FIELD WORK REPORT

The Role Of Dost Welfare Foundation in Rehabilitation of Drug Addicts

Sher Zada M.A Sociology (Final) Session 2010-12

Institute Of Social Work, Sociology and Gender Studies (ISSG) University of Peshawar
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APPROVAL SHEET Submitted for approval to

Dr.Anwar Alam; __________________________________ The Supervisor

Prof.Dr Johar Ali; _________________________________ Director ISSG

External Examiner; ________________________________

Institute of Social work, Sociology and Gender studies (ISSG) University of Peshawar
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TABLE OF CONTENTS CHAPTER CONTENTS List of tables Acknowledgment PAGE NO iv v 1 1 1 2 3 5 5 7 7 10 10 10 10 10 11 11 12 14 15 15

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INTRODUCTION
1.1 Drug 1.2 Definitions of drug 1.3 History of drug 1.4 Drugs in Pakistan 1.5 Drug abuse and Drug addiction 1.6 Drug types 1.7 Reasons of Drug addictions 1.8 Treatment Approaches

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ORGANIZATIONAL PROFILE
2.1 History 2.2 Mission 2.3 Areas of focus 2.4 Partners 2.5 The working staff at DOST Foundation 2.6 Team and services 2.7 Dost programs for the rehabilitation of drug addicts 2.8 Drop-in center and outreach services for street drug addicts in Peshawar 2.9 faith-based drug demand reduction services in FATA regions of Pakistan 2.10 drug demand reduction services and strengthening local community organizations in Afghanistan 2.11 community-based drug demand reduction center, Khazana 2.12 HIV awareness and voluntary counseling testing Services for drugs addicts 2.13 fieldwork and internship program for University students and graduates 2.14 Training programs for national and international government organization and NGOs 2.15 Programs utilized for the rehabilitation of drug addicted patients 2.16 Treatment procedures for the resident drug addicts at Dost foundation TC’s
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16 17 17 18 19 20

2.17 Components of morning meeting

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FIELD WORK DESIGN
3.1 Tile 3.2 Scope 3.3 Purpose 3.4 Objectives 3.5 Universe 3.6 Methodology 3.7 Tools 3.8 Duration of the study

23 25 25 25 25 25 25 25 25 25 26 26 26 28 28 29 30

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CASE HISTORY
4.1 Case histories at Shahi Bala 4.2 Case histories at Guloona Koor at Haji camp

5

CONCLUSION OF THE FIELD WORK REPORT
5.1 conclusion 5.2 Recommendations /Suggestions

BIBLIOGRAPHY

iii

LIST OF TABLES NO
1 2 3 4 5 6 7 8 9 10 11

CONTENTS OF THE TABLE Summary for Sakoon Kor-I Summary for Sakoon Kor-II Summary for Sakoon Kor-III Summary for Sakoon Kor-IV Summary of achievements drop-in center and outreach services for street Drug addicts in Peshawar Summary of achievements faith-based drug demand reduction services in FATA regions of Pakistan Summary of achievements drug demand reduction services and strengthening local community organizations in Afghanistan Summary of achievements community-based drug demand reduction center, Khazana Summary of achievements HIV awareness and voluntary counseling testing Services for drugs addicts Summary of achievements fieldwork and internship program for University students and graduates Summary of achievements Training program for national and International government organizations and NGOs

PAGE NO.
13 13 13 14 14 15 16 16 17 18 18

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ACKNOWLEDGMENT First of all I am very thankful to Allah Almighty who bestowed me with the opportunity to do my master degree in sociology at university of Peshawar, and enabled me to successfully complete my field work report. Though it was really a tough job, but as Dr. Anwar Alam supervised and guided me at every stage, I am. Very thankful to him who arranged this field work activity for exploring our theoretical knowledge into practical form. I am very thankful to Dr.Johar Ali Director of Institute of Social Work, Sociology and Gender studies (ISSG).I present my gratitude to Mr.Shams-ud-Din VRC at Shahi Bala who briefed about DOST programs and gave me visits of the treatment center. I also recognize the welcoming attitude of Mr.Azmat Ullah Focal person at Guloona Kor Haji camp who guided me about the field work procedures. I appreciate the cooperation from my group members who give me a funny company while visiting the field sites. Specially I am very thankful to Atta-ur-Rehman,Noor Ahmen,Sahir Ullah and Zahid Akrm who guided me when I got any difficulty. I am very thankful for the support of my parents that are looking for my bright future.

