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[ANNUAL FIELD WORK REPORT ON DRUG ADDICATION

AT DATC LADY READING HOSPITAL PESHAWAR] October 30, 2010

Acknowledgement

My all Glory, thanks to Almighty Allah who gives me


courage and blessed me to complete this field work report.
I am extremely thankful to my Family for their financial
Support, My Special thanks to Supervisor Mr. Faiq Sajjad
Shah Department of Social Work ISSG. My Deepest Respect
to Mr. Sher Naeem Khan Senior Social Medical Officer Drug
abuse Treatment Center (DATC) L.R.H Peshawar, for his kind
lectures and practical guidance on Drugs and their uses and
their effects.
I also want to thanks my all field work Classmates Aslam,
Abdullah, Salim, Faiza, Namra, Komal.

By:Akbar Aziz

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[ANNUAL FIELD WORK REPORT ON DRUG ADDICATION


AT DATC LADY READING HOSPITAL PESHAWAR] October 30, 2010

S. No.

Description

Lady Reading Hospital

D.A.T.C

Aims and Objectives

Services of D.A.t.C

Admission Procedure

Administrative Setup

History of Drugs

Introduction to Drug

Definition of Drugs

10

Types of Drugs

11

Main Drugs Used for addiction

12

What is Drug Addiction

13

Drug Wise Breakup Of Drug Users

14

Identification of Drug Addict

15

Diseases Due to Addiction

16

Withdrawal Symptoms

17

Detoxification

18

Methods of Detoxification

19

Relapse

20

Prevention and Causes of Relapse

21

Counseling

22

The Role of a Social Worker

23

Case Histories

Page Nos.

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Lady Reading Hospital


Lady Reading Hospital is one of the oldest and largest teaching institutions of the
country, which provide state of art and excellent Curative and Preventive services to
the living Humanity of the Khyber Pukhtoonkha Province.
Mr. Lard Reading Viceroy of the Subcontinent from 1921 to 1926 happens to visit
Peshawar. He was a companied by his spouse lady Reading, she was fascinated by the
view of the city from Balahisar where they had lodge .she expressed her desire to see
the city as she was returning back to the Fort the horse took the fright causing fall of
the lady from the horse back. This resulted in some injuries to the lady Reading, none
availability of medical aid instantly made her unconscious; she was rushed to Agertor
Hospital where the facilities were scantly. Uncomforting to cater for the requirements,
she was shifted to the Royal Artillery Hospital now called CMH Peshawar where she
was given proper treatment. The immense impact of this incidence on her made it
imperative to construct a hospital on retirement of lady Reading in 1926, she come to
Peshawar from Delhi and companied to construct a standard Hospital in place of
Agerton Hospital. This new Hospital was subsequently named as LADY READING
HOSPITAL.
Mr. Khan Bahadar Abdus Samad khan had been the first medical Supurtendent of
the Hospital. Dr Muhammad Ayaz khan was appointed the First administrator of the
Hospital in 1973, this Hospital become affiliated to Khyber Medical College in
1955,with Medical, Surgical, ENT, TB, words over up is going above 2500 patients per
day and the lasvalty attendance of A and E departments is more then 1500 or 1800
per day .
Every Machine of this Hospital is running round the clock and so are the Doctors and
Nurses.

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[ANNUAL FIELD WORK REPORT ON DRUG ADDICATION


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DATC (Drug Addicts Treatment Center)


Drug Addicts Treatment center is one of the important Department of Lady Reading
Hospital. it was in a small building but a new block was build for psychiatry and
D.A.T.C. This block was inaugurated by Syed Zahir Ali Shah (Minister of Health)On
15th of December 2008.It is a three story building .On ground ,first and second floor
Psychiatry ward exist and D.A.T.C ward is on 3rd floor.

Aims and Objectives of D.A.T.C


There is a wide range of Aims and Objectives of Drug Addicts Treatment Center but
we will mention here some of them.
Drug Addicts Treatment Center is try for Sustenance in Motivation to Drug free,
Drug Addicts Treatment Center Support the Client for Drug Detoxification
Programme,
Drug Addicts Treatment giving Treatment of active Withdrawal Symptoms in a
safe and Compassionate environment,
Drug Addicts Treatment Center Orientation to the Client to remain Drug free to
motivate the Client the Community for reintegration,
Continuous/ periodic assessment is also among the Aims and Objectives of the
Drug Addiction Treatment Center.

