Jurnal Anti Dadah Malaysia 2

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Diterbitkan Oleh: AGENSI ANTIDADAH KEBANGSAAN KEMENTERIAN DALAM

NEGERI Aras 3-6, Bangunan Two IOI Square, IOI Resort, 62502 Putrajaya,
Malaysia. Tel: 603-8949 8466 Faks: 603-8941 5659
© 2007 Hak cipta terpelihara oleh AGENSI ANTIDADAH KEBANGSAAN
JURNAL ANTIDADAH MALAYSIA 2
Cetakan Pertama 2007
Hak cipta terpelihara. Semua bahagian dalam buku ini tidak boleh diterbitkan
semula, disimpan dalam cara yang boleh dipergunakan lagi, ataupun
dipindahkan dalam sebarang bentuk atau sebarang cara, sama ada dengan
cara elektronik, fotologi, mekanik, rakaman dan sebagainya sebelum
mendapat izin bertulis daripada AGENSI ANTIDADAH KEBANGSAAN.
Atur Huruf dan Reka Bentuk Kulit: Persada Ilmu
Dicetak oleh: Percetakan Nasional Malaysia Berhad
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PENAUNG : Y. Bhg. Dato’ Haji Sabran bin Napiah Ketua Pengarah Agensi
Antidadah Kebangsaan
KUMPULAN EDITOR : Ketua Pengarang Y. Bhg. Profesor Dr. Mahmood bin

Nazar Mohamed Timbalan Ketua Pengarah (Operasi) Agensi Antidadah
Kebangsaan
Ahli- Ahli • Y. Bhg. En. Tanasengran Sinnathambi Timbalan Ketua Pengarah

(Pengurusan) Agensi Antidadah Kebangsaan
• En. Mohd Rohani bin Mat Diah Pengarah Dasar, Perancangan dan
Penyelidikan Agensi Antidadah Kebangsaan
• Tuan Haji Lasimon bin Matokrem Pengarah Rawatan dan Pemulihan Agensi
• Y. Bhg. Dr. Sabri bin Zainudin Zainul Pengarah Penguatkuasaan dan

Keselamatan Agensi Antidadah Kebangsaan
• Tuan Haji Izhar bin Abu Talib Pengarah Pencegahan Agensi Antidadah
Kebangsaan
PEMBANTU EDITOR : • Pn. Rohaida bt. Shariff • En. Megat Khas bin Sulong •
En. Khairi bin Ab. Razak • Pn. Rokiah bt. Jusoh
SETIAUSAHA : Pn. Nor Akmal bt. Embong Agensi Antidadah Kebangsaan
PEJABAT EDITOR : Bahagian Dasar, Perancangan dan Penyelidikan Agensi

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LEMBAGA PENASIHAT: • Y. Bhg. Lt. Kol. Prof. Dato’ Dr. Haji Kamarudin bin
Hussin ( Naib Canselor UniMAP ) / PEMADAM ) • Y. Bhg. Professor Dr. Md.
Shuaib bin Che Din, Dekan Sekolah Psikologi dan Kerja Sosial, UNIMAS • Y.
Bhg. Professor Dr. Suradi bin Salim, Ketua Jabatan Jabatan Pendidikan
Psikologi dan Kaunseling (UM) • En. Abd. Halim bin Mohd Hussin, Fakulti
Kepimpinan dan Pengurusan, Universiti Sains Islam Malaysia • Tuan Mazdi bin
Abdul Hamid Penasihat Undang-undang AADK • Y. Bhg. Dr. Mahmud bin
Mazlan – Substance Abuse Research Center, Muar, Johor • Y. Bhg. Dato’ Dr.
Faisal bin Hj. Ibrahim Bahagian Kawalan Penyakit, KKM • Bahagian Sekolah,
Jabatan Sekolah, Kementerian Pelajaran Malaysia • Pengarah Jabatan
Siasatan Jenayah Narkotik Polis DiRaja Malaysia • Pengarah Rawatan &
Pemulihan Dadah, Jabatan Penjara Malaysia
Kajian Pengaruh Dadah di Kalangan Pelajar Baru 1-12 Institusi Pengajian

Tinggi Kamarudin Hussin Abd. Majid Mohd Isa Abdull Halim Abdul Husili
Hussin Mohd Amran Hasan
Keberkesanan Program Kaunseling Rawatan dan Pemulihan 13-28 Dadah dari

Perspektif Penghuni Pusat Serenti Zulkhairi Ahmad Mahmood Nazar
Mohamed
Needle Syringe Exchange Program in Malaysia 29-58 Faisal Hj. Ibrahim
Reading to Recover: Exploring Bibliotherapy as a Motivational 59-72 Tool for

Recovering Addicts Abd. Halim Mohd Hussin Mardziah Hayati Abdullah
Harm Reduction Programme in Thailand 73-84 Usaneya Perngparn
Relapse Prevention: Strategies and Techniques 85-96 James F.Scorzelli
The Relationship Between the Age of Onset for Delinquent 97-110 Behavior
and Chronic Drug Abuse Among Adolescents Mohd Muzafar Shah bin Hj. Mohd
Razali
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Trend dan Punca Penggunaan Dadah di Kalangan 111-136 Penagih Dadah

Wanita di Negeri Sabah: Implikasi kepada Rawatan dan Pemulihan Dadah
Sabitha Marican Mahmood Nazar Mohamed Rosnah Ismail
Peranan Kerohanian dalam Menangani Gejala Dadah 137-154 Yuseri bin

Ahmad Sapora bt. Sipon Marina Munira Abdul Mutalib
Demographic Determinants of the Drug Abuse Problem 155-172 Among

Secondary School Students in an Urban Area Rafidah Aga Mohd Jaladin
Cyber Counseling for Addiction and Drug Related Problems 173-192 Huzili
Hussin Irma Ahmad Mohamad Hashim Othman
Drug Dependants’ Treatments and Rehabilitation: 193-226 From ‘Cold Turkey’

to ‘Hot Turkey’ Abdul Rani bin Kamarudin
Drug Dependants’ Treatments and Rehabilitation : From the ‘Cold Turkey’ to

‘Hot Turkey’
193Dr Abdul Rani bin Kamarudin , m/s 193-226
DRUG DEPENDANTS’ TREATMENTS AND REHABILITATION : FROM ‘COLD

TURKEY’ TO ‘HOT TURKEY’
Dr Abdul Rani Bin Kamarudin1
ABSTRACT
This article concerns the treatment and rehabilitation of drug dependants in

Malaysia and it assesses the country’s drug policy in dealing with problem
drug takers since the introduction of compulsory treatment and rehabilitation
of certified drug dependants since 1975. It looks at the strength and
weaknesses of the ‘Cold Turkey’ method of treatment which until very lately
has been the thrust in the government’s policy, and recently, the
maintenance on drug prescription to drug dependants. Given the limitations
in achievement of residential treatment and rehabilitation cum the ‘cold
turkey’ method, there is now renewed readiness on the government’s part to
adopt the maintenance on drug prescription for treating and rehabilitating
drug dependants, hence gradually moving away from the ‘cold turkey’
approach. Central to the maintenance on drug prescription for treating and
rehabilitating drug dependants is the concept of harm reduction, and this
concept will be duly discussed. The experience of United Kingdom in dealing
with the treatment and rehabilitation of drug dependants through
maintenance on drug prescription cum harm reduction is also highlighted to
drive the point why the “cold turkey” method of treating and rehabilitating
drug dependants is by now a spent force, and why it is also high time that
more leeway should be given to the medical approach rather than penal.
1 Associate Professor, Ahmad Ibrahim Kulliyyah of Laws, International

Islamic University, Malaysia; LL.B Hons (IIUM – 1988); MCL (IIUM -1990); PhD
in Law (Exeter – 2002); Non- practicing Advocates & Solicitors (High Court of
Malaya – 1991 & 1992) & Peguam Syarie (KL & NS – 1996)
JURNAL ANTIDADAH MALAYSIA JURNAL ANTIDADAH MALAYSIA
ABSTRAK
Artikel ini memberi tumpuan kepada aspek rawatan dan pemulihan penagih
dadah di Malaysia dengan meneliti Dasar Dadah Negara yang menguruskan
masalah penyalahgunaan dadah sejak tatacara rawatan dan pemulihan dadah
yang wajib diperkenalkan pada tahun 1975. Ia melihat kepada kekuatan dan
kelemahan kaedah rawatan “Cold Turkey” yang menjadi teras kepada dasar
kerajaan masa itu dan kini. Pada masa ini, terdapat kesediaan daripada pihak
kerajaan untuk menerima kaedah pengekalan melalui preskripsi dadah
kepada mereka yang bergantung kepada dadah yang mana sedikit sebanyak
ia menunjukkan bahawa dasar dadah telah mula bergerak meninggalkan
kaedah “Cold Turkey”. Pendekatan pengurangan kemudaratan merupakan
asas kepada kaedah pengekalan pengantungan dadah juga dihuraikan.
Pengalaman United Kingdom dalam menjalankan pendekatan pengurangan
kemudaratan dibincangkan dalam konteks. Oleh yang demikian, dasar kini
lebih memandu program kepulihan ke arah pendekatan perubatan dan
bukannya undang- undang.
INTRODUCTION Under Article 38 of the Single Convention on Narcotics

Drugs, 1961, parties are required to take all practical measures for the
prevention of narcotics drug abuse or psychotropic substances and “for the
early identification, treatment, education, aftercare, rehabilitation and social
reintegration of the persons involved’.2
On 8th - 10th June 1998, a United Nations drug summit attended by

presidents, prime ministers and senior ministers from 150 countries met at
New York and adopted a global strategy to tackle the worldwide drug
problem. The three-day special session of the General Assembly adopted a
political declaration, which among others commits government to
substantially reduce illicit drug demand and supply by 2008. The Assembly
also adopted a declaration on the principles of demand reduction to guide
governments in setting up effective drug prevention, treatment and
rehabilitation programs.
2 Malaysia is a party to all three United Nations Conventions, namely, the

Single Convention on Narcotics Drugs 1961, the 1971 Convention on
Psychotropic Substances, as amended by the 1972 Protocol, article 20 of the
1971 Convention on Psychotropic Substances, and the United Nations
Convention against Illicit Trafficking in Narcotic Drugs and Psychotropic
Substances 1988 - see Malaysia’s National Narcotics Agency 1998 Annual
Report, at pg 76, Ministry of Home Affairs, Kuala Lumpur.

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THE EARLY STAGES OF COMPULSORY TREATMENT AND REHABILITATION In

the early 1970s, treatment facilities that were available for drug dependants
in Malaysia were associated with psychiatric and general hospitals. There
were no centres for the psychosocial rehabilitation of drug dependants. On
1st October 1975, the Minister of Welfare Services appointed 24 hospitals as
detection and detoxification centres (7 detoxification and 17 Detection
Centres). The detection centres were there to ensure that a person would be
identified as a drug dependant through appropriate tests and observations.
These detoxification centres had supportive therapy for the physical building
up of the patient and the treatment of other accompanying physical
complications.3 Compulsory treatment and rehabilitation of drug dependants
at approved institutions was introduced in 1975 as section 37B of the
Dangerous Drugs Act 1952, giving social welfare officers and police officers
the power to require a drug dependant to undergo treatment. There was also
a provision to enable a drug dependant to undergo treatment voluntarily.4
Nevertheless, there were very few rehabilitation homes in 1975 to cope with
the huge number of drug addicts and the rate of relapse and recidivism
among drug addicts was fairly high.5 Section 37B was repealed in 1977 and
substituted with Part VA comprising of 25 sections, namely section 25A to
25O providing better treatment and rehabilitation structures to drug
dependants. With that, a drug dependant may be ordered to undergo
treatment and rehabilitation at a rehabilitation centre for a period between
six months and one year or a two-year supervision.6
Since 1976, every registered medical practitioner, including the government

medical officer is obliged to notify the Director-General of any person he
treats for drug dependency. Unauthorized treatment and rehabilitation of any
drug dependant is not permitted, save those who are lawfully providing
medical treatment to any person in relation to any physical or mental
condition arising from or involving or relating to the drug dependency of such
person.7 This is to strengthen the control against drug misuse, and indirectly
ensure that no drug dependant
3 Central Narcotics Bureau, Malaysia (1977), The Drug Abuse Problem in

Malaysia, at pg 17 – 18. 4 Dangerous Drugs (Amendment) Act A293/75. 5 Syed
M. Haq (1990), Three Decades of Drugs Abuse on the Malaysian Scene, at pg
16, 22, 24 -25, Universiti Kebangsaan Malaysia, Bangi, Malaysia 6 Dangerous
Drugs (Amendment) Act A389/77. 7 Section 18 & 16(5), Drug Dependants
(Treatment and Rehabilitation) Act 1983.
can evade or escape from undergoing treatment and rehabilitation lawfully.8
ONE STOP TREATMENT AND REHABILITATION CENTRES The development of

rehabilitation centres in 1976 was in response to the urgency and
seriousness of the drug problems then prevailing. With these centres, a
suspected or certified drug dependant could undergo examination, detection,
detoxification, counseling, vocational, physical restoration, moral and civic
education, agricultural and training under one roof. Accordingly, this
psychosocial rehabilitation programme has officials from a variety of
disciplines who work as a team to rebuild the personality of an addict.
Officers and staff placed in these one-stop centres comprise of social
workers (social welfare officers and assistants), psychologists, medical
officers, religious teachers, youth, agricultural, education and military
personnel, industrial trade instructors and security officers.9 The number of
centres had steadily risen to 21 by early 1995 with a total capacity of
10,000.10 By the end of November 1997, there were 28 of these centres with
a total capacity of 12,550.11
Both military and ex-military personnel seconded to these centres deliver

military-like training to the residents. The objectives are to instil discipline
and achieve the physical restoration of the residents. Vocational training and
or socio-economic projects, such as agriculture and livestock farming serve
to provide residents with coping skills. The residents undergo 4 phases of
treatment and rehabilitation. In phase one (3-5 months period), a resident
undergoes orientation (civic classes), physical restoration (drills),
counseling, moral and spiritual rehabilitation. Physical training, religious,
moral and civic education, and counseling hours are reduced as a resident
proceeds to the next phase. At the same time, vocational training and or
socio-economic projects are greatly increased as a resident
8 House of Representatives, Parliamentary Debate, the Dangerous Drugs
(Amendment) Ordinance 1952, 14th January 1976, at pg 7225 –7226,
Malaysia. 9 Read the House of Representatives (Parliamentary Debate), 2nd
and 3rd reading of the Drugs Dependants (Treatment and Rehabilitation) Act
1983’s Bill, 25th March 1983, pg 7585 - 7586; House of Representatives
(Parliamentary Debate), 2nd and 3rd reading of Dangerous Drugs (Forfeiture
of Property) Act 1988’s Bill, 24th March 1988, pg 36 - 71, at pg 69; National
Narcotics Agency (1997), Kenali dan Perangi Dadah, Ministry of Home Affairs,
Malaysia, at pg 62 - 63. 10 Abdul Malik bin Hj. Ishak (1995), Re; Some Legal
Aspects of the Drugs Problem in Malaysia – A Perspective, Malaysian Current
Law Journal, Vol. 1, cxxv-cxxxi at pg cxxvi 11 National Narcotics Agency
(1997), Maklumat Dadah Semasa – Special Edition, at pg. 1& 27, Ministry of
Home Affairs, Kuala Lumpur, Malaysia; National Narcotics Agency, Narcotics
Report 1996, at pg. 47, Ministry of Home Affairs, Kuala Lumpur, Malaysia

‘Hot Turkey’
proceeds from one phase to another. In phase two (4-7 months), in addition to
his daily routine as above, a resident participates in vocational training. In
phase three (4 – 7 months), a resident is given job attachments. In phase four
(4-5 months), a resident is allowed to visit his family, is involved in socio-
economic projects as well as re-entry programmes.12 The Medical Officer is
responsible for overseeing medical welfare, including the medical treatment
of the residents.13 The Director-General, who has superintendence over all
matters relating to the apprehension, treatment and rehabilitation of drugs
dependants under the Drug Dependants (Treatment and Rehabilitation) Act
1983, may shorten a resident’s period of residence in the centre, if he had
already completed a period of twelve months for reasons that appear to him
to be sufficient for such person. The Director-General could with the
Minister’s consent, discharge a resident if the period of residence already
served is less than twelve months for special reasons pertaining to the
welfare of such person.14 The period of residency in the centre is meant to
be flexible, allowing the period of each resident to be assessed on a case-by-
case basis. Accordingly, a resident in the centre can be discharged earlier to
undergo supervision.
These centres help take away the element of supply by severing the demand
for drugs when drug dependants are rounded up and confined for treatment.
Compulsory residential treatment and rehabilitation presents an important
means to stabilize the chaotic lifestyles of many drug addicts or drug-
misusing offenders. Under this regime of treatment and rehabilitation, the
effect of achieving improvements in drug dependants’ personal health and
inculcating a positive attitude should not be underestimated.15 It reduces
the acceptability of drugs to young people and increases the safety of every
community from drug related crimes. In fact coercive treatment ensures that
drug misusers get into treatment early, and keeps them in treatment.16 In
Malaysia, drug dependants in prison undergo physical
12 National Narcotics Agency, Narcotics Report 1996, Ministry of Home

Affairs, Malaysia, pg 41 – 43; Scorzelli, Drug Abuse: Prevention and
Rehabilitation in Malaysia, at pg 93 – 95, Universiti Kebangsaan Malaysia,
1987, 13 Rule 28, Drug Rehabilitation Centre Rules, 1983. 14 Section 12; Prior
to the Drug Dependants (Treatment and Rehabilitation) (Amendment) Act
A1018/98, the discretion was with the Board of Visitors. See also Rule 78, 79
& 80, Drug Rehabilitation Centre Rules, 1983. 15 Advisory Council on the
Misuse of Drugs (1996), Drug Misusers and the Criminal Justice System, in
Part 3: Drug Misusers and The Prison System - An Integrated Approach”, pg
18, London. 16 Hough, M. (1996) Drugs Misuse and the Criminal Justice
System: A Review of the Literature, Home Office Drugs Prevention Initiative,
Paper 15, at pg 8 of 11, chapter 4: Communities Penalties. London: Home
Office.
treatment, and psychological rehabilitation through counseling, sports and

recreation. The programme imitates the therapeutic community approach in
instilling positive values in life. Treatment and rehabilitation in prison
includes detoxification, orientation, physical restoration, moral and civil
education, medication and counseling. A model drug inmate would be given
unpaid vocational/trade training and recreational benefits. Incentives are
given to residents with good attitude and wages are given for doing work.17
THE SERIOUSNESS OF THE DRUG PROBLEM On the 19th of February 1983,

drug misuse was declared as the main threat to national security. The
declaration was made because drug addiction could reach epidemic
proportions if a tough stand was not taken to address the menace. 65% of the
addicts were young men between the age of 20 and 29. They represented the
backbone and hope of the nation’s future. The adverse effect on the
uncontrolled drug addiction and trafficking could threaten the socio-
economic well-being, spiritual and natural culture of the nation’s population,
hence undermining national resilience and national security.18 The then
Home Affairs Minster, Dato’ Musa Hitam when tabling the Dangerous Drugs
(Amendment) Act A553/83 before the House of Representatives on 24th
March 1983, spoke of the growing seriousness of the drug problem that
threatened and had threatened national security and integrity - it was not
merely a social problem. The then Prime Minister, Dato’ Seri Dr Mahathir
Mohammed, on the 10th of September 1983, following a Cabinet decision
signed the National Security Council Directive number 13. The Directive
provided for the setting up of an Anti-Narcotics Committee under the National
Security Council. Consequently, the earlier Cabinet Committee on Narcotics
and all bodies set up on its instruction at federal and state levels were
dissolved. The Directive also provided for the establishment of an Anti-
Narcotics Task Force to serve as Secretariat to the Anti-Narcotics Committee
and to be responsible in carrying out a planned, integrated and coordinated
anti- drug efforts. Thus, the Narcotics Secretariat was replaced with the Anti-
17 National Narcotics Agency (1997), Kenali dan Perangi Dadah, at pg 67 – 68.

18 National Narcotics Agency, Laporan Dadah, 1997, Ministry of Home Affairs,
Malaysia at pg 12; National Narcotics Agency, Kenali dan Perangi Dadah, at
pg 48; National Narcotics Agency, Narcotics Report 1996, Ministry of Home
Affairs, Malaysia, at pg 7; Anti Narcotics Task Force, Narcotics Report 1995,
Ministry of Home Affairs, Malaysia, at pg 9; Anti Narcotics Task Force,
Narcotics Report 1994, Ministry of Home Affairs, Malaysia, at pg 5.

‘Hot Turkey’
Narcotics Task Force.19 The Anti-Narcotics Task Force was subsequently put
under the jurisdiction of the Ministry of Home Affairs with effect from 8th May
1995. The Anti-Narcotics Committee and the Anti-Narcotics Task Force were
dissolved on the 7th February 1996, and in their place, the National Narcotics
Council and a department under the Ministry of Home Affairs known as the
National Narcotics Agency were established in an effort to restructure the
government machinery to prevent and control the drug situation. The Agency
serves as Secretariat to the Council and is responsible for all aspects of
national anti-drug efforts.20 The National Narcotic Agency has now been
renamed as the National Anti-Drugs Agency.
DRUG DEPENDANTS (TREATMENT AND REHABILITATION) ACT 1983 The

Malaysian government eventually felt that the time had come for a
comprehensive Act that could specifically and seriously deal with the
treatment and rehabilitation of drug dependants. The government pointed out
that the Dangerous Drugs Act 1952 had become overly complicated in its
attempt to achieve a number of objectives simultaneously. It would be more
effective to produce another Act, which concentrates on the treatment and
rehabilitation of drug dependants. In 1983, Drug Dependants (Treatment and
Rehabilitation) Act 1983 was enacted to replace and repeal part VA of the
Dangerous Drugs Act 1952, the provisions that deal with treatment and
rehabilitation.21 Section 38A and 38B were correspondingly introduced in the
Dangerous Drugs Act 1952.22 Section 38A of that Act enables the court to
send a drug offender under the age of 18 years for treatment and
rehabilitation under the Drug Dependants (Treatment and Rehabilitation) Act
1983, if it is expedient to do so. It however excludes serious drug offences of
trafficking, cultivation or possession under section 39B, 6B and 39A of the
Dangerous Drugs Act, 1952 respectively. Understandably, these offences
were considered
19 Anti-Narcotics Task Force, Narcotics Report 1995, pg 4 – 5, Ministry of

Home Affairs, Malaysia; Anti Narcotics Task Force, Narcotics Report 1994, pg
2 – 4, National Security Council, Prime Minister’s Department, Malaysia,;
Yahya Ismail, Cawangan Antidadah: Peranan Dalam Memerangi Pengedaran/
Penagihan Dadah, Pengaman, Majalah, Polis DiRaja Malaysia (1995), vol.47,
page 6-15, at pg 10. 20 National Narcotics Agency, Narcotics Report 1996, at
pg 3 – 4; National Narcotics Agency, Laporan Dadah 1997, Ministry of Home
Affairs, Malaysia, at pg 5. 21 Act 283/83 -passed on the 16th April 1983. 22
Dangerous Drugs (Amendment) Act 283/83, passed on 16th April 1983. See
section 29 and 30, of Drug Dependants (Treatment and Rehabilitation) Act
1983 (Act 283): w.e.f. 16th April 1983.
grave and serious. A punitive approach to curb the growing drug menace that
was seen as threatening the social fabric of society was preferred here.
Under section 38B of the Dangerous Drugs Act 1952, the court is required to
order a person convicted of the offence of self-administration of dangerous
drugs to undergo supervision between two to three years under the Drug
Dependants (Treatment and Rehabilitation) Act 1983, after having completed
his prison term.23 A drug addict could still be charged with the offence of
self-administration under Section 15 of the Dangerous Drugs Act 1952, and if
convicted could be sent to prison, which also has parallel treatment and
rehabilitation facilities.24
Section 3 of the Drug Dependants (Treatment and Rehabilitation) Act 1983,

enables an officer (rehabilitation officer or any police officer not below the
rank of sergeant or any police officer in charge of a police station) to take
into custody any person he reasonably suspects to be a drug dependant.25
He could be detained for twenty-four hours at any appropriate place for the
purpose of undergoing tests. The officer may release him on bail (with or
without surety), if the tests cannot be held or completed within twenty-four
hours. Beyond that period, the officer would have to produce him before a
magistrate for an order to detain him for up to 14 days. The magistrate may
release him on bail-bond (with or without surety) to attend at such time and
place as may be mentioned in the bond for the purpose of undergoing tests.
Where tests have been done but the result is yet to be obtained, the
magistrate may release him on bail (with or without surety) to appear at such
place and time, as may be mentioned in the bond to receive the result of the
tests.26
A person who is detained for suspicion of being a drug dependant must be a

certified drug dependant before a magistrate can make an order for his
treatment and rehabilitation.27 An assessment of his drug dependency will
be made, which means that he is obliged to do all acts or procedures that the
rehabilitation officer, or government medical officer or practitioner deems
necessary.28 Section 2 of the Drug
23 Public Prosecutor v Ng Hock Lai [1994] 4 CLJ 1056. 24 The Public

Prosecutor determines the charge he prefers (section 376 of Criminal
Procedure Code). 25 Social welfare officer was deleted from the definition of
“officer” by the Drug Dependants (Treatment and Rehabilitation)
(Amendment) Act A1018/ 98. 26 Section 3 & 4, Drug Dependants (Treatment
and Rehabilitation) Act 1983. 27 Section 6(1), Drug Dependants (Treatment
and Rehabilitation) Act 1983. 28 Section 5, Drug Dependants (Treatment and
Rehabilitation) Act 1983; Public Prosecutor v Soh Teh Foh [1990] 2 MLJ 383 -
High Court

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Dependants (Treatment and Rehabilitation) Act 1983, defines a drug

dependant as someone who through the use of any dangerous drug,
undergoes a psychological and sometimes physical state, which is
characterized by behavioral and other responses including the compulsion to
take drugs on a continuous or periodic basis, in order to experience the
psychological effect, and to avoid the discomfort of its absence. Urine tests
serve to corroborate clinical assessments.
The magistrate must decide whether a drug dependant should reside in a

rehabilitation centre for a two-year period and thereafter undergo
supervision, or otherwise supervision for 2 to 3 years under an officer
(rehabilitation officer or police officer), where treatment and rehabilitation
may be carried out.29 A drug dependant placed on supervision whether in the
first instance or subsequent to being discharged from the centre or prison,30
has conditions imposed upon him. These conditions relate to his residence,
reporting of his whereabouts, abstaining from drugs, undergoing tests (as
and when required by the officer) and attending rehabilitation programs.
Breaching these conditions is an offence and punishable with imprisonment
of up to three years or whipping of up to three strokes or both.31
It is considered that an experimental drug dependant or a new addict does

not require an intensive or long period of rehabilitation in the centre. What is
needed is counseling and therapy, not forgetting that other factors such as
co-operation from the society, family, stable employment and user friendly
environment is equally instrumental in keeping him free of drugs. This is done
through intensive supervision involving a rehabilitation officer, parents and
local leaders. Supervision is a community-based programme that is designed
for a drug dependant who does not need residential rehabilitation. It includes
orientation, discussion, evaluation and review of rehabilitation objective or
plan, urine tests, counseling, work placement, family and society
involvement. Supervision inevitably works best for drug dependants with
families, relatives, employer or peer’s co-operation and support. However, the
paramount consideration in deciding whether a drug dependant is placed
29 Section 6(1), Drug Dependants (Treatment and Rehabilitation) Act 1983.

Prior to this 1983 Act, treatment and rehabilitation in rehabilitation centre
was for six months only or a two- year supervision by a social welfare officer
(see Dangerous Drugs (Amendment) Act A389/ 77 & A413/77). 30 See section
38B, Dangerous Drugs Act 1952. 31 Section 6(2), as amended by the Drug
Dependants (Treatment and Rehabilitation) (Amendment) Act A1018/1998.
in the centre or on supervision is his own motivation towards his treatment

and rehabilitation. A problem drug user however, is a threat to himself and
the society. His activities and craving for drugs inevitably results in the
emergence of new addicts, particularly among his peers and colleagues. He
would peddle drugs to support his habit and is likely to commit drug-related
crimes. Preventive enforcement in the centre would positively keep this
“menace” in check. These centres enable the intake of many drug
dependants for treatment and rehabilitation, hence severing the demand and
supply of controlled drugs. Ultimately, it is the determination of drug
dependants to stay free from drugs that is crucial and central to the success
of the rehabilitation programme.32
The Supreme Court in Ang Gin Lee v Public Prosecutor held that there is no
appeal to or revision by the High Court from the order of the magistrate under
section 6 of the Act. The order by the magistrate was not an order
pronounced by a Magistrate’s court in a criminal case or matter for the
purpose of section 307(I) of the Criminal Procedure Code. The reason given
by the court was that, the criminal jurisdiction of the Magistrate court is
provided in section 85 of the Subordinate Courts Act of 1948. Thus, the power
of the magistrate to make an order under section 6 was conferred on the
magistrate as distinct from the Magistrates’ court.33 Moreover, a drug
dependant under the Act is not charged with any offence nor he is convicted
of any charges.
THE COLD TURKEY TREATMENT METHOD Since 1977, the treatment and
rehabilitation concept practiced in Malaysia has been the ‘cold-turkey`
approach i.e. without the use of substitute drugs. Its strategy is to
rehabilitate drug dependants to be effective members of society, by severing
their dependency on illicit drugs and preventing recidivism. Hence, it works
towards sustaining the attitudinal and behavioral change of the recovering
addicts to remain free from illicit drugs. Treatment and rehabilitation in
Malaysia through opiate maintenance was stopped in 1977, because it does
not eradicate dependence and could be abused. A drug dependant may have
built up remarkable tolerance, hence may need a higher dosage, which leads
to increased health risks from overdose and respiratory problems.
Furthermore, it could also cause the patient to find other drugs, the moment
the effects of the substitute drugs lose their effect (it may well be due to a
smaller dosage of the methadone itself). There is also no
32 National Narcotics Agency (1997), Kenali Dan Perangi Dadah, at pg 52-53,

& 63. 33 [1991] 1 MLJ 498 - Supreme Court.

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guarantee especially of drug addicts undergoing outpatient maintenance

treatment that they would abstain from taking drugs illicitly. Similarly,
providing needles and syringes to addicts is not a guarantee that the same
will not be shared or used more than once. Such a policy would also convey
the wrong signal as to drug taking. Moreover, such a move is incompatible
with Malaysia’s policy of a lifestyle free from drugs.34 Furthermore,
maintenance on methadone would also not work with non- opiate misusers
(e.g. cocaine) or multi-drug misusers, thus making in- patient detoxification
seemingly the only solution.
Treatment and rehabilitation centres, however, amount to centralization and

imprisonment, making it less accessible for drug dependants to get support
from families and friends. It may also however, operate as a place for some
addicts to establish their drug networking and thus detrimental to their
rehabilitation upon their release. The Malaysian government is quite lost,
bearing in mind that the treatment and rehabilitation centres have been in
Malaysia for quite a long time, yet the relapse rate at times is 75 %,35 and
may even be higher i.e. 85%.36 It is now conceded that 75% to 80% of drug
dependants relapse after their discharge from rehabilitation centres. There
are now an estimated of 293,000 identified drug addicts between the age of
21 to 29 years old despite an overwhelming budget of RM200 million spent in
2005 on treatment and rehabilitation and RM 92 million in just the first 4
months of 2006.37 Datuk Wira Abu Seman, the Deputy Minister of Federal
Territories said that the campaign against drug misuse for the past 20 years
amounting to RM 1.3 billion failed to achieve its goal due chiefly to society’s
attitude of “dumping” the problem solely unto the government.38
34 National Narcotics Agency (1997), Kenali Dan Perangi Dadah, at pg 27, 63 –

67; See also Hough, M. (1996) Drugs Misuse and the Criminal Justice System:
A Review of the Literature, Home Office Drugs Prevention Initiative, Paper 15
at pg 2 of 3 of Executive Summary, and pg 3 of 11 of chapter 4: Communities
Penalties. 35 Berita Harian Online (1998b) Mahkamah Berhak Tentukan
Hukuman, Wednesday, 6th January 1998; Singapore Straits Times (1999a)
Spruce up offices to curb drug abuse, August 29, 1999: http:/
/straitstimes.asia1.com.sg/reg/mal4 0829.html; Singapore Strait Times,
400,000 workers lost to drug abuse: KL, August 30, 1999:
http://straitstimes.asia1.com.sg/reg/mal9 0830.html 36 Parliamentary Debate,
House of Representatives, 25th April 2000, pg 39 - 89 at pg 78 82 – a survey
by PEMADAM on 24,000 residents revealed that 85% are relapse cases. This
percentage was, however, disputed by the Deputy Home Affairs Minister. 37
Rohana Mohd Nawi reporting for Berita Harian Tuesday, 27th Jun 2006, at pg
17, Hanya 25 Peratus Pelatih Pusat Serenti Dipulihkan, in an interview
session with Deputy Minister of Internal Security, Datuk Mohd Johari
Baharun, after the launching of the International Anti-Narcotics and State of
Kelantan Anti-Narcotics Carnival in Kota Baru, Kelantan. 38 Utusan Malaysia
(oleh Norizan Abdul Muhid), Kempen Antidadah Gagal, Kerajaan Rugi RM 1.3
Billion, at pg 30, Tuesday 27th June 2006.
MAINTENANCE ON DRUG PRESCRIPTION & HARM REDUCTION Malaysia has

however, taken a pilot scheme since March 1997 to supplement the “cold
turkey” treatment with maintenance on the Naltrexone drug prescription.
Maintenance on Naltrexone is believed to be able to cut down relapse up to
30% by the year 2003 and its effectiveness has been proven in Singapore,
United States, Canada and Germany. More enlightened is the willingness of
the Malaysian Government to fully fund those addicts who undertake the
program. The intake of addicts to the program would be increased in
accordance with the available funding. The pilot scheme runs along the line
of compulsory treatment and rehabilitation. Selected candidates with good
motivation, family support and good job prospects upon the completion of
their duration of treatment and rehabilitation are given Naltrexone to see
whether it is effective in stopping recidivism. They are required to take
Naltrexone 3 months prior to being released from a rehabilitation centre, and
to continue taking it for another 12 months. The scheme is for two and a half
years, and is expected to be completed by the year 2000. Naltrexone is an
opiate antagonist, and it counters the opiates’ desired effect or its desired
properties, so that an opiate taker who succumbs to temptation experiences
none of its effects, and probably will not bother to try it again. It is taken
orally and because its effects last for up to 72 hours, it requires only a thrice-
weekly administration. Although theoretically simple, Naltrexone
administration does not provide an easy answer to opiate dependence. It
requires a high degree of motivation on the part of the patient to continue
taking the drug, which should be administered under supervision, either by a
relative or at the clinic, so as to make sure that it is taken. Naltrexone works
best on those with a history of stable relationships and employment, and who
have a lot to lose, if they resume opiate abuse.39
This scheme is identical to the maintenance on prescriptions of drug addicts

in the United Kingdom (UK), where addicts are encouraged to maintain a
steady and stable life on prescription until such time when they are deemed
ready for withdrawal. The advantages are that addicts can be weaned off the
drug after a period of time, while maintaining a steady and stable life and
career. Furthermore, under maintenance, there is no stigma of detention. It is
also very humane, cost-effective and
39 Berita Harian Online, Naltrexone Berupaya Bantu Penagih,

www.jaring.my/bharian, 10th January 1998; See also National Narcotics
Agency, Laporan Dadah 1997, at pg 72 – 73, Ministry of Home Affairs, Kuala
Lumpur, Malaysia.

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practical. In contrast, those treated in boot camps when released, are less
prepared or less able to face the vagaries of life in the real world because of
the confinement. A lengthy detention period for treatment is ‘disruptive’
because it puts an abrupt end to the life and career of the drug dependant as
a person. Residential treatment and rehabilitation should therefore be limited
to special cases only. Supervision of addicts in cooperation with doctors at
private drug treatment clinics or the National Narcotics Agency provides a
positive treatment and rehabilitation environment, as long as there is proper
and consistent monitoring and reporting. An addict can off course be sent to
prison, if he breaches his conditions of supervision. It will do Malaysia a lot
of good if maintenance on a script is given a bigger role in the treatment and
rehabilitation of drug dependants. Residential treatment and rehabilitation
can be very costly and the results may not be conclusively better than the
maintenance treatment. However, certain drug dependence has no specific
treatment, and detoxification with medical and constant careful supervision
seems to be the only option. In-patient detoxification or a limited period of
detention in the centre therefore would seem most appropriate.40
The move to reconsider the “cold turkey” method to maintenance on drug

prescription (such as methadone, subutex) was because the current
treatment and rehabilitation of drug dependants was considered a failure,
and the Prime Minister Datuk Abdullah Ahmad Badawi was unhappy that the
relapse rate was almost as high as 90%.41 The government has turned
around its policy almost 360 degrees to not only treat addicts on
maintenance of drug therapy prescription but also to supply needles and
condoms to drug dependants to control the spread of HIV. However, the final
decision will be made in consultation with the National Fatwa (Islamic legal
ruling) Council. The Deputy Prime Minister, Datuk Najib Tun Razak, when
opening the 30th National PEMADAM annual general assembly in Perak Darul
Redzuan on 25th June 2005 said that harm reduction is a drastic step
necessitated under dire conditions and is allowed under Islamic law. He said
that there were 64, 000 people infected with HIV and if drastic actions were
not taken, an estimated 200,000 to 300, 000 people would be infected within
the next two or three years.42 The Health Minister, Chua Soi Lek on 4th
40 Bucknell and Ghodse (1991), Misuse of Drugs, at pg 80 – 81, Waterlow

Publishers. London 41 Berita Harian, Malaysia Timbang Kaedah Baru Pulih
Penagih, at pg 1, 21st January 2004 42 The Star Newspaper, Islamic Way For
Needle, Condom Programme, at pg 2, Monday 27th June 2005.
September 2005 said that treatment and rehabilitation based on harm

reduction vis a vis giving of free needles and condoms which was supposed
to commence in October 2005 was rescheduled to January 2006 to lay down
more systematic rules, training of staffs and the implementation. However,
prescribing problematic drug dependants with drug prescriptions on
methadone took off as planned in October 2005. This method of treatment
and rehabilitation was done in a few major cities and would be monitored
after six months, and if proven successful, it would be implemented
nationwide.43 The deputy health minister Datuk Dr Abdul Latiff Ahmad also
said that drug addicts who have voluntarily undergone replacement therapy
treatment with methadone can continue doing so for the rest of their lives.
The therapy treatment on methadone was to help addicts get back to society.
There were 1,200 drug addicts who had undergone the treatment nationwide
since October 2005 with 18 centres in government hospitals, health clinics
and selected private clinics. This maintenance on methadone drug
prescription scheme is expected to cater for 15,000 drug addicts by 2010.
The deputy health minister also said that based on the National Anti-Dadah
Agency, there were some 130,000 registered drug addicts in the country.44
Obviously, doctors given permission by the Ministry of Health to lawfully
prescribe drug dependants on drug maintenance such as subutex and
methadone should not act irresponsibly by selling them to non-drug
dependants.45
PERMANENT RELAPSING NATURE OF DRUG DEPENDENCY It is a fact that

many and probably most drug dependent individuals take a long time to learn
to live without drugs. Though, liberal prescriptions do not seem to lead to a
reduced use of illicit drugs any more than abstinence after a prison
sentence, drug withdrawal is merely the first stage of treatment and will be
ineffective unless followed by the all-important process of rehabilitation. It
has been proven for opiates and the same may be true for other drugs that
minor symptoms of abstinence may persist for months after the last dose of
opiate. In other words, subtle physiological and psychological changes may
last long after drug withdrawal, predisposing the individual to relapse.46 This
43 Utusan Malaysia (by Sadatul Mahiran Rosli), Jarum, Kondom Percuma

Mulai Januari, at pg 1 & 4, Monday, 5th September 2005. 44 The Star
Newspaper, Lifelong Meth Treatment for Addicts, Friday, 10th February 2006,
at pg 21. 45 New Straits Times, New Programme to Help Addicts Kick the
Habit, at pg 13,Tuesday, 25th May 2004; Berita Harian, Perangi Gejala Dadah
Usaha Berterusan, at pg 17, Tuesday 27th June 2006 46 See Bucknell and
Ghodse (1991) Misuse of Drugs, pg 71, Waterlow Publishers. London

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outcome is common for all treatment approaches.47 Detoxifying is the first

part of the treatment and not really that difficult to accomplish, but
preventing relapse or recidivism is the main problem. This relapsing
condition is even acknowledged by local drug expert Dr Mahmud Mazlan that
the craving for drugs seem to be permanent, and a former drug addict may
easily be tempted into taking drugs again even though he may have been free
of drugs for 100 years: Drug taking, he warned, even on a couple of occasions
is a one way ticket to hell. He claims that drug dependants undergoing
maintenance treatment on drug Buprenorphine prescription achieved 65 %
success between 6 to 12 months compared to the “cold turkey” method
success rate of 20%. More importantly, the drug dependants are able to work
and be with their family members.48 Maintenance on drug prescription as a
pragmatic and effective mode of treatment and rehabilitation of drug
dependence cum harm reduction is also shared by lecturer, Dr Rusli Ismail of
Molecule Medication Research Institute, Universiti Sains Malaysia,
Kelantan.49
TREATMENT AND REHABILITATION IN UK The treatment of addicts in the

United Kingdom (UK) is the responsibility of the local health authorities.50
Special clinics (drug treatment clinics) funded by the health or social
services and mainly staffed by nurses and/or social workers working with
doctors exists for the treatment of drug dependants receiving maintenance
prescription, while rehabilitation is the statutory responsibility of the social
services. The National Health Service (NHS) and the Community Care Act
1990 imposed a duty on local authorities to assess the needs of, and arrange
for provisions of residential and other services for drug misusers. Under the
community care legislation, there are social services funds and social care
for drug misusers including residential rehabilitation. The community drug
team would normally consist of senior level executives from local authorities
(e.g. City or County representatives), health authorities (a community nurse
and administrative staff working with a consultant psychiatrist and/or with
links to GP), local criminal justice agencies (a social worker or probation
officer) and other representatives,
47 Hough (1996), Drugs Misuse and the Criminal Justice System: A Review of
the Literature, at pg 2 of 3 of the ‘Executive Summary’. Home Office Drugs
Prevention Initiative, paper 15, London: Home Office 48 Laporan Shafinaz
Sheik Maznan, Ketagihan Dadah Ubah Fungsi Otak dengan pakar penagihan
dan psikiatri, Dr Mahmud Mazlan, Mingguan Malaysia, at pg 27, Ahad, 1hb
Februari 2004. 49 Rusli Ismail, Tukar Paradigma Tangani Dadah, Utusan
Melaysia, at pg 6, Thursday, 9th December 2004. 50 National Health Services
Act 1977 (as directed by the Secretary of State for Social Services).
for example, from the voluntary sector.51 Social workers are vitally
important members of the multi-disciplinary team of drug treatment
clinics.52
Rolleston Committee & the Brain Committee53 The treatment in Britain for
drug dependence is mainly via the methadone maintenance. This is in
accordance with the recommendation of the Rolleston Committee, who in its
1926 report stated that the problem of drug addiction must be regarded as a
manifestation of disease, and not as a mere form of vicious indulgence. In
other words, a drug is taken in such cases not for the purpose of obtaining
pleasure, but in order to relieve a morbid and overpowering craving. The
Committee also stated that relapse appeared to be the rule and that
permanent cure was an exception. The Committee concluded that it was
legitimate to use heroin and morphine for the relief of pain due to organic
disease such as inoperable cancer, even if it might lead to addiction. It also
concluded that it was legitimate to use such drugs for the treatment of
addicts by the gradual reduction method, as part of the treatment plan.
Finally, and more controversially, it concluded that it was legitimate to
prescribe such drugs for persons who would otherwise develop such serious
symptoms that they could not be treated in private practice, and for those
who were capable of living a normal and useful life, so long as they took a
certain quantity, usually small. The responsibility for dealing with them
therefore lay with the medical profession, and not with the authorities
dealing with law enforcement. In other words, it was the doctor’s right to
prescribe drugs, if he judged them necessary for the treatment of his patient
and was not challenged.
The problem of drug addiction however, had increased at the beginning of the
1960s, and the majority of the new addicts were recreational rather than
therapeutic (in the sense of becoming dependent
51 Cabinet Office Press Release, Government’s Largest-Ever Push To Tackle

Drug Menace, CAB 182/98, 1st September 1998, Cabinet Office: London;
Institute for the Study of Drug Dependance – www.isdd.co.uk/trends/, UK
Trends and Update, at content 2.2. 52 Cabinet Office Press Release, Working
Together To Make A Difference, CAB 214/98, 21st October 1998, Cabinet
Office: London. 53 Advisory Council on the Misuse of Drugs (1982), Treatment
and Rehabilitation – Report of the Advisory Council on the Misuse of Drugs, at
pg 7-9, Department of Health and Social Security. London: Her Majesty
Stationery Office; Bucknell & Ghodse (1991), Misuse of Drugs, at pg 6- 7 & 9;
Central Office of Information, The Prevention and Treatment of Drug Misuse
in Britain, at pg. 3 – 5, London: Central Office of Information, Reference
Division, October 1978; Social Morality Council (1975), Education and Drug
Dependence, at pg 21-22, Metheun Educational Ltd, London

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on opiates usually morphine or, after 1945, pethidine, in the course of
medical treatment). However, an interdepartmental Committee of the
Ministry of Health chaired by Sir Russel Brain (Brain Committee) was able to
report in November 1960, that no change was required in the British approach
to drug addiction because the situation had not changed appreciably in the
years since the issue of the Rolleston report. The overall picture later
changed for the worse and the Brain Committee reconvened in July 1964 to
consider whether their 1961 advice in relation to the prescribing of addictive
drugs by doctors needed revision. There had been significant increases in the
number of persons known at some time in the year to be addicted to
dangerous drugs (from 454 addicts in 1959 to 753 addicts in 1964), and in
particular of known heroin addicts (from 68 addicts to 342 addicts over the
same period). An added cause for concern was that these new addicts had
not originally taken the drugs for therapeutic purposes, but were young
addicts introduced into heroin in other ways. In its second report, it stated
that the increase in the number of drug addicts was attributed to a few
‘unscrupulous’ doctors who prescribed large quantities of dangerous drugs,
and thus created a surplus in the market conducive towards recruiting of new
addicts. In 1962, one doctor alone had prescribed for addicts no fewer than
600,000 normal doses of heroin. There were other examples just as bad, but
these doctors were acting legally under the law as it then stood. The Brain
Committee made extensive proposals to limit the number of doctors
authorized to supply heroin and cocaine to addicts, and to ensure that the
supply of such drugs only took place in a setting where there was a
comprehensive range of treatment facilities for drug dependency. They also
suggested that treatment centres should have the power to detain addicts
compulsorily.
Legislative Controls The Dangerous Drugs Act of 1967 implemented the

recommendations of the Second Brain Committee’s report, with the
exception to compulsory detention. The Home Secretary was given power to
make regulations that require medical practitioners to furnish particulars of
patients who were addicts, and to prohibit medical practitioners, unless
specifically authorized (notably doctors working in treatment centres) from
prescribing specified drugs to addicts. Under that Act, the Dangerous Drugs
(Supply to Addicts) Regulations 1968, which came into force in early 1968,
made it obligatory for a medical practitioner to notify the Chief Medical
Officer of the Drugs Branch of the Home Office, when he discovered a patient
who was dependent on heroin or cocaine.

With the exception of heroin (diamorphine) and cocaine, where specially
licensed doctors could prescribe these drugs when they are being used in the
treatment of people regarded as addicts, i.e. for so-called ‘maintenance’
treatment, the long established right of a doctor to prescribe controlled
drugs without restriction was maintained. In practice, licenses have only
been issued to doctors working in treatment centres, hospitals and other
special institutions. However, there is no bar on their prescription for the
relief of pain in organic disease (in the case of heroin) or as local anesthetic
(cocaine). That Act too, gave the Home Secretary power over any medical
practitioner who contravenes the regulations.
These regulations of notifying addicts had been re-enacted, essentially

unchanged as the Misuse of Drugs (Notification of and Supply to Addicts)
Regulations 1973 (S.I. no. 799).54 Rule 3 of Regulation 1973 required a doctor
who attended an addict to furnish within seven days a written notification to
the Chief Medical Officer at the Home Office of the personal particulars of
the addict, unless the controlled drug was required for the purpose of
treating organic disease or injury. If possible, the name, address, sex, date of
birth and national health number, together with the date of attendance and
the name of the drug or drugs concerned should be given. There was no such
status as ‘registered addict’ because these notifications were used only to
compile the Addicts Index (strictly confidential) used for epidemiological
data, as a check against addicts seeking simultaneous treatment from more
than one clinic or doctor, and as an early warning of possible over
prescribing.55 This notification was limited to persons addicted to one of the
drugs listed in the Schedule to the Regulations. Regulation 3(2)(b) made it
unnecessary for a doctor to furnish a notification, if one had already been
given within the last twelve months.56 These statutory requirements on
doctors to notify treatment of addicts were revoked on 14th May 1997 by the
Misuse of Drugs (Supply to Addicts) Regulations 1997. The restricted range of
drugs on which the index focused over the past three decades, meant that its
usefulness for epidemiological research had become limited, as more and
newer drugs gained popularity amongst drug misusers.
54 Central Office of Information (1978), The Prevention and Treatment of Drug

Misuse in Britain, at pg 4; Bucknell and Ghodse (1991), Misuse of Drugs, at pg
7; Leech and Jordan (1973), Drugs for Young People: Their Use and Misuse, pg
44, The Religious Education Press, Pergamon Press Ltd Hill hall, Oxford. 55
ACMD (1982) Treatment & Rehabilitation-Report of the Advisory Council on
the Misuse of Drugs, at pg 96. 56 See section 10 (h) and (i), Misuse of Drugs
Act 1971.

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Furthermore, there was also the question of the high costs of maintaining the
index in the face of alternative database systems.57 Information about how
many people are asking for help with drugs problem is now collected
regionally (Regional Drug Misuse Databases). Thus, the closure of the
addicts’ index is logical in that it overlapped with the other help- seeking
treatment-led indicator, the Regional Drug Misuse Databases, overseen by the
Department of Health. This system utilizes a regional reporting structure
based on returns from specialist drug and alcohol agencies, GPs, police,
surgeons, some hospital departments and prison medical officers. Annual
reports are available through the Department of Health’s Statistical Bulletin.
Regional returns provide data referring to the sex of individuals, area of the
return, drugs misused, injecting behavior and agency treatment episodes.58
At present, the power of control over medical practitioners and pharmacists

are provided by section 12 to 17 of the Misuse of Drugs Act 1971. There are
provisions for a tribunal to advise the Home Secretary in respect to
practitioners. The Home Office is primarily responsible for the policy and for
administering the legislation concerning the misuse of dangerous drugs,
including the licensing of doctors to treat addicts and the disciplining of
doctors who prescribe irresponsibly. The Home Secretary may issue licenses
to certain doctors authorizing them to supply heroin and cocaine to addicts.
Generally, any medical practitioner can treat patients with problems of drug
dependence, although only those with a license from the Home Office may
prescribe those drugs.59
Drug Action Team Community drug teams offer greater opportunities for drug
misusers to maintain positive relationships, find stable employment, develop
through educational and training courses, and gain access to good quality
medical services and counseling support to help achieve a drug-free lifestyle.
The drug team may be based in a hospital or clinic, or may be
57 Corkery J.M. (1997), Statistics of Drug Addicts Notified to the Home Office,
United Kingdom, 1996, at pg 3, Home Office Research and Statistics
Directorate, Issue 22/97, London: Home Office. 58 Parker, Bury and Egginton
(1998), New Heroin Outbreaks Amongst Young People in England and Wales,
at pg 11, Home Office Police Research Group: Crime Detection and
Prevention Series paper 92, London: Home Office; United Kingdom Home
Office Annual Report 1998-99: Chapter 9 - Drugs. 59 Section 30, Misuse of
Drugs Act 1971; Regulation 4, Misuse of Drugs (Notification of and Supply to
Addicts) Regulations 1973.

based in the community or local authority boundaries. Their interventions

commonly involve assessment and counseling, sometimes detoxification and
prescribing. Activities include advocacy work, child protection work,
complementary therapy, writing of court reports, and liaison with the
criminal justice system, with prisons and probation officers and referrals on
to other services. The majority described their approach as based on
concepts of harm-reduction but with abstinence being the ideal eventual
goal. They aim is at improving the quality of life of substance misusers by
prescribing methadone (for opiate users) in place of heroin, offering advice
and counseling and encouraging safer drug use and where appropriate,
abstinence. In the case of some addicts, the prescriptions of methadone
were available over a longer period of time to discourage a return to street
drug misuse and the additional risk of physical harm inherent with drug
injecting, such as HIV and Hepatitis. Patients may be referred on to mental
health services, specialized services such as Genito- Urinary Medicine or HIV
services and to residential rehabilitation as appropriate. The team is also in
contact with self-help groups. 60
Drug-Treatment Clinic The first stage for an addict seeking treatment is

usually to register with an outpatient clinic. This is a clinic that is attached
to a hospital and staffed by psychiatrists, social workers, nurses, and
probably probation officers. Some clinics have day centres where the addict
can spend a good deal of time. Patients may be referred for treatment by
their general practitioner or other doctors or by a social worker, probation
officer or another agency. Some refer themselves, although some clinics
insist on a formal referral letter from another doctor. A probation officer may
have clients who are drug dependants, who agree or are obliged to undergo
treatment and rehabilitation as requirements of probation under the Criminal
Justice Act 1991,61 or as an additional requirement to his probation order
imposed by the Courts under section 3(1) of the Powers of the Criminal
Courts Act 1973. Even though the Criminal Justice Act 1991 introduced
treatment and rehabilitation of drug offenders, their consent was still
required.62 The requirement for consent for community sentences for
offences has, however, been removed by the Crime
60 ACMD (1996), Drug Misusers and the Criminal Justice System. Part 3: Drug
Misusers and the Prison System - An Integrated Approach, at pg 15; See also
Institute for the Study of Drug Dependence (1998), UK Trends and Update, in
content 3.30 – www.isdd.co.uk/rends/. 61 As amended by Criminal Justice Act
1993, & supplemented by Criminal Justice and Public Order Act 1994. 62
Section 1A of the Powers of the Criminal Courts Act 1973.
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(Sentence) Act 1997. Therefore, it is now by no means certain that any

probationer receiving treatment as an outpatient under the terms of his
license is a volunteer.
All the outpatient centres may refer patients for in-patient treatment for
withdrawal and for supportive treatment during acute episodes of their
condition. The support of social work, occupational therapy, and other
specialized departments of the hospital are equally available where in-
patient treatment is given. Patients may be admitted into in-patient facilities
for assessment, for stabilization of dosages, for detoxification and for
treatment of the complications of drug dependence. They may remain in
hospital for a period, which may be on or off drugs. In-patient detoxification is
essential for those who are severely dependent on sedative hypnotic drugs
because of the risks associated with their withdrawal.63 If an addict wishes
to come off all drugs, he will probably be admitted into an in-patient unit
(although some addicts come on and off, on an outpatient basis). Once
withdrawal is complete, the major task of encouragement to abstain from
drugs commences. In this manner, treatment and rehabilitation become
almost indistinguishable terms. A long period of after-care is inevitably
necessary after the discharge because much of the work of treating the
causes of addiction must be done outside hospitals. Co-operation between
medical staffs, social workers and lay organizations is therefore crucial.
Assessment of Drug Dependency At the clinic, an accurate diagnosis of a

patient’s dependent status is essential, as regular prescription of opiates
could convert an occasional user into an addict. A clinical/social assessment
on a multi-disciplinary basis needs to be thoroughly done and this usually
takes 2-3 weeks. Various means are used to gauge the presence and extent
of addiction, including biochemical tests to establish the actual fact of drug
use. The diagnosis of opiate dependence also relies heavily on urine tests
being positive for opiates. A careful history is taken, including the age at first
use, subsequent drug taking, injecting, medical complications, etc. Checks
are made at the drug misuse databases to ensure that the patient is not
already obtaining drugs from another centre. A patient is not normally
accepted at his or her first appearance, but is asked to return on at least one
further occasion, so that it can be ascertained whether he
63 Bucknell and Ghodse (1991), Misuse of Drugs, at pg 74 and 80; Leech and
Jordan (1973), Drugs for Young People: Their Use and Misuse, at pg 89 - 90.
or she is using the drugs in question persistently.64 In practice, there are

wide variations in assessment, treatment and prescribing policies, depending
on the facilities and the available staffs, the needs of the individual patient
and the philosophy of the clinic. Some clinics operate on a non-opiate
prescription policy.65
Prescribing The clinic has to decide whether it is justifiable to prescribe

drugs, either as a prelude to gradual withdrawal or for maintenance therapy,
if the patient is genuinely addicted. The aim is to stabilize the patient and
enable him or her to function normally in the community until he or she is
motivated to accept the withdrawal treatment. If the patient is diagnosed as
being physically dependent on opiates, an opiate will be prescribed. The dose
to be prescribed is decided individually, the aim being to prescribe the
minimum dose so that the patient has to take it all personally to prevent the
onset of the withdrawal syndrome, and has no surplus, either to produce
euphoria or to sell. In some areas, the risk of diversion of supplies of the
drugs prescribed is avoided by posting prescription forms to retail
pharmacists willing to undertake this type of dispensing, usually on a daily
basis in the first instance. In other words, the patient goes to the pharmacy
each day to collect the day’s supply, with two days supply on Saturdays since
pharmacies are generally closed on Sundays.66
Some clinicians are prepared to continue the maintenance prescription over

an indefinite period of time to enable stabilization, but lately this is less
commonly accepted. More recently there has been a marked trend away from
opiate maintenance for newly notified addicts, and strenuous, often
repeated, attempts are made to effect opiate withdrawal and to encourage a
drug free lifestyle, though the option of maintenance treatment for opiate
dependence remains.67 This could be due to the fact that the drugs they had
received legitimately for many years, has diminished for good their prospect
of becoming drug-free in the foreseeable future. Another reason is, many drug
misusers have little or no wish to opt for rehabilitation, and seek medical
help for the sole
64 Central Office of Information (1978), The Prevention and Treatment of Drug

Misuse in Britain, at pg 21; Bucknell and Ghodse (1991), Misuse of Drugs, at
pg 79. 65 ACMD (1982), Treatment & Rehabilitation - Report of the Advisory
Council on the Misuse of Drugs, at pg 14-15, & 28. 66 Central Office of
Information (1978), The Prevention and Treatment of Drug Misuse in Britain,
at pg 21-22; Bucknell and Ghodse (1991), Misuse of Drugs, at pg 79. 67 ACMD
(1982), Treatment and Rehabilitation - Report of the Advisory Council on the
Misuse of Drugs, at pg 27; Bucknell and Ghodse (1991), Misuse of Drugs, at pg
73.

