"I was an occasional smoker, one at night or during a party, but after COVID-19 outbreak, work pressure has gone up so much that I am almost floating in nicotine," said Abraham, an Abu-Dhabi based expatriate sales representative.
That is not the random cry of a panic-stricken individual, but one of the many voices of anguish caught in the web of addiction, following the global coronavirus pandemic.
Stuck in a rapidly-closing web, unaware of the consequences and without the desire to escape, that in a nutshell is what addictions are all about.
Beware of that addiction trap, once in it freedom is a distant reality. The best option is to keep far away. Unfortunately, with the advent of coronavirus pandemic and the fear it spreads globally, an increase in addictions of all kind – physical, psychological and behavioural – are being reported by mental health professionals in the UAE and around the world.
“That one cigarette after dinner, have now become two packets a day. I smell like a burning cigarette nowadays,” said Abraham, who does not want to give out more of his personal details.
While Abraham is struggling to stub that addiction, another expat based in Sharjah is hit by the fear of illnesses and is over exercising. She is addicted to exercise so much so that she has now sought the help of a mental health professional to get her out of the web.
Fear, anxiety, stress are some of the many triggers for addictions. Addiction can happen to any, weak-minded or strong willed, black or white. It has no age barriers or gender concerns.
From hardcore substance abuse to comparatively milder addiction to prayer, it all has the same implications: stuck in the rut.
Panic has hit Shalon so bad that she started over eating, all in the name of consuming healthy food to ward of coronavirus. The Dubai-based expat, who does not want her identity to be revealed, bloated up so fast that she finally ended up in the hospital with non-COVID related health issues.
She is now being treated for eating disorder, an addiction that has grown large during the pandemic.
Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, “addiction is progressive and can result in disability or premature death”.
What is an addiction? How to identify an addict?
“Addiction is a compulsive psychological or physiological need for a habit-forming substance, behaviour or activity, despite knowing about its harmful physical and psychological consequences,” explained Marisa Lobo Biddappa, psychologist, Kids Neuro Clinic and Rehab Center, Dubai.
Addiction is a compulsive psychological or physiological need for a habit-forming substance, behaviour or activity, despite knowing about its harmful physical and psychological consequences.
The craving or need to do or engage in certain activities like checking social media posts or smoking can eventually become physically and psychologically addictive. Finally, the person’s body begins to crave for the substance, activity or behaviour more and more, leading to complete addiction and dependence.
Experiencing enjoyment or going through withdrawal do not in themselves mean a person has an addiction.
Addiction is often used to refer to a behaviour that is out of control, added Dr Sreekumar V. Nair, Specialist Psychiatrist, Mediclinic Welcare Hospital, Dubai. "People often say they are addicted to a TV show or shopping or say things like: ‘I get a headache when I don’t have my cup of coffee in the morning: I must be addicted to coffee’. However, experiencing enjoyment or going through withdrawal do not in themselves mean a person has an addiction," Dr Sreekumar said.
The American Psychiatric Association defines addiction as “a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence”.
What triggers addiction in people?
Anxiety, frustration, dissatisfaction, depressed mood and difficulty in managing impulses can be triggers for addictions, said Dr Andrea Tosatto, a Dubai-based clinical psychologist. Addictions can be related to drugs, alcohol, smoke, sex, work, gambling, internet, videogames or even another person, said Dr Tosatto.
Explaining further, Dr Sreekumar said, people become addicted because of a combination of factors:
Genetic factors: Some people may inherit a vulnerability to the addictive properties of drugs. This vulnerability is usually not for any specific substance.
In order to avoid triggers, stay far from HALT: Hungry, Angry, Lonely and Tired.
Drug interaction with brain and dopamine: People use alcohol and other drugs because they stimulate the brain in ways that makes them ‘feel good’. All substances with addictive potential stimulate the release of dopamine, a chemical in the brain that is associated with reward and pleasure.
Environment: Peoples' home, community and the attitude of peers, family all help develop substance use problems.
Mental health issues: More than 50 per cent of people with substance use disorders have also had mental health problems at some point during their lifetimes.
Coping with thoughts and feelings: People may turn to substance abuse as a way of coping with difficult emotions or situations. They start to rely on substances to regulate their emotions.
In order to avoid triggers, warned Dr Tosatto, stay far from HALT: Hungry, Angry, Lonely and Tired. These addiction triggers are found almost everywhere in life.
With the advent of coronavirus pandemic, they are almost epidemic.
Risk factors for youngsters:
- Alcohol or other drug problems among family members
- Poor social skills
- Aggressive behaviour in childhood
- Availability of drugs in school and neighborhood
- Family conflicts, chaos or stress
- Lack of parental supervision
- Having friends who drink or use drugs
- Not fitting in socially or being excluded because of factors which are beyond their control
- Emotional, physical or sexual abuse
- Experiencing discrimination or oppression
- Having a positive adult role model
- Good self-control
- Positive relationships
- Good parental or other caregiver supervision
- Having a strong attachment to family, school and community
- Having goals and dreams
- Being involved in meaningful, well-supervised activities (sports, volunteer work)
Different types of addictions
Addictions can be broadly classified in to three categories: physical, psychological and behavioural.
