Drug Addiction Treatment and Rehabilitation-Imran Ahmad Sajid

Field Work Report Dec, 07 to May2008
Drug addiction
Treatment and Rehabilitation
FIELD WORK activities
Dost Welfare Foundation
Dec 2007 – to-May 2008
Submitted By:
Imran Ahmad Sajid
M.A. final evening-22
Submitted to:
Sir. S. Faiq Sajjad Shah
May 2008
DEPARTMENT OF SOCIAL WORK

UNIVERSITY OF PESHAWAR
Imran Ahmad MA final [0]

In the
name of
allah
Imran Ahmad MA final [i]

ACKNOWLEDGMENTS
Al-Hamd & As-Sana, all the Glories and all the Sanctity is to be Allah who is the Rabal-
Alamin, who is Karim, who is Rahim, and who is Aleem, who is Jalil, who is Qadir, and who
loves Man 70 times more then his own mother. Darood & Salam to be on His Prophet
(PHUH), who is the most learned in the world and who is a blessing for the world and the
world hereafter. Fazl-e-Rub and Nazr-e-Karam of Al-e-Rasool has enabled me to work for
the completion of this report.
Some times in our life we loose our energies and courage and the simple things seems to us
very complicated. The same happened to me while compiling field work activities. But my
Murshid has given me a new bank of courage and energy through his counseling and prayers.
Therefore I have no words to say thanks to my Murshid.
Further more I would like to pay extreme thanks to Sir. Naeem Asif, the center manager dost
welfare foundation, whose continues guidance, appreciation and encouragement was of great
help for me.
It was really an interesting experience while talking to Sir. Faiq Sjjad Shah about my field
work activities. His guidance and encouragement has a great value for me.
Last but not the least, I would like to say, Thank You my brothers, to my group members,
Fahim Khattak, Adnan Ashraf, M. Hazrat Mohmand, Iqbal, Hikmat Shat, Rafique, Modassir,
Anayat And one of the staff member, Israr.
Imran Ahmad Sajid
Imran Ahmad MA final [ii]

SUMMARY
Drug use is not new. Humans have been using alcohol and plant-derived drugs for thousands
of years- as far as we know, since Homo sapiens first appeared on the planet. What recorded
history we have indicates that some of these drugs were used not just for their presumed
therapeutic effects but also for recreational purposes. In some of the highly developed ancient
cultures, psychoactive plants played important economic and religious roles. There is also
evidence that some people have always overused, misused, or abused these substances.
Drug addiction is a problem in western world, in Europe to some extent, in America to a
greater extent depending on the nature of the drug. At the moment there are some 0.8 million
Heroin Addicts in USA, more then 20 million people use chars for addiction. Cocaine and
stimulants are at the top among youth.
In Pakistan the situation is a bit changing. The traditional drug of addiction is Opium and by
70‘s we have the drug culture of synthetic medicines. Tunal was a very famous drug at that
time and the tunal addicts were used to call ―Tunalee‖. But by 80‘s the ―Tunalee‖ is replaced
as ―Poodary‖. By 2005 we have some other new incents in drug culture. One is called
Cocaine and the other is called Crystalline.
Imran Ahmad MA final [iii]

TABLE OF CONTENTS
S. No Detail Page. No.

CHAPTER NO.1
INTRODUCTION TO The drug problem-1,
1 Drugs in the History, Dost Welfare
1
DRUG ADDICTION
Foundation – 2
AND DOST WELFARE Mission Statement, Objectives – 3
FOUNDATION Milestone – 4, Milestone-4, Drug Culture in
Pakistan, Some Commonly used Drugs in
Pakistan- 5
CHAPTER NO.2
DRUG, ADDICTION Drug, Addiction, Addictive Drug – 7, Drug
2 7
AND DISEASE CONCEPT Addiction, Definition – 8, Some important
concepts – 9, three basic processes of drug
addiction – 10, types of addiction - 12
CHAPTER NO.3
CAUSES AND SIDE- Why start drug addiction-13, Side Effects of
3 Drug Addiction: physiological, social – 14,
13
EFFECTS OF DRUG
psychological, spiritual, financial, effects on
ADDICTION family – 15, Community - 16
CHAPTER NO.4
CLASSIFICATION OF Major classes of drugs – 17, Depressants:
4 Alcohol-18, tranquilizers, barbiturates– 20,
17
DRUGS – WITH
Painkillers: Narcotics – 21, opium, Heroin –
REFERENCE TO 22, Codeine, Stimulants – 23, amphetamine-
ADDICTION 24, cocaine, caffeine-25, tobacco-26,
nicotine-27, khat, steroids-28 ,
Hallucinogens: 29, Marijuana-30, Ketamine,
LSD-31, Table of drugs and effects-33
CHAPTER NO.5
TREATMENT Introduction, pretreatment phase-35,
5 treatment phase-36, post treatment phase-38,
35
PHILOSOPHY
CHAPTER NO.6
COUNSELING what do we mean by counseling, why do
6 people have counseling-40, objectives and
39
goals of counseling-41, skills required for a
counselor-42, stages of counseling-43,
qualities required for a counselor-44,
common errors-44
CHAPTER NO.7
BEHAVIOR Introduction -45, spoken to-46, dealt with-
7 47, pull up-48, pull up on board-50, time out,
45
MANAGEMENT TOOLS
hair cut-51, prospect chair-52, confrontation-
53
CHAPTER NO.8
MORNING MEETING importance of morning meeting, the purpose
8 of morning meeting, components of morning
54
meeting -54, Dua-e-Sakoon-55, pic-56
Imran Ahmad MA final [iv]

CHAPTER NO.9
RELAPSE PREVENTION Introduction, understanding relapse-57,
9 contributing factors-58, categories of
57
PROGRAMME
patients-59, warning signs/ principles of
relapse prevention-60, conclusion-64
11
Follow Up and After Care 65
12 CHAPTER NO.10
DOST PROGRAMME IN Harm Reduction and Social Services-66,
Drug Abuse prevention programme-67,
66
BRIEF
treatment plane-68, 11 steps-69, 12 steps-70
13 CHAPTER NO. 11
SUGGESTIONS AND 71
RECOMMENDATIONS
14 CHAPTER NO. 12
ROLE OF SOCIAL Pre-treatment/awareness phase-73, treatment
phse-74, post-treatment phase-74
73
WORKER
CHAPTER NO. 13
15 CASE HISTORIES 76
16 REFERENCES 82
17 BIBLIOGRAPHY 85
Imran Ahmad MA final [v]

INTRODUCTION
To Drug Addiction and Dost Welfare
Foundation
CHAPTER NO. 1

INTRODUCTION TO
ORGANIZATION
The Drug Problem
―Drug Use on the Rise‖ is a headline that has been seen quit regularly over the years. It gets
our attention, but ―drug use‖ can‘t always be rising, can it? No, but at any given time the
unwanted use of some kind of drug can be found to be increasing at least in some group of
people. How big a problem does the current headline represent?
Before you can meaningfully evaluate the extent of such a problem or propose possible
solutions, it helps to define what you are talking about. In other words, it helps to be more
specific about just what the problem is. Most of us don‘t really view drug use as the problem,
if that include your Uncle taking two aspirins when he has a headache. What we really mean
is that some drugs being used by some people or in some situations constitute problems with
which our society must deal.1
Drug Addiction is a disease which is characterized by gradual loss of control over mood
altering chemicals which makes the person dysfunctional socially, psychologically,
physiologically, and spiritually. This is the European module of Addiction. And according to
US module drug addiction is deviancy. Drug addiction is a problem in western world, in
Europe to some extent, in America to a greater extent depending on the nature of the drug. At
the moment there are some 0.8 million Heroin Addicts in USA, more then 20 million people
use chars for addiction. Cocaine and stimulants are at the top among youth.
In Pakistan the situation is a bit changing. The traditional drug of addiction is Opium and by
70‘s we have the drug culture of synthetic medicines. Tunal was a very famous drug at that
time and the tunal addicts were used to call ―Tunalee‖. But by 80‘s the ―Tunalee‖ is replaced
as ―Poodary‖. By 2005 we have some other new incents in drug culture. One is called
Cocaine and the other is called Crystalline.2
1
Ray, O. Ksir, C. (2002). Drug, Society, and Human Behavior. 9th Ed. New York. McGraw-Hill Companies Inc.
P. 3
2
Amirzada (2007) Fields and Services of Social Work; Lecture Delivered to the MA final evening class.
Peshawar. Department of Social Work, University of Peshawar

Drugs in the History

Drug use is not new. Humans have been using alcohol and plant-derived drugs for thousands
of years- as far as we know, since Homo sapiens first appeared on the planet. What recorded
history we have indicates that some of these drugs were used not just for their presumed
therapeutic effects but also for recreational purposes. In some of the highly developed ancient
cultures, psychoactive plants played important economic and religious roles. There is also
evidence that some people have always overused, misused, or abused these substances. Drugs
play a much different role in modern society than they did even 100 years ago. Major events
have occurred in pharmacology and medicine that have produced revolutionary changes in
the way in which we view drugs. In addition, recent cultural revolutions have influenced our
attitudes and behavior regarding drugs and drug use. 3
DOST WELFARE FOUNDATION
DOST Welfare Foundation (DOST) is a non-profit,

non-governmental organization established in
August 1992 in response to the need for combating
the increasing drug use and other related problems
in Pakistan.4
DOST is not an abbreviation of some other terms

but DOST is DOST which is an Urdu word which means friend. Or we can say that this
agency is a friend in need. The Full name of the organization is Dost Welfare Foundation just
calling it DOST Foundation is not correct.5 Drug Addiction is a very big problem in the area
like Peshawar and surrounding. The people of the Tribal area (FATA) cultivate the Opium
Poppy in their houses due to its beauty. 75% addictive drugs are produced and paddled by
Afghans. During the Taliban period, the production of drugs decreased almost to 0% in the
area but with the overtake of US Military forces in Afghanistan, the drug production and
smuggling started again with an extreme enthusiasm.
3
Ray, O. Ksir, C. (2002) Opt Cit. P. 7
4
Introduction. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation. Thursday, November 22, 2007
<http://www.dost.sdnpk.org/Introduction.htm >
5
Brekhna (2007). Lecture to the students of final year. Peshawar. HRD Manager Dost Welfare Foundation
Peshawar

DOST provides a comprehensive range of drug demand and drug harm reduction services for
drug users in different community settings. DOST also works for the human rights protection,
rehabilitation and social reintegration of destitute street children, juvenile offenders, women
and minor children in prisons.
With a staff of over 100, DOST provides a continuum of care and quality services through its
programmes for drug abuse prevention, treatment and rehabilitation, drug harm reduction,
HIV/AIDS prevention, vocational skills training, research, advocacy and networking.
All DOST programmes are based on human rights protection of marginalized groups such as
drug users, street children, juvenile offenders, women and minor children in prisons. DOST
enables these vulnerable persons to explore the underlying factors of their drug misuse and
imprisonment, to come to terms with past traumatic experiences, examine attitudes and
behaviour patterns, receive training in life and social skills and re-integrate into the
community and society.
Mission Statement
"To establish Therapeutic Communities for the most marginalized and disadvantaged groups
in society, to empower and heal them in body, mind and spirit and enable them to lead
productive and fulfilling lives"6
OBJECTIVES:
Treatment and rehabilitation of drug users
Outreach harm reduction services for street drug users
Drug abuse prevention among different community groups
Human rights protection and social reintegration of vulnerable prisoners i.e. drug
users, juvenile offenders, women and children
Training and capacity building of NGOs, CBOs, GOs, students and community
groups in drug harm and drug demand reduction
Development of awareness and resource materials
Networking with national and international NGOs, GOs and CBOs
6
Mission Statement. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation. Thursday, November 22,
2007 <http://www.dost.sdnpk.org/ >

Milestones
Sep 1992 Dost Foundation established and registered
Feb 1993 Therapeutic Community for the treatment and rehabilitation of drug addicts established
Family program, relapse prevention program and narcotics anonymous meetings

Feb 1993
commence
Mar 1993 Drug abuse prevention program started
Dec 1994 Street outreach program for drug addicts started
May 1995 Drop In Centre for drug addicts established
Jan 1996 Sakoon Kore treatment centre for women addicts established
Jul 1998 Drug addiction treatment and rehabilitation program started in Peshawar Central Prison
Jan 1999 Tc for women and minor children in Peshawar Central Prison
Jan 1999 Tc for juvenile offenders in Peshawar Central Prison
Jan 2000 Juvenile rights awareness program all over NWFP started
Jan 2000 Second street outreach program and Drop In Centre started for street drug addicts
Sep 2000 Detoxification started in the Drop In Centers
HIV/AIDS Awareness became important part of the Demand and Harm Reduction
Jun 2001
Programs
HIV/AIDS and STIs prevention program for juvenile prisoners in three Central Jails of
Jan 2002
NWFP
Drug demand reduction training program started for women in Afghan refugee camps in
Feb 2002
NWFP
Jun 2002 Advice and Legal Assistance Centre established for Afghan refugees in Peshawar
Sakoon Kore legal aid & social reintegration services centre for women & juvenile
Jan 2003
prisoners in Peshawar

DRUGS CULTURE IN PAKISTAN7
Golden Triangle is the area where the poppy was use to produced before 1979. Golden
triangle is composed of some area of Nepal, China and India. After the production the drug
was used to be sent to the border of Iran, where the drugs industries were established
illegally. There the drugs had been processed in factories and then paddled to central Asia
and rest of the world.
After the Islamic revolution in Iran in 1979, this process was abandoned by the newly Islamic
government of Iran, as there is high restriction on the use of any dangerous drug in Islam. So
the people involved in the process and trade of poppy migrated from Iran to Afghanistan and
the Tribal area of Pakistan, to save their business.
Now when the red revolution came in Afghanistan, and Taliban revolution, these people
again migrated from Afghanistan to the tribal area of Pakistan. Now our tribal area is the
place where the poppy and other drugs are producing, processing and paddling as well.
Darrah, Barha, Jamrood, Khyber and many other areas are famous for its business. But now
we can exclude Barha from this list due to the involvement of Mangal Bahgj. The drugs of
addiction can of various types but there are some drugs which are most commonly used in
Pakistan.
SOME COMMONLY USED

DRUGS IN PAKISTAN
1. HEROIN or Diamorphine, powerful analgesic (pain-relieving) drug derived from

opium, an acetyl derivative of morphine. Heroin is more addictive than morphine but
causes less nausea. It is one of the most abused drugs in Pakistan. The drug is most
commonly injected into the blood stream with a needle and syringe. It may simply be
smoked or ingested orally. Pure heroin is white powder generated from the opium, but
the one commonly used in our country is light brown in colour due to impurities still
in it. Taking heroin depresses brain activities and makes the person dependent on it.
7
Sara Safder (2007) Lecture for the student of MA previous evening. Peshawar. Department of Social Work
University of Peshawar

2. CHARS is the most commonly used drug in Pakistan. It is usually mixed with
tobacco and smoked with a cigarette or used in Chilum. It can strengthen the feelings
of anxiety and depression. It can also relax the mental activity of a person.
3. BHANG, also called Marijuana. Marijuana is formed from the dried leaves and
flowering tops of the Indian hemp plant Cannabis sativa. Popularly known as ―grass,‖
―pot,‖ ―reefer,‖ and ―Mary Jane,‖ marijuana is smoked or chewed for its intoxicating
effect, and it has also been used as a sedative and analgesic.
4. HASHISH is formed from the resin of the flowering tops of the same plant, and it is
five to eight times more potent than marijuana when smoked.
5. OPIUM It is obtained from milky discharge of poppy. For centuries it has been used
in medical and recreational drugs.
6. ALCOHOL, the common name for alcohol in Pakistan, and the entire Muslim world,
is SHARAB. It is a mixture of fruits and vegetables or grains. Taking alcohol in small
amount causes relaxation. Alcohol reduces physical and mental performance, so the
danger is from falling or improper driving and many more. Usually the alcohol is used
by the university students during a trip or on a tour. It is also used in urban areas on
special occasions like marriages or other such gatherings and parties.
7. INHALANTS, it includes petro-chemicals, samad bond, thiner, fluid, paints, and

other kind of chemicals. These are inhaled through the nose for a sense of relaxation.