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purpose of obtaining drugs.68 This is so as indefinite maintenance on

prescribed opiates is permissible and theoretically possible, even though, it
may lead to a state of chronic dependence. Clinic staffs in such situations
merely operate in the manner of a vending machine issuing prescriptions.
They become frustrated by their therapeutic impotence and frequent
confrontations with patients about which drugs should be prescribed and as
well as the dosage.69 Furthermore, addicts who are expected to attend
treatment clinics, whereby after stabilization they are to be weaned off
drugs, rarely do so, and often remain on opiate (methadone) maintenance.70
Harm Reduction On the other hand, a policy not to prescribe drugs at clinics
would without doubt deter opiate misusers from seeking treatment, and
hence induce an illicit market in drug dealing. It would also prompt them to
turn to doctors in general practices who are prepared to prescribe on a
regular basis. The problem then is that they do not have the resources to
provide the full range of support services needed for the treatment and
rehabilitation of drug misusers. General practitioners in the UK are quite free
to prescribe any drugs (e.g. methadone is mostly dispensed by retail
pharmacists for unsupervised use) they consider to be appropriate in the
treatment of addiction, with the exception of diamorphine, cocaine and
dipanone, which can only be prescribed under special licence.71 On the
other hand, continued maintenance prescribing has not prevented a
substantial growth in drug misuse or the availability of the drug in the illegal
market.72 Addicts undergoing treatment sometimes also use illicit supplies
of drugs other than those prescribed.73 This has prompted an
68 ACMD (1982), Treatment and Rehabilitation - Report of the Advisory

Council on the Misuse of Drugs, at pg 33; Flemming, Philip M. (1995),
Prescribing Policy in the UK- A Swing Away from Harm Reduction?,
International Journal of Drug Policy, Vol. 6, No. 3, 1995. 69 Bucknell and
Ghodse (1991), Misuse of Drugs, at pg 79. 70 Bucknell and Ghodse (1991),
Misuse of Drugs, at pg 73; Leech and Jordan (1973), Drugs for Young People:
Their Use and Misuse, at pg 87. 71 Section 30, Misuse of Drugs Act 1971;
Regulation 4, Misuse of Drugs (Notification of and Supply to Addicts)
Regulations 1973; Hough (1996), Drugs Misuse and the Criminal Justice
System: A Review of the Literature, at pg 3 of 11 of chapter 4:’ communities
penalties’. 72 ACMD (1982), Treatment and Rehabilitation - Report of the
Advisory Council on the Misuse of Drugs, at pg 28 and 33; HM Government
(1998), The Government’s Ten-Year Strategy for Tackling Drugs, pg 1 of 3;
Greenwood, J. (1991) Persuading General Practitioners to Prescribe – Good
Husbandry or a Recipe for Chaos, British Journal of Addiction, Vol. 87, 1992;
at 567-575; Flemming, Philip M. (1995), Prescribing Policy in the UK- A Swing
Away from Harm Reduction?, International Journal of Drug Policy, Vol. 6, No.
3, 1995. 73 Central Office of Information (1978), The Prevention and
Treatment of Drug Misuse in Britain, at pg 22; Bucknell and Ghodse (1991),
Misuse of Drugs, at pg 73.
approach whereby a contract is agreed between patients and staffs before

opiates are prescribed for the first time. Opiate prescription is only part of
the contract, which includes weekly attendance, getting a job wherever
possible, and giving up illicit drug use. The dose of opiate is gradually
reduced over an agreed period (a few months), and other goals towards a
drug free lifestyle are worked on simultaneously. This approach reduces
confrontations between staffs and patients regarding drug dosage and
enables them to work together towards other goals, putting the drug abuse
into its true perspective. Repeated assessment of the patient’s drug
dependency may be necessary, if the prescription is to continue.74 The
Edinburgh Community Problem Service (EDCPS) for example, in liaison with a
general practitioner would ask a drug dependant offered a script to agree to
a schedule of medication, regular contact with a key worker and random
urine checks. Continued use of street drugs by mouth or injection would risk
the cessation of the script. ECDPS would also not tolerate any lost scripts or
aggression to the surgery staff members. The agreement would be reviewed
periodically to evaluate changes in behavior etc.75
Prescribing is generally used to attract drug users to the services offered,

help stabilize the patient’s lifestyle, reduce harmful injecting and the spread
of diseases such as AIDS or HIV, remove the need to deal in drugs – thus
reduces the supply, causes an impact upon criminal offending (particularly
acquisitive crimes), and enables a therapeutic relationship between the drug
taker and clinicians. The basic rationale for drug substitution and
maintenance is that of harm reduction: if some people are unable to quit
using drugs, both users and society at large benefit if these users, i.e.,
addicts, are able to switch from the “black market” drugs of indeterminate
quality, purity or potency to legal drugs, of known purity and potency,
obtained from physicians, pharmacies and other legal channels. The risks of
overdose and other medical complications decline; the motivation and need
for addicts to commit crimes to support their habits drop; for addicts are
more likely to maintain contact with drug treatment and other services, and
more able and likely to stabilize their lives and become productive citizens.
74 Bucknell and Ghodse (1991), Misuse of Drugs, at pg 79. 75 Greenwood, J.

(1992), Persuading General Practitioners to Prescribe – Good Husbandry or a
Recipe for Chaos, at pg. 2 & 3 of 10.

‘Hot Turkey’
The objective of this conciliatory and reciprocal approach is to make contact

with as many drug users as possible, in order to offer a broad spectrum of
services. These might range from services intended to support continued
drug use in a safer manner (for example, needle exchanges or advice on safer
sex) to opportunities for detoxification or support for abstention. The
strength of the programme lies in the fact that it enables treatment to be
carried out by helping the client to develop a more stable lifestyle, and dose
reduction and the achievement of abstinence can then be approached within
this context. The ultimate goal without doubt is abstinence, though it may
take years to realize, but stability on a prescription without illicit drug use is
conceded to be less harmful than chaotic, illicit multiple drug use. In order to
establish this, regular monitoring is essential, which includes urine tests,
psychiatric and therapeutic help when required.
These arguments have been reinforced by the advent of AIDS. Intravenous

drug-abusers are high-risk groups for AIDS and an important route for the
transmission of HIV into the general heterosexual population. The ACMD has
brought out three reports on AIDS and drug misuse in 1988, 1989 and 1993.
Its report on AIDS and drug misuse of 1988 and 1989, acknowledged that
AIDS was more of a threat to the individual and the public’s health than
drugs. Its 1993 report stated that the methadone maintenance programme
were beneficial for both the individual and the public’s health. Maintenance is
one way of keeping clients in treatment, whilst other therapeutic processes
can take place. In other words, it may provide the client both the time and
environment he requires to acquire the confidence and strength to change:76
Harm reduction is however, only a short-term strategy.
Drug substitution and maintenance experiments have shown that prescribing

reduces both illegal heroin use and related crimes. It also revealed that those
on higher dosages, aimed for maintenance rather than abstinence fared even
better.77 It must, however, be emphasized that though maintenance on
prescription reduces crime and has health benefits to society, it still does
not remove the dependency of the addicts, and thus it is acknowledged that
the reductions and benefits are at most
76 Hough (1996), Drugs Misuse and the Criminal Justice System: A Review of
the Literature, at pg 7 of 11, chapter 4: Communities Penalties. 77 Hough
(1996), Drugs Misuse and the Criminal Justice System: A Review of the
Literature, at pg 2 of 3 of ‘Executive Summary, and pg 3 of 11 of Chapter 4:
Community Penalties; The Lindesmith Centre, Focal Point: Drug Substitution
and Maintenance Approaches, www.lindesmith.org/library/focal11.htm, at pg
1 and 2 of 4 – 11th September 98.
superficial or superimposed.78 Furthermore, such a policy has its inherent

risks and dangers, as it may lead to the widespread use of drugs in society,
rather than abstention.
The maintenance treatment favored in the UK can lead to chronic

dependence on drugs as well as the danger that once tolerance is developed,
addicts would strive to acquire more potent drugs illicitly. Moreover, the
prescribed methadone can be sold to subsidize the illicit purchase of heroin,
which is dearer. Prescribing as a panacea to drug related harm is an
oversimplified response to the drug problem. Addicts on a methadone
prescription could still continue to use street heroin as well, and may
therefore continue to raise money for heroin through crime. The leakage of
prescribed drugs in significant quantities onto the illicit market is inevitable
because the methadone prescribed may fail to meet addicts’ needs.79 For
many addicts, remaining on a prescription for a long time seems to be the
rule. Furthermore, despite the considerable benefits of methadone (like crime
reduction, client stabilization, reduction of illicit drug use) there is little
evidence of success in weaning heroin users off methadone.80
The Home Office Police Research Group study – New Heroin Outbreak
Amongst Youth in England and Wales – made recommendations for better and
more widely available drug services for young people, which do not involve
the routine prescribing of methadone as a first instance. Further, it accepted
that maintenance on prescriptions should not and cannot be a first response
to the treatment of drug addicts except in a desperate situation, namely for
detoxification.81 Prescribing drugs is not an effective answer to drug
dependency. It leads to spillage or leakage in the illicit drug market, and
encourages complacency in the addicts’ and in the society as well. The
Brixton Drug Project in London asserted that over the past ten years, the
British drug strategy has been nothing
78 Parker, Bury & Egginton (1998), New Heroin Outbreaks Amongst Young
People in England & Wales, at pg 55. 79 HM Government (1998) Tackling
Drugs to Build a Better Britain: The Government Ten-Year Strategy for
Tackling Drug Misuse; Hough (1996), Drugs Misuse and the Criminal Justice
System: A Review of the Literature, at pg 3 of 11, chapter 4: Communities
Penalties; See also Central Office of Information (1987), The Prevention and
Treatment of Drug Misuse in Britain, at pg 22. 80 ACMD (1982), Treatment &
Rehabilitation - Report of the Advisory Council on the Misuse of Drugs, at pg
1; Central Office of Information (1978), The Prevention & Treatment of Drug
Misuse in Britain, at pg 22, and 27. 81 Parker, Bury and Egginton (1998), New
Heroin Outbreaks Amongst Young People in England and Wales, at pg vii and
56; Home Office News Release 314/98, Tackling Drugs in Northumberland:
George Howarth Launches New Project, 3rd November 1998, London: Home
Office.

‘Hot Turkey’
more than harm-reduction. Harm reduction honestly is not about eradicating

drug addiction or dependence, but rather, of reducing drug- related problems.
The provision of drugs arguably will help addicts avoid the illicit market,
HIV/AIDS and acquisitive crime. However, prescription by general
practitioners as a first step has the potential to pave the way to drug use, not
abstention, unless there is clear advice and guidelines. It also sends a wrong
signal to the addicts themselves and their peers that drug taking is not a
taboo. The harm reduction policy, which should be a short-term strategy,
inevitably continues in practice to be a permanent and integral part of the
treatment and education policy, though such a move is technically an affront
to the criminal justice system. It is like an indirect endorsement to drug use
in the face of its widespread use in the society. What it amounts to is a
pragmatic response to the fact that drug use cannot be curtailed. The view is
that, the least that can be done is to ensure that it is used responsibly to
reduce the drug related problems. It might be thought that this is an
acceptable response, as far as the health issue is concerned, but quite
incompatible with the criminal justice system.
The UK Central Drugs Co-ordination Unit, in its document published in May

1995 titled ‘Tackling Drugs Together’ recognized the need to take effective
action by vigorous law enforcement, accessible treatment and new emphasis
on education and prevention to: increase the safety of communities from
drug-related crime; reduce the acceptability of drugs to young people; and to
reduce the health risks and other damages related to drug misuse, through
multi-agency coordination at national and local levels. The Home Office
Minister, George Howarth told senior police officers that though much of the
Government’s emphasis in the ten-year strategy, ‘Tackling Drugs to Build a
Better Britain’, is on treatment, education and harm reduction, enforcement
is still a priority.82 The recent Public Entertainments Licenses (Drug Misuse)
Act 1997 introduced in May 1998 enables the local authorities to shut down
clubs immediately where the operators cannot, or will not, deal with a
serious problem of drug misuse on the premises. The UK Government’s
White paper ‘Tackling Drugs Together, 1995 is silent on harm- reduction. The
strategy or the ultimate goal must be to ensure that people
82 HM Government (1998), Tackling Drugs to Build a Better Britain: The

Government Ten-Year Strategy for Tackling Drug Misuse, Cm 3945, London:
Home Office. (1998), in ‘Aim (ii): Communities – To Protect our Communities
from Drug-Related Anti-Social and Criminal Behaviour’, pg 1 of 3; Home Office
News Release 219/98, Minister Praises Police Commitment to Tackling Drugs,
15th June, 1998, London: Home Office.
do not take drugs in the first place, but if they do, they should be helped to
become and remain drug free. The UK government does not condone drug
taking or support any initiatives that could be interpreted as such. It however
acknowledged that there would always be those, who through ignorance or
other reasons will misuse drugs, whatever the consequences. For these
people, information and facilities aimed at reducing the risks should be
provided because that may save lives. However, such information must be
coupled with the unambiguous message that abstinence from drugs is the
only risk-free option. Sections 61 – 64 (Drug Treatment and Testing Orders) of
the Act which received Royal Assent on the 31st July, 1998, introduced a new
community penalty, the Drug Treatment and Testing Order (DTTO), which is
aimed at those who are convicted of crime(s) to fund their drug habit and
who show a willingness to co-operate with treatment. DTTO was created in
order to break the links between drug misuse and other types of offences,
thereby preventing further offences. Section 61 allows the court with the
offenders’ consent, to order the offender to undergo treatment for their drug
problem, either in tandem with another community order, or on its own.
Unlike the Criminal Justice Act 1991, proof of drug misuse is not necessary
so long as the court is satisfied that the offender is a dependent drug-
misuser. It is open to the court, with the offender’s consent, to order a drug
test before sentencing, which may assist in the court’s assessment of
whether the offender is a dependent drug-misuser. The order is available for
any offender aged 16 or over whom the court considers is dependent on
drugs and is assessed as being a suitable candidate for treatment. It is a
community order within the meaning of section 6 of the Criminal Justice Act
1991 and will last between six months to three years. Section 62 requires
that the order specify the nature of the treatment required, whether the
treatment is residential or non-residential, its location, the frequency of drug
testing, and the petty session area where the offender will reside. Section 62
(1) requires the offender to submit for treatment with a view to the reduction
or elimination of his dependency on or the propensity to misuse drugs. The
offender is thus obliged to provide samples for testing at such times or in
such circumstances as may be determined by the treatment provider. The
offender may have ulterior motives for consenting to the order without
seriously wanting to change. Section 63 therefore enables the court to
periodically review the offender’s DTTO progress from the probation officer’s
written report. The report would necessarily include the results of drug tests
or the regularity of the offender’s attendance at appointments. It will also
include judgments by the treatment provider on the offender’s attitude

‘Hot Turkey’
and the responses to the treatment programme. Hence, the treatment

provider’s confidentiality policy must be compatible with the necessary
provision of information to the Probation Service and the court. DTTO
provides that the offender should liaise (not to frustrate the supervision) with
the officer responsible, if the letter and spirit of the order is to be achieved.
During the review, the court may amend the order. If the offender does not
consent, it may revoke the order and re-sentence the offender for the original
offence with the possibility of a custodial sentence. Since addiction is a
relapsing condition, the court needs to recognise that a degree of failure
must be viewed as part of the treatment process, and not by itself a breach
of the DTTO orders. The manner and extent of the failure to comply with the
requirements of the order, rather than simply not responding well to the
treatment needs to be distinguished by the court. Section 64 therefore
ensures that the offender knows the effect and meaning of the order, and the
consequences of failing to comply with it.
The prison practices a policy aimed at reducing the demand and supply of
drugs in prison. Accordingly, it will not tolerate the presence and use of illicit
drugs in its establishments, and mandatory drug testing remains the
centrepiece of this punitive supply-focused strategy. Consequently, the harm
reduction approach is less important in the treatment and rehabilitation of
inmates with a drug problem. The ACMD (1996)83 was of the view that the
harm reduction measures should be accorded a more important role than
was allowed in view of the legal, medical and practical issues prevalent in
prison. The ACMD (1996) believed that the consequences of drug misuse in
terms of violence, intimidation and extortion are as important as the impact
on the individual’s health. The prison programme (varies from prison to
prison) includes detoxification services, therapeutic communities, education,
and counseling. Detoxification through education prescribing of methadone
or other drugs is normally the case, though the practice is less common than
under the NHS treatment. Usually, a limited number of prison staff such as
probation officers, psychologists and hospital officers can provide basic help
and advice, and the Medical Officer is responsible for providing
detoxification, which is done more quickly, and on a much more limited basis
than in the community. These facilities are in-house, but may also use
expertise from other agencies, particularly from the
Misusers and the Prison System - An Integrated Approach, at pg 33-34, 38 and
76 –77.
drug action teams. There is no provision for needle exchange or other

services to minimize the harm from drug use. The best help usually comes
from the small number of drug agencies around the country who specialize in
working in prisons, and whom most prisoners prefer because they are seen
as independent from the prisons, and as having specialist knowledge. These
agencies provide counseling, group work programs, information, support and
advice, and try to link prisoners into drug services in the community when
they go to court or are due to leave prison. This partnership with other drug-
related agencies may continue after their release from prison.84 Since 1995
(Prison Rule 86), prisoners will be required to provide urine sample for testing
purposes, and it is a disciplinary offence for inmates to use controlled drugs
without medical authorization. Drug testing on prisoners is done at reception
and randomly throughout their sentences. Those prisoners suspected of
taking drugs, or those prisoners who have persistently tested positive over a
period of time, will be tested most frequently. Though prison inmates cannot
be forced to provide a sample for testing, refusal to provide a sample (not
necessarily urine) for testing is a disciplinary offence. The same goes for
adulterating or substitution of the sample given. Prisoners who test positive
are subject to a range of punishments, including additional days of
imprisonment, or the loss of privileges and earnings.85
CONCLUSION The non-prescribing policy of Malaysia on therapeutic drugs in

the past for purposes of weaning and stabilization would mean that a drug
dependant seeking treatment and rehabilitation would have to think ‘very
hard’. This policy could in actual fact deter problem drug takers from seeking
treatment, though giving prescriptions liberally may lead to dependence or
spillage of the same into the illicit market. Further, there is also no guarantee
that an addict undergoing treatment (whether
Misusers and The Prison System - An Integrated Approach, at pg 36, 70-71;
Hellawell, K. (1998) Making the Community A Safer Place; Cabinet Office
Press Release 276/98, 18th December 1998, London: Cabinet Office; Hough
(1996), Drugs Misuse and the Criminal Justice System: A Review of the
Literature, at pg 2 –3 of 6, Chapter 5: Intervention in Prisons;
Durham/Darlington Drug Action Team Home Homepage, Prison Matters: What
Help Is There for Drug Users in Prison? in
http://web.ukonline.co.uk/drug.action/Prison.htm. 85 Flynn N. (1995) Drugs in
Prison: Another quick fix?, pg 2 of 4, Drugs Edition, Issue Four, in
www.drugtext.nl/release/four1.html. - Release Publications Ltd, London;
ACMD (1996), Drug Misusers and the Criminal Justice System. Part 3: Drug
Misusers and the Prison System - An Integrated Approach, at pg 49-51.

‘Hot Turkey’
for gradual withdrawal or on maintenance) would not take drugs illicitly (even
by way of acquisitive crime). Harm reduction is less about eradicating drug
addiction or dependence than reducing drug-related problems. Thus,
Malaysia’s initial “cold turkey” approach is quite justified i.e. abstinence from
drugs is the only risk-free option. As such, it is important not to overlook the
acknowledged benefit inherent with maintenance on prescription in terms of
health, drug use, offences and social integration. Stabilization of clients for a
longer period of time till such a period when he is prepared for withdrawal
might seem the most practical avenue, particularly for hard-core addicts who
are ‘hooked for good’. The “cold turkey” approach is idealistic and
impractical. It must be recognized that the problem of drug addiction or
misuse is also undeniably a medical one. The best approach for dealing with
and combating the drug problem is one that combines effective enforcement
with humanity. In this respect, the Malaysian Dangerous Drugs Act 1952
makes referral to treatment and rehabilitation, in accordance with the Drug
Dependants (Treatment and Rehabilitation) Act 1983. Treating drug addiction
through medical and educational supervision within the criminal justice
system is the best way forward, preserving proportionality and therefore
fairness.
Malaysia must exercise a certain degree of patience and restraint, so that
stabilization and weaning are acceptable methods of treating addicts,
especially for those who have taken drugs for many years. A certain degree
of failure to come off the drugs must be viewed as part of the treatment
process and not by itself a breach of the order. Addiction is a relapsing
condition, and so a degree of failure must be viewed as part of the treatment.
The manner and extent of the failure to comply with the requirements of the
order, rather than simply not responding well to the treatment would have to
be distinguished by the treatment provider. However, the period should not be
very long and should not lead to chronic dependence of the drugs being
prescribed. Malaysia has now acknowledged that opiate maintenance has its
benefits. With proper and careful use of it on drug dependants, there is no
reason why drug dependants could not eventually be weaned. The
responsibility has to be entrusted to the services and advisory centre or
private doctors or private clinics (in liaison with the centre) to review the
progress report of the drug dependants. It would also help to take the
pressure off the limited numbers of boot camps with the heavy financial
burden they face. Promising drug dependants from rehabilitation centres
could be released early to undergo supervision at private centres or the
government’s drug treatment clinics, as a transition into society. Progress

reports of every drug dependant at private centres have to be submitted to
the nearest government advisory and services centre or the National Anti-
Drugs Agency for evaluation.
The probation–like form of supervision is a good move that signals to the

discharged drug dependants that any untoward relapse to drugs cannot be
tolerated. Putting penal sanctions for relapse is inevitable and is no more
different than undergoing treatment as part of a probation order. Drug
dependants must also be forewarned that they must show progress and be
committed to the terms and conditions of the supervision. Punishing them for
breaching the terms and conditions is therefore justified, provided that the
breaches are because of the manner and extent of the failure to comply with
the requirements of the order, rather than not responding well to the
treatment provider. Mandatory drug testing in prison for drug inmates is also
inevitable to curb drug misuse in prison, so that it doesn’t become a nesting
ground for the misuse of drugs. Penalization or disciplinary actions are
inevitable to ensure compliance. Efforts must however, be taken to ensure
that they get treatment and rehabilitation in the prison as well as after their
discharge.
Rehabilitation centres should not be the main thrust in the treatment and
rehabilitation of drug dependants. Given the fact that most drug dependants
need a longer time to learn to live without drugs, their treatment and
rehabilitation for the period should not be done in confinement, except for
special cases, namely on medical grounds (problem drug takers). The patient
must immediately thereafter be put on supervision and their family must be
made responsible in monitoring him. The period of residency should be
limited, as opposed to what is now being currently practiced. Residential
treatment should not be prolonged but designed merely to stabilize the
problem drug takers, or reserved for critical cases. Its role should end there.
The answer therefore is to make available conveniently accessible multi-
disciplinary drug treatment clinics in many localities, to effectively monitor
patients who are put on a drug prescription for weaning and gradual
withdrawal. Even though these measures may or may not be able to affect
permanent recoveries, at least they do not constitute severe intrusions into
human rights and may help some addicts. More leeway has to be given to the
more open and decentralized drug treatment clinics with facilities for
detoxification, stabilization, the supervision and monitoring of drug
dependants on an outpatient basis, and possibly inpatient basis too.

‘Hot Turkey’
Prolonged residential treatment and rehabilitation is not necessary,

especially when outpatient treatment and rehabilitation is no less effective.
Keeping a drug dependant incarcerated for a lengthy period can be counter-
productive because treatment and rehabilitation cannot work in confinement.
It also highlights the need for Malaysia to give more emphasis to supervision,
and reconsider the entrenched idea against maintenance on prescriptions
when treating addicts. Supervision, which requires the drug dependants to
regularly register with the service and advisory centre, or the police station,
achieve the same effect as confining addicts at boot camps. It also allows a
drug dependant the time he needs to kick the drug habit, and at the same
time avoid causing major disruptions in terms of his finance, family and
social circumstances. There is also no stigma. These are important factors of
treatment and rehabilitation the Malaysian government perhaps seems to
have overlooked and is now seriously re-evaluating.
Malaysia should not be overzealous to obtain quick results. Zero- tolerance

policy need not mean opposing maintenance on prescription for the
stabilization and weaning of addicts. In fact, it is compatible with the aims of
the zero-tolerance policy. It is the doctor-client relationship that matters
most. Flexibility is important, especially when the period of treatment and
rehabilitation of drug dependants is inevitably very long and resources tend
to be limited. Supervision at localized multi disciplinary drug treatment
clinics allow a drug dependant the time he needs to kick the drug habit while
continuing his socio-economic activities, which is also vital to the
rehabilitation process. Here the concept of harm reduction and maintenance
on a script are intertwined, as are both sides of the same coin. Prolonged
residential treatment and rehabilitation, and the “cold turkey” approach, have
fared no better than the UK’s approach. Given the lack of evidence that any
of these treatments are effective, the individuals’ rights and freedoms should
be protected. Here, UK’s practice is less invasive than Malaysia.
Malaysia has decided to be patient by extending the deadline to make the

country narcotics-free by end of 2015 since declaring it as enemy of the
State in 1983. Drug taking is only a symptom. There is no easy and fast way
to eradicate the drug menace and Malaysia needs to be more sensitive in
treating and rehabilitating drug dependants the way drinkers and smokers
are tolerated. What is required is, to deal severely against those who
intentionally and illicitly cultivate, supply and finance drug taking.
With the move from the “cold turkey” to maintenance on drug prescription
and the harm reduction approach, it is also high time that the families of drug
dependants play a proactive role physically and monetarily in their treatment
and rehabilitation by not making treatment and rehabilitation centres as their
easy dumping ground. Drug dependants and their families should also realize
that they too have to find ways to change and improve themselves, and they
should also look into the possibility of training their own drug dependants to
be self- employed or worthy of employment. Without these, the treatment and
rehabilitation by the government, no matter how superb would eventually go
down the drain. The question is whose fault is it then (the government or the
individuals)? The government can only do to a certain extent, but families are
equally responsible for the end products of their own members. It is never too
late to ponder what the Prime Minister Datuk Seri Dr Mahathir (as he then
was) said in May 2003 that inculcation of good values and proper education
is the key to success in eradicating drug misuse in the younger generation,
and severe punishment alone could not possibly wipe out the drug menace in
the society. He emphasized that parents too must inculcate in their children
the heinous nature of narcotic drugs if misused or unlawfully used.86
86 New Straits Times, Dr Mahathir on the Only Way to Rid the Country of Drug
Scourge, at pg 2, 20th May 2003.
Cyber Counseling for Addiction and Drug Related Problems
173Huzili Hussin, Irma Ahmad & Dr. Mohamad Hashim Othman, m/s 173-192
1 Universiti Malaysia Perlis (UniMAP) 2 Pensyarah, Universiti Sains Malaysia

(USM)
CYBER COUNSELING FOR ADDICTION AND DRUG RELATED PROBLEMS
Huzili Hussin & Irma Ahmad1 Mohamad Hashim Othman2
ABSTRACT
Drug abuse is not a new issue in Malaysia. The Prime Minister of Malaysia
had announced drug as the number one national enemy. According to the
National Anti-Drugs Agency, there were 289,763 individuals addicted to drugs
from 1988 until 2005. At present, government, private agencies as well as the
NGOs are taking initiatives towards reducing the demand for drugs. One such
initiative is the cyber counseling service which was implemented by the
National Association for the Prevention of Dadah - PEMADAM, a national NGO
that focuses on drug prevention programs. This paper highlights a few drug
abuse cases handled by a registered counselor who is also a reference
person and volunteer counselor for PEMADAM. This paper will further discuss
on how the cyber counselor responds to his clients and the approaches that
were used by the counselor to handle his clients in cyber space. This paper
also elaborate on the possible service and effectiveness of cyber counseling
to overcome drug problems and outline suggestions for practical cyber drug
counseling service for the Malaysian public.
ABSTRAK
Penagihan dadah bukanlah satu isu baru di Malaysia. Yang Amat Berhormat
Perdana Menteri Malaysia telahpun mengisytiharkan bahawa dadah adalah
musuh nombor satu negara. Menurut perangkaan Agensi Antidadah
Kebangsaan (AADK), terdapat seramai 289,763 individu yang menagih dadah
di Malaysia dari tahun 1988 hingga 2005. Sekarang ini, pihak kerajaan, agensi
swasta dan juga NGO telah mengerakkan pelbagai inisiatif ke arah

mengurangkan permintaan terhadap dadah. Satu daripada usaha sedemikian
ialah perkhidmatan kaunseling siber yang digerakkan oleh PEMADAM, sebuah
NGO kebangsaan yang memberi tumpuan kepada pencegahan penagihan
dadah. Artikel ini memaklumkan beberapa kes penagihan dadah yang diurus
oleh seorang kaunselor berdaftar yang juga bertindak sebagai pakar rujuk
dan kaunselor sukarela untuk PEMADAM. Artikel ini seterusnya
membincangkan bagaimana kaunselor siber bertindak ke arah klien dan
pendekatan yang telah digunakan bagi mengurus klien beliau dalam ruang
siber. Pada masa yang sama, artikel ini akan menghuraikan kemungkinan
perkhidmatan keberkesanan kaunseling siber dalam mengatasi masalah
dadah serta menggariskan beberapa cadangan untuk perkhidmatan
kaunseling siber kepada masyarakat Malaysia secara lebih praktikal.
INTRODUCTION Drug abuse is not a new issue. It is how governments of the

world look at it. At one time, drug was a trading commodity. But since the
Geneva Convention (No.1) in 1925, Geneva Convention (No.2) in 1931 and New
York Narcotics Declaration in 1961 governments started re-thinking the
impacts of drug abuse on societies. Now NGOs, such as PENGASIH,
PENDAMAI and PEMADAM are taking initiatives and efforts towards demand
reduction. One of the initiatives is through cyber counseling services.
There are various definitions for cyber counseling. In fact, terms such as
online therapy, e-therapy and internet counseling have similar definitions
with cyber counseling but with different terminologies. However, in this
study, cyber counseling is defined based on the term coined by John Grohol
(2000) that is the process of interacting with the counselor online in an
ongoing series of conversations over time. Meanwhile Feltham and Dryden,
(2004) defined cyber counseling as email counseling, that is counseling by
electronic means. Some growth in this took place in the late 1990s and it
seems set to expand if problems of confidentiality can be addressed. Some
clients prefer its privacy, easy access and ability to use from home, but some
counselors lament that it undermines the importance of the relationship. In
different variants, it is also known as online and cyber therapy.
According to Grohol (2000), the development of cyber counseling started in

1972. It began with a simulated psychotherapy session between
computers at Stanford and UCLA during the International Conference on

Computer Communication in October, 1972. He also pointed out that the
earliest known organized service to provide mental health advice online was
“Ask Uncle Ezra”. It is a free service offered to students of Cornell University
in Ithaca and it has been in continuous operation since September, 1986.
David Sommers is considered to be the primary pioneer of e-therapy as he
was the first to establish a free-based Internet service.
In 1997, a nonprofit society named International Society for Mental Health
Online (ISMHO) was formed to promote the understanding, use and
development of online communication, information and technology for the
mental health community. While in Malaysia, there are many universities and
other agencies such as government and non-government agencies offering
help via internet. For drug issues, PEMADAM and the National Anti-Drugs
Agency (NADA) have developed a website for the drug addicts to
communicate with the selected counselors via e-mails. In other words, it
offers cyber counseling services for the drug addicts. Thus in the 21st
century, it is clear that interaction between counselor and his clients is not
only through face to face session but also through the internet.
ISSUES IN CYBER COUNSELING Cyber counseling is a new leading edge.

There are potential benefits and also some risks. According to Grohol (2000)
the potential benefits of receiving cyber counseling may include: 1) clients
are able to send and receive messages at any time, day or night and at any
place; 2) clients are able to take as long as they want to compose, and have
the opportunity to reflect upon the messages; 3) clients automatically have a
record of communications to refer to later; and 4) clients feel less introverted
than in person (http://www.ismho.org/suggestions). Clients also should be
informed about the potential risks such as messages not being received and
confidentiality being breached. According to Ainsworth (2001) e-mails could
fail and not be received if they are sent to the wrong address and
confidentiality could be breached in transit by hackers or internet service
providers or at either end by others with access to the e-mail account or the
computer.
Other than potential benefits and risks, there are also some issues that need
to be raised in cyber counseling. Ainsworth
(http://www.metanoia. org/imhs/issues.htm) pointed out that clients should

ask themselves four questions about cyber counseling. They are: i. Is cyber
counseling right for me? ii. Who is the counselor? iii. Is it effective? and iv. Is
it confidential?
Cyber counseling is not appropriate for every condition. It is not for people
who are in the midst of a serious crisis such as suicide. In cyber counseling,
clients need to communicate to the counselor via e- mail. Thus they must be
comfortable to write expressively, informally and with some detail. Cyber
counseling is also a new field. Thus it may have some risks. When counselor
and client meet in virtual reality, the client should be informed of the name of
counselor, the qualifications and how to confirm the existence of the
counselor. Thus it will expose the personal background of the counselor and
reduce the risk of misuse of identity which may occur.
Cyber counseling will never replace the traditional face-to-face method.

However, it is not meant to replace the traditional counseling but it is another
way of caring and helping. Ainsworth (2001) found out that 90% of the people
who seek help online say that it helped them. Communicating to a counselor
via e-mail is probably as safe as talking to one in person. Cyber counselors
will take their responsibility seriously to protect the privacy and
confidentiality as long as there are no other person who can gain access to
the e-mail account.
According to Tuti Iryani Mohd Daud et al. (2005), the U.S. Department of
Education 2003 reported 59% of children and adolescent use the internet.
However, the percentage for Malaysian adolescents is not available.
Nevertheless according to the Malaysian Communications and Multimedia
Commission 2004, the number of internet subscribers in Malaysia has
increased up to 8 times within the past 6 years.
REVIEW OF LITERATURE The empirical studies of cyber counseling are few

and far between. However, online support groups for a variety of mental
health issues such as eating disorder, sexual abuse, breast and other cancer,
HIV and substance abuse/addiction have been studied. According to Laszlo
et al. (1999) most studies used small groups which limit their external
validity. Because the literature in this area is scarce, we have included
some findings from other studies that could influence the discussion on the
effectiveness of cyber counseling.
Based on the reports by the Surgeon General’s Report on Mental Health 1999
(cited from http://www.metanioa.org/imhs) one out of five Americans have
been diagnosed with psychological problems and nearly two-third of them
never seek help. According to Ainsworth (2001), the primary reason for them
not to seek help is the stigma. They are too embarrassed to talk to a
therapist. In this study, cyber counseling is used as a method of treatment
because it offers more privacy for the drug addicts to voice their feelings and
their problems.
Shernoff, (2000) found out that cyber counseling has increased the additional
complexity to treatment. He pointed out that cyber counseling allows his
clients to send him immediate and brief e-mails if something very pertinent
to what they are working on happens between the sessions. In other words,
through e-mails, his clients do not have to waste their time jotting down the
event or feelings and bringing them to the next session. This could avoid the
client from forgetting important events or feelings from the perspective of
the past several days. Thus, this could give opportunity to the counselor to
glimpse into a deeper level of his clients’ feelings.
Another benefit of cyber counseling is it can be done at any time and place
as long as both the counselor and the client have access to the internet and
e-mail accounts. Laszlo, Esterman and Zabko (1999) stated that one of the
reasons why cyber counseling is effective is both the client and counselor do
not have to sit down at the same time for the counseling session. In other
words, clients are free to send their e-mails anytime they want to and the
counselor will have more time to respond to the e- mails.
Almost every counselor will have various types of clients with different
background and work. Some clients need to travel and are not able to attend
all the face-to-face sessions. Shernoff, (2000) stated that because not all his
clients are able to attend the face-to-face session; he decided to do it via e-
mail. According to him, cyber counseling allows his clients to send an e-mail
to reflect on the issues that they are working on and to share all feelings or
any practical issues that arise in their lives.
Although it is not as ideal as a face-to-face session or even a phone session,

it keeps the interactions alive.
Tuti Iryani Mohd. Daud et.al, (2005) who described the pattern of help seeking
behavior using the internet and perceived efficacy of the internet, found that
two thirds of 362 subjects sought help from informal sources like parents,
siblings and friends. On the other hand, the percentage of those seeking help
from formal sources like mental health professionals, other health
professionals, telephone crisis hotlines and the internet were very low. The
research also showed that only 10% of the subjects thought that internet had
helped them a lot in dealing with their problems effectively. Meanwhile 51%
of the subjects perceived that seeking help on the internet only helped them
a little.
Grohol (1997) pointed out that there were three advantages in choosing cyber
counseling as an alternative. They are an increased perception of anonymity,
ease of contact and expert opinion from all over the world. As the internet is
an open network, communicating through it means communicating without
boundaries. Clients can contact the counselors at anytime and anyplace and
they manage to get opinions from experts all around the world to treat them
or to get a second opinion on their problems.
Roles, (2006) stated privacy and anonymity by e-mail are more appealing and
comfortable (cited from www.e-mailtherapy.com). Suler (2001) supported this
statement. According to Suler, one of the attractions of online counseling for
some clients might be its anonymity. The anonymity and convenience may
break down some of the barriers to seeking help on personal problems. In
other words, you can be more open when you are at your keyboard than in
person with a professional.
While others were discussing more into the advantages of cyber counseling,
Stephen Snow criticized and questioned this service. In his article (cited in
http://www.commcure.com/ethicsonline.html/), he questioned whether online
counseling is ethical to be practiced nowadays. He questioned the
confidentiality and privacy as well as the client and counselor’s identification
and disclosure. There is no doubt that clients who use the computer at work
are subjected to corporate policies such as their e-mails being read. John J.
Paris, (2001) supported this point of
view. “The computer equipment belongs to the employer, so does everything

in it.” (Cited in http://www.commcure.com/ ethicsonline.html/).
Grohol (1997) pointed out that the disadvantage of online counseling is the
lack of nonverbal communication. Cyber counseling is different from
telephone counseling. Stuart Klien (1997) hypothesized that the lack of
visual cues intensifies the need to listen and the ability to listen. However, in
cyber counseling, the session is done via e-mail. Thus, it does not involve
listening. In fact this modality lacks nearly all nonverbal cues. However,
Grohol (1997) stated again that e-mail exchanges allows for greater thought
and elaboration on one’s emotions.
In conclusion, cyber counseling or counseling online is not meant to be a

replacement for face-to-face psychotherapy. It may be an important source
of help for you as you face a variety of challenges in life. Cyber counseling
offers an opportunity for you to communicate about the dilemmas you are
facing with a professional as a guide for consultation, feedback and support.
THEORY AND APPROACHES IN CYBER COUNSELING There is no doubt that
there are naturally needs for improvising or an adaptation of the
psychotherapeutic concepts and theories in cyber counseling due to the lack
of face-to-face contact. In fact, there are a number of writers who proposed
a variety of practice possibilities and theoretical modalities that can be
potentially adapted to cyber counseling.
The Crisis Intervention Theory as suggested by Polauf (1996- 99:1998) could

be an effective framework. He termed it as an e-mail based crisis
intervention. Parad & Parad, (1990) defined crisis intervention as “a process
of actively influencing psychosocial functioning during a period of
disequilibrium in order to alleviate the immediate impact of disruptive
stressful events and to help mobilize the manifest and latent psychological
capabilities and social resources of persons directly affected by the crisis.”
He suggested that the problem should be framed during initial messages
(cited from Laszlo et al. 1999). Polauf (1996-99; 1998) further describes that
the process starts upon receiving the initial
e-mail from the client. He said that counselors should explore the problem
and reframe it in cognitive terms after receiving the initial e-mail. This could
help to instill hope, reduce the client’s anxiety, develop trust and allow them
some space. Thus the client feels that he or she is listened to and is
understood.
To promote the client’s autonomy and sense of competence, the formulation

of concrete and attainable goals should be collaboratively agreed between
the client and the counselor. According to Laszlo et al. (1999), this process
should include symptom reduction, restoration of functioning, insight into
stressors and increased repertoire of problem solving skills. Polauf (1996-99;
1998) added towards the end, a specific time frame is then set up within
which goals can be met and during which structured and active interventions
are used.
Cognitive-behavioral intervention could be compatible in this study because

they rely on conscious processes and thinking. Beck, (1976, cited in Laszlo
et al., 1999) stated that cognitive theory works on examining the individual’s
thought processes, detecting cognitive error and helping the individual to
develop alternatives and be more flexible in understanding the individual/self
and environment via re-framing techniques. Gabriel and Holden (1999)
recommend a possible adaptation in text-to-text intervention by looking at
the emergent patterns in text to be intervened on (cited in Laszlo et al.,
1999). They are over-generalization, excessive responsibility, predicting
without sufficient evidence, making self-referential statements and turning
situations into catastrophes and only focusing on the negatives. These
emergent patterns give cue to begin restructuring the individual’s thought
processes and to foster change.
Narrative therapy is another approach that could be used in this study.

According to White, (1990) narrative therapy is based on a theory of
interpretation and holds (cited in Laszlo et al., 1999). It is focused on people’s
expression on experiences in their lives. Laszlo et al., (1999) said that as the
clients tell the story of their problems, the therapist will explore their
interpretation of the story and bring forth the contradictory or ambiguous
experiences of their subjective reality. Then, the therapist works on
externalizing and re-framing the problem in a manner that is more enabling
and empowering to its resolution. Laszlo et al., (1999) mentioned that
generally this process occurs face-to-face but it can
happen easily through writing and therefore via-email. In fact, Murphy and
Mitchell (1998), consider the writing process could enhance the
externalization of the problem (cited in Laszlo et al., 1989). This is because
as the client views their issues on the computer screen; it could promote
therapeutic changes.
CASE STUDIES OF DRUG ADDICTION ISSUES Cyber counseling services for

drug addiction cases have been implemented systematically by PEMADAM in
the mid of 2005. Previously, all the clients shared their experiences in a
specific column provided by PEMADAM. However, there were no responses or
feedback given to them. Due to the vast responses given by the society to
the column, PEMADAM has been suggested to offer cyber counseling
services to help those target groups.
Recently, PEMADAM gathered more than thirty counselors to support this

cyber counseling. Generally, all the counselors will be given usernames and
password to access all the problems sent by the clients to the portal.
Initially, all the problems that are sent by clients will be received by the
secretariat before they are distributed to the volunteering counselors. The
most important thing is that, all discussions between the counselor and
client are confidential. In order to get feedback on the cyber counseling
services, PEMADAM will arrange a series of meeting with the volunteer
counselors to discuss the problems that occurred throughout the process of
cyber counseling. At the same time, they also share their views on related
issues that have been pointed out by clients.
Basically, all the cases that are related to drug addiction are divided into two
aspects. Firstly, the issues that relate to problems faced by the drug addicts
themselves. Secondly, are the problems faced by the drug addicts’ families or
relatives such as their parents, siblings and spouse. This paperwork will
portray three cases on problems faced by the drug addicts and three cases
on problems faced by their families. It is to be informed that, all cases
portrayed in this paperwork have been edited by the writer so that it will be
suitable for academic purposes. This is because, the entire original context
written by clients consists of short formed sentences and some of them have
used inappropriate and foul language.
Problems That Been Faced by the Drug Addict Case 1 : I was an acute drug
addict. I was released from prison three months ago, charged for having ATS
pills. While in prison, I met a lady who at that time was my counselor. Now,
after being released, I still keep in touch with her. The problem is, I have
fallen in love with her. Now at the age of 28, I have the desire to get married.
I already have a job as a construction worker. But I am HIV positive. Can I
proceed with my desire to marry her? Does my action make any sense? What
shall I do?
Case 2 : I am 26 years old and am married with a child. I started drug

addiction when I was 15 years old and at that time I was addicted to
marijuana. Now, I am into heroine and I find it too hard to control this
addiction. The worst moment in my life came about when I was accused of
raping a girl although in the beginning it took place with the consent given by
the girl (at the time of the incident, I was under the influence of heroine). Due
to that incident, I ran away from my village. The police are now tracking me.
I regret what I have done. I miss my wife and child. I still don’t know what to
do and where to go. I am sick and am suffering due to my addiction to
heroine. I still have hope to rebuild a new life just like other people. Please
help me start!
Case 3 : I have been having problems with drugs for more than 10 years. Now
I am taking subutex. However, that medicine is hard to find and is always out
of stock. I can’t control myself and must take subutex and now I am addicted
to it. Recently, I have been disturbed by a mystic voice. I even tried to kill
myself because I couldn’t stand to hear those voices mocking me! I once
asked my wife to tie me up and to chain me when I was highly addicted to
the drug. I am saddened by my condition. What can I do to return to the “right
path”?
Problems Faced By Drug Addicts’ Families Case 4 : I just got married to the
girl of my choice. The major problem that I am facing right now is that both
my father and mother in-law are drug addicts. However, they are divorced
now. My mother in-law has just been released from prison. In the beginning, I
wanted to take care of her but she preferred to stay with her old friends. As a
result, now she has started her old habit; drug addiction. My father in-law, on
the other hand always asks money from my wife. I am so depressed with this
situation because my salary is low and at the same time, there are lots of
things that I need to do for my family. Is it possible for me to divorce my wife
if this problem still persists?
Case 5 : I have been married since 2003. In the beginning of our marriage,
we were happy. In fact, we now have a child. However, my husband started to
change when he was offered a better job. Finally, he was drawn into drug
addiction. I can still hardly believe that my husband is a drug addict even
though I’ve witnessed him inject morphine, subutex, dormicum, ATS pills etc.
Initially, I tried to think positively. I even accompanied my husband to get
treatment for his addiction on methadone and subutex. However, he did not
obey the doctor’s advice. I became very disappointed. He always mixes
subutex and dormicum and injects to his body. My husband acts like a
person who has lost his mind when he is high on drugs. I ran away from him
four times. However, each time I ran away, I felt sympathetic and returned. He
always promised to change each time I came back to him. But, the promises
were never fulfilled. Now I’m staying with my family. I am trying to get a
divorce but I can’t seem to do it because of his persuasions. I also pity my
child who misses his father very much. What should I do? I’m too weak and
scared to make the decision.
Case 6 : I am so disappointed with my father and my sister who do not want

to quit taking drugs. My mother and I have advised them so many times but
they are still the same. I am embarrassed to face society. I am afraid that my
other siblings will follow their footsteps. Please help me get out of this
problem.
APPROACHES THAT HAVE BEEN IMPLEMENTED IN THE CASE STUDIES Every

approach that is implemented in counseling should be based on objectives.
According to Burks & Stefflre, (cited in George & Cristiani, 1990) the main
reason for counseling services is to help the client to understand and to
state their views on life and to learn how to achieve their objectives based on
the right choices and problem solving skills. Mizan et al. (1998) pointed out
that the good thing of using the counseling approach is that it guides clients
to search for the factor within them that led to the issues or problems. The
ability to accept themselves as the cause of the problem is very important in
the changing process. In fact in
the counseling process, it also helps the clients to understand and to accept
their weaknesses as one of the source of the problem and how they are
exposed to the problem. Thus, in this discussion, the focus is on the clients
and their roles in the problems and not on the problems that they are facing.
According to Albert Ellis (cited in Amir Awang, 1987) counselors should

understand the qualities of human beings first before they could offer their
services to their clients. According to Ellis; A human being is born with a
potential to think or not to think rationally. In other words, a human being is
given a brain which enables him or her to differentiate between good and
bad, right and wrong and logical and illogical things.
Human beings also naturally yearn to take care of themselves in order to

achieve happiness, to think and to convey their ideas, to love and to be loved
and finally to “move” towards nirvana.
On the other hand, human beings also naturally yearn to ruin themselves, to
avoid from thinking, to hold onto things, to continually do mistakes, to believe
in the supernatural, to be impatient, to blame themselves and to avoid from
progressing towards nirvana.
Furthermore, Ellis stressed that there are lots of irrational beliefs in an

individual’s life. Some of them are as follows: i. A person should be loved and
accepted by others and the society. ii. Human misfortune is caused by
external pressure and humans only have little ability to control them from
becoming disappointed and disturbed. iii. Humans tend to think that all their
past will be the grounds for their actions now. They cannot get rid of the
pressure from their past. iv. They think that a person who wants to be
accepted as a useful person must be those who are very efficient, multi
skilled and is successful in every field.
According to Amir Awang (1987), the approaches that can be used to help the
clients are through counseling therapy and group counseling. The important
thing is the counselors should play their roles whether through persuasion,
propaganda, questioning, challenging or putting up a demonstration in order
to get rid of those irrational beliefs they
have. Some of the implementations that could be applied to the clients are: i.
Encouraging the clients to get hold of their philosophy or views on living and
that it is not necessary to burden their lives with negative values. ii. Clients
are asked to challenge or question their own belief system with certain
proofs and evidence. iii. Clients are asked to prove why they should feel bad
or worse if something they do does not work.
Noraini Ahmad (1996) views the counselors’ roles as not just to give advice
but more into the introspection process. For example; counseling services
should help them to understand themselves and the reality of life, to make
some realistic plans in their lives, to be a responsible person and to be a
person who will function as they rightly should. Thus, based on the
discussion above, the best approach that could be implemented by
counselors is by making them understand and realize on their own on how
they should accept the reality for every problem and to develop actions that
could be taken to overcome those problems.
Before a counselor decides which implementation will fit and work on the
drug addicts and their families, he or she should first understand the concept
of drugs and its implications towards oneself and the society. According to
the National Anti-Drug Association (1998), drug is a psychoactive component
which could cause complications on the nerve system, lead to physical and
psychology dependency and badly affect the health and social function of an
individual.
Mahmood & Md Shuaib Che Din (2003) explained that drug addicts become
addicted to drugs for several reasons. However, the major reason why they
could not stop from becoming addicted is because they want to avoid the
withdrawal syndrome. For those who are addicted to heroine, the withdrawal
syndrome will appear 4-6 hours after taking the last dosage. Drug addicts
will face several problems such as diarrhea, stomachache, cold, sweat,
morning sickness, fear and panic. The climax for this syndrome will be after
24 hours till 72 hours. They will face other problems such as insomnia and
panic without any specific reasons. All these syndromes will disappear if
they take the drug again but with a higher dosage.