Physical addiction could be anything from drug to food addiction. It happens when a person becomes dependent on any particular substance that starts to give that person pleasure. “Trying to give it up can make that person suffer withdrawal symptoms which can last for quite a long time and make one feel terrible physically and mentally that they want to go back to whatever they were taking to feel good again,” said Marisa.
Psychological addiction unlike physical addiction is the alteration of the mental state. In doing so, the person will derive pleasure and change the mood. “The person may not get physical withdrawal symptoms, but may feel anxious, irritable, lonely or depressed if they can't get the thing that they desire,” said Marisa.
Behavioural addictions on the other hand can present in a variety of subtle and deceptive patterns. It could initially seem harmless, but could draw people into a cesspool from which it is often difficult to escape, she said.
Some of the behavioural addictions
- Internet addiction
- Compulsive overeating
- Compulsive gambling
- Compulsive shopping
- Compulsive exercise
Addicted to anger
Anger is as real as any other addiction. Some people are addicted to the feeling of anger. It’s the only way they feel alive. They live in such a depressed state, buried in a mountain of emotional oppression: the only way they can actually feel good, alive and energetic is to get mad at somebody.
Psychologists warn that getting a kick out of the feeling of anger can lead to a dysfunctional emotional response, and even result in disability.
Be careful who you hang out with
Over the past few years, an exciting event in neurosciences has been the discovery of “mirror neurons”, the mechanism that unifies action-perception and action-execution.
It refers to the mental process in which way an individual perceives the action of another person, and mimics that same action.
Here’s the bottomline: Be careful who you hang out with. If that person is addicted to something that leads to destruction, you better watch out. Pretty soon, you could be mirroring that person.
This is one way neurology experts explain as “mirror” mechanism in the brain. Here’s the interesting part: A study published in Nature Clinical Practice Neurology in 2009 shows evidence of such “mirror neurons”, which they considered clinically relevant.
Whenever an individual observes an action being done by someone else, a set of neurons that code for that action is activated in the observer's motor system. Since the observers are aware of the outcome of their motor acts, they also understand what the other individual is doing without the need for intermediate cognitive mediation (The mental processes or activities that take place between the occurrence of a stimulus and initiation of an associated response).
Addictions among children and youngsters
Adolescence is said to be a period of stress. A complex period in life, a time of questioning, exploring and risk taking. Studies have shown that the area in the brain that is very critical in planning and habit formation is directly tapped by reward in adolescents, which means the reward probably has a stronger influence in their decision-making. This could make adolescents more vulnerable to peer pressure and could make their brain more susceptible to addictions.
Adolescents who are at risk of developing serious addictions are:
- Those who are depressed
- Those who have repeated failures
- Those who have a poor self esteem
- Those who feel left out or feel they don’t fit in
- Those with a family history of substance abuse
Some of the major addictive substances
- PCP, LSD and other hallucinogens
- Inhalants, such as paint thinners butane and glue
- Opioid pain killers
- Muscle relaxants
- Sedatives, hypnotics and anxiolytics
- Cocaine, methamphetamine and other stimulants
Are adolescents more vulnerable to drug addiction than adults?
The balance of pleasure versus negative effects of drugs is tipped towards reward in adolescents, which could increase consumption of drugs by adolescents. Adolescents are also less sensitive to withdrawal effects. In adolescents peer pressure is a very important factor in substance use.
The effects of drug abuse
People with a substance use disorder have distorted thinking, behaviour and body functions. Changes in the brain’s wiring cause people to have intense cravings for the drug. These substances can cause harmful changes in how the brain functions. These changes can last long after the immediate effects of the drug: intoxication.
Risk factors for youngsters:
According to the National Institute on Drug Abuse, people begin taking drugs for a variety of reasons:
- To feel good: feeling of pleasure or ‘high’
- To feel better or to relieve stress
- To do better: improve performance
- Curiosity and peer pressure
People with addictive disorders may be aware of their problem, but will not be able to stop it even if they want to. The addiction may cause health problems as well as problems at work and with family members and friends. The misuse of drugs and alcohol is the leading cause of preventable illnesses and premature death.
Symptoms of substance use disorder are grouped into four categories:
Impaired control: A craving or strong urge to use the substance; desire or failed attempts to cut down or control substance use.
Social problems: Substance use causes failure to complete major tasks at work, school or home; social, work or leisure activities are given up or cut back because of substance use.
Risky use: Substance is used in risky settings; continued use despite known problems.
Drug effects: Tolerance (need for larger amounts to get the same effect); Withdrawal symptoms (different for each substance)
Many experience both mental illness and addiction. Mental illness may be present before the addiction. Or the addiction may trigger or make a mental disorder worse. It can also cause Depression, Anxiety and Paranoia.
Is there a marked rise in addictions among children during COVID-19?
Children and adolescents are the most affected during this pandemic. Studies have shown an increase in anxiety and stress levels during coronavirus pandemic. Recent studies suggest that depression is likely to increase by seven per cent and the rate of psychological trauma to increase by 4 to 41 per cent by the end of the pandemic, said psychologist Marisa Lobo Biddappa.
