|Year : 2013 | Volume
| Issue : 1 | Page : 23-25
A unique case of substance abuse
K Krishnamurthy, Wilona J Braganza
Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka, India
|Date of Web Publication||20-May-2013|
Wilona J Braganza
Department of Psychiatry, Father Muller Medical College, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
The desire to periodically alter consciousness by using psychoactive substances is an innate drive similar to hunger, thirst or sex. WHO has defined various substances, psychoactive or otherwise which may potentially be abused. An innovative method of intake was observed while evaluating a patient under our care. An 18-year-old boy was brought for consultation with a history of multiple substance use and anti-social personality traits. On interviewing, patient reported of the use of a white powder in the form of a snake bite. Patient described the technique of the snake bite and his experience following the bite. There have been two previous reports of patients resorting to snake bites for recreational purposes and this unique and extreme mode of undergoing a psychoactive experience needs to be studied further.
Keywords: Extreme psychoactive experience, multiple substance use, snake bite intoxication
|How to cite this article:|
Krishnamurthy K, Braganza WJ. A unique case of substance abuse. Muller J Med Sci Res 2013;4:23-5
| Introduction|| |
"To break the monotony of life, man makes certain holes in the wall to peep into the outside."
- Aldous Huxley
Festivals, carnivals and social events are some of these. Similarly, drug use for recreational purposes is also one of the approaches to deal with the tedium of living.
Since time immemorial, the use of drugs to alter consciousness has been a feature of human life all over the earth. Though the pattern, the doses, the preferred intoxicant and the mode of intake vary the world over, the universality of substance use suggests that we are dealing with something that is more biologically based rather than originating socially or culturally. Indeed, it appears that the desire to periodically alter consciousness by using psychoactive substances is an innate drive similar to hunger, thirst or sex. In fact, drug abuse is actually an interaction between the host, substance, and environment. Thus, any substance can potentially be considered to have a risk of being abused.
Substance abuse is defined as "A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following:
WHO has included alcohol, opioids, cannabinoids, sedative-hypnotics, cocaine, stimulants, hallucinogens, tobacco, and volatile solvents in the group of psychoactive substances producing various states such as intoxication, harmful use, dependence, withdrawal states and other complications. However, it has also described the use of non-psychotropic substances that do not produce dependence, such as anti-depressants and neuroleptics, laxatives, analgesics, steroids and other hormones, vitamins and antacids. 
- Failure to fulfill major role obligations at home, school or work
- Substance use in situations in which it is physically hazardous
- Recurrent substance-related legal problems
- Continued substance use despite having persistent or recurrent social or interpersonal problems exacerbated by the effects of the substance." 
Current diagnostic guidelines in International Classification of Diseases (ICD) 10 do not support the concept of substance abuse but rather focus on the clinical conditions that are a result of it.
Although, most individuals prefer the traditional mode of intake of their preferred substance, there are several who have explored innovative options. One such method came to light recently while evaluating a patient admitted under our care.
| Case Report|| |
An 18-year-old boy was brought for admission by his mother with complaints of multiple substance use, frequent lying, stealing, engaging in suspicious dealings involving money and drugs, irritability, abusiveness, and assaultive behavior. He was admitted and evaluated in detail. During assessment he was diagnosed to have alcohol, tobacco, opioid, and benzodiazepine dependence and had used stimulants in the past. On questioning about mode of intake of these substances, he reported the use of a white powder (the content of which was not known to the patient) in the form of a snake bite. He had already experienced the snake bite three times at the time of presenting to us. He would usually get in touch with a known person who would make the necessary arrangements and then inform the patient. The patient would pay a certain amount per bite and he would be put up in a hotel room with two other persons. The snake which was a new-born snake would be given to the patient in a small box such as a match box. According to the patient the snake would have been fed the white powder previously by the person supplying them. He was not aware of the form in which the powder would be ingested by the snake. The patient would sit upright in bed protruding his tongue and another person would hold the snake in front of him. The snake would then be incited to bite the patient by tapping it on the head. Following the bite the patient would feel an increased sense of well-being, lethargy and on one occasion reported of blurring of vision. In his own words, the patient describes it as "feeling so restless that he could neither sit down nor stand up." He would then fall into a deep sleep and wake-up 30-36 h later. He would stay there for another day as he would feel weak and tired and then go back home. He reported that the snake would usually die following the bite and they would dispose of the snakes by burning them. The patient did not report of any local inflammation or pain subsequently at the puncture site. Patient did not report of any craving for the snake bite. No mood or psychotic symptoms were noted in the patient. During his stay patient was not found to have any derangement of metabolic or hematological parameters. This was his first contact with de-addiction services.
| Discussion|| |
There have been frequent reports of individuals who have tolerated snake bites with minimal effects. However, there are very few instances of people seeking snake bites for recreational purposes. The venom of elapids such as cobras has been found to release pharmacologically active substances in the body such as 5-hydroxytryptamine, bradykinin, slow-reacting substances, prostaglandins, and lysophosphatides. Furthermore, the effect of the venom on the nervous system can produce symptoms such as blurred vision, drowsiness, dizziness, lethargy, a sense of euphoria, muscular paralysis, and an analgesic effect.  It has been hypothesized that the reward pathway of the mesolimbic dopamine system, which governs addiction may be similar to the neural pathways that govern snake bites.  This behavior is typically seen in individuals with a tendency to use a variety of substances, those with high impulsivity and novelty seeking traits  and among those who have a social and cultural background of honoring or worshipping snakes. Two case reports from Mumbai have described snake bite as a form of intoxication among individuals with a history of heroin, cannabis and mandrax use.  Investigators from Ranchi have also described two patients with multiple substance use disorders who resorted to occasional snake bites for recreational purposes and have assessed them using the revised Neuroticism-Extroversion-Openness personality inventory (NEO). 
| Conclusion|| |
Although, this behavior may appear to seem extreme, is should be borne in mind that the craving for substances can induce individuals to go to great lengths to obtain it. Furthermore, the high-risk taking behavior frequently seen in multiple substance users may induce them to seek more unique and diverse ways for a psychoactive experience. It would be interesting and informative to study the use of snake bites for intoxication and compare it with the other patterns of psychoactive substance use.
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