History and Living Arrangements: Enquire about substance use within the family and available social support.
9. Motivation Level: Assess the client's motivation to reduce risky behaviors and substance use.
10. Pregnancy Status: If a client is pregnant, that should be prioritized.

5) What are the common substances used by adolescents and which are usually termed as the “gateway drugs”?

Common Substances Used by Adolescents and "Gateway Drugs":

1. Common Substances: Alcohol and tobacco are frequently the initial substances of use, followed by cannabis and inhalants.
2. Gateway Drugs: Tobacco is often termed a "gateway drug" as its use may precede the use of other addictive substances. Additionally, inhalants like solvents have emerged as gateway drugs, with initiation of solvent use preceding tobacco in many cases.
3. Progression: Some adolescents may discontinue substance use, while others progress to abuse and dependence.

6) Write a short note on importance of prevention in the context of substance use disorders in women and adolescents.

Importance of Prevention for Substance Use Disorders in Women and Adolescents:

• Early Intervention: Adolescence is a critical period for preventing substance use disorders, and early intervention is more effective.
• Addressing Risk Factors: Prevention should address risk factors such as peer pressure, family dysfunction, and lack of coping skills.
• Promoting Protective Factors: Prevention should promote protective factors such as strong family relationships, positive peer groups, and social support.
• Comprehensive Approaches: Effective prevention programs are evidence-based and culturally relevant.
• Specific Strategies: This includes disseminating information, social and interpersonal skill building, and comprehensive programmes.
• Targeting different groups: Indicated interventions target individuals who already demonstrate problem behaviours. Selective interventions target those at high risk, and universal interventions are for the entire population.

7) Ms Sujata (fictional name), a 24 year old women has come to the attention of a counsellor with complaint of smoking cigarettes for last 6 months and smoking ganja for last 4 months. She also complains of mood swings, difficulty in adjusting with friends in college and inability to say NO. She started using ganja because her boyfriend offered this to her and she didn’t want him to think that she was “un-cool”. She realizes that drug use is not a good habit but is unable to leave it. She belongs to a middle socioeconomic status family and her father takes about 3 drinks of alcohol everyday after which there usually is a fight between the parents. Chalk out the areas of assessment and an intervention plan for Sujata.

Assessment and Intervention Plan for Ms. Sujata:

1. Areas of Assessment:

   • Socio-demographic profile: Assess her age, education, and socio-economic background.
   • Substance use history: Detailed history of her cigarette and ganja use, including frequency, amount, and reasons for use.
   • Psychological factors: Assess for mood swings, difficulty in social adjustment, and reasons for inability to refuse.
   • Family history: Evaluate her family dynamics, including her father's alcohol use and parental conflict.
   • Peer influence: Assess the influence of her boyfriend and the need to fit in with her peer group.
   • Motivation Level: Assess her desire to quit and her understanding of the problem.
   • High risk behaviors: Assess for unsafe sexual practices, if any, especially in context of her relationship.

2. Intervention Plan:

   • Psycho-education: Educate Ms. Sujata about the effects of tobacco and ganja use.
   • Assertiveness training: Teach her skills to say "no" to peer pressure, especially in the context of drug use and relationships.
   • Coping mechanisms: Develop skills to manage mood swings and social adjustment issues.
   • Cognitive restructuring: Help her challenge the belief that using drugs makes her "cool", and reframe her negative thoughts.
   • Family therapy: Involve family in the therapy to address dysfunctional family patterns and to improve family communication.
   • Anger management: Address any anger issues arising out of the conflict at home.
   • Referral: Refer her for treatment of any comorbid psychological problems and substance use treatment.

8) Describe the various risk behaviors present in the prison population and the reasons for carrying out these risk behaviors.

Risk Behaviours in the Prison Population and Reasons:

1. Risk Behaviours:
   • Drug use: Continued drug use within prison due to stress and lack of access to support.
   • Injecting drug use: Sharing of needles and syringes, sometimes due to scarcity, increases risk of blood borne diseases.
   • High-risk sexual practices: Unprotected sex, sometimes forced or coerced, leads to an increased risk of contracting STIs.
   • Criminal activities: Engaging in illegal activities within the prison and increased risk of violence.
2. Reasons for Risk Behaviours:
   • Lack of access to clean injecting equipment: Sharing needles is common as a result of not having access to sterile equipment.
   • Stress and boredom: Inmates experience stress, boredom, and other psychological factors that increase drug use and risky behaviours.
   • Trauma: Inmates often experience trauma and violence in prisons.
   • Lack of support: Insufficient access to adequate health services, counseling, and treatment facilities increase risky behaviour.
   • Pre-existing issues: Many prisoners have pre-existing substance use disorders, mental health issues and criminal behaviour which may be exacerbated by prison environment.
3. Criminalisation of drug use: The illegal nature of drug use leads to more risk behaviour, like injecting in unsafe places.

Important Points

i) In women, genetic factors play as important a role as the environment in development of substance use disorders.

ii) There are significant physiological differences between men and women which makes the latter vulnerable to development of dependence on alcohol/substance.

iii) Women who have been sexually abused may or may not end up becoming dependent on alcohol/substance.

iv) Social factors may not play a protective role towards women with respect to substance use.

v) Women who have undergone tremendous stress or trauma are more vulnerable to substance use

vi) Questions asked during the assessment of a women with drug use problem:

• What made you decide to quit now?
• Do you feel guilty for using drugs?
• Have you had sexual relationship with anyone?

vii) Risk factors for development of substance use disorders in adolescents:

• Non-conforming attitude
• Alcohol dependence in father
• Lack of prosocial peer group