SUBSTANCE misuse is an enduring social problem. According to the United States Center for Disease Control and Prevention, over 81,000 drug overdose deaths occurred in the US in the past 12 months – the highest number ever recorded.
Meanwhile, the United Kingdom’s Office of National Statistics recorded a sharp increase in alcohol-related fatalities during and after the first Covid-19 lockdown, up 16.4%. During Malaysia’s first movement control order (MCO) that began in March last year, about 3,923 people were detained for drug-related offences within the first month.
As isolation co-exists with addiction, the MCOs have further exacerbated increased usage and related deaths in not only substance but also behavioural addictions such as online gambling and pornography. Recognising this, Malaysia has recently revisited its policies to include treatment for substance misusers instead of draconian jail terms. Indeed, the Drug Dependants (Treatment and Rehabilitation) Act 1983 is due to be replaced by the proposed Drug and Substance Abuse Act later this year. It is hence timely to revisit existing treatment models to better address this public health concern.
What is addiction?
Addiction, or substance misuse disorder, is the inability to abstain from abusing substances. The American Medical Association officially declared alcoholism as an illness in 1956. However, it was not until 33 years later that addiction was officially termed a disease.
For Malaysia, amphetamine-type stimulants such as methamphetamine tablets or Ecstasy are the most abused drugs, followed by opiates like heroin and morphine, as well as cannabis.
From January to June 2020, there were a total of 95,505 drug and substance misusers in the country. Meanwhile, tobacco use among Malaysians has arguably plateaued, where in 2015, 22.8% of individuals above age 15 were cigarette smokers, compared to 21.3% in 2019.
We know today that there is a small percentage of the population who are at a higher risk of dependency mainly because of their biological, psychological and social predispositions. Another factor is the rapid release of the neurotransmitter dopamine in the reward systems of the brain caused by abusing the substances.
Take nicotine for example. Nicotine is a compound naturally found in plants, specifically the Solanaceae family, which includes tomatoes, potatoes and tobacco leaves. However, only in tobacco leaves can you find a considerable amount to produce the desired pharmacological action.
My years dealing with patients have shown me that nicotine – especially in the form of cigarettes – is an addictive substance. It is rapidly delivered to the brain and produces a reinforcement effect similar to amphetamines or alcohol. Smokers become addicted and unfortunately develop health problems due to exposure to toxins in cigarette smoke, and not nicotine.
Treating addiction in Malaysia
Kicking the habit is certainly not easy, given that addiction is a disease that requires scientific treatment approaches. From my experience in addiction psychology field, I am convinced that an integrated treatment approach combining various interventions such as cognitive behavioural therapy, relapse prevention and other therapeutic tools is effective.
The key is to realise that treatment models have and will continue to evolve or adapt. Certainly, the abstinence model of treatment is not the only option.
In the last two decades, Malaysia has successfully used medications to treat substance misusers, including agonist maintenance treatment for heroin dependents and nicotine replacement therapies for tobacco users. These methods have been mostly successful. For instance, the needle syringe exchange programme of the Harm Reduction Working Group of Malaysia from 2004 was proven to be an effective, safe and cost-effective method in containing the spread of human immunodeficiency virus (HIV) among syringe users. Increasingly elsewhere, harm reduction strategies are being used, such as e-cigarette and heated tobacco products to substitute for combustible cigarettes.
Malaysia has come a long way in treating addictions, evolving from punishment to treatment and rehabilitation programmes, replacement therapy and medication. Harm reduction strategies are the logical next phase, especially in harmful behaviours like smoking. To better manage this ‘invisible pandemic’, there needs to be flexibility in accepting treatment approaches.
Dr Prem Kumar Shanmugam is the chief executive officer and clinical director of Solace Academy, Solace Wellness and Solace Asia Addiction Retreat.