An Approach to Drug Addict Rehabilitation

Abstract

No nation on earth is untouched by the effects of drug abuse. The problem has reached such a proportion that it has become a global threat (Tabani). From the impoverished villages where drugs are grown to the modern cities where they are ultimately sold, drugs follow a complex route that hits every country in the world; Bangladesh is no exception. As drug abuse and international drug trade are ever increasing global threats. There are millions of drug-addicted people in Bangladesh and most of them are young, between the ages of 18 and 30. And they are from all strata of the society.

A recent epidemiological survey carried out in the three divisions of Bangladesh shows that the country is going to be transformed into a potential user of drugs with the rapid increase in the number of addicts. For the safety of our people and the society from this deadly game, we have to control illicit drug transportation immediately. Bangladesh finds itself struggling against a powerful force that has become a “menace to the society.”

To address drug and substance abuse, Bangladesh requires a drug program that takes a comprehensive approach and works to change the psychology and behavior of addicts through drug addict rehabilitation and aftercare.

Current Scenario

The number of drug addicts has increased alarmingly, especially among the young generation in the past few years. Earlier, drug addiction was associated with the lower class of the city. “These days it has become a pressing problem for all segments of the society. People from all walks of life; students, teachers, businessmen, rickshaw pullers and workers are all becoming addicted to chemical substance.” stated Nehal, a volunteer working at APON. The immeasurable price of addiction is reflected on the medical costs, wasted potential, family problems and the social misery. (Quoreshi) Research shows that many of the users first take drugs as a sort of experiment or adventure (Brother Ronald). It is considered “trendy” and “smart” among the youngsters to indulge in them. After using the drug several times, they develop an overwhelming craving for the substance, often accompanied by physical dependence and gradually gliding into addiction (Firoz). The addicts will resort to anything to acquire the drug of their choice. As a large percentage of the addicts are not financially independent, many of them resort to criminal activities to support the habit. (Momin)

Drug addiction and type of drugs

What is drug addiction?

The word addiction means getting habituated with something. In case of drugs when a human body gets dependent on some stimulating things, and after a certain period it creates a habit which means that the body has become dependent on the stimulant which is addiction. World Health Organization (WHO) defines it: Drug is a chemical substance of synthetic, semi synthetic or natural origin intended for diagnostic, therapeutic or palliative use or for modifying physiological functions of man and animal.

A drug abuser can undergo different stages of tasting apart from normal lifestyle. Drug abuse can decay normal human senses through deep feelings. It creates different types of excitement both in the body and mind. Finally, it makes a person passionate to drugs. In the long run the user has to increase the dose day by day.
Addiction has some stages.

a) Initial stage
b) Pre-mature stage
c) Mature stage and
d) Dangerous stage

a) Initial stage (starting): This is the first stage of drug addiction. At first, a person starts to take drug without concerning his body. At the early stage he takes it just normally, and gets the ordinary happiness, which makes him feel better. Sometimes, he wants to touch heavenly excitement and dreams himself as a floating constituent in the sky. This is the first stage of drug abusing. Amateurs are in this group. They take drug once or twice a week with their friends or seniors in their locality, who are already addicted. He collects it and processes it to take.

b) Pre-mature stage (the real test of drug): In this stage, drugs become a habit, and the abuser wants more. Feeling better s/he tries to increase the dosage drugs. It is taken at least 4-5 times a week. This is the primary stage for abusers in becoming addicted. At the initial stage they can easily manage or collect the money for purchasing. They collect money from their family, and sometimes from other sources. They take drugs with their friends. After a few days they need to take more and become dependent on it both mentally and physically. The sudden need for excess money, involvs them in criminal acts like hijacking, and they feel thrilled to do it.

c) Mature stage: After the pre-mature stage abusers become seriously addicted. They have to take it every day, after a certain period. In maximum of cases it is taken from evening to night time. For that, they are busy all day long in collecting the expenditure of drug. They need much more money for it and sometimes they turn against the law. Many discontinue their education after failing to concentrate on any kind of discipline. They forget social protocol, always remain bad tempered and feel they are always in the right. They do not want to hear any advice and count themselves as very aware and competent. Sometimes they feel frustrated and even lose the will to live.

d) Decaying stage: After mature stage most of the abusers stay on the verge of decaying. It means gradually their lives crumble. They can realize, how imbalanced they are. They lose taste for food. At this stage they become fully dependent on drug, gradually after a few hours they have to take it, otherwise their body system stops. In that situation the abuser loses human characteristics and behaves like a monster. They have no sense to evaluate good or bad, to enjoy anything, they lose interest in normal male/female yeamings. And finally one day they fully surrender to drugs, which lead them to their graves.

II. Types of drugs found in Bangladesh

There are three types of drugs available in use in Bangladesh.
1. Opium
a) Heroin
b) Phensidyl
c) Tidijesic
d) Pethidine

2. Cannabis
a) Ganja
b) Chorosh
c) Bhang
3. Sleeping pill
a) Tranquilizer
b) Seduxene (Diazapam)

c) Opium
In Bangladesh, the drugs mostly in use are phensidyl, cannabis and heroine. There is also an increasing number of Intravenous Drug Users or IDUs in Bangladesh. (Satparkash). Phensidyl, Bangladesher Dak, an online news channel explains that until it was banned in the early eighties, phensidyl (commonly known as phensi or dyl), was a cough syrup prescription drug used as an antidote for cold. According to Dr Ali Askar Quoreshi, the owner of Mukti Drug Treatment Center, it was not until the early nineties that it was recognized as a narcotic substance.

