DRUG REHAB, AN UNGLAMOROUS YET VITAL PART OF DRUG-FREE CAMPAIGN
Jakarta Post - July 1, 2008
The affliction of drug addiction, with its
poisonous impact on new layers of the Indonesian younger generation and the
consequent rapid spread of HIV/AIDS among intravenous drug users, is perhaps
not news.
Media and public service announcements with city
billboards depicting scary skull and cross-bones, probably designed to frighten
children against drugs, have helped alert and alarm the public.
The slogan "Say No To Drugs", both in
its English or Indonesian version, has become familiar, at youth functions from
rock concerts to rave parties, or plastered on walls and vehicles in towns and
countrysides all over
What needs to be understood, however, is that
dissemination of information on the dangers of drugs comes under the heading of
prevention, which is only part of the overall strategy to combat drug
addiction. Prevention is a means to reach those who have not fallen into drug
abuse and the support system around them, such as parents and teachers.
It is through prevention that public awareness of
drug addiction has been raised, hopefully with fewer people getting themselves
hooked on drugs as a result. Prevention is the most "visible" aspect
of the campaign against illegal drugs, because its message is continuously
before the public.
Another equally important aspect that is often
overlooked is the rehabilitation of individuals already deeply buried in
addiction. The attempt to stop using drugs is a very difficult process. Many
drug addicts end up relapsing back into drug use, if they are not
professionally supported.
In the rehabilitation process former addicts are
guided and assisted in regaining social skills and self-esteem, which are
severely impaired, if not lost, after years of drug abuse. They are also
furnished with knowledge on the nature of addiction and skills to nurture and
maintain a drug-free lifestyle.
Rehabilitation centers are a necessary part of
social welfare services as they serve as "one-stop-shops" where drug
addicts can undergo a healing process and hopefully be rehabilitated and become
productive members of society.
Prevention and rehabilitation should go hand in
hand, with the former as an effort to curtail the number of people falling into
addiction, and the latter to help turn those damaged by drugs back into
positive roles in society. If addicts are left untreated, one can only imagine
the negative repercussions with society having to cope with so many
dysfunctional people.
Unfortunately, in
There are two reasons for this lack of enthusiasm
when it comes to drug rehabilitation: high costs and low success rates. The
average cost of care for residential or outpatient treatment, for programs
ranging from 28 days to a year, is quite high.
The typical program fee in a private drug
treatment center in
The second unfortunate fact is that this high
cost doesn't necessarily reflect an equally impressive result in terms of
non-recidivism. This social enterprise is therefore less likely to find donors
and philanthropists rushing to its aid.
The criteria for success is hard to determine in
the drug rehabilitation world, and difficult to standardize. For example, if a
patient completes the program in a center, can that be counted already as a
success? How many years of staying clean from drugs after discharge from the
program is considered a "success"? What if a patient manages to stay
clean for five years after a program, but then relapses into active addiction,
can the center be held responsible for this so that a previous
"success" point can be withdrawn for this patient?
Almost every treatment center has its own
yardstick, often devised to project a favorable outcome to the public. However,
as a general rule of thumb in the therapeutic community, albeit unsupported by
credible and continuous research, a 30 percent success rate, meaning patients
achieving a significant amount of clean time after discharge, is already quite
good.
While high costs and low success rates may
question the effectiveness of drug rehabilitation, it would be negligent on the
part of society to completely dismiss this branch of social services. The
negative impact of drug abuse can be found in almost every province in the
country. The effort to develop the expertise and resources to build a
rehabilitation center in every province therefore becomes more pressing.
Active drug users cause expensive damage to
society, mostly through crime. They also breed more users, by introducing the
destructive habit to others through social contacts. If the government has
proposals for building correctional centers specifically for drug cases
(because they happen to be the largest group of criminal inmates), why not
funnel the funding into building government sponsored rehabilitation centers in
the provinces as well?
The answer is that currently there is not enough
support and awareness expressed by the public on the need for more drug
treatment centers. On the prevention front, many agencies around the country
such as the government's National Narcotics Agency (BNN) have taken part in
campaigns with admirable enthusiasm, as demonstrated by the familiar slogan
"Say No To Drugs."
