I sighed as I bent to search my patient's foot and ankle for a vein to draw blood from.

He had gone back to injecting himself with drugs and the blood vessels where one usually draws blood from, in the forearms and hands, had hardened.

He was shivering with abdominal cramps from drug withdrawal. His situation was made even more awkward by the constant recriminations from his relatives and the unsympathetic responses from the medical staff.

Patients with drug and alcohol dependency face much discrimination and lack of sympathy because a typical public perception is that they are the sole cause of their predicament and they should shoulder all the pain and blame.

In my opinion, the upshot is that individuals with addiction issues will play down or hide their problems until the dependency escalates, creating much bigger medical and social problems.

In my practice, patients with an alcohol problem come in when they have stomach bleeding, liver damage or after falls or being pulled up for drunken driving. Patients with a drug addiction come in with infections, injuries and problems with the law.

When a person is addicted to a chemical or to an activity, this addiction takes over his life. He lives to make enough money to satisfy his addiction, which becomes the most important thing occupying his daily thoughts and activities.

While such cravings can be satisfied by giving in to his desires, these only provide a temporary measure of relief. Such an individual will, on the next occasion, need more of the source of addiction to arrive at his previous level of satisfaction.

The situation is compounded when the person abuses alcohol and certain drugs which can cause physical withdrawal symptoms when the individual voluntarily stops or is deprived of the substance.

Many are unable to tolerate the associated withdrawal pains and other discomforting bodily symptoms, especially with increasing age. They find themselves unable to stop the substances on their own.

Such patients require a period of hospitalisation care to cope with their physical withdrawal symptoms. Once these symptoms have abated, counselling can take place, which has to be continued after they are discharged.

We now have medication to reduce the urge to return to substances and to even block some of the substances from affecting the body, thus preventing a relapse.

Counselling is long term and family therapy is essential. The person with the addiction may believe that after his treatment, everything will return to the way things were before his illness.

He often fails to realise that - due to his inability to take on the role of parent, spouse and reliable work colleague when he was under the influence of substances - his family, friends and peers might have changed their attitude towards him. They might also have much less confidence in him.

His recovery period needs to take into consideration the time he may need to re-establish a new level of trust and to engender empathy among his daily contacts.

Support Groups like Alcoholics Anonymous and Narcotics Anonymous help in providing peer counselling and understanding. Community resources like the Singapore Anti-Narcotics Association, half-way houses and religious organisations provide resources, counselling and support to people with addictions to avert relapses.

However, despite our best efforts, patients can and do relapse. Some argue that, in treating addictions, cases of relapse are unfortunately part and parcel of the long journey to eventual recovery.

An addiction can evolve into a chronic disorder. Patients do understand that everyone is trying to help and at times they do have higher motivation to stay clean. Yet, as the addiction community would point out, it is a very powerful force that needs all the individual's efforts to counter it on a daily basis.

In other words, one does not fully remove the addiction but is always in recovery with a constant and real risk of relapse if one becomes too complacent.

The availability of constant support from loved ones is crucial.

I can vouch that there are many who have successfully stayed the course.

Never give up. Everyone can change.

brianyeoclinic@yahoo.com.sg

Dr Brian Yeo is a consultant psychiatrist in private practice and an adjunct associate professor at the department of psychological medicine at the Yong Loo Lin School of Medicine, National University of Singapore. He is also a certified master substance abuse counsellor and is currently the Singapore Medical Association representative to the Board of Management, Singapore Anti-Narcotics Association.

This article was first published in Mind Your Body, The Straits Times.