A Case Report on Alcohol Dependence Syndrome with Cannabis Addiction

Background: Alcohol dependence syndrome (ADS) and Cannabis use disorder (CUD) are every now and again co-happening or comorbid substance issues in the two young people and grownups. Indications of cross-over between ADS and CUD in people as they slowly move from preadulthood to adulthood. The researchers reasoned that the two substance-related issues are comorbid, albeit the closeness of their association ordinarily shifts over the long haul. Aim and Objective: The purpose of this case report is to determine the first-line approach for a person with alcohol dependence syndrome with cannabis addiction who has been referred to a public mental health facility for treatment. To identifying symptoms of ADS with cannabis addiction early, providing treatment and preventing possible complications. Methods: Knowledge used to write this case description was gathered from PubMed outlets, search hand, searching college and personal libraries looking for research techniques and case report texts, engaging in or writing many case reports with experience. Results: The patient was taken psychopharmacological treatment AntiAnxiety drugs Lorazepam along with Tab. Benalgis, Tab. Neurobion fort and psycho social therapy, coping strategies, family therapy, yoga, cognitive behavioural therapy, medication. After those symptoms was minimized. Conclusion: Patients achieve positive outcomes not only through the support of their treatment management, but also through adaptation and family support. Then, with appropriate psychophysiological treatment, the patient gave a positive response and gradually all the planned goals were achieved. Finally, the patient was discharged and he is currently being monitored. Case Study Ekhar et al.; JPRI, 33(57B): 439-444, 2021; Article no.JPRI.75067 440


INTRODUCTION
Alcoholism has been known by a variety of terms, including alcohol abuse and alcohol dependence. Today, it's referred to as ADS. It happens when you drink such a lot of that your body in the end becomes reliant upon or dependent on liquor. At the point when this occurs, alcohol turns into the main thing in your life. Individuals with alcohol use issue will keep on drinking in any event, when drinking causes adverse results, such as losing an employment or obliterating associations with individuals they love. They might realize that their alcohol use contrarily influences their lives, however it's generally expected insufficient to make them quit drinking. Comorbid conditions are medical issues that show up together in one individual and cause a bigger number of troubles for that individual than they would all alone [1]. Chronic alcoholism is a pathologic condition due to excessive and habitual intake of alcohol. Alcoholism can affect and damage the brain in several ways and this depends on various factors such as age, sex, history of intake, diet, and vulnerability of specific brain regions [2]. Individual may drink to relieve or decrease his/her stress, but the problem is that drinking to relieve stress may lead to further social, emotional, and physical problems, including sexual dysfunction [3].
CUD, also known as cannabis addiction or marijuana addiction [4]. CUD are regularly connected with reliance-in which an individual feels withdrawal manifestations when not taking the medication. Individuals who use marijuana frequently report peevishness, mind-set and rest troubles, diminished hunger, yearnings, anxiety, as well as different types of actual uneasiness that top inside the primary week in the wake of stopping and last up to two weeks [5]. Marijuana contains more than 400 synthetics, with delta-9tetrahydro-cannabinol (THC) the key psychoactive (mind-adjusting) substance in the medication. The potential impacts of marijuana incorporate state of mind changes, selfdestructive reasoning and interruption to ordinary learning capacities. It might likewise be fit for creating reliance, psychosis and enslavement [6]. Albeit numerous consumers don't utilize different medications, it is normal for somebody drinking alcohol to likewise smoke tobacco or marijuana. Following alcohol's 90% worldwide use, tobacco is second at 58% and cannabis comes in third at 48%. There is a known relationship with drinking alcohol and smoking cigarettes: the individuals who drink are significantly more liable to smoke and the people who smoke are substantially more prone to drink. On the off chance that somebody utilizes alcohol, they are bound to utilize weed around the same time and in the event that somebody utilizes weed, they are bound to utilize alcohol around the same time [4]. Excess alcohol intake leads to various medical, psychosocial and legal problems. The cost in terms of loss of productivity, health and family problems is immense [7].
People who have recuperated from a substance use issue are consistently at an expanded danger for backslide; notwithstanding, the danger for backslide diminishes pointedly after the individual has been abstinent for 5-7 years and kept up with dynamic interest in treatment-related exercises. Regardless, it is as yet normal to hear accounts of people who have been abstinent from alcohol or cannabis for over 10 years and afterward backslid. Hence, deep rooted interest in some type of treatment-related exercises, for example, peer support gatherings, is unequivocally suggested for people who are recuperating from any type of substance use issue [8].