Drugs are divided into a few categories. Among them are the plant-based
ones such as cannabis, ganja, heroine and morphine. The other one is the
synthetic drug which is also known as ATS (Amphetamine-type-stimulants).
ATS is very popular nowadays. In fact, this type of drug is found widely in the
form of pills and is well known such as ecstasy and pil kuda. This type of
drug is very dangerous because it could cause the drug addict to become
aggressive and could cause substantial damage to their brains.
In Malaysia, drug addicts are classified into two categories. They are the
acute drug addicts and the novice drug addicts. Acute drug addicts are
those who have been taking drugs for 10 years and have undergone
treatments more than twice at the rehab centre. Novice drug addicts are
those who have been taking drugs for a short period of time and have gone
for treatment once or are yet to go for any treatments.
According to Abdullah Al-Hadi & Iran Herman, (1997) drug addicts will lose
their own pride and not respect their own parents. They treat the slums as
their home, they no longer take care of themselves and are often involved in
crime. Based on a research done by Yahya Don (2000), addiction to drugs will
lead them to commit crimes in two situations: The impact of drugs will lead
them to criminal thoughts as their feelings are no longer stable. The costs of
drugs are also very high thus will lead drug addicts to criminal activities in
order to support their addiction.
Not only that, drug addicts also show some changes physically such as
becoming very thin, weak and aggressive. They are also highly exposed to
HIV due to their sexual habits and the tendency to share needles.
In this study, the approaches that are used to deal with drug addicts differ
from the approaches used for the drug addicts’ families. The approaches are :
Case 1 : Based on the input given by the client, it is clearly stated that he
cannot accept the reality that he is HIV positive. He has plans to start a new
life after being freed from prison. At the same time he assumes that society
will accept him back. Thus to him, there should be no problem
in marrying his previous counselor. In this case, it shows that the client has
a few irrational beliefs within him. Therefore, the counselor has to try to
make his client understand that for the time being, there is no cure for HIV
and he should accept it. In fact, HIV can be transmitted through sexual and
intimate relationships. Not only that, the counselor also needs to explain to
his client that all the good values that were shown by his previous counselor,
such as her caring nature, is in fact part of her job. This is because one of the
counselor’s roles in conducting counseling is to build a conducive
relationship with the client. The counselor also needs to suggest that the
client continues his treatment because he was an acute drug addict; so his
tendency to relapse is high. Finally, the counselor also needs to advise the
client to be a volunteer at the Malaysian AIDS Association. Although he is HIV
positive, he can use his experience to save other people from becoming
involved in activities that could lead them to contract HIV.
Case 2 : In this case, the client has run away from his village and has left his
wife and child. He did this because he was accused of raping a girl and now
he is being tracked down by the police. Thus the counselor should advise him
to surrender himself to the police and return to his family. The counselor can
also list out the advantages and disadvantages of listening to him or
otherwise. The counselor also should explain to his client that for
overcoming drug addiction, support from family members is very important.
Case 3 : Based on the input given, it is clearly stated that the client’s level of
addiction is very serious. This is based on how he described the
hallucination that he is facing at the moment. Thus, the counselor advises
him to get treatment as soon as possible. He could get the treatment at the
clinic which uses methadone and subutex. The counselor also explains the
risks that he has to face if he does not get the treatment. The client will also
be told how lucky he is to have a supportive wife. Thus, the counselor
advises him not to feel ashamed or scared. He should prepare himself to be
strong and to gain support from his family.
Overall, the approaches that have been implemented to drug addicts and
former addicts are focused on making them think rationally and to accept the
reality of life before they could plan some other approach to overcome their
problems. It was stressed to the client to accept the
fact that the best way to cure their addiction is through professional
treatment, their own strength and will power as well as the support from
their families.
Case 4 : Issues that have been pointed out by the client concerns his father
and mother in-law who are addicted to drugs. As a result, the client feels
confused and has decided to divorce his wife. Thus, the counselor should try
to make the client understand that his problem actually concerns his father
and mother in-law. His wife is merely a victim of circumstances. The
counselor explains to the client that the addiction issue needs to be
addressed through a special treatment conducted by a group of specialists.
The counselor also lists out several places that he could contact for help.
Finally, he also advises his client to give full support to his wife in facing this
problem.
Case 5 : Based on the problem, it shows that the client could not accept the
reality that her husband is a drug addict. She is frustrated because her
husband has disappointed her by not following the doctor’s advice. Not only
that, she is still in love with her husband although she ran away from him four
times. Thus to help her, the counselor has to list out the characteristics of
drug addicts and their attitude. The counselor also tries to make the client
understand that addiction to drugs can only be treated at a professional
institution. The counselor also mentions that her love for her husband is
something to be praised but in reality; she should look at other factors too.
Thus, her wish to divorce her husband should be seen in a variety of
contexts. It should not be solely based on the reason that her husband is a
drug addict. She could do it for other reasons such as her husband being
incapable of maintaining a harmonious marriage and family.
Case 6 : In this case, the client has expressed his frustration towards his
father and his sister who are addicted to drugs. As a result, he feels
ashamed to face society. He is also afraid that their habit could influence his
other siblings. Thus, the counselor explains to his client that drug addiction
can happen to anyone. The most important thing is that, he should not feel
ashamed to bring his father and his sister to the drug rehabilitation centre.
This is because only through rehabilitation treatment could their addiction be
cured. The counselor agrees that the attitude of his father and his sister
could influence the other siblings. Thus, the counselor advises his client to
increase his
confidence level and strength to face this problem rationally and not
emotionally.
In conclusion, the approaches that have been implemented by the counselor

to the drug addicts’ families are based on real facts of the drug addicts’
condition and attitude. The counselor also stressed the fact that drug
addiction can only be cured through professional treatment. The counselor
also reminded his clients not to be emotional in dealing with drug addiction.
In fact, the most important thing is they should support each other and be
strong.
EFFECTIVENESS OF CYBER COUNSELING SERVICES As noted before, the

empirical studies of cyber counseling are few and far between. Thus, there is
no specific method that could be used to measure the effectiveness of cyber
counseling in this study. In order to strengthen this services, all the
problems that occur whether related or not with the system and the
processes of implementing; as well as the response from the clients have
been highlighted and given full attention.
Based on the cases that have been discussed earlier in this paper, out of the
six cases, only four responded to the feedback given by the counselor. The
counselor has come up with three possibilities on why the other two clients
did not respond to the feedback. The possibilities are: i. They do not have
access to a computer or internet at home. Probably, when they sent the
initial messages, they used their friends’ computer or sent it from a cyber
café. ii. They received the feedback. They understood and were satisfied with
the feedback or advices given to them. They probably thought that it was not
important to respond and give their feedback because they already
understood what to do or they already got what they were looking for. iii.
They receive the feedback but they cannot accept the feedback given to
them. Probably they still cannot accept the reality of life. In other words,
they are not satisfied with the feedback given to them and they may have
used other channels to help them overcome the problem.
Based on the responses given by the clients, the counselor found out that it
is difficult to conclude whether the client could accept and benefit from the
comments and suggestions. This is because; the responses given by the
clients were too short and simple: Thank you for your advice and point of
view. I will try my best to overcome it. Although all the responses given by
the client were simple and short, the counselors still sent them some
supportive phrases with the hope that it would benefit them all.
CONCLUSION AND RECOMMENDATION Based on this study, the counselor

found out that he did not achieve the satisfaction in handling those cases via
cyber counseling. However, due to the rapid changes in the IT world, every
counselor should prepare themselves for this service as well as other
challenges. In Malaysia, the awareness of using cyber counseling services is
still at the novice stage. The counselor gives two probabilities for this
situation. Firstly, there are still many Malaysians who cannot afford to own a
computer. Secondly, they probably prefer to use the traditional method of
counseling, which is face-to-face counseling rather than cyber counseling.
However, we should use all methods that we have in handling drug addiction
issues. This is because these issues could harm our country if we do not give
it our full attention. It is hoped that cyber counseling services could be
reinforced and more counseling centres could be opened, if possible one
center for each district so that more drug addicts will be able to come
forward to seek help. It is also hoped that both the government and the
private sector could train more counselors in handling drug addiction cases
so that more services could be offered to them. Finally, the anti-drug
campaign should be done comprehensively and extensively to ensure the
society is united to say “NO” to drugs!
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Demographic Determinants of Drug Abuse Problem Among Secondary School

Students in an Urban Area
155Rafidah Aga Mohd Jaladin , m/s 155-172
DEMOGRAPHIC DETERMINANTS OF THE DRUG ABUSE PROBLEM AMONG

SECONDARY SCHOOL STUDENTS IN AN URBAN AREA
Rafidah Aga Mohd Jaladin1
ABSTRACT
The demographic determinants among students with drug abuse problem

were investigated in order to identify the high-risk factors of drug abuse. An
examination of records and an informal interview were used as methods of
collecting data. It was predicted that male students in their late adolescence
whose parents are both working and are living in poor conditions, are more
prone to drug abuse than others. Findings indicated a mixture of results. The
main predictors for drug abuse were gender and age but the other predictor
variables were inconclusive. The adolescents' personality and the quality of
family involvement were also discussed to account for the results.
ABSTRAK
Penentu demografi bagi pelajar yang mempunyai masalah dengan

penyalahgunaan dadah diteliti bagi mengenal pasti faktor-faktor berisiko
tinggi ke arah penggunaan dadah. Data kajian ini dikumpul melalui penelitian
ke atas rekod dan temu duga tidak formal. Kajian ini meramalkan bahawa
pelajar laki-laki di tahap akhir zaman remaja yang kedua-dua ibu- bapa
mereka bekerja, hidup dalam suasana tempat tinggal yang tidak begitu
kondusif dan persekitaran yang mempunyai dadah adalah lebih cenderung
untuk menyalahgunakan dadah berbanding dengan pelajar dari latar
belakang yang berlainan. Dapatan kajian menemui hasil yang berbeza-beza.
Peramal utama untuk penyalahgunaan dadah ialah gender dan umur, dan
variabel
1 Department of Educational Psychology and Counselling, Faculty of

Education, University of Malaya
peramal lain tidak dapat dirumuskan. Personaliti dan kualiti penglibatan

keluarga bagi seseorang remaja turut dibincangkan bagi memberi
penerangan kepada dapatan yang ditemui.
INTRODUCTION In many countries, drug abuse is no longer a common issue.

In fact, drug abuse has become the most serious and contagious problem
that affects all countries and all levels of society (DSP Dzuraidi Ibrahim,
2002). The most worrisome aspect of this issue is that drug abuse has
overpowered quite a number of adolescents in our society. Here, "adolescent"
refers to the student population aged between 11 to 18 years old (Papalia &
Olds, 1998).
Due to this, the Malaysian government launched an Anti-Drug Campaign at

the national level on 19th February 1983. This campaign was carried out
because of three foreseeable risks: (i) drug addiction may reach an epidemic
level if there was no strict law and enforcement carried out to prevent its
spread; (ii) the target group of drug addiction is mainly youths and
adolescents who are the country's future leaders and the hope of the nation;
and (iii) the addiction and distribution of drugs have affected the harmony
and security of the country economically, socially, and politically (Ee Ah
Meng, 1997).
However, there seemed to be a lack of response from the community in
helping to prevent this social ill. As a result, the government has taken an
aggressive measure by declaring the year 2003 as the year for seriously
combating the drug abuse problem. The theme for the year was Perangi
Dadah Habis-habisan.
Statistical report showed that in 1970, there were 711 drug addicts in our
country (Ee Ah Meng, 1997). However, the number kept on increasing as the
years went by, as shown in Table 1. Current data from the statistical report in
2003 showed that there was a substantial increment in the number of drug
addicts with a total number of 36,996 drug addicts all together (Sistem
Maklumat Dadah Kebangsaan -NADI, 2003).
A total of 695 adolescents below the age of 18 were involved in drug abuse.
The distribution of these addicts according to their levels of education is
tabulated in Table 2. Based on this data, it is expected that the number will
increase if no proper measures are taken.

Table 1 : Total Number of Drug Addicts Traced According to Case Status
New Relapse Total Year Number Percentage NumberPercentageNumber

Percentage (%) (%) (%) 1994 11,672 40.59 17,084 59.41 28,756 100 1995
13,140 38.53 20,964 61.47 34,104 100 1996 13,846 45.25 16,752 54.75 30,598
100 1997 17,342 47.80 18,942 52.20 36,284 100 1998 21,073 56.06 16,515
43.94 37,588 100 1999 17,915 50.67 17,444 49.33 35,359 100 2000 14,850
48.54 15,743 51.46 30,593 100 2001 15,831 50.17 15,725 49.83 31,556 100
2002 17,080 53.55 14,813 46.45 31,893 100 2003 20,194 54.58 16,802 45.42
36,996 100
Source: National Drug Information System (NADI, 2003)
Table 2 : The Distribution of Drug Addicts Among Students According to Their

Levels of Education
Year Primary Form 1 Form 2 Form 3 Form 4 Form 5 Form 6University/ school
Colleges 1999 - - 5 24 29 67 62 88 - - 1.82% 48.73% 10.55% 24.36% 22.55%
32.00% 2000 1 2 9 26 49 58 - 134 0.36% 0.72% 3.23% 9.32% 17.56% 20.79%
0.00% 48.03% 2001 1 2 11 38 59 85 84 128 0.25% 0.49% 2.70% 9.31% 14.46%
20.83% 20.59% 31.37% 2002 - 1 5 26 54 102 100 165 - 0.22% 1.10% 5.74%
11.92% 22.52% 22.08% 36.42% 2003 - - 7 18 26 68 116 226 - - 1.52% 3.90%
5.64% 14.75% 25.16% 49.02%
Source: National Drug Information System (NADI, 2003)
Since drug abuse cases among students (especially those in secondary

schools) are worrisome, corrective and preventive measures should be taken
in order to reduce the number of drug addicts among students. However, due
to limited time, energy, resources, and not to mention financial assistance,
the corrective and preventive measures cannot be implemented on all
students. As an alternative, it is best to focus on those students who are
categorized as vulnerable or in the high- risk groups. Unfortunately, there
aren't many studies that examined the predictors of students' involvement in
drug abuse. Thus, there is a great need for parents, teachers, policy makers,
law enforcers and the education ministry to understand the basic information
regarding those who are vulnerable or the high-risk group. This basic
information encompasses the demographic details of those students who
have been convicted for drug abuse crimes.
The present study examines the demographic details of students convicted

for drug abuse crimes in terms of gender, age, number of siblings, parental
vocational status, home location and home environment. The study is also
interested to find out the reasons and resources of drug abuse. Specifically,
the study has the following objectives: i. To examine the demographic
determinants of students convicted for drug abuse crimes; ii. To identify the
source of involvement of these students in drug abuse; and iii. To identify the
drug resources available to students.
Based on these objectives, there are three research questions that need to
be addressed in this study: i. What are the demographic determinants of
students convicted for drug abuse crimes? ii. What are the sources of
involvement that make the students become drug addicts? iii. What are the
means of getting the drugs?
For the purpose of this study, 'drug' is defined as a psychoactive chemical

substance that is used as medicine or narcotics. Whereas, 'drug abuse' refers
to a drug that is taken for non-medicinal reasons (usually

for mind-altering effects); drug abuse can lead to physical and mental
damage and (with some substances) dependence and addiction (Agensi
Dadah Kebangsaan, 2003). Drug abuse also means the use of one or more
type(s) of drug by means of injection, inhalation, drinking, sniffing, or any
other ways that can cause the person stupor or become subconscious. Drug
abuse also refers to improper and excessive use of drug to alter
consciousness. 'Student' refers to an adolescent within the schooling age
range and is still studying at any private or government school.
LITERATURE REVIEW Previous studies have found that many reasons

contribute to the involvement of students in drug abuse. Some of these
reasons summarized by Ee Ah Meng (1997) are as follows: i. The curiosity to
know the effects of drugs; ii. the ignorance of the dangers of drug abuse; iii.
Peer influence and the desire to be accepted into a group; iv. A means of
seeking inner peace when faced with life problems such as inability to cope
with failures in examinations, love, or life in general; v. A means of forgetting
worries, hardship in life and bad experiences; vi. On impulse without
considering the possible consequences of drug abuse; vii. Lack of love from
parents; viii. Boredom towards schools and school activities; ix. Loneliness
because of exclusion from peer group; x. Inability to adapt to life in the city
where there is so much stress and life pressures; and xi. Parents give their
children too much pocket money.
Contrary to popular belief, poverty is not linked with drug abuse unless
deprivation is extreme (Hawkins, Catalano & Miller, 1992).
Papalia and Olds (1998) also listed a number of characteristics of young

individuals and the environment that make them likely to misuse drugs:
i. Poor impulse control and a tendency to seek out sensation rather than to
avoid harm (which may have a biochemical basis), ii. Family influences (such
as a genetic predisposition to alcoholism, parental use or acceptance of
drugs, poor or inconsistent parenting practices, family conflicts, and troubled
or distant family relationships), iii. Difficult temperament, iv. Early and
persistent behavior problems, particularly aggression, v. Academic failure
and lack of commitment to education, vi. Peer rejection, vii. Association with
drug users, viii. Alienation and rebellion, ix. Favorable attitudes towards drug
abuse, and x. Early initiation into drug abuse.
The earlier young people start misusing drugs, the more frequent they are to
use it, and the greater the tendency for them to abuse it.
Based on this discussion, it can be summarized that the reasons for
adolescent students to abuse drugs can be categorized into two main
factors: the individual and the environment. Examples of the sub-
components of the individual are gender, age, race/ethnicity, the number of
siblings, education status, and parental vocational status. On the other hand,
examples of the components of the environment are the location of the
house, type of housing area, and the home environment. Unfortunately, there
are still insufficient studies in the local context that have looked closer into
each of these factors. Therefore, this study is very significant because it
strives to examine some of these demographic details listed above among
students who have been convicted for committing drug abuse crimes. The
selected predictor variables are as follows:
Gender An extensive study conducted by Jenkins (1995) has reviewed some

studies to investigate the role of gender in school delinquency. Based on the
review, girls have consistently been found to have lower levels of delinquency
than boys. Riley (1987) provided some explanation for the findings by
reporting that offenses made by teenage girls could be related

more to low levels of parental supervision and negative attitude toward

schools and not peer-group associations which often characterizes crimes
committed by teenage boys. Thus, in the present study, it is expected that
girls would be less likely involved in drug abuse than boys.
Age Generally, age is positively associated with delinquency (Jenkins, 1995).

The most critical age that signifies serious involvement in delinquency is
during adolescence. Previous studies have shown that serious involvement in
delinquency rose during early adolescence and peaked in the middle to late
teens (Dusek, 1987; Gottfredson & Hirschi, 1990). However, there was no
specific age range mentioned in those studies. Papalia and Olds (1998)
provided some information concerning age- specific rates for the prevalence
of high-risk behaviors. They commented that across ethnic and social-class
lines, many young adolescents (aged 12 to 14) used drugs, drove while being
intoxicated, and are sexually active. They further argued that these behaviors
increased throughout the teenage years. For these reasons, it is predicted
that as age increases, the involvement in drug abuse also increases.
Number of Siblings A number of studies have concluded that family size is a

factor in delinquent behavior (see Jenkins, 1995 for details). In large families
(four or more children), parents may have less time to attend teacher
conferences and PIBG (Parent-Teacher Association) meetings, to check on
homework, or to monitor the school discipline problems of each child and
may have less money to buy basic necessities. Furthermore, Jenkins (1995)
reported that parents of large families have less time to supervise their
children, thus leave the setting of behavioral standards to older siblings,
peers or schools. For these reasons, it is predicted that students who commit
drug abuse come from large families (four or more siblings) and not from
small families (less than four siblings).
Parental Vocational Status There aren't any direct studies investigating the
role of parents' vocational status in the students' involvement in delinquent
behaviors. However, studies investigating the role of socioeconomic status
(SES) of parents in relation to the students' achievement are abundant. Thus,
it can be deduced that if both parents are working, they may have higher
income thus making the SES of the family higher.
SES seems to affect the amount and quality of verbal interaction between
parents and children (Papalia & Olds, 1998). Besides that, SES is a powerful
factor in educational achievement through its influence on family
atmosphere, on the choice of neighborhood, and on parents' way of rearing
children. Is the family stable and harmonious, or conflict- ridden? Do the
parents talk to their children? What goals do they have for their children, and
how do they help them achieve their goals? Do parents show interest in
schoolwork and expect children to go to college? Whether a family is rich or
poor, the answers to questions like these are important; but the answers are
more likely to be in favor of the higher- income, better-educated family
(White, 1982).
Children of poor and uneducated parents are more likely to experience

negative family and school atmospheres and more stressful events (Felner et
al., 1995). Thus, it is hypothesized that students who come from a family
whose parents are both working are more at risk to drug abuse than those
who come from a family with only one parent working. If both parents work,
they have less time to have quality interaction with their children, and less
time to be involved in their children's schooling.
House Location The neighborhood a family can afford generally determines

the quality of life a person may have. House location determines the quality
of schooling available, as well as opportunities for higher education; and the
availability of such opportunities, along with the neighborhood's peer groups'
attitude, can affect the motivation and the students' involvement in school
crimes (Papalia & Olds, 1998). Studies have shown that house location is
greatly influenced by SES and poverty factors. Many studies reported that
poor children are also at high risk of injury, unhealthiness, and problematic
behavior. Many poor families live in crowded and poor sanitary housing areas
and the children may lack adequate supervision, especially when the parents
are at work. They are more likely than other children to suffer from lead
poisoning, hearing and vision loss, and iron-deficiency anemia, as well as
stress-related conditions such as asthma, headaches, insomnia, and irritable
bowel. They also tend to have more behavioral problems, psychological
disturbances, and learning disabilities (Brown, 1987; Egbuono & Starfield,
1982; Santer & Stocking, 1991; and Starfield, 1991). Thus, in this study, it is
predicted that students who live in an unhealthy area, such as squatters, will
be more involved in drug abuse than those living in proper housing areas.

Home Environment Papalia and Olds (1998) stated that the family's SES,
including financial resources and the parents' educational background, could
have a major influence on the children's school achievement. In one study of
90 rural African American families with their firstborn children between the
ages of 9 to 12 years old, it was found that parents with education were more
likely to have higher incomes and to be more involved in the child's
schooling. Higher-income families also tended to be more supportive and
harmonious. Children growing up in a positive family atmosphere, whose
mothers were involved in their schooling, tended to develop better self-
regulation and perform better in school (Brody, Stoneman, & Flor, 1995).
Thus, SES in itself does not determine school achievement and delinquent
involvement; it is its effects on family life that can make a difference.
Family factors such as a chaotic home environment, ineffective parenting,

and lack of attachments and nurturing are thought to be among the most
significant risk factors for substance abuse. Others include
social/environmental factors such as excessive shyness, aggressive
classroom behavior, academic failure, poor social coping skills, involvement
with deviant peers, and perceptions of approval of substance use among
peers in the school and community (NIDA, 1997). In the present study, it is
predicted that students who reported of having an unsatisfactory home
environment would tend to be more likely involved in drug abuse than those
who reported a satisfactory home environment.
METHODOLOGY Forty-three secondary school students who have been

confirmed to be involved in drug abuse by the Unit Pendidikan Pencegahan
Dadah (PPDa) were the participants of this study. All participants were male
students aged between 15 to 17 years old and the mean age was 16.09. They
were Form 3, 4, and 5 students from various schools in Bangsar, Sentul, Pudu
and Keramat zones.
The questionnaire used in this study is called the Borang Biodata Pelajar
Ujian Urin Positif. It comprises of three attachments: The first attachment is
the demographic information section and it consists of 28 items; the second
attachment is the supervision section for recording school attendance; and
the third attachment is the supervision section for recording students'
misconduct in schools.
The questionnaire was designed by the PPDa unit. The reliability and validity
of the instrument was never reported and investigated. However, the form has
been extensively used to record detailed information of students who have
positive results in the urine test for drugs since 2002. For the purpose of this
research, only items 8 (gender), 9 (form), 16 (usage stage), 19
(parents’/guardian’s background: father’s and mother's occupation), 20
(number of siblings), 21 (house location), 22 (house condition), 25 (source of
drugs), and 26 (cause of involvement) from the demography section were
examined and analyzed. The rest of the items were not included in this study
because they were beyond the scope of this study and thus classified as
“strictly private and confidential”.
The data were collected and analyzed by using an examination of records

method. In order to substantiate the finding and to get further information
regarding some of the items, an informal interview was carried out. The
interviewer was a drug education-and-prevention officer who was in-charge
of the files and records of the students confirmed having drug abuse
problems. Most of the analyses use frequency distribution to present the
findings.
PROCEDURE The procedure involved several parties such as the school

authorities, the National Anti-Drug Agency, and the PPDa Unit. Firstly, the
PPDa Unit officers informed the school administration regarding the specific
details of the date and time to carry out the urine test. The urine test was
carried out randomly. The urine test was administered to both male and
female students of various ethnicity, different educational levels and student
bodies (such as prefects and librarians). The students were tested randomly
with the help of the National Anti-Drug Agency. If the results were positive,
the PPDa Unit officers informed the school principals to collect detailed
information of the convicted students by using the Borang Biodata Pelajar
Ujian Urin Positif. Once comprehensive information of the students was
obtained, the school counselors conducted counseling sessions to help those
students to rehabilitate. On the other hand, by using a special logbook, the
PPDa Unit officers act as supervisors to monitor the counseling sessions. Up
to this stage, the main task of the PPDa Unit was to continuously design
several appropriate rehabilitative and preventive programs to speed up the
rehabilitation process of the students who tested positive for drugs. The
researcher's main task, on the other hand, was to

examine every single completed form collected by the PPDa Unit officers
(with the permission of the PPDa Unit) and to carry out data analysis on
these records.
RESULTS AND DISCUSSION Generally, the results showed mixed findings. The
main predictors for drug abuse were found to be the gender and age factors
but the other predictor variables were inconclusive.
Gender Based on the examination of records, it was found that all drug abuse
offenders were male students. This finding is consistent with Jenkins's
(1995) and Riley's (1987) findings, which suggest that males are more prone
to commit drug abuse crime than females. It was argued that the gender
differences in personality development could be the explanation for this
finding (Papalia & Olds, 1998). Popular belief holds that boys and girls
develop differently; that girls mature earlier and are more empathic, and that
boys are more aggressive. But in 80 years of research about development,
this belief has rarely been investigated scientifically. Now, a statistical
analysis of 65 studies of personality growth involving 9000 participants has
found that adolescent girls apparently do mature earlier in some ways than
boys (Cohn, 1991). Thus, this concludes that adolescent males are in the
high-risk group for drug abuse.
Age Based on the records, it was found that there were three age groups
among the drug abuse offenders: 15 year olds (25.58%), 16 year olds
(39.53%), and 17 year olds (34.88%). The mean age for them was 16.09 years
old. This finding does not support the hypothesis, which predicts that older
adolescents commit drug abuse more than the younger ones. The explanation
for this finding could be the education system in Malaysia. In Malaysia, there
are two major achievement examinations for secondary students: the
Penilaian Menengah Rendah or PMR for Form Three students (aged 15 years
old) and the Sijil Pelajaran Malaysia or SPM for Form Five students (aged 17
years old). These two examinations are important for students' academic
placement and achievement. Thus, school authorities place special attention
in monitoring the academics and discipline of these two age-groups.
However, the Form Four students (aged 16 years old) are more relaxed
because theirs is considered as the "honeymoon year". This
indicates that the Form Four students get less attention from the school
authorities as well as parents. Due to this, they spend more time with their
peers and get easily influenced by them.
Number of Siblings As for the number of siblings, there seems to be a bell-

shaped pattern of findings to illustrate the family size of the drug abuse
offenders. Figure 1 presents the details of this finding.
Figure 1 : The Number of Siblings of The Drug Abuse Offenders
The finding was quite surprising and did not support the earlier hypothesis.
Figure 1 depicts that there is a critical number of siblings (i.e., ranging from
4-6) that most drug abuse offenders have. Most of them have four to six
siblings in the family. One explanation for this finding could be due to the
family trend in today's society. Most big families in the urban area have only
four to six children. Only a very small percentage of urban families have more
than six children. Since a majority of these families have four to six children,
there is a tendency that these children might get less supervision and
parental control. Thus, there is a high tendency for them to abuse drugs.
Parental Vocational Status Based on the data, it was found that the drug
abuse offenders have the following percentage distribution for parental
vocational status: (1) only the father works (44.19%), (2) both parents work
(32.56%), (3) only the mother works (11.63%), and (4) both parents do not
work (9.30%). The finding did not support the hypothesis and did not present
any specific
Percentage (%)
Number of Siblings


pattern. Based on the record, it was hard to determine whether those
students who reported that only the father works or only the mother works
came from single-parent families or not. If they did, Jenkins (1995) has
sufficient explanation to account for the high percentage of 44.19% and
11.63% (which totals up to 55.82%) (See Jenkins, 1995 for details). However,
if this assumption is invalid, it is hard to draw any specific conclusion.
Moreover, previous studies have shown that among the family variables, the
largest coefficients were the bond between mother and child, followed by
family drug problems. The bond between father and child, parental
supervision, and family aggression were relatively weak predictors of
adolescent drug use. This was unexpected because most researches show
that parental supervision influences the likelihood of delinquency (Glueck &
Glueck, 1950; Hirschi, 1995; Sampson & Lanb, 1993).
House Location The finding for this variable is quite surprising and did not
support the hypothesis. It was found that the majority of the drug abuse
offenders lived at residential parks or “Taman Perumahan” (58.14%), followed
by other dwellings such as flats (16.28%), squatters (11.63%), and villages
(4.65%). This suggests that the house location itself does not determine the
students' involvement in drug abuse. It is the quality of the neighborhood that
makes a difference.
The lifestyle of the city folks could be the explanation for this finding. In the
city, people mainly live in terrace houses or flats. Most areas in the city have
been developed into proper housing areas. The “Taman Perumahan” is
mushrooming all over the city. Very few people live in other types of
accommodation. Thus, the high percentage could be due to the high
probability of people staying at “Taman Perumahan”. Hence, house location
could also be the main predictor for the students' involvement in drug abuse.
However, one can still explain the findings from the peer socialization
perspective. One of the main reasons why students are involved in drug
abuse is peer influence. Compared to other types of housing location, “Taman
Perumahan” is the most common place for students to socialize. Hence,
there is a high tendency for adolescent residents to meet deviant peer
groups and to be involved in drug abuse. Overall, the findings indicated that it
is the accessibility to peer socialization that predicts students' involvement
in drug abuse rather than the location of the house itself.
Home Environment This is another surprising finding revealed by the data.

Contrary to the earlier hypothesis, it was found that most drug abuse
offenders reported that they evaluated their home environment as good
(53.49%) and satisfactory (23.26%). This means that most of them are
satisfied with their living conditions. Hence, it strengthens the earlier
contention that most students commit drug abuse not only because of the
environmental factors but due to their personal traits too.
In addition to the above findings, it was also reported that the reasons given
by these students to account for their involvement in drug abuse were
consistent with the reasons given by previous studies. The characteristics of
the self such as impulsiveness, curiosity, and the desire for sensation, serve
as the roots of delinquency (Papalia & Olds, 1998). The characteristic of the
environment refers to peer pressure or to escape from overwhelming
problems, and thereby endanger their present and future physical and
psychological health. Of course, these characteristics do not necessarily
cause drug abuse, but they are fairly reliable predictors of it. It can be
deduced that when there are more risk factors present; the probability of an
adolescent or a young adult to abuse drug becomes greater.
Surprisingly, two participants reported that their family was the reason why
they were involved in drugs: family conflict (after a quarrel between the
participant and his father) and family history of drug problems (the
participant's brother was a drug addict). This finding is consistent with
Hawkins et al. (1992) who identified four family characteristics that influence
the likelihood of adolescent drug use: (a) low levels of bonding with the
family; (b) poor and inconsistent family management practices; (c) family
conflict, and (d) family alcohol and drug behavior and attitude. The
implication of this heavily relies on the role of the family in preventing the
use and abuse of drugs among secondary school students.
The data also contained information on the accessibility to drugs. Most

participants reported that they get drugs mainly from their friends, i.e., they
either bought it from their friends or shared it with them. Consistent with
other researches, this study found that those who used drugs tended to have
close friends who also used drugs. Perhaps the

critical question for prevention is how to minimize the involvement of

students with their drug-abusing peers. Previous studies indicated that
students who were religious tended not to have close friends who use drugs
(Bahr and Maughan, 1998). Thus, religious involvement may be an important
protective factor that helps to decrease the probability of a young person to
choose friends who are drug addicts. This is important because religion has
been ignored in the research on risk and protective factors.
CONCLUSION Although a great majority of adolescents do not abuse drugs, a

significant minority does. This study has illustrated the demographic
determinants that could predict the high-risk group among the secondary
school students in some areas in Wilayah Persekutuan. The study showed
that male students aged 16 years old are more vulnerable than others to
abuse drugs. Thus, gender and age are the main predictors for supervision
and prevention purposes. The study also showed that those who come from
fairly large families with four to six siblings are also at risk. On the other
hand, the house location, the parents' vocational status, and the home
environment do not have strong predictive values. However, these factors are
also important to be considered for prevention purposes.
The present study also highlights the importance of close supervision by

parents and teachers in handling drug abuse problems among secondary
school students. The aspect that needs closer supervision is peer
socialization.
The study also has some limitations: 1. The finding is limited by the number
of items permissible to be revealed to the public; 2. The questionnaire is not
comprehensive enough to provide students' demographic details; 3. Some of
the items are not clear in meaning, for example, items 22 and 26; and 4. The
sample size is insufficient to draw conclusions on the population.
Thus, it is recommended that future researches should address these

limitations and perhaps also consider the following suggestions for
improvement: 1. To interview some of the drug abuse offenders in order to
substantiate the findings and to get data from a different perspective; 2. To
investigate the supervision records of absenteeism and misconduct
behaviors of the drug abuse offenders in their respective schools; 3. To
investigate and establish the reliability and validity of the questionnaire; and
4. To use a qualitative approach in the study.

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Peranan Kerohanian Dalam Menangani Gejala Dadah

137Yuseri bin Ahmad, Dr. Sapora bt. Sipon & Marina Munira Abdul Mutalib, m/s
137-154
PERANAN KEROHANIAN DALAM MENANGANI GEJALA DADAH
Yuseri bin Ahmad Sapora bt. Sipon Marina Munira Abdul Mutalib1
ABSTRAK
Pelbagai pendekatan pencegahan dan pemulihan telah digunakan untuk

menyelesaikan masalah penagihan dadah dan salah satu yang sering
dibincangkan ialah pendekatan agama. Artikel ini membincangkan tatacara
menangani masalah dadah dengan melihat kepada perspektif agama sebagai
satu alternatif yang boleh memantapkan kerohanian generasi pewaris.
Elemen ini sangat berperanan sebagai benteng sahsiah yang boleh
menghalang individu daripada terjebak dengan masalah-masalah sosial hari
ini. Antara perkara-perkara yang dihuraikan di dalam kertas kerja ini ialah
peranan agama dalam kehidupan manusia, manusia sebagai khalifah Allah
dan pemegang amanah, unsur-unsur yang membentuk manusia seperti unsur
qalb (hati), aql, nafs, yang dilihat berperanan untuk menghalang manusia
daripada terjebak dengan gejala ini dan cara-cara pembersihan jiwa melalui
tingkatan-tingkatan nafs di dalam Islam.
ABSTRACT
A multitude of prevention and rehabilitation approaches have been used to

solve the problem of drug addiction and one that was frequently discussed is
the religious approach. This article discusses the method to solve the drug
problem by adopting views from the religious perspective as an alternative
that is capable to strengthen the spirituality of the present generation. This
element plays an important role as a deterrant factor that can assist
individuals from getting involved in social ills. The issues presented in this
article include the role of religion in human lives; humans as the Caliph of
1 Universiti Sains Islam Malaysia
137-154
Allah on earth representing those who can be trusted; fundamental elements

that form humans such as “qalb, aql and nafs”, of which are seen as taking on
the role of preventing humans from getting involved with these social
problems. Also discussed here are the methods for spiritual cleansing
through the levels of “nafs” in Islam.
PENGENALAN Masalah dadah adalah masalah sejagat dan satu-satunya
masalah sosial paling rumit yang sedang dihadapi oleh negara. Sehubungan
itu, pihak kerajaan telah membelanjakan beratus-ratus juta ringgit dalam
memerangi gejala penagihan dadah namun masih lagi belum menampakkan
keberkesanan yang positif. Walaupun terdapat organisasi-organisasi yang
sentiasa berkempen untuk pencegahan dadah tetapi masalah ini masih
menjadi masalah utama negara. Apa yang paling membimbangkan ialah
penyalahgunaan dadah dalam kalangan remaja semakin berleluasa dan
masih belum dapat diselesaikan. Di samping itu, penyalahgunaan dadah
berkait rapat dengan bermacam penyakit sosial seperti pelacuran, lepak dan
perjudian. Perkara inilah yang banyak menggugat dan memudaratkan
keadaan sesebuah negara sama ada dalam bidang ekonomi, sosiobudaya,
politik mahupun keselamatan.
Gejala sosial negatif yang berlaku akhir-akhir ini benar-benar mencabar

emosi dan intelek mereka yang prihatin terhadap nilai-nilai kemanusiaan.
Hampir setiap pakar dalam pelbagai bidang telah memberikan pandangan
mengenai cara-cara mengatasi gejala sosial ini. (Muhammad Yusuf Khalid,
2005, 82) Masing-masing berusaha untuk memperlihatkan melalui kajian-
kajian yang dijalankan, faktor- faktor utama yang menyumbang kepada
masalah ini serta bagaimana usaha atau cara-cara untuk menghalang gejala
ini daripada terus menular dalam masyarakat kita. Yusuf (2005) ada
menyatakan di dalam tulisannya antara faktor penyumbang kepada masalah
sosial yang kian meruncing ini adalah disebabkan oleh kurangnya
penghayatan agama terutamanya dalam kalangan generasi muda dan belia
yang menjadi penyumbang utama kepada statistik masalah sosial termasuk
penyalahgunaan dadah. Ternyata, semua pihak amat prihatin terhadap musuh
nombor satu negara ini dan pelbagai usaha telah direncana dan dilaksanakan
untuk melihat satu generasi yang bebas daripada belenggu dadah.
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Berdasarkan Laporan Buletin Dadah AADK Bil:1.2006, sepanjang suku

pertama tahun 2006 iaitu dari Januari hingga Mac, seramai 7,001 orang
penagih dadah telah dikesan. Mereka terdiri daripada 2,933 orang (41.89%),
penagih baru dari 4,068 orang (58.11%) penagih berulang. Keseluruhannya
berlaku peningkatan sebanyak 1.32% berbanding tempoh masa yang sama
tahun lalu (6,910 orang). Taburan jumlah penagih yang dikesan menunjukkan,
Kedah mencatatkan bilangan penagih paling ramai dikesan berbanding
negeri-negeri lain iaitu seramai 1,282 orang diikuti Pualau Pinang (1,086),
Perak (1,000), Kelantan (843) dan WP Kuala Lumpur (756). Jumlah penagih
terkumpul yang direkodkan oleh Agensi Antidadah Kebangsaan sejak tahun
1988 hingga Mac 2006 adalah seramai 292,696 orang iaitu kira-kira 1.10%
daripada jumlah penduduk Malaysia.
Jadual 1 : Taburan Penagih yang Dikesan Mengikut Negeri Pada Tahun 2006
Negeri Bil Kedah 1282 Pulau Pinang 1086 Perak 1000 Kelantan 843 WP
K.Lumpur 756 Johor 565 Selangor 459 Melaka 210 Sarawak 210 Pahang 201
N.Sembilan 179 Terengganu 86 Perlis 67 Sabah 57 WP Labuan - Jumlah 7001
Sumber : Buletin Dadah AADK Bil:1/2006
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Jadual 2 : Penagih Dadah yang Berdaftar dengan Agensi Dadah Kebangsaan

(1988-2001)
Negeri Jumlah Jumlah Ratio Penagih Penagih Populasi Kepada Populasi (1:1
000) Johor 24,965 2,783.8 9 Kedah 12,605 1,689.6 9 Kelantan 15,297 1,344.9
11 Melaka 7,304 648.5 11 Negeri Sembilan 11,348 878.5 11 Pahang 13,537
1,319.3 10 Perak 26,941 2,157.7 12 Perlis 2,256 209.1 11 Pulau Pinang 26,941
1,337.4 20 Sabah 8,422 2,716.8 3 Sarawak 2,144 2,119.0 1 Selangor 27,488
4,270.0 6 Terengganu 10,092 919.3 11 WPKL 30,783 1,401.4 22
Sumber : NADI 2002
PROFIL PENAGIH Profil penagih-penagih yang dikesan bagi tempoh Januari

hingga Mac 2006 adalah 97.94% adalah lelaki dan sebanyak 72.73% terdiri
daripada kaum Melayu. Majoriti iaitu sebanyak 69.60% terdiri daripada
golongan belia dan majoriti adalah berumur antara 20-29 tahun. 78.65%
berpendidikan hingga sekolah menengah di mana 89.74% mempunyai
pekerjaan yang kebanyakan adalah buruh am. 60.73% mengakui mula
terjebak dengan dadah disebabkan oleh pengaruh kawan. Faktor-faktor lain
yang menyebabkan individu terlibat dengan dadah ialah untuk keseronokan,
perasaan ingin tahu, rangsangan, tahan sakit dan tekanan jiwa.
Kesan Secara ringkasnya, dadah menunjukkan kesan ketagihan dalam

bentuk pergantungan fizikal, mental dan emosi. Kesan fizikal dapat dilihat
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daripada beberapa aspek. Ini termasuk pengaruhnya terhadap sistem penting
pada tubuh manusia seperti sistem pernafasan, saraf, jantung, metabolisme
dan otot-otot. Dengan lain perkataan, keadaan mereka tidak terurus, proses
kehidupan akan terjejas dan menjadi tidak normal. Kadar pernafasan menjadi
lebih pendek dan perlahan, kadar degupan jantung berkurangan, tubuh
menggigil akibat penurunan kadar metabolisme badan. Selain daripada itu,
mata penagih akan menjadi merah dan kuyu serta serta badan akan terjejas
(Dzulkifli Abdul Razak, 2002).
Kesan Mental dan Emosi Kesan ini lazimnya dipanggil kesan psikologi iaitu
kesan akibat pengaruh dadah pada otak dan minda. Ini termasuk rasa
seronok dan khayal (euphoria). Mereka seakan-akan tidak berpijak di alam
nyata. Pada masa yang sama seseorang itu hilang kawalan diri dan
pemikiran. Sekiranya bekalan dadah tidak diperoleh mereka akan berasa
keluh kesah, gian dan amat menderita. Penagih boleh bertindak ganas dan
hilang kawalan emosi. Apabila rasa ketagih berterusan, penagih akan
mungkin mengalami gangguan mental dan menjadi tidak waras. Penagih mula
melakukan sesuatu yang tidak masuk akal yang berlawanan dengan
tatasusila dan peradaban masyarakat.
Kesan Sosial Dari kesan sosial pula, kebanyakan penagih akan hilang minat
dan tidak mempedulikan tanggungjawab terhadap pekerjaan, keluarga serta
masyarakat sekeliling. Prestasi dan disiplin kerja merosot, tingkah laku dan
sikap berubah daripada apa yang biasa diamalkan. Mereka juga tidak
menghiraukan keselamatan diri. Kebanyakan penagih tidak tinggal bersama
keluarga. Mereka hidup di tempat-tempat yang tersorok atau terpencil untuk
memudahkan mereka menggunakan dadah.
PERANAN AGAMA DALAM KEHIDUPAN MANUSIA Agama ISLAM yang

diturunkan kepada manusia bersifat rahmatan lil‘alamin iaitu
penganugerahan rahmat yang tidak ternilai kepada sekalian makhluk ciptaan
Allah sepertimana yang dikhabarkan di dalam al-Quran, Surah al-Anbiya‘ ayat
107 yang bermaksud “Dan tiadalah Kami mengutuskan Engkau (Wahai
Muhammad), melainkan untuk menjadi rahmat bagi seluruh alam.”
137-154
Rahmat ditakrifkan sebagai satu kebaikan yang berterusan. Malah sebagai

Muslim kita percaya bahawa rahmat ini akan berkekalan selagi mana
manusia itu berada utuh di atas landasan agama. Maka, rahmat dan agama
ternyata mempunyai satu rabitah yang tidak boleh dipisahkan sama sekali
dalam hidup manusia. Sepertimana dinukilkan di dalam al-Quran, “…Aku telah
sempurnakan bagi kamu agama kamu, dan Aku telah cukupkan nikmatKu
kepada kamu, dan Aku telah redakan Islam itu menjadi agama untuk kamu.”
(Al-Maidah, 5: 3). Ini kerana agama berupaya membentuk dan menjadikan
manusia lebih berdisiplin dan sentiasa akur kepada fitrah semula jadi yang
sesuai dengan kehendak dan naluri seorang insan.
Sebagai Muslim kita mengakui agama Islam adalah agama yang benar akan
tetapi ramai saudara seislam kita yang mengalami krisis nilai yang sangat
mendukacitakan. Sepatutnya Islam diturunkan untuk membimbing manusia
ke jalan yang benar tetapi apa yang terjadi adalah sebaliknya. ‘Ini adalah
kerana Islam tidak dihayati dan tidak diamalkan, maka Islam tidak akan
menjadi rahmat sebaliknya menjadi satu fenomena alam yang biasa seperti
sejarah.’ (Muhammad Yusuf Khalid. 2005. 84) Malah, gejala sosial yang kian
meruncing ini membuktikan bahawa lemahnya iman pemuda-pemudi kita
akhir- akhir ini serta kurangnya penghayatan kerohanian terhadap ajaran
agama Islam itu sendiri.
Hadis Nabi SAW riwayat Muslim ada menyebut bahawa; “Seseorang tidak
akan mencuri ketika dalam keadaan beriman, dan seseorang tidak akan
berzina selagi mana dia beriman.” Jika diamati hadis ini sedalam- dalamnya
bolehlah disimpulkan bahawa seseorang yang mempunyai penghayatan
agama yang tinggi mampu menjadi benteng diri yang boleh menghalang
seseorang itu daripada terjerumus dengan masalah krisis nilai dan
keruntuhan akhlak.
Fitrah manusia yang diciptakan juga mampu bertindak selari dengan

kehendak Ilahi seperti mana ia diciptakan untuk mengenal siapa
Penciptanya, seterusnya mendekatkan diri dan mengakui KetuhananNya
(Muhammad Asad. 2003). Justeru, manusia yang lari atau terpesong daripada
fitrah ini ialah manusia yang tidak kenal siapa Tuhannya malah terpesong
jauh dengan fenomena-fenomena yang rosak nilainya serta jauh sekali
diterima oleh akal fikiran dan perasaan seseorang manusia. Ini sesuai
dengan kata-kata seorang ulama tersohor Islam Abu Hassan al-Syaziliyy: “
Sesiapa berupaya mengenali dirinya serba
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lemah, akan mengenali Tuhannya yang Maha Berkuasa, sesiapa yang

mengenali dirinya akan mati, akan mengenali Tuhannya Yang Kekal Abadi,
sesiapa yang mengenali dirinya sebagai makhluk yang diciptakan akan
mengenali Tuhannya Yang Maha Pencipta.”
INSAN : KHALIFAH DAN PEMEGANG AMANAH ALLAH Allah berfirman di
dalam surah al-Ahzab, ayat 72 yang bermaksud “Sesungguhnya Kami telah
bentangkan amanah ini kepada langit dan bumi, tetapi ditolak dan mereka
meminta belas kasihan, sebaliknya manusia menerima amanah ini walaupun
sesungguhnya manusia jahil dan menzalimi diri mereka sendiri.” Amanah iaitu
tanggungjawab sebagai khalifah Allah inilah yang menyumbang kepada raison
d’etre iaitu sebab kewujudan dan kejadian manusia ketika diciptakan
manusia pertama iaitu Adam a.s untuk mentadbir alam ini. Jelas di dalam
ayat di atas, Allah telah menawarkan amanah ini kepada makhluk lain seperti
langit, bumi dan gunung-ganang tetapi ternyata semuanya takut untuk
memikulnya. Faruqi (1992) di dalam bukunya al-Tawhid: Its Implications for
Thought and Life menyebut; “The trust or divine will, which no heaven and
earth can realize is the moral law which demands freedom from the agent. In
heaven and earth the will of God is realized with the necessity of natural
law.” (p.5) Amanah yang tidak mampu dipikul oleh makhluk lain ini ialah
amanah meletakkan akhlak dan nilai di tempatnya dan menjadikan ia sebagai
pedoman manusia di mana ia memerlukan sepenuh kebebasan dalam setiap
tindakan manusia. Natijahnya, manusia diberi dua pilihan sama ada memilih
jalan yang benar atau jalan yang tidak diredai oleh Tuhannya. “Dan Kami telah
menunjukkan kepadanya dua jalan, (jalan kebaikan untuk dijalaninya, dan
jalan kejahatan untuk dijauhi)?” (Al-Balad, 90 : 10)
Sesungguhnya manusia diciptakan dengan tujuan yang satu iaitu memikul

beban amanah yang telah dipilih oleh manusia sendiri dan ia bukanlah untuk
sesuatu yang sia-sia. Kejadian Adam dan Hawa kedua- keduanya juga
membawa misi Tuhan iaitu bersama-sama merealisasikan amanah ini dan
seterusnya bertindak sebagai khalifah Allah yang memakmurkan bumi ini
dengan kalimah-kalimah Allah yang benar. Malah, pengusiran Adam dan Hawa
ke muka bumi ini juga dilihat sebagai terkandung dalam ilmu Allah yang Maha
Agung. (Ibrahim Zain, 1998)
Pengurniaan amanah ini kepada manusia merupakan satu penghormatan dan

kelebihan yang mana dapat dilihat sebelum manusia
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diciptakan, Allah SWT telah pun meletakkan manusia di atas satu kedudukan
yang amat mulia di sisiNya. Sehinggakan para malaikat turut sama
mempersoalkan kedudukan ini yang jelas digambarkan di dalam surah al-
Baqarah ayat 30 di mana Allah berfirman yang bermaksud, “Bahawasanya
Aku mengetahui apa yang engkau tidak ketahui”. Ini juga menggambarkan
betapa Allah memandang tinggi akan makhluk ciptaan- Nya ini iaitu manusia.
TANGGUNGJAWAB MANUSIA Faruqi (1992) pernah menyebut bahawa, “Since
everything is created for a purpose – the totality of being no less – the
realization of that purpose must be possible in space and time.” (13) Oleh
kerana manusia dijadikan untuk menunaikan satu tanggungjawab yang telah
direncanakan, maka pelaksanaan kepada beban tugas itu mestilah sesuatu
yang mampu dilaksanakan oleh manusia. Atau dengan kata lain, manusia
dibekalkan dengan keupayaan-keupayaan ini. Justeru, melalui tindakan dan
keupayaan inilah manusia akan dinilai, dan juga ia akan dipersoalkan di
hadapan Tuhan yang Maha Agung.
UNSUR KEROHANIAN Manusia dicipta oleh Allah SWT dengan mempunyai

dua unsur yang utama. Selain jasad yang merupakan unsur zahir bagi
manusia terdapat unsur lain yang lebih penting iaitu roh yang sebenarnya
menjadi hakikat diri insan. Namun begitu terdapat juga beberapa istilah lain
yang berkaitan dengan unsur roh ini seperti aql, nafs, dan qalb yang
sebenarnya menunjukkan kepada zat diri yang sama tetapi berbeza dari segi
peringkat seseorang itu berada. Sebagaimana jasad yang perlu kepada
penjagaan dan makanan agar ia menjadi sihat dan bertenaga, begitu jugalah
roh ini memerlukan penjagaan dan rawatan agar ia sentiasa segar dan
bersifat positif dalam menjalani kehidupan seharian. Sebenarnya kekuatan
kerohanian inilah yang paling diperlukan oleh manusia bagi mengawal dirinya
agar tidak terjebak ke dalam perkara-perkara negatif seperti penagihan
dadah contohnya. Justeru itu kita perlu mengenal diri sendiri dengan
mengenali istilah-istilah yang disebutkan tadi supaya ia dapat digunakan
sebagai benteng dalaman bagi mengekang gejala sosial yang kini semakin
parah.
ROH Kita tidak didedahkan menerusi sumber syariat mengenai hakikat

sebenar roh. Di dalam al-Quran Allah SWT berfirman:
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Surah al-Isra’, 17: 85 Terjemahannya “... dan mereka bertanya kepada kamu
tentang roh, katakan bahawa roh itu adalah urusan Tuhanku.”
Menurut Imam al-Ghazali roh adalah ‘Latifah’2 yang dengannya manusia dapat
memahami dan mengerti, ia sesuatu yang menakjubkan yang datang
daripada Tuhan dan tidak mampu segala akal untuk memahami hakikatnya.
(al-Ghazali .1987. jilid 3 : 5). Oleh kerana roh adalah sesuatu yang tidak
dijelaskan hakikatnya oleh al-Quran dan hadis maka para ulama
membataskan perbahasan mereka tentang roh ini kepada dua sudut iaitu: 1.
Mengembalikan roh kepada pengetahuannya yang asal 2. Mengembalikan
kesempurnaan pengabdiannya kepada Tuhannya
Pada asal kejadian, roh sebenarnya mengenal Allah sebagai pencipta dan
mengakui kehambaannya pada Allah SWT. Namun setelah ia bercampur
dengan jasad dan bergelumang dengan anasir-anasir luar yang mendatang
maka pengetahuan dan kehambaannya pada Tuhan itu semakin hilang akibat
faktor persekitarannya. Ini sebagaimana yang disabdakan oleh Rasulullah
SAW :
Riwayat al-Bukhari Maksudnya : “Manusia dilahirkan dalam keadaan fitrah