MORE ABOUT
ADDICTION
 Drug, Addiction and

Disease Concept
CHAPTER NO. 2

Drug, Addiction, &

Disease Concept
DRUG
A drug is any substance that can be used to modify a chemical process or processes in the
body, for example to treat an illness, relieve a symptom, enhance a performance or
ability, or to alter states of mind. The word "drug" is etymologically derived from the
Dutch/Low German word "droog", which means "dry", since in the past; most drugs were
dried plant parts8. Or we can say that Any chemical substance which could effects the
physical, social, psychological, spiritual and economical well being of an individual and
bring change in his behavior is called drug. A drug is any chemical substance that can
alter the normal structure and function of body.
ADDICTION
There are some conditions when these conditions prevail; we
term the person as addict. i.e. when;
o There is Dependency
o Loose control upon one self
o It becomes unmanageable to carry on routine works-
----like job
o Increased tolerance
o Deviant behavior---Behavior becomes harmful
When these above conditions occur and the drug of use brings with it these changes then we
are addict. Not the other way else.
ADDICTIVE DRUG
―Any chemical substance which could affect the physical, social, and psychological
wellbeing of an individual and brings change in his behavior, such a substance is called
an addictive drug.‖
8
―Drug‖ Wikipedia, Wikipedia the free encyclopedia Saturday, June 30, 2007 Wikipedia foundation Inc.
<http://en.wikipedia.org/wiki/Drug>

DRUG ADDICTION
―It is a disease which is characterized by gradual loss of control over mood altering
chemicals which makes the person dysfunctional socially, psychologically, physiologically,
and spiritually.‖
So drug addiction is a disease and it is said to be the largest disease of the world because it
affects four sides of our life. i.e. physiological, social, psychological, and spiritual. Socially
the person is isolated, psychologically he become irritable, depressed, anxious, spiritually he
goes far away from his religion, no Nimaz and no Roza.
When you see a flower why you become happy? It is due to a stimulus-response system and
it‘s natural. The drug addict blocks this natural process of stimulus-response and creates an
artificial system to experience mood change. Whenever these results occur in a person by
using any drug then the person will be termed drug addict.
We need a reaction for any situation but the drugs eradicate the reaction system in our body
and the result is that we don‘t feel any happiness or sadness to any environment i.e. no
response.
DEFINITIONS OF DRUG ADDICTION
Thirty years ago, the term addict had a pretty narrow meaning for most people; someone who
used heroin several times daily and who would suffer terrible withdrawal symptoms if he or
she were late getting a ―fix‖. Now it seems that addiction is everywhere; not only are
alcoholics and cigarette smokers referred to as addicts, but we also hear about sex addicts,
food addicts, gambling addicts, addictive relationships, and even addictive forms of politics.
What do we mean by addiction, and how have models of addiction become important for
describing such a wide variety of human conduct?
We begin by attempting to define drug addiction. A leading addiction researcher has offered
the following definition of drug addiction: ―a behavioral pattern of drug use, characterized by
overwhelming involvement with the use of a drug, the securing of its supply, and a high
tendency to relapse after withdrawal‖. 9
9
Ray, O. Ksir, C. (2002) Opt Cit. Pp. 44-45

The dictionary meaning of addiction is ―give oneself up to a habit‖.10 According to the WHO
experts committee drug addiction has been defined as
A state of periodic or chronic intoxication detrimental to the individual and to society,

produced by repeated consumption of a drug, either natural or synthetic.11
Drug addiction is characterized by frequent use of the drug (usually at least daily) and
by the fact that a great deal of the individual‘s behavior is focused on using the drug,
obtaining the drug, or talking about the drug or, is focused on the paraphernalia
associated with the drug‘s use12.
The continued compulsive use of drugs in spite of adverse health or social

consequences.
A behavior disorder characterized by drug-seeking behavior and the use of the drugs
for that other than medical indications.
Drug addiction or substance dependence is the compulsive use of drugs, to the point
where the user has no effective choice but to continue use.13
From the above given definitions we can conclude that drug addiction is state in which a
person has heavy dependence on drugs to the point where the user continuously uses the
drugs in order to experience satisfaction or mood change.
SOME IMPORTANT CONCEPTS
Drug: any substance, natural or artificial, other than food, that by its chemical nature alters
structure or function in the living organism.‖
Illicit Drug: a drug that is unlawful to possess or use.
10
Ibid. p. 5
11
Khalid. M, ―Social Work Theory and Practice‖ 3rd Edition, Kifayat Academy, Karachi. pp. 1-310
12
Ray. O & Ksir. C, ―Drugs, Society, and Human Behavior‖, 9th edition, McGraw-Hill Companies Inc. pp 4-81
13
Imran Ahmad (2007). Social Work with Drug Addicts; Assignment. Department of Social Work UOP

Deviant Drug Use: is a drug use that is not common within a social group and that is
disapproved of by the majority, causing members of the group to take corrective action when
it occurs.
Drug Misuse: generally referrers to the use of prescribed drugs in greater amounts than, or
for purpose other than, those prescribed by a physician or dentist.
Drug Abuse: consists of the use of a substance in a manner, amounts, or situations such that
the drug use causes problems or greatly increases the chances of problems occurring.
Drug Addiction: is a very controversial term. Its dictionary meaning is ―give one self up to a
habit”. Drug addiction is thus usually characterized by frequent use of the drug usually at
least daily and by the fact that a great deal of the individual‘s behavior is focused on using the
drug, obtaining the drug, or talking but the drug or , is focused on the paraphernalia
associated with the drug‘s use.14
THREE BASIC PROCESSES

OF DRUG ADDICTION15
There are three basic processes related to addiction that have been important in the history of
drug addiction research. i.e.
a. Tolerance,
b. Physical dependency, and
c. Psychological dependency;
a. Tolerance
Tolerance in drug addiction means “reduced effect of a drug after repeated use. Or the need
for an increase in the amount of drugs ingested to produce the same effect as before.‖
Tolerance is a form of physical dependence, occurs when the body becomes accustomed to a
drug and requires ever-increasing amounts of it to achieve the same pharmacological effects.
14
Ray, O. Ksir, C. (2002) Opt Cit. P. 5
15
ibid. Pp. 45-46

This condition is worsened when certain drugs are used at high doses for long periods (weeks
or months), and may lead to more frequent use of the drug. However, when use of the drug is
stopped, drug withdrawal may result, which is characterized by nausea, headaches,
restlessness, sweating, and difficulty sleeping. The severity of drug withdrawal symptoms
varies depending on the drug involved.
Tolerance refers to phenomena seen with many drugs, in which repeated exposure to the
same dose of the drug results in a lesser effect. There are many ways this diminished effect
can occur. As the individual experience less and less of the desired effect, it is often possible
to overcome the tolerance by increasing the dose of the drug.
b. Physical Dependence
Physical dependence is defined by the occurrence of a withdrawal syndrome. Suppose a
person has begun to take a drug and a tolerance has been developed. The person increases the
amount of drug taken and continues to take these higher doses so regularly that the body is
continuously exposed to the drug for days or weeks. When the person stops taking drug some
symptoms begin to appear in the body, as the drug level diminishes. e.g. as the level of heroin
decreases in heroin addict, that person‘s nose might run and he might begin to experience
chill, fever, diarrhea and other symptoms. When we have a drug that produces a consistent set
of these symptoms in different individuals, we refer to the collection of symptoms as the
withdrawal syndrome. In simple words we can say that the individual has come to depend on
the presence of some amount of that drug to function normally. Removing the drug leads to
an imbalance which is slowly corrected over a period of a few days.
Physical dependence is a state which occurs only with certain classes of drug, notably the
opiates, barbiturates and minor tranquilizers. It required a period of regular use before
dependence is produced. Over time, the body becomes accustomed to the presence of the
drug and adjusts so as to continue working as normally as possible. If the drug is then
suddenly removed, the body is thrown off balance and takes some time to re-establish
equilibrium, a process which manifests itself in more or less unpleasant withdrawal
symptoms.
c. Psychological Dependence
Psychological dependence (also called behavioral or habitual dependence) can be defined in
terms of observable behavior. It is indicated by the frequency of using a drug or by the

amount of time or effort an individual spends in drug seeking behavior. Often it is

accompanied by report of craving the drug or its effects. A major contribution of behavioral
psychology has been to point out the scientific value of the concept of reinforcement for
understanding psychological dependence.
TYPES OF ADDICTION
There are two types of drug addiction.
Intoxicated Addiction
Medicated Addiction
a) Intoxicated addiction is the abuse of the illegal drugs. For example the person using
chars, heroin, marijuana (Bhang) or chillum in Pakistan is intoxicating them in his
body. The use and trade of such drugs is not allowed in our country. The misuse of
hallucinogens is also included in intoxicated addiction.
b) Medicated addiction is started due to misuse of the legal drugs. For example, people
often use painkillers or sleeping pills, which are prescribed by the physician. But
whenever they use them for the long time without prescription, this leads to the abuse.
They become dependent on them. They feel that they can‘t function normally without
the use of painkiller, or can‘t sleep without having sleeping pills.

CAUSES & SIDE

EFFECTS
 Causes & Side effects of

Drug Addiction
CHAPTER NO. 3

Causes & Side-Effects of

Drug Addiction
WHY START DRUG ADDICTION?
The causes of starting drug addiction can be several in numbers but for our convenience we
can divide them in four main categories;
1. Medical Causes
People often use painkillers or energy drinks to relieve the pain or to get the energy. They
use it most of the times without the prescription of the physician. When the use of
painkillers is prolonged, the person becomes dependent on it. He can‘t feel ease without
using painkiller. The person who uses sleeping pills for sound sleep often becomes
dependent on it. These drugs have a tolerance effect in them. i.e. if a person uses one pill
per day, this need will be increased with the passage of the time. He will need more and
more drug. This leads us to believe that Self medication often leads to drug addiction.
2. Psychological Causes
The person with a weak personality can become addict. Weak personality leads to drug
addiction. When the person is under depression or who has anxiety, starts taking drugs to
reveal tension.
3. Economic Causes
Unemployment among youth is the one major cause for drug addiction. The individual
with no job has very much leisure time to spend. So such individual easily become
addicts. A known saying is that ―an empty brain is the house of the devil‖. Loss in ones
business also leads to drug addiction.
4. Social Causes

There are so many social causes which lead to drug addiction in our society. The
disbursed or disturbed family can leads to drug addiction. When there is the drug
culture in family, so the younger can then also become addict very easily. Easy
availability is an other reason. The peer or the friends‘ pressure is the biggest cause
for drug addiction. Often young people start taking drug just for fun or enjoyment.
But with the passage of time they become addicted. Excess of wealth may leads to
addiction.
16
SIDE-EFFECTS OF DRUG ADDICTION
The effects of drugs are categorized in four or five different ways, i.e.
1. Physiological
2. Social
3. Psychological
4. Spiritual
5. Family
6. Community
These are detailed in the following lines;
1. Physiological
o lake of apatite – bhook ka na lagna o Jerks
o sleep disorder – bey khabee o Hepatitis
o HIV/AIDS
o lethargy - sustee
o Cirrhosis of Lever
o muscle twitching o Gastroenteritis
o skin disorder o Intestinal Bleeding
o Anemia
o Vomiting - ulti
o Diarrhea
o Body pane o Increase risk of cancer
o Weight loss o Mild Fever
o Runny Nose
o Watering and Redness of the eyes
16
Naeem. A. (2008).Notes for Social Work Student. Peshawar. Unpublished notes of The Center Manager, Dost
Welfare Foundation

2. Social
o Isolation - tanhai
o No interaction with community
o Imbalance in relations
o Dependency upon others
o Theft---crimes
o Disturbed nexus with family
o Anti Social Personality
3. Psychological
o Disorientation
o Guilt o Memory Loss
o Shame o Feeling of
o Anger Uncertaininty
o Irritation – chirh chirha pun

o Mood swings- kabi khoshi khabi ghum-
but don‘t know why
o Mind-Body coordination lost
o Intolerance-the major side effect
o Difficulty in concentration
o Anxiety
o Depression
o Low self esteem
4. Spiritual o Dishonesty
o Loss of belief o Resentments
o Blaming God and
o Loss of confidence
people
o Fear of every thing o Does not care for
o Distrustful respect
o In-acceptance
o No Nimaz and Roza
o Ingratitude

5. Financial
Although it can be included in social but we take it separaely/
o Job loss
o Decrease in income
o Unemployment
o Crime increases
o Burden on fmily
o Business loss
6. Effects on Family
o Dysfunctional
o Disruption of family life
o Co-dependency
o Spousal abuse
o Child abuse
o Assaults
o Physical and psychological trauma
o Financial loss from incarceration (imprisonment) or death of the addict
7. Community
o Crime (assault, rape, murder, theft)
o Accidents
o Spread of disease
o Broken homes
o Low productivity
o Addicts – street / jail drug subculture

CLASSIFICATION
 Of Drugs with reference to

addiction
CHAPTER NO. 4

Classification of Drugs With reference to addiction
The drugs are classified into four classes;
1. Depressants
2. Painkillers / Narcotics
3. Stimulants
4. Hallucinogens
There detail is given on the next pages...
S.N. MAJOR DRUGS

CATEGORY
1 Alcoholic Beverages
2 Minor Tranquilizers – Benzodiazepines à
Sleeping Pills
A Depressants 3 Barbiturates
4 Solvents and Gasses
5 GHB/GBH à Gammhydroxybutyrate
1 Opiates
I Natural Derivative of Opium poppy, heroin,
morphine, codeine
B Pain Killers II Opoiodis --> Synthetic Drugs with effects
similar to opiates
I Narcotic Analgesics
1 Amphetamines
2 Cocaine
3 Caffeine
4 Tobacco --> Nicotine
C Stimulants 5 Khat
6 Anabolic Steroids
7 Hallucinogenic Amphetamines
8 Alkyl Nitrites
1 LSD --> Lysergic Acid Diethylamide

