FIELD WORK REPORT

ON
DRUG ADDICT TREATMENT CENTER AT
KHYBER TEACHING HOSPITAL, PESHAWAR

Submitted By

Fakhre Alam
R No (09)
B.S (6th Semester) Social Work

INSTITUTE OF SOCIAL WORK, SOCIOLOGY AND GENDER STUDIES

UNIVERSITY OF PESHAWAR

FIELD WORK REPORT

ON
DRUG ADDICT TREATMENT CENTER AT
KHYBER TEACHING HOSPITAL, PESHAWAR

Submitted By
FAKHRE ALAM
Roll No. 09
B.S (6 Semester) Social Work
th

Submitted To
S Faiq Sajjad Shah
Field Work Supervisor (Social Work)
I.S.S.G. University of Peshawar

Dr. Alam Shah

Medical Social Worker
at KTH Peshawar

INSTITUTE OF SOCIAL WORK, SOCIOLOGY & GENDER STUDIES

UNIVERSITY OF PESHAWAR
SESSION 2014-2015

APPROVAL SHEET

Fakhre Alam

_______________________

Dr. Alam Shah Medical Social

Worker at KTH (D.A.T.C)
Ward Peshawar

_______________________

Dated:

_______________________

Acknowledgments
All praises to ALLAH, the most Merciful, Kind, and Beneficent, and source of all knowledge,
Wisdom within and beyond our comprehension. All respects and possible tributes goes to our
HOLY PROPHET MUHAMMAD (Swal Allaho Alaihy Wasallam), who is forever guidance and
knowledge for all human beings on this earth.
I express my gratitude to Sir Dr. Niaz Muhammad (Director of ISSG University of
Peshawar) and Sir Basharat (Chairman Social Work) for arranging this field work for us.
Thanks to Sir. Faiq Sajjad Shah, the field instructor, who has contributed enthusiasm, support,
sound advice, particularly his supportive attitude was always a source of motivation for me. He
guided me in a polite and cooperative manner at every step.
At this juncture I feel deeply honored in expressing my sincere thanks to my field supervisor Sir
Alam Shah for making the resources available at right time and providing valuable insights
leading to the successful completion of my report.
I am also in debt to all those writers who has written such informative and thought provoking
books related to drugs.
I extend special thanks to my respectable parents, who support me spiritually and financially and
made me able to achieve this target.

Fakhre Alam

Abstract
This field work report is about drugs. This report is divided into three sections. The first section
is introduction to institution, which includes historical background, structure aims objectives etc.
The second part contains main topic or body of the report. Which includes introduction, drugs
related laws in Pakistan, drugs and Islam etc.
The third part contains experience regarding field works, which include observations,
suggestions and role of social worker.

Table of Contents
S.No

Headings

Page. No

Acknowledgments

Abstract

ii

Background of KTH Peshawar

Historical background of D.A.T.C

What is Drug?
Drug use in Pakistan

1-2
3
4-5

Drugs related laws and policies in Pakistan

Drug and Islam

6-7

Classifications of drugs

8-14

Progression of Drug use

15-17

10

Stages of Addiction

18-19

11

Methods of detoxification

20-21

12

Observations

22

13

Suggestion

22

14

Role of Social Worker

23

15

Case History 1,2 and 3

24-25

16

Bibliography

26

Background of KTH Peshawar

Khyber Teaching Hospital, NWFP, and Peshawar was commissioned in 1976 for the
development of scientific and research base of the province. It is octagonal in shape with
extension of Y shaped wings in the form of units. The recently constructed underground passage
and the over-head bridge have made safer the smooth flow of patients and students between
KMC, IRNUM and KTH.

The Khyber Teaching Hospital

Khyber Teaching Hospital (KTH) Peshawar has been providing tertiary health care delivery and
teaching facilities to local population in NWFP ever since 1976. established over a covered area
of 962,000 square feet on busy Jamrud Road, this 1202 bed hospital caters for the health
requirements through OPD, Casualty and Evening OPD of over 739500 patients (in the Year
2007) (approx) an year.1

Historical Background of D.A.T.C

When the numbers of drug dependents were increasing the UNO and the govt. of Pakistan
thought about alarming situation and took some practical steps in this regard to meet the
challenges. For this purpose one Drug Abuse Treatment Center was established in December
1978 at Khyber Teaching Hospital Peshawar. It was meant for the users of Opium, Chars,
Morphine, Heroin and other Drugs.

Finance
In the beginning D.A.T.C was separate having no relation with hospital and was financed by
UNICEF but now Government of Pakistan is financing it.