Sher zada

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CHAPTER NO 1 INTRODUCTION
1.1 DRUG Long before the first towns were built, before written language was invented, and even before plants were cultivated for food, the basic human desires to relieve pain and prolong life fueled the search for medicines. No one knows for sure what the earliest humans did to treat their ailments, but they probably sought cures in the plants, animals, and minerals around them. (Chapter 3: Drugs From Nature, , 2011) 1.2 DEFINITIONS OF DRUG Drug is very wider term and that can be used for both medicinal and non-medicinal purposes. Drug problem or drug abuse is really a short hand for socially disapproved. (Mir, 1997) The very word “drug” means different things for different people. For some people, drugs are those substances, which are illegal and socially disapproved of associated with stereotypes images of “junkies” or solvent snuffers and not wish every day substances that ordinary people use, on other hand manly people increasingly refer to all medicinal preparations as drugs. One useful definition suggest that, drug is a substances which, when introduced to the body, alters the structure or function of the organism. (Dixon,1987). Weiss man has pointed out that “drug is any substance (other than food) which by its chemical nature affects the structure or functioning of living organism”. (1978). According to oxford English dictionary “A substance which when swallowed, inhaled or human body induces drowsiness, sleep and insensibility according to its potency and amount taken”. (Murry,1978).

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In the sociological literature drug as a term, has become synonymous with illicit or socially concerned substance. It other words, it is not the substance itself, rather it is the use or the purpose and the methods of its use which confers upon it the little for its classification either as a “drug” or otherwise (such as medicine) (Ashraf 1987). (Ramzan, 2007) After all defined definitions by some authors, what is a drug? One narrow definition comes up that a drug is a substance, which may be used both in positive (for curing purposes) and negative (for intoxication purposes) ways. 1.3 HISTORY OF DRUG The more we discover about how early civilizations lived the more we find out about early drug use. It is easy to believe that drug use is a modern phenomenon starting with the hippy culture of the 1960s or alternately the earlier beat generation of the 50s and early 60s. However, this would be quite wrong. Humans have used drugs for millennium. In respect of early drug use one of the earliest records of naturally occurring drugs and their medicinal use comes from China. The scholar emperor Shen Nung who lived around 2700 BC compiled a pharmacopoeia (book of medicines) listing all the known drugs and the use that they may have. One of the remedies listed was a plant called Ch’ang Shan, which was effective for fevers. Nearly 5000 years later American scientists used this same plant as the basis for the synthesized anti-malarial medication for the troops fighting in the pacific during World War II. Shen Nung also identified another plant called Ma Huang, which had a stimulant effect. Japanese chemists have isolated the active ingredient, which is ephedrine. So at least in China, although presumably elsewhere, there would appear to have been not only early drug use but also a relatively sophisticated knowledge of drugs and their uses as far back as 5000 years ago. The knowledge gained for this early drug use was almost certainly through trial and error. The nature of this early drug use is unclear, but it was probably not too different from the way drugs are used today. For example just as we do today, early civilizations used drugs as medicines, as part of religious ceremonies and for recreation, as well as other purposes. Historically psychoactive drugs have been important for many religions. The role of the Shaman
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(wise man/woman) has been, in some cultures, inextricably linked with the use of hallucinogenic that allowed contact to be made with spirits or deities. For example the South American Indians used the hallucinogenic properties of the distilled cactus peyote in their rituals to enter the presence of the great god Peyote. This, they believed would allow them to see and speak to the god and receive guidance for themselves and the tribe. It is believed that other shaman who reported that they turned into animals during rituals were in fact under the influence of hallucinogenic drugs. Thus drug use, for some, could be regarded as being a sacred activity. Some commentators have suggested that, quite apart from any pleasurable affects that might accrue, the use of drugs in this way brought power and status to the user as it brought both a mystique and legitimacy to their activities. This way of using drugs is not found only in the early drug use of ancient civilizations but instead some societies continue these traditions today. An obvious example would be practitioners of the increasingly popular Shamanism or some Native American religious traditions. Indeed in June 2004 the Utah Supreme Court ruled that non-American Indian members of the Native American Church can use peyote as part of their religious ceremonies. However the religious use of psychoactive substances can be found in more mainstream religions and in modern times, witness the use of alcohol in Judo/Christian religions. Across the various denominations the use of wine varies from the purely symbolic or commemorative of the last supper to the mystical (trans-substantiation). As with other shaman and priests, the enactment of the rites brings power and/or status to the practitioner (McMahon) 1.4 DRUGS IN PAKISTAN Pakistan's geographic location next to Afghanistan, the world's largest producer of illicit opium, places the country in a vulnerable position in terms of drug trafficking as well as drug abuse. Patterns of illicit drug production, distribution and abuse change as a result of social, economic and political developments. Narcotics have become a multiple challenge to law enforcement authorities. In the late 1980s, Pakistan and Afghanistan exported nearly half the world's heroin, and, although their relative share declined somewhat thereafter, they remain among the world's major producers. Pakistan,
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especially under United States prodding, has attempted to cut back the cultivation of poppies, but the government's influence has not extended effectively into tribal areas. In addition, various political and economic forces have been brought to bear to keep narcotics police from pursuing their work too assiduously. Pakistan's cultivation of opium poppy largely declined during the 1990's to near zero levels in 1999 and 2000. The commitment of the Government of Pakistan (GOP) to measures for eliminating opium poppy cultivation, together with alternative development projects funded by the international community, led to a decrease in poppy cultivation from approximately 9,441 acres.in 1992 to some 213 acres In 2001 however, there was a reemergence of poppy cultivation, probably as a result of high opium prices following the Taliban's prohibition of poppy cultivation in Afghanistan in 2001. In 2003 poppy cultivation was reported at 6,703 hectors, including for the first time cultivation in the Balochistan Province. The total area cultivated declined to 2,306 hectors, By May2007 as a result of concerted eradication efforts. Pakistan is one of the primary transit countries for drugs from Afghanistan and hence knowledge of new routes and evolving methods of drug trafficking is essential for successful interdiction. In 2007, law enforcement agencies seized 13,736 kg of heroin/morphine base, 101,069 kg of cannabis and 15,362 kg of opium (down from the 2006 seizures of 35,478 kg of heroin heroin/morphine base and 115,443 kg of cannabis and up from the 2006 opium seizures of 8,907 kg). Intelligence on groups involved in drug trafficking and their links to other crime groups is also key to controlling drug trafficking. The problematic areas in terms of poppy cultivation are largely concentrated in the Federally Administered Tribal Areas (FATA). Concerns about losing community acquiescence in counter terrorism operations and a lack of available security forces due to ongoing counter terrorism operations in the Pakistan-Afghanistan border areas are factors that hamper the eradication efforts in FATA. Eradication efforts need to be improved, particularly in Khyber Agency where there is a trend towards cultivation within walled compounds to conceal the crop from the authorities.(Drugs in Pakistan)

