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Gutka user. Having blood shot eye, getting stress and depression. What should be done to get relief?

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Practicing since : 1998
Answered : 415 Questions
My wife who is 41 years old has been taking Gutka (Indian chewing tobacco laced with intoxicants) for the last 6 years, sometimes more and sometimes less depending on her emotional and mental state. She binges on it rather than taking it regularly and it is detectable from her blood shot eyes and breath as well as her erratic and aggressive behavior when she takes this stuff. She has a habit of using Gutka or alcohol to cope with emotional stress and depression to which she is quite prone. However, her alcohol and/or gutka binging makes her condition worse and she starts behaving very aggressively and psychotically. Recently, she has reduced alcohol binging, but instead she now binges on gutka and this causes her personality to change drastically from a mild and calm person to one who is abusive and aggressive. With her history of addictions and depression what can I do to help her? She refuses to acknowledge that this is a major problem inspite of her past history, and I am greatly concerned about her health and well being as gutka is cancer causing or carcinogenic. I would like her to get rid of this gutka addiction, and am tired of always finding it hidden in her cupboard and disposing of it. How can I convince her to see a Specialist Oral surgeon to check her oral health, and also someone to help her with the addiction? In the UK it is not possible to get medical help for a family member unless they themselves agree to it.
Posted Sun, 14 Oct 2012 in Smoking and Alcohol Addiction
Answered by Dr. Susanta Padhy 1 hour later

Thanks for the query

Individuals who are having psychotic illness, self-medicate themselves with many medications, substances like alcohol, nicotine etc, so as to get relief of such distressing symptoms.

Such individuals do suffer from distress but they may not express it or they may not seem to be distressed

And indulging in consuming alcohol, ghutka etc is a way of coping

At the same time they do not admit that they have any illness nor that they admit that they need treatment

They may have coexistent depression

There are NGOs, social workers attached to mental health services who take care of such issues. And their job is to make the patient available for treatment

I think treating the underlying mental state will automatically help him to get rid off such substances and hence the risk of cancer

And if needed, your psychiatrist will evaluate the risk of oral cancer and will do the relevant tests and will do the needful

Above answer was peer-reviewed by
Follow-up: Gutka user. Having blood shot eye, getting stress and depression. What should be done to get relief? 22 hours later
My wife is already taking anti-depressive medication to help her cope with her problem. She has been treated several times by Psychiatrists/Specialists for mental illness. Inspite of this, she continues to have these episodes when she has this urge and binges on Ghutka or alcohol. She has also undergone Psychological Counseling by an Alcohol support organisation. Does she need to change her medication? How can I help convince her to seek help as she refuses to discuss this problem with her doctor? I have informed her doctor about her Ghutka addiction many times and expressed my concern over her health and welfare, but the GP has informed me that she must ask for help herself.
Answered by Dr. Susanta Padhy 2 hours later
Thanks for the response

As I mentioned earlier and as you have rightly observed that her ghutka / alcohol intake increases during the period of XXXXXX depression" / "psychosis", shows that the 'Psychiatric illness" is primary and substance intake is secondary.

This emphasizes that adequate and appropriate diagnosis and treatment of mental illness is primary

If your psychiatrist is sure enough that she does not have psychotic illness, then the answer that I have written you earlier may not be fully applied

In such case, "motivation enhancement therapy" for increasing her motivation to decrease or stop ghutka / alcohol would be appropriate along with treatment of depression.

Moreover, if you are not satisfied with your psychiatrist, I think you can consult another psychiatrist for second opinion

Plus, the social service agencies that I mentioned earlier should help you further, in this regard (how to take her to appropriate treatment network)

You can discuss this with your GP, too

Hope this clarifies

Wish her good luck
Above answer was peer-reviewed by
Follow-up: Gutka user. Having blood shot eye, getting stress and depression. What should be done to get relief? 2 hours later
Thank you but I am not hearing anything new from you Sir. We have tried all the approaches but she keeps going back to alcohol and Ghutka. I am more concerned now about Ghutka as her use of alcohol is less frequent now although not stopped completely. What does Ghutka (Indian Chewing tobacco) contain that she takes it in the first place? I dont know much about the abuse of Ghutka except that it is carcinogenic and cancer causing and hence my great anxiety and concern for my Wife's health. In the Public Health system here in the UK, you cannot force somebody to seek medical help and they must seek it themself. My wife does not want to seek either GP or Specialist help for this problem. As I said earlier, I have informed GP but they will not act unless my Wife goes to them herself. She feels satisfied with her GP and the current medication she has been on for depression. However, I still dont see this medication helping her to cope with emotional distress and depression. Is there a condition you know about where taking aclohol or Ghutka type substances causes radical mood change and erratic emotional behaviour? My wife behaves psychotic, aggressive and her behaviour and personality changes completely when she takes Ghutka or alcohol. She puts hersefl in risky situations when under the influence of these substances. Is she more sensitive to these things? I know many other people who consume alcohol or ghutka, but it doesnt effect them and make them unable to function the way it does for my wife. Please advise as I am still not clear what course of action to follow?
Answered by Dr. Susanta Padhy 2 hours later

I can sense and do understand the level of anxiety and concern you are going through.

This is the time to control your anxiety, not feel helpless, to keep patience and courage. I know these are easy to say but difficult to follow.

Indian ghutkha contains nicotine (the same harmful ingredient that cigarette contains) in more crude form. Hence, the harmful effects of ghuthka are more or less same as chronic smoking except that chances of oral cancer are more with ghutkha and chances of lungs problems more with smoking.

Humbly, I want to emphasize and re-emphasise some points that I have repeated. And they are as below:

1. Diagnosis may not be depression, to me seems may be a psychotic illness. Because you have mentioned that she behave psychotic after ghuthka or alcohol. Also because you say medicines for depression have not worked for her, indicates that the diagnosis may not be depression.

2. Such problems after ghuthka / alcohol are called "substance induced psychotic disorder".

What to do?

a) To change the medication from antidepressants to antipsychotics. This will take care of her psychotic behaviour even if she takes ghuthka and alcohol, for a while

b) Take a second opinion from another psychiatrist

c) Take the help of social worker to pursue her to go to hospital

d) You can consider giving benzodiazepine like clonazepam / lorazepamam / oxazepam in moderate doses, for a short time to control her acute behavioural problems.

e) You can request your doctor for considering hospitalization

Hope this will help you.

Wish you patience, courage and her, a good mental health.

Above answer was peer-reviewed by
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