field work sher zada( dost foundation)

1

FIELD WORK REPORT

The Role Of Dost Welfare Foundation in Rehabilitation of Drug Addicts

Sher Zada

M.A Sociology (Final)

Session 2010-12

Institute Of Social Work, Sociology and Gender Studies (ISSG)

University of Peshawar

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APPROVAL SHEET

Submitted for approval to

Dr.Anwar Alam; __________________________________

The Supervisor

Prof.Dr Johar Ali; _________________________________

Director ISSG

External Examiner; ________________________________

Institute of Social work, Sociology and Gender studies (ISSG)

University of Peshawar

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TABLE OF CONTENTS

CHAPTER CONTENTS PAGE NO

List of tables iv

Acknowledgment v

1 INTRODUCTION 1

1.1 Drug 1

1.2 Definitions of drug 1

1.3 History of drug 2

1.4 Drugs in Pakistan 3

1.5 Drug abuse and Drug addiction 5

1.6 Drug types 5

1.7 Reasons of Drug addictions 7

1.8 Treatment Approaches 7

2 ORGANIZATIONAL PROFILE 10

2.1 History 10

2.2 Mission 10

2.3 Areas of focus 10

2.4 Partners 10

2.5 The working staff at DOST Foundation 11

2.6 Team and services 11

2.7 Dost programs for the rehabilitation of drug

addicts

12

2.8 Drop-in center and outreach services for street

drug addicts in Peshawar

14

2.9 faith-based drug demand reduction services in

FATA regions of Pakistan 15

2.10 drug demand reduction services and

strengthening local community organizations in

Afghanistan

15

2.11 community-based drug demand reduction

center, Khazana

16

2.12 HIV awareness and voluntary counseling

testing Services for drugs addicts

17

2.13 fieldwork and internship program for

University students and graduates

17

2.14 Training programs for national and

international government organization and NGOs

18

2.15 Programs utilized for the rehabilitation of drug

addicted patients

19

2.16 Treatment procedures for the resident drug

addicts at Dost foundation TC’s

20

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2.17 Components of morning meeting 23

3 FIELD WORK DESIGN 25

3.1 Tile 25

3.2 Scope 25

3.3 Purpose 25

3.4 Objectives 25

3.5 Universe 25

3.6 Methodology 25

3.7 Tools 25

3.8 Duration of the study 25

4 CASE HISTORY 26

4.1 Case histories at Shahi Bala 26

4.2 Case histories at Guloona Koor at Haji camp 26

5 CONCLUSION OF THE FIELD WORK

REPORT

28

5.1 conclusion 28

5.2 Recommendations /Suggestions 29

BIBLIOGRAPHY 30

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LIST OF TABLES

NO CONTENTS OF THE TABLE PAGE NO.

1 Summary for Sakoon Kor-I 13

2 Summary for Sakoon Kor-II 13

3 Summary for Sakoon Kor-III 13

4 Summary for Sakoon Kor-IV 14

5 Summary of achievements drop-in center and outreach services for

street Drug addicts in Peshawar

14

6 Summary of achievements faith-based drug demand reduction

services in FATA regions of Pakistan

15

7 Summary of achievements drug demand reduction services and

strengthening local community organizations in Afghanistan

16

8 Summary of achievements community-based drug demand reduction

center, Khazana

16

9 Summary of achievements HIV awareness and voluntary counseling

testing Services for drugs addicts

17

10 Summary of achievements fieldwork and internship program for

University students and graduates

18

11 Summary of achievements Training program for national and

International government organizations and NGOs

18

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ACKNOWLEDGMENT

First of all I am very thankful to Allah Almighty who bestowed me with the

opportunity to do my master degree in sociology at university of Peshawar, and

enabled me to successfully complete my field work report. Though it was really a

tough job, but as Dr. Anwar Alam supervised and guided me at every stage, I am.

Very thankful to him who arranged this field work activity for exploring our

theoretical knowledge into practical form. I am very thankful to Dr.Johar Ali

Director of Institute of Social Work, Sociology and Gender studies (ISSG).I

present my gratitude to Mr.Shams-ud-Din VRC at Shahi Bala who briefed about

DOST programs and gave me visits of the treatment center. I also recognize the

welcoming attitude of Mr.Azmat Ullah Focal person at Guloona Kor Haji camp

who guided me about the field work procedures.

I appreciate the cooperation from my group members who give me a funny company

while visiting the field sites. Specially I am very thankful to Atta-ur-Rehman,Noor

Ahmen,Sahir Ullah and Zahid Akrm who guided me when I got any difficulty. I

am very thankful for the support of my parents that are looking for my bright

future.

Sher zada

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CHAPTER NO 1

INTRODUCTION

1.1 DRUG

Long before the first towns were built, before written language was invented, and even before

plants were cultivated for food, the basic human desires to relieve pain and prolong life fueled

the search for medicines. No one knows for sure what the earliest humans did to treat their

ailments, but they probably sought cures in the plants, animals, and minerals around them.

