TRAINING IN THE REHABILITATION OF DRUG ADDICTS INTRODUCTION DRUGS Drug
TRAINING IN THE REHABILITATION OF DRUG ADDICTS INTRODUCTION DRUGS Drug
TRAINING IN THE REHABILITATION OF DRUG ADDICTS INTRODUCTION DRUGS Drug
INTRODUCTION
DRUGS
Drugs are chemical compounds that modify the way the body and mind work. Most
people think that these biological activities should help or heal sick people or animals.
There is, however, no known drug that is not harmful or even poisonous at high
doses, and much of the scientific work on drugs has attempted to widen the gap between
effective and toxic doses.
The word drug has acquired bad connotations in recent years because the
widespread abuse of a few chemicals that affect the central nervous system has become a
serious sociological problem. Nevertheless, drugs act on many other organs in the body,
can benefit as well as harm the nervous system, and have made possible a revolution in
the way modern doctors treat disease.
It used to be said that what distinguishes humans from animals is that people take
drugs. This old adage is no longer quite true. Rats and monkeys that have been addicted
experimentally to some drugs will inject themselves with those drugs to support their
addictions. But otherwise the old saying still holds
History of Drugs
The history of drugs is shrouded in the beginnings of the human race. Alcohol was
made, drunk, and used to excess as far back as memory and records go. Tobacco
(Nicotiana), hemp (Cannabis sativa), opium poppy (Papaver somniferum), and other
plants containing drugs have been chewed and smoked almost as long as alcohol, and
coffee has been served in the Middle East throughout that area's history.
Tobacco was carried from Virginia to England by Sir Walter Raleigh, whose pipe
smoking prompted Elizabeth I to remark, "I don't like this herb." Of course, the queen did
not know anything about tar and nicotine, but she became one of the first people to
initiate the acrimonious debate about tobacco constituents that we face today. Likewise,
the effects of cannabis have given it a bad name.
Coffee was introduced by the Ottomans to the Western world when the Turks made
a foray into central Europe in the 16th century. Its active alkaloid, caffeine, is often on the
forbidden list for patients suffering from rapid heart beat or angina. Some of the
chemicals that flavor coffee, such as esters of caffeic acid, stimulate cardiac hormones
and thus add to the danger of disturbing the rhythm of the heartbeat.
Fortunately, some medicine men and women were careful observers, who had a
patient's recovery uppermost in mind. Especially those who had risen to power and
influence and had a scientific bent or deep compassion could be relied upon to search for
valid explanations of their findings.
He was able to judge the value of some Chinese herbs. For example, he found that
Ch'ang Shan was helpful in treating fevers. Such fevers were, and still are, caused by
malaria parasites.
The drug consists of the powdered roots of a plant in the breakstone family
(Saxifragaceae, now identified as Dichroa febrifuga, Lour.). Almost 4700 years later, a
group of Chinese chemists isolated two compounds (the dichroines) from the plants, one
of which later proved to control bird malaria.
The leaves of this plant-called Shun Chi or chuine in present-day China-also contain
antimalarial chemicals (the febrifugines), one of which is identical with one of the
dichroines. These alkaloids (organic bases) were studied and synthesized during World
War II in an effort to protect Americans from malaria in the Pacific and other tropical
campaigns. However, chemists could not separate the nausea the drugs produced from
their antimalarial effects.
c. Ancient Drugs
Much knowledge of early drugs has been lost from every civilization. What remains
is passed on in sporadically recorded epics and folklore unearthed by archaeologists and
linguistic scholars. Tropical and subtropical regions, with their greater variety of plants,
have given us most of the descriptions of these medicines.
Although some ancient drugs have survived throughout the ages and are still used in
a refined form, they amount to a small percentage of modern medications.
d. Hindu
Ancient Hindu records mention eating chaulmoogra fruit to treat leprosy. We now know
that the fruit contains several oils not very effective against leprosy bacteria. Treating the
disfigured areas with these oils has been replaced entirely by swallowing dapsone, a
synthetic drug, or by using other medicines
DRUGS
Drug is any chemical that is not food and that affects your body.
• Some drugs are given to people by doctors to make them healthy. These are called
prescription (say pre-scrip-shun) drugs.
• Some drugs are natural and can be found in some kinds of food or plants that are
not a normal part of a person’s diet.
• Some drugs are illegal which means it is against the law to buy, sell or use them.
• Some drugs are legal but because they are dangerous to health, the law says that
you have to be an adult to use them.
