Table of contents

Introduction 2

Case presentation 3

History of the case 3

Interview with patient 5

Early therapy and treatment goals 7

Management and outcome 8

Discussion/Conclusion 12

References 14

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Introduction
Abstract

There has been increasing the incidence of addiction to certain drugs amongst people belonging to various
strata of society particularly amongst young people in our country as well as western countries. Our patient is a
36 year old male with a history of heroin addiction for 14 years. Without having it he can’t do anything. If he
cannot take it, he get auditory and tactile hallucinations and he doesn’t wish to work or even talk. He collects
drugs from the local spots or particular person/friends. This condition is very much dangerous both to the
individual and socio-economic condition of a country. Drugs addiction is a condition of periodic or chronic
intoxication produced by the repeated consumption of a drug or drugs by and individual effect of which is
detrimental to the individual or to the society. A more intensive research, action program, and social movement
are needed. It is also needed to strengthen family and social values and religious ethics in order to maintain a
stable and drug-free society.

Introduction

Mauritius is a country blessed with many natural resources and warm smiles but most unfortunately, this land
and its youth are being gradually invaded by one of the worst social evils — that of drug abuse.
The causes of drug addiction are many and include increased availability of drugs, expansion of communication,
socio-economic factors, migration and rapid urbanization, changes in attitude and values towards society,
community, family, religion, morality and the ruthless exploitation of fellow human beings by drug traffickers.
Since the high-risk group is primarily in the 15-35 years category, the loss in manpower and productivity as a
result, is enormous. Cannabis, heroin and opium amongst other types of drugs are very effectively 'marketed' to
the country's future generation.

The government needs to desperately formulate and review its national policy on drugs. This would primarily
treating drug addicts, rehabilitating and mooting preventive education. So far the government needs to get
involved with the day to day enforcement activities. Once they do that, it will combat the infiltration of drugs in
certain ghettoes of our country.
More and more youngsters are taking soft and hard drugs. To a nation that firmly believes that its citizens have a
right to a decent life with moral, humanitarian and spiritual values in a healthy and safe environment, this is a
matter of grave concern.
It is vital that all agencies of the government and non-government organizations work in tandem with regard to
enforcing the laws to reduce, if not totally eliminate the availability and distribution of illicit drugs.

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Case presentation
History of the case
The victim of this case is a young chap named Daramsing Baboo and he’s a manual worker who has a history of
polysubstance abuse and recurrent depression (with auditory and tactile hallucinations). Though he is 36 years
of age he looks much older than his age. He stays with his father. He is separated from his wife and has a 14 year
old child. Firstly, his friends introduced him to drugs as a means of enjoyment. Gradually he became addicted.
He started with marijuana. He sometimes changes his drugs to meet his satisfaction level. He changes drugs one
after another from marijuana, wine occasionally to injecting heroin (brown sugar) and even synthetic drugs.
Now he is fully addicted to heroin for 14 years, and has to take it 2 doses in a day and smokes around 20
cigarettes per day. Daramsing has been on methadone treatment for past 7 years. Without having his 2 doses of
heroin he cannot do his normal activities. He is most of the time unemployed and he spends Rs 500-800
everyday for drug purposes. For the excess money, sometimes he takes loan from friends or steals his own
household materials. He collects drugs from the local spots or a particular person. On physical examination he
was uncleanness, anxious looking and irritated. Speech was slowed. Physique was lean. Mild anemia and
jaundice was present.

Feelings and reactions of drug according to patient: Just after I'd shoot up, I'd get an amazing rush.
I'd be on top of the world. It'd feel like I was sinking into the floor. I'd forget if I was asleep or awake, and time
just passed me by.
After a while, I needed heroin just to get by. Too long without a fix, and I can't even describe it. It's like I was
dying in every awful way you could think of, all at once. Pain in all my bones, throwing up, chills, and I couldn't
sleep for days.

Heroin: Heroin (diacetylmorphine) is derived from the morphine alkaloid found in opium and is roughly 2-3
times more potent. A highly addictive drug, heroin exhibits euphoric rush, anxiolytic and analgesic central
nervous system properties. Heroin is classified as a Schedule I drug under the Controlled Substances Act of 1970.

Side effects
 Nausea and vomiting.
 Confusion.
 Dry mouth.
 Itchy skin.
 Miotic or constricted pupils.
 Light sensitivity.
 Lower than normal body temperature.
 Slowed respiration.
 Slowed heart rate.
 Cyanotic (bluish) hands, feet, lips, etc.