(bersih, suci, kenal Tuhan) maka kedua-dua ibu bapanyalah yang
mencorakkannya sama ada menjadikannya Yahudi, Nasrani atau Majusi).”
Faktor-faktor luaran itu mula mempengaruhi roh dan akibatnya roh itu
semakin menjauh daripada pengetahuan dan kehambaan asalnya pada Allah
SWT. (Said Hawwa, 1999: 43)
Apabila roh semakin jauh daripada Allah SWT maka ia sebenarnya semakin
mendekat kepada hawa nafsunya yang sentiasa mendorong
2 Istilah Sufi: Makna asalnya adalah kelembutan. Setiap isyarat yang terlalu
halus untuk difahami yang tidak dapat diungkapkan dengan kata-kata
seumpama ilmu rasa. (al-Jurjani. 1991)
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melakukan dosa dan maksiat. Oleh itu untuk membolehkan seseorang itu
meninggalkan kejahatan dan maksiat maka perlulah rohnya dikembalikan
kepada asal pengetahuan dan kehambaannya pada Allah SWT. Untuk
mengembalikan roh pada asalnya memerlukan kepada mujahadah dan perlu
diikuti jalannya yang sudah digariskan sendiri oleh Allah SWT di dalam al-
Quran. Said Hawwa dalam kitabnya Tarbiyyatuna al-Ruhiyyah menjelaskan
bahawa jalan untuk mengembalikan roh pada asalnya adalah dengan
memiliki ilmu yang sahih, bergaul dengan ahli ilmu dan zikir pada Allah SWT.
Ilmu yang sahih yang perlu diketahui ialah ilmu tentang sifat- sifat Allah SWT
yang maha sempurna dan ilmu tentang melakukan ibadah dengan ikhlas pada
Allah. Untuk memperolehi ilmu ini maka perlulah bertanya pada ahlinya.
Firman Allah SWT:
Surah al-Furqan, 25: 59 Maksudnya: “Maka bertanyalah tentangNya (Allah)

kepada yang lebih mengetahui”.
Mengenai zikir pula ia amat diperlukan kerana sabda Rasulullah SAW di
dalam sebuah hadis Qudsi bahawa Allah SWT berfirman :
Riwayat al-Bukhari dan Muslim Maksudnya: “dan Aku (Allah) bersama

dengannya (hamba) apabila dia berzikir kepadaKu.”
Maka Allah SWT akan bersama-sama dengan hamba yang berzikir

mengingatiNya. Kesannya adalah sangat banyak, antaranya ia akan dipelihara
oleh Allah dan terjaga daripada tersilap dan tergelincir dalam kehidupan.
QALB Perkataan Qalb bermaksud hati. Perkataan ini digunakan untuk

menunjukkan hati yang zahir iaitu jantung manusia, dan hati yang bukan
zahir iaitu hati nurani manusia. Dalam al-Quran perkataan qalb ini banyak
disebut oleh Allah dan apabila disebut ia bermaksud hati yang
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bukan zahir. Qalb diertikan sebagai “Latifah Rabbaniyyah atau unsur halus
yang bersifat rabbani atau yang dibangsakan kepada rabbani dan mempunyai
hubungan dengan jantung hati jasmani”. (Mohd Sulaiman Yasin. 1992 : 195)
Dalam hadis Rasulullah SAW menjelaskan bahawa hatilah yang menjadi

penentu seseorang itu menjadi baik atau jahat. Menurut Islam hati inilah
yang menjadikan manusia hidup dengan kehidupan yang sebenar dan ia
jugalah yang menjadikan manusia sebenarnya mati dalam hidupnya. Hati juga
menjadi tempat bagi iman, taqwa, ikhlas, amanah dan tempat mengambil
peringatan. Sebaliknya hati juga menjadi tempat kekufuran dan kemunafikan.
Ia juga menjadi tempat bagi segala sifat terpuji dan sifat tercela. Justeru,
hati manusia boleh jadi ia sakit atau ia sihat.
Di antara penyakit hati ialah kekufuran, kesesatan, kemunafikan, kesangsian

kepada tanda-tanda kebenaran dan kesempurnaan Allah, berat hati daripada
berjihad di jalan Allah, kerakusan hati kepada maksiat, kederhakaan kepada
perintah Allah, bersifat dengan sifat-sifat tercela seperti takabbur, hasad,
riya’, marah, bakhil, khianat, hubbul jah, hubbul mal, mengikut hawa nafsu,
buruk sangka dengan Allah, putus asa daripada rahmat Allah, memusuhi dan
membenci ulama dan lain- lain.
Manakala hati yang sihat pula sudah tentulah hati yang tidak mempunyai
penyakit-penyakit yang telah disebutkan. Hati yang sihat disebut sebagai hati
yang salim (sejahtera). Di antara sifat hati yang salim ialah hati yang sentiasa
kembali kepada Allah. Hati orang yang kembali kepada Allah ialah mereka
yang mempunyai sifat seperti rasa takut kepada Allah, penyerahan kepada
Allah, tawakal, mengingati ayat-ayat Allah, bersih daripada bentuk kesyirikan
dan penyembahan taghut, bertaqwa dan yang paling asas sekali ialah tetap
mendirikan solat dan rukun-rukun Islam yang lain. (Mohd Sulaiman Yasin,
1992 : 200)
Oleh itu bagi merawat hati yang berpenyakit, sebahagian daripada ulama
merumuskan terdapat lima penawar iaitu: • Membaca al-Quran •
Mengosongkan perut (puasa) • Qiyamullail • Memohon keampunan dan
rahmat di waktu sahur • Menduduki majlis para solihin
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‘AQL Menurut Imam al-Ghazali ‘aql adalah sumber bagi ilmu dan asas ilmu.
Maka ilmu dinisbahkan kepada ‘aql adalah seumpama buah bagi pokok, atau
cahaya bagi matahari, atau melihat bagi mata. Justeru, salah satu maksud
‘aql yang ditakrifkan oleh al-Ghazali ialah “mengetahui hakikat sesuatu
perkara.” (al-Ghazali ,1987, j1 : 5). Takrifan seperti ini adalah merujuk kepada
hasil daripada sesuatu perkara itu. Maka ilmu itu adalah hasil daripada
kewujudan akal yang mana dengan ilmu itu manusia boleh membezakan
mana yang baik dan mana yang buruk, seterusnya memilih untuk melakukan
yang baik atau yang buruk.
Pada peringkat ini seseorang manusia itu selalunya akan berperang dengan
nafsunya dalam memilih mana yang mahu dibuat, kerana kemahuan akal
yang dibantu oleh ilham malaikat itu mahu melakukan kebaikan tetapi
kemahuan nafsu yang disokong pula oleh was-was syaitan mahukan
sebaliknya. Dalam keadaan sedemikian sekiranya seseorang itu
menggunakan daya akal untuk melawan, mengawal dan bermujahadah
terhadap hawa nafsunya maka hatinya akan menjadi tempat penurunan
malaikat untuk mencampakkan ilham yang memberikan kebaikan kepadanya
sama ada dalam bentuk peringatan, panduan atau makluman. (Mohd
Sulaiman Yasin, 1992: 191)
Ulama juga membahagikan ‘aql kepada dua jenis iaitu ‘aql taklifi dan ‘aql
syar’i. Aql taklifi (akal yang menerima bebanan hukum) dimiliki oleh semua
manusia selagi ia tidak gila, dan dengan adanya akal itu maka manusia
menjadi mukallaf. Ini adalah peringkat aql yang paling rendah. ‘Aql syar’i pula
ialah aql yang dimiliki oleh manusia yang mampu mengawal nafsunya kepada
taat pada Allah, di samping mengenal Tuhannya dan tunduk kepadaNya.
Dalam keadaan manusia ini, berlaku pertembungan antara kemahuan nafsu

dan kemahuan akalnya maka apakah yang seharusnya dia buat untuk
menjauhkan dirinya daripada maksiat tersebut. Said Hawwa menjelaskan
dalam masalah ini, katanya “Terdapat beberapa perkara, sama ada dia
meningkatkan cahaya hatinya, meninggikan kejiwaannya, mengikuti jalan
yang betul untuk memenuhi syahwatnya dalam batas-batas yang dibenarkan,
ataupun dia mengendurkan dorongan syahwatnya dengan cara latihan seperti
mengawal pemakanan, memenatkan tubuh badannya, mengurangkan makan,
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menjauhkan diri daripada faktor-faktor yang menaikkan nafsu dan

sebagainya, semua itu adalah sebahagian daripada rawatan bagi Muslim
mengatasi maksiat, dan menang melawan maksiat itu sebenarnya adalah
aql.” (Said Hawwa, 1999: 49) Inilah aql syar’ i yang perlu ada pada diri setiap
Muslim bagi mengatasi maksiat.
NAFS Kalimah ini selalunya merujuk kepada hawa nafsu yang mengajak
kepada kejahatan. Imam al-Ghazali menjelaskan bahawa kalimah ini
mempunyai dua pengertian. Yang pertama ia bermaksud daya marah dan
syahwat yang ada pada manusia. Penggunaan ini sering digunakan oleh ahli
tasawuf kerana mereka memaksudkan dengan nafs itu ialah asal yang
menghimpunkan segala sifat-sifat mazmumah pada manusia. Contohnya
mereka mengatakan “mestilah ada mujahadah nafsu dan mematahkannya”.
Pengertian kedua pula ialah Latifah yang menjadikan manusia itu pada
hakikatnya. Ia adalah diri manusia dan zatnya. (al-Ghazali, 1987, jilid 3: 5)
Pengertian ini membawa maksud bahawa manusia yang sebenarnya adalah
pada nafs (diri)nya, bukan pada jasadnya. Adapun jasad hanyalah alat yang
akan patuh pada segala kemahuan nafsnya.
Peringkat-peringkat Nafs Seperti yang telah dijelaskan bahawa hakikat

manusia yang sebenarnya adalah pada diri nafsnya, semakin tinggi tahap
nafsnya itu maka semakin tinggilah tahap kemuliaan seseorang, sebaliknya
semakin rendah tahap nafsnya maka semakin rendahlah tahap kemuliaannya.
Justeru, para ulama membahagikan nafs kepada beberapa peringkat. Hanya
disebut di sini empat yang utama sahaja iaitu: • Nafs Ammarah • Nafs
Lawwamah • Nafs Mulhimah • Nafs Mutma‘innah
1. Nafs Ammarah - Ini adalah peringkat nafs yang paling rendah sekali.
Bahasa Melayu menyebutnya sebagai nafsu amarah. Al-Quran menyifatkan
peringkat ini sebagai peringkat yang menyuruh kepada kejahatan semata.

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Firman Allah SWT:
Surah Yusuf, 12: 53 Maksudnya : “Sesungguhnya nafsu itu sentiasa menyuruh

kepada kejahatan.”
Pada peringkat ini diri insan itu telah dikuasai sepenuhnya oleh unsur
kejahatan dan kerendahan sehingga manusia itu menjadi hamba kepada
hawa nafsunya. Malah dia tidak berasa apa-apa sesalan di atas kejahatan
yang dilakukannya. Pada peringkat ini seseorang perlu bermujahadah
melawan nafsu syahwahnya dengan mendidik nafsunya supaya ia meningkat
ke peringkat yang kedua iaitu nafs lawwamah.
2. Nafs Lawwamah – Firman Allah SWT:
Surah al-Qiyamah, 75: 2 Maksudnya : “Aku bersumpah dengan diri yang

mencela.”
Dinamakan dengan Lawwamah kerana diambil daripada ayat Quran di atas.

Pada peringkat ini diri nafs insan itu sudah meningkat daripada yang pertama
kerana pada peringkat ini seseorang yang melakukan dosa akan berasa
menyesal di atas perbuatannya. Dirasakan dalam dirinya semacam ada
sesuatu yang mengutuk dan mencela. Adanya suara kutukan atau celaan dari
dalam diri ini menunjukkan bahawa nafsnya masih hidup, walaupun
berpenyakit tetapi penyakit itu masih belum parah menjadi barah, dan masih
menerima rawatan dan pemulihan melalui usaha tazkiyah untuk kembali
sembuh dan sihat. (Mohd Sulaiman Yasin, 1992: 189)
3. Nafs Mulhimah – Dinamakan Mulhimah (yang memberi ilham) berdasarkan

firman Allah SWT dalam surah al-Syams ayat 8:
Maksudnya: “Serta mengilhamkannya (diri) jalan yang membawa kepada

kejahatan dan yang membawanya kepada bertaqwa.”
Ayat ini menjelaskan bahawa diri manusia boleh menerima suatu saranan
dalam dirinya sama ada yang berunsur kejahatan atau berunsur
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kebaikan. Peringkat ini adalah lebih baik daripada peringkat kedua kerana
kebarangkalian seseorang itu melakukan dosa tidak begitu kuat. Maksudnya
hati yang menjadi markas bagi nafs manusia sentiasa menjadi tempat
pertarungan antara lintasan malaikat dan lintasan syaitan. Hanya berbeza
dari segi kuat atau lemahnya salah satu daripada dua unsur tersebut. Kuat
atau lemahnya adalah bergantung kepada sejauh mana kuat atau lemahnya
mujahadah kita untuk menentang hawa nafsu, dan untuk mempergunakan
akal bagi memikirkan kebenaran Allah dan ayat- ayatNya. (Mohd Sulaiman
Yasin, 1992 : 192)
4. Nafs Mutma’innah – Ia bermaksud jiwa yang tenang. Inilah peringkat nafs

yang ingin dicapai oleh oleh manusia hasil daripada mujahadahnya melawan
nafsu. Pada peringkat ini nafs seseorang itu akan mudah terasa dengan
kesalahan dosa. Ukuran dan timbangan ke atas sesuatu amalan kebaikan
semakin halus. Ketenangannya bukan sahaja dinikmati oleh dirinya tetapi
juga oleh orang sekelilingnya.
Peringkat ini tidak dapat dirasakan melainkan setelah diri insan merasakan
seperti mana yang disebutkan oleh Mohd Sulaiman Yasin, (1992: 192) •
Tenang dengan hukum-hukum Allah dan manhajNya • Tenang dengan qada’
dan taqdirNya • Tenang dengan mengingati Allah • Khusyuk dalam ibadah •
Menghayati konsep kehambaan diri kepada Allah • Sentiasa kembali pada
Allah • Hatinya sihat daripada segala penyakit-penyakitnya
Firman Allah SWT:
Surah al-Fajr, 89: 27-28 Maksudnya: “Wahai jiwa yang tenang, kembalilah
kepada Tuhanmu dengan hati yang puas lagi diredhaiNya.”
KAITAN PERINGKAT NAFS DENGAN ISTILAH SEBELUMNYA Apabila diteliti

keempat-empat peringkat nafs ini maka didapati ia tidak terkeluar daripada
lingkungan istilah-istilah lain yang telah dijelaskan sebelum ini iaitu aql, qalb
dan roh. Penjelasannya adalah seperti berikut; (Mohd Sulaiman Yasin, 1992:
194)
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1. Apa yang dimaksudkan dengan al-Nafs (nafsu) dalam istilah ini ialah diri
insan yang tertumpu kepada keinginan (syahwah) dan hawa nafsunya yang
rendah. Inilah dia yang dinamakan Nafs Ammarah. 2. Apa yang dimaksudkan
dengan aql pula ialah diri insan yang telah dikawal daripada kebebasan
keinginan nafsunya dan dikekang dengan tali syariat. Walaupun demikian ia
masih dipengaruhi oleh nafsu rendahnya. Ini adalah Nafs Lawwamah. 3.
Manakala qalb pula adalah diri insan yang telah agak tenang daripada nafsu
kerendahan dan kejahatan tetapi masih dalam perubahan (bolak-balik) antara
lalai dan sedar. Cahaya dalam dirinya sudah mula memancar. Ini adalah Nafs
Mulhimah. 4. Akhirnya istilah roh merupakan keadaan diri insan yang sudah
meningkat kepada sifat damai dan tenang, damai kembali kepada Allah dan
tenang dengan mengingatiNya. Ia adalah Nafs Mutma’innah.
RAWATAN UNTUK KELUH KESAH DAN PEMBERSIHAN HATI Al-Quran

menjelaskan bahawa manusia dicipta dalam keadaan keluh kesah. Akibat
keluh kesah itulah banyak berlakunya perlakuan salah dan tidak bermoral
termasuklah penagihan dadah. Lalu rawatan kepada keluh kesah itu
dijelaskan sendiri oleh Allah SWT sebagai kemudahan bagi manusia untuk
mengikutinya. Firman Allah dalam surah al-Maarij ayat 19 - 35:
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Maksudnya: “Sesungguhnya manusia dicipta bersifat keluh kesah lagi kikir.

Apabila ia ditimpa kesusahan ia berkeluh kesah. Dan apabila mendapat
kebaikan ia amat kikir, kecuali orang yang mengerjakan solat, yang mereka
itu tetap mengerjakan solatnya, dan orang-orang yang dalam hartanya
tersedia bahagian tertentu, bagi orang (miskin) yang meminta dan orang yang
tidak mempunyai apa-apa (yang tidak mahu meminta), dan orang-orang yang
mempercayai hari pembalasan, dan orang-orang yang takut terhadap azab
Tuhannya, kerana sesungguhnya azab Tuhan mereka tidak dapat orang
berasa aman (daripada kedatangannya), dan orang-orang yang memelihara
kemaluannya, kecuali terhadap isteri-isteri mereka atau hamba-hamba yang
mereka miliki, maka mereka dalam hal ini tiada tercela. Barangsiapa mencari
yang sebalik itu maka mereka itulah orang-orang yang melampaui batas, dan
orang-orang yang memelihara amanah- amanah dan janjinya, dan orang-orang
yang memberikan kesaksiannya, dan orang-orang yang memelihara solatnya,
mereka itu (kekal) di syurga lagi dimuliakan.”
Said Hawwa menjelaskan bahawa sifat keluh kesah ini (yang utamanya
terlalu resah ketika musibah, dan tidak bersyukur ketika dapat nikmat) tidak
dapat diatasi oleh manusia melainkan apabila terhimpun padanya sifat-sifat
berikut: solat, infaq, membenarkan hari akhirat, rasa gerun dengan azab
Allah, memelihara kemaluan, dan memberikan kesaksian dengan penuh
kebenaran dan keadilan. Sesiapa yang terhimpun padanya sifat-sifat ini
hatinya akan terlepas daripada penyakit dan mendapat sihat. Apabila
seseorang benar-benar mencapai sifat-sifat ini maka secara automatiknya
sifat keluh kesah akan hilang daripadanya. (Said Hawwa, 1999: 155)
Para ulama juga telah menggesa agar kita melakukan perkara- perkara
berikut sebagai amalan harian kita bagi mempertingkatkan tahap nafs kita
ke tahap yang lebih tinggi: 1. Solat berjemaah, termasuk Solat Rawatib,
Qiyamullail dan Solat Duha 2. Istighfar tidak kurang 100 kali 3. Membaca:
Tidak kurang daripada 100 kali.
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4. Selawat ke atas nabi SAW tidak kurang daripada 100 kali 5. Membaca
surah al-Ikhlas tiga kali 6. Membaca al-Quran 7. Membaca doa-doa bagi setiap
perbuatan seperti doa makan, tidur, masuk/keluar rumah dan sebagainya 8.
Perbanyakkan zikir-zikir yang sangat dituntut seperti istighfar, selawat atas
nabi, tahlil, tasbih, tahmid dan sebagainya yang kita digesa agar
melakukannya
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Kepimpinan dan Pengurusan: KUIM. NADI. (2002). Buletin Dadah AADK
Bil:1/2006. Said Hawwa. (1999). Tarbiyyatuna al-Ruhiyyah. Cetakan ke-6.
Kaherah: Darus Salam.
Trend dan Punca Penggunaan Dadah di Kalangan Penagih Dadah Wanita di

Negeri Sabah: Implikasi kepada Rawatan dan Pemulihan Dadah
111
Prof. Madya Dr. Sabitha Marican, Prof. Dr. Mahmood Nazar Mohamed & Prof.
Dr. Rosnah Ismail, m/s 111-136
TREND DAN PUNCA PENGGUNAAN DADAH DI KALANGAN PENAGIH DADAH
WANITA DI NEGERI SABAH: IMPLIKASI KEPADA RAWATAN DAN PEMULIHAN
DADAH1
Sabitha Marican2 Mahmood Nazar Mohamed3 Rosnah Ismail4
ABSTRACT
The involvement of women with psychoactive drugs is found to be most

serious in the state of Sabah as compared to the other states in Malaysia.
The National Anti-Drugs Agency (NADA) ranked Sabah 6th on the severity of
incidence of drug addiction with 1,229 drug users identified between the
months of January to September, 2005, out of which a total of 686 were
women ranging from young adolescents to those in their 40s. Sabahan
women drug addicts used drugs not only for its euphoric effect but for
various other reasons including to escape from their problems, to maintain
their ‘slim’ figures and to remain beautiful. Syabu is the drug of choice for
most Sabahan women addicted to drugs because it is cheaper and can be
easily obtained as compared to heroin or other drugs. The purpose of this
study is to identify the profile of Sabahan women addicted to drugs, the
etiology of drug use and the effect of drugs especially on their mental state.
This study employed a cross-sectional survey design on a sample of 96
respondents, purposely selected from drug users and addicts presently
undergoing drug treatment and rehabilitation at Pusat Serenti Bachok
Kelantan, and those incarcerated at the Kota Kinabalu Women Prison, Tawau
and Sandakan Prisons. Among the reasons for using drugs is because they
were curious of its effects. Other reasons pertain to adjustment
1 Sebahagian daripada laporan kajian PENGGUNAAN DADAH DI KALANGAN

WANITA DI NEGERI SABAH: PROFAIL, PUNCA DAN KESAN, Unit Penyelidikan
Psikologi dan Kesihatan Sosial, UMS 2 Profesor Madya, Fakulti Ekonomi dan
Pentadbiran, Universiti Malaya (UM) 3 Profesor Psikologi, Universiti Utara
Malaysia (UUM) 4 Profesor dan Pengarah, Pusat Penyelidikan dan Inovasi,
Universiti Malaysia Sabah (UMS)
112
and mental problems like wanting to escape from stress, family problems and
the intention to commit suicide. The study identified that their early
experience with substance use led them to addiction and crime. Many of the
Sabahan women addicted to drugs started smoking at the age of 16, drinking
alcohol at the age of 17 and first used drugs when they were at an average
age of 19.8 years old. For those who were involved in crime, they commited
their first act of crime at the age of 21. In conclusion, the study outlined
some strategies for the treatment and rehabilitation of female drug addicts.
ABSTRAK
Di negeri Sabah, statistik penglibatan wanita dengan penagihan dadah kini

adalah yang tertinggi berbanding negeri-negeri lain di Malaysia. Perangkaan
Agensi Antidadah Kebangsaan (AADK) menunjukkan negeri Sabah menduduki
tangga keenam paling atas berbanding negeri-negeri lain di Malaysia dengan
jumlah 1,229 orang penagih yang dikesan dari bulan Januari- September
2005. Daripada jumlah tersebut, penagih wanita di negeri Sabah yang
seramai 686 orang menduduki tangga yang teratas berbanding negeri- negeri
lain. Penglibatan wanita di Sabah dalam gejala penagihan dadah
membabitkan gadis berusia dari seawal remaja sehinggalah kepada wanita
yang berusia dalam lingkungan empat puluhan, bukan semata-mata
disebabkan kenikmatan dadah itu sendiri tetapi didorong oleh faktor lain
seperti ingin menjaga kecantikan dan menguruskan badan. Lebih serius lagi,
dadah yang lazimnya digunakan penagih wanita di Sabah adalah dadah jenis
syabu kerana ia mudah diperoleh dan lebih murah berbanding heroin dan
ganja. Kajian ini diusahakan untuk mengenal pasti profil penagih dadah
wanita di negeri Sabah, mengkaji punca-punca yang menyebabkan
penglibatan wanita dengan dadah dan mengenal pasti kesan penglibatan
wanita dengan dadah terhadap kesihatan mental. Kajian tinjauan keratan
rentas terhadap 96 responden yang terdiri daripada pengguna dan penagih
dadah wanita di negeri Sabah yang ditempatkan di Pusat Serenti Bachok,
Kelantan dan di penjara-penjara sekitar negeri Sabah seperti Penjara Wanita
Kota Kinabalu, Penjara Tawau dan juga Penjara Sandakan. Dapatan kajian
membentangkan maklumat penggunaan dadah dan pemulihan yang pernah
dilalui mereka, yang mana hampir semua dilaporkan menggunakan dadah
jenis syabu. Punca-punca penggunaan dadah dikenal pasti, yang mana ramai
menggunakan dadah kerana perasaan ingin tahu dan sebab-sebab yang
menunjukkan bahawa penagih dadah mempunyai masalah kesihatan mental
seperti untuk menghilangkan stres, perpecahan dalam keluarga, melarikan
diri daripada masalah dan mencari ketenangan. Kajian ini turut mendapati
bahawa pengalaman awal dengan masalah sosial bahan dan mendorong
mereka menggunakan dadah. Rata-rata penagih dadah

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wanita Sabah mula merokok pada umur 16 tahun, minum minuman keras
pada purata umur 17 tahun, menggunakan dadah pada purata umur 19.8
tahun, dan bagi yang terlibat dengan jenayah, umur pertama mereka terlibat
dengan perbuatan jenayah ialah 21 tahun. Kajian ini memberi beberapa
implikasi dan cadangan yang berkaitan dengan rawatan dan pemulihan
penagihan dadah dalam kalangan wanita.
PENGENALAN Dadah merupakan satu-satunya masalah keselamatan, sosial

dan kesihatan yang sehingga kini masih memberi kesan besar kepada
negara. Dari dahulu hingga sekarang, statistik penggunaan dan penagihan
terhadap dadah masih belum menunjukkan perkembangan yang positif
walaupun pelbagai cara telah dilakukan oleh pihak kerajaan untuk
membendung gejala tersebut daripada berleluasa. Penyalahgunaan dadah
dalam kalangan masyarakat amat membimbangkan terutama apabila ia mula
menular dalam kalangan remaja-remaja sekolah (Mahmood, 2002). Tambahan
lagi, kalau dahulu dikatakan kaum lelaki lebih sinonim dengan gejala seperti
ini, tetapi kini kaum wanita turut terlibat dengan masalah ini.
Perkembangan pesat negara dari aspek sosial dan ekonomi menyebabkan

perubahan peranan kaum wanita dari segi kerjaya, tanggungjawab dan
identiti. Pelbagai tekanan dihadapi oleh kaum wanita akibat perubahan-
perubahan yang berlaku sedikit sebanyak telah menyumbang kepada
peningkatan gejala sosial dalam kalangan wanita terutama dalam masalah
penagihan dadah. Tambahan pula, dalam kehidupan yang didesak oleh
kepentingan materialistik, tidak kurang juga sebilangan wanita terikut-ikut
dengan cara hidup sedemikian hinggakan ada yang menggadai nilai serta
moral untuk mencapai kemewahan dalam kehidupan. Lantas mereka ini juga
terperangkap dalam penggunaan dan penagihan dadah (Mahmood, 2005a).
Di negeri Sabah sahaja, statistik penglibatan wanita dalam gejala penagihan

dadah kini adalah yang tertinggi berbanding dengan negeri- negeri lain di
Malaysia (AADK Sabah, 2005). Dalam satu ucapan yang telah disampaikan
oleh Y.A.B. Ketua Menteri Sabah, Datuk Musa Haji Aman sempena pelancaran
papan tanda kempen antidadah peringkat negeri Sabah pada 22 Disember
2005, keadaan penagihan dadah di Sabah telah menjadi satu fenomena yang
amat merunsingkan iaitu mengikut perangkaan daripada Agensi Antidadah
Kebangsaan (AADK), negeri Sabah menduduki tangga keenam antara negeri-
negeri di Malaysia
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dengan jumlah 1,229 orang penagih yang dikesan dari bulan Januari-
September 2005. Daripada jumlah tersebut, penagih wanita adalah seramai
686 orang dan menduduki tangga yang teratas antara negeri- negeri di
Malaysia.
Penglibatan wanita dengan gejala penagihan dadah bukan semata-mata

disebabkan kenikmatan dadah itu sendiri tetapi didorong oleh faktor lain
seperti ingin menjaga kecantikan dan menguruskan badan (Mahmood, 2005a)
di samping faktor pengaruh suami yang juga menjadi penagih. Adalah
diandaikan bahawa faktor gaya hidup memainkan peranan penting dalam
tabiat penggunaan dadah dalam kalangan wanita. Lebih berat lagi, dadah
yang biasa diambil penagih wanita di Sabah adalah dadah jenis syabu kerana
ia mudah diperoleh dan lebih murah berbanding dadah tradisional seperti
heroin dan ganja.
AADK Negeri Sabah turut menjelaskan bahawa pembabitan wanita di dalam

gejala penagihan dadah di negeri Sabah merentas usia dari seawal remaja
sehinggalah yang berusia 40-an. Walaupun terdapat peningkatan bilangan
penagih wanita di Sabah berbanding negeri-negeri lain di Malaysia, namun
tindakan untuk menangani masalah ini di Sabah tidaklah seserius berbanding
penagih lelaki. Memandangkan tiada pusat pemulihan khas wanita
diwujudkan di negeri Sabah, maka kebanyakan penagih-penagih wanita di
negeri Sabah ditempatkan di Pusat Serenti Bachok, Kelantan. Manakala
selebihnya akan dirujuk kepada Agensi Antidadah Kebangsaan Negeri Sabah
untuk diawasi dan menjalani pemulihan dalam komuniti. Di samping itu
terdapat juga penagih wanita yang turut melakukan kesalahan jenayah lain
ditempatkan di Penjara Wanita Kota Kinabalu, Penjara Tawau dan Penjara
Sandakan untuk menjalani hukuman.
Kajian mengenai pembabitan kaum wanita dengan gejala dadah lebih

berfokus kepada perubahan peranan wanita akibat perkembangan
sosiobudaya dan ekonomi jika dibandingkan dengan peranan kaum lelaki.
Kebanyakan pengkaji yang mengkaji tentang wanita dan dadah memperoleh
dapatan signifikan yang membezakan antara penagih dadah wanita dan
lelaki. Kajian Rosenbaum (1981), Hser (1987), Thom (1995), Nelson-Zlupko et
al. (1996), Ettorre (1996), dan Estebanez & Cifuentes (1997) mendapati
bahawa penagih wanita mengambil kuantiti dadah yang lebih rendah
berbanding penagih lelaki tetapi lebih cepat menjadi ketagih dan lebih gemar
mengambil bahan-bahan bersifat sedatif. Jenis dadah yang selalu digunakan
adalah berlainan, dan ini
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bermakna mereka perlu diberikan rawatan dan pemulihan yang berbeza

daripada penagih dadah lelaki.
Kebanyakan penagih wanita juga berlatarbelakangkan tahap pendidikan yang

rendah, kurang sumber kewangan dan lebih memberi perhatian terhadap
usaha untuk meneruskan kehidupan seharian. Ini menunjukkan bahawa
mereka terpaksa bergantung kepada orang lain seperti ibu bapa, suami
ataupun teman lelaki bagi sumber ekonomi. Lanjutan daripada itu, masalah
penagihan dadah dalam kalangan wanita turut memberi kesan terhadap
risiko perkembangan normal anak-anak. Bagi wanita yang menggunakan
dadah, anak-anak sering terbiar dan diletakkan di bawah penjagaan orang
lain seperti ibu bapa dan saudara mara. Mereka tidak dapat menikmati kasih
sayang ibu, dan mungkin juga akan belajar menggunakan bahan psikoaktif
apabila remaja kelak.
Kajian juga mengenal pasti sebilangan pengguna dadah wanita pernah

menjadi mangsa penderaan seksual dan fizikal yang mengakibatkan tekanan
perasaan yang begitu mendalam (Mahmood, 2005a; 2005b). Tekanan
perasaan ini sering diatribusi sebagai sebab mereka mencuba dadah dan
lama-kelamaan akan menjadi ketagih. Ini antara sebabnya mengapa penagih
wanita lebih mendapat perhatian dari aspek rawatan psikitrik dan mereka
lebih kerap mengalami ’’dual- diagnosis” kerana pelbagai simptom psikiatrik
yang dialami bersama- sama dengan penagihan dadah (Khantzian & Treece,
1985; Blume, 1989; Rousanville et al., 1987). Hal ini menyukarkan lagi proses
pemulihan penagih dadah wanita.
Dual-diagnosis di kalangan penagih wanita bukanlah perkara baru.

Hesselbrock, Meyer & Keener (1985) mendapati 80% daripada sampel 90
orang pengguna dadah dan alkohol mengalami dual-diagnosis. Satu perhatian
yang agak konsisten melalui banyak kajian ialah episod kemurungan dalam
kalangan penagih wanita adalah lebih tinggi berbanding dengan pengguna
atau penagih lelaki (Rounsaville & Kleber, 1985; Mahmood, 2005). Malah
Hesselbrock, Meyer & Keener (1985) turut menemui gangguan major
depression di kalangan penagih wanita. Pelbagai kajian juga mendapati
hubungan penagihan dadah dalam kalangan wanita dengan kecelaruan
makanan (Bulik, 1997); kecelaruan “borderline” (Nace et al., 1988) kecelaruan
personaliti (Vaglum & Vaglum, 1997), kecelaruan afektif, bulimia, gangguan
anxieti dan kecelaruan seksual (Ross, Glaser & Stiasny, 1988) dan
kecelaruan panik dan OCD (Hesselbrock, Meyer & Keener, 1985).
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Hal ini juga ada kaitan dengan tahap motivasi mereka untuk berubah, bahawa
penagih-penagih wanita mempunyai tahap motivasi yang berbeza sama ada
dari aspek usaha untuk menghapuskan atau meneruskan ketagihan. Kajian
Mahmood dan Edman (1997) umpamanya mendapati penagih dadah wanita
lebih cenderung menyalahkan diri mereka sendiri berbanding penagih lelaki,
yang bermakna mereka lebih terdedah kepada perasaan bersalah, kurang
yakin dan mempunyai harga diri yang rendah. Kajian juga mendapati bahawa
apabila penagih-penagih wanita telah mencapai tahap memerlukan sokongan
terapeutik yang tertentu, jika tidak ditangani dengan baik, akan membawa
kepada masalah dalam mencapai kaedah rawatan yang berkesan (Mahmood
2005a). Selain itu, disebabkan pembabitan wanita dalam gejala dadah yang
tidak begitu ketara berbanding lelaki, kajian mendapati bahawa penagih
dadah wanita hanyalah golongan minoriti yang tidak diambil peduli oleh
sesetengah pihak terutama dalam penyediaan rawatan dan intervensi
terhadap proses pemulihan dadah (Stocco, Liacer, DeFazio, Calafat &
Mendes, 2000).
Sehubungan itu, ada keperluan mendesak untuk mengetahui fenomena

penagihan dadah di kalangan wanita di negeri Sabah dan Malaysia amnya
serta faktor-faktor yang mempengaruhi penggunaan di samping kesan
penagihan dadah. Pembabitan wanita dengan dadah adalah satu gejala yang
serius kerana ini akan melibatkan pendedahan kaum wanita kepada risiko
kesihatan mental dan fizikal yang akan memudaratkan kualiti kehidupan
mereka. Dengan adanya kajian seperti ini, diharap perkhidmatan sistem
kesihatan sosial di negara ini dan di negeri Sabah khususnya akan lebih
terurus dan akan turut menitikberatkan rawatan dan pemulihan dalam
kalangan penagih wanita selain penagih lelaki.
Sebagai rumusan, apa yang dinyatakan oleh Duongsaa (1998) telah

menjelaskan situasi ini dengan agak jelas, bahawa “...it is time to recognize
the fact that, … because of drug use; many girls and women have been
robbed of their identity, their dignity, their quality of life, and their right to
protection. It is time to review our development paradigm and strategies, as
well as our approaches to the drug issue, in order to make a real change…,
and that will enable women who are affected by the drug problem to reclaim
their humanity and their rights.”
OBJEKTIF Secara amnya, kajian ini dibuat untuk mengenal pasti profil
penagih dadah wanita di negeri Sabah, manakala objektif khusus kajian ini
adalah

117
untuk: i. Mengenal pasti profil penagih dadah wanita negeri Sabah ii.
Mengkaji punca-punca menyebabkan penglibatan wanita dengan dadah iii.
Menentukan kesan penglibatan wanita dengan dadah terhadap kesihatan
mental
METODOLOGI Kajian ini menggunakan reka bentuk tinjauan keratan rentas

serta kaedah persampelan bertujuan (purposive sampling). Seramai 96
penagih dadah dalam kepulihan bertindak sebagai responden. Mereka
ditempatkan di pusat-pusat pemulihan seperti Pusat Serenti Bachok
Kelantan, di penjara- penjara di sekitar negeri Sabah seperti Penjara Wanita
Kota Kinabalu, Penjara Tawau dan Penjara Sandakan serta mereka yang
menjalani pemulihan dalam komuniti (kes pengawasan) di bawah seliaan
AADK negeri Sabah.
Satu set soal selidik digunakan sebagai instrumen yang dibahagikan kepada
2 bahagian. Bahagian A mengandungi soalan yang berkaitan dengan faktor
demografi dan profil penagih meliputi maklumat diri, pekerjaan, pendidikan,
keluarga, rakan-rakan, penggunaan dadah dan juga maklumat rawatan dan
pemulihan yang perlu dijawab oleh setiap responden.
Bahagian B pula mengandungi soalan-soalan yang lebih menjurus kepada

kesan negatif penggunaan dadah ke atas diri pengguna.
Pasukan kajian mendapatkan keizinan (consent) daripada institusi terlibat

dan responden sebelum pengumpulan data bagi memelihara etika
penyelidikan.
HASIL KAJIAN Sejumlah 13 orang (16.88%) terdiri daripada etnik Bajau, 12

orang (15.58%) etnik Kadazan dan 12 orang (12.99%) terdiri daripada etnik
Melayu. Manakala selebihnya adalah daripada etnik-etnik lain. Ini
menunjukkan bahawa bilangan penagih dadah wanita lebih ramai di kalangan
etnik Bajau berbanding dengan etnik-etnik yang lain. Faktor ini mungkin
disebabkan etnik Bajau merupakan etnik yang antaranya paling ramai di
Sabah selain daripada etnik Kadazan-Dusun dan Melayu- Brunei (Jadual 1).
118
Jadual 1 : Penagihan Dadah dengan Merujuk kepada Bangsa Responden
Bangsa Bilangan Peratus Bajau 13 16.88 Kadazan 12 15.58 Melayu 10 12.99

Sino-Kadazan & Suluk 5 setiap etnik 6.49 @ 2 Bisaya & Cina 4 setiap etnik
5.19 @ 2 Filipino & Iban 3 setiap etnik 3.89 @ 2 Bugis, Indonesia, Brunei, 2
setiap etnik 2.59 @ 5 Murut dan Sungai Visaya, Bidayuh, Bolongan, 1 setiap
etnik 1.29 @ 8 Dusun, Jawa, Lindayu, Rungus & Tidung
Lebih separuh daripada responden beragama Islam iaitu seramai 56 orang

(72.2%), diikuti oleh responden yang beragama Kristian seramai 19 orang
(24.0%). Selebihnya beragama Buddha iaitu seramai 2 orang (2.6%). Dari segi
umur, 77 responden, sejumlah 45 orang (58.4%) berumur di antara 20 – 29
tahun, 18 orang berumur 30 – 51 tahun (23.4%) dan selebihnya berumur di
antara 15 – 19 tahun. Hasil ini menunjukkan lebih separuh daripada penagih
dadah wanita di negeri Sabah berumur dalam lingkungan 20 – 29 tahun.
Purata umur responden terlibat dalam penagihan dadah iaitu dalam
lingkungan 26 tahun.
Penagih wanita dari Sabah yang terlibat dengan dadah terdiri daripada
mereka yang mempunyai tahap pendidikan yang sederhana dan hanya sedikit
jumlah yang tidak pernah bersekolah ataupun hanya mendapat pendidikan
sehingga darjah tiga sahaja iaitu seramai 13 orang (16.9%). Kajian juga
mendapati seramai 29 orang (37.7%) pernah mendapat pendidikan dari
tingkatan 1 – 3; 18 orang (23.4%) mendapat pendidikan dari tingkatan 4 – 5;
dan 3 orang lagi (3.8%) pernah bersekolah sehingga ke tingkatan 6 dan ke
atas. Data ini menunjukkan mereka yang terlibat dengan dadah bukanlah
terdiri daripada mereka yang buta huruf.

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Bilangan rakan-rakan penagih wanita sebelum mereka ditahan adalah agak
ramai, yang mana secara purata bilangan rakan-rakan mereka adalah 14.27
orang. Manakala bilangan rakan yang paling rapat dengan penagih wanita ini
sebelum mereka ditahan adalah dalam purata 3.47 orang. Rakan-rakan
perempuan penagih wanita dengan tingkah laku negatif, di mana didapati
seramai 64 orang (83.1%) responden mempunyai rakan-rakan perempuan
yang juga menggunakan dadah, 63 orang (81.8%) responden memiliki rakan
perempuan yang perokok manakala 59 orang (76.6%) responden pula
mempunyai rakan-rakan perempuan yang minum minuman keras. 4 orang
(5.2%) daripada rakan-rakan penagih wanita ini pula turut terlibat dengan
jenayah-jenayah lain seperti mencuri, mengedar dadah dan merompak
(Jadual 2).
Tidak seorang pun rakan-rakan lelaki penagih wanita tersebut terlibat

dengan penggunaan dadah. Sungguhpun demikian, tingkah laku negatif lain
seperti merokok dan minum minuman keras amat tinggi di mana, 64 orang
(83.1%) penagih wanita ini mempunyai rakan- rakan lelaki yang merokok dan
63 orang (81.8%) pula mempunyai rakan lelaki yang minum alkohol. Sejumlah
14 orang daripada penagih wanita ini pula memiliki kawan-kawan lelaki yang
terlibat dengan beberapa jenayah lain seperti mengedar dadah, merompak,
mencuri, pecah rumah, pusher dan suka bergaduh (Jadual 2).
Jadual 2 : Penglibatan Rakan-rakan Perempuan dan Laki-laki dengan Tingkah

Laku Negatif
Tingkah Laku Negatif Perempuan Laki-laki 1. Menggunakan dadah 64 (83.1%)

- 2. Merokok 63 (81.8%) 64 (83.1%) 3. Minum minuman keras 59 (76.6%) 63
(81.8%) 4. Jenayah lain (mengedar dadah, 4 (5.2%) 14 (18.2%) merompak,
mencuri, pecah rumah, pusher, bergaduh)
Jadual 3 pula menunjukkan aktiviti hiburan yang dilakukan penagih wanita

bersama rakan-rakan mereka pada waktu lapang. Aktiviti yang paling banyak
dilakukan oleh penagih-penagih wanita ini ketika bersama rakan-rakan
mereka adalah merokok dan berhibur di
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pusat-pusat hiburan seperti disko, konsert dan karaoke, yang mana, 60 orang
(77.9%) responden yang diajukan mengatakan ‘ya’ pada aktiviti- aktiviti ini. Ini
diikuti dengan aktiviti minum minuman yang memabukkan seperti arak, bir,
todi dan air tapai yang dipersetujui oleh 52 (67.5%) responden dan juga
aktiviti melepak 49 orang (59.7%).
Jadual 3 : Bentuk Hiburan yang Dilakukan Bersama-sama Rakan di Waktu

Lapang
Item Ya Tidak 1. Merokok 60 (77.9%) 17 (22.1%) 2. Berhibur di pusat

hiburan / disko / 60 (77.9%) 17 (22.1%) konsert / karaoke) 3. Lain-lain (game /
snuker / 6 (7.8%) 71 (92.2%) beli belah / mengambil dadah / menggunakan
dadah) 4. Minum arak / bir / todi / air tapai 52 (67.5%) 25 (32.5%) 5. Melepak
46 (59.7%) 31 (40.3%) 6. Menonton wayang / video 44 (57.1%) 33 (42.9%) 7.
Bersukan 32 (41.6%) 45 (58.4%) 8. Judi /nombor ekor / mesin slot 25 (32.5%)
52 (67.5%) 9. Snuker / billiard 23 (29.9%) 54 (70.1%) 10. Melancong 22 (28.6%)
55 (71.4%) 11. Menonton video lucah 12 (15.6%) 65 (84.4%)
PENGGUNAAN BAHAN PSIKOAKTIF Sejumlah besar responden penagih

wanita ini iaitu 68 orang (88.3%) didapati merokok manakala selebihnya iaitu
9 orang (11.7%) lagi tidak merokok. Mereka merokok buat kali pertama pada
umur 16.05 tahun dengan sisihan piawai sebanyak 5.97 tahun, Rakan-rakan
paling mendominasi responden belajar merokok, di mana seramai 37 orang
(55.2%) mengatakan mereka belajar merokok daripada rakan-rakan mereka.
Ini diikuti dengan 27 orang (40.3%) responden mengatakan diri sendiri dan
selebihnya iaitu 3 orang atau 4.5% pula mengatakan orang yang mengajar
mereka merokok adalah suami, teman lelaki dan juga ibu bapa mereka.

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Pada masa yang sama, sejumlah 69 orang (89.6%) mengaku merupakan

seorang peminum minuman keras manakala selebihnya iaitu 8 orang atau
10.4% pula tidak. Mereka pertama kali minum minuman keras pada kadar
umur 17.13 tahun. Pengaruh yang paling kuat mengajar mereka minum
minuman keras, sama seperti juga rokok di mana rata-rata responden
penagih wanita ini mengaku bahawa rakan- rakan menjadi pengajar utama
mereka melakukan kegiatan ini. Seramai 42 orang atau 61.8% responden
mengatakan mereka belajar minum minuman keras ini daripada rakan-rakan
mereka. Ini diikuti dengan 23 orang penagih mengatakan diri sendiri
manakala selebihnya pula iaitu 3 orang mengatakan belajar daripada suami,
teman lelaki dan ibu bapa mereka.
Ramai penagih dadah terlibat dengan aktiviti jenayah dan ini termasuklah
penagih dadah wanita. Sejumlah 16 orang atau 21.6% penagih ini
mengatakan pernah melakukan jenayah manakala selebihnya iaitu 58 (78.4%)
mengatakan tidak pernah. Purata umur penagih wanita ini mula-mula
melakukan jenayah iaitu pada kadar purata umur 21.00 tahun dengan sisihan
piawai sebanyak 4.60 tahun. Antara jenayah yang sering dilakukan oleh
penagih wanita ini. Seramai 3 orang (21.4%) mengatakan mereka turut
melakukan jenayah mengedar dadah diikuti dengan perbuatan mencuri oleh 2
orang (14.3%) penagih dan selebihnya adalah jenayah-jenayah lain seperti
bersubahat dengan kawan, membunuh, memukul, menggugurkan kandungan,
seks tanpa nikah, menjual syabu, meragut, merompak dan menyamun orang,
yang mana setiap jenayah ini pernah dilakukan oleh setiap seorang (7.1%)
responden penagih ini.
Purata umur responden mula-mula menggunakan dadah adalah 19.88 tahun.

Secara puratanya, responden kajian ditangkap sebanyak 2.74 kali kerana
kesalahan menggunakan dadah. Jadual 4 menunjukkan status responden
semasa mula-mula menggunakan dadah, di mana 31 (40.3%) responden
telahpun berhenti dari alam persekolahan mereka semasa mula
menggunakan dadah. Ini diikuti dengan 21 orang (27.3%) mengambil dadah
selepas berkahwin manakala 15 orang (19.5%) lagi mengatakan mereka mula
menggunakan dadah ketika masih lagi bersekolah.
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Jadual 4 : Status Responden Semasa Mula-mula Menggunakan Dadah
Item Ya Tidak 1. Masih bersekolah 15 (19.5%) 41 (53.2%) 2. Sudah berhenti

sekolah 31 (40.3%) 29 (37.7%) 3. Sudah tamat sekolah 11 (14.3%) 40 (51.9%)
4. Sedang belajar di pusat pengajian tinggi - 50 (64.9%) 5. Sedang bekerja 18
(23.4%) 34 (44.2%) 6. Selepas berkahwin 21 (27.3%) 34 (44.2%) 7. Lain-lain
(selepas bercerai, selepas 7 (9.0%) 70 (91.0%) kematian anak, ketika
mengambil SPM)
Jadual 5 pula menunjukkan majoriti penagih wanita ini mengatakan mula-

mula berjinak dengan dadah semasa berada dan bergaul dengan orang lain,
di mana 22 orang atau 28.6% responden mengatakan mereka mula berjinak-
jinak dengan dadah ketika berada di tempat melepak dan 17 orang responden
atau 22.1% pula mengatakannya ketika mereka berada di rumah kawan
mereka. Sungguhpun demikian, 15 orang penagih wanita atau 19.5% pula
berkata mereka mula berjinak-jinak dengan dadah ketika berada di rumah.
Jadual 5 : Tempat di Mana Responden Mula-mula Berjinak dengan Dadah
Item Bilangan Peratus 1. Di tempat melepak 22 28.6 2. Di rumah kawan 17

22.1 3. Di rumah 15 19.5 4. Di tempat hiburan 12 15.6 5. Di tempat kerja 9 11.7
6. Di sekolah 2 2.6
Jadual 6 memperihalkan sumber kewangan penagih wanita ini untuk membeli

dadah. Majoriti penagih wanita ini iaitu 35 orang responden atau 50.7%
membeli dadah dengan menggunakan duit sendiri.

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Selain itu, 23 orang (33.3%) pula mengatakan membeli dadah dengan

menggunakan duit ibu bapa manakala 9 orang (13.0%) pula dengan cara
meminta duit daripada orang yang paling rapat dengan mereka seperti teman
lelaki, kekasih atau suami mereka. Hanya 2 orang (3.0%) responden berkata
bahawa sumber kewangan untuk membeli dadah adalah dengan mencuri.
Jadual 6 : Sumber Kewangan Responden Membeli Dadah
Item Bilangan Peratus 1. Duit sendiri 35 50.7 2. Duit ibu bapa 23 33.3 3. Minta
teman lelaki / kekasih / suami 9 13.0 4. Mencuri 2 3.0
Sejumlah 43 orang penagih wanita atau 57.3% mengatakan mereka mendapat

sumber bekalan dadah daripada rakan mereka (Jadual 7). Ini diikuti dengan
sumber yang diperoleh daripada pusher iaitu 22 (29.3%) jawapan dan 8 orang
(10.7%) responden mengatakan mendapat bekalan dadah daripada pasangan
rapat mereka seperti teman lelaki, kekasih atau suami. Hanya 2 orang (2.7%)
sahaja yang mendapat bekalan dadah daripada adik beradik mereka.
Jadual 7 : Sumber Responden Mendapat Bekalan Dadah
Item Bilangan Peratus 1. Diberi oleh rakan 43 57.3 2. Membeli daripada

Pusher 22 29.3 3. Diberi oleh teman lelaki / kekasih suami 8 10.7 4. Diberi
oleh adik beradik 2 2.7
Jadual 8 pula menunjukkan penggunaan jenis dadah di kalangan responden
kajian yang terlibat. Hasil kajian mendapati bahawa, kebanyakan penagih
dadah wanita di negeri Sabah menggunakan dadah jenis syabu. Daripada 77
orang responden kajian ini, 75 orang (97.4%) penagih wanita ini
menggunakan dadah jenis syabu diikuti
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dengan dadah jenis marijuana atau ganja dengan 35 orang (45.5%) pengguna
dan dadah jenis ekstasi seramai 26 orang atau 33.8% pengguna. Dadah lain
yang mendapat tempat dalam kalangan penagih wanita ini adalah seperti
kodein atau ubat batuk 20 orang (26.0%) dan heroin 11 orang ( 14.3%)
penagih.
Jadual 8 : Jenis Dadah yang Digunakan oleh Responden
Jenis Dadah Bilangan Peratus 1. Syabu 75 97.4 2. Marijuana/ganja 35 45.5 3.

Ekstasi 26 33.8 4. Kodein/ubat batuk 20 26.0 5. Heroin 11 14.3 6.
Gam/inhaler/thinners/marker 10 13.0 7. Amfetamin 10 13.0 8. Kokain 8 10.4 9.
Pain killer 7 9.1 10. Morfin 6 7.8 11. Subutex 4 5.2 12. Candu 3 3.9 13.
Ketamin/rophynol/GHB 2 2.6 14. Methadone 1 1.3
Jadual 9 menunjukkan cara penggunaan dadah di kalangan penagih-penagih

dadah tersebut di mana, kebanyakan dadah digunakan dengan cara
menghisap, iaitu 57 orang (74.0%) penagih yang disoal berkata mereka
menggunakan dadah dengan cara menghisap. Bilangan ini tinggi disebabkan
oleh penggunaan dadah jenis syabu dalam kalangan penagih wanita yang
amat tinggi. Ini diikuti dengan cara makan oleh 14 orang (18.2%) penagih,
sementara 5 orang (6.5%) penagih pula menggunakan dadah dengan cara
menghidu dan selebihnya iaitu seorang (1.5%) dengan cara suntikan.