Aims and Objectives

Detoxification and helping in rehabilitation
To help them become hard working independent and contributing member of the society.
To help them develop self esteem.
1

https://www.docstoc.com/pass/95684267/?download=1

To help them to discover and realize the potentials they possess.

Admission Procedure of D.A.T.C (K.T.H)

At the time of admission the patient undergoes a proper procedure. Firstly they go to O.P.D
where the Doctor examines him the Doctor advice some tests to the patient. The general test of
the patient which the doctor suggests to the patient is Chest X-rays, ECG & FBC with ESR. If
any of these tests are negative the patient referred to D.A.T.C for treatment. The patient is
properly examined prior to admission to decide either he/she are fit to tolerate withdrawal
agonies or needs some medical intervention before detoxification.

Admission fee of D.A.T.C (K.T.H)

Admission fee in D.A.T.C is Rs.100 as in other wards of the hospital. Poor patients who cannot
afford the admission fee or other expenses are helped out through the ward Funds.
Bed Capacity: They are ten beds for the patients 8 for male and 2 for female patients.
Treatment: Patients are hospitalized for 10 days. This duration may be prolonged if the patient
is having some medical or other problem or not fully recovered.
Recreational Facilities: DATC provide many facilities to the patients. There is TV, VCR,
CAROM, and BOARD for the enjoyment of the patients.
Staff OF D.A.T.C: The following is the staff of DATC ward in KTH hospital:
1. Social medical officer=1
2. Medical officer=1
3. Staff nurse=2 and student nurses=3-4
4. Ward orderly=3
5. Cleaner=12

Shah, A,Hisotry of KTH,D.A.T.C,2014

What is Drugs?
Drugs is any chemical that changes the way the body works or thinks feels or act is called is
called is called drugs.
In medical terms drugs is any substance that changes or enhances any physical or psychological
function in the body.

History of Drugs
Drug exist history is unknown because human being is using drugs as long as he is born. Some
time human beings use it for treatment purposes and some time for addiction. But remember
every drug is firstly used for treatment purposes. The first drugs were likely discovered through
Accident and Observation. Drugs affect biologic systems in both positive and negative ways.3
As early humans tried different plant, animal, and mineral substances, they realized that some
substances produced specific effects.4 The use of natural products with therapeutic /beneficial
properties is as ancient as human civilization and, for a long time, mineral, plant and animal
products were the main sources of drug.5

Process of Drug Use

Use

Abuse

Dependence

Addicion

Upson DW: General principles, Handbook of Clinical Veterinary Pharmacology, ed 4. Manhattan, KS, Dan Upson
Enterprises,1993, pp 1
2
Davis LE: Veterinary pharmacology: An introduction to the discipline, in Booth NH, McDonald LE (eds):
Veterinary Pharmacology and Therapeutics, ed 5. Ames, Iowa State University Press, 1982, pp 17.
5

De Pasquale, A., 1984. Pharmacognosy: the oldest modern science. Journal of Ethno pharmacology 11, 116

The above graph show that first time it is simply use. After some time use then it become abuse.
Abuse means misuse after sometimes then it becomes dependence in dependence the drug
become a part of life. Addiction is the last process where he knows about the harms but cannot
live without that.6

Drug Use in Pakistan

Pakistan, a country already tormented by regional insurgencies, is fighting a losing battle against
a different kind of foe: drug addiction. Pakistans illegal drug trade is believed to generate $2
billion a year. Pakistan the most heroin-addicted country, per capita, in the world, wrote David
Browne, who covered the mujahedeen insurgency in the 1980s, in a recent expos for The
Telegraph. Peshawar is at the center of this phenomenon, in close proximity to extensive
opium-poppy fields in the Afghan provinces of Badakhshan, Kunar and Nangarhar, and the
rudimentary heroin-processing labs clustered around Landi Kotal in the adjoining Khyber tribal
agency.
According to the United Nations Office on Drugs and Crime (UNODC) in a report titled Drug
Use in Pakistan 2013, 6.7 million Pakistanis used drugs last year. A staggering 4.25 million are
thought to be drug dependent. Drug rehabilitation programs and other treatments were provided
for only 30,000 of the countrys addicts in 2013. While cannabis was listed as the most
commonly used drug in Pakistan, opiates (including opium and heroin) were a close second. It is
estimated that 44 tons of processed heroin is smoked or injected in Pakistan each year a figure
that suggests a rate of use that is two or three times higher than in the U.S. An additional 110
tons of Afghani heroin is trafficked through Pakistan each year on its way to international drug
markets. Intravenous drug use is a popular conduit for the transmission of blood-borne disease if
the needles are shared another increasingly common practice. In one recent survey of regular
injecting opiate users in Pakistan 73 percent of respondents reported sharing a syringe and it is
estimated that about a third of those are HIV-positive, Browne added. In 2005, only 11 percent
of Pakistani drug users were HIV positive. UNODC has called on the Pakistani government to