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Drug addiction

The word addiction means getting habituated with something. In case of drugs when a human body gets
dependent on some stimulating things, and after a certain period it creates a habit which means that the body
has become dependent on the stimulant which is addiction. It creates different types of excitement both in the
body and mind. Finally, it makes a person passionate to drugs. In the long run the user has to increase the dose
day by day.

Stages of drugs addiction

Drug abuse may exist with or without dependence and dependence may occur without abuse. Improper or
excessive use of therapeutic drugs may be termed as abuse even in the absence of addiction. Addiction is
defined as a chronic disorder characterized by compulsive use of drugs resulting in physical, psychological and
social harm, and continued use despite evidence of that harm. Addiction evolves through the followings stages:
Habituation, Dependence, Tolerance. Drug habituation is a condition resulting from the repeated consumption
of a drug in which there is a psychological or emotional dependency on the drug. Physical dependencies defined
as an alteration in neural systems which are manifested by tolerance and appearance of withdrawal phenomena
when a chronically administered drug is discontinued or displaced from its receptor. Withdrawal illness occurs
after abrupt discontinuation of the drug. Tolerance is an interesting phenomenon characterized by the need of
increasing amount of a drug to obtain the same therapeutic effect. So that they may increase his drug dosage
causes toxicity and death.

Admission of patient

It was a voluntary admission accompanied by his father, Mr. Mahen.

Father : “Li pe droguer, li pe faire mauvais pendant deux mois. Li pas reconnaitre so papa”

Patient : “Mo pe droguer ine gagne 14 ans. Mo pas conner ki mo pe faire. Mo fatiguer”

He was having the withdrawal symptoms of unknown drugs.

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Interview with patient

Ki lage to ti ena et kan tone commence prend la drogue ?

Mo ti dan college et mone commencer ek cigarette, lalcol ek gandia.Lerla mone vine lor heroine.

Comment to ti introduit a la drogue ?

Kan mo ti jeune mo ti content amuser ek camarades. Nou ti p ale discotheques danser tousala.
Et finalement mauvais compagnie ine mette moi dans la drougue.

To rapel to banne premier experience ?

Commencement mo ti pe peur tention mo gagne traper lacaz, alors mo ti pe prend li en ti quantier.

Mo ti pe peur tention mo vine addict et mo ti penser mo pou garde li tout le temps en control.
Mo pane conner meme kan sa ine coumence controle moi.

Okay
Par ki la drogue tone commencer ?

Gandia. Union Park cotte mo rester bien facile pou gagne sa. Lerla mne bizin coumance fume trop buku pou ggn
nissa. Temps en temps mone zwen dimounes plus experiencer mone coumance fume lapoudre lerla.

Combien temps to lor la drogue ?

14 ans mo penser. Mo ti coumancer lage 22 ans.

Kisanla ti cone to problem lor la drogue ?

Au commencement juste mo banne camarades proches, lerla ban dimounes en dehors et apres mo famille

Persone pane coze ek toi ?

Zotte ti coner mo gagne bcu colere. Zote tou ti pe peur moi. Persone pas capav coze ek moi.

Mais persone pane essaie aide toisi ?

Letemps zotte ine coner ti trop tard. Mo ti fini addict. Mo ti bisin sa chaque nuit sinon mo pas ti pou cpav dormi.

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Kan et couma tne decide kitte la drogue ?

Ine gagne 11 ans mo fam ine conner mo droguer et line kitte moi line aler. Mo ti essaie areter mais avek sa
soufance la mone bizin re coumence droguer. Avant sa mo ti p zis fumer lerla mone commence piquer tout.
Dernier 4 mois mo pas p travail ditout la. Mo pena cass pou acheter la drogue. Lerla mo papa ine avoy moi ici.

Ki changement ena en toi sa 4 mois la ?

Mo pas capav explique sa. Mo pas gagne someil ditout. Si mo dormi si après 2 hr temps mo someil casser. Mo les
os extra fermal. Mo gagn douleur partout. Mo senti fourmi p marcher lor mo lecorps.

Ki attitude dimoune dans to societer montrer envers zotte ?

Dimoune jamais traite nou bien et ni zotte essaie aide nou aussi. Zotte coze mauvais lor nou.

Merci.

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Early therapy and treatment goals

At the start of therapy, Daramsing was admitted to the ward and under one-to-one observation due to his
suicidal ideas. The nursing staffs and the treating psychiatrist collaboratively constructed the following problem
list, which was the focus of therapy:

• Drug misuse and the possibility of relapse.