Phensidyl: Now it can safely be said that phensidyl is the most popular drug among the youngsters in the city. In the article The drug scenario in Dhaka, it states that the main ingredient of phensidyl is codeine phosphate. Codeine dulls the sensation and produces an artificial sense of comfort. The users of this drug drink many cups of tea with lots of milk and sugar and smoke cigarettes claiming that these help linger the feeling (Drug Scenario). In fact, while talking with Mohammad Ali, a street tea stall owner in Wari, it was evident that many of the roadside tea-stalls including his, make special tea for the phensidyl addicts with lots of sugar and milk calling it “dyl-cha” (cha is tea in Bangla).

However, the users rarely get the chance to taste phensi in its pure form. Once it reaches the hands of the dealers; many other substances like sweeteners and cough syrups are mixed with it. Moreover the bottles are stored in dirty and unhygienic places. Phensidyl can be found anywhere in the city, but the main spot is the old town area where most addicts thrive. “Peddlers appointed by the main dealers carry out the actual process of selling the drugs” (Momin). Unfortunately, most of this occurs right under the nose of the law enforcement authorities, said the founder of APON, Brother Ronald. He added that the police take money from the drug dealers. This shows that the local police force is deeply involved in the illegal trade. He also explained that although peddlers are arrested, soon after they are released. These raids are carried out when there is a disagreement over the dealer and the police over money issues.

Cannabis
Ganja or cannabis was legally cultivated in Bangladesh for a long time (Momin). Kashif Tabani’s Senior Project states that even though the government banned its cultivation, it is still being surreptitiously grown in many parts of the country. However, most of the cannabis used here are smuggled from India, Nepal and Myanmar and is much more potent.(Firoz). Cannabis is widely used in the country because of its low price and ample availability. It is sold in different forms such as Puria (5-10 Taka/US $0.08-0.16), and Shiki (25 Taka/ US S$0.40) (Momin).

The cannabis plant is made of a hallucinogen called tetrahydrocannabinnol, the active ingredient of the drug. The top, twigs and leaves of the female plant are dried and smoked like tobacco for the hallucinogenic affect, stated Dr Vivek Vishal, the Indian resident medical doctor at Prottay Drug Treatment Center. Addicts also purchase cigarettes made of ganja, but the die-hard pot smokers prefer using clay pipes. Ganja users, usually get together in gatherings known as addas/ashars (Drug – Abuse). One striking thing about the side effect of ganja ashars is that the participants all appear very happy and cheerful. They break into helpless laughter over the most normal things (Nehal). This drug has been glamorized amongst youngsters by its use by western pop stars like Bob Marley and Jim Morrison (Momin). Surprisingly, many of the Bengali band musicians also follow suit and that provokes the adolescent clan even more (Chowdhury).

Heroin
Another substance that gained popularity in the eighties is heroin (Tabani). Though its prevalence is a lot less, it is still a favorite among many. Heroin, a derivative of opium was initially introduced as a painkiller (Momin). It is the most dangerous drug in the sense that people can get addicted from the first day of using it (Satparkash). As described in The Drug Scenario in Dhaka, the dealers use homeopathic powder sugar, fertilizers and other such harmful substances with the brown sugar, which itself is an impure form of real heroin and is very expensive. Heroin users suffer from severe withdrawal symptoms making it harder for them to get rid of the habit. In most cases these addicts turn to more heinous forms of crime and become aggressive with family members. (Brother Ronald)

Intravenous Drug Users (IDUs) Recently, according to Dr Robert Kelly, the country Director of Family Health International, a group of addicts known as Intravenous Drug Users have started mushrooming. This new trend has brought in a high extent of vulnerability towards HIV/AIDS. He also added that according to available data, 90% of IDUs acquire this disease through the sharing of needles.

The drug that is injected by IDUs is called buprenorphine or tejiti acid locally (Vishal). It is injected straight into the veins and is mixed with other substances such as painkillers beforehand. “The addicts push the needle into their skin and wait for it to bleed which is the sign that it has hit the vein and then pushes the needle in. That way, the syringe not only has left over substance but also has blood from the user’s body. So, when that same syringe and needle are used amongst twenty to thirty people at the same time, germs like HIV spread easily” (Kelly). One reason people turn to this substance is because it is the cheapest. Usually heroin addicts start injecting themselves with buprenorphine when the cost of heroin increases (Satparkash). Institutional Response According to all the interviewees, it is not possible to completely eradicate drug abuse in today’s world. In some western countries, like Holland, as cited in the article by Syed A. Momin, drugs have been legalized. However, considering our socio-economic realities in Bangladesh, it is not possible to do so. In order to bring down the level of addiction in the country, the roots of the problem must be investigated (Brother Ronald). As long as there is frustration, social inequality, lack of opportunities, entertainment and employment, the problem will persist (Chowdhury). One solution to this problem seems to be good rehabilitation centers.

Khat:
Khat (pronounced cot) is a natural stimulant from the Catha Edulis plant, found in the flowering evergreen tree or large shrub which grows in East Africa and Southern Arabia. It reaches heights from 10 feet to 20 feet and its scrawny leaves resemble withered basil.

