Dealing with addiction

Drug addiction is a chronic disease that ought to be approached with compassion and a system mapped for recovery, writes Soheir Loutfy*

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While the problem of addiction has worsened considerably, society's perception of it has narrowed to vision of considering it a problem of deviant behaviour, or as type of black economic activity that damages the wealth of many nations and their peoples. Whether we agree or disagree with this narrow vision, there is a reality that cannot be ignored: drugs destroy mainly the young generation and that generation is the most precious wealth of mankind.

Experts in the field have come to the realisation that drug addiction is caused by negative aspects prevalent in given societies or communities, and not by the character of the individual or family involved. This realisation has led to the success of new awareness programmes and to the establishment of a knowledge platform that emphasises the danger of addiction on youth, society, civic and work ethics, and national security.

Yet is this addiction-awareness foundation enough to solve the problem of addiction? The resounding answer is "No." The clearest evidence is that the desired reduction in supply and demand of illegal drugs among youth has not been achieved. This may be due to the fact that the majority of drug awareness and treatment programmes are outdated, which leads to the ineffectiveness of these programmes in confronting the ever-adapting global trade of illegal drug trafficking. It may also be due to the fact that programmes of early prevention do not give sufficient weight to changing society's perception, attitudes and behaviours towards drug addiction.

To put it bluntly, we as a society need to come to a clear conviction on whether to deal with drug addicts as victims or as criminals. Currently for a young drug addict it is the luck of the draw: it depends on which authority will reach him first, a treatment institution or a correctional institution. We have to closely examine and analyze the costs and benefits of both paths for our youth, their families, and society as a whole.

Recognising addiction as a disease has significant and broad implications for public perception of addicts and their families, for addiction treatment practice and for many important aspects of public policy. It is worth mentioning here that some researchers are currently investigating the possibility of producing addiction vaccines. These vaccines could prove the ultimate weapons against drug addiction. They are supposed to arm the immune system against addictive drugs and prevent the drugs from making addicts feel high. A large-scale clinical trial of a cocaine vaccine in humans will be initiated this year, and vaccines against nicotine, heroin and methamphetamine are also currently in development ( Newsweek, 3 March 2008).

Also, parents should be trained on sound methods of raising children in modern society to pre-empt children from approaching drugs in the first place. Parents should be trained on methods of dialogue in dealing with children at all stages, especially not to stifle their opinions and to always listen to them. Parents should recognise that children's freedom should not mean chaos, lack of responsibility, or disrespect for the system. Further, parents should be able to monitor children without spying on them. Parents should be familiar with their children's friends in school and also in any other social activities. For parents to be effective in monitoring their children, they need a lot of help to cross the ever-increasing technological gap between their generation and that of their children, in particular in the area of computers and the Internet.

Parents should treat all their children equally with no preference or bias. And families should be trained in new methods of treating addiction, and on their vital role in achieving that goal.

Along with the recognition of addiction is a chronic disease, it is critical to recognise that addiction is prone to relapses and setbacks. Another fact to be recognised is that drug addiction is not curable. Drug addicts may recover from addiction but are never totally cured. A recovered drug addict will always struggle to uphold his recovery in the face of temptation and frustration. To achieve this he will depend on his will power and on the support of his loved ones, forever. Drug addicts should believe in the old truism: "A recovering addict is an individual who cannot afford to give up."

There are many models for the treatment of addiction. One of the most successful models is Dual Disorders Recovery Counselling (DDRC). The DDRC model is an integrated approach to the treatment of patients with drug use disorders and co-morbid psychiatric disorders. It integrates individual and group addiction counselling approaches with psychiatric interventions. It attempts to address both the patient's addiction and the patient's psychiatric disorder. In DDRC a positive therapeutic alliance helps patients become involved, and stay involved, in the recovery process. The model has several treatment phases that patients go through.

The first phase is detoxification. In this phase drug withdrawal symptoms accompanied by physical and psychological symptoms should be dealt with. Usually this stage is administered in a drug treatment hospital or facility under the supervision of a psychiatrist and with the full support of the patient's family. The desire of such families to care for their addict loved ones, and to surround them with understanding, care and love, is vital. A grave mistake that many drug addicts' families make is the erroneous belief that a drug addict is cured once withdrawal symptoms are successfully overcome. Withdrawal treatment is only the first stage out of five in the therapeutic addiction treatment. If the patient is pulled out after that first phase of treatment, a setback will surely follow.

Phase two is the phase of awareness in which the drug addict patient stops using drugs and feels that he is drug free. He becomes aware of his environment and surroundings. However, he finds himself incapable of dealing with them. Phase three is the adjustment phase, which deals with the drug addict's thought -- to train him to get out of the vicious circle of addiction behaviour in all of its components. Phase four is the accountability phase. It is a three-role phase. These three roles are: education, knowledge enhancement and training. Each of these roles impacts one another. Phase five is the recovery phase, which is the crown of all previous phases and is their final objective goal. We, at this point, remind the recovering addict's family that addiction is a chronic disease prone to relapse and that the real objective of the treatment is continued recovery. As mentioned, addiction is a chronic disease that should be accompanied by recovery training on how to deal with "slips" and "setbacks".

Implementation of the five-phase treatment requires stakeholder participation of five partners, which affect and are affected by cases of the disease and of recovery. This quintet consists of the patient, who wants to recover with the help and support from the other four parties, the psychiatrist, who is well aware that his role is not limited to the treatment of physical and psychological aspects but extends to full communication with the rest of the quintet, the family, which must be aware of the characteristics of the disease of addiction and of its fundamental role in the journey of treatment, the extended family and friends that surround the patient, which have to nurture a spirit of empathy for the patient and his family, and the wider community, which often holds an unfair view towards recovered addicts and their families. The community has to move away from this kind of judgmental mentality and view recovered addicts as good citizens who have been victorious in overcoming addiction and who are trying hard to be good to themselves and to the community. Recovering addicts should be welcomed as productive members of the community.

Finally, the success of the treatment journey requires a mediator. This is the role played by the Egyptian Centre for Enhancement and the Fight Against Addiction, which seeks to draw private associations in to participate in this role. This complements weekly meetings organised by the centre between the recovering addict, his doctor, his family, and friends of recovered drug addicts.

* The writer is professor of sociology, and director of the Egyptian Centre for the Prevention of Addiction