Dr Mahesh Rajasuriya
A senior lecturer at the University of Colombo’s faculty of medicine, Dr Mahesh Rajasuriya is a specialist in psychotherapy, with a particular focus on drug and alcohol abuse. A consultant for Mel Medura, an organisation which… and the Highly recommended to Team LT as the person to talk to gain a deeper insight into substance use and abuse in Colombo, we met him in his office at the National Hospital. He spoke to us about the culture which surrounds drug and alcohol use, how the problem of substance abuse should be addressed and whether drugs can make us happy.
Tell me about the spectrum of patients you treat?
I treat people with alcohol and tobacco problems from all social classes. The higher the social class the fewer people I treat, but according to the ratios of each social background there are equal proportions from each.
What is the relative percentage of male and female patients you see?
99% of the substance abuse patients I see are men.
What are the most commonly abused substances in your experience?
Among the patients I treat, tobacco and alcohol are the most common issue by a mile. After that would be heroin and cannabis in equal proportions. The rest of the substances, perhaps they are used in clubs, discos, etc., in my clinical practice – it is very rare people come for help regarding these.
Is drug abuse a major problem in the country?
In Sri Lanka most drug use is found in Colombo, and in perhaps one or two metropolitan areas around the island, but if we consider drug use across the country, it’s not as a major or significant problem as alcohol or tobacco.
How should this problem of substance abuse be addressed, in your opinion?
If you look at any problem, prevention is better than the cure, it’s much more cost effective and despite being a curative doctor – I recommend prevention. While laws can be used to prevent drug use, this shouldn’t be the main means. Not that the laws aren’t effective, the NATA (National Authority on Tobacco and Alcohol) NART act in 2005 which banned smoking in public places saw hundreds of patients coming to me to for help them to quit smoking. Still, the laws have to be in combination with other psychosocial culture change strategies. If we can reduce the number of people using the substance, and the overall amount they use, in the country, we can reduce the problem. It’s not just about treating those in trouble. Disorder level drug abuse is very small in any community, but that proportion has a direct relationship to overall use of that substance in society. To change the overall level of use, we need to address the culture associated with drug and alcohol use.
So, how do we change the culture associated with drug and alcohol use?
People never say that they are going to ‘drink alcohol’; they say that they are going to ‘have a drink’ or ‘be in high spirits’. There are all these code words we use, and this is part of our alcohol culture. Rituals like toasting express solidarity, friendship, even religion. And when someone is drunk, they have certain privileges, they get away with things. People believe that alcohol can make them happy, but clinically speaking, it is a depressant. Culture determines how we perceive alcohol. This needs to change.
As a community, we need to focus not just on those who use drugs or alcohol, but on those who don’t. If a man goes out drinking because he believes he needs alcohol to make friends, he is part of the problem. So too is his wife if she believes the same (even if she doesn’t drink), it still contributes to the problem. Another common thing wife’s say is that, “My husband is a gem of a guy, he only beats me when he’s drunk,” which is again problematic, it gives the husband permission to beat her when he is drunk. Again, prevention and a change in cultural perception are key.
Why do you think people take drugs?
My concern is that there is a lot of hype about drugs. They are painted as these magical molecules that can change everything – it makes them seem worth experiencing. If we think about why people take drugs, it seems to be because they think it will make them happier and less stressed. What we need to ask ourselves is whether chemicals can make us happy?
So, do you think chemicals can make us happy?
Well first we would have to define happiness, which is complicated in itself. But we could look at a simple layer of happiness, like the pleasure derived from a nice scene or from the touch of skin; pleasures associated with the 5 senses. It is a question if alcohol or tobacco can give us such pleasure. If so, in what sense? Touch? Vision or what?
I can teach you to derive pleasure from looking at this window pane, or salivate when a bell is rung like the Pavlovian dogs, with enough time. It’s a learnt behaviour, it’s a response. The same is true of the pleasure derived from alcohol and drugs.
Dopamine is a chemical released as part of the brain’s reward system and is produced on taking various drugs, but did you know that receiving money can also produce dopamine? It’s a learnt response which is clear from the fact that if you show a two year old money, no dopamine is produced.
This is why companies make products like vodka flavoured lipsticks and alcopops. It’s why the culture and mystique surrounding these products plays such a big and troubling role. They are used to teach people to derive pleasure from these substances. It’s funny, the number of patients who receive amphetaminesopioids in hospital, which are a heroin like medication, and yet never appear high or particularly happy. It just reduces their physical pain, an ‘unlearnt’ true effect, because they haven’t learnt to associate the drug with pleasure. There are several experiments which support this, but given the stakeholders involved, it’s no wonder that there is an active effort to cover up the knowledge that the pleasure taken from alcohol and drugs is not so much a chemically mediated effect, but a learnt behaviour.