Hallucinogens 2 Hallucinogenic Mushrooms

D 3 Cannabis/ Marijuana
4 Ketamine
A. DEPRESSANTS
These are drugs, which depress the physical functions of the CNS. The main drugs in this
group are alcohol, barbiturates and benzodiazepines, but solvents and gases are included
because they produce similar effects.
Symptoms of Depressants:
• Appear as intoxicated
• Slurred as intoxicated
• Loss of motor co-ordination
• weak & rapid impulse
• Slow breathing
• Cold skin
1) Alcoholic Beverages17
• OTHER NAMES; whisky, sherry, beer, tarra (local)

• Legal status: legal in western countries, not legal in
Pakistan
• Rout of administration:
Can be swallowed as a drink
This is included in Depressants class. There are various

kinds of alcoholic beverages which include ales, beer,
brandy, gin, liqueurs, mead, rum, sake, vodka, whisky,
and wine. Among all of them only wine is produced from
17
Hewitt, Brenda G., and Gordis, Enoch. "Alcoholism." Microsoft® Encarta® 2006 [DVD]. Redmond, WA:
Microsoft Corporation, 2005.

fruits juice while the others are from other sources.
Alcoholism or Alcohol Dependence is

chronic disease marked by a craving for
alcohol. People who suffer from this
illness are known as alcoholics. They
cannot control their drinking even when
it becomes the underlying cause of
serious harm, including medical
disorders, marital difficulties, job loss, or
automobile crashes. Medical science has
yet to identify the exact cause of alcoholism, but research suggests
that genetic, psychological, and social factors influence its
development. Alcoholism cannot be cured yet, but various
treatment options can help an alcoholic avoid drinking and regain a
healthy life.
Alcoholics develop a craving, or a strong urge, to drink despite awareness that drinking is
creating problems in their lives. They suffer from impaired control, an inability to stop
drinking once they have begun. Alcoholics also become physically dependent on alcohol.
When they stop drinking after a period of heavy alcohol use, they suffer unpleasant physical
ailments, known as withdrawal symptoms, which include nausea, sweating, shakiness, and
anxiety. Alcoholics develop a greater tolerance for alcohol—that is, they need to drink
increasing amounts of alcohol to reach intoxication. The World Health Organization (WHO)
notes that other behaviors common in people who are alcohol dependent include seeking out
opportunities to drink alcoholic beverages—often to the exclusion of other activities—and
rapidly returning to established drinking patterns following periods of abstinence. Alcohol
now a days have so many kinds.

2) Tranquilizer18
Tranquilizer, common name applied to a class of drugs

used to treat anxiety and insomnia. Originally the term
comprised two groups: the major tranquilizers—the
phenothiazines, such as chlorpromazine (Thorazine)—useful in the treatment of acutely ill
mental patients; and the minor tranquilizers—the benzodiazepines, such as diazepam
(Valium). By popular usage, the term now refers only to the latter group. In the early 1980s,
these minor tranquilizers were the most frequently prescribed drugs in the world. They are
useful for relief of temporary anxiety and insomnia.
The minor tranquilizers are safe when taken alone, but taking substantial amounts of these
substances at the same time as alcohol can lead to coma or even death. Long-term
administration of larger than usual doses of the benzodiazepines can cause physical
dependence, with typical withdrawal symptoms ranging from nightmares to convulsions
when the drug intake is stopped.
3) Barbiturate19
Other names: Tunial, downers, Sleepers, barbs etc

Legal Status: prescribed as medicine, controlled drugs, illegal to
process without prescription.
Barbiturate, any of an important group of drugs that depress brain function; they are derived
from barbituric acid (C4H44N203), a combination of urea and malonic acid. Depending on the
dosage or formulation, barbiturates have a sedative (tranquilizing), hypnotic (sleep-inducing),
anticonvulsant, or anesthetic effect. Very short-acting barbiturates such as thiopental are
injected intravenously to induce rapid anesthesia before surgery. Phenobarbital, a long-acting
barbiturate, is prescribed with other medications to prevent epileptic seizures. Other
barbituric-acid derivatives, such as secobarbital, were used as antianxiety medications until
the development of the tranquilizer; they are still in use for the short-term treatment of
18
"Tranquilizer." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005
19
Berger, Philip A. "Barbiturate." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.

insomnia, although tranquilizers are more suitable sleep inducers. Barbiturates are common
drugs of abuse. Taken orally or intravenously, they produce symptoms similar to
drunkenness: loss of inhibition, boisterous or violent behavior, muscle incoordination,
depression, and sedation. They are physically addicting and produce severe withdrawal
symptoms; overdoses can cause profound shock, coma, or death.
B. PAINKILLERS - OPIATES
1) Narcotics
Narcotics, term originally applied to all compounds that produce insensibility to external
stimuli through depression of the central nervous system, but now applied primarily to the
drugs known as opiates—compounds extracted from the opium poppy and their chemical
derivatives. Also classed as narcotics are the opioids, chemical compounds that are wholly
synthesized, but which resemble the opiates in their actions.
The most important attribute of narcotics is their capacity to decrease pain, not only by
decreasing the perception of pain, but also by altering the reaction to it. Although they do
have sedative properties when used in large doses, they are not used primarily for sedation.
The major constituent of opium and the prototype of all narcotic analgesics is morphine.
Heroin, synthesized from morphine, is a potent analgesic, but its use is forbidden. Some of
the newer synthetic compounds are 1000 to 10,000 times more potent than morphine.
In addition to their painkilling properties, the narcotic analgesics cause a profound feeling of
well-being (euphoria). It is this feeling that is in part responsible for the psychological drive
of certain persons to obtain and self-administer these drugs. When taken chronically in large
doses, the narcotics have the capacity to induce tolerance (whereby a larger and larger dose is
required by the body to achieve the same effect), and ultimately psychological and physical
dependence, or addiction. In this respect they are similar to the barbiturates and to alcohol.
These properties make the medical use of narcotics extremely difficult and have led to strict
regulation of the prescription and dispensing of this class of drugs. Even so, they are widely
abused.

2) Opium 20
Opium, narcotic drug produced from the drying resin of unripe

capsules of the opium poppy. Opium is grown mainly in
Myanmar (formerly Burma) and Afghanistan.
In its commercial form, opium is a chestnut-colored globular

mass, sticky and rather soft, but hardening from within as it ages.
It is processed into the alkaloid morphine which has long served as the chief painkiller in
medical practice, although synthetic substitutes such as meperidine (trade name Demerol) are
now available. Heroin, a derivative of morphine, is about three times more potent. Codeine is
another important opium alkaloid.
The molecules of opiates have painkilling properties similar to those of compounds called
endorphins or enkephalins produced in the body. Being of similar structure, the opiate
molecules occupy many of the same nerve-receptor sites and bring on the same analgesic
effect as the body's natural painkillers. Opiates first produce a feeling of pleasure and
euphoria, but with their continued use the body demands larger amounts to reach the same
sense of well-being. Withdrawal is extremely uncomfortable, and addicts typically continue
taking the drug to avoid pain rather than to attain the initial state of euphoria. Malnutrition,
respiratory complications, and low blood pressure are some of the illnesses associated with
addiction.
3) Heroin21
Heroin is derivative of Morphine, which itself is derived

from opium, a substance found in the poppy plant. The
drug is most commonly injected into the blood stream
with a needle and syringe, although it may also be
simplified, smoked, or ingested orally.
20
―Opium." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.
21
Khalid, M. (2002). Social Work Theory and Practice, with special reference to Pakistan. 2nd Ed, P\Karachi:
Kifayat Academy. Pp. 308-309

The effects of heroin are thought to vary. Nevertheless, most regular

users report pleasurable experiences with the drug. Upon injecting it,
many users experience a ―rush‖ or wave of sensations. The rush does
not last long and is followed by a mild sense of euphoria, the
relaxation of tensions and the disappearance of any physical pains.
Users who take heroin repeatedly develop tolerance to it. This means
that they must use larger and larger doses in order to achieve
pleasurable effects. Heroin and other opiates are physically addictive. Heroin addicts who
stop using the drug suffer from serious withdrawal symptoms including cramps, nausea,
muscle tremors, diarrhoea, chills, and extreme nervousness. Regular heroin users are literally
driven toward continues use of heroin, not necessarily to gain pleasure but to avoid the pain
of withdrawal.
Common disease among heroin users, such as hepatitis and tetanus, are a result of the ;use of
insanitary paraphrenalia – as when several persons share the same needles.
4) Codeine22
Codeine, alkaloid, C18H21NO3H2O, derivative of opium. It is a white

crystalline solid, slightly soluble in water and soluble in organic
solvents. When heated, it first loses water and then melts at 157° C
(315° F). Chemically a methyl ether of morphine, codeine has similar
physiological effects but to a lesser degree, particularly because it is less
habit-forming. It is used to reduce pain and to suppress coughing.
C. STIMULANTS
The primary definition of a stimulant drug is one that excited the CNS. Cocaine, caffeine,
tobacco, and amphetamines all do this, but in different degrees. Other drugs are also misuse
for their stimulants-like effects; the alkyl nitrate dilate the blood vessels causing a ―rush‖
while an anabolic, (slang terms uppers, speed).
22
"Codeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

1) Amphetamine23
Principal drug: Amphetamine sulphate, Ritalin, ice, cokes,

snow, Charlie etc.
Legal Status: Illegal to posses without prescription.
Route of administration: Sniffed, injected, pills/capsules,
smoked, chewed.
Amphetamine, any of a group of powerful stimulant drugs that act

on the central nervous system (the brain and the spinal cord),
increasing heart rate and blood pressure while reducing fatigue.
Although amphetamines were originally prescribed to suppress
appetite and to treat depression, their medical use is now restricted
primarily to treating narcolepsy (sudden and uncontrollable sleep
attacks) and hyperactivity. The amphetamines include drugs that
are classified as amphetamines, dextroamphetamines, and methamphetamines.
Amphetamines act by stimulating the release of neurotransmitters such as norepinephrine that

increase brain activity and raise blood pressure. When initially taken, amphetamines produce
feelings of well-being, increased competence, and alertness. High doses of amphetamines can
cause tremors, sweating, heart palpitations, or anxiety. Exhaustion and depression follow
when the effects of amphetamines wear off. Serious mental illness including paranoia,
delusions, hallucinations, and violent behavior may occur after prolonged use. Since chronic
use reduces appetite, weight loss may be drastic, resulting in a gaunt, wasted appearance.
Amphetamines are commonly abused by individuals seeking mood elevation, increased
alertness, or improved athletic performance. Intravenous injection of methamphetamines, for
example, produces a sudden, pleasurable, euphoric feeling.
Regular medical and recreational use of amphetamines can lead to greater physical tolerance
of the drug, requiring progressively higher doses to achieve the same effects. Ultimately,
psychological drug dependency may result, characterized by a craving for the drug and belief
that one cannot function without taking it.
23
"Amphetamine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

2) Cocaine24
Legal Status: controlled drugs, illegal to posses.

Route of administration: Powder sniffed and injected.
Cocaine, alkaloid obtained from leaves of the coca plant and used medically as a local
anesthetic. It is also widely abused as a drug. Native Americans of the Inca Empire chewed
coca leaves to obtain mild euphoria, stimulation, and
alertness. The drug was first isolated in 1855 and came to be
used widely as a local anesthetic in minor surgery. At present,
local anesthetics with less abuse potential, such as lidocaine,
are commonly used instead.
Cocaine has long been known as a drug of abuse, but it came

into particular prominence in the late 1970s and the 1980s.
Cocaine hydrochloride, a water-soluble salt, is a dry white powder (known on the street as
―snow‖) that is usually inhaled through a thin tube inserted into the nostril. More rarely,
cocaine is injected into a vein. The drug may also be smoked in a purified form through a
water pipe (―freebasing‖) or in a concentrated form (―crack‖) shaped into pellets and placed
in special smoking gear. Users experience euphoria, exhilaration, and a decreased appetite.
The drug also increases heart rate, elevates blood pressure, and dilates the pupils. Chronic use
can lead to skin abscesses, perforation of the septum of the nose, weight loss, and damage to
the nervous system. Negative mental effects include extreme restlessness, anxiety, irritability,
and, occasionally, paranoid psychosis. Death from even a small dose can
occur, and is usually caused by seizures or heart attacks. It
causes strong psychological dependence.
3) Caffeine25
Coffee, tea, cocoa, soft drinks, chocolate, analgesic pills etc.
24
Berger, Philip A. "Cocaine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.
25
"Caffeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

Legal Status: legal and unrestricted.

Route of administration: swallowed as a beverage in confectionary or in pills.
Caffeine, an alkaloid (C8H10O2N4·H2O) found in coffee, tea, cacao, and some other plants. It
is also present in most cola beverages. Caffeine was discovered in coffee in 1820. In 1838 it
was established that theine, discovered in tea in 1827, is identical to caffeine. The drug
increases the blood pressure, stimulates the central nervous system, promotes urine
formation, and stimulates the action of the heart and lungs. Caffeine is used in treating
migraine because it constricts the dilated blood vessels and thereby reduces the pain. It also
increases the potency of analgesics such as aspirin, and it can somewhat relieve asthma
attacks by widening the bronchial airways. Caffeine is produced commercially chiefly as a
by-product in making caffeine-free coffee.
Caffeine has been suggested as a possible cause of cancer or of birth defects. No studies,
however, have yet confirmed any of these charges. Persons who stop drinking coffee do
sometimes experience withdrawal headaches.
4) Tobacco26
Tobacco, cigarette, snuff, naswar, pipe etc.