Fresh Khat leaves are crimson-brown and glossy but become yellow – green and leathery as they age. They also emit a strong smell.

The most favored part of the leaves are the young shoots near the top of the plant. However, leaves and stems at the middle and lower sections are also used.

Khat leaves contain psychoactive ingredients known as cathinone, which is structurally and chemically similar to d-amphetamine, and cathine, a milder form of cathinone.

Fresh leaves contain both ingredients ; those left unrefrigerated beyond 48 hours would contain only cathine, which explains users preference for fresh leaves.

Other names by which Khat is known include: Qat, Kat, Chat, Kus-es-Salahin, Mirra, Tohai, Tschat, Catha, Quat, Abyssinian Tea, African Tea, and African Salad.

Effects of Khat
Fresh Khat leaves, which are typically chewed like tobacco, produce a mild cocaine or amphetamine-like euphoria that is much less potent than either substance with no reports of a rush sensation or paranoia indicated.
By filling the mouth to capacity with fresh leaves the user then chews intermittently to release the active components. Chewing Khat leaves produces a strong aroma and generates intense thirst.
Casual users claim Khat lifts spirits, sharpens thinking, and, when its effects wear off, generates mild lapses of depression similar to those observed among cocaine users.
Since there appears to be an absence of physical tolerance, due in part to limitations in how much can be ingested by chewing, there are no reports of physical symptoms accompanying withdrawal.
Advocates of Khat use claim that it eases symptoms of diabetes, asthma, and stomach/intestinal tract disorders, Opponents claim that Khat damages health, suppresses appetite, and prevents sleep.
Reasons for being addicted to drugs

• Easy access to drugs
• Unemployment problem/economic insolvency
• Surrounding atmosphere
• Estranged in love
• Mental stress due to family problem

Sources of money for buying drugs
• From own income
• From pocket money
• Loan from friends, family members
• Collect money by criminal activities like hijacking, extortion etc.

Where from respondents collect drugs/the nearest drug spots
• Specific sellers in the locality
• Drug smugglers in town
• Houses near border area
• Drug smugglers in border crossing points
• From police, BDR
• Spots beside lanes/roads

Persons involved in drug business/smuggling: Respondents opinion
• Some elites in society
• Some political leaders/so-called student leaders
• A syndicate of smugglers
• Some members of the police/BDR

Causes why respondents change drugs one after another
• A tendency to increase the dose because the same dose doesn’t create the desired effect.
• Impatience in body and insomnia in not having drug after a certain time.
• A psychological and physical dependence on the effects of the drugs.
• to feel better
• Easy access to other drugs
• Lower cost
• Adventure in tasting different drugs
• Desire to have an extreme taste of addiction

Negative effects due to drug abusing: Respondents view
• Physical impatience
• Insomnia
• Sense of perception doesn’t work
• Increased head-ache
• Feeling dizziness until taking drugs
• Hallucination syndromes
• Decreased working capability and stability
• Sexual problem
• Abnormal behavior
• Loose humanity and every kind of assessment
• Lack of discipline in daily life

Suggestions of respondents to get rid of drug addiction
• Personal will is the main way to get rid of addiction
• Creating more employment opportunities
• Ensuring proper treatment and rehabilitation measures
• Healthy drug free working environment
• To involve in any creative work
• To avoid mixing with bad company
• Enactment of articles on anti-drug issues in the text books and newspapers
• Media campaign against drugs

Changes in social behavior according to the respondents
• Increased hijacking
• Increased extortion
• Increased stealing, robbery
• Deteriorated law and order situation and respect ness to elder
• Increased personal and family expenditure
• Lost of interest in education
Change in morality

Case Study

Study 1:
Personal Profile: The victim of this case is a young chap named Khaled. Though he is 20 years of age, he looks like a man of 40 years. He continued up to class eight and afterwards was involved in a clothing business. His monthly income is around Tk. 3000. His father also earns. Total family member is 7.

Main findings: He has been useing drugs for 10 years. He started to use drugs since he was a schoolboy. Firstly, his friends introduced him to drugs as a means of enjoyment. Gradually he became addicted. He started with ‘ganja’. He sometimes changes his drugs to meet his satisfaction level. He changes drugs one after another from ‘ganja’, ‘phensidyl’, and ‘wine’ to ‘heroin’. Now he is fully addicted to ‘heroin’, and has to take it four times in a day. Without having it he can’t do anything. He has to take at least two ‘puria’s of ‘heroin’ every morning. A psychological and physical dependence has grown in his body. He spends Tk. 80-100 everyday for drugs. Sometimes, for collecting money, he turns to hijacking. He collects drugs from local spots or from particular persons. These drugs come mainly from India through Bibir Bazar border area.

Study 2:
Personal Profile: He is Masum (21), looks healthy, studying at graduate level. His monthly pocket money is approximately Tk. 1000. His father is the only earning member of the family consisting of seven members.

