ASSIGNMENT

SOCIAL WORK & DRUG ADDICTION

Submitted by

Imran Ahmad Sajid
M.A previous (evening) Class No. 22

Submitted to Dr. Sara Safdar
Date: 12-03-2007

DEPARTMENT OF SOCIAL WORK UNIVERSITY OF PESHAWAR

TABLE OF CONTENTS
Contents
1. Introduction to social work 01 Description, Definition- 02 Introduction to Drug Addiction

Page#

2. 03 3. 4. 05

What is a drug? Drug Misuse, Drug Abuse

Drug Addiction, Drug Dependence 04 Process of Drug Addiction

Tolerance, Physical Dependence Psychological Dependence – 06

5. 06 6. 7. 8.

Some Common Drugs Types of Addiction 07 History of Drugs in Pakistan 07 Causes of Drug Addiction 08

Medical, Psychological, Economic and Social causes

9.

Impacts of Drugs 09

Physiological, Social, Economic & Psychological Causes

10. 10 11.

Prevention of Drug Addiction

Types of Prevention 10 Primary prevention-10, Secondary Prevention-11, Tertiary prevention-12

12. 13 13. 14.

The Role of Social Worker 14 15

Summery

References

SOCIAL WORK

Social Work is a professional activity aimed generally at enriching and enhancing individual and group development or at alleviating adverse social and economic conditions. Its practitioners work to provide care for abused or neglected children; rehabilitate people with physical, mental, or emotional disabilities; and extend financial aid to the poor and the aged. Social workers also carry out treatment, counseling, and direct-service activities to help those individuals with mental and emotional disorders, to help rehabilitate those with disabilities, or to provide preventive services. Formerly, all forms of philanthropic and charitable activities, including those of untrained, civic-minded individuals, were regarded as social work. Such activities focused primarily on solving the immediate problems of the indigent and did little to change the conditions that caused those problems. More recently, however, a vast amount of new social research has made possible analyses of the social and economic maladjustments of modern society, and the activities of social workers have been coordinated in an effort to achieve the maximum possible benefit both for those individuals who are in need and for the entire community. DESCRIPTION Human being is the basic unit of the society and the society is made alive through the interaction system of individuals. This is a give and take process. This give and take process creates the life pattern. This life pattern is sometimes smooth living and sometimes there comes hurdles. These hurdles can be drug addiction, delinquency, mental illness or so many other social problems. Problem is defined by Paul B. Horton as “social problem is a situation which exist anywhere, at anytime and effect any person; this situation creates hurdles in the life of a person. When these hurdles are there the people became conscious of it and try to find out the solution. Sometimes the problem is solved by there own effort but sometimes they need external help. This external help is given to them by a professional social worker. Dr. Sara

There was a time when life was simple and moved with a set pattern. But now we live in a challenging world. We have learned how to travel to the moon and projected a satellite around mars, yet we often have difficulties reaching someone in the same room. We live in a fast-moving, push-button space age, yet we find the people are still the centre of the world and its values. As people live together, the problem of relationship and interaction emerge. Personal problems, family problems and community problems appear on the horizon of every day living. Drug abuse, homelessness, crime, delinquency, mental illness, suicide, school dropouts, aids and numerous other social problems abound at every day turn. Due to a lot of social problems, the need for a professional approach of solving these problems has been realized. Sir. Shakeel DEFINITION Social work is defined by different people and organizations. Some of its definitions are given below; • Social work is a professional activity based upon scientific knowledge and skills in human relations which helps individuals, groups or communities to obtain social or personal satisfaction and independence. Dr. Zari • • Social work is a process of helping people to cope more effectively with their problems in social functioning. Dr. Sara Social work is a process of enabling people to help themselves. Dr. Ameer Zada

According to Werner (Council on Social Work Education, New York, 1959) • “Social work is a scientific based profession that seeks to enhance the social functioning of the individual, singly or in groups, by activities focused upon their social relationships which constitute the interaction between man and his environment, these activities can be grouped into three functions 1. restoration of impaired capacity 2. provision of individual and social resources 3. prevention of social dysfunction” A new and the international definition of social work is given by the international association of schools of social work (IASSW) and International Federation of Social Workers (IFSW) in a conference held in Copenhagen, Denmark in Jun 2001: • “Social work profession promotes social change, problem-solving in human relationships and the empowerment and liberation of people to enhance wellbeing. Utilizing theories of human behavior and social system, social work intervene at the point where the people interact with their environment. Principle of human rights and social justice are fundamental to social work.”

