TRAINING IN THE REHABILITATION OF DRUG ADDICTS INTRODUCTION DRUGS Drug

8/14/2019 TRAINING IN THE REHABILITATION OF DRUG ADDICTS INTRODUCTION DRUGS Drug

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TRAINING IN THE REHABILITATION OF DRUG ADDICTS


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INTRODUCTION

DRUGS

Drugs are chemical compounds that modify the way the body and mind work. Most

people think that these biological activities should help or heal sick people or animals.

There is, however, no known drug that is not harmful or even poisonous at high

doses, and much of the scientific work on drugs has attempted to widen the gap between

effective and toxic doses.

The word drug has acquired bad connotations in recent years because the

widespread abuse of a few chemicals that affect the central nervous system has become a

serious sociological problem. Nevertheless, drugs act on many other organs in the body,

can benefit as well as harm the nervous system, and have made possible a revolution in

the way modern doctors treat disease.

It used to be said that what distinguishes humans from animals is that people take

drugs. This old adage is no longer quite true. Rats and monkeys that have been addicted

experimentally to some drugs will inject themselves with those drugs to support their

addictions. But otherwise the old saying still holds

History of Drugs

The history of drugs is shrouded in the beginnings of the human race. Alcohol was

made, drunk, and used to excess as far back as memory and records go. Tobacco

(Nicotiana), hemp (Cannabis sativa), opium poppy (Papaver somniferum), and other

plants containing drugs have been chewed and smoked almost as long as alcohol, and

coffee has been served in the Middle East throughout that area's history.

Tobacco was carried from Virginia to England by Sir Walter Raleigh, whose pipe

smoking prompted Elizabeth I to remark, "I don't like this herb." Of course, the queen did

not know anything about tar and nicotine, but she became one of the first people to

initiate the acrimonious debate about tobacco constituents that we face today. Likewise,

the effects of cannabis have given it a bad name.


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Coffee was introduced by the Ottomans to the Western world when the Turks made

a foray into central Europe in the 16th century. Its active alkaloid, caffeine, is often on the

forbidden list for patients suffering from rapid heart beat or angina. Some of the

chemicals that flavor coffee, such as esters of caffeic acid, stimulate cardiac hormones

and thus add to the danger of disturbing the rhythm of the heartbeat.

a. Early Records Of Natural Drugs

Fortunately, some medicine men and women were careful observers, who had a

patient's recovery uppermost in mind. Especially those who had risen to power and

influence and had a scientific bent or deep compassion could be relied upon to search for

valid explanations of their findings.

b. China And The Chinese

One of the oldest records of such medicinal recommendations is found in the

writings of the Chinese scholar-emperor Shen Nung, who lived in 2735 B.C., or 4730

B.P. (before the present). He compiled a book about herbs, a forerunner of the medieval

pharmacopoeias that listed all the then-known medications.

He was able to judge the value of some Chinese herbs. For example, he found that

Ch'ang Shan was helpful in treating fevers. Such fevers were, and still are, caused by

malaria parasites.

The drug consists of the powdered roots of a plant in the breakstone family

(Saxifragaceae, now identified as Dichroa febrifuga, Lour.). Almost 4700 years later, a

group of Chinese chemists isolated two compounds (the dichroines) from the plants, one

of which later proved to control bird malaria.

The leaves of this plant-called Shun Chi or chuine in present-day China-also contain

antimalarial chemicals (the febrifugines), one of which is identical with one of the

dichroines. These alkaloids (organic bases) were studied and synthesized during World

War II in an effort to protect Americans from malaria in the Pacific and other tropical


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campaigns. However, chemists could not separate the nausea the drugs produced from

their antimalarial effects.

c. Ancient Drugs

Much knowledge of early drugs has been lost from every civilization. What remains

is passed on in sporadically recorded epics and folklore unearthed by archaeologists and

linguistic scholars. Tropical and subtropical regions, with their greater variety of plants,

have given us most of the descriptions of these medicines.

Although some ancient drugs have survived throughout the ages and are still used in

a refined form, they amount to a small percentage of modern medications.

d. Hindu

Ancient Hindu records mention eating chaulmoogra fruit to treat leprosy. We now know

that the fruit contains several oils not very effective against leprosy bacteria. Treating the

disfigured areas with these oils has been replaced entirely by swallowing dapsone, a

synthetic drug, or by using other medicines

DRUGS

Drug is any chemical that is not food and that affects your body.