Main findings: He has been drug abused for the last 2 years. He started drugs as enjoyment through friends. He started with ‘ganja’. He changes his drugs for more satisfaction. Now he is fully addicted to ‘heroin’, and has to take it at least twice a day. Without having it he can’t do anything. He has to take at least a puria heroin every morning. He spends Tk. 80-100 everyday for drug purposes. For the excess money, sometimes he takes loan from friends or steals his own household materials. He collects drugs from the local spots or a particular person

Institutional Response According to all the interviewees, it is not possible to completely eradicate drug abuse in today’s world. In some western countries, like Holland, as cited in the article by Syed A. Momin, drugs have been legalized. However, considering our socio-economic realities in Bangladesh, it is not possible to do so.

In order to bring down the level of addiction in the country, the roots of the problem must be investigated (Brother Ronald). As long as there is frustration, social inequality, lack of opportunities, entertainment and employment, the problem will persist (Chowdhury). One solution to this problem seems to be good drug addict rehabilitation centers.

The Organizations involved for drug addict rehabilitation:

Bangladesh has quite a few drug treatment centers. Two prominent drug treatment centers are Mukti and Prottay. Unfortunately they only provide medical treatment and which usually leads to unsuccessful outcome. As a result, addiction remains a huge problem in the country.

Mukti

Mukti, the first center for treatment of drug addicts and mentally ill people was built in 1988 in a small house in Eskaton by Dr. Ali Askar Quoreshi (Mukti). Over time, it kept growing and now has two branches; one in Gulshan and the other on Elephant Road. Both of these branches are quite big, bedding fifty to a hundred people. Mukti is well known for its drug detoxification program which lasts two to four weeks. Apart from that, Mukti also provides space for psychotherapy which includes drug counseling and group discussions. The small group discussions allow each addict share experiences and drug counseling provides mental support for the addicts (Mukti).

Prottay

Keeping in mind, the alarming amount of addicts in the country, another Drug Treatment center was founded on the 17th of February 2003, said Dr. Vivek Vishal, the resident medical doctor at Prottay Drug Treatment Center. This one, like Mukti, is located in Gulshan and beds fifty people. Prottay, has about ten doctors, out of which many are Indians. It also welcomes visiting doctors. Just like other treatment centers, it offers detoxification and psychotherapy. The doctors seem to be very caring and pleasant. What makes this center productive is the doctor’s involvement with the patients. For example, when the addicts play sports, the doctors play with them. Prottay has space for all sorts of sports; pool, yoga, badminton and other activities. (Prottay). It even has its own little gymnasium where each addict can work out. The center itself is very clean and hygienic and is centered around a good environment, where addicts feel comfortable and safe. Dr Satparkash, another resident medical doctor explained that recently Prottay has also started carrying out blocker treatment where the addicts are given medication that blocks their ability to be chemically dependant. In other words, if they take drugs after using blockers, it will not have any effect on them.

Although, Mukti and Prottay appear to be good treatment centers, they may not be enough to cut down on the amount of addiction in the country. Moreover these treatment centers are very expensive and not everyone can afford them. Prottoy for example, charges about 70,000 Taka (US $ 1129.03). Also, the newly started blocker treatment at Prottay is a dangerous step as ten times more substance is required to overcome the effect of blockers in order to get high. That could lead to serious heart problems and eventually to death. Furthermore, these are short-term treatment centers that lasts three weeks maximum. Once out of the center, chances are that the addictswill relapse and return to their old habit. (Firoz). Sadly, statistics on this issue were unavailable. Both Mukti and Prottay were very hesitant in providing statistics on this issue. Could this be because they know they are not being able to meet success in addressing addicts? In a situation like this, a good treatment and rehabilitation curriculum that is not over priced and provides all the necessary aid is required. APON is an effective example of that.

APON Drug Rehabilitation Residence

Brother Ronald Drahozal, CSC founded Ashokti Punorbashon Nibash or APON Drug Rehabilitation Residence in October 1, 1994. He came to Dhaka from America in 1962 as a teacher and has been here ever since (APON). Over the past years he became actively involved with various youth activities. During the 1980s, when drug addiction was first recognized as a problem in Bangladesh, he opened the first ever rehabilitation center in Bangladesh. Under his direction this residence was soon recognized as providing the most fruitful service to the addicts and their families (APON). “Addiction is a multi-dimensional problem, the whole person is sick physically, mentally, emotionally, spiritually. So the whole person needs to be treated”, quoted Bother Ronald.

OBJECTIVES:

The objectives of the program are as follows:
1. To establish a fellowship of recovering addicts living in a healthy atmosphere, helping fellow addicts and their families recover from addiction.
2. To disseminate knowledge of basic facts about drug abuse, addiction, the Twelve Steps Program of Narcotics Anonymous and the recovery process.
3. To provide an environment in which addicts review their lifestyle, develop healthy attitudes, demonstrate sobriety and form good habits in daily life and work.
4. To provide an environment in which addicts acquire sufficient skill training, education and other preparatory knowledge that will lead to constructive and gainful employment.
5. To enable recovering addicts to make a full and active positive contribution to family and society, living a happy drug free and crime free life, who are constructively and gainfully employed, motivating others to stay off drugs or to get off drugs. Special emphasis is on high-risk youngsters of the nearby slums.
6. To provide drug prevention, motivational and training assistance for young drug addicts and high-risk youngsters, especially those from poor and/or dysfunctional families.