(Chapter 3: Drugs From Nature, , 2011)

1.2 DEFINITIONS OF DRUG

Drug is very wider term and that can be used for both medicinal and non-medicinal purposes.

Drug problem or drug abuse is really a short hand for socially disapproved. (Mir, 1997)

The very word “drug” means different things for different people. For some people, drugs are

those substances, which are illegal and socially disapproved of associated with stereotypes

images of “junkies” or solvent snuffers and not wish every day substances that ordinary people

use, on other hand manly people increasingly refer to all medicinal preparations as drugs. One

useful definition suggest that, drug is a substances which, when introduced to the body, alters the

structure or function of the organism.

(Dixon,1987).

Weiss man has pointed out that “drug is any substance (other than food) which by its chemical

nature affects the structure or functioning of living organism”. (1978).

According to oxford English dictionary “A substance which when swallowed, inhaled or human

body induces drowsiness, sleep and insensibility according to its potency and amount taken”.

(Murry,1978).

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In the sociological literature drug as a term, has become synonymous with illicit or socially

concerned substance. It other words, it is not the substance itself, rather it is the use or the

purpose and the methods of its use which confers upon it the little for its classification either as a

“drug” or otherwise (such as medicine) (Ashraf 1987).

(Ramzan, 2007)

After all defined definitions by some authors, what is a drug? One narrow definition comes up

that a drug is a substance, which may be used both in positive (for curing purposes) and negative

(for intoxication purposes) ways.

1.3 HISTORY OF DRUG

The more we discover about how early civilizations lived the more we find out about early drug

use. It is easy to believe that drug use is a modern phenomenon starting with the hippy culture of

the 1960s or alternately the earlier beat generation of the 50s and early 60s.

However, this would be quite wrong. Humans have used drugs for millennium. In respect of

early drug use one of the earliest records of naturally occurring drugs and their medicinal use

comes from China. The scholar emperor Shen Nung who lived around 2700 BC compiled a

pharmacopoeia (book of medicines) listing all the known drugs and the use that they may have.

One of the remedies listed was a plant called Ch’ang Shan, which was effective for fevers.

Nearly 5000 years later American scientists used this same plant as the basis for the synthesized

anti-malarial medication for the troops fighting in the pacific during World War II. Shen Nung

also identified another plant called Ma Huang, which had a stimulant effect. Japanese chemists

have isolated the active ingredient, which is ephedrine. So at least in China, although presumably

elsewhere, there would appear to have been not only early drug use but also a relatively

sophisticated knowledge of drugs and their uses as far back as 5000 years ago. The knowledge

gained for this early drug use was almost certainly through trial and error.

The nature of this early drug use is unclear, but it was probably not too different from the way

drugs are used today. For example just as we do today, early civilizations used drugs as

medicines, as part of religious ceremonies and for recreation, as well as other purposes.

Historically psychoactive drugs have been important for many religions. The role of the Shaman

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(wise man/woman) has been, in some cultures, inextricably linked with the use of hallucinogenic

that allowed contact to be made with spirits or deities. For example the South American Indians

used the hallucinogenic properties of the distilled cactus peyote in their rituals to enter the

presence of the great god Peyote. This, they believed would allow them to see and speak to the

god and receive guidance for themselves and the tribe.

It is believed that other shaman who reported that they turned into animals during rituals were in

fact under the influence of hallucinogenic drugs. Thus drug use, for some, could be regarded as

being a sacred activity. Some commentators have suggested that, quite apart from any

pleasurable affects that might accrue, the use of drugs in this way brought power and status to the

user as it brought both a mystique and legitimacy to their activities. This way of using drugs is

not found only in the early drug use of ancient civilizations but instead some societies continue

these traditions today. An obvious example would be practitioners of the increasingly popular

Shamanism or some Native American religious traditions. Indeed in June 2004 the Utah

Supreme Court ruled that non-American Indian members of the Native American Church can use

peyote as part of their religious ceremonies.

However the religious use of psychoactive substances can be found in more mainstream religions

and in modern times, witness the use of alcohol in Judo/Christian religions. Across the various

denominations the use of wine varies from the purely symbolic or commemorative of the last

supper to the mystical (trans-substantiation). As with other shaman and priests, the enactment of

the rites brings power and/or status to the practitioner (McMahon)

1.4 DRUGS IN PAKISTAN

Pakistan's geographic location next to Afghanistan, the world's largest producer of illicit opium,

places the country in a vulnerable position in terms of drug trafficking as well as drug abuse.

Patterns of illicit drug production, distribution and abuse change as a result of social, economic

and political developments.