Legal Status: illegal to sell to children under 16.
Route of administration: smoked, sniffed, and chewed.
Tobacco, plant grown commercially

for its leaves and stems, which are
rolled into cigars, shredded for use in
cigarettes and pipes, processed for
chewing, or ground into snuff, a fine
powder that is inhaled through the
nose. Tobacco is the source of
nicotine, an addictive drug that is also
the basis for many insecticides.
26
Hynes, Erin. "Tobacco." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

Tobacco is a member of the nightshade family. There are more than 70 species of tobacco.
The two cultivated species, common tobacco and wild tobacco, are annuals—they live only
one growing season. Common tobacco is 1 to 3 m (3 to 10 ft) tall and has a thick, woody
stem with few side branches. One plant typically produces 10 to 20 broad leaves that branch
alternately from the central stalk. The leaf size depends on the strain. The narrow, trumpet-
shaped flowers are dark pink to almost white. Wild tobacco is about 0.6 m (2 ft) tall and has a
stem that is more slender and less woody than common tobacco. The leaves have a short stalk
that attaches to the stem. The flowers are pale yellow with five separate lobes.
5) Nicotine27
Nicotine, an oily liquid substance found in tobacco leaves

that acts as a stimulant and also contributes to smoking
addiction. When extracted from the leaves, nicotine is
colorless, but quickly turns brown when exposed to air. It
has an acrid, burning taste. Nicotine is a very powerful
poison, and it forms the base of many insecticides.
Cigarette tobacco contains only a small amount of nicotine and most of this nicotine is
destroyed by the heat of burning so that the actual concentration of nicotine in smoke is low.
However, even a small amount of nicotine is sufficient to be addictive. The amount of
nicotine absorbed by the body from inhaling smoke depends on many factors including the
type of tobacco, whether the smoke is inhaled, and whether a filter is used.
Tobacco smokers absorb small amounts of nicotine by inhaling smoke from cigars, cigarettes,
or pipes. Nicotine is drawn into the lungs where it enters the bloodstream and is pumped by
the heart to the brain. It takes only seven seconds for nicotine to enter the brain after being
inhaled.
Nicotine has various effects on the body. In small doses nicotine serves as a nerve stimulant,
entering the bloodstream and promoting the flow of adrenaline, a stimulating hormone. It
speeds up the heartbeat and may cause it to become irregular. It also raises the blood pressure
27
"Nicotine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

and reduces the appetite, and it may cause nausea and vomiting. The known health risks
associated with cigarette smoking, such as damage to the lungs and lung cancer, are thought
to be caused by other components of cigarettes such as tars and other by-products of
smoking, and by the irritating effects of smoke on the lung tissue. Addiction to smoking is
caused by nicotine itself. Stopping smoking produces withdrawal symptoms within 24 to 48
hours, which commonly include irritability, headaches, and anxiety, in addition to the strong
desire to smoke.
6) Khat28
Legal Status: May not be lawfully possessed, accept under license.

Route of administration: chewed or swallowed
Khat, also spelled qat or kat, tree of the

bittersweet family (also known as the
staff tree family). The khat is an
evergreen that grows in East Africa and
Arabia. It has small white flowers and oblong toothed leaves. The leaves and tender shoots of
the tree are used to make Arabian tea. Khat leaves contain a drug with effects similar to an
amphetamine and are chewed as a stimulant in some regions of the Middle East and Africa.
The tree is also known as the cafta and the Arabian tea tree.
7) Steroids29
Steroids, large group of naturally occurring and synthetic

lipids, or fat-soluble chemicals, with a great diversity of
physiological activity. Included among the steroids are
certain alcohols (sterols), bile acids, many important
hormones, some natural drugs, and the poisons found in the
skin of some toads. Various sterols found in the skin of human beings are transformed into
vitamin D when they are exposed to the ultraviolet rays of the sun.
28
"Khat." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.
29
"Steroids." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

Anabolic steroids induce weight gain and increased muscle mass. Originally developed to
help cancer patients and victims of starvation, they are derived from the male sex hormone
testosterone. In recent decades steroids have been abused by many athletes hoping to improve
performance. Besides the unfairness their use introduces into competition, steroids can have
serious psychological and physiological side effects, including increased aggressive behavior
and cancer of the liver. The International Olympics Committee banned the use of steroids in
1974, after gas chromatography testing for their presence became possible. A number of
athletes have been disqualified in competitions.
D. HALLUCINOGENS
1) Hallucinogen30
Hallucinogen, any one of a large number of natural or

synthetic psychoactive drugs that produce marked distortions
of the senses and changes in perception. Hallucinogens
generally alter the way time is perceived, making it appear to Magic Mushrooms
slow down. As the name suggests, hallucinogens may produce
hallucinations, which are shape- and color-shifts in the
appearance of the outside world or, in extreme cases, the
replacement of external reality with imaginary beings and
landscapes. Hallucinogens may also lead to bizarre and
antisocial thoughts as well as to disorientation and confusion.

The physiological basis of such experiences is not clear, but
evidence suggests that hallucinogens work by inhibiting the
availability of serotonin, an important neurotransmitter in the
brain.
Hallucinogens may be taken orally, injected, or, in the case of marijuana (a mild
hallucinogen), smoked and inhaled. They usually take effect within an hour and cause
30
"Hallucinogen." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation, 2005.

increases in blood pressure, body temperature, and pulse rate as well as dilation, or
enlargement, of the pupils of the eyes. These drugs may also cause nausea and numbness.
Individual reactions to hallucinogens are unpredictable, especially when these drugs are used
recreationally—that is, for the pleasurable effects they produce and not for medical purposes.
The experience of the drug may be pleasurable one day and highly disturbing the next,
depending on the setting and circumstances in which the drug is taken and the individual‘s
personality and mood at the time. The effects of hallucinogenic drugs may last from a few
hours to several days, and may recur months later in what are referred to as flashbacks.
Most hallucinogens do not cause physical dependence with chronic use, although tolerance of
behavioral effects can develop, in which case more of the drug is needed to create the same
mental states.
2) Marijuana31 / Cannabis
Marijuana, common name for a drug made from the dried leaves and flowering tops of the
Indian hemp plant Cannabis sativa. People smoke, chew, or eat marijuana for its
hallucinogenic and intoxicating effects. It is known by a
number of slang names, including ―pot,‖ ―grass,‖
―reefer,‖ ―weed,‖ and ―Mary Jane.‖
The flowering tops of the Cannabis plant secrete a sticky

resin that contains the active ingredient of marijuana,
known as delta-9-tetrahydrocannabinol (THC). The
plant has both male and female forms, and the sticky
flowers of the female plant are the most potent. Hashish is a similar drug prepared from the
same plant. It differs from marijuana in that it is comprised of only the resin from the plant,
whereas marijuana is made up of flowering tops and leaves.
31
Iversen, Leslie. "Marijuana." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.

Known in India, Central Asia, and China as early as 3000 BC, marijuana has long been used
as both a medicine and an intoxicant. Most countries consider marijuana an illegal substance,
but individual countries vary on how they prosecute the use and possession of marijuana.
Some countries only impose small fines, while others impose
harsher punishment, including imprisonment.
3) Ketamine32
Ketamine is a drug for use in human and veterinary medicine

developed by Parke-Davis (1962). Like other pharmaceuticals Medical Use
of this type, ketamine is used as a recreational drug.
Ketamine has a wide range of effects in humans,

including analgesia, anesthesia, hallucinations, elevated
blood pressure, and bronchodilation. It is primarily used
for the induction and maintenance of general anesthesia,
usually in combination with some sedative drug. Other
uses include sedation in intensive care, analgesia
(particularly in emergency medicine), and treatment of Recreational Use
bronchospasm. It is also a popular anesthetic in veterinary
medicine.
4) Lysergic Acid Diethylamide33
Lysergic Acid Diethylamide (LSD) is a potent hallucinogenic drug, also called a psychedelic,
first synthesized from lysergic acid in Switzerland in 1938 by scientist Albert Hofmann. The
drug evokes dreamlike changes in mood and thought and alters the perception of time and
space. It can also create a feeling of lack of self-control and extreme terror. Physical effects
include drowsiness, dizziness, dilated pupils, numbness and tingling, weakness, tremors, and
nausea.
32
―Katamine‖, Wikipedia the Free Encyclopedia. Wikipedia Foundation Inc. April, 03, 2008
http://en.wikipedia.org/wiki/Ketamine
33
Berger, Philip A. "Lysergic Acid Diethylamide." Microsoft® Student 2008 [DVD]. Redmond, WA: Microsoft
Corporation, 2007.

Transient abnormal thinking induced by LSD, such as a sense of omnipotence or a state of

acute paranoia, can result in dangerous behavior. Long-term adverse reactions such as
persistent psychosis, prolonged depression, or faulty judgment have also been reported
following LSD ingestion, but whether these are a direct result of ingestion is difficult to
establish. Physiologically, LSD may cause chromosomal damage to white blood cells; no
hard evidence has been found, however, that LSD causes genetic defects in the children of
users.
Although LSD is not physiologically addicting, the drug‘s potent mind-altering effects can
lead to chronic use. In the 1960s LSD use was widespread among people who sought to alter
and intensify their physical senses; to achieve supposed insights into the universe, nature, and
themselves; and to intensify emotional connections with others.

Another table which was given by Compton and Galawa 34in their book Social Work and Social Welfae is also given .....
Drug Method of Administration Desired Effect Hazards and Side Effects
A NORCOTICS
1 Smoking, injecting a vain Euphoria – Extreme Happiness Withdrawal symptoms resemble flu but are not life
("Mainlining"); or under the threatening; use of unsterile needles results in AIDS and
Heroin
skin ("skin popping"); other diseases and infections, addiction
inhaling ("snorting")
2 Injection into vein Euphoria; kill pain Risk from unsterile needles; malnutrition; continued use
results in depressive states, withdrawal, anxiety, elevated
Morphine
blood pressure, and fever, addicting
3 Swallowed by mouth in pill Deaden pain Less addicting than heroin or morphine; withdrawal
Codeine from or with a liquid such as discomfort not as severe
cough medicine
4
B CENTRAL NERVOUS SYSTEM STIMULANTS
1 Inhaled ("snorted"); injected; Increase in energy; sense of strength prolonged use; anxiety, depression so severe that suicide
smoked as crack in glass and well-being; sexual prowess may occur; persecutory delusions; paranoia
Cocaine
pipes
2 Taken by Mouth Increased alertness and energy; as above

Amphetamines {"Uppers", weight loss
"Crystal")
34
Compto, B. Galawa. Introduction to Social Work and Social Welfare . McGrawHill Publications

C CENTRAL NERVOUS SYSTEM DEPRESSENTS
1 Relieve pain; often taken to reverse Confusion and other forms of mental disorder; seizures;
Taken by mouth or injected the effects of stimulants such as death from suicidal overdose
Barbiturates ("Downers") amphetamines
2 Psychological dependence; severe health hazed with

Taken by mouth in pill form Reduction of anxiety unpredictable results when combined with alcohol or
Tranquilizers
other drugs
3 increased sociability; sense of Depression; irregular sleep patterns; intoxication;

Taken by mouth in liquid pleasure; to feel good; to alter the confusion; loss of consciousness; psychological
Alcohol form mood; relieve anxiety dependence; physical addiction withdrawal can be fatal
D HALLUCINOGENS
1 Smoked in a cigarette (a Psychological dependence is a potential side effect; use
Marijuana "joint" )or a pipe; may be sense of wellbeing relaxation may result in impaired judgment, anxiety, panic attacks
orally ingested
2 Produces dreamlike experiences with Confusion; hallucinations with frightening visualization;
LSD (Lysergic Acid Oral ingestion beautiful illusions and hallucinations suicide; flashback experiences months after use
Diethylamide)
3 Mescaline (derived from Confusion; hallucinations; repeated use can intensify

peyote cactus) Oral ingestion Dreamlike hallucinations underlying mental disorders
4 Psilocybin (derived from Oral ingestion Dreamlike hallucinations As above
psilocybin mushroom)
E INHALANTS
1 Sense of euphoria; a "high" improved Blindness; eye infections
Various substances; Inhalations sexual performance
gasoline, pain thinner, glue,
ether, cleaning solutions

Field Work Report Dec, 07 to May 08
TREATMENT
PHILOSOPHY
 Why treatment is given?

Major phases of treatment
CHAPTER NO. 5
Imran Ahmad [0]

Treatment philosophy35
Introduction
The treatment which is offered in dost welfare foundation is called classical-systematic-and
lifetime treatment.
Classical in the sense that it is a multidimensional treatment. It involves new scientific, faith
based, and traditional Approach. When we combine these three approaches then we call it the
classical treatment.
Systematic in the sense that there is a complete system of treatment. All the process goes
stepwise, rather then haphazardly.
Life time---it is life time treatment because drug addiction is the life time problem.
The treatment plan in Dost Welfare Foundation is divided into three phases;
A. Pre-treatment phase
B. Treatment phase
C. Post-treatment phase
PRE-TREATMENT PHASE
Change Begins
This phase starts before the treatment and before the patient enters the TC. It includes
various steps;
1. Awareness Lectures
2. Harm Reduction
3. Individual Motivational Counseling Sessions
4. Family Contacts
5. Client Registration
6. Enquiry Session
35
Naeem. A (2007). Lecture for Social Work Students. Peshawar, Lecture Delivered by Center Manager Dost
Welfare Foundation, 07-12-2007
Imran Ahmad [36]

The objectives of this session are;

Awareness
Motivation
Make the client ready for treatment
TREATMENT PHASE
Development of Change
This phase includes three steps
a) Detoxification
b) Primary Rehabilitation
c) Secondary Rehabilitation
Intake Interviews
Medical Checkup
These two steps are before detoxification.
a) Detoxification Period
This is the first phase in the treatment process, and lasts for 10 to 15 days. During this period
the physical withdrawal of the drug takes place. The main features of therapy include:
1. Symptomatic medical treatment

2. No substitute drugs
3. Bath therapy
4. Open door policy
5. Individual counseling
6. Peer support 36
7. 7Handing over of client to Supervisor/psychologist/ counselor
8. Data Sessions
9. Brief History of the Client
o Physical history
36
“Treatment Programme” Treatment Programme for Drug Users (2003). Dost Welfare Foundation Thursday,
November 22, 2007, <http://www.dost.sdnpk.org/Programmes.htm >
Imran Ahmad [37]

o Psychological history
o Social history
o Economic history
o Addiction History
 Type of drug addicted
 Nature of Addiction
 Time Span of addiction
b) Primary Rehabilitation
This period last for up to 45 days i.e. 8 weeks and it is a 30 days period after detoxification. It
includes the following features;
1. Life story in written form

2. Client profile
3. Lectures
4. Groups of the clients
5. Dars
6. Individual Counseling Sessions --- ICS
7. Different Therapeutic Techniques are started
8. Behavior Shaping Tools are applied
9. Assigning of Therapeutic Duties
10. Family Therapeutic Sessions
11. Need Based Assessment for Vocational Skills
c) Secondary Rehabilitation/ Vocational Skill Development

This phase may be residential or out-patient and includes vocational training in
automotive/electrical repair, welding, carpentry, handicrafts, sewing, food preparation etc.
Main features of this phase include:37
1. Some duties and responsibilities are assigned to the client and he is held
responsible for it.
2. Social reintegration
3. Vocational Rehabilitation
37
ibid
Imran Ahmad [38]

4. Internship
5. Job Placement---if available
POST TREATMENT PHASE – Follow-Up and Aftercare
Change Continuation
This phase of treatment last up to 90 days i.e. 45 days period after the first 2 phases. This
phase include the following;
1. Follow up and After Care

2. NA meetings ----Narcotic Anonymous Meetings
3. RPP-Relapse Prevention Programs
4. Letters and Telephone Calls
5. Home Visits of Ex-Clients
6. Social Gathering
The most important job for social worker is Relapse Prevention.
For the treatment of any client, it is necessary that s/he himself should be motivated for
treatment. The registration of the client should be voluntary in TC,
Imran Ahmad [39]

COUNSELING
CHAPTER NO. 6
Imran Ahmad [0]