Goal:

As described by the APON community, the goal of the Rehabilitation Residence is to help an addict break free of addiction. This fundamentally means changing how an addict lives by dismantling the addictive framework of his life; how he sees himself, his beliefs, self-care and how he relates with others. Perhaps more importantly however, is the need to create a healthy structure to replace the addiction and its associated lifestyle effect. (APON). Brother Ronald defined APON’s work in an interesting way. “The purpose is not to make a bad person good but to make a sick person healthy.”

Target Audience:

APON’s target group continues to be poor and young addicts, but people from all socio-economic strata are welcomed from all over Bangladesh.

Price:
Unlike institutes like Prottay and Mukti that are overpriced, those who attend APON pay according to their status. As a result, APON is usually left with very little or no money at all.

Activities:
The activity of this institute covers all aspects of treatment and rehabilitation, as well as aftercare. These aspects can be grouped into several forms of service provision:

1) APON’s Treatment Program

APON operates its Drug Treatment program, utilizing the Narcotics Anonymous (N.A.) 12 Steps to Rehabilitation and the Therapeutic Community as a learning and behavior modification tool oriented to enhance the opportunity of personal growth. Narcotics Anonymous (N.A.) Brother Ronald described Narcotics Anonymous (N.A.). as a worldwide, nonprofit society of men and women for whom drugs have become a major problem in their lives.
This program promotes complete moderation from all drugs and so the only requirement for joining it is the desire to stop using drugs. The core activity APON is the N.A. meetings held everyday. The meetings are designed to help the resident of the drug center to modify their addiction problems and lives (Brother Ronald). The benefits of the meetings are achieved through the personal sharing that occurs in the forum. The new client; often a practicing addict is given the most importance, as the exchange of feelings is informational and brings in the side effect of self-affirmation, which is critical to a successful recovery (Nehal). Most drug institutes in Bangladesh are reluctant in operating the N.A. system of meetings, whereas APON conducts them regularly. This sets APON apart from all the other drug centers in Bangladesh that mostly emphasize on medical detoxification treatment rather than mental support. However, this is not all it implements. APON is also strongly based on the Therapeutic Community Treatment model (APON).

Therapeutic Community

A Therapeutic Community is a model for operating a healthy environment for a group of people living and working together towards a common goal. Knowing that the Bangladesh population is extremely vulnerable to addiction, the therapeutic community model that APON follows is based on the social learning theory, which advocates behavioral change (APON). No other institute in Bangladesh appears to have ever taken this important step before. Ideally to achieve the behavioral change, the community actively participates and shares norms and values with each other.

2) APON’s Rehabilitation Program

Rehabilitation is the key factor necessary to help addicts overcome the problem. A good rehabilitation center should deal with the psychological aspects and work on how to change the addict’s lifestyle so that in the future they don’t return to their old habit. APON has its own ways of dealing with that. The program is made up of therapies that help create a better environment. Each resident of APON has to go through these therapies for six and one-half month or more if necessary before returning home. (APON). The therapies are described below:

a) Lifestyle adjustments (Group Therapy)

This is based on the assumption that the residents have the freedom to control their own behavior so they can reflect upon their problems and make positive choices.

Brother Ronald said these sessions are designed to bring in a climate of understanding, acceptance and freedom. The addicts use their own knowledge and experiences to approach problems and discover solutions. In order to make this therapy work well,

APON has groups that work together to keep their residence clean and going. Some residents work in the kitchen, while others clean the house or go out to repair items (APON). Activities like these are very important for an addict’s mental peace and seldesteem, as it does not make them feel worthless and a burden. Instead it helps them gain self-confidence and feel productive.

b: Professional development/adjustments (Occupational Therapy)

While looking around APON, it was not hard to notice that occupational therapy is based around workshop that includes making wooden handicrafts, sowing and candle-making. Apart from keeping the residents busy and occupied, these activities also create a sense of discipline, responsibility, co-operation, self-respect and compromise, which are all necessary components of a healthy, content life. It helps those involved to practice how to be an effective member of the community. APON has even contacts with a small handicraft store in Mohammadpur, close to their institute, where the candles and the wooden handicrafts are sold (Brother Ronad).

Aside from that, the main office of APON has a cupboard full of candles for sale. The price ranges from ten to two hundred Taka (US $0.16-3.19) depending on the candle shape and size. This therapy not only develops skills, but also shows them the path to income-generation. Due to therapies like this, APON so far, has been successful in liberating addicts of chemical dependence.

c) Social adjustment (relaxation/recreational Therapy)

This consists of indoor/outdoor sports as well as free time for watching TV. Sports help identify where the weaknesses of an addict lies. During one of the visits, Brother Ronald came up and said “If a player keeps getting angry on the field for little mistakes, it shows that he needs to work on anger management and APON works to fix that problem.” Other than that, sports also allow a certain degree of fitness. Television, on the other hand provides entertainment.

c) Counseling

Counseling is a confidential, face-to-face relationship. It is about helping people understand themselves and their feelings better, particularly with regard to specific problems (Chowdhury). “Any problem presented in front of the counselor is often just superficial, a symptom and not the root cause” (Vishal).

The APON counselor’s job is to identify that root cause and help in overcoming it. The objective of counseling at APON is not automatic abstinence. Rather, it is aimed to show individual addicts a clear picture of where they stand with the problem and the possibilities left to get better. This helps them make good decisions for their new future (Nehal). Reflection of a client’s behavior and feelings is one of the main tasks of the counseling.