Services of the Department


Last year this Department was able to treat 14650 outpatients, with 709 inpatients, in
which 303 are from OPD and 387 from Casulty.there were 593 admission of Drug
Addiction Treatment Center in which 283 were street Addicts, 1013 patients received
Psychotherapy and 3889 patients received ECTs.

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Admission Procedure in Drug Addicts Treatment Center


For admission in Drug Addicts Treatment Center Patients comes Through OPD , the
Doctors examine the patient by different tests and X-rays of chest, If any patient have
any chronic illness then he referred to Medical Treatment first.
Due to lack of beds patients are given waiting list, when a patient come for admission
then a person with him is also necessary to attend Shim, he may be his Father,
Brother, Son or a friend.
A patient Treatment procedure continues till 12 to 15 days. During this period he gets
different types of Treatment process, after this he will discharge.

Administrative Setup of Drug Addicts Treatment Center


Mr. Shamsher (Head of the Department)
Mr.Sher Naeem (Ward in charge)
Admission Fees

Rs. 150

Security (Refundable) Rs. 1000


Beds capacity

12

Staff of Drug Addicts Treatment Center


Social Welfare Officers,
Mr.Sher Naeem Khan and Mr.Fida Muhammad
Consultant Psychiatrists,
Mr. Masood jalal, Mr. Rabani and Mr. Ataullah
Clinical Psychologists,
Dr.Humaoon, Dr.Amir, Dr. Arshad, Dr. Gohar
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Social Workers,
Mr. Bilal, Mr.Mukhtiar Azmi, Mr.Zahid Nazar
Nurses Staff,
Only one Ms, Shaista,
Student Nurses,
Four Students for a month,
Peon
Mr.Zahid Khan
Sweeper,
Mr.Gul Daraz

History of Drugs
Opium the parent compound is the dried juice from unripe seed capsules of the
opium poppy, which is indigenous in Asia minor but is now widely cultivated. The
alkaloids of opium include morphine and 18 others. Heroin or diamorphine was
introduced as a remedy for cough and paradoxically as a treatment for morphine
addiction.
Morphine derived from Opium was well known in ancient times and was used
as far back as 4000, BC for its psychological effects as well as a powerful pain relieving
compound, in Greek and Roman civilization it was used as a sleeping draught and this
use persisted in Europe in to the early part of the twenty century. Arab physicians in
ancient times were well versed in the use of Opium and introduced the drug to the
Orient, where it was largely used for treating dysentery.
In the sixteen century Paracelsus the Swiss physician gave the name laudanum
(to praise) to preparations of Opium and about 1680, Thomas Sydenham introduced it
to Britain. In the east British and French colonization created problems when in 1840
the Chinese Emperor Tao kaungtried to impose restrictions on Opium smoking,

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which by then had increased to enormous proportions. The subsequent Opium was
(1839-1842) and 1856, in which the British victorious saw the increase in Opium trade
between India and China greatly increasing the size of the problem. At the end of the
first Opium war the treaty of Nanking agreed that the British took possession of Hong
Kong and were allowed unlimited importation of Opium to China, at that time official
recognition of this trade as an important source of revenue was undoubtedly the
reason for official approval which continued well in to the present century.

Introduction to Drugs
The word drug means different things for different people. For some peoples
drugs are those substances which are illegal and socially disapproved of associated
with serotypes images of junkies or solvent sniffers and not with every day
substance that ordinary people use? On other hand many people increasingly refer to
all preparations as drugs. Some drugs are given to people by Doctors to make them
healthy. These are called prescription.
Some drugs are natural and can be found in some kinds of food or plants that are not
a normal part of a persons diet. Some drugs are illegal which means it is against the
law to buy, sell or use them. Some drugs are legal but because they are dangerous to
health, the law says that you have to be an adult to use them.

Definitions of Drugs
Drug is an illegal substance that some people smoke; inject, etc to give them
pleasant or exciting feelings.