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1.5 DRUG ABUSE AND DRUG ADDICTION The terms "drug abuse" and "drug addiction" are often used interchangeably, but in fact, they denote very different conditions. The term "drug abuse" refers to the use of a substance in a manner that deviates from the culturally acceptable norms, while the term "drug addiction" describes a disorder where the drug appears to be the dominant influence on the individual's behavior. More specially, drug addiction is behavioral syndrome where the individual’s motivation is dominated by the procurement and use of a drug and where the normal constraints on the individual’s behavior are largely ineffective. (Bozarth, 2009) 1.6 DRUG TYPES I. STIMULANTS

These drugs speed up the body’s nervous system and create a feeling of energy. They are also called “uppers” because of their ability to make you feel very awake. Stimulants have the opposite effect of depressants. When the effects of a stimulant wear off, the user is typically left with feelings of sickness and a loss of energy. Constant use of such drugs can have very negative effects on the user. In order to prevent extreme negative side effects of these drugs and the impact they have on life, drug treatment centers are often recommended Drugs including      II. Cocaine Methamphetamines Amphetamines Ritalin Cyclert DEPRESSANTS

Depressants slow down activity in the central nervous system of your body. These drugs are also called “downers” because they slow the body down and seem to give feelings of relaxation. Depressants are available as prescription drugs to relieve stress and anger, although drowsiness is
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often a side effect. The “relaxation” felt from these drugs is not a healthy feeling for the body to experience, to stop abuse of this drug, drug treatment is suggested. Drugs including
      

Barbiturates Benzodiazepines Flunitrazepam GHB (Gamma-hydroxybutyrate) Methaqualone Alcohol Tranquillizers HALLUCINOGENS

III.

When taking hallucinogens, switching emotions is frequent. These drugs change the mind and cause the appearance of things that are not really there. Hallucinogens affect the body’s selfcontrol, such as speech and movement, and often bring about hostility. Other negative side effects of these drugs include heart failure, increased heart rate, higher blood pressure and changes in the body’s hormones Drugs including
    

LSD (lysergic acid diethylamide) Mescaline Psilocybin Cannabis Magic Mushrooms INHALANTS

IV.

Inhalants are sniffed or huffed and give the user immediate results. Unfortunately, these immediate results can also result in sudden mental damage. When inhalants are taken, the body becomes deprived of oxygen, causing a rapid heartbeat. Other effects include liver, lung and kidney problems, affected sense of smell, difficulty walking and confusion.
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Drugs including:
    

Glues Paint thinner Gasoline Laughing gas Aerosol sprays CANNABINOIDS

V.