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Jadual 9 : Cara Responden Menggunakan Dadah

Jenis Dadah Bilangan Peratus 1. Hisap 57 74.0 2. Makan 14 18.2 3. Hidu 5 6.5
4. Suntikan 1 1.3
Jadual 10 memaparkan jenis-jenis dadah yang paling kerap digunakan oleh

penagih wanita di Sabah. Hasil dapatan menunjukkan majoriti penagih wanita
di Sabah ini menggunakan dadah jenis syabu memandangkan ia amat mudah
diperoleh dengan harganya yang murah jika dibandingkan dengan dadah jenis
lain. Dapatan menunjukkan bahawa, 65 (84.4%) responden ini kerap
menggunakan dadah jenis syabu sahaja. Hanya 2 orang (2.6%) responden
kerap menggunakan syabu dan ekstasi, sementara 2 orang lagi (2.6%)
menggunakan syabu dan ganja.
Jadual 10 : Jenis Dadah yang Kerap Digunakan oleh Responden
Jenis Dadah Bilangan Peratus Syabu 65 84.4 Syabu dan ekstasi 2 2.6 Syabu
dan ganja 2 2.6 Ekstasi; Ganja; Heroin; Marijuana & 1 setiap satu/ 1.3 @ 10
Ekstasi; Morfin; Syabu & Heroin; gabungan Syabu, Ganja dan Ekstasi; Syabu &
Kokain; Methadone; Subutex; dan Amfetamine
Kekerapan responden menggunakan dadah dalam seminggu ialah pada kadar

purata 5.20 kali, iaitu mereka menggunakan dadah hampir setiap hari.
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FAKTOR PENDORONG PENGGUNAAN DADAH Faktor-faktor yang mendorong

kepada penggunaan dadah di kalangan wanita di negeri Sabah adalah seperti
dalam Jadual 11. Perasaan ingin tahu mendominasi sebanyak 61 orang atau
79.2% daripada responden yang mengikuti kajian ini dengan menyatakannya
sebagai punca utama mereka terjebak dengan dadah. Kajian juga mendapati
antara penyebab utama wanita mengambil dadah adalah untuk
menghilangkan stres seperti yang dinyatakan oleh 56 orang (72.7%)
responden kajian ini diikuti oleh faktor jiwa memberontak dan perpecahan
keluarga seperti yang dinyatakan oleh 50 orang (64.9%) responden yang
menjadikan alasan ini untuk menagih, dan 50 (64.9%) orang lagi mengatakan
ingin melarikan diri daripada masalah hidup atau kerunsingan mereka buat
sementara waktu. Seramai 47 penagih (61.1%) pula mengatakan mereka
menggunakan dadah bertujuan untuk menguruskan badan dan kecantikan.
Manakala, punca lain adalah rasa seronok seperti yang dirasakan oleh 42
(54.5%) responden, bekalan mudah diperoleh seperti yang dinyatakan oleh 35
orang (45.5%) penagih wanita ini.
Jadual 11 : Sebab-sebab Responden Menggunakan Dadah
Sebab-Sebab Penggunaan Dadah Bilangan Peratus Rasa ingin tahu/ingin

mencuba 61 79.2% Untuk menghilangkan stres/ kerunsingan 56 72.7%
Pengaruh rakan sebaya 51 66.2% Perpecahan keluarga dan pergolakan rumah
tangga 50 65.0% Melarikan diri daripada masalah hidup/kerunsingan 50
64.9% Menguruskan badan dan kecantikan 47 61.1% Rasa seronok 42 54.5%
Bekalan mudah diperoleh 36 46.8% Jiwa memberontak 30 39.0% Perubatan
19 24.7% Putus cinta 17 22.1% Terpedaya/ditipu 13 16.9% Dipaksa oleh
teman/rakan 13 16.9% Pengaruh suami 10 13.0% Dipaksa oleh
suami/kekasih/teman lelaki 6 7.8% Untuk membunuh diri 5 6.5%

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Jadual 12 menunjukkan bahawa rakan memainkan peranan yang besar dalam

mempengaruhi responden menggunakan dadah. 54 orang (70.1%) penagih
mengatakan bahawa rakan banyak mempengaruhi mereka menggunakan
dadah dan diikuti dengan usaha diri sendiri sebanyak 14 orang (18.2%) dan
pengaruh suami dan teman lelaki seramai 8 orang (10.4%). Hanya seorang
(1.3%) responden mengatakan bahawa ibu bapa banyak mempengaruhi
mereka menggunakan dadah.
Jadual 12 : Siapakah Paling Banyak Mempengaruhi Responden Menggunakan

Dadah
Pihak yang Mempengaruhi Responden Bilangan Peratus 1. Rakan 54 70.1 2.

Diri sendiri 14 18.2 3. Suami/teman lelaki 8 10.4 4. Ibu bapa 1 1.3
Mungkin disebabkan oleh rakan banyak mempengaruhi penggunaan dadah di

kalangan penagih-penagih wanita ini, maka tidak hairanlah rakan-rakan juga
menjadi tempat mereka berkongsi pengalaman pertama menggunakan
dadah. Daripada 77 orang responden kajian ini, seramai 62 orang (83.8%)
penagih mengatakan mereka berkongsi pengalaman pertama menggunakan
dadah bersama rakan-rakan. Sejumlah 7 orang (9.5%) responden telah
berkongsi dengan suami/teman lelaki/kekasih dan 5 orang (6.8%) responden
lagi berkata mereka berkongsi pengalaman tersebut dengan keluarga mereka
(Jadual 13).
Jadual 13 : Responden Berkongsi Pengalaman Pertama Menggunakan Dadah

Kongsi Pengalaman Dadah dengan Bilangan Peratus 1. Rakan-rakan 62 83.8
2. Suami/teman lelaki/kekasih 7 9.5 3. Keluarga 5 6.8
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Jadual 14 menunjukkan bahawa seramai 19 orang (25.0%) responden penagih

wanita mengaku mereka cuba mengajak orang lain menggunakan dadah
manakala 57 orang (75.0%) responden lagi mengatakan tidak.
Jadual 14 : Pernahkah Responden Mengajak Orang Lain Menggunakan Dadah
Responden Mengajak Orang Lain Bilangan Peratus Menggunakan Dadah 1. Ya

19 25.0 2. Tidak 57 75.0
Jadual 15 menunjukkan bilangan orang yang cuba dipengaruhi oleh penagih

dadah wanita ini, di mana 5 orang (6.5%) di kalangan penagih berkata telah
cuba mempengaruhi seorang untuk terlibat dengan dadah, 4 orang (5.2%)
responden pula cuba mempengaruhi 5 orang lain, 3 orang responden (3.9%)
pula mengaku cuba mengajak 3 orang lain untuk terlibat dengan najis dadah
ini.
Jadual 15 : Berapa Ramai yang Cuba Dipengaruhi Responden
Item Bilangan Peratus 1. 1 orang 5 6.5 2. 2 orang 2 2.6 3. 3 orang 3 3.9 4. 5

orang 4 5.2 5. 10 orang 1 1.3 6. 50 orang 1 1.3 Min 6.13 Sisihan Piawai 11.94

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Jadual 16 menunjukkan bilangan orang yang terpengaruh dengan ajakan

penagih dadah wanita ini, yang mana seramai 5 orang (31.25%) responden
mengatakan mereka telah berjaya mempengaruhi sekurang-kurangnya
seorang untuk terlibat dengan dadah, 4 orang (25.0%) pula mengatakan
mereka berjaya mempengaruhi 3 orang, 3 orang responden (18.8%) pula
berkata telah berjaya mempengaruhi 2 orang untuk terlibat dengan dadah.
Adalah amat mendukacitakan bila mana ada 2 orang (12.5%) responden
kajian ini mengaku bahawa 30 orang turut terpengaruh dengan ajakan
mereka untuk menagih.
Jadual 16 : Berapa Ramai yang Terpengaruh untuk Menggunakan Dadah
Bilangan yang Terpengaruh Bilangan Peratus 1. 1 orang 5 31.25 2. 3 orang 4

25.0 3. 2 orang 3 18.8 4. 30 orang 2 12.5 5. 5 orang 1 6.3 6. 9 orang 1 6.3 Min
6.06 Sisihan Piawai 9.56
Jikalau ditinjau, pihak yang paling berpengaruh mendorong mereka

menggunakan dadah adalah rakan-rakan mereka (70.1%) (Rajah 1). Ini adalah
benar bagi semua peringkat umur. Jika ditinjau pada tahap umur 20-29 tahun,
kekasih dan diri mereka sendiri turut dilihat sebagai punca utama mereka
menggunakan dadah. Dari sini bolehlah dianggarkan bahawa apabila
responden memasuki zaman dewasa, walaupun rakan-rakan masih menjadi
pengaruh utama, namun ada juga yang dipengaruhi oleh kekasih masing-
masing.
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Rajah 1 : Umur dengan Siapa yang Mempengaruhi Penagih
KESAN TERHADAP KESIHATAN MENTAL Objektif kajian yang ketiga ialah

untuk menentukan tahap kesihatan mental pengguna dadah wanita dari
negeri Sabah. Ini penting kerana ramai wanita menggunakan syabu, sejenis
dadah yang telah diketahui kesannya yang menyebabkan "drug psychosis",
dan hal ini disokong oleh pelbagai kajian di mana pengguna dadah wanita
turut mengalami kemurungan dan simptom psikiatri lain lebih kerap lagi
berbanding penagih lelaki.
Jika ditinjau sebab dan kesan dadah digunakan (Rajah 2), antara yang
dinyatakan sebab utama ialah untuk mengurangkan stres (72.7%) dan diikuti
dengan melarikan diri daripada masalah (64.9%) dan faktor ini menunjukkan
bahawa daya tindak penagih wanita terhadap pengawalan masalah adalah
lemah, dan menggunakan strategi daya tindak yang tidak dapat membantu
kesihatan mental.
Penggunaan dadah turut diatribusikan kepada faktor jiwa yang memberontak

(39%), perpecahan dan pergolakan rumah tangga (36.4%), putus cinta
(22.1%), dan yang paling serius ialah untuk membunuh diri (6.5%). Kajian
Mahmood (2005) turut mendapati bahawa sebab penggunaan dadah di
kalangan penagih lelaki dan wanita adalah amat berbeza, yang mana wanita
lebih terdorong untuk mengelak atau melarikan diri daripada masalah,
manakala lelaki pula menggunakannya untuk kesan euforia atau keenakan
dadah itu sendiri.

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Rajah 2 : Sebab-sebab Penggunaan Dadah di Kalangan Penagih Wanita
Jadual 17 menunjukkan kesan penglibatan wanita dengan dadah ini terhadap

kesihatan mental mereka. Hasil kajian mendapati daripada keseluruhan
responden yang ditanya, 53 orang (68.8%) responden mengatakan rasa
menyesal menggunakan dadah manakala selebihnya 24 orang (31.2%) pula
tidak berasa menyesal. Seramai 49 penagih (63.6%) pula berasa malu
terhadap diri sendiri dan orang lain diikuti dengan rasa sakit seperti yang
dinyatakan oleh 27 orang (35.1%) penagih wanita ini. Sungguhpun demikian,
kesan ini tidak pula dirasakan oleh 50 orang responden kajian, malah 24
orang (31.2%) mengaku tidak mengalami perasaan bersalah kerana
menggunakan dadah.
Dapatan kajian menunjukkan bahawa perasaan ingin tahu mendominasi

punca utama penggunaan dadah manakala penyebab utama wanita
mengambil dadah adalah untuk menghilangkan stres diikuti dengan faktor
jiwa memberontak dan perpecahan keluarga, ingin melarikan diri daripada
masalah hidup atau kerunsingan dan ada yang menggunakan dadah
bertujuan untuk menguruskan badan dan kecantikan. Kesan dadah juga
dilihat memberi sedikit gangguan pada tingkah laku dan mental penagih
dadah wanita seperti perasaan hendak membunuh diri atau mati, rasa
bersalah, putus asa dan malu, yang mana perkara ini haruslah diberikan
tumpuan dalam rawatan dan pemulihan mereka.
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Jadual 17 : Kesan Negatif Penggunaan Dadah

No. Kesan Negatif Penggunaan Dadah Bilangan Peratus 1. Rasa menyesal Ya
53 68.8% Tidak 24 31.2% 2. Rasa malu Ya 49 63.6% Tidak 28 36.4% 3. Rasa
sakit Ya 27 35.1% Tidak 50 64.9% 4. Tidak rasa bersalah Ya 24 31.2% Tidak
41 68.8% 5. Rasa putus asa Ya 23 29.9% Tidak 54 70.1% 6. Rasa seperti mahu
mati Ya 18 23.4% Tidak 59 76.6% 7. Rasa hendak bunuh diri Ya 8 10.4% Tidak
69 89.6%
IMPLIKASI KEPADA PEMULIHAN Sebilangan besar penagih dadah wanita

menggunakan dadah selepas mereka berhenti sekolah dan kerana pengaruh
kawan sebaya, bukan sahaja di tahap umur remaja, tetapi juga di tahap awal
dan lanjut dewasa. Sebilangan besar juga menggunakan dadah dalam dan di
tempat-tempat hiburan. Pendedahan awal kepada rokok dan alkohol juga
kelihatan sebagai sesuatu yang agak lazim di kalangan kumpulan ini. Setelah
bekerja, mereka membeli dadah dengan menggunakan pendapatan sendiri,
tetapi bagi yang belum bekerja, mereka menggunakan wang daripada ibu
bapa. Hal ini seharusnya diambil kira dalam merangka strategi rawatan dan
pemulihan penagih wanita.
Di samping itu, terdapat pelbagai kajian menemui bahawa wanita lebih

terdedah kepada masalah jiwa, penyesuaian, mental atau psikiatri

133
(Bulik,1987, Duongsaa, 1989; Hesselbrock et al., 1985; Nace et al., 1986; Ross
et al, 1988; dan Stocco et al., 2000). Kajian ini turut menemui bahawa di
kalangan penagih wanita Sabah, dadah yang sering mereka gunakan ialah
syabu, sejenis dadah ATS yang boleh membawa kepada kerosakan urat saraf
dan otak. Kerosakan ini akan menyebabkan berlakunya 'drug psychosis",
yang mana simptomnya adalah seperti halusinasi, delusi, paranoia dan ada
kalanya kemurungan yang teruk.
Keadaan ini dikukuhkan lagi dengan maklumat bahawa penggunaan dadah

adalah kerana sebab-sebab seperti hendak menghilangkan kerungsingan
(72.7%), melarikan diri daripada masalah (64.9%), menenangkan jiwa yang
memberontak (39.0%), melepaskan diri daripada masalah perpecahan
keluarga dan pergolakan rumah tangga (36.4%), melupakan masalah putus
cinta (22.1%) dan ada sebilangan yang menggunakan dengan niat untuk
membunuh diri (6.5%). Hal ini menunjukkan bahawa aspek penyesuaian,
ketenangan emosi, penggunaan strategi daya tindak yang membantu
menyelesaikan masalah, ketenangan dan kestabilan jiwa perlu diambil kira
dalam rangka rawatan dan pemulihan wanita. Penelitian Mahmood (2005a;
2005b) mendapati bahawa gangguan-gangguan mental seperti ini telah
membawa kepada episod kemurungan, yang juga pernah didokumentasikan
oleh Vaglum et al. (1985) di kalangan wanita alkoholik.
Ini bermakna khidmat psikiatri harus disediakan untuk pemulihan penagih

wanita. Bagi mereka yang mengalami kemurungan dan psikosis lain,
penilaian menyeluruh perlu dilakukan bagi mengetahui tahap kecelaruan
yang dialami dan intervensi tingkah laku serta perubatan harus disediakan.
Tambahan pada itu, bagi penagih wanita yang menghadapi masalah

penyesuaian, maka haruslah diwujudkan "partner in recovery" agar mereka
boleh berkongsi pengalaman, emosi dan masalah dengan rakan sebaya
(Mahmood 2003; Mahmood & Yunos 2004; Yunos & Mahmood, 2004). Tatacara
ini didapati berkesan dalam rawatan dan pemulihan dadah secara TC yang
dijalankan di Rumah Pengasih Malaysia (Yunos et al; 2004).
Selain itu pengisian kepada jiwa yang kosong juga amat penting (Mahmood et
al, 1997; Mahmood, 1995; 1999; Nelson-Zlupko, 1996). Sebilangan signifikan
penagih yang ditemui adalah beragama Islam, dan
134
kebanyakan mereka amat kurang pengetahuan mengenai agama, apatah lagi

melakukan ibadah seperti yang dituntut agama Islam. Memperkenalkan Islam
‘semula’ secara mendadak mungkin akan menyebabkan mereka menolak
terus agama. Oleh yang demikian, strategi pintar perlu dirangka oleh pakar
agama bagi meniup semula jiwa Islam ke dalam diri mereka secara perlahan-
lahan agar ia dapat diterima dengan rela hati. Keperluan ilmu agama ini
diakui oleh penagih wanita yang mana 90.9% merasakan pendidikan agama
sebagai penting kerana itu adalah pengisian jiwa yang bermakna kepada
mereka untuk membantu menahan diri daripada terus menggunakan dadah.
Pada masa yang sama, dalam sesi temu duga yang dijalankan di pusat-pusat
pemulihan, mereka turut mengatakan bahawa kaedahnya perlulah sesuai dan
berkesan.
Walaupun usaha rawatan dan pemulihan dapat dimantapkan untuk penagih

wanita, namun yang lebih penting ialah usaha untuk mencegah mereka
daripada terlibat dengan penggunaan dadah. Pengaruh rakan sebaya,
masalah disiplin di sekolah, sikap ambil peduli ibu bapa serta masyarakat
adalah antara faktor yang harus diintegrasikan dalam program pendidikan
pencegahan dadah. Kempen hubungan kekeluargaan, gaya hidup sihat serta
kepentingan pembelajaran boleh digerakkan untuk membentuk pemikiran
serta sikap remaja, ibu bapa dan masyarakat untuk bersama bergerak ke
arah keharmonian kehidupan.
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The Relationship Between Age of Onset For Delinquent Behaviour and

Chronic Drug Abuse Among Adolescents
97Mohd Muzafar Shah bin Hj. Mohd Razali , m/s 97-110
THE RELATIONSHIP BETWEEN THE AGE OF ONSET FOR DELINQUENT

BEHAVIOR AND CHRONIC DRUG ABUSE AMONG ADOLESCENTS
Mohd Muzafar Shah bin Hj. Mohd Razali1
ABSTRACT
The aim of this study is to investigate whether chronic drug abusers begin
their involvement in delinquent behaviors at a significantly early age than
non-chronic abusers. The total participants of this study consisted of 138
male adolescents from a drug treatment and rehabilitation center. Their ages
ranged between 17 to 21 years old. The instruments used in this study are an
adaptation version of the Measuring Risk and Protective Factors For Drug
Abuse and Other Delinquents Behavior and the Drug Use Screening Inventory.
The result shows that the majority of the chronic drug abusers began their
involvement in delinquent behaviors at a significantly early age than the non-
chronic abusers. The implications of this study towards developing
counseling and preventive efforts are also discussed.
ABSTRAK
Tujuan kajian ini adalah untuk mengkaji sama ada penagih dadah kronik mula
terlibat dengan tingkah laku delinkuen di tahap umur yang muda berbanding
dengan penagih yang tidak kronik. Peserta yang terlibat dengan kajian ini
adalah 138 orang remaja dari pusat rawatan dan pemulihan dadah. Julat
umur mereka adalah di antara 17 hingga 21 tahun. Alat-alat ukuran yang
digunakan dalam kajian ini adalah versi adaptasi Pengukuran Faktor Risiko
dan Perlindungan bagi Penyalahgunaan Dadah
1 Lecturer, Department of Guidance and Counseling, Faculty of Cognitive
Sciences and Human Development, University Pendidikan Sultan Idris (UPSI)
dan Tingkah Laku Delinkuen lain dan Inventori Saringan Penyalahgunaan

Dadah. Dapatan kajian menunjukkan bahawa kebanyakan daripada penagih
dadah kronik terlibat dengan tingkah laku delinkuen pada peringkat umur
yang lebih awal berbanding dengan penagih yang tidak kronik. Implikasi
kajian untuk membentuk usaha kaunseling dan pencegahan turut
dibincangkan.
INTRODUCTION The drug abuse problem in Malaysia, which was once

perceived as a social malaise has, became a threat to national security. The
government in 1983 elevated the drug problem to an unprecedented level of
priority by declaring it as a security concern (Scorzelli, 1987).
However, after two decades of the government’s declaration on drugs as the

country’s number one enemy, the problem seems to be in the state of coming
to an endless point. Despite the efforts done by the government and the
support from various non-governmental organizations to control and prevent
the drug menace, what has happened instead is the other way round as the
situation has gotten more serious.
According to Tay (1996), the incidence rate is deemed to be a reliable

indicator on the dynamics of the spreading as well as the magnitude of drug
abuse in Malaysia whereby the number of new addicts has increased from
7,389 persons in 1990 to 13,140 persons in 1995, of which is an increase of
77.8%. Besides that, the rate of relapse among addicts is also of great
concern to the government. Mohamad Hussain and Mustafa (2001) stated
that studies conducted have noted that 90% of them return to using heroin
within six months after being discharged from the Serenti rehabilitation
centres. About 40% claimed that they only maintain a drug free life for a
duration of one month before returning to heroin again. In fact, there are
relapsed addicts who have been in the Serenti rehabilitation centers for not
less than five times. Yet they still return to abusing heroin after being
discharged from the center. In cognizance of the seriousness of the drug
problem, the government in 2003 declared war against drugs.
The drug menace is not merely a problem among adults but has gradually
influenced adolescents including school pupils too. The Ministry of Education
(2003) reported that from 1992 to 2002, a total of
2,643 pupils had been detected as being involved in various drug related
offenses. Navaratnam (1992) estimated that for every single drug addict,
there are another five individuals who are at risk of getting involved in this
destructive habit. Therefore, based on his estimation and from the 1992 to
2002 drug abuse report by the educational ministry, there are approximately
13,000 teenagers who are potential drug abusers.
The National Anti-Drugs Agency (2005) reported that there is a new trend
among young people taking drugs such as amphetamine and ecstasy.
According to Mohamad Hussain and Mustafa (2001), amphetamine is a
stimulant drug, which has powerful effects on the brain. It can produce
psychosis and for the chronic user, he or she will have labile mood and at
times be violent. Ecstasy is a hallucinogenic drug and its effects are similar
to amphetamine. These drugs are available in discos and nightclubs and are
usually used to alter moods so that the user can dance and sing throughout
the night without feeling exhausted.
Malaysia is striving fast to be a developed nation by the year 2020. It cannot

afford to have its younger generation crippled by drugs. These young people
are the backbone of the country and the future of this country is in their
hands. In order to achieve its vision, the country needs young people who are
energetic and have the capability to contribute to the development of the
country. Therefore, much effort must be taken by all parties in order to
ensure a healthy, safe and productive life for all Malaysians.
PROBLEM STATEMENT The age of onset for delinquent behavior is an

important risk factor for drug abuse occurrences among adolescents.
Delinquent behaviors such as smoking, sniffing glue and alcohol consumption
are related to drug abuse. Cigarettes, alcohol and marijuana are known as
the “gateway drugs”. Research has shown that young people are unlikely to
use marijuana if they have not already used cigarettes or alcohol (Coombs
and Ziedonis, 1995). Mohamad Hussain and Mustafa (2001) reasoned out that
although not all smokers will be drug abusers but research among drug
addicts found that all them are smokers. Numerous studies have also found a
positive relationship between delinquency and drug abuse, with minor
delinquency or deviant acts

typically preceding the onset of drug abuse (Brook et.al. 1998, DeWit &
Silverman, 1995; Newcomb, 1992; Oetting & Beauvais, 1986; Petraitis et. al,
1995).
Kandel, in her stage theory of drug abuse mentioned that participation at the
first level “puts adolescents at risk for progression to the next stage”
(Coombs and Ziedonis, 1995). The progression of these stages mentioned
also included the age factor and the type of drugs used by those young users.
For example, Kilpatrick et al. (2000) stated that drug abuse initiation at an
early age increases the risk of dysfunctional use or abuse in later years.
According to the National Institute on Drug Abuse (1997), research has
shown that the earlier anyone gets involved in abusing drugs, the higher the
risk for him or her to develop into a chronic user. For example, if an individual
was to get involved in abusing drugs at the age of 12 and if this habit
continuously surrounded his life, then by the age of 20 he might already be
very much addicted to drugs. Of course, at this point of time great effort
should be taken to help them recover and lead a normal life. However, this is
easier said than done because drugs have completely taken control of their
entire lives. In other words, for this particular group of drugs addicts, they
cannot function as a normal person without taking drugs daily.
Most of the researches on risk factors for drug abuse among adolescents
have been conducted in other countries especially in the United States. It is
from those studies that researchers develop various drug prevention models
such as the information model, effective model and social influence models.
Coombs and Ziedonis (1995) said that research on how drug abuse begins
and continues has clear implications to the prevention program’s goals and
strategies. For example, keeping children or adolescents who have already
experimented drugs from continuing the abusive patterns will probably
require different and more intensive programs than those designed for the
general population. In Malaysia, not many studies are conducted in the area
of drug prevention although the problem is considered as the national
number one enemy and the government has declared war against it. Thus, it
is high time that more researches are needed in this area so as to develop
effective prevention programs in the Malaysian context.

OBJECTIVE OF STUDY This research is part of a larger study and its aim is to
investigate the relationship between the age of onset for delinquent
behaviors and chronic drug abuse among adolescents. In this research
delinquent behavior refers to smoking, sniffing glue and drinking beer.
RESEARCH QUESTIONS i. What is the user level of severity of consequences
for drug abuse among adolescents? ii. Is there a difference on the age of
onset for smoking among chronic drug abusers and non-chronic drug
abusers? iii. Is there a difference on the age of onset for sniffing glue among
chronic drug abusers and non-chronic drug abusers? iv. Is there a difference
on the age of onset for drinking beer among chronic drug abusers and non-
chronic drug abusers?
METHODOLOGY This study was conducted at the Serenti Drug Rehabilitation

Center in Karak, Pahang Darul Makmur. It is a drug treatment and
rehabilitation center specifically for male adolescents. This center is run by
the National Anti-Drugs Agency. The respondents of this study were 138 male
adolescents whose age ranged between 17 to 21 years old.
INSTRUMENTATION Two sets of instruments were used in this study. The first
instrument is an adaptation of measuring risk and protective factors for drug
abuse and other delinquent behaviors. It consisted of 140 items of which
there are three questions concerning the particular age at which the
respondents experimented with smoking, sniffing glue and drinking alcohol
(For example: How old were you when you first smoked a cigarette, even if it
was just a puff?; How old were you when you first sniffed glue to get high?;
How old were you when you first drank beer, even just a sip?). The onset ages
for the three items were categorized as “never; 17 years old and above; 15 –
16 years old; 13 – 14 years old; 12 years old and below”. The original
instrument was developed by Arthur et al. (2002). The adapted instrument
has
been through the process of translation into Bahasa Melayu and tested for its
content validity and reliability. The Cronbach alpha for the adapted
instrument is .88.
The second instrument is an adaptation of one of the domains from the Drug
Use Screening Inventory (DUSI) to measure the gradation of involvement and
severity of consequences for drug abuse. It comprises of fifteen questions
with either a “yes” or a “no” answer. (For example: Have you had a craving or
a very strong desire for drugs?; Have you had to use more and more drugs to
get the effect you desire?; Did you break the law or rules because you were
high on drugs?). The score is computed by counting the endorsements (“yes”
responses = 1; “no” responses = 0). Subsequently, the total number of “yes”
responses is divided by 15 and the quotient is then multiplied by 100. The
overall severity index has a range of 0 – 100%. Cut-off scores for diagnosis
are not provided but an overall density index exceeding 15% is considered as
significant (Tarter, 1990). For the purpose of this study, respondents with a
score of 0 – 15% were classified as non-chronic users. Respondents with
scores of 16 – 100% were classified as chronic drug users. The original
instrument was developed by Ralph Tarter (1990). The adapted instrument
has been through the process of translation into Bahasa Melayu and has
been tested for its content validity and reliability. The Cronbach alpha for the
adapted instrument is .81.
PROCEDURES One of the ways to examine the relationship between the age
of onset for delinquent behavior and chronic drug abuse among adolescents
is to compare the age at which the chronic drug abusers and non- chronic
drug abusers began their “abusive” behaviours.
DATA ANALYSIS The data was analyzed by using the Statistical Package for
the Social Science (SPSS) version 11. The statistical procedure used in this
study was the cross tabulation between the age of onset for smoking,
sniffing glue and drinking alcohol with two levels of severity of consequences
namely the non-chronic user and the chronic user. Meanwhile the onset ages
for the three delinquent behaviors were grouped as follows:

“Never”; “17 years old and above”; “15 – 16 years old”; “13 – 14 years old”; “12
years old and below”.
FINDINGS Research Question 1 : What is the user level of severity of

consequences for drug abuse among adolescents?
Table 1 shows the respondents user level of severity of consequences for

drug abuse. Out of the 138 respondents who tested for their level of severity
of consequences for drug abuse, 29% (40) were non-chronic users and 71%
(98) were considered as chronic users. This implies that the majority of them
are categorized as chronic drug users.
Table 1 : Respondents’ User Level of Severity of Consequences for Drug

Abuse
User level Frequency Percentage Non chronic user 40 29 Chronic user 98 71

Total 138 100
Research Question 2 : Is there a difference on the age of onset for smoking

between chronic drug abusers and non-chronic drug abusers?
Table 2 shows the comparison between the age of onset for smoking between
non-chronic users and chronic users. The findings indicate that all of them
are smokers. For both non-chronic and chronic users, the majority started
smoking at the age of 12 years and below and as they got older the lesser the
rate of first time smokers. In relationship to the age of onset for smoking, it
is found that the majority of the chronic users started smoking at an earlier
age than non-chronic users. This indicates that the earlier a drug addict
starts smoking, the more chronic the user level of severity for drug abuse is.
Table 2 : Comparison Between the Age of Onset for Smoking and the User
Level
Research Question 3 : Is there a difference on the age of onset for sniffing

glue among chronic drug abusers and non-chronic drug abusers?
Table 3 shows the comparison between the onset age for sniffing glue
between non-chronic users and chronic users. The findings of the comparison
on the age of onset for sniffing glue shows that not all of them had
experienced it, the majority had never sniffed glue before. For the chronic
users who sniffed glue, the majority had experienced it between 13 to 14
years old whereas for the non-chronic user they experienced it at an older
age that is between 15 to 16 years old. This shows that the earlier a drug
addict starts sniffing glue, the more chronic the user level of severity for drug
abuse is.
Table 3 : Comparing the Age of Onset for Inhaling Glue or Gum and the User
Level Age of onset
Non chronic user Chronic user
Total
Never
62.5% (25)
30.6% (30) 39.9% (55)
17 yrs. old and above
10% (4)
8.2% (8) 8.7% (12)
15 – 16 yrs. old
15% (6)
18.4% (18) 17.4% (24)
13 – 14 yrs. old
7.5% (3)
32.7% (32) 26.4% (35)
12 yrs. old and below
5% (2)
10.2% (65) 8.7% (82)
Total
100% (40)
100% (98) 100% (138)
User level
Age of onset
Total
Never
7.5% (3)
2% (2) 3.6% (5)

15 – 16 yrs. old
17.5% (7)
10.2% (10) 12.3% (17)
13 – 14 yrs. old
32.5% (13)
21.4% (21) 24.6% (34)
42.5% (17)
66.3% (65) 59.4% (82)
Total
100% (40)
100% (98) 100% (138)
User level

Research Question 4 : Is there a difference on the age of onset for drinking

beer among chronic drug abusers and non-chronic drug abusers?
Table 4 shows the comparison age of onset for drinking beer between non-
chronic users and chronic users. The findings show that not all of them had
experienced drinking beer. For the chronic user who has had experienced
drinking beer, the majority of them experienced it at the age of 15 to 16 years
old whereas for the non-chronic user they experienced it at an older age of 17
years and above. This shows that the earlier a drug addict starts drinking
beer, the more chronic the user level of severity for drug abuse is.
Table 4 : Comparing the Age of Onset for Drinking Beer and the User Level
DISCUSSION AND IMPLICATION The findings on the respondents' user level of

severity of consequences for drug abuse clearly shows that addiction is not
categorized at any one level but it is of different levels for both the chronic
user and the non-chronic user. It also shows that the majority of the
respondents who are adolescents with drug abuse problems are classified as
chronic users. Being a chronic drug user at a young age leads to a bigger
problem whereby they develop a "no drugs, no life" syndrome.
In other words, drugs have taken control of their entire lives and they have to
take drugs in order to maintain a normal life as others do. Putting them into
the drug treatment and rehabilitation program is the right thing to do so that
they can cope and manage their addiction.
Age of onset
Total
Never
30% (12)
9.2% (9) 15.2% (21)
35% (14)
25.5% (25) 28.3% (39)
15 – 16 yrs. old
25% (10)
30.6% (30) 29% (40)
13 – 14 yrs. old
10% (4)
28.6% (28) 23.2% (32)
6.1% (6) 4.3% (6)
Total
100% (40)
100% (98) 100% (138)
User level
In order to make the rehabilitation program more effective, it is suggested

that chronic and non-chronic drug users be separated. As it is now, both
users are treated with a single modality namely the "tough and rugged"
approach or are put into the Therapeutic Community program. By putting the
two groups together, more harm is done because it is likely that the non-
chronic users will learn and gain knowledge of many more drugs in the
market. As a result they may want to try and experiment with other drugs
that had been introduced by their friends at the center as soon as they leave
the center. It is probably due to this factor that the rate of relapse among
addicts who had undergone the drug treatment and rehabilitation programs
in Serenti is becoming higher.
Overall, the pattern of results is clear. Findings from the relationship between
the age of onset for smoking, sniffing glue and drinking beer and chronic drug
abuse indicates that the majority of the chronic drug abusers began their
involvement in those three delinquent behaviors at a significantly earlier age
than other abusers. The research on the relationship between the age of
onset and chronic drug abuse among adolescents has clear implications for
the prevention program's goals and strategies.
There is a need for an effective strategy to curb and prevent drug abuse
among adolescents. This could be well suggested by the implementation of
drug prevention education in schools (Fisher & Harrison, 2000; Pagliero &
Pagliero, 1996; Sales, 2004). The rationale is that children spend many of
their waking hours in the classrooms (Tay, 1996). Schools have a captive
audience that encompasses nearly everyone in the appropriate age range for
primary prevention. They also provide opportunities for face-to-face
communication and feedback, both of which enhance the prospects for
changing behavior (Fisher & Harrison, 2000). They are micro communities
within which a wide variety of educational, environmental and policy
strategies can be implemented with respect to drugs. Schools are a fulcrum
between homes and the wider community, through which communication and
influence can pass in both directions (Tay, 1996).
School counselors must take a vital role in leading the effort to not only
prevent the influence of drugs at schools but at the same time

they have to draw up strategies to overcome the problem of gateway drugs

namely cigarettes, inhalants and alcohol. School counselors have the
advantage of providing school-based programs with the support from parents,
community and other societal institutions. They must be proactive so as to
develop drug preventive programs at the primary, secondary and tertiary
level. They have to work with the school management to set up their own
school’s anti-drug policy as what schools are doing now to have their own
visions and missions. In relation to this matter, school counselors should
continuously run drug prevention programs instead of having it as an ad hoc
program or at a certain time of the year, that is as a day or a week of anti-
drugs campaign.
Risk reduction programs and activities should address risks at or before the
time they become predictive of later problems. Intervening early to reduce
risk is likely to minimize the effort needed and maximize the outcome
(Howell et. al., 1995). Interventions at the primary level should not only be
focusing on giving information on the various kinds of drugs in the market
and the dangers of it but more importantly is to impart the knowledge of how
to resist the influence of abusing drugs. Therefore, school counselors must
equip their students with the essential interpersonal skills such as managing
feelings (being aware of and understanding their own feelings; learning to
manage negative emotions such as anger, fear and hurt; developing self-
confidence; and developing assertion skills in resisting pressures to use
drugs), decision making (setting goals; gathering information; generating
alternatives; evaluating the results of a decision; making the right choice by
saying "no" to drugs), communication (sending clear messages; listening;
learning positive strategies for handling conflicts and solving problems) and
personal skills (handling stress; time management; thinking positively; and
setting achievable goals).
CONCLUSION The influence of drug abuse is still prevalent in our society and
if it is left unattended or if no preventive measures are taken, we will be in a
critical situation when this phenomenon becomes totally out of control. If
more and more of our young citizens come under the influence of drugs then
many more social problems will occur because it is related to other
delinquent and anti-social behaviors. In the long run this multiple effect
problem will create chaos within the family and the community
and greatly ruin the vision envisaged by the government to be a developed

nation by the year 2020. Therefore, continuous prevention efforts to
overcome the drug abuse problem must begin at an early age because the
earlier they start experimenting drugs then the sooner they will become
addicted to it. It is high time for all concerned parties at various levels
including the individual, family, school, community, voluntary organizations
and the government to work collectively in order to overcome this problem
for a better future for our coming generations and our beloved nation.

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Relapse Prevention: Strategies and Techniques
85Prof. Dr. James F. Scorzelli, m/s 85-96
1 Professor Department of Counseling and Applied Educational Psychology,

Northeastern University, Boston, USA
RELAPSE PREVENTION: STRATEGIES AND TECHNIQUES
James F. Scorzelli1
ABSTRACT
This article presents some views of strategies and techniques of relapse

prevention in the context of drug treatment and rehabilitation in Malaysia. It
outlines some strategies for relapse prevention, with the primary focus on
anxiety reduction among drug dependents through several approaches such
as spiritual, muscle relaxation and emotional imagery techniques. However,
in Malaysia, focus should be given to finding employment for recovering drug
dependents because they had a positive employment record before they were
brought in for treatment and rehabilitation. The article also touches on the
service delivery system of the drug rehabilitation program which among
others suggests capacity building of personnel involved in the program.
ABSTRAK
Artikel ini membentangkan strategi dan teknik pencegahan penagihan

semula dengan merujuk kepada program rawatan dan pemulihan dadah di
Malaysia. Ia menggariskan beberapa strategi pencegahan penagihan semula
dengan memberi tumpuan kepada pengurangan kebimbangan melalui
beberapa pendekatan seperti kerohanian, teknik-teknik penyantaian otot dan
pembayangan perasaan. Walaupun demikian, di Malaysia, tumpuan harus
diberikan kepada mencari pekerjaan untuk mereka yang menghadapi
masalah kebergantungan kepada dadah kerana mereka mempunyai rekod
pekerjaan yang agak baik sebelum dimasukkan ke program pemulihan dadah.
Artikel ini turut menyentuh isu mengenai sistem penyampaian perkhidmatan
yang antara lainnya mencadangkan peningkatan keupayaan kakitangan yang
berkhidmat dengan program rawatan dan pemulihan dadah.
INTRODUCTION Drug abuse is a major health concern and has reached

epidemic proportions. The seriousness of drug abuse as a threat to the
security of a country was best illustrated when Malaysia, on February 19,
1983, declared its drug problem a national emergency and launched a
massive effort in law enforcement, preventive education and rehabilitation to
eliminate this drug or “dadah” menace.
When drug abuse is discussed, one often fails to mention the vast
contributions of medical research which has resulted in the discovery of a
wide variety of drugs and antibiotics, which besides eliminating many of our
most feared diseases, have been responsible for the world’s present level of
technology and scientific sophistication. Few of us would dare question the
importance and benefits of Pasteur’s discovery of vaccines in 1828, the
development of sulfur drugs, or the development and use of tranquillizers to
treat the mentally ill. The fact that the world is small pox-free is still difficult
for many people to comprehend and because of the discovery of the Salk
vaccine; parents no longer need to fear the dreaded child “crippler” of polio.
Although these medical miracles have been of immense benefit to
humankind, they have also contributed to the mentality that drugs are a
panacea, and can cure all of our ills. The enormous amphetamine epidemic
that Japan faced after World War II was caused by both poor regulation and
the belief that amphetamines could provide a person with the extra energy
and “zip” necessary to help in the rebuilding of his or her war torn country.
In fact, most of today’s dangerous drugs were at one time viewed as

panaceas. Morphine was supposed to be a non-addictive anesthetic or
analgesic. A similar view was held when heroin was first synthesized. In fact,
it took the medical profession 13 years before they acknowledged that a
person could become physically dependent on heroin. Although the
discovery of LSD was by accident, it was initially viewed as a possible
treatment for schizophrenia and lauded for its mind expanding qualities.
Therefore, it is the belief that drugs can be used as a means of problem
solving and/or as a life organizing factor that contributes to abuse.
Furthermore, I sincerely believe that a person must make a commitment that
he or she wants to be drug-free. If not, I don’t feel that any intervention
strategy will be effective.
I recall an old study that indicated that a person who simply decided to stop
using drugs was as successful at maintaining sobriety as someone that
avails him or herself to any of the numerous treatment interventions. Thus, I
support the stages of change put forth by James Prochaska and Carlo
DiClemente. It is interesting to note that Prochaska’s interest in self change
for the addict was aroused out of his anger and disappointment at not being
able to help a person who was an alcoholic and was frequently depressed.
That person was his father, who denied that he had a problem with alcohol,
refused professional help and died when Prochaska was a junior in college.
Anyway, the theory of self-change involves six stages including Pre-

contemplation, Contemplation, Preparation, Action, Maintenance and
Termination. In Pre-contemplation, although others may believe the person
has a problem with drugs, he or she denies it and the issues that others see
as problems are viewed by the person as trusted ways of coping and as being
under control. In Contemplation, the person admits that he or she has a drug
problem and tries to understand how things got to be the way they are. He or
she acknowledges that change is necessary but that the intended effort will
be in the future. The person will delay any attempts to stop until there are
perfect conditions. Unfortunately, there are never perfect conditions in life.
In Preparation, the person is certain that the right decision is to stop taking
drugs and makes arrangements to do so. The plan should be specific and
realistic. In Action, the person takes the necessary steps that were
developed during the Preparation stage. In Maintenance, he or she
acknowledges a vulnerability to resort to old ways but makes a sustained
effort to avoid relapses. In Termination, old behavior or cravings no longer
tempt the person, and he or she has no fear of relapse. In this theory, it is
important to note that the therapist acknowledges that a slip does not
constitute a relapse. Among self- changers, 20% or less are completely
successful in the first attempt and it is normal to recycle several times.
RELAPSE – REVOLVING DOOR SYNDROME A major problem with treating drug

abusers is the high recidivism rate. In America, research studies have
indicated that the relapse rate (based on the use of one year as the time
period) can range from 50% to 75%. I often use the term, “revolving door
syndrome” when discussing the treatment of the drug abuser. That is, the
addict comes for treatment, leaves and then returns.
In Malaysia, 1986 as a reference date to record drug addits in the country,

and based on that, the relapse rate is approximately 75%. There are two
ways to look at recidivism and drug usage. The first view is that of the self-
help movement or the 12 steps, such as Narcotics Anonymous. Their belief is
that addiction is a disease and has no cure. Furthermore, relapse is a normal
part of the disease process and can be expected since it may take many
relapses before a person is able to maintain sobriety. Although this view has
many supporters, and if applied to Malaysia, would indicate that your high
relapse rate should be expected because addiction is a disease. Furthermore,
the government should be tolerant because it may take a released inmate
several attempts before he or she can maintain sobriety.
A Learning Process Another view, which I adhere to, is that addiction is a

learning process. That is, people learn either consciously or unconsciously,
to become addicts and then they assume a deviant identity. They become
addicts because of their positive expectations of the effects of drugs.
Therefore, if a drug resulted in no positive effects, a person would not be
motivated to take it. Thus, I believe a possible treatment approach for the
opiate dependent is the use of opiate antagonists. These are drugs that
block the receptor sites in the brain and prevent an opiate from occupying
the site and having its effect. Nevertheless, this approach is not used in
Malaysia.
High-risk Situation With respect to relapse, I believe that it occurs when a
person is in a high risk situation. This may pertain to a place, people or
things (straw, needle or pipe). If the individual has good coping skills, he or
she should be able to resist the temptation of drug usage. By resisting, he or
she feels better, is reinforced and his or her self-efficacy is enhanced. With
respect to rehabilitation and prevention, it is important to help clients
identify their high risk situations and then to teach them how they can be
avoided. However, this is often easier said than done in that an inmate who
is released from a center may find him or herself among previous
acquaintances who use drugs or in situations where drugs are used. If the
person has poor coping mechanisms, then he or
she will use it voluntarily. When this is done, there is often self-blame and
guilt, which unfortunately will lead to relapse.
Service Delivery System In trying to explain the high relapse rate in Malaysia,
one first must look at the rehabilitation model. This model is excellent in
that research indicates that the longer a drug addict is confined to a
treatment facility, the greater will be his or her chances of recovery. Thus,
the 16-month program in a rehabilitation center should enhance sobriety.
Because this is not happening, one must now look at the service delivery
system. In order to truly help the drug abuser, who is in a rehabilitation
center, the counselors must be well trained and competent in dealing with
the substance abusers. The training received at the Islamic Science
University of Malaysia (USIM) and Universiti Malaysia Sabah (UMS) is an
example of this level of competency.
Furthermore, the religious teachers should be competent in the area of drug

abuse. He should know the causes of addiction and have an understanding of
the effects of drugs.
Finally, there is a need for trained, well-qualified occupational therapists. An

occupational therapist is a professional who helps a client have an
independent and productive life. They can help improve the person’s coping
skills, time management skills and help them develop activities that they can
enjoy. They can plan work activities and assess whether the client is able to
work, as well as develop recreational activities. It is important to note that
sometimes drug abuse results from boredom in that the person does not
know what to do with his or her free time.
STRATEGIES In addition to improving the qualifications of the personnel in
the rehabilitation centers, in the remainder of this presentation I will also
propose two strategies that I feel would be effective in helping the inmate
develop good coping skills so that he or she can resist temptation once he or
she is released.
First of all, when one reviews the research about factors which help maintain
sobriety, one finds evidence of a variety of personality
correlates and environmental factors that are supposedly related to sobriety

or relapse. The personality correlates range from anti-social behavior to
depression, while the environmental factors consist of things such as
unemployment and family dysfunction. However, there are only two things
that always appear consistent and this is anxiety reduction and employment.
There is a belief among many that drug addicts take drugs as a means of
self-medication. Among opiate addicts, there is a belief that drug usage is
ultimately for anxiety reduction. Thus, one can find many research and
position papers that discuss the importance of anxiety reduction in treating
the opiate dependent.
Within the last two years, I have conducted two empirical studies, on drug
addiction and recidivism. The first consisted of reviewing the psychological
evaluations of 266 drug addicts, of which 75% or 200 were opiate dependent.
Of this group, 140 or 70% had anxiety disorders. The majority consisted of
white, single males and the mean age was 28.6 years. The results of the
study indicated that there was a significant relationship among the opiate
dependent and a diagnosis of an anxiety disorder. The anxiety disorders of
the sample ranged from panic disorders to generalized anxiety disorder.
In a follow-up that involved a letter and a phone call, 77 or 55% of those

clients with an anxiety disorder responded. Among the 77 clients, 54 or 70%
stated that they sought out treatment for their anxiety. The treatment
consisted of methadone maintenance that included weekly drug counseling
sessions, the use of benzodiazepines with a psychiatrist and individual
counseling. All these clients stated that their anxiety was either eliminated
or significantly reduced. Furthermore, all of them had a negative urinalysis
for opiate use. Therefore, this small study was supportive of the research
that indicates that anxiety reduction may be one way to help a client
maintain sobriety.
However, anxiety reduction only pertains to opiod abuse, and does relate to
cannabis, ecstasy or shabu—the other drugs that are causing difficulties in
Malaysia. I believe that anxiety reduction is beneficial in itself and the
beneficial results would carry over. This reminds me of what I do when I
teach a class in substance abuse.
I always ask the students whether they smoke cigarettes. Of those that raise
their hands, I then ask them to give the reasons for smoking. In all cases, the
first reason given by the students is to reduce tension, stress or anxiety. I
find this amusing, since you all know that nicotine is a stimulant, and it will
not cause someone to relax. Yet, all the students still have the false belief
that cigarette smoking results in relaxation.
Spiritual Approach There are many ways to help a person reduce his or her
anxiety. Among them are meditation and yoga as well as centering prayer.
With respect to the latter, centering prayer is a spiritual technique in which a
person focuses on a religious name, such as a prophet or God, closes his or
her eyes, and repeats the name many times silently. As he or she does that,
the tension leaves one’s body. Of course, a person would have to believe in
God to use the centering prayer.
Progressive Muscle Relaxation The last two methods are referred to as

muscle relaxation and emotive imagery. In muscle relaxation, a person
tightens each of his muscle groups for 10 seconds three times. It takes
about 30 minutes to go through the process but when completed the person
is completely relaxed. For example, make a fist. Make it tighter, tighter and
then release it. As you release, for a few microseconds, you felt the tension
leave your hands and wrists. Thus, that body part was relaxed. The
technique begins at your toes, and ends at your forehead in that you tighten
the muscle group and then release it. With practice, a person can complete
the exercises in less time.
Emotional Imagery Emotional imagery involves the use of your active

imagination in that you are actually imagining being in a specific situation.
Basically, a client is asked to describe two situations, other than drug usage,
which are relaxing to him or her. Once the situations are described, the
client is asked to imagine as vividly as he or she can, that he or she is in the
situation. When the person does that, he or she is relaxed and will not be
anxious. In summary, these approaches are really counter conditioning or
that you cannot stand and sit down at the
same time, or in these examples, it is impossible to be anxious if you are

relaxed. Thus, I am suggesting that when you counsel an inmate in a
rehabilitation center or prison, that you help him or her learn how to reduce
his or her anxiety through any of these methods. Although I personally prefer
muscle relaxation or emotive imagery, any one of these techniques will be
effective. Therefore, once released the inmate is now able to reduce his or
her anxiety without taking an opiate.
Employment The last approach is employment, and again, I would like to

briefly describe an empirical research study that I have conducted. In this
study, a group of 110 opiate dependent patients of an outpatient
detoxification center was the initial sample, and with their informed consent,
demographic information, which included their employment status, was
collected. The mean age of the group was 30.2 years, and most were white,
single males. Briefly, outpatient detoxification is a medical approach in
which a physician, with a specialty in addiction medicine, helps a client
medically withdraw from a substance. Basically, the patient will see the
physician seven times during a two- week period, and he or she is given a
prescription for two days that includes anti-anxiety drugs, drugs to relieve
nausea, muscle aches, diarrhea, chills, and all the signs of physical
withdrawal. Each time the person sees the physician, he or she is given a
urinalysis to ensure that he or she is still drug-free. After two weeks, the
person is now free of the addictive drug, and a follow-up appointment is made
for six months. Sometimes the patient may be prescribed an opium
antagonist, or if he or she is an alcoholic, antabuse or campral. Campral is a
new drug that when combined with counseling helps an alcoholic maintain
sobriety. Once the demographic information was collected, each client was
given the MMPI-2, which is a personality test that assesses psychopathology.
Briefly, the MMPI was developed in 1941 by a physician J. Charnley McKinley,

and a psychologist, Starke Hathaway. The purpose of the test was to identify
psychiatric disorders. Although the test was unable to do so, it did provide a
thorough description of a person’s abnormal behavior. The test has three
validity scales and ten clinical scales. Since there are numerous studies
about the MMPI,

many supplementary scales have been developed during the last 50 odd
years. However, in my study, I only used the original clinical scales.
I will provide a brief overview of the MMPI for the benefit of those who has
not been exposed to the instrument. First of all, the validity scales include a
L or fake good scale, a F or fake bad scale and a K, or defensive scale. A
high score on any of these scales may invalidate the test, since a high score
on L or Lie would artificially deflate the clinical scores, a high F (eccentric
responses that only 10% of the normal ones endorsed) would artificially
elevate the clinical scales, and a high score on the K scale would artificially
deflate the clinical scores. The clinical scales include: Scale 1 is anxiety
related to bodily concerns or hypochondrias, Scale 2 is depression, Scale 3
measures anxiety or a person’s inability to deal with any type of stress,
referred to as hysteria; Scale 4 is immoral or sociopathic behavior, referred
to as psychopathic deviate; Scale 5 is for masculine-feminine. When first
developed, there was a belief that homosexuality was abnormal, and thus, if
you are a male and got a high score it would indicate that your interests,
likes and dislikes were more like women. Thus, the scale measures
stereotype attitudes of women and men. When I was a child, only women
were nurses and only men were police officers. But now as you know, there
is no longer that much of gender biasness in the world of work and I usually
ignore this scale. Scale 6 is paranoia; Scale 7 is really a measure of
obsessive-compulsiveness; Scale 8 is schizoprehenia; Scale 9 is hypomania
or hyper activity and agitation while Scale 10 is social-introversion. A high
score on this scale indicates that the person is introverted. The test uses t-
scores, mean 50 and s.d. of 10. Based on the 1989 revision (MMP-2) a high
score is 65 or above and a low score is 35 and below. After six months, the
clients were re- contacted for a follow-up visit. Of this initial group, only 65
could be contacted, and of this 65, most had relapsed (self-report and
positive urinalysis).
A discriminate function analysis was used to determine what factors could

discriminate clients who maintained sobriety versus those who relapsed.
First of all, there were no significant differences between the sober group
and those who relapsed on any of the MMPI- 2 scales. Surprisingly, most of
the clinical scales, especially the three
anxiety scales were very high and the validity scale of F was high for both
groups of subjects. Therefore, the clinical scales may have been artificially
elevated, but again t-tests indicated no significant differences between the
groups. In fact, the only significant factor was employment in that those who
maintained sobriety versus those who relapsed were more likely to be
employed. The relationship between employment and sobriety again
supported the literature on methods that prevent relapse.
With respect to Malaysia, I feel that if inmates were provided with suitable
employment upon their release, this employment would enhance their self-
esteem, increase their self-efficacy, and decrease the risk of relapse. Even
though work does not have to involve paid employment and can pertain to
any physical or mental activity, it is usually described in the framework of an
activity resulting in some type of financial reimbursement. Most people,
when asked, “Why do you work?” will probably indicate that they work in
order to provide for themselves and their families with the basic needs of
food and shelter. However, there are also other reasons that people work,
and it may involve such things as a higher standard of living, contributing to
humankind, a feeling of accomplishment, or that work is fulfilling and
provides a sense of intrinsic satisfaction. Ideally, this last reason, a sense of
intrinsic satisfaction, is of major importance when discussing the meaning of
work, and is the best criteria in determining whether a person has obtained
an optimal level of vocational adjustment. This is well illustrated by Japan,
in that fostering employee satisfaction among its workers, the country has
become a major industrial power, and has the second highest gross national
product in the world (GNP). As previously stated, there is a relationship
between drug abuse and un/under employment.
I apologize for the oldness of the data, but in a study in 1984, when there
were only six rehabilitation centers in the country, approximately 83% of the
inmates were employed before their detention. However, in examining the
positions held by these drug abusers, the jobs were mainly unskilled and
transitory in nature. In fact, in a survey of 300 inmates at the Pusat Serenti
Rehabilitation Center, 19.7% were previously unemployed (compared to the
national rate of 9%) and most of their jobs were unskilled, with
labourer, being the most frequently identified occupation. Now, it would be

interesting to examine the employment rates in 2006, but I believe they may
be similar. That is, the inmates worked only to obtain the basic needs of food
and shelter, and that their work was not intrinsically satisfying.
Many drug abusers are unable to find or keep employment because of the
lack of basic behaviors necessary for employment. Therefore, before one can
implement vocational training and placement programs, attention must be
focused on correcting these deficit behaviors. The term “work adjustment
training” refers to the procedure and is frequently the first step in the
process of community reintegration. As stated, the occupational therapist
can help the inmate with preparation for the eventual entry into the world of
employment. This may be incorporated into any work related activity, and
enables a client to understand the importance of work factors such as
production rates, quality of work, role of supervisors, how to get along with
fellow employees, proper dressing and other work related behaviors. The
drug abuser, because of an unsteady employment history and related
personality problems may lack those appropriate work behaviors that many
of us take for granted.
In helping the client correct these hindrances to employment, counseling,

group discussions and simulated work are helpful. Moreover, transitional or
supported work can be beneficial. This involves a job structuring technique
in which a worker or group of workers (work crew) are provided with
subsidized employment. The work brigade at the palm oil estates would be an
example of this in Malaysia. As can be seen, it is important that vocational
counseling or work adjustment training is implemented in the rehabilitation
centers. Furthermore, it would be helpful if all the major corporations or
companies in the country would agree to hire a selective number of inmates,
based on the recommendations of the rehabilitation staff. By providing jobs,
that involved a career ladder, inmates would have an incentive to remain drug
free. Furthermore, a job which is satisfying will enhance one’s self-esteem,
strengthen self-efficacy, which in turn strengthens one’s coping skills.
CONCLUSION In closing, I would like to caution the audience that these are
only my views and opinions, that I am a foreigner, and not a Malaysian. Yet all
positions that were taken are backed by research. Therefore, if the
personnel in the rehabilitation centers are well trained, anxiety reduction is
utilized during counseling, and the inmates receive vocational counseling,
work adjustment training and suitable employment, the relapse rate in
Malaysia should significantly decrease.
Harm Reduction Programme in Thailand
73Usaneya Perngparn, m/s 73-84
HARM REDUCTION PROGRAMME IN THAILAND
Usaneya Perngparn1
ABSTRACT
This article is specifically on the harm reduction programme that has been in
practise in Thailand in the past as well as the present on-going project. The
Thai government’s initiative in declaring war against drugs has greatly
helped in this programme. The working group on HIV and Drug Risk Reduction
have outlined six projects, from public awareness right up to the prevention
of HIV in prisons. Careful implementation and coordination would be the key
success factors in order to make these projects successful.
ABSTRAK
Artikel ini adalah berkenaan program “harm reduction” yang dijalankan di

Thailand. Dalam usaha memerangi dadah, kerajaan Thai telah pun
mengisytiharkan program antidadahnya pada peringkat nasional. Enam
projek telah dikenal pasti oleh jawatankuasa HIV dan “Drug Risk Reduction”.
Ianya meliputi program kesedaran awam sehingga kepada usaha mengelak
jangkitan HIV di penjara. Program-program ini memerlukan perancangan yang
rapi dan dijalankan secara teratur untuk memastikan ikejayaannya.
Epidemiology of Drug Use in Thailand Among the many drugs used in

Thailand, opium has its longest history of usage dating back to the year 1857.
This was when it was legalized and by the 20th century, opium dens were
common. After the closure of many opium dens over the past 40 years, in
1959, opium smoking and selling were finally banned. This change of policy
resulted in a shift to
1 Drug Dependence Research Centre (WHOCCR), Institute of Health

Research, Chulalongkorn University Bangkok, Thailand
the usage of heroin, and consequently, heavy importing of the substance.