(Oxford advanced learners Dictionary)

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A substance used in the diagnosis, treatment or prevention of a disease or as a
component of a medication.(National institute for Drug abuse NIDA)
A chemical substance such as a narcotic or hallucinogen that affect the central
nerves system, causing changes in behavior and often addiction.(NIDA)

Types of Drugs
Drug that either depress or stimulated central nerves system may be categorized in to
many major groups, but we are mentioning some of them here,

1. Cannabis
Cannabis is a tobacco like greenish or brownish material made up of the dried
flowering tops and leaves of the flowering tops of the cannabis plant.
Cannabis resin or hash is the dried black or brown secretion of the flowering tops
of the cannabis plant, which is made in to a powder or pressed into slabs or cakes.
Cannabis oil or hash oil is a liquid extracted from either the dried plant material or
the

resin.

How is it taken?
All forms of cannabis are usually smoked .cannabis resin and oil can be eaten or
brewed in tea.

How does it affect users?


Cannabis can make users feel pleasurably relaxed and sometimes euphoric. Users may
also experience a more vivid sense of sight, smell, taste and hearing.

What are the risks associated with cannabis use?

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In the short term, users have an increased appetite and pulse rate. Users also have
problems performing physical and intellectual tasks such as driving a car and thinking
logically.
Regular users of cannabis risk developing psychological dependence to the point
where they lose interest in all other activities, such as work and personal relationships.

2. Heroin
Heroin is an addictive drug with painkilling properties processed from morphine, a
naturally occurring substance from the opium poppy plant. Pure heroin is a white
powder. Street heroin is usually brownish white because it is diluted or cut with
impurities, meaning each dose is different.

How is it taken?
It is usually injected but can also be snorted, smoked or inhaled.

How does it affect users?


Heroin can relieve users tension, anxiety, and depression. Users feel detached from
emotional or physical distress or pain with large doses, users may experience
euphoria.

What are the risks associated with heroin use?


Short tern effects include constricted pupils, nausea, vomiting, drowsiness, inability to
concentrate and apathy. Heroin is very and users may quickly develop physical and
psychological dependence. They also risk developing tolerance for the drug, which
means they need constantly higher doses to achieve the effect they want.

3. Ecstasy
Ecstasy is a psychoactive stimulant, usually made in illegal laboratories. In fact the term
Ecstasy has evolved and no longer refers to a single substance but a range of
substances similar in effect on users. Frequently any tablet with a logo is now referred
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to as Ecstasy regardless of its chemical makeup. While the drug is usually
distributed as a tablet, it can be also powder or capsule. Tablets can have many
different shapes and sizes.

How is it taken?
It is usually swallowed but can also be snorted or injected.

How does it affect users?


Ecstasy can heighten users empathy levels and induce a feeling of closeness to
people around them. It can also make users feel more sociable and energetic.

What are the risks associated with ecstasy use?


In the short term, ecstasy can make the body ignore distress signals such as
dehydration, dizziness and exhaustion and it can interfere whit the body s ability to
regulate temperature. Furthermore ecstasy can severely damage organs such as the
liver and the kidneys. It sometimes leads to convulsions and heart failure.

4. Cocaine
Cocaine is a fine white or off-white powder that acts as a powerful stimulant. It is
extracted from the leaves of the coca plant. On the street, it can be diluted or cut
whit other substances to increase the quantity. Crack is cocaine that has been further
processed with ammonia or sodium bicarbonate (baking soda) and looks like small
flakes or rocks.

How is it taken?
Cocaine is usually sniffed/snorted or injected, whereas crack is smoked.

How does it affect users?

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Cocaine can make users feel exhilarated and euphoric. Furthermore, users often
experience a temporary increase in alertness and energy levels and a postponement
of hunger and fatigue.

What are the risks associated with cocaine use?


Short term effects include loss of appetite, faster breathing and increases in body
temperature and heart rate .users may behave bizarrely, erratically and sometimes
violently.

5. Hallucinogens
Hallucinogens, or psychedelics, are drugs that alter users state of consciousness
and produce different kinds of hallucinations. The main types of hallucinogens are dlysergic acid diethylamide (LSD), phencyclidine (PCP), hallucinogenic amphetamines,
and mescaline and psilocybin mushrooms.

How is it taken?
It is usually swallowed.

How does it affect users?


Taking LSD leads to strong changes in thought, mood and senses in addition to
feelings of empathy and sociability. However, the exact effects of LSD vary depending
on the mental state of the user and the environment when taking the drug.