COUNSELING 38
1. Counseling is a professional relationship between the client and the

counselor.
A counselor can be any one. It can be a doctor, it can be a psychologist, a therapist, a

social worker, a community health worker, a nurse, a teacher, a community based
worker, a care taker, or a care provider. Any one of these can be a counselor.
2. Counseling is an Act of exchanging ideas and opinions.
It is a process in which we exchange our opinions and our ideas with others.
Counseling is an opportunity for those people who need help and who want to solve
their problem. When they come to the counselor, their problem is satisfied.
3. Counseling is a communication process between two or more then two people to

solve a problem, resolve a crisis, create new perspectives and changes within the
person or group enabling to make decisions, and think differently and to change the
conditions in the immediate environment. It is a process to make the person identify
the actual problem, realize and actualize capabilities, and create a power in him for
the solution of the problem. The biggest thing in the world is to identify the actual
problem and then to adopt the proper way for the solution of this problem. Because
when there is a problem there is a way.
4. Counseling is a plan of action. It is a planning that how to act for a particular

situation.
The British Association of Counselling and Psychotherapy (BACP) define that ―Counselling
takes place when a counsellor sees a client in a private and confidential setting to explore a
difficulty the client is having, distress they may be experiencing or perhaps their
38
Naeem. A (2008). Counseling Notes . Peshawar, Notes of The Center Manager Dost Welfare Foundation
Imran Ahmad [40]

dissatisfaction with life, or loss of a sense of direction and purpose. It is always at the request
of the client as no one can properly be 'sent' for counselling.‖
By listening attentively and patiently the counsellor can begin to perceive the difficulties
from the client's point of view and can help them to see things more clearly, possibly from a
different perspective. Counselling is a way of enabling choice or change or of reducing
confusion. It does not involve giving advice or directing a client to take a particular course of
action. Counsellors do not judge or exploit their clients in any way39.
In other words counseling can be defined as a relatively short-term, interpersonal, theory-

based process of helping persons who are fundamentally psychologically healthy resolve
developmental and situational issues.
What do we mean by counselling40?
By counselling, we mean talking to someone who is properly trained. The person may be
called a counsellor or a psychotherapist. The difference between these two is sometimes
difficult to distinguish. Some people use the terms to mean the same thing, as much of their
work does overlap. The differences are usually to do with the type of training and special
interests of the individual counsellor or psychotherapist.
Why do people have counselling41?
There are many times in our lives when we all really feel we need someone to listen to us.
This is basically what counselling is - someone to listen to you. Being heard properly, for
example, can be really important if you have a life threatening disease like cancer. You‘re
probably finding it difficult to deal with the diagnosis. And you may be feeling a bit lost
amongst all the treatments and doctors' appointments.
39
―what is counseling‖, Education: British Association for Counseling and Psychotherapy, May 10, 2007,
British Association for Counselling and Psychotherapy, BACP House, Unit 15 St John's Business Park,
Lutterworth, Leicestershire LE17 4HB < http://www.bacp.co.uk/education/whatiscounselling.html>
40
―Living with Cancer, What is Counseling‖(2007). Cancer Research UK. Cancer Research UK 2002. May 01,
2007, < http://www.cancerhelp.org.uk/help/default.asp?page=214&order=2252>
41
ibid
Imran Ahmad [41]

Most people feel very shocked when they are told they have a life threatening disease. It can
turn your life ‗upside down‘. Things you can normally cope with, such as going to work,
shopping, looking after the kids and socializing, may become more difficult, and have less
meaning for you. Your intimate relationships might change because of changes in how you
look and the way you feel about yourself. The stress you‘re under may mean you can‘t show
the love and attention you want to your partner or children.
You may want to continue with life as normal, but feel frustrated that you can‘t. Many
people with life threatening disease have confusing and upsetting feelings such as anger and
sadness. And feeling that you‘re not in control of your life at this time can be very upsetting.
It‘s not uncommon to worry that your disease could come back again after your treatment
has finished. Or you may fear you are going to die. All of these feelings are very real and
frightening. There‘s only so much your mind can process at one time, so these feelings can
become overwhelming.
But bottling feelings up can become very draining and make living your life very difficult.
Counselling gives you an opportunity to explore your feelings and express them in a safe
place. A counsellor can help you to find a way to make things less difficult to deal with.
If you‘re a relative of someone with such a disease, you could probably do with spending a
bit of time thinking about yourself in the midst of everything else. You are bound to have
feelings of your own which you don‘t want to burden your sick loved one with. And being
able to express your feelings may help you to support your relative more effectively. 42
OBJECTIVES & GOALS OF COUNSELING
1. Finding Meaning in Life: - this phrase needs some elaboration. Meaning in life, what
dose it mean? We will answer it in such words as it means that, for example, if you
are a student then you have to know that why you are a student and if you are in this
setup then what is the aim of your being here and what should you do. This is the
main objective of our counseling that we have to enable the person so that he could
find the meaning in his life.
42
ibid
Imran Ahmad [42]

2. Curing Emotional Distress: - this is another objective of counseling. If any one has
some emotional problems then counseling is there to help him come out of it.
3. Adjusting to Society: - it means to create adaptability in the client. How to adjust

within the society, and how to adapt oneself to the environment? This will be our
goal. A drug addict, for example, we have to enable this person so that he can adapt to
his family environment.
4. Attaining Happiness and Satisfaction
5. Self Actualization: - self actualization means that you should know what you actually
are. The goal of our counseling is to enable the client to know his potentialities, to
know his weaknesses, to know where he has got a mistake.
6. Reduce Anxiety: - one of the objectives of the counseling is to reduce the anxiety of
the client. If he is angry or depressed then after counseling he should be without them.
7. Reduce Maladaptive Behavior: - Maladaptive behavior occurs when we respond to

the situation without analysis. The objective of counseling is to create the quality of
analyzing the situation in the client.
8. Increase Adaptive Behavior
SKILLS REQUIRED FOR A COUNSELOR
There are some skills which should be acquired in order to be a professional counselor; these
are as below;
1. Clarification: - the counselor should be skillful in clarifying the situation. He has to

clarify that why the client has come to him. If the client is a doctor then how to deal
Imran Ahmad [43]

with him and if he is someone else then on which track he is to be lead. How to deal
with different people is the skill of a professional counselor.
2. Ask Open-ended and Probing Questions: - asking open-ended and probing

questions is a skillful technique. The counselor should not ask the point question
which could be answered in a word or two rather he has to ask probing questions so
that there is continuity in the client‘s information giving process.
3. Listening: - the most important skill for a counselor is the active listening.
4. Appropriate Use of Silence
5. Focusing: - during the client‘s information giving process, the counselor has to focus
on those issues which are related to the client‘s problem. Whatever the information is
provided by the client, you have to focus on the causal factors which are creating this
problem.
6. Unconditional Acceptance: - the client has to be accepted by the counselor

unconditionally. There should be no discrimination on any ground.
7. Non-Judgmental Attitude
8. Confidentiality: - whatever the information the client is giving to you, you are not
suppose to disclose it publically. This is only the confidentiality guaranteed by the
counselor, that the client gives his secret information to you.
STAGES OF COUNSELING
A counseling session is divided into four (4) stages;
Imran Ahmad [44]

1. Active Listening: - the first phase of the client begins with active listening to the
client. First of all the counselor has to actively, patiently, carefully, and attentively
listen to the client so that the counselor can get the clients problem as the client sees
it, and the problem as the counselor perceived it.
2. Paraphrasing
3. Reflecting and validating feelings
4. And Summarizing; the most important
QUALITIES REQUIRED FOR A COUNSELOR
The counselor should have the following qualities;
Empathetic Responsible
Consistent Honest
Respectful Discreet – Door andash
Committed Self assured
Friendly Efficient
Informed/ knowledgeable Flexible
COMMON ERRORS THE COUNSELORS OFTEN DO
Controlling Advising
Judging or moralizing Interrogating
Labeling Encouraging dependence
Unwarranted reassuring Cajoling (to persuade)
Not accepting
Imran Ahmad [45]

BEHAVIOR
MANAGEMENT
 Tools for modifying behavior

of drug addicts
CHAPTER NO. 7
Imran Ahmad [0]

BEHAVIOR MANAGEMENT
TOOLS43
After the detoxification most of the drug addicts relapse not because of physical dependency
for drug but because of the underplaying psychosocial causal factors of addiction which may
not be fully resolved and the lack of ability of the addict to cope with high-risk relapse
situation.
The treatment centre is a place for a drug addict, where he is cut off from the streets, and it is
a place where he has taken a break from all of his anti-social behavior and activities
connected to his drug addict lifestyle. It is, now, a good opportunity for him to;
Get rid of drugs physically, &

To educate and motivate himself to get additional help for the more serious
problems then his drug addiction.
The principles of effective treatment tell us that no single treatment is effective for all the
individuals. A treatment is effective, if it focus on multiple needs of the individual, and not
just his drug use.
The treatment of a drug addict requires not only detoxification, i.e. medication, but it also
requires counseling, psychotherapy, along with behavior management. Because, the most
obvious symptom of drug addiction is in observed behavior. An addicted individual is often
in conflict with other individuals and with his environment,,,,,,
why? ? ?
it is due to his drug taking behavior, due to his anti-social behavior, due to his self centered
behavior. Behavior management and behavior shaping is, therefore, the first and the most
difficult step in changing his lifestyle.
43
Naeem. A. (2008). Behavior Management Tool (Day Top New York). Peshawar. Notes provided by The
Center Manager Dost Welfare Foundation
Imran Ahmad [46]

Behavior management and behavior shaping tools are some techniques which are used in
community centre in order to bring the change in thoughts, in attitudes & behavior. It is a
journey from negativity to positivity i.e. to modify the negative behavior in positive one of
the drug addict. The behavior management tools are applied to the environment and to the
individual as well. The common tools which are used in DOST Community Centre are;
1. Pull-up
2. Pull-up On the Board
3. Spoken to, or talking to
4. Dealt With
5. Hair-cut
a. Silent Hair Cut
b. Global Hair Cut
6. Time out
7. Confrontation
8. Prospect chair
These are some of the community tools which provide a collectivity for individual change.
They promote social learning by role modeling, peer pressure and learning by experience.
1. SPOKEN TO / TALKING TO
Introduction
It is a verbal correction regarding an observed behavior or attitude. It provides
information to the person in a positive way about how he is expected to behave in the
community. This is an initial correction intervention to shape and manage behavior.
This tool is used for minor negative behaviors, less intrusive and also for the younger
members of the community center.
Purpose
The main purpose of this tool is to make the individual aware about a negative
behavior and to correct it by showing the right way to act.
Imran Ahmad [47]

Procedure
The ―spoken to‖ panel is made by 2 persons, one coordinator/counselor and one
resident of the community centre. The second person from the panel must be from the
same peer group with the resident involved in the incident, because he can also learn
something out of this tool.
The subject is called by an expeditor in the same day when the incident happened, the subject
wait to the office door, until the coordinator/counselor tells him to come in the office. The
coordinator tells the subject to sit in front of them and then he, the counselor, tells him about
the incident or the error he has done.
The counselor will use both, naram and garam method. The coordinator will give the teaching
about the negative behavior and will address to the subject the rule that he didn‘t respect.
After that he will talk about the meaning of that rule or regulation behavior and in what way
can help him to behave in the T. C. and also in the real life.
The subject can go out when the coordinator tells him that the ―spoken to/ talking to‖ is over.
This tool is used when the subject has a minor negative attitude in the community centre, but
which did not affect other people. When, for example, the resident doesn‘t respect a minor
rule or don‘t shave, did not respect a pull-up etc.
Time Duration and Place

The time for giving a ―talking to‖ is every day after dinner or seminar. The duration
of session is 5-10 minutes.
2. DEALT WITH
Introduction
The ―dealt with‖ is the second verbal correction (after talking to….) regarding a
negative attitude or behavior. This tool is used when the subject has a little bigger
negative behavior or attitude. The subject (drug addict who is found to be behaving
negatively) is provided with the information in a positive way that how he is expected
Imran Ahmad [48]

to behave. The panel for this tool consists of 3 counselors or 1 counselor and 2
residents.
Purpose
The purpose of this tool is similar to that of ―spoken to‖. Our purpose is to make the
individual aware about his negative behavior and we try to correct it by showing the
right way to behave.
Procedure
An expeditor calls the subject in the same day when the incident happened. The
expeditor tells him to go behind the scratch. The resident goes behind the scratch and
he must stand or sit there until the expeditor calls him. He must not talk with other
residents and nobody can talk with him. When resident is called by the expeditor he
must take a metallic chair and walk to the office.
The subject knocks the door. The people inside ask him; ―who is there?‖ and the resident says
his name (―my name is Asif‖). After their answer he comes in. The coordinator tells him to
sit in front of them and he asks him ―what is the reason that you are here?‖ or ―do you know
why you are here‖. The subject can speak about the incident or fact. The coordinator is the
first one who will give the teaching. He will talk about the negative behavior and will address
to the resident the rule that he didn‘t respect. After that he will talk about the reason/ meaning
of that rule or regulation and in what way can help him to behave in the TC and also in the
real life. The other persons address the teaching to the resident speaking about the importance
of positive behavior/ attitude in the house and they can relate the incident with the drug
issues.
The resident can go out when the coordinator tells him that the ―dealt with‖ is over.
3. PULL-UP
Introduction
It is on the spot verbal tool for a minor negative behavior. It is a reminder of an error/
lapse in the awareness of expected behaviors and attitude. The pull-up is given by the
peers, elders and staff and is the most effective mean of teaching. The pull-up is the
most obvious and significant example of mutual self-help. The person receiving the
Imran Ahmad [49]

pull-up is expected to listen, without comment assume that it is valid, quickly display
the corrected behavior and expressed gratitude at receiving it.
Objective
Our objective from this tool is to create awareness and to bring immediate change in
the behavior of the subject.
Procedure
Since the ―pull-ups‖ often refer to behaviors that have anonymous perpetrators, such
as, those who used and left the toilet dirty, those who failed to pick-up after
themselves and left dirty dishes on the dining table, the offenders, when the pull-up is
called, are given the change to exercise honesty by standing to the pull-up in spite of
the potentially publically embarrassing situation. In Therapeutic Community norm,
saving face is less important than the practice of honesty.
The facilitator could then ask the members to elaborate on the behavior being corrected or
shaped by the pull-up. The elaborations are focused on the underlying attitude that triggers
the behaviors such as the lack of awareness or laziness, or lack of concern on the part of the
perpetrator who has done something wrong.
Connections are made between the current behavior and the underlying addict‘s attitude that
led to substance use. At the end of the pull-up, a commitment to change that errant behavior
for which he was pulled-up, is obtained from him.
Time and place

The ―pull-up‖ is used in first part of the morning meeting (detail about morning meeting will
be given on proceeding pages), or when the subject don‘t respect minor rules. Whenever a
resident cope with the negative behavior addressed by the pull-up he will be given a teaching
in that moment without bringing the incident in morning meeting.
To clarify the concept, it is nothing more then DAANT DAPAT Pilna.
Imran Ahmad [50]

