DOST of the Hopeless

This article is a good window for looking at the tip of this iceberg. Drugs are now a major social problem in Pakistan, one that needs to be confronted with pragmatism and much urgency.
DOST Welfare Foundation and other centers like it need Pakistani-American financial support. Is there someone out there who wants to take this
initiative here in America to promote DOST?

Zeejah Sahiba, this article may not get hundreds
of responses but it is your best yet to grace
CHOWK. Your observation:

``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.``

I could write a long-winded reply here about who is responsible for this mess. But I wont, and not because the extremists will get on my case. Because today, even they cannot deny the magnitude of this problem. But I will say that a people have been used in the worst manner ``to make the world safe for democracy``.
ZJ, Do You have an address or a account number for DOST that we can circulate in North America?
And thanks for bringing up this issue here.

Ras

I am retired medical doctor and seen and treated some patients in 60s to mid 80s. There is no answer and medication to overcome addiction.I may have treated about 45 patients only 2 were able to overcome addiction.Most were controlled addicts. There was one of my relative and I could not help him. Most lived about 65% of their normal life span, and it was miserable life a wasted life. It is a sorrow of our profession we cannot help addicts. Now things may be more dangerous due many diseases like AIDS and others.I will like to know from readers if they `really` know people who were saved from drug problems.

zeejah,

Good work! what DOST is doing is fairdinkum ``Jihad``... I would like to enlist! account details would be good.

And yeah, God damn those who are responsible for spreading drugs.

mo2000,

I agree with you. My rotation in ``addiction psychiatry`` was frustrating because there were far more failures than successes. Heck, if we cant successfully treat nicotine addiction, what hope do we have against heroine addiction.

Zeejah,

{{Yet, compared to heroin, `charas` (hemp, marijuana) withdrawal causes more hallucinations, drug-induced psychosis, agitation and irritability.}}

Are you sure about that? Correct me if I`m wrong, but hemp is not the same as marijuana. Yes, withdrawal from marijuana can cause craving, irritability & agitation. A minority of patients can get severe panic attacks & paranoia under the influence of marijuana, but I`ve yet to come across a case where marijuana caused hallucinations (unless the drug was laced with PCP or the patient had an underlying psychotic disorder).

Compared to marijuana, alcohol is perhaps far more dangerous.

I had gotten a bit tired of Chowk, but this article is one of the few (in recent months) i`ve seen on Chowk that constructively addresses an important issues - i.e. it shows the problem, and what is being done about the problem - not just the same `ol criticisms, and exposes... that don`t lead to any change. So, first of all a big thank you for this article - we need more of these kinds -

I work as a Psychiatric Social Worker in the US, and work with people who not only have a pyschiatric diagnosis, but also have a substance abuse (called dually diagnosed in the US) - this is undoubtedly one of the more difficult populations to treat - but still we have had some success - a particular treatment mode to look at is something called ``harm reduction`` - many abusers will simply not give up their choice of drugs - and so complete abstinence while a good goal- it is unrealistic for many - ``harm reduction`` teaches these folks how to reduce their drug use, and to also begin to realize the harm that is being done to their own well-being, and strategies they can use to reduce this harm ...

Another treatment possiblity is hinted in the article about the use of ``self`` - within Pakistan, you may be able to talk/discuss this issue with those who are true Sufi teachers/masters - and learn more about the self - the techniques of zikr, reaching one`s inner ``true self`` versus only remaining at one`s conditioned self - could prove to be valuable in treating some of these folks - particularly the use of imagery from one`s religious/cultural background can be very useful (such is also used in Native American healing ceremonies ...)

Once again, thank you for this excellent article -

Altaf

Shankar

Thanks for your input. I assume your are not in 70s. I use to hope some drugs will come on line to improve situation.( we did not have any training in treating such problems or drugs in real sense. We use to act as sympathetic elder and encourage)

We are extremely poor country and drug tratment is waste of money. We donot have basic medical health care to most citizens.There is absolutely no hope it will be better. It will be fashionable for NGO to help drug addicts and photos to ask for money. NGO`s should do what they want ( They do very good things) as they are not taking money from GOVT. But as GOVT should not throw money towards addicts. We need to make basic health clinics in rural areas. In 1975 I travelled to India to attend conference in Bombay. After conference I visited basic health ( near Shirdi)centers in Kopergoan . (I am follower of SaiBaba- he lived in Sirdi) It had population of 4500 people and met young recent medical graduate. She was in charge of 10 basic health clinics.( in india majority doctors are female). She said she visits each center once in two weeks. She said this works good as many problems can be attacked before they become big problems. For serious problems the doctor writes note to senior doctors and ask patients to refer to Govt.Zilla Hospitals. ( these were spartan but well functioning little hospitals) The state provided Jeep and nurse and driver.The price of medication was 1 Rs. I talked to local people who were there and they were happy. The doctor was paid only Rs 450 per month and living quarters and have to work for three years. In district places senior doctors are there to help young doctors. This is condition for getting admission to medical college.I am aware that Maharashtra is rich and socially progressive state and these conditions may not exist in other states. (After talking to local people they said they prefer male doctors as lady doctors get married and get transfers or get pregnant and go on leave.) I always felt we can study systems in India and see which works and can be used.

Lastly we need to start thinking of compulsory family planning. We need to set a goal that we will start for families no more than one child from say 2005. It should be mandetory. This is most critical problem. If the population growth is same then nobody can save us. Most urgent is family planning not drug treatment. With best wishes to every body.

All muslim countries are suffering from overpopulation but IOC never says a word. I do not understand why they gather and discuss worlds problems when this population explosion is killing us.