Some drugs are given to people by doctors to make them healthy. These are called

prescription (say pre-scrip-shun) drugs.

Some drugs are natural and can be found in some kinds of food or plants that are

not a normal part of a persons diet.

Some drugs are illegal which means it is against the law to buy, sell or use them.

Some drugs are legal but because they are dangerous to health, the law says that

you have to be an adult to use them.


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Drug addiction

Itis considered a pathological state. The disorder of addiction involves the

progression of acute drug use to the development of drug-seeking behavior, the

vulnerability to relapse, and the decreased, slowed ability to respond to naturally

rewarding stimuli. The Diagnostic and Statistical Manual of Mental Disorders, Fourth

Edition (DSM-IV) has categorized three stages of addiction: preoccupation/anticipation,

binge/intoxication, and withdrawal/negative affect. These stages are characterized,

respectively, by constant cravings and preoccupation with obtaining the substance; using

more of the substance than necessary to experience the intoxicating effects; and

experiencing tolerance, withdrawal symptoms, and decreased motivation for normal life

activities. By definition, drug addiction differs from drug dependence and drug tolerance.

TYPES OF DRUGS USED IN ADDICTION

There are many different drugs, but we can put some of them into three groups by the

effect that they have on the human brain.

Stimulants

(Stim-you-lants) Sometimes called uppers

These drugs stimulatethe central nervous system into working faster.

The heart beats faster.

Blood pressure goes higher.

It can be hard to get to sleep.

The body is so busy it sometimes doesn't feel hungry.

These drugs include caffeine, nicotine, amphetamines, cocaine and ecstasy.

Depressants
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(Dee-press-ants) Sometimes called downers

These drugs have the opposite effect to stimulants. They slow down the central nervous

system.

The heart beats slower.

Blood pressure goes down.

Breathing gets slower.

The body may feel relaxed.

These drugs include alcohol, tranquillisers (tran-kwill-eye-zers), cannabis, and inhalants

(in-hay-lants) and solvents (like glue).

Hallucinogens

(Hal-loo-sin-o-jens) Sometimes called 'psychedelic' (s-eye-k-a-del-ik) drugs.

These drugs alter how a person feels and thinks.

They can have lots of different effects on the mind.

The senses - sight, hearing, taste, touch and smell - may be affected, giving a false

idea of what is happening around the body.

These drugs include LSD and magic mushrooms.

The most serious consequences are abuse and addiction. The drugs most often

associated with abuse ate psychoactive drugs, those designed to alter a persons

experiences or consciousness, in short term, psychoactive drugs can cause intoxication, a

state in which sometimes-unpredictable physical and emotional problems occur.

Drugs causing addiction

Drugs known to cause addiction include illegal drugs as well asprescription or

over-the-counter drugs.
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Stimulants:

o Amphetamine andMethamphetamine

o Caffeine

o Cocaine

o Nicotine

Sedatives andHypnotics:

o Alcohol

o Barbiturates

o Benzodiazepines , particularlyalprazolam, clonazepam,temazepam, and

nimetazepam

o Methaqualone and the related quinazolinonesedative-hypnotics

o GHB and analogues (specifically GBL)

Opiate andOpioidanalgesics

o Morphine and Codeine, the two naturally-occurring opiate analgesics

o Semi-synthetic opiates, such as Heroin(Diacetylmorphine), Oxycodone,

andHydromorphone

o Fully synthetic opiods, such as Fentanyl and its analogs,

Meperidine/Pethidine, and Methadone

Anabolic steroids

Addictive drugs also include a large number of substrates that are currently considered to

have no medical value and are not available over the counter or by prescription.

Addictive potency

The addictive potency of drugs varies from substance to substance, and from individual

to individual

Drugs such as codeine oralcohol, for instance, typically require many more exposures to

addict their users than drugs such as heroin orcocaine. Likewise, a person who is
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psychologically orgenetically predisposed to addiction is much more likely to suffer

from it.