Narcotics have become a multiple challenge to law enforcement authorities. In the late 1980s,

Pakistan and Afghanistan exported nearly half the world's heroin, and, although their relative

share declined somewhat thereafter, they remain among the world's major producers. Pakistan,

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especially under United States prodding, has attempted to cut back the cultivation of poppies, but

the government's influence has not extended effectively into tribal areas. In addition, various

political and economic forces have been brought to bear to keep narcotics police from pursuing

their work too assiduously.

Pakistan's cultivation of opium poppy largely declined during the 1990's to near zero levels in

1999 and 2000. The commitment of the Government of Pakistan (GOP) to measures for

eliminating opium poppy cultivation, together with alternative development projects funded by

the international community, led to a decrease in poppy cultivation from approximately 9,441

acres.in 1992 to some 213 acres In 2001 however, there was a reemergence of poppy cultivation,

probably as a result of high opium prices following the Taliban's prohibition of poppy cultivation

in Afghanistan in 2001. In 2003 poppy cultivation was reported at 6,703 hectors, including for

the first time cultivation in the Balochistan Province.

The total area cultivated declined to 2,306 hectors, By May2007 as a result of concerted

eradication efforts. Pakistan is one of the primary transit countries for drugs from Afghanistan

and hence knowledge of new routes and evolving methods of drug trafficking is essential for

successful interdiction. In 2007, law enforcement agencies seized 13,736 kg of heroin/morphine

base, 101,069 kg of cannabis and 15,362 kg of opium (down from the 2006 seizures of 35,478 kg

of heroin heroin/morphine base and 115,443 kg of cannabis and up from the 2006 opium seizures

of 8,907 kg). Intelligence on groups involved in drug trafficking and their links to other crime

groups is also key to controlling drug trafficking.

The problematic areas in terms of poppy cultivation are largely concentrated in the Federally

Administered Tribal Areas (FATA). Concerns about losing community acquiescence in counter

terrorism operations and a lack of available security forces due to ongoing counter terrorism

operations in the Pakistan-Afghanistan border areas are factors that hamper the eradication

efforts in FATA. Eradication efforts need to be improved, particularly in Khyber Agency where

there is a trend towards cultivation within walled compounds to conceal the crop from the

authorities.(Drugs in Pakistan)

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1.5 DRUG ABUSE AND DRUG ADDICTION

The terms "drug abuse" and "drug addiction" are often used interchangeably, but in fact, they

denote very different conditions. The term "drug abuse" refers to the use of a substance in a

manner that deviates from the culturally acceptable norms, while the term "drug addiction"

describes a disorder where the drug appears to be the dominant influence on the individual's

behavior. More specially, drug addiction is behavioral syndrome where the individual’s

motivation is dominated by the procurement and use of a drug and where the normal constraints

on the individual’s behavior are largely ineffective.

(Bozarth, 2009)

1.6 DRUG TYPES

I. STIMULANTS

These drugs speed up the body’s nervous system and create a feeling of energy. They are also

called “uppers” because of their ability to make you feel very awake. Stimulants have the

opposite effect of depressants. When the effects of a stimulant wear off, the user is typically left

with feelings of sickness and a loss of energy. Constant use of such drugs can have very negative

effects on the user. In order to prevent extreme negative side effects of these drugs and the

impact they have on life, drug treatment centers are often recommended

Drugs including

Cocaine

Methamphetamines

Amphetamines

Ritalin

Cyclert

II. DEPRESSANTS

Depressants slow down activity in the central nervous system of your body. These drugs are also

called “downers” because they slow the body down and seem to give feelings of relaxation.

Depressants are available as prescription drugs to relieve stress and anger, although drowsiness is

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often a side effect. The “relaxation” felt from these drugs is not a healthy feeling for the body to

experience, to stop abuse of this drug, drug treatment is suggested.

Drugs including

Barbiturates

Benzodiazepines

Flunitrazepam

GHB (Gamma-hydroxybutyrate)

Methaqualone

Alcohol

Tranquillizers

III. HALLUCINOGENS

When taking hallucinogens, switching emotions is frequent. These drugs change the mind and

cause the appearance of things that are not really there. Hallucinogens affect the body’s self-

control, such as speech and movement, and often bring about hostility. Other negative side

effects of these drugs include heart failure, increased heart rate, higher blood pressure and

changes in the body’s hormones

Drugs including

LSD (lysergic acid diethylamide)

Mescaline

Psilocybin

Cannabis

Magic Mushrooms

IV. INHALANTS

Inhalants are sniffed or huffed and give the user immediate results. Unfortunately, these

immediate results can also result in sudden mental damage. When inhalants are taken, the body

becomes deprived of oxygen, causing a rapid heartbeat. Other effects include liver, lung and

kidney problems, affected sense of smell, difficulty walking and confusion.

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Drugs including:

Glues

Paint thinner

Gasoline

Laughing gas

Aerosol sprays

V. CANNABINOIDS

These drugs result in feelings of euphoria, cause confusion and memory problems, anxiety, a

higher heart rate, as well as staggering and poor reaction time.