But on the largely overlooked other side of the
"war against drugs" coin, rehabilitation services that promote a
healthy, new lifestyle totally abstinent from all drugs are not as much
appreciated or supported.
Quite a stark contrast to the ubiquities presence
of the HIV/AIDS campaign in public health institutions, both government and
private. Funding flows freely into the effort to combat this pandemic on all
fronts, including advocacy, education, and providing medicines for the
infected.
In the midst of this worldwide concern (on
HIV/AIDS), sometimes the public forgets that one of the main causes of the rapid
spread of HIV infection is intravenous drug use. Therefore, drug rehabilitation
as a social service component needs to be supported and more widely available
to the public if we are to instigate a comprehensive, all-out effort to
eliminate the negative impact of chemical dependence in
Andrei Simanjuntak
ADDICTION, A DISEASE?
Long perceived as a condition of moral or sometimes religious impairment in an individual, addiction by more and more experts at present are defined as closer to being a disease. This theory, developed by doctors working with chemically dependent patients in the early part of the twentieth century in the USA, is the latest paradigm on the definition and therefore treatment of addiction. One of the most notable of the experts is Dr. Elfrin Jellineck, who in the 1960s developed this Disease Model based on his work with alcoholic patients. The model developed by Dr. Jellineck also fits with the condition found in various other substance dependence, hence providing a ground theory for treatment models based on the Disease Model of Addiction.
This model defines addiction as a chronic, relapsing disease that affects both mental and physical aspect of the individual. Interestingly, the root of the condition is not believed to be caused by external factors, a view widely held by the general public. Like some other chronic diseases such as cancer or diabetes, the onset of the condition is a starting point which is still difficult to identify. It is still unclear when the drinking man starts to become alcoholic, yet when the condition is present its symptoms in the form of dysfunctional behavior and thinking is easily detectable. As a consequence, this theory clears the blame from what traditionally is thought of as the usual culprits of the cause of addiction, i.e., bad neighbourhood or social environment, bad parenting or unhappy home, or even bad lifes choices made by the addicts themselves.
The Disease Model defines addiction with several key characteristics that may also serve as entry points on which the condition can be addressed in its treatment. They are; loss of control in the consuming behavior of the chemicals, tendency to isolate or self-centeredness, obsessive behavior, and the fact that it is incurable yet possible to be brought into remission through a continuous sobriety maintenance program that may be life-long in its application.
Such sobriety maintenance program, or recovery program, is perhaps best exemplified by Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), self help groups of alcoholics and addicts utilizing a method called the 12 steps to help them live a substance free life. Founded in the 1930s by two alcoholics in the USA, the 12 steps has also the Disease Model as its ground theory of addiction, only they add one more component to be addressed in the treatment of the disease, the spiritual factor. Albeit unsupported by scientific evidence, members of these groups believe that the disease affect the spiritual core of the addicted individual. Thus, its solution is spiritual growth that would bring about holistic change to the individual, preventing him or her from returning to active addiction, and lead a life totally abstinent from all chemicals thereafter. Applying the 12 steps in their daily affairs and participating in the meetings of these groups are the principal methods of this program.
At present, The American Psychiatric Association has listed substance abuse as a mental disorder in its diagnostic manual, officially recognizing it as a disease. Many more in the medical profession has done the same, even though not all are ready to embrace the idea of addiction as a spiritual malady espoused by the 12 steps community. However, the 12 steps program has done quite well in proving its efficacy, with AA boasting some 2 million members worldwide and NA approximately half of that. Its literatures has been translated in many languages and its meetings can be found in almost every major city of the world, creating a worldwide net of support for the addict and alcoholic regardless of nationality or culture. The Disease Model, as the latest paradigm on defining addiction, has come a long way not only to enrich our knowledge of this complex condition, but also to furnish us with resourceful solutions.
Andrei Simanjuntak
Jl.Gunung Sari III No.7, Br.Sari Buana, Ds.Tegal Harum, Monang Maning, Denpasar - Bali. 80119 marketing@balinurani.org or info@balinurani.org