Although dependency on hallucinogens like LSD ("acid") andpsilocybin (key

hallucinogen in "magic mushrooms") is listed as Substance-Related Disorder in the

DSM-IV, most psychologists do not classify them as addictive drugs.

Prevalence

The most common drug addictions are to legal substances such as:

Alcohol

Nicotine in the form oftobacco, particularly cigarettes

The biological basis of drug addiction

Researchers have conducted numerous investigations using animal models and functional

brain imaging on humans in order to define the mechanisms underlying drug addiction in

the brain. This intriguing topic incorporates several areas of the brain and synaptic

changes, orneuroplasticity, which occurs in these areas.

Depressants

Depressants such as alcohol andbenzodiazepines work by increasing the affinity of

the GABA receptor for its ligand; GABA.Narcotics such as morphine and methadone,

work by mimicking endorphinschemicals produced naturally by the body which have

effects similar to dopamineor by disabling the neurons that normally inhibit the release

of dopamine in the reward system. These substances (sometimes called "downers")

typically facilitate relaxation and pain-relief.

Stimulants

Stimulants such as amphetamines, nicotine, and cocaine, increase dopamine

signaling in the reward system either by directly stimulating its release, or by blocking its
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absorption (see "reuptake"). These substances (sometimes called "uppers") typically

cause heightened alertness and energy. They cause a pleasant feeling in the body, and

euphoria, known as a high. This high wears off leaving the user feeling depressed. This

makes them want more of the drug, worsening the addiction.

CHARACTERISTICS OF ADDICTIVE BEHAVIOR

The characteristics of addictive behavior are as below;

1. Reinforcement

Physcially or psychologically reinforcing behavior produces pleasureable physical or

emotional states, or relieves negative ones.

2. Compulsion

The individual feels a a strong compulsive behavior to use drugs.

3.Loss of control

The individual loses control over the behavior and cant block the impulse to engage in it.

4. Esclation

Addiction often involves a pattern of escalation on which more of a particular substances

or activity is required to produce its desired effects.

5. Negative consequences

Such as problems with acadamic or job performance, difficulties with legal or financial

problems/troubles.

THE DEVELOPMENT OF ADDICTION

There is no single cause of addiction.an addiction often starts when a person do

something and thinks will bring pleasure or dull pain, the person is likely to repeat it.
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Then, becomes increasilngly dependent on the behavior and tolerance develops that is,

the person needs more of the behavior to feel the same effect. Eventually, the behavior

becomes a central focus of the persons life and there is detrioration in other areas, such

as school or job performance or personal relation.

Some people may have a genetic predisposition to addiction to particular

substances;such as predisposition may involve variables in brain chemistry, people with

addictive disorder usually have a distinct predisposition for a particular drug addiction.

CAUSES OF DRUG ADDICTION

Causes of drug addiction are as follows;

1.Lack of knowledge

Most people who are addicted have less knowledge about drugs or its

consequences. Mean while awareness of education is is less, as our religion Islam never

admires to use drugs.

2. Easy Availability

If government makes strict rules on such type of things it would and can be

vanished from our society. Easy availability makes everybody curious to buy such drugs.

3. Peer Pressure

It is one of the major causes of addiction. Friends or company makes one good or

bad.if friends are drug addict they will pressurise their non addict friends to take drugs.

4. Poverty and unemployment

Poverty and unemployment is the major causes of addiction especially in the third

worlds countries. They cause depression and frustration and in order to get rid from these

tension people start drug addiction.


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5. Curosity

Mostly ddrug addicts start taking drug because they are curious about the effect ofdrugs. They take it as a thrilling experience but after using them they become addict.

6. Modling

Modling or immitation plays crucial role in learning. If there is any role model in

front of people they may get inspiration from them and start taking drugs. Mass media

can also play a role of modeling.

7. Anger and Depression

It is the wrong notion prevalent in our society that drugs usage reduces depression.

People blindly belive it and start taking drugs out of hope that they are curing their anger

and depression.

8. Lonliness and Disturbed Relations

Usually people are antisocial and have disturbed relation with their spouse and

family may develop frustration. So addiuction seems to them as instant way of coping

with frustration.

9.Excess of Money

Excess of money makes people spoiled. Pampered child with lots of money

induldged in such activities.