The ball to progress begins with looking after your own and I guess the ball to progress is beggining to roll. Keep up the good work.

ouch, toothache.

rizvi

Altaf Bhimji,

It was very interesting to read your post. I`m a psychiatrist practicing in Michigan. I dont do substance abuse treatment in my practice. I send those patients to a few places who do so, near here. This is the first time I`ve heard of ``harm reduction``. But then, alas, I`ve not kept up in the advances in that field. If it is successful, I hope more substance abuse centers would adopt that model.

Unfortunately, due to managed care, many substance abuse centers had to fold up in the US. Is this an out pt treatment & do most health insurance plans cover it?

mo2000

No, I`m in my 40s:)

It was interesting to know you are a Sai Baba devotee (I`m assuming you are Pakistani). Both hindus & muslims are attracted to his teachings. In the same vein, I have a few hindu relatives who are very ardent devotees of Sufi saints.

As far as medication treatment of addiction is concerned, I have limited knowlege in the advances in the field. Nicotine cravings can be reduced with Bupropion (Zyban/Wellbutrin). The ``nasha`` of heroine/opiates/alcohol can be blocked by Naltrexone (ReVia).

Unfortunately, the whole problem of addiction (whether it is to drugs, alcohol, gamling, food etc) is a complex phenomena which has genetic, behavioral, cultural & biological roots. So the only type of treatment that can really help is a multimodal approach--someting SAsian countries can ill afford.

Shankar, i don`t know if any harm reduction models are covered by insurance, but it is not something that is currently in wide use - it is usesd in San Francisco county, and somewhat in Los Angeles county, and probably other counties that i`m not aware off --

The issue of substance abuse is not only the abuse itself, as you may be aware, it is the ideological politics around this issue (so-called ``war on drugs) that considers these folks to be criminal - Harm reduction is based on looking at people as people - and understanding the complexities of the problem - fundamental to this is recognizing that 100% abstinence has only worked for a small minority of people - what about the rest? - Well we can let them rot, and not give `em treatment - as we are doing now, or we can teach these folks how to manage the problem - so that people can still maintain their housing, jobs etc. - while continuing to work on the abuse problem - But because it implicity recognizes that people will continue to use illegal substances, the model is controversial -

However, things are changing in California, we passed a propisition that requires treatment for those who are in the criminal justice system for the first time due to the substance abuse related crimes - that is a good start - now more funding, and research on this problem - and less ideological politics -

It is so good and heartwarming to know that there are people out there who instead of whining and complaining and simply shaking their heads and saying that the country has no future are actually doing something about the situation . Drugs are a big problem all over the world and more so in a country like Pakistan . Keep up the good work . You sure are the DOST that we all need .I happen to be living in the US . IS there anything i can do to help ??????

Zeejah: Thanks for the article. You mentioned a similar organization in Lahore, Nai Zindagi, that provides similar services. There was a fairly extensive article on it, along with pictures of the addicts, in the Washington Post last month. While I am sure that the article offended the sophisticates in the Pakistan government, I think one cannot give enough attention to the miseries of people living in dirt poor conditions and of the noble organizations that need public funds to continue their uphill work. I think people like those who run DOST and Nai Zindagi provide hope not just to those poor souls who need their services, but also to the rest of us who are disappointed by the poor results shown by the various governments of Pakistan in either solving internal or external problems. I think it is very inspiring what these people are doing, and something we can all be proud of.

mo2000: You write that ``But as GOVT should not throw money towards addicts.`` I dont see any danger of this happening. The government itself is addicted to maintaining large, unproductive empires (civilian and military) that are dedicated first and foremost to self-preservation and has virtually nothing left for anything else including health and education.

Zeejah:

Thank you for this article. Very uplifting to read about organisations such as these. It`s nice to know there are so many people who are constantly ``at it`` despite all the problems they have to face.

Reply to Shankar (#5)

You are right. Hemp is not merijuana, but it is the same plant. Marijuana is just the part of the female hemp plant (the buds or flowers) that people injest to get high. Hemp refers the the entire plant (stems, stalk, fiber etc.) The chemical that gets people hight (THC) is present in such small quantities in the rest of the hemp plant that injesting it is unlikely to get anyone hight, no matter how much is consumed.

The hemp plant is an exellent source of fiber, and is used in many societies to make cloth, ropes, paper etc. It was widely used in America in earlier times, and some claim that the first American flag was made of hemp. I am sure that there are many web sites devoted to this topic. In recent years it has become quite fashinable (with certain hipsters) to hemp clothing in the US. It is completely legal. The terms hemp and marijuana are often used interchangably to refer to the intoxicant.



Chars, on the other hand, refers to hashish (I think). Hashish is not a naturally occuring substance or plant. It needs to be manufactured. I am not certain how, but I suspect that oil from marijauna is one of the ingredients.

You are right that consumption of (or withdrawl from) marijuana is unlikely to produce hullicinations, but then hallucinations (mild ones especially) are a very subjective thing.

Hope this helps

Jawad

Jawad # 15

In Pakistan where I used to live the hemp grows as a wild shrub. When there is season, July to October you will find it everywhere- road side, pastures, fields, even your lawn.

Our mother used to give us a glass of milk at night while me and my siblings used to study together. We could never stay awake after 9:00 no matter how hard we tried.

My father at last was able to discover the reason behind this mystery. He saw our Doodh Wala was grazing his cows in that hemp land.

Hi All! ...I can get some of that information on Dost if you want to support ..I just need to know who is interested in helping out ..e mail me on khaldun@usa.net so I can contact you directly :)