-III
247
248
249
*
11-1 vfèkxe mís';
11-2 ifjp;
11-3 fd'kksjkoLFkk ds nkSjku fodklkRed ifjorZu 11-4 O;ogkjxr vkSj lkaosfxd fodkj
11-5 fodklkRed fodkj 11-6 eknd inkFkks± dk lsou
11-6-1 fd'kksjksa ij eknd inkFkks± ds lsou ds çHkko
11-7 cPpksa vkSj fd'kksjksa dks ijke'kZ nsuk 11-8 eknd inkFkZ lsou fodkj esa ijke'kZ
11-8-1 jksdFkke vkSj mipkj
11-9 eknd inkFkZ lsou fodkjksa ds mipkj ds fy, lkekU;r% ç;qä mikxe 11-10 lkjka'k
11-11 çeq[k 'kCn
11-12 Lo&vkdyu ç'uksa ds mÙkj 11-13 bdkà ls lacfèkr ç'u 11-14 lanHkZ
11-15 ikBî lq>ko
bl bdkà ds vè;;u ds ckn vki fuEufyf[kr esa l{ke gksaxs%
• cPpksa vkSj fd'kksjksa esa fofHkUu çdkj ds fodkjksa dks le>uk(
• cky ,oa fd'kksj ijke'kZ esa mi;ksx dh tkus okyh ijke'kZ rduhdksa dh O;k[;k djuk(
• eknd inkFkks± ds lsou dh voèkkj.kk dks le>uk( vkSj
• eknd inkFkks± ds lsou esa ç;qä cqfu;knh ijke'kZ rduhdksa dk o.kZu djuk
*
( )
250
cpiu vkSj fd'kksjkoLFkk ekuo thou dky esa lcls egRoiw.kZ vkSj laosnu'khy pj.k gSaA mUgsa dà çdkj ds fodklkRed ifjorZuksa lfgr o;Ldrk ds fy, çkjafHkd pj.k ekuk tkrk gSA cPpk fofHkUu tSfod ço`fÙk;ksa ds lkFk iSnk gksrk gS tks ,sls VsEiysV ds :i esa dk;Z djrh gSa ftl ij 'kkjhfjd] laKkukRed] lkaosfxd vkSj lkekftd igyqvksa esa dqN ifjorZu gksrs gSaA fd'kksjkoLFkk dks cpiu vkSj o;Ldrk ds chp lsrq ds :i esa ekuk tkrk gS ftls 'kkjhfjd] laKkukRed vkSj lkaosfxd igyqvksa esa rsth ls gksus okys ifjorZuksa }kjk fpfàr fd;k tkrk gSA vkerkSj ij ;g dgk tkrk gS fd bu ifjorZuksa dh rsth ds dkj.k fd'kksj Þmrkj&p<+ko okyh ;k=kÞ ls xqtjrk gSA ;gh dkj.k gS fd fd'kksjkoLFkk dks fdlh O;fä ds thou esa lcls uktqd voLFkk ds :i esa fpfàr fd;k tkrk gSA
bl bdkà esa vki cPpksa vkSj fd'kksjksa esa fofHkUu O;ogkjxr vkSj fodklkRed leL;kvksa@fodkjksa ds ckjs esa lh[ksaxsA blds vykok vki uSnkfud ekgkSy esa vkerkSj ij mi;ksx dh tkus okyh fofHkUu ijke'kZ rduhdksa dh lgk;rk ls bu eqíksa ds çcaèku ds ckjs esa tkusaxsA var esa vki fo'ks"k :i ls fd'kksjksa ds lkekU;
dq&vuqdwfyr O;ogkj tSls eknd inkFkks± ds lsou dks le>saxs vkSj mudk çcaèku lh[ksaxsA
cpiu vkSj fd'kksjkoLFkk dks LoLFk o;Ldrk dk egRoiw.kZ Hkfo";lwpd ekuk tkrk gSA fd'kksjkoLFkk esa muds 'kkjhfjd] euksoSKkfud vkSj lkekftd dk;ks± esa dà çdkj ds ifjorZu gksrs gSaA bl pj.k dks ,sls laØe.k {ks= ds :i esa ekuk tkrk gS ftlds Hkhrj cPpk o;Ld cuus dh ;k=k iwjh djrk gSA foÜo LokLF; laxBu ds vuqlkj fd'kksjkoLFkk 10&19 o"kZ dh vk;q lhek dks doj djrh gS( tcfd 10&24 o"kZ vk;q oxZ dks r#.k yksxksa ds :i esa oÆ.kr fd;k x;k gS ftlesa 15&24 o"kZ dk ;qok vk;q oxZ 'kkfey gSaA gkykafd cPps vkSj fd'kksj vk;q ds vuqlkj fof'k"V fodklkRed ifjorZuksa vkSj fo'ks"krkvksa ls xqtjrs gSa] fQj Hkh bl vk;q oxZ esa Hkh fofHkUu lkekftd&lkaL—frd i`"BHkwfe vkSj lanHkks± ds çHkkoksa ds pyrs fofoèkrk ikà tkrh gSA blfy, ;g ;qok vkcknh ç—fr esa xfr'khy gS vkSj bl vk;q oxZ ds fy, ijke'kZ esa bl rF; dks è;ku esa j[kuk vko';d gSA ijke'kZnkrk dks fd'kksjksa esa fofHkUu fodklkRed ifjorZuksa ds ckjs esa Hkh irk gksuk pkfg,A
fd'kksjkoLFkk ds pj.k esa laKkukRed] lkaosfxd] euks&lkekftd vkSj 'kkjhfjd Mksesu esa rsth ls ifjorZu gksrs gSaA 'kkjhfjd ifjorZuksa esa 'kkjhfjd fodkl tSls dn] otu esa c<+ksrjh vkSj xkS.k ;kSu fo'ks"krk,a tSls vkokt dh fip esa cnyko 'kkfey gSaA laKkukRed ifjorZu ekufld çfØ;kvksa tSls rdZuk] lkjxzg.k] –';&LFkkfud vfHkfoU;kl vkSj leL;k lekèkku {kerk ls lacafèkr gSaA lkaosfxd ifjorZuksa esa igys ls vfèkd Øksèk] 'k=qrk] Hk; vkSj nqÇ'prk çnÆ'kr djuk vkSj lkaosfxd {kerk esa deh 'kkfey gSA eukslkekftd ifjorZuksa dks Lora=rk] lkekftd lacaèkksa] Lok;Ùkrk]
igpku fuekZ.k vkSj Hkfo"; ds mUeq[khdj.k ds lacaèk esa ifjorZuksa ls fpfàr fd;k tkrk gSA
251
fd'kksjkoLFkk ds nkSjku fd'kksjksa esa 'kkjhfjd fodkl esa LQqj.k ;k rsth gkeksZu lacaèkh ifjorZuksa ds dkj.k gksrh gSA bl çfØ;k esa lcls çeq[k Hkwfedk fiVîwVjh xzafFk }kjk fuHkkà tkrh gSA bls ekLVj xzafFk ds :i esa tkuk tkrk gS vkSj ;g 'kjhj esa vU; xzafFk;ksa ds lzko dks fu;af=r djrh gSA ;g xzafFk o`f) ¼growth½ gkeksZu iSnk djrh gS tks fd'kksjksa ds lexz 'kkjhfjd fodkl dk vfuok;Z fgLlk gSA bl le; dà 'kkjhfjd ifjorZu tSls tka?kksa ds ckyksa dk c<+uk] Lruksa dk vkdkj c<+uk] vkokt dh fip esa cnyko vkfn gksrs gSaA
fi;kts ds laKkukRed fodkl ds fl)kar ds vuqlkj fd'kksj vkSipkfjd fØ;k'khy fopkj ds pj.k esa gSaA fd'kksjksa esa laKkukRed fodkl rdZuk dkS'ky vkSj vewrZ lksp ¼abstract thinking½ ds fodkl ls fpfàr gksrk gSA rdZuk fdlh leL;k dk lekèkku [kkstus ;k fu"d"kZ fudkyus ds fy, iwoZ Kku dk mi;ksx djus dh {kerk gSA ;g ,d mPp laKkukRed çdk;Z gS tks leL;k lekèkku dkS'ky ls lac) gSA bu dkS'kyksa ls fd'kksj fofHkUu laHkkoukvksa dk vUos"k.k djrs gq, leL;k ds fofHkUu oSdfYid lekèkkuksa dh ryk'k djrs gSaA
;s dkS'ky rkÆdd fopkj çfØ;kvksa ij vkèkkfjr gksrs gSaA vewrZ lksp ,slh mPp Lrj dh lksp gS tks tfVy laçR;;ksa dks vklkuh ls le>us esa vkSj leL;k dks gy djus esa lgk;rk djrh gSA fd'kksjkoLFkk dh voLFkk esa vfèklaKku
¼metacognition½ {kerk dk fodkl Hkh gksrk gSA bl voLFkk esa fd'kksj viuh lkaosfxd voLFkkvksa] viuh Hkkoukvksa ds ckjs esa lkspus dh {kerk fodflr dj ysrs gSa vkSj vius ckjs esa lkekftd rRoksa dh èkkj.kkvksa ds ckjs esa O;k[;k djuk 'kq: dj nsrs gSaA ljy 'kCnksa esa bls fdlh O;fä }kjk viuh lksp ds ckjs esa lkspus ds :i esa oÆ.kr fd;k tk ldrk gSA
Hkkouk,a fdlh tho dh euksHkkSfrd voLFkk,a gksrh gSa tks fopkj çfØ;kvksa]
Hkkoukvksa] O;ogkjxr iSVuks± vkSj vkuan dh Hkkouk] Øksèk] nq[k vkfn ls tqM+h gksrh gSaA tSlk fd vki tkurs gSa] LoLFk O;fä mls ekuk tkrk gS tks le;]
LFkku vkSj O;fä ds lacaèk esa viuh Hkkoukvksa dks çcafèkr djus dh {kerk j[krk gksA bl {kerk dks lkaosfxd {kerk ds :i esa tkuk tkrk gSA lkaosfxd {kerk ds fodkl dh uÈo fd'kksjkoLFkk dh vofèk ds nkSjku gh j[kh tkrh gSA bl pj.k ds nkSjku fd'kksj viuh Hkkoukvksa vkSj lkaosfxd voLFkkvksa ds ckjs esa vfèkd xgjkà ls lh[krs gSa vkSj bUgsa vius ifjtuksa vkSj muds lacafèkr lektksa esa vU; lkekftd rRoksa }kjk muds çfr çLrqr ekudksa ds vuqlkj yscy djus dk ç;kl djrs gSaA
euks&
lkekftd lkaosfxd
laKkukRed 'kkjhfjd
252
fd'kksjksa esa eukslkekftd fodkl dà {ks=ksa esa gksrk gS%
• Lok;Ùkrk% bl mez ds nkSjku fd'kksj vius thou thus ds rjhdksa dks ifjHkkf"kr djuk 'kq: dj nsrs gSa vkSj dqN ,sls O;ogkj viukrs gSa tks muds Hkfo"; ds fodkl ds fy, iwoZo`Ùk gks ldrs gSaA os vius dqN fu.kZ;
ysus tSls vius fe=ksa ds lkFk jguk] muds }kjk [kk, tkus okys Hkkstu dk pquko djuk] muds igukos ls lacafèkr fu.kZ; vkfn ds fy, viuh xksiuh;rk vkSj Lora=rk dh ekax djrs gSaA fd'kksjkoLFkk ds var esa os o;Ldksa dh rjg O;ogkj djuk 'kq: dj nsrs gSa vkSj Lok;Ùkrk dh ekax djrs gSaA
• igpku fuekZ.k% ljy 'kCnksa esa igpku dk vFkZ Lo;a ds ckjs esa cukà xÃèkkj.kk,a gSaA ;g O;fä ds fnekx esa mldh i`"BHkwfe] dkS'kyksa] vuqHkoksa]
miyfCèk;ksa] y{;ksa vkfn ls çHkkfor vius ckjs esa Nfo ls lacafèkr gSA ;g O;fä dh tkrh;rk vkSj lkaL—frd fojklr ds fgLls ls Hkh lacafèkr gks ldrh gSA fd'kksjkoLFkk dk pj.k mu O;fäxr Hkwfedkvksa ds vUos"k.k }kjk fpfàr fd;k tkrk gS ftls fd'kksj viuh o;Ldrk esa fuHkkus okys gSaA
• Hkfo"; mUeq[khdj.k% ;g {ks= Hkfo"; ds dfj;j vkSj O;kolkf;d fodYiksa ij dsafær gSA igpku fuekZ.k ds nkSjku fuÆer mudh vkRe&igpku ds vkèkkj ij O;fäRo fo'ks"krkvksa ds vuqlkj fdlh fo'ks"k Hkwfedk dks pquus ds fy, Hkfo"; mUeq[khdj.k csgn vko';d gSaA bldh 'kq:vkr fd'kksjkoLFkk ds ckn ds pj.kksa esa vFkkZr yxHkx 16 ls 18 lky ds nkSjku 'kq: gksrh gSA Lok;Ùkrk çkIr gksus ds lkFk laKkukRed ifjiDork çkIr gksrh gS ftls igys ç—fr esa vèkZ&Lok;Ùk ekuk tkrk FkkA bl mez esa fd'kksj o;Ld ds :i esa viuh ;k=k 'kq: djus ds fy, rS;kj gSa vkSj bl rjg 'kjkc] rackdw vkSj vU; eknd inkFkks± tSls miyCèk inkFkks± rd mudh igqap c<+ tkrh gSA
• cpiu dks 'kS'kokoLFkk vkSj fd'kksjkoLFkk ds chp dh voLFkk ds :i esa le>k tk ldrk gSA
