Drug Addiction Treatment and Rehabilitation-Imran Ahmad Sajid

Field Work Report Dec, 07 to May2008

Imran Ahmad MA final [0]

FIELD WORK activities Dost Welfare Foundation

Dec 2007 – to-May 2008

Submitted By:

Imran Ahmad Sajid M.A. final evening-22

Submitted to:

Sir. S. Faiq Sajjad Shah

May 2008

Drug addiction

Treatment and Rehabilitation

DEPARTMENT OF SOCIAL WORK

UNIVERSITY OF PESHAWAR


Imran Ahmad MA final [i]

In the name of allah


Imran Ahmad MA final [ii]

Al-Hamd & As-Sana, all the Glories and all the Sanctity is to be Allah who is the Rabal-

Alamin, who is Karim, who is Rahim, and who is Aleem, who is Jalil, who is Qadir, and who

loves Man 70 times more then his own mother. Darood & Salam to be on His Prophet

(PHUH), who is the most learned in the world and who is a blessing for the world and the

world hereafter. Fazl-e-Rub and Nazr-e-Karam of Al-e-Rasool has enabled me to work for

the completion of this report.

Some times in our life we loose our energies and courage and the simple things seems to us

very complicated. The same happened to me while compiling field work activities. But my

Murshid has given me a new bank of courage and energy through his counseling and prayers.

Therefore I have no words to say thanks to my Murshid.

Further more I would like to pay extreme thanks to Sir. Naeem Asif, the center manager dost

welfare foundation, whose continues guidance, appreciation and encouragement was of great

help for me.

It was really an interesting experience while talking to Sir. Faiq Sjjad Shah about my field

work activities. His guidance and encouragement has a great value for me.

Last but not the least, I would like to say, Thank You my brothers, to my group members,

Fahim Khattak, Adnan Ashraf, M. Hazrat Mohmand, Iqbal, Hikmat Shat, Rafique, Modassir,

Anayat And one of the staff member, Israr.

Imran Ahmad Sajid

ACKNOWLEDGMENTS


Imran Ahmad MA final [iii]

Drug use is not new. Humans have been using alcohol and plant-derived drugs for thousands

of years- as far as we know, since Homo sapiens first appeared on the planet. What recorded

history we have indicates that some of these drugs were used not just for their presumed

therapeutic effects but also for recreational purposes. In some of the highly developed ancient

cultures, psychoactive plants played important economic and religious roles. There is also

evidence that some people have always overused, misused, or abused these substances.

Drug addiction is a problem in western world, in Europe to some extent, in America to a

greater extent depending on the nature of the drug. At the moment there are some 0.8 million

Heroin Addicts in USA, more then 20 million people use chars for addiction. Cocaine and

stimulants are at the top among youth.

In Pakistan the situation is a bit changing. The traditional drug of addiction is Opium and by

70‘s we have the drug culture of synthetic medicines. Tunal was a very famous drug at that

time and the tunal addicts were used to call ―Tunalee‖. But by 80‘s the ―Tunalee‖ is replaced

as ―Poodary‖. By 2005 we have some other new incents in drug culture. One is called

Cocaine and the other is called Crystalline.

SUMMARY


Imran Ahmad MA final [iv]

S. No Detail Page. No.

CHAPTER NO.1

1 INTRODUCTION TO

DRUG ADDICTION

AND DOST WELFARE

FOUNDATION

The drug problem-1,

Drugs in the History, Dost Welfare

Foundation – 2

Mission Statement, Objectives – 3

Milestone – 4, Milestone-4, Drug Culture in

Pakistan, Some Commonly used Drugs in

Pakistan- 5

1

CHAPTER NO.2

2 DRUG, ADDICTION

AND DISEASE CONCEPT

Drug, Addiction, Addictive Drug – 7, Drug

Addiction, Definition – 8, Some important

concepts – 9, three basic processes of drug

addiction – 10, types of addiction - 12

7

CHAPTER NO.3

3 CAUSES AND SIDE-

EFFECTS OF DRUG

ADDICTION

Why start drug addiction-13, Side Effects of

Drug Addiction: physiological, social – 14,

psychological, spiritual, financial, effects on

family – 15, Community - 16

13

CHAPTER NO.4

4 CLASSIFICATION OF

DRUGS – WITH

REFERENCE TO

ADDICTION

Major classes of drugs – 17, Depressants:

Alcohol-18, tranquilizers, barbiturates– 20,

Painkillers: Narcotics – 21, opium, Heroin –

22, Codeine, Stimulants – 23, amphetamine-

24, cocaine, caffeine-25, tobacco-26,

nicotine-27, khat, steroids-28 ,

Hallucinogens: 29, Marijuana-30, Ketamine,

LSD-31, Table of drugs and effects-33

17

CHAPTER NO.5

5 TREATMENT

PHILOSOPHY

Introduction, pretreatment phase-35,

treatment phase-36, post treatment phase-38, 35

CHAPTER NO.6

6 COUNSELING what do we mean by counseling, why do

people have counseling-40, objectives and

goals of counseling-41, skills required for a

counselor-42, stages of counseling-43,

qualities required for a counselor-44,

common errors-44

39

CHAPTER NO.7

7 BEHAVIOR

MANAGEMENT TOOLS

Introduction -45, spoken to-46, dealt with-

47, pull up-48, pull up on board-50, time out,

hair cut-51, prospect chair-52, confrontation-

53

45

CHAPTER NO.8

8 MORNING MEETING importance of morning meeting, the purpose

of morning meeting, components of morning

meeting -54, Dua-e-Sakoon-55, pic-56

54

TABLE OF CONTENTS


Imran Ahmad MA final [v]

CHAPTER NO.9

9 RELAPSE PREVENTION

PROGRAMME

Introduction, understanding relapse-57,

contributing factors-58, categories of

patients-59, warning signs/ principles of

relapse prevention-60, conclusion-64

57

11

Follow Up and After Care 65

12 CHAPTER NO.10

DOST PROGRAMME IN

BRIEF

Harm Reduction and Social Services-66,

Drug Abuse prevention programme-67,

treatment plane-68, 11 steps-69, 12 steps-70

66

13 CHAPTER NO. 11

SUGGESTIONS AND

RECOMMENDATIONS

71

14 CHAPTER NO. 12

ROLE OF SOCIAL

WORKER

Pre-treatment/awareness phase-73, treatment

phse-74, post-treatment phase-74 73

CHAPTER NO. 13

15 CASE HISTORIES 76

16 REFERENCES 82

17 BIBLIOGRAPHY 85



INTRODUCTIONTo Drug Addiction and Dost Welfare

Foundation

CHAPTER NO. 1



INTRODUCTION TO

ORGANIZATION

The Drug Problem

―Drug Use on the Rise‖ is a headline that has been seen quit regularly over the years. It gets

our attention, but ―drug use‖ can‘t always be rising, can it? No, but at any given time the

unwanted use of some kind of drug can be found to be increasing at least in some group of

people. How big a problem does the current headline represent?

Before you can meaningfully evaluate the extent of such a problem or propose possible

solutions, it helps to define what you are talking about. In other words, it helps to be more

specific about just what the problem is. Most of us don‘t really view drug use as the problem,

if that include your Uncle taking two aspirins when he has a headache. What we really mean

is that some drugs being used by some people or in some situations constitute problems with

which our society must deal.1

Drug Addiction is a disease which is characterized by gradual loss of control over mood

altering chemicals which makes the person dysfunctional socially, psychologically,

physiologically, and spiritually. This is the European module of Addiction. And according to

US module drug addiction is deviancy. Drug addiction is a problem in western world, in

Europe to some extent, in America to a greater extent depending on the nature of the drug. At

the moment there are some 0.8 million Heroin Addicts in USA, more then 20 million people

use chars for addiction. Cocaine and stimulants are at the top among youth.

In Pakistan the situation is a bit changing. The traditional drug of addiction is Opium and by

70‘s we have the drug culture of synthetic medicines. Tunal was a very famous drug at that

time and the tunal addicts were used to call ―Tunalee‖. But by 80‘s the ―Tunalee‖ is replaced

as ―Poodary‖. By 2005 we have some other new incents in drug culture. One is called

Cocaine and the other is called Crystalline.2

1 Ray, O. Ksir, C. (2002). Drug, Society, and Human Behavior. 9

th Ed. New York. McGraw-Hill Companies Inc.

P. 3 2 Amirzada (2007) Fields and Services of Social Work; Lecture Delivered to the MA final evening class.

Peshawar. Department of Social Work, University of Peshawar



Drugs in the History

Drug use is not new. Humans have been using alcohol and plant-derived drugs for thousands

of years- as far as we know, since Homo sapiens first appeared on the planet. What recorded

history we have indicates that some of these drugs were used not just for their presumed

therapeutic effects but also for recreational purposes. In some of the highly developed ancient

cultures, psychoactive plants played important economic and religious roles. There is also

evidence that some people have always overused, misused, or abused these substances. Drugs

play a much different role in modern society than they did even 100 years ago. Major events

have occurred in pharmacology and medicine that have produced revolutionary changes in

the way in which we view drugs. In addition, recent cultural revolutions have influenced our

attitudes and behavior regarding drugs and drug use. 3

DOST WELFARE FOUNDATION

DOST Welfare Foundation (DOST) is a non-profit,

non-governmental organization established in

August 1992 in response to the need for combating

the increasing drug use and other related problems

in Pakistan.4

DOST is not an abbreviation of some other terms

but DOST is DOST which is an Urdu word which means friend. Or we can say that this

agency is a friend in need. The Full name of the organization is Dost Welfare Foundation just

calling it DOST Foundation is not correct.5 Drug Addiction is a very big problem in the area

like Peshawar and surrounding. The people of the Tribal area (FATA) cultivate the Opium

Poppy in their houses due to its beauty. 75% addictive drugs are produced and paddled by

Afghans. During the Taliban period, the production of drugs decreased almost to 0% in the

area but with the overtake of US Military forces in Afghanistan, the drug production and

smuggling started again with an extreme enthusiasm.

3 Ray, O. Ksir, C. (2002) Opt Cit. P. 7

4 Introduction. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation. Thursday, November 22, 2007

<http://www.dost.sdnpk.org/Introduction.htm > 5 Brekhna (2007). Lecture to the students of final year. Peshawar. HRD Manager Dost Welfare Foundation

Peshawar

http://www.dost.sdnpk.org/Introduction.htm



DOST provides a comprehensive range of drug demand and drug harm reduction services for

drug users in different community settings. DOST also works for the human rights protection,

rehabilitation and social reintegration of destitute street children, juvenile offenders, women

and minor children in prisons.

With a staff of over 100, DOST provides a continuum of care and quality services through its

programmes for drug abuse prevention, treatment and rehabilitation, drug harm reduction,

HIV/AIDS prevention, vocational skills training, research, advocacy and networking.

All DOST programmes are based on human rights protection of marginalized groups such as

drug users, street children, juvenile offenders, women and minor children in prisons. DOST

enables these vulnerable persons to explore the underlying factors of their drug misuse and

imprisonment, to come to terms with past traumatic experiences, examine attitudes and

behaviour patterns, receive training in life and social skills and re-integrate into the

community and society.

Mission Statement

"To establish Therapeutic Communities for the most marginalized and disadvantaged groups

in society, to empower and heal them in body, mind and spirit and enable them to lead

productive and fulfilling lives"6

OBJECTIVES:

Treatment and rehabilitation of drug users

Outreach harm reduction services for street drug users

Drug abuse prevention among different community groups

Human rights protection and social reintegration of vulnerable prisoners i.e. drug

users, juvenile offenders, women and children

Training and capacity building of NGOs, CBOs, GOs, students and community

groups in drug harm and drug demand reduction

Development of awareness and resource materials

Networking with national and international NGOs, GOs and CBOs

6Mission Statement. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation. Thursday, November 22,

2007 <http://www.dost.sdnpk.org/ >

http://www.dost.sdnpk.org/



Milestones

Sep 1992 Dost Foundation established and registered

Feb 1993 Therapeutic Community for the treatment and rehabilitation of drug addicts established

Feb 1993 Family program, relapse prevention program and narcotics anonymous meetings

commence

Mar 1993 Drug abuse prevention program started

Dec 1994 Street outreach program for drug addicts started

May 1995 Drop In Centre for drug addicts established

Jan 1996 Sakoon Kore treatment centre for women addicts established

Jul 1998 Drug addiction treatment and rehabilitation program started in Peshawar Central Prison

Jan 1999 Tc for women and minor children in Peshawar Central Prison

Jan 1999 Tc for juvenile offenders in Peshawar Central Prison

Jan 2000 Juvenile rights awareness program all over NWFP started

Jan 2000 Second street outreach program and Drop In Centre started for street drug addicts

Sep 2000 Detoxification started in the Drop In Centers

Jun 2001 HIV/AIDS Awareness became important part of the Demand and Harm Reduction

Programs

Jan 2002 HIV/AIDS and STIs prevention program for juvenile prisoners in three Central Jails of

NWFP

Feb 2002 Drug demand reduction training program started for women in Afghan refugee camps in

NWFP

Jun 2002 Advice and Legal Assistance Centre established for Afghan refugees in Peshawar

Jan 2003 Sakoon Kore legal aid & social reintegration services centre for women & juvenile

prisoners in Peshawar



DRUGS CULTURE IN PAKISTAN7

Golden Triangle is the area where the poppy was use to produced before 1979. Golden

triangle is composed of some area of Nepal, China and India. After the production the drug

was used to be sent to the border of Iran, where the drugs industries were established

illegally. There the drugs had been processed in factories and then paddled to central Asia

and rest of the world.

After the Islamic revolution in Iran in 1979, this process was abandoned by the newly Islamic

government of Iran, as there is high restriction on the use of any dangerous drug in Islam. So

the people involved in the process and trade of poppy migrated from Iran to Afghanistan and

the Tribal area of Pakistan, to save their business.

Now when the red revolution came in Afghanistan, and Taliban revolution, these people

again migrated from Afghanistan to the tribal area of Pakistan. Now our tribal area is the

place where the poppy and other drugs are producing, processing and paddling as well.

Darrah, Barha, Jamrood, Khyber and many other areas are famous for its business. But now

we can exclude Barha from this list due to the involvement of Mangal Bahgj. The drugs of

addiction can of various types but there are some drugs which are most commonly used in

Pakistan.

SOME COMMONLY USED

DRUGS IN PAKISTAN

1. HEROIN or Diamorphine, powerful analgesic (pain-relieving) drug derived from

opium, an acetyl derivative of morphine. Heroin is more addictive than morphine but

causes less nausea. It is one of the most abused drugs in Pakistan. The drug is most

commonly injected into the blood stream with a needle and syringe. It may simply be

smoked or ingested orally. Pure heroin is white powder generated from the opium, but

the one commonly used in our country is light brown in colour due to impurities still

in it. Taking heroin depresses brain activities and makes the person dependent on it.