However, according to both Nehal and Brother Ronald the most critical aspect of counseling is listening and understanding what the addict is saying or showing. Another very important part to counseling is keeping the addict’s problems confidential. The counselor first needs to make a promise of that before helping.

APON counselors appear to carry this out very efficiently and it’s a very important reason behind their success story.

“The rehabilitation Center cannot become a fixed premise for an addict’s lifetime” (Chowdhury). After a few months of exposure to therapies, the addict needs to return home and lead a normal life with family. In that case, the home environment has to be conducive for maintaining and strengthening their sobriety. As described by the few doctors interviewed, it is not uncommon for family members to pile up negative feelings toward an addict. In order to remove such feelings and help the addict sustain and nurture the newly adopted life, family members require help (Nehal). APON, unlike other institutes stress enormously on family counseling and teaches the parents how to deal with their addicted child to make them feel inclusive and not excluded from family matters.

3. Skill Training and Basic Education Program

The APON center does not keep their residents shunned from education and skill training. The center teaches Bangla and English along with computer basics like Microsoft Words. A lot of the teachers and volunteers are old APON residents that have successfully come out of their addiction problems. The main reason behind running the program by them is because they are experienced and know exactly how to help. “It is a peer run program where each and everyone benefits in some way or the other from each other” (Brother Ronald). This shows how comprehensive APON is. Along with treating addicts, the center also encourages education. Most other drug centers seem to be isolated from this.

APON Halfway House

A few years back, APON bought a piece of land in Fulbaria, Savar and started a Halfway House. This is where addicts that have been through the six and a half month rehabilitation session and are capable of living independently live together in a group.

Currently, there are about seven to ten people living there. However, not everyone has the luck to be a part of this luxury. A resident is only allowed to move to the halfway house if the whole APON administration agrees that the patient is well enough to move on by himself.

The Halfway house provides participants with the option to obtain various skills and to participate in income-generation activities. Addicts living there have the freedom to choose their own career depending on what kind of work they enjoy or are good at. When the halfway house started off, it was built with tins and hay. As part of the skill training program, the residents of the house rebuilt it themselves with bricks and cement. Currently, the halfway house residents are working on a separate skill training program. With the help of local shoemakers in Savar, they are producing sandals to be sold in different areas and cities of Bangladesh. Along with that, they are also working on building fences for their house area to keep robbers out. The residents have also built their own garden where they grow vegetables like tomatoes and other plants and flowers. All of this happens under the control of APON which continuously supports each and every resident and assists them in strengthening their sober lives free of drugs (APON).

4) APON Women’s Outreach project (AWOP)
Recently, APON is working on a new project. All these years, the rehabilitation residence was focused on men and young boys, but now it is starting to spread its wings to help addicted women (APON). The

APON Women’s Outreach Project

(AWOP) works the same way as the normal APON rehabilitation program. The only difference is that the women live separately in a different building beside the main office. Women in the outreach program receive the same sort of care and attention as the men. They are provided with counseling, skill training, basic education and entertainment which usually include watching television and or playing indoor games (APON). They are also taught career building activities like flower making, sewing, hand embroidery, block and boutique. AWOP extends throughout the city, from the local areas like Tejgaon to the newer ones like Gulshan. This new project basically another wing of the whole APON rehabilitation program and all the institutional rules and regulations apply to it (APON).

Recently, Family Health International (FHI), an NGO that has a segment concentrating on addicts, especially Intravenous Drug Users (IDUs) has voluntarily agreed to finance the APON Women’s Outreach Project, which solved the financial problem the APON was facing to carry this project out. Four miles away from the Halfway House in Savar, APON has registered for land that FHI will soon be paying for.

APON’s Admission Procedure:

Although APON has certain rules and regulations regarding admission, emphasis is put on the weekly N.A. Before getting admission, APON encourages each addict and his family to join these meetings as they provide an opportunity for each member to share feelings, experiences and reflections about their drug practicing life.

This form of meeting is also a forum for the addicts to gain a better understanding of APON’s Treatment Procedure.

APON has gone a long way since it first opened its door. Brother Ronald deserves applauds for the work he has been doing in Bangladesh. In spite of financial problem, the Rehabilitation Center has, is working well and will do the same in the future. Many addicts have come out of APON with successful results.

The therapies held by APON prove that the comprehensiveness of the institute is effective. Along with treatment, the residents are also provided skill-training and education. This develops confidence in the addict’s mind and helps them gain self-respect and reliance. It changes the person as a whole. As addiction has taken a very critical turn recently, it requires serious attention. In order to help the addicts, the country definitely needs more rehabilitations centers like APON and more people would benefit if it is replicated in each and every city of Bangladesh. Along with that, the local schools of Bangladesh should follow the footsteps of Sunbeams school and raise awareness.

Case Studies:

(names have been changed in order to protect identity)
To further prove APON’s success and effectiveness, here are two case studies:
1. Ayesha, a twenty-seven year old girl became an addict at the age of 18. Like most addicts her reason for starting was curiosity. First she only used tablets and painkillers. Slowly she moved onto phensidyl and then heroin. Later on, she started mixing both the substances. Over this, she lost her husband and was sent off to various clinics and drug treatment centers. Unfortunately none of them helped her at all as all of them only provided detoxification treatment. Every time she came out of the treatment centers, she had a relapse and started using drugs again. She is still suffering over addiction now and could benefit from being a part of the APON program.