Drugs including:

Hashish

Marijuana

(Palmera)

1.7 REASON OF DRUG ABUSE AND ADDICTION

People abuse drugs for many different reasons. Some people use drugs because of peer pressure.

Some may think that they might be immune and the effects of drugs won’t affect them. When

some people are stressed and need something to get them past their problems they may take

drugs. Others might take drugs just for a thrill or just curiosity. Once people get caught on drugs

they usually become dependent. When people take drugs it over stimulates the reward path on

the brain causing them to become dependent. (TQ0310171, 2003)

1.8 TREATMENT APPROACHES FOR THE REHABILITATION OF DRUG ADDICTS

a) MEDICATION

Medication can be used to help reestablish normal brain function and to prevent relapse and

diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco

(nicotine), and alcohol addiction and are developing others for treatment stimulants (cocaine,

http://library.thinkquest.org/TQ0310171/wordbank.htm#Peer Pressure

http://library.thinkquest.org/TQ0310171/wordbank.htm#Peer Pressure

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methamphetamine) and cannabis (marijuana) addiction. Most people with serve addiction

problems, however, are poly drug users (users of more than one drug) and will require treatment

for all of the substances that they abuse.

Medications offer help in suppressing withdrawal symptoms during detoxification. However,

medically assisted detoxification is not in itself “treatment” it is only the first step in the

treatment process. Patients who go through medically assisted withdrawal but do not receive any

further treatment show drug abuse patterns similar to those who were never treated.

b) BEHAVIORAL TREATMENT

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

behavior related to drug abuse, and increase healthy like skills. These treatments can also

enhance the effectiveness of medications and help people stay in treatment longer. Treatment for

drug abuse and addiction can be delivered in many different settings using a variety of

behavioral approaches. A variety of programs are used for the treatment of those drug patients

who visit the treatment clinic on regular intervals some of these are following.

Outpatient behavioral treatment encompasses a wide variety of programs for patients who

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

counseling. Some pragmas also offer other forms of behavioral treatment pragmas like;

Cognitive-behavioral therapy, which seeks to help patients recognize, avoid, and cope

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

Multidimensional family, which was develop for adolescents with drug abuse problems

as well as their families, addresses a range of influences on their drug abuse patterns and

is designed to improve overall family functioning.

Motivational interviewing, which capitalizes on the readiness of individuals to change

their behavior and enter treatment.

Motivational incentives (contingency management), which uses positive reinforcement to

encourage abstinence from drugs.

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c) RESIDENTIAL TREATMENT

These programs can also be very effective, especially for those with more severe problems. For

example, therapeutic communities (TCs) are highly structure programs in which patients remain

at a residence, typically for 6 to 12 months. TCs differ from other treatment approached

principally in their use of the community treatment staff and those in recovery as a key agent of

change to influence patient attitudes, perceptions, and behaviors associated with drug use.

Patients in TCs may include those with relatively long histories of drug abdication, involvement

in serious criminal activities, and seriously impaired social functioning. TCs are now also being

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

the TC is on the re-socialization of the patient to a drug-free, crime-free lifestyle.

d) TREATMENT WITHIN THE CRIMINAL JUSTICE SYSTEM

Treatment in a criminal justice setting can succeed in preventing an offender’s return to criminal

behavior, particularly when treatment continues as the person transition back into the

community. Studies show that treatment does not need to be voluntary to be effective (Treatment

Approaches).

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CHAPTER NO 2

DOST WELFARE FOUNDATION

2.1 HISTORY

Dost Welfare Foundation (DOST) commenced its journey in July 1992 in Peshawar, in the

Khyber Pakthun Khwa(KPK) Pakistan.

DOST which means "friend", reaches out with a message of hope and healing to these

unfortunate human beings- drug addicts, street children, prisoners, refugees, destitute women and

children.

2.2 MISSION OF DOST

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.

2.3 AREAS OF FOCUS

1. Community Awareness and Sensitization for Drug Abuse Prevention

2. Drug Addiction Treatment and Rehabilitation

3. HIV Prevention, Treatment and Care

4. Rights Protection and Rehabilitation of Prisoners, Street Children and Refugees

5. Human Resource Development

(PILDAT)

2.4 PARTNERS OF DOST WELFARE FOUNDATION

1. INTERNATIONAL PARTNERS

The Royal Netherlands Embassy Islamabad

British High commission Islamabad

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AusAid

Unicef

Department for international development (DFID)

United Nations office of Drugs and Crimes

CRC(Catholic Relief Services)

German Technical Cooperation(gtz)

Save the children

2. NATIONAL PARTNERS

Infaq Foundation(INFF)