10. Fun And Enjoyment

Young boys welcome drugs just for the sake of fun and enjoyment because it makes

them active. They take it as an adventourous experience of their life.


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11. Lake Of Parental Care

Parents who dont have awareness of the activities and where about of their children, arethe major factor in making their children addict.

12. Self medication

Making a new experience s upon self can have dangerous effects and results.

13.Excess Of leisure Time

People with lake of any activity and work load, engaged in such behaviors just for the

sake of new activities. Busy minds are devoid of such thoughts. As it has been said

empty brain is staying spot of evil.

14. Ignorance About Relogion

Lack of religious knowledge and practices, leads to the development of addict

personalities. Money carvings may lead many people to adopt behaviors just like role of

drugs. It is only because that we are ignorant about right means of earning money.

15.Failur In Love

Rejection from loved ones may lead to depression and frustration, which makes them to

take help from drugs.

EFFECTS OF DRUG ADDICTION

A.Effects on individuals

Life is disrupted and become unmanageable.

The whole system becomes unmanagable

Negative attitude and behavior


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Loss of income

Accidents, injuries

Suicide

Retarded growth and development

High risk behavior

2. Effects on Family

disruption of family life

co-dependency

physical, mental and verbal abuse

physical and psychological trauma

3. Effects on Community

crime, rape, assault, murders

accidents

broken homes

Low productivity

Drug Classification

The drugs here are classified in groups, according to their effects

The following drug classification system divides frequently abused drugs into categories

according to how they imitate or interfere with messages within your brain and moving

between your brain and body.

Drug Class Primary Effects/Approved

Medicinal Uses

Names of the

substances

Opiates/Opioidd/

Narcotic Analgesics

analgesia, cough suppression,

antidiarrhea, suppression of opiate

opium, morphine,

codeine, heroin (diacetyl
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withdrawal, sedation; currently used

therapeutically for the first four

effects

morphine), fentanyl,

methadone, meperidine,

L-alpha-acetylmethadol

(LAAM)

Narcotic/Opiate

Antagonists

block the effects of narcotics; used to

treat opiate overdose

naloxone, naltrexone

Psychomotor

Stimulants

stimulate psychological and sensory-

motor functioning; used

therapeutically to treat ADHD and

narcolepsy, sometimes as an appetite

suppressant, occasionally antifatigue,

formerly for asthma and for sinsus

decongestion

amphetamine,

methamphetamine,

cocaine, methylphenidate

Other Stimulants similar to psychomotor stimulants but

with much less efficacy; various

therapeutic effects including caffeine

compounded with aspirin in some

OTC pain relievers, ephedrine in OTC

asthma medicines, pseudoephedrine

in OTC sinus decongestants and OTC

appetite suppressants

caffeine, nicotine,

ephedrine,

pseudoephedrine

Barbiturates general decrease in CNS

arousal/excitability level; used

therapeutically for anesthetic,

anticonvulsant, sedative, and hypnoticeffects

thiopental, secobarbital,

pentobarbital,

phenobarbital

Minor Tranquilizers general decrease in CNS

arousal/excitability level, but low

dose are somewhat selective for

includes two subclasses:

benzodiazepines (e.g.,.

diazepam,
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anxiety and much less sedative than

barbiturates; used therapeutically as

anxiolytics, benzodiazepines also as

anesthetics and anticonvulsants

chlordiazepoxide,

flunitrazepam

[Rohypnol]) and muscle

relaxants (e.g.,meprobamate)

Major Tranquilizers

(antipsychotics/

neuroleptics)

general sedation at high doses, with

selective antipsychotic activity at

lower doses; used therapeutically to

treat schizophrenia and other major

psychotic disorders

haloperidol, pimozide,

flupenthixol,

chlorpromazine,

spiroperidol, clozapine

Antidepressants no perceptible CNS effects in

normals, but effectively alleviate

depression in many depressives; used

therapeutically to treat depression

includes three

subclasses: monoamine

oxidase inhibitors (e.g.,

pargyline), tricyclic

antidepressants (e.g.,

amitriptyline,

desmethylimipramine),

andselective serotonin

reuptake inhibitors

(SSRIs: e.g., sertaline)