• Relationship difficulties with son.

• Unemployment.

• Social isolation.

On completion of the problem list, Daramsing prioritised and listed his treatment goals (as outlined below). He
acknowledged that he would probably not be able to “fix” all his problems in a short time.

• To say no to drugs.

• To get on better with his son.

• To find a job.

• To make new friends who don’t use drugs.

• To become a good man, so that “my son can be proud of me.”

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Management and outcome
Treatment

First week
For the first 3 days of treatment and counseling, there were gradual improvements in his mood, levels of
hopelessness, as well as overall social functioning in the ward and little suicidal ideas.
The activity schedule in the ward and drugs helped him realize that his mood improved with increases in activity,
and that he was less likely to use drugs (heroin) when he kept himself busy and subsequent avoidance of these
minimized his risk of relapse.

He was still having auditory hallucinations of a female voice telling him to commit suicide.
Patient : “ Parfois li dire moi ale suicide”

He identified drug misuse as one of his main problems, and his treatment goal was to develop the ability to say
no to drugs.

On the first day, the psychiatrist advised to put the client on close observation. (one to one nursing)

Drugs administered
Tab Kemadrin 10mg nocte

Tab phenergan 25 mg nocte

Tab largactil 25 mg mane and 50 mg nocte

Methadone (from Mahebourg methadone centre)

Nurses’ observations
He was sleeping well, had a calm behavior and was drug compliant.

The table below shows the vital signs recorded by the nurses during the first week of treatment.

Date 4/8 5/8 6/8 7/8 8/8

Blood pressure 110/70 130/90 120/80 120/80 110/70
Pulse 84 78 80 82 80
Resp. rate 17 16 16 15 16

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Recommendations in care plan
Despite the patient was still having hallucinations, the psychiatrist advised the nursing staff to continue with the
same treatment and keep him under close observation.

Second week
On the second week of treatment and counseling, the client was calm and cooperative. There was clear
improvement in his mood, suicidal ideas was denied after interview but physical appearance still shows signs of
frustration. Patient was participating in daily ward activities and was not showing physical symptoms of
withdrawal from heroin. But still the client was complaining of auditory hallucination.

The patient was drug compliant during the second week, showing willingness to continue treatment and was
willing to go home.

Drug administered
Tab kemadrin 10mg nocté

Tab phenergan 25mg nocté

Tab largactil 25mg mane and 50mg nocté

Methadone (from mahebourg methadone centre)

Nurses’ observations
The client was sleeping well, was calm and cooperative and was drug compliant.

The table below shows the vital signs during the schedule week

Date 9/8 10/8 11/8 12/8 13/8

Blood pressure 120/80 110/70 110/70 110/70 120/80
Pulse 78 82 80 80 82
Resp.rate 15 16 15 15 15

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Recommendation in care plan
The psychiatrist adviced to continue same treatment on patient and to observe for behavioral changes in ward.
Close observation was maintained.

Third week
On the third week on treatment and counseling, the client was reacting positively to treatment. Suicidal ideas
disappeared and patient’s mood was better. The observations in ward state that he was interacting well with
the other patients, making friends and started adopting a good social behaviour. Hallucination was not
completely absent but the client state that it was relatively better than before.

Patient: " mo tann ban la voix lah zis assoir kan ale dormi ek mo fer cauchmare »

The patient state that he was now feeling better and would take his medication continuously once at home.

Drugs administered
Tab kemadrin 10mg nocté

Tab phenergan 25mg nocté

Tab largactil 25mg mane and 50mg nocté

Methadone (from mahebourg methadone centre)

Nurses’ observation
The client was sleeping well, calm and cooperative in ward and was drug compliant.

The vital signs observed daily were stable.

Recommendations in care plan

The psychiatrist advice to continue same treatment on patient and referred the case to the Mental Health Board
for further management. The board advice to discharge the client if/when stabilized and advice a review in six
months.
The patient was kept in ward for further observation

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Fourth week
On the fourth week of treatment and counseling, the client was stable. Mood was good, coherent in speech and
action, no hallucination, no delusion and no suicidal thoughts. He was calm in ward.

Patient says “mo bien / mo fit » and asked for discharge.

Drug administered
Tab kemadrin 10mg nocté

Tab phenergan 25mg nocté

Tab largactil 25mg mane and 50mg nocté

Methadone (from mahebourg methadone centre)

Nurses’ observation
The client was sleeping well, calm and cooperative in ward and was drug compliant.