• fd'kksjkoLFkk dks cpiu vkSj o;Ldrk ds chp dk lsrq ekuk tkrk gSA
• 'kkjhfjd] laKkukRed] lkaosfxd vkSj eukslkekftd igyqvksa esa ifjorZu dh xfr ds dkj.k fd'kksjkoLFkk Þmrkj&p<+ko Hkjh ;k=kÞ gSA
• fd'kksjkoLFkk 10 o"kZ dh mez ls 'kq: gksrh gS vkSj 19 o"kZ rd jgrh gSA
• fd'kksjkoLFkk esa gksus okys 'kkjhfjd ifjorZuksa esa 'kkjhfjd fodkl tSls dn]
otu esa c<+ksrjh vkSj xkS.k ;kSu fo'ks"krk,a tSls vkokt dh fip esa cnyko 'kkfey gSaA
• laKkukRed ifjorZuksa esa rdZuk] lkjxzg.k] –';&LFkkfud vfHkfoU;kl vkSj leL;k lekèkku {kerk tSls ekufld çdk;ks± esa ifjorZu 'kkfey gSaA
253
• lkaosfxd ifjorZuksa esa lkaosfxd l{kerk] Øksèk] 'k=qrk] Hk; vkSj nqÇ'prk 'kkfey gSaA
• eukslkekftd ifjorZuksa esa Lora=rk] lkekftd lacaèk] Lok;Ùkrk] igpku fuekZ.k vkSj Hkfo"; ds #>ku 'kkfey gSaA
1½ foÜo LokLF; laxBu ds vuqlkj fd'kksjksa dh vk;q lhek D;k gS\
d½ 9 ls 18 o"kZ [k½ 10 ls 19 o"kZ x½ 11 ls 18 o"kZ
?k½ 12 ls 18 o"kZ
2½ fd'kksjksa esa fdu çeq[k {ks=ksa esa laKkukRed fodkl gksrk gS\
3½ O;fä }kjk viuh lkaosfxd fLFkfr dks çcafèkr djus dh {kerk dks --- ds :i esa tkuk tkrk gSA
4½ fd'kksjksa esa eukslkekftd fodkl ds çeq[k {ks= ---] ---] vkSj --- --- gSaA
O;ogkjxr vkSj lkaosfxd fodkjksa dks cPps ;k fd'kksjksa ds çHkkfor ;k =Lr O;ogkj vkSj lkaosfxd voLFkkvksa ls fpfàr fd;k tkrk gSA muesa vkpj.k fodkj] Loyhurk
¼autism½] Hkkstu fodkj] nqHkÊfr ¼phobia½] nqÇ'prk vkSj volkn 'kkfey gks ldrs gSaA bu fodkjksa dk laf{kIr fooj.k uhps nh xà rkfydk esa fn;k x;k gSA
O;ogkjxr fodkj çeq[k y{k.k
voèkku&U;wurk vfrfØ;k fodkj
(Attention-deficit hyperactivity disorder)¼,Mh,pMh½
bls è;ku esa deh] vkosx] vfr lfØ;rk vkSj visf{kr le;
rd cSBus esa vleFkZrk ls fpfàr fd;k tkrk gSA ,Mh,pMh okys cPpksa dks muds ftEes dke ij è;ku dsafær djus esa dfBukà gksrh gS vkSj os d{kk ds dkedkt dks ckfèkr dj ldrs gSaA gkykafd] blesa vfr lfØ; cPpksa ls Hkzfer ugÈ gksuk pkfg, tks vfèkd thoar gksrs gSa vkSj ekrk&firk ds fy, mUgsa fu;af=r djuk eqf'dy gks tkrk gSA bldk lgh funku djus dh t:jr gSA
Hkkstu fodkj (Eating disorder)
fd'kksjksa ds [kkus ds iSVuZ lkfFk;ksa] ehfM;k vkSj lkekftd&lkaL—frd ncko ls çHkkfor gksrs gSaA [kkus ds fodkjksa esa fof{kfIrt v#fp
¼anorexia nervosa½ 'kkfey gS tgka mUgsa otu c<+us dk ,d rdZghu Mj lrkrk gS] blfy, os irys jgus ds fy, [kqn dks Hkw[kk j[krs gSa( vkSj nwljh rjQ vfrcqHkq{kk ¼bulimia nervosa½ gS tgka os vR;fèkd [kkuk [kkrs gSa vkSj fQj vijkèkcksèk dh Hkkouk ds dkj.k eyR;kx djrs gSaA
254
vkpj.k fodkj
(Conduct Disorder)
bls yksxksa ;k tkuojksa ds çfr ckj&ckj vkSj yxkrkj Øwjrk] csÃekuh] vkØkedrk] fouk'kdkfjrk] i'pkrki dh deh vkSj mnklhurk ls fpfàr fd;k tkrk gSA ;g cpiu dh lkekU; 'kjkjrksa ls ijs gSA
euksxzfLr&ckè;rk fodkj (Obsessive Compulsive disorder)
fo;ksxt nqf”prk fodkj (Sepration anxiety disorder)
bl fodkj dks nksgjk, tkus okys vkSj euksxzfLr okys fopkjksa vkSj ckè;dkjh O;ogkjksa tSls ckj&ckj xanxh@dhVk.kqvksa dk è;ku vkuk vkSj gkFkksa dh euksxzLr èkqykÃA
;g ekrk&firk ls dfFkr vyxko ds dkjx vR;f/kd Hk;
vkSj ?kcjkgV ;k nqf”kaprk ds mRiUu ls tqM+k gSA
fof'k"V nqHkÊfr
(Specific phobias)
;s dqN oLrqvksa] LFkkuksa] xfrfofèk;ksa vkSj@;k ifjfLFkfr;ksa ds çfr rhoz rdZghu Hk; gSa tks ç—fr esa lrr vkSj ckèkd gSaA
lkekftd nqHkÊfr
(Social Phobia)
lkekftd nqHkÊfr esa cPpk@fd'kksj lkekftd fLFkfr;ksa ls cprk gS D;ksafd os rhoz nqÇ'prk dk dkj.k curh gSa
¼mnkgj.k ds fy, d{kk ds Hkhrj cksyus vkSj ckrphr djus dk Hk; pwafd vU; yksx mldk etkd mM+k ldrs gSa½A volkn
(Depression)
volkn ,d Hkkon'kk lacaèkh fodkj gS ftls yxkrkj [kjkc Hkkon'kk ;k mnklh] ÅtkZ ds fuEu Lrj vkSj vkuannk;d xfrfofèk;ksa esa #fp dh deh ¼tSls cPpk [ksy xfrfofèk;ksa esa Hkkx ysuk can dj ldrk gS½ ls fpfàr fd;k tkrk gSA
fodkl lacaèkh lacaèkh fodkj vkerkSj ij cpiu dh 'kq#vkr esa gksrs gSaA ;s cPps ds nsjh ls ;k ean 'kkjhfjd] laKkukRed] lkekftd ;k lkaosfxd fodkl ls lacafèkr gSaA
;s cPps ds nSfud thou vkSj lkekU; dkedkt dh xfrfofèk;ksa esa ckèkk Mkyrs gSaA dqN lkekU; :i ls Kkr fodkl lacaèkh fodkj ckSf)d v{kerk] vfèkxe fodkj]
efLr"d i{kk?kkr vkSj Mkmu ÇlMªkse vkfn gSaA fodkl lacaèkh fodkjksa vkSj vkuqoaf'kd ço`fÙk;ksa esa lq–<+ lacaèk gSaA
dqN egRoiw.kZ fodkl lacaèkh fodkjksa@v{kerkvksa dk mYys[k uhps rkfydk 10-2 esa oÆ.kr gS%
çefLr"d vax?kkr
¼Cerebral Palsy½
;g xSj&Øfed fodkj gS ftls eq[;r;k fodkl lacaèkh nsjh vkSj is'kh; fo—fr;ksa ls fpfàr fd;k tkrk gSA blesa vfr'kf;r@[kjkc çfrorZ] vaxksa esa dBksjrk vkSj Hkko&Hkafxek vkSj leUo; cjdjkj j[kus esa vleFkZrk 'kkfey gSA
Loyhurk LisDVªe fodkj ¼Autism
;g ,d O;kid 'kCn gS ftlesa fofHkUu çdkj ds fodkj
¼tSls Loyhu fodkj] O;kid fodklkRed fodkj] ,Lijxj
255 spectrum disorder½ ÇlMªkse½ 'kkfey gSa ftUgsa çHkkoh lkekftd laokn]
:<+@nksgjko okys O;ogkj vkSj lkaosfxd vHkko ¼tSls fd cPpk ekrk&firk }kjk fn, x, I;kj vkSj Lusg ds çfr çfrnku ugÈ dj ik,½ ls fpfàr fd;k tkrk gSA
Mkmu
ÇlMªkse(Down’s syndrome)
Mkmu ÇlMªkse dks 21osa xq.klw= ¼Øksekslkse½ dh Vªkbl‚eh }kjk fpfàr fd;k tkrk gSA blds y{k.kksa esa eaxksfy;kà psgjk] [kqjnjh ;k eksVh Ropk] gYdh ls eè;e ckSf)d v{kerk] laxhr vkSj u`R; ds çfr >qdko] eS=hiw.kZ O;ogkj 'kkfey gSaA
ckSf)d
v{kerk(Intellectual disability)
ckSf)d v{kerk 70 ls de vkÃD;w vkSj vuqdwyh dk;kZRedrk esa nsjh@deh ls fpfàr fd;k tkrk gSA blesa foyafcr fodklkRed ehyiRFkj] lh[kus esa vleFkZrk] vkBoÈ d{kk ls vkxs dh f'k{kk iwjh ugÈ dj ikuk] nSfud dk;ks± ds fy, nwljksa ij fuHkZjrk Hkh 'kkfey gSaA ckSf)d v{kerk dks gYdh ¼vkÃD;w% 50&69½] eè;e ¼vkÃD;w% 35&49½] xaHkhj
¼vkÃD;w% 20&34½ vkSj xgjh ¼vkÃD;w <20½ esa Js.khc) fd;k tk ldrk gSA
vfèkxe
v{kerk(Learning
disability)
vfèkxe ;k lh[kus dh v{kerk lh[kus dh leL;kvksa ds fofHkUu çdkjksa tSls i<+us ¼fMLysfDl;k½] ys[ku ¼fMLxzkfQ;k½ vkSj x.kuk ¼fMLdSYdqfy;k½ esa dfBukà dks lanÆHkr djrh gSA blls cqf) 'kk;n çHkkfor ugÈ gks ijarq lwpuk dk lalkèku çHkkfor gksrk gS] blfy, os cpdkuh xyfr;ka djrs gSaA
SUBSTANCE USE
cPpksa vkSj fd'kksjksa ds chp eknd inkFkks± dk lsou eq[; Çprk vkSj leL;k gSA 'kjkc ¼fc;j] je] foLdh½ vkSj rackdw ¼flxjsV] chM+h] [kSuh] dqcsj] rqylh vkfn½ O;kid :i ls lsou fd, tkus okys eknd inkFkZ gSaA rEckdw dks 'kq:vkrh eknd inkFkZ ds :i esa ekuk tkrk gS tks ckn esa vU; laHkkfor gkfudkjd eknd inkFkks±
tSls 'kjkc] bugsysaV~l] Hkkax] vksfivksbM] csatksMk;tsikbUl] ,EQ+SVsfeUl vkfn dh 'kq:vkr dk dkj.k curk gSA vfèkdka'k fd'kksj u'khyh nokvksa ds mi;ksx dh 'kq#vkr rackdw ls djrs gSaA eknd inkFkks± ds mi;ksx dh 'kq#vkr fofHkUu dkjdksa tSls lgdeÊ ncko] ehfM;k çHkko] lkekftd oxZ] vkÆFkd fLFkfr] xjhch]
vkl&iM+ksl vkfn ls çHkkfor gksrh gSA vkb, igys ge eknd inkFkks± ds mi;ksx ls lacafèkr dqN cqfu;knh 'kCnksa dks le>sa ftudk uSnkfud ekgkSy esa mi;ksx fd;k tkrk gSA
• eknd inkFkks± dk lsou ¼Substance use½% lkekU; 'kCnksa esa ;g fdlh ,sls inkFkZ dk dHkh dHkkj@'kkSfd;k mi;ksx gS tks fdlh rRdky fpfdRlk ;k euksoSKkfud fodkj ¼inkFkZ&çsfjr fodkj½ ls tqM+k ugÈ gksrk gSA ,slk vke rkSj ij lkfFk;ksa ds çHkko esa ;k flQZ vkuan ds fy, lkekftd esy feyki esa fd;k tkrk gSA
• eknd inkFkks± dk vR;fèkd lsou@gkfudkjd mi;ksx ¼Substance abuse@harmful use½% bls inkFkZ dh vfèkd ek=k@l?kurk esa u'ks ds
256
lanHkZ esa le>k tk ldrk gSA ;g u'ks esa xkM+h pykus tSls tksf[ke iw.kZ eknd inkFkZ lsou O;ogkj ls lac) gSA
• eknd inkFkks± ij fuHkZjrk (Substance dependence)% bls eknd inkFkZ dh vuqifLFkfr esa bldh rhoz ykylk ds :i esa lanÆHkr fd;k tkrk gSA bls lárk] eknd inkFkks± dk çfrdkj] buds lsou ds fy, etcwjh ls fpfàr fd;k tkrk gS vkSj nSfud thou dh xfrfofèk;ka çHkkfor gksrh gSaA eknd inkFkks± ij fuHkZjrk rc gksrh gS tc budk yxHkx nSfud mi;ksx 'kq: gks tkrk gS vkSj lárk fodflr gks tkrh gSA tc inkFkZ miyCèk ugÈ gksrk gS rks O;fä dks fljnnZ] daidaih] 'kjhj esa nnZ vkSj vfuæk tSls çfrdkj ds y{k.k gks ldrs gSaA eknd inkFkks± ds fu;fer lsou ls nSfud dkedkt çHkkfor gksrk gSA