Antimanic dampens extreme mood swings in

some people; used to treat manic-

depressive (bipolar) disorders

lithium

Alcohol general decrease in CNS

arousal/excitability level; no currenttherapeutic uses, but formerly used as

an anesthetic and a sedative

ethyl alcohol (other

alcohols have similaractions but are associated

with very toxic effects,

e.g., methanol)

Volatile Anesthetics general decrease in CNS nitrous oxide, halothane,
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arousal/excitability level; used

therapeutically for anesthesia

ether

Volatile Solvents produce feelings of intoxication, can

produce hallucinations at high doses;

no therapeutics uses (all can cause

marked brain damage in moderately

low concentrations

toluene, benzene,

naphtha

Psychogenics produce altered states of

consciousness; hallucinogenics

produce hallucinations sometimes

reported as "mystic" experiences;

cannabinoids usually produce

increased feelings of "well being" and

"mellow" intoxication; the

"pleasantness" of the states produced

by both classes probably depends

partially on expectancies; no

approved therapeutic uses, but

cannabinoids are being increasingly

used for their antinausea, anxiolytic,

and appetite-stimulating effects in

severely ill patients (e.g., AIDS)

includes two subclasses:

hallucinogenics (e.g.,

lysergic acid

diethylaminde [LSD],

mescaline,psilocybin)

andcannabinoids (e.g.,

marijuana, hashish).

Stimulatory

Hallucinogenics (cf.

former

psychotomimetics)

produce a mixture of psychomotor

stimulant and hallucinogenic effects,

depending on dose and other factors;

no therapeutic uses, except

phencyclidine as a veterinary

anesthetic

MDMA (ecstasy),

phencyclidine (PCP),

ketamine (?)

Treatment Approaches for Drug Addiction
http://library.thinkquest.org/C0115926/drugs/inhalants.htm#etherhttp://library.thinkquest.org/C0115926/drugs/lsd.htmhttp://library.thinkquest.org/C0115926/drugs/peyote.htmhttp://library.thinkquest.org/C0115926/drugs/indole_hallucinogens2.htmhttp://library.thinkquest.org/C0115926/drugs/cannabis.htmhttp://library.thinkquest.org/C0115926/drugs/cannabis.htmhttp://library.thinkquest.org/C0115926/drugs/phenalkilamines3.htmhttp://library.thinkquest.org/C0115926/drugs/phenalkilamines3.htmhttp://library.thinkquest.org/C0115926/drugs/anesthetics3.htmhttp://library.thinkquest.org/C0115926/drugs/inhalants.htm#etherhttp://library.thinkquest.org/C0115926/drugs/lsd.htmhttp://library.thinkquest.org/C0115926/drugs/peyote.htmhttp://library.thinkquest.org/C0115926/drugs/indole_hallucinogens2.htmhttp://library.thinkquest.org/C0115926/drugs/cannabis.htmhttp://library.thinkquest.org/C0115926/drugs/phenalkilamines3.htmhttp://library.thinkquest.org/C0115926/drugs/phenalkilamines3.htmhttp://library.thinkquest.org/C0115926/drugs/anesthetics3.htm


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Drug addiction is a complex disorder that can involve virtually every aspect of an

individual's functioning in the family, at work, and in the community. Because of

addiction's complexity and pervasive consequences, drug addiction treatment typically

must involve many components. Some of those components focus directly on the

individual's drug use. Others focus on restoring the addicted individual to productive

membership in the family and society.

Drug addiction is a complex but treatable brain disease. It is characterized by

compulsive drug craving, seeking, and use that persist even in the face of severe adverse

consequences. For many people, drug addiction becomes chronic, with relapses possible

even after long periods of abstinence. In fact, relapse to drug abuse occurs at rates similar

to those for other well-characterized, chronic medical illnesses such as diabetes,hypertension, and asthma. As a chronic, recurring illness, addiction may require repeated

treatments to increase the intervals between relapses and diminish their intensity, until

abstinence is achieved. Through treatment tailored to individual needs, people with drug

addiction can recover and lead productive lives.

The ultimate goal of drug addiction treatment is to enable an individual to achieve

lasting abstinence, but the immediate goals are to reduce drug abuse, improve the

patient's ability to function, and minimize the medical and social complications of drug

abuse and addiction. Like people with diabetes or heart disease, people in treatment for

drug addiction will need to change behavior to adopt a more healthful lifestyle.

