Generation Z is less into alcohol and cigarettes, which is good news. But the bad news is the increased popularity of newer addictive substances such as kratom and HHC and the rise of digital addicts. "There is clear evidence of addictive elements in some apps, games and social networking sites that the child and teenage brain is very sensitive to. But the development of new technologies cannot be prevented and simply banning their use does not lead to effective prevention," says an addiction psychologist and coach in an interview Adam Kulhanek.
Young and addicted
Is it possible to get telling data on how many people have a problem with alcohol or other addictions?
We have accurate data for the Czech Republic based on annual monitoring of the rates of substance use in the adult population. The situation is worst for highly available legal substances, especially alcohol. Approximately 1.5 million Czech adults drink alcohol at risk. Of these, an estimated 800-900 thousand show so-called harmful use. This means that their long-term drinking has led to demonstrable damage to their physical and mental health or they are already dependent on alcohol.
In the case of cigarettes, there are approximately 1.5-2 million smokers. In particular, the use of new products such as electronic cigarettes and nicotine sachets is increasing.
The population of illicit drug users in the Czech Republic has been stable for a long time. Estimates indicate approximately 45 000 people using either methamphetamine or opiates and opioids.
I notice that alcohol is less attractive to today's younger generation. But there is a growing use of HHC (hexahydrocannabinol, one of the cannabinoids derived from cannabis; it was added to the list of banned substances in March this year, ed.)...kratom, smoking e-cigarettes... How big a problem is that?
There is a marked change among young people. They consume less alcohol and smoke fewer conventional cigarettes. Simply put, we can say that alcohol is the traditional psychoactive substance of the parents of today's Generation Z. We are also growing a generation that will smoke very few cigarettes. On the other hand, there has been a sharp increase in the use of new nicotine products, most notably disposable flavoured e-cigarettes and nicotine sachets.
Young people are more attracted by new psychoactive substances and their derivatives, such as HHC or kratom. Unfortunately, many influencers play a negative role here, presenting the effects of these substances as role models in a distorted and professionally incorrect way. There are also increasing cases of abuse of psychoactive drugs, i.e. their use outside the prescription of a doctor. The overuse of technology, social networks and excessive online gaming will also be a long-term phenomenon.
International research Health Behaviour in School-Aged Children last year showed that the proportion of children who may be dependent on social assistance is higher than the proportion of children who are dependent on social assistance. has risen to eight per cent. What is your experience of digital addiction in your practice?
Problems with excessive use of technology are among the most frequent cases in the offices of paediatric addictionologists. We live in a digital age and partly in an online world, which brings with it these risks. It is impossible to abstain from technology and the Internet at the same time. The development of new technologies cannot be prevented and simply banning their use does not lead to effective prevention. There are therefore recommendations on how long and what content is safe to use at different ages, including recommendations for parents (parental control). Some apps, games or social networks have clearly demonstrated addictive elements to which the child and adolescent brain is very sensitive.
Origin and predisposition
How big a role do genetic predispositions play in the development of addiction?
Heredity is one of the factors influencing addiction and addictive behaviour. According to studies, the proportion of heredity may be 5-30 %. However, new findings on so-called epigenetics partially disturb this pattern. In practice, the key point for us is that addiction is multifactorial. Family, upbringing, mental and physical health, peer relationships and other factors influence its development.
A higher risk of substance use disorders is said to occur in families with low socioeconomic status and possibly in single-parent families. Would you confirm that social environment plays a role in the development of addiction?
Patterns of risky and harmful substance use are generally higher in populations of low socioeconomic status and in excluded localities. But the resulting addiction is a society-wide phenomenon. A methamphetamine user living in a squat, a lawyer who uses alcohol excessively, the son of rich parents addicted to cocaine, or a senior citizen whose husband died and developed a dependence on benzodiazepines because of poor medication can end up in treatment in our country. We know from studies what factors can prevent addiction in families, but even a combination of all these factors is not a 100% guarantee.
How often are mental illnesses such as depression or anxiety associated with addiction?
Unfortunately, this is a common phenomenon. It can be in various combinations. Substance abuse that leads to the development of mental illness. Or the patient first has a psychiatric diagnosis and only secondarily becomes an addict. People with mental illness sometimes try to self-medicate with addictive substances. The addictive substance gives them short-term "relief". In the long term, however, this is a very risky pattern.
How can those around you tell if someone is addicted? How to treat the person?
Substance use is often unrecognised by people close to you. Our patients often try to hide their behaviour. But the problems start to mount over time - mental health changes, health complications, accidents, financial problems, inability to go to work, isolation from friends and loved ones, neglect of hobbies and things that used to fulfill them. Addiction becomes central to the person's life. If you notice noticeable changes in your loved one's behavior, outward expressions, reactions, or appearance, I recommend taking an interest in your loved one and sensitively asking him or her if you have noticed these changes and if there is anything wrong. It could be an illness, relationship difficulties, a psycho-social crisis, or even an incipient addiction. Family and loved ones are often at the beginning of a person's entry into treatment.
Treatment and prevention
Is treatment for addictions, such as digital or work-related addictions, any different from treatment for alcohol or drug users?
The principle of addiction treatment is identical at its core. Rather, the type of service differs according to the needs and indications of the client. Some clients manage and benefit from outpatient treatment. They attend therapy or therapy groups once or twice a week. However, more severe cases require weekly detoxification and subsequent residential inpatient treatment, either in a hospital setting in an addiction treatment unit or in a therapeutic community. However, modern forms such as mobile apps or online psychotherapy are also now available.
They say that addiction is for life, that it cannot be completely cured. Is that really true? How often do you relapse?
Relapse, i.e. returning to use after a prolonged period of abstinence, is the most common outcome of treatment. Addiction is a complicated and difficult diagnosis that requires a complete lifestyle change. Therefore, the treatment process is also intensive and long-term. However, every attempt to treat addiction is very important and beneficial.
Prevention is of course important. In your opinion, is it sufficient?
Prevention is crucial in the field of addiction. In the Czech Republic, we have a very robust and sophisticated system of school prevention and prevention programmes in schools. However, there is a lack of public health campaigns aimed at the whole population. Parents also play a key role here, as they are essential role models for their children up to lower school age.
Seek help
Do you feel that you can't stop using an addictive substance, or do you experience withdrawal symptoms when you step away from your mobile phone or computer screen? Do you notice signs of addiction in someone around you? If at any stage you feel that you cannot cope with the situation on your own or with the help of loved ones, seek psychotherapy or an addiction specialist. In case of acute problems, do not hesitate to call the crisis line. Treatment for addiction is either on an outpatient basis in a psychiatrist's office, an addiction clinic, a day hospital or a residential facility. The type and length of treatment is always individual, based on the current state of addiction. Some services are covered by health insurance. Check with your health insurance company and the centre for more information.
We have selected a few places for you to contact:
- Department of Addiction Medicine, General University Hospital in Prague
- National Alcohol Quitline
- Alkos Centre - founded by Michaela Duff, author of The Alcoholic's Notebook (following the film of the same name, which is based on Michaela's story, an awareness campaign was created Women with courage); the centre offers residential programmes, outpatient treatment, family counselling or a treatment programme in the form of group sessions and individual therapy
- Magdaléna - includes an addiction services centre, an outpatient clinic, a treatment centre, a therapeutic community and a primary prevention and education centre
- Adikto, addiction treatment center
- Neo Centre - treatment of addictions and other psychological problems
- Sananim - non-governmental non-profit organization providing multidisciplinary addiction services
The first step is always the hardest. Fingers crossed. You're not alone.