CASE HISTORY
A case was from selected Hospital Wardha where lack of mental health services for the remote population and underprivileged population, selected Hospital provides mental health care services for all the needy people.

PATIENT INFORMATION
A 32years old male patient got admitted in psychiatric ward, selected Hospital with the complaints of sleep disturbance, loss of appetite, seeing death people not seen by others and hearing voices not heard by others, aggressions, irritability, habit of drinking alcohol with cannabis and tobacco daily. As per relative of patient he was apparently asymptomatic 18 years ago i.e., when he was 14 years of age. He started taking alcohol out of curiosity and soon take it regularly like 3-4 times a month. His consumption soon increased from occasionally to daily basic needs and quantity also increased 2 years before marriage (2015), his doses of alcohol increased and needed a eye opener. In the last 1 month, my patient experienced decrease sleep and appetite, low mood, he also started hallucinating a things like death body in the mirror when he is in intoxicated state and also heard a voice of ghungroo which in not seen or heard by others. He started seeing his cousin sister who died 2 months back in mirror and he also started to seeing his neighbour who had died 2yrs ago due to suicide after that he saw them, he started to run away from that place. He also started to suspect that his neighbour had did some black magic on him. Because hi think that his neighbour had started to like him but he rejected her so she is taking revenge on him. All necessary investigation like history collection, physical examination mental status examination blood investigation like CBC report shows red blood cells count 4.1millions, total white blood cells 3.4 million hemoglobin level 12.3gm% was done and Doctor Diagnose here as a Schizophrenia. He was admitted in ward for further evaluation and treatment.

PAST PSYCHIATRIC HISTORY
Patient seek medical help from 2011 he got admitted in deaddiction for his habit of drinking and cannabis, but after 1 month he left deaddiction centre without completing his treatment no document was found of that admission. After that he got admitted in Maruti deaddiction centre in Nagpur in 2017, but also from there he left without completing his treatment after 1 and half month no document was found of that admission. After that he got admitted in Hospital at 6/07/202 and was started with injection thiamine 100mg OD injection neurobion fort OD tab. Benfomet plus, but also left the hospital without completing his treatment.

Physical Examination
In physical examination in abdomen, he is having mild splenomegaly and also 1 st grade fatty liver and also tremors present in his hand, Scar on the left hand's palm other than that no any abnormality is find out.

Mental status examination
Mental status examination was done and finding of patient was facial expression was anxious and sad, mannerism present, eye to eye contact was initiated but not maintained, Speech reaction time was normal, mood and affect are impaired. From of thought was normal, stream of thought was also normal, delusion of persecutory is present. Disorder of perception in this 2 nd person auditory and visual hallucination is present, he was well oriented of time, place and person. Memory, abstract, intelligence, judgement is intact. Insight was Insight II. (Intellectual insight).

DATA EXTRACTION
Data extracted from PUB MED, Medline, and Cochrane database library.

PSYCHO PHARMACOLOGIC INTERVENTIONS
The patient is on following treatment regimen which is antipsychotics are prescribed from the date of admission Anti-Anxiety drugs tab Lorazepam X OD along with Tab. Benalgis X BD and Tab. Neurobion fort X BD.

 Tab. Lorazepam X OD
This medication is used to treat anxiety. Lorazepam belongs to a class of drugs known as benzodiazepines which act on the brain and nerves (central nervous system) to produce a calming effect. This drug works by enhancing the effects of a certain natural chemical in the body (GABA) [9].