7 Sara Safder (2007) Lecture for the student of MA previous evening. Peshawar. Department of Social Work

University of Peshawar



2. CHARS is the most commonly used drug in Pakistan. It is usually mixed with

tobacco and smoked with a cigarette or used in Chilum. It can strengthen the feelings

of anxiety and depression. It can also relax the mental activity of a person.

3. BHANG, also called Marijuana. Marijuana is formed from the dried leaves and

flowering tops of the Indian hemp plant Cannabis sativa. Popularly known as ―grass,‖

―pot,‖ ―reefer,‖ and ―Mary Jane,‖ marijuana is smoked or chewed for its intoxicating

effect, and it has also been used as a sedative and analgesic.

4. HASHISH is formed from the resin of the flowering tops of the same plant, and it is

five to eight times more potent than marijuana when smoked.

5. OPIUM It is obtained from milky discharge of poppy. For centuries it has been used

in medical and recreational drugs.

6. ALCOHOL, the common name for alcohol in Pakistan, and the entire Muslim world,

is SHARAB. It is a mixture of fruits and vegetables or grains. Taking alcohol in small

amount causes relaxation. Alcohol reduces physical and mental performance, so the

danger is from falling or improper driving and many more. Usually the alcohol is used

by the university students during a trip or on a tour. It is also used in urban areas on

special occasions like marriages or other such gatherings and parties.

7. INHALANTS, it includes petro-chemicals, samad bond, thiner, fluid, paints, and

other kind of chemicals. These are inhaled through the nose for a sense of relaxation.



MORE ABOUT

ADDICTION

Drug, Addiction and

Disease Concept

CHAPTER NO. 2



Drug, Addiction, &

Disease Concept

DRUG

A drug is any substance that can be used to modify a chemical process or processes in the

body, for example to treat an illness, relieve a symptom, enhance a performance or

ability, or to alter states of mind. The word "drug" is etymologically derived from the

Dutch/Low German word "droog", which means "dry", since in the past; most drugs were

dried plant parts8. Or we can say that Any chemical substance which could effects the

physical, social, psychological, spiritual and economical well being of an individual and

bring change in his behavior is called drug. A drug is any chemical substance that can

alter the normal structure and function of body.

ADDICTION

There are some conditions when these conditions prevail; we

term the person as addict. i.e. when;

o There is Dependency

o Loose control upon one self

o It becomes unmanageable to carry on routine works-

----like job

o Increased tolerance

o Deviant behavior---Behavior becomes harmful

When these above conditions occur and the drug of use brings with it these changes then we

are addict. Not the other way else.

ADDICTIVE DRUG

―Any chemical substance which could affect the physical, social, and psychological

wellbeing of an individual and brings change in his behavior, such a substance is called

an addictive drug.‖

8 ―Drug‖ Wikipedia, Wikipedia the free encyclopedia Saturday, June 30, 2007 Wikipedia foundation Inc.

<http://en.wikipedia.org/wiki/Drug>

http://www.google.com.pk/url?sa=X&start=3&oi=define&q=http://en.wikipedia.org/wiki/Drug&usg=__Nd4-5QBOwnWn_iWze5KG4TXvNiA=



DRUG ADDICTION

―It is a disease which is characterized by gradual loss of control over mood altering

chemicals which makes the person dysfunctional socially, psychologically, physiologically,

and spiritually.‖

So drug addiction is a disease and it is said to be the largest disease of the world because it

affects four sides of our life. i.e. physiological, social, psychological, and spiritual. Socially

the person is isolated, psychologically he become irritable, depressed, anxious, spiritually he

goes far away from his religion, no Nimaz and no Roza.

When you see a flower why you become happy? It is due to a stimulus-response system and

it‘s natural. The drug addict blocks this natural process of stimulus-response and creates an

artificial system to experience mood change. Whenever these results occur in a person by

using any drug then the person will be termed drug addict.

We need a reaction for any situation but the drugs eradicate the reaction system in our body

and the result is that we don‘t feel any happiness or sadness to any environment i.e. no

response.

DEFINITIONS OF DRUG ADDICTION

Thirty years ago, the term addict had a pretty narrow meaning for most people; someone who

used heroin several times daily and who would suffer terrible withdrawal symptoms if he or

she were late getting a ―fix‖. Now it seems that addiction is everywhere; not only are

alcoholics and cigarette smokers referred to as addicts, but we also hear about sex addicts,

food addicts, gambling addicts, addictive relationships, and even addictive forms of politics.

What do we mean by addiction, and how have models of addiction become important for

describing such a wide variety of human conduct?

We begin by attempting to define drug addiction. A leading addiction researcher has offered

the following definition of drug addiction: ―a behavioral pattern of drug use, characterized by

overwhelming involvement with the use of a drug, the securing of its supply, and a high

tendency to relapse after withdrawal‖. 9

9 Ray, O. Ksir, C. (2002) Opt Cit. Pp. 44-45



The dictionary meaning of addiction is ―give oneself up to a habit‖.10

According to the WHO

experts committee drug addiction has been defined as

A state of periodic or chronic intoxication detrimental to the individual and to society,

produced by repeated consumption of a drug, either natural or synthetic.11

Drug addiction is characterized by frequent use of the drug (usually at least daily) and

by the fact that a great deal of the individual‘s behavior is focused on using the drug,

obtaining the drug, or talking about the drug or, is focused on the paraphernalia

associated with the drug‘s use12

.

The continued compulsive use of drugs in spite of adverse health or social

consequences.

A behavior disorder characterized by drug-seeking behavior and the use of the drugs

for that other than medical indications.

Drug addiction or substance dependence is the compulsive use of drugs, to the point

where the user has no effective choice but to continue use.13

From the above given definitions we can conclude that drug addiction is state in which a

person has heavy dependence on drugs to the point where the user continuously uses the

drugs in order to experience satisfaction or mood change.

SOME IMPORTANT CONCEPTS

Drug: any substance, natural or artificial, other than food, that by its chemical nature alters

structure or function in the living organism.‖

Illicit Drug: a drug that is unlawful to possess or use.

10

Ibid. p. 5 11

Khalid. M, ―Social Work Theory and Practice‖ 3rd Edition, Kifayat Academy, Karachi. pp. 1-310 12

Ray. O & Ksir. C, ―Drugs, Society, and Human Behavior‖, 9th edition, McGraw-Hill Companies Inc. pp 4-81 13

Imran Ahmad (2007). Social Work with Drug Addicts; Assignment. Department of Social Work UOP



Deviant Drug Use: is a drug use that is not common within a social group and that is

disapproved of by the majority, causing members of the group to take corrective action when

it occurs.

Drug Misuse: generally referrers to the use of prescribed drugs in greater amounts than, or

for purpose other than, those prescribed by a physician or dentist.

Drug Abuse: consists of the use of a substance in a manner, amounts, or situations such that

the drug use causes problems or greatly increases the chances of problems occurring.

Drug Addiction: is a very controversial term. Its dictionary meaning is ―give one self up to a

habit”. Drug addiction is thus usually characterized by frequent use of the drug usually at

least daily and by the fact that a great deal of the individual‘s behavior is focused on using the

drug, obtaining the drug, or talking but the drug or , is focused on the paraphernalia

associated with the drug‘s use.14

THREE BASIC PROCESSES

OF DRUG ADDICTION15

There are three basic processes related to addiction that have been important in the history of

drug addiction research. i.e.

a. Tolerance,

b. Physical dependency, and

c. Psychological dependency;

a. Tolerance

Tolerance in drug addiction means “reduced effect of a drug after repeated use. Or the need

for an increase in the amount of drugs ingested to produce the same effect as before.‖

Tolerance is a form of physical dependence, occurs when the body becomes accustomed to a

drug and requires ever-increasing amounts of it to achieve the same pharmacological effects.

14

Ray, O. Ksir, C. (2002) Opt Cit. P. 5 15

ibid. Pp. 45-46



This condition is worsened when certain drugs are used at high doses for long periods (weeks

or months), and may lead to more frequent use of the drug. However, when use of the drug is

stopped, drug withdrawal may result, which is characterized by nausea, headaches,

restlessness, sweating, and difficulty sleeping. The severity of drug withdrawal symptoms

varies depending on the drug involved.

Tolerance refers to phenomena seen with many drugs, in which repeated exposure to the

same dose of the drug results in a lesser effect. There are many ways this diminished effect

can occur. As the individual experience less and less of the desired effect, it is often possible

to overcome the tolerance by increasing the dose of the drug.

b. Physical Dependence

Physical dependence is defined by the occurrence of a withdrawal syndrome. Suppose a

person has begun to take a drug and a tolerance has been developed. The person increases the

amount of drug taken and continues to take these higher doses so regularly that the body is

continuously exposed to the drug for days or weeks. When the person stops taking drug some

symptoms begin to appear in the body, as the drug level diminishes. e.g. as the level of heroin

decreases in heroin addict, that person‘s nose might run and he might begin to experience

chill, fever, diarrhea and other symptoms. When we have a drug that produces a consistent set

of these symptoms in different individuals, we refer to the collection of symptoms as the

withdrawal syndrome. In simple words we can say that the individual has come to depend on

the presence of some amount of that drug to function normally. Removing the drug leads to

an imbalance which is slowly corrected over a period of a few days.

Physical dependence is a state which occurs only with certain classes of drug, notably the

opiates, barbiturates and minor tranquilizers. It required a period of regular use before

dependence is produced. Over time, the body becomes accustomed to the presence of the

drug and adjusts so as to continue working as normally as possible. If the drug is then

suddenly removed, the body is thrown off balance and takes some time to re-establish

equilibrium, a process which manifests itself in more or less unpleasant withdrawal

symptoms.

c. Psychological Dependence

Psychological dependence (also called behavioral or habitual dependence) can be defined in

terms of observable behavior. It is indicated by the frequency of using a drug or by the



amount of time or effort an individual spends in drug seeking behavior. Often it is

accompanied by report of craving the drug or its effects. A major contribution of behavioral

psychology has been to point out the scientific value of the concept of reinforcement for

understanding psychological dependence.

TYPES OF ADDICTION

There are two types of drug addiction.

Intoxicated Addiction

Medicated Addiction

a) Intoxicated addiction is the abuse of the illegal drugs. For example the person using

chars, heroin, marijuana (Bhang) or chillum in Pakistan is intoxicating them in his

body. The use and trade of such drugs is not allowed in our country. The misuse of

hallucinogens is also included in intoxicated addiction.

b) Medicated addiction is started due to misuse of the legal drugs. For example, people

often use painkillers or sleeping pills, which are prescribed by the physician. But

whenever they use them for the long time without prescription, this leads to the abuse.

They become dependent on them. They feel that they can‘t function normally without

the use of painkiller, or can‘t sleep without having sleeping pills.



CAUSES & SIDE

EFFECTS

Causes & Side effects of

Drug Addiction

CHAPTER NO. 3



Causes & Side-Effects of

Drug Addiction

WHY START DRUG ADDICTION?

The causes of starting drug addiction can be several in numbers but for our convenience we

can divide them in four main categories;

1. Medical Causes

People often use painkillers or energy drinks to relieve the pain or to get the energy. They

use it most of the times without the prescription of the physician. When the use of

painkillers is prolonged, the person becomes dependent on it. He can‘t feel ease without

using painkiller. The person who uses sleeping pills for sound sleep often becomes

dependent on it. These drugs have a tolerance effect in them. i.e. if a person uses one pill

per day, this need will be increased with the passage of the time. He will need more and

more drug. This leads us to believe that Self medication often leads to drug addiction.

2. Psychological Causes

The person with a weak personality can become addict. Weak personality leads to drug

addiction. When the person is under depression or who has anxiety, starts taking drugs to

reveal tension.

3. Economic Causes

Unemployment among youth is the one major cause for drug addiction. The individual

with no job has very much leisure time to spend. So such individual easily become

addicts. A known saying is that ―an empty brain is the house of the devil‖. Loss in ones

business also leads to drug addiction.

4. Social Causes



There are so many social causes which lead to drug addiction in our society. The

disbursed or disturbed family can leads to drug addiction. When there is the drug

culture in family, so the younger can then also become addict very easily. Easy

availability is an other reason. The peer or the friends‘ pressure is the biggest cause

for drug addiction. Often young people start taking drug just for fun or enjoyment.

But with the passage of time they become addicted. Excess of wealth may leads to

addiction.

SIDE-EFFECTS OF DRUG ADDICTION16

The effects of drugs are categorized in four or five different ways, i.e.

1. Physiological

2. Social

3. Psychological

4. Spiritual

5. Family

6. Community

These are detailed in the following lines;

1. Physiological

o lake of apatite – bhook ka na lagna

o sleep disorder – bey khabee

o lethargy - sustee

o muscle twitching

o skin disorder

o Vomiting - ulti

o Body pane

o Weight loss

o Runny Nose

o Watering and Redness of the eyes

16

Naeem. A. (2008).Notes for Social Work Student. Peshawar. Unpublished notes of The Center Manager, Dost

Welfare Foundation

o Jerks

o Hepatitis

o HIV/AIDS

o Cirrhosis of Lever

o Gastroenteritis

o Intestinal Bleeding

o Anemia

o Diarrhea

o Increase risk of cancer

o Mild Fever



2. Social

o Isolation - tanhai

o No interaction with community

o Imbalance in relations

o Dependency upon others

o Theft---crimes

o Disturbed nexus with family

o Anti Social Personality

3. Psychological

o Guilt

o Shame

o Anger

o Irritation – chirh chirha pun

o Mood swings- kabi khoshi khabi ghum-

but don‘t know why

o Mind-Body coordination lost

o Intolerance-the major side effect

o Difficulty in concentration

o Anxiety

o Depression

o Low self esteem

4. Spiritual

o Loss of belief

o Loss of confidence

o Fear of every thing

o Distrustful

o In-acceptance

o No Nimaz and Roza

o Ingratitude

o Disorientation

o Memory Loss

o Feeling of

Uncertaininty

o Dishonesty

o Resentments

o Blaming God and

people

o Does not care for

respect



5. Financial

Although it can be included in social but we take it separaely/

o Job loss

o Decrease in income

o Unemployment

o Crime increases

o Burden on fmily

o Business loss

6. Effects on Family

o Dysfunctional

o Disruption of family life

o Co-dependency

o Spousal abuse

o Child abuse

o Assaults

o Physical and psychological trauma

o Financial loss from incarceration (imprisonment) or death of the addict

7. Community

o Crime (assault, rape, murder, theft)

o Accidents

o Spread of disease

o Broken homes

o Low productivity

o Addicts – street / jail drug subculture



CLASSIFICATION

Of Drugs with reference to

addiction

CHAPTER NO. 4



Classification of Drugs With reference to addiction

The drugs are classified into four classes;

1. Depressants

2. Painkillers / Narcotics

3. Stimulants

4. Hallucinogens

There detail is given on the next pages...

