People who can’t say no

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“Substances are fantastic,” says clinical psychologist Scott Wood. “Nothing makes you feel better in the short term.

“The problem comes when you withdraw from the substance. You move up the grades on a scale of antisocial behaviour – starting with selling your own clothes for money, then stealing, then snatch and grabs.

“At the top end of the scale is psychosis, either intoxication induced or withdrawal induced.”

That’s the state in which people sometimes commit violent acts, says Wood, who runs Fort England Hosopital’s substance abuse rehabilitation programme.

The programme serves a huge area, from the Tsitsikamma in the west, to the Kei River in the east and Cradock to the north, for which it is the only one available in a state institution. Not all of those enrolled are from Grahamstown.

“I’ve been running this programme for 11 years,” Wood said. “It was five years ago that we had the first methamphetamine [tik]addiction. The second case was a few months later, towards the end of that year.

“Now, 60-70% of the people on the programme are trying to recover from methamphetamine use.”

Wood says drug use is primarily a personality issue, triggered by past and present trauma. Substances are used to escape from this.

There is no single cause, and definitely no straightforward solution. But one predictor is having a domineering individual within the home.

“A child in such a household learns to please to avoid abuse,” Wood says. “They learn to submit. Ninety percent of the substance addicts we see are people who’ve been brought up to please,” Wood says. “They are people who can’t say no.

“The question is how do you get healthier families, so that when children eventually leave home, they feel they’re good enough?”

Think twice before you light up

The most common gateway drug, Wood says, is nicotine and he refers to Denise Kandel’s 2007 study on the causes of drug dependence. It’s titled ‘On the development of nicotine dependence in adolescence’ and in it, Kandel and her co-authors study tobacco use as a model for the study of the transition to drug dependence – “since many drugs of abuse share the same neurobiological processes”.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2042038/

A 2015 study also led by Kandel concluded that adolescents were more likely to become lifetime smokers if their parents were nicotine dependent.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605183/

Kandel is Professor of Sociomedical Sciences (in Psychiatry) at Columbia University. Her studies of the developmental phases of drug use and what the specific risk factors are for adolescent initiation into each major stage provided the basis for the Gateway Hypothesis.

“None of the people checking into the programme are here to recover from nicotine addiction,” Wood said. “But most of them smoke a lot.”

“For most people the gateway drug is nicotine,” Wood says. “Cigarettes are often freely available in the person’s home or social support system.”

And of course, they’re legal.

“A substance user will start at the shallow end first – cannabis, then mandrax. After a while, they build up tolerance and methamphetamine becomes the third option.”

Mostly, drugs are used in combination. Cannabis and mandrax are downers, meth is an upper, Wood explains.

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