 Tab. Benalgis X BD
Benalgis Tablet helps treat low levels of thiamine in the body and its associated conditions such as heart and nerverelated disorders [10].

 Tab. Neurobion fort X BD
Neurobion Forte is a vitamin product that contains a mixture of different B vitamins. It's available as an oral tablet. The Neurobion Forte tablet strengthens your immune system while also increasing your energy levels [11].

SCIENTIFIC DISCUSSION AND STRENGTH REGARDING THE CASE REPORT
This is a pure case of a with alcohol dependence syndrome with cannabis addiction. The 32-year-old male admitted in an Acharya Vinobha Bhava Rural hospital with the typical symptoms of sleep disturbance, loss of appetite, seeing death people not seen by others and hearing voices not heard by others, aggressions, irritability, habit of drinking alcohol with cannabis and tobacco daily. The plan of care completely based on interventions were includes a various management that were pharmacological management, medical management, nursing management as well as the therapeutic management. Since from the first day of hospitalization, plan of action was planned with rationale; and according to the planning the implementation also done with positive outcomes. Patient achieved positive outcomes not only through the support of their treatment management, but also through adaptation and family support. With appropriate psychosocial treatment, the patient's response was positive and gradually all goals were meet. The patient was finally discharged after month, he continues the follow up treatment.

PROGNOSIS
The prognosis is the first and foremost dependent on early and successful treatment of alcohol dependence syndrome with cannabis addiction. As well as the prognosis also depend upon the severity of the disease condition but also the socioeconomic background of the family and meanwhile family coping. Treatment regimen, later on the patient given a positive outcome and finally she discharged from the hospital while staying in hospital near about 1 month. During the hospitalization of a patient, as family were not able to afford the cost of treatment regimen, family approached for the fund and Rajiv Gandhi Yojana; from these sources the family got little bit of help.

DISCUSSION
Alcohol and cannabis abuse are identified with impeded perception. This review assessed the neuropsychological exhibition of members with alcohol reliance and weed reliance with co-happening liquor use (MJ + ALC).
Critical gathering contrasts were distinguished between the two gatherings where the members with marijuana reliance with co-happening alcohol use have shown intellectual decrements in the areas of visuospatial capacity, handling speed, working memory, verbal learning and memory, and language abilities [12].
In the review distributed in Drug and Alcohol Dependence, specialists utilized data given by 816 grown-up people to perceive how regularly substance clients have comorbid instances of alcohol use issue and cannabis use problem. The specialists searched for a crossover at three focuses on schedule: youth/preadulthood, youthful adulthood and resulting long stretches of adulthood. Subsequent to exploring the past and flow accounts of the review members, the scientists reasoned that alcohol use problem and cannabis use issue show up together in a critical number of cases in youth/youthfulness, youthful adulthood and later long stretches of adulthood. They likewise presumed that three important arrangements of occasions can happen among alcohol and cannabis buyers who create comorbid issues: alcohol use problem in youth/immaturity followed by the expansion of cannabis use issue in early adulthood, cannabis use issue in adolescence/puberty followed by the expansion of alcohol use issue in early adulthood and cannabis use issue in adolescence/youthfulness followed by the expansion of liquor use issue in later phases of adulthood. The review's creators note that similar connections and examples related with comorbid alcohol use issue and cannabis use issue in men additionally to a great extent happen in ladies, albeit some sexual orientation-based contrast happens. They additionally note that the associated examples of alcohol and cannabis issues found in youth/puberty show up again in later adulthood yet in a more fragile structure [13].

CONCLUSION
Patients achieve positive outcomes not only through the support of their treatment management, but also through adaptation and family support. Then, with appropriate psychophysiological treatment, the patient gave a positive response and gradually all the planned goals were achieved. Finally, the patient was discharged and he is currently being monitored.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
Before making case report author had taken a written consent from the patient.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).