Drug addiction
It is considered a pathological state. The disorder of addiction involves the
progression of acute drug use to the development of drug-seeking behavior, the
vulnerability to relapse, and the decreased, slowed ability to respond to naturally
rewarding stimuli. The Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV) has categorized three stages of addiction: preoccupation/anticipation,
binge/intoxication, and withdrawal/negative affect. These stages are characterized,
respectively, by constant cravings and preoccupation with obtaining the substance; using
more of the substance than necessary to experience the intoxicating effects; and
experiencing tolerance, withdrawal symptoms, and decreased motivation for normal life
activities. By definition, drug addiction differs from drug dependence and drug tolerance.
There are many different drugs, but we can put some of them into three groups by the
effect that they have on the human brain.
Stimulants
These drugs stimulate the central nervous system into working faster.
Depressants
(Dee-press-ants) Sometimes called ’downers’
These drugs have the opposite effect to stimulants. They slow down the central nervous
system.
The most serious consequences are abuse and addiction. The drugs most often
associated with abuse ate psychoactive drugs, those designed to alter a person’s
experiences or consciousness, in short term, psychoactive drugs can cause intoxication, a
state in which sometimes-unpredictable physical and emotional problems occur.
• Anabolic steroids
Addictive drugs also include a large number of substrates that are currently considered to
have no medical value and are not available over the counter or by prescription.
Addictive potency
The addictive potency of drugs varies from substance to substance, and from individual
to individual
Drugs such as codeine or alcohol, for instance, typically require many more exposures to
addict their users than drugs such as heroin or cocaine. Likewise, a person who is
psychologically or genetically predisposed to addiction is much more likely to suffer
from it.
Prevalence
The most common drug addictions are to legal substances such as:
• Alcohol
• Nicotine in the form of tobacco, particularly cigarettes
Researchers have conducted numerous investigations using animal models and functional
brain imaging on humans in order to define the mechanisms underlying drug addiction in
the brain. This intriguing topic incorporates several areas of the brain and synaptic
changes, or neuroplasticity, which occurs in these areas.
Depressants
Stimulants
1. Reinforcement
2. Compulsion
3. Loss of control
The individual loses control over the behavior and can’t block the impulse to engage in it.
4. Esclation
5. Negative consequences
Such as problems with acadamic or job performance, difficulties with legal or financial
problems/troubles.
1. Lack of knowledge
Most people who are addicted have less knowledge about drugs or its
consequences. Mean while awareness of education is is less, as our religion Islam never
admires to use drugs.
2. Easy Availability
If government makes strict rules on such type of things it would and can be
vanished from our society. Easy availability makes everybody curious to buy such drugs.
3. Peer Pressure
It is one of the major causes of addiction. Friends or company makes one good or
bad.if friends are drug addict they will pressurise their non addict friends to take drugs.
Poverty and unemployment is the major causes of addiction especially in the third
world’s countries. They cause depression and frustration and in order to get rid from these
tension people start drug addiction.
5. Curosity
Mostly ddrug addicts start taking drug because they are curious about the effect of
drugs. They take it as a thrilling experience but after using them they become addict.
6. Modling
Modling or immitation plays crucial role in learning. If there is any role model in
front of people they may get inspiration from them and start taking drugs. Mass media
can also play a role of modeling.
It is the wrong notion prevalent in our society that drugs usage reduces depression.
People blindly belive it and start taking drugs out of hope that they are curing their anger
and depression.
Usually people are antisocial and have disturbed relation with their spouse and
family may develop frustration. So addiuction seems to them as instant way of coping
with frustration.
9. Excess of Money
Excess of money makes people spoiled. Pampered child with lots of money
induldged in such activities.
Young boys welcome drugs just for the sake of fun and enjoyment because it makes
them active. They take it as an adventourous experience of their life.
11. Lake Of Parental Care
Parents who don’t have awareness of the activities and where about of their children, are
the major factor in making their children addict.
Making a new experience s upon self can have dangerous effects and results.
People with lake of any activity and work load, engaged in such behaviors just for the
sake of new activities. Busy minds are devoid of such thoughts. As it has been said
“empty brain is staying spot of evil.”
Rejection from loved ones may lead to depression and frustration, which makes them to
take help from drugs.
A.Effects on individuals
2. Effects on Family
3. Effects on Community
Drug Classification
Untreated substance abuse and addiction add significant costs to families and
communities, including those related to violence and property crimes, prison expenses,
court and criminal costs, emergency room visits, healthcare utilization, child abuse and
neglect, lost child support, foster care and welfare costs, reduced productivity, and
unemployment.
