Persons who were suspected of taking the drug secretly were placed under observation, and their urine was examined for the presence of opium alkaloid
Persons who were suspected of taking the drug secretly were placed under observation, and their urine was examined for the presence of opium alkaloid there are three aspects of addiction
craver - your ego
craving - the impulse    
craved - the substance     

To overcome addiction one needs to be detached from your addiction. To become detached, observe your ego craving for more and more of the physical substance
Once you overcome ego you will naturally become less dependant on the addiction, especially when you know you can create a natural high from within. You gain an inner power.
I understand I was there. For me it was the fear of not being happy without the drugs, also maybe because of my stressful environment, and fear of losing approval.
         Now I am not dependant. The craver is not me! I have an inner power!
      Just being concious of your ego's fears and desires is a step in the right directionOpium Smoking
      The experience in India is that the habit of opium smoking is much more difficult to eradicate than opium eating. Fortunately, owing to enforcement of very strict regulations, the habit of smoking opium has practically disappeared. There appears to be little doubt that an opium smoker is much more attached to the drug than an opium eater. It would appear that, although smaller quantities of the alkaloids are absorbed (most of them must be destroyed by the heat produced), the absorption is very rapid through the large surface of the capillaries of the lungs, and the effects are sudden and more intense, resembling those of an injection of morphine. The treatment of opium smoking has not been properly worked out in India. Some authorities allow the patient to take the drug by mouth and gradually cut down smoking. Once eating is successfully substituted for smoking, the addict becomes more amenable to treatment.

Treatment for different types of drugs

Cannabis Drugs
       The treatment of the cannabis drug habit is not so difficult, though here again, as in the case of opium, it is easier to cure the eating habit than the smoking habit. Withdrawal symptoms, as they are met with in the case of opium addicts, are hardly ever seen in the case of cannabis drugs - indeed, the patients find no difficulty in giving up the habit of their own accord if they wish. In northern India, many people indulge in bhang drinking in the hot weather, on account of its reputed cooling and refreshing properties, and give it up in the winter quite suddenly without any discomfort. Cannabis preparations, when taken habitually by mouth, can be suddenly withdrawn without producing any marked abstinence symptoms, though keen desire to indulge in the drug is there. Temporary loss of appetite, constipation lasting for a few days and rarely palpitations and restlessness may occur; all these can easily be dealt with.

    Charas and ganja are stronger preparations and, as these are generally indulged in by smoking, their effects on the system and particularly on the nervous system are more pronounced. The will-power of the smoker is weakened, and without the physician's help he is not able to give up the habit. Treatment in special institutions with facilities for forcible withdrawal is likely to give the best results. The psychological and mental treatment, and training and education of the addict are as important in the case of cannabis smokers as in opium addicts, in spite of the fact that the physical distress accompanying withdrawal is largely absent.

Cocaine
       The habit of eating cocaine is easier to cure than that of cocaine injected parenterally. Removal of the addict from the environment in which he has acquired the habit and from associates in whose company he indulges in the drug, preferably to a place where he cannot get it, often effects a cure. The present writers know of many instances where individuals from one part of the country went for months to another part where they were unable to get the drug and where they had no associates; they were able to conquer the craving for many months at a time without difficulty or any marked distress. When, however, they returned to their old surroundings and associates they again succumbed to the temptation. Similar facts have been observed in addicts who have been confined in prisons. They also give up the habit during confinement and go for years without the drug, but they generally take it up again after discharge. We are convinced that cocaine eating is comparatively a much milder form of indulgence than cocaine administered by the parenteral route.
   

Symptomatic Treatment
   The following is a brief summary of the symptoms and complications which were observed and controlled in the course of treatment of this series of 200 cases in the hospital.

    Pains in the body and limbs, cramps and general malaise. The first two were very troublesome and often did not yield to ordinary analgesics; cramps were commonly met with, but they were not very severe. Simple measures such as massage, hot baths, aspirin and veramon were successful in some cases, but when the pain was severe an intramuscular injection of novalgin (Bayer) 2 ml. often proved effective. Hyoscine hydrobromide in 1/200 grain doses was also tried but was not found to be effective. The pains and cramps generally disappeared in three to four days after the administration of lecithin and glucose.

    Nausea and vomiting were common symptoms, and were observed in 40% of this series. In twenty addicts there was actual vomiting, and in two it was very severe and incessant. Sucking of ice greatly relieved these symptoms, and in severe cases 10 drops of adrenaline hydrochloride (1 in 1,000 in normal saline) under the tongue every two to four hours often gave relief.

    In two patients, severe bilious vomiting occurred, and the stomach had to be washed out with a solution of sodium bicarbonate (one drachm to a pint of water), after which the patients were relieved.

     Constipation was treated with administration of saline every morning and, if necessary, calomel in half-grain doses was given the previous night. diarrhea was also frequently met with, and for this condition no special treatment was given except fluid diet and withholding the daily dose of saline. In severe cases, bismuth and chalk mixture was given.