The vital signs observed daily were stable.

Recommendation in care plan

The psychiatrist discharged patient. He referred the case to a rehabilitation centre - Centre de Solidarité for
further management. He adviced the patient to be more responsible in society and to respect others. Patient
was due to promise to go to the rehabilitation centre and follow his treatment.

The rehabilitation centre, a non-governmental organization in Beau Bassin-Rose Hill, Mauritius, helps drug
addict patients to rehabilitate in society and prevent them from relaps.

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Discussion/Conclusion
Discussion

Drug abuse is a major medical problem with extensive legal and social problems. Indiscriminate use of drugs
becomes dangerous and produces a gradual mental, physical and moral deterioration of the individual and
sometimes also sexual perversions or crime. To obtain the money for the drug the addict often turns to
prostitution or crime. The majority of drug victims are neurotic individuals who are mentally unbalanced. A
normal person has no tendency to become a drug addict and is most unlikely to become one, even when all the
facilities are available. Hereditary factors, abnormal mental conditions, frustrations in life, anxiety, chronic
tensions, physical inability to do a job, curiosity, etc are some of the causes of drug addiction. Addicts fall in
two groups:

(I) Those who are originally used the drug for some disease and thus have acquired the habit and
(II) those who use the drug for its narcotic effect alone.

The first groups are more easily cured than the second. The inability to discontinue the use of drug may be due
to either to a desire for satisfaction or an anxiety to avoid the discomfort of withdrawal symptoms or both.
When a disease breaks out like en epidemic in all segments of the society, it indicates a social change. It is not
only the youth, drug addiction has also grabbed the social leaders. Even the teachers and physicians who are
supposed to guide the society are more or less getting addicted. Law enforcing agencies and other concerned
authorities are in most cases either refraining from their job or associated with the drug business. Undoubtedly
it is an awesome situation. Every disease has a cure. We must come out of this monopolistic deadly game. A
more intensive research, action program, and social movement are needed. It is also needed to strengthen
family and social values and religious ethics in order to maintain a stable and drug-free society.

Conclusions

Because substance abuse and delinquency are inextricably interrelated, identifying substance-abusing youth in
the juvenile justice system is an important first step for intervening in both their substance abuse and their
delinquent behavior. Drug identification strategies, followed by effective interventions, help prevent further
illicit drug use and delinquency. Drug testing can be a constructive means of helping youth overcome denial of
their substance abuse. As a part of intervention, drug testing can be used to help youth achieve and maintain
recovery and curtail other deviant behaviors. Over time, effective drug identification will help juvenile justice
agencies achieve the goals of a balanced approach including community protection, youth accountability, and
competency development.

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Recommendations

Several fieldwork studies found that many people, especially the youths are eager to get rid of drugs. But
unfortunately they can hardly find any way out. According to the discussion with the concerned people such as
drug abusers, guardians, teachers, policemen, it is clear that behavioural modification of the abusers is not
enough to check the spread of drug taking and drug trafficking. The concerned people gave the following
suggestions in order to control of drug addiction:

• Leaders of social institutions like schools, colleges, clubs etc. should come forward to build resistance against
drugs.

• The NGOs can play a great role, especially in the awareness and rehabilitation processes.

• Rapid diagnosis and treatment.

• Mass education.

Program planning, development, and implementation should include all potentially affected persons, including
agency administrators, line personnel, key juvenile justice stakeholders (e.g., judges, court administrators,
prosecuting and defense attorneys), and important community representatives (e.g., substance abuse, mental
health, and medical treatment providers).

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2010;10:1360-69. 2. Shamim SB. A study on drug abuser in mohakhali slum. Journal of BIDS 2005;13:13-18.

Reddy KSN. Drug dependence and Abuse. The essentials of Forensic Medicine and Toxicology. 26th edition.
Hyderabad. K. Suguna devi 2007:531-37.

Fujita W, Takahashi M, Tokuyama S. The mechanism of the development of drug dependence. Prog Neurobiol
2010; 64(8):1445-50.

https://www.ojjdp.gov/pubs/drugid/conclusion.html Drug Identification and Testing in the

Juvenile Justice System 1998 May

Gropper, B.A. 1985 (February). Probing the Links Between Drugs and Crime. Washington, DC: U.S.
Department of Justice, Office of Justice Programs, National Institute of Justice.

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