Field Work Report

Dec, 07 to May2008

Drug addiction
Treatment and Rehabilitation
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

DEPARTMENT OF SOCIAL WORK UNIVERSITY OF PESHAWAR

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In the name of allah

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

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SUMMARY
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.

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TABLE OF CONTENTS
S. No
CHAPTER NO.1

Detail
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

Page. No. 1

1

CHAPTER NO.2

2

Drug, Addiction, Addictive Drug – 7, Drug DRUG, ADDICTION AND DISEASE CONCEPT 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 SIDEEFFECTS OF DRUG ADDICTION CHAPTER NO.4 CLASSIFICATION OF DRUGS – WITH REFERENCE TO ADDICTION

Why start drug addiction-13, Side Effects of Drug Addiction: physiological, social – 14, psychological, spiritual, financial, effects on family – 15, Community - 16 Major classes of drugs – 17, Depressants: Alcohol-18, tranquilizers, barbiturates– 20, Painkillers: Narcotics – 21, opium, Heroin – 22, Codeine, Stimulants – 23, amphetamine24, cocaine, caffeine-25, tobacco-26, nicotine-27, khat, steroids-28 , Hallucinogens: 29, Marijuana-30, Ketamine, LSD-31, Table of drugs and effects-33 Introduction, pretreatment phase-35, treatment phase-36, post treatment phase-38,

13

4

17

CHAPTER NO.5

5 6

TREATMENT PHILOSOPHY CHAPTER NO.6 COUNSELING

35 39

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 Introduction -45, spoken to-46, dealt with47, pull up-48, pull up on board-50, time out, hair cut-51, prospect chair-52, confrontation53 importance of morning meeting, the purpose of morning meeting, components of morning meeting -54, Dua-e-Sakoon-55, pic-56

CHAPTER NO.7

7

BEHAVIOR MANAGEMENT TOOLS CHAPTER NO.8

45

8

MORNING MEETING

54

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9 11

RELAPSE PREVENTION PROGRAMME

Introduction, understanding relapse-57, contributing factors-58, categories of patients-59, warning signs/ principles of relapse prevention-60, conclusion-64

57

Follow Up and After Care

65
Harm Reduction and Social Services-66, Drug Abuse prevention programme-67, treatment plane-68, 11 steps-69, 12 steps-70

12

CHAPTER NO.10 DOST PROGRAMME IN BRIEF

66

13 14

CHAPTER NO. 11 SUGGESTIONS AND RECOMMENDATIONS CHAPTER NO. 12 ROLE OF SOCIAL WORKER CHAPTER NO. 13
Pre-treatment/awareness phase-73, treatment phse-74, post-treatment phase-74

71 73

15 16 17

CASE HISTORIES

76 82 85

REFERENCES

BIBLIOGRAPHY

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INTRODUCTION
To Drug Addiction and Dost Welfare Foundation

CHAPTER NO. 1

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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. 9th 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

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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 4

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

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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
6

Mission Statement. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation. Thursday, November 22, 2007 <http://www.dost.sdnpk.org/ >

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Milestones
Sep 1992 Feb 1993 Feb 1993 Mar 1993 Dec 1994 May 1995 Jan 1996 Jul 1998 Jan 1999 Jan 1999 Jan 2000 Jan 2000 Sep 2000 Jun 2001 Jan 2002 Feb 2002 Jun 2002 Jan 2003 Dost Foundation established and registered Therapeutic Community for the treatment and rehabilitation of drug addicts established Family program, relapse prevention program and narcotics anonymous meetings commence Drug abuse prevention program started Street outreach program for drug addicts started Drop In Centre for drug addicts established Sakoon Kore treatment centre for women addicts established Drug addiction treatment and rehabilitation program started in Peshawar Central Prison Tc for women and minor children in Peshawar Central Prison Tc for juvenile offenders in Peshawar Central Prison Juvenile rights awareness program all over NWFP started Second street outreach program and Drop In Centre started for street drug addicts Detoxification started in the Drop In Centers HIV/AIDS Awareness became important part of the Demand and Harm Reduction Programs HIV/AIDS and STIs prevention program for juvenile prisoners in three Central Jails of NWFP Drug demand reduction training program started for women in Afghan refugee camps in NWFP Advice and Legal Assistance Centre established for Afghan refugees in Peshawar Sakoon Kore legal aid & social reintegration services centre for women & juvenile prisoners in Peshawar

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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

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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.

