TRAINING IN THE REHABILITATION OF DRUG ADDICTS

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.
 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
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 person’s 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.
Drug addiction
It is 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 stimulate the 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
(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 person’s
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 as prescription or

over-the-counter drugs.
 • Stimulants:
o Amphetamine and Methamphetamine
o Caffeine
o Cocaine
o Nicotine

• Sedatives and Hypnotics:

o Alcohol
o Barbiturates
o Benzodiazepines, particularly alprazolam, clonazepam, temazepam, and
nimetazepam
o Methaqualone and the related quinazolinone sedative-hypnotics
o GHB and analogues (specifically GBL)

• Opiate and Opioid analgesics

o Morphine and Codeine, the two naturally-occurring opiate analgesics
o Semi-synthetic opiates, such as Heroin (Diacetylmorphine), Oxycodone,
and Hydromorphone
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 or alcohol, for instance, typically require many more exposures to
addict their users than drugs such as heroin or cocaine. Likewise, a person who is
psychologically or genetically predisposed to addiction is much more likely to suffer
from it.

Although dependency on hallucinogens like LSD ("acid") and psilocybin (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 of tobacco, 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, or neuroplasticity, which occurs in these areas.

Depressants

Depressants such as alcohol and benzodiazepines work by increasing the affinity of

the GABA receptor for its ligand; GABA. Narcotics such as morphine and methadone,
work by mimicking endorphins—chemicals produced naturally by the body which have
effects similar to dopamine—or 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
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 can’t 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.
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 person’s 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
world’s countries. They cause depression and frustration and in order to get rid from these
tension people start drug addiction.
5. Curosity

Mostly ddrug addicts start taking drug because they are curious about the effect of
drugs. 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.
11. Lake Of Parental Care

Parents who don’t have awareness of the activities and where about of their children, are
the 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
  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 Names of the

Medicinal Uses substances

Opiates/Opioidd/ analgesia, cough suppression, opium, morphine,

Narcotic Analgesics antidiarrhea, suppression of opiate codeine, heroin (diacetyl
 withdrawal, sedation; currently used morphine), fentanyl,
therapeutically for the first four methadone, meperidine,
effects L-alpha-acetylmethadol
(LAAM)

Narcotic/Opiate block the effects of narcotics; used to naloxone, naltrexone

Antagonists treat opiate overdose

Psychomotor stimulate psychological and sensory- amphetamine,

Stimulants motor functioning; used methamphetamine,
therapeutically to treat ADHD and cocaine, methylphenidate
narcolepsy, sometimes as an appetite
suppressant, occasionally antifatigue,
formerly for asthma and for sinsus
decongestion

Other Stimulants similar to psychomotor stimulants but caffeine, nicotine,

with much less efficacy; various ephedrine,
therapeutic effects including caffeine pseudoephedrine
compounded with aspirin in some
OTC pain relievers, ephedrine in OTC
asthma medicines, pseudoephedrine
in OTC sinus decongestants and OTC
appetite suppressants

Barbiturates general decrease in CNS thiopental, secobarbital,

arousal/excitability level; used pentobarbital,
therapeutically for anesthetic, phenobarbital
anticonvulsant, sedative, and hypnotic
effects

Minor Tranquilizers general decrease in CNS includes two subclasses:

arousal/excitability level, but low benzodiazepines (e.g.,.
dose are somewhat selective for diazepam,
 anxiety and much less sedative than
barbiturates; used therapeutically as
anxiolytics, benzodiazepines also as
anesthetics and anticonvulsants
Major Tranquilizers general sedation at high doses, with
(antipsychotics/ selective antipsychotic activity at
neuroleptics) lower doses; used therapeutically to
treat schizophrenia and other major
psychotic disorders
Antidepressants no perceptible CNS effects in
normals, but effectively alleviate
depression in many depressives; used
therapeutically to treat depression
Antimanic dampens extreme mood swings in
some people; used to treat manic-
depressive (bipolar) disorders
Alcohol general decrease in CNS
arousal/excitability level; no current
therapeutic uses, but formerly used as
an anesthetic and a sedative
Volatile Anesthetics general decrease in CNS
chlordiazepoxide,
flunitrazepam
[Rohypnol]) and muscle
relaxants (e.g.,
meprobamate)
haloperidol, pimozide,
flupenthixol,
chlorpromazine,
spiroperidol, clozapine
includes three
subclasses: monoamine
oxidase inhibitors (e.g.,
pargyline), tricyclic
antidepressants (e.g.,
amitriptyline,
desmethylimipramine),
and selective serotonin
reuptake inhibitors
(SSRIs: e.g., sertaline)
lithium
ethyl alcohol (other
alcohols have similar
actions but are associated
with very toxic effects,
e.g., methanol)
nitrous oxide, halothane,
 arousal/excitability level; used ether
therapeutically for anesthesia

Volatile Solvents produce feelings of intoxication, can toluene, benzene,

produce hallucinations at high doses; naphtha
no therapeutics uses (all can cause
marked brain damage in moderately
low concentrations

Psychogenics produce altered states of includes two subclasses:

consciousness; hallucinogenics hallucinogenics (e.g.,
produce hallucinations sometimes lysergic acid
reported as "mystic" experiences; diethylaminde [LSD],
cannabinoids usually produce mescaline, psilocybin)
increased feelings of "well being" and and cannabinoids (e.g.,
"mellow" intoxication; the marijuana, hashish).
"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)

Stimulatory produce a mixture of psychomotor MDMA (ecstasy),

Hallucinogenics (cf. stimulant and hallucinogenic effects, phencyclidine (PCP),
former depending on dose and other factors; ketamine (?)
psychotomimetics) no therapeutic uses, except
phencyclidine as a veterinary
anesthetic

Treatment Approaches for Drug Addiction

 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.
 The latest estimate for the costs to society of illicit drug abuse alone is $181 billion
(2002). When combined with alcohol and tobacco costs, they exceed $500 billion
including healthcare, criminal justice, and lost productivity. Successful drug abuse
treatment can help reduce this cost; crime; and the spread of HIV/AIDS, hepatitis, and
other infectious diseases. It is estimated that for every dollar spent on addiction treatment
programs, there is a $4 to $7 reduction in the cost of drug-related crimes. With some
outpatient programs, total savings can exceed costs by a ratio of 12:1.

Basis for Effective Treatment

Scientific research since the mid-1970s shows that treatment can help many people
change destructive behaviors, avoid relapse, and successfully remove themselves from a
life of substance abuse and addiction. Recovery from drug addiction is a long-term
process and frequently requires multiple episodes of treatment. Based on this research,
key principles have been identified that should form the basis of any effective treatment
program:

• No single treatment is appropriate for all individuals.

• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her
drug addiction.
• An individual’s treatment and services plan must be assessed often and modified
to meet the person’s changing needs.
• Remaining in treatment for an adequate period of time is critical for treatment
effectiveness.
• Counseling and other behavioral therapies are critical components of virtually all
effective treatments for addiction.
• For certain types of disorders, medications are an important element of treatment,
especially when combined with counseling and other behavioral therapies.
• Addicted or drug-abusing individuals with coexisting mental disorders should
have both disorders treated in an integrated way.
 • 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 person’s 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
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
can also enhance the effectiveness of medications and help people stay in treatment
longer.

Outpatient behavioral treatment encompasses 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 treatment programs 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 in
serious 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.*
 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 NGO’s, CBO’s, GO’s students and community
groups.
• Development of awareness and resource materials.
• Net working with national NGO’s.

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:
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
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
 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
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.
 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.
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.
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.