De Pasquale, A., 1984. Pharmacognosy: the oldest modern science. Journal of Ethno pharmacology 11, 1

address the problem through wide-ranging policy changes, HIV prevention campaigns, and a
support network for those struggling with addiction.7
In Pakistan drugs addicted number has increased 100 %. In women sleeping pills were also
increasing. Due to the lack of free drug treatment centre this number is increasing day by day. In
Punjab cannabis is used as a main drug. In last one year 6.7 million people use drug in some
forms. Previous year this number was 2.9 million.8

Drug Use in KP
According to the statistics of the Directorate of Social Welfare Department Khyber
Pakhtunkhwa, 11% people are using drugs in KP while in Punjab and Sindh they are about 6.5%
of the population. Despite decades old efforts by official and non-governmental organizations
against drug addiction, number of drug addicts is increasing alarmingly in the provincial
metropolis of Peshawar and other parts of the province. An official of Directorate of Social
Welfare Department Khyber Pakhtunkhwa told APP that their department was working in this
regard since 2004. He said that the number of drug addicted people was increasing due to
presence of Afghan Refugees, poverty and unemployment. Social Welfare department was
working in five districts of KP including Peshawar, Kohat, Swat, Dir Lower and Dera Ismail
Khan, adding they have rehabilitated 1250 drug addicts only in Peshawar. The official said that
the directorate needs assistance of big hospitals and has held several meetings to discuss possible
ways of coordination. Committees including officials of police, anti-narcotics team, social
workers, Khyber Teaching Hospital (KTH), Lady Reading Hospital (LRH), Al-Khidmat
Foundation, Dost Foundation and Caritas foundation have been formed to treat the everincreasing number of drug addicts, he said. The sale of drugs is carried out in the open and even
the children have access to it, he told APP, adding that Karkhano market was the main point in
the city where all kinds of drugs are easily available.9
7

J.T Quigley (2014, March 24), in Diplomat. Retrieved May 5, 2014 from http://thediplomat.com/2014/03/pakistanthe-most-heroin-addicted-country-in-the-world/
8
Drug use in Pakistan (2014, May 23).in Daily Mashriq Retrieved May 2014, 04, from
http://www.dailymashriq.com.pk: http://www.dailymashriq.com.pk/index.php?date=2014-05-23&edition=&type=
9

Number of drug addicts highest in KP (2014, May 23), in Pakistan Today. Retrieved May 24, 2014 from
http://www.pakistantoday.com.pk/2014/05/23/national/number-of-drug-addicts-highest-in-kp/

DRUGS RELATED LAWS AND POLICES IN PAKISTAN

Constitution
The state cannot prevent or hinder a person from doing something not prohibited under law and
cannot compel a person to do something that is not required under law. Other claims against the
State that are protected under the Constitution include the right to movement, association and
peaceful assembly subject to reasonable restrictions imposed by law for preservation of
sovereignty, integrity, public order and morality.

Religious Law
The Enforcement of Sharia Act, 1991 was aimed at instilling Islamic values into the legislative
and judicial regime. The Act proclaims the supremacy of injunctions of Islam as laid in the
Quran and Sunnah over other laws and requires statutes to be interpreted in conformity with
Islamic provisions.
The Act orders all Muslim citizens to observe the Shari at and act accordingly., adopt Islamic
principles in governance promote Islamic values through mass Among other declaratory
provisions, the Act directs the state to introduce the Shariat in education and teaching media and
enact a range of legislative and administrative measures to ensure compliance with the Shariat.

Courts
The judiciary, which comprises the district Courts exercising civil and criminal jurisdiction,
special Courts and tribunals, High Courts and the Supreme Court, is responsible for the
enforcement of legal and fundamental rights. At the district level, civil judges and the Court of
District Judge decide civil cases. Special Courts and tribunals have been set up under various
statutes to hear specialized matters pertaining to labor, traffic, insurance, narcotics etc.10

DRUG AND ISLAM

Islam prohibits all drugs that are not medically prescribed. Islam's prohibition of drugs stems
from two concerns:

10

Awan,H (2009,November),in ssd. Retrieved 04 May,2014 in www.ssd.com.pk/pub/Literature%20Review.pdf

