NASHA MUKT BHARAT CAMPAIGN

IN 272 DISTRICTS

15TH AUGUST 2020 – 31ST MARCH 2021

COMPENDIUM

MINISTRY OF SOCIAL JUSTICE & EMPOWERMENT

GOVTERNMENT OF INDIA

ANNEXURE VII

INDEX TOPICS

SUBSTANCE & ITS TYPES

SIGNS & SYMPTOMS OF SUBSTANCE ABUSE

NYTHS & FACTS RELATED TO SRUG ABUSE

GOVERNMENT INITIATIVES

LIFE SKILLS MODULE

ANEXXURE:

SCRIPT FOR MASTER VOLUNTEERS

CHAPTER 1: TYPES OF SUBSTANCES & ITS EFFECTS

In India, substance abuse and its addiction has surfaced as an urgent problem having high-risk repercussions, which poses a threat for the person, their family and the society. For this, prevention has proved to be the most effective approach. Ministry of Social Justice and Empowerment being the Nodal Ministry for Drug Demand Reduction coordinates, implements and monitors several interventions which include prevention, assessment of extent of the problem, treatment and rehabilitation of users, dissemination of information and generation of awareness among the public.

Prevalence of Substance use in India

The Ministry has conducted the first National Survey on Extent and Pattern of Substance Use in India through the National Drug Dependence Treatment Centre (NDDTC) of the All India Institute of Medical Sciences (AIIMS), New Delhi during 2018. Some of the findings as per the report are (1) Alcohol is the most common psychoactive substance used by Indians followed by Cannabis and Opioids. (2) About 16 Crore persons consume alcohol in the country; more than 5.7 Crore individuals are affected by harmful or dependent alcohol use and need help for their alcohol use problems. (3) 3.1 Crore individuals in India use cannabis products; about 25 lakh suffer from cannabis dependence. (4) 2.26 Crore use opioids; approximately 77 lakh individuals are required help for their opioid use problems. (5) 1.7% of children and adolescents are inhalant users. Nearly 18 lakh children need help for inhalant use. (5) About 8.5 lakh people are injecting drug users (PWID). Findings also indicates that most vulnerable age group is that of children who has to be protected from widespread prevalence of substance abuse.

Ministry of Social Justice and Empowerment has developed a National Action Plan for Drug Demand Reduction (NAPDDR) in this regard. This plan serves as an umbrella scheme which includes elements of preventive education and awareness generation, capacity building, treatment and rehabilitation, setting quality standards, focussed intervention in vulnerable areas, skill development, vocational training and livelihood support of ex-drug addicts, surveys, studies, evaluation and research. Projects and schemes are funded for implementation and initiatives towards the Drug Demand Reduction in the country are carried out through the Government of India, State/UT Governments, implementing agencies like NGOs, Trusts, and Autonomous organisations, Technical Forums, Hospitals, and Prison Administrations and so on and so forth.

Nasha Mukt Bharat Campaign (NMBC)

For the year 2020-21 Ministry of Social Justice and Empowerment has formulated an Annual Action Plan ‘Nasha Mukt Bharat’ to be implemented in 272 districts which are identified as most vulnerable in terms of usage of drugs. It has been launched with an aim to train

responsible young population to increase community participation and public cooperation in the reduction of demand for dependence-producing substances and promote collective initiatives among individuals and groups vulnerable to prevent the usage of drugs in the first place.

SUBSTANCE AND ITS TYPES

Before going into the details of drugs, let us have a look at the major classification of the

substances first:

Types of Substances at a glance

Name Examples

Stimulants Cocaine, Caffiene Nicotine, Amphetamine and Meth Amphetamine

Depressants(Sedatives)

Alcohol and Barbiturates

Hallucinogens LSD, MDA

Dissociative. DXM

Opioids Heroin

Inhalants Volatile gases and solvents, Nitrates and Aerosols

Cannabis Marijuana, Ganja , Hemp, Hashish, Grass, Skunk

Stimulants

Stimulants are drugs that stimulate the Central Nervous System. These substances tend to increase alertness and physical activity. They include Amphetamines, Cocaine, Crack and some inhalants like

Amyl or Butyl Nitrites. Caffeine (present in tea, coffee and many soft drinks) is also a mild stimulant drug.

Which stimulants are abused?

The most widely abused stimulants are cocaine, crack (a pure form of cocaine) and amphetamines

What do they look like?

Stimulants appear in many forms. Pharmaceutical amphetamines are usually produced as pills or capsules, whereas street amphetamines come in the form of a fine, white dull powder. Inhalants can be prescribed or purchased in small glass vials, which are crushed to release the vaporising fluid inside, or in small bottles. Cocaine is a relatively fine, white crystalline powder. Crack is seen as cloudy white crystals that are irregular and fairly large (pea-sized).

Effects of stimulants

o Suffer from mood swings, high temperature, irregular heartbeat, increased anxiety.o Physical symptoms include chest pain, nausea, blurred vision, fever, and muscle

contractions.o The person also experiences insomnia and weight loss.

Depressants

These are substances that slow down or depress the Central Nervous System. Depressant drugs include alcohol, barbiturates and tranquillisers. It's worth remembering that, although alcohol is a legal drug and can be purchased by any person over 18 years old, it can be a dangerous drug, particularly when abused.

Alcohol

Alcohol is the common name for ethyl alcohol. It's a Central Nervous System depressant and is one of the most widely used (and abused) drugs in our society.

Effects of Alcohol:

o Causes slurred speech and lack of emotional controlo Increase in violent actions. o Higher dosage can cause unconsciousness or even death.o Long-term effects include memory loss, difficulty in thinking clearly, difficulty in

problem-solving, poor concentration, and addiction.

Barbiturates

Barbiturates are central nervous system depressants. They act in a similar manner to alcohol and slow down many areas of the brain. Drugs of this class are known as sedative/hypnotics,

in that they can be used as sedatives to calm people and also (at higher doses) as hypnotics to assist sleep.

Hallucinogens

Hallucinogens - or psychedelics - are drugs that affect a person's perception of sights, sounds, touch, smell etc. Some of the stronger hallucenogenics can exert a powerful effect on a drug users thinking and self-awareness.

Which hallucinogens are abused?

Hallucinogens do not have any legal medicinal uses and are therefore all classed as drugs of abuse. The most commonly seen are LSD, Ecstasy and psilocybin (magic mushrooms). Other hallucinogenic substances such as mescaline and DMT are not widely available in the illicit drug market of the UK.

Effects: o rapid and intense emotional swingso user disassociates from their surroundingso leads to an altered sense of space and timeo difficult to think clearlyo panic attacks and anxietyo delusionso paranoia

Dissociative

Consumption of this type of drugs causes feelings of being separate from one’s body and environment and impaired motor function. Ketamine drug leads to analgesia, impaired memory, delirium, respiratory depression and arrest, death. Intake of DXM causes euphoria, slurred speech, confusion, dizziness, distorted visual perceptions. Some of the health risks that these drugs poses are anxiety, tremors, numbness, memory loss, nausea. Etc.

Opioids

Opioids refers to Opium (including doda/phukki/poppy husk), Heroin (including brown sugar/smack) and Pharmaceutical Opioids. A substantial proportion of people using opioids are using it in a dependent or harmful pattern.“Heroin is the most popular form of opioid consumption. It is a white powder, which has a bitter taste. It is made from the sap of the opium poppy plant. It typically binds / numbs the receptors in the central nervous system, which causes the feeling of pain. It was previously used as an anaesthetic, but now its usage is illegal.

Short- and long-term effectso depressiono loss of libidoo hallucinations and other psychotic symptomso feelings of detachment

Inhalants

Inhalants are chemicals that produce mood-altering vapors. Many people don't usually think of inhalants as drugs because most of them were never meant to be used that way. There are more than a thousand different commercial products that can be abused for their mood-altering properties.

They can be divided into three main categories:

o Volatile gases and solvents: Such as cigarette lighter gas, cleaning fluids, spray paint, paint thinner, correction fluid, nail polish remover, petrol and glues.

o Aerosols: Such as hair spray, deodorants and other spray products that are abused more for the propellant gas, than for the contents.

o Nitrates: Such as Amyl nitrite, which has medical applications for heart patients and Butyl nitrite, which is used in room deodorizers.

Effects of Inhalants

o Headache, nausea, vomitingo Loss of motor coordinationo Breathing problems o Loss of coordinationo Mood swingso Sniffing can lead to suffocation and heart failure and instant death

Cannabis

Cannabis, also known as marijuana among other names, is a psychoactive drug from the Cannabis plant used for medical or recreational purposes. People take cannabis as a way of relaxing and getting high. The affects you experience will largely depend on: whether you are used to taking the drug, how much you take, the type of cannabis you use, your genes, if you have experience of anxiety and depression - you are more likely to experience negative side effects.