Methods of social work There are three primary methods in which a social worker tries to help the people. These three methods are i. Social Case Work ii. Social Group Work

iii. Community Development Work Case work is the method of dealing with the individual problems. It is the method of helping people about their personal problems. Social group work is the method of dealing with groups problems and socialization Community worker deals with the community’s problems, organization and development After having several definitions of social work and understanding the concept of social work, there is no need to further explanations. My aim here is to find out the application of social work principles and processes in the field of drug addiction. Now we will move on to the track of drug addiction. In which we will see what is a drug? What are its misuses? What are the impacts of drugs on a person? How drug culture came into Pakistan? What are the causes of drug addiction? How can we prevent our younger generation from its bad effects? And what role social worker can play in this field?

DRUG ADDICTION

What is a drug? The word drug is defined as “any substance, natural or artificial, other then food, that by its chemical nature alters structure or function in the living organism”. 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 parts. Drug Misuse Drug misuse generally refers to the use of prescribed drugs in greater amounts then, or for the purposes other then, those prescribed by a physician. Drug Abuse • Drug abuse consists of the use of a substance in a manner, amount, and situations such that the drug use causes problems or greatly increases the chances of problems occurring. The problems may be social, occupational, psychological, or physical. The use of illegal drugs or the inappropriate use of legal drugs. The repeated use of drugs to produce pleasure, to alleviate stress, or to alter or avoid reality (or all three). The use of a drug for a purpose other than that for which it is normally prescribed or recommended.

Drug Addiction

The dictionary meaning of Drug addiction is “give oneself up to a habit”. 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.
M. Kalid

A behavioral pattern of drug use, characterized by overwhelming involvement with the compulsive use of a drug, the securing of its supply, and a high tendency to relapse after withdrawal. 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 use. The continued compulsive use of drugs in spite of adverse health or social consequences.

A state of heavy dependence on a drug; sometimes defined as physical dependence but usually also including emotional dependence, ie, compulsive or pathological drug use. • • 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.

Drug dependence World Health Organization (WHO 1970) defined drug dependency as: • A state, psychic and sometimes also physical, resulting from the interaction between a living organism and a drug, characterized by behavioral and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of its absence. Tolerance may or may not be present. A person may be dependent on more then one drug.

THREE BASIC PROCESSES OF DRUG ADDICTION

There are three basic processes related to addiction that have been important in the history of drug addiction research. 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 everincreasing amounts of it to achieve the same pharmacological effects. 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. Encarta ® 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. 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. Griffits Pearson

Psychological Dependence Psychological dependence (also called behavioral or habitual dependence) can be defined in terms of observable behavior. It is indicated by the frequency of using a drug or by the amount of time or effort an individual spends in drug seeking behavior.

SOME COMMONLY USED DRUGS IN PAKISTAN
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 infected into the blood stream with a needle and syringe. It may simply be smoked or ingested orally. Chars, chars is the most commonly used drug in Pakistan. It is usually mixed with tobacco and smoked with a cigarette 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. 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. Opium. It is obtained from milky discharge of poppy. For centuries it has been used in medical and recreational drugs. Hallucinogens, 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.

TYPES OF ADDICTION
There are two types of drug addiction. • • Intoxicated Addiction Medicated Addiction

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. Medicated addiction could be started because of the misuse of the legal dru_gs. 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 cant sleep without having sleeping pills.

HISTORY OF DRUGS IN PAKISTAN
Golden triangle is the area where the poppy was produced before 1979. Golden triangle is composed of some area of Nepal, China and India. After the production it would 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.