Their intoxication effects

Their harm to the human body

There are numerous verses in the Qur'an and hadith that ban intoxicants (including alcohol). The
prophet Muhammad (SwalAllahoAlaihyWasallam) said:
Every intoxicant is like alcohol, and every (type of) alcohol is prohibited. (Muslim)
The second reason for banning drugs is that they are believed to have a harmful effect on the
body. The Qur'an says, "And makes not your own hands contribute to your destruction." Surah,
Al-Baqara, 2: 195
Prophet Mohammad (PBUH) has described drugs together with all sorts of intoxicants as:
1. The key to all evils.
2. The head of all errors and lapses.
3. the most terrible of major sins.
4. The mother of all atrocities.
5. The mother of all evils. 11
Imam Zarakhshee narrates in his book upon the prohibition of Hashish (Cocaine) from Zakariyah
Razee, a famous doctor, that consuming hashish causes headaches, desiccates semen, brings
about confusion, Neurosis, and dries up all body fluids which could cause sudden death. Also it
defects the mind, induces hectic fever, and tuberculosis.12

CLASSIFACTION OF DRUGS
There are four types of drugs they are
Opioids, Stimulants, Depressants & Hallucinogens
5

What does Islam say about drugs (2009),in Book signs retrieved
http://www.bookofsigns.org/2009/04/what-does-islam-say-about-drugs/
10
Yousaf,
M
(2008,
December
9),
in
Norbury
retrieved
04
http://www.norbury.org/?section=articles&id=34

2
May,

May,2014
2014

from
from

OPIOIDS

Origin
Opioids are those drugs which are derived from opium. Opioids are also called narcotics, can be
synthetic, semi synthetic or natural. Opium is 100 % natural. Morphine and codeine are two main
alkaloids of opium. Heroin is semi synthetic. Means some chemical are mixed with it.

Appearance of Opioids
Opium and heroin are almost in tar like black or brown blocks. Heroin is often sold in powder
form. Morphine can be in liquid or tablet form. Majority synthetic Opioids are available as
tablets or capsules.

Mode of administration
There are many modes or methods in which Opioids can be used. Following are some modes of
administration. In most cases Opium is smoked. Heroin can be smoked, inhaled (either as a
powder or liquefied in a nasal spray bottle), or injected (intramuscularly or intravenously).Some
Opioids can be taken orally in tablet. When used medically for pain relief Opioids are
administered via slow-release capsules or patches. People break open the capsule, dilute the
contents, and inject the solution. Some Opioids are short acting, and some are long acting. The
interesting thing about Heroin is that it effects last 3 to 4 hours.

Medical Uses of Opioids

Every drug when it is discovered it was used for medical purposes same is the case with opium.
And besides that opium is used almost in every medicine. Opium can be use as a pain killer and
for Diarrhea and coughing. 13

Desirable Effects of Opioids

Opioids can be used for Physical pain relief and can also be used for Emotional numbness.
Other medical effects are Euphoria, strong felling of happiness and Dreaminess etc.
13

Shah, A,Classification of drugs,2014

Side Effect of Opioids

Some main side effects of Opioids are following.
Nausea and vomiting.
Confusion.
Slowed breathing.
Constipation.
Dizziness, faintness, floating feeling, light-headedness.
Uncoordinated muscle movements, rigid muscles.
Facial flushing.
Dry mouth.
Weakness.
Agitation.
Headache.
Memory loss.

Withdrawal Syndrome of Opioids

In addition to intense drug craving, Opioids withdrawal symptoms include
Restlessness

Depressants
Depressants slow normal brain function. Because of this effect, depressants are often used to
treat anxiety and sleep disorders. Despite their prescription for treatment of anxiety and sleep
disorders, depressants also carry high addictive potential. 14

Appearance of Depressants
Depressant can be in tablets, capsules, white powder forms and clear liquid.

14

Shah, A,Classification of drugs,2014

Mode of administration of Depressants

Oral

Medical Uses of Depressants

Depressant can be used
To treat anxiety, acute stress reactions, panic attacks, and sleep disorders
As muscles relaxants
In medically managed alcohol withdrawal
As preserver sedation

Desirable effects of Depressants

Relaxation
Decreased anxiety
Decreased inhibitions
Sense of well-being
Mild euphoria

Side Effects of Depressants

Poor concentration
Muscle weakness
Lack of coordination
Slurred speech
Dizziness
Slowed reflexes
Nausea and vomiting
Mental confusion
Memory loss
Emotional blunting15

