Technological Key to Escape the Death Trap of Substance Abuse

Substance Abuse is a disease of addiction that takes the addicted individual to hell, which they disguise as 'heaven'. Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health, in one of his interviews, said, "In all my years as a physician, I have never, ever met an addicted person who wanted to be an addict". It has been observed that at the early stages of this disease, substance use could be a choice for someone to escape reality, prescription, well-intentioned usage to self-medicate. However, over time the individuals lose control of their senses in a problematic pattern. Even though they are well aware of harmful consequences, they continue using the substance. The ill effects of Substance Abuse Disease (SUD) in a person are visible in their changed behavioural pattern, social function and physiological symptoms. SUD has been recognized as a chronic medical condition for more than 60 years ago and can influence anyone regardless of race, sex, caste, income level, or social class. Alcohol, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, or anxiolytics; stimulants; tobacco (nicotine); and other (or unknown) compounds can all be classified as SUDs. This essay will help in developing a fundamental understanding of SUD as a chronic medical condition, factors determining the development of SUD in an individual, an overview of the current epidemic in India, the impact of the stigma, and technology-driven treatment on SUD individuals in India.

The National Drug Dependence Treatment Centre reported that regardless of strict drug control laws in India and a multitude of agencies functioning to control the supply of banned substances, these are still in circulation. In India, 10 crore people are reported to be addicts of various narcotics substances, as per the Narcotics Control Bureau (NCB) data. The government of India introduced the Narcotic Drugs and Psychotropic Substances Act of 1985 (NDP Act) to restrain drug abuse which banned cultivating several drugs and even recommended jail terms for offenders. However, the laws could not contain the drug racket, which has increased uncontrollably over the years. The biggest reason for the failure of the law is India's Geographical Vulnerability to the biggest drug-producing areas of the world, the golden crescent and the golden triangle (Figure 1). India is sandwiched between the golden crescent in the West, comprising Iran, Afghanistan, Pakistan, and the golden triangle in the East, comprising Myanmar, Laos and Thailand, from where the drugs are trafficked to Indian states sharing a border and then supplied to entire India. Several Research articles also claim India's fight to contain drug Menace has been dented by the Taliban takeover and COVID-19 crisis. The rising unemployment and changing lifestyle is also a cause of increasing cases of SUDs. Therefore, the way forward to the problem lies in its root cause which can be tackled by awareness and prevention programs related to the ill effects of these substances on health and social factors. Having said that, people suffering from SUD should be identified and motivated for treatment without fear of social stigma.

So what motivates individuals to turn hardcore addicts? Well, it's the changes that occur in the brain after the consumption of drugs (Figure 2). The substance binds to a number of receptors that affect a large part of the brain; for example, opioids bind with the thalamus, which can provide analgesic effects. The nucleus accumbens is a part of our brain that plays a large role in an individual's addiction. This is part of our brain where we get a massive dopamine release greater than what is used in medical sciences and greater than even ever intended. The huge dopamine leads to a really intense amount of liking and wanting that substance. This causes individuals to repeat that experience of feeling good and remember some circumstances to intake the substances again. The more one repeats that process, the more reinforced the pathways can be in one's brain and cause long-term changes. Now, to back all the experiences, another part of our brain called Amygada gets simulated, due to which individuals feel less anxiety, less fear and less distress. To sum up, the individuals will not only feel good and have less physical pain but also feel less bad or guilty. Now, the prefrontal cortex, which is responsible for attention, thinking, judgement, and complex decision-making, will start prioritizing the addictive substance which makes one feel good. People with SUDs recognize this good feeling as a 'positive response'?from these substances at earlier stages. Over time, the body and brain adapt to start building up a tolerance, so the individuals use more of that substance to get the same effects. As time passes, the body changes and the individuals develop dependence such that they need to use so much of that substance just to feel normal and not feel sick. Even if they want, they cannot cut down on substances. They eventually start excessive time in the acquisition and finally give up on other activities to use the substances.

Environmental factors, genetic predisposition, intermediate phenotype lead to the development of SUD in an individual. According to the reports, around 50% of someone's risk for developing a SUD is based upon genetic factors such as family history and biological makeup. These genetic factors are unchangeable, but the other 50% of the associated risks are intractable. According to studies, the age of substance consumption plays a huge role in the development of SUDs. If an individual starts consuming the substances before the age of 15, they become 6 to 7 times more likely to develop SUD because the brain at such ages has not fully been developed. An NGO revealed that in India, 63.6% of the patients coming in for treatment were introduced to drugs at a young age, below 15. In December 2022, the GOI informed the supreme court that 1.5 crore kids are into substance abuse. Children are likely to consume banned substances as they are more curious and are often influenced by their peers who may indulge in substance abuse. Psychological consequences such as past trauma, depression, anxiety and other mental health ailments can also raise the risk of developing SUD.