What are the risks associated with LSD use?


Short-term, LSD produces delusions and distorted perceptions. The users sense of
Depth and time changes and colors, sound and touch seem more intense. Some LSD
users experience severe, terrifying thoughts and feelings such as fear of losing control,
fear of insanity and death, and despair.

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6. Methamphetamine
Methamphetamine is part of the group of drugs called amphetamine-type stimulants
(ATS). It is a synthetic drug that is usually manufactured in illegal laboratories.
Methamphetamine comes as a powder, tablet or as crystals that look like shards of
glass.

How is it taken?
It can be swallowed, sniffed/snorted, smoked or injected.

How does it affect users?


Methamphetamine stimulates a feeling of physical and mental well being, as well as
a surge of euphoria and exhilaration. Users experience a temporary rise in energy,
Often perceived to improve their performance at manual or intellectual tasks. Users
also feel postponement of hunger and fatigue.

What are the risks associated with methamphetamine


use?
Short-term, users can lose their appetite and start breathing faster. Their heart rate
and blood pressure may increase and the body temperature may go up and cause
Sweating. With large doses, users may feel restless and irritable and they may
experience panic attacks.

Main Drugs Used for Addiction


What is Drug Addiction?
Drug addiction is a chronic, relapsing brain disease characterized by compulsive drug
seeking and use despite often devastating consequences. It results from a complex
interplay of biological vulnerability, environmental exposure, and developmental
factors
Like stage of brain maturity.

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Drug Addiction as continued use of the drug than is necessary to maintain normal
physiological functions and discontinuance of the drug results in definite physical and
mental symptoms.
Poppy and opium have been cultivated in northern part of Pakistan for centuries. At
the time of independence in1947 there were approximately 100,000 regular and
registered opium users in Pakistan mainly in lower Socioeconomic groups.
Heroin as a drug of use was virtually unknown in Pakistan prior to 1979, since then
heroin addiction has reached epidemic proportions and has affected nearly all socio
economic groups and Pakistani society is now embroiled in a growing complex and
multifaceted narcotic menace.

Drug Wise Breakup of Drug Users,


Heroin

50%

Chars

28.5%

Alcohol

04.5%

Bhang

02.3%

Tranquilizers

01.1%

Mantras

00.1%
(National survey on Drug abuse 19193)

Below table is showing that majority of the drug dependence patients (63 %) were
abusing multiple drugs simultaneously (heroin, morphine, various forms of cannabis,
inject able Opioids and sedatives etc)

Types

of

drugs Frequency used

percentage

used
Single Drug

24

37.5%

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Multiple Drug

40

62.5%

Total

64

100%

(Association between Drug dependence and anemia in Pakistani patients)

Identification of Drug Addict


Identification of a drug addict is not so difficult now a days, every where they are
easily available in Pakistan especially in Peshawar. (Khyber Pukhtoonkha) But some
futures of Drug addicts are mentioning here,

He has watery eyes

Dizzy spell

His lips are Dry

He do not care cleanness especially his cloths and always telling lies.

Lives in a filling places

His color is pale

Moral ill

Stay more time in bed rooms

Poor

Behavior change /not normal behavior

Spots on his cloths

Lack of work

Absence minded

Memory weak

Quarreling with every one

Sealing his things

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Diseases Due to Addiction


The problem of Drug Addiction has seriously implication for the health and happiness
of the individual, family, community and society at large.
The social functioning of the individual is impaired due to poor health, loss of income
and social isolation. The growth and development of the family is blocked. The social
environment of the community is adversely effected, eventually whole society and its
proper functioning effected by the drug abuse. Some major diseases due to addiction
are,

HIV-AIDS a fatal transmissible disorder of the immune system, is caused by the


HIV (human immune-deficiency virus) in Drug Addicts are vulnerable because
of the practice of sharing needles and syringes for intravenous drug use.
CANCER with the increase in population and longevity, cancer cases are on the
rise among the elderly population. Uses of tobacco and pollution have been
identified as major cases of morality among people above the age of 50 all
over the world. The ratio of tobacco related cancer incidence alone is one third
of all cancers.
COMMON diseases among drug users, such as hepatitis and tetanus, are a
result of the use of insanitary paraphernalia as when several persons share the
same needles.