15

Shah, A,Classification of drugs,2014

Withdrawal Syndrome of Depressants

Depressant withdrawal can be medically dangerous and difficult to manage, in part because the
drugs tend to stay in body tissues for long periods. Symptoms tend to last for 7 to 20 days for
short-acting drugs and up to 28 days for longer acting drugs. Symptoms include:
Drug craving
Headache
Tremors and muscle twitches
Nausea and vomiting
Anxiety
Restlessness
Yawning
Rapid heart rate and increased blood pressure
Muscle cramps
Sleep problems
Hallucinations16

Examples include:
Alcohol, Valium, Heroin, Cannabis etc

Stimulants
Stimulants are those drugs which increase alertness in mood, increase feeling of well being and
increase energy. Stimulants change the brain the way nerve cells communicate with one another.
As with many other drugs, stimulants possess very high addictive potential.17

Appearance of Stimulants
Stimulants can be available in tablet, capsule form white powder etc forms
Modes of Administration of Stimulants
Stimulants are taken as
16

17

Shah, A,Classification of drugs,2014

https://www1.villanova.edu/villanova/studentlife/health/promotion/goto/resources/drugclassifications.html

Orally
By snorting (inhaled nasally after crushing tables)
By smoking
By injecting after dissolving crushed tablets in water

Medical Uses of Stimulants

Stimulant can be used for attention deficit/hyperactivity disorder (ADHD).
Cocaine is a topical anesthetic, sometimes used to numb nasal passages when insrting breathing
tube, to numb the eye or throat during surgery, and to deaden the pain of chronic sores.
Desirable effects of Stimulants:
Euphoria
Increased energy
Talkativeness
Increased mental alertness
Fallings of happiness and power
Release of social inhibitions
Enhanced sensations of sight, sound, and touch
Enhanced sexual desire and performance (at low doses) 18

Side Effects of Stimulants

Dilated pupils
Increased body temperature, heart rate, and blood pressure
Headaches
Restlessness and insomnia
Anxiety and irritability
Abdominal pain and nausea
Increased aggression and violence
Decreased sexual response (at higher doses)

18

Shah, A,Classification of drugs,2014

Withdrawal Syndrome of stimulants

Stimulants with drawl symptoms are very unpleasant. Starts within 5 to 7 days and can be
continues to weeks or months.
Severe drug cravings
Energy level drops again
Increased depression
Loss of motivation, initiative
unpleasant dreams
Insomnia19

Examples include:
Cocaine, nicotine, and caffeine etc.20

Hallucinogens
Those drugs which causes hallucinations. Hallucination means when our five senses did not
work properly. In this category our connection cut with reality.

Appearance of Hallucinogens
Peyote; small, gray-green buttons Mescaline; Usually a white or brown powder in capsules LSD:
manufactured as a liquid, then converted to different forms; tablets or capsules of varying sizes,
and colors; liquid on blotter paper; powder.

Modes of administration of Hallucinogens

Peyote buttons or psilocybin mushrooms can be chewed or brewed into tea.
Mescaline or psilocybin also can be taken orally in capsule form.
LSD is taken orally.

19

Shah, A,Classification of drugs,2014

Drug
Classifications
(1990-2013),
in
Villanova
retrieved
1
May,
2014
https://www1.villanova.edu/villanova/studentlife/health/promotion/goto/resources/drugclassifications.html

20

from

The psychoactive effects of hallucinogens begin within about with about 1 hour and last up to 12
hours.

Medical uses of Hallucinogens

None
Desirable effects of Hallucinogens
Effects vary widely based on dose size, setting, and the users expectations and personality
(called set and setting):
Heightened sensory experiences (e.g., brighter colors, sharper visual definition , increased
hearing acuity, more distinguished taste)
Vivid mental images and distorted vision
Altered space and time perception
Loss of sense of reality
Intense emotions
Altered sense of time of self
Synesthesia: Experiences seem to cross over different senses, giving the user the feeling of
hearing colors and seeing sounds

Side Effects of Hallucinogens

Intense nausea and vomiting (very common with peyote)
Chills and shivering
Highly adverse reaction (bad trip), including freighting hallucination, confusion, agitation,
depression, panic, and/or terror
Difficulty focusing, maintaining attention, concentrating, and thinking
Dilated pupils
Increased body temperature
Increased heart rate and blood pressure21
Sweating
21

Shah, A,Classification of drugs,2014

Loss of appetite
Sleeplessness
Dry mouth
Tremors
Difficult focusing, minting attention, concentrating, and thinking

Withdrawal Syndrome of Hallucinogens

None 22

Examples include
Magic Mushrooms, Peyote Cactus, Marijuana23

Progression of Drug use

Experimental/ Recreational use
Recreational

use

is

the

least

severe

level.