S.N. MAJOR

CATEGORY

DRUGS

A Depressants

1 Alcoholic Beverages

2 Minor Tranquilizers – Benzodiazepines à

Sleeping Pills

3 Barbiturates

4 Solvents and Gasses

5 GHB/GBH à Gammhydroxybutyrate

B Pain Killers

1 Opiates

I Natural Derivative of Opium poppy, heroin,

morphine, codeine

II Opoiodis --> Synthetic Drugs with effects

similar to opiates

I Narcotic Analgesics

C Stimulants

1 Amphetamines

2 Cocaine

3 Caffeine

4 Tobacco --> Nicotine

5 Khat

6 Anabolic Steroids

7 Hallucinogenic Amphetamines

8 Alkyl Nitrites

1 LSD --> Lysergic Acid Diethylamide



A. DEPRESSANTS

These are drugs, which depress the physical functions of the CNS. The main drugs in this

group are alcohol, barbiturates and benzodiazepines, but solvents and gases are included

because they produce similar effects.

Symptoms of Depressants:

• Appear as intoxicated

• Slurred as intoxicated

• Loss of motor co-ordination

• weak & rapid impulse

• Slow breathing

• Cold skin

1) Alcoholic Beverages17

• OTHER NAMES; whisky, sherry, beer, tarra (local)

• Legal status: legal in western countries, not legal in

Pakistan

• Rout of administration:

Can be swallowed as a drink

This is included in Depressants class. There are various

kinds of alcoholic beverages which include ales, beer,

brandy, gin, liqueurs, mead, rum, sake, vodka, whisky,

and wine. Among all of them only wine is produced from

17

Hewitt, Brenda G., and Gordis, Enoch. "Alcoholism." Microsoft® Encarta® 2006 [DVD]. Redmond, WA:

Microsoft Corporation, 2005.

D

Hallucinogens 2 Hallucinogenic Mushrooms

3 Cannabis/ Marijuana

4 Ketamine



fruits juice while the others are from other sources.

Alcoholism or Alcohol Dependence is

chronic disease marked by a craving for

alcohol. People who suffer from this

illness are known as alcoholics. They

cannot control their drinking even when

it becomes the underlying cause of

serious harm, including medical

disorders, marital difficulties, job loss, or

automobile crashes. Medical science has

yet to identify the exact cause of alcoholism, but research suggests

that genetic, psychological, and social factors influence its

development. Alcoholism cannot be cured yet, but various

treatment options can help an alcoholic avoid drinking and regain a

healthy life.

Alcoholics develop a craving, or a strong urge, to drink despite awareness that drinking is

creating problems in their lives. They suffer from impaired control, an inability to stop

drinking once they have begun. Alcoholics also become physically dependent on alcohol.

When they stop drinking after a period of heavy alcohol use, they suffer unpleasant physical

ailments, known as withdrawal symptoms, which include nausea, sweating, shakiness, and

anxiety. Alcoholics develop a greater tolerance for alcohol—that is, they need to drink

increasing amounts of alcohol to reach intoxication. The World Health Organization (WHO)

notes that other behaviors common in people who are alcohol dependent include seeking out

opportunities to drink alcoholic beverages—often to the exclusion of other activities—and

rapidly returning to established drinking patterns following periods of abstinence. Alcohol

now a days have so many kinds.



2) Tranquilizer18

Tranquilizer, common name applied to a class of drugs

used to treat anxiety and insomnia. Originally the term

comprised two groups: the major tranquilizers—the

phenothiazines, such as chlorpromazine (Thorazine)—useful in the treatment of acutely ill

mental patients; and the minor tranquilizers—the benzodiazepines, such as diazepam

(Valium). By popular usage, the term now refers only to the latter group. In the early 1980s,

these minor tranquilizers were the most frequently prescribed drugs in the world. They are

useful for relief of temporary anxiety and insomnia.

The minor tranquilizers are safe when taken alone, but taking substantial amounts of these

substances at the same time as alcohol can lead to coma or even death. Long-term

administration of larger than usual doses of the benzodiazepines can cause physical

dependence, with typical withdrawal symptoms ranging from nightmares to convulsions

when the drug intake is stopped.

3) Barbiturate19

Other names: Tunial, downers, Sleepers, barbs etc

Legal Status: prescribed as medicine, controlled drugs, illegal to

process without prescription.

Barbiturate, any of an important group of drugs that depress brain function; they are derived

from barbituric acid (C4H44N203), a combination of urea and malonic acid. Depending on the

dosage or formulation, barbiturates have a sedative (tranquilizing), hypnotic (sleep-inducing),

anticonvulsant, or anesthetic effect. Very short-acting barbiturates such as thiopental are

injected intravenously to induce rapid anesthesia before surgery. Phenobarbital, a long-acting

barbiturate, is prescribed with other medications to prevent epileptic seizures. Other

barbituric-acid derivatives, such as secobarbital, were used as antianxiety medications until

the development of the tranquilizer; they are still in use for the short-term treatment of

18

"Tranquilizer." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005 19

Berger, Philip A. "Barbiturate." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,

2005.



insomnia, although tranquilizers are more suitable sleep inducers. Barbiturates are common

drugs of abuse. Taken orally or intravenously, they produce symptoms similar to

drunkenness: loss of inhibition, boisterous or violent behavior, muscle incoordination,

depression, and sedation. They are physically addicting and produce severe withdrawal

symptoms; overdoses can cause profound shock, coma, or death.

B. PAINKILLERS - OPIATES

1) Narcotics

Narcotics, term originally applied to all compounds that produce insensibility to external

stimuli through depression of the central nervous system, but now applied primarily to the

drugs known as opiates—compounds extracted from the opium poppy and their chemical

derivatives. Also classed as narcotics are the opioids, chemical compounds that are wholly

synthesized, but which resemble the opiates in their actions.

The most important attribute of narcotics is their capacity to decrease pain, not only by

decreasing the perception of pain, but also by altering the reaction to it. Although they do

have sedative properties when used in large doses, they are not used primarily for sedation.

The major constituent of opium and the prototype of all narcotic analgesics is morphine.

Heroin, synthesized from morphine, is a potent analgesic, but its use is forbidden. Some of

the newer synthetic compounds are 1000 to 10,000 times more potent than morphine.

In addition to their painkilling properties, the narcotic analgesics cause a profound feeling of

well-being (euphoria). It is this feeling that is in part responsible for the psychological drive

of certain persons to obtain and self-administer these drugs. When taken chronically in large

doses, the narcotics have the capacity to induce tolerance (whereby a larger and larger dose is

required by the body to achieve the same effect), and ultimately psychological and physical

dependence, or addiction. In this respect they are similar to the barbiturates and to alcohol.

These properties make the medical use of narcotics extremely difficult and have led to strict

regulation of the prescription and dispensing of this class of drugs. Even so, they are widely

abused.



2) Opium 20

Opium, narcotic drug produced from the drying resin of unripe

capsules of the opium poppy. Opium is grown mainly in

Myanmar (formerly Burma) and Afghanistan.

In its commercial form, opium is a chestnut-colored globular

mass, sticky and rather soft, but hardening from within as it ages.

It is processed into the alkaloid morphine which has long served as the chief painkiller in

medical practice, although synthetic substitutes such as meperidine (trade name Demerol) are

now available. Heroin, a derivative of morphine, is about three times more potent. Codeine is

another important opium alkaloid.

The molecules of opiates have painkilling properties similar to those of compounds called

endorphins or enkephalins produced in the body. Being of similar structure, the opiate

molecules occupy many of the same nerve-receptor sites and bring on the same analgesic

effect as the body's natural painkillers. Opiates first produce a feeling of pleasure and

euphoria, but with their continued use the body demands larger amounts to reach the same

sense of well-being. Withdrawal is extremely uncomfortable, and addicts typically continue

taking the drug to avoid pain rather than to attain the initial state of euphoria. Malnutrition,

respiratory complications, and low blood pressure are some of the illnesses associated with

addiction.

3) Heroin21

Heroin is derivative of Morphine, which itself is derived

from opium, a substance found in the poppy plant. The

drug is most commonly injected into the blood stream

with a needle and syringe, although it may also be

simplified, smoked, or ingested orally.

20

―Opium." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 21

Khalid, M. (2002). Social Work Theory and Practice, with special reference to Pakistan. 2nd

Ed, P\Karachi:

Kifayat Academy. Pp. 308-309



The effects of heroin are thought to vary. Nevertheless, most regular

users report pleasurable experiences with the drug. Upon injecting it,

many users experience a ―rush‖ or wave of sensations. The rush does

not last long and is followed by a mild sense of euphoria, the

relaxation of tensions and the disappearance of any physical pains.

Users who take heroin repeatedly develop tolerance to it. This means

that they must use larger and larger doses in order to achieve

pleasurable effects. Heroin and other opiates are physically addictive. Heroin addicts who

stop using the drug suffer from serious withdrawal symptoms including cramps, nausea,

muscle tremors, diarrhoea, chills, and extreme nervousness. Regular heroin users are literally

driven toward continues use of heroin, not necessarily to gain pleasure but to avoid the pain

of withdrawal.

Common disease among heroin users, such as hepatitis and tetanus, are a result of the ;use of

insanitary paraphrenalia – as when several persons share the same needles.

4) Codeine22

Codeine, alkaloid, C18H21NO3H2O, derivative of opium. It is a white

crystalline solid, slightly soluble in water and soluble in organic

solvents. When heated, it first loses water and then melts at 157° C

(315° F). Chemically a methyl ether of morphine, codeine has similar

physiological effects but to a lesser degree, particularly because it is less

habit-forming. It is used to reduce pain and to suppress coughing.

C. STIMULANTS

The primary definition of a stimulant drug is one that excited the CNS. Cocaine, caffeine,

tobacco, and amphetamines all do this, but in different degrees. Other drugs are also misuse

for their stimulants-like effects; the alkyl nitrate dilate the blood vessels causing a ―rush‖

while an anabolic, (slang terms uppers, speed).

22

"Codeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.



1) Amphetamine23

Principal drug: Amphetamine sulphate, Ritalin, ice, cokes,

snow, Charlie etc.

Legal Status: Illegal to posses without prescription.

Route of administration: Sniffed, injected, pills/capsules,

smoked, chewed.

Amphetamine, any of a group of powerful stimulant drugs that act

on the central nervous system (the brain and the spinal cord),

increasing heart rate and blood pressure while reducing fatigue.

Although amphetamines were originally prescribed to suppress

appetite and to treat depression, their medical use is now restricted

primarily to treating narcolepsy (sudden and uncontrollable sleep

attacks) and hyperactivity. The amphetamines include drugs that

are classified as amphetamines, dextroamphetamines, and methamphetamines.

Amphetamines act by stimulating the release of neurotransmitters such as norepinephrine that

increase brain activity and raise blood pressure. When initially taken, amphetamines produce

feelings of well-being, increased competence, and alertness. High doses of amphetamines can

cause tremors, sweating, heart palpitations, or anxiety. Exhaustion and depression follow

when the effects of amphetamines wear off. Serious mental illness including paranoia,

delusions, hallucinations, and violent behavior may occur after prolonged use. Since chronic

use reduces appetite, weight loss may be drastic, resulting in a gaunt, wasted appearance.

Amphetamines are commonly abused by individuals seeking mood elevation, increased

alertness, or improved athletic performance. Intravenous injection of methamphetamines, for

example, produces a sudden, pleasurable, euphoric feeling.

Regular medical and recreational use of amphetamines can lead to greater physical tolerance

of the drug, requiring progressively higher doses to achieve the same effects. Ultimately,

psychological drug dependency may result, characterized by a craving for the drug and belief

that one cannot function without taking it.

23

"Amphetamine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.



2) Cocaine24

Legal Status: controlled drugs, illegal to posses.

Route of administration: Powder sniffed and injected.

Cocaine, alkaloid obtained from leaves of the coca plant and used medically as a local

anesthetic. It is also widely abused as a drug. Native Americans of the Inca Empire chewed

coca leaves to obtain mild euphoria, stimulation, and

alertness. The drug was first isolated in 1855 and came to be

used widely as a local anesthetic in minor surgery. At present,

local anesthetics with less abuse potential, such as lidocaine,

are commonly used instead.

Cocaine has long been known as a drug of abuse, but it came

into particular prominence in the late 1970s and the 1980s.

Cocaine hydrochloride, a water-soluble salt, is a dry white powder (known on the street as

―snow‖) that is usually inhaled through a thin tube inserted into the nostril. More rarely,

cocaine is injected into a vein. The drug may also be smoked in a purified form through a

water pipe (―freebasing‖) or in a concentrated form (―crack‖) shaped into pellets and placed

in special smoking gear. Users experience euphoria, exhilaration, and a decreased appetite.

The drug also increases heart rate, elevates blood pressure, and dilates the pupils. Chronic use

can lead to skin abscesses, perforation of the septum of the nose, weight loss, and damage to

the nervous system. Negative mental effects include extreme restlessness, anxiety, irritability,

and, occasionally, paranoid psychosis. Death from even a small dose can

occur, and is usually caused by seizures or heart attacks. It

causes strong psychological dependence.

3) Caffeine25

Coffee, tea, cocoa, soft drinks, chocolate, analgesic pills etc.

24

Berger, Philip A. "Cocaine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,

2005. 25

"Caffeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.



Legal Status: legal and unrestricted.

Route of administration: swallowed as a beverage in confectionary or in pills.

Caffeine, an alkaloid (C8H10O2N4·H2O) found in coffee, tea, cacao, and some other plants. It

is also present in most cola beverages. Caffeine was discovered in coffee in 1820. In 1838 it

was established that theine, discovered in tea in 1827, is identical to caffeine. The drug

increases the blood pressure, stimulates the central nervous system, promotes urine

formation, and stimulates the action of the heart and lungs. Caffeine is used in treating

migraine because it constricts the dilated blood vessels and thereby reduces the pain. It also

increases the potency of analgesics such as aspirin, and it can somewhat relieve asthma

attacks by widening the bronchial airways. Caffeine is produced commercially chiefly as a

by-product in making caffeine-free coffee.