Withdrawal Symptoms
After 10 hours of admission of a patient withdrawal symptoms were appears,
these

symptoms

are,

Nose

running,

eyes

droping,sever

pain

in

body,insomania,dayria etc,this condition remain in 72 hours ,during this period

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he received systematic treatment. After 72 hours he become normal and just
feel it psycologicaly.after this doctor, nurses, social workers and psychiatrist are
here to treat him.

Detoxification
Detoxification is the facilities and guidance provided by the medical social
worker to the Drug Addicts during their treatment in hospitals as patients

Methods of Detoxification
A. Symphetatic treatment,
In this method the treatment of the patient is symphethatic, in here pain killer or
any other pain reduce tablets will given to the patient.

B. Gradual withdrawal,
In this method the daily frequency of drug will reduce gradually and given to
the patient.

C. Cold turkey method, in this method only cold water bath and meal will
give to the patient till 72 hours.

D.

Substitute therapy,

In this method Heroin replaces to opium in capsules and given to the patient and
gradually reduced the frequency and end blank capsules were given to the patient.

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Relapse
A relapse occurs when a person in recovery re-experiences problems or symptoms
associated to problem substance use after a period of abstinence or controlled use.
With mental health disorders, a relapse is a flare-up of symptoms that are associated
with the disorder. A relapse of one disorder can sometimes trigger relapse of the
other.
There are many contributing factors and warning signs that indicate that a person
may
be in danger of returning to substance use or redeveloping symptoms related to
mental
Health problems.
In first three months of rehabilitation relapse is integral or we can say relapse is 100
percent, in second three months relapse come to 85 to 87percent and in third three
months relapse percentage come to 40 to 60 percent, after one year the relapse
percentage become 10 to 15 percent and this percentage remain in his whole life.

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Relapse prevention
A relapse is an expected part of the recovery process in substance use treatment.
Usually there are warning signs that start long before the relapse. It is possible to
identify these warning signs and take action to prevent a relapse
.If a relapse does occur, it is not a sign that treatment has failed, or that a person has
weak character, or that the caregiver is at fault in any way. A person with a substance
use problem needs to learn and practice a variety of skills to prevent relapses. A
relapse should be seen as an opportunity for the person to think about how to
manage similar situations in the future. However, if someone relapses over and over
again, it may be a sign of a more serious, undiagnosed disorder, such as
posttraumatic stress disorder.
Without paying proper attention to the medical, psychological and rehabilitative
needs of the drug victims and without making an all-round effort to eliminate the
factors that breed addiction, indeed the control of narcotics supply and introducing
measures to reduce the demand for drugs must go hand in hand if this menace is to
be eliminated. It is also important to start an active campaign against the causes of
Drug Addiction while helping victims recover from their addiction.curently the relapse
rate is very high owing to non availability of rehabilitative measures.

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Causes of Relapse
There are many Social, Psychological and Physical causes of Relapse, but some of
them are,
Lack of acceptance.
No status in society.
Weak personality.
Psychological craving or magnetic power of drugs.
Easy availability of drugs.
Unemployment.
Environmental factors.

Counseling
Counseling is used to help individuals to deal with variety of problem situations.
During counseling, the counselor establishes a warm, supportive, therapeutic
relationship with the client using a variety of skills. Based on the strength of this
relationship, the counselor helps the client explore problem areas, set goals and
assists the client to work through problems in order to establish a more meaningful
and productive life style. During learn how to identify and pursue realistic and
satisfying solutions to his individual counseling effective, the counselor has to
understand the client as an individual the influences which have affected him, his
perception of himself and others around him so that she can help the client realize
how those forces have led to unhealthy ways of coping both prior to and after the
onset of addiction.. This understanding at the level of feelings rather than at the
intellectual level (or the objective level), will enable him to cope with life more
satisfactorily. The purpose is to help the client in making decisions about his life and

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enable him to understand the need to take responsibility for his actions as well as their
consequences.
The qualification required for a counselor is a post-graduation in Social Work or
Psychology with training in counseling. However, in the field of addiction, recovering
addicts by virtue of their own experience at recovery can work as counselors after
adequate training. He should have however maintained at least 3 years of sobriety
during which he has made qualitative changes in his life. He must also be emotionally
stable and should have dealt with his personality defects like impulsiveness,
irresponsibility, aggressiveness, selfishness and indiscipline.
Counseling has three main parts,

Listening
Listening is much more than merely hearing words. It involves intuitive perception,
watching for cues other than those conveyed through words (tone of voice, gesture,
and posture) and understanding the messages that the client is trying to convey
overemphasize or avoid.

