Field Work Report Sher Zada (Role of DOST Foundation)
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Transcript of Field Work Report Sher Zada (Role of DOST Foundation)
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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
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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
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2.12 HIV awareness and voluntary counseling
testing Services for drugs addicts
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2.13 fieldwork and internship program for
University students and graduates
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2.14 Training programs for national and
international government organization and NGOs
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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
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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
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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
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9 Summary of achievements HIV awareness and voluntary counseling
testing Services for drugs addicts
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10 Summary of achievements fieldwork and internship program for
University students and graduates
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11 Summary of achievements Training program for national and
International government organizations and NGOs
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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,
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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
Total Jul-Sep Oct-Dec
Total No. of clients given Drug
Treatment
4113 225 221 4559
Entered into Primary Rehab 1637 94 117 1848
No. of families involved in
rehabilitation of clients
1877 220 218 2315
Summary for Sakoon Kor-III
Indicators So far 2010
2010 Grand
Total Jul-Sep Oct-Dec
Total No. of clients given Drug
Treatment
228 19 16 263
No. of families involved in
rehabilitation of their children
176 19 16 211
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Summary for Sakoon Kor-IV
Indicators So far 2010
2010 Grand
Total Jul-Sep Oct-Dec
Total No. of clients given Drug
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
Total Jul-Sep Oct-Dec
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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Summary of Achievements
Indicators Till Jun 07 2007 Grand
Total Jul-Sep Oct-Dec
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.
Summary of Achievements
Indicators So far 2010 2010
Grand
Total Jul-Sep Oct-Dec
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.
Summary of Achievements
Indicators So far 2010 2010 Grand
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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Summary of Achievements
Indicators So far 2010 2010 Grand
Total Jul-Sep Oct-Dec
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.
Summary of Achievements
Indicators so for 2010 Grand
Total Jul-Sep Oct-Dec
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
24
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.
28
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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