Everyone knew him as the village crazy Deodine Ntenzimana, the man who mumbled strange nothings to himself by the roadside on good days, and ran after complete strangers or chased imaginary enemies on bad ones. 

Unlike other mentally disturbed people in the area, whose illness was often explained mysteriously as an act of God or his opposite, most people in the village thought they knew what had finally got Ntenzimana unhinged: he was a notorious drug user; an addict to a deadly cocktail of marijuana, narcotics and liquor. 

Every day he would wake up early in the morning hide behind the house and apply what he called ‘the wonder breakfast’: a home-rolled blunt and a half glass of liquor. Unfortunately for Ntenzimana, this magic ‘breakfast’ would ultimately lead him into self-destruction.

Although it may be comforting for us to think that his is an isolated case, the sad truth is that many mentally unstable people we meet are, like Ntenzimana, victims of drug abuse. 

It all begins with addiction. The disease that kills a man begins as an appetite. A sip on a glass, a pullon a joint; just one. Then one more, and another, each sweeter than the previous sniff or draw. 

Many chronic drug abusers—the individuals we commonly regard as addicts—often simultaneously suffer from a serious mental disorder. Drug treatment and medical professionals call this condition a co-occurring disorder or a dual diagnosis.

Chronic drug abuse is the habitual abuse of licit or illicit drugs to the extent that the abuse substantially injures a person’s health or substantially interferes with their social or economic functioning. 

Psychiatrists say any person who has lost the power of self-control over the use of drugs is considered a chronic drug abuser.

Some common serious mental disorders associated with chronic drug abuse include schizophrenia, bipolar disorder, manic depression, attention deficit hyperactivity disorder (ADHD), generalised anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder and panic disorder.

Some of these disorders carry with them an increased risk of drug abuse.

Saddening stats

And the situation is far from encouraging. Statistics from Kigali Health Institute indicate that more than 50 per cent of the youth between 14 and 35 years of age have consumed one or more kinds of drugs.

Sheikh Fazil Musa Harelimana, the minister for internal security, in an interview with The New Times, said: "Ndera Mental Hospital, Kigali, figures show that 11 per cent of the patients registered have ailments related to drug abuse.”

Dr Yvonne Kayiteshonga, the head of mental health division at Rwanda Biomedical Centre, warns that one young man or woman out of every 13 is alcohol-dependent.

But Solange Mukaritamu, a social worker at Kabuga Transit Centre, says sources to these drugs are quite many, and whether we like it or not they are from the community. Most young people are confused by their friends, forcing them to fall for these drugs, which eventually come with consequences towards mental health.

While most people in the community find alcohol as their solace, the Rwanda Bureau of Standards (RBS) says any drink whose alcohol content exceeds 45 per cent is considered a narcotic drug.

Mental health & drug addiction

When two disorders or illnesses occur simultaneously in the same person, they are called comorbid. Surveys show that drug abuse and other mental illnesses are often comorbid. 

Six out of ten people with a substance use disorder also suffer from another form of mental illness. But the high prevalence of these comorbidities does not mean that one condition caused the other, even if one appeared first. 

Drug addiction changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires by substituting new priorities connected with procuring and using the drug. Similarly, the resulting compulsive behaviour that override the ability to control impulses despite the consequences are similar to hallmarks of other mental illnesses.

Drug dependence is synonymous with addiction. By comparison, the criteria for drug abuse hinge on the harmful consequences of repeated use but do not include the compulsive use, tolerance for example needing higher doses to achieve the same effect, or withdrawal (symptoms that occur when use is stopped) that can be signs of addiction

Dr Roxanne Dryden-Edwards, an adult, child, and adolescent psychiatrist at Johns Hopkins Hospital in Baltimore, says drug addiction has many additional social and occupational complications which are medical while others may result from chemical dependency.

The obvious one is respiratory arrest associated with heroin or sedative overdose. This may also cause heart attack while strokecan be caused by cocaine or amphetamine intoxication, death is a highly possibleoccurence from complication of drug addiction. People who are dependent on drugs are also at higher risk of developing chronic medical conditions as complications of drug addiction. 

Liver failure and pancreatitis associated with alcoholism or inhalants and brain damage are just two such examples.

What to do

Here is what experts suggest as possible solutions to overcome drug related mental illness.

If treated, the prognosis of alcoholism and other drug addictions improves but is not without challenges. 

Recovery from substance abuse is usually characterised by episodes of remission (abstinence from drug use) and relapses. A person experiencing body pain resulting from an illness may resort to drugs to relieve the pain.

This shows that physical illnesses are also related to mental disorders.

Dr Agnes Binagwaho, the minister for health, said: "We need to also deal with mental health problems of people with chronic physical illnesses and physical care of mental health sufferers through continued integrated care. Both physical and mental illnesses are linked”

Dr Roxanne adds that several prevention approaches have been found to be effective in decreasing the risk of drug abuse and addiction. Simple lifestyle changes, like increased physical activity and using other stress reduction techniques, are thought to help. 

Mayo Clinic says there is no sure way to prevent mental illness. However, if you have a mental illness, taking steps to control stress, to increase your resilience and to boost low self-esteem may help keep your symptoms under control.

It adds that, suicidal thoughts and behaviour are common with some mental illnesses. If your loved one shows signs of mental illness, have an open and honest discussion with him or her about your concerns or try to force withdrawal of the causative (drugs). 

While you may not be able to force someone to get professional care, you can offer encouragement and support. You can also help your loved one find a qualified mental health provider and make an appointment or ensure to go along with them for the appointment.