Pakistan Baitul Mal

Govern of KPK

NACP

MARRIE STOPES SOCIETY

2.5 THE WORKING STAFF AT DOST FOUNDATION

Dr. Parveen Azam Khan President/Chief Executive

Mr. Muhammad Azam Khan Director

Dr. Sikandar Azam Khan Director

Mrs. Munawar Humayun Director

Ms. Maryam Babar Director

Mr. Bahram Azam Khan Director

Mr. Khalid Mohtadullah Director

Ms. Maryam Bib Director

Dr. Tariq Khan Director

(BoD 2010 Dost, 2010)

2.6 TEAM AND SEVICES

198 full-time workers

240 volunteers and internees

10 projects / donors

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04 residential treatment centres

14 community-based centres

14 mobile teams

04 prison-based centres

(Our Team, 2010)

2.7 DOST WELFARE FOUNDATION PROGRAMS FOR THE

TREATMENT AND REHABILIATION OF DRUG ADDICTS

SAKOON KOR RESIDENTIAL DRUG ADDICTION TREATMENT

SERVICES

Drug addiction treatment services are operational since 1993, which include residential and

community-based services. Clients in treatment are provided detoxification, behavioural change

counselling, family and social interventions, religious and spiritual groups, relapse prevention

skills, vocational skills development and aftercare services.

Currently with a total capacity of 200-beds six residential treatment centres are operational,

which are:

Sakoon Kor 1

Sakoon Kor 2

Sakoon Kor 3

Sakoon Kor 4

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Summary for Sakoon Kor-I

Indicators So Far 2010

2010 Grand

Total Jul-Sep Oct-Dec

Total No. of clients given Drug

Treatment

4529 98 74 4701

Entered into Primary Rehab 1176 0 7 1183

No. of families involved in

rehabilitation of clients

2275 98 74 2447

Summary for Sakoon Kor-II

Indicators So far 2010

2010 Grand



Treatment

4113 225 221 4559

Entered into Primary Rehab 1637 94 117 1848


rehabilitation of clients

1877 220 218 2315

Summary for Sakoon Kor-III


2010 Grand



Treatment

228 19 16 263


rehabilitation of their children

176 19 16 211

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Summary for Sakoon Kor-IV


2010 Grand



Treatment (Detox)

3113 120 72 3305

NO of Patients in Rehab Barrack 693 77 51 821

(Dost Foundation, Treatment, 2012)

2.8 DROP-IN CENTRE AND OUTREACH SERVICES FOR STREET

DRUG ADDICTS IN PESHAWAR

Outreach and drop-in center-based services are available to the street drug users of Peshawar

since 1994. Services include psycho-social support, healthcare, drug awareness, pre-treatment

counseling and HIV prevention services.

DOST currently provides these services through two static drop-in centers, three outreach

teams and one mobile drop-in Centre reaching to more than 3000 street drug addicts every

month.

Summary of achievements

Indicators So far 2010 Grand

Total

Jul- Sep Oct-Dec

No of DUS/IDUs registered 7755 221 362 8338

Clients STI Management services

(services provided)

2112 64 135 2311

No. of clients tested for HIV 2568 14 28 2610

Drug users detoxified 1990 56 54 2100

(Dost Foundation, DIC, 2012)

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2.9 FAITH-BASED DRUG DEMAND REDUCTION SERVICES IN

FATA/PATA REGIONS OF PAKISTAN

In 2006, Faith-based drug demand reduction services were established in four FATA/PATA

regions of Pakistan. Presently Dar-ul-Falah faith-based centres are operational in four agencies

namely Mohmand, Malakand, Khyber and Kurram.

These centres mainly work to mobilize religious leaders and community influential, provide pre

and post treatment interventions with drug users and their families and create general mass

awareness.

Summary of Achievements

Indicators So far 2010 2010 Grand


No. of clients were counseled and provided

other services in Dar-ul-Falah centers

7328 275 259 7862

Number of clients referred for treatment 1758 200 130 2088

No. of religious leaders were sensitized and

mobilized

3857 528 430 4815

(Dost Foundation, Faith-Based, 2012)

2.10 DRUG DEMAND REDUCTION SERVICES AND STRENGTHENING

LOCAL COMMUNITY ORGANIZATIONS IN AFGHANISTAN

DOST established drug demand reduction services for Afghanistan in 2007. Presently two

residential treatment and two outreach drop-in centres are operational in Bamyan and Daikundi

Provinces of Afghanistan through partnerships with local organizations.

Moreover, a training and resource centre is working in Peshawar to enhance the capacity

Pakistan.

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Indicators Till Jun 07 2007 Grand


Drug addicts were provided pre-

treatment services - - 48 48

Drug addicts were provided

treatment services - - 9 9

Families of clients were reached - - 33 33

Community elders were reached - - 37 37

(Dost Foundation, DDR in Afghanistan, 2012)

2.11 COMMUNITY-BASED DRUG DEMAND REDUCTION CENTRE,

KHAZANA

Khazana community-based drug demand reduction centre was established in 2005.