Caffeine has been suggested as a possible cause of cancer or of birth defects. No studies,

however, have yet confirmed any of these charges. Persons who stop drinking coffee do

sometimes experience withdrawal headaches.

4) Tobacco26

Tobacco, cigarette, snuff, naswar, pipe etc.

Legal Status: illegal to sell to children under 16.

Route of administration: smoked, sniffed, and chewed.

Tobacco, plant grown commercially

for its leaves and stems, which are

rolled into cigars, shredded for use in

cigarettes and pipes, processed for

chewing, or ground into snuff, a fine

powder that is inhaled through the

nose. Tobacco is the source of

nicotine, an addictive drug that is also

the basis for many insecticides.

26

Hynes, Erin. "Tobacco." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.



Tobacco is a member of the nightshade family. There are more than 70 species of tobacco.

The two cultivated species, common tobacco and wild tobacco, are annuals—they live only

one growing season. Common tobacco is 1 to 3 m (3 to 10 ft) tall and has a thick, woody

stem with few side branches. One plant typically produces 10 to 20 broad leaves that branch

alternately from the central stalk. The leaf size depends on the strain. The narrow, trumpet-

shaped flowers are dark pink to almost white. Wild tobacco is about 0.6 m (2 ft) tall and has a

stem that is more slender and less woody than common tobacco. The leaves have a short stalk

that attaches to the stem. The flowers are pale yellow with five separate lobes.

5) Nicotine27

Nicotine, an oily liquid substance found in tobacco leaves

that acts as a stimulant and also contributes to smoking

addiction. When extracted from the leaves, nicotine is

colorless, but quickly turns brown when exposed to air. It

has an acrid, burning taste. Nicotine is a very powerful

poison, and it forms the base of many insecticides.

Cigarette tobacco contains only a small amount of nicotine and most of this nicotine is

destroyed by the heat of burning so that the actual concentration of nicotine in smoke is low.

However, even a small amount of nicotine is sufficient to be addictive. The amount of

nicotine absorbed by the body from inhaling smoke depends on many factors including the

type of tobacco, whether the smoke is inhaled, and whether a filter is used.

Tobacco smokers absorb small amounts of nicotine by inhaling smoke from cigars, cigarettes,

or pipes. Nicotine is drawn into the lungs where it enters the bloodstream and is pumped by

the heart to the brain. It takes only seven seconds for nicotine to enter the brain after being

inhaled.

Nicotine has various effects on the body. In small doses nicotine serves as a nerve stimulant,

entering the bloodstream and promoting the flow of adrenaline, a stimulating hormone. It

speeds up the heartbeat and may cause it to become irregular. It also raises the blood pressure

27

"Nicotine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.



and reduces the appetite, and it may cause nausea and vomiting. The known health risks

associated with cigarette smoking, such as damage to the lungs and lung cancer, are thought

to be caused by other components of cigarettes such as tars and other by-products of

smoking, and by the irritating effects of smoke on the lung tissue. Addiction to smoking is

caused by nicotine itself. Stopping smoking produces withdrawal symptoms within 24 to 48

hours, which commonly include irritability, headaches, and anxiety, in addition to the strong

desire to smoke.

6) Khat28

Legal Status: May not be lawfully possessed, accept under license.

Route of administration: chewed or swallowed

Khat, also spelled qat or kat, tree of the

bittersweet family (also known as the

staff tree family). The khat is an

evergreen that grows in East Africa and

Arabia. It has small white flowers and oblong toothed leaves. The leaves and tender shoots of

the tree are used to make Arabian tea. Khat leaves contain a drug with effects similar to an

amphetamine and are chewed as a stimulant in some regions of the Middle East and Africa.

The tree is also known as the cafta and the Arabian tea tree.

7) Steroids29

Steroids, large group of naturally occurring and synthetic

lipids, or fat-soluble chemicals, with a great diversity of

physiological activity. Included among the steroids are

certain alcohols (sterols), bile acids, many important

hormones, some natural drugs, and the poisons found in the

skin of some toads. Various sterols found in the skin of human beings are transformed into

vitamin D when they are exposed to the ultraviolet rays of the sun.

28

"Khat." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 29

"Steroids." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.



Anabolic steroids induce weight gain and increased muscle mass. Originally developed to

help cancer patients and victims of starvation, they are derived from the male sex hormone

testosterone. In recent decades steroids have been abused by many athletes hoping to improve

performance. Besides the unfairness their use introduces into competition, steroids can have

serious psychological and physiological side effects, including increased aggressive behavior

and cancer of the liver. The International Olympics Committee banned the use of steroids in

1974, after gas chromatography testing for their presence became possible. A number of

athletes have been disqualified in competitions.

D. HALLUCINOGENS

1) Hallucinogen30

Hallucinogen, any one of a large number of natural or

synthetic psychoactive drugs that produce marked distortions

of the senses and changes in perception. Hallucinogens

generally alter the way time is perceived, making it appear to

slow down. As the name suggests, hallucinogens may produce

hallucinations, which are shape- and color-shifts in the

appearance of the outside world or, in extreme cases, the

replacement of external reality with imaginary beings and

landscapes. Hallucinogens may also lead to bizarre and

antisocial thoughts as well as to disorientation and confusion.

The physiological basis of such experiences is not clear, but

evidence suggests that hallucinogens work by inhibiting the

availability of serotonin, an important neurotransmitter in the

brain.

Hallucinogens may be taken orally, injected, or, in the case of marijuana (a mild

hallucinogen), smoked and inhaled. They usually take effect within an hour and cause

30

"Hallucinogen." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

Magic Mushrooms



increases in blood pressure, body temperature, and pulse rate as well as dilation, or

enlargement, of the pupils of the eyes. These drugs may also cause nausea and numbness.

Individual reactions to hallucinogens are unpredictable, especially when these drugs are used

recreationally—that is, for the pleasurable effects they produce and not for medical purposes.

The experience of the drug may be pleasurable one day and highly disturbing the next,

depending on the setting and circumstances in which the drug is taken and the individual‘s

personality and mood at the time. The effects of hallucinogenic drugs may last from a few

hours to several days, and may recur months later in what are referred to as flashbacks.

Most hallucinogens do not cause physical dependence with chronic use, although tolerance of

behavioral effects can develop, in which case more of the drug is needed to create the same

mental states.

2) Marijuana31 / Cannabis

Marijuana, common name for a drug made from the dried leaves and flowering tops of the

Indian hemp plant Cannabis sativa. People smoke, chew, or eat marijuana for its

hallucinogenic and intoxicating effects. It is known by a

number of slang names, including ―pot,‖ ―grass,‖

―reefer,‖ ―weed,‖ and ―Mary Jane.‖

The flowering tops of the Cannabis plant secrete a sticky

resin that contains the active ingredient of marijuana,

known as delta-9-tetrahydrocannabinol (THC). The

plant has both male and female forms, and the sticky

flowers of the female plant are the most potent. Hashish is a similar drug prepared from the

same plant. It differs from marijuana in that it is comprised of only the resin from the plant,

whereas marijuana is made up of flowering tops and leaves.

31

Iversen, Leslie. "Marijuana." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,

2005.



Known in India, Central Asia, and China as early as 3000 BC, marijuana has long been used

as both a medicine and an intoxicant. Most countries consider marijuana an illegal substance,

but individual countries vary on how they prosecute the use and possession of marijuana.

Some countries only impose small fines, while others impose

harsher punishment, including imprisonment.

3) Ketamine32

Ketamine is a drug for use in human and veterinary medicine

developed by Parke-Davis (1962). Like other pharmaceuticals

of this type, ketamine is used as a recreational drug.

Ketamine has a wide range of effects in humans,

including analgesia, anesthesia, hallucinations, elevated

blood pressure, and bronchodilation. It is primarily used

for the induction and maintenance of general anesthesia,

usually in combination with some sedative drug. Other

uses include sedation in intensive care, analgesia

(particularly in emergency medicine), and treatment of

bronchospasm. It is also a popular anesthetic in veterinary

medicine.

4) Lysergic Acid Diethylamide33

Lysergic Acid Diethylamide (LSD) is a potent hallucinogenic drug, also called a psychedelic,

first synthesized from lysergic acid in Switzerland in 1938 by scientist Albert Hofmann. The

drug evokes dreamlike changes in mood and thought and alters the perception of time and

space. It can also create a feeling of lack of self-control and extreme terror. Physical effects

include drowsiness, dizziness, dilated pupils, numbness and tingling, weakness, tremors, and

nausea.

32

―Katamine‖, Wikipedia the Free Encyclopedia. Wikipedia Foundation Inc. April, 03, 2008

http://en.wikipedia.org/wiki/Ketamine 33

Berger, Philip A. "Lysergic Acid Diethylamide." Microsoft® Student 2008 [DVD]. Redmond, WA: Microsoft

Corporation, 2007.

Medical Use

Recreational Use

http://en.wikipedia.org/wiki/Recreational_drug

http://en.wikipedia.org/wiki/Analgesia

http://en.wikipedia.org/wiki/Anesthesia

http://en.wikipedia.org/wiki/Hallucination

http://en.wikipedia.org/wiki/Blood_pressure

http://en.wikipedia.org/wiki/Bronchodilator

http://en.wikipedia.org/wiki/General_anesthesia

http://en.wikipedia.org/wiki/Sedative

http://en.wikipedia.org/wiki/Intensive_care

http://en.wikipedia.org/wiki/Analgesia

http://en.wikipedia.org/wiki/Bronchospasm

http://en.wikipedia.org/wiki/Veterinary_medicine



http://en.wikipedia.org/wiki/Ketamine



Transient abnormal thinking induced by LSD, such as a sense of omnipotence or a state of

acute paranoia, can result in dangerous behavior. Long-term adverse reactions such as

persistent psychosis, prolonged depression, or faulty judgment have also been reported

following LSD ingestion, but whether these are a direct result of ingestion is difficult to

establish. Physiologically, LSD may cause chromosomal damage to white blood cells; no

hard evidence has been found, however, that LSD causes genetic defects in the children of

users.

Although LSD is not physiologically addicting, the drug‘s potent mind-altering effects can

lead to chronic use. In the 1960s LSD use was widespread among people who sought to alter

and intensify their physical senses; to achieve supposed insights into the universe, nature, and

themselves; and to intensify emotional connections with others.



Another table which was given by Compton and Galawa 34

in their book Social Work and Social Welfae is also given .....

Drug Method of Administration Desired Effect Hazards and Side Effects

A NORCOTICS

1

Heroin

Smoking, injecting a vain

("Mainlining"); or under the

skin ("skin popping");

inhaling ("snorting")

Euphoria – Extreme Happiness Withdrawal symptoms resemble flu but are not life

threatening; use of unsterile needles results in AIDS and

other diseases and infections, addiction

2

Morphine

Injection into vein Euphoria; kill pain Risk from unsterile needles; malnutrition; continued use

results in depressive states, withdrawal, anxiety, elevated

blood pressure, and fever, addicting

3

Codeine

Swallowed by mouth in pill

from or with a liquid such as

cough medicine

Deaden pain Less addicting than heroin or morphine; withdrawal

discomfort not as severe

4

B CENTRAL NERVOUS SYSTEM STIMULANTS

1

Cocaine

Inhaled ("snorted"); injected;

smoked as crack in glass

pipes

Increase in energy; sense of strength

and well-being; sexual prowess

prolonged use; anxiety, depression so severe that suicide

may occur; persecutory delusions; paranoia

2

Amphetamines {"Uppers",

"Crystal")

Taken by Mouth

Increased alertness and energy;

weight loss

as above

34

Compto, B. Galawa. Introduction to Social Work and Social Welfare . McGrawHill Publications



C CENTRAL NERVOUS SYSTEM DEPRESSENTS

1

Barbiturates ("Downers")

Taken by mouth or injected

Relieve pain; often taken to reverse

the effects of stimulants such as

amphetamines

Confusion and other forms of mental disorder; seizures;

death from suicidal overdose

2

Tranquilizers

Taken by mouth in pill form

Reduction of anxiety

Psychological dependence; severe health hazed with

unpredictable results when combined with alcohol or

other drugs

3

Alcohol

Taken by mouth in liquid

form

increased sociability; sense of

pleasure; to feel good; to alter the

mood; relieve anxiety

Depression; irregular sleep patterns; intoxication;

confusion; loss of consciousness; psychological

dependence; physical addiction withdrawal can be fatal

D HALLUCINOGENS

1

Marijuana

Smoked in a cigarette (a

"joint" )or a pipe; may be

orally ingested

sense of wellbeing relaxation

Psychological dependence is a potential side effect; use

may result in impaired judgment, anxiety, panic attacks

2 LSD (Lysergic Acid

Diethylamide)

Oral ingestion

Produces dreamlike experiences with

beautiful illusions and hallucinations

Confusion; hallucinations with frightening visualization;

suicide; flashback experiences months after use

3 Mescaline (derived from

peyote cactus)

Oral ingestion

Dreamlike hallucinations

Confusion; hallucinations; repeated use can intensify

underlying mental disorders

4 Psilocybin (derived from

psilocybin mushroom)

Oral ingestion Dreamlike hallucinations As above

E INHALANTS

1

Various substances;

gasoline, pain thinner, glue,

ether, cleaning solutions

Inhalations

Sense of euphoria; a "high" improved

sexual performance

Blindness; eye infections

Field Work Report Dec, 07 to May 08

Imran Ahmad [0]

TREATMENT

PHILOSOPHY

Why treatment is given?

Major phases of treatment

CHAPTER NO. 5


Imran Ahmad [36]

Treatment philosophy35

Introduction

The treatment which is offered in dost welfare foundation is called classical-systematic-and

lifetime treatment.

Classical in the sense that it is a multidimensional treatment. It involves new scientific, faith

based, and traditional Approach. When we combine these three approaches then we call it the

classical treatment.

Systematic in the sense that there is a complete system of treatment. All the process goes

stepwise, rather then haphazardly.

Life time---it is life time treatment because drug addiction is the life time problem.