It

usually

occurs

in

setting among friends, does not happen very, and typically involves consuming small to
moderate amounts of psychoactive substance. It is often driven by curiosity or peer pressure. A
person using recreationally rarely experiences problems related to use. A possible exception is if
the substance used is illegal.

Circumstantial/Occasional Use
Circumstantial use happens often when an individual is motivated to achieve a desirable effect as
a way of coping with something circumstantial. For example, a very shy person may find that
smoking marijuana makes him or her more relaxed and able to talk to people, dance, or
otherwise be more social. Or a person with depression may try a substance to feel livelier and
better. An extreme example is that soldiers in combat have been known to use marijuana, heroin,
or other available substances to help them relax and escape the stresses of war. A person at this
22

Shah, A,Classification of drugs,2014

Drug
Classifications
(1990-2013),
in
Villanova
retrieved
1
May,
2014
https://www1.villanova.edu/villanova/studentlife/health/promotion/goto/resources/drugclassifications.html
23

from

level also may use occasionally for fun or to be social. A person may not experience problems
because of use at this level.

Intensified/Regular use
Some people start out with recreational or circumstantial use but begin to use more of the
substance, more often. When psychoactive are used daily or almost daily, in low to moderate
doses, the effect is intensified. At this level, a person is often motivated by a need to get regular
relief from an ongoing problem, such as anxiety or depression, or to maintain a desired level of
performance.

Compulsive/Additive use
Compulsive use is the most dangerous and severe. At this level, high doses are needed daily or
almost daily to reach. Desired physical and / or psychological effect or to avoid withdrawal
symptoms. At this level, the substance becomes the most important thing in a persons life, round
which all other activities are organized. At this level, a person experiences problem related to use
but continues in spite of them. This level of substance use is considered addiction.

Other Factors of Drugs Addiction:

Following are the other contributing factors to Drug Addiction
1. Pear influence
2. Just for Joy
3. Curiosity
4. Leak of Parental Care
5. Lack of Affection
6. Drug Abuse in Family Members / Family Culture
7. Lack of Recreation Facilities
8. Lack of Time for Recreation
9. Poverty24
10. Illiteracy

24

Shah, A, Progression of Drug use,2014

11. Unemployment
12. Family conflicts
13. Broken Or Destitute Family
14. Disorganization e.g. IDPs
15. Failure in Love
16. To Improve Working Capacity
17. To Improve Sexual Potency
18. Lack of Medical Facilities
19. Medical Problems
20. Experimentation
21. Easy Availability
22. Drugs Business
23. Working in Heroin Factories25

STAGES OF ADDICTION
Pre Contemplation

Recurrence

Contemplation

Maintence

Preparation

25

Shah, A, Progression of Drug use,2014

Action

Stages of Addiction
There are six stages of addiction they are following
1)

Pre contempaltion

2)

Comtemplaltion

3)

Prepation

4)

Action

5)

Maintence

6)

Recurrence

Pre Contemplation
It is the first satge and in this satge the person need treatment,by self motivation.In this stage the
person did not think about his treatment.according to him what is going on is reight. In life there
are 150-200 pleasures only in heroin there is 1500-2000 pleasures.in short we can say that he has
no planning to leave the drugs.

Contemplation
Contemplation means to thinks seriously. In this stage the person thinks about himself that things
are going wrong. He is motivated by some person or some particular situation. In this stage he
became aware of drugs and ready for change.

Preparation
Between stage 2 and 3: A decision is made. People conclude that the negatives of their behavior
outweigh the positives. In this stage physical involvement is very necessary. It means that the
person takes a practical decision. 26

Action
At this stage the person leave the drugs; means some action is taken on his decision by better
preparation action can be strong, while by weak preparation action is not so much effective.
26

Shah, A,Stages of Addicion ,2014

Maintenance
In Maintenance the person is free from drugs and almost he adopted new behavior. Maintenance
can be negative or positive general example related to maintenance, if a person wanted that his
became physical strong and wanted to maintain his body so regular exercise would be very
important for him.

Recurrence
It is also called relapse. Relapse means to return a former bad or under desirable state. It is a
repeated process. And from here the person start drugs so he will be refer again to action stage.27

METHODS OF DETOXIFICATION

Introduction of Detoxification:
Detoxification is the process of purifying the body of compounds that have a detrimental effect
on cell functions or structures. When one starts the process of detoxification, the body begins to
discharge excesses that have been carried for years.

