"Dost" (friend) of the Friendless.
Imagine a people, totally unaware of themselves; who, like a dog that has been kicked too many times, cannot defend themselves; a people who are without any rights; are powerless and without any self-esteem; a people who, after having sold everything else, sell their own children for a pittance; a people who are forgotten, ignored and abused by the world; a people who have nothing left; nothing, but for a little life. Imagine the task of giving them back their pride, their humanity, their very lives. Impossible?
Not if you are working for the DOST Welfare Foundation (Hayatabad, Peshawar). DOST ('friend')is an organization with a difference. Drug addicts are fed, housed and treated here for the two-month course, free of charge.
The business-like atmosphere at DOST was the first thing that struck me. Yet, there was also something else; something indefinable, that makes DOST different. The difference was the palpable benevolence and compassion that permeates its atmosphere. This, above all, is what makes DOST a sanctuary for the rejected, the outcast and the unwanted.
Unlike other detoxification clinics in Pakistan, there are no locks on DOST's doors. There is no need. The patients stay here voluntarily, strengthened and supported through counselling. Some patients only come to DOST as a last resort, before the liberation of death. In just two months time they are ready to return to the world; healthy in mind, body and spirit.
The DOST Treatment Model is based on the premise that drug-addiction is a disease, affecting a person's physiological, psychological, social and spiritual well-being. All drugs are equally dangerous, as they upset the natural hormonal balance of the brain. 'Charas' (marijuana, hemp) is often considered relatively harmless, because addiction results in less physiological dependence. Heroin addiction, on the other hand, causes both psychological and physiological dependence. Yet, compared to heroin, 'charas' (hemp, marijuana) withdrawal causes more hallucinations, drug-induced psychosis, agitation and irritability.
In 1992, at DOST's inception, its staff was trained in the Minnesota Twelve Step Program by Mehmood and Sheryar from `Nai Zindagi' Lahore. In its infancy, DOST faithfully followed this Model. Later the high rate of relapses forced them to adapt the treatment procedures, resulting in a more tailored approach. This is now called the DOST Treatment Model.
At DOST the day starts at 6.00am. and the patients are kept busy until 10.00pm. As it is run entirely by the patients, after the initial 7-10 days of detoxification each one joins a Therapeutic Duty Group. Divided into Housekeeping, Kitchen and Administration, each group has a leader and crew members. Every fortnight the staff and patients meet to decide who will be promoted or demoted to the next group. As therapy is a 24 hour process in a therapeutic community, all aspects of a patient are taken into account, such as attitudes, behaviour, manners, responsibility for self, care of others, maintaining the rules and thus demonstrating their commitment to recovery.
The DOST Therapeutic Community encourages the patients to share their experiences and feelings with each other. While speaking of their experiences with denial, anxiety, resentment and family problems, patients eventually begin to understand their disease. They learn to accept addiction as an illness such as diabetes, separating it from their `Self'. They are taught not to feel shame; and to understand that it was the disease, the drug that made them do terrible things, while they were in its control.
In 1993 DOST started a Community Intervention Program. The general public were told about the dangers of AIDS, HIV and Hepatitis, and about the treatment and rehabilitation facilities at DOST and SUKOON KOR. The positive response that followed the initial seminars led to an enlargement of the programme.
Drug addicts are neither violent and dangerous nor weak-willed and bad. A personality profile of people at risk would be that of high achieving, sensitive and intelligent people. They tend to expect too much from life, and from themselves. They are frequently very idealistic, with dreams of changing the world. They are often really nice people, who do not want to hurt anyone; and they end up by hurting the people they love most. Pragmatic, down to earth, practical people are less likely to take the escape-route offered by drugs. Addiction breeds a deeper desperation and a more complete resignation to hopelessness than one can understand. Detoxification and rehabilitation therefore result in a greater sensitivity and understanding of pain.
This was brought home to me when I interviewed Jamila.
Haltingly, painfully, she told me the story of her gradual slide to destruction. It all started when she had found her husband in bed with her sister, and she had ranted and raved. Finally her husband, a peddlar and an addict, introduced her to heroin, so there could be peace in the house. The drug-induced euphoria was a new experience for Jamila. Within the month she was addicted.
One day Jamila, her husband and daughter came to Jamrud to buy drugs. When Jamila awoke bleary-eyed from the drug-induced stupor she found herself alone in the Karkhano Bazaar. Her husband and child were gone. What happened then is unrepeatable. Squeezing her hand to show I cared, I found them cold and clammy with the effort of reliving her own private hell.