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MORE ABOUT ADDICTION

Drug, Addiction and Disease Concept

CHAPTER NO. 2

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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>

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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

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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 11

Ibid. p. 5 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

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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 15

Ray, O. Ksir, C. (2002) Opt Cit. P. 5 ibid. Pp. 45-46

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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

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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.

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CAUSES & SIDE EFFECTS

Causes & Side effects of Drug Addiction

CHAPTER NO. 3

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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

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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.
16

SIDE-EFFECTS OF DRUG ADDICTION

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

o o o o o o o o o o

Jerks Hepatitis HIV/AIDS Cirrhosis of Lever Gastroenteritis Intestinal Bleeding Anemia Diarrhea Increase risk of cancer Mild Fever

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

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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 ghumbut 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

o Disorientation o Memory Loss o Feeling of Uncertaininty

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 Dishonesty o Resentments o Blaming God and people o Does not care for respect

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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

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CLASSIFICATION

Of Drugs with reference to addiction

CHAPTER NO. 4

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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 1 2 Alcoholic Beverages Minor Tranquilizers – Benzodiazepines à DRUGS

Sleeping Pills A Depressants 3 4 5 Barbiturates Solvents and Gasses GHB/GBH à Gammhydroxybutyrate

1 I

Opiates Natural Derivative of Opium poppy, heroin, morphine, codeine

B

Pain Killers

II

Opoiodis --> Synthetic Drugs with effects similar to opiates

I

Narcotic Analgesics

1 2 3 4 C Stimulants 5 6 7 8 1

Amphetamines Cocaine Caffeine Tobacco --> Nicotine Khat Anabolic Steroids Hallucinogenic Amphetamines Alkyl Nitrites LSD --> Lysergic Acid Diethylamide

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Hallucinogens D 2 3 4 Hallucinogenic Mushrooms Cannabis/ Marijuana Ketamine

Dec, 07 to May2008

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.

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Dec, 07 to May2008

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.

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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 19

"Tranquilizer." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005 Berger, Philip A. "Barbiturate." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

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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.

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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 21

―Opium." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. Khalid, M. (2002). Social Work Theory and Practice, with special reference to Pakistan. 2nd Ed, P\Karachi: Kifayat Academy. Pp. 308-309

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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.

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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.

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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.

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Dec, 07 to May2008

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.

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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, trumpetshaped 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.

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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 29

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

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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. Magic Mushrooms

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.

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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.

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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.
Medical Use

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.
Recreational Use

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.

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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.

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Another table which was given by Compton and Galawa 34in their book Social Work and Social Welfae is also given .....

Drug A 1 NORCOTICS Heroin 2 Morphine 3 Codeine 4 B 1 Cocaine

Method of Administration

Desired Effect Euphoria – Extreme Happiness

Hazards and Side Effects

Smoking, injecting a vain ("Mainlining"); or under the skin ("skin popping"); inhaling ("snorting") Injection into vein

Withdrawal symptoms resemble flu but are not life threatening; use of unsterile needles results in AIDS and other diseases and infections, addiction Risk from unsterile needles; malnutrition; continued use results in depressive states, withdrawal, anxiety, elevated blood pressure, and fever, addicting Less addicting than heroin or morphine; withdrawal discomfort not as severe