'kjkc tSls inkFkks± dk lsou djus okys yksx vkerkSj ij dqN tksf[ke Hkjs O;ogkjksa tSls tYnckth esa xkM+h pykuk] >xM+ksa esa 'kkfey gksuk] pksjh djuk] vlqjf{kr ;kSu lacaèk cukuk vkfn esa 'kkfey gks tkrs gSaA
dqN cPpksa vkSj fd'kksjksa esa 'kjkc] rackdw] Hkkax vkfn tSls eukslfØ; inkFkks± ij fuHkZjrk fodflr gksus dh vk'kadk vfèkd D;ksa jgrh gS] bldk lVhd dkj.k Kkr ugÈ gSA gkykafd] tSo&euks&lkekftd e‚My crkrk gS fd tSfod iwoZo`fÙk
¼biological predispositions½ okys yksx dqN fo'ks"k inkFkks± ls Lo;a dks u'kkxzLr djus dh vfèkd vk'kadk j[krs gSaA gkykafd] cgqr de vè;;uksa us eknd inkFkks± ds lsou ds çfr euq";ksa dh bl iwoZ fuèkkZfjr >qdko dh lwpuk nh gS( dqN ,sls euks&lkekftd dkjd ¼tSls çfrdwy ifjos'k] cky 'kks"k.k] O;fäRo y{k.k] lgdeÊ çHkko vkfn½ gSa ftUgsa lq–<+ Hkfo"; lwpd ekuk tkrk gSA
ekuoksa esa eknd inkFkks± ds lsou ds fy, eq[; ;ksxnkudrkZ lkekftd vkSj euksoSKkfud dkjd gSaA eknd inkFkks± ds lsou ds bfrgkl okys ifjokjksa esa iSnk gq, cPps Hkh bu inkFkks± ds lsou dh vfèkd vk'kadk j[krs gSaA blds vykok eknd inkFkks± ds lsou dk iSVuZ fuèkkZfjr djus esa lgdeÊ lewg eq[; çHkko'kkyh dkjd ds :i esa dk;Z djrs gSaA gkykafd] dqN fd'kksj fuf'pr le; vofèk ds ckn fcuk fdlh çdkj ds gLr{ksi ;k ijke'kZ ds vius ne ij eknd inkFkks± dk lsou NksM+
nsrs gSaA ijarq u'kksa dks vius vki NksM+us esa v{ke yksxksa esa tc fuHkZjrk fodflr gks tkrh gS vkSj nqHkkZoukiw.kZ ;k tksf[ke Hkjk O;ogkj iSVuZ j[krs gSa] rc gLr{ksi dh vko';drk eglwl dh tkrh gSA
eknd inkFkks± dk lsou dà çdkj dh lg&#X.krkvksa ls tqM+k gqvk gSA lg&#X.krk dk rkRi;Z eknd inkFkks± ds lsou lacaèkh fodkjksa ¼,l;wMh½ ds lkFk&lkFk 'kkjhfjd
;k ekufld chekjh ds gksus ls gSA dà ckj lg&#X.krk,a eknd inkFkks± ds lsou ds fy, iwoZlwpd dkjd gksrh gSaA vkerkSj ij vkpj.k fodkj vkSj volkn ,l;wMh ls lac) gksrs gSaA
vkÃlhMh&10 ds vuqlkj] eknd inkFkZ lsou fodkj (Substance use disorder)¼,l;wMh½ ds funku esa 12 eghus dh vofèk ds Hkhrj fuEufyf[kr lwphc) ekunaMksa esa ls de ls de rhu 'kkfey gksus pkfg,%
• inkFkZ ysus dh rhoz mRdaBk ;k foo'krk dh Hkkouk
257
• bldh 'kq#vkr] lekfIr ;k mi;ksx ds Lrj ds lanHkZ esa eknd inkFkZ ysus lacaèkh O;ogkj dks fu;af=r djus esa dfBukb;ka
• eknd inkFkZ lsou jksdus ;k ?kVkus ij 'kjhj foKku lacaèkh fofuorZu dh fLFkfr% ftlds lk{; eknd inkFkZ ds fy, fof'k"V fofuorZu ÇlMªkse( ;k fofuorZu ds y{k.kksa ls jkgr ikus ;k cpus ds bjkns ls mlh ¼;k mlls lacafèkr½ inkFkZ ds mi;ksx ls feyrs gSa
• lárk ds lk{;] tSls fd ewy :i ls de [kqjkd }kjk l`ftr çHkkoksa dks çkIr djus ds fy, eukslfØ; eknd inkFkZ dh c<+h gqà [kqjkd dh vko';drk gksrh gS
• euks lfØ; inkFkks± ds mi;ksx ds dkj.k oSdfYid lq[kksa ;k #fp;ksa dh mÙkjksÙkj mis{kk] eknd inkFkks± dks çkIr djus ;k ysus ;k blds çHkkoksa ls mcjus ds fy, visf{kr le; dh c<+h gqà vofèk
• vR;fèkd gkfudkjd ifj.kkeksa ds Li"V çek.kksa tSls vR;fèkd 'kjkc ihus ls ftxj dks uqdlku] eknd inkFkks± ds vR;fèkd lsou ds ifj.kkeLo:i volkn xzLr gksus dh fLFkfr ;k laKkukRed dk;kZRedrk esa eknd inkFkZ ls lacafèkr [kkeh] ds ckotwn eknd inkFkks± dk lsou NksM+ ugÈ ikukA ;g fuèkkZfjr djus dk ç;kl fd;k tkuk pkfg, fd D;k mi;ksxdrkZ oLrqr%
{kfr dh ç—fr vkSj lhek ls voxr Fkk ;k mlls ,slk gksus dh mEehn dh tk ldrh FkhA
fdlh Hkh çdkj ds u'khys inkFkks± dk vfèkd le; rd u'kk djuk fdlh Hkh O;fä ds LokLF; ds fy, [krjukd gS( fQj Hkh fd'kksjksa esa mudk lcls udkjkRed çHkko ns[kk tkrk gSA eknd inkFkks± ds lsou dk çHkko 'kq:vkr dh mez] ckjackjrk vkSj 'kq#vkr dh mez ls [kir dh lexz le; vofèk ls tqM+k gqvk gSA 'kq: djus dh vk;q ftruh de gksxh] efLr"d vkSj 'kjhj ds lacafèkr ?kVdksa dh {kfr mruh gh vfèkd gksxhA blfy, mi;ksx ftruk iqjkuk gksrk gS] u'kk djus okys esa euksoSKkfud lg&#X.krk dh ekStwnxh mruh gh vfèkd gksrh gSA
eknd inkFkks± dk lsou fd'kksjksa dks fuEufyf[kr {ks=ksa esa çHkkfor dj ldrk gS%
• [kjkc 'kSf{kd fu"iknu dh vksj ys tkus okys laKkukRed çdk;ks± dks çHkkfor djuk
• 'kkjhfjd fodkl vkSj mlls tqM+s udkjkRed çHkko 'kkjhfjd ds lkFk&lkFk eukslkekftd igyqvksa ds fodkl dks çHkkfor djrs gSa
• U;wjksVªkalfeVlZ ls gLr{ksi
• QsQM+s] yhoj] fdMuh vkfn tSls egRoiw.kZ vaxksa dks {kfrA
• bugsysaV vkSj ghV cuZ rackdw ¼flxjsV] chM+h vkSj ekfjtqvkuk½ ds ekeys esa lkal ysus esa leL;k
• ikpu vkSj çtuu ç.kkyh ij udkjkRed ifj.kke
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• lkekftd tksf[ke tSls vfu;ksftr xHkZèkkj.k] ;kSu lapkfjr jksx] fookn]
vkijkfèkd fjdkMZ] vkÆFkd f'kfFkyrk] ?kfu"B lacaèkksa dks uqdlku vkfnA q
lkekU; O;ogkjxr fodkj% ,Mh,pMh] Hkkstu fodkj] vkpj.k fodkj] vkslhMh]
vyxko lacaèkh Çprk fodkj] fof'k"V Hk;] lkekftd Hk; vkSj volknA
lkekU; fodklkRed fodkj% efLr"d i{kk?kkr ¼lsjsczy ikYlh½] ,,lMh] Mkmu ÇlMªkse] ckSf)d v{kerk vkSj vfèkxe v{kerkA
eknd inkFkks± ds mi;ksx esa fyIr gksus vkSj >wB cksyuk] Ldwy ls Hkkxuk] voKk djus vkfn tSls dqN dq:i O;ogkjksa dks viukus esa tksf[ke iw.kZ vkSj vkuan ryk'kus okyk O;ogkj ftEesnkj gSA
çHkkfor lkaosfxd voLFkkvksa ds ifj.kkeLo:i vkosx] fpM+fpM+kiu] vkØkedrk]
?kkrd O;ogkj vkSj eknd inkFkks± dk lsou c<+ tkrk gSA
eknd inkFkks± dk mi;ksx% ;g inkFkZ dk dHkh dHkkj@eu cgyko lacaèkh mi;ksx gS tks fdlh rRdky fpfdRlh; ;k euksoSKkfud fodkj ¼eknd æO;&çsfjr fodkj½ ls lac) ugÈ gks gksrk gSA
eknd inkFkks± dk lsou@gkfudkjd mi;ksx% bls eknd inkFkZ esa u'ks dh vfèkd ek=k@l?kurk ds lanHkZ esa le>k tk ldrk gSA
eknd inkFkZ ij fuHkZjrk% ;g eknd inkFkZ ds mi;ksx ugÈ fd, tkus ij inkFkZ dh rhoz ykylk lanÆHkr djrh gSA bls lárk] fouorZu] eknd inkFkks± ds lsou ds fy, etcwjh vkSj nSfud thou dh çHkkfor xfrfofèk;ksa fpfàr fd;k tkrk gSA 'kjkc tSls inkFkks± dk lsou djus okys yksx vkerkSj ij dqN tksf[ke Hkjs O;ogkjksa tSls tYnckth esa xkM+h pykuk] >xM+ksa esa 'kkfey gksuk] pksjh djuk] vlqjf{kr ;kSu lacaèk cukuk vkfn esa 'kkfey gks tkrs gSaA
eknd inkFkks± ds mi;ksx ds bfrgkl okys ifjokjksa esa iSnk gq, cPps bu inkFkks± dk mi;ksx 'kq: djus dh vfèkd laHkkouk j[krs gSaA
eknd inkFkks± ds mi;ksx iSVuZ ds fuèkkZj.k esa lgdeÊ lewg çeq[k çHkkodkjh dkjd ds :i esa dk;Z djrs gSaA
'kjkc ¼fc;j] je] foLdh½ vkSj rackdw ¼flxjsV] chM+h] [kSuh] dqcsj] rqylh vkfn½ O;kid :i ls lsou fd, tkus okys eknd inkFkZ gSaA
rackdw dks vU; laHkkfor gkfudkjd MªXl tSls 'kjkc] bugsysaV] Hkkax] vksfiv‚;M]
csatksMk;tsikbu] ,EQ+SVsfeu] vkfn ds fy, 'kq:vkrh Mªx ds :i esa ekuk tkrk gSA 15 o"kZ ls de vk;q oxZ ds dqy 14-6% Ldwyh fd'kksj rackdw dk lsou djrs ik, x,A ¼thokÃVh,l] 2009½
vkÃlhMh 10 ekunaM ds vuqlkj eknd inkFkks± ij fuHkZjrk dk funku djus ds fy, mi;ksx fd, tkus okys eq[; y{k.k% blds gkfudkjd mi;ksx tkuus ds ckotwn miHkksx djus dh rhoz bPNk ;k etcwjh tgka fofuorZu y{k.kksa vkSj blds ifj.kkeLo:i ek=k esa dVkSrh djus ds vlQy ç;klksa lfgr lárk ds çek.k ik, tkrs gSaA
lg&#X.krk ,l;wMh lfgr 'kkjhfjd ;k ekufld chekjh dh mifLFkfr dks lanÆHkr djrh gSA
eknd inkFkks± dk mi;ksx fofHkUu çdkj dh lg&#X.krkvksa tSls vkpj.k fodkj]
Çprk vkSj volkn ls lac) gSA
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1½ fuEufyf[kr esa ls dkSu lk fodklkRed fodkj ugÈ gS\
a½ efLr"d i{kk?kkr ¼lsjsczy ikYlh½
b½ ckSf)d v{kerk
c½ lkekU;h—r nqÇ'prk fodkj
d½ vkRedsafær
2½ fMLysfDl;k ,d çdkj dh vfèkxe ¼lh[kus dh½ v{kerk gS tks blls lacafèkr gS%
a½ ckSf)d foyac
b½ lkaosfxd leL;k,a
c½ ckj&ckj nksgjk;k tkus okyk O;ogkj
d½ i<+us esa eqf'dy
3½ eknd inkFkks± ds lsou ls thou dk nSfud dkedkt çHkkfor gksus okyh fLFkfr D;k dgykrh gS%
a½ eknd inkFkks± dk lsou
b½ eknd inkFkks± dk vR;fèkd lsou
c½ eknd inkFkks± ij fuHkZjrk
d½ mijksä esa ls dksà ugÈ
4½ eknd inkFkks± ds mi;ksx ds udkjkRed çHkkoksa dk mYys[k dhft,A
tSlk fd vki igys gh bdkà 1 esa i<+ pqds gSa] ijke'kZ ,slh euksoSKkfud çfØ;k gS ftlesa ,d çf'kf{kr O;fä mís';iw.kZ ckrphr ds ekè;e ls DykbaV dh lgk;rk djus ds fy, mlds lkFk is'ksoj lacaèk LFkkfir djrk gSA fofHkUu vU; rduhdksa ds vykok leL;k&lekèkku vkSj lek;ksth dkS'ky ds ekè;e ls DykbaV esa lkaosfxd la?k"kZ vkSj lexz ladV ds Lrj dks de djuk ijke'kZ dk mís'; gSA