The centre provides general community awareness, sensitization and mobilization of

community elders, outreach and drop-in centre services for drug addicts, family interventions,

referral of drug addicts for treatment, home-based treatment and follow-up services.


Indicators So far 2010 2010

Grand


No. of clients were counseled and provided other

services in DIC

1261 39 46 1346

No. of drug addicts were referred for treatment to

DOST

365 35 26 426

No. of families of drug addicts were counseled

and advised

2839 108 81 3028

(Dost Foundation, Community Based, 2012)

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2.12 HIV AWARENESS AND VOLUNTARY COUNSELLING TESTING

SERVICES FOR DRUGS ADDICTS

In 2001 DOST commenced HIV prevention and STI management services for drug addicts in

addition to the outreach and residential treatment services. These services, which mainly

include HIV awareness, Voluntary Counselling and Testing, management of STIs and condom

education and provision, are offered through outreach teams, drop-in centres and residential

treatment centres.



Total July-Sep Oct-Dec

Drug addicts were provided HIV

awareness

27650 49 69 27768

Clients were provided VCT

services

4215 14 28 4257

Clients were provided STI

treatment

1880 29 19 1928

(Dost Foundation, VctIDu, 2012)

2.13 FIELDWORK AND INTERNSHIP PROGRAMME FOR

UNIVERSITY STUDENTS AND GRADUATES

In 1996, DOST commenced the fieldwork and internship programme for the new university

graduates and students of different disciplines including social work, psychology, sociology,

medicine and management sciences from various universities and colleges of Peshawar.

Presently, DOST offers internships and fieldwork opportunities in different service delivery

areas including drug abuse prevention and treatment, HIV prevention, rights protection,

management areas including monitoring and evaluation, finance and human resource

management.

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Training sessions with students held

(psychology, social work, medical students

etc.)

556 13 0 569

graduates joined internship program 2199 6 5 2010

(Dost Foundation, F&I Programme, 2012)

2.14 TRAINING PROGRAMME FOR NATIONAL AND

INTERNATIONAL GOVERNMENT ORGANIZATIONS AND NGOS

In 1999, DOST launch the training programme for GOs and NGOs working in Pakistan and

Afghanistan in the fields of drug demand reduction, HIV prevention and protection of women

and child rights. Presently, DOST is working in collaboration with the Ministry of Public

Health and Ministry of Counter Narcotics Gov. of Afghanistan and the Home Department and

Civil Defence Department of Pakistan for training their staff. Trainees include doctors,

counsellors, social workers, police officials, prison health personnel and prison management

staff and probation officers.

DOST’s own staff, working in different programmes also receive regular trainings and capacity

building. Training is also offered to various NGOs working in Pakistan and Afghanistan.


Indicators so for 2010 Grand


Drug abuse awareness sessions held with police

official at civil defence

304 7 10 321

Police officials were trained 3654 116 133 3903

(Dost Foundation, Training Programme, 2012)

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2.15 PROGRAMS UTILIZED FOR THE REHABILITATION OF DRUG

ADDICTED PATIENTS

DAY CARE CENTER (DCC)

RESIDENTIAL PROGRAM

The bulk of clients in the program are referred from the day care center that the Dost Foundation

is running for street addicts in Peshawar. The philosophy of intervention with street addicts is

based on the maxim “ rehabilitation even before detoxification” where addicts are given time to

restore some of their physical strength, health and hygiene, bring a level of manageability to their

lives and establish contact with their families before they are formally inducted into the treatment

program.

One recovering addict and two medical technicians-cum-counselors visit the street scene in

Peshawar 6 days a week. The team gathers together addicts and talks to them about their health

and other immediate concerns of survival on the streets, and gradually brings them to the point of

considering to quit drug use and admitting themselves for treatment. The message for these

addicts is that their first step towards demonstrating a desire to quit is to come to the Day Care

Centre on a daily basis. Once the addict has been coming to the center fairly regularly, and has

established contact with his family, he or she is formally accepted for admission and treatment

into the residential program.

In the Day Care Centre, addicts may come in to bathe themselves, wash their clothes, have tea

and bread, get first aid or medical treatment for minor ailments and/or attend the Narcotics

Anonymous meeting held there. All of these activities are carried out on a fixed schedule. On the

average, 20 to 25 people, some of them recovering addicts and some actively using drugs, come

to the day care center each day. From among them, active drug users, who have been

demonstrating some changes in their behavior in terms of manageability and have established

contacts with their family, are referred for treatment into the residential program at DOST. The

number of such referrals does not exceed ten in a month.

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2.16 TREATMENT PROCEDURES USED FOR RESIDENT DRUG

ADDICTS AT DOST FOUNDATION TREATMENT CENTERS (TC’S)

DETOXIFICATION

When the drug addicts are brought to the Drop In Center (DIC) then after preliminary checkup

are referred to TC for treatment purposes they are referred to Treatment Center (TC) at Shahi

Bala(SK-2) for treatment.