The treatment plan in Dost Welfare Foundation is divided into three phases;

A. Pre-treatment phase

B. Treatment phase

C. Post-treatment phase

PRE-TREATMENT PHASE

Change Begins

This phase starts before the treatment and before the patient enters the TC. It includes

various steps;

1. Awareness Lectures

2. Harm Reduction

3. Individual Motivational Counseling Sessions

4. Family Contacts

5. Client Registration

6. Enquiry Session

35

Naeem. A (2007). Lecture for Social Work Students. Peshawar, Lecture Delivered by Center Manager Dost

Welfare Foundation, 07-12-2007


Imran Ahmad [37]

The objectives of this session are;

Awareness

Motivation

Make the client ready for treatment

TREATMENT PHASE

Development of Change

This phase includes three steps

a) Detoxification

b) Primary Rehabilitation

c) Secondary Rehabilitation

Intake Interviews

Medical Checkup

These two steps are before detoxification.

a) Detoxification Period

This is the first phase in the treatment process, and lasts for 10 to 15 days. During this period

the physical withdrawal of the drug takes place. The main features of therapy include:

1. Symptomatic medical treatment

2. No substitute drugs

3. Bath therapy

4. Open door policy

5. Individual counseling

6. Peer support 36

7. 7Handing over of client to Supervisor/psychologist/ counselor

8. Data Sessions

9. Brief History of the Client

o Physical history

36

“Treatment Programme” Treatment Programme for Drug Users (2003). Dost Welfare Foundation Thursday,

November 22, 2007, <http://www.dost.sdnpk.org/Programmes.htm >

http://www.dost.sdnpk.org/Programmes.htm


Imran Ahmad [38]

o Psychological history

o Social history

o Economic history

o Addiction History

Type of drug addicted

Nature of Addiction

Time Span of addiction

b) Primary Rehabilitation

This period last for up to 45 days i.e. 8 weeks and it is a 30 days period after detoxification. It

includes the following features;

1. Life story in written form

2. Client profile

3. Lectures

4. Groups of the clients

5. Dars

6. Individual Counseling Sessions --- ICS

7. Different Therapeutic Techniques are started

8. Behavior Shaping Tools are applied

9. Assigning of Therapeutic Duties

10. Family Therapeutic Sessions

11. Need Based Assessment for Vocational Skills

c) Secondary Rehabilitation/ Vocational Skill Development

This phase may be residential or out-patient and includes vocational training in

automotive/electrical repair, welding, carpentry, handicrafts, sewing, food preparation etc.

Main features of this phase include:37

1. Some duties and responsibilities are assigned to the client and he is held

responsible for it.

2. Social reintegration

3. Vocational Rehabilitation

37

ibid


Imran Ahmad [39]

4. Internship

5. Job Placement---if available

POST TREATMENT PHASE – Follow-Up and Aftercare

Change Continuation

This phase of treatment last up to 90 days i.e. 45 days period after the first 2 phases. This

phase include the following;

1. Follow up and After Care

2. NA meetings ----Narcotic Anonymous Meetings

3. RPP-Relapse Prevention Programs

4. Letters and Telephone Calls

5. Home Visits of Ex-Clients

6. Social Gathering

The most important job for social worker is Relapse Prevention.

For the treatment of any client, it is necessary that s/he himself should be motivated for

treatment. The registration of the client should be voluntary in TC,


Imran Ahmad [0]

COUNSELING

CHAPTER NO. 6


Imran Ahmad [40]

COUNSELING 38

1. Counseling is a professional relationship between the client and the

counselor.

A counselor can be any one. It can be a doctor, it can be a psychologist, a therapist, a

social worker, a community health worker, a nurse, a teacher, a community based

worker, a care taker, or a care provider. Any one of these can be a counselor.

2. Counseling is an Act of exchanging ideas and opinions.

It is a process in which we exchange our opinions and our ideas with others.

Counseling is an opportunity for those people who need help and who want to solve

their problem. When they come to the counselor, their problem is satisfied.

3. Counseling is a communication process between two or more then two people to

solve a problem, resolve a crisis, create new perspectives and changes within the

person or group enabling to make decisions, and think differently and to change the

conditions in the immediate environment. It is a process to make the person identify

the actual problem, realize and actualize capabilities, and create a power in him for

the solution of the problem. The biggest thing in the world is to identify the actual

problem and then to adopt the proper way for the solution of this problem. Because

when there is a problem there is a way.

4. Counseling is a plan of action. It is a planning that how to act for a particular

situation.

The British Association of Counselling and Psychotherapy (BACP) define that ―Counselling

takes place when a counsellor sees a client in a private and confidential setting to explore a

difficulty the client is having, distress they may be experiencing or perhaps their

38

Naeem. A (2008). Counseling Notes . Peshawar, Notes of The Center Manager Dost Welfare Foundation


Imran Ahmad [41]

dissatisfaction with life, or loss of a sense of direction and purpose. It is always at the request

of the client as no one can properly be 'sent' for counselling.‖

By listening attentively and patiently the counsellor can begin to perceive the difficulties

from the client's point of view and can help them to see things more clearly, possibly from a

different perspective. Counselling is a way of enabling choice or change or of reducing

confusion. It does not involve giving advice or directing a client to take a particular course of

action. Counsellors do not judge or exploit their clients in any way39

.

In other words counseling can be defined as a relatively short-term, interpersonal, theory-

based process of helping persons who are fundamentally psychologically healthy resolve

developmental and situational issues.

What do we mean by counselling40

?

By counselling, we mean talking to someone who is properly trained. The person may be

called a counsellor or a psychotherapist. The difference between these two is sometimes

difficult to distinguish. Some people use the terms to mean the same thing, as much of their

work does overlap. The differences are usually to do with the type of training and special

interests of the individual counsellor or psychotherapist.

Why do people have counselling41

?

There are many times in our lives when we all really feel we need someone to listen to us.

This is basically what counselling is - someone to listen to you. Being heard properly, for

example, can be really important if you have a life threatening disease like cancer. You‘re

probably finding it difficult to deal with the diagnosis. And you may be feeling a bit lost

amongst all the treatments and doctors' appointments.

39

―what is counseling‖, Education: British Association for Counseling and Psychotherapy, May 10, 2007,

British Association for Counselling and Psychotherapy, BACP House, Unit 15 St John's Business Park,

Lutterworth, Leicestershire LE17 4HB < http://www.bacp.co.uk/education/whatiscounselling.html> 40

―Living with Cancer, What is Counseling‖(2007). Cancer Research UK. Cancer Research UK 2002. May 01,

2007, < http://www.cancerhelp.org.uk/help/default.asp?page=214&order=2252> 41

ibid

http://www.bacp.co.uk/education/whatiscounselling.html

http://www.cancerhelp.org.uk/help/default.asp?page=214&order=2252


Imran Ahmad [42]

Most people feel very shocked when they are told they have a life threatening disease. It can

turn your life ‗upside down‘. Things you can normally cope with, such as going to work,

shopping, looking after the kids and socializing, may become more difficult, and have less

meaning for you. Your intimate relationships might change because of changes in how you

look and the way you feel about yourself. The stress you‘re under may mean you can‘t show

the love and attention you want to your partner or children.

You may want to continue with life as normal, but feel frustrated that you can‘t. Many

people with life threatening disease have confusing and upsetting feelings such as anger and

sadness. And feeling that you‘re not in control of your life at this time can be very upsetting.

It‘s not uncommon to worry that your disease could come back again after your treatment

has finished. Or you may fear you are going to die. All of these feelings are very real and

frightening. There‘s only so much your mind can process at one time, so these feelings can

become overwhelming.

But bottling feelings up can become very draining and make living your life very difficult.

Counselling gives you an opportunity to explore your feelings and express them in a safe

place. A counsellor can help you to find a way to make things less difficult to deal with.

If you‘re a relative of someone with such a disease, you could probably do with spending a

bit of time thinking about yourself in the midst of everything else. You are bound to have

feelings of your own which you don‘t want to burden your sick loved one with. And being

able to express your feelings may help you to support your relative more effectively.42

OBJECTIVES & GOALS OF COUNSELING

1. Finding Meaning in Life: - this phrase needs some elaboration. Meaning in life, what

dose it mean? We will answer it in such words as it means that, for example, if you

are a student then you have to know that why you are a student and if you are in this

setup then what is the aim of your being here and what should you do. This is the

main objective of our counseling that we have to enable the person so that he could

find the meaning in his life.

42

ibid


Imran Ahmad [43]

2. Curing Emotional Distress: - this is another objective of counseling. If any one has

some emotional problems then counseling is there to help him come out of it.

3. Adjusting to Society: - it means to create adaptability in the client. How to adjust

within the society, and how to adapt oneself to the environment? This will be our

goal. A drug addict, for example, we have to enable this person so that he can adapt to

his family environment.

4. Attaining Happiness and Satisfaction

5. Self Actualization: - self actualization means that you should know what you actually

are. The goal of our counseling is to enable the client to know his potentialities, to

know his weaknesses, to know where he has got a mistake.

6. Reduce Anxiety: - one of the objectives of the counseling is to reduce the anxiety of

the client. If he is angry or depressed then after counseling he should be without them.

7. Reduce Maladaptive Behavior: - Maladaptive behavior occurs when we respond to

the situation without analysis. The objective of counseling is to create the quality of

analyzing the situation in the client.

8. Increase Adaptive Behavior

SKILLS REQUIRED FOR A COUNSELOR

There are some skills which should be acquired in order to be a professional counselor; these

are as below;

1. Clarification: - the counselor should be skillful in clarifying the situation. He has to

clarify that why the client has come to him. If the client is a doctor then how to deal


Imran Ahmad [44]

with him and if he is someone else then on which track he is to be lead. How to deal

with different people is the skill of a professional counselor.

2. Ask Open-ended and Probing Questions: - asking open-ended and probing

questions is a skillful technique. The counselor should not ask the point question

which could be answered in a word or two rather he has to ask probing questions so

that there is continuity in the client‘s information giving process.

3. Listening: - the most important skill for a counselor is the active listening.

4. Appropriate Use of Silence

5. Focusing: - during the client‘s information giving process, the counselor has to focus

on those issues which are related to the client‘s problem. Whatever the information is

provided by the client, you have to focus on the causal factors which are creating this

problem.

6. Unconditional Acceptance: - the client has to be accepted by the counselor

unconditionally. There should be no discrimination on any ground.

7. Non-Judgmental Attitude

8. Confidentiality: - whatever the information the client is giving to you, you are not

suppose to disclose it publically. This is only the confidentiality guaranteed by the

counselor, that the client gives his secret information to you.

STAGES OF COUNSELING

A counseling session is divided into four (4) stages;


Imran Ahmad [45]

1. Active Listening: - the first phase of the client begins with active listening to the

client. First of all the counselor has to actively, patiently, carefully, and attentively

listen to the client so that the counselor can get the clients problem as the client sees

it, and the problem as the counselor perceived it.

2. Paraphrasing

3. Reflecting and validating feelings

4. And Summarizing; the most important

QUALITIES REQUIRED FOR A COUNSELOR

The counselor should have the following qualities;

Empathetic

Consistent

Respectful

Committed

Friendly

Informed/ knowledgeable

Responsible

Honest

Discreet – Door andash

Self assured

Efficient

Flexible

COMMON ERRORS THE COUNSELORS OFTEN DO

Controlling

Judging or moralizing

Labeling

Unwarranted reassuring

Not accepting

Advising

Interrogating

Encouraging dependence

Cajoling (to persuade)


Imran Ahmad [0]

BEHAVIOR

MANAGEMENT

Tools for modifying behavior

of drug addicts

CHAPTER NO. 7


Imran Ahmad [46]

BEHAVIOR MANAGEMENT

TOOLS43

After the detoxification most of the drug addicts relapse not because of physical dependency

for drug but because of the underplaying psychosocial causal factors of addiction which may

not be fully resolved and the lack of ability of the addict to cope with high-risk relapse

situation.

The treatment centre is a place for a drug addict, where he is cut off from the streets, and it is

a place where he has taken a break from all of his anti-social behavior and activities

connected to his drug addict lifestyle. It is, now, a good opportunity for him to;

Get rid of drugs physically, &

To educate and motivate himself to get additional help for the more serious

problems then his drug addiction.

The principles of effective treatment tell us that no single treatment is effective for all the

individuals. A treatment is effective, if it focus on multiple needs of the individual, and not

just his drug use.

The treatment of a drug addict requires not only detoxification, i.e. medication, but it also

requires counseling, psychotherapy, along with behavior management. Because, the most

obvious symptom of drug addiction is in observed behavior. An addicted individual is often

in conflict with other individuals and with his environment,,,,,,

why? ? ?

it is due to his drug taking behavior, due to his anti-social behavior, due to his self centered

behavior. Behavior management and behavior shaping is, therefore, the first and the most

difficult step in changing his lifestyle.

43

Naeem. A. (2008). Behavior Management Tool (Day Top New York). Peshawar. Notes provided by The

Center Manager Dost Welfare Foundation


Imran Ahmad [47]

Behavior management and behavior shaping tools are some techniques which are used in

community centre in order to bring the change in thoughts, in attitudes & behavior. It is a

journey from negativity to positivity i.e. to modify the negative behavior in positive one of

the drug addict. The behavior management tools are applied to the environment and to the

individual as well. The common tools which are used in DOST Community Centre are;

1. Pull-up

2. Pull-up On the Board

3. Spoken to, or talking to

4. Dealt With

5. Hair-cut

a. Silent Hair Cut

b. Global Hair Cut

6. Time out

7. Confrontation

8. Prospect chair

These are some of the community tools which provide a collectivity for individual change.

They promote social learning by role modeling, peer pressure and learning by experience.

1. SPOKEN TO / TALKING TO

Introduction

It is a verbal correction regarding an observed behavior or attitude. It provides

information to the person in a positive way about how he is expected to behave in the

community. This is an initial correction intervention to shape and manage behavior.

This tool is used for minor negative behaviors, less intrusive and also for the younger

members of the community center.

Purpose

The main purpose of this tool is to make the individual aware about a negative

behavior and to correct it by showing the right way to act.


Imran Ahmad [48]

Procedure

The ―spoken to‖ panel is made by 2 persons, one coordinator/counselor and one

resident of the community centre. The second person from the panel must be from the

same peer group with the resident involved in the incident, because he can also learn

something out of this tool.

The subject is called by an expeditor in the same day when the incident happened, the subject

wait to the office door, until the coordinator/counselor tells him to come in the office. The

coordinator tells the subject to sit in front of them and then he, the counselor, tells him about

the incident or the error he has done.

The counselor will use both, naram and garam method. The coordinator will give the teaching

about the negative behavior and will address to the subject the rule that he didn‘t respect.

After that he will talk about the meaning of that rule or regulation behavior and in what way

can help him to behave in the T. C. and also in the real life.

The subject can go out when the coordinator tells him that the ―spoken to/ talking to‖ is over.

This tool is used when the subject has a minor negative attitude in the community centre, but

which did not affect other people. When, for example, the resident doesn‘t respect a minor

rule or don‘t shave, did not respect a pull-up etc.

Time Duration and Place

The time for giving a ―talking to‖ is every day after dinner or seminar. The duration

of session is 5-10 minutes.