O;ogkj lacaèkh fodkjksa esa cPpksa vkSj fd'kksjksa dks ijke'kZ nsuk cPpksa vkSj fd'kksjksa esa nqO;Zogkj iw.kZ O;ogkj dks yf{kr djrk gSA ijke'kZnkrk cPpksa vkSj fd'kksjksa esa dqfRlr O;ogkjksa] muds Lo;a ij vkSj muds djhch yksxksa ij iM+us okys çHkko ds ckjs esa le> fodflr djus esa lgk;rk djrk gSA nwljh vksj ijke'kZ fodklkRed fodkjksa esa fu"iknu vkèkkfjr eqíksa ij è;ku dsafær djus] cPps@fd'kksjksa dh rkdrksa vkSj detksfj;ksa dks fuèkkZfjr djus vkSj fnu&çfrfnu dk;ks± dks djus ds fy, cqfu;knh dkS'ky ds fuekZ.k ds fy, mi;qä lek;ksth j.kuhfr;ksa dks viukus esa lgk;d gksrk gSA
cPpksa vkSj fd'kksjksa dks ijke'kZ çnku djrs le; dqN ckrksa dks è;ku esa j[kuk vko';d gS%
260
• cPpksa vkSj fd'kksjksa ds ekeys esa T;knkrj tc os ijke'kZ ds fy, vkrs gSa]
;g jsQjy dk ekeyk gksrk gSA mUgsa ;k rks ekrk&firk ;k f'k{kdksa ;k Ldwy ç'kklu }kjk lanÆHkr fd;k tkrk gSA blfy, ijke'kZ çfØ;k ds vuqikyu esa leL;k,a lkeus vk ldrh gSaA os ijke'kZ l= esa igqap ldrs gSa ijarq os 'kk;n ijke'kZ çfØ;k dk vuqikyu vkSj blesa lg;ksx 'kk;n ugÈ djsaA
• mUgsa 'kk;n ijke'kZ çfØ;k ds ckjs esa tkx:drk ;k bldh le> ugÈ gks vkSj mUgsa bldh t:jr vkSj blesa viuh Hkwfedk ds ckjs esa Hkh 'kk;n irk ugÈ gksA
• cPpksa dh vlqjf{kr fLFkfr ds pyrs os tksf[ke esa gksrs gSA ijke'kZnkrk }kjk
;g lqfuf'pr djus dh t:jr jgrh gS fd og cPpksa ;k ekrk&firk dks dqN ,slk djus ds fy, ugÈ dgsa ftlls ifjokjksa vkSj cM+s ifjtuksa ls muds lehdj.k cny tk,aA blfy, ekrk&firk vkSj ifjokj dks Hkh ijke'kZ esa 'kkfey djus dh t:jr gSA
• ,slk gks ldrk gS fd cPpksa esa Hkk"kk {kerk iw.kZr;k fodflr ugÈ gksA blfy, ijke'kZ ds fy, xSj&ekSf[kd rduhdksa tSls [ksy fpfdRlk] dyk fpfdRlk] iqLrd lwph fpfdRlk vkfn dk mi;ksx djus dh t:jr gSA vkb, vc ge cPpksa vkSj fd'kksjksa ds fy, mi;ksx dh tkus okyh dqN ijke'kZ rduhdksa vkSj fpfdRlk i)fr;ksa dks ns[ksaA
ifjokj ijke'kZ ifjokj ç.kkyh ds Hkhrj ifjtuksa dh fuf"Ø; Hkwfedkvksa dks yf{kr djrk gSA ifjokj ijke'kZ esa cPps vkSj ifjtuksa nksuksa dks 'kkfey fd;k tkrk gSA ikfjokfjd O;oLFkk esa varÆufgr leL;kvksa ds dkj.k cPps dqN nqHkkZoukiw.kZ O;ogkj viuk ldrs gSaA ikfjokfjd ijke'kZ esa ekrk&firk vkSj ifjtuksa dks bu leL;kvksa ds ckjs esa le> fodflr djus vkSj csgrj lek;ksth j.kuhfr;ka viukus esa lgk;rk djds bu leL;kvksa dk lekèkku fd;k tkrk gSA ikfjokfjd ijke'kZ O;ogkj lacaèkh leL;kvksa tSls vkpj.k fodkjksa vkSj vkslhMh vkfn ds çcaèku esa lgk;d gSA
(Applies Behaviour Analysis)
,ch, ds rgr ijke'kZ cPpksa vkSj fd'kksjksa dks d{kk tSlh dqN lkekftd ekgkSy esa muds lkaosfxd igyqvksa] nSfud thou dh xfrfofèk;ksa] O;ogkjxr ifj.kkeksa ds çcaèku esa lgk;rk djrk gSA blesa laçs"k.k dkS'ky] Lo;a lgk;rk dkS'ky] vuqdwyh vfèkxe dkS'ky] LoPNrk çf'k{k.k ,oa [kkus ds rjhds vkSj le; çcaèku vkfn 'kkfey gks ldrs gSaA vuqç;qä O;ogkj fo'ys"k.k ds rgr ijke'kZ ckSf)d v{kerkvksa vkSj vkRedsafær gksus ¼v‚fVTe½ ds çcaèku esa lgk;d gksrk gSA
ØhM+k fpfdRlk laçs"k.k ds :i esa [ksy dk mi;ksx djrh gSA viuh lhfer 'kCnkoyh vkSj vewrZ rdZuk ds dkj.k cPps viuh t#jrksa] laosxksa] fopkjksa vkSj èkkj.kkvksa dks lVhd 'kCnksa esa O;ä ugÈ dj ikrs gSaA ijke'kZnkrk vkSj cPps ds chp lekuqHkwfriw.kZ lacaèk fodflr djus ds fy, [ksy laçs"k.k ekè;e ds :i esa dk;Z djrk gSA [ksy fpfdRlk,a nqÇ'prk] vkRedsafær gksus] vk?kkr] volkn vkfn ds çcaèku esa lgk;rk djrh gSA [ksy ijke'kZ dh egRoiw.kZ rduhd ds :i esa dk;Z
261
djrk gS D;ksafd ;g cPpksa dks mudh Hkkoukvksa] nqÇ'prkvksa vkSj Hk; dks O;ä djus esa l{ke cukdj jspu esa lgk;rk djrk gSA ;g muds ikjLifjd lacaèk vkSj leL;k lekèkku dkS'kyksa dks Hkh c<+krk gSA
fofHkUu çdkj ds l`tukRed dyk mipkj Mkmu ÇlMªkse vkSj ,,lMh tSls fodkl lacaèkh fodkjksa esa lgk;d gks ldrs gSaA cPps vkSj fd'kksj vius ckgjh lkekftd O;ogkjksa dks çcafèkr djus vkSj Li'kZ] –f"V vkfn tSlh viuh bafæ;ksa dks lfØ;
djus ds fy, laxhr] u`R;] jax] isaÇVx] dqEgkj deZ vkfn tSlh xfrfofèk;ksa esa 'kkfey gksrs gSaA blls mudh laKkukRed {kerkvksa esa lqèkkj djus esa Hkh lgk;rk feyrh gSA
lpsrurk(Mindfulness) fuf'pr fLFkfr esa viuh bafæ;ksa] Hkkoukvksa vkSj mudh mifLFkfr ds ckjs esa tkx:d gksus dh {kerk ls lacafèkr gSA lpsrurk vH;kl mudh Hkkoukvksa vkSj bafæ;ksa dks le>us esa fd'kksjksa dh lgk;rk djrh gS vkSj 'kjhj&Nfo tSlh mudh euks&'kkjhfjd igyqvksa ls lacafèkr leL;kvksa dks gy djus esa lgk;rk djrs gSaA lpsrurk vH;kl cPpksa vkSj fd'kksjksa esa volkn vkSj nqÇ'prk dks çcafèkr djus esa lgk;rk djrs gSaA
eknd inkFkks± ds lsou lacaèkh fodkjksa ¼,l;wMh½ ds fy, ijke'kZ esa lcls igys ;g irk yxkus dk ç;kl fd;k tkrk gS fd DykbaV cnyko ds fy, fdruk çsfjr gSaA eknd inkFkks± ds lsou lacaèkh fodkj ds fy, vfèkdka'k gLr{ksi O;ogkj cnyus lacaèkh DykbaV dh çsj.kk ds pj.kksa ij vkèkkfjr gksrs gSaA tsEl çkspLdk ¼James Prochaska½ vkSj dkyksZ fMDysesaVs ¼Carlo DiClemente½ dk VªkalfFk;ksjsfVdy e‚My
;k cnyko ds pj.k e‚My cnyko ds fy, DykbaV dh rRijrk dks n'kkZrk gS
¼çkspLdk ,oa fMDysesaVs ¼Prochaska&DiClemente½] 2005½A bl e‚My esa eq[;r%
ikap pj.k gksrs gSa%
• iwoZ Çpru (Pre-contemplation)% bl Lrj ij fd'kksj vkerkSj ij laHkkfor uqdlku@tksf[keksa vkSj@;k inkFkZ ls tqM+h leL;kvksa ls vutku gksrs gSaA
;gh dkj.k gS fd os eknd inkFkks± dk lsou NksM+uk ugÈ pkgrs gSaA gkykafd os eknd inkFkks± ds lsou ds ckjs esa csgrj le> fodflr ds fy, çnku dh xà tkudkjh ds çfr xzg.k'khy gks ldrs gSaA bl rjg dh le>
eknd inkFkks± ds lsou dh rhozrk ;k ckjackjrk dks de djus esa ;k bls iwjh rjg ls NksM+us esa lgk;d gks ldrh gSA tSls fd'kksj DykbaV dg ldrk gS% eSa Hkkax dk mi;ksx lIrkg esa ,d ckj gh djrk gw¡A ;g ek=
Hkkax gh rks gSA vkSj blls eq>s D;k uqdlku gksxk\ ;g rackdw ugÈ gS tks dSalj dk dkj.k cu ldrk gSA ;g Li"V :i ls ifjorZu ds iwoZ&Çpru pj.k dks n'kkZrk gSA gkykafd DykbaV Hkkax ;k eknd inkFkks± ds uqdlku ls lacafèkr vfèkd tkudkjh ds çfr xzg.k'khy vkSj [kqyk gSA
• Çpru ¼Contemplation)% bl Lrj ij DykbaV us eknd inkFkks± ds lsou ds vius iSVuZ ls tqM+h leL;kvksa dks ns[kuk 'kq: dj fn;k gS vkSj mlus NksM+us ds ckjs esa lkspuk 'kq: dj fn;k gS ijarq ,slk rqjar ugÈ gksxkA bl
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mís'; ds fy,] og eknd inkFkks± ds lsou ds ykHk&gkfu ds ckjs esa lksprk gS vkSj bUgsa rkSyrk gSA
• ladYi@rS;kjh (Determination/Preparation)% ;g eknd inkFkZ NksM+us dh
;kstuk dk pj.k gS ftlesa vxys dk;Z pj.k ds fy, ;kstuk rS;kj dh tkrh gSA ijke'kZnkrk eknd inkFkZ dk mi;ksx NksM+us ds fy, ;FkkFkZoknh vkSj O;kogkfjd y{; rS;kj djus esa DykbaV dh lgk;rk djrk gSA
• dkjZokÃ(Action)% bl pj.k esa eknd inkFkZ NksM+us ds fy, dh xà dkjZokb;ka 'kkfey gSaA bl pj.k esa ijke'kZnkrk eè;LFk dh Hkwfedk fuHkkrk gS vkSj eknd inkFkZ NksM+us vkSj çsj.kk çnku djus dh çfØ;k esa eè;LFkrk esa lgk;rk çnku djrk gSA
• cjdjkj j[kuk ;k iqu% iru (Maintenance or Relapse)% bl pj.k esa ijke'kZnkrk yf{kr O;ogkj cuk, j[kus esa DykbaV dh lgk;rk djrk gSA
;fn DykbaV la;fer jgrk gS rks fpfdRlk@ijke'kZ lekIr dj fn;k tkrk gSA gkykafd la;e cuk, j[kuk mruk vklku ugÈ gS ftruk çrhr gksrk gSA mRdV bPNk ;k dqN vU; dkjdksa ds dkj.k DykbaV iwoZ voLFkk esa okil vk ldrk gS vkSj fQj ls eknd inkFkZ dk lsou 'kq: dj ldrk gS ftls iqu% iru ds :i esa tkuk tkrk gSA bl pj.k esa ijke'kZnkrk dh çkFkfed Hkwfedk DykbaV ls laidZ cuk, j[kdj vkSj t:jr iM+us ij lgk;rk l=
nksckjk nsdj iqu% iru gksus dh laHkkouk dks jksdus dh gSA
dksà Hkh mipkj 'kjkc] èkweziku vkSj eknd inkFkks± dh Hkkxhnkjh LØhÇux ijh{k.k