This program consists of a 15-day detoxification period followed by primary rehabilitation for

another 15 days. The main drugs used for detoxification include Diazepam, a non-narcotic

analgesic such as Panadol, an antihistamine such as Phenargan, along with supportive therapy for

diarrhea, vomiting etc. The purpose of the medication is to stabilize the client during the acute

phase of withdrawal from drugs. Frequent baths, showers and dips in the outside pool have also

been found to be beneficial to clients in easing their withdrawal symptoms. Counseling for

clients is another intervention found to be useful during the withdrawal phase.

PRIMARY REHABILITATION(REHAB)

After completing detox period then the patients (drug addicts) are taken for primary

rehabilitation

The patients are taught behavioral moralities through lectures, counseling, group sharing .and

some minor responsibility like making tea, cleanliness etc. are also given to the patients within

the premises.

SECONDARY REHABILITATION(REHAB)

The next phase of treatment is secondary rehabilitation, consisting primarily of vocational

rehabilitation. During this period, the clients work as security guards, counselors to those who

are under withdrawal through and group leaders or they work as support staff in the center or

participate in the street or jail

programs. Some of these residents are also taken up as full-time staff in the program.

Reintegration into the community is gradual. During this phase, the client may go, once a

21

weekend, to his home and back. The frequency of visits is gradually increased until the client is

completely ready and confident to spend full time at his home.

FAMILIES PROGRAM(FOLLOW UP)

The program for families is another program component at Dost Foundation. Starting from the

tenth day of detoxification; the families of the addicts begin visiting the center every week.

During this time, families are given lectures about addiction, co-dependence and counseling and

have the opportunity to share among each other as a family unit or within the larger group of

parents and families.

(UN international Drugs controll Program, 2000)

COUNSELING

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, and a community based worker, a care taker, or a care provider.

Any one of these can be a counselor.

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.

Counseling is a communication process between two or more than two people to solve 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.

At Treatment Center there are psychologists and physiologists (doctors) and Para (recovered

addict) counselors, who counsel the drug addicts about the Drug and their physical and

22

psychological impacts. They also give chance to the patients to discuss their Problems which

come during detoxification period.

By listening attentively and patiently the counselor 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. Counseling 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. Counselors 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.

BEHAVIOR SHAPING

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 center 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.

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.

23

Behavior management and behavior shaping tools are some techniques which are used in

community center 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 following.

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) Full Hair Cut

6. Time out

7. Confrontation

8. Prospect chair

MORNING MEETING

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 redefines social self and the socially

responsible role. It is designed to help people appropriately and constructively identify, express,

and manage their feelings.

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

everybody to learn and respect the environment and, most of all, to change the negative aspects

of the behavior and the careless attitudes

2.17 COMPONENTS OF MORNING MEETING

The contents or rituals of the morning meeting, , are as following;

1. Recitation of the Holy Quran – Tilawat

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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. Newspaper 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. Program for the next day

17. Closure: Dua-e-Sakoon, meeting,

(Shams-ud_Din, 2012)

Before 2007 DOST Welfare Foundation have almost 24 projects, but when the militancy started

in KPK and FATA. The donor partners have decreased their funding, though some of these

projects successfully have been completed. But due to decrease in funding the DOST Welfare

have trouble in the completion of its projected goals. Currently DOST is working on 14 projects

(Ahmed, 2012)

25

CHAPTER NO 3

FIELD WORK DESIGN

3.1 TITLE

Role of DOST welfare foundation in the rehabilitation of drug addicts

3.2 SCOPE

The Study is limited to dost welfare foundation treatment center (sk-2) at Shahi Bala and

Guloona Kor at haji camp

3.3 PURPOSE

The purpose of this field work study is to know about the services of DOST welfare foundation

for the treatment and rehabilitation of drug addicts in Peshawar

3.4 OBJECTIVES

1. To know about the DOST services provided for the rehabilitation of drug addicts.

2. To find out the procedures of treatment at Treatment Centers (TC’s) at DOST.

3. To find out the views of drug addicts (patients) about facilities at TC and DCC at DOST.

3.5 UNIVERSE

The drug addicts at Treatment Center (TC) Shahi Bala(SK-2) and Guloona Kor Day Care

Center(DCC) Haji camp.

3.6 METHODOLOGY

CASE STUDY

3.7 TOOLS OF DATA COLLECTION

Individual case history is used for the collection of relevant data

3.8 DURATION OF THE STUDY

The duration of the study was from 15 May, 2012 to 15 June, 2012.

26

CHAPTER NO 4

CASE HISTORY

4.1 CASE HISTORIES AT SHAHI BALA (SK-2)

After studying case histories of all drug addicts at this center, it is concluded that most of the

drug addicts started using drugs due to luxurious life, failure in love and emotional traumas.