2. DEALT WITH

Introduction

The ―dealt with‖ is the second verbal correction (after talking to….) regarding a

negative attitude or behavior. This tool is used when the subject has a little bigger

negative behavior or attitude. The subject (drug addict who is found to be behaving

negatively) is provided with the information in a positive way that how he is expected


Imran Ahmad [49]

to behave. The panel for this tool consists of 3 counselors or 1 counselor and 2

residents.

Purpose

The purpose of this tool is similar to that of ―spoken to‖. Our purpose is to make the

individual aware about his negative behavior and we try to correct it by showing the

right way to behave.

Procedure

An expeditor calls the subject in the same day when the incident happened. The

expeditor tells him to go behind the scratch. The resident goes behind the scratch and

he must stand or sit there until the expeditor calls him. He must not talk with other

residents and nobody can talk with him. When resident is called by the expeditor he

must take a metallic chair and walk to the office.

The subject knocks the door. The people inside ask him; ―who is there?‖ and the resident says

his name (―my name is Asif‖). After their answer he comes in. The coordinator tells him to

sit in front of them and he asks him ―what is the reason that you are here?‖ or ―do you know

why you are here‖. The subject can speak about the incident or fact. The coordinator is the

first one who will give the teaching. He will talk about the negative behavior and will address

to the resident the rule that he didn‘t respect. After that he will talk about the reason/ meaning

of that rule or regulation and in what way can help him to behave in the TC and also in the

real life. The other persons address the teaching to the resident speaking about the importance

of positive behavior/ attitude in the house and they can relate the incident with the drug

issues.

The resident can go out when the coordinator tells him that the ―dealt with‖ is over.

3. PULL-UP

Introduction

It is on the spot verbal tool for a minor negative behavior. It is a reminder of an error/

lapse in the awareness of expected behaviors and attitude. The pull-up is given by the

peers, elders and staff and is the most effective mean of teaching. The pull-up is the

most obvious and significant example of mutual self-help. The person receiving the


Imran Ahmad [50]

pull-up is expected to listen, without comment assume that it is valid, quickly display

the corrected behavior and expressed gratitude at receiving it.

Objective

Our objective from this tool is to create awareness and to bring immediate change in

the behavior of the subject.

Procedure

Since the ―pull-ups‖ often refer to behaviors that have anonymous perpetrators, such

as, those who used and left the toilet dirty, those who failed to pick-up after

themselves and left dirty dishes on the dining table, the offenders, when the pull-up is

called, are given the change to exercise honesty by standing to the pull-up in spite of

the potentially publically embarrassing situation. In Therapeutic Community norm,

saving face is less important than the practice of honesty.

The facilitator could then ask the members to elaborate on the behavior being corrected or

shaped by the pull-up. The elaborations are focused on the underlying attitude that triggers

the behaviors such as the lack of awareness or laziness, or lack of concern on the part of the

perpetrator who has done something wrong.

Connections are made between the current behavior and the underlying addict‘s attitude that

led to substance use. At the end of the pull-up, a commitment to change that errant behavior

for which he was pulled-up, is obtained from him.

Time and place

The ―pull-up‖ is used in first part of the morning meeting (detail about morning meeting will

be given on proceeding pages), or when the subject don‘t respect minor rules. Whenever a

resident cope with the negative behavior addressed by the pull-up he will be given a teaching

in that moment without bringing the incident in morning meeting.

To clarify the concept, it is nothing more then DAANT DAPAT Pilna.


Imran Ahmad [51]

4. PULL-UP ON BOARD

Introduction

Pull-up on board is used to address physical attitudes around house and on grounds.

Objective

Our objective from this tool is to create honesty in the person, to create awareness

regarding his negative behavior, and to bring immediate change in that behavior.

Procedure

The structure of pull-up board is;

Name;

Pull-up;

Name for; - announcement;

Philosophy

It will be described with the help of an example;

Ex; pull-up

―Who is the person who left a cup of tea on the table, in the dining room, last night,

after the NA meeting?‖

Elaboration: - ―thank you for showing your honesty, but the fact that you left the cup of tea

on the table shows a lazy attitude and lack of consideration for other residents work. It seems

that you keep behaving as careless as you were used to in your past life and you expect for

somebody to take care of your mass. If you want to change something you must start

respecting every little rule of this community, improve your awareness, and Pull your self

up‖.

Time and Place

The pull-up on board is done during the morning meeting.


Imran Ahmad [52]

5. TIME OUT

This is a specific period of time that a younger member of the community center can

use, think about his problems, his future plans and the obstacles that don‘t allow him

to plug in the program, in the first period of residence.

The subject has to ask for time out from his primary counselor. A chair is placed into a

visible space in order for every member of the TC or staff to see him. This tool is used when

a younger member has problems involving in the program and coping with the pressure of the

environment.

While on the chair he has to think about leaving or staying in the program. Time out last for

15-20 minutes. The primary counselor will interfere and have a one-to-one counseling in

order for the resident to make an optimal decision.

6. HAIR CUT

Introduction

It is structured verbal reminder that is delivered by the staff and peers. Its tone is more

serious and there is maximum use of anxiety to induce change. The use of peers to

support community expectations is a key element of the hair-cut.

Procedure

In hair-cut, there are 5 people for the subject and the subject is not allowed to talk to

any of them. The staff uses each other to clarify issues, plan effective interventions or

develop creative settings for the haircut. The post intervention plan for the resident is

developed usually including some disciplinary sanction. The ritual for haircut is the

same like in the case of talking-to and dealt with.

Importance

The haircut is very important in order to;

Clarify issues, goal and outcome desired;


Imran Ahmad [53]

To point out a major negative behavior

To remind the meaning and the rule itself was not respected

To point out the consequences of this behavior in the real life in society

To teach the resident different ways of conduct in similar situation

To relate the incident with drug use and revel its negative effects

Global Haircut

The rituals for this tool are also the same but in this tool; all the staff of the community center

and all the residents of the center are involved in giving haircut to the subject. He is asked to

stand up in front of all the people and then is given haircut by all the members.

Silent Haircut

It is some kind of Social Boycott of the offender. Through this tool all the members of the

community are forbade to talk to the subject. There could be the ban of some facilities on

him. Our purpose form this tool, and all other tools, is to bring a change in behavior.

7. PROSPECT CHAIR/ CONFRONTATION CHAIR

The prospect chair is the chair on which the resident sits when he come in the facility. It can

also be used in the situation when a resident has to decide between staying and being

committed to the program or leaving the facility (especially after breaking a cardinal rule).

The confrontation chair is a tool of the environment used for those residents that can‘t deal

with their own issues during a confrontation with other peers or family members.

It is used to increased anxiety and loss of association with the community. The person is

asked to sit on the chair for 3 days. The time duration is from 9:00 AM to 8:00 PM at

evening. During this time, he is allowed only to go for toilet, for eating meal, and for Nimaz

etc. After completing his three days prospect chair, the counselor decides another punishment

for him.


Imran Ahmad [54]

Prospect chair is for major offenders.

Confrontation

Introduction

It is very important tool in TC. It must be carefully used among the residents. It is the

way to ask questions about issues, attitudes, behaviors, theme of the day, the

involvement in the program etc.

Procedure

The confrontation has certain structure that has to be followed such as;

One resident can ask another one; ―I would like to confront you‖ or ―can I

confront you? Are you open to talk about this?‖

The confronted resident has to stop and answer the question. Honestly and

seriously.

The answers must point out the issue, must be direct and not avoiding the real

subject.

If the resident, who is confronted, doesn‘t want to talk about the issue and give

vague answers, he can be confronted in group about his attitude.

The confrontation involves 2 persons.

Why we are using these various tools?

Our objective through these tools is to bring a change in the behavior of the drug addict and

we want to manage his behavior, to reshape his behavior in a positive way.


Imran Ahmad [0]

MORNING MEETING

Of drug addicts for behavior

modification

CHAPTER NO. 8


Imran Ahmad [55]

MORNING MEETING OF

DRUG ADDICTS

Morning meeting is a daily ritual attended by the entire community and facilitated by a senior

member or staff; It is a socially engineered activity that redefine social self and the socially

responsible role; It is designed to help people appropriately and constructively identify,

express, and manage their feelings44

.

Importance of Morning Meeting

Morning meeting is conducted to create a structure and system that foster positive behavior.

It is an important tool to promote social learning by role modeling, peer pressure and learning

by experience. It is important to point out the wrong attitude that need to be addressed in

order for every body to learn and respect the environment and, most of all, to change the

negative aspects of the behavior and the careless attitudes.

The Purpose of Morning Meeting

o You can change; (in attitude and behaviour)

o Involvement in group activities can foster this change;

o In order to change an individual must take responsibilities for his behavior;

o Structures can be created to accommodate and measures this change;

o Commitment must be made. This individual needs to: act as if they are going through

the motions.

Components of Morning Meeting

The contents or rituals of the morning meeting, which have been observed by the internee

himself, are as following;

1. Recitation of the Holy Quran - Tilawat

44

Naeem Asif (2008) Morning Meeting. Peshawar. Unpublished Notes of Dost Welfare Foundation


Imran Ahmad [56]

2. Theme for the day / the concept of the day

3. Pull-ups on board

4. Pull-up in the meeting

5. Express the house/TC related problems

6. Leaders Report

7. Express the Personal Problem

8. Appointment from Counselor

9. Affirmation, good remarks about a patient

10. Booking

11. News paper reading

12. S.E.S. (Significant Event Sheet)

13. Schedule Activities of the last 24 hours

14. Up ritual; games, jokes, poems etc.

15. Critical Analysis of the Morning Meeting

16. Programme for the next day

17. Closure: Dua-e-Sakoon, meeting, hugs

The most interesting time of the internee was the time in morning meetings. It was a

wonderful MAZA being a participant in their meeting. Particularly the Game for fun and

then the poetry and songs of the addicts were very much interesting.

Dua – Sakoon

“O My Lord! Grant me peace so that I can accept those

conditions which I can not change and give me such a

courage so that I can change those conditions which I can

and give me sober mentality so that I can differentiate

between the two. Ameen”


Imran Ahmad [57]

Romen Urdu

“A mery Khuda mujy etna sakoon day k mh un halat ko

tasleem ker saku jinhai mh nahi badal sakta aur mujy etni

jurrat dy k mh un halat ko badal saku jinhai mh badal sakta

hu aur mujy aqal –e-saleem day k mh en dono mh farq kr

saku. Ameen”


Imran Ahmad [0]

RPP

Relapse Prevention

Programme – After Care

CHAPTER NO. 9


Imran Ahmad [58]

RELAPSE PREVENTION

PROGRAMME – RPP 45

Addiction is a chronic relapsing disorder, thereby making the prevention of

relapse one of the critical elements of effective treatment for alcohol and other

drug (AOD) abuse. Studies have shown that 54 percent of all alcohol and other

drug abuse patients can be expected to relapse, and that 61 percent of that

number will have multiple periods of relapse. It is not unusual for addicts to

relapse within one month following treatment, nor is it unusual for addicts to relapse 12

months after treatment; 47 percent will relapse within the first year after treatment. Although

relapse is a symptom of addiction, it is preventable. A key factor in preventing relapse is

improved social adjustment. Model of Relapse Prevention Therapy is a comprehensive

method for preventing chemically dependent clients from returning to alcohol and other drug

use after initial treatment and for early intervention should chemical use occur.46

Relapse

prevention methodologies are critical to the success of substance abuse treatment. This

chapter will examine the process of relapse, along with information about recognizing its

"warning signs," or triggers, and the elements of relapse prevention treatment methodologies.

UNDERSTANDING RELAPSE

Relapse does not occur within a vacuum. There are many contributing factors, as well as

identifiable evidence and warning signs which indicate that a patient may be in danger of

returning to substance abuse. Relapse can be understood as not only the actual return to the

pattern of substance abuse, but also as the process during which indicators appear prior to the

patient's resumption of substance use.

Relapse, however, is not an automatic sentence to a lifetime of substance abuse for an

individual. Studies of lifelong patterns of recovery and relapse indicate that approximately

45

―Relapse prevention & Drug Addiction”. (2008) When sobriety is priority. March 26, 2008,

<http://www.relapse-prevention.org/user-news.htm?id=163> 46

Naeem Asif (2008). Model of Relapse Prevention Therapy .Peshawar. Unpublished Notes of Dost Welfare

Foundation

http://www.relapse-prevention.org/user-news.htm?id=163


Imran Ahmad [59]

one-third of patients achieve permanent abstinence through their first serious attempt at

recovery. Another third have brief relapse episodes which eventually result in long-term

abstinence. An additional one-third has chronic relapses which result in eventual recovery

from chemical addiction.

Because relapse is a common occurrence during the process of substance abuse recovery, it is

imperative that it be examined carefully. Treating the disease of AOD abuse is not possible

without a thorough understanding of the role that relapse prevention plays.

Whether or not treatment and criminal justice personnel provide initial treatment services,

these personnel have a significant opportunity and responsibility to intervene with recovering

persons when they recognize signs of relapse. Some of the skills required include assessment,

education, and confrontation of denial, brokering of community resources, and building

support systems.

In order for relapse prevention to be successful, effective systems coordination is necessary.

This involves coordination and communication between various agencies and systems.

Community treatment programs must work cooperatively to ensure that relapse prevention

programming is an integral part of treatment for all patients. State and community decision

makers need to recognize that relapse prevention is a critical component of the treatment

process, and consider and coordinate policy and funding decisions with this in mind. When it

is treated as such, with comprehensive efforts on the parts of all involved agencies and

systems, treatment expenditures are spent most effectively.

Several situations may lead to relapse, such as social and peer pressure or anxiety and

depression. Studies have indicated that the highest proportion of high-risk situations for

alcoholics involve interpersonal negative emotional states, while the highest proportion of

high-risk situations reported by heroin addicts involves social pressure.

CONTRIBUTING FACTORS

An understanding of some of the personal factors which may contribute to substance abuse

relapse is useful in any discussion of relapse prevention. These may include:


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inadequate skills to deal with social pressure to use substances;

frequent exposure to "high-risk situations" that have led to drug or alcohol use in the

past;

physical or psychological reminders of past drug or alcohol use (e.g., drug

paraphernalia, drug-using friends, money);

inadequate skills to deal with interpersonal conflict or negative emotions;

desires to test personal control over drug or alcohol use; and

Recurrent thoughts or physical desires to use drugs or alcohol.

Drug and alcohol addiction is a chronic and relapsing condition. Recovery requires changes

in attitudes, behaviors, and values. Because of these issues, recovery is not a static condition;

it is an ongoing process. Relapse occurs when attitudes and behaviors revert to ones similar to

those exhibited when the person was actively using drugs or alcohol. Although relapse can

occur at any time, it is more likely earlier in the recovery process. At this stage, habits and

attitudes needed for continued sobriety, skills required to replace substance use, and identity

with positive peers are not firmly entrenched.