¼,flLV ¼ASSIST½½ tSls ewY;kadu midj.kksa ls eknd inkFkks± ds mi;ksx ds fy, 'kq#vkrh tkap ls 'kq: gksrk gSA lkeqnkf;d Lrjksa ij eknd inkFkks± ds lsou dks jksdus ds fy, dqN fuokjd mik; Hkh fodflr fd, x, gSaA LoLFk thou 'kSyh ds ckjs esa f'k{kk çnku djuk] lkfFk;ksa ds ncko dk çcaèku] *ugÈ* dguk lh[kuk vkSj eknd inkFkks± ds lsou ls tqM+s uqdlku] Ldwyh cPpksa ds fy, eknd inkFkks± ds mi;ksx ds ckjs esa euks&f'k{kk] eknd inkFkks± ds lsou ds dkj.k fofHkUu tSo&eukslkekftd leL;kvksa ds ckjs esa vke turk dks voxr djokus vkSj Kku nsus ds fy, Vsyhfotu 'kks vkfn buesa ls dqN mnkgj.k gSaA fofHkUu ljdkjh vkSj xSj&ljdkjh ,tsafl;ksa dh lgk;rk ls ikfjokfjd] Ldwyh vkSj lkeqnkf;d Lrjksa ij bu fuokjd j.kuhfr;ksa dks ykxw fd;k tk ldrk gSA
fuokjd mik;ksa ds vykok] cPpksa vkSj fd'kksjksa esa ,l;wMh ds mipkj ds fy, mipkj ds fofHkUu rkSj&rjhds tSls vfHkçsj.kk laoèkZu fpfdRlk ;k vfHkçsj.kkRed lk{kkRdkj]
iqu% iru jksdFkke ijke'kZ] ifjokj ijke'kZ vkSj O;ogkjxr ijke'kZ ¼vkdfLed çcaèku½ fodflr fd, x, gSaA
eknd inkFkks± ds lsou vkSj ekufld LokLF; lsok ç'kklu ¼,l,,e,p,l,
(SAMHSA)) us çkjafHkd tkap@vkdyu] laf{kIr gLr{ksi vkSj mipkj ds fy, jsQjy ¼,lchvkÃvkjVh½ lfgr O;kid dk;ZØe 'kq: fd;k ftls uSnkfud ekgkSy esa eknd inkFkZ lsou fodkjksa ds mipkj esa 'kq:vkrh dne ds :i esa çLrqr fd;k x;k gSA
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1½ [ksy fpfdRlk ijke'kZnkrk vkSj cPps ds chp &&&&&&& ds ekè;e ds :i esa dk;Z djrh gSA
2½ Vªkal&lS)kafrd e‚My ds vuqlkj yksx fdl pj.k esa eknd inkFkZ dk mi;ksx NksM+us ds fy, vfuPNqd ijarq lq>koksa ds fy, [kqys gksrs gSa\
3½ Vªkal&lS)kafrd e‚My ds vuqlkj] okafNr O;ogkj tSls eknd inkFkZ ls cps jguk dks cjdjkj j[kus esa foQyrk dks &&&&&&&&&& ds :i esa ekuk tk ldrk gSA
4½ ,flLV ¼ASSIST½ og midj.k gS tks eknd inkFkZ ds lsou ds &&&&&&&&
ds fy, mi;ksx fd;k tkrk gSA
vkb, vc ge eknd inkFkZ lsou lacaèkh fodkjksa ¼,l;wMh½ ds fy, dqN lkekU;r%
ç;qä mipkj ds rkSj&rjhdksa ij ppkZ djsaA
1½ (Psychoeducation)
euks&f'k{kk lk{;&vkèkkfjr euks&fpfdRlh; gLr{ksi gS ftlesa DykbaV ;k mlls tqM+s yksxksa dks euksoSKkfud fodkjksa vkSj muds fy, ftEesnkj dkjdksa ds ckjs esa f'kf{kr djuk 'kkfey gSA fd'kksjksa esa eknd inkFkks± dk lsou jksdus ds fy, fuokjd mik; ds :i esa Hkh bldk mi;ksx fd;k tk ldrk gSA ;g lacafèkr chekjh ds ckjs esa var–Zf"V çnku djus ds fy, vfHkçsr gSA
blls DykbaV dks viuh lkaosfxd voLFkkvksa dk çcaèku djus vkSj bl fLFkfr ds çfr vius xyr dq&vuqdwfyr O;ogkj vkSj –f"Vdks.k dks cnyus ds fy, lek;ksth dkS'ky lh[kus esa lgk;rk feyrh gSA ;g eknd inkFkks± ds ckjs esa lkekU; tkudkjh] mi;ksx ¼vknr½ vkSj fuHkZjrk ¼jksx½ ds chp varj djus]
chekjh ds y{k.kksa] fofHkUu dkj.kksa] mipkj ;k çcaèku] jksx funku vkSj nksckjk gksus dh vk'kadk ds ckjs esa lkekU; tkudkjh çnku djus ls 'kq: gksrh gSA ;g DykbaV vkSj mlds djhch yksxksa ij jksx ds çHkko dks lkekU; djus esa lgk;rk djrh gSA
euks&f'k{kk fofHkUu ekgkSy ;k ifjos”k esa çnku dh tk ldrh gS tSls]
• O;fäxr ekgkSy
• ikfjokfjd ekgkSy
• lewg ekgkSy
• lkeqnkf;d ekgkSy
,d O;fä ls vkeus&lkeus l=ksa esa gksrh gSA ,slk rc fd;k tkrk gS tc DykbaV nwljksa dh mifLFkfr esa viuh leL;kvksa ij ppkZ djus esa lgt ugÈ gksrk gSA esa ijke'kZnkrk vke rkSj ij mudh leku t:jrksa ij è;ku dsafær djrs gq, 5 ls 8 DykbaV~l dk lewg cukrk gSA l=
esa DykbaV lewg ds vU; lnL;ksa ls eknd inkFkks± ds lsou ls lacafèkr vius vuqHko] dfBukb;ka vkSj fofHkUu vU; leL;kvksa dks lk>k djrs gSaA blls mUgsa
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lgk;d okrkoj.k çnku djus vkSj 'keZ ,oa vijkèk cksèk ij dkcw ikus esa lgk;rk feyrh gSA
ifjtuksa ds dkedkt] mudh ekufld LokLF; voLFkkvksa] ikjLifjd lacaèkksa vkSj leks;ksth dkS'kyksa ds ckjs esa tkx:drk çnku djuk
esa euks&f'k{kk dk vfèkxe mís’; gSA
tulapkj dk midj.k ds :i esa mi;ksx djds ,d lkFk cM+h vkcknh ¼;k rks le:i ;k xSj&le:i½ dks Kku nsuk esa euks&f'k{kk dk vfèkxe mís’; gSA Ldwyksa] d‚ystksa] èkkÆed lewgksa vkSj LFkkuh; leqnk; dks euks&lkekftd lgk;rk çnku djuk bldk mís'; gSA
2½ (Motivational Interviewing)
jksyfud vkSj feyj ¼Rollnick and Miller½ ¼2012½ us y{; funsZf'kr O;ogkj ifjorZu viukus ds fy, muds DykbaV~l ¼iwoZ&Çpru@Çpru ds pj.k esa½ dh çsj.kk c<+kus ds fy, çsjd lk{kkRdkj uked ,d DykbaV&dsafær rduhd rS;kj dhA ;g xSj&funsZ'kd euks&fpfdRlh; –f"Vdks.k gS ftlesa ijke'kZnkrk DykbaV dks mlds leL;kxzLr O;ogkj ¼O;ogkjksa½ dks cnyus ds fy, csgrj jkLrk pquus vkSj viukus esa vLi"Vrk ¼;fn dksà gks½ dks gy djus esa lgk;rk djrk gSA og ;g Hkh lqfuf'pr djrk gS fd ijke'kZ çfØ;k ds nkSjku DykbaV çsfjr cuk jgsA bl rjg ijke'kZnkrk vfHkçsj.kk laoèkZu fpfdRlkvksa ¼,eÃVh½ dk mi;ksx djrk gSA bl çdkj ,eÃVh ,evkà –f"Vdks.k vkSj O;ogkjksa ij vkèkkfjr gSaA ifjorZu dh çsj.kk c<+kuk ;gka eq[; y{; gSA fd'kksjksa dks ijke'kZ nsus esa ;s cgqr mi;ksxh gSa D;ksafd lkekU;r% os cnyko ds fy, de çsfjr gksrs gSa vkSj mUgsa cM+s yksxksa }kjk ijke'kZnkrk ds ikl Hkstk tkrk gSA
,evkà l= vk;ksftr djus ds fy, fpfdRld dks dqN dkS'ky fodflr djus pkfg,A bu dkS'kyksa esa O;k[;kRed ç'u iwNuk] fopkjiw.kZ Jo.k vkSj ldkjkRed çfrfØ;k nsuk 'kkfey gSA blls DykbaV dks lEeku vkSj vkRe&çHkkodkfjrk dh Hkkouk Hkh feyrh gS ftlls DykbaV vkSj ijke'kZnkrk ds chp Hkjkslsean is'ksoj lacaèk curk gSA 'kjkc mi;ksx fodkj ;k 'kjkc ds leL;kiw.kZ mi;ksx ls fuiVus ds nkSjku ,evkà dkQh çHkkoh gS( gkykafd rackdw
;k Hkkax tSls vU; eknd inkFkks± dk mi;ksx jksdus esa Hkh bldk mi;ksx fd;k tk ldrk gSA
• lekuqHkwfr O;ä djsa (express empathy)% lekuqHkwfr fdlh O;fä }kjk vU; O;fä ds lanHkZ Ýse ls ml O;fä dh fLFkfr dks le>us dh {kerk gSA bls chekjh ds ckjs esa i;kZIr Kku çkIr djds vkSj Çpru'khy Jo.k tSls ijke'kZ dkS'ky viukdj fodflr fd;k tk ldrk gSA blls fu"diVrk dk cksèk çkIr gksrk gS vkSj ijke'kZnkrk vkSj DykbaV ds chp lekuqHkwfriw.kZ lacaèk LFkkfir djus esa lgk;rk feyrh gSA
• fu.kkZ;kRed larqyu (decisional balance)% fpfdRld DykbaV dks eknd inkFkks± dk mi;ksx tkjh j[kus vkSj mls NksM+us dh ykxrksa vkSj ykHkksa dk ewY;kadu djus esa lgk;rk djrk gSA eknd inkFkks± ds vkjkenk;d çHkko] euksn'kk tSls çHkko gks ldrs gSa ftUgsa DykbaV eglwl djrk gSA gkykafd T;knkrj DykbaV eknd inkFkks± dk lsou tkjh j[kus ds fy, pqdkà tkus okyh ykxr ¼[kjkc LokLF;] ijh{kk esa [kjkc vad]
nqO;Zogkj dk f'kdkj gksuk vkfn½ igpku ugÈ ikrsA
265
• varj iSnk djuk% (develop discrepancy) ;g ewyr% eknd inkFkZ dk mi;ksx 'kq: djus ls igys vkSj ml ij fuHkZj gksus ds ckn thou dh xq.koÙkk ds chp vk, varj ls lacafèkr gSA ijke'kZnkrk O;fä ds orZeku thou ij eknd inkFkks± ds lsou ds udkjkRed igyqvksa vkSj ifj.kkeksa tSls eknd inkFkks± ds lsou ds dkj.k [kjkc 'kSf{kd fu"iknu dks çdV djus dk bjknk j[krk gSA blls leL;k dk csgrj lekèkku çnku djus esa lgk;rk feyrh gSA
• çfrjksèk ds lkFk vkxs c<+uk (rolling with resistance)% dqN DykbaV vius orZeku leL;kxzLr O;ogkj dks cnyus ds bPNqd ugÈ gksrs vkSj os çfrjksèk çdV djrs gSaA DykbaV ds çfrjksèk ls fuiVus dk lcls vPNk rjhdk mlds lkFk vkxs c<+uk gSA ,slh fLFkfr;ksa ds nkSjku rdZ&fordZ ls cpuk pkfg, D;ksafd blls rkyesy cukus dh çfØ;k esa ckèkk [kM+h gks ldrh gS vkSj DykbaV ijke'kZ l=ksa esa Hkkx ysuk NksM+ ldrk gSA
• vkRe&l{kerk esa lg;ksx djsa (support self-efficacy)% vfèkdka'k DykbaV~l esa vkRe&çHkko dh deh gksrh gSA ,slk laHkor% muds dq&vuqdwfyr O;ogkjksa dks cnyus esa muds lkeus vkà foQyrkvksa ds dkj.k gksrk gSA ijke'kZnkrk dks çR;sd eqykdkr esa DykbaV dh rkdr mtkxj djuh pkfg,A blls DykbaV~l dks muds vkRe&ewY; ds cksèk esa lqèkkj djus vkSj muds dq&vuqdwfyr O;ogkj dks cnyus esa foÜokl gkfly djus esa lgk;rk feysxhA
3½ (Relapse Prevention Therapy (RPT))
iqu% iru cpko fpfdRlk ¼vkjihVh½ ,slk vU; lk{;&vkèkkfjr rhljs Lrj dk gLr{ksi gSA leL;kxzLr eknd inkFkks± ds mi;ksx dh lekfIr ;k deh ds ckn iqu% iru nj dks de djuk bldk mís'; gSA ;gka ge iru vkSj iqu% iru ds chp varj dj ldrs gSaA iru rc gksrk gS tc buls ijgst j[kus ¼u'khyh nokvksa ls eqä jgus½ ds ckn DykbaV igyh ckj eknd inkFkZ ysrk gS ¼tSls fdlh ikVÊ esa 'kjkc ysuk½ vkSj fQj nksckjk buls ijgst+ djrk gSA tcfd iqu%