The latest estimate for the costs to society of illicit drug abuse alone is $181 billion
(2002). When combined with alcohol and tobacco costs, they exceed $500 billion
including healthcare, criminal justice, and lost productivity. Successful drug abuse
treatment can help reduce this cost; crime; and the spread of HIV/AIDS, hepatitis, and
other infectious diseases. It is estimated that for every dollar spent on addiction treatment
programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some
outpatient programs, total savings can exceed costs by a ratio of 12:1.
Scientific research since the mid-1970s shows that treatment can help many people
change destructive behaviors, avoid relapse, and successfully remove themselves from a
life of substance abuse and addiction. Recovery from drug addiction is a long-term
process and frequently requires multiple episodes of treatment. Based on this research,
key principles have been identified that should form the basis of any effective treatment
program:
Medications
Withdrawal:
Treatment:
Medications can be used to help re-establish normal brain function and to prevent relapse
and diminish cravings throughout the treatment process. Currently, we have medications
for opioid (heroin, morphine) and tobacco (nicotine) addiction, and are developing others
for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction.
Methadone and buprenorphine, for example, are effective medications for the treatment
of opiate addiction. Acting on the same targets in the brain as heroin and morphine, these
medications block the drug's effects, suppress withdrawal symptoms, and relieve craving
for the drug. This helps patients to disengage from drug-seeking and related criminal
behavior and be more receptive to behavioral treatments.
Buprenorphine:
This is a relatively new and important treatment medication. NIDA-supported basic and
clinical research led to the development of buprenorphine (Subutex or, in combination
with naloxone, Suboxone), and demonstrated it to be a safe and acceptable addiction
treatment. While these products were being developed in concert with industry partners,
Congress passed the Drug Addiction Treatment Act (DATA 2000), permitting qualified
physicians to prescribe narcotic medications (Schedules III to V) for the treatment of
opioid addiction. This legislation created a major paradigm shift by allowing access to
opiate treatment in a medical setting rather than limiting it to specialized drug treatment
clinics. To date, nearly 10,000 physicians have taken the training needed to prescribe
these two medications, and nearly 7,000 have registered as potential providers.
Behavioral Treatments
They help patients engage in the treatment process, modify their attitudes and
behaviors related to drug abuse, and increase healthy life skills. Behavioral treatments
can also enhance the effectiveness of medications and help people stay in treatment
longer.
• Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and
cope with the situations in which they are most likely to abuse drugs.
• Multidimensional Family Therapy, which addresses a range of influences on the
drug abuse patterns of adolescents and is designed for them and their families.
• Motivational Interviewing, which capitalizes on the readiness of individuals to
change their behavior and enter treatment.
• Motivational Incentives (contingency management), which uses positive
reinforcement to encourage abstinence from drugs.
Residential treatment programs can also be very effective, especially for those with more
severe problems. For example, therapeutic communities (TCs) are highly structured
programs in which patients remain at a residence, typically for 6 to 12 months. Patients in
TCs may include those with relatively long histories of drug addiction, involvement in
serious criminal activities, and seriously impaired social functioning. TCs are now also
being designed to accommodate the needs of women who are pregnant or have children.
The focus of the TC is on the re-socialization of the patient to a drug-free, crime-free
lifestyle.
Treatment within the criminal justice system can succeed in preventing an offender's
return to criminal behavior, particularly when treatment continues as the person
transitions back into the community. Studies show that treatment does not need to be
voluntary to be effective. Research from the Substance Abuse and Mental Health Services
Administration suggests that treatment can cut drug abuse in half, reduce criminal
activity up to 80 percent, and reduce arrests up to 64 percent.*
DOST WELFARE FOUNDATION
Dost foundations have established two DICs in Peshawar and one in Kohat. These
three DICs are in close proximity to the street sights where the drug users are found
and are providing drug harm reduction, HIV prevention a and social services to the
street drug users. Detoxification and out patients rehabilitation services are also
provided in these DICs
These are:
1. Dar-ul-salam Dic:
It was established in 1995 and located in Sikandar Town area of Peshawar city. It serves
the mixed street drug addict population comprised of clients from all provinces of
Pakistan and Afghanistan.
2. Dar-ul-Shifa Dic:
It was established in 2000 and located in Hayatabad Industrial estate on the border
between Peshawar and the Tribal areas. It also serves the street drug edicts comprised
largely from Afghans.