Definition:
Detoxification is a set of interventions aimed at managing acute intoxication and withdrawal. It
denotes a clearing of toxins from the body of the patient who is acutely intoxicated and/or
dependent on substances of abuse. Detoxification seeks to minimize the physical harm caused by
the abuse of substances. The acute medical management of life-threatening intoxication and
related medical problems generally is not included within the term detoxification and is not
covered in detail in this TIP. (Treatment improvement protocol). 28

27

Shah, A,Stages of Addicion ,2014

Detoxification and Substance Abuse Treatment (n.
http://www.ncbi.nlm.nih.gov/books/NBK64119/#A85312
28

d),

in ncbi retrieved May 13,2014

from

Methods of Detoxification:
Following are some methods of Detoxification
COLD TURKEY METHED
The term cold turkey is an American idiom which means to quit instantly, or to talk
plainly. Most people use the term in the sense of quitting drugs, with the cold turkey approach
being one method to use in an attempt to beat a addiction Quitting cold turkey is definitely not
for everyone, as the symptoms of withdrawal can be very severe, since no tapering of the dosage
is involved In fact, in some cases an abrupt cessation of drug use can lead to death due to
systemic shock.
When someone goes cold turkey, he or she immediately abandons a habit, with no preparation or
tapering off. Some people think that this method is very effective for treatment of drug abuse,
while others feel that it may result in recidivism, as people are not gradually eased into quitting.
One advantage of quitting cold turkey is that it requires no preparation, meaning that someone
can wake up one morning and decide to quit then and there, as opposed to someone who embarks
on a lengthy treatment plan, which can lead to a loss of motivation over time.
GRADUAL WITHDRAWAL
The Gradual reduction of the consumption without using nicotine plasters is not recommended
by experts. But some people manage to undergo a withdrawal successfully by this method. (It
should be noted this passage is wrong, many experts say this method is vastly better than cold
turkey. Cold turkey results in mostly relapse)
The reason why this method is not very likely to be successful is, that the symptoms of the
withdrawal depend on how much a person its determined to get rid of the habit and how much
the persons concentrates on the unpleasant feeling of the symptoms. Reducing the consumption
of cigarettes means to plan to smoke a certain number of cigarettes a day. 29

29

http://www.wisegeek.com/what-does-cold-turkey-mean.htm

OPIATE THERAPY METHOD

In this method of detoxification the addict is given opium in a capsule as a substitute to the drug
on which the person is dependent. The dose of opium starts from 250 mg and is gradually
reduced to 0 mg. This method is also known as substitution method as the drug to which the
person is addicted is substituted or replaced by opium which is comparatively less addictive
substance. Doctors may substitute artificial opiates (substances or drugs made of opium) such as
Opioids, methadone for heroin or similar sedative and intoxicating drugs.30
ACUPUNCTURE METHOD
Acupuncture is very effective. In this method needles are used and work very effectively. It is
only needed to find a compliant acupuncturist that can make it less painful and make it a more
satisfying experience. In this method the toxins are usually expelled out of the body through the
kidneys and urinary tract. The pain received by the needle pricks gives the addict a strange kind
of sensation, which relieves withdrawal symptoms and prevents the patients craving for drugs.
A traditional Chinese Medicine practitioner extremely recommends acupuncture as a way to
cleanse your body. It is believed that the more toxins, the stronger the effects of acupuncture will
be felt. So even if there is pain involved in acupuncture, it can still cure or heal your problems in
an instant instead of suffering from a longer pain for the rest of your life.
SYMPTOMATIC TREATMENT
This is also a commonly practiced method of detoxification. In this method the addicts are given
medicines according to the withdrawal symptoms shown by them. Withdrawal symptoms are the
physical or psychological problems faced by the addicts while trying to abstain from the drugs to
which they are addicted. 31

30

31

http://quitsmoking.wikia.com/wiki/Gradual_reduction
http://detoxguide.hubpages.com/hub/Body-Detoxification-With-Acupuncture

EXPERIENCE REGARDING FIELD WORK

OBSERVATIONS
o The DATC Centre should be separate and it should autonomous in decision making.
o Recreational facilities are limited.
o The DATC centre is in upper floor difficult for both addicted people and their relatives
especially to old age people.
o The number of doctors and other staff is very less.
o There is always a chance of improvement in services and facilities. Same is the case in KTH

SUGGESTIONS
The ward should be separated so that it became a self sufficient in decision making and other
polices making.
The number of social worker in staff should be maximized. For the better treatment of patient
it is very necessary.
There should be a separate room for those students who are linked with KTH in the form of
Field Work.
The students should give participation in drugs related seminars, worships.
The recreational facilities should not be limited to TV, but it should be extended to play
grounds etc.
The duration of treatment which is 10 days should also be extended.
As Family members visit is necessary in registration, but it should also be necessary on each
and every step of treatment in DATC.
Modern medicines and equipment are very necessary for better treatment. There should be
modern medicines.
These all thing are still possible when the government increase fund for DATC and also it, s the
responsibility of private sector to collaborate with government for the better and effective
treatment.