These drugs result in feelings of euphoria, cause confusion and memory problems, anxiety, a higher heart rate, as well as staggering and poor reaction time. Drugs including:
 

Hashish Marijuana

(Palmera) 1.7 REASON OF DRUG ABUSE AND ADDICTION People abuse drugs for many different reasons. Some people use drugs because of peer pressure. Some may think that they might be immune and the effects of drugs won’t affect them. When some people are stressed and need something to get them past their problems they may take drugs. Others might take drugs just for a thrill or just curiosity. Once people get caught on drugs they usually become dependent. When people take drugs it over stimulates the reward path on the brain causing them to become dependent. (TQ0310171, 2003) 1.8 TREATMENT APPROACHES FOR THE REHABILITATION OF DRUG ADDICTS a) MEDICATION Medication can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treatment stimulants (cocaine,
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methamphetamine) and cannabis (marijuana) addiction. Most people with serve addiction problems, however, are poly drug users (users of more than one drug) and will require treatment for all of the substances that they abuse. Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted detoxification is not in itself “treatment” it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated. b) BEHAVIORAL TREATMENT Behavioral treatment help patients engage in the treatment process, modify their attitudes and behavior related to drug abuse, and increase healthy like skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioral approaches. A variety of programs are used for the treatment of those drug patients who visit the treatment clinic on regular intervals some of these are following. Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some pragmas also offer other forms of behavioral treatment pragmas like;  Cognitive-behavioral therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.  Multidimensional family, which was develop for adolescents with drug abuse problems as well as their families, addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.  Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.  Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

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c) RESIDENTIAL TREATMENT These programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structure programs in which patients remain at a residence, typically for 6 to 12 months. TCs differ from other treatment approached principally in their use of the community treatment staff and those in recovery as a key agent of change to influence patient attitudes, perceptions, and behaviors associated with drug use. Patients in TCs may include those with relatively long histories of drug abdication, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the re-socialization of the patient to a drug-free, crime-free lifestyle. d) TREATMENT WITHIN THE CRIMINAL JUSTICE SYSTEM Treatment in a criminal justice setting can succeed in preventing an offender’s return to criminal behavior, particularly when treatment continues as the person transition back into the community. Studies show that treatment does not need to be voluntary to be effective (Treatment Approaches).

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CHAPTER NO 2 DOST WELFARE FOUNDATION 2.1 HISTORY
Dost Welfare Foundation (DOST) commenced its journey in July 1992 in Peshawar, in the Khyber Pakthun Khwa(KPK) Pakistan. DOST which means "friend", reaches out with a message of hope and healing to these unfortunate human beings- drug addicts, street children, prisoners, refugees, destitute women and children.

2.2 MISSION OF DOST
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.

2.3 AREAS OF FOCUS
1. Community Awareness and Sensitization for Drug Abuse Prevention 2. Drug Addiction Treatment and Rehabilitation 3. HIV Prevention, Treatment and Care 4. Rights Protection and Rehabilitation of Prisoners, Street Children and Refugees 5. Human Resource Development (PILDAT)

2.4 PARTNERS OF DOST WELFARE FOUNDATION 1. INTERNATIONAL PARTNERS

 The Royal Netherlands Embassy Islamabad  British High commission Islamabad

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 AusAid  Unicef  Department for international development (DFID)  United Nations office of Drugs and Crimes  CRC(Catholic Relief Services)  German Technical Cooperation(gtz)  Save the children

2. NATIONAL PARTNERS
 Infaq Foundation(INFF)  Pakistan Baitul Mal  Govern of KPK  NACP  MARRIE STOPES SOCIETY

2.5 THE WORKING STAFF AT DOST FOUNDATION
 Dr. Parveen Azam Khan  Mr. Muhammad Azam Khan  Dr. Sikandar Azam Khan  Mrs. Munawar Humayun  Ms. Maryam Babar  Mr. Bahram Azam Khan  Mr. Khalid Mohtadullah  Ms. Maryam Bib  Dr. Tariq Khan (BoD 2010 Dost, 2010) President/Chief Executive Director Director Director Director Director Director Director Director

2.6 TEAM AND SEVICES
  

198 full-time workers 240 volunteers and internees 10 projects / donors
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   

04 residential treatment centres 14 community-based centres 14 mobile teams 04 prison-based centres

(Our Team, 2010)

