Just how well trained in providing an effective treatment are the rehabilitation centre staff?
he treatment and rehabilitation of drug addicts is a long and painful journey, from drug dependence to a healthy normal life. Not many drug addicts are able to complete that journey as it requires medical care, long term psychological counselling, support from both professionals and the family, effective reintegration into the society and, above all, a strong will to come out of the vicious cycle.
“A time came when I was in so much pain that when I saw a stray dog looking for food from garbage, I wished that I was that dog instead of a drug addict,” recalls Ghulam Nabi*, a 41-year-old community mobiliser and counsellor for Nai Zindagi Drug Rehabilitation Centre. He is one of the fortunate few who were able to put up a fight against heroin addiction.
The trouble started when, at the age of 16, he was rejected by a girl. “I thought my life had ended. I felt that no one was able to understand my pain. I started spending time with friends who were into drugs. I didn’t resist when they encouraged me to try cannabis. For a while, it helped me forget my suffering. I kept taking it and eventually ended up taking my first heroin injection in 2001.”
In 2008, Ghulam Nabi was diagnosed with HIV. He was sharing syringes with some friend who had tested positive earlier. “By that time, I was married and had four children. Luckily, they all tested negative. But that was the turning point for me. I realised that it was not only my pain. My family suffered with me. At that time, I was ready to endure all pain to be able to quit drugs. But sadly, at the cost of my health,” he says.
A report, Pattern of addiction and its relapse among habitual drug abusers in Lahore, Pakistan, published in Eastern Mediterranean Health Journal of World Health Organisation in 2017, identifies parental disharmony, paternal absence or maternal illiteracy as some of the reasons why young boys and girls get attracted to drugs. Other psychosocial factors like loneliness, parental coldness and peer pressure besides curiosity to try new things are other most common reasons reported by drug users.
The report mentions that approximately 15.9 million people inject drugs worldwide, with the largest numbers found in China, America and Russia. Annual prevalence of all illicit drug use in Pakistan was reported as 6 percent in 2013. The annual prevalence in Pakistan of cannabis use is 3.6 percent, opioids 2.4 percent, tranquilisers 1.4 percent, amphetamine 0.08 percent, solvents 0.03 percent and cocaine 0.01 percent. The highest number of intravenous drug abusers among all provinces is in the Punjab, which includes a high ratio of polydrug abuse among addicts in Lahore using heroin and opium together.
According to the National Institute on Drug Abuse of Pakistan, only 11.2 percent of the addicts who need treatment actually seek it. Treatment of drug addiction and rehabilitation services are provided through a wide range of public and private institutes throughout the country. A Google search of such centres in Islamabad shows 66 results. There are six Model Addiction Treatment and Rehabilitation Centres run by Anti-Narcotics Force (ANF) in Islamabad and Sindh.
“These centres have treated 30,895 drug addicts so far. In addition to detoxification and rehabilitation, these centres work on reducing the risk of relapse and re-integration of the recovering addicts in the society besides providing vocational training to detoxified addicts so that they can become a valuable part of the society,” says Anti Narcotics Force Joint Director Ehsan-ul Haq. He says that the services are provided free of cost.
Regarding the process of registering with a facility, he says that it is voluntary and through application. “The only restriction is that these centres don’t accept patients with transmittable or chronic diseases.” As the ANF website mentions, in case of known tuberculosis, cardiac issues, physical disability, severe surgical and psychotic (schizophrenia, major depression, suicidal tendencies and mentally retarded) issues, the patients are referred to other hospitals.
Ehsan-ul Haq says that after the 18th Amendment, the responsibility of establishing such centres has shifted to the provinces. “We have had a great response from Sindh but unfortunately, the response is not as good from other provinces,” he says. He adds that rehabilitation of drug addicts has slowly become a business. “Private rehabilitation centres charge from Rs 500 per night to Rs 10,000 per night depending on the facilities they provide.”
Regarding follow-up of the cases, he says that after treatment which includes detoxification, primary rehabilitation, secondary rehabilitation and job placement, the centres follow-up with the clients every 15 days at the start, and later after each month. “If the patient keeps improving, we extend the follow-up period to three months, then six months and then annual consultation.”
But experts believe that only a few specialised rehabilitation facilities are available for drug addicts in the country. They say that most of such facilities, public or private, resemble jails. Families or guardians admit addicts who then remain confined in these facilities for specific periods. They claim that a majority of the addicts start reusing drugs as soon as they leave the facilities.
Malika Zafar, executive director of Nai Zindagi Drug Rehabilitation Centre, says that in many private facilities, ethical standards are not sustained. “International standards require that a client is first persuaded for rehabilitation and must be allowed to leave the facility anytime. These standards call for long-term counselling with the client and the family, so that they can help an addict come entirely out of the addiction.”
“In our country, the family makes the call and people who use drugs are forcibly admitted to rehab centres. When a person is forcibly admitted in an involuntary rehabilitation centre, he or she ends up scarred and goes back to drugs whenever they get a chance.”
She says that the strategy should focus on “reducing harm” instead of “criminalisation” so that those who want to come out of the addiction can approach rehabilitation facilities without the fear of ending up in jail. She also calls for a regulatory authority to monitor thousands of private rehabilitation centres operating around the country.
Ghulam Nabi agrees with Malika Zafar that an addict’s willingness to quit is the basic prerequisite. “It all starts in fun but ends very ugly. It is very important to create awareness around the dangers of such conduct among the youth. And to make them realise that they can come out of this cycle any time. Only if they are willing to have a healthy and happy life.”
*Name changed to protect the identity.
The writer is a reporter for The News International