iru rc gksrk gS tc dksà DykbaV ijgst ds ckn eknd inkFkks± ds lsou ds fiNys rjhds ;k iSVuZ ij okil vk tkrk gSA ;g DykbaV ds fy, ,d rjg dk èkôk gS vkSj blls okafNr y{; vFkkZr eknd inkFkks± dk lsou NksM+us dks çkIr djus esa pqukSfr;ka [kM+h gks tkrh gSA
LoLFk lek;ksth dkS'kyksa dh deh iqu% iru dk eq[; dkj.k gSA mPp tksf[ke fLFkfr;ksa okys DykbaV LoLFk lek;ksth dkS'kyksa ds vHkko esa eknd inkFkks± ds mi;ksx ds çfr vlqjf{kr gks ldrs gSa] ftlls iru gks ldrk gSA ;g iru vlQyrk ds vijkèk cksèk vkSj Hkkouk dks çsfjr dj ldrk gS ftlls vkxs iqu%
iru gks ldrk gSA pwafd eknd inkFkZ lsou fodkjksa dks nh?kZdkfyd iqu% iru fLFkfr;ksa ds :i esa ekuk tkrk gS] vr% eknd inkFkks± ls eqä gksus ls igys dà ckj iqu% iru gksrk gSA
tSls 11oÈ d{kk dk ,d Nk= Ng eghus rd flxjsV ihus ls ijgst djrk jgkA Ldwy tkrs le; mldh eqykdkr vius ,d iqjkus fe= ls gqà ftlds lkFk og èkweziku djrk FkkA mlds nksLr us mls ,d flxjsV is'k dh ¼mPp tksf[ke fLFkfr½A pwafd Nk= us mipkj ds nkSjku fofHkUu LoLFk lek;ksth
266
dkS'ky ¼budkj djus ds dkS'ky½ lh[ks Fks blfy, mlus –<+rkiwoZd euk dj fn;k vkSj og vius Ldwy pyk x;kA
vc eku yhft,] ;fn Nk= us LoLFk lek;ksth dkS'ky ugÈ lh[ks gksrs rks og fLFkfr ds nkSjku vlqjf{kr eglwl dj ldrk gSA og 'kk;n èkweziku ugÈ djus dk dksà cgkuk nsrk ijarq var esa og ncko ds vkxs >qd tkrk vkSj varr%
èkweziku ¼iru½ dks Lohdkj dj ysrkA
(Family counselling)
O;ogkjxr leL;kvksa ;k leL;kxzLr eknd inkFkks± ds mi;ksx okys fd'kksjksa ds ekeys esa ifjokj ijke'kZ lcls vfèkd ekaxs tkus okys Lo:iksa esa ls ,d gSA dà ckj ikfjokfjd eqíksa ¼tSls [kjkc ikyu&iks"k.k] laokn dh deh vkfn½ ds dkj.k leL;k mRiUu gks tkrh gSA bu leL;kvksa dks gy djus ds fy,]
ifjokj fpfdRlk ds rgr ijke'kZ l= esa cPps vkSj fd'kksj vkSj muds ekrk&firk@ vfHkHkkod nksuksa 'kkfey gksrs gSaA cPpksa vkSj fd'kksjksa dh O;ogkjxr ,oa lkaosfxd leL;kvksa esa cnyko lekfo"V djuk] 'kS{kf.kd ekspsZ esa lqèkkj ykuk vkSj ifjokj dh dk;Z i)fr csgrj djuk ifjokj ijke'kZ dk mís'; gSA fuf"Ø; ifjokj lokZfèkd pksV igqapkrs gSa vkSj fd'kksj dks viwj.kh;
{kfr igqapk ldrs gSaA ifjokj ds Hkhrj vlaxfr vkSj vU; leL;kvksa dks gy djuk vkSj bl rjg ifjokj ds eukslkekftd dkedkt esa lqèkkj ykuk ijke'kZ dk eq[; mís'; gSA
fd'kksj ,oa ekrk&firk@vfHkHkkodksa dh j{kkRedrk dks de djuk vkSj muds O;ogkjksa dks vyx vFkZ esa le>us esa mudh lgk;rk djuk fpfdRld dk mís'; gSA blls ifjtuksa dks ,d&nwljs ls vfèkd dq'kyrk ls tqM+us esa lgk;rk feyrh gSA
layXurk% bl pj.k esa fpfdRld ifjtuksa ls dk;Z'khy xBcaèku cukrk ,oa muls tqM+us dk ç;kl djrk gSA csgrjh dh dqN vk'kk txkus vkSj ijke'kZ tkjh j[kus ds fy, ifjokj dk fcuk 'krZ lg;ksx fd;k tkrk gSA
ikfjokj vkdyu% bl pj.k esa ijke'kZnkrk ifjtuksa ds O;ogkjxr iSVuks± ds ckjs esa detksj ,oa etcwr Çcnqvksa dk vkdyu djus dk ç;kl djrk gSA cnyko dh vfHkçsj.kk l`ftr djuk% iqjkus O;ogkj iSVuZ dks cnyus ds fy, ekrk&firk vkSj DykbaV nksuksa esa dqN vk'kk fodflr djus ds fy, dqN ldkjkRed c;kuksa ¼tSls 'kjkc NksM+uk vklku ugÈ gS vkSj bl lQj esa T;knkrj yksx viuh fiNyh vknrsa viuk ysrs gSa ijarq eSa [kq'k gwa fd vkius bls NksM+us esa esjh lgk;rk ysus dk fu.kZ; fy;k gSA blls irk pyrk gS fd vki okLro esa bls NksM+us ds fy, —r ladYi gSa½ dk mi;ksx djds vfHkçsj.kk çkIr dh tk ldrh gSA
çkFkfed gLr{ksi lapkfyr djuk% bl pj.k esa DykbaV ds leL;kxzLr O;ogkj ds udkjkRed pØksa esa gLr{ksi djus vkSj bUgs rksM+us ds fy, ijke'kZ rduhdksa dk mi;ksx fd;k tkrk gSA O;ogkj la'kksèku bu gLr{ksiksa dk eq[; mís'; gSA tSls cgq&vk;keh ifjokj fpfdRlk ¼,eMh,QVh½ dk mi;ksx fd;k tk ldrk gSA
lekiu% ;g ikfjokfjd fpfdRlk dk vafre pj.k gS ftlesa iwjh çfØ;k ds ckjs esa tkudkjh nsuk 'kkfey gSA DykbaV ds O;ogkjxr iSVuZ esa ik, x, fdlh Hkh ifjorZu ds ckjs esa ç'u iwNs tkrs gSaA ;g è;ku fn;k tkuk pkfg, fd laçs"k.k J`a[kyk fdlh Hkh dher ij rksM+h ugÈ tkuh pkfg, vkSj çfrHkkfx;ksa dks crk;k
267
tkuk pkfg, fd tc Hkh mUgsa t:jr gks] os viuh t:jr ds vuqlkj vkxs ds l=ksa esa Hkkx ysus ds fy, ijke'kZnkrk ls laidZ dj ldrs gSaA
(Multi-Dimensional Family Therapy)
,eMh,QVh ,d ifjokj&dsafær cgqvk;keh –f"Vdks.k gS ftldk mi;ksx fd'kksjksa esa euksoSKkfud fodkjksa tSls eknd inkFkks± ds lsou lacaèkh fodkj] vkpj.k lacaèkh fodkjksa] lkaosfxd v{kerkvksa] 'k=qrk] Øksèk] volkn vkSj nqÇ'prk ds lkFk&lkFk ikfjokfjd leL;kvksa ds bykt ds fy, fd;k tkrk gSA blesa eknd inkFkks± ds lsou lacaèkh fodkj dks ikfjokfjd dkedkt esa [kjkch ds dkj.k fdlh O;fä ds LoLFk vkSj vuqdwyh dkedkt ls fopyu ds :i esa ekuk tkrk gSA lkekU; iFk ls fopyu ;k eknd inkFkZ ds mi;ksx dh laHkkouk pkj vk;keksa ij fuHkZj djrh gS% ¼i½ eknd inkFkZ mi;ksxdrkZ ¼cPpk
;k fd'kksj½] ¼ii½ ekrk&firk] ¼iii½ ikfjokfjd laokn@lapkj] ¼iv½ ifjokj ls ckgj lacaèkA bu {ks=ksa esa csgrj dkedkt ds ifj.kkeLo:i cPps ;k fd'kksj }kjk eknd inkFkks± ds lsou ds tksf[ke esa deh vkrh gS vkSj leL;kxzLr O;ogkj de gksrk gSA
• fd'kksjksa dh leL;k,a cgqvk;keh ç—fr dh gksrh gSa tSls 'kkjhfjd fodkl]
thou dk mís'; [kkstuk] igpku cukuk] Lora=rk dh voLFkk] viusiu dh t:jr] lkaosfxd vkSj ;kSu lacaèk cukukA
• vfHkçsj.kk vklkuh ls cnyus ;ksX; gS vkSj bls cnyk tk ldrk gSA vfHkçsj.kk ls rkRi;Z euq"; dh t:jrksa vkSj@;k bPNkvksa dks iwjk djus ds fy, tSo&euksoSKkfud&lkekftd çsjdksa ls gSA ;g vkarfjd vkSj ckgjh ç—fr dh gks ldrh gS vkSj bls ckgjh ?kVukvksa ;k míhidksa dh lgk;rk ls cnyk tk ldrk gSA
• csgrj vkSj LoLFk ikfjokfjd dkedkt volkn] nqÇ'prk vkSj ladV Lrjksa dks ?kVkrk gS vkSj blls fd'kksjksa esa yacs le; rd jgus okyk ifjorZu l`ftr gksrs gSaA
1½ ikfjokfjd fLFkjrk esa o`f)% ,eMh,QVh ifjokj ds Hkhrj fNis eqíksa dks lqy>kus esa lgk;rk djrk gS vkSj bl rjg ekrk&firk&cPps ds lacaèkksa dks etcwr djrk gSA
2½ eknd inkFkks± ds lsou@vR;fèkd lsou dk 'keu% u'khyh nokvksa ds ijh{k.k] fd'kksj dsafær l=] ekrk&firk dks ijke'kZ vkfn tSlh fofHkUu rduhdksa dk mi;ksx djds ,eMh,QVh }kjk fd'kksjksa esa eknd inkFkks± ds lsou dh laHkkouk dks de djuk vfHkçsr gSA
3½ Ldwy fu"iknu esa o`f)% fd'kksjksa dks le; çcaèku vkSj lekt&vuqdwy O;ogkjksa tSls LoLFk dkS'ky çnku djds Ldwy fu"iknu esa lqèkkjA
4½ de euksoSKkfud y{k.k% phtksa dks vyx&vyx –f"Vdks.k ls ns[kuk lh[kdj vçdV Øksèk] ruko] Çprk vkfn tSls y{k.kksa dks de djukA ,eMh,QVh rhu Øfed pj.kksa esa dke djrk gSA ;s bl çdkj gSa%
268
pj.k 1% fpfdRlh; xBcaèku cukuk% bl pj.k esa gLr{ksi dh çfØ;k ds fy, ifjokj vkSj fd'kksj dks rS;kj djuk] gLr{ksi dh çfØ;k dks lg;ksxh çfØ;k ds :i esa çLrqr djuk] gLr{ksi y{;ksa dks ifjHkkf"kr djuk vkSj fd'kksjksa vkSj ifjtuksa esa vk'kk vkSj çsj.kk iSnk djuk 'kkfey gSA
pj.k 2% ifjorZu djuk% bl pj.k esa O;ogkjxr la'kksèku tSls fu.kZ; ysuk]
lekt&vuqdwy O;ogkj fl[kkuk] csgrj lkekftd usVodks± dk fodkl] Ldwy xfrfofèk;ksa ij vfèkd è;ku dsafær djuk vkSj fd'kksjksa vkSj ifjtuksa nksuksa esa eknd inkFkks± ds çfr cnyrs –f"Vdks.k vkSj ekU;rk,a 'kkfey gSA
pj.k 3% mipkj dk lekiu% bl pj.k esa O;ogkjxr] lkaosfxd vkSj laKkukRed ifjorZuksa dks cjdjkj j[kk tkrk gS vkSj ijke'kZnkrk gLr{ksi çfØ;k laiUu djus dh vksj c<+rk gSA l=ksa dh la[;k ijke'kZnkrk ij fuHkZj djrh gS gkykafd fd'kksjksa esa xSj&vQhe fuHkZjrk ds ekeys esa ekud :i esa 6 eghus esa 25 l= yx ldrs gSaA
O;ogkj mipkj ,sls vfèkxe fl)karksa ij vkèkkfjr gSa ftlesa okaNuh; O;ogkjksa dks lq–<+ fd;k tkrk gS vkSj vokafNr O;ogkjksa dks muds mUewyu ds fy, yf{kr fd;k tkrk gSA u, LoLFk O;ogkj viukus vkSj iqjkus leL;kxzLr O;ogkjksa dks de djus esa DykbaV dh lgk;rk djuk O;ogkj fpfdRlk dk ewy y{; gSA fofHkUu O;ogkjxr mipkj fuEufyf[kr gSa%
(Cue exposure therapy) bl fpfdRlk esa DykbaV~l ds le{k flxjsV ds iSdsV] [kkyh cksry] foKkiu] cSuj] 'kjkc dh nqdkuksa vkfn tSls eknd inkFkks± ds mi;ksx ls lacafèkr ckgjh míhid çnÆ'kr fd, tkrs gSaA bl rjg ds çn'kZu ds ihNs dk mís'; ;g gS fd vuqdwfyr mÙkstuk vkSj vuqdwfyr çfrfØ;k ds chp dh dM+h detksj dh tk ldsA bl fpfdRlk esa DykbaV~l dks dqN lek;ksth dkS'ky fl[kk, tkrs gSa tks muds eknd inkFkks± ds lsou dks fu;af=r djus ds fy, visf{kr gksrs gSaA