CAUSES
There are so many causes of drug addiction. We can divide them in four main categories. Medical Causes People often use painkillers to get the energy. They use it 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 use 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. Self medication often leads to drug addiction. 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. Economic Causes Unemployment 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. Social Causes There are so many social causes which lead to drug addiction in our society. The distributed 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.

IMPACTS OF DRUGS
A person will be called addict when;  He uses or takes the drug regularly, at least daily  He experience unpleasant symptoms if stop taking it _ The drug addict is affected by the drug from different angles. We can explain its impacts in the following ways; Physiological Impact The 1st impact of drugs is on the person itself. The 1st thing which is affected is the over all physic of the person. 1st it affects the brain functioning. Then move on to the nervous system. Nervous system gets affected. So the person loses his memory. Short memory is affected. Then heart is affected. Kidney, lever, intestine, lungs and stomach got affected. His eyesight becomes weak. There is also the loss of weight, his eyes become watery, and tips of the fingers are burnt.

It means that the overall body functioning is impaired by the drugs. The extreme effect of drugs on the body is that the person may die. Social Impacts A drug dependent often leads an isolated life. He is cutoff by his family. As he is always taking drugs, because of it his social functioning is disturbed. He is no more a father, brother, son or husband. He is now just an addict. No one likes to be friend of a drug addict. His friends slowly and gradually leave him. Because they start thinking that he is not a good person now. And secondly no one wants to be identified by an addicted person. As “man is known by the company he keeps.” People do not trust him, as he is morally degraded. Socially he becomes isolated. He is rejected by his family, friends, community and society. Economic Impacts Chars, opium, heroin and all other drugs have a tolerance effect in them. So the addicted person needs more and more amount of drug to gain the same effect of the drug, to fulfill there need. These drugs are very much costly. A drug addict sell every thing he keeps to meet his need. 1st he losses all his cash in hand, then he starts selling his house crockery or other material. So economically he becomes poor and poorer. He then starts crime, stealing, robbery and murder etc. All the social problems take place. Psychological Impacts Psychologically an addicted becomes weak. He loses his courage and confidence. He can’t make decisions. He is now unable to differentiate in right and wrong, good and bad. His IQ is impaired. He loses concentration. His mental ability is impaired. There is no correlation between his speech and action.

PREVENTION OF DRUG ADDICTION : A Systematic Approach
Often it is said that prevention is better then cure. Now what is prevention, let us see 1st its dictionary meaning. According to Microsoft® Encarta® Reference Library 2005, prevention means • • An action that stops something from happening An action or measure that makes it impossible or very difficult for somebody to do a certain thing, or for something to happen

TYPES OF PREVENTION

Drug abuse prevention programs have been classified according to a public health model in three ways . • Primary Prevention Awareness • Secondary Prevention Treatment • Tertiary Prevention Rehabilitation Primary Prevention Primary prevention in social work means to control the situation before existence of the problem. Primary prevention includes; • • Awareness Education Healthy alternatives

Awareness programs are aimed mainly at young people who have not yet tried the chars, heroin, bhang or any substance. Or who may have tried and smoked a cigarette for few times. There is a two prong strategy awareness programs, the focus is on two sides. First those people who are involved, and second those who are not involved In the 1st phase of our strategy, we will be preparing the minds of the young people to say no to drugs. Because they. We can create awareness in young people or we can teach them how to view drugs and the potential influences of drugs on their lives, emotions, and social relationships. In the 2nd phase of primary prevention program, awareness is aimed to be created in parents and teachers. Although parents and teachers are not involved but they can play a vital role in prevention. So that they know about the drugs, their effects, and symptoms. They would be able to identify or control the situation. Primary prevention programs can be arranged in different settings. e.g. prisons, work places, streets, parks and in educational institute. For example in schools and colleges, a social worker can visit a school where he could tell a few horror stories; describe legal trouble to the students. He can also show what the drugs looked like and also can demonstrate the smell of burning marijuana, so that the students know what to avoid. It is a well known saying that “an empty brain is the house of devil”. The young people who have leisure time could easily become addict. To prevent him from becoming addicted social worker can create healthy alternatives for them to spend their leisure time. There can be speeches, debates, cricket or football matches or other kind of healthy activities. Such activities might be helpful in primary prevention. Social worker can show them the alternatives of drugs. For example, if a person uses the drugs to experience physical relaxation, he can have a relaxation exercises.