(Poshyachinda 1982)2. In the 1970’s, injecting heroin and smoking cannabis,
opium, morphine and methamphetamine (yaba) increased tremendously. It
wasn’t until the mid 1990’s that heroin’s popularity weakened, and the drug
trend towards amphetamine-type-stimulants (ATS) amplified, which in turn
has driven the price increase of heroin. (Office of the Narcotics Control Board
(ONCB), Thailand 19963; Farrell et al 20024).
The most common method used for heroin is by injecting of which the rate of
users rose from about 50% in 1994 to nearly 80% by the end of that decade.
By 2001, heroin accounted for only approximately 10% of the illicit drug
market; however, in Bangkok there were still 40,000 heroin users of whom
90% were injecting themselves (ESCAP/UNODC/ UNAIDS 2001)5. The age
range of heroin users is older than that of ATS users. In 2002, an estimated
0.5% of the general population abused opiates (UNODC 2004a)6.
The first stimulant abuse epidemic occurred in the late 1970s, concurrent
with the second wave of the heroin epidemic. Since then, local
manufacturing of ATS increased dramatically, with methamphetamine,
ephedrine, and caffeine being common ingredients in ATS tablets. As
indicated by law enforcement statistics, the ATS retail market expanded
extensively and women over the age of 40 were assuming a progressively
greater role in the retail distribution of ATS (Poshyachinda et al 2000)7. ATS is
most commonly smoked or ingested, though there have been reports of
injecting. The transition to ATS in Thailand is described in several reports.
2 Poshyachinda V 1982, Heroin in Thailand. Bangkok: Drug Dependence

Research Center, Institute of Health Research, Chulalongkorn University 3
Office of the Narcotics Control Board 1996, A Rapid Survey of Impact from
Heroin Price Escalation on Illicit Retail Distribution and the Users. Bangkok 4
Farrell M, Ali R, Ling W, Marsden J 2002, The Practices and Context of
Pharmacotherapy of Opioid Dependence in South-East Asia and Western
Pacific Regions. Department of Mental Health and Substance Dependence,
World Health Organization. Geneva 5 ESCAP/ UNODC/ UNAIDS 2001, Injecting
Drug Use and HIV Vulnerability: Choices and Consequences in Asia and the
Pacific. Report to the Secretary General for the Special Session of the
General Assembly on HIV/AIDS. Bangkok 6 UNODC 2004a, World Drug Report.
Volume 2: Statistics. Vienna 7 Poshyachinda V, Perngparn U and
Danthumrongkul V 2000, The Amphetamine-Type- Stimulants Epidemic in
Thailand: A Case Study of the Treatment, Student, and Wage Laborer
Populations. CEWG Community Epidemiology Work Group, National Institute
on Drug Abuse
From 1990 to 2002, heroin users being arrested and treated were decreasing,
ATS users were markedly increasing and reached its peak in 2002.
Nevertheless, the “War on Drugs” policy in Thailand has affected the
reduction of ATS usage. The comparison of the 2001 and 2003 national
household surveys on drug abuse also confirmed the decreasing trend of ATS
usage but the trend of club drugs and kratom (mitragynine or biak/ketum – a
term commonly used by Malaysians) have also increased (Poshyachinda et al
2005)8. Although, the data on heroin users showed minimal decreases, the
sample size was too small to indicate a definite interpretation (The
Administrative Committee of Substance Abuse Academic Network, ONCB,
Thailand 2004)9. However, ATS was still the most prominent drug used in
2003. According to recent reports assessing the impact on drug users who
inject themselves in Chiang Mai, northern Thailand (Vongchak et al 2005)10,
most of them who could not obtain heroin turned to alcohol, ATS and sleeping
pills as substitutes. Subsequently, the use of cannabis increased in
Mookdaharn, Nakornpanom and Sakonakorn. In addition, volatile substances
are particularly used by the younger population.
Epidemiology of HIV/AIDS in Thailand Two decades have passed since the

first case of acquired immunodeficiency syndrome (AIDS) was reported in
1984.11,12,13 The rapid outbreak among high risk groups of which the best
known were the intravenous injection drug users (IDU) and the female
commercial sex worker (CSW), has changed considerably mainly due to
strong national responses.
8 Poshyachinda V, Sirivongse ANA, Aramrattana A, Kanato M,

Assanangkornchai S, Jitpiromsri S 2005, Illicit Substance Supply and Abuse
in 2000-2004: An Approach to Assess the Outcome of the War on Drug
Operation. Drug and Alcohol Review (September), 24, 461- 466. 9 The
Administrative Committee of Substance Abuse Academic Network, Office of
Narcotic Control Board 2004, 2003 National Household Survey on Drug Abuse.
Bangkok 10 Vongchak T, Kawichai S, Sherman S, Celentano DD, Sirisanthana
T, Latkin C, Wiboonnatakul K, Srirak N., Jittiwutikarn J and Aramrattana A.
2005. The influence of Thailand’s 2003 ‘war on Drugs’ Policy on Self-reported
Drug Use among Injection Drug Users in Chiang Mai, Thailand. International
Journal of Drug Policy 16: 115–121 11 Bureau of Epidemiology, Ministry of
Public Health 1984 .Weekly Epidemiological Surveillance Report,15(39): 509-
512 12 Phanuphak P, Locharernkul C, Panmuong W and Wide H 1985. A Report
of Three Case of AIDS in Thailand, Asian Pacific J. Allerg Immun, 3: 195-199
13 Limsuwan A, Kanapa S. and Siristonapun Y 1986. Acquired Immune
Deficiency Syndrome in Thailand. A report of Two Cases, J Med Assoc Thai,
69(3): 164-165
Sentinel surveillance was introduced in June 1989. Henceforth, the HIV

epidemic in Thailand can be presented in four categories, i.e. firstly in IDUs,
secondly among sex workers, thirdly among the male partners of sex workers
and finally the general population (World Bank 2000)14. In 2003,
approximately 1.7% of the 36 million population, between the ages of 15-49
years, were reported to be HIV positive (UNAIDS 2004b)15, predominantly
through male-female sexual activity and drug abuse by way of injecting.
The national HIV prevalence among injecting drug users remains high at 45%
in 2004 despite its reduction from its peak in the late 1990s. The high HIV
prevalence among IDUs was reported in Bangkok and in the southern region
in recent years, rising from 40% in 1995 to 57% in 2002 (MOPH Thailand
2000/2001)16. In addition, HIV incidence among IDUs was shown to range
from 5.8 /100 (person- years) in central Thailand to about 8.5 /100 (person-
years) in northern Thailand at the turn of the century (Vanichseni et al
200117; Celentano et al 199918).
HIV prevalence among ATS users was about 2.4% in 2001 (Vongsheree et al
2001)19: i.e., significantly higher than the national adult HIV prevalence
(1.7%). There is also a report revealing 3.7-11.4% infection among non-
intravenous drug users who received treatment in Thanyarak Hospitals, and
0.9-3.9% infection among non- intravenous drug users who received
treatment at the Drug Treatment Center in Chiang Mai (Perngparn et al
2005)20.
14 World Bank 2000. Thailand’s Response to AIDS; Building on Success,

Confronting the Future. Bangkok 15 UNAIDS 2004b. Epidemiological Fact
Sheet on HIV and STIs: Thailand. Geneva 16 MOPH (Ministry of Public Health
Thailand) 2000/ 2001. HIV/AIDS Prevalence. Division of Epidemiology.
Bangkok 17 Vanichseni S, Choopanya K, Des Jarlais D, Sakuntanga P,
Kityaporn D et al 2001. HIV among Injecting Drug Users in Bangkok: The First
Decade. J AIDS : 397-405. 18 Celentano D, Hodge M, Razak M, Beyrer C,
Kawichai S, et al 1999. HIV-1 Incidence among Opiate Users in Northern
Thailand. American Journal of Epidemiology. 149(6): 558-564 19 Vongsheree
et al 2001. High HIV-1 Prevalence among Methamphetamine Users in Central
Thailand, 1999-2000. J Med Assoc Thai :Sep; 84(9)1263-7. 20 Perngparn U
and Sirinirand P 2005. Mid-term Review on National Plan for the Prevention
and Alleviation of HIV/AIDS in Thailand 2002-2006: Drug Dependents,
Bangkok
HIV and Drug Risk Reduction Thailand has implemented three major HIV
prevention strategies for IDUs, i.e. psychosocial services including the
outreach programme, sterile needle and syringe access, and the drug
dependence treatment. The Ministry of Public Health has used media
campaigns to disseminate information on HIV transmission as part of the
psychosocial services since the early 1990s. Needle exchange and syringe
distribution trials started on a pilot basis in Bangkok and some areas of the
northern region (Gray 199521; Vanichseni et al 200422). In southern Thailand,
while no needle and syringe exchange exist, IDUs can purchase equipment
legally and at very low cost from local pharmacies (Perngmark et al 2003)23.
District hospitals nationwide continuously offer short-term, tapered
methadone treatment, although many addicts eventually resume drug use
and return to the clinic (Saelim et al 1998)24. Nevertheless, there are a few
clinics, most of them in Bangkok, which offer long-term maintenance therapy
(Choopanya et al 2003)25.
According to the National policy, the Working Group on HIV and Drug Risk
Reduction has categorized its operations into the following three periods.
The 1st Period Under Task Force on IDU in 2000 to Mid-2003 : The Taskforce
on IDU in Thailand was formed in accordance with the recommendations of
the 2000 World Bank’s Social Monitor report. In 2000, it was affirmed that
Thailand should continue its prevention and care efforts through three
taskforces including the taskforce on condom promotion, on IDU and
opportunistic infection (OI). The taskforces on condoms and OI functioned for
two years and were
21 Gray J. 1995. Operating Needle Exchange Programmes in the Hills of

Thailand. AIDS Care. 7(4):489–499. 22 Vanichseni S, Des Jarlais DC,
Choopanya K, et al. 2004 . Sexual Risk Reduction in a Cohort of Injecting
Drug Users in Bangkok, Thailand. J Acquir Immune Defic Syndro. 37(1):1170–
1179. 23 Perngmark P, Celentano DD, and Kawichai S. 2003. Needle Sharing
among Southern Thai Drug Injectors. Addiction. 98:1153-1161. 24 Saelim A,
Geater A, Chongsuvivatwong V, Rodkla A, Bechtel GA 1998. Needle Sharing
and High-Risk Sexual Behaviors among IV Drug Users in Southern Thailand.
AIDS Patient Care and STDs. 12:707–713. 25 Choopanya K, Des Jarlais DC,
Vanichseni S, Mock PA, Kitayaporn D, Sangkhum U, Prasithiphol B, Hiranrus K,
van Griensven F, Tappero JW, Mastro TD 2003. HIV Risk Reduction in a Cohort
of Injecting Drug Users in Bangkok, Thailand. J AIDS. 33(1):88–95.
abolished. This is due to the shift in focus on social marketing by promoting

condom vending machines in public institutions, whereas OI was merged into
the early national health insurance scheme. Under international pressures on
Thailand’s drug situation and policy, the taskforce on IDU was in a dilemma,
fighting unstably in putting IDU as a social agenda within the movement of
HIV/AIDS national response. More difficulties mound from the rigid mandatory
roles among the concerned government bodies and there is a lack of
coordination especially when the issue became more complicated. This
period ended when the changing atmosphere led to more acceptance on the
harm reduction approach before the world AIDS Conference took place in
Thailand.
The 2nd Period Under Harm Reduction Working Group - Mid 2003 - Mid 2005 :
Under this period, the taskforce changed its name to Harm Reduction
Working Group. In July 2004 the group was active in hosting the XV
International AIDS Conference. At the opening of the Conference, the Prime
Minister emphasized harm reduction among IDUs and urged it as a national
policy.
The 3rd Period Under Thai Working Group on HIV and Drug Risk Reduction -
Mid 2005 - Present : From mid 2005, while the ongoing outreach project was
being implemented under the 1st joint plan and was gaining momentum of
partnership among key organizations including Department Medical Services
by Thanyarak Institute, NGOs, Universities and TDN, more members and
partners were interested in participating in the Harm Reduction Group
especially the planning meeting to develop the 2nd Joint Plan of Action for
2006- 2007. The draft plan is currently under technical review and will be
finalized soon.
By 2007, Thailand ensured increased access to the utilization of effective,

comprehensive and holistic prevention, treatment, care and support services
for HIV/AIDS and IDUs. It is a prominent challenge for Thailand to implement
this joint plan with a more- harmonized working process among partners
under the supervision of the Thai HIV/AIDS and Drug Risk Reduction group.
The draft plan is outlined as follows:
1. Public awareness advocacy on stigma and discrimination, law and policy
1.a) Stigma & discrimination reduced b) Community participation & public

awareness/ positive perception increased c) Policy related Information
developed and shared consistently d)Policy related activities are
continuously implemented e) Policy and law harmonized at appropriate levels
f) Campaigning publications developed and utilized.
1.a) Organise a national event (Conference/ seminar) b) Organise community

forums and workshops c) Develop policy implementation Guidelines
d)Develop campaigning publications
1.a) Increased participation of drug users and partners, b) Policy involvement

activities and resource included in the national plan to support activities
under the plan c) Legal documents and policy guidelines introduced. d)Public
coverage with good quality materials through campaigning and distribution.
Project Title Objectives Major Activities Key Outputs
2.Finding evidence based and concerning issues related to drugs and

HIV/AIDS
2.1 Evidence based and evaluative Information provided to decision makers

and the public
2.1 Research/ Survey/on evidence concerned such as: a) To address public

attitude b) Access to MMT policy and technical documents, ART Guidelines,
VCT for IDUs guidelines etc. c) TB guideline
2.a) Evidence based and evaluative reports on each issue b) Policy document
on MMT, technical guidelines on ART-IDUs and VCT. c) TB document
26 With complement from Mr. Sompong Chareonsuk, UNAIDS, Thailand
Joint Plan of Action on HIV/AIDS and Drug Risk Reduction in Thailand for
2006-200726
Project Title Objectives Major Activities Key Outputs 2.2. a) HIV/AIDS and
Drugs situation updated b) Existing services documented and shared. c) A
national workshop attended by policy makers, technical officers and
practitioners 2.2 a) Mapping of recent studies and results. b) Mapping of
existing services c) National Workshop to present each map 2.2. a) Study
reports presented and submitted b) Two maps c) Numbers of decision
makers, national experts/ academics and practitioners attending the national
workshop
3.Drug and HIV/AIDS outreach programme (on-going)
3.1 Access to information and service increased
3.1. a) Building outreach teams composed of existing treatment center

personnel and partners, including peer educators and outreach workers
through recruitment and training b) Set up VCT and organize related training
on VCT for IDUs c) NSP
3.1. a) Number of service providers and partners trained b) Peer to peer

outreach coverage in major provinces (Bangkok, Chiang Mai and Songkla) is
achieved. c) Two best practices are documented
Project Title Objectives Major Activities Key Outputs 4.Comprehen- sive care
and treatment services 4. a) Comprehensive capacity of service providers
strengthened with active participation of drug users and partners b)
Comprehensive Health care services system consistently and completely
developed with active participation from the community 4.a) Workshop for
health providers and care givers on how to provide HIVAIDS patients and TB
on effective ART b) Develop one-stop service for holistic care in hospitals,
drugs treatment centers and health centers (MMT, CBT, ART, TB, Alternative
treatment) c) Activities to encourage networking of IDUs with HIV/ AIDS and
families d)Integration of key drop-in centers in major regions into existing
health care 4. a)More DUs to receive quality services b) Increased
satisfaction of clients - effective referral system in place for friendly
continuous services - more PWAs with HIV/ AIDS TB & BBD receive
services c) Number of networks
5. Comprehen- sive HIV prevention in prison
5. HIV prevalence among IDUs in prisons is reduced
5.a) Training of officers, prisoners and NGO staffs on VCT / education /

counseling / access to condom b) Conduct regular briefings and meetings
with key officers on VCT and IEC
5.a) Number of officers, prisoners and NGO staff trained . b) Number of

condoms distributed in targeted prisons. c) Appropriate IEC materials
developed and used specifically for prisoners and partners.
Project Title Objectives Major Activities Key Outputs 6. Programme

coordination and management 6. Programme coordination effectiveness
under the joint plan is increased. 6.a) Recruit a programme coordinator b) Set
up a programme management system with the budget plan and monitoring
activities 6.a) Programme coordinator is contracted and tasks and
responsibilities are completed b) Work plan is done by the Coordinator

REFERENCES
1. Administrative Committee of Substance Abuse Academic Network, Office

of Narcotic Control Board, Thailand. 2004. 2003 National Household Survey
on Drug Abuse. Bangkok 2. Bureau of Epidemiology, Ministry of Public Health.
1984 Weekly Epidemiological Surveillance Report, 15 (39): 509-512. 3.
Celentano D, Hodge M, Razak M, Beyrer C, Kawichai S, et al. 1999 HIV-1
Incidence among Opiate Users in Northern Thailand. American Journal of
Epidemiology, 149(6): 558-564. 4. Choopanya K, Des Jarlais DC, Vanichseni S,
Mock PA, Kitayaporn D, Sangkhum U, Prasithiphol B, Hiranrus K, van
Griensven F, Tappero JW, Mastro TD. 2003 HIV risk reduction in a cohort of
injecting drug users in Bangkok, Thailand. J AIDS, 33(1): 88–95. 5. ESCAP/
UNODC/ UNAIDS. 2001 Injecting drug use and HIV vulnerability : choices and
consequences in Asia and the Pacific. Report to the Secretary General for the
Special Session of the General Assembly on HIV/AIDS. Bangkok 6. Farrell M,
Ali R, Ling W, Marsden J. 2002 The practices and context of pharmacotherapy
of opioid dependence in South-East Asia and Western Pacific Regions.
Department of Mental Health and Substance Dependence, World Health
Organization. Geneva 7. Gray J. 1995. Operating needle exchange
programmes in the hills of Thailand. AIDS Care, 7(4):489–499. 8. Limsuwan A,
Kanapa S. and Siristonapun Y. 1986. Acquired immune deficiency syndrome in
Thailand. A report of two cases, J Med Assoc Thai, 69(3): 164-165. 9. MOPH
(Ministry of Public Health Thailand. 2000/ 2001 HIV/AIDS prevalence. Division
of Epidemiology. Bangkok 10. Office of the Narcotics Control Board, Thailand.
1996 A rapid survey of impact from heroin price escalation on illicit retail
distribution and the users. Bangkok. 11. Perngmark P, Celentano DD, and
Kawichai S. 2003 Needle sharing among southern Thai drug injectors.
Addiction, 98: 1153-1161
12. Perngparn U and Sirinirand P. 2005 Mid-term review on national plan for
the prevention and alleviation of HIV/AIDS in Thailand 2002-2006: Drug
dependents. Bangkok 13. Phanuphak P, Locharernkul C, Panmuong W and
Wide H. 1985 A report of three case of AIDS in Thailand, Asian Pacific J Allerg
Immun, 3: 195-199 14. Poshyachinda V. 1982 Heroin in Thailand. Bangkok:
Drug Dependence Research Center, Institute of Health Research,
Chulalongkorn University 15. Poshyachinda V, Perngparn U and
Danthumrongkul V. 2000 The amphetamine-type stimulants epidemic in
Thailand: A case study of the Treatment, student, and wage laborer
populations. CEWG community epidemiology work group, National Institute
on Drug Abuse. 16. Poshyachinda V, Sirivongse ANA, Aramrattana A, Kanato
M, Assanangkornchai S, Jitpiromsri S. 2005 Illicit substance supply and
abuse in 2000-2004: An approach to assess the outcome of the War on Drug
operation. Drug and Alcohol Review (September), 24, 461-466. 17. Saelim A,
Geater A, Chongsuvivatwong V, Rodkla A, Bechtel GA. 1998 Needle sharing
and high-risk sexual behaviors among IV drug users in southern Thailand.
AIDS Patient Care and STDs. 12:707–713. 18. UNODC. 2004 a World Drug
Report. Volume 2: statistics. Vienna 19. UNAIDS. 2004b Epidemiological fact
sheet on HIV and STIs : Thailand. Geneva 20. Vanichseni S, Choopanya K, Des
Jarlais D, Sakuntanga P, Kityaporn D et al. 2001 HIV among injecting drug
users in Bangkok : the first decade. J AIDS: 397-405. 21. Vanichseni S, Des
Jarlais DC, Choopanya K, et al. 2004 Sexual risk reduction in a cohort of
injecting drug users in Bangkok, Thailand. J Acquir Immune Defic Syndro.
37(1): 1170–1179. 22. Vongchak T, Kawichai S, Sherman S, Celentano DD,
Sirisanthana T, Latkin C, Wiboonnatakul K, Srirak N, Jittiwutikarn J and
Aramrattana A. 2005 The influence of Thailand’s 2003 ‘War on Drugs’ policy
on self- reported drug use among injection drug users in Chiang Mai,
Thailand. International Journal of Drug Policy 16: 115–121. 23. Vongsheree et
al. 2001 Thailand, 1999-2000. J Med Assoc Thai : Sep; 84(9): 1263-7. 24. World
Bank. 2000 Thailand’s response to AIDS; building on success, confronting the
future. Bangkok
Reading to Recover: Exploring Bibliotherapy as a Motivational Tool for

Recovering Addicts
59Abd. Halim Mohd Hussin & Dr. Mardziah Hayati Abdullah, m/s 59-72
READING TO RECOVER: EXPLORING BIBLIOTHERAPY AS A MOTIVATIONAL

TOOL FOR RECOVERING ADDICTS
Abd. Halim Mohd Hussin1 Mardziah Hayati Abdullah2
ABSTRACT
Bibliotherapy is a technique for structuring interaction between the client

and the therapist based on mutual sharing of literature in fulfilling the
client’s therapeutic needs. It is also a form of supportive psychotherapy in
which carefully selected reading materials are used. A study was conducted
to explore the use of bibliotherapy with addicts undergoing treatment and
rehabilitation in a government-aided rehabilitation center in Malaysia. The
center employs the psychosocial modality in its approach to treatment and
rehabilitation, in which counseling is one of the components. The
respondents in the study consisted of ten inmates from the center, who were
selected based on their readiness to change using the URICA Stage of
Change instrument screening process, which placed them at the Stage of
Contemplation before the study began. A series of six group counseling
sessions were conducted with these ten respondents. At the first session,
each inmate was assigned one narrative for reading. The narratives were
selected from a collection of stories on the real-life experiences of
successfully rehabilitated Malaysian addicts, compiled earlier by a group of
counselors. Over the next five sessions, the respondents were encouraged to
discuss their feelings and thoughts about the rehabilitated addicts in the
stories and to reflect on their own recovery process. After the last session,
the URICA was used again to determine the respondents’ stage of change.
The findings show that reading the narratives had a positive motivational
impact on the respondents’ beliefs about their potential to change and
helped them move from the Contemplation Stage to the Action Stage. The
sessions also reshaped their beliefs about the recovery process and helped
them
1 Islamic Science University of Malaysia (USIM) 2 Faculty of Modern

Languages and Communication, Universiti Putra Malaysia (UPM)
feel less alone. The results suggest that bibliotherapy is worth exploring
further as a tool for motivating recovering addicts. However, careful planning
and the selection of suitable materials is an issue to be considered, as are
exposure and training in the application of the technique.
ABSTRAK
Kaedah “bibliotherapy” secara definisinya adalah satu teknik untuk

menstrukturkan interaksi di antara seseorang pelanggan dengan ahli terapi.
Ianya adalah berdasarkan persefahaman kedua-dua pihak untuk memastikan
keperluan terapi pelanggan tersebut akan dapat dipenuhi. Ia juga merupakan
satu kaedah berbentuk “supportive psychotheraphy” di mana bahan-bahan
bacaan yang terpilih sahaja akan diguna pakai. Satu kajian telah dijalankan
untuk mengkaji penggunaan “bibliotherapy” di kalangan penagih dadah yang
sedang menjalani rawatan pemulihan di sebuah pusat pemulihan dadah
kerajaan di Malaysia. Pusat ini mempraktikkan kaedah “psychosocial
modality” dalam proses rawatan pemulihannya. Salah satu komponen
rawatan ini adalah khidmat kaunseling. Responden kajian ini adalah terdiri
daripada 10 orang bekas penagih dadah pusat ini. Mereka telah dipilih
berdasarkan tahap kesediaan mereka untuk melakukan sesuatu perubahan.
Tahap mereka ini telah ditentukan melalui ukuran “URICA Stage of Change”
di mana mereka kesemuanya berada di tahap “Contemplation” di tahap awal
kajian ini (iaitu sebelum kajian bermula). Sebanyak 6 siri kaunseling secara
berkumpulan telah dijalankan ke atas kesepuluh responden kajian ini. Di sesi
pertama, setiap responden telah diberikan tugasan membaca. Bahan bacaan
yang diberikan adalah di antara satu koleksi pengalaman sebenar bekas
penagih dadah yang berjaya dipulihkan. Lima sesi seterusnya pula bertujuan
menggalakkan para responden untuk meluahkan perasaan dan fikiran
mereka mengenai bekas penagih dadah yang berjaya dipulihkan serta
mengimbas kembali proses pemulihan para responden sendiri. Selepas sesi
terakhir, “URICA” digunakan sekali lagi untuk memastikan tahap kesediaan
responden untuk berubah. Kajian menunjukkan bahawa bahan bacaan yang
diedarkan telah memberikan satu impak motivasi positif terhadap
kepercayaan para responden mengenai potensi mereka untuk mengalami
proses perubahan. Ianya juga telah membantu mengubah tahap para
responden dari “Contemplation” kepada tahap “Action”. Kesemua sesi
tersebut juga telah mengubah persepsi mereka mengenai proses pemulihan
secara positif. Di samping itu, sesi-sesi tersebut telah membantu
mengurangkan tahap “keseorangan” yang telah dialami mereka sebelum ini.
Hasil kajian ini menunjukkan bahawa kaedah “bibliotherapy” mempunyai
potensi menjadi salah satu alat motivasi untuk para penagih dadah yang
sedang menjalani proses pemulihan. Walau bagaimanapun, bahan bacaan
yang

Recovering Addicts
diberikan perlulah dirancang dan dipilih dengan teliti. Di samping itu, tahap
pendedahan dan latihan juga seharusnya dipantau dengan sebaiknya dalam
aplikasi teknik ini.
INTRODUCTION In the past decades, the repertoire of methods available for

helping people cope with problems has increased with the introduction of
numerous alternative approaches. One such approach has utilized the art of
enabling catharsis. Catharsis refers to the cleansing of emotions brought
about by expressing oneself through some form of art, such as music,
movement, painting or writing. This approach includes bibliotherapy.
The term bibliotherapy comes from biblio, or books, (from the Greek vivlion
which means book) and from the Greek therapeia, or therapy. Bibliotherapy
generally refers to the use of books – literary works in particular – to help
people cope with problems such as emotional conflict, mental illness, or
changes in their lives (Pardeck, 1994). Themes that may be found in literature
include separation and divorce, child abuse, foster care, and adoption. In
addition to helping people with problems, bibliotherapy is also employed in
enhancing the well being of individuals who are not necessarily faced with
such difficulties, but who could benefit from effective change, as well as
personality growth and development (Lenkowsky, 1987; Adderholdt-Elliott &
Eller, 1989). The aim of bibliotherapy practitioners is to help people of all
ages to understand themselves and to cope with problems by providing
literature relevant to their personal situations and developmental needs at
appropriate times (Hebert & Kent, 2000).
REACTIVE AND INTERACTIVE APPROACHES IN BIBLIOTHERAPY

Bibliotherapy dates back to the 1930s when librarians began compiling lists
of written material that helped individuals modify their thoughts, feelings, or
behaviors for therapeutic purposes. Counselors selected and ‘prescribed’
chosen literature for clients experiencing problems by working in tandem
with librarians who had greater familiarity with literary themes (Pardeck,
1994). The underlying premise of bibliotherapy has always been that clients
identify with literary characters similar to themselves, an association that
helps the clients release emotions, gain new directions in life, and explore
new ways of interacting (Gladding & Gladding, 1991). However, since the
1930s, bibliotherapy practice has varied in its approach and focus.
The earlier, more traditional approach tended to be more reactive in its

approach in that the process focused on getting individuals to react
positively or negatively to the reading material. More recently, however, the
therapeutic process has been given a more interactive dimension, a
development that is consistent with experiential theories of Reader
Response that views reading as a transactional process between reader and
text. Based on Rosenblatt’s publication of The Reader, The Text, The Poem in
1978, experiential Reader Response theories propose that during the reading
process, readers become emotionally involved, construct alternative worlds
and conceptualize characters, events and settings, create visual images,
connect the text with their own experiences, and evaluate their own
experiences against what happens in the texts (Beach, 1993). In other words,
readers interact with texts, becoming part of the intellectual and emotional
process as each story unfolds. As they attempt to process what is being
communicated at the deepest level, readers engage in activities that help
them reflect on what they read, such as group discussion and dialogue
journal writings (Palmer, et al., 1997; Anderson & MacCurdy, 2000; Morawski
& Gilbert, 2000). The readers also interact with their faciltators or counselors
through discussion and “therapeutic interactions” (Hynes & Hynes-Berry,
1986, p. 10). These activities are aimed at helping readers make a positive
alternation or modification in behavior or attitude (Myers, 1998).
The use of literature in the helping process has translated into therapeutic
methods employed for various purposes. In clinical bibliotherapy and
bibliocounselling, skilled practitioners use therapeutic methods to help
individuals experiencing serious emotional problems. Classroom teachers,
however, are more likely to use developmental bibliotherapy, which involves
helping ‘normal’ students in their general health and development. While the
focus of bibliocounselling is on helping people cope with problems as and
after the problems arise, developmental bibliotherapy focuses on helping
teachers identify the concerns of their students and address the issues
before problems arise. The latter approach can also be used to guide
students through predictable stages of adolescence so that they are
equipped with some knowledge of what to expect as well as examples of how
other teenagers have dealt with the same concerns (Hebert & Kent, 2000).
Hynes and Hynes-Berry use ‘literature’ in a broad sense to include print,

video and creative writing materials (Schumaker, Wantz, & Taricone, 1995).
Thus, clients may be asked to consume literature through reading or viewing,
or to create literature in the form of writing, painting

Recovering Addicts
or movement. The benefits of these techniques are similar regardless of the

medium used and they all require careful planning.
BASIC STAGES IN BIBLIOTHERAPY Activities in bibliotherapy are generally

designed to provide information; provide insight; stimulate discussion about
problems; communicate new values and attitudes; create awareness that
other people also have similar problems and provide realistic solutions to
problems. The process goes through four basic stages (Pardeck, 1993)
namely identification, selection, presentation and follow-up.
Identification and Selection During the first two stages, the clients’ needs
must be identified, and appropriate stories or poems are selected to match
their particular problems. One of the aims of bibliotherapy is to help readers
feel relieved that they are not the only ones facing a specific problem or that
they are the only ones who possess certain personality traits. Thus, the
characters in the literature should resemble the readers in some aspects of
behaviour or they should experience circumstances very similar to those of
the readers.
The materials also need to be age-appropriate so that the readers can better
relate to the content. The reading level should also be appropriate so that the
readers will not have to struggle excessively to make sense of what goes on,
as the focus should be on drawing parallels between literary characters and
real-life characters. However, there should be enough depth in the stories or
poems to enable a discussion of the issues. In addition, the books must
provide correct information about a problem while not imparting a false
sense of hope (Pardeck, 1994). Clearly, the selection process takes a great
deal of skill and insight. Obtaining the opinions of other teachers or helpers
can be extremely useful and sharing resources with is one way of developing
a repertory of literary materials.
Presentation After the books or literary pieces have been selected, they must
be presented carefully and strategically so that the clients are able to see
similarities between themselves and the book’s characters. Eventually,
readers have to learn vicariously how to solve their problems by reflecting on
how the characters in the book solve theirs (Hebert & Kent, 2000); this can
also be seen as the “copying of character behaviours” (Gladding & Gladding,
1991).
The procedure used in the helping process need not vary greatly from normal
interactive literature lessons in the classroom. During such lessons, teachers
and students may begin by reading a book or poem. The literary material
provides students with characters to react to and common experiences to
discuss after the reading. In individual or group bibliocounselling, one way to
begin is to have the individual or group read a piece of literature before a
session. During the session, the participants are asked to talk about their
reaction to what they have read. For example, if the assigned book is The
Blind Men and the Elephant: An Old Tale from the Land of India (Quigley,
1959), participants are guided to see that personal perceptions differ
according to experience. A discussion of the central theme can then lead to a
more personalized examination of its meaning by individuals (Gladding &
Gladding, 1991). In addition to the examination of themes, however,
participants have to be helped to relate to one or more characters presented
in the books or poems.
An alternative method is for counselors to get each participant to share a

piece of literature that has a special significance to him or her. As he or she
talks, the participant must be helped to realize what the story means to him
or her, and why it has an impact. If this technique is carried out in a group
setting, other participants may also identify themselves with particular
characters.
Follow-up Once the participants can identify with relevant characters, they
enter the follow-up stage during which they share what they have learnt
about themselves as a result of identifying with and examining the literary
characters and their experiences. This cathartic activity is designed to help
readers come to terms with their problems and to cleanse themselves
emotionally. They may express catharsis verbally during oral discussion or
writing, or nonverbal means such as art (Sridhar & Vaughn, 2000), role-
playing, creative problem solving, or self-selected options for students to
pursue individually (Hebert & Kent, 2000).
Once catharsis has occurred, the clients can be guided to gain further insight
into the problem. Examples of activities suggested by Sridhar and Vaughn
(2000) for this purpose include the following: • Develop a summary of the
book, through the point of view of a character other than that who is the
focal point of the story. • Create a diary for a character in the story.

Recovering Addicts
• Write a letter from one character in the book to another, or from the student
to one of the characters. • Compose a different ending to the story. •
Compose a “Dear Abby” letter that a book character could have written about
a problem situation (Pardeck, 1995).
Such activities help readers study issues from a variety of perspectives, and
in doing so, they may obtain solutions to their own problems.
THE ROLE OF THE HELPER The success of the bibliotherapy program

depends largely on how well helpers play their role throughout the entire
process. Helpers must carefully design a programme that will take the
clients through the stages of the therapy and they must be able to carry it
out effectively. To do so, bibliotherapy helpers need to draw from the basic
principles of a counsellor’s behaviour such as being non-judgemental and
empathic, and being good listeners.
In addition to these essential counselling skills, bibliotherapy helpers also

need to develop a familiarity with a reasonably wide range of literary
materials on various themes, perhaps by enlisting the assistance of literature
teachers and librarians. The helpers must also be effective facilitators who
can help readers see aspects of their own behaviour or problems in the
literary materials, and later help the readers participate in cathartic
activities.
A basic knowledge of literary appreciation would also be an advantage, as

literary materials often make use of metaphors or images that, if explored,
can provide readers with a framework for viewing – or not viewing – their
problems in specific ways. For example, Robert Frosts’s poem The Road Not
Taken looks at each of us as a traveller and compares the choices we make
in life to roads – one is well travelled and secure, the other is unfamiliar and
possibly full of risks and uncertainties. The poem leads us to ponder the
question: Which road is more worth taking? In the poem, Frost voices the
concern that “knowing how way leads on to way, I doubted if I should ever
come back”, and ends the poem with the decision the Traveller finally makes.
A helper who is able to read into this metaphor and the poet’s meaning can
introduce the poem to readers who are struggling with life’s choices
themselves –
perhaps with career paths or more immediate concerns such as whether or

not to befriend someone – to help them view the choices as roads on which
they have to travel. Frost’s words suggest that readers could take a safer
route: explore the different ways one path could lead, before making a
decision. On the other hand, the poem could also encourage readers to take
the plunge and explore the less travelled path. A sensitive helper can,
through skilfully facilitated discussion, capitalise on this metaphoric
representation of life to help readers draw parallels between poetry and real
life. Whichever ‘path’ readers end up with, the realisation that there are
others who face the same situation would leave them feeling less lonely and
the discussions would definitely help them attain greater insight into their
own inclinations.
Although the development of literary appreciation seems at first glance to be

unrelated to the practice of counselling and helping, they are in fact not so
far removed from each other. Reading and discussing literary material
involves activities such as restating or paraphrasing, clarifying, questioning,
summarizing and reflection – strategies that are also employed in the
counselling domain. Thus, the exercise of literary appreciation actually
complements and may even enhance counselling skills.
It is important to remember that unlike traditional counselling sessions in

which only the counsellor is expected to paraphrase, summarise, question
and clarify, both helper and client in a bibliotherapy approach apply these
strategies in studying the literary material. This shared activity helps create
a complementary and reciprocal relationship between both parties –
constructing a common ground for discussions.
BENEFITS AND LIMITATIONS OF BIBLIOTHERAPY In addition to the “how” of
conducting bibliotherapy, practitioners also need to be aware of potential
benefits and pitfalls associated with this procedure. Bibliotherapy has
obvious value in that it provides the opportunity for the participants to
recognize and understand themselves, their characteristics, and the
complexity of human thought and behaviour. It may also promote social
development as well as garner the love for literature in general, and reading
in particular (Gladding & Gladding, 1991). It reduces feelings of isolation that
may be felt by people with problems.

Recovering Addicts
The effectiveness of bibliotherapy, however, may be limited by several

factors, including the unavailability of materials on certain topics, as well as
the lack of materials in certain languages. This problem is especially relevant
for counselling practitioners in the multi-ethnic context of Malaysia. For this
reason, it would be beneficial for a network of bibliotherapy practitioners to
include literature teachers and writers in addition to counsellors, so that lists
of books on specific themes may be compiled and shared.
Another limitation to the bibliotherapy approach is a possible lack of client

readiness and willingness to read. In order for the approach to work, clients
must be willing to take time to read and reflect on the material. The material
and presentation must therefore be attractive and relevant enough to the
clients to stimulate and sustain their interest.
Clients may also project their own motives onto the characters and thus
reinforce their own perceptions and solutions. In addition to that,
participants may be defensive, thus discounting the actions of the characters
and failing to identify with them, or even end up using them as scapegoats.
Some of these limitations can be overcome through the continuation of the
process itself, role-playing, and the use of group discussions (Gladding &
Gladding, 1991).
Facilitator limitations are also a challenge: facilitators may have limited

knowledge of human development and developmental problems as well as
inadequate knowledge about appropriate literature. Facilitators thus need to
be properly trained and exposed to a repertoire of literature suitable for use
in bibliotherapy.
One other limitation may lie in the bibliotherapy process itself: for example,
clients may be unwilling to discuss areas that are uncomfortable, or
facilitators may insist on making a point at the client’s expense. The process
is also limited if both the client and the counsellor only dwell on surface
issues. These limitations can be addressed by suspending sessions until both
parties are ready and willing to work, by taping and critiquing selected
sessions so that facilitators can monitor their own reactions to certain
clients or problem areas, and by revisiting issues in stories that have been
treated superficially in previous sessions (Gladding & Gladding, 1991).
OBJECTIVES OF STUDY The objectives of this study are to examine the

suitability of bibliotherapy technique as a recovery tool for helping recovering
addicts in a counseling process and to investigate the impact of reading true
success stories of total recovery addicts at the stage of change and the
motivation to change amongst recovering addicts.
METHODOLOGY Ten recovering addicts undergoing counseling in a

rehabilitation program were given true success stories of recovered addicts
to read. Six counseling sessions applying the bibliotherapy technique were
conducted with them over a period of six consecutive weeks. They were pre-
tested and post-tested on their readiness to change using URICA -the
Readiness to Change Instrument and the level of self- esteem.
INSTRUMENTS URICA Stage of Change: A translated version of the Stage of

Change Questionnaire, consisting of 30 items to measure the level of
readiness to change, was used. The five stages of change are pre-
contemplation, contemplation, preparation, action, and maintenance. Pre-
contemplation is the stage at which there is no intention to change behavior
in the foreseeable future. Many individuals in this stage are unaware or less
aware of their problems. Contemplation is the stage in which people are
aware that a problem exists and are seriously thinking about overcoming it
but have not yet made a commitment to take action. Preparation is the stage
that combines intention and behavioral criteria. Individuals at this stage are
intending to take action in the next month and have unsuccessfully taken
action in the past year. Action is the stage in which individuals modify their
behavior, experiences, or environment in order to overcome their problems.
Action involves the most overt behavioral changes and requires considerable
commitment of time and energy. Maintenance is the stage in which people
work to prevent relapse and consolidate the gains attained during action. For
addictive behaviors, this stage extends from six months to an indeterminate
period past the initial action.
Rosenberg Self Esteem Scale - An adapted and translated version of
Rosenberg Self- Esteem Scale of 10 items that describe the level of self
esteem of personal self.

Recovering Addicts
DATA COLLECTION PROCEDURE A series of counseling sessions were

conducted where issues of recovery were discussed based on the true
stories of successfully recovering addicts.
Session 1: Getting Acquainted a. Structuring of the group process. Clients

were given information on the purpose of the group work and the
responsibilities of group members. Structuring includes rules and regulation,
expectations, involvement and as well as other issues related to group
procedures and protocols. b. Distribution of reading material. Clients were
given literatures of true story of recovering addicts to be read through by
each of the group members. c. Pre-test using Rosenberg Self Esteem Scales
& URICA were conducted.
Session 2 to Session 5 Group process and sharing of experiences, feelings,

thought, insight and other related issues leading to the motivation to change
from the article read. Every member was given the opportunity to share their
feelings, thoughts and responses to the respective articles they have read.
Session 6: The Post-test and Termination of the Counseling Process Post-

tests were conducted using the same instruments to investigate changes
that may have taken place in terms of their readiness to change. During the
termination process, every individual was given the opportunity to reflect
what they felt and what they have in mind regarding changes, getting into a
normal life as well as developing their personal beings.
FINDINGS The findings of the study show that bibliotherapy can be used as
an approach or recovery tool in addition to other recovery tools in helping
addicts on their journey to recovery. The following are the results of the
psychometric test – URICA- used to measure the readiness to change.
Res- Type Number Number Statements pon- Pre- test of of years of Post-test
and dent Drug addicted relapses thoughts
R1 Contemplation Opiate 5 3 Action Never thought there are people who can
gain total recovery
R2 Contemplation Opiate 4 3 Action Would like to follow what the client in the
literature have done
R3 Contemplation ATS 6 5 Preparation Don’t know if he can ever recover but

it seems that there are people who can do it. That means I can too.
R4 Contemplation Opiate 3 2 Action Motivated by the fact that there are

people who managed to get out of this loop.
R5 Contemplation ATS 4 3 Action Gain confidence and wants to follow the

footstep of that person in the literature
R6 Contemplation ATS 4 3 Action Wants to speak to family members to seek

for help because that person in the literature managed to gain recovery with
the support of his family
R7 Contemplation Opiate 2 1 Maintenance Very highly motivated and has

hope
R8 Contemplation Opiate 2 1 Maintenance Believe in self and will stay strong

with the believe that he will recover.
R9 Contemplation ATS 3 2 Action It’s difficult to go through but other people

have managed to do it.
R10 Contemplation ATS 5 4 Preparation Don’t really know if he can because

the family members have given up on him and he has no where to return.

Recovering Addicts
Based on the table, the use of literature has a strong influence of the
perception of respondents towards change. All respondents demonstrated a
change of attitude in which they viewed that there was room for improvement
in themselves. Those respondents who were still engaged with their families
hoped to be able to talk to their families about their plan of action to change.
The following are the post-test result of self esteem levels amongst
respondents using Rosenberg Self-Esteem Scale ( SA- Strongly Agree, A-
Agree, D- Disagree, SD- Strongly Disagree).
DISCUSSION There is evidence of change in behavior as an outcome from the
bibliotherapy technique in working with addicts.
Literature consisting of true accounts of successful recovering addicts can

be a helpful recovery tool to boost motivation to change as well as to help
improve cognitive distortion of individuals who are in the treatment process.
Sharing true stories of recovering addicts helps clients to investigate and be

aware of their personal strengths in preparing themselves to change.
Items R1 R2 R3 R4 R5 R6 R7 R8 R9 R10 On the whole, I am satisfied with

myself D D SD D A A SA SA A SD At times, I think I am not good at all A SA A A
A A A A A SA I feel that I have a number of good qualities A A A A A A SA SA
SA A I am able to do things as well as most other people A D SD A SA SA SA
SA SA A I feel I do not have much to be proud of SA D A A D D D D A A I
certainly feel useless at times SA A A A D D D D A SA I feel that I am a person
of worth, at least on an equal plane as others A A D A A A SA SA A A I wish I
could have more respect for my self SA SA SA SA SA SA SA SA SA SA All in
all, I am inclined to feel that I am a failure D D A D D D SD SD D A I take a
positive attitude towards myself D A A A A A A A A D
Addiction counselors need to use various approaches when working with

addicts especially in helping develop the addicts’ emotional and
psychological levels as well as personal beliefs about the treatment and the
ability to change.
CONCLUSION Bibliotherapy is a potentially powerful method for counsellors

to use at different levels and types of cognitive distortion and personal
beliefs. In order to establish a strong bibliotherapy program in an institution,
practitioners must present the procedure as a non-threatening one, starting
by calling the process biblioguidance, for instance. They must also solicit the
input and advice of colleagues, parents, and administrators. Nevertheless,
they must always be alert and aware of the limitations of bibliotherapy.
Adderholdt-Elliott, M. & Eler, S. H. (1989). Counseling students who are gifted

through bibliotherapy. Teaching Exceptional Children, 22(1), 26-31. Anderson,
C. M. & MacCurdy, M. M. (2000). Writing and healing: Toward an informed
practice. Urbana, IL: National Council of Teachers of English. Gladding, S. T. &
Gladding, C. (1991). The ABCs of bibliotherapy for school counselors. School
Counselor, 39(1), 7-13. Hebert, T. P. & Kent, R. (2000). Nurturing social and
emotional development in gifted teenagers through young adult literature.
Roeper Review, 22(3), 167- 171. Lenkowsky, R. S. (1987). Bibliotherapy: A
review and analysis of the literature. Journal of Special Education, 2(2), 123-
32. Morawski, C. M. & Gilbert, J. N. (2000). Developmental interactive
bibliotherapy. College Teaching, 48(3), 108-114. Myers, J. E. (1998).
Bibliotherapy and DCT: Co-constructing the therapeutic metaphor. Journal of
Counseling and Development, 76(3), 243-250. Palmer, B. C. Biller, D. L.,
Rancourt, R. E. & Teets, K. A. (1997). Interactive bibliotherapy: An effective
method for healing and empowering emotionally-abused women. Journal of
Poetry Therapy, 11(1), 3-15. Pardeck, J. T. (1993). Literature and adoptive
children with disabilities. Early Child Development and Care, 91, 33-39.
Pardeck, J.T. (1994). Using literature to help adolescents cope with problems.
Adolescence, 29(114), 421-427. Sridhar, D. & Vaughn, S. (2000). Bibliotherapy
for all. Teaching Exceptional Children, 33(2), 74-82.
REFERENCES
Needle Syringe Exchange Program in Malaysia
29Dato’ Dr. Faisal Hj. Ibrahim, m/s 29-58
NEEDLE SYRINGE EXCHANGE PROGRAM IN MALAYSIA
Faisal Hj. Ibrahim1
ABSTRACT
The pilot Malaysian Needle Syringe Exchange Program (NSEP) commenced

operations at 3 sites in February and March 2006. The sites involved are
AARG Alternatif Community Centre in Jelutong, Penang (ACC); Intan Life
Zone in Ngee Heng, Johor Bahru (ILZ); Pusat Komuniti Ikhlas in Chow Kit,
Kuala Lumpur (PKI). From February 2006 to February 2007, the sites
distributed approximately 83,800 NSEP kits (containing 4 needles and
syringes, antiseptic swabs and cotton balls). The rate of return of used
injecting equipment for new ones steadily increased since the program
started, and now approximates at 60%, which is commendable for a new
program. Needle syringe exchange has occurred through more than 34,300
contacts with more than 4,300 different clients. IDUs who have participated
in needle exchange are male (96%), Malay (76% ) and over the age of 30 (77%
). The majority (72%) of needle exchanges have occurred through the
outreach; the drop- in centres provide a wider range of referrals and some
other services that cannot be provided in the outreach setting. Other
services provided through the NSEP include discussions with clients on safer
usage (27,947), and safer sex (8,832), as well as written resources (3,238)
and sessions with a case worker (1,259). There have been numerous referrals
to other services, including health/medical services (281), voluntary
counselling and testing for HIV (130), drug/alcohol treatment (51), methadone
(119) and welfare or legal services (72). There have been some positive signs
of behavioral change occurring amongst injecting drug users (IDUs) in the 3
pilot NSEP areas. There has been a significant reduction in the number of
IDUs passing on their injecting equipment to others, and also a reduction of
the use of street/port doctors. However, there is much more that needs to be
done. There are still many IDUs who are reusing injecting equipment of
others and are not always using a new and clean needle. The behaviour
survey also showed that knowledge of Hepatitis C is very poor amongst these
IDUs, with approximately 40% of them who have not heard of Hepatitis C, and
very few who know how the virus is transmitted.
1 Dato’ Dr. Faisal Hj. Ibrahim, Coordinator NSEP Program, Ministry of Health.
A high proportion of participants reported risky sexual behaviour in the last

month. As such the first year of the pilot NSEP has seen the successful
commencement of NSEP activities at all 3 sites, with adherence to the
National Standard Operating Policy and the Sites Standard Operating
Procedures.
ABSTRAK
Program Pertukaran Jarum Suntikan (NSEP) Malaysia diadakan secara

percubaan (perintis) pada bulan Februari dan Mac di tiga tempat. Tempat
atau kawasan yang terlibat membabitkan AARG Alternative Community
Centre (ACC) di Jelutong, Penang; Intan Life Zone (ILZ) di Ngee Heng, Johor
Bahru; dan Pusat Komuniti Ikhlas (PKI) di Chow Kit, Kuala Lumpur. Sejak
Februari 2006 hingga Februari 2007, ketiga-tiga pusat berkenaan telah
mengagihkan lebih kurang 83,300 kit NSEP (yang setiap satu mengandungi 4
jarum dan syringe, cecair antiseptik dan kapas). Kadar pemulangan set alat
suntikan yang telah digunakan bagi mendapatkan set suntikan yang baru
menunjukkan peningkatan yang berterusan, sejak program tersebut bermula
sehingga mencecah 60 % sekarang. Pertukaran peralatan suntikan tersebut
sekarang telah melibatkan seramai 34,300 perhubungan dengan lebih
daripada 4,300 klien yang berbeza. Para penagih yang menggunakan jarum
suntikan (IDUs) yang terlibat di dalam program ini adalah lelaki (96%), Melayu
(76%) dan berusia sekitar 30-an (77%). Sebahagian besar daripada program
pertukaran jarum penyuntik (72%) dilaksanakan melalui ‘outreach’; pusat
‘drop in’ yang menyediakan lebih banyak kemudahan rujukan dan
perkhidmatan yang tidak dapat disediakan di tempat-tempat lain.
Kemudahan-kemudahan lain yang turut disediakan melalui program NSEP ini
termasuklah penerangan kepada klien tentang peri pentingnya penggunaan
jarum suntikan secara yang lebih selamat (27,947), dan hubungan seks
secara lebih selamat (8,832), selain daripada penyediaan rujukan bertulis
(3,238) dan sesi bersama pekerja kes (1,259). Terdapat juga beberapa
keadaan di mana rujukan terhadap perkhidmatan lain turut dilakukan
termasuklah perkhidmatan kesihatan dan perubatan (281), kaunseling secara
sukarela dan ujian HIV (130), rawatan bagi ketagihan arak dan alkohol (51),
methadone (119), serta khidmat perundangan dan kebajikan (72). Terdapat
beberapa perubahan perlakuan yang positif dikesan di kalangan para penagih
yang terbabit dalam projek perintis di ketiga-tiga kawasan di atas. Bilangan
perkongsian jarum suntikan di kalangan para penagih dadah mengalami
penurunan yang ketara serta penurunan penggunaan jarum suntikan secara
jalanan (port doctors). Di sebalik perubahan-perubahan positif tersebut,
masih banyak yang perlu dilakukan. Masih ada penagih dadah yang tidak
menggunakan jarum suntikan yang baru, sebaliknya berkongsi jarum
suntikan atau mengitar semula jarum suntikan yang telah digunakan oleh
penagih lain. Kajian perilaku turut menunjukkan bahawa pengetahuan
tentang Hepatitis C di kalangan para penagih yang menggunakan jarum
suntikan adalah amat rendah, dengan hampir
40% daripada mereka sama sekali tidak pernah mendengar tentang Hepatits
C serta hanya sejumlah kecil daripada mereka yang tahu tentang bagaimana
virus tersebut disebarkan. Sebilangan besar daripada peserta pada bulan
lepas dilaporkan mengamalkan hubungan seks secara berisiko. Walau
bagaimanapun, dapatlah disimpulkan bahawa Projek Perintis NSEP pada
tahun pertama di tiga buah tempat telah menampakkan kejayaan, dengan
mematuhi peraturan-peraturan yang ditetapkan di bawah ‘National Standard
Operating Policy’ dan ‘Sites Standard Operating Procedures’.
INTRODUCTION The report is the final progress report for the Needle Syringe
Exchange Program (NSEP) pilot. The three sites currently operating the Pilot
NSEP are AARG Alternatif Community Centre in Jelutong, Penang (ACC); Intan
Life Zone in Ngee Heng, Johor Bahru (ILZ); and Pusat Komuniti Ikhlas in
Chow Kit, Kuala Lumpur (PKI).
The aim of the evaluation of the pilot NSEP is to assess the feasibility of
NSEP in the Malaysian context and whether the pilot NSEP can act as an
appropriate model for future expansion in Malaysia.
The objectives of the evaluation of the pilot NSEP are to assess whether: 1.
the sites have successfully implemented the pilot NSEP according to the
Standard Operating Policy (SOP) 2. the pilot NSEP has reached the targeted
injecting drug users in the 3 selected areas 3. the pilot NSEP has brought
about a change in unsafe injecting behaviour amongst injecting drug users
(IDUs) 4. the pilot NSEP has improved access for IDUs participating in this
project to HIV prevention education and health and welfare services and
community criticism
OBJECTIVE 1: IMPLEMENTING THE NSEP ACCORDING TO THE SOP Needle

and Syringe Suitability At the start of the program, the clients from the 3
NSEP sites complained about the quality of needles and syringes provided. In
response to these complaints, the Monitoring and Evaluation Unit undertook
an assessment
of the acceptability of needles and syringes. Over time, this problem was
addressed and has largely been overcome by working together with State
Health Office (JKN) and the MOH at large.
As a follow up to the previously conducted needle assessment, a client

satisfaction survey was conducted amongst 150 clients in February 2007.
Clients were opportunistically recruited (50 from each site; 40: outreach
clients, 10: DIC clients). The survey showed that 79% of client agreed that
the quality of needles given out now is good, 88% that the syringe quality is
good. At ACC and ILZ, about 90% - 95% of clients are happy with the
currently provided needles and syringes. But, this is not the case at PKI,
where 38% of clients disagree or slightly disagree that the quality of needles
currently provided is good and 24% of clients had similar opinions on the
quality of the syringes provided currently. This indicates that quality issues
have largely (but not completely) been resolved in the view of the clients,
with issues remaining for PKI clients. A staff survey on the issue of needle
and syringe suitability showed that 76% of staff agree or slightly agree that
the quality of needles and syringes given out now is good. Approximately 14%
of staff disagreed, emphasising the fact that in the view of the staffs, this
issue has not been completely resolved. Overall the two surveys showed that
the needles and syringes provided since the initial batch of NSEP kits have
improved considerably and been of a more acceptable quality and more
suitable sizes for clients. The pilot program has highlighted the importance of
obtaining regular client input from all sites and target areas before selecting
needles and syringes to procure and distribute.
Standard Operating Policy All sites have exceeded the target number of
clients doing needle exchange by the end of the pilot program (target 400
clients at each site by Feb 2007: actual figures = ACC 1109; ILZ 2285; PKI
1600). However, on average each client has attended less than once per
week, with the number of contacts per month for clients ranging from 2.2 to
3.4 for this past 1 year, rather than the forecast number of 8 to 9. Therefore
the expected number of contacts per month with clients has not been
reached (target - 3600 contacts in February 2007: ACC 810, ILZ 900, March
2007: PKI 1010). However, these figures do satisfy the latest WHO definitions
of “regular client” as discussed below.
Staffs are aware that some clients will not meet them twice in some weeks,
so discussions with clients and judgement regarding demand
informs how many NSEP kits are provided for individuals. As a result, the
average number of kits provided at each contact is approximately 2 per visit
according to data collected from February 06 to February 07 (ACC 1.4; ILZ
2.7; PKI 2.6). The reasons for providing more than 1 kit at a time include: one
needle could be used for no more than 1 or 2 injections before it became
blunt (remembering that most IDUs in Malaysia inject 3-5 times per day);
clients who have veins that are difficult to find may pierce the skin a number
of times before finding a vein, making the needle blunt after only one drug
injection. In addition most of these clients are mobile, and the service is only
available for a limited number of hours, so they may not come into contact
twice per week and therefore need the equipment to cover a longer time
period. In combination with the number of client contacts for needle
exchange, this has resulted in less than the expected number of kits per
month being distributed in the first few months, but more than expected in
July to September in ILZ and PKI on average (Figure 1). From October 2006 to
March 2007, the number of kits distributed per month in PKI fell below target,
as the number of contact was much lower than expected. ILZ was continuing
to distribute more kits per month than expected till December 2006. ACC has
continuously distributed fewer kits than expected throughout the programme.
An alternative to providing only kits is to also stock and encourage clients to
take additional needles. A single syringe per day for a number of injections is
probably usually adequate, but as needles may become blunt faster, more
than one needle per day may be needed. This may be a good compromise
between cost constraints and best public health practice.
Figure 1 : Target and Actual Number of NSEP Kits1 Distributed by Each Site
Each Month
1 A kit contains 4 needles and 4 syringes, disinfectant swabs and cotton
balls.
Numbers of Needles and Syringes Provided and Returned Approximately