Cannabis is a Central Nervous System depressant obtained from the plant Cannabis sativa, which grows in many parts of the world. It is available for use as a drug in three main forms: as the dried leaves and buds, known as grass or marijuana, as a solid resin (hashish or hash) which is collected from the buds and flower heads, and also as a thick liquid prepared from the flowers or resin (hash oil).

Drug abuse leads to addiction.Addiction is a complex disease to understand. It can affect the brain and the body and you can be addicted to a substance or an activity. There have been suggestions that addiction can be genetic. It can cause harm to your families, ruin relationships and put jobs in danger.

Effects of drugs and alcohol on health?

Increase of cardiovascular disease Liver damage from both drug and alcohol abuse Kidney damage resulting in dialysis Pain and pleasure receptors can be affected by drug abuse alongside mental health and

memory. Increased risk of lung cancer when smoking drugs

How Drug Abuse is caused?

Stages of Addiction

Frequency Source Reasons

Stage 1 Experimental or social use

Occasional, few times a month

Friends and Peers

Curiosity, peer pressure, social acceptance, experience pleasure.

Stage 2 Abuse Regular, Several times a week.

Friends, may sell drugs to ensure personal supply

Manipulate emotions, cope with stress, guilt, maintain high.

Stage 3 Dependency Daily Use Will adopt any means to obtain drugs.

Escape life realities, withdrawal symptoms.

The above table suggests how a person moves from just a ‘user’ to a ‘dependency’ stage. During this process of movement from user to dependent, there is also a change in frequency of drug usage, sources of drugs, and reasons for drug usage itself. Therefore, it can be concluded here that precautionary measures and prevention is necessary to be taken right at the 1 st stage, otherwise a strong dependency will develop by the user. Hence, the Nasha Mukt Bharat Campaign is an important intervention. It endeavours to nurture the spirit of volunteerism amongst the community and hold them accountable for working towards a drug-free society.

Cycle of Substance Abuse

Activity 1:

ACTIVITY

CHAPTER 2: SIGNS & SYMPTOMS OF SUBSTANCE ABUSE

To identify whether a person is suffering from addiction, one needs to be aware about the signs, so that help could be provided. Addiction can be seen through physical and behavioural changes in a person, but it has to be noted that symptoms vary depending upon the type of drug consumed.

Physical symptoms could occur due to two main reasons.

i. Side effect of drug usage. ii. As a result of withdrawal which mainly arises when the body is trying to adjust to the

absence of drug intake.

Recognising physical signs can be difficult in the starting phase but severe cases may require immediate medical treatment. Needle marks on lower arm, leg, or bottom of feet and tremors/shakes of hands, feet or head are important identifiers.

Other signs/symptoms are as mentioned:

i. Inability to sleep leading to insomnia in extreme cases. ii. Feeling of lethargy. iii. Loss of or increase in appetite. iv. Bloodshot or glazed eyes. v. Unusual smell from clothes or individual, especially breath. vi. Extreme hyperactivity, increased/ irregular heartbeat.vii. Walking slow or staggering due to poor loco-motor coordination. viii. Nausea, vomiting or excessive sweating.ix. Running nose or cough. x. Frequently rubbing nose or twisting jaw back and forth. xi. Sense of hygiene is poor and physical health also goes down. xii. Puffiness with redness/paleness of face could also be seen.

Behavioural symptoms

Drug use can affect an individual’s personality to the point where there is a significant change in their behaviour/attitude leading to impairment of societal relationships and social functioning. It can influence the way they perceive their environment as the brain’s ability to comprehend situations get altered.

Signs/symptoms are as mentioned:

i. Change in overall personality/attitude with no other identifiable cause.

ii. Low performance in school/work, skipping or being late to daily events.

iii. Change in hobbies or activities iv. Chronic dishonestyv. Increased anger or irritabilityvi. Difficulty concentrating or

forgetfulnessvii. Lack of motivation, energy, or self-

esteem, general fatigue

viii. Disinterested attitudeix. Loss of interest in activities with

family/friends leading to isolation x. Depressionxi. Unexplained need for money,

stealingxii. Paranoia xiii. Excessive need for privacy xiv. Secretive or suspicious behaviour xv. Involvement in criminal activityxvi. Complaints of sore jaw (from teeth

grinding during an ecstasy high)

Drug specific symptoms

Alcohol

Effects can be individual specific depending upon factors such as age, health status, tolerance level, amount of consumption, frequency of intake, family history.

Signs/symptoms

i. Difficulty in walkingii. Slurred speechiii. Sleepinessiv. Dilated pupils

v. Poor judgementvi. Blacking out- failing to remember

events which occurred after heavy drinking episode

Stimulants- Cocaine, Crack, Meth.

Stimulants activate the reward system in the brain which releases feel-good hormone during a high episode making it highly addictive.

Signs/symptoms

i. Increased Hyperactivity. ii. Euphoria. iii. Irritability. iv. Anxiety. v. Talking a lot followed by depression. vi. Sleeping at odd times excessively.

vii. Going a long period of time without eating or sleeping.

viii. Dilated pupils.ix. Dry mouth and nose. x. Weight lossxi. Sexual dysfunction.

Heroin

Heroin has various forms and it can be consumed through smoking, snorting, or injecting it under the skin, into muscle or directly into the veins.

Signs/symptoms

i. Needle marks on arms or legsii. Sleeping at unusual timeiii. Sweatingiv. Vomiting v. Coughing and sniffling

vi. Twitchingvii. Loss of appetite viii. Contracted pupils with no

response to light

Spoons with burns marks is a significant sign of heroin addiction.

Depressants including barbiturates and tranquilizers

Depressants are prescribed drugs; it has been indicated by studies that 41% of individuals battling alcohol addiction use barbiturates and benzodiazepines. Among heroin users about 15% also use these drugs as reported by National Institute of Social Defence. So, the drug dependence vary based on medication and category.

Signs/symptoms

i. Difficulty concentratingii. Clumsinessiii. Poor judgementiv. Slurred speechv. Sleepiness or drowsiness

vi. Contracted or rapid involuntary eye movement

vii. Agitation viii. Impulsive behaviour ix. Lack of coordination x. Irritability

Inhalants

This category covers a range of chemicals which can be inhaled without burning or heating.

Signs/symptoms

i. Watery eyes ii. Impaired vision, memory and thoughtiii. Secretion from the nose or rashes around nasal area and mouth iv. Headache and nausea v. Drowsiness vi. Poor muscle control vii. Anxiety viii. Irritability

Lots of can/aerosols in the trash is a significant sign of inhalant user.

Hallucinogens

This drug alters the thinking process and perception of the user leading to distortion or creation of a false reality which is unique to this category.

Signs/symptoms

i. Dilated pupils ii. Slurred speechiii. Unusual and irrational behaviour iv. Hallucinations v. Paranoia vi. Mood swings and inability to

control emotions vii. Detachment from other people

viii. Manipulated perception of reality ix. Absorption with self or other

objects x. High blood pressure and tremors xi. Confusion

CHAPTER 3: MYTHS & FACTS RELATED TO SUBSTANCE ABUSE

Drugs and drug abuse not only affect the user, but also their family and, eventually, society at large. Any person who uses drugs has a relatively higher chance of progressing to drug abuse and addiction. Initially, he/she might not even realise the extent of their addiction. What makes drugs more dangerous are the myths and misconceptions around them. This adds to the stigma, and most people, due to lack of proper information are not able to overcome their addiction. Therefore, it is important to dispel all myths related to substance and substance abuse.

There are several myths and misconceptions related to drugs and drug abuse. These myths can be broadly categorised into 3 types:

Psychological Myth Social Myth Economical Myth

1.

Psychological myths related to drugs

Psychological myths are those that are related to human psychology or mind. We will first attempt to bust the myths and then study how drugs actually affect the human brain and its functioning.

Myth: Drugs increase creativity and make the user more imaginative.

Fact: It changes the user’s perception of surroundings and alters the integration of sensory stimuli. It also decreases the ability of the user to appreciate cause and effect, and to “organise, categorise and differentiate the constituents of the conscious experience.”

Myth: Drugs sharpen one’s thinking and lead to greater concentration.

Fact: Drugs induce dullness and adversely affect normal functioning of the body and mind.

Myth: Once you’re addicted, there is no hope for you.

Fact: With the help of treatment and medication, one can distance himself/ herself from substances.

Myth: One can manage to drive well enough even after a few drinks.

Fact: The effects of alcohol start sooner than people realize, with mild impairment starting to affect speech, memory, attention, coordination and balance.

Myth: Marijuana isn’t addictive.

Fact: Around 1 in 11 people who use marijuana can become addicted.