In 2004, approximately 22.5 million Americans aged 12 or older needed treatment

for substance (alcohol or illicit drug) abuse and addiction. Of these, only 3.8 million

people received it. (National Sruvey on Drug Use and Health (NSDUH), 2004 )

Untreated substance abuse and addiction add significant costs to families and

communities, including those related to violence and property crimes, prison expenses,

court and criminal costs, emergency room visits, healthcare utilization, child abuse and

neglect, lost child support, foster care and welfare costs, reduced productivity, and

unemployment.
http://www.oas.samhsa.gov/NSDUH/2k4NSDUH/2k4results/2k4results.htm#ch7http://www.oas.samhsa.gov/NSDUH/2k4NSDUH/2k4results/2k4results.htm#ch7


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Medical management of withdrawal syndrome is only the first stage of addiction

treatment and by itself does little to change long-term drug use.

Treatment does not need to be voluntary to be effective.

Possible drug use during treatment must be monitored continuously.

Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C,

tuberculosis, and other infectious diseases, and should provide counseling to help

patients modify or change behaviors that place themselves or others at risk of

infection.

As is the case with other chronic, relapsing diseases, recovery from drug addiction

can be a long-term process and typically requires multiple episodes of treatment,

including "booster" sessions and other forms of continuing care.

Effective Treatment Approaches

Medication and behavioral therapy, alone or in combination, are aspects of an overall

therapeutic process that often begins with detoxification, followed by treatment and

relapse prevention. Easing withdrawal symptoms can be important in the initiation of

treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as

with other chronic conditions, episodes of relapse may require a return to prior treatment

components. A continuum of care that includes a customized treatment regimen,

addressing all aspects of an individual's life, including medical and mental health

services, and follow up options (e.g., community- or family-based recovery support

systems) can be crucial to a persons success in achieving and maintaining a drug-free

lifestyle.

Medications

Can be used to help with different aspects of the treatment process.

Withdrawal:

Medications offer help in suppressing withdrawal symptoms during detoxification.

However, medically assisted withdrawal is not in itself "treatment"it is only the first

step in the treatment process. Patients who go through medically assisted withdrawal but


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do not receive any further treatment show drug abuse patterns similar to those who were

never treated.

Treatment:

Medications can be used to help re-establish normal brain function and to prevent relapse

and diminish cravings throughout the treatment process. Currently, we have medications

for opioid (heroin, morphine) and tobacco (nicotine) addiction, and are developing others

for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction.

Methadone and buprenorphine, for example, are effective medications for the treatment

of opiate addiction. Acting on the same targets in the brain as heroin and morphine, these

medications block the drug's effects, suppress withdrawal symptoms, and relieve craving

for the drug. This helps patients to disengage from drug-seeking and related criminal

behavior and be more receptive to behavioral treatments.

Buprenorphine:

This is a relatively new and important treatment medication. NIDA-supported basic and

clinical research led to the development of buprenorphine (Subutex or, in combination

with naloxone, Suboxone), and demonstrated it to be a safe and acceptable addiction

treatment. While these products were being developed in concert with industry partners,

Congress passed the Drug Addiction Treatment Act (DATA 2000), permitting qualified

physicians to prescribe narcotic medications (Schedules III to V) for the treatment of

opioid addiction. This legislation created a major paradigm shift by allowing access to

opiate treatment in a medical setting rather than limiting it to specialized drug treatment

clinics. To date, nearly 10,000 physicians have taken the training needed to prescribe

these two medications, and nearly 7,000 have registered as potential providers.

Behavioral Treatments

They help patients engage in the treatment process, modify their attitudes and

behaviors related to drug abuse, and increase healthy life skills. Behavioral treatments


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can also enhance the effectiveness of medications and help people stay in treatment

longer.

Outpatient behavioral treatmentencompasses a wide variety of programs for patients

who visit a clinic at regular intervals. Most of the programs involve individual or group

drug counseling. Some programs also offer other forms of behavioral treatment such as:

Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and

cope with the situations in which they are most likely to abuse drugs.