Euphoria; kill pain

Swallowed by mouth in pill from or with a liquid such as cough medicine

Deaden pain

CENTRAL NERVOUS SYSTEM STIMULANTS 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 weight loss

and

energy;

as above

34

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

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C 1

CENTRAL NERVOUS SYSTEM DEPRESSENTS Taken by mouth or injected Barbiturates ("Downers") 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 3 Alcohol Taken by mouth in liquid form Taken by mouth in pill form Reduction of anxiety

Psychological dependence; severe health hazed with unpredictable results when combined with alcohol or other drugs Depression; irregular sleep patterns; intoxication; confusion; loss of consciousness; psychological dependence; physical addiction withdrawal can be fatal

increased sociability; sense of pleasure; to feel good; to alter the mood; relieve anxiety

D 1

HALLUCINOGENS Marijuana Smoked in a cigarette (a "joint" )or a pipe; may be orally ingested Oral ingestion sense of wellbeing relaxation Produces dreamlike experiences with beautiful illusions and hallucinations Psychological dependence is a potential side effect; use may result in impaired judgment, anxiety, panic attacks Confusion; hallucinations with frightening visualization; suicide; flashback experiences months after use

2 LSD (Lysergic Acid Diethylamide) 3 4 E 1 Mescaline (derived from peyote cactus) Psilocybin (derived from psilocybin mushroom) INHALANTS Various substances; gasoline, pain thinner, glue, ether, cleaning solutions Inhalations

Oral ingestion Oral ingestion

Dreamlike hallucinations Dreamlike hallucinations

Confusion; hallucinations; repeated use can intensify underlying mental disorders As above

Sense of euphoria; a "high" improved sexual performance

Blindness; eye infections

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TREATMENT PHILOSOPHY
Why treatment is given? Major phases of treatment

CHAPTER NO. 5

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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

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Field Work Report The objectives of this session are; Awareness Motivation Make the client ready for treatment

Dec, 07 to May 08

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 >

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Field Work Report o Psychological history o Social history o Economic history o Addiction History    Type of drug addicted Nature of Addiction Time Span of addiction

Dec, 07 to May 08

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

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Field Work Report 4. Internship 5. Job Placement---if available

Dec, 07 to May 08

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,

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COUNSELING

CHAPTER NO. 6

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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

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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, theorybased 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

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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

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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

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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;

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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)

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BEHAVIOR MANAGEMENT

Tools for modifying behavior of drug addicts

CHAPTER NO. 7

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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

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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

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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

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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

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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.

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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.

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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;

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Field Work Report To point out a major negative behavior To remind the meaning and the rule itself was not respected

Dec, 07 to May 08

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.

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Field Work Report Prospect chair is for major offenders.

Dec, 07 to May 08

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.

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MORNING MEETING

Of drug addicts for behavior modification

CHAPTER NO. 8

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

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Field Work Report 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

Dec, 07 to May 08

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”

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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”

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RPP

Relapse Prevention Programme – After Care

CHAPTER NO. 9

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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

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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

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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

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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. 2. 3. 4. 5. 6. 7. 8. 9.

Stabilization Assessment Relapse education Warning sign identification Cope the problem Recovering planning Inventory training Family involvement 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 48

Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager Dost Welfare Foundation ibid 49 ibid

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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 51

Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager Dost Welfare Foundation 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

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FOLLOW UP/AFTER CARE
The post treatment phase in which the treated clients are being followed for their current status

Means of follow up
► 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

Why follow up?

        

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

Who are responsible to carry out the follow up services?
► ► ► ► Center Family Clients Community workers

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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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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
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

11 Steps

1. Foundation: Total Submission, Acceptance of Powerlessness and unmanageability

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.