2. Shahir is 18 years old. He used to be a student of Agakhan School and at the age of 14 he started using drugs. He started off with painkillers and moved into heroin in about 2 years. First he was sent to Prottay where he was given medical detoxifications and blockers. But as soon as he came out, he started taking drugs again. When things got out of control, his parents sent him to APON. Like everyone else he went through the six and one-half month session there. Now, he is back to normal and works at APON as a volunteer. Awareness and education. The drug situation in Bangladesh has become treacherous. Rehabilitation centers are very important indeed, but to reach the roots of the problem, adequate education and awareness is very necessary; something Bangladesh lacks at present.

APON Successes and Achievements:

Work at APON is very difficult. Funding can be hard to come by and APON’s commitment to fighting drug addiction through complete abstinence (unlike other ‘revolving door’ detoxification programs at clinics) can sometimes feel like an uphill battle. It takes much energy and patience for everyone involved, but especially for our small group of staff. Despite this adversity, however, there are many wonderful things happening.

The APON program provides its participants with a forum to reflect on their life and the environment they live in which often leads to self initiated change. This is a very empowering process and for the guardians the results often seem to be miraculous i.e. after many years of addiction, a change in their son, husband or father seemed impossibility before they came to APON.

We count our successes according to the quality of life that results from a person being at APON. The most obvious and rewarding successes are those addicts who get off and stay off drugs, the young and old recovered addicts who are alive today because they completed the APON program. One such person is a 16-year-old boy who grew up in the local market after his father remarried and his mother died. I recall the day he heard that his best friend (whom he had spent most of his time with – using drugs, etc.) had died. They used to eat the same food, sleep in the same public/open places in the market (upstairs where they use drugs), share the same drugs and do the same work, etc. His only response to the sad news was that the same thing would have happened to him if he had not come to APON.
Over the past five and a half years APON has treated 354 addicts (of which 71 have been aged 8-18) and 27 ‘at-risk’ youngsters. At present there are usually approximately 85 residents at APON and a number waiting for admission. Space in the small house we rent makes it difficult to admit the constant flow of addicts coming for assistance. But APON has never refused an addict the chance for treatment because he could not pay anything. All of those who come to APON get off drugs and begin the recovery process, but not all of these participants have been rehabilitated. In fact the 12 Step Program of Narcotics Anonymous that APON maintains acknowledges the fact that an addiction can never be completely cured, and that recovery can be a lifelong struggle. Those addicts who do slip and use drugs again can still live a better life. Once they have been to APON they know there is hope and a way to get off drugs again, and are more aware of what they are doing.

These addicts will be more careful about the ways they can contact HIV/AIDS; more informed about how the drugs they use affect their body, mind and spirit. Most of all they are more aware of their own options in life and this knowledge is invaluable.

One ongoing achievement of the APON program is the positive, community enhancing attitude or spirit that continues to thrive. This is most obvious by the response of people in the local area who genuinely appreciate and respect the work that APON is doing. Besides this there is the rally for International Day Against Drug Abuse and Drug Trafficking, where APON consistently fronts a lively, colorful contingent of young program participants and other youngsters of the local area. As a result APON is regularly recognized as one of the top prizewinners for this event. The Director General of the department of Narcotics Control and the Coordinator of the UNDCP in Dhaka both regularly speak very highly of APON. Also, in UNDCP’s South Asia Drug Demand Reduction Report (1998) APON was acknowledged through the publishing of an article detailing the program and what it has to offer.

FUTURE PLANS:

1. Development of Land:

Currently APON resides in a two-story rented building which is not very suitable for the program’s needs. We have been paying a high price for rent at this location, but it has been impossible to find a better place that the owners are willing to rent for an addict rehabilitation center. If we had a more appropriate residence then the program would more often attract clients that can pay the relevant fees and we would be more self-sufficient. The ideal residence has already been designed and recently APON was donated some land in a small sub-rural area just outside of Dhaka (Fulbaria, Savar). The land is .27 decimal (108 sq.ft.) in size, lies adjacent to a river and on a rather good road linking it to the nearby main highway.

We have various plans for this land, but in order to implement them we require funds. We want to build an entirely new APON residence and expand our program to include this location. Currently we have been granted some funds for the preliminary development of the land by Ireland Aid, through the Irish Embassy. We have now measured the land and are very eager to proceed with this first stage of development. This will include the process of filling the land, constructing an access road, building a retaining wall and laying the foundations.
Also, we have some other project ideas which we are only partially implementing at the moment. The reason these ideas can not be completely achieved is because of a lack of funding. Below are two of these project ideas.

2. Community Outreach Project:

This project idea is based around the enormous need for outreach and harm reduction work in the local area (Mohammadpur). The local bazaar is a place where many young children begin to spend a lot of their time. The lifestyle cycle associated with this location includes stealing, street fighting, gambling, prostitution and the abuse of poor quality drugs.

A very large percentage of the youth of the area are at some level of chemical dependency, an example of which is depicted in the above case study. We see an urgent need to provide these types of children with an alternative to the bazaar and it’s trappings through one-year project of outreach and community based work.
This project would provide many of the regular APON services like skill training, basic education and sports but would also offer extra alternatives like HIV/AIDS awareness education and a safe place for recreation. Even when the main drug addict rehabilitation center moves to Savar we will keep an office in the area and continue this outreach program.