2.7 DOST WELFARE FOUNDATION PROGRAMS FOR TREATMENT AND REHABILIATION OF DRUG ADDICTS

THE

SAKOON KOR RESIDENTIAL DRUG ADDICTION TREATMENT SERVICES

Drug addiction treatment services are operational since 1993, which include residential and community-based services. Clients in treatment are provided detoxification, behavioural change counselling, family and social interventions, religious and spiritual groups, relapse prevention skills, vocational skills development and aftercare services. Currently with a total capacity of 200-beds six residential treatment centres are operational, which are:
   

Sakoon Kor 1 Sakoon Kor 2 Sakoon Kor 3 Sakoon Kor 4

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Summary for Sakoon Kor-I Indicators So Far 2010 Jul-Sep Total No. of clients given Drug Treatment Entered into Primary Rehab No. of families involved in 1176 2275 0 98 7 74 1183 2447 4529 98 2010 Oct-Dec 74 Grand Total 4701

rehabilitation of clients

Summary for Sakoon Kor-II Indicators So far 2010 Jul-Sep Total No. of clients given Drug Treatment Entered into Primary Rehab No. of families involved 1637 in 1877 94 220 117 218 1848 2315 4113 225 2010 Oct-Dec 221 Grand Total 4559

rehabilitation of clients Summary for Sakoon Kor-III Indicators So far 2010 Jul-Sep Total No. of clients given Drug Treatment No. of families involved in 176 19 16 211 228 19 2010 Oct-Dec 16 Grand Total 263

rehabilitation of their children

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Summary for Sakoon Kor-IV Indicators So far 2010 Jul-Sep Total No. of clients given Drug Treatment (Detox) NO of Patients in Rehab Barrack 693 77 51 821 3113 120 2010 Oct-Dec 72 3305 Grand Total

(Dost Foundation, Treatment, 2012)

2.8 DROP-IN CENTRE AND OUTREACH SERVICES FOR STREET DRUG ADDICTS IN PESHAWAR
Outreach and drop-in center-based services are available to the street drug users of Peshawar since 1994. Services include psycho-social support, healthcare, drug awareness, pre-treatment counseling and HIV prevention services. DOST currently provides these services through two static drop-in centers, three outreach teams and one mobile drop-in Centre reaching to more than 3000 street drug addicts every month. Summary of achievements
Indicators So far 2010 Jul- Sep No of DUS/IDUs registered Oct-Dec Grand Total

7755 services 2112 2568 1990

221 64 14 56

362 135 28 54

8338 2311 2610 2100

Clients

STI

Management

(services provided) No. of clients tested for HIV Drug users detoxified (Dost Foundation, DIC, 2012)

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2.9 FAITH-BASED DRUG DEMAND REDUCTION SERVICES IN FATA/PATA REGIONS OF PAKISTAN
In 2006, Faith-based drug demand reduction services were established in four FATA/PATA regions of Pakistan. Presently Dar-ul-Falah faith-based centres are operational in four agencies namely Mohmand, Malakand, Khyber and Kurram. These centres mainly work to mobilize religious leaders and community influential, provide pre and post treatment interventions with drug users and their families and create general mass awareness. Summary of Achievements Indicators No. of clients were counseled and provided other services in Dar-ul-Falah centers Number of clients referred for treatment No. of religious leaders were sensitized and mobilized (Dost Foundation, Faith-Based, 2012) 1758 3857 200 528 130 430 2088 4815 So far 7328 2010 Jul-Sep 275 2010 Oct-Dec 259 Grand Total 7862

2.10 DRUG DEMAND REDUCTION SERVICES AND STRENGTHENING LOCAL COMMUNITY ORGANIZATIONS IN AFGHANISTAN
DOST established drug demand reduction services for Afghanistan in 2007. Presently two residential treatment and two outreach drop-in centres are operational in Bamyan and Daikundi Provinces of Afghanistan through partnerships with local organizations. Moreover, a training and resource centre is working in Peshawar to enhance the capacity Pakistan.

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Summary of Achievements Indicators Till Jun 07 2007 Jul-Sep Drug addicts were provided pretreatment services Drug addicts were provided treatment services Families of clients were reached Community elders were reached 33 37 33 37 9 9 Oct-Dec 48 48 Grand Total

(Dost Foundation, DDR in Afghanistan, 2012)

2.11 COMMUNITY-BASED DRUG DEMAND REDUCTION CENTRE, KHAZANA
Khazana community-based drug demand reduction centre was established in 2005. The centre provides general community awareness, sensitization and mobilization of community elders, outreach and drop-in centre services for drug addicts, family interventions, referral of drug addicts for treatment, home-based treatment and follow-up services.
Summary of Achievements Indicators So far 2010

2010 Oct-Dec 46 26 81

Grand Total

Jul-Sep
No. of clients were counseled and provided other services in DIC No. of drug addicts were referred for treatment to DOST No. of families of drug addicts were counseled and advised