Myth: Drug dependence is simply a failure of will or of the strength of one’s character.

Fact: Not many people know but different types of drugs have different effects on the brain. Every type of drug abuse has its own mechanism for changing how the brain functions. There comes a time when the user becomes totally dependent on drugs. He or she will do almost anything for the drug.

Myth: Nothing happens if you take drugs in small quantity.

Fact: The truth is that different drugs do different things. They all affect the brain—that’s why drugs make you feel high, low, speeded up, slowed down, or hallucinate.

Myth: Drug addiction is voluntary behaviour.

Fact: A person goes from being a voluntary drug user to being a compulsive drug user. Why? Because over time, continued use of drugs changes your brain’s functioning – at times

in dramatic, toxic ways, otherwise in subtler ways, but virtually always in ways that result in compulsive and even uncontrollable drug use.

2. Social myths related to drugs

Myth: People who use drugs can’t change. It is a hopeless condition. More than anything else, drug addiction is a character flaw.

Fact: Change is always possible with the right treatment and continued support, provided the person is willing to seek help.

Myth: Drug addiction can’t be cured.

Fact: Addiction to any substance is a chronic brain disease that can be managed with counselling and sometimes with medication, but relapse is always possible. Surrounding yourself with caring, competent clinicians and loved ones can help you maintain long-term sobriety.

Myth: Most of the addicts get their first drug from a peddler or a pusher.

Fact: Most of the addict get their drug from friend or event at a home.

Myth: Substance users do not receive sufficient punishment.

Fact: The possible short and long-term consequences of substance use include morbidity, comorbidity, social isolation and stigma. People with substance dependence are among the most marginalized in societies and are in need of treatment and care.

Myth: Drinking isn’t all that dangerous.

Fact: Among college students, alcohol contributes to deaths from alcohol-related unintentional injuries, as well as assaults, sexual assaults or date rapes, and poor academic performance.

3. Economical myths related to drugs

Myth: Substance abuse is a problem only in the lower-income or socio-economic layers of society.

Fact: Substance abuse and addiction are societal issues. From urban centres to the suburbs to rural areas, no one is exempt from the impact of substance abuse.

Myth: Drug addicts are homeless, unemployed, or basically losers.

Fact: Anyone can get addicted to drugs, including doctors, lawyers, and teachers.

Myth: It's not worthwhile to invest in the treatment of individuals who have drug dependence.

Fact: Investing in evidence-based treatment for substance dependence decreases negative health consequences and social effects (e.g. crime, economic burden and HIV infection). Treatment has proven to be cost-effective in both developed and developing countries.

Myth: Drug and alcohol-related problems only affect individuals in developed countries.

Fact: There is a strong evidence showing an increase in drug-related problems in developing countries with a significant impact on mortality, disease and injury.

Myth: Rehabilitation doesn’t work for everyone. It is a waste of time and money.

Fact: It is true that it takes time to recover from addiction, especially for someone who has been abusing substances for a long time. It takes time for the brain to re-adjust and make lifestyle changes to avoid drugs. But eventually, the perseverance pays and the treatment helps people in quitting drugs — it might take several rounds of treatment, but things improve for the better.

Myth: There is already enough research for policy-making on drug and alcohol-related problems, there is no need for more.

Fact: More research is necessary to develop new treatments and preventive strategies, support services and to understand the associations between substance dependence and other risky behaviours.

CHAPTER 4: GOVERNEMENT INITATIVES TO COMBAT SUBSTANCE

ABUSE

The Ministry of Social Justice and Empowerment is implementing a Central Sector Scheme of Assistance for Prevention of Alcoholism and Substance (Drugs) Abuse under which, financial assistance is given to the voluntary organizations and other eligible agencies for, inter-alia, running and maintenance of State Level Coordination Agencies (SLCA), Integration Rehabilitation Centres for Addicts (IRCAs), Outreach Drop-In Centers (ODIC) and Community Peer Led Intervention (CPLI).

State Level Coordinating Agency (SLCA)Ministry have designated Organisations/Institutions of repute with adequate experience in the field of Drug Demand Reduction and having consistently good track record as State Level Coordinating Agency (SLCA) following the procedure prescribed by it.

Following are the roles and responsibilities of these SLCAs:

● The SLCAs shall act as technical support group to the State Government

● They will help the State Government in preparing their Annual Action Plan

● They will coordinate with the State Government in proper implementation of the

annual Action Plan

● They prepare the Annual Action Plan for their activities which should include visits,

capacity Building, Monitoring and evaluation exercise

● They should report their field visit on the E- Anudaan portal, upload the photograph

and their observations as and when the visit is carried out. This will help the Ministry in taking decisions for renewal of projects

Integrated Rehabilitation Centres For Addicts (IRCAs)

● The Integrated Rehabilitation Centre for Addicts (IRCA) provides composite /

integrated services for the rehabilitation of the substance dependent person.

● IRCA is responsible for preventive education and awareness generation among the

target groups (vulnerable and at-risk groups) in their neighbourhood

● IRCA envisages total recovery of the addicted person leading to his socio-economic

rehabilitation through an appropriate combination of individual counselling.

● IRCA also aims to enable the addict to achieve total abstinence and improve the quality of their lives. The detoxification services are given for safe and ethical management of withdrawal symptoms. The addicts are helped to overcome the desire to use drugs even when he/she is in situations which were once tempting.

Outreach and Drop-In Centre (ODIC)ODIC is a community-based facility for substance users. The ODIC caters to individuals, particularly the youth who use various substances and those who have the least access to resources. ODIC is client-focused with an ultimate goal to prevent youth in the community to initiate substance use, also to help the current users to become sober by taking treatment. An ODIC is a doorway for substance users to a non-threatening and caring environment. It is a hub for all services, which substance users can access as per his or her need and convenience. The ODIC must be within close proximity of substance users and located in the hotspot area of the substance users. In addition to addressing health needs of the substance users, ODIC will support their right to treatment and care services that are respectful and non-discriminatory. Other activities necessary for substance users will also be conducted in the ODIC (like recreational activity, group therapy, individual counselling, family counselling etc.) The ODIC will also provide psychosocial support, a space for rest and recreation, as well as access to other substance users and Outreach Workers for support and care through mutual sharing of experiences.

ODIC provides a safe, supportive and normalizing environment for individuals labelled as "Substance Users" in the community, especially among the youth who are isolated in society, and to whom even sheltered employment settings are not meeting their needs. It would provide an atmosphere of acceptance where individuals have a sense of belonging and grow in self-worth, dignity and self-respect. It would emphasise on helping individuals feel autonomous and having the capacity to make decisions. An important outcome is these individuals should develop a sense of usefulness, increase their feelings of well-being, and minimize their risk of serious health problems that may have led to hospitalization.

Target Group: Vulnerable young population prone to substance use and using substances in select geographical areas

Objectives

a) To reduce substance use in the community

b) To protect and promote human and youth rightsc) To ensure that services are accessible, community based and differentiated along a

continuum of care including psychosocial support for substance users, their primary caregivers and families

d) To conduct outreach activities among the vulnerable young population in the community for prevention of substance use

e) To provide a safe and secure drop-in space for substance users in the community, which would have provisions of screening, assessment and counselling.

f) To render psycho social interventions particularly based on behavioural approaches including Adolescent Community Reinforcement Approach, Cognitive Behavioural Therapy, Contingency Management, Motivational Enhancement Therapy, Twelve- step facilitation therapy and Group therapy.

g) To provide referral and linkage to treatment, care and rehabilitation services for substance dependents.

Program Structure

1. The centre will be led by trained staff, which will be part of a multidisciplinary team that is adequately trained in the delivery of evidence-based interventions

2. Comprehensive outreach, screening and counselling system consisting of evidence-based and integrated psychosocial interventions will be provided.