They are using drug from many years. It is found that most of the addicts are self-earners and

have no familial financial support. They are doing their jobs and are earning to buy drugs for

themselves. Some of the drug users also depend on their familial support to full fill their demand

of drug addiction.

Saeed Ullah is a shopkeeper he is earning money himself. He started heroin when his parents

rejected his demand for love marriage, he told “I was so depressed when my parents rejected my

proposal and started heroin”. Akhtar khan is HTV driver; he was spending happy life .But when

his brother in law was blown away in a bomb blast, all the burden of his sister came into his

shoulders. He became addict of hash, heroin and alcohol.Ijaz was working overseas (Saudi

Arabia), when he came back to homeland his friends forced him to take heroin, he told “one day

I was sitting with my friends they forced me to sniff , the next when I demanded them to share

with me and they refused so I started to buy heroin”. When he took once felt moody and thus he

became drug addict. Aorang zeb is working as Nan bai at charsada, a friend suggested him to

start drug trafficking when started this business he became regular drug user. Amir Islam a

retired supervisor (PTCL).He started using heroin when someone misguided him that it increases

intercourse time period.

4.2 CASE HISTORIES AT GULOONA KOR (DCC) HAJI CAMP

After studying all the case histories at this center it is concluded that most of teen agers became

drug addicts due to bad family financial situation which forced them to go on street scavenging

and as a result of bad peer company they started using drugs.

27

Muslim is an afghan refugee he got training in a religious extremist center; he became heroin

addict because of his company with unknown people, he told “when I was getting my training at

Bara Khyber agency at training center my trainer suggested me to use hash to become alert”.

Mashal started hash using when his father died and he shifted to an extended family where he

has no parental control, and striving poverty thoughts came to his mind. Ismail who is cattle

grazer, he became hash addict because of his company with adults village drug addicts. Amin is

an afghan refugee he has started heroin and alcohol addiction because of broken family.

All the above listed individuals have realized that drug addiction is an evil which has disturbed

their life and also brought shame to them and to their families. They wish to quit it and start a

new life.

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CHAPTER NO 5

CONCLUSION AND RECOMENDATIONS

5.1 CONCLUSION

OST welfare foundation is doing really a well job for the treatment and rehabilitation

of drug addicts .It is covering that part of society which has been neglected and

rejected by others, and is trying to light those candles which have been switched off

by the destructing winds of drug addictions. The part of society which is dealt with abuse and is

thought as disgraceful on the open roads and streets is getting shelter at DOST. They can become

able to speak out that they are also same to others.

From outside DOST welfare just looks like a name, and someone would think that it is pretty

easy job to handle the persons who are mentally retarded drug addicts. But when the internal

situation is seemed this argument will change to “this is really a difficult job to cope with those

who are intentionally and unintentionally agree to quit an action which was their habitual. Where

there is felt a need the DOST forward its hands for help.

It is a well-known saying “a friend in need is a friend indeed” which is followed by DOST

welfare foundation in practical sense.it has given patients name to the drug addicts to let them

realized that they can be cured and come back to their previous normal life. There is no

discrimination on the base of class, caste, race and religion at DOST. All of them are treated on

equal basis.

DOST takes start from spiritual healing of the patients, the patients are taught that the drug

misuse is forbidden in all sacred religions on the planet. They are realized that they have their

responsibilities from the family side and also in society, to fulfill them they should to quit

addictive drugs and become curious about their role.

They are provided with information about past drug addicts and their dreadful closure, and

glimpse of prosperous future of the drug quitter is also presented to prepare their mind for

quitting drug addiction.

D

29

Physical and psychological treatment facilities are provided to patients at DOST. There is

medical doctor available at every center for the manual checkup and treatment. Psychotherapists

are available at every center that does psychological therapy of the patients. Counselors are

available at DOST centers .who make discussion with patients and get information about their

improvement. This counseling may be individual or of group wised. It also trains them in

vocational skills to prepare them for upcoming responsibilities.

5.2 RECOMENDATIOS

The DOST should expand its services to the far-flung areas especially to the rural areas of

Khyber Pakhtunkhwa (KPK)and Federally administrated tribal areas (FATA), because the rural

population of KPK and FATA is mostly illiterate and the higher tendencies to drug addiction is

found there .DOST should separate the drug addicted children from street children at DCC,

because when these children mix up there at DCC then the children who are not using drugs they

imitate from those drug addicted children who come to DCC. The counselor should brief the

children to take care of their cleanliness, because it has been seemed that most of children are

dirty. They eat with their dirty hands which cause food infection. During entertainment time

period they should be monitored and the medium of entertainment (which is mainly TV) should

be consisted on Pakistani culture not of west.

30

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field work sher zada( dost foundation)

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