83,830 NSEP kits (670,640 needles and syringes) have been supplied since
the program began (Table 1). The return rate of used injecting equipment
returned by clients for disposal has been 58% of the quantity of needles and
syringes distributed since the start of the program. Overall, since the
beginning of the program the return rate has gradually improved (Figure 2).
More than 4,500 used items have been collected by the staff from the ground,
giving a slightly higher overall return rate of 60%, and particularly raising
ACC’s return rate to 43% through collection of nearly 3,700 items. Many
things influence return rates, including client trust, understanding of the
need to return items and mobility, relationship with port doctors, and
especially police activities.
Table 1 : Provision of Sterile Needles and Syringes, and Disposal of Used

Needles and Syringes
Figure 2 : Return Rates of Used for New Injecting Equipment at Each Site by
Month
Number of kits’ given to clients
Number of extra needles
Number of used needles returned for disposal
Number of used syringes returned for disposal
% Return rate (items returned / items given out)
Site
ACC, PP (17/02/06 – 17/02/07 ILZ, JB (24/02/06 – 24/02/07) PKI, KL (23/03/06 –

23/03/07) Total
18307
36014
29508
83829
106
784
998
1888
30276
99980
65778
196,034
27352
98430
64684
190,466
40.4
69.7
56.2
58.6
In the last quarter, all sites showed a decrease in return rates. This can
largely be attributed to a sizeable port with a busy port doctor becoming
inactive following police raids, and regular clients from there becoming hard
to find. The fear of being caught with injecting paraphernalia is another
significant factor affecting return rates. Even though the Guidelines for
Police in relation to NSEP have been signed and the said document has been
widely distributed to all police stations, there are still police officers who are
unaware and have little knowledge of the programme. Given the relative
short period of this programme and the coverage that is expected, this is not
a surprising finding. This is further discussed in the section below on Client
ID cards.
Overall the return rate at the DIC is higher than the outreach despite more
needle exchanges occurring on the outreach at all 3 pilot sites (Figure 3).
This could be due largely to the education provided to the clients on the
importance of returning used needles and syringes. DICs provide a relatively
safe and enabling environment which allows lengthy discussion with clients
to ensure return. This can be a challenge at the outreach, where clients, and
potentially the outreach workers, are exposed to the threat of arrest. At
times the bustling activities at the ports amongst clients can be distracting
for clients to discuss with the outreach workers as the clients’ main priority
is to use drugs to avoid withdrawal. Therefore, the outreach workers have to
be patient to allow clients to complete their activities before engaging in
discussions and exploring with clients the challenges in returning used
injecting equipment. Considering all these factors, an overall return rate that
is close to 60% after one year of the pilot program is encouraging as reported
return rates for different NSEP programs worldwide have varied widely
between 15 -115%.
Figure 3 : Return Rate at DIC and Outreach.
OBJECTIVE 2 : TO ASSESS WHETHER THE PILOT NSEP HAS REACHED THE

INJECTING DRUG USERS IN THE 3 SELECTED AREAS Number of Clients and
Contacts With Services The total number of contacts and the number and
proportion of these contacts that are specifically for needle syringe
exchange (NSE) services are shown for each site in Table 3 for the entire
time of operation as a NSEP site. The total number of contacts varies
substantially between sites, probably related to how established the DIC for
each site was before NSEP services commenced, rather than the amount of
time the NSE service has been functioning. The proportion of contacts that
involved NSE was also substantially different between sites, but did not
correlate to the number of contacts. In PKI, this proportion was much lower
than the other sites, reflecting PKI’s historical role in providing many other
services to a range of client types. More than 51,500 contacts with the NSEP
sites for various services have occurred in 1 year, with nearly 34,400 of these
involving needle exchange.
Table 2 shows the total number of clients (based on counting the client ID
code as unique) and the number and proportion of clients using the NSE
service. A high proportion (74%) of all clients in ACC and ILZ are accessing
the NSE service, indicating that the majority of clients are part of the target
audience. The same is not true for PKI, again reflecting the fact that PKI has
had a long established DIC that is utilised by a wide range of people. DIC
data collection forms were adjusted after the program commencement to
collect client drug use status (IDU, DU and non drug user). Data indicates
that 30- 40% of PKI clients, 80- 90% of, ACC clients, and 70-80% of ILZ clients
are IDUs.
Table 2 : Number of Clients and Contacts – Total and Subset Using Needle
Exchange Services
* Based on client ID code where needles and syringes have been taken
and/or returned. Note: a client code will only be counted once in the entire 12
months, so the total will not equal monthly totals added together because a
client may be counted in more than one month.
Number of Contacts (client may be counted many times)
Number of Contacts for Needle Syringe Exchange
% of Contacts Involving Needle Syringe Exchange
Number of Unique Clients (based on client ID code)
Number of Clients Who Have Done Needle Exchange
% of Clients Who Have Done Needle Syringe Exchange
ACC, PP 17/2/06 - 17/2/07 ILZ, JB 24/2/06 - 24/2/07 PKI, KL 23/3/06 - 23/3/07

Total
Site
16484
15674
19373
51531
11378
11795
11184
34375
69
75
57
66
1340
2800
2803
6943
992
2074
1291
4375
74
74
46
62
While focusing their efforts on IDU clients using the NSE service, the pilot
sites are keen to provide a comprehensive and holistic service that also
allows services access to non-IDUs. This is particularly relevant as an
individual’s using behaviour may change repeatedly over time, and it is
important that they feel welcome to access services that will minimise the
harm of their activities. There is, however, some potential harm with having a
DIG where ex-IDUs (including those on MMT) mix with current IDUs, and the
sites should be mindful of this and refer non- IDU clients to other agencies
wherever possible. Given that there is limited services that meet the needs
of ex-IDUs, development and funding of these additional services such as
skills training and job placement are urgently required.
Number of Regular and Irregular Client A recent technical paper from WHO
and UN defines “regular at tenders/ clients” as those who are in regular
contact with NSEP. The principle behind this definition is to capture IDUs
who come at least once a month or more over a period of time and not just
IDUs who come regularly on a weekly basis compared with those who only
came once (one off visit). Therefore, taking into consideration this definition,
clients for this, pilot NSEP is divided into 2 broad categories, i.e. “regular
clients” and “irregular clients”. “Regular” clients are defined as having
attended NSEP more than once monthly (at least 2 times) since February
2006 to January 2007. Whereas “irregular clients” are defined as having
attended once only (one off visit) during the entire program. Overall, 62% of
NSEP clients are regular clients and 38% are irregular clients (Figure 4). The
proportion of regular clients at all sites in the first quarter was between 38%
to 60% (Figure 5). ACC maintained higher number of regular clients followed
by PKI and ILZ. For all sites, there are a substantial number of irregular
clients, which may be influenced by many factors including client mobility,
drug supply and availability, police raids and arrest, acceptability of NS
equipment, length of time since that first NSE, trust and rapport with NSEP
staff, operation hours and frequency of contact opportunities (Figure 6). The
reality of the needle exchange client contact is considerably different from
the target that was set at the beginning of the program, but confirms to the
latest WHO/UN recommendations. Therefore, it is important to consider the
internationally recommended definition together with the reality of clients’
pattern of use of the services to redefine the term “regular” and “irregular”
client in the SOP.
Figure 4 : Regularity of Service Use Over
Figure 5 : Regular Clients at Each Site by Months
Figure 6 : Irregular Clients at Each Site by Month
Client Demographics The vast majority of clients who have done needle
exchange in the one year of the pilot NSEP are male (Figure 7). There are very
few clients below the age of 20 years (Figure 8), with the age group
proportions similar for sites after 12 months as they were after 6 months;
ACC has had a significant increase in the number of clients aged 40 and
above; ILZ served a significantly large number of clients aged 30 -39 years
and 20 -29 years in the last quarter; while PKI has had a significant shift to
more clients aged 40 and above. The majority of clients who have done
needle exchange are Malay, with a higher proportion of Chinese and Indian in
ACC than elsewhere (Figure 9). Ethnicity proportions are similar to those at
12 months; at ILZ and PKI there has been an increase in the proportion of
Chinese and Indian clients. Figure 7 : Gender of Clients Who Have Done
Needle Exchange in 12 Months of NSEP Pilot at Each Site
Figure 8 : Age Group of Clients Who Have Done Needle Exchange in 12 Months
of NSEP Pilot at Each Site
Figure 9 : Ethnicity of Clients Who Have Done Needle Exchange in 12 months

of NSEP Pilot at Each Site
Two Models (DIC and outreach) for Reaching the Population The two models
being used for the NSEP pilot have different advantages and disadvantages,
and in combination should facilitate the provision of a comprehensive harm
reduction service. Staffs said the DIC is a safe place for clients where their
needs can be taken care of, however the fixed location and hours may reduce
accessibility, and entering the DIC may mark a client as an IDU. The outreach
can reach more clients, and in their own space where they may feel more
comfortable; however it can be difficult or dangerous to find clients.
Overall there is little difference in demographics (gender, age, and ethnicity)

of clients using the outreach and the DIC in the 12 months (Figure 10).
Most needle exchange service occurs through the outreach, with 79% of
needles & syringes given out through the outreach, 77% of needle exchange
clients being seen through the outreach, and 72% of all needle exchange
contacts being through the outreach (Figure 11). Based on client codes, there
are many needle exchange clients who have used services at both DIC and
the outreach (ACC 171, ILZ 329, PKI 309).
Despite more needle exchanges occurring through the outreach, overall the
return rate of used for new injecting equipment is higher at the DIC as
discussed in objective 1 on the needle and syringe suitability (Figure 3). At
ACC and PKI, the proportions of NSE contacts are about

Figure 10 : Demographics of Clients Who Have Done Needle Exchange in 12

Months of NSEP Pilot, Comparing the Outreach and the DIC Service Models
[A: gender, B: age group, C: ethnicity] (Outreach, n = 3822 ; DIC, n = 1162)
Gender of clients who have done needle exchange in 12 months on NSEP

pilot, shown by point of contact with service - all sites
Age group of clients who have done needle exchange in 12 months on NSEP
Ethnicity of clients who have done needle exchange in 12 months on NSEP

the same for both the outreach and DIC. At ILZ, the contacts for NSE at the
outreach are significantly higher than DIC. Overall, the outreach model is
more effective in reaching the target population and must be emphasized
during the scale up.
OBJECTIVE 3: TO ASSESS WHETHER THE PILOT NSEP HAS BROUGHT ABOUT

A CHANGE IN UNSAFE INJECTING BEHAVIOUR AMONGST IDUS IN THE 3
TARGET SITES Assessment of Behavioural Changes A behaviour surveillance
survey (BSS) of 300 IDUs in the three cities (100 per location) where pilot
sites operate was conducted shortly after the NSEP commenced at all three
sites in April 2006. A second BSS was repeated in February 2007, 12 months
after the commencement of NSEP by the M&E Unit. Participants were
selected through the targeted snowball sampling. It is important to note that
this was not a longitudinal cohort study and therefore the participants from
the two studies were not necessarily the same individuals. As personal
information was not collected for the purposes of the study, identification of
individuals who may have participated in both surveys was not possible. This
method of recruitment is acknowledged and accepted, as it is the only
alternative way to gather data from population whose members do not
congregate in fixed location such as IDUs. The purpose of doing the BSS at
the start of the programme and upon conclusion of the pilot was to get some
baseline data of HIV risk behaviour at the start and for assessment of
behavioural changes that may have occurred.
Figure 11 : Number of Contacts for NSE Through DIC and the Outreach
Number of contacts for needle exchange through DIC and outreach

Participants were asked standardised questions about their drug use habits,
sexual behaviour, and knowledge of HIV and Hepatitis C. Rapid tests for HIV
were also conducted at all locations. Although ideally the first round of BSS
should have been conducted prior to the commencement, in reality it was
only conducted after NSEP had commenced at all 3 sites, due to the lack of
manpower and capacity within the unit.
Unsafe Injecting Behaviour Amongst IDUs From the two BSS, the majority
(88%) of participants were male, the average age was 38, and the average
time of injecting drugs was 12 years. During the 1st BSS, approximately 44%
of IDUs interviewed had obtained needles and syringes from the NSEP, while
in the 2nd BSS about 88% of IDUs were clients of the NSEP.
A high proportion of participants reported injecting risk behaviour in the last

month, being ever re-using someone else’s needle or syringe (52%) in the 1st
BSS. The 2nd round of BSS indicated (56%) of participants reported of having
ever used someone else’s needle and syringe in the last month. This reported
increase was not statistically significant. However, it points to the need to
ensure consistent risk reduction and behaviour change messages are given
alongside the needle and syringe exchange. It is also important to remember
that behavioural change is gradual and the provision of clean injecting
equipment alone does not appear to be sufficient to motivate major changes
in contextual risk behaviors. 0ther factors such as sample size and study
design buisness whereby the 1st round BSS was only conducted after the
commencement and police activities might have an impact why a significant
change was not observed.
However, more detailed data analysis revealed positive results. About 43% of
IDUs in the 2nd BSS reported passing on their used equipment, a significant
decrease compared to 56% during the 1st BSS (p <0.01). The 2nd BSS showed
a reduction in the proportion of IDUs using the services of street/port doctors
from 42% to 33% during the 1st BSS. This was a significant (p<O.O25)
positive change, as street / port doctors have been acknowledged as a major
factor in accelerating HIV transmission amongst IDUs.
Figure 12 : Reported Injecting Risk Behaviours Within the Preceding 1 Month

Amongst IDUs (1st round, n = 300 and 2nd round, n = 300 BSS results)
Those whose HIV rapid test was positive were more likely to report passing
on their used equipment (58%) within the preceding 1 month during the 1st
BSS. The 2nd BSS indicated that there has been a significant reduction
(p<O.O21) in the proportion (44%) of HIV positive IDUs reporting this risky
behaviour. This represents a vital step in the efforts to interrupt HIV
transmissions.
One of the key elements that increases and promotes episodes of safer
injecting behaviour is the frequency of using new and clean needles and
injecting equipment. During the 1st BSS, 49% of IDUs reported always using
new and clean needles and syringes in the last month compared to (41%)
during the 2nd BSS. This change was however not statistically significant.
Significant change may not have been observed in IDUs reporting always
using new and clean needles and injecting equipment as the 1st BSS was
conducted several months after commencement, therefore clients were
already accessing new and clean needles.
OBJECTIVE 4 : TO ASSESS WHETHER THE PILOT NSEP HAS IMPROVED

ACCESS (FOR IDUS PARTICIPATING IN THIS PROJECT) TO HIV PREVENTION,
EDUCATION & HEALTH AND WELFARE SERVICES Knowledge of HIV and
hepatitis among IDUs In the 2nd BSS, all of the respondents have heard of
HIV/AIDS. About 75% of respondents demonstrated correct basic knowledge
about HIV 11. This is a vast improvement compared to the previous BSS (42%
had sufficient knowledge on HIV/AIDS). Knowledge about Hepatitis C was
considerably lower than for HIV, but the 2nd BSS did show slight
improvement in the level of Hepatitis C knowledge amongst IDUs compared
to the 1st. The proportion of IDUs who have heard about Hepatitis C, and
know its mode of transmission (Figure 13) has increased slightly. But, more
has to be done to educate IDUs as the level of knowledge regarding Hepatitis
C is very low with only 40% of those surveyed knew about this virus.
Figure 13 : IDU Knowledge About Hepatitis C Virus and Transmission (BSS

2nd round results)
HIV Prevention Education Printed information: In addition to providing verbal

information, NSEP staff have provided clients with written resources on HIV,
and information about the DIC and NSEP (Table 5). There is an urgent need
for more Information, Education, Communication (IEC) materials tailored for
IDUs, most specifically about safer usage, safer sex, abscesses and blood
borne viruses.
Malaysian Aids Council (MAC) is in the process of developing more IEC

materials. It is important that IEC materials are appropriate for the target
audience. Focus groups with IDUs have been conducted to help ensure that
the materials are suitable for the target group and effectively convey key
messages. Currently there are two items on safer injecting and blood borne
viruses available. More appropriate IEC materials must be developed as IEC
materials can be extremely beneficial for helping to convert brief outreach
encounters into potential safe behaviour promoting interactions. Written
resources covering information about referrals services will also be
extremely useful in helping act as a bridge to other health services. MAC
must ensure that appropriate IEC materials in other topics such as vein care,
abscess management and overdose are developed and made available to all
sites before the scale up takes place. The delay in the development of more
IEC materials has definitely hampered the ability of NSEP staff to effectively
educate clients.
Case Worker Sessions and Verbal Education: Approximately a third of all

contacts with the pilot sites led to education around risk reduction and
behaviour change education being conducted (Table 3). Initial education
efforts have focused on the importance of not sharing needles and syringes
and on explaining the appropriate use of the content of the NSEP kits. As the
site staff became more experienced, other subjects were discussed with
clients such as the importance of not sharing cookers, water, vein care and
abscess prevention. MAC started supplying cookers (bottle caps) to ACC and
PKI, while ILZ was supplied with small glass bottles used as cookers (Figure
19). The NSEP kits should consider the provision of cookers and sterile water
which are vital to reduce the risk of infection to blood borne viruses (HIV and
Hepatitis C) and other pathogens.
Only 1 -2% of service contacts have resulted in a client having a session with
a case worker (2 case workers per site). The number of case worker sessions
may be influenced by the needs of the clients, the approachability,
experience and skills of the DIC staff and the rapport developed with clients.
The low number of sessions may be as result of high staff turnover, as most
case workers at all sites have resigned or switched roles at all sites. During
this 1 year pilot program, there has been no formal training sessions
conducted specifically for case workers on case management based on harm
reduction principles. MAC should make this a priority before scale UD.

Table 3 : Services Provided by NSEP Sites to Clients, Number and Percentage

of All Contacts
Provision of Referral to Drug, Health and Welfare Agencies at Client’s Request

Referral to services : In the first year of operation, each site has provided a
range of referrals for the clients (Table 4). There have been a total of 799
referrals, with approximately 36% of referrals to health and medical services.
About 9% have been welfare or legal referrals, which usually consist of
obtaining IG for clients, required for job applications. When a referral is given
to a client, all 3 sites usually provide transport and someone to accompany
the client. This has proved very successful in helping clients to attend
referrals. However, a single referral will often take between 2-4 hours time for
one staff member. This can be an added burden on staffs in the longer run.
Volunteers can be engaged to ensure sustainability of referrals as the client
base grows. Only about 7% of referrals have been to MMT, a number far less
compared to the demand and has resulted in long waiting lists. Most clients
are referred for MMT to private clinics, where clients are required to pay for
the methadone, which is often prohibitively expensive for most of these
clients who do not have steady incomes.
There are very few appropriate services available in Malaysia to meet the
needs of IDUs within a reasonable distance of the NSEP DICs, which places
pressure on NSEP staff who are committed to helping clients, but in such
situations are unable to. For example, ACC has provided no referrals for
methadone maintenance treatment because there is no government provider
of this service on the Penang Island, with the nearest provider being more
than an hour away on the mainland. In addition, NSEP sites must establish
links with referral agencies so
Case Worker Sessions
Safer Using discussion
Safer Sex discussion
Written Resources
Total Contacts
ACC, PP 17/02/06 - 17/02/07 ILZ, JB 24/02/06 - 24/02/07 PKI, KL 23/03/06 -

23/03/07
Total
Site
35 (1%)
736 (3%)
488 (2%)
1259
8914 (30%)
10446 (44%)
8587 (22%)
27947
6102 (21%)
1372 (6%)
1359 (4%)
8832
1062 (4%)
1721 (8%)
455 (2%)
3238
29672
23984
38992
92648
that referrals are more likely to be appropriate, efficient and supported. This
requires significant time and investment in building such links.
The client satisfaction survey indicated that several clients who were
interviewed did not have their National Identity Card (IC) with them (ACC: 8,
ILZ: 17, PKI: 16), i.e. they have lost their IC and could not afford the fee
required for a replacement IC. Having an IC is extremely important in
Malaysia, as it is required for admission to hospitals, schools, and at the
workplace. Clients who do not have an IC might face difficulties in seeking
health and medical services and securing jobs. NSEP sites should assist
clients in obtaining IC with help from the Welfare and Registration
Department.
Table 4: Number of Referrals Provided by NSEP Sites for Clients
Provision of Safe Sex Education and Condoms to Encourage Safer Sex

Practices In the recently conducted BSS, about 60% of participants reported
having sex in the last month, but the percentage of these clients reporting
that they always used condoms was low. However, the proportion of those
always using condoms with regular partners has increased compared to the
previous BSS (Figure 14). The proportion of those always using a condom
during sex with casual partners decreased compared to the previous BSS.
Overall, the number of IDUs who do not always use a condom is much higher
compared to those who use condoms consistently (Figure 15). Safer sex
education and appropriate condom promotion strategies need to be
emphasized to promote safer behaviours amongst IDUs. Of those who
reported having sex in the last month, 44% reported having sex with more
than one category of partner (regular, casual, sold sex, or bought sex). These
results highlight the ongoing risk of HIV transmission to the sexual partners
of IDUs and into the general
Health, Medical Referrals
Voluntary Counseling & Testing Referalls
Drug/Alcohol Treatment Referalls
Methadone Treatment Referrals
Welfare or Legal Referrals
ACC, PP 17/02/06 - 17/02/07 ILZ, JB 24/02/06 - 24/02/07 PKI, KL 23/03/06 -

23/03/07
Total
Site
54
122
105
281
22
96
12
130
15
15
21
51
98
21
119
39
26
72
community. This highlights the importance for continuing the provision of

both safe sex education and condoms to IDUs.
Figure 14 : Sex Risk Behaviour Amongst IDUs Who Reported That They Always
Used a Condom
Figure 15 : Sex Risk Behaviour Amongst IDUs Who Did Not Always Use a
Condom
In the staff survey, opinions about condoms varied considerably. In the 1st
BSS, nearly half of the staff who were surveyed disagreed that most clients
used the condoms provided in the kits, as staffs had noticed that condoms
were being discarded by clients who do not use them. Therefore, condoms
are currently provided to clients upon request to reduce wastage. The
proportion of staff who agreed or slightly agreed that there were some
clients who wanted more condoms to be provided has increased (Figure 16)
compared to the previous staff survey.
Figure 16 : Staffs Opinion on Provision of Condom
OBJECTIVE 5: TOASSESS WHETHER THERE HAVE BEEN UNINTENDED

NEGATIVE CONSEQUENCES OF THE PILOT NSEP. Increased Drug Use
(Initiation/Frequency/Duration) From the 2nd BSS, it was noted that
approximately 98% of IDUs injected at least once daily compared to 95% in
the 1st BSS, indicating that the provision of free needles and syringes
through the NSEP has not resulted in increased drug use.
The mean duration of injecting amongst the clients in both surveys was 12
years, indicating that the majority of the clients are long term drug users.
The NSEP is attracting those drug injectors who are many years into their
drug “careers” and are most likely to be amenable to both harm reduction
and drug prevention interventions. Interventions also need to contact drug
injectors earlier in their “careers” to give them the opportunity to access
services before they suffer too many adverse social and health
consequences.
Reports from police officers have indicated no increase in the number of

injecting drug users since the start of NSEP, but instead police have observed
a rise in amphetamine type stimulant usage for the last year.
Outreach staffs are asked to observe changes in the client population and
behaviours and these observations are included in the site monthly reports.
There have not been any reports of people commencing drugs as a result of
the NSEP, or of clients increasing their drug usage.
Public Disorder (Needle & Syringe Litter, Crime) Discarded Needles Prior to
the commencement of the NSEP, outreach workers from all 3 NSEP sites
observed discarded needles and syringes in most of the places used by IDUs
for injecting. Several clients have said that they throw away needles and
syringes because they are fearful of arrest if found carrying them.
The staff safely collect and dispose of discarded needles and syringes they
find in areas where they conduct the outreach. At ACC a total of 3690
discarded items (needles and syringes) were collected since the start of the
program. ACC outreach workers have noticed a reduction in discarded
equipment after targeting areas where lots of items were found (before NSEP
started) and after consistently talking to clients about the importance of
returning used equipment. ILZ outreach workers have also noticed a
reduction and since the start of the program have collected about 330
discarded items. PKI outreach workers have not noticed a significant change
in the amount of discarded equipment, and have reported collecting a total of
532 items since the start of the program.
Stakeholder interviews conducted with the community and businesses

around the outreach site and DICs have not noticed or reported more
discarded needles and syringes for the past 1 year since NSEP started.
Crime Rates Police raids of IDU ports have increased at all sites in the last
quarter, as Malaysia prepares for the Visit Malaysia Year 2007. A sizeable port
in Johor Bahru was closed due to constant raids and a main port in KL saw a
reduction in the number of clients accessing it.
Chief Inspectors (CI) from the 3 NSEP site areas were asked whether there
had been any change in crime rates in the last 12 months.
One CI said that overall there has been a 20% increase in crime involving
drug users in 2006 compared to 2005. The CI in Johor Bahru commented that
there has been a decrease in crime involving drug users and was not sure of
the absolute figure. Another CI replied that there has been a slight increase
in crime, but through his observations and talking with the staff, the crime
rate amongst drug users had remained the same. Another CI said that crime
amongst injecting drug users has declined.
Community Criticism The police CIs interviewed had not any complaints
about the program from their staff. Police are concerned about the possibility
that clients will misuse the NSEP card, although there are no reports of this
happening.
Some responses to the program have been quite positive, with police
expressing that: “No, in the first place if you tell me that the drug addicts
contribute to crime, I wouldn’t agree. The NSEP doesn’t affect anything.
Nobody can produce statistics to say drug addicts contribute to crime”
However, in March 2007, an article in a national newspaper that questioned

the effectiveness of NSEP was published, which included comments from the
Chief of Narcotics, PDRM who viewed the program as a “headache” for the
police force. In Penang, some residents have signed a petition to ask for the
relocation of DIC from their neighbourhood after a fire which occurred in an
empty house that is regularly used by IDUs. In light of some of these
criticisms, the program should implement a sound and effective media
strategy to garner public acceptance of this challenging programme to
ensure its continuity and sustainability.
SUMMARY OF PROGRESS Given the socio-cultural environment in which this

NSEP pilot has been operating, it can be concluded thus far the program has
progressed well, although as would be reasonably anticipated, not without
challenges.
Objective 1 : The sites are successfully implementing the SOP. More than
83,800 NSEP kits of new needles and syringes have been distributed. The
overall return rate of used items is close to 60% over the last 1 year. Most
staffs
enjoyed their work, are confident that they know how to do their job, and
think their site is being reasonably well managed and supported. Staff
turnover has been relatively high and strategy is needed to address the
relapse amongst the staff. Training of staffs is ongoing to continually improve
the quality of services being delivered, with focus on management skills for
site management and case management techniques for case workers at all
sites. Staff health and safety is important, with all staff finding work
sometimes upsetting, and some feeling unsafe at times. There have been
improvements in the quality and delivery of various stock items; further
improvement is possible through formal documentation and usage of stock
tracking systems. Sites have invested time in building links with community
and stakeholder groups, with clear benefits resulting from these efforts.
Continued effort in this area is vital for the long term success of this
program. Enhanced support from the police, particularly at recognising the
credibility and validity of the client ID cards, is also essential for the
program.
Objective 2 : The NSEP sites have provided numerous services, including

more than 34,300 contacts for needle exchange, with more than 4,300 clients
from February 2006 to February 2007. Some of these clients have only used
the service once, but 62% are regular clients; with 29% of them using the
needle exchange service once per week on the average. Most clients are
Malay males over the age of 30. This differs a little between clients who do
needle exchange through the outreach or the DICs. Most needle exchange is
done through the outreach, with return rates slightly higher at the DIC than
the outreach.
Objective 3 : There have been some positive signs of behavioural change

amongst IDUs in the 3 areas. There has been a significant reduction in the
number of IDUs passing on their injecting equipment to others and in the use
of street/port doctors. However, there is much more to be done, for instance
there are still many IDUs who are reusing injecting equipment from others
and not always using a new and clean needle. Further reduction in risk
behaviour is crucial to interrupt HIV and Hepatitis C transmission.
Objective 4 : Amongst IDUs surveyed, most had heard of HIV, whereas 40%
have not heard of Hepatitis C and very few know how it is transmitted.
Overall
there was improvement noted in the level of knowledge since the

commencement of the NSEP for HIV and Hepatitis C. The NSEP pilot has
resulted in numerous discussions on safer usage and safer sex, case work
sessions and distribution of written resources. Many referrals to other
services have also been provided, which often require substantial resources
(i.e. staff time and travel costs to accompany clients to appointments).
Amongst IDUs surveyed, 60% reported having sex in the preceding month,
with low reported rates of always using condoms. This highlights the
significant risk of HIV transmission from IDUs to other members of the
community and for the ongoing need for education on safer sex and provision
of condoms.
Objective 5: There has been no major evidence of unintended negative

consequences of the NSEP pilot, including increase in drug use, crime or
needle and syringe litter specifically related to the NSEP. There have been 2
separate incidents in recent months of community criticisms, one reported in
a national newspaper and the other a petition from residents trying to force
the relocation of the DIG in Penang. A media and advocacy strategy is
urgently needed to address these issues to ensure greater public and
community acceptance of this challenging program to ensure its long term
continuity and sustainability.
KEY ISSUES FOR PROGRAM CONTINUATION AND SCALE UP Program

Structure / Management The program structure of NSEP has changed
considerably since the SOP. The HRS and NSEP and DST Working Groups
were added later onto the program structure. It is acknowledged that the
formation of HRS to coordinate the communication between MAC and MOH
has improved the communication and has resulted in a better and more
effective working relationship. Since the start of the program, the state JKN
has been a valuable stakeholder and contact point for sites in issues related
to stock, coordination for stakeholder meetings and others. It is important to
ensure the new program structure together with TOR for HRS, NSEP and DST
Working Group and state JKNs is reflected correctly in the SOP to avoid
duplication and conflicting decisions in the future.
Training Peer Education There is a need for further “on the job” training of the
NSEP site staffs especially in areas of management techniques, teamwork,
dealing with relapsing staff members and others. It is crucial that case
workers are trained on case management based on harm reduction principles
before the scale up. Additionally, on going training must be conducted for the
outreach staff on the outreach strategies, communicating with IDUs on safer
usage, specifically for vein care and Hepatitis C.
Peer education is an effective method that could be used to continuously

educate street IDUs and at the ports. The task of educating clients now rely
solely on the outreach workers, who are responsible for distributing NSEP
kits and engaging clients in safer usage and safer sex discussions. Due to
constraints of time and hours of operation and manpower, the outreach
worker cannot remain permanently at a particular port. Therefore, the use of
peer educators, who are IDUs, can be effective in educating the clients
before and after the outreach. MAC and MOH have considered the
introduction of a peer education project to be implemented at the NSEP sites.
As for any peer based project, it is vital to ensure the involvement of current
IDUs from the planning through to the implementation stages. Many
countries have been successful in implementing peer education for IDUs, and
lessons from these countries can serve as a guidance in designing a well
tailored local program coupled with advice from the experts in the field.
Sites Staff turnover at all sites has been high. It is recognised that finding
people with the right balance of attitude and skills can be difficult. However,
the turnover of staff may sometimes indicate other underlying problems and
this should be addressed. One particular issue to be addressed is how sites
should respond in the event that an employee is rumoured to be using illegal
drugs. It is crucial that a guideline on this issue is developed by MAC and
MOH as soon as possible.
Outreach workers should develop strategies as to how they will aim to

maintain and increase the repeat use of service by clients, and the return
rates of used injecting equipment; monitor discarded needles and institute
regular clean ups if required; use rapport from brief regular contacts with
clients to create opportunities for clients; learn more about
safer injecting practices and have access to all other components of NSEP
services if they require.
The quality of interaction between the NSEP staff and clients should be
evaluated as the program expands and contacts more IDUs.
Relationship with Police, RELA, Local Council and AADK The role of the
police and other enforcement agencies in the success of the NSEP is
extremely important. On one hand, the law has not changed, so police
continue to focus as they should on upholding the law and reducing drug
supply. However, extensive work between the MOH and the police has
resulted in several positive outcomes. The Guidelines for the Police has been
endorsed and circulated widely. More police officers through the exposure
during the police trainings and workshops are supportive and in away have
become valuable allies in convincing other counterparts to support the NSEP.
It is crucial to ensure that these trained police officers are supported and
given opportunity to train other police officers under their supervision at
their respective workplace.
These ongoing advocacy efforts should also be extended to other

enforcement agencies such as RELA, local councils such as DBKL, anti- Vice
Department of the PDRM and AADK. AADK has recently been given sanction
by the government to conduct more enforcement activities amongst IDUs.
Stock Including Needles and Syringes Providing clients with a consistent and
reliable service is critical to maintaining trust and retaining clients in the
program who need needle exchange services. Part of this is having an
uninterrupted supply of needles and syringes of an appropriate size and
quality. Where current stock is totally suitable, changes should only be made
after careful consideration and consultation with a number of regular clients.
Supply forecast must take into consideration current activity levels. If this is
not considered, current funding allocation to the state JKN for stocks may be
insufficient and may result in service interruption.
The sharp disposal containers are not optimal for the outreach, therefore
other options should be sought, taking into consideration safety
(most notably the risk of needles falling out when sharp disposals are carried
in a bag), size and shape (to aid ease of carriage, rectangular shaped bins
that are narrower but longer as used in other exchange programs are more
appropriate).
The NSEP kit should consider the provision of other injecting equipment such
as cookers and sterile water that are vehicles for transmission of blood
borne viruses if shared.
Information, Education & Communication (IEC) Material IEC materials that

are appropriate for the target population are extremely important tools and
can be very effective in conveying knowledge and promoting safer behaviour.
It is acknowledged that MAC has produced some IEC materials, but these are
not sufficient. More IEC materials have to be produced in the area of vein
care, abscess prevention, overdose etc. These materials must be made
available to all NSEP sites and distributed widely amongst clients at the
outreach and the DIC. In addition, IEC materials should be assessed for
effects on behaviour and attitudes, providing information on whether the
materials can be further improved in the future.
Establishing Link with Government MMT The NSEP must work on building a
stronger link with the government MMT program. The number of clients at all
sites requesting for MMT have increased considerably, but due to the limited
number of patients that can be enrolled, many IDUs are still on the waiting
list.
NSEP program could potentially reach an agreement with the MMT program
that the NSEP clients be given priority (or, for example, 20% of each
enrolment cycle is reserved for clients referred by NSEP sites). The linkage of
these two programs is vital for the success of the harm reduction program in
Malaysia and should be looked into before the scale up.
Media and Advocacy Strategy The one year pilot program has provided
evidence that it is feasible to conduct this program in the Malaysian context
and therefore, efforts now should be focused on improving the capacity of
current sites and starting
up new sites. As the program expands and progresses, it is crucial for the
program to implement good and effective media and advocacy strategies.
These will act to ensure better community acceptance of this challenging
measure and assist in the program’s continuity and sustainability in the
future. The low profile approach adopted for the one-year pilot program might
not be as effective when the program grows nationwide, which will
undoubtedly attract a lot of media attention which may lead to negative
reports and create negative consequences for the program if not addressed
properly.
There are many positive findings from the monitoring and evaluation of the
program that show the valuable public health impacts of harm reduction.
These findings show benefits both to the individual and the community.
Consequently, a dissemination strategy needs to be developed to showcase
this work and educate the public and society at large as to the contribution
of harm reduction in reducing the spread of HIV infection and other unwanted
consequences of injecting drugs.
Keberkesanan Program Kaunseling Rawatan dan Pemulihan Dadah dari

Perspektif Penghuni Pusat Serenti
13Zulkhairi Ahmad & Profesor Dr. Mahmood Nazar Mohamed , m/s 13-28
1 Graduan Program Pengurusan Kerja Sosial, Universiti Utara Malaysia 2

Profesor Psikologi, Penyelia Latihan Ilmiah, Fakulti Pembangunan Sosial dan
Manusia, UUM
KEBERKESANAN PROGRAM KAUNSELING RAWATAN DAN PEMULIHAN

DADAH DARI PERSPEKTIF PENGHUNI PUSAT SERENTI
Zulkhairi Ahmad1 Mahmood Nazar Mohamed2
ABSTRAK
Kajian ini bertujuan meneliti persepsi penghuni yang menjalani program
pemulihan dadah di pusat serenti mengenai keberkesanan program
kaunseling yang ditawarkan kepada mereka. Secara khususnya ia melihat
keberkesanan kaunseling dengan merujuk kepada umur responden, jumlah
jam kaunseling yang diikuti mereka dan fasa rawatan mereka. Tambahan
pula, ia juga meneliti hubungan di antara harga diri dengan keberkesanan
kaunseling di pusat pemulihan. Sejumlah 205 responden dipilih secara rawak
dan mereka menjawab soal selidik “Comprehensive Scale of Psychotherapy
Session Constructs” (CSPSC) dan “Rosenberg Self-esteem Scale” (RSES).
Hasil kajian mendapati tiada hubungan di antara umur dengan persepsi
keberkesanan kaunseling, tetapi terdapat hubungan signifikan di antara
jumlah jam serta bilangan sesi kaunseling dengan persepsi keberkesanan
kaunseling. Kajian turut mendapati mereka yang harga dirinya tinggi, juga
mempersepsi kaunseling sebagai lebih berkesan.
ABSTRACT
The aim of this study is to evaluate the perception of residents who were
currently undergoing the drug rehabilitation programme at the Serenti Centre
regarding the effectiveness of the counselling sessions that were offerred to
them. This study was specifically carried out to analyse the effectiveness of
the counselling sessions based on the respondents’ age, number of hours
spent
undergoing counselling and their rehabilitation treatment phase. Besides

that, this study was also conducted to assess the correlation between the
residents’ self respect and the effectiveness of the counseling sessions at
the rehabilitation centre. A total of 205 respondents were randomly chosen to
answer the Comprehensive Scale of Psychotheraphy Session Contructs
(CSPSC) questionnaire as well as the Rosenberg Self-esteem Scale (RSES)
questionnaire. This study revealed that there was no correlation between the
age factor and the perception of the effectiveness of the counselling
sessions. However, there was a significant correlation between the number of
counselling hours and the effectiveness of the counselling sessions. Besides
that, this study also revealed that respondents who had high self respect
also perceived the counselling sessions to be effective.
PENGENALAN Gelagat luar tabii dan gejala sosial terutamanya di kalangan

muda mudi sejak beberapa tahun kebelakangan ini dikatakan mempunyai
kaitan dengan masalah penyalahgunaan dadah. Malah peningkatan
penggunaan dadah sintetik (ATS) turut dihubungkaitkan dengan peningkatan
indeks jenayah melalui kenyataan Ketua Polis Negara dalam akhbar Utusan
Malaysia pada bulan Ogos 2006.
Penagihan dadah turut dikaitkan dengan pelbagai jenis penyakit. Sharol Lail
Sujak (2001) mencatatkan bahawa sehingga 1998, jumlah keseluruhan
penagih dadah di Malaysia seramai 160,427 orang dan daripada jumlah itu
seramai 20,301 orang penagih telah disahkan dijangkiti virus HIV+.
Perangkaan pada tahun 2006 oleh Kementerian Kesihatan Malaysia
menunjukkan bahawa lebih daripada 75% kes- kes HIV+ adalah dari kalangan
penagih dadah yang menggunakan jarum suntikan. Ini pula memberi
gambaran bahawa masalah penagihan tidak hanya berhenti di situ tetapi
telah merebak ke tahap yang lebih menyulitkan.
Sememangnya, permasalahan penyalahgunaan dadah merupakan satu krisis

yang perlu ditangani oleh Agensi Antidadah Kebangsaan dengan kerjasama
pelbagai jabatan lain akibat peningkatan pelbagai jenis penagih yang dikesan
setiap tahun, sama ada kes-kes penagih baru ataupun kes penagihan
berulang (Laporan ADK, 2002). Peningkatan ini juga menunjukkan bahawa
strategi antidadah yang digunakan sejak penggubalannya pada tahun 1983
mungkin belum dapat memberikan impak seperti yang diharapkan.

Dua pendekatan digunakan oleh AADK3 untuk membanteras masalah ini,

iaitu dengan menggunakan strategi pengurangan bekalan dan pengurangan
permintaan. Tumpuan yang diberikan di sini ialah pendekatan pemulihan
penagih dadah. Pemulihan penagih dadah merupakan satu aspek penting
dalam mengurangkan permintaan terhadap dadah dan aspek ini kerap
menjadi tumpuan oleh para penyelidik bidang penagihan dadah (Mahmood,
Md. Shuaib & Abdul Halim, 1993). Kaedah dan pendekatan rawatan dan
pemulihan yang baru telah dipraktikkan dengan lebih berkesan melalui
pendekatan psikologi yang digunakan menerusi program kaunseling.
Dalam program rawatan dan pemulihan dadah yang diamalkan di luar negara
seperti di Britain dan Amerika Syarikat, pendekatan tingkah laku dan
psikososial, khususnya kaunseling adalah di antara kaedah utama untuk
memulihkan penagih dadah. Melalui kaunseling, seseorang itu akan dibantu
untuk membina kemahiran mengurus tekanan seharian, meningkatkan
keupayaan ‘coping skills’ serta ‘self- mastery’ dalam penyesuaian diri dan
penyelesaian masalah, seterusnya mendorong mereka untuk membina gaya
hidup yang sihat. Justeru itu, adalah penting untuk mengetahui
keberkesanan program kaunseling yang dijalankan di pusat-pusat pemulihan
dadah.
PENYATAAN MASALAH Masalah penagihan semula di kalangan bekas

penghuni yang dibebaskan dari pusat serenti sememangnya menjadi isu
setiap kali subjek dadah dibincangkan (Mahmood, 1999; Mahmood, Md.
Shuaib, Lasimon, Dzahir & Rusli, 1999). Keadaan ini menimbulkan
kebimbangan pelbagai pihak kerana keadaan ini boleh menggugat
keharmonian dan keselamatan sosial. Ini kerana mereka yang terbabit dalam
masalah penagihan adalah golongan remaja dan belia yang mana mereka
merupakan tonggak kekuatan negara pada masa akan datang (Mohamad
Samad, 1998).
Persoalan yang diajukan adalah adakah pihak Agensi Antidadah Kebangsaan

khususnya pengurusan di pusat serenti telah menyediakan program rawatan
dan pemulihan yang berkesan dan adakah penghuni- penghuni dapat
menerima program kaunseling yang dilaksanakan di
3 Penggunaan singkatan ADK dan AADK adalah berkaitan dengan perubahan

nama Agensi Dadah Kebangsaan (ADK) kepada Agensi Antidadah Kebangsaan
(AADK) pada tahun 2004. Semua bahan rujukan rasmi adalah berpandukan
kepada nama rasmi agensi pada ketika ia diterbitkan.
pusat serenti? Seperti yang dinyatakan di atas, kaunseling merupakan

tonggak khidmat pemulihan psikologi di pusat-pusat pemulihan dadah
(Agensi Dadah Kebangsaan,1998) dan seandainya program ini menampakkan
kejayaan, maka pemulihan di pusat-pusat pemulihan boleh dirumuskan
sebagai telah memberi input baik ke arah kepulihan penagih dadah.
OBJEKTIF Sehubungan dengan itu, keberkesanan kaunseling ini dikaji

daripada perspektif penghuni serta diteliti dengan merujuk kepada satu
konstruk psikologi yang telah terbukti berkaitan dengan kepulihan penagih
dadah. Secara khususnya, objektif kajian ini ialah untuk: i. Mengkaji persepsi
keberkesanan program kaunseling dengan umur penghuni; ii. Mengkaji
persepsi keberkesanan program kaunseling dengan jumlah jam kaunseling
individu dan kelompok yang dilalui oleh penghuni; iii. Mengkaji keberkesanan
persepsi terhadap program kaunseling dengan merujuk kepada fasa rawatan
penghuni; dan iv. Mengkaji peningkatan harga diri dengan merujuk kepada
persepsi penghuni terhadap program kaunseling yang diikuti mereka.
Seperti yang dihuraikan di atas, kajian ini bertujuan untuk melihat
keberkesanan program kaunseling kepada penghuni yang sedang menjalani
program rawatan dan pemulihan di Pusat Serenti Rawang. Aktiviti kaunseling
dalam kajian ini adalah program kaunseling yang dibentuk melalui Perintah-
perintah Tetap Ketua Pengarah Agensi Dadah Kebangsaan Bil. 2/98.
ULASAN KAJIAN Kaunseling merupakan kaedah untuk membantu individu

yang mengalami masalah salah suai untuk kembali kepada kehidupan lazim
(Amir Awang, 1987; Mohd Mansur, 1993; Suradi, 1996) termasuklah untuk
mereka yang menggunakan ataupun yang sudah ketagih dengan dadah
(Mahmood, 1999). Banyak kajian telah dilakukan sama ada di dalam mahupun
di luar negara untuk meneliti keberkesanan sesuatu program yang dikaitkan
dengan usaha memulihkan penagih dadah. Kebanyakan kajian ini melihat
kepada aspek kaunseling yang diberikan kepada penghuni-penghuni pusat
pemulihan (Jackson & Muth, 1999; Mahmood, Md Shuaib & Abdul Halim,
1993; Mahmood, 1999; Zickler, 1999).