3. Basic services including outreach, drop-in and counselling support to the clients4. Basic health services and medical check-up and follow up support by a part time

Physician5. Render psychosocial interventions and linkage for treatment, rehabilitation and

vocational training

Program Activitiesa. Outreach activities in the community among young vulnerable population:

Outreach workers try to find people who need help or support rather than waiting for those people to come and ask for help. It is an activity of providing services to any populations who might not otherwise have access to the services. The agency should aim in setting up a static service point known as ODIC in the most common populated substance use sites situated among substance users in the community where substance users can freely access the centre.

b. Behaviour Change Communication (BCC) one to one and group sessions in the community by outreach workers:The Outreach Worker would help and assist the ODIC in-charge on a day to day basis and ensure that all activities of the ODIC are conducted as per the schedule and plan. The outreach worker would go to the community and interact with the substance users individually or as a group to help the substance users to identify their own problems and needs, understand what solutions can be used to address their

problems with their own resources combined with outside support. Most importantly an outreach worker would motivate and encourage the substance users to visit ODIC.

c. Screening and assessment of clients on substance use disorder at ODIC:Assessment and diagnosis of the substance users would be carried out by the doctor, nurse or counsellor of the ODIC. Assessment would be conducted on basic medical history, information on the type of substance, mode and patterns of use, abstinence attempts in the past, help or treatment sought earlier and history of exposure to contaminated blood and other risk behaviours

d. Drop-in-Centre facility for people vulnerable on substance use: Among substance users who are also injecting substances, there is a high incidence of abscesses, wounds, cellulites, vein collapse etc. that result in physical discomfort or pain often affecting normal duties and chores. Substance overdoses can arise and these can be fatal. Such centres will cater to the needs of substance users and serve as a critical point to initiate risk reduction. The ODIC would provide facilit ies like the recreation room, counselling room and medical room. It will also provide outpatient treatment services for substance use related issues such as abscess and wound management, substance overdose management, psychiatric treatment support, as well as issues of HIV/AIDS and hepatitis B and C. Harm reduction services and messages will be provided to substance users who do not have the capacity to cease their substance use with immediate effect in their life. The aim is to keep substance users alive, healthy and productive until treatment works or they grow out of their substance use.

e. Individual, group and family counselling:The ODIC would provide counselling service to the substance users individually and as a group. The counselling session would be taken up by a trained counsellor on a daily basis where he/she would help and assist the substance users to retrospect what was the reason and cause behind the intake of substances by the substance users and give awareness on the negative impact the substances can cause to the substance users.

The substance users would be involved in group discussion where various issues pertaining to substances and other related issues and information will be discussed. The counsellor would also give counselling to the family of the substance user because family play a vital role in avoiding their children in taking substances.

f. Specific Psychosocial interventions based on behavioural approaches:

Behavioural interventions help adolescents to actively participate in their recovery from substance abuse and addiction and enhance their ability to resist substance use. In such approaches, therapists may provide incentives to remain abstinent, modify attitudes and behaviours related to substance abuse, assist families in improving their communication and overall interactions, and increase life skills to handle stressful circumstances and deal with environmental cues that may trigger intense craving for substances. Few such interventions include Adolescent Community Reinforcement Approach, Cognitive Behavioural Therapy, Contingency Management, Motivational Enhancement Therapy, Twelve- step facilitation therapy and Group therapy.

g. Provision of consultation with doctor for referral and linkage with treatment facility:Upon visit to the ODIC by the substance users, the substance users would be introduced to the various services offered in the ODIC. Then, the staff of the ODIC would make an assessment of the client regarding the basic medical history, information on the type of substances, mode and pattern of use, abstinence in the past, history of exposure to contaminated blood and other risk behaviours. Based on the assessment, the substance users would be referred to various services like HIV related issues, TB centre, shelter home, absence prevention, detoxification-cum-rehabilitation centre etc.

h. Safe and secure space for substance dependent youth accessible, in the community: The ODIC would have a recreation room which would be the main entry room and the biggest of all the other rooms in the centre, a separate counselling room, and a medical room.

i. Complementary therapies including art, music, dance and yoga for early recovery/Life Skills Program:The organization would involve the client practically using Life Skills as a tool to help the substance users to recover faster. The organization believes that involving and doing physical activity would have an impact on the substance users rather than making them sit and listen. The organization would focus on the impact it can give to the substance users on holistic development be it in literacy, coping skill, behavioural change, adaptive behaviour etc.

j. Vocational training of the Substance Users:Substance users during the course of the treatment will have the option of linking with vocational training, so that post treatment they could seek a job to sustain themselves.

k. Follow up care including family counselling:

With the objective to make the best possible intervention among the substance users, the substance user would be assessed post their recovery from the centre. Follow up on a weekly/monthly basis would be adopted by the organization. The staff of the organization would keep regular in touch with the substance user parents and family counselling would be given/provided even at the centre and also at home during the house visit by the team of the organization. The organization aims to update and keep on track about the status of those substance users who are released from the centre

Community based Peer led Intervention (CPI) for Early Drug Use Prevention among Adolescents

Community based Peer led Intervention programmes would be launched in the identified districts depending upon the requirement. Through these programmes, the youth would be trained as Peer Educators to lead peer led community intervention and implement early prevention education especially for vulnerable adolescents and youth in the

community. This programme would also provide referral and linkage to counselling, treatment and rehabilitation services for drug dependents identified in the community.

Objectives:a) Outreach activities in the community among young vulnerable population for

community mapping and assessment b) Identification and Training of youth as Peer Educators to lead peer led community

interventionc) Behavioural change communication sessions for community by Peer Educators d) Individual, group and family counsellinge) Screening and assessment of clients on substance use disorderf) Ensure referral and linkage to service centresg) Complementary therapies including art, music & dance for early recoveryh) Follow up care including family counselling

Programme Structure

1. The Peer Educators will focus on creating awareness among the vulnerable children and adolescents on prevention of substance use

2. The staff will deliver early prevention interventions on substance use3. Render psychosocial interventions including educational sessions on life skill

education, ill effects of substance use, risk assessment on substance use among youth and linkage for treatment and rehabilitation

A peer educator would train the peers to

• Plan and organize awareness programs through life skill education • Facilitate, record and evaluate the work • Encourage reflection on substance use amongst their peers• Identify adolescents with substance use disorders

Programme Activities

a) Peer led activities in the community among young vulnerable populations for community mapping and assessment

b) Identification and training of young adolescent as Peer Educators to lead peer led community intervention

c) Life Skill education sessions by Peer Educators d) Promoting life skillse) Dissemination of substance information and educationf) Ensure referral and linkage to service centresg) Psycho social care including follow up and support

The other activities for integrating and disseminating information include sports and other recreational activities that are promoted and used as opportunities for young people to progress. Each one becomes ‘the other’s keeper’, providing good role models that portray health-seeking behaviour, peer pressure, managing one’s own emotions and a step-by-step process on how to sustain the desired positive behaviour.

ACTIVITY:

LIST OUT THE NUMBER AND LOCATIONS OF GOVERNMENT INITIATIVE IN YOUR STATE AND DISTRICT

STATE: _______________________________________

IRCAS: ________________________________________

ODICS : _______________________________________

CPLIS: ________________________________________

OTHERS: _______________________________________

CHAPTER 5: LIFE SKILLS TRAINING MODULE

INDEX

S.No Life Skills

1 Empathy - (Fear will lead to Tear)

2 Problem Solving - (Knot Knot)

3 Critical Thinking - (Mad Angle)

4 Self-Awareness - (Know yourself)

5 Coping with Emotions - (Self- Musing/Care)

6 Coping with Stress - (Action and Reaction)

7 Interpersonal Skills - (Wheel of Refusal)

8 Decision Making - (Ice & Fire)

9 Creative Thinking - (Strike a pose)

10 Effective Communication - (Your Influences- Peer resistance skills)

Activity 1Fear will lead to Tear

Skill – Empathy

Empathy – is the ability to imagine what life is like for another person. Without empathy, our communication with others will amount to one-way traffic. Worst, we will be acting and behaving according to our self interest and are bound to run into problems. No man is an island, no woman either! We grow up in relationships with many people – parent, brothers and sisters, friends. Empathy can help us to accept others, who may be very different from ourselves. Purpose- Provide the opportunity to know other people and understand their feelings.

Materials Needed: - Pen, paper and bowl or empty box

Procedure: - Everyone should anonymously write a fear one piece of paper and put it into

bowl. - The bowl should then be passed around the group and each individual should

draw a piece of paper and talk about the fear they selected. - How do you think the person who wrote on that paper developed their fear?- Do you share the same fear? - Can you think of any ways to conquer that fear or turn it into something

constructive? - Do this exercise with other emotions and scenarios as well to further practice

empathy.

Outcome:- This will help to understand what other person feels. This practice will help to

encourage nurturing behaviour towards people in need of care and assistance who may be stigmatized and ostracized by the very people they depend upon for support.

Activity 2

Knot-Knot

Skill – Problem SolvingProblem Solving helps us to deal constructively with problems in our lives.Significant problems that are left unresolved can cause mental stress and give rise to accompanying physical strain.

Purpose- Learn and understand the source/ reason of problem and find out solution

patiently. - Problem-solving gives us a mechanism for identifying these things, figuring out

why they are broken and determining a course of action to fix them.

Materials Needed: - Rope or long Ribbon

Procedure: - Make a pair of participants (Male with male and female with female to make

them comfortable). - Each participant receives one rope and ties loops on either end large enough to

insert their hands like a pair of handcuffs. Tip: the loops should be loose enough that participants can easily take their hands out for safety purposes. It will also make the trick easier to accomplish (Shown in picture below).