1261 365 2839

39 35 108

1346 426 3028

(Dost Foundation, Community Based, 2012)
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2.12 HIV AWARENESS AND VOLUNTARY COUNSELLING TESTING SERVICES FOR DRUGS ADDICTS
In 2001 DOST commenced HIV prevention and STI management services for drug addicts in addition to the outreach and residential treatment services. These services, which mainly include HIV awareness, Voluntary Counselling and Testing, management of STIs and condom education and provision, are offered through outreach teams, drop-in centres and residential treatment centres.
Summary of Achievements Indicators So far

2010 July-Sep

2010 Oct-Dec 69

Grand Total 27768

Drug addicts were provided HIV 27650 awareness Clients services Clients treatment (Dost Foundation, VctIDu, 2012) were provided STI 1880 were provided VCT 4215

49

14

28

4257

29

19

1928

2.13

FIELDWORK

AND

INTERNSHIP

PROGRAMME

FOR

UNIVERSITY STUDENTS AND GRADUATES
In 1996, DOST commenced the fieldwork and internship programme for the new university graduates and students of different disciplines including social work, psychology, sociology, medicine and management sciences from various universities and colleges of Peshawar. Presently, DOST offers internships and fieldwork opportunities in different service delivery areas including drug abuse prevention and treatment, HIV prevention, rights protection, management areas including monitoring and evaluation, finance and human resource management.

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Summary of Achievements Indicators So far 2010 Jul-Sep Training sessions with students held 556 13

2010
Oct-Dec 0

Grand Total 569

(psychology, social work, medical students etc.) graduates joined internship program 2199 6 5 2010

(Dost Foundation, F&I Programme, 2012)

2.14

TRAINING

PROGRAMME

FOR

NATIONAL

AND

INTERNATIONAL GOVERNMENT ORGANIZATIONS AND NGOS
In 1999, DOST launch the training programme for GOs and NGOs working in Pakistan and Afghanistan in the fields of drug demand reduction, HIV prevention and protection of women and child rights. Presently, DOST is working in collaboration with the Ministry of Public Health and Ministry of Counter Narcotics Gov. of Afghanistan and the Home Department and Civil Defence Department of Pakistan for training their staff. Trainees include doctors, counsellors, social workers, police officials, prison health personnel and prison management staff and probation officers. DOST’s own staff, working in different programmes also receive regular trainings and capacity building. Training is also offered to various NGOs working in Pakistan and Afghanistan.
Summary of Achievements Indicators so for

2010 Jul-Sep Oct-Dec 10

Grand Total 321

Drug abuse awareness sessions held with police 304 official at civil defence Police officials were trained

7

3654

116

133

3903

(Dost Foundation, Training Programme, 2012)
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2.15 PROGRAMS UTILIZED FOR THE REHABILITATION OF DRUG ADDICTED PATIENTS DAY CARE CENTER (DCC) RESIDENTIAL PROGRAM
The bulk of clients in the program are referred from the day care center that the Dost Foundation is running for street addicts in Peshawar. The philosophy of intervention with street addicts is based on the maxim “ rehabilitation even before detoxification” where addicts are given time to restore some of their physical strength, health and hygiene, bring a level of manageability to their lives and establish contact with their families before they are formally inducted into the treatment program. One recovering addict and two medical technicians-cum-counselors visit the street scene in Peshawar 6 days a week. The team gathers together addicts and talks to them about their health and other immediate concerns of survival on the streets, and gradually brings them to the point of considering to quit drug use and admitting themselves for treatment. The message for these addicts is that their first step towards demonstrating a desire to quit is to come to the Day Care Centre on a daily basis. Once the addict has been coming to the center fairly regularly, and has established contact with his family, he or she is formally accepted for admission and treatment into the residential program. In the Day Care Centre, addicts may come in to bathe themselves, wash their clothes, have tea and bread, get first aid or medical treatment for minor ailments and/or attend the Narcotics Anonymous meeting held there. All of these activities are carried out on a fixed schedule. On the average, 20 to 25 people, some of them recovering addicts and some actively using drugs, come to the day care center each day. From among them, active drug users, who have been demonstrating some changes in their behavior in terms of manageability and have established contacts with their family, are referred for treatment into the residential program at DOST. The number of such referrals does not exceed ten in a month.