Multidimensional Family Therapy, which addresses a range of influences on the

drug abuse patterns of adolescents and is designed for them and their families.

Motivational Interviewing, which capitalizes on the readiness of individuals to

change their behavior and enter treatment.

Motivational Incentives (contingency management), which uses positive

reinforcement to encourage abstinence from drugs.

Residential treatmentprograms can also be very effective, especially for those with more

severe problems. For example, therapeutic communities (TCs) are highly structured

programs in which patients remain at a residence, typically for 6 to 12 months. Patients in

TCs may include those with relatively long histories of drug addiction, involvement inserious criminal activities, and seriously impaired social functioning. TCs are now also

being designed to accommodate the needs of women who are pregnant or have children.

The focus of the TC is on the re-socialization of the patient to a drug-free, crime-free

lifestyle.

Treatment within the criminal justice system can succeed in preventing an offender's

return to criminal behavior, particularly when treatment continues as the person

transitions back into the community. Studies show that treatment does not need to be

voluntary to be effective. Research from the Substance Abuse and Mental Health Services

Administration suggests that treatment can cut drug abuse in half, reduce criminal

activity up to 80 percent, and reduce arrests up to 64 percent.*


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DOST WELFARE FOUNDATION

Dost foundation is a non profit NGO providing a comprehensive range of drug

demand and drug harm reduction services in various settings, it works for the human

rights, rehabilitation and social reintegration of vulnerable groups in prisons, that is , drug

users juvenile offenders, women and children. it was found in 1992 with over 100

persons, it provides a.continum of care and quality services through its programs for drug

abuse prevention, detoxification, rehabilitation, vocational skills training, human rights

protection legal-assistance, research and networking with government departments, civil

society organizations and community groups.

Main objectives:

Treatment and rehabilitation of drug users.

Out reach harm reduction services for street drugs users.

Drug abuse prevention among different community groups.

Human rights protection and social integration of vulnerable prisoners.

Training and capacity building of NGOs, CBOs, GOs students and community

groups.

Development of awareness and resource materials.

Net working with national NGOs.

DOST DROP IN CENTERS (DIC)

Dost foundations have established two DICs in Peshawar and one in Kohat. These

three DICs are in close proximity to the street sights where the drug users are found

and are providing drug harm reduction, HIV prevention a and social services to the

street drug users. Detoxification and out patients rehabilitation services are also

provided in these DICs

These are:


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1. Dar-ul-salam Dic:

It was established in 1995 and located in Sikandar Town area of Peshawar city. It serves

the mixed street drug addict population comprised of clients from all provinces of

Pakistan and Afghanistan.

2. Dar-ul-Shifa Dic:

It was established in 2000 and located in Hayatabad Industrial estate on the border

between Peshawar and the Tribal areas. It also serves the street drug edicts comprised

largely from Afghans.

3. Dar-ul-shifa dic (Kohat):

It was established in 2003 and located in sheno khel area of kohat and serves the clients

of Kohat and the adjoining tribal areas, particularly from the Darra Adam Khel.

CORE CONCEPTS

1. Therapeutic concepts

2. Self help basis

3. 12 steps of NA(Narcotic Anonymous) and AA(Alcoholism Anonymous)

4. Culture and religion

TREATMENT PHASE

1. Preadmission

a. Counseling

b. Assessment

2. Detoxification

a. Symptomatic treatment

b. Bath therapy and open door policy

c. Peer to peer counseling

3. Reintegration with family and society

a. Personal growth

b. Life satisfaction

4. Primary Rehabilitation

a. individual and group counseling


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b. Lectures duty

c. Therapeutic duty

d. Behavioral therapy

e. Family programming

f. Vocational Therapy

RECOVERY GOALS

a. Recovery from emotionally short tempered also social, physical and spiritual

recovery.

b. Emotional treatment including commitment to drug free life

c. Low esteem (self acceptance).

d. Adaptation to work and responsibility

e. Reintegration with family and society.