- Participants now need to figure out how to separate themselves from their partner without removing the handcuffs or breaking or damaging the ropes in any way. They must be able to show you how they accomplished it.

- The goal is to get the ropes untangled without opening the knots or otherwise removing the rope from around your wrists.

Outcome:

- A problem-solving strategy is a plan of action used to find a solution. Different strategies have different action plans associated with them ([link]). For

example, a well-known strategy is trial and error. When using trial and error, you would continue to try different solutions until you solved your problem.

- Having the support of others in solving problems is important. Diversity of thought and of problem solving style can result in better solutions.

Activity 3Mad Angle

Skill – Critical thinking

Critical thinking is an ability to analyze information and experiences in an objective manner. Critical thinking can contribute to health by helping us to recognize and assess the factors that influence attitudes and behaviour, such as values, peer pressure and the media. Purpose- Thinking clearly and systematically can improve the way we express our ideas.

Materials Needed: - Worksheet and Pen (Worksheet 3.1)

Procedure: - Provide worksheet to each participant. - Give 10 mins to solve the worksheet. - Discuss the answer in joyful manner.

Outcome:- In learning how to analyse the logical structure of text, critical thinking also

improves comprehension abilities. No answer is incorrect. It is just a perspective. Critical thinking enhances language and presentation skills.

- Critical thinkers rigorously question ideas and assumptions rather than accepting them at face value. They will always seek to determine whether the ideas, arguments and findings represent the entire picture and are open finding that they do not.

Worksheet 3.1

1. Connect all the dots by drawing four straight, continuous lines that pass through each of the nine dots, and never lifting the pencil from the paper.

2.

3.

4.

5.

6. How many blocks are there in this picture?

7.

8. How many circles contain the black dot?

9.

10.

Activity 4Know yourself

Skill – Self AwarenessSelf-awareness includes recognition of ‘self’, our character, our strengths and weaknesses, desires and dislikes. Developing self-awareness can help us to recognize when we are stressed or feel under pressure. It is often a prerequisite to effective communication and interpersonal relations, as well as for developing empathy with others.

Purpose- Provide the opportunity for participants to know yourself.

Materials Needed: - Worksheet, pen and paper

Describe yourself in words

Describes anyone person in your life in words

Your Strength

Your Weakness

describe an ideal person

Why descriptions differ

Handout: “Worksheet: Know Yourself” (Worksheet 4.1)

Procedure- Project the “worksheet: Know Yourself” hand out or provide participants with a

copy, and have they fill in thought blocks about themselves. Ask for a few volunteers to share their experiences related to strength and weaknesses and worksheet. .

- This activity can be done individually.

Outcome- In the end of the activity, participants will get to know about their personality traits.

Worksheet 4.1Activity 4

Know yourself

Describe yourself in words

Describes anyone person in your life in words

Your Strength

Your Weakness

describe an ideal person

Why descriptions differ

Activity 5Self- Musing (Care)

‘Healthy habits will lead to healthy and happy life’

Skill – Coping with Emotions

Coping with emotions means involving recognizing emotions within us and others, being aware of how emotions influence behaviour and being able to respond to emotions appropriately. Intense emotions like anger or sadness can have negative effects on our health if we do not respond appropriately.

Purpose- Provide the opportunity for participants to coping with emotions

Materials Needed: - Pen and paper, flash cards of emotions.

Procedure- Ask participants to make a circle. (If the participants are more than 20 above than

two circles can form and assign two group leaders)- Trainer will describe what self-care is. (Description given in script)- Trainer will ask participants few questions related to self-care.- Questions are:-

A. What are your self-care goals? (eg. Maintain good health)B. What are you currently doing to achieve these goals? (eg. Eating healthy food)C. What can you do in the future? (eg. Meditation and yoga)D. What should you stop doing? (eg. Stop eating junk food)E. Would you say you currently have a healthy lifestyle? (eg. Yes/No)F. Why or why not? (Participants will give their views)

Outcome- In the end of the activity, participants will get to know the importance of self-caring/love.

Activity 6Action and Reaction

“Every Actions Has Equal and Opposite Reactions”

Skill – Coping with StressCoping with stress means recognizing the sources of stress in our lives, recognizing how this affects us, and acting in ways that help us control our levels of stress, by changing our environment or lifestyle and learning how to relax.

Purpose- To cope with day today stress without any negativity reaction.

Procedure- Ask participants to make a circle. (If the participants are more than 20 above than

two circles can form and assign two group leaders)- Trainer will describe what forgiveness is. (Description given in script)- Trainer will ask participants few questions related to self-care.- Questions are: -

A. Is there anyone in your life that you would like to forgive? (eg. Yes/No)B. What would you say to them in that scenario? (eg. Please do not behave

in that manner which you have shown in the past)C. How would you like them to respond? (eg. Polite)D. Have you ever forgiven yourself for your past actions and reactions? (eg.

Yes/No)E. Share your experience of forgiving self and others?

Outcome- Holding anger/guilt/disgust within yourself then it leads to unnecessary stress.

This stress can harm our relations with others. The act of forgiveness helps you to coping with stress. So, it is important to recognize the sources of stress in our lives, how this affects us, and acting in ways that help us control our levels of stress, by changing our environment or lifestyle and learning how to relax.

Activity 7WHEEL OF REFUSAL

Skill – Interpersonal SkillsInterpersonal relationship skills help us to relate in positive ways with the people we interact with. This may mean being able to make and keep friendly relationships, which can be of great importance to our mental and social well-being. It may mean keeping, good relations with family members, which are an important source of social support. It may also mean being able to end relationships constructively.

Purpose:

- To initiate conversation between participants and help brainstorm various ways to refuse offered drugs/alcohol.

- Participants will gain and be exposed to new strategies by composing a wheel with refusal skills.

Materials:- Piece of paper- Pen or Pencil- Large easel pad, whiteboard, or chalkboard (optional)- Reference sheet (Optional) (Reference sheet 7.1)

Procedure:1. Activity:

- Instruct participants to draw a wheel with 8 equal pie pieces, on a blank piece of paper

- Allow participants 3-5 minutes to fill out half of the wheel with strategies/ways to “say no” or refuse alcohol or any drugs.

- If participants are struggling to come up with strategies, state that they will have an opportunity to fill out their wheel as the activity continues

- Once completed, have participants meet in pairs- For 2-3 minutes, participants can discuss their answers- To conclude the activity trainer will draw the same wheel on a large easel

pad, whiteboard or chalkboard. This will be the wheel represents present group of participants.

- Ask a few participants to share one or two of the refusal skills they wrote down with the entire group.

- While listening to the responses think about the common themes and use that information to fill out the common wheel. (Description given in script)

- When looking at the answers/responses, make sure none of these are making fun of or putting down people

- We want to encourage, if at all, possible answers that do not make fun of, put down or humiliate anyone.

- Encourage participants to use the common wheel as guide to complete the rest of their wheel.

2. Wrap- up: (Questions)

i) What strategies could you see yourself using? Why?

ii) Any strategies you may not want to use? Why?

Reference sheet 7.1Activity 7

ACTIVITY-8Ice & Fire

‘When you have a big problem, melt it down to solve it’

Skill – Decision MakingDecision making helps us to deal constructively with decisions about our lives. This can have consequences for health. It can teach people how to actively make decisions about their actions in relation to healthy assessment of different options and, what effects these different decisions are likely to have.

Purpose- Participants begin to learn a decision making strategy that will help them improve the quality of the choices they make.Procedure-

- Setting the stage: Open a discussion on decision-making. Have you ever made a choice that resulted in a consequence that you did not want? Invite the participants to share. How do we decide whether we should do something or not? How do you make a choice or a decision? If we want to improve our consequences, we have to improve our decision-making strategies.

- Read definition for decision making: The process of examining your possibilities, options, comparing them, and choosing a course of action.

- Explain the strategies & flow of decision making through notion of “ICE & HEAT” –- First write/project/tell the full form of ICE & HEAT:-

- Explain participants that when we would encounter with any problem than we should: -

First collect the information, Secondly calculate the positive and negative consequences, Lastly execute with our decision.

- In order to melt down the problem we should use HEAT exercise:- We may explore our support system, Wisely use our emotions and values, Always think about the as many alternatives and .

One should resolve it on first encounter. - Divide participants into two or four group in any play-way manner.

I - InformationC- ConsequencesE – Execute

H – HelpE – Emotions & ValuesA – AlternativesT- Time

- Provide a situation(s) and answer sheets to each group. (situation(s) Card 8.1 & Answer sheet 8.2)

- Ask them to write solution to a given problem in by following rules mentioned below:- (15min)

A. One solution by each individual of group secretly (DO NOT SHARE WITH OWN GROUP MEMBERS)

B. Another one solution should be written by discussing with group members.

For example- If the group is of 20 members than 4 groups can be made. Each group have 5 members Than 6 solutions from each group (5 individual + 1 group decision = 6)

- After 15min everyone ask to share their individual and group suggestions. (Resource person can facilitate a controlled group discussion)

- Once everyone is completed with their views than outcome & conclusion of activity can be discussed.