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2.16 TREATMENT PROCEDURES USED FOR RESIDENT DRUG ADDICTS AT DOST FOUNDATION TREATMENT CENTERS (TC’S)
 DETOXIFICATION

When the drug addicts are brought to the Drop In Center (DIC) then after preliminary checkup are referred to TC for treatment purposes they are referred to Treatment Center (TC) at Shahi Bala(SK-2) for treatment. This program consists of a 15-day detoxification period followed by primary rehabilitation for another 15 days. The main drugs used for detoxification include Diazepam, a non-narcotic analgesic such as Panadol, an antihistamine such as Phenargan, along with supportive therapy for diarrhea, vomiting etc. The purpose of the medication is to stabilize the client during the acute phase of withdrawal from drugs. Frequent baths, showers and dips in the outside pool have also been found to be beneficial to clients in easing their withdrawal symptoms. Counseling for clients is another intervention found to be useful during the withdrawal phase.  PRIMARY REHABILITATION(REHAB)

After completing detox period then the patients (drug addicts) are taken for primary rehabilitation The patients are taught behavioral moralities through lectures, counseling, group sharing .and some minor responsibility like making tea, cleanliness etc. are also given to the patients within the premises.  SECONDARY REHABILITATION(REHAB)

The next phase of treatment is secondary rehabilitation, consisting primarily of vocational rehabilitation. During this period, the clients work as security guards, counselors to those who are under withdrawal through and group leaders or they work as support staff in the center or participate in the street or jail programs. Some of these residents are also taken up as full-time staff in the program. Reintegration into the community is gradual. During this phase, the client may go, once a

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weekend, to his home and back. The frequency of visits is gradually increased until the client is completely ready and confident to spend full time at his home.  FAMILIES PROGRAM(FOLLOW UP)

The program for families is another program component at Dost Foundation. Starting from the tenth day of detoxification; the families of the addicts begin visiting the center every week. During this time, families are given lectures about addiction, co-dependence and counseling and have the opportunity to share among each other as a family unit or within the larger group of parents and families. (UN international Drugs controll Program, 2000)  COUNSELING

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, and a community based worker, a care taker, or a care provider. Any one of these can be a counselor. 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. Counseling is a communication process between two or more than two people to solve 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. At Treatment Center there are psychologists and physiologists (doctors) and Para (recovered addict) counselors, who counsel the drug addicts about the Drug and their physical and

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psychological impacts. They also give chance to the patients to discuss their Problems which come during detoxification period.

By listening attentively and patiently the counselor 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. Counseling 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. Counselors 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.  BEHAVIOR SHAPING

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 center 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. 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 selfcentered behavior. Behavior management and behavior shaping is therefore, the first and the most difficult step in changing his lifestyle.

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Behavior management and behavior shaping tools are some techniques which are used in community center 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 following. 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) Full Hair Cut 6. Time out 7. Confrontation 8. Prospect chair  MORNING MEETING

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 redefines social self and the socially responsible role. It is designed to help people appropriately and constructively identify, express, and manage their feelings. 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 everybody to learn and respect the environment and, most of all, to change the negative aspects of the behavior and the careless attitudes

2.17 COMPONENTS OF MORNING MEETING
The contents or rituals of the morning meeting, , are as following; 1. Recitation of the Holy Quran – Tilawat
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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. Newspaper 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. Program for the next day 17. Closure: Dua-e-Sakoon, meeting, (Shams-ud_Din, 2012) Before 2007 DOST Welfare Foundation have almost 24 projects, but when the militancy started in KPK and FATA. The donor partners have decreased their funding, though some of these projects successfully have been completed. But due to decrease in funding the DOST Welfare have trouble in the completion of its projected goals. Currently DOST is working on 14 projects (Ahmed, 2012)

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CHAPTER NO 3 FIELD WORK DESIGN
3.1 TITLE Role of DOST welfare foundation in the rehabilitation of drug addicts 3.2 SCOPE The Study is limited to dost welfare foundation Guloona Kor at haji camp 3.3 PURPOSE The purpose of this field work study is to know about the services of DOST welfare foundation for the treatment and rehabilitation of drug addicts in Peshawar 3.4 OBJECTIVES 1. To know about the DOST services provided for the rehabilitation of drug addicts. 2. To find out the procedures of treatment at Treatment Centers (TC’s) at DOST. 3. To find out the views of drug addicts (patients) about facilities at TC and DCC at DOST. 3.5 UNIVERSE The drug addicts at Treatment Center (TC) Shahi Bala(SK-2) and Guloona Kor Day Care Center(DCC) Haji camp. 3.6 METHODOLOGY  CASE STUDY 3.7 TOOLS OF DATA COLLECTION Individual case history is used for the collection of relevant data 3.8 DURATION OF THE STUDY The duration of the study was from 15 May, 2012 to 15 June, 2012. treatment center (sk-2) at Shahi Bala and