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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 Ethnicity: Shinwari Age: 32 years Siblings: 9, 3 sisters and 6 brothers Marital Status: Single DOC: Chars + Heroin Period in TC: 40th day Parents: Alive Address: Kohat Road financial Support: Family, Father Education: Nil Clients Birth Order: 2nd Profession: Nan-Bai Period of Addiction: started from 11 year of age S/O: Musafar Khan

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 Kill pain Avoid reality Sleep Enjoyment Feel peace Reduce stress In the morning Have you ever tried to Reduce DOC intake Change to milder drug Use medicines instead Use more than anticipated Control DOC and use anyway y y n n y y y y n y y y n

Because of your chemical dependency have you ever felt the following Suicide Guilt Shame Anger Angry when asked Not to use Imran Ahmad y y y y y y

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Field Work Report Sorry for using Mental torture After dost treatment will you Attend NA Meetings Have a sponsor Follow the 12 steps Attend RPP Are you hopeful for this treatment? Yes y n y y y y

Dec, 07 to May 08

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 Ethnicity: Jondal Age: 38 years Marital Status: Married DOC: Chars + Heroin Period in TC: 17th day Address: Gondal Attock Education: Nil Children: 6, 3 sons and 3 daughters Period of Addiction: 25 years Financial Support: Family S/O: M. Saeed

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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Field Work Report Yes my wife Have your tolerance increased or decreased? Decreased Have you ever used to Avoid problem Kill pain Avoid reality Sleep Enjoyment Feel peace Reduce stress In the morning y y y y y y y n

Dec, 07 to May 08

Have you ever tried to Reduce DOC intake Change to milder drug Use medicines instead Use more than anticipated Control DOC and use anyway y y n n y

Because of your chemical dependency have you ever felt the following Guilt Shame Anger Angry when asked Not to use Sorry for using Mental torture After dost treatment will you Attend NA Meetings Have a sponsor y n y y y y y y y

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Field Work Report Follow the 12 steps Attend RPP Are you hopeful for this treatment? yes y y

Dec, 07 to May 08

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.

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REFERENCES

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REFERENCESS

1.

1

Ray, O. Ksir, C. (2002). Drug, Society, and Human Behavior. 9th 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. 4.
1 1

Ray, O. Ksir, C. (2002) Opt Cit. P. 7 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.
1

Mission 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. ―Drug‖ Wikipedia, Wikipedia the free encyclopedia Saturday, June 30, 2007 Wikipedia

Department of Social Work University of Peshawar 8.
1

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

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17. 1 Hewitt, Brenda G., and Gordis, Enoch. "Alcoholism." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 18. 1 "Tranquilizer." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005 19. 1 Berger, Philip A. "Barbiturate." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 20. 1 ―Opium." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 21. 1 Khalid, M. (2002). Social Work Theory and Practice, with special reference to Pakistan. 2nd Ed, P\Karachi: Kifayat Academy. Pp. 308-309 22. 1 "Codeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 23. 1 "Amphetamine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 24. 1 Berger, Philip A. "Cocaine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 25. 1 "Caffeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 26. 1 Hynes, Erin. "Tobacco." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 27. 1 "Nicotine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 28. 1 "Khat." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 29. 1 "Steroids." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 30. 1 "Hallucinogen." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 31. 1 Iversen, Leslie. "Marijuana." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005. 32. 1 ―Katamine‖, Wikipedia the Free Encyclopedia. Wikipedia Foundation Inc. April, 03, 2008 http://en.wikipedia.org/wiki/Ketamine 33. 1 Berger, Philip A. "Lysergic Acid Diethylamide." Microsoft® Student 2008 [DVD]. Redmond, WA:
Microsoft Corporation, 2007.

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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 Dost Welfare Foundation 46. 1 Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager Dost Welfare Foundation 47. 1 ibid 48. 1 ibid 49. 1 ibid

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Bibliography
1. Ray. O & Ksir. C, ―Drugs, Society, and Human Behavior‖, 9th edition, McGrawHill 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, GeorgetownOntario 4. 5. 6. Lectures of Sir, Naeem.A, ―The Manager Dost Welfare Foundation‖
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Naeem. A. (2008).Notes for Social Work Student. Peshawar. Unpublished notes of The Center Manager, Dost Welfare Foundation

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>

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1

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Field Work Report

Dec, 07 to May 08

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

[87]

Field Work Report

Dec, 07 to May 08

Imran Ahmad

[0]