Recommendation:

Open education and awareness supported by the local schools and the media are also necessary and could result in a significant positive impact on addiction in Bangladesh.

Awareness and education:

The drug situation in Bangladesh has become treacherous. Drug addict rehabilitation centers are very important indeed, but to reach the roots of the problem, adequate education and awareness is very necessary; something Bangladesh lacks at present. The major task of the authorities is to develop a real social awareness of the existing situation.

 This should be done through the media and by publishing preventative materials, magazines and posters.
 Furthermore, it is essential that drug education is included in the school curriculum, which at present ignores it. It will take time for the Bangladeshi society to truly acknowledge the problem, as it is often denied and drug addicts are shunned, but this problem requires serious attention.
 Recently the Bengali television channels have shown concern over this issue. For example, they have started a serial based on an addict’s life and how his actions affect the whole family and the troubles he faces. This is a very important step that the Bangladeshi media has taken.
 Sadly, this message is limited only to the cities, where people have televisions. So what about the rural areas? The poor population is thriving with addicts. These people need to know and realize the harmful effects of drugs use and abuse. The media has to somehow reach them. Almost all villages or any poverty stricken places have radios available, so it can easily be advertised there.
 Another way to spread the message would be to get the Bauls or the Bengali classical and pop singers to come up with music/songs and stretch the note on that basis.

The problem with addicts is only increasing and it is important that these steps are taken rather quickly.

Starting from elementary school, students should be taught about the consequences of drug abuse. Based on the Bengali culture, where issues like these are viewed as sins and wrong to even talk about, this might be a hard step, but is definitely critical to the country at this point.

Many of the teachers and principals know that addiction is a huge problem, but they do not feel comfortable talking and teaching about it. They think by talking about it, they will be corrupting the minds of the youngsters rather than helping. This is not a healthy mindset at all. No schools in Bangladesh teach about drug addiction and the kids are not benefiting from it. This leads the youngsters into a world of darkness where they suffer out of serious health hazards.

Some interviews showed that schools are now starting to think deeper about the drug problem than they used to before. Although there are still schools that believe that prohibiting smoking and drug use within the campus will discourage addiction, other schools like Sunbeams, located in Dhanmondi, are holding seminars and lectures by bringing in experts in the field to raise awareness in the community. According to the administration of this particular school, they are also thinking of starting a new subject called Bangladesh Studies for their yearly O’Levels exams that will include drug issues (Moinuddin). This seems to be a step to the right direction.

STEPS OF INTERVENTION

Q) If an addict is unwilling to seek help, is there any way to get him into treatment?

A. This can be a challenging situation. An addict cannot be forced to get help except under certain circumstances, such as when a violent incident results in police being called or following a medical emergency. This doesn’t mean, however, that you have to wait for a crisis to make an impact. Based on clinical experience, many treatment specialists recommend the following steps to help an addict accept treatment:

B. Stop all “rescue missions.” Family members often try to protect an addict from the results of his behavior by making excuses to others about his addiction problem and by getting him out of drug-related jams. It is important to stop all such rescue attempts immediately, so that the addict will fully experience the harmful effects of his use—and thereby become more motivated to stop.

C. Don’t enable him. Sometimes family members feel sorry for the addict or tend to avoid the addict, let him come and go as he pleases. This comes across to the addict as a reward—after all, all he wants is to be left alone. Be careful not to reward by paying his bills, bailing him out of jail, letting him stay for free, etc. This kind of reward creates out exchange and criminal behavior.

D. Time your intervention. If possible, plan to talk with the addict when he is straight, when all of you are in a calm frame of mind and when you can speak privately.

E. Be specific. Tell the family member that you are concerned about his addiction and want to be supportive in getting help. Back up your concern with examples of the ways in which his drug use has caused problems for you, including any recent incidents.

F. State the consequences. Tell the family member that until he gets help, you will carry out consequences—not to punish the addict, but to protect yourself from the harmful effects of the addiction. These may range from refusing to be with the person when they are under the influence, to having them move out of the house. Do NOT make any threats you are not prepared to carry out. The basic intention is to make the addict’s life more uncomfortable if he continues using drugs than it would be for him to get help.

G. Find strength in numbers with the help of family members, relatives and friends to confront the addict as a group but choose one person to be the initial spokesperson. It will be much more effective for the others to simply be there nodding their heads, than it would be for everyone to talk at once and “gang up on him.” Remember the idea is to make it safe for him to come clean and seek help.

H. Listen. If during your intervention the addict begins asking questions like; Where would I have to go? For how long? This is a sign that he is reaching for help. Do not directly answer these questions. Instead have him call in to talk to a professional. Support him. Don’t wait. Once you’ve gotten his agreement, get him admitted immediately. Therefore, you should have a bag packed for him, any travel arrangements made and prior acceptance into a program.

Conclusion

Drug abuse has become one of the greatest health and social problems in Bangladesh, having a grave impact on the society. This is a culture that has been using intoxicating substances such as cannabis and heroin for centuries and has historically accepted the use of drugs. Therefore, the overuse and abuse of the highly refined and much more potent drugs that suddenly swept the country was a shock to man.