Outcome & conclusion-

We all encountered with difficult situation in our day today. Our decisions are affected by –

Personal & private actions (thoughts, memories, experience & emotions effects) Peer and social actions (persuade, support, teach, lead & effects) Organizational action (policies, procedure, products, laws & organizations effects) Culture changes (products, symbols, stories and norms)

Today we have learnt to think about options and the consequences of those options in making decisions. This ICE-HEAT modal will help you to make better choices in your life. When you have an important decision to make, start by stating the problem. Next, move through HEAT waves one by one to melt down the problem. When you have a decision to make fill in the blanks and chose the wiser one for yourself.

Situation cards 8.1

Family Party/get together

Scene: You are at a family get-together and the adults there are busy with themselves; not paying attention to the young people. Your older, popular cousin from high school is [using

Hanging Out at the Mall/ somewhere outside

Scene: You are at the mall, in the food court. You are sitting with a small group of mainly new friends. One of these new friends pulls out a [using drugs/alcohol/any other substance] and

Answer sheet 8.2

A. Individual suggestion (Not be disclosed with group members)

B. One mutual suggestion of a group

Family Party/get together

Scene: You are at a family get-together and the adults there are busy with themselves; not paying attention to the young people. Your older, popular cousin from high school is [using

Huge Friends house Party

Scene: You have been invited to a huge house party in which you know approximately half of the people. Many of the people there are high schoolers. One of the cool kids is outside [using drugs/alcohol/any other substance]. You notice, and he/she turns to your group and asks who would like to try it.

Task: As a group, discuss how each of you would respond to this high schooler. Use that discussion to develop a 1-3 minute skit showing the scene and how different kinds of people would respond to the offer. Keep in mind where you are and who is there. You will be presenting this skit to the entire group.

Hanging Out at the Mall/ somewhere outside

Scene: You are at the mall, in the food court. You are sitting with a small group of mainly new friends. One of these new friends pulls out a [using drugs/alcohol/any other substance] and

1 2 3 4

Who can help Choices Values & Emotions

consequences

1 2 3 4

Who can help Choices Values & Emotions

consequences

ACTIVITY-9Strike a pose

Skill Creative Thinking

Creative thinking is a novel way of seeing or doing things that is characteristic of four components – fluency (generating new ideas), flexibility (shifting perspective easily), originality (conceiving of something new), and elaboration (building on other ideas).

Purpose- Participants begin to learn a creative ways of thinking that will help them dealing with problems in creative manner.

Setting the stage- “A cardboard box became a racing car. Children are used to looking at objects for what they can be, instead of what they are at face value. As adults, as we experience more criticism and feedback, we become less open to playful and creative thinking. We get embarrassed more easily at our ideas. And, in turn, we lose our creative freedom.As humans sometime we rely on our creativity to keep us pushing forward and feeling satisfied with our work. In simple terms creativity is thinking ‘Out of the box’, Luckily, just like any skill, we can train our creativity and strengthen it through exercises.

Procedure-- To start the activity divides the whole group into two equal teams. (name them A

& B)- Ask 2 participants from each team to come forward/can be nominated by their

teams.- These 2 + 2 nominated participants provided five hint cards each have different

picture on it. (handout 9.1)- Team A is provided with blank sheets and team B is provided sheets with abstract

figures on it. (handout 9.2)- Ask nominated person (namely ‘X’) from team A to come at the front and provide

him a hint card.- Then ask ‘X’ to think for a minute and tell resource person what object came into

in his mind after seeing a hint card to form a body posture for it. - Resource person can note down the object name with him and ask ‘X’ to form a

body posture of that object. Eg Tree.- Ask team A & B to think what object ‘X’ is and start drawing on given sheet. (No

one should be allowed to say any word or else participant can be disqualified and sit as an observer during whole exercise.

- 5 min will be given to each finish each drawing.

Outcome & conclusion-- This exercise can produce some silly results, but it's ultimately a helpful way of

getting the group out of a creative rut.- Now, reveal the reason behind giving blank sheets to team A and team B was

provided sheets with abstract figures.- The reason is the team A can begin to draw more realistically than the team B.- Team B was focusing more on the abstract figure than the real creative instinct of

themselves- Drawing of Team B effected by the given abstract figure (external factors) but on

the other hand it can be used as a resource, if they apply creative thinking. - Creative thinking is like when we are applying past experiences to the present

resources in order to resolve a problem(s).

Handout 9.1Note* any picture cards can be used.

Handout 9.2

Note* Any small abstract lines can be drawn on plain sheets for team B.

A

B

C

D

ACTIVITY 10

YOUR INFLUENCES (Peer resistance skills)

Skill: Effective communication Effective communication means that we are able to express ourselves, both verbally and non-verbally, in ways that are appropriate to our cultures and situations. This means being able to express opinions and desires, and also needs and fears. And it may mean being able to ask for advice and help in a time of need.Peer resistance skills are those required to resist peer pressure, the pressure put on you by your peers, and by your own concerns about what those around you will think of you. Peer resistance is a term often used when talking about young people, particularly adolescents, but it is just as applicable for adults.

Purpose- Provide the opportunity for participants to brainstorm and practice resistance

skills.

Materials Needed: - Pen, Paper

Handout: “Worksheet: Your Influences” (Worksheet 10.1)

Procedure

Brainstorm (5 minutes)- Provide the worksheet of “Activity 10 : Your Influences” .- They fill in thought bubbles with examples of people or facts that influence their

opinions about Substance/Drugs. - Ask for a few volunteers to share examples that came to mind and fill them in the

thought bubbles on the worksheet.

Role Play (10-20 minutes)

- Two situations will provide to any two pairs from the group on which they will act.

Situation IYou will visit your friend’s birthday party. There your friends offer you alcohol to take and you need to refuse act politely without damaging your friendship.

Situation IIYou will visit your friend’s birthday party. There your friends offer you alcohol to take and you need to refuse it firmly and walk out from the situation.

- This activity can be done in pairs or in small groups. The group option will probably take more time but can be very engaging and impactful.

- After brainstorm each participants will write their views in the given worksheet.

Small Group Option: - In this options, split the participants into small groups of three. Each group will

create and act out a real life scenario of a young person being pressured to use substance/drugs/alcohol.

- Then, the rest of the participants will brainstorm ways for the group to resolve the situation and the group will act out the participants’ suggestions.

- Thank the participant(s) for their participation and acknowledge the importance of body language and tone of voice. Saying no isn’t just what we say, but how we say it!

-Pair Option: - This option will allow participants to take turns role playing a young person

resisting pressure to use substance/drugs/alcohol. (If time allows, a couple of pairs should act out the scenario in front of the other participants).

- Thank the participant(s) for their participation and acknowledge the importance of body language and tone of voice. Saying no isn’t just what we say, but how we say it.

Worksheet 10.1 (your influences)

Based on your personal experiences, who or what influences your opinion about substance abuse?

Based on what we have talked about, what are some reasons that you would not use any substance/drugs/alcohol?

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ANNEXURES

ANNEXURE 1

SCRIPT FOR MASTER VOLUNTEERS

Overview- This is a sample script designed to be used by volunteers in outreach activity for the Nasha Mukt Bharat Campaign, the topic of discussion would be “signs and symptoms of substance abuse” it is designed to act as a guideline in terms of key talking points.

Upon reaching the location, address the group/community.

Introductions: “My name is________________ I am working as a volunteer for Nasha Mukt Bharat Campaign, I would be speaking to you today about signs and symptoms of drug abuse.”

Ice breaking tips Breaking the ice is important if you are interacting with the target group for the first time, it helps in building a repo and create connection between the speaker and receiver.

You may ask them to introduce themselves, this only works in a small group setting otherwise it is a time-consuming process, if it is a large group you may ask the following--

i. “would anyone like to introduce themselves please?”

If no one volunteers, you can proceed to ask them questions.

ii. “everyone here watches movie? What type of movie do you prefer?”

Based on your experience you can draft your questions around songs, movies, current issues which portray drug abuse and can be used as a reference.

You may receive few answers depending upon the audience, if not then ask closed questions such as these can be asked- (taking movies as an example)

iii. “Kabir Singh anyone? It was a box office hit? If you have watched it, please raise your hand?”

Now this is a good conversation starter, you may give few more examples of movies where drug addiction has been portrayed such as “Udta Punjab”, “Devdas” and ask their point of view as to what is common about these movies.

You can make correlation between the characters in the movie and ask questions--

i. What kind of drug did you see them using the most?ii. Why do you think they use it?iii. Any common signs you saw in all of these characters? Can you mention them?