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CHAPTER NO 4 CASE HISTORY 4.1 CASE HISTORIES AT SHAHI BALA (SK-2)
After studying case histories of all drug addicts at this center, it is concluded that most of the drug addicts started using drugs due to luxurious life, failure in love and emotional traumas. They are using drug from many years. It is found that most of the addicts are self-earners and have no familial financial support. They are doing their jobs and are earning to buy drugs for themselves. Some of the drug users also depend on their familial support to full fill their demand of drug addiction. Saeed Ullah is a shopkeeper he is earning money himself. He started heroin when his parents rejected his demand for love marriage, he told “I was so depressed when my parents rejected my proposal and started heroin”. Akhtar khan is HTV driver; he was spending happy life .But when his brother in law was blown away in a bomb blast, all the burden of his sister came into his shoulders. He became addict of hash, heroin and alcohol.Ijaz was working overseas (Saudi Arabia), when he came back to homeland his friends forced him to take heroin, he told “one day I was sitting with my friends they forced me to sniff , the next when I demanded them to share with me and they refused so I started to buy heroin”. When he took once felt moody and thus he became drug addict. Aorang zeb is working as Nan bai at charsada, a friend suggested him to start drug trafficking when started this business he became regular drug user. Amir Islam a retired supervisor (PTCL).He started using heroin when someone misguided him that it increases intercourse time period.

4.2 CASE HISTORIES AT GULOONA KOR (DCC) HAJI CAMP
After studying all the case histories at this center it is concluded that most of teen agers became drug addicts due to bad family financial situation which forced them to go on street scavenging and as a result of bad peer company they started using drugs.

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Muslim is an afghan refugee he got training in a religious extremist center; he became heroin addict because of his company with unknown people, he told “when I was getting my training at Bara Khyber agency at training center my trainer suggested me to use hash to become alert”. Mashal started hash using when his father died and he shifted to an extended family where he has no parental control, and striving poverty thoughts came to his mind. Ismail who is cattle grazer, he became hash addict because of his company with adults village drug addicts. Amin is an afghan refugee he has started heroin and alcohol addiction because of broken family. All the above listed individuals have realized that drug addiction is an evil which has disturbed their life and also brought shame to them and to their families. They wish to quit it and start a new life.

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CHAPTER NO 5 CONCLUSION AND RECOMENDATIONS 5.1 CONCLUSION

D

OST welfare foundation is doing really a well job for the treatment and rehabilitation of drug addicts .It is covering that part of society which has been neglected and rejected by others, and is trying to light those candles which have been switched off

by the destructing winds of drug addictions. The part of society which is dealt with abuse and is thought as disgraceful on the open roads and streets is getting shelter at DOST. They can become able to speak out that they are also same to others. From outside DOST welfare just looks like a name, and someone would think that it is pretty easy job to handle the persons who are mentally retarded drug addicts. But when the internal situation is seemed this argument will change to “this is really a difficult job to cope with those who are intentionally and unintentionally agree to quit an action which was their habitual. Where there is felt a need the DOST forward its hands for help. It is a well-known saying “a friend in need is a friend indeed” which is followed by DOST welfare foundation in practical sense.it has given patients name to the drug addicts to let them realized that they can be cured and come back to their previous normal life. There is no discrimination on the base of class, caste, race and religion at DOST. All of them are treated on equal basis. DOST takes start from spiritual healing of the patients, the patients are taught that the drug misuse is forbidden in all sacred religions on the planet. They are realized that they have their responsibilities from the family side and also in society, to fulfill them they should to quit addictive drugs and become curious about their role. They are provided with information about past drug addicts and their dreadful closure, and glimpse of prosperous future of the drug quitter is also presented to prepare their mind for quitting drug addiction.

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Physical and psychological treatment facilities are provided to patients at DOST. There is medical doctor available at every center for the manual checkup and treatment. Psychotherapists are available at every center that does psychological therapy of the patients. Counselors are available at DOST centers .who make discussion with patients and get information about their improvement. This counseling may be individual or of group wised. It also trains them in vocational skills to prepare them for upcoming responsibilities. 5.2 RECOMENDATIOS The DOST should expand its services to the far-flung areas especially to the rural areas of Khyber Pakhtunkhwa (KPK)and Federally administrated tribal areas (FATA), because the rural population of KPK and FATA is mostly illiterate and the higher tendencies to drug addiction is found there .DOST should separate the drug addicted children from street children at DCC, because when these children mix up there at DCC then the children who are not using drugs they imitate from those drug addicted children who come to DCC. The counselor should brief the children to take care of their cleanliness, because it has been seemed that most of children are dirty. They eat with their dirty hands which cause food infection. During entertainment time period they should be monitored and the medium of entertainment (which is mainly TV) should be consisted on Pakistani culture not of west.

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