CATEGORIES OF PATIENTS

Chemically addicted individuals can be categorized according to their recovery and relapse

history. Patients are: prone to recovery; briefly prone to relapse; or chronically prone to

relapse. Individuals who are relapse-prone can be further divided into three subgroups:

1. Transition patients

Transition patients do not accept or recognize that they are suffering from chemical

addiction, even though their substance abuse may have created obvious adverse

consequences. This usually results from the patient's inability to accurately perceive

reality, due to chemical interference.

2. Un-stabilized relapse-prone patient

Un-stabilized patients have not been taught skills to identify their addiction. In such

cases, treatment fails to provide these patients with the necessary skills to interrupt the


Imran Ahmad [61]

process and disease of addiction. As a result, they are unable to adhere to a recovery

program requiring abstinence, treatment, and lifestyle change.

3. Stabilized relapse-prone patients

Stabilized patients recognize and are aware of their chemical addiction, that

abstinence is necessary for recovery, and that an ongoing recovery program may be

required to maintain sobriety. Despite their efforts, however, these individuals

develop dysfunctional symptoms which ultimately lead them back to AOD abuse.

It has been estimated that 40 to 60 percent of persons who are recovering from chemical

dependence relapse at least once following their first serious attempt at treatment. Studies

have shown that offenders who are actively using drugs are involved in approximately three

to five times the number of crime days as non-drug users; thus, relapse tends to accelerate the

level of subsequent criminal activity.

To put it simply we can divide the relapsers into three categories;

Cross

Clean

Sober

Cross: the cross addicts are those who start another drug instead with the same quantity and

amount. e.g. to leave Heroin and Start Crystalline

Clean: it is the category of those relapsers who start again drugs addiction but it is

manageable for them. e.g. start taking one cigarette in a week.

Sober: a sober person is that one who do not use any drug after his treatment. Therefore we

say ―when sobriety is priority‖ you should follow relapse prevention programme.

WARNING SIGNS / Principles of Relapse Prevention

People who relapse aren‘t suddenly taken it. Most experience progressive warning signs that

reactive denial cause so much pain that self-medication with alcohol or other drugs seems

like a good idea. This is not a conscious process. This warning signs develop automatically

and unconsciously. Since most recovering people have never been taught how to identify and


Imran Ahmad [62]

manage relapse warning signs, they don‘t notice them until the pain becomes too severe to

ignore.

There are nine principles underlying relapse prevention therapy to recognize and stop early

warning signs of relapse. They include the following:

1. Stabilization 2. Assessment 3. Relapse education 4. Warning sign identification 5. Cope the problem 6. Recovering planning 7. Inventory training 8. Family involvement 9. Follow up programme

All of them will be discussed in details in proceeding pages.

1. Self-regulation and stabilization

As the patient's capacity to self-regulate thinking, feeling, memory, judgment, and

behavior increases, the risk of relapse will decrease. Self-regulation can be achieved

through stabilization. Stabilization may include:

detoxification from alcohol and other drugs;

recuperation from the effects of stress that preceded the chemical use;

resolution of immediate interpersonal and situational crises that threaten sobriety;

or

Establishment of a daily structure including proper diet, exercise, stress

management, and regular contact with both treatment personnel and self-help

groups.

The risk of relapse is highest during this period of stabilization.

2. Integration and self-assessment

As understanding and acceptance increases, the risk of relapse will decrease. During

this phase, it is important to explore the presenting problems which may have led to

relapse in the past, and which might trigger future relapse.


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(The assessment process is designed to identify the recurrent pattern of problems that caused

past relapses and resolve the pain associated with those problems. This is accomplished by

reconstructing the presenting problems, the life history, the alcohol and drug use history and

the recovery history. The life history explores each developmental life period including

childhood, primary school, high school, college, military, adult work history, friendship

history and intimate relationship history. Drug history contains following question; the

amount of drug, the time duration and extent of use, consequences etc). 47

3. Understanding and relapse education

An understanding of the general factors which cause relapse will aid patients in relapse

prevention. Relapsers need to learn about the relapse process and how to manage it. Its

not a bad idea to get their family involved. First relapse is a normal and natural part of

recovery from chemical dependence. There is nothing to be ashamed or embarrassed

about48

.

It should be noted that many relapse-prone patients may have memory problems

associated with the chemical abuse, which may impede the learning process and retention

of educational information.

4. Self-knowledge and identification warning signs

This process teaches patients to identify the sequence of problems that has led from

stable recovery to chemical use in the past, and then to synthesize those steps into

future circumstances that could cause relapse. The relapsers need to identify the

problems that caused relapse. The goal is to write a list of personal warning signs that

lead them from stable recovery back to chemical use. Usually a series of warning

signs build one on the other to create relapse. A number of procedures are used to

help recovering people identify the early warning signs relapse. Patient must identify

the irrational thoughts, unmanageable feelings and the self defeating behavior. Patient

thinks him self loneliness. Understanding the warning signs is not enough. We need to

learn how to manage them. 49

47

Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager Dost Welfare Foundation 48

ibid 49

ibid


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5. Coping skills and warning sign management

This process involves teaching relapse-prone patients how to manage or cope with

their warning signs as they occur. Unmanageable feelings and self defeating behaviors

that accompany each warning signs, self defeating behavior and constructive

behavior, and to cope with irrational thoughts, this is all in this step.

6. Change and recovery planning

Recovery planning involves the development of a schedule of recovery activities that

will help patients recognize and manage warning signs as they occur in sobriety. (A

recovery plan is a schedule of activities that puts relapsers into regular contact with

people who will help them to avoid drug use, they must stay sober by working the

twelve step program (which are given in the up coming pages) and attending relapse

prevention support groups that teach them to recognize and manage relapse warning

signs)50

.

7. Awareness and inventory training

Inventory training teaches relapse-prone patients to do daily inventories that monitor

compliance with their recovery program and check for the development of relapse

warning signs. (Most relapsers find it helpful to get in the habit of doing a morning

and evening inventory. The goal of the morning inventory is to prepare to recognize

and manage warning signs. The goal of the evening inventory is to review progress

and problems. This allows relapse to stay anticipate high risk situations and monitor

for relapse51

).

8. Family involvement

Relapse-prone individuals need the help of others during the process of recovery.

Treatment should ensure that others (e.g., family members, 12-step sponsors,

supportive peers) are involved in the recovery. (A supportive family can make the

difference between recovery and relapse. So we can work together to avoid future

relapse. Family must be prepared to take fast and decisive action if we return to

chemical use. We can work out in advance, when we are in sober state of mind)52

.

50

Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager Dost Welfare Foundation 51

ibid 52

ibid


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9. Follow-up Programme: -----Maintenance and relapse prevention plan updating

Ongoing outpatient treatment is necessary for effective relapse prevention. Even highly

effective short-term inpatient or primary outpatient programs will be unable to interrupt

long-term relapse cycles without the ongoing reinforcement of some type of outpatient

therapy. A relapse prevention plan update session may involve:

a review of the original assessment, warning sign list, management strategies, and

recovery plan;

an update of the assessment by adding as an addendum any documents that are

significant to the patient's progress or problems since the previous update;

a revision of the relapse warning sign list to incorporate new warning signs that

have developed since the previous update;

the development of management strategies for the newly identified warning signs;

and

a revision of the recovery program to add recovery activities, to address the new

warning signs, and to eliminate activities that are no longer needed.

Our warning signs will change as we progress in recovery. Each stage of recovery has

unique warning signs. To deal with warning signs at one stage is different at the next

stage. Our relapse prevention plan needs to be updated, monthly for the first three

months, quarterly for the first two years, and annually thereafter53

.

CONCLUSION

Chemical addiction is a disease, and, like many diseases, there is always the possibility of

relapse. The process of AOD abuse is complex, and is impacted by social, clinical, and

medical factors. The solutions to the problem of chemical addiction are multi-faceted.

Treatment strategies benefit from a relapse prevention component in virtually every case. In

order for relapse prevention to work, agencies and systems must cooperate and communicate

in their search for the best means of successfully intervening with substance abusing patients.

53

ibid


Imran Ahmad [66]

The post treatment phase in which the treated clients are being followed for their current

status

► Center based

The clients are advised to come to the center twice a week. A group NA is conducted

► Community based

Other means

► Telephone

► Email

► Letter

Relapse is recurring problem

Strengthening of recovery

Lessening in codependence

Decrease in crimes

Increase in productivity

Role modeling

Value of norms

Drug free environment

Establish healthy community

► Center

► Family

► Clients

► Community workers

Why follow up?

Means of follow up

FOLLOW UP/AFTER CARE

Who are responsible to carry out the follow up

services?


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DOST PROGRAMMES

& ACTIVITIES

In brief

CHAPTER NO. 10


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DOST PROGRAMME ----

IN BRIEF

HARM REDUCTION AND SOCIAL SERVICES

The focus of harm reduction and social services is to reduce drug use and drug related harm

among the drug users and provide them with hope for a new life. These services are being

provided through Street Outreach Program and Drop-in Centers (DICs) since 1994.

Most of the staff involved in the provision of these services are ex-drug users who have been

treated and trained by DOST. The DICs are situated in different locations in Peshawar and

Kohat. These are:

Dar-us-Salam DIC, Sikandar Town, Peshawar city

Dar-ul-Shifa DIC, Industrial Estate Hayatabad, Peshawar

Dar-ul-Shifa DIC, Shino Khel, Kohat

1) Street Outreach Program

Street Outreach harm reduction and social services are being provided to street drug users in

various street locations of Peshawar and Charsadda districts. Three street mobile teams

contact 200-250 drug users daily at various street sites and provide them with:

Motivational counseling

Health education

First aid

social support

Encouragement to attend Drop-in centers.


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2) Drop-in Centers

Drop-in Centers, operational in two different locations of Peshawar, are attended by 80 to 100

street drug users daily, where they are provided with Detoxification and other outpatient harm

reduction and social services including:

Registration

Counseling

Motivation

Therapeutic sessions

Medical care

Health education

Food & clothing

Recreation Bathing and washing facilities.

Goals are set for drug users the achievement of which guarantees their admission in TCs for

rehabilitation.

DRUG ABUSE PREVENTION PROGRAMS

Primary Prevention Programs

Since 1993, DOST is conducting various drug abuse prevention and early intervention

activities for different community groups. In these programs special focus has remained on

youth. The drug abuse prevention programs of DOST include:

Community meetings

Awareness sessions

One-day seminars

Training workshops

Formation of anti-drug self-help groups

Training and follow-up of self-help groups


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Drug abuse prevention activities are conducted in various community settings i.e. schools,

colleges, universities, mosques, work places etc.

Drug abuse prevention activities also serve the purpose of:

Early identification of drug use

Motivation and referrals for intervention

Treatment Plan

ADMISSION

1. Initial interview

2. Admission form filling

DETOXIFICATION 1 – 15

DAYS – PRIMARY

REHABILITATION, 16-30Days

1. Primary Rehabilitation 5 – 60 days

2. Lectures, groups, seminars, family groups

sessions etc.

3. Life history 16th

day

4. Detail history form filling 20th

day

5. Individual treatment plan 23rd

day

6. Treatment duties

7. VR (Vocational Rehabilitational) form filling

30th

day

8. Basic vocational skill development

9. Peer evaluation 45th

day


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SECONDARY

REHABILITATION 60 – 90

DAYS

1. Lectures, groups, seminars, visits

2. Re-evaluation of P.E. 60th

day

3. Advanced vocational training 85th

day

4. FOG (Future Orientation Group)

5. discharge 90th

day

Faith Based Project 11 Steps

1. Foundation: Total Submission, Acceptance of Powerlessness and unmanageability

2. Hope: Restoration of Sanity by greater power

3. Faith and Surrender: Divine Power

4. Self Analysis: Admitted character defects

5. Sharing an Confession: Ready for Help

6. Start to Change: ask for help

7. Social interaction: list of whom we harmed

8. Social interaction: make amends

9. Preserve in positive change

10. Spirituality: prayers and meditation

11. Help others: carry the message


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12 Steps

1. We admitted that we were powerless over our addiction. That our lives have become

unmanageable

2. We came to believe that A power greater then our selves could restore us to sanity

3. We made a decision to turn our will and our lives over to the care of God as we

understood him

4. We made a searching and fearless moral inventory of ourselves

5. We admitted to God, to ourselves, and to another human being the exact nature of our

wrongs

6. We were entirely ready to have God remove all these defects of character

7. We humbly ask Him to remove our shortcomings

8. We made a list of all persons we had harmed and become willing to make amends to

them all

9. We made direct amend to such people wherever possible except when to do so would

injure them or others

10. We continue to take personal inventory and when we were wrong promptly admitted

it

11. We sought through prayers and meditation to improve our conscious contact with God

as we understood Him, praying only for knowledge of His will for us and the power

to carry out

12. Having had a spiritual awakening as a result of these steps, we tried to carry this

message to addicts and to practice these principles in all our affairs.


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SUGGESTIONS &

RECOMMENDATIONS

For Dost and Department of

Social Work

CHAPTER NO. 11


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SUGGESTIONS AND

RECOMMENDATIONS

Dost Welfare Foundation

Dost welfare foundation is providing a comprehensive treatment for the drug addicts in

Peshawar, not only for Peshawar‘s but for all human beings. The Dost TC in which our group

was on field work, is situated in Hayatabad Phase 5. This is the main Therapeutic Community

of Dost Welfare Foundation.

The overall staff of Dost is very much co-operative. They work with us with a great care and

we learnt a lot here.

The lectures delivered by Sir. Naeem Asif, the Centre Manager, help us in clarifying our

concept about Addiction and Drug Addiction and other related phenomena. Although over all

time spent there was good, and the method they offer for patients treatment(90 days treatment

plan) is very effective. If someone follow this method completely then there are 80 %

chances for his recovery. Where as the same treatment offered in Germany takes 1 year time

period with 10 % chances of recovery.

Although every thing goes in favour of Dost Welfare Foundation yet there are some areas

which needs to be further improved. Some suggestions and recommendations regarding them

are as following:

Although students at field work are taught well but their practical work is not

sufficient to give them experience. The emphasis in field works must be put on their

practical involvement in treatment or RPP at least.

Counseling is an art and a very effective tool for social worker in his profession and it

can only be learnt through practical experience. Field work is an opportunity for the

social workers to gain that experience but during our field work we haven‘t learnt that

experience. I am sorry to say but, we didn‘t know about a, b, c, of counseling.