Secondary Prevention Secondary prevention is basically the treatment. These are the measures taken after the existence of the situation. Secondary prevention programs include early intervention and treatment. These programs are designed for those people who have tried the drug or who have become a regular addict of the drugs. The goal of such programs is to prevent the patient from further deteriorations. This includes • • Medication Counseling

Medicated treatment is detoxification. Different medicines are given to the patient to reduce the effect of the drug. The detoxification session depends upon the condition of the patient. It long for at least ten days and at most two months, if the addict is not psychiatric patient. Typically the idea behind the counseling is that the drug abusers are emotionally immature and must be given a second chance to grow up. Through counseling the will power of the person is increased. So that they can take personal responsibility of their problem. If an addicted person says I have no job to do there for I take drugs. Now you have to make him morally strong. If he is unable to get a job, he can teach tuitions if he is a literate person. Problems are created only when we become weak. When our personality becomes weak. A social worker will arrange individual and group counseling sessions for addicts in the agency. He can deliver lectures to narcotic anonymous. The core concept of the secondary treatment is to improve their cultural and religious values. A concept of self-Help is tried to develop in drug addicts. Tertiary Prevention It is the adjustment between the client and his community. Social worker has to prepare the minds of the people to accept the client as a normal person. Tertiary prevention programs are basically the rehabilitation or follow-up programs. We call it Harm Reduction and Behavioral Changing Program. The concept of tertiary treatment is that the addicted person after having medication and treatment has to go back to his community. They have to live their. To lead an honorable life. But there is a problem with such person. In our society when a person becomes addictive, no one trusts him, he is rejected by the society. He get stigmatized. He is stamped for a particular behavior. After treatment it is not easy to change the idea and thoughts of other people about this person. There are miss concepts in the minds of his friends, relatives and neighbors. The social worker has to change the attitude and the behavior of the people towards his client. Often the people say that don’t let him enter in the house, he is an addict and he is a thief. These attitudes of the people are very much harmful for the client. His inner self get hurt by such attitudes. He begins to think that it was better to live in the previous state.

Harm reduction strategy includes, substitute drugs, dose reduction. The counseling in this case can be given in streets location, at the home of the client or in the community of the client.

THE ROLE OF SOCIAL WORKER

Social worker has a vital role in the prevention of drug addiction in all the three prevention phases. I will try to identify some of his very important roles, phase by phase; 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 show the symptoms of an addict to the parents. Treatment Phase The most important task of the social worker begins at this stage. What are his duties when a person became addict? The first thing which has to be done is that the social worker has to identify the addicted person in the society. After the identification he will motivate him for treatment in any Drug Addiction Treatment Centre (DATC). This can be done through motivational counseling. When the client reaches the DATC, he will also help him in taking admission. After detoxification and medicated prevention, the real work of the social workers begins. When the client become 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. Now when social worker has a complete study of the case, and have sufficient knowledge about the client and his problem, he then diagnose him. He looks for the alternatives so that his client spends his leisure time in those activities. In the diagnosis stage, the actual cause 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.

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. 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.

SUMMERY
Social work is a helping profession. It can help in the prevention of drug addiction. Or in the rehabilitation. All the three methods of social work i.e. case work, group work, and community development work are applicable in the field of drug addition. One should be very careful in using any kind of drugs whether legal or illegal. Parents have very much responsibility in preventing their children from becoming addict. We as Social workers have to work day and night, in streets and parks, in hujras and schools to save our younger generation from the bad effects of drugs.

REFERENCES

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