ROLE OF SOCIAL WORKER

Social work can play a very important role to minimize the use of drugs and also can be very
helpful to treat addicted people. Social worker can educate, motivate the society and addicted
people.
Social worker can motivate, educate and counsel the children, youth and old age people who
are addicted to drugs.
As a subject drugs is teach to social worker especially to BS student in one semester. Better
and effective work in community is still possible when you have command on your subject.
As social workers are expert how to make polices. And also they know the effects of polices.
So by comprehensive polices they can reduce this social problem.
As by one person the whole family, community and society is disturbed especially their
families are hurter. Social worker role is very important to guide, counsel and give courage to
their family and recover their emotional feeling from stress.
Medical Social worker work can unite the staff to work as team or group in hospital so with
collaboration and cooperation with doctor, nurse and other staff he can be very effective.
It is the role of social worker to visit home of addicted people, so that there is rapport
building between them, but due to lack of time we did not perform this duty.

Case History 1
The client name is Mansoor Rehman, and his father name is Shams u Rehman, belong to Karak.
His age is 18 years. He is matriculate, and his bed number is 5.it is his second day in DATC
KTH Peshawar. Mansoor case is experimental or recreational case.
According to him he has a shop in which he sold Cannabis, Although Cannabis is not allowed to
sell freely but he sells it hidden. Due to no such proper and continue work he was enjoying
himself with his company and some friends of him were addicted to cannabis. From that he was
also addicted to cannabis. He used cannabis from 3-4 years.
After that there were some other friends who were addicted to Heroin and Mansoor Rehman
spent some time with that group due to his close relation with that group. Forms that company
which was addicted to Heroin he also use it for the first time just for recreational purpose, when
he was sitting in Hujra. He used heroin 3 to 4 times per day, which cost is Rs 500. His father was
known by his condition and was referred to KTH Peshawar by his father because there is no
DATC in Karak. He used Heroin up to one year. Now his treatment is started and he is satisfied
from his treatment.

Case History 2
The client name is Zahid and his father name is Faqir Muhammad. His age is 27 year. And he is
addicted to Cannabis and Heroin. By profession he is a daily wager. And he belongs to Shahab
Khel Bada Bira Peshawar. The client is matriculate and is working as a daily wager.
According to him he was always enjoying his time with his company, although in that company
there were some friends who were addicted to smoking. One day one of his friends offered him
to smoke he accepted just for recreation purpose. From that he also started smoking regularly and
was addicted to smoking. This addiction was continues to seven years.
One night while enjoying himself with his friends in Hujra, and in that company there was a
friend who was addicted to cannabis. That friend offered him to smoke cannabis and from that
time he used cannabis daily and was addicted .His per day cost of cannabis is 150-200 rupees.
This was continues to 5 years after that he stared tablets like Restorial, Valium ten etc. The

company was also changing as the drug was change, there was another friend who was addicted
to Heroin and he also started Heroin with him and was also addicted to Heroin.
Since from 5 years he is addicted and is using Heroin. His per day cost of heroin is 200 rupees.
Now he is admitted in KTH, and the date is 7/5/2014.He is facing withdrawal symptoms like
Insomnia Mental confusion. The client is not totally satisfied from his treatment. And has certain
objection on medicines.

Case History 3
The person name is Manzoor Alam. His father name is Haji Noor Alam belongs to Abdara
Peshawar. His education qualification is intermediate. His date of admission is 30 April 2014.
His age is 65 years. His bed number is 3. He is addicted to opium and cannabis. He was admitted
in KTH three times. And each time he passed ten days.
He start Cannabis when he was 12 years old. And the addiction was continuous till his 35 years
of age. His per day cost of Cannabis was Rs 250.
He started opium in 15 years of age till yet. His cost of opium is Rs. 400.He started drugs due to
failure in love. Although in his company there were some friends who were addicted to opium,
chars and sleeping pills and it was the time when he was admitted in F.A. After F.A he also
done diploma.
The person was employed in PDA before his drug use and his salary was 35000. Means his
economic status was very good. But as we have discussed above that his main problem was
failure in love.
His family status is nuclear. He has two sons and two daughters. His wife is educated and her
qualification is also F.A.
Withdrawal symptoms are abdominal pain, less hunger, continuous nose. He is not fully satisfied
from his treatment.

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