(Aversion therapy): bl çdkj dh fpfdRlk esa vokaNuh;
O;ogkj tSls eknd inkFkZ mi;ksx dks v#fpdj míhidksa ls tksM+k tkrk gSA tSls 'kjkc ds lkFk fMlqyfQje ¼,d nok½ ysus ls ;g xaHkhj fljnnZ] eryh]
mYVh vkSj Çprk dk dkj.k curh gSA ;g nok M‚DVj }kjk DykbaV dh lgefr ls fuèkkZfjr dh tkrh gSA iqjkus le; esa 'kjkc ds lsou ds lkFk&lkFk fctyh ds >Vds dk Hkh bLrseky fd;k tkrk FkkA gkykafd uSfrd dkj.kksa ls vc bls can dj fn;k x;k gS vkSj vc eknd inkFkZ mi;ksx fodkjksa ds mipkj esa bldk mi;ksx ugÈ fd;k tkrk gSA
(Contingency management): ;g fpfdRlk LQwrZ vuqdwyu ds fl)karksa ls yh xà gSA O;ogkjxr fl)karksa ds vuqlkj eknd inkFkks± ds mi;ksx dks lfØ; O;ogkj ds :i esa ekuk tkrk gS ftls dqN çcydksa tSls eknd inkFkks± ds çHkko vkSj lkekftd ;k lkaL—frd vuqeksnu }kjk lq–<+ fd;k tkrk gSA vkdfLed çcaèku dk mís'; gS fd ,sls lq–<+hdj.k ds çHkkoksa dks detksj fd;k tk,A LoLFk O;ogkjksa ¼tSls i<+us] isaÇVx vkfn tSls 'kkSd ij le; fcrkuk½ dks ldkjkRed lq–<+hdj.k çnku djuk bldk mís';
gS rkfd eknd inkFkks± ds lsou tSls dq&vuqdwfyr O;ogkjksa dks çfrLFkkfir fd;k tk ldsA
bl fpfdRlk esa eq[; :i ls nks çdkj dh vkdfLedrkvksa dk mi;ksx fd;k tkrk gS& lq–<+hdj.k ¼fdlh O;ogkj dh laHkkouk c<+kus ds fy,½ vkSj naM
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¼fdlh O;ogkj dh laHkkouk de djus ds fy,½ ftls vkxs bl rjg foHkkftr fd;k tk ldrk gS%
1½ ldkjkRed izcyu (Positive reinforcement) blesa çR;kf'kr@okafNr O;ogkj ¼Ldwy mifLFkfr esa o`f)] lekt&vuqdwy O;ogkj] eknd inkFkks±
ds mi;ksx esa deh vkfn½ ds vkèkkj ij okafNr ifj.kkeksa ¼csgrj lsok,a] èku lacaèkh iqjLdkj vkfn çnku djuk½ dk mi;ksx djuk 'kkfey gSA
2½ udkjkRed izcyu (Negative reinforcement) blesa çR;kf'kr@okafNr O;ogkj ds vkèkkj ij v#fpdj míhidksa ¼tSls [ksy ls çfrcaèk gVkuk½ dks gVkuk 'kkfey gSA
3½ ldkjkRed ltk (Positive punishment) blesa vokaNuh; O;ogkj ¼eknd inkFkks± ds mi;ksx½ ds vkèkkj ij ltk ds fdlh :i ¼ckgj tkus ij jksd]
Ldwy ls fuyacu] MkaV vkfn½ dk mi;ksx djuk 'kkfey gSA
4½ udkjkRed ltk (Negative punishment): blesa vokafNr O;ogkj ¼eknd inkFkks± ds mi;ksx½ ij ldkjkRed fLFkfr ;k ifjfLFkfr dks gVkuk ¼i‚dsV euh esa deh] xeZtks'kh] I;kj vkSj Lusg ds Lrj dks de djuk vkfn½ 'kkfey gSA
eknd inkFkZ ds leL;kxzLr mi;ksx ds ekeys esa] ;s mipkj ijke'kZnkrk dh igyh ilan gksrs gSaA gkykafd os ,l;wMh ds lkFk fd'kksjksa ds leL;kxzLr O;ogkjksa ds bykt esa Hkh çHkkoh gSaA
6½
LoLFk jgus vkSj LoLFk thou 'kSyh dks cuk, j[kus ds fy, nSfud fnup;kZ esa dqN cnykoksa dks 'kkfey djuk vko';d gSA fd'kksjksa dks dqN LoLFk xfrfofèk;ksa tSls ckgjh [ksy] ;ksx] Üolu O;k;ke] è;ku vkfn esa layXu gksuk pkfg,A fdlh Hkh çdkj dk 'kkjhfjd O;k;ke csgrj eukslkekftd dk;Zç.kkyh ls tqM+k gksrk gS ftlesa fdlh O;fä ds ekufld vkSj 'kkjhfjd LokLF; ds lcls lq–<+ iwoZ&fuèkkZjd gksrs gSaA thou'kSyh esa cnyko ls la;e cuk, j[kus esa lgk;rk feyrh gSA
bl rjg cPpksa vkSj fd'kksjksa esa O;ogkjxr] fodklkRed fodkjksa vkSj eknd inkFkZ lsou fodkjksa ds mipkj ds fy, vke rkSj ij O;ogkjxr] çsj.kkRed laoèkZu fpfdRlk@lk{kkRdkj] euks&f'k{kk vkSj ifjokj&vkèkkfjr ijke'kZ rduhdksa tSlh fofHkUu rduhdksa dk mi;ksx fd;k tkrk gSA
• ijke'kZ ,d euksoSKkfud çfØ;k gS tgka ,d çf'kf{kr O;fä DykbaV ds lkFk is'ksoj lacaèk LFkkfir djrk gS rkfd mís';iw.kZ ckrphr ds ekè;e ls mldh lgk;rk dh tk ldsA
• fodklkRed fodkjksa esa ijke'kZ fu"iknu vkèkkfjr leL;kvksa dks [kkstus]
cPps@fd'kksjksa dh rkdrksa vkSj detksfj;ksa dks fuèkkZfjr djus vkSj nSfud dk;ks± dks djus esa cqfu;knh dkS'ky ds fuekZ.k ds fy, mi;qä lek;ksth j.kuhfr;ka viukus esa lgk;d gSA
• O;ogkjxr vkSj fodklkRed fodkjksa esa fofHkUu ijke'kZ –f"Vdks.k% ifjokj ijke'kZ] jpukRed dyk fpfdRlk,a] vuqç;qä O;ogkj fo'ys"k.k] lpsrurk vH;kl vkSj [ksy fpfdRlkA
270
• eknd inkFkZ lsou fodkjksa esa fofHkUu ijke'kZ% euks&f'k{kk] çsjd lk{kkRdkj]
iqu% iru jksdFkke fpfdRlk] ikfjokfjd ijke'kZ] O;ogkjxr fpfdRlk,a
¼vkdfLed çcaèku½] thou 'kSyh esa la'kksèku ¼;ksx] è;ku] [ksy] O;k;ke vkfn½A
• euks&f'k{kk f'k{kkçn –f"Vdks.k viukdj DykbaV ;k mlls tqM+s yksxksa dks fdlh O;fä esa fdlh Hkh euksoSKkfud ladV iSnk djus ds fy, ftEesnkj fdlh fuf'pr fLFkfr ;k ifjfLFkfr ds ckjs esa f'kf{kr djus dh çfØ;k gSA blesa fuEufyf[kr 'kkfey gSa% O;fäxr] lewg] ifjokj] leqnk; vkèkkfjr euks&f'k{kkA
• ,e vkà ,d xSj&funsZ'kd ijke'kZ –f"Vdks.k gS tks ml laHkkfor fn'kk dk irk yxkus dk bjknk j[krk gS ftls O;ogkj ifjorZu ds fy, DykbaV viuk ldrk gSA çsjd lk{kkRdkj ds ikap çeq[k ?kVd fuEufyf[kr gS%
lekuqHkwfr çdV djuk] fu.kZ;kRed larqyu] varj fodflr djuk] çfrjksèk lgrs gq, vkxs c<+uk] vkRe&çHkko esa lg;ksx djukA
• leL;kRed inkFkZ ds mi;ksx esa deh ;k lekfIr ds ckn iqu% iru nj dks de djus ds fy, iqu% iru jksdFkke fpfdRlk dk mi;ksx fd;k tkrk gSA
• fd'kksjksa esa O;ogkj lacaèkh leL;kvksa ;k eknd inkFkks± ds leL;kxzLr mi;ksx ds mipkj ds fy, ifjokj ijke'kZ dk mi;ksx fd;k tkrk gSA blesa ;g ekU;rk gS fd ifjtu O;fä ds thou dh çkFkfed O;oLFkk gSA
• ,eMh,QVh ifjokj dsafær cgqvk;keh –f"Vdks.k gS ftldk mi;ksx fd'kksjksa esa euksoSKkfud jksxksa tSls eknd inkFkZ lsou fodkj] vkpj.k fodkj]
lkaosfxd v{kerk] 'k=qrk] Øksèk] ikfjokfjd leL;kvksa ds lkFk volkn vkSj Çprk ds mipkj esa fd;k tkrk gSA
• ikfjokfjd fpfdRlk ds ikap pj.kksa esa layXurk] ikfjokfjd vkdyu]
ifjorZu ds fy, vfHkçsj.kk dk l`tu] çkFkfed fpfdRlk gLr{ksi dk lapkyu vkSj lekiu 'kkfey gSA
• O;ogkjxr mipkjksa ds çdkj fuEufyf[kr gSa% ladsr çn'kZu fpfdRlk] v#fp fpfdRlk] vkdfLedrk çcaèku
• vkdfLedrk çcaèku O;ogkjxr fpfdRlk dk :i gS tks fØ;kçlwr vuqdwyu ij vkèkkfjr gSA bl fpfdRlk esa nks çdkj dh vkdfLedrkvksa dk mi;ksx fd;k tkrk gS& lq–<hdj.k ¼fdlh O;ogkj dh laHkkouk c<+kus ds fy,½ vkSj naM ¼fdlh O;ogkj dh laHkkouk de djus ds fy,½A
• thou 'kSyh esa la'kksèku ls la;e cjdjkj j[kus esa lgk;rk feyrh gSA
• 'kkjhfjd O;k;ke dk çR;sd :i csgrj eukslkekftd dk;Zç.kkyh ls tqM+k gSA blesa fdlh O;fä ds ekufld ds lkFk&lkFk 'kkjhfjd LokLF; ds lcls etcwr iwoZ&fuèkkZjd gksrs gSaA
271
1½ tulkèkkj.k dks euks&f'k{kk fdl lsÇVx esa çnku dh tk ldrh gS\
• O;fäxr
• lewg
• ifjokj
• lkeqnkf;d
2½ ikfjokfjd ekgkSy esa ekrk&firk dks euks&f'k{kk çnku djuk D;ksa vko';d gS\
• vius cPpksa ds çfr muds O;ogkj ds fy, mUgsa nks"kh eglwl djkus ds fy,
• mUgsa vius cPpksa ds lkFk eknd inkFkks± dk lsou 'kq: djus dk fodYi nsus ds fy,
• mudh ;g le>kus esa lgk;rk djus ds fy, fd vc dà ns'kksa esa Hkkax vkfn dk lsou dkuwuh gSA
• mUgsa vius cPpksa ds fofHkUu O;ogkjxr iSVuks± vkSj eknd inkFkks± ds lsou dks jksdus esa muds egRo ds ckjs esa tkx:d djus ds fy,A
3½ ,evkà ds ikap çeq[k ?kVdksa dh lwph cuk,aA
4½ çfrjksèk ds lkFk vkxs c<+uk ,evkà dk egRoiw.kZ ?kVd D;ksa gS\
• ;g DykbaV ds fopkjksa dks fu;af=r djus esa fpfdRld dh lgk;rk djrk gS
• ;g vius Øksèk vkSj grk'kk dks ckgj fudkyus esa DykbaV dh lgk;rk djrk gS
• blls DykbaV dks vkarfjd }a}ksa vkSj leL;kvksa dks ekSf[kd :i ls crkus esa lgk;rk feyrh gS
• blls fpfdRld dks fpfdRlk l= chp esa NksM+us dh laHkkouk de djus esa lgk;rk feyrh gSA
5½ fpfdRlk dk eq[; mís'; ifjtuksa ds chp --- dk gy djuk gS rkfd mudh eukslkekftd dk;Zç.kkyh dks lqèkkjk tk ldsA
6½ vkdfLedrk çcaèku fuEufyf[kr fl)karksa ij vkèkkfjr gS%
1½ dk;Zçlwr vuqdwyu 2½ ikjaifjd vuqdwyu
3½ ikjaifjd vkSj dk;Zçlwr vuqdwyu nksuksa 4½ mijksä esa ls dksà ugÈ
272