f. Personal growth and life satisfaction

5. SECONDARY REHABILIATION

a. community development

6. AFTER CARE AND FOLLOWUP

b. home visit

c. Letters

d. Lectures on Thursday and Friday

12 STEPS OF DOST FOUNDATION

1. Foundation

2. Hope

3. Faith and Surrender

4. Self Analysis

5. Sharing and confession

6. To attend the lectures

7. Ready to change

8. Youth project


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9. Social interaction

10. Continue positive change

11. Prayer and medication

12. Carry NA (Narcotics Anonymous) message

DOST THERAPEUTIC PROGRAMS AND THERAPEUTIC COMMUNITY

It includes:

1. Family programs

2. Prevention programs

3. Narcotics anonymous meeting

4. Sakoon core crises intervention programs

5. Street addicts therapeutic community

6. Asra care center therapeutic community

7. Male prison

8. Youth project

9. Training for human resource development

10. Juvenile offender TC in central jail Peshawar

11. Female prison


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VISIT TO DOST FOUNDATION

We the students of Women Institute of Learning (WIL) visited Dost Foundation

twice for our assignment purpose regarding to internship process in March, 2008 with our

staff members.

1ST VISIT

1st visit was held on 19th of March. The organizational staff received us and first one of

their members (a female Barekhna) gave us a short introductory lecture about Dost

Foundation and its exclusive works and therapeutic processes. Then a psychologist

named Arshad gave us a lecture and told us lot more about Drugs, types of drugs and

also what type of treatments they use in Dost Foundation. After taking lecture we went to

the hall where we had to take case histories from patients. There two staff members

Muhammad Nabi and Managing director Muhammad Ayub also gave us lecture and

explained the model of treatment of the addicts and steps involved in it. Then addicts

were referred to us and we took case history and also gave them counseling and guidance.

2ND VISIT

The second visit was held on 27th march. We visited all the departments under the

supervision of Muhammad Nabi and also took case history of second patient. In all

department and rooms we talked to the patients who were taking treatments and also

doing work there. We asked their views about the institute as well. All were happy and

satisfied there. It was a really knowledge gaining trip to that institute.


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CASE HISTORIES OF THE DRUG ADDICTS

CASE HISTORY 1.

Name: Suleman

Gender: Male

Age: 22

Marital status: Single

Religion: Muslim

Education: 5th

Occupation: Motor mechanic

Siblings: 5

Birth order: 1st

The client belonged to a middle family and is from a Pathan family. He is getting

treatment from 36 days. He started drugs at the age of 15 due to peer pressure, he took

start from Hash and with the passage of time his demand for the drugs increased and he

used tablets and injections as well. His chief complaints were restlessness, shivering of

body, sleeplessness, aggression. He even tried suicidal attempts and also tried to injure

others after usage of the drugs. He used to cut his body to get relaxed while using drugs.

His father brought him in the institute and now he wants to get rid from drugs to live a

healthy life. And he got positive improvement from the institute.


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CASE HISTORY 2.

Name: Muhammad Arshad khan

Age: 56

Marital status: yes but wife dead

Religion: Muslim

Education: nil

Occupation: shopkeeper

Siblings: 9

Birth order: 1st

He is from a Pathan family; he was in the institute since 3 months. He started drug

addiction at the age of 26 just for fun with friends. His demand increased and reached to

high level when his elder son died at the age of 20, later his wife died and after that his

second son of 12 years died as well. Due to theses shocks he started alcohol, injections

and lived life like animals. But later his brother brought him into Dost Foundation where

due to proper care he is getting well. His chief complaints were sleeplessness, tiredness,

body shivering, and aggression. But due to proper treatment and care he is getting much

better and now he wants to live healthy life and to be a perfect Muslim and offer his

prayers. He said that he want to die with peace and people may take him to grave with

respect not hatter .he is much better now.


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REFERENCES

Khan,A.P. (2004-2005). Annual Report Dost Foundation. Peshawar Pakistan.

Neal,T.M. & Davison, G.C. (1975). Abnormal Psychology. (8th ed.).

New York. John Willey & Sons. Inc.

Paul, M.l. et al. (1950). Core Concepts In Health. (8th ed.). London: May

Field Publishing Company.

Nora, D. Volkow, M.D. (2001).NIDA Research Report - Prescription Drugs:

Abuse and Addiction:NIH Publication No. 01-4881, Printed 2001. Revised

August 2005.

TRAINING IN THE REHABILITATION OF DRUG ADDICTS INTRODUCTION DRUGS Drug

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