Kajian oleh National Institute on Drug Abuse (NIDA) ( Jackson & Muth; 1999;
Zickler, 1999)) mendapati bahawa rawatan kaunseling yang diberikan kepada
penagih kokain adalah lebih berkesan dalam menghentikan pengambilan
dadah berbanding dengan kumpulan penagih dadah yang cuba berhenti
sendiri. Dalam kajian ini, rata-rata individu yang menerima kaunseling
menunjukkan penurunan dalam kekerapan menggunakan dadah daripada
mereka yang tidak menjalani kaunseling.
Hal ini turut ditemui oleh Mahmood (1999) dan beliau berpendapat bahawa
peranan kaunseling dalam pemulihan dapat membantu residen pusat
pemulihan mengurus reentry crisis yang dihadapi mereka ketika keluar dari
pusat serenti kerana ia dapat membantu residen membina tingkah laku baru
untuk menyelesaikan masalah, menimbulkan kesedaran kerjaya, merapatkan
dan mengukuhkan hubungan kekeluargaan, meningkatkan konsep kendiri,
mewujudkan kesedaran tentang tanggungjawab diri, berfikiran positif,
mencegah relapse dan mendorong pembinaan sikap berdikari.
Kajian yang dijalankan oleh Flisher dan De Beer (2002) bagi melihat kepada
932 pelajar lelaki dan perempuan yang menerima perkhidmatan kaunseling di
University of Cape Town Afrika mendapati bahawa wujud hubungan yang
signifikan di antara faktor umur dengan penerimaan sesi kaunseling. Kajian
ini juga bagi melihat keberkesanan perkhidmatan kaunseling mengikut
pencapaian akademik. Keputusan mendapati bahawa wujud hubungan yang
signifikan di antara taraf pendidikan dengan penerimaan sesi kaunseling.
Peratus yang ditunjukkan dalam keberkesanan program kaunseling yang
mempunyai pencapaian akademik yang baik adalah 85% berbanding 15%
yang mempunyai tahap akademik yang rendah. Mahmood (2001) turut
menggariskan bahawa kaunseling penagihan dadah berupaya memberi
kesedaran kepada penuntut institusi pengajian tinggi untuk menjauhi dadah.
Zickler (1999) yang melakukan kajian terhadap 487 orang pengguna dadah di
lima buah universiti di Pennsylvania, mendapati bahawa penggunaan kaedah
kaunseling amat berkesan dalam memberi kesedaran tentang bahaya dadah.
Kajian mereka menunjukkan bahawa bagi pengguna dadah yang menjalani
sesi kaunseling selama enam bulan, sejumlah 38% daripada 487 pengguna
dadah telah berjaya dipulihkan. Manakala bagi pengguna dadah yang
menjalani sesi
kaunseling selama tiga bulan, hanya 27% dapat dipulihkan. Ini menunjukkan
bahawa semakin banyak dan lama sesi kaunseling diterima oleh pengguna
dadah, semakin berkesan kaunseling itu ke atas dirinya untuk menjauhi
dadah. Perubahan tingkah laku lain yang dapat dilihat daripada pengguna
dadah yang mengikuti program kaunseling individu dan kelompok ialah
perubahan pada personaliti dan harga diri mereka.
Di Malaysia, kajian yang diusahakan oleh Mahmood, Md. Shuaib, Lasimon, Md.
Dzahir dan Rusli (1999) mengenai aspek psikologikal penagih telah
menemuduga seramai 2,819 orang penghuni pusat serenti untuk mendapat
maklumat pemulihan psikososial mereka. Kajian ini meneliti perubahan
psikologi (aspek-aspek psikologikal seperti kebimbangan, kemurungan dan
harga diri) semasa mereka menjalani program rawatan dan pemulihan selama
hampir dua tahun. Ia juga meneliti perkembangan dan kemajuan mereka
setelah keluar dari pusat pemulihan. Daripada bilangan penagih dadah yang
ditemuduga di peringkat awal, kajian tracer dilakukan ke atas sejumlah
2,416 orang yang telah dibebaskan dari pusat serenti dan sejumlah 1,941
orang dapat dihubungi untuk proses pemantauan. Daripada bilangan yang
dikesan iaitu 958, sejumlah 584 orang relapse dan 374 orang masih bebas
daripada pengaruh dadah. Hasil kajian mendapati bahawa tahap harga diri
bekas- bekas penghuni pusat serenti yang masih bebas dadah rata-rata
adalah lebih tinggi berbanding dengan rakan mereka yang relapse.
Dengan berpandukan kepada beberapa ulasan kajian lalu, ia sedikit sebanyak

telah menunjukkan bahawa kaunseling adalah berkesan dalam proses
pemulihan penagih-penagih dadah dan jika ianya dikendalikan secara
profesional dan teratur, maka ia akan meningkatkan lagi keberkesanan
pemulihan berterusan.
METODOLOGI Kajian ini menggunakan reka bentuk tinjauan keratan rentas

yang dilakukan ke atas penghuni Pusat Serenti Rawang, Selangor. Data
dikumpulkan dengan menggunakan borang soal selidik yang diedarkan
kepada responden di Pusat Serenti Rawang. Penggunaan borang soal selidik
ini dilakukan adalah kerana ia dapat mengkaji lebih ramai responden dalam
tempoh kajian yang terhad dan lebih banyak data dapat dikumpulkan (Syed
Arabi Idid, 1992; Heppner, Kivilighan & Wampold, 1999). Populasi kajian di
Pusat Serenti Rawang ialah 457 orang. Persampelan rawak digunakan untuk
memilih responden. Menurut

Sekaran (2000), bilangan sampel yang sesuai bagi mewakili populasi

berjumlah 457 orang adalah seramai 205 orang.
Instrumen yang digunakan dalam kajian ini ialah borang soal selidik yang
memuatkan latar belakang penghuni serta soal selidik mengukur persepsi
keberkesanan kaunseling dan tahap harga diri. Alat pengukuran yang
digunakan bagi meneliti keberkesanan kaunseling merujuk kepada
Comprehensive Scale of Psychotherapy Session Constructs (CSPSC) (Eugster
& Wampold, 1996). Nilai alpha Cronbach bagi CSPSC ialah 0.84, manakala
bagi konstruk harga diri, Skala Harga Diri Rosenberg (RSES) (Rosenberg,
1965) dengan nilai alpha Cronbach ialah 0.86.
Perisian Statistical Package for the Social Science (SPSS) digunakan untuk
menganalisis melalui statistik perihalan dan inferensi. Korelasi Pearson
digunakan untuk melihat hubungan faktor demografi seperti umur, jumlah jam
kaunseling dan harga diri, sementara ujian ANOVA sehala digunakan untuk
melihat perbezaan persepsi penghuni terhadap program kaunseling dengan
fasa rawatan mereka.
KEPUTUSAN KAJIAN Sejumlah 205 orang penghuni Pusat Serenti Rawang

bertindak sebagai responden kajian. Mereka terdiri 67 orang dari fasa 1; 59
orang dari fasa 2; 55 orang dari fasa 3 dan 24 orang penghuni dari fasa 4.
Seramai 73% daripada responden berbangsa Melayu dan min umur adalah
29.5 tahun.
i. Umur dengan Program Kaunseling Ujian korelasi Pearson dilakukan bagi

melihat hubungan di antara faktor umur dengan program kaunseling yang
dijalankan. Keputusan menunjukkan tidak wujud hubungan yang signifikan
antara umur penghuni dengan persepsi terhadap program kaunseling (r =
0.04, p>0.05). Ini menunjukkan bahawa umur tidak ada kaitan dengan
persepsi terhadap keberkesanan program kaunseling yang dijalankan.
ii. Jangka Masa Kaunseling Individu dan Kelompok Ujian korelasi Pearson
juga dilakukan bagi melihat hubungan antara jumlah jam kaunseling individu
dengan program kaunseling yang dijalankan. Keputusan menunjukkan jumlah
jam kaunseling individu mempunyai hubungan positif yang signifikan dengan
program kaunseling (r = 0.178, p<0.05). Ini menunjukkan bahawa semakin
banyak tempoh jam kaunseling individu yang dijalani
seseorang itu, semakin tinggi keberkesanan program kaunseling kepada

penghuni yang terlibat.
Seterusnya ujian korelasi dilakukan untuk melihat hubungan jumlah jam

kaunseling kelompok dengan program kaunseling. Keputusan menunjukkan
jumlah jam kaunseling kelompok mempunyai hubungan yang positif lagi
signifikan dengan program kaunseling (r = 0.161, p<0.05). Ini menunjukkan
bahawa semakin kerap tempoh kaunseling kelompok yang diikuti oleh
penghuni, mereka mempunyai persepsi bahawa sesi-sesi kaunseling tersebut
adalah berkesan untuk pemulihan mereka.
iii. Fasa Rawatan dengan Program Kaunseling Ujian ANOVA sehala dilakukan
untuk melihat perbezaan persepsi terhadap program kaunseling dengan
merujuk kepada fasa rawatan responden. Keputusan mendapati bahawa
wujud perbezaan yang signifikan antara fasa rawatan dengan program
kaunseling (F = 5.829, p<0.05). Ini bermakna kedudukan fasa yang berbeza
akan membawa kepada tahap keberkesanan program kaunseling yang
berbeza kepada setiap penghuni yang menjalani program pemulihan.
Penghuni yang berada di fasa tiga mencatatkan nilai min persepsi yang
paling tinggi iaitu 77.36 diikuti oleh penghuni di fasa dua dengan jumlah min
75.65, sementara penghuni fasa empat dengan jumlah min 74.62 dan akhir
sekali penghuni di fasa satu dengan jumlah min 71.62. Keputusan min
penghuni fasa empat rendah sedikit daripada penghuni fasa tiga dan dua,
kerana di fasa akhir, mereka lebih tertumpu kepada aktiviti pra-bebas seperti
khidmat serta integrasi masyarakat. Ini menunjukkan bahawa semakin lama
penghuni menjalani tempoh rawatan semakin berkesan program kaunseling
yang dijalankan ke atas mereka.
Jadual 1 : Ujian ANOVA Sehala Untuk Melihat Hubungan Jam Kaunseling
Kelompok dengan Program Kaunseling
PEMBOLEH UBAH FASA n Min F Sig Program Kaunseling 1 67 71.62 2 59

75.62 5.829 0.001 3 55 77.36 4 24 74.62

iv. Harga Diri dengan Program Kaunseling Ujian korelasi Pearson dilakukan
bagi melihat hubungan peningkatan harga diri dengan program kaunseling.
Keputusan menunjukkan bahawa wujud hubungan yang signifikan antara
peningkatan harga diri dengan program kaunseling (r = 0.384, p<0.05). Ini
bermakna penghuni yang mempunyai persepsi yang tinggi terhadap
keberkesanan program kaunseling juga mempunyai tahap harga diri yang
lebih tinggi.
PERBINCANGAN Kaunseling adalah satu proses penting dalam menguruskan

pergantungan psikologi penagih dadah terhadap dadah. Sememangnya
banyak jenis kaunseling yang diamalkan di pelbagai pusat pemulihan dadah
tetapi kebanyakannya berbentuk individu dan kelompok. Begitu juga dengan
sesi kaunseling yang dijalankan di Pusat Serenti Rawang, yang mana ia
mengikuti garis panduan yang dikeluarkan melalui Arahan Tetap Ketua
Pengarah Agensi Dadah Kebangsaan 2/98.
Pelbagai kajian juga telah menunjukkan bukti bahawa kaunseling adalah

perlu, penting dan berkesan dalam proses pemulihan penagihan dadah
(Zickle, 1999). Antara matlamat kajian ini ialah untuk meneliti sama ada
penghuni yang mengikuti kaunseling merasakan ianya berguna dan berkesan
ke arah pemulihan penagihan dadah di kalangan mereka.
Secara umumnya dapatan kajian menunjukkan bahawa kaunseling dipersepsi

sebagai berguna untuk pemulihan penghuni di Pusat Serenti Rawang. Namun,
dapatan kajian juga menunjukkan bahawa tidak wujud hubungan yang
signifikan antara umur dengan program kaunseling. Ini bermakna, faktor
umur yang berbeza-beza tidak ada kaitan dengan keberkesanan kepada
seseorang penghuni itu selepas mereka menjalani program kaunseling di
Pusat Serenti Rawang.
Hasil kajian ini tidak selari dengan kajian yang dilakukan oleh Flisher dan
DeBeer (2002) ke atas pelajar-pelajar di Universiti of Cape Town yang
menyatakan bahawa wujud hubungan yang signifikan antara faktor umur
dengan sesi program kaunseling. Namun demikian, kajian berkenaan bukan
dilakukan di kalangan penagih dadah. Mungkin juga kerana program
kaunseling di pusat serenti tidak diarahkan untuk
melihat isu-isu berkaitan dengan umur seseorang klien (age specific issue)
tetapi hanya kaunseling penagihan sahaja.
Di samping itu, boleh dikatakan bahawa keberkesanan program kaunseling

yang dijalani oleh setiap penghuni terbabit adalah terletak pada diri penghuni
itu sendiri yang telah menerima program kaunseling, bukanlah terletak pada
faktor umur dan taraf pendidikan. Menurut Muhd. Mansur (1993) faktor umur
tidak boleh dijadikan ukuran pada diri individu dalam penerimaan kaunseling.
Faktor kerelaan klien penting semasa menjalani kaunseling seperti
mempunyai sifat keterbukaan dan membahaskan masalahnya bagi
menentukan matlamat-matlamat perubahan tingkah lakunya untuk
merancang masa hadapan.
i. Jumlah Jam Kaunseling Individu dan Kelompok Keputusan kajian

mendapati wujud kaitan yang signifikan di antara jumlah jam kaunseling
individu dan kelompok dengan program kaunseling. Ini menunjukkan bahawa
semakin banyak masa dan tempoh jam kaunseling yang dihadiri oleh
penghuni-penghuni, maka mereka merasakan bahawa ia semakin berkesan.
Keputusan ini boleh menunjukkan bahawa semakin kerap seseorang klien
(penghuni) berjumpa dengan kaunselor, ia akan menghasilkan satu bentuk
hubungan yang kukuh antara klien dengan kaunselor. Dalam proses ini secara
langsung akan menimbulkan kepercayaan tinggi klien terhadap kaunselor
sekali gus mempertingkatkan keberkesanan program kaunseling yang
dijalankan. Menurut Muhd. Mansur (1993), kaunseling adalah suatu proses
aktif di antara kedua-dua belah pihak, dicorakkan dengan hubungan yang
tertentu di antara kaunselor dengan kliennya bagi tujuan mengubah tingkah
laku seseorang. Dapatlah dikatakan bahawa semakin tinggi jumlah jam
kaunseling yang dihadiri oleh seseorang penghuni itu, ia menandakan suatu
proses yang aktif di antara kaunselor dengan kliennya. Pada masa yang
sama, lebih lama mereka menghadiri kaunseling, lebih banyak isu dapat
diterokai, dan kemungkinan ini ada kaitan dengan tahap kepuasan penghuni
itu sendiri.
Keputusan kajian ini juga adalah selari dengan dapatan kajian oleh Zickle
(1999) yang menyatakan bahawa semakin banyak dan lama sesi kaunseling
yang dilalui seseorang penagih dadah, maka semakin meningkat tahap harga
dirinya. Menurut Zickler (1999) keberkesanan
sesuatu program kaunseling adalah berpandukan kepada perubahan

personaliti penagih dadah itu. Keberkesanan sesuatu program kaunseling
juga dilihat berdasarkan kepada tingkah laku penagih- penagih yang tidak
lagi mengambil dadah.
ii. Fasa Rawatan Keputusan kajian ini mendapati wujud perbezaan yang
signifikan di antara fasa rawatan penghuni dengan program kaunseling.
Dapatan kajian ini selari dengan dapatan kajian oleh Mahmood, Md. Shuaib,
Lasimon, Muhamad Dzahir dan Rusli (1999) yang menyatakan bahawa wujud
perbezaan perubahan psikosial yang dialami oleh penghuni bagi setiap fasa
rawatan iaitu fasa 1 dengan fasa 4 semasa menjalani program pemulihan
yang membabitkan program psikologi. Menurut Mahmood (2001) setiap fasa
mempunyai objektif kaunseling yang berbeza iaitu, objektif kaunseling di fasa
1 ialah memberi kefahaman dan peningkatan kesediaan klien mengikuti
program pemulihan. Objektif kaunseling di fasa 2 ialah membolehkan
penghuni mengatasi masalah-masalah yang dialami secara positif dan kreatif.
Objektif fasa 3 pula ialah membina kemahiran daya tindak untuk mencegah
penagihan semula, membolehkan klien menguruskan tekanan dengan
berkesan dan memberi kemahiran kepada klien dalam aspek pengurusan diri.
Manakala objektif fasa 4 adalah untuk mengukuhkan ‘coping skills’ untuk
mencegah penagihan semula dan mengintegrasikan semula klien ke dalam
masyarakat.
Dilihat daripada perbezaan min, penghuni yang berada pada fasa 3 mendapat
min tertinggi dari segi berkesannya program kaunseling iaitu 77.36. Ini diikuti
oleh penghuni yang berada dalam fasa 2 dengan jumlah min 75.62.
Sementara penghuni yang berada dalam fasa 4 dengan jumlah min 74.62.
Bagi penghuni yang berada dalam fasa 1, jumlah min yang diperoleh hanyalah
71.62. Berdasarkan keputusan ini, perbezaan min begitu ketara antara
penghuni yang berada dalam fasa 3 dengan penghuni yang berada dalam fasa
1. Begitu juga penghuni yang berada dalam fasa 2 dengan penghuni yang
berada dalam fasa 4. Ini bermakna kedudukan fasa penghuni yang berbeza
akan membawa kepada tahap keberkesanan yang berbeza terhadap program
kaunseling yang dijalankan ke atas mereka. Kajian ini menunjukkan bahawa
program kaunseling yang dijalankan kepada penghuni-penghuni adalah
bersesuaian mengikut fasa-fasa yang berbeza.
iii. Harga Diri Dapatan kajian ini menunjukkan bahawa wujud hubungan yang
signifikan di antara tahap harga diri yang tinggi dengan persepsi bahawa
program kaunseling itu berguna untuk mereka. Ini menunjukkan bahawa
penghuni-penghuni yang telah menjalani program kaunseling dapat merasai
peningkatan harga diri mereka. Perasaan atau persepsi lampau seperti
merasakan diri mereka sudah tidak berguna mungkin dapat dihilangkan
daripada pemikiran dan sanubari mereka. Melalui program kaunseling,
penghuni-penghuni dapat meningkatkan semula harga diri dan menangkis
apa yang telah berlaku kepada diri mereka semasa di alam penagihan dan
merasakan bahawa diri mereka masih mempunyai nilai sekurang-kurangnya
sama seperti orang lain. Peningkatan harga diri ini dapat dilihat melalui
perubahan fizikal penghuni di mana mereka kelihatan yakin, berketrampilan
dan lebih sihat berbanding dengan semasa baru masuk ke pusat serenti.
Hubungan yang ditunjukkan di antara persepsi program kaunseling dengan

peningkatan harga diri adalah secara positif. Ini bermakna semakin tinggi
keberkesanan program kaunseling, semakin tinggi peningkatan harga diri.
Dapatan kajian ini menyokong keputusan kajian oleh Mahmood (1999)
bahawa peranan kaunseling dalam pemulihan dapat membantu klien
membina tingkah laku baru yang positif, mengembangkan kemahiran dan
berpotensi menyelesaikan masalah, merapatkan dan mengukuhkan hubungan
kekeluargaan, meningkatkan harga diri, mewujudkan kesedaran diri,
berfikiran positif dan menolong mereka untuk membina sikap berdikari.
Keputusan kajian ini juga turut menyokong dapatan penelitian Mahmood, Md.
Shuaib, Lasimon, Muhamad Dzahir dan Rusli (1999) yang mengkaji aspek
psikologi penagih. Kajian mereka yang menumpukan terhadap aspek-aspek
psikologikal seperti kemurungan, kebimbangan dan harga diri, mendapati
bahawa berlaku perubahan yang signifikan pada aspek peningkatan harga
diri, penurunan tahap kebimbangan serta kemurungan pada penagih.
CADANGAN Sehubungan dengan itu, bagi mempertingkatkan lagi

keberkesanan program kaunseling yang dijalani oleh penghuni Pusat Serenti
Rawang dalam konteks pemulihan terutama dari aspek kaunseling boleh
diperkemaskan lagi, beberapa cadangan disampaikan untuk pertimbangan
pengurusan.

Memandangkan harga diri merupakan satu petunjuk penting ke arah

kepulihan, ini boleh digunakan sebagai indikator untuk pembebasan dari
pusat. Bagi penghuni yang dicalonkan untuk pembebasan, satu penilaian
boleh diwujudkan untuk mengetahui sama ada berlaku peningkatan harga
diri penghuni setelah menjalani program pemulihan. Seandainya diperhatikan
peningkatan harga diri maka ini boleh digunakan sebagai satu daripada
kriteria untuk pembebasan. Borang penilaian pembebasan boleh juga
memperuntukkan syarat kehadiran pada program kaunseling yang lebih
signifikan berbanding dengan program-program lain. Ini adalah kerana
program kaunseling merupakan tunjang utama kepada program rawatan dan
pemulihan dadah yang dijalankan di pusat serenti.
Pihak Agensi Antidadah Kebangsaan juga perlu memberikan latihan yang

secukupnya kepada para kaunselor yang baru diambil sebelum mereka
ditempatkan ke pusat serenti untuk berkhidmat. Ini disebabkan mereka yang
diambil kurang mempunyai asas dalam bidang kaunseling kerana kebanyakan
mereka yang diambil adalah yang mempunyai kelulusan di luar bidang
kaunseling penagihan dadah. Pihak AADK boleh mempertimbangkan dengan
mengadakan kursus kaunseling kepada pegawai asrama dan unit
keselamatan. Ini adalah penting kerana mereka juga terlibat dalam aktiviti
yang dijalankan dan sering berdampingan dengan penghuni. Dengan adanya
kemahiran dan pengetahuan kaunseling, kakitangan berkenaan dapat
menjalinkan hubungan yang lebih rapat dengan penghuni serta dapat
menenangkan ketegangan yang timbul dalam kalangan penghuni.
Pemantauan program kaunseling yang dijalankan di pusat serenti adalah

perlu bagi mendapatkan maklum balas daripada pihak kaunselor dan juga
penghuni. Ini adalah untuk mengetahui kaedah mana yang dirasakan sesuai
dan dapat memberikan input yang lebih berkesan kepada penghuni. Langkah
ini dapat meningkatkan lagi keberkesanan program kaunseling dan dapat
mengurangkan ketidakhadiran penghuni untuk menjalani sesi kaunseling
yang ditetapkan. Modul-modul program kaunseling yang dijalankan kepada
penghuni haruslah sentiasa dikaji, adakah ia bersesuaian mengikut semua
peringkat. Kalau ia didapati sesuai ia haruslah dikekalkan, manakala yang
didapati tidak sesuai haruslah diperbaiki dan dipertingkatkan lagi.
KESIMPULAN Dapatan kajian ini secara keseluruhannya menunjukkan

bahawa program kaunseling yang dijalankan terhadap penghuni di Pusat
Serenti Rawang adalah berkesan dan mencapai objektifnya. Ini dapat dilihat
melalui hasil dapatan yang dijalankan bahawa ada perbezaan dari kalangan
penghuni fasa 1 ke fasa 2, 3 dan 4 yang mana perbezaan yang ditunjukkan
menampakkan bahawa semakin lama tempoh kaunseling yang diterima oleh
penghuni, ia semakin berkesan pada diri mereka.
Hasil dapatan kajian juga mendapati bahawa ada peningkatan harga diri di
kalangan penghuni yang telah menjalani program kaunseling. Bolehlah
dikatakan bahawa perubahan pada penghuni menampakkan bahawa mereka
kembali ke tahap yang positif sebelum mereka menjalani program pemulihan
yang membabitkan program kaunseling. Ini menunjukkan bahawa program
kaunseling yang diterima oleh penghuni dianggap berkesan.

RUJUKAN
Agensi Dadah Kebangsaan. (1998). Panduan Kaunseling Rawatan dan

Pemulihan Dadah: Arahan Tetap Ketua Pengarah 2/98. Kuala Lumpur: ADK.
Akta Rawatan Pemulihan Dadah (APD) (1983). Amir Awang. (1987). Teori dan
Amalan Psikoterapi. Pulau Pinang: Penerbit Universiti Sains Malaysia.
Baumeister, R.F. & Tice D.M. (1985). Self-esteem and Response to Success
and Failure: Subsequent Performance and Intrinsic Motivation. Journal of
Personality, 53(3), 34-45. Jackson, B. & Muth, M. (1999). Counseling
Approaches in Treating Cocaine Addiction. Washington DC: National Institute
on Drug Abuse. Dyer, W.W. & Vriend J. (1993). Effective Group Counseling
Process Intervention. Educational Technology, 13, 15-18. Eugster, R. &
Wampold, B.E. (1996). Comprehensive Scale of Psychotherapy Session
Constructs (CSPSC). Flisher, A. J. & De Beer, J. P. (2002). Characteristics of
Students Receiving Counseling Services at The University of Cape Town,
South Africa, British Journal of Counselling, 3(3), 89-94. Goldenson, R.M
(1994). Longman Dictionary of Psychology and Psychiatry. New York:
Longman. Laporan Agensi Dadah Kebangsaan, (1997). Kuala Lumpur: ADK.
Laporan Agensi Dadah Kebangsaan, (2002). Kuala Lumpur: ADK. Mahmood
Nazar Mohamed, Md. Shuaib Che Din & Abdul Halim Othman. (1993).
Alteration of Defense Mechanisms Among Psychoactive Drug Addicts. Kertas
Kerja, XVI World Conference of Therapeutic Communities. Kuala Lumpur.
Mahmood Nazar Mohamed (1999). Memulihkan Penagih Tegar: Implikasi
Kepada Modiliti Masa Kini. Prosiding Kerja Sosial. Sintok: Penerbit Universiti
Utara Malaysia. Mahmood Nazar Mohamed, Md Shuaib Che Din, Lasimon
Matokrem, Muhamad Dzahir Kasa dan Rusli Ahmad. (1999). Penagihan Dadah
dan Residivisme: Aspek-Aspek Psikososial dan Persekitaran. Sintok:
Universiti Utara Malaysia.
Mahmood Nazar Mohamed. (2001). Kaunseling Penagih Dadah: Aplikasi Dalam
Proses Bimbingan dan Kaunseling Di Institut Pengajian Tinggi. Kertas Kerja,
Seminar Kaunseling Kebangsaan Ke III, Universiti Utara Malaysia.
Mohammad Samad. (1998). Proses Pulihkan Penagih Dadah, Utusan Malaysia.
Muhd. Mansur Abdullah. (1993). Kaunseling Teori, Proses dan Kaedah. Kuala
Lumpur: Fajar Bakti. Heppner, P., Kivlighan, D.M. Jr. & Wampold, B.E. (1999).
Research Design in Counseling, (2nd Edition). New York : International
Thomson Publishing Company. Rosenberg, M. (1965). Society and The
Adolescent Self-image. Princeton, N.J.: Princeton University Press. Sekaran,
U. (2000). Research Method for Business. A Skill-based Approach (2nd Ed).
New York: John Wiley and Sons. Sharol Lail Sujak. (2001). Penagih Dadah dan
HIV di Malaysia: Suatu Krisis, Utusan Melayu: Kuala Lumpur. Suradi Salim.
(1996). Bimbingan dan Kaunseling. Kuala Lumpur: Utusan Publication &
Distributors. Syed Arabi Idid (1992). Kaedah Penyelidikan Komunikasi dan
Sains Sosial. Kuala Lumpur: Dewan Bahasa dan Pustaka. Zickler, P. (1999).
Combining Drug Counseling Methods for The Treatment of Cocaine Addiction.
Washington DC: National Institute on Drug Abuse.
Kajian Pengaruh Dadah di Kalangan Pelajar Baru Institusi Pengajian Tinggi
1Profesor Dato’ Dr. Kamarusin Husin, Profesor Dr. Abd Majid Mohd Isa,
Profesor Madya Abdull Halim Abdul, Huzili Hussin & Mohd Amran Hasan , m/s
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KAJIAN PENGARUH DADAH DALAM KALANGAN PELAJAR BARU INSTITUSI

PENGAJIAN TINGGI1
Dr Kamarudin Hussin2 Abd Majid Mohd Isa3 Abdull Halim Abdul4 Huzili
Hussin4 Mohd Amran Hasan5
ABSTRAK
Jawatankuasa Membanteras Gejala Dadah Kebangsaan telah memutuskan

bahawa Kementerian Pengajian Tinggi perlu memantau penyalahgunaaan
dadah dalam kalangan pelajar Institusi Pengajian Tinggi. Satu kajian telah
dijalankan di 16 buah IPTA dan dua buah IPTS. Seramai 3,558 pelajar tahun
satu dipilih secara rawak daripada institusi tersebut telah menjalani ujian air
kencing antara 4-10 Ogos 2005. Di samping itu, satu soal selidik ringkas
telah dijalankan untuk mengetahui latar belakang, pengetahuan kesan,
pengalaman dengan dadah dan melaporkan sama ada responden mengenali
rakan mereka yang terlibat dalam penyalahgunaan dadah. Dapatan kajian
mendapati bahawa dua dalam seribu (0.02%) pelajar IPT positif ujian air
kencing. Profil responden yang didapati positif ujian air kencing pula ialah
mereka yang dibesarkan dalam keluarga sederhana dan dari negeri yang
mempunyai kes penyalahgunaan dadah. Untuk keseluruhan pelajar IPT,
pengetahuan tentang kesan dadah adalah kurang. Berdasarkan kepada
kenyataan mereka sama ada pernah menyentuh dadah dan tahu ada rakan
yang terlibat dengan dadah, risiko pelajar melibatkan diri dalam
penyalahgunaan terutama ekstasi, syabu dan pil kuda adalah
membimbangkan.
1 Kajian diselenggarakan oleh Kementerian Pengajian Tinggi Malaysia untuk

dibentangkan kepada Majlis Tindakan Membanteras Dadah Peringkat
Kebangsaan (MTMD) 2005. 2 Naib Canselor Universiti Malaysia Perlis. 3 TNC
HEPA, Universiti Malaysia Terengganu. 4 Pensyarah Universiti Malaysia Perlis.
5 Ketua Penolong Setiausaha, Kementerian Pengajian Tinggi.
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ABSTRACT
The National Anti-drugs Council has called upon the Ministry of Higher
Education to study the misuse of drugs among students of higher learning
institutions. A study was then conducted at 16 public higher learning
institutions as well as two private higher learning institutions. A total number
of 3,558 first-year students were randomly picked from these institutions to
undergo a urine test between 4th – 10th August 2005. A questionnaire was
also administered to ascertain the respondents’ social background,
knowledge on the ill-effects of drugs, past experiences with drugs as well as
determining whether the respondents knew of friends who were misusing
drugs. The study revealed that that two out of a thousand (0.02%) students
tested positive for drugs. Those who tested positive showed a similarity in
their background profiles whereby they were mostly from middle- class
families who were residing in states that had cases of misuse of drugs.
Generally, it was deduced that the knowledge regarding the effects of drugs
was relatively low among the students of higher learning institutions. Based
on the respondents’ admission to having tried drugs and knowing friends who
were involved with drugs, it can be construed that the risk of students
misusing drugs especially amphetamine-type-stimulants like ecstasy, syabu
and “yoba” is rather alarming.
PENDAHULUAN Mesyuarat Majlis Tindakan Membanteras Dadah (MTMD)

Peringkat Kebangsaan yang dipengerusikan oleh Y.A.B. Timbalan Perdana
Menteri pada 12 Julai 2005 telah memutuskan bahawa ujian urin atau air
kencing hendaklah dilaksanakan ke atas pelajar IPT sebagai satu elemen
pencegahan pengunaan dadah dalam kalangan kumpulan ini. Mesyuarat turut
membuat keputusan agar program-program kesedaran tentang bahaya
penyalahgunaan dadah perlu diadakan di IPT.
Berikutan dengan keputusan ini, satu Mesyuarat Penyelarasan

Aktiviti/Program Pencegahan Dadah di peringkat IPT yang telah
dipengerusikan oleh Ketua Setiausaha Kementerian Pengajian Tinggi telah
diadakan pada 26 Julai 2005. Mesyuarat telah memutuskan tiga perkara.
Pertama, ujian urin diadakan kepada semua pelajar IPTA dan tiga buah IPTS
iaitu UTP, UNITEN dan MMU. Tumpuan awal ujian adalah terhadap pelajar-
pelajar baru sebelum diperluas kepada pelajar-
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pelajar lain. Kedua, program kesedaran tentang bahaya dadah perlu

dimasukkan dalam program orientasi pelajar. Ketiga, supaya dijalankan
Kajian Pengaruh Dadah dalam kalangan pelajar tahun pertama.
Berdasarkan kepada maklumat ini, maka satu kajian telah dijalankan oleh
kumpulan penyelidik untuk meneroka penyalahgunaan dadah dalam kalangan
pelajar tahun pertama.
OBJEKTIF KAJIAN Kajian ini dijalankan untuk: a. Mengenal pasti bilangan

pelajar tahun pertama di IPTA/S yang terlibat dengan penyalahgunaan dadah
b. Membina profil pelajar yang menyalahgunakan dadah c. Meninjau
pengetahuan kesan, pengalaman dan rakan yang terlibat dengan penggunaan
dadah d. Mengenal pasti pelajar yang berisiko tinggi melalui pengetahuan
kesan, pengalaman dan rakan mereka yang terlibat dengan dadah
METODOLOGI Pendekatan Kajian Kajian ini adalah satu kajian penerokaan

dan ianya menggunakan pendekatan deskriptif. Data yang dikumpulkan
dianalisis untuk mencari pola penggunaan dadah dalam kalangan pelajar
tahun pertama di institusi pengajian tinggi awam dan swasta (IPTA/S).
Berdasarkan dapatan yang diperoleh, diharapkan kajian lanjut yang lebih
sistematik dan terperinci dapat dilakukan.
Sampel dan Pemilihan Responden Kajian Sebagai satu kajian penerokaan,

statistik yang diperoleh dijangka dapat meramalkan parameter populasi.
Dianggarkan seramai 280,000 pelajar sedang mengikuti pengajian dalam 17
buah IPTA dan tiga buah IPTS yang ada kaitan dengan kerajaan, maka satu
anggaran sampel kajian perlu dibuat untuk menentukan bilangan sampel
yang minimum.
Berdasarkan teori taburan statistik, formula berikut boleh digunakan untuk
menganggarkan bilangan sampel yang diperlukan.
1-12
Dengan nilai z=1.96 pada aras signifikan p=0.05, dengan andaian tidak
melebihi 2% populasi terlibat dengan dadah dan ralat anggaran 2%, maka n
yang dianggarkan ialah 189. Untuk mengurangkan ralat anggaran, seramai
200 pelajar setiap IPTA/S dipilih secara rawak sebagai responden kajian.
Pemilihan Responden Teknik pemilihan rawak berkumpulan digunakan untuk

memilih 200 responden bagi setiap IPTA/S. Pegawai Perubatan yang
ditugaskan oleh IPTA/S dengan kerjasama pegawai Agensi Antidadah
Kebangsaan (AADK) diminta supaya memilih kelompok pelajar sama ada
mengikut program pengajian, tempat penginapan ataupun kumpulan kuliah
secara rawak. Setelah sampel air kencing diambil, responden diminta
mengisi soal selidik. Jika ujian air kencing adalah positif, sampel hendaklah
dihantar untuk ujian lanjut oleh pegawai AADK.
Ujian Air Kencing Satu alat screening test telah digunakan untuk menguji
sama ada pelajar tersebut positif atau tidak terhadap najis dadah. Alat ini
dikenali sebagai DOA Tests (Drugs Of Abuse in Urine) di mana boleh
mengesan empat jenis dadah sekaligus iaitu Amphetamine (AMP);
Methamphetamine (MET) seperti syabu dan ekstasi; Tetrahydrocannabinol
(THC) iaitu ganja/ marijuan; Opiate (OPI) iaitu morfin serta heroin.
Berpandukan kepada Jadual 1 di bawah, ketepatan alat ujian yang digunakan

ialah 99.7%. Manakala cut-off points yang digunakan adalah berdasarkan
piawai yang telah ditetapkan oleh NIDA (National Institute of Drug Abuse).
Petunjuk nilai cut off points bagi empat jenis dadah adalah 1000 ng/ml bagi
Amphetamine (AMP); syabu, 50 ng/ml bagi Tetrahydrocannabinol (THC);
Ganja/Marijuana, 300 ng/ml Opiate (OPI); Morfin, Heroin dan 1000 ng/ml bagi
Methamphetamine (MET) seperti ekstasi.
Tempoh penahanan (retention period) bagi 3 jenis dadah iaitu Amphetamine

(AMP); syabu, Opiate (OPI); Morfin, Heroin dan Methamphetamine (MET);
Ecstasy adalah selama 2 hingga 4 hari dan 1 - 30 hari bagi dadah jenis
Tetrahydrocannabinol (THC); Ganja/Marijuana.
2
E zpq
n=
1-12
Jadual 1 : Spesifikasi Ujian DOA (Drugs Of Abuse in Urine)
Jenis Dadah Cut off Points Tempoh Kemungkinan Ketepatan Yang Dikesan
(NIDA)* Penahanan Positif Ujian AMP 1000 ng/ml 2 - 4 hari Hari 1 & Hari 4
99.7% THC 50 ng/ml 1 - 30 hari (± 50%) OPI 300 ng/ml 2 - 4 hari Hari 2 & Hari
3 MET 1000ng/ml 2 - 4 hari (± 100%)
Soal Selidik Satu soal selidik ringkas dirangka oleh pasukan penyelidik
(Lampiran). Ia mengandungi empat bahagian iaitu biodata, pengetahuan atau
pengalaman berkenaan dadah, faktor pendorong penyalahgunaan dadah dan
keputusan ujian air kencing. Soal selidik kajian ini adalah seperti lampiran.
Data yang dikumpulkan dianalisis dengan menggunakan pakej SPSS versi

13.0. Peratusan dan ujian statistik yang berkaitan digunakan.
DAPATAN KAJIAN Latar Belakang Responden Kajian Sebanyak 16 daripada 17

IPTA dan dua daripada tiga IPTS terlibat dalam kajian ini. Bilangan responden
ialah sebanyak 3,558 pelajar tahun pertama.
Daripada 3,558 responden kajian, Jadual 2 mendapati bahawa berdasarkan

komposisi gender, 52.2% responden ialah lelaki dan 47.8% ialah perempuan.
Majoriti responden berbangsa Melayu (74.6%). Responden yang berbangsa
Cina ialah 12.1%, Bumiputera Sabah dan Sarawak 8.8%. Kebanyakan
responden (58.5%) datang daripada keluarga yang berpendapatan sedarhana
(RM500 - 2,000). Tiga (3) negeri asal responden yang terbanyak ialah
Kelantan (12.8%), Johor (10.1%) dan Selangor (11.1%)
1-12
Jadual 2 : Latar Belakang Responden (n = 3,558)

Latar Belakang Peratus a. Jantina : Lelaki 52.2 Perempuan 47.8 b. Bangsa :
Melayu 74.6 Bumiputera Sabah/Sarawak 8.8 Cina 12.1 India 3.4 Lain-lain 1.0 c.
Pendapatan Keluarga : Kurang dari RM500 18.4 RM501 - RM1000 30.7 RM1001
- RM2000 27.8 RM 2001 - RM3000 10.4 RM3001 ke atas 12.7 d. Negeri
Dibesarkan : Johor 10.1 Kedah 8.3 Kelantan 12.8 Melaka 3.1 Negeri Sembilan
3.9 Pahang 7.3 Penang 4.6 Perak 9.7 Perlis 1.2 Selangor 11.1 Terengganu 8.3
Sabah 7.0 Sarawak 7.0 Wilayah Persekutuan 5.6
Pelajar IPT yang Terlibat dengan Dadah Seramai 10 daripada 3,558 didapati
ujian air kencingnya positif. Berdasarkan ujian binomial, bolehlah dirumuskan
bahawa daripada 1,000 pelajar tahun pertama di IPT, hanya dua orang sahaja
yang terlibat dalam penyalahgunaan dadah (nilai p=0.004). Profil 10
responden yang ujian air kencingnya positif ialah seperti dalam Jadual 3:
1-12
Pelajar lelaki yang terlibat ialah enam dan perempuan ialah empat orang.
Dari segi bangsa, empat orang ialah Melayu, tiga bumiputera Sabah/Sarawak,
dua India dan seorang Cina. Seramai tujuh daripada 10 (70%) yang didapati
ujian air kencing positif datang daripada keluarga yang berpendapatan
RM1001 - 2000.
Berdasarkan negeri asal, tiga pelajar datang dari Sarawak, masing- masing
dua dari Perak dan Selangor dan masing-masing satu dari Kedah, Terengganu
dan Sabah.
Jenis dadah yang didapati positif ialah tiga orang AMP (amphetamine),
masing-masing dua THC (Ganja/Marijuana), MET (methamphetamine) dan
kombinasi THC dengan OPI (Opium). Seorang positif untuk kombinasi AMP
dengan THC.
Jadual 3 : Profil Responden yang Positif Ujian Kencing
Latar Belakang N (10) a. Jantina : Lelaki 6 Perempuan 4 b. Bangsa Melayu 4

Bumiputera Sabah/Sarawak 3 Cina 1 India 2 c. Pendapatan Keluarga RM500 -
1000 3 RM1001 - 2000 7 d. Tempat Tinggal : Tingkatan 4-5 Asrama 1 Rumah
Sewa - Ibu bapa/penjaga 8 Tingkatan 6/Matrikulasi Asrama 2 Rumah Sewa -
Ibu bapa/penjaga 7 e. Negeri Asal Kedah 1 Perak 2 Selangor 2 Terengganu 1
Sabah 1 Sarawak 3

1-12
f. Jenis Dadah
THC 2 AMP 3 MET 2 OPI - Kombinasi AMP&THC 1 Kombinasi THC&OPI 2
Pengetahuan, Pengalaman dan Rakan yang Terlibat dengan Dadah

Berdasarkan maklumat dalam Jadual 4, tidak semua pelajar tahun pertama
tahu akan kesan mengambil dadah kecuali pil ecstasy (70.3%), ganja (60.4%)
dan heroin (53,8%). Pelajar tahun pertama kurang pengetahuan tentang
kesan dadah kodein (17.4%) dan depresen (19.9%).
Responden yang pernah memegang atau menyentuh dadah dan mengetahui

bahawa rakannya mereka terlibat adalah golongan yang berisiko tinggi.
Empat jenis dadah yang paling ramai pelajar tahun satu pernah pegang dan
sentuh ialah pil ecstasy (2.7%), ganja (2.6%), pil kuda (yaba) (1.5%) dan syabu
(1.5%). Bagi yang mengenali rakan mereka terlibat dengan pula menunjukkan
bahawa dadah yang digunakan adalah empat jenis dadah yang sama.
Jadual 4 : Pengetahuan Kesan, Pengalaman dan Penglibatan Rakan dalam

Dadah
JENIS Tahu Pernah Sentuh/ Ada Rakan DADAH Kesan Pegang Terlibat Pil
Ecstasy 70.3% 2.7% 7.7% Ganja 60.4% 2.6% 10.1% Heroin 53.8% 0.9% 2.4%
Candu 48.9% 0.8% 2.6% Pil kuda (Yaba) 43.9% 1.5% 5.1% Syabu 40.0% 1.5%
5.4% Morfin 38.6% 0.8% 1.2% Depresen 19.9% 0.7% 1.2% Kodein 17.4% 1.1%
0.9%
1-12
Pelajar Berisiko Tinggi Walaupun bilangan pelajar IPT yang terlibat dalam
penyalahgunaan dadah berdasarkan keputusan air kencing ialah 0.02% (dua
dalam 1000), dapatan kajian juga menunjukkan secara tidak langsung pelajar
tahun pertama juga berisiko tinggi. Berdasarkan kepada maklumat dalam
Jadual 5, hanya seramai 1893 (53.3%) tahu akan bahaya empat daripada
sembilan jenis dadah yang biasa disalahgunakan.
Seramai 328 (6.4%) pernah menyentuh sekurang-kurangnya satu daripada

sembilan jenis dadah yang biasa disalahgunakan. Juga, seramai 595 (16.8%)
mengenali rakannya pernah mengambil sekurang-kurangnya satu daripada
sembilan jenis dadah yang biasa disalahgunakan. Jadual 5 : Responden
Berisiko Tinggi
Bilangan Jenis Dadah Bilangan Jenis Dadah yang Tahu Kesan yang Tahu
Kesan Tiada 1 2 3 4 Lelaki Bilangan 496 117 136 132 974 % 26.7% 6.3% 7.3%
7.1% 52.5% Perempuan Bilangan 346 125 138 168 919 % 20.4% 7.4% 8.1%
9.9% 54.2% Jumlah Bilangan 842 242 274 300 1893 % 23.7% 6.8% 7.7% 8.4%
53.3% Bilangan Jenis Dadah Bilangan Jenis Dadah Pernah Disentuh yang
Pernah Disentuh Tiada 1 2 3 4 Lelaki Bilangan 1691 90 42 14 18 % 91.2%
4.9% 2.3% .8% 1.0% Perempuan Bilangan 1632 40 13 5 6 % 96.2% 2.4% .8% .
3% .4% Jumlah Bilangan 3323 130 55 19 24 % 93.6% 3.7% 1.5% .5% .7%
Rakan Terlibat Dengan Rakan Terlibat (Bilangan Jenis Dadah) Bilangan Jenis
Dadah Tiada 1 2 3 4 Lelaki Bilangan 1436 192 100 62 65 % 77.4% 10.4% 5.4%
3.3% 3.5% Perempuan Bilangan 1520 91 51 14 20 % 89.6% 5.4% 3.0% .8%
1.2% Jumlah Bilangan 2956 283 151 76 85 % 83.2% 8.0% 4.3% 2.1% 2.4%
1-12
RUMUSAN Berdasarkan kepada dapatan kajian, kesimpulan yang boleh

dibuat ialah hanya 10 daripada 3,558 orang pelajar tahun pertama IPT, positif
ujian air kencingnya. Oleh itu, hanya dua dalam seribu (0.02%) terlibat secara
aktif dalam penyalahgunaan dadah.
Berdasarkan profil pelajar yang ujian air kencingnya positif, mereka datang
daripada keluarga sederhana dan negeri berisiko tinggi. Walaupun banyak
kempen yang dijalankan dalam menerangkan bahaya dadah, tidak ramai
pelajar yang tahu akan kesan menggunakan sembilan jenis dadah yang biasa
digunakan oleh penagih dadah.
Berpandukan maklumat daripada responden tentang pernah menyentuh

dadah dan mengenali rakan yang pernah mengambil dadah adalah
membimbangkan dan perlu diambil tindakan.
CADANGAN Oleh kerana ini satu kajian penerokaan dan dikendalikan

terhadap pelajar tahun pertama maka dicadangkan agar kajian berterusan
dan berkala kepada pelajar pelbagai peringkat dijalankan. Maklumat yang
diperoleh dapat membantu dalam merancang pelan tindakan yang lebih
efektif, efisien dan menjimatkan kos serta tenaga.
Ujian air kencing secara berkala hendaklah dilakukan oleh pihak berkuasa
IPT. Jika boleh, kuasa untuk mewajibkan pihak berkuasa IPT menjalankan
ujian ini hendaklah diberikan oleh pihak yang berkenaan.
Oleh kerana pelajar masih tidak mengetahui kesan penyalahgunaan sembilan

jenis dadah yang biasa digunakan oleh penagih dadah, kempen yang
berterusan hendaklah dijalankan di IPT.
Satu mekanisme perlu diwujudkan untuk mengurangkan risiko pelajar

terlibat dengan penyalahgunaan dadah. Oleh itu, agensi seperti Agensi
Antidadah Kebangsaan (AADK), Polis dan Pertubuhan Bukan Kerajaan (NGO)
perlu bekerjasama bagi mengurangkan pelajar IPT daripada terdedah dengan
bahaya ini.
1-12
LAMPIRAN
SOAL SELIDIK KAJIAN PENGARUH DADAH DI IPT
A BIODATA (Bulatkan atau isikan ruang berkenaan)
1. Jantina 1. Lelaki 2. Perempuan
2. Bangsa 1. Melayu 2. Bumiputera Sabah/Sarawak 3. Cina 4. India 5. Lain-lain
3. Tempat tinggal semasa a. Tingkatan 1 – 3 1. Asrama 2. Rumah Sewa 3.

Ibu bapa/penjaga
b. Tingkatan 4 – 5 1. Asrama 2. Rumah Sewa 3. Ibu bapa/penjaga
c. Tingkatan 6 / Matrikulasi 1. Asrama 2. Rumah Sewa 3. Ibu bapa/penjaga
d. Di Universiti 1. Asrama 2. Rumah Sewa 3. Ibu bapa/penjaga
4. Pendapatan Bulanan Keluarga : RM ____________
5. IPT :
6. Negeri dibesarkan **
* ** Kod IPTA Kod Negeri 01 UM 01 Johor 02 UKM 02 Kedah 03 USM 03

Kelantan 04 UPM 04 Melaka 05 UTM 05 Negeri Sembilan 06 UUM 06 Pahang
07 UIAM 07 Penang 08 UNIMAS 08 Perak 09 UMS 09 Perlis 10 UiTM 10
Selangor 11 UPSI 11 Terengganu 12 KUiTTHO 12 Sabah 13 KUSTEM 13
Sarawak 14 KUIM 14 Wilayah Persekutuan. 15 KUTKM 16 KUKTEM 17 KUKUM
18 UTP 19 MMU 20 UNITEN
1-12
B. PENGETAHUAN/PENGALAMAN BERKENAAN DADAH
1. Berdasarkan jenis dadah yang disenaraikan di bawah adakah anda tahu

kesannya, pernah lihat atau pegangnya dan adakah terdapat di kalangan
rakan anda yang pernah terlibat/menggunakannya? (Tandakan di ruang
berkenaan).
Jenis Pengetahuan Pernah Rakan Dadah Kesan Sentuh/Pegang Terlibat Tahu

Tak Tahu Ya Tidak Ada Tiada Candu Depresen Ganja Heroin Kodein Morfin
Pil Ecstacy Pil Kuda Syabu
C. FAKTOR PENDORONG
2. Banyak faktor dikatakan mendorong remaja/belia mengambil dadah. Sila

nyatakan pandangan anda tentang faktor berikut. (Bulatkan nombor
berkenaan) Sangat Tak Tak Sangat Penting Penting Pasti Penting Tak Penting
a. Perasaan ingin tahu 1 2 3 4 5 b. Pengaruh rakan 1 2 3
4 5 c. Secara tak sengaja 1 2 3 4 5 d. Masalah keluarga/ tempat
tinggal 1 2 3 4 5 e. Mengatasi tekanan hidup/jiwa 1 2 3
4 5 f. Seronok-seronok 1 2 3 4 5
Kegunaan Urus Setia Keputusan (1. Positif 2. Negatif)
Jenis:
Instruction for Authors
227
Instructions for authors
THE JOURNAL. The Malaysian Anti-Drugs Journal (MADJ) is published two

times a year (June and December) by the National Anti-Drugs Agency,
Malaysia. It receives articles covering treatment and rehabilitation of drug
dependents; prevention of drug use; enforcement; legal and policy issues
pertaining to drugs in Malaysia and the region.
MANUSCRIPTS. Manuscripts should be submitted to the Editor, Malaysia Anti-

Drugs Journal (MADJ), online to MADJEditor@adk.gov.my and carbon copy
(cc) to mahmoodnazar@adk.gov.my. MADJ is refereed journal: all manuscripts
are reviewed anonymously by several readers. Manuscripts should contain (i)
a 200-300 words abstract in English that describe the problem statement of
the study, objectives (and hypothesis), methodology, results and discussion,
or a thematic description, output and implication of the article. (ii) the body
of study that includes current pertinent literature review; problem statement
and rationale of the study; objectives and hypothesis of the study;
methodology which include research design, population, sample,
instrumentations, limitations; results; discussion and implication of the
study. For other articles, reviews and meta-analysis, proper thematic
headings should be provided covering introduction or rationale; pertinent and
current reviews of the themes, discussion, implication and conclusion.
ORIGINALITY. Submission of a manuscript to this journal represents a

certification on the part of the author(s) that it is an original work, and that
neither this manuscript nor a version of it has been published nor is being
considered for publication elsewhere.
COPYRIGHT. Copyright ownership of your manuscript is transferred officially

to National Anti-Drugs Agency, when you submit your manuscrip to MADJ.
Authors can request to withdraw the copyright from MADJ by submitting a
letter to the editor, upon which results in the withdrawal of the manuscrip
from MADJ.
COPIES. The authors will receive one copy of the journal issue. They will be
sent 4 weeks after the journal issue is published and in circulation. Please do
not query the Journal’s Editor about reprints. Additional copies can be
downloaded from the agency’s website at http://adk.gov.my/MADJ, 6 weeks
after the publication of the issues.
For information on the Instruction for Authors please go to:

http://www.adk.gov.my/MADJ/ authors.

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Diterbitkan Oleh: AGENSI ANTIDADAH KEBANGSAAN KEMENTERIAN DALAM

© 2007 Hak cipta terpelihara oleh AGENSI ANTIDADAH KEBANGSAAN

JURNAL ANTIDADAH MALAYSIA 2

Cetakan Pertama 2007

Atur Huruf dan Reka Bentuk Kulit: Persada Ilmu

Dicetak oleh: Percetakan Nasional Malaysia Berhad

KUMPULAN EDITOR : Ketua Pengarang Y. Bhg. Profesor Dr. Mahmood bin

Ahli- Ahli • Y. Bhg. En. Tanasengran Sinnathambi Timbalan Ketua Pengarah

• Y. Bhg. Dr. Sabri bin Zainudin Zainul Pengarah Penguatkuasaan dan

SETIAUSAHA : Pn. Nor Akmal bt. Embong Agensi Antidadah Kebangsaan

PEJABAT EDITOR : Bahagian Dasar, Perancangan dan Penyelidikan Agensi

Kajian Pengaruh Dadah di Kalangan Pelajar Baru 1-12 Institusi Pengajian

Keberkesanan Program Kaunseling Rawatan dan Pemulihan 13-28 Dadah dari

Needle Syringe Exchange Program in Malaysia 29-58 Faisal Hj. Ibrahim

Reading to Recover: Exploring Bibliotherapy as a Motivational 59-72 Tool for

Harm Reduction Programme in Thailand 73-84 Usaneya Perngparn

Relapse Prevention: Strategies and Techniques 85-96 James F.Scorzelli

Trend dan Punca Penggunaan Dadah di Kalangan 111-136 Penagih Dadah

Peranan Kerohanian dalam Menangani Gejala Dadah 137-154 Yuseri bin

Demographic Determinants of the Drug Abuse Problem 155-172 Among

Drug Dependants’ Treatments and Rehabilitation: 193-226 From ‘Cold Turkey’

Drug Dependants’ Treatments and Rehabilitation : From the ‘Cold Turkey’ to

193Dr Abdul Rani bin Kamarudin , m/s 193-226

DRUG DEPENDANTS’ TREATMENTS AND REHABILITATION : FROM ‘COLD

Dr Abdul Rani Bin Kamarudin1

This article concerns the treatment and rehabilitation of drug dependants in

1 Associate Professor, Ahmad Ibrahim Kulliyyah of Laws, International

JURNAL ANTIDADAH MALAYSIA JURNAL ANTIDADAH MALAYSIA

194Dr Abdul Rani bin Kamarudin , m/s 193-226

INTRODUCTION Under Article 38 of the Single Convention on Narcotics

On 8th - 10th June 1998, a United Nations drug summit attended by

2 Malaysia is a party to all three United Nations Conventions, namely, the

Drug Dependants’ Treatments and Rehabilitation : From the ‘Cold Turkey’ to

195Dr Abdul Rani bin Kamarudin , m/s 193-226

THE EARLY STAGES OF COMPULSORY TREATMENT AND REHABILITATION In

Since 1976, every registered medical practitioner, including the government

3 Central Narcotics Bureau, Malaysia (1977), The Drug Abuse Problem in

JURNAL ANTIDADAH MALAYSIA JURNAL ANTIDADAH MALAYSIA

196Dr Abdul Rani bin Kamarudin , m/s 193-226

can evade or escape from undergoing treatment and rehabilitation lawfully.8

ONE STOP TREATMENT AND REHABILITATION CENTRES The development of

Both military and ex-military personnel seconded to these centres deliver

Drug Dependants’ Treatments and Rehabilitation : From the ‘Cold Turkey’ to

197Dr Abdul Rani bin Kamarudin , m/s 193-226

12 National Narcotics Agency, Narcotics Report 1996, Ministry of Home

JURNAL ANTIDADAH MALAYSIA JURNAL ANTIDADAH MALAYSIA

198Dr Abdul Rani bin Kamarudin , m/s 193-226

treatment, and psychological rehabilitation through counseling, sports and

THE SERIOUSNESS OF THE DRUG PROBLEM On the 19th of February 1983,

17 National Narcotics Agency (1997), Kenali dan Perangi Dadah, at pg 67 – 68.

Drug Dependants’ Treatments and Rehabilitation : From the ‘Cold Turkey’ to

199Dr Abdul Rani bin Kamarudin , m/s 193-226

DRUG DEPENDANTS (TREATMENT AND REHABILITATION) ACT 1983 The

19 Anti-Narcotics Task Force, Narcotics Report 1995, pg 4 – 5, Ministry of

JURNAL ANTIDADAH MALAYSIA JURNAL ANTIDADAH MALAYSIA

200Dr Abdul Rani bin Kamarudin , m/s 193-226

Section 3 of the Drug Dependants (Treatment and Rehabilitation) Act 1983,

A person who is detained for suspicion of being a drug dependant must be a

23 Public Prosecutor v Ng Hock Lai [1994] 4 CLJ 1056. 24 The Public

Drug Dependants’ Treatments and Rehabilitation : From the ‘Cold Turkey’ to

201Dr Abdul Rani bin Kamarudin , m/s 193-226

Dependants (Treatment and Rehabilitation) Act 1983, defines a drug