4. PULL-UP ON BOARD
Introduction
Pull-up on board is used to address physical attitudes around house and on grounds.
Objective
Our objective from this tool is to create honesty in the person, to create awareness
regarding his negative behavior, and to bring immediate change in that behavior.
Procedure
The structure of pull-up board is;
Name;
Pull-up;
Name for; - announcement;
Philosophy
It will be described with the help of an example;

Ex; pull-up
―Who is the person who left a cup of tea on the table, in the dining room, last night,
after the NA meeting?‖
Elaboration: - ―thank you for showing your honesty, but the fact that you left the cup of tea
on the table shows a lazy attitude and lack of consideration for other residents work. It seems
that you keep behaving as careless as you were used to in your past life and you expect for
somebody to take care of your mass. If you want to change something you must start
respecting every little rule of this community, improve your awareness, and Pull your self
up‖.
Time and Place

The pull-up on board is done during the morning meeting.
Imran Ahmad [51]

5. TIME OUT
This is a specific period of time that a younger member of the community center can
use, think about his problems, his future plans and the obstacles that don‘t allow him
to plug in the program, in the first period of residence.
The subject has to ask for time out from his primary counselor. A chair is placed into a
visible space in order for every member of the TC or staff to see him. This tool is used when
a younger member has problems involving in the program and coping with the pressure of the
environment.
While on the chair he has to think about leaving or staying in the program. Time out last for
15-20 minutes. The primary counselor will interfere and have a one-to-one counseling in
order for the resident to make an optimal decision.
6. HAIR CUT
Introduction
It is structured verbal reminder that is delivered by the staff and peers. Its tone is more
serious and there is maximum use of anxiety to induce change. The use of peers to
support community expectations is a key element of the hair-cut.
Procedure
In hair-cut, there are 5 people for the subject and the subject is not allowed to talk to
any of them. The staff uses each other to clarify issues, plan effective interventions or
develop creative settings for the haircut. The post intervention plan for the resident is
developed usually including some disciplinary sanction. The ritual for haircut is the
same like in the case of talking-to and dealt with.
Importance
The haircut is very important in order to;
Clarify issues, goal and outcome desired;
Imran Ahmad [52]

To point out a major negative behavior

To remind the meaning and the rule itself was not respected
To point out the consequences of this behavior in the real life in society
To teach the resident different ways of conduct in similar situation
To relate the incident with drug use and revel its negative effects
Global Haircut
The rituals for this tool are also the same but in this tool; all the staff of the community center
and all the residents of the center are involved in giving haircut to the subject. He is asked to
stand up in front of all the people and then is given haircut by all the members.
Silent Haircut
It is some kind of Social Boycott of the offender. Through this tool all the members of the
community are forbade to talk to the subject. There could be the ban of some facilities on
him. Our purpose form this tool, and all other tools, is to bring a change in behavior.
7. PROSPECT CHAIR/ CONFRONTATION CHAIR
The prospect chair is the chair on which the resident sits when he come in the facility. It can
also be used in the situation when a resident has to decide between staying and being
committed to the program or leaving the facility (especially after breaking a cardinal rule).
The confrontation chair is a tool of the environment used for those residents that can‘t deal
with their own issues during a confrontation with other peers or family members.
It is used to increased anxiety and loss of association with the community. The person is
asked to sit on the chair for 3 days. The time duration is from 9:00 AM to 8:00 PM at
evening. During this time, he is allowed only to go for toilet, for eating meal, and for Nimaz
etc. After completing his three days prospect chair, the counselor decides another punishment
for him.
Imran Ahmad [53]

Prospect chair is for major offenders.
Confrontation
Introduction
It is very important tool in TC. It must be carefully used among the residents. It is the
way to ask questions about issues, attitudes, behaviors, theme of the day, the
involvement in the program etc.
Procedure
The confrontation has certain structure that has to be followed such as;
One resident can ask another one; ―I would like to confront you‖ or ―can I
confront you? Are you open to talk about this?‖
The confronted resident has to stop and answer the question. Honestly and
seriously.
The answers must point out the issue, must be direct and not avoiding the real
subject.
If the resident, who is confronted, doesn‘t want to talk about the issue and give
vague answers, he can be confronted in group about his attitude.
The confrontation involves 2 persons.
Why we are using these various tools?

Our objective through these tools is to bring a change in the behavior of the drug addict and
we want to manage his behavior, to reshape his behavior in a positive way.
Imran Ahmad [54]

MORNING MEETING
 Of drug addicts for behavior

modification
CHAPTER NO. 8
Imran Ahmad [0]

MORNING MEETING OF
DRUG ADDICTS
Morning meeting is a daily ritual attended by the entire community and facilitated by a senior
member or staff; It is a socially engineered activity that redefine social self and the socially
responsible role; It is designed to help people appropriately and constructively identify,
express, and manage their feelings44.
Importance of Morning Meeting

Morning meeting is conducted to create a structure and system that foster positive behavior.
It is an important tool to promote social learning by role modeling, peer pressure and learning
by experience. It is important to point out the wrong attitude that need to be addressed in
order for every body to learn and respect the environment and, most of all, to change the
negative aspects of the behavior and the careless attitudes.
The Purpose of Morning Meeting

o You can change; (in attitude and behaviour)
o Involvement in group activities can foster this change;
o In order to change an individual must take responsibilities for his behavior;
o Structures can be created to accommodate and measures this change;
o Commitment must be made. This individual needs to: act as if they are going through
the motions.
Components of Morning Meeting
The contents or rituals of the morning meeting, which have been observed by the internee
himself, are as following;
1. Recitation of the Holy Quran - Tilawat
44
Naeem Asif (2008) Morning Meeting. Peshawar. Unpublished Notes of Dost Welfare Foundation
Imran Ahmad [55]

2. Theme for the day / the concept of the day

3. Pull-ups on board
4. Pull-up in the meeting
5. Express the house/TC related problems
6. Leaders Report
7. Express the Personal Problem
8. Appointment from Counselor
9. Affirmation, good remarks about a patient
10. Booking
11. News paper reading
12. S.E.S. (Significant Event Sheet)
13. Schedule Activities of the last 24 hours
14. Up ritual; games, jokes, poems etc.
15. Critical Analysis of the Morning Meeting
16. Programme for the next day
17. Closure: Dua-e-Sakoon, meeting, hugs
The most interesting time of the internee was the time in morning meetings. It was a
wonderful MAZA being a participant in their meeting. Particularly the Game for fun and
then the poetry and songs of the addicts were very much interesting.
Dua – Sakoon
“O My Lord! Grant me peace so that I can accept those
conditions which I can not change and give me such a
courage so that I can change those conditions which I can
and give me sober mentality so that I can differentiate
between the two. Ameen”
Imran Ahmad [56]

Romen Urdu
“A mery Khuda mujy etna sakoon day k mh un halat ko
tasleem ker saku jinhai mh nahi badal sakta aur mujy etni
jurrat dy k mh un halat ko badal saku jinhai mh badal sakta
hu aur mujy aqal –e-saleem day k mh en dono mh farq kr
saku. Ameen”
Imran Ahmad [57]

RPP
 Relapse Prevention
Programme – After Care
CHAPTER NO. 9
Imran Ahmad [0]

RELAPSE PREVENTION
PROGRAMME – RPP 45
Addiction is a chronic relapsing disorder, thereby making the prevention of

relapse one of the critical elements of effective treatment for alcohol and other
drug (AOD) abuse. Studies have shown that 54 percent of all alcohol and other
drug abuse patients can be expected to relapse, and that 61 percent of that
number will have multiple periods of relapse. It is not unusual for addicts to
relapse within one month following treatment, nor is it unusual for addicts to relapse 12
months after treatment; 47 percent will relapse within the first year after treatment. Although
relapse is a symptom of addiction, it is preventable. A key factor in preventing relapse is
improved social adjustment. Model of Relapse Prevention Therapy is a comprehensive
method for preventing chemically dependent clients from returning to alcohol and other drug
use after initial treatment and for early intervention should chemical use occur.46 Relapse
prevention methodologies are critical to the success of substance abuse treatment. This
chapter will examine the process of relapse, along with information about recognizing its
"warning signs," or triggers, and the elements of relapse prevention treatment methodologies.
UNDERSTANDING RELAPSE
Relapse does not occur within a vacuum. There are many contributing factors, as well as
identifiable evidence and warning signs which indicate that a patient may be in danger of
returning to substance abuse. Relapse can be understood as not only the actual return to the
pattern of substance abuse, but also as the process during which indicators appear prior to the
patient's resumption of substance use.
Relapse, however, is not an automatic sentence to a lifetime of substance abuse for an

individual. Studies of lifelong patterns of recovery and relapse indicate that approximately
45
―Relapse prevention & Drug Addiction”. (2008) When sobriety is priority. March 26, 2008,
<http://www.relapse-prevention.org/user-news.htm?id=163>
46
Naeem Asif (2008). Model of Relapse Prevention Therapy .Peshawar. Unpublished Notes of Dost Welfare
Foundation
Imran Ahmad [58]

one-third of patients achieve permanent abstinence through their first serious attempt at
recovery. Another third have brief relapse episodes which eventually result in long-term
abstinence. An additional one-third has chronic relapses which result in eventual recovery
from chemical addiction.
Because relapse is a common occurrence during the process of substance abuse recovery, it is
imperative that it be examined carefully. Treating the disease of AOD abuse is not possible
without a thorough understanding of the role that relapse prevention plays.
Whether or not treatment and criminal justice personnel provide initial treatment services,
these personnel have a significant opportunity and responsibility to intervene with recovering
persons when they recognize signs of relapse. Some of the skills required include assessment,
education, and confrontation of denial, brokering of community resources, and building
support systems.
In order for relapse prevention to be successful, effective systems coordination is necessary.

This involves coordination and communication between various agencies and systems.
Community treatment programs must work cooperatively to ensure that relapse prevention
programming is an integral part of treatment for all patients. State and community decision
makers need to recognize that relapse prevention is a critical component of the treatment
process, and consider and coordinate policy and funding decisions with this in mind. When it
is treated as such, with comprehensive efforts on the parts of all involved agencies and
systems, treatment expenditures are spent most effectively.
Several situations may lead to relapse, such as social and peer pressure or anxiety and
depression. Studies have indicated that the highest proportion of high-risk situations for
alcoholics involve interpersonal negative emotional states, while the highest proportion of
high-risk situations reported by heroin addicts involves social pressure.
CONTRIBUTING FACTORS
An understanding of some of the personal factors which may contribute to substance abuse
relapse is useful in any discussion of relapse prevention. These may include:
Imran Ahmad [59]

inadequate skills to deal with social pressure to use substances;

frequent exposure to "high-risk situations" that have led to drug or alcohol use in the
past;
physical or psychological reminders of past drug or alcohol use (e.g., drug
paraphernalia, drug-using friends, money);
inadequate skills to deal with interpersonal conflict or negative emotions;
desires to test personal control over drug or alcohol use; and
Recurrent thoughts or physical desires to use drugs or alcohol.
Drug and alcohol addiction is a chronic and relapsing condition. Recovery requires changes
in attitudes, behaviors, and values. Because of these issues, recovery is not a static condition;
it is an ongoing process. Relapse occurs when attitudes and behaviors revert to ones similar to
those exhibited when the person was actively using drugs or alcohol. Although relapse can
occur at any time, it is more likely earlier in the recovery process. At this stage, habits and
attitudes needed for continued sobriety, skills required to replace substance use, and identity
with positive peers are not firmly entrenched.
CATEGORIES OF PATIENTS
Chemically addicted individuals can be categorized according to their recovery and relapse
history. Patients are: prone to recovery; briefly prone to relapse; or chronically prone to
relapse. Individuals who are relapse-prone can be further divided into three subgroups:
1. Transition patients
Transition patients do not accept or recognize that they are suffering from chemical
addiction, even though their substance abuse may have created obvious adverse
consequences. This usually results from the patient's inability to accurately perceive
reality, due to chemical interference.
2. Un-stabilized relapse-prone patient
Un-stabilized patients have not been taught skills to identify their addiction. In such
cases, treatment fails to provide these patients with the necessary skills to interrupt the
Imran Ahmad [60]

process and disease of addiction. As a result, they are unable to adhere to a recovery
program requiring abstinence, treatment, and lifestyle change.
3. Stabilized relapse-prone patients
Stabilized patients recognize and are aware of their chemical addiction, that
abstinence is necessary for recovery, and that an ongoing recovery program may be
required to maintain sobriety. Despite their efforts, however, these individuals
develop dysfunctional symptoms which ultimately lead them back to AOD abuse.
It has been estimated that 40 to 60 percent of persons who are recovering from chemical
dependence relapse at least once following their first serious attempt at treatment. Studies
have shown that offenders who are actively using drugs are involved in approximately three
to five times the number of crime days as non-drug users; thus, relapse tends to accelerate the
level of subsequent criminal activity.
To put it simply we can divide the relapsers into three categories;

Cross
Clean
Sober
Cross: the cross addicts are those who start another drug instead with the same quantity and
amount. e.g. to leave Heroin and Start Crystalline
Clean: it is the category of those relapsers who start again drugs addiction but it is
manageable for them. e.g. start taking one cigarette in a week.
Sober: a sober person is that one who do not use any drug after his treatment. Therefore we
say ―when sobriety is priority‖ you should follow relapse prevention programme.
WARNING SIGNS / Principles of Relapse Prevention

People who relapse aren‘t suddenly taken it. Most experience progressive warning signs that
reactive denial cause so much pain that self-medication with alcohol or other drugs seems
like a good idea. This is not a conscious process. This warning signs develop automatically
and unconsciously. Since most recovering people have never been taught how to identify and
Imran Ahmad [61]

manage relapse warning signs, they don‘t notice them until the pain becomes too severe to
ignore.
There are nine principles underlying relapse prevention therapy to recognize and stop early
warning signs of relapse. They include the following:
1. Stabilization
2. Assessment
3. Relapse education
4. Warning sign identification
5. Cope the problem
6. Recovering planning
7. Inventory training
8. Family involvement
9. Follow up programme
All of them will be discussed in details in proceeding pages.
1. Self-regulation and stabilization

As the patient's capacity to self-regulate thinking, feeling, memory, judgment, and
behavior increases, the risk of relapse will decrease. Self-regulation can be achieved
through stabilization. Stabilization may include:
detoxification from alcohol and other drugs;

recuperation from the effects of stress that preceded the chemical use;
resolution of immediate interpersonal and situational crises that threaten sobriety;
or
Establishment of a daily structure including proper diet, exercise, stress
management, and regular contact with both treatment personnel and self-help
groups.
The risk of relapse is highest during this period of stabilization.
2. Integration and self-assessment

As understanding and acceptance increases, the risk of relapse will decrease. During
this phase, it is important to explore the presenting problems which may have led to
relapse in the past, and which might trigger future relapse.
Imran Ahmad [62]