In December 1995 DOST finally struck at the source of the drug problem. They moved to the Karkhano Bazaar in the tribal areas, the place where it all happens. Just a stone's throw from the busy Hayatabad market, drugs, alcohol and pornography are easily available. Drug addicts are charged three rupees for the privilege of sitting there, amidst the filth and squalor. When an addict dies, the others bury him in a shallow grave, as no one else will touch the vermin infested corpse. Jackals and dogs feast on the bony carcass at night.
At first the addicts ignored the presence of the DOST workers, then they began to reduce their dosage. The drug mafia tried to intimidate DOST workers, but they did not falter; they were fired with a missionary zeal to help the wretched addicts. Recovered addicts were a part of the team, and they spoke of their experiences at DOST. Finally, one by one, the street addicts began coming to DOST for treatment. One of DOST's most motivated workers is a recovered addict. The only sign that he is any different from the others is his deeper empathy and compassion for humanity, in its most degraded form.
It takes about a month for a person to become addicted to heroin. At first the drug induces a euphoric feeling of total well being. Later it has to be taken, to avoid excruciating pain. Heroin withdrawal starts within a few hours of the last fix. After about a week of detoxification, the natural opiate centers in the brain start functioning normally.
According to DOST Psychologists, treatment of poly-drug abusers is the most difficult. Nowhere in the world is it so easy to buy any drug (from Valium to Morphine) as it is in Pakistan. People frequently become addicted under the mistaken belief that if frequently changed, no drug will become addictive. Little realizing that whatever the base, all mind-altering drugs have a similar effect.
Another reason for the insidious spread of drug addiction is that hospitals do not examine a patient's drug history. After an operation, the prescribed painkillers may cause a relapse in recovered addicts. Such people must be given medicines with a different base drug, or they should be helped to get over their dependency before leaving hospital. This aspect of drug control is often ignored in Pakistan.
Similarly, when there is a family history of drug abuse an individual may become addicted more easily than another. Doctors must be careful about prescribing addictive drugs as there is a genetic predisposition to alcoholism and drug addiction.
A recurring theme heard by psychologists at DOST is of men using drugs to increase their libido. Friends often introduced them to heroin on their wedding night. Similarly, addicts are frequently the cause of their wives' addiction, as it helped them to lose their inhibitions. More than any other single cause, the crux of the drug problem seems to be misconceptions arising from the lack of knowledge about drugs and sexuality. Drugs are believed to have aphrodisiac qualities!
Drug addiction is now becoming a family disease. Passive inhalation of the smoke results in the family becoming addicted and whole families are coming to Dost for treatment. Marium, her nine year old daughter Zubaida, two sons and four cousins were all undergoing treatment at DOST and SUKOON KOR when I visited it.
Dost had to launch a separate treatment center for women because of the steep increase in female addicts. SUKOON KOR (House of peace) is the first women's only detoxification and rehabilitation center in Pakistan. Besides treatment for addiction to an assorted number of drugs, from Valium and Lexotinal to heroin, SUKOON KOR also has psycho-therapeutic facilities for problems such as domestic violence, neuroses and stress management. After-care, and a Relapse Prevention Programme (RPP) are an important part of the DOST Treatment. The RPP facility is provided to patients who have been treated at the DOST Therapeutic Community, their family members and to recovering addicts from other centers.
When I heard Jahangir's story, it sounded like poetic justice. Life had been good to Jahangir, and he had more money than he could spend; he was the owner of a heroin producing factory. By inhaling the heroin dust, while keeping watch over his labourers, Jahangir became addicted, and the degradation started. One day, his thirteen year old son's disgust cut him to the quick. Jahangir went to his `factory' and aiming with his klashnikov, shot holes in all the drums full of heroin. He then joined the DOST programme and is now one of their many success stories.
I asked Psychologists at DOST what was the most heart-rending story they had heard in the four years since the inception of DOST. Each said that the story of Karim Khan had distressed them the most. He had sold his nine year old daughter for a gram of heroin (fifteen rupees or 25 cents). After that, his wife used to leave the children with neighbours when she went to work. She lived in terror that he would sell all her children, one by one. After detoxification, when Karim Khan realized what he had done, he tried to look for his child. She was nowhere to be found. He kept relapsing into a haze of drug-induced forgetfulness until, he was taught to detach the unforgivable behaviour from his `Self'. Only then could he forgive himself, only then could he overcome his self-loathing, only then could he learn to live with himself.
Listening to these and other stories of pain and anguish, the thought that kept coming to my mind was, `there go I, but for the Grace of GOD'.
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