cpiu vkSj fd'kksjkoLFkk nksuksa dks euq"; ds thou esa lcls egRoiw.kZ pj.k ekuk tkrk gSA ;s pj.k o;Ldrk dk ekxZ ç'kLr djus okys mYys[kuh; ifjorZuksa ls tqM+s gSaA vkuqoaf'kdh vkSj i;kZoj.k lacaèkh dkjdksa dh la;qä Hkwfedk cPps ds fodkl dh fn'kk fuèkkZfjr djus esa egRoiw.kZ Hkwfedk fuHkkrh gSA ;g ,slk le; gS tc fd'kksj ç;ksx djrs gSa vkSj nqfu;k dh [kkst djrs gSaA os vius lkfFk;ksa vkSj ekrk&firk vkSj lkekftd ncko ls çHkkfor gksrs gSaA ;s lc c<+rs cPpksa vkSj fd'kksjksa esa O;ogkjxr vkSj lkaosfxd fodkj iSnk dj ldrs gSaA bl bdkà esa fofHkUu fodklkRed fodkjksa dk Hkh o.kZu fd;k x;k gSA fd'kksjksa }kjk eknd inkFkks± ds lsou dks ekufld LokLF; lacaèkh mYys[kuh; leL;k ds :i esa mtkxj fd;k x;k gSA cPpksa vkSj fd'kksjksa ds fy, ijke'kZ dks fo'ks"k :i ls lkaosfxd vkSj O;ogkjxr fodkjksa vkSj eknd inkFkks± ds lsou fodkjksa ds lanHkZ esa oÆ.kr fd;k x;k gSA eknd inkFkZ mi;ksx fodkjksa ds mipkj ds fy, fof'k"V rduhdksa ij çdk'k Mkyk x;k gSA çsjd lk{kkRdkj] iqu% iru jksdFkke fpfdRlk] O;ogkjxr fpfdRlk ¼vkdfLed çcaèku½]
euks&f'k{kk vkSj ifjokj&vkèkkfjr fpfdRlk,a eknd inkFkks± ds lsou lacaèkh fodkjksa ds mipkj ds fy, dqN lkekU; euks&fpfdRlh; gLr{ksi ;kstuk,a gSaA
Cerebral Palsy ,d xSj&Øfed fodkj gS ftls eq[;r;k fodklkRed nsjh vkSj is'kh; fo—fr;ksa ls fpfàr fd;k tkrk gSA blesa vfr'kf;r@[kjkc çfrorZ] vaxksa esa dBksjrk vkSj Hkko&Hkafxek vkSj leUo;
cjdjkj j[kus esa vleFkZrk 'kkfey gSaA
(Learning disability) lh[kus dh leL;kvksa ds fofHkUu çdkjksa tSls i<+us ¼fMLysfDl;k½] ys[ku ¼fMLxzkfQ;k½ vkSj x.kuk ¼fMLdSYdqfy;k½ esa dfBukà dks lanÆHkr djrh gSA blls cqf) 'kk;n çHkkfor ugÈ gks ijarq lwpuk dk lalkèku çHkkfor gksrk gSA
(Substance dependence) dks eknd æO; dh vuqifLFkfr esa bldh rhoz ykylk ds :i esa lanÆHkr fd;k tkrk gS vkSj bls lárk] fofuorZu] buds lsou ds fy, etcwjh vkSj nSfud thou dh xfrfofèk;ksa ds çHkkfor gksus ls fpfàr fd;k tkrk gSA
(Lapse) tc DykbaV eknd æO;ksa ls ijgst j[kus ¼u'khyh nokvksa ls eqä jgus½ ds ckn igyh ckj eknd æO; ysrk gS ¼tSls fdlh ikVÊ esa 'kjkc ysuk½ vkSj fQj nksckjk buls ijgst+ djrk gSA
(Relapse) tc dksà DykbaV ijgst ds ckn eknd æO;ksa ds lsou ds fiNys rjhds ;k iSVuZ ij okil vk tkrk gSA ;g DykbaV ds fy, ,d rjg dk èkôk gS vkSj blls okafNr y{; vFkkZr eknd æO;ksa dk lsou NksM+us dks çkIr djus esa pqukSfr;ka [kM+h gks tkrh gSaA
(Psycho-education) lk{;&vkèkkfjr euks&fpfdRlh; gLr{ksi gS ftlesa xzkgd ;k mlls tqM+s yksxksa dks euksoSKkfud fodkjksa vkSj muds fy, ftEesnkj dkjdksa ds ckjs esa f'kf{kr djuk 'kkfey gSA
273 (Motivational Interviewing) ,d xSj&funsZ'kd euks&
fpfdRlh; mikxe gS ftlesa ijke'kZnkrk mlds leL;kxzLr O;ogkj¼jksa½ dks cnyus ds fy, csgrj jkLrk pquus vkSj viukus esa vLi"Vrk ¼;fn dksà gks½ dk gy djus esa DykbaV dh lgk;rk djrk gSA
(Aversion Therapy) esa vokaNuh; O;ogkj tSls eknd æO;
mi;ksx dks v#fpdj míhidksa ls tksM+k tkrk gSA
1½ 10 ls 19 o"kZ
2½ rdZuk dkS'ky] vewrZ lksp vkSj vfèklaKku 3½ lkaosfxd l{kerk
4½ Lora=rk] igpku fuekZ.k] Hkfo"; mUeq[khdj.k
1½ lkekU;h—r nqÇ'prk fodkj 2½ i<+kà esa dfBukÃ
3½ eknd inkFkZ ij fuHkZjrk
4½ [kjkc 'kSf{kd fu"iknu] çtuu {kerk ij udkjkRed ifj.kke] vfu;ksftr xHkZèkkj.k] fookn] vkijkfèkd fjdkMZ] vkÆFkd f'kfFkyrk] djhch lacaèkksa dks uqdlku vkfn tSls lkekftd tksf[ke eknd inkFkks± ds lsou ds udkjkRed çHkkoksa esa 'kkfey gSaA
1½ laçs"k.k 2½ iwoZ Çpru 3½ iqu% iru 4½ çkjafHkd tkap
1½ lkeqnkf;d
2½ mUgsa vius cPpksa ds fofHkUu O;ogkjxr iSVuks± vkSj eknd inkFkks± ds lsou dks jksdus esa muds egRo ds ckjs esa tkx:d djus ds fy,A
3½ lekuqHkwfr O;ä djsa] fu.kZ;kRed larqyu] varj fodflr djuk] çfrjksèk ds lkFk vkxs c<+uk] vkRe&çHkko esa lg;ksx djuk
4½ blls fpfdRld dks fpfdRlk l= chp esa NksM+us dh laHkkouk de djus esa lgk;rk feyrh gSA
5½ folaxfr
6½ dk;Z çlwr vuqdwyu
274
1½ fd'kksjksa esa O;ogkjxr ds lkFk&lkFk fodkl ds lkaosfxd igyqvksa dks fpf=r djsaA muesa tksf[ke Hkjs O;ogkjksa dks viukus dh vfèkd vk'kadk D;ksa jgrh gS\
2½ fd'kksjkoLFkk pj.k ls tqM+s fofHkUu çdkj ds O;ogkjxr fodkjksa dh O;k[;k djsaA
3½ lcls vke çdkj ds fodklkRed fodkj D;k gSa\ bu fodklkRed fodkjksa ds fd'kksjksa ds euksoSKkfud fØ;kdykiksa ij iM+us okys çHkko dh O;k[;k dhft,A 4½ fd'kksjksa ij eknd inkFkks± ds lsou ds fofHkUu çHkko D;k gSa\
5½ euks&f'k{kk D;k gS\ fd'kksjksa esa eknd inkFkks± ds lsou dks yf{kr djrs gq, euks&f'k{kk ds fofHkUu çdkjksa dk mYys[k djsaA
6½ çsj.kkRed lk{kkRdkj dh fofHkUu rduhdksa dk o.kZu dhft,A mipkj ds rkSj&rjhdksa dh çHkkodkfjrk esa lqèkkj djus esa ;g dSls mi;ksxh gS\
7½ iqu% iru jksdFkke D;k gS\ bls foLrkj ls le>k,aA
8½ ikfjokfjd fpfdRlk D;k gS\ ikfjokfjd fpfdRlk ds çkFkfed y{; D;k gSa\
crk,a fd buy{;ksa dks dSls gkfly fd;k tk ldrk gS\
9½ ,eMh,QVh dks foLrkj ls le>k,aA
10½ O;ogkjxr fpfdRlk D;k gS\ fd'kksjksa esa mi;ksx dh tkus okyh fofHkUu çdkj dh O;ogkjxr fpfdRlk D;k gSa\ vkdfLedrk çcaèku dks foLrkj ls le>k,aA
Brewer, S., Godley, M.D., & Hulvershorn, L.A. (2017). Treating Mental Health and Substance Use Disorders in Adolescents: What is on the Menu?.Current Psychiatry Reports, 19 (1), 5.https://doi.org/10.1007/s11920- 017-0755-0Eun, J.D., Paksarian, D., He, J.P., & Merikangas, K.R.
(2018).Parenting style and mental disorders in a nationally representative sample of US adolescents.Social Psychiatry and Psychiatric Epidemiology, 53(1), 11–20. https://doi.org/10.1007/s00127-017-1435-4Global Youth Tobacco Survey (GYTS, 2021). Retrieved 31 January 2021, fromhttps://www.who.int/tobacco/surveillance/gyts/en/
Hinckley, J.D., & Riggs, P. (2019). Integrated Treatment of Adolescents with Co-occurring Depression and Substance Use Disorder.Child & Adolescent Psychiatric Clinics of North America, 28(3), 461–472.
https://doi.org/10.1016/j.chc.2019.02.006Kulak, J.A., & Griswold, K.S.
(2019). Adolescent Substance Use and Misuse: Recognition and Management. American Family Physician, 99 (11), 689–696.
Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rded.). New York: Guilford Press.
Prochaska, James O.; DiClemente, Carlo C. (2005). "The transtheoretical approach". In Norcross, John C.; Goldfried, Marvin R. (eds.). Handbook of psychotherapy integration. Oxford series in clinical psychology (2nd ed.).
275 Oxford; New York: Oxford University Press. pp. 147–171. ISBN 978-
0195165791. OCLC 54803644.
Sanders, R. (2013). Adolescent Psychosocial and Cognitive Development.
Pediatrics in Review, 34(8), 354-359. doi: 10.1542/pir.34-8-354Simmons S, Suárez L. (2016). Substance Abuse and Trauma.Child Adolesc Psychiatr Clin N Am.Oct; 25(4): 723-34. doi: 10.1016/j.chc.2016.05.006.
• Alan E Kazdin (1987). Conduct Disorders in Childhood and Adolescence. Newbury Park, Calif.: Sage Publication
• David A Wolfe & Eric J Mash. (2008). Behavioural and Emotional Disorders in
• Adolescents: Nature, Assessment, and Treatment. New York: Guilford Press
• Jonathan D Avery & John W Barnhill. (2018). Co-occurring Mental Illness and Substance Use Disorders: A Guide to Diagnosis and Treatment. Arlington, Virginia: American Psychiatric Association Publishing
• Ken C Winters; (2008). Treatment of Adolescents with Substance Use Disorders. Rockville, MD: U.S. Dept. of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment.
• Yifraḥ Ḳaminer (2010). Adolescent Substance Use Disorders. St. Louis, Mo; Elsevier Health Sciences
276
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12-1 vfèkxe mís';
12-2 ifjp;
12-3 Ldwy ijke'kZ
12-3-1 Ldwy ijke'kZ dk egRo 12-3-2 Ldwy ijke'kZnkrk dh Hkwfedk 12-3-3 Ldwy ijke'kZ esa uSfrdrk
12-4 Ldwy ijke'kZ dk nk;jk
12-4-1 f'k{kk ds izkjafHkd Lrj ij ijke'kZ 12-4-2 f'k{kk ds ek/;fed Lrj ij ijke'kZ 12-4-3 f'k{kk ds mPp ek/;fed Lrj ij ijke'kZ
12-5 Hkkjr esa Ldwy ijke'kZ 12-6 dfj;j ijke'kZ
12-6-1 dfj;j ijke'kZ dh ç—fr 12-6-2 dfj;j ijke'kZ dh lajpuk
12-7 dfj;j fodkl ds fl)kar
12-7-1 fo'ks"kd vkSj dkjd fl)kar 12-7-2 fodklkRed fl)kar
12-7-3 lkekftd&laKkukRed dfj;j fl)kar 12-7-4 fufeZfr dfj;j fl)kar
12-8 Hkkjr esa dfj;j ijke'kZ 12-9 lkjka'k
12-10 çeq[k 'kCn
12-11 Lo vkdyu ç'uksa ds mÙkj 12-12 bdkà ls lacafèkr ç'u 12-13 lanHkZ
12-14 ikBî lq>ko
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