“Another isolation associated threat is an increased risk of online sexual exploitation. Since children and adolescents are spending more time online, the risk of contact with online predators is also increasing. Due to limited social outings there is an increase in kids reaching out to new contacts and groups online. As more adults have been isolated at home, there may also be an increase in pornography,” she said.
Children's screen addiction and how to tackle it
Since the pandemic began there has definitely been an increase in TV, streaming, and app downloads. Parents too are spending more time on TV and social media.
The American Academy of Pediatrics, responding to coronavirus outbreak and children’s screen time, stressed that screen time limits “are still important” and urged parents to “preserve offline experiences”.
It is imperative both parents and the school establish a pragmatic ‘balancing act’ to foster a healthy, balanced digital diet, said Marisa.
Tips on how parents can help children keep away from addictions
Set example: Parents are the biggest influence on children in how they respond to media and need to set example by restricting their own use of the phone, social media and TV watching.
Change the home environment: Encourage a more active, less sedentary lifestyle by devoting space and time to a home workout area, and limiting screens to a dedicated area and time.
Improve communication: Nurture healthy relationship with children. It’s important to have open communication even with adolescents.
Monitor the time, content and use of screen time: Have a healthy discussion and share the usefulness and joys of screen time while also discussing the negative effects.
Be a role model: Restrict your own use of various devices and technology for creation, discovery and connection.
Make an activity schedule: A schedule with a good balance of various activities, including reading, appropriate brain stimulation activities like crosswords, word search, simple art and craft, do it yourself activities, board games, physical activity, calming down and relaxation activities like mindfulness and yoga.
Avoid giving young children a smart phone: Children do not need a smart phone. If you feel they need a phone due to their extra-curricular activities, give them a phone without internet access.
Screen-free meals: Avoid screen time during meals as it has been linked to eating junk food and increased weight in children.
Avoid screen time before bed: Restrict screen time for two hours before bedtime for younger kids and at least 1 hour before bed time for adolescents. This will help them sleep better and wake up on time as the “blue light” from screens can disrupt the natural sleep cycle.
Use positive reinforcers: Positive reinforcements like points (rewards) can be given following adhering to rules.
How to prevent addictions, treat and cure?
Treatment depends on the stage of the addiction, ranging from management of risk factors and education, to out-patient treatment such as counseling, to intensive in patient medical treatment followed by long-term outpatient care.
A healthy home environment during childhood is essential for reducing the risk of addiction. Teach children not only science and mathematics, but coping with the realities of life, like failures and stress. Learning to deal with ups and downs of life at a young age is vital to deal with the pressures of life at a later stage.
Active role of the school
School should include a topic on substance abuse, its ill-effects and how to deal with peer pressure, become assertive and learn to say ‘No’ for things that are not good as part of the curriculum. Teachers should be alert to changes in behaviour, drop in grades or change of attitude.
Volunteers in the community could reach out to those who are lonely and vulnerable and be alert to adolescents hanging around and experimenting with various substances.
Addictions, warning signs and symptoms
Some behaviours can be considered normal in teenagers. It is important to pay attention if there are several signs happening at the same time, if they occur suddenly, and if the behaviours are extreme:
- Mood changes: irritability, anger outbursts, defensiveness
- Emotional changes: lack of confidence, poor self-esteem, depression, personality changes
- Family relationship: breaks rules, starts arguments, withdrawing from the family
- Physical changes: loss of weight, blank vacant look, glazed look, flushed face, lack of coordination, slurred speech, smell of alcohol, smoke etc.
- Cognitive changes: poor concentration, memory lapses, forgetting instructions
- School and academic problems: poor attendance, drop in grades, getting into fights, complaints from school or college
- Indifference and a ‘I don’t care’ attitude
- Behaviour changes: Being secretive, lying, stealing
- Change in friends and a reluctance to let parents know about new friends
- Finding cigarettes, drugs or alcohol in your child’s possessions
Detoxification and medication
Addicts would require detoxification to clear the substance from the body and limit withdrawal reactions. The doctor may prescribe medication if necessary. Counselling and various psychological therapies to change attitudes and behaviours associated with using a substance and strengthening life skills.
Family therapy and motivational counselling
Family should be involved in the treatment. Engage individuals in treatment to maximize motivation to change, use concrete concepts, help identify triggers that lead to loss-of-control and learn self- regulation, abstinence, adapting to situations and problem solving skills.
Cognitive Behaviour Therapy (CBT)
CBT will help the individual recognize and change ways of thinking, particularly those thoughts associated with substances, learn self -control and replace those thoughts with helpful positive thoughts. It will help reduce anxiety, build confidence and self-esteem.
Enroll for group therapy and physical activity
Enroll for group therapy as it will help in understanding that it is not a lonely fight against the killer addiction and also include physical activity.
At the end of the day, dependence or compulsion for anything to feel happy is as good as being in a cage and never wanting to leave. Seek professional help, if you can’t check out of that addiction. It’s better to be free and sober, rather than live in the illusion of freedom and elation.
With inputs from Jay Hilotin, Senior Assistant Editor