Dr. Umaharan Thamotharampillai and Dr Ruwan M Jayatunge
The
long-term accumulation of stressors in post-conflict regions is under-discussed. Experts believe that there is a close connection between war trauma
and addiction disorders. People living in post-conflict settings are at high
risk of developing addictions. The trauma of war can significantly increase the
risk of developing alcohol and substance use disorders. Alcohol and substance
use addiction has been identified as a war-related social problem.
Complex
interaction between biological predispositions and psychological and social
factors upsurges substance abuse (Coleman, 1993). There is a comorbidity
between problematic alcohol and substance use and war trauma exposure. Victims
of war trauma are deeply affected—emotionally, physically, politically, and
spiritually. These individuals can be considered a vulnerable population. These
individuals with trauma-related distress often use alcohol and drugs as a
negative stress coping mechanism and in a problematic manner.
The
30-year armed conflict in Sri Lanka had a negative impact on the health and
well-being of people. The aftermath of the Eelam War has triggered mental
health problems, including addiction issues. War trauma has been identified as
a key risk factor for the emergence of alcohol and substance use disorders.
These addictions cause negative health and social outcomes, affecting individuals,
families, and communities.
Substance
use disorders are cumulative in conflict-affected areas in Sri Lanka. The
prevalence of depression, post-traumatic stress disorder, adjustment disorders,
and other mental health issues has contributed to a rise in addiction-related
behaviors. Moreover, weakened infrastructure, under-functioning healthcare
systems, mass unemployment, poverty, and lack of social opportunities have
created a breeding ground for addiction issues. Alcohol and substance abuse
contribute significantly to the morbidity and mortality in war-affected areas.
There
is a strong, bidirectional link between substance abuse and traumatic
experiences (Simmons & Suárez, 2016). McFall and colleagues (1992) were of
the view that PTSD arousal symptoms are strongly related to the substance.
Mostly the people use drugs/alcohol to escape from their emotional and physical pain. Drug addiction may be regarded as a disease of the brain reward system (Vetulani, 2001). According to Baker and team (1986), drug cravings are organized within a memory network. Addictive substances enhance the functioning of the reward circuitry of the brain, producing the 'high' that the drug user seeks (Gardner, 2011). It causes hedonic dysregulation within brain circuits, and it leads to addiction.
People
who persistently abuse substances often experience an array of social,
financial, and mental/physical health problems. As described by Liang et al.
(2011), there is a strong relationship among alcohol, tobacco, and illicit drug
usage and mental disorders. These addictions negatively affect their quality of
life. There is a high morbidity and mortality related to alcohol and substance
abuse. Data indicate that conflict-affected populations are at risk, and
effective psychosocial measures are needed to address these issues. The
identification and management of alcohol and substance use disorders are
essential in the war-affected areas. A multidisciplinary approach is needed to
provide psychosocial support for the conflict-affected population. The affected
individuals require intense monitoring and supportive therapy. The mental
health authorities should implement programs on drug prevention and
rehabilitation in affected areas.
Dr. Umaharan Thamotharampillai, MBBS MD, is a Consultant Psychiatrist at Jaffna Teaching Hospital
References
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McFall, M. E., Mackay, P. W., & Donovan, D. M. (1992). Combat-related posttraumatic stress disorder and severity of substance abuse in Vietnam veterans. Journal of Studies on Alcohol, 53(4), 357–363.
Simmons S, Suárez L. Substance Abuse and Trauma. Child Adolesc Psychiatr Clin N Am. 2016 Oct;25(4):723-34. doi: 10.1016/j.chc.2016.05.006. Epub 2016 Aug 2. PMID: 27613348.
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