     Cardiovascular manifestations. These were feeble and irregular pulse, sinking sensations, cardiac embarrassment and collapse. These symptoms were greatly relieved by administration of glucose by the intravenous route and cardiac tonics such as brandy, cardiazol, digifortis, etc., were effective. Special treatment for heart conditions had to be resorted to in ten cases. They were all aged persons who had been taking the drug for over twenty years and in doses above 40 grains a day, who showed severe reactions during the period of abstinence. In one patient, an old man, aged sixty-five years, who had been taking the drug in doses of 45 grains for a period of forty years, collapse occurred on the fourth day of withdrawal owing to excessive loss of fluid, due to persistent bilious vomiting and diarrhea. The treatment adopted was intravenous administration of four to five pints of glucose saline, cardiazol and atropine sulphate injections and brandy by mouth. No opium was given. This patient was discharged from the hospital as apparently cured after twenty-one days.

     Vasomotor disturbances such as sneezing, coughing and running from the nose and eyes. Unless severe these require little or no treatment but, when troublesome, a small dose of Dover's powder (5 grains) at bedtime gave relief.

     Spermatorrhoea was treated by a simple mixture containing 10 grains each of potassium bromide and ammonium bromide and 30 minims of tincture of valerian, administered twice daily; it allayed restlessness and induced sleep. This mixture was allowed to be taken after the patient was discharged from the hospital in cases where there were signs of restlessness and irritability.

Insomnia

     This was a very troublesome symptom and was often difficult to treat. It generally started early in the course of treatment and sometimes continued for weeks. This drug should not be repeated for more than four successive nights. Other barbiturates and hypnotics, such as adaline, evipan, luminal, ortal (Parke, Davis & Co.) were tried with good results. In one serious case with intractable insomnia where nothing succeeded, 30 minims of tincture of Rauvolfia serpentina succeeded in producing sleep.

    General asthenia and loss of appetite. For anorexia, which was a common symptom during the first week or so, a mixture containing gentian, alkalies and nux vomica before food was useful. The general lassitude and weakness following withdrawal were relieved by a simple mixture containing iron, strychnine and arsenic, which was usually prescribed to be continued for a few weeks after discharge from the hospital

Withdrawal Symptoms
In spite of the intensive treatment given, withdrawal symptoms were encountered in quite a large number of addicts.


Principal withdrawal symptoms observed, with their relative preponderance in the cases of the different groups
Withdrawal symptoms
1.Pain in the body and limbs, cramps, general malaise, etc.
2. Vaso-motor disturbances, such as sneezing, running from the eyes and nose.
3. Cardio-vascular manifestations, such as feeble and irregular pulse, sinking sensation, cardiac embarrassment and collapse
4. Gastro-intestinal disturbances, such as nausea, vomiting and diarrhea

Summary and conclusion
      After a detailed study of the problem, the present authors tried various methods of treatment of drug addicts. The sudden withdrawal method from opium addiction was unsuccessful because there were no special institutes in which addicts could be admitted and treated. Some success was obtained with the slow or gradual withdrawal method. In the case of cannabis and cocaine, the sudden with
Type of Drug Addicts to be treated
      From the point of view of treatment, the drug addicts in India can be divided into three main groups:

     There is a large group which uses opium or cannabis drugs in small or very moderate quantities. The majority of these started the drug after middle age, generally for some minor disease or ailment. They usually started with a small dose and did not increase it. The narcotic and the euphoric effects of the drug have no attraction for them; indeed, these were not produced in this group at all. The habitu�s thus have not the temptation to increase the dose, in fact they fully appreciate the evil effects which could result from such an increase. Most of them are good and successful citizens, and carry on their daily work quite efficiently. The present writers have known numerous persons who have taken small doses of opium (half a grain or so) or cannabis drugs for twenty to thirty years without any apparent harm, and have lived to a ripe old age. The use of the drug was started during the middle period of life for some minor ailment such as cough, looseness of the bowels, mild joint pains, etc., and it was found that it afforded relief. It appeared to do no apparent harm and was therefore taken daily. As a matter of fact it appeared that the drug was actually doing them good, as its discontinuance made them ill and prevented them from carrying on their ordinary work. It stands to reason that, when a person can lead an active and useful life on fixed and unchanging doses, there could hardly be any mental or moral deterioration. Treatment in this group, which was not insignificant in the old days, would appear to be quite unnecessary. Some of this group, however, gradually increased their doses and suffered from the effects of the drug. In such cases only was treatment desirable or necessary.

      The next group - and a very large one - consisted of those who owed their entry into the paths of addiction entirely to association with and the example of other addicts. Some of these were normal individuals who were anxious to be treated, and they responded quite well to treatment. A proportion, however, started the habit from idle or deliberate seeking after new sensations. They took to the drug for its pleasure-giving effect and for sexual stimulation; these people were generally found in large towns. Many of them had some defect in their character and mental make-up, and appeared to be engrossed in furthering their indulgence and increasing the doses. They also had a tendency to indulge in more than one drug at the same time - e.g., alcohol and opium; alcohol and cocaine; alcohol, opium and cannabis drugs. This class of vicious addict was the most difficult from the point of view of treatment. Fortunately, this type, corresponding more to those met with in western countries, was not commonly met with in India. The few that existed belonged generally to the rich and indolent classes. They did not seek treatment, and nothing short of forced confinement in a special institution and prolonged training and reconstruction of character would restore them.

          There was the third smaller group of habitu�s who had started using the drug in an attempt to tide over a period of special strain, overwork and fatigue. This class of addict was the product of large towns, and their percentage was not nearly so high in India as in the west. This was the class anxious to get rid of the habit; they were easily amenable to treatment, and did very well even under non-institutional treatment.