A person suffering from SUDs must get timely, assessable, convenient and personalized treatments with low-cost and low-waiting times. Technology can play a significant role in the treatment of SUDs in India (Figure 3). There are 692 million active Internet users in India, according to a survey by the Internet and Mobile Association of India (IAMAI), and much of the growth is still being driven by rural India (351 million users with 37% penetration), as urban India appears to have reached a plateau (341 million users with 69 per cent penetration). In the modern era, using digital technology to treat medical condition includes using emails and smartphone applications. Internet today offers a wide range of health tools for addiction recovery, from informative and educational websites to assessment and psychotherapeutic software, self-help programs, social network therapeutic communities etc. These tools with smartphones and other mobile technologies are called 'mhealth'. Feedback provided directly by participants combined with data collection from special sensors that provide information on a person's location, heart rate or substance concentration levels in the blood can boost research and treatment of addictions. These types of applications include not only providing therapeutic interventions but also measuring follow-up. Information collected by digital technologies can also be used by doctors and family members to help patients in real-time or to better predict the risk of relapse, but they also give rise to serious concerns related to patients' privacy and data confidentiality. There are other apps, such as Mobile MORE Field Guide to Life App, which has daily affirmations, weekly sober challenges and various other engaging, interactive features that people can utilize to stay engaged and to help them feel motivated and excited about their recovery. In the past, beepers and alarm watches were used in mental health studies to prompt participants about any paper-based evaluations. The Experience Sampling Method (ESM) or ecological momentary assessment was the name given to this procedure. The utility of EMA was, however, constrained by the use of labour-intensive paper-based approaches for gathering outcome-related data. Subsequently, programmable electronic gadgets like cell phones and palmtop computers became more widely accessible. These tools improved the feasibility of data collecting and reduced the bias inherent in paper-based research.

The best indicator of relapse is stress. Consequently, autonomic nervous system activity can be observed by applying a covert wireless patch to the recovering person. The Biomonitoring patch can interface with a warning system and send an automatic message to the user asking whether they need assistance if it detects elevated skin conductance, heart rate, pulse, and/or increased muscle tension. Also, the warning system might be set up to alert that person's network of supporters. In addition to checking in with addicts when they're highly aroused, treatment professionals can use biomonitoring data to cross-check a client's calendar and objectively discuss behaviours or circumstances that could be linked to poor arousal and a higher risk of relapse (e.g., "I see that last Tuesday evening was especially stressful for you; do you want to discuss it?").

The recovering addict can practise scenarios that would have previously resulted in substance abuse by participating in virtual reality training through multiplayer video games with friends and family. In order to maintain a long-lasting recovery, gamers can practise a healthy, abstinent lifestyle by creating and controlling characters that resemble them and creating social circumstances that are similar to their own.

Online support groups have many advantages over in-person support groups, including being much more convenient, available anywhere there is Internet connectivity, and, if wanted, maintaining user privacy. Although some groups also use instant messaging or video conferencing, these groups are most frequently set up as asynchronous text-based groups supplied via listservs or accessed online.

Another method technology can improve access to services and eliminate wasteful procedures is by using animated counsellors, or "Avatars," to ensure that the limited time clients have with their counsellors is of the highest quality. As users ask questions or provide input, avatars intelligently respond with voiced, context-sensitive responses. It is possible to choose an avatar's age, gender, haircut, skin tone, hair and eye colour, and apparel. A more engaging method of delivering online education and support for those in recovery, avatars may be used to collect data from patients with poor literacy abilities and supply routine information.

Cell phones that use GPS technology provide services considerably beyond what is typically provided. For instance, if a recovering person chooses to be tracked by GPS, the system may alert the person's support network as well when they approach an area where relapse is more likely. Also, in an emergency, GPS can be utilized to find nearby providers or gatherings.

It's high time that we as a society recognise SUD not as a moral failure or choice of addicts but as a chronic medical condition that has been scientifically proven to respond very well to treatments. By not giving medical treatment to people with SUD, our country is losing productive members of society, which is dragging down our country's economy. Also, cured addicts should not be made to live in isolation. Society should understand that they are now recovered and should be treated well and given a chance to improve.