Paraphrasing
After carefully listening the next step is paraphrasing or express the passage before
the patient in short that he already told you to get his confident.

Probing
After the two the third step is probing, for more informations that can be helpful for
you in solving the patient problem.

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The Role of Social Worker


Medical social work deals with social, physical and psychological processes of a
patient. The role of a medical social worker is to supervise the arrangements made for
the treatment of patients and also take proper steps for their rehabilitation and social
adjustment. More specifically a medical social worker helps patients;
1. By interpreting their meaning of illness and disease;
2. By giving information and facts about the disease and thereby removing any
misconception they may have about the disease and its effects;
3. By giving an emotional support to overcome their emotional tensions caused
by worries and anxieties about disease, family or other matters;
4. By making them understand and accept the situation through needed
adjustment;
5. By securing material resources of the community for the maintenance of their
families during their illness and for their rehabilitation after recovery;
6. By preparing their families to accept him by making necessary adjustments;
7. By giving needed information to their families regarding their care and
treatment during convalescence and thereby removing risk of relapses;
8. By giving necessary health guidance ,knowledge about sanitation, health care
etc.during home visits or discussions with family and neighbors ;and
9. By providing needed facilities and guidance to drug addicts during their
treatment in hospitals or as outdoor patients.

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Case Histories of the Drug Addicts


Case

Name

Taj Akbar

Gender

Male

Age

51 years

Religion

Muslim

Education

Primary

Occupation

Labour

Marital status

Married

Siblings

The client belonged to a middle family. He is getting treatment from 12 days .he
started taking drugs when he was in Dubai. He took start from cannabis and with the
passage of time his demand for the drugs increased and he used tablets and heroin
as well. His chief complaints are weakness, body pain, and aggression. He even tried
suicidal attempts and also tried to injure others. Due to all of these he also faced legal
problems and spent one month in prison. His children brought him in the institute and

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now he wants to get rid of from drugs to live a healthy life. And he also is getting
positive improvement from the institute.

Case

Name

Sultan Zeb

Gender

Male

Age

21 years

Marital status

Single

Education

primary

Occupation

Nil

Siblings

He belonged to the rural area of nowshehra. He has been admitted here by his father,
and now he is getting treatment here. According to him he was started taking drugs
from cannabis and after some time he was also started using heroin and alcohol. He is
also suffering from hepatitis C. Now he is getting treatment here not only for the
drugs addiction but also Hepatitis C, and he wants a healthy drug free life.

Akbar Aziz University of Peshawar Session 2010-2012 Social


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Page 23

[ANNUAL FIELD WORK REPORT ON DRUG ADDICATION


AT DATC LADY READING HOSPITAL PESHAWAR] October 30, 2010

Name

Taufeequllah

Gender

Male

Age

21 years

Religion

Muslim

Education

Intermediate

Occupation

Student

Siblings

This client is belonged to district chitral; he started taking drugs at the age of 18 due
to Bed Company, he start from cannabis and promotes it to alcohol.
Due to abuse use of drugs he has some psychological problem also. His father
brought him in the institute and he is getting treatment here from 10 days, and also
showing some positive improvements.

Akbar Aziz University of Peshawar Session 2010-2012 Social


work

Page 24

[ANNUAL FIELD WORK REPORT ON DRUG ADDICATION


AT DATC LADY READING HOSPITAL PESHAWAR] October 30, 2010

Case 4

Name

Syed Fayaz Ali Shah

Gender

Male

Age

36 years

Religion

Muslim

Education

Primary

Occupation

Auto Mechanic

Siblings

This client is also from a middle family at charsadda. He was started taking drugs due
to tension in work ,He start from cannabis and to the passage of time his demand
took to Heroin also, his main complains are head ache and body pain during work. He
was also caught by police and result he prison one and half month. His brother brings
him to the institution and he is receiving treatment here.

Akbar Aziz University of Peshawar Session 2010-2012 Social


work

Page 25

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