You can now come to the topic of discussion “signs and symptoms”.

“so what we have gathered from this discussion is that most of the people use drugs to feel good about themselves as it provides a false sense of security, it could be due to peer pressure as in they saw their friends doing it so they tried and continued the consumption, so basically these drugs affects our brain functioning, making it easier to forget about events or issues for a short period of time which can be harmful in the long run.”

Question- “so, why do you think drug consumption is bad?”

You may take few answers from the group, but it is more of a rhetorical question. “because of the physical and behavioural changes, it brings, they become a significant part of the individual over time if they continue to use drugs, hampering their ability to function properly causing long term effects which if left untreated or unchecked can lead to permanent damage.”

SIGNS AND SYMPTOMS OF SUBSTANCE ABUSE

“The signs differ because of the variety of drug and its unique effects but there are few common symptoms among drug users which can act as identifiers so that help could be provided to them.”

You may ask the group if they know about any signs of drug use.

These symptoms have been categorised and examples have been provided as to how to explain them to the audience.

1. Slurred speech, impulsive behaviour, lack of physical coordination.

Examples- “XY went out to drink with his friends on New Year’s Eve, his friends encouraged him to drink more, when it was time to go home, he was unable to stand straight and kept falling down, he started shouting at the cab driver but no one could understand a word, so his friends tried to calm him down and helped him get home. ”

Question—if a bypasser saw this event, how would they analyse if someone is drunk?

Interact with the audience.

2. Change in personality, isolating from friends and family, general detachment, increased anger/ irritability, poor physical health, and sense of hygiene, missing important events such as school/office, feeling lethargic, tremors, headaches, lack of concentration, blood shot eyes.

Example- “YZ is addicted to cocaine it activates the reward system of the brain by releasing feel good hormone, so it gives her a false sense of happiness and energy. Her family is worried because she has stopped eating food properly and her sleep patterns have also changed but after her episodic high, she feels extremely tired.”

“Her mother stated that she constantly asks for more pocket money, one day she was seen stealing and when asked, she became extremely angry and irritated, her friends are worried because she has stopped being regular at school and is seen talking to strangers, her performance has also reduced drastically as drugs make it difficult to concentrate properly”

“On days when she does not get money to buy drugs, her body starts shaking uncontrollably.”

Question- “what could be gathered as signs of addiction here?”

“there is a similar pattern followed by majority of the users, a dead give-away would be needle marks on arms, legs and uncontrollable shaking (tremors), for example hallucinogens make people see things differently, they might be experiencing things, a sober person could not; making them suffer from psychological distress and mood swings”

From this we can infer that all these are signs of addiction, though sometimes it can be pretty abstract as running nose and cough can also mean common cold, so by combining signs we can identify a vulnerable person.

Now you may ask the group if they have any doubts or questions regarding the session.

Closing of the session- you can conclude the session by stating that “there are a lot of signs to identify drug addiction, I hope this session helped you understand some of them, thank you for being such an enthusiastic group.”

The volunteer can also mention, “if you identify anyone on the basis of signs and symptoms of drug addiction, please talk them so that necessary help could be provided.”

SUBSTANCE AND THEIR TYPES

Next, ask the members if they can identify some characters who they think can be associated with drug usage. This can be based on their social interactions, movies or TV shows, songs, etc. If some responses are received from the community, then you can further build on the interaction by seeking responses to the following questions:

➔ Which kinds of drugs are they consuming? ➔ What kinds of signs can you relate to drug usage by observing these characters?➔ According to you, what are the harmful effects of drugs?

(While the participants share their views, make sure that you listen to them and do not disregard any of their views as they may be sharing difficult things from personal experiences)

INTRODUCING THE TOPIC (Time: 15-20minutes)

(Note: Before starting this discussion, if pictures of the different types of drugs can be visualised somewhere on a screen or can be carried in the form of flashcards, it will be easy for the participants to understand in brief. Although this is optional, it is highly recommended.)

During this session, explain to the community members in brief that we will talk about various kinds of drugs and its effects.

➢ Introduce the term “drugs” to the participants. A drug is a substance which causes changes in the functioning of the human body both physically and/or psychologically. It may lead to a false sense of well-being. You can ask the participants if they have noticed people consuming drugs in a specific place or have any instances to share.

★ Cannabis

Different forms of cannabis like marijuana, hashish/hash, and bhang can be told to the community- locally called names can be used for a better understanding. Method of consumption- can be smoked or eaten. It is the most commonly consumed drug in India. It is considered illegal in many parts of the world. You can also ask if cannabis is legal in India? Also, if they have ever seen a plant growing near their homes, schools, common public places etc.? You can ask people to share stories of friends or some observations about a person who has consumed it. After listening to the participants, discuss the ill-effects of cannabis such as

❖ lead to dryness in mouth ❖ loss of appetite ❖ impair short term memory❖ loss of coordination

★ Depressants

Depressants are substances that slow down the activity of the central nervous system, which reduces a person's alertness and also slows down functions such as breathing and heart rate. Alcohol is the most popular and widely available form in most parts of India. Examples like beer, whiskey, wine, vodka, rum, brandy, locally brewed alcohol, and rice beer etc. can be shared with them.(For explaining use of depressants an example of some popular movie can be taken to indicate alcohol addiction and its harmful effect)

Effects of alcohol

❖ Causes slurred speech and lack of emotional control❖ Increase in violent actions. ❖ Higher dosage can cause unconsciousness or even death.❖ Long-term effects include memory loss, difficulty in thinking clearly, difficulty in

problem-solving, poor concentration, and addiction.

★ Inhalants

Ask the participants: Have you observed anyone inhale whitener, paints, fluids, smell of petrol or children who like the smell of fevicol? Inhalants are chemicals which once inhaled can produce mood-altering effects. Examples include spray paint, paint thinner, correction fluid, nail polish remover, petrol and glues. Briefly explain that this is the most common method used by children. You can now discuss the ill effects of inhalants which are:

❖ Headache, nausea, vomiting❖ Loss of motor coordination❖ Breathing problems ❖ Loss of coordination❖ Mood swings❖ Sniffing can lead to suffocation and heart failure and instant death

(Note: If there are more children in the group, try to explain and emphasize the ill effects and how habitual use becomes problematic. Why is it possible for them? - Easily available, inexpensive, no criminal penalties)

★ Stimulants

(Before explaining to the community what stimulants are, ask them if they have come across people who may have a habit of drinking tea or coffee at certain times or say, every three hours throughout the day. Taking cues from their responses, then explain to them that our body becomes used to caffeine and if they do not get it- they experience discomfort or

fatigue. Explain to the participants that caffeine is a mild stimulant drug and thus does not cause major harm.)These are most commonly used in the form of caffeine, nicotine, and cocaine (or crack). It is found in the form of a white powder. Method: They are swallowed or injected in liquid form or crushed and snorted. This directly affects our central nervous system.Next, discuss the effects of stimulants with the community members:

❖ Suffer from mood swings, high temperature, irregular heartbeat, increased anxiety.❖ Physical symptoms include chest pain, nausea, blurred vision, fever, and muscle

contractions❖ Insomnia and weight loss are also experienced by the person.

★ Opioids

“Heroin is the most popular form of opioid consumption. It is a white powder which has a bitter taste. It is made from the sap of the opium poppy plant. It typically binds / numbs the receptors in the central nervous system which causes the feeling of pain. It was previously used as an anaesthetic, but now its usage is illegal. Method: Can be sniffed or dissolved in water and injected into the skin; smoked through heating a tin foil as well.”

Effects of Opioids ❖ Feelings of confusion and detachment❖ Restlessness❖ Loss of libido❖ Slowed or stopped breathing due to fatal overdose❖ Nausea and vomiting ❖ Contaminated syringes can lead to heart infection, muscle infection and lung

infection

★ Hallucinogens

(Ask the participants if they know what hallucinogens are or if someone they know has experienced it? If there is not much response from the audience, explain the drug as it will help to understand it better.)A drug that causes distorted perception/ altering reality. Under the influence of hallucinogens, people’s perceptions of their sensory organs get affected. 2 examples are LSD & ecstasy. Since this drug is of no medicinal use, it is considered a drug which can be abused in the form of tablets or liquid. A bad trip may make you violent, suicidal or likely to harm yourself

Effects:

❖ rapid and intense emotional swings❖ user disassociates from their surroundings❖ leads to an altered sense of space and time❖ difficult to think clearly❖ panic attacks and anxiety❖ delusions❖ paranoia

CONCLUDING THE DISCUSSION: FEEDBACK AND EXPERIENCE SHARING (Time: 8-10minutes)(You can conclude the session by asking the audience, what was the most common effect of drug intake: feeling of disconnect, short term relaxation but harmful side effects in the long run , how it can cause damage to human body and people around, interact with the audience and understand their views)Summarize the whole session and focus on the important points such as common drugs found and their effects, and a vote of thanks to all the participants and the community for taking out time and being participative and a good audience. If there are some details about the next session to be discussed, you can also do that-decide the venue, place and time for it. (Tip: You could ask some members of the community to provide feedback about the session)

MYTHS & FATCS RELATED TO DRUG ABUSE

Resource person: Hello everyone. Today we will talk about substance abuse and the myths and facts associated with it. We often hear a lot of things related to drugs, but have you thought how much of that information is actually true? There are several misconceptions about drugs, and today we will understand what are the actual facts related to drugs and drug abuse.