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Therapeutic Communities like the main TC of DOST should be established in other

places of the province, because the strength of Addiction is far greater then the Main

TC to support it. The capacity of main TC is 80 patients at a time while we can see

drug and substance addicts laying beside the Main gait of University of Peshawar.

Suggestions for Department of Social Work

I thought it important to recommend at this point some suggestions for my own department

officials.

The field work director or supervisor should have regular visits of the Field Work Agencies

in order to improve the attendance of the students on their field. Because I have seen that

most of the students consider field work a burden on their studies when field work is such an

important activity for social workers.

The students should be guided about their field activities before sending them to the agency

so that they know what they have to accomplish there as a trainee.

Last Words

There may be or could be a lots of suggestions for improvement in field work placement and

for Dost welfare foundation but I am contending on the above mentioned as my field work

report is moving out of the boundaries.


Imran Ahmad [0]

ROLE OF SOCIAL

WORKER

In the treatment plane

CHAPTER NO. 12


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Role of Social Worker

Most of the diseases of the world has a medical solution or medical cure but there are some

diseases which could not be cured through medicines alone. Drug addiction is one of those

diseases which could not be cured through medicines only. It need a societal solution, a

spiritual solution, a psychological solution i.e. we need a whole treatment plane composed of

different therapeutic techniques, behavior modification tools, counseling plus medication etc.

We have mentioned it before that the whole treatment plan for drug addicts is divided into

three 3 phases

1. Pre-treatment phase

2. Treatment phase

3. Post-treatment phase

In each and every phase we need a whole team of professional for planning. We need

psychologists, we need counselors, we need social workers, we need family, we need his

friends and peer support etc. social worker is one amongst the team members with

professional skills and trainings. He has already studied about the drugs, its effects, addiction

and how to contribute in its treatment plane.

We, here now, are to find out where and how social worker can play, and is playing, his role

in each phase. Let us see below;

Pre-treatment / Awareness Phase

________________________________________

What can social worker do in the awareness phase? It is the duty of social worker to create

awareness among young people, particularly students and parents as well. He explains the

dark effects of drugs to the younger one and shows the symptoms of an addict to the parents.

We mentioned that in pre-treatment phase there is the beginning of change in drug addict. It

is the duty of the social worker to go to the street patients and conduct counseling sessions

with them. The social worker has to motivate him. As social worker is aware of the society


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and how does it work, and he is aware of the human growth and development so therefore

due to these specialties it is his job to create awareness and to start a beginning of change.

Treatment Phase

________________________________________

After detoxification and medicated prevention, the real work of the social workers begins.

When the client becomes conscious of his environment i.e. when the poison is removed from

his body, social worker interviews the patient. The aim of the 1st interview is to get

information about the client. He tries to find out what were the causes which lead him for

addiction. He asks the client of his past. He also tries to find out the potentials, capabilities,

weaknesses and limitations of the client. He looks for the resources i.e. his family, friends

and other resources. We have a 10 pages questionnaire to be filled in order to asses the clients

life history.

Now when social worker has a complete study of the case, and has sufficient knowledge

about the client and his problem, he then diagnoses him. He looks for the alternatives so that

his client spends his leisure time in those activities. In the diagnosis stage, the actual causes

which lead the client to addiction is find out.

An action plane is made for the client. He is given different counseling in individual and

group form. He explains to his patient his qualities and capabilities. He creates a sense of

worth in the client. He tells him about his importance.

The social worker sits in the morning meetings; he sits in behavior management tools

implications. Social worker meets with the family etc.

Post treatment / Rehabilitation phase

________________________________________

When the client is ready to go back to his home, social worker helps the patient and his

family to understand each other. The patient after treatment is no more addicted. He is now a

normal person. The family should accept him as a normal human being.


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The patients who are in need of financial assistance in the rehabilitation process, social

worker also help them to overcome this problem.

social worker provide good environment to the patient who is being rehabilitated. So that he

may not indulge into the addiction again.

Different technical skills are taught to the patients. So that they may be able to get a job for

themselves or start their own business. Religious therapies can be given in the masques

through the imam.

The social worker has to build a support system for the patient in the community.

Why?

So that the patient may not relapse to addiction again. For this purpose he involves his family,

his friends, his near ones etc in meetings and tell them how to behave with the client now.

The social worker visits his home and community and he could tell his villagers that how

they have to look at him now.

The role of the social worker in drug abuse treatment and rehabilitation is a big one and if I

started to right all of them then a whole book, or may be so many versions of the book could

be written on him. So therefore we will limit ourselves to the above information as this report

is stepping out of the boundaries.


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CASE HISTORIES

Two patients life stories

CHAPTER NO. 13


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CASE HISTORIES

Case No. 1

Personal Information

Client Name: Sarfaraz Khan S/O: Musafar Khan

Ethnicity: Shinwari

Age: 32 years Education: Nil

Siblings: 9, 3 sisters and 6 brothers Clients Birth Order: 2nd

Marital Status: Single Profession: Nan-Bai

DOC: Chars + Heroin Period of Addiction: started from 11 year of age

Period in TC: 40th

day

Parents: Alive financial Support: Family, Father

Address: Kohat Road

Life Story:

The client (Srfaraz) has started drug addiction in a very young age. He use to go to school but

when he was in class 2nd

he become a truant and he joined a group of addicts students. First

he started from cigarette and then gradual proceeded to other dangerous substances. Due to

his addiction habit he left the school in class two and now he has no ability to read or write.

How you have come to treatment:

According to him he is self motivated for treatment and he has come through Dar_ul_Shafa

TC in Industrial State Hayatabad.

How many years of schooling

2 years

Ability to read

no

Do you have professional trade or skill? Usual occupation

Yes, I m a good NAN BAI. (who cock breads) and this is my usual occupation

Does any one contribute to you financially?

Yes my family


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Have you ever been arrested? If yes then for how much time you were jailed?

Yes 2 times I have been arrested for 3 nights.

Have you ever been engaged in illegal activities?

yes

Do you have any resentment from any one in the family?

no

Have your tolerance increased or decreased?

Decreased

Have you ever used to

Avoid problem y

Kill pain y

Avoid reality y

Sleep n

Enjoyment y

Feel peace y

Reduce stress y

In the morning n

Have you ever tried to

Reduce DOC intake y

Change to milder drug y

Use medicines instead n

Use more than anticipated n

Control DOC and use anyway y

Because of your chemical dependency have you ever felt the following

Suicide y

Guilt y

Shame y

Anger y

Angry when asked y

Not to use y


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Sorry for using y

Mental torture y

After dost treatment will you

Attend NA Meetings y

Have a sponsor n

Follow the 12 steps y

Attend RPP y

Are you hopeful for this treatment?

Yes

Remarks: Sarfaraz is now in the rehabilitation phase of treatment and he seem to be

overcoming his addictive habit. According his staff he will overcome soon and his relapse

chances are very few.


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Case No. 2

Personal Information

Client Name: M. Ramzan S/O: M. Saeed

Ethnicity: Jondal

Age: 38 years Education: Nil

Marital Status: Married Children: 6, 3 sons and 3 daughters

DOC: Chars + Heroin Period of Addiction: 25 years

Period in TC: 17th

day Financial Support: Family

Address: Gondal Attock

Life Story:

According to the client (Ramzan) he has started from using Naswar when he was a child in

Karachi and used to be a Condector with a mini bus. But slowly and gradually he proceeded

to other dangerous drugs

How you have come to treatment:

According to him he is self motivated for treatment.

How many years of schooling

1 years

Ability to read

no

Do you have professional trade or skill? Usual occupation

no but we have our own family farm lands which support us financially

Does any one contribute to you financially?

Yes my family

Have you ever been arrested? If yes then for how much time you were jailed?

No

Have you ever been engaged in illegal activities?

yes

Do you have any resentment from any one in the family?


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Yes my wife

Have your tolerance increased or decreased?

Decreased

Have you ever used to

Avoid problem y

Kill pain y

Avoid reality y

Sleep y

Enjoyment y

Feel peace y

Reduce stress y

In the morning n

Have you ever tried to

Reduce DOC intake y

Change to milder drug y

Use medicines instead n

Use more than anticipated n

Control DOC and use anyway y

Because of your chemical dependency have you ever felt the following

Guilt y

Shame y

Anger y

Angry when asked y

Not to use y

Sorry for using y

Mental torture y

After dost treatment will you

Attend NA Meetings y

Have a sponsor n


Imran Ahmad [82]

Follow the 12 steps y

Attend RPP y

Are you hopeful for this treatment?

yes

Remarks: Ramzan is in his first phase of treatment. But he seem to be not happy of living

in TC and want to go home. He thought he is well now but his relapse chances are very

greater. He should have a complete time spent here in DOST TC.


Imran Ahmad [0]

REFERENCES


Imran Ahmad [83]

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1. 1 Ray, O. Ksir, C. (2002). Drug, Society, and Human Behavior. 9

th Ed. New York.

McGraw-Hill Companies Inc. P. 3

2. 1 Amirzada (2007) Fields and Services of Social Work; Lecture Delivered to the MA final

evening class. Peshawar. Department of Social Work, University of Peshawar

3. 1 Ray, O. Ksir, C. (2002) Opt Cit. P. 7

4. 1 Introduction. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation. Thursday,

November 22, 2007 <http://www.dost.sdnpk.org/Introduction.htm >

5. 1 Brekhna (2007). Lecture to the students of final year. Peshawar. HRD Manager Dost

Welfare Foundation Peshawar

6. 1Mission Statement. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation.

Thursday, November 22, 2007 <http://www.dost.sdnpk.org/ >

7. 1 Sara Safder (2007) Lecture for the student of MA previous evening. Peshawar.

Department of Social Work University of Peshawar

8. 1 ―Drug‖ Wikipedia, Wikipedia the free encyclopedia Saturday, June 30, 2007 Wikipedia

foundation Inc. <http://en.wikipedia.org/wiki/Drug>

9. 1 Ray, O. Ksir, C. (2002) Opt Cit. Pp. 44-45

10. 1 Ibid. p. 5

11. 1 Khalid. M, ―Social Work Theory and Practice‖ 3rd Edition, Kifayat Academy, Karachi.

pp. 1-310

12. 1 Ray. O & Ksir. C, ―Drugs, Society, and Human Behavior‖, 9th edition, McGraw-Hill

Companies Inc. pp 4-81

13. 1 Imran Ahmad (2007). Social Work with Drug Addicts; Assignment. Department of

Social Work UOP

14. 1 Ray, O. Ksir, C. (2002) Opt Cit. P. 5

15. 1 ibid. Pp. 45-46

16. 1 Naeem. A. (2008).Notes for Social Work Student. Peshawar. Unpublished notes of The

Center Manager, Dost Welfare Foundation

http://www.dost.sdnpk.org/Introduction.htm

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Imran Ahmad [84]

17. 1 Hewitt, Brenda G., and Gordis, Enoch. "Alcoholism." Microsoft® Encarta® 2006

[DVD]. Redmond, WA: Microsoft Corporation, 2005.

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20. 1 ―Opium." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,

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2nd

Ed, P\Karachi: Kifayat Academy. Pp. 308-309

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2005.

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32. 1 ―Katamine‖, Wikipedia the Free Encyclopedia. Wikipedia Foundation Inc. April, 03,

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33. 1 Berger, Philip A. "Lysergic Acid Diethylamide." Microsoft® Student 2008 [DVD]. Redmond, WA:


http://en.wikipedia.org/wiki/Ketamine


Imran Ahmad [85]

34. 1 Compto, B. Galawa. Introduction to Social Work and Social Welfare . McGrawHill

Publications

35. 1 Naeem. A (2007). Lecture for Social Work Students. Peshawar, Lecture Delivered by

Center Manager Dost Welfare Foundation, 07-12-2007

36. 1 “Treatment Programme” Treatment Programme for Drug Users (2003). Dost Welfare

Foundation Thursday, November 22, 2007, <http://www.dost.sdnpk.org/Programmes.htm

>

37. 1 ibid

38. 1 Naeem. A (2008). Counseling Notes . Peshawar, Notes of The Center Manager Dost

Welfare Foundation

39. 1 ―what is counseling‖, Education: British Association for Counseling and

Psychotherapy, May 10, 2007, British Association for Counselling and Psychotherapy,

BACP House, Unit 15 St John's Business Park, Lutterworth, Leicestershire LE17 4HB <

http://www.bacp.co.uk/education/whatiscounselling.html>

40. 1 ―Living with Cancer, What is Counseling‖(2007). Cancer Research UK. Cancer

Research UK 2002. May 01, 2007, <

http://www.cancerhelp.org.uk/help/default.asp?page=214&order=2252>

41. 1 ibid

42. 1 ibid

43. 1 Naeem. A. (2008). Behavior Management Tool (Day Top New York). Peshawar. Notes

provided by The Center Manager Dost Welfare Foundation

44. 1 ―Relapse prevention & Drug Addiction”. (2008) When sobriety is priority. March 26,

2008, <http://www.relapse-prevention.org/user-news.htm?id=163>

45. 1 Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager


46. 1 Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager


47. 1 ibid

48. 1 ibid

49. 1 ibid

http://www.dost.sdnpk.org/Programmes.htm





Imran Ahmad [86]

Bibliography

1. Ray. O & Ksir. C, ―Drugs, Society, and Human Behavior‖, 9th

edition, McGraw-

Hill Companies Inc.

2. Khalid. M, ―Social Work Theory and Practice‖ 3rd

Edition, Kifayat Academy,

Lahore-Karachi.

3. Compton & Galaway, ―Social Work Process‖, The Dorsey Press, Georgetown-

Ontario

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Manager, Dost Welfare Foundation

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2007, British Association for Counselling and Psychotherapy, BACP House, Unit 15 St John's

Business Park, Lutterworth, Leicestershire LE17 4HB <

http://www.bacp.co.uk/education/whatiscounselling.html>

7. 1 ―Living with Cancer, What is Counseling‖(2007). Cancer Research UK. Cancer Research UK

2002. May 01, 2007, < http://www.cancerhelp.org.uk/help/default.asp?page=214&order=2252>

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<http://www.relapse-prevention.org/user-news.htm?id=163>

9. Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

10. Wikipedia the Free Encyclopedia. Wikipedia Foundation Inc. April, 03, 2008

http://en.wikipedia.org/wiki/

11. Britanica Encyclopedia Britanica Ultimate Reference Suit2008 [DVD]




http://en.wikipedia.org/wiki/


Imran Ahmad [87]

Addiction is not a Crime,

It’s a Treatable Illness.

Addicted People are Not Criminals

Who Need to be Punished,

They are Sick People Who Need to get

Well.


Imran Ahmad [0]

Documents

Drug Addiction Treatment and Rehabilitation-Imran Ahmad Sajid