(The assessment process is designed to identify the recurrent pattern of problems that caused
past relapses and resolve the pain associated with those problems. This is accomplished by
reconstructing the presenting problems, the life history, the alcohol and drug use history and
the recovery history. The life history explores each developmental life period including
childhood, primary school, high school, college, military, adult work history, friendship
history and intimate relationship history. Drug history contains following question; the
amount of drug, the time duration and extent of use, consequences etc). 47
3. Understanding and relapse education

An understanding of the general factors which cause relapse will aid patients in relapse
prevention. Relapsers need to learn about the relapse process and how to manage it. Its
not a bad idea to get their family involved. First relapse is a normal and natural part of
recovery from chemical dependence. There is nothing to be ashamed or embarrassed
about48.
It should be noted that many relapse-prone patients may have memory problems
associated with the chemical abuse, which may impede the learning process and retention
of educational information.
4. Self-knowledge and identification warning signs

This process teaches patients to identify the sequence of problems that has led from
stable recovery to chemical use in the past, and then to synthesize those steps into
future circumstances that could cause relapse. The relapsers need to identify the
problems that caused relapse. The goal is to write a list of personal warning signs that
lead them from stable recovery back to chemical use. Usually a series of warning
signs build one on the other to create relapse. A number of procedures are used to
help recovering people identify the early warning signs relapse. Patient must identify
the irrational thoughts, unmanageable feelings and the self defeating behavior. Patient
thinks him self loneliness. Understanding the warning signs is not enough. We need to
learn how to manage them. 49
47
Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager Dost Welfare Foundation
48
ibid
49
ibid
Imran Ahmad [63]

5. Coping skills and warning sign management

This process involves teaching relapse-prone patients how to manage or cope with
their warning signs as they occur. Unmanageable feelings and self defeating behaviors
that accompany each warning signs, self defeating behavior and constructive
behavior, and to cope with irrational thoughts, this is all in this step.
6. Change and recovery planning

Recovery planning involves the development of a schedule of recovery activities that
will help patients recognize and manage warning signs as they occur in sobriety. (A
recovery plan is a schedule of activities that puts relapsers into regular contact with
people who will help them to avoid drug use, they must stay sober by working the
twelve step program (which are given in the up coming pages) and attending relapse
prevention support groups that teach them to recognize and manage relapse warning
signs)50.
7. Awareness and inventory training

Inventory training teaches relapse-prone patients to do daily inventories that monitor
compliance with their recovery program and check for the development of relapse
warning signs. (Most relapsers find it helpful to get in the habit of doing a morning
and evening inventory. The goal of the morning inventory is to prepare to recognize
and manage warning signs. The goal of the evening inventory is to review progress
and problems. This allows relapse to stay anticipate high risk situations and monitor
for relapse51).
8. Family involvement
Relapse-prone individuals need the help of others during the process of recovery.
Treatment should ensure that others (e.g., family members, 12-step sponsors,
supportive peers) are involved in the recovery. (A supportive family can make the
difference between recovery and relapse. So we can work together to avoid future
relapse. Family must be prepared to take fast and decisive action if we return to
chemical use. We can work out in advance, when we are in sober state of mind)52.
50
Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager Dost Welfare Foundation
51
ibid
52
ibid
Imran Ahmad [64]

9. Follow-up Programme: -----Maintenance and relapse prevention plan updating

Ongoing outpatient treatment is necessary for effective relapse prevention. Even highly
effective short-term inpatient or primary outpatient programs will be unable to interrupt
long-term relapse cycles without the ongoing reinforcement of some type of outpatient
therapy. A relapse prevention plan update session may involve:
a review of the original assessment, warning sign list, management strategies, and
recovery plan;
an update of the assessment by adding as an addendum any documents that are
significant to the patient's progress or problems since the previous update;
a revision of the relapse warning sign list to incorporate new warning signs that
have developed since the previous update;
the development of management strategies for the newly identified warning signs;
and
a revision of the recovery program to add recovery activities, to address the new
warning signs, and to eliminate activities that are no longer needed.
Our warning signs will change as we progress in recovery. Each stage of recovery has
unique warning signs. To deal with warning signs at one stage is different at the next
stage. Our relapse prevention plan needs to be updated, monthly for the first three
months, quarterly for the first two years, and annually thereafter53.
CONCLUSION
Chemical addiction is a disease, and, like many diseases, there is always the possibility of
relapse. The process of AOD abuse is complex, and is impacted by social, clinical, and
medical factors. The solutions to the problem of chemical addiction are multi-faceted.
Treatment strategies benefit from a relapse prevention component in virtually every case. In
order for relapse prevention to work, agencies and systems must cooperate and communicate
in their search for the best means of successfully intervening with substance abusing patients.
53
ibid
Imran Ahmad [65]

FOLLOW UP/AFTER CARE

The post treatment phase in which the treated clients are being followed for their current
status
Means of follow up
► Center based
The clients are advised to come to the center twice a week. A group NA is conducted
► Community based
Other means
► Telephone
► Email
► Letter
Why follow up?
 Relapse is recurring problem

 Strengthening of recovery
 Lessening in codependence
 Decrease in crimes
 Increase in productivity
 Role modeling
 Value of norms
 Drug free environment
 Establish healthy community
Who are responsible to carry out the follow up

services?
► Center
► Family
► Clients
► Community workers
Imran Ahmad [66]

DOST PROGRAMMES
& ACTIVITIES
 In brief
CHAPTER NO. 10
Imran Ahmad [0]

DOST PROGRAMME ----

IN BRIEF
HARM REDUCTION AND SOCIAL SERVICES
The focus of harm reduction and social services is to reduce drug use and drug related harm
among the drug users and provide them with hope for a new life. These services are being
provided through Street Outreach Program and Drop-in Centers (DICs) since 1994.
Most of the staff involved in the provision of these services are ex-drug users who have been
treated and trained by DOST. The DICs are situated in different locations in Peshawar and
Kohat. These are:
Dar-us-Salam DIC, Sikandar Town, Peshawar city

Dar-ul-Shifa DIC, Industrial Estate Hayatabad, Peshawar
Dar-ul-Shifa DIC, Shino Khel, Kohat
1) Street Outreach Program
Street Outreach harm reduction and social services are being provided to street drug users in
various street locations of Peshawar and Charsadda districts. Three street mobile teams
contact 200-250 drug users daily at various street sites and provide them with:
Motivational counseling
Health education
First aid
social support
Encouragement to attend Drop-in centers.
Imran Ahmad [67]

2) Drop-in Centers
Drop-in Centers, operational in two different locations of Peshawar, are attended by 80 to 100
street drug users daily, where they are provided with Detoxification and other outpatient harm
reduction and social services including:
Registration
Counseling
Motivation
Therapeutic sessions
Medical care
Health education
Food & clothing
Recreation
Bathing and washing facilities.
Goals are set for drug users the achievement of which guarantees their admission in TCs for
rehabilitation.
DRUG ABUSE PREVENTION PROGRAMS
Primary Prevention Programs
Since 1993, DOST is conducting various drug abuse prevention and early intervention
activities for different community groups. In these programs special focus has remained on
youth. The drug abuse prevention programs of DOST include:
Community meetings
Awareness sessions
One-day seminars
Training workshops
Formation of anti-drug self-help groups
Training and follow-up of self-help groups
Imran Ahmad [68]

Drug abuse prevention activities are conducted in various community settings i.e. schools,
colleges, universities, mosques, work places etc.
Drug abuse prevention activities also serve the purpose of:

Early identification of drug use
Motivation and referrals for intervention
Treatment Plan
ADMISSION
1. Initial interview
2. Admission form filling
DETOXIFICATION 1 – 15
DAYS – PRIMARY
REHABILITATION, 16-30Days
1. Primary Rehabilitation 5 – 60 days
2. Lectures, groups, seminars, family groups

sessions etc.
3. Life history 16th day
4. Detail history form filling 20th day
5. Individual treatment plan 23rd day
6. Treatment duties
7. VR (Vocational Rehabilitational) form filling

30th day
8. Basic vocational skill development
9. Peer evaluation 45th day
Imran Ahmad [69]

SECONDARY
REHABILITATION 60 – 90
DAYS
1. Lectures, groups, seminars, visits
2. Re-evaluation of P.E. 60th day
3. Advanced vocational training 85th day
4. FOG (Future Orientation Group)
5. discharge 90th day
Faith Based Project 11 Steps

1. Foundation: Total Submission, Acceptance of Powerlessness and unmanageability
2. Hope: Restoration of Sanity by greater power
3. Faith and Surrender: Divine Power
4. Self Analysis: Admitted character defects
5. Sharing an Confession: Ready for Help
6. Start to Change: ask for help
7. Social interaction: list of whom we harmed
8. Social interaction: make amends
9. Preserve in positive change

10. Spirituality: prayers and meditation
11. Help others: carry the message
Imran Ahmad [70]

12 Steps
1. We admitted that we were powerless over our addiction. That our lives have become
unmanageable
2. We came to believe that A power greater then our selves could restore us to sanity
3. We made a decision to turn our will and our lives over to the care of God as we
understood him
4. We made a searching and fearless moral inventory of ourselves
5. We admitted to God, to ourselves, and to another human being the exact nature of our
wrongs
6. We were entirely ready to have God remove all these defects of character
7. We humbly ask Him to remove our shortcomings
8. We made a list of all persons we had harmed and become willing to make amends to
them all
9. We made direct amend to such people wherever possible except when to do so would
injure them or others
10. We continue to take personal inventory and when we were wrong promptly admitted
it
11. We sought through prayers and meditation to improve our conscious contact with God
as we understood Him, praying only for knowledge of His will for us and the power
to carry out
12. Having had a spiritual awakening as a result of these steps, we tried to carry this
message to addicts and to practice these principles in all our affairs.
Imran Ahmad [71]

SUGGESTIONS &
RECOMMENDATIONS
 For Dost and Department of

Social Work
CHAPTER NO. 11
Imran Ahmad [0]

SUGGESTIONS AND
RECOMMENDATIONS

Dost welfare foundation is providing a comprehensive treatment for the drug addicts in
Peshawar, not only for Peshawar‘s but for all human beings. The Dost TC in which our group
was on field work, is situated in Hayatabad Phase 5. This is the main Therapeutic Community
of Dost Welfare Foundation.
The overall staff of Dost is very much co-operative. They work with us with a great care and
we learnt a lot here.
The lectures delivered by Sir. Naeem Asif, the Centre Manager, help us in clarifying our
concept about Addiction and Drug Addiction and other related phenomena. Although over all
time spent there was good, and the method they offer for patients treatment(90 days treatment
plan) is very effective. If someone follow this method completely then there are 80 %
chances for his recovery. Where as the same treatment offered in Germany takes 1 year time
period with 10 % chances of recovery.
Although every thing goes in favour of Dost Welfare Foundation yet there are some areas
which needs to be further improved. Some suggestions and recommendations regarding them
are as following:
Although students at field work are taught well but their practical work is not
sufficient to give them experience. The emphasis in field works must be put on their
practical involvement in treatment or RPP at least.
Counseling is an art and a very effective tool for social worker in his profession and it
can only be learnt through practical experience. Field work is an opportunity for the
social workers to gain that experience but during our field work we haven‘t learnt that
experience. I am sorry to say but, we didn‘t know about a, b, c, of counseling.
Imran Ahmad [72]

Therapeutic Communities like the main TC of DOST should be established in other

places of the province, because the strength of Addiction is far greater then the Main
TC to support it. The capacity of main TC is 80 patients at a time while we can see
drug and substance addicts laying beside the Main gait of University of Peshawar.
Suggestions for Department of Social Work

I thought it important to recommend at this point some suggestions for my own department
officials.
The field work director or supervisor should have regular visits of the Field Work Agencies
in order to improve the attendance of the students on their field. Because I have seen that
most of the students consider field work a burden on their studies when field work is such an
important activity for social workers.
The students should be guided about their field activities before sending them to the agency
so that they know what they have to accomplish there as a trainee.
Last Words
There may be or could be a lots of suggestions for improvement in field work placement and
for Dost welfare foundation but I am contending on the above mentioned as my field work
report is moving out of the boundaries.
Imran Ahmad [73]

ROLE OF SOCIAL
WORKER
 In the treatment plane
CHAPTER NO. 12
Imran Ahmad [0]

Role of Social Worker
Most of the diseases of the world has a medical solution or medical cure but there are some
diseases which could not be cured through medicines alone. Drug addiction is one of those
diseases which could not be cured through medicines only. It need a societal solution, a
spiritual solution, a psychological solution i.e. we need a whole treatment plane composed of
different therapeutic techniques, behavior modification tools, counseling plus medication etc.
We have mentioned it before that the whole treatment plan for drug addicts is divided into
three 3 phases
1. Pre-treatment phase
2. Treatment phase
3. Post-treatment phase
In each and every phase we need a whole team of professional for planning. We need
psychologists, we need counselors, we need social workers, we need family, we need his
friends and peer support etc. social worker is one amongst the team members with
professional skills and trainings. He has already studied about the drugs, its effects, addiction
and how to contribute in its treatment plane.
We, here now, are to find out where and how social worker can play, and is playing, his role
in each phase. Let us see below;
Pre-treatment / Awareness Phase

________________________________________
What can social worker do in the awareness phase? It is the duty of social worker to create
awareness among young people, particularly students and parents as well. He explains the
dark effects of drugs to the younger one and shows the symptoms of an addict to the parents.
We mentioned that in pre-treatment phase there is the beginning of change in drug addict. It
is the duty of the social worker to go to the street patients and conduct counseling sessions
with them. The social worker has to motivate him. As social worker is aware of the society
Imran Ahmad [74]

and how does it work, and he is aware of the human growth and development so therefore
due to these specialties it is his job to create awareness and to start a beginning of change.
Treatment Phase
________________________________________
After detoxification and medicated prevention, the real work of the social workers begins.
When the client becomes conscious of his environment i.e. when the poison is removed from
his body, social worker interviews the patient. The aim of the 1st interview is to get
information about the client. He tries to find out what were the causes which lead him for
addiction. He asks the client of his past. He also tries to find out the potentials, capabilities,
weaknesses and limitations of the client. He looks for the resources i.e. his family, friends
and other resources. We have a 10 pages questionnaire to be filled in order to asses the clients
life history.
Now when social worker has a complete study of the case, and has sufficient knowledge
about the client and his problem, he then diagnoses him. He looks for the alternatives so that
his client spends his leisure time in those activities. In the diagnosis stage, the actual causes
which lead the client to addiction is find out.
An action plane is made for the client. He is given different counseling in individual and
group form. He explains to his patient his qualities and capabilities. He creates a sense of
worth in the client. He tells him about his importance.
The social worker sits in the morning meetings; he sits in behavior management tools
implications. Social worker meets with the family etc.
Post treatment / Rehabilitation phase

________________________________________
When the client is ready to go back to his home, social worker helps the patient and his
family to understand each other. The patient after treatment is no more addicted. He is now a
normal person. The family should accept him as a normal human being.
Imran Ahmad [75]

The patients who are in need of financial assistance in the rehabilitation process, social
worker also help them to overcome this problem.
social worker provide good environment to the patient who is being rehabilitated. So that he
may not indulge into the addiction again.
Different technical skills are taught to the patients. So that they may be able to get a job for
themselves or start their own business. Religious therapies can be given in the masques
through the imam.
The social worker has to build a support system for the patient in the community.
Why?
So that the patient may not relapse to addiction again. For this purpose he involves his family,
his friends, his near ones etc in meetings and tell them how to behave with the client now.
The social worker visits his home and community and he could tell his villagers that how
they have to look at him now.
The role of the social worker in drug abuse treatment and rehabilitation is a big one and if I
started to right all of them then a whole book, or may be so many versions of the book could
be written on him. So therefore we will limit ourselves to the above information as this report
is stepping out of the boundaries.
Imran Ahmad [76]

Imran Ahmad [77]

CASE HISTORIES
 Two patients life stories
CHAPTER NO. 13
Imran Ahmad [0]

CASE HISTORIES
Case No. 1
Personal Information
Client Name: Sarfaraz Khan S/O: Musafar Khan
Ethnicity: Shinwari
Age: 32 years Education: Nil
Siblings: 9, 3 sisters and 6 brothers Clients Birth Order: 2nd
Marital Status: Single Profession: Nan-Bai
DOC: Chars + Heroin Period of Addiction: started from 11 year of age
Period in TC: 40th day
Parents: Alive financial Support: Family, Father
Address: Kohat Road
Life Story:
The client (Srfaraz) has started drug addiction in a very young age. He use to go to school but
when he was in class 2nd he become a truant and he joined a group of addicts students. First
he started from cigarette and then gradual proceeded to other dangerous substances. Due to
his addiction habit he left the school in class two and now he has no ability to read or write.
How you have come to treatment:
According to him he is self motivated for treatment and he has come through Dar_ul_Shafa
TC in Industrial State Hayatabad.
How many years of schooling
2 years
Ability to read
no
Do you have professional trade or skill? Usual occupation

Yes, I m a good NAN BAI. (who cock breads) and this is my usual occupation
Does any one contribute to you financially?