But first let’s understand what is a myth.

A myth is a widely held but false belief or idea. For example – it was widely believed that Earth was flat, but gradually scholars proved that earth is in fact spherical.

Pause and ask everyone present whether they understood the difference between a myth and fact.

Proceed

RP: We will now first attempt to bust the myths and then study how drugs actually affect the human brain and its functioning.

Myth: Drugs increase creativity and make the user more imaginative.

Fact: It actually changes the user’s perception of surroundings and alters the integration of sensory stimuli. It also decreases the ability of the user to appreciate cause and effect, and to “organise, categorise and differentiate the constituents of the conscious experience.”

Myth: Drugs sharpen one’s thinking and lead to greater concentration.

Fact: Drugs induce dullness and adversely affect normal functioning of the body and mind.

Myth: It is often said that once you’re addicted, there is no hope for you.

Fact: The truth is that with the help of treatment and medication, one can distance himself/ herself from substances and recover from substance abuse.

Myth: You must have heard many people saying that they can manage to drive well enough even after they have had a few drinks.

* Here, you can pause and ask the listeners if they have also had friends or acquaintances saying the same thing. This makes the whole exercise interactive and ensures greater attention from the audience. Now proceed to tell the fact*

Fact: You must understand that the effects of alcohol start sooner than people realize. It begins with mild impairment starting to affect your speech, memory, attention, coordination and balance. Therefore, it is very dangerous to drive in a drunken state.

Myth: Lots of people say that marijuana isn’t addictive.

Fact: The truth is, studies have shown that around 1 in 11 people who use marijuana can become addicted.

Myth: One might believe that drug dependence is a failure of will power or of the strength of one’s character.

Fact: The fact is that drug addiction is a brain disorder. Every type of drug abuse has its own individual mechanism for changing how the brain functions. The drug becomes the single most powerful motivator in the drug abuser's existence. He or she will do almost anything for the drug.

Myth: It is widely stated that drug addiction is a voluntary behaviour.

Fact: The fact is that a person goes from being a voluntary drug user to being a compulsive drug user. Why? Because over time, continued use of drugs changes your brain’s functioning – at times in toxic ways, otherwise in subtler ways, but virtually always in ways that result in compulsive and even uncontrollable drug use.

Myth: People who use drugs can’t change. It is a hopeless condition.

Fact: The fact is that change is always possible with the right treatment and continued support, provided the person is willing to seek help.

Myth: Drug addiction can’t be cured.

Fact: Addiction to any substance is a chronic brain disease that can be managed with counselling and sometimes with medication, but relapse is always possible. Surrounding yourself with caring, competent clinicians and loved ones can help you maintain long-term sobriety.

Myth: Many believe that most of the addicts get their first drug from a peddler or a pusher.

Fact: But the harsh reality is that most addicts get their drug from friend or event at a home.

Myth: Substance users do not receive sufficient punishment.

Fact: The possible short and long-term consequences of substance use include morbidity, comorbidity, social isolation and stigma. People with substance dependence are among the most marginalized in societies and should get proper treatment and care.

Myth: We must have often heard, mostly from youngsters, that drinking isn’t all that dangerous.

Fact: But that fact is that among college students, alcohol contributes to deaths from alcohol-related unintentional injuries, as well as assaults, sexual assaults or date rapes, and poor academic performance.

Myth: Substance abuse is a problem that only exists in the lower-income groups of society.

Fact: Substance abuse and addiction are societal issues. From urban centres to the suburbs to rural areas, no one is exempt from the harmful effects of substance abuse.

Myth: Drug addicts are usually homeless, unemployed, or basically losers.

Fact: The harsh reality is that anyone can get addicted to drugs, including even the most qualified people like doctors, lawyers, and teachers.

GOVERNMENT INITIATIVES

Introduction:

You may start by asking the people present on the services that are available to people who are dependent on substance abuse in general. Such questions can be asked:

“Can anyone tell me about what are the kind of services that are available for the people who want to get rid of their drug dependence?”

You may receive answers such as Nasha Mukti Kendra etc.

“Are you aware about any such service/facility in your area?”

You may not receive response as many might not be aware of any such institutions present in their community.

“I would be speaking to you today about various initiatives taken by the Government to tackle the issue of drug abuse and also inform you what are the options one can reach out to in case they want to be addiction free.”

Initiative 1: IRCA

Introduction: Deaddiction Centres, also known as IRCA, are one of the most visible forms of institutions that help people fight substance abuse. But there is much more than medical treatment that is provided here. Let us look at what all services do they provide if we take admission there.

Services:

● They aim at total recovery of the addicted person leading to his socio-economic rehabilitation i.e. ensure that he is accepted by the society as its member and is given opportunities of employment without having the tag of ‘drug addict’ attached to him. This will motivate him to fight the battle against drug and live a dignified life

● They impart preventive education and generate awareness among the target groups (vulnerable and at risk groups) in their neighbourhood

● They also aim to enable the addict to achieve total abstinence i.e. the addicts are helped to overcome the desire to use drugs at all times, even when he/she is in situations which were once tempting. This leads to improvement in the quality of their lives

● The detoxification services that is provided are safe and help manage the withdrawal symptoms

Initiative 2: Outreach & Drop-In Centers (ODIC)

The ODICs cater particularly for the youth who are into substance abuse not not necessarily are dependent on drugs.

Here you can talk about the difference between the two terms: drug use and drug dependence

ODICs not only help the current users become sober, but also prevent the youth present in the community from initiating substance use. The centre acts as a hub for all services, which substance users can access as per their convenience. Activities such as recreational activity, group therapy, individual counselling, family counselling etc keep them engaged in a non-threatening and caring environment.

Now let us talk about the kind of services that are provided at an ODIC:

● Assessment and diagnosis of the substance users would be carried out by the doctor, nurse or counsellor of the ODIC

● Consultation with doctors and linkage to treatment and care services as per their assessment

● Individual, group and family counselling● Specific Psychosocial interventions for recovery from addiction and ability to resist

use● Art, music, dance and yoga for early recovery/Life Skills Program● Linkages to vocational training for economic support for users once they recover● Follow up care including family counselling

Initiative 3: Community based Peer Led Intervention (CPLI)

Introduction: As a community, we too have a role to play in the fight against drug abuse. CPLI is one such initiative where we aim to build a safe environment for young people who are vulnerable to substance use and also those who started experimenting it, through outreach activities. It aims to prevent and reduce the substance use among the young people. Through peer led intervention the aim is to reach vulnerable children and early adolescents in the age group 10 – 18 who are non-users.

Well, you might think how can the young volunteers address this issue?

Active participation, along with the training provided by us, helps them to become change agents who can prevent and disseminate information on substance use prevention. CPLI gives a platform to the young people to learn from each other and support themselves. Each one becomes ‘the other’s keeper’, providing good role models that portray health-seeking

behaviour, peer pressure, managing one’s own emotions and a step-by-step process on how to sustain the desired positive behaviour.

Services:

● Dissemination of substance information and education against the ills caused by it● Outreach activities in the community among vulnerable children and adolescents● Life skill education sessions● Referral and linkage to service centres● Providing psychosocial therapies including follow up and support● Follow-up care including family counselling● Other activities for integrating and disseminating information include sports and

other recreational activities that are promoted and used as opportunities for young people to progress.

Concluding

At the end of the session about the govt. initiatives, you can inform the members present about the IRCAs, ODICs and CPLIs present in their area where drug users and non-users can reach out for their services.

“In your district/area, the nearest IRCA, ODIC and CPLI are __________________”

Apart from this, you can also identify users/vulnerable people from the people present by physical as well as behavioural signs and symptoms and provide them on-spot counselling and guidance.

Points to be noted while speaking.

i. Do not use derogatory words to talk about person affected with addiction, they are also humans and should be portrayed with dignity and worth.

ii. While talking to groups, usage of drugs should not be portrayed in a positive, fun light, so as to avoid poking their curiosity.

iii. Avoid personal biases while addressing the target group.

iv. You may take/give a break wherever required

FIELD NOTES