3. Dar-ul-shifa dic (Kohat):
It was established in 2003 and located in sheno khel area of kohat and serves the clients
of Kohat and the adjoining tribal areas, particularly from the Darra Adam Khel.
CORE CONCEPTS
1. Therapeutic concepts
2. Self help basis
3. 12 steps of NA(Narcotic Anonymous) and AA(Alcoholism Anonymous)
4. Culture and religion
TREATMENT PHASE
1. Preadmission
a. Counseling
b. Assessment
2. Detoxification
a. Symptomatic treatment
b. Bath therapy and open door policy
c. Peer to peer counseling
3. Reintegration with family and society
a. Personal growth
b. Life satisfaction
4. Primary Rehabilitation
a. individual and group counseling
b. Lectures duty
c. Therapeutic duty
d. Behavioral therapy
e. Family programming
f. Vocational Therapy
RECOVERY GOALS
a. Recovery from emotionally short tempered also social, physical and spiritual
recovery.
b. Emotional treatment including commitment to drug free life
c. Low esteem (self acceptance).
d. Adaptation to work and responsibility
e. Reintegration with family and society.
f. Personal growth and life satisfaction
5. SECONDARY REHABILIATION
a. community development
6. AFTER CARE AND FOLLOWUP
b. home visit
c. Letters
d. Lectures on Thursday and Friday
It includes:
1. Family programs
2. Prevention programs
3. Narcotics anonymous meeting
4. Sakoon core crises intervention programs
5. Street addicts therapeutic community
6. Asra care center therapeutic community
7. Male prison
8. Youth project
9. Training for human resource development
10. Juvenile offender TC in central jail Peshawar
11. Female prison
VISIT TO DOST FOUNDATION
We the students of Women Institute of Learning (WIL) visited Dost Foundation
twice for our assignment purpose regarding to internship process in March, 2008 with our
staff members.
1ST VISIT
1st visit was held on 19th of March. The organizational staff received us and first one of
their members (a female Barekhna) gave us a short introductory lecture about Dost
Foundation and its exclusive works and therapeutic processes. Then a psychologist
named ‘Arshad’ gave us a lecture and told us lot more about Drugs, types of drugs and
also what type of treatments they use in Dost Foundation. After taking lecture we went to
the hall where we had to take case histories from patients. There two staff members
‘Muhammad Nabi’ and Managing director ‘Muhammad Ayub’ also gave us lecture and
explained the model of treatment of the addicts and steps involved in it. Then addicts
were referred to us and we took case history and also gave them counseling and guidance.
2ND VISIT
The second visit was held on 27th march. We visited all the departments under the
supervision of Muhammad Nabi and also took case history of second patient. In all
department and rooms we talked to the patients who were taking treatments and also
doing work there. We asked their views about the institute as well. All were happy and
satisfied there. It was a really knowledge gaining trip to that institute.
CASE HISTORIES OF THE DRUG ADDICTS
CASE HISTORY 1.
Name: Suleman
Gender: Male
Age: 22
Marital status: Single
Religion: Muslim
Education: 5th
Occupation: Motor mechanic
Siblings: 5
Birth order: 1st
The client belonged to a middle family and is from a Pathan family. He is getting
treatment from 36 days. He started drugs at the age of 15 due to peer pressure, he took
start from Hash and with the passage of time his demand for the drugs increased and he
used tablets and injections as well. His chief complaints were restlessness, shivering of
body, sleeplessness, aggression. He even tried suicidal attempts and also tried to injure
others after usage of the drugs. He used to cut his body to get relaxed while using drugs.
His father brought him in the institute and now he wants to get rid from drugs to live a
healthy life. And he got positive improvement from the institute.
CASE HISTORY 2.
He is from a Pathan family; he was in the institute since 3 months. He started drug
addiction at the age of 26 just for fun with friends. His demand increased and reached to
high level when his elder son died at the age of 20, later his wife died and after that his
second son of 12 years died as well. Due to theses shocks he started alcohol, injections
and lived life like animals. But later his brother brought him into Dost Foundation where
due to proper care he is getting well. His chief complaints were sleeplessness, tiredness,
body shivering, and aggression. But due to proper treatment and care he is getting much
better and now he wants to live healthy life and to be a perfect Muslim and offer his
prayers. He said that he want to die with peace and people may take him to grave with
respect not hatter .he is much better now.
REFERENCES
Paul, M.l. et al. (1950). “Core Concepts In Health”. (8th ed.). London: May
Field Publishing Company.