Yes my family
Imran Ahmad [77]

Have you ever been arrested? If yes then for how much time you were jailed?
Yes 2 times I have been arrested for 3 nights.
Have you ever been engaged in illegal activities?

yes
Do you have any resentment from any one in the family?

no
Have your tolerance increased or decreased?

Decreased
Have you ever used to

Avoid problem y
Kill pain y
Avoid reality y
Sleep n
Enjoyment y
Feel peace y
Reduce stress y
In the morning n
Have you ever tried to

Reduce DOC intake y
Change to milder drug y
Use medicines instead n
Use more than anticipated n
Control DOC and use anyway y
Because of your chemical dependency have you ever felt the following
Suicide y
Guilt y
Shame y
Anger y
Angry when asked y
Not to use y
Imran Ahmad [78]

Sorry for using y

Mental torture y
After dost treatment will you

Attend NA Meetings y
Have a sponsor n
Follow the 12 steps y
Attend RPP y
Are you hopeful for this treatment?

Yes
Remarks: Sarfaraz is now in the rehabilitation phase of treatment and he seem to be

overcoming his addictive habit. According his staff he will overcome soon and his relapse
chances are very few.
Imran Ahmad [79]

Case No. 2
Personal Information
Client Name: M. Ramzan S/O: M. Saeed
Ethnicity: Jondal
Age: 38 years Education: Nil
Marital Status: Married Children: 6, 3 sons and 3 daughters
DOC: Chars + Heroin Period of Addiction: 25 years
Period in TC: 17th day Financial Support: Family
Address: Gondal Attock
Life Story:
According to the client (Ramzan) he has started from using Naswar when he was a child in
Karachi and used to be a Condector with a mini bus. But slowly and gradually he proceeded
to other dangerous drugs
How you have come to treatment:
According to him he is self motivated for treatment.
How many years of schooling
1 years
Ability to read
no
Do you have professional trade or skill? Usual occupation

no but we have our own family farm lands which support us financially
Does any one contribute to you financially?

Yes my family
Have you ever been arrested? If yes then for how much time you were jailed?
No
Have you ever been engaged in illegal activities?

yes
Do you have any resentment from any one in the family?
Imran Ahmad [80]

Yes my wife
Have your tolerance increased or decreased?

Decreased
Have you ever used to

Avoid problem y
Kill pain y
Avoid reality y
Sleep y
Enjoyment y
Feel peace y
Reduce stress y
In the morning n
Have you ever tried to

Reduce DOC intake y
Change to milder drug y
Use medicines instead n
Use more than anticipated n
Control DOC and use anyway y
Because of your chemical dependency have you ever felt the following
Guilt y
Shame y
Anger y
Angry when asked y
Not to use y
Sorry for using y
Mental torture y
After dost treatment will you

Attend NA Meetings y
Have a sponsor n
Imran Ahmad [81]

Follow the 12 steps y

Attend RPP y
Are you hopeful for this treatment?

yes
Remarks: Ramzan is in his first phase of treatment. But he seem to be not happy of living
in TC and want to go home. He thought he is well now but his relapse chances are very
greater. He should have a complete time spent here in DOST TC.
Imran Ahmad [82]

REFERENCES
Imran Ahmad [0]

REFERENCESS
1
1. Ray, O. Ksir, C. (2002). Drug, Society, and Human Behavior. 9th Ed. New York.
McGraw-Hill Companies Inc. P. 3
1
2. Amirzada (2007) Fields and Services of Social Work; Lecture Delivered to the MA final
evening class. Peshawar. Department of Social Work, University of Peshawar
1
3. Ray, O. Ksir, C. (2002) Opt Cit. P. 7
1
4. Introduction. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation. Thursday,
November 22, 2007 <http://www.dost.sdnpk.org/Introduction.htm >
1
5. Brekhna (2007). Lecture to the students of final year. Peshawar. HRD Manager Dost
Welfare Foundation Peshawar
1
6. Mission Statement. (2003) Dost Foundation; Peshawar. Dost Welfare Foundation.
Thursday, November 22, 2007 <http://www.dost.sdnpk.org/ >
1
7. Sara Safder (2007) Lecture for the student of MA previous evening. Peshawar.
Department of Social Work University of Peshawar
1
8. ―Drug‖ Wikipedia, Wikipedia the free encyclopedia Saturday, June 30, 2007 Wikipedia
foundation Inc. <http://en.wikipedia.org/wiki/Drug>
1
9. Ray, O. Ksir, C. (2002) Opt Cit. Pp. 44-45
10. 1 Ibid. p. 5
11. 1 Khalid. M, ―Social Work Theory and Practice‖ 3rd Edition, Kifayat Academy, Karachi.
pp. 1-310
12. 1 Ray. O & Ksir. C, ―Drugs, Society, and Human Behavior‖, 9th edition, McGraw-Hill
Companies Inc. pp 4-81
13. 1 Imran Ahmad (2007). Social Work with Drug Addicts; Assignment. Department of
Social Work UOP
14. 1 Ray, O. Ksir, C. (2002) Opt Cit. P. 5
15. 1 ibid. Pp. 45-46
16. 1 Naeem. A. (2008).Notes for Social Work Student. Peshawar. Unpublished notes of The
Center Manager, Dost Welfare Foundation
Imran Ahmad [83]

17. 1 Hewitt, Brenda G., and Gordis, Enoch. "Alcoholism." Microsoft® Encarta® 2006
[DVD]. Redmond, WA: Microsoft Corporation, 2005.
18. 1 "Tranquilizer." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft
Corporation, 2005
19. 1 Berger, Philip A. "Barbiturate." Microsoft® Encarta® 2006 [DVD]. Redmond, WA:
20. 1 ―Opium." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.
21. 1 Khalid, M. (2002). Social Work Theory and Practice, with special reference to Pakistan.
2nd Ed, P\Karachi: Kifayat Academy. Pp. 308-309
22. 1 "Codeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.
23. 1 "Amphetamine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft
Corporation, 2005.
24. 1 Berger, Philip A. "Cocaine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA:
25. 1 "Caffeine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.
26. 1 Hynes, Erin. "Tobacco." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft
Corporation, 2005.
27. 1 "Nicotine." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.
28. 1 "Khat." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.
29. 1 "Steroids." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft Corporation,
2005.
30. 1 "Hallucinogen." Microsoft® Encarta® 2006 [DVD]. Redmond, WA: Microsoft
Corporation, 2005.
31. 1 Iversen, Leslie. "Marijuana." Microsoft® Encarta® 2006 [DVD]. Redmond, WA:
32. 1 ―Katamine‖, Wikipedia the Free Encyclopedia. Wikipedia Foundation Inc. April, 03,
2008 http://en.wikipedia.org/wiki/Ketamine
33. 1 Berger, Philip A. "Lysergic Acid Diethylamide." Microsoft® Student 2008 [DVD]. Redmond, WA:
Imran Ahmad [84]

34. 1 Compto, B. Galawa. Introduction to Social Work and Social Welfare . McGrawHill
Publications
35. 1 Naeem. A (2007). Lecture for Social Work Students. Peshawar, Lecture Delivered by
Center Manager Dost Welfare Foundation, 07-12-2007
36. 1 “Treatment Programme” Treatment Programme for Drug Users (2003). Dost Welfare
Foundation Thursday, November 22, 2007, <http://www.dost.sdnpk.org/Programmes.htm
>
37. 1 ibid
38. 1 Naeem. A (2008). Counseling Notes . Peshawar, Notes of The Center Manager Dost
Welfare Foundation
39. 1 ―what is counseling‖, Education: British Association for Counseling and
Psychotherapy, May 10, 2007, British Association for Counselling and Psychotherapy,
BACP House, Unit 15 St John's Business Park, Lutterworth, Leicestershire LE17 4HB <
http://www.bacp.co.uk/education/whatiscounselling.html>
40. 1 ―Living with Cancer, What is Counseling‖(2007). Cancer Research UK. Cancer
Research UK 2002. May 01, 2007, <
http://www.cancerhelp.org.uk/help/default.asp?page=214&order=2252>
41. 1 ibid
42. 1 ibid
43. 1 Naeem. A. (2008). Behavior Management Tool (Day Top New York). Peshawar. Notes
provided by The Center Manager Dost Welfare Foundation
44. 1 ―Relapse prevention & Drug Addiction”. (2008) When sobriety is priority. March 26,
2008, <http://www.relapse-prevention.org/user-news.htm?id=163>
45. 1 Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager
46. 1 Naeem Asif. (2008). Warning signs. Peshawar. Unpublished notes of The Manager
47. 1 ibid
48. 1 ibid
49. 1 ibid
Imran Ahmad [85]

Bibliography
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Hill Companies Inc.
2. Khalid. M, ―Social Work Theory and Practice‖ 3rd Edition, Kifayat Academy,
Lahore-Karachi.
3. Compton & Galaway, ―Social Work Process‖, The Dorsey Press, Georgetown-
Ontario
4. Lectures of Sir, Naeem.A, ―The Manager Dost Welfare Foundation‖
1
5. Naeem. A. (2008).Notes for Social Work Student. Peshawar. Unpublished notes of The Center
Manager, Dost Welfare Foundation
1
6. ―what is counseling‖, Education: British Association for Counseling and Psychotherapy, May 10,
2007, British Association for Counselling and Psychotherapy, BACP House, Unit 15 St John's
Business Park, Lutterworth, Leicestershire LE17 4HB <
http://www.bacp.co.uk/education/whatiscounselling.html>
1
7. ―Living with Cancer, What is Counseling‖(2007). Cancer Research UK. Cancer Research UK
2002. May 01, 2007, < http://www.cancerhelp.org.uk/help/default.asp?page=214&order=2252>
1
8. ―Relapse prevention & Drug Addiction”. (2008) When sobriety is priority. March 26, 2008,
<http://www.relapse-prevention.org/user-news.htm?id=163>
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10. Wikipedia the Free Encyclopedia. Wikipedia Foundation Inc. April, 03, 2008
http://en.wikipedia.org/wiki/
11. Britanica Encyclopedia Britanica Ultimate Reference Suit2008 [DVD]
Imran Ahmad [86]

Addiction is not a Crime,

It’s a Treatable Illness.
Addicted People are Not Criminals
Who Need to be Punished,
They are Sick People Who Need to get
Well.
Imran Ahmad [87]

Imran Ahmad [0]

Drug Addiction Treatment and Rehabilitation-Imran Ahmad Sajid

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Field Work Report Dec, 07 to May2008

DEPARTMENT OF SOCIAL WORK

Imran Ahmad MA final [0]

Imran Ahmad MA final [i]

Imran Ahmad Sajid

Imran Ahmad MA final [ii]

Imran Ahmad MA final [iii]

S. No Detail Page. No.

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Imran Ahmad MA final [v]

Imran Ahmad MA final [0]

Imran Ahmad MA final [1]

Drugs in the History

DOST WELFARE FOUNDATION

DOST Welfare Foundation (DOST) is a non-profit,

DOST is not an abbreviation of some other terms

Imran Ahmad MA final [2]

Outreach harm reduction services for street drug users

Drug abuse prevention among different community groups

Development of awareness and resource materials

Networking with national and international NGOs, GOs and CBOs

Imran Ahmad MA final [3]

Sep 1992 Dost Foundation established and registered

Family program, relapse prevention program and narcotics anonymous meetings

Mar 1993 Drug abuse prevention program started

Dec 1994 Street outreach program for drug addicts started

May 1995 Drop In Centre for drug addicts established

Jan 1999 Tc for juvenile offenders in Peshawar Central Prison

Sep 2000 Detoxification started in the Drop In Centers

Imran Ahmad MA final [4]

DRUGS CULTURE IN PAKISTAN7

SOME COMMONLY USED

1. HEROIN or Diamorphine, powerful analgesic (pain-relieving) drug derived from

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7. INHALANTS, it includes petro-chemicals, samad bond, thiner, fluid, paints, and

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 Drug, Addiction and

Imran Ahmad MA final [0]

Drug, Addiction, &

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DEFINITIONS OF DRUG ADDICTION

Imran Ahmad MA final [9]

A state of periodic or chronic intoxication detrimental to the individual and to society,

The continued compulsive use of drugs in spite of adverse health or social

SOME IMPORTANT CONCEPTS

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THREE BASIC PROCESSES

Imran Ahmad MA final [11]

Imran Ahmad MA final [12]

amount of time or effort an individual spends in drug seeking behavior. Often it is

There are two types of drug addiction.

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CAUSES & SIDE

 Causes & Side effects of

Imran Ahmad MA final [0]

Causes & Side-Effects of

WHY START DRUG ADDICTION?

Imran Ahmad MA final [14]

These are detailed in the following lines;

Imran Ahmad MA final [15]

o Irritation – chirh chirha pun

Imran Ahmad MA final [16]

Imran Ahmad MA final [17]

 Of Drugs with reference to