Is someone in your family abusing drugs?

Question: I have a 17-year-old brother who has been acting differently for the past four months. I came across some of his test papers and I was shocked to see that his scores were way below the passing mark.

My mom and dad have also noticed that they have been losing cash from their wallets. I lost my gold bracelet lately. We are only four people at home–my parents, myself and my brother; we have no helper.

I learned that my brother has been hanging around with teenagers in our subdivision who are allegedly using drugs. He also seems to have a sleeping problem and has been losing weight. He recently said that he is being persecuted by his teachers and classmates.

Is my brother a drug addict or is he becoming crazy? How can I help him? – Concerned Sister

Dear Concerned Sister,

From what you have related, your brother appears to be suffering from substance abuse. His change in behavior–his delusions of being persecuted, his poor academic performance and his insomnia–are symptoms of a drug-induced psychosis. Money and jewelry are also missing at home and sad to say, it appears your brother is the culprit.

The most easily acquired prohibited substance abused in local communities is metamphetamine (shabu). Try to look for aluminum foils and other tube paraphernalia or small plastic containers with white crystal residues. If you find any of these, then your brother is most probably abusing shabu.

Are you close to your brother? If so, try to have a heart-to-heart talk with him and tell him your concerns and your desire to help him. If you’re not buddies, it’s wiser to tell your parents your suspicion that he may be abusing a prohibited substance. Your parents are in a better position anyway to influence your brother to seek treatment.

At this point, before undergoing drug rehabilitation, your brother must first undergo at least two weeks to detoxify the abused substance from his body. Detoxification is best done in a hospital setting under a psychiatrist and a clinical toxicologist.

To be sure of the substance being abused by your brother, a narcotic analysis of his urine must be done. This will tell you if he is abusing just one substance or several substances. Blood alcohol level determination must be done if you suspect that he may also be a chronic drinker.

When do we psychiatrists say that a person is a drug-dependent? According to the DSM-IV Diagnostic Criteria for Substance Dependence, we can make this diagnosis if there is a pattern of substance abuse leading to significant impairment or distress with three or more of the following manifestations occurring at any time within the same 12-month period:

1) Tolerance, as defined by either of the following:

a) Need for markedly increased amounts of the substance to achieve intoxication or the desired effect.

b) Markedly diminished effect with continued use of the same amount of substance.

2) Withdrawal as manifested by either of the following:

a) The characteristic withdrawal symptom for the substance.

b) The same substance is taken to relieve or avoid withdrawal symptoms.

3) The substance is often taken in large amounts or over a longer period than was intended.

4) There is persistent desire or unsuccessful efforts to cut down or control substance abuse.

5) A great deal of time is spent in activities necessary to obtain the substance.

6) Important social, occupational or recreational activities are given up or reduced because of the substance abuse.

7) The substance use is continued despite knowledge of having a persistent or current physical or psychological problem that is likely to have been caused or exacerbated by the substance.

From your description, your brother may not yet be a drug dependent but he will be if your family does not act now and help him receive treatment. Once seen by a psychiatrist, the drug (or drugs) will be removed from his body and he will also receive treatment for his drug-induced psychosis.

Usually in psychiatric facilities, individual and group therapy are given to persons undergoing detoxification and abatement of the psychotic state induced by a prohibited substance. This is expected to be achieved within a two-week period. The next step of therapy–that of a drug rehabilitation program–will then be discussed with the patient and the family.

The existence of other psychiatric problems will also be checked at this point to find out, for example, if the patient has a personality disorder.

I advise you and your family to take your brother to a qualified psychiatrist and to a medical center with accredited drug detoxification and rehabilitation programs. You may make such inquiries from the Philippine Psychiatric Association, Inc. (tel. nos. 635-9858; 632-7814; ppa@pacific.net.ph; www.ppa.org.ph)

* * *

(In case you have other problems, particularly about love, looks and relationships you would want me to discuss in this column, do send your letters to me at the Philippine STAR c/o Allure Section or send them directly to Suite 506 Medico Bldg., Lourdes Street, Pasig.)