Saturday,18 August, 2018
Current issue | Issue 1130, 10 - 16 January 2013
Saturday,18 August, 2018
Issue 1130, 10 - 16 January 2013

Ahram Weekly

The group cure

Mainstream medicine in Egypt has often dismissed a group-based therapeutic approach to drug addiction, something that may now be changing thanks to the work of an innovative treatment centre, writes Victoria Harper

Al-Ahram Weekly

Imagine the cravings a smoker gets the day after his last cigarette. Add aching muscles, insomnia, diarrhoea, vomiting and cold flashes and you have an inkling of what it’s like coming off a heroin addiction. And that’s the easy part. The real work begins once the drugs are out of the system. It’s a tough row to hoe and Sherif knows it, firsthand.

Sherif, 43, was addicted to heroin for 13 years. Today, having been clean for seven years, he’s an addiction counsellor. He works with people who have serious problems with drugs. He helps them come to terms with the issues that led them into addiction, and assists them in rebuilding the human bonds that were broken under the weight of narcotics.

Sherif smiles as he tells his story, a smile that is shy and charming. It takes a lot of charm to work a habit for that long, to fool family and friends into thinking you are just going through a rough patch, not sinking deeper and deeper with every passing day.

Now, he puts his charm and years of struggle to good use. Professional training gave him the tools, but nothing trumps his experience on the street when it comes to connecting with the men who come through Freedom Centre, an independent facility that provides treatment and care for addicts.

When you visit Freedom’s Farm Centre, you get the feeling you’ve arrived at summer camp. The horizon is open, the air is clean, and there are olive groves as far as the eye can see. There is even a swimming pool and football field, for the facility is adjacent to a hotel used by a church for retreats and recreation.

To get there you have to drive to the desert of Wadi Al-Natroun, about an hour away from Cairo and home to four of the oldest monasteries in the world. Some fourth-century monks discovered this desolate piece of land, perfect for meditation and perfect to start an isolated community where no one would bother them.

Now, it’s a 10-minute ride once you turn at a congested intersection off the busy highway that runs between Cairo and Alexandria. Those who drive to their villas on the North Coast pass by there often. Few stop to see the ancient sites, and fewer still know or have heard of Freedom Centre, the largest drug-addiction treatment facility in the Middle East.

Sherif is one of the most popular counsellors at Freedom, and he knows it. The confidence he has now contrasts starkly with his former years of self deprecation, during which he was estranged from his wife and daughter, lost his job, and most of his self respect. He knows what it means to be an addict in need of help, to be desperate for someone to fathom the depth of his helplessness.

“We speak the same language and know all the same tricks,” Sherif says. “We’ve suffered from the same stigma and lived through the same nightmares. An addict will never trust a non-addict. He has no reason to.”

Before joining the Freedom programme, Sherif was in and out of hospitals for nearly four years. The hospitals helped him detox several times. That’s the easy part, the part the doctors do for you. Give them someone hooked on drugs, and they’ll sedate her, keep her safe until she stabilises, and until the physical craving dies down. But the psychological cravings are still there, as well as all the problems that led to the drug use in the first place. So once the patient leaves the hospital, she relapses, as Sherif did repeatedly.

The trick with drug addiction, the trick that Egypt is still grappling with, and the one most doctors fail to grasp, is that addiction is not just a physical problem, but a psychological one. To treat an addict, you can’t stop at getting the drugs out of his system; you need to help him build confidence, build trust in himself, in others, and in the universe.

When Sherif came to Freedom Centre, he discovered that the staff and other addicts weren’t expecting anything from him. They weren’t expecting him to man up, to pull himself up by the bootstraps, or “repent”. They only asked him to be himself, to be himself long enough to trust himself and learn to love himself. This is essential for treatment and part of the answer that the Egyptian medical community often ignores in its response to the problem of addiction.

“At Freedom Centre, I found acceptance and unconditional love,” says Sherif. “I was ready to stop and no one was forcing me to stay. There were no locked doors. It was my choice and it was up to me to stick around long enough to get better. I felt my hope growing stronger every day. I changed gradually and as I was accepted, I learned to accept myself. Then I became eager to help others.”

Sherif says that the key to gaining an addict’s trust is empathy. He talks a lot to the addicts in recovery. But more importantly, he listens. For many of those in his care, he is not just an addiction worker, he is a friend, a brother — the kind they never had.

The Freedom programme now runs 18 rehab centres in Egypt, Dr Mourad Girgis, a senior training specialist says. Girgis, who speaks fluent English and wears his hair in a long ponytail, looks more like a jazz musician than a trainer, which adds to his popularity among the young men in his groups.

Before Freedom, Girgis explained, addicts who sought treatment had no option but to check into a hospital. The idea of rehabilitation didn’t exist. The idea that addicts can learn to abstain from drugs permanently through peer education, through building self-confidence and life skills, through spiritual connection, only started with Freedom.

“Egypt had so many addicts, but no one who could really help them,” he said.

The medical profession tried to help, but it lacked imagination and knowledge. Often, the addicts ended up incarcerated in hospitals. Those who deteriorated further risked ending up in mental wards. Others landed in prison for stealing to finance their habit. Most dropped out of school, work, family, and ultimately life.

The man who changed all that is Dr Ehab Al-Kharrat, one of Egypt’s top psychiatrists and a man with immense compassion for society’s most vulnerable. He is also a member of the Shura Council and a senior member of the Egyptian Social Democratic Party.

In the early 1990s, with the help of some volunteers, Al-Kharrat guided a small group of addicts through a successful rehabilitation process. The method he used was based on the Twelve Steps of A A (Alcoholics Anonymous), a programme that guides people with addictions to examine their past, make amends to family and friends, and learn to be of service to others. The programme also encourages participants to use their faith in a higher power, which they may call God if they are religiously inclined, to help turn their lives around.

Crucial to a 12-step programme’s success is that it ends the isolation in which addicts usually find themselves, for it involves close interaction with former addicts who have intimate knowledge of the struggle those in early recovery must go through. In this formula, each newcomer chooses someone called a “sponsor” to monitor progress and offer the kind of informed support that family and friends cannot normally provide. These elements — faith, introspection, taking responsibility, making amends and working with others — have proved helpful to millions in America and Europe.

Before long, Al-Kharrat conceived of a therapeutic community outside the city for recovery from drug addiction. He wanted to create a facility where addicts could learn to lead a completely drug-free life. He wanted to offer the possibility of going beyond detoxing and doing better than substitution (a therapy that seeks to reduce dependence on heroin by substituting methadone, a more benign compound) to restore physical and mental health through abstinence. He began looking around for help, and one day the right kind of help showed up.

Friends at the Qasr Al-Dobara Evangelical Church, a rustic Presbyterian church on a busy street behind the Mogamma Al-Tahrir, told him that a philanthropist was looking to donate 68 acres of her desert farmland to a good cause. This was perfect. A peaceful, quiet location, away from the daily temptations and pressures of city life, conducive to the soul searching an addict in recovery must do. Humanitarian organisations, including the Qasr Al-Dobara Church and TEAR, a UK-based charity, provided enough funding to cover the building costs.

Freedom’s Farm Centre in Wadi Al-Natroun opened its doors to the public in 1995. With its 140 beds, eight classrooms, swimming pool, football pitch and 6,000 olive trees, it has become the gold standard for all rehab centres in the Middle East. Still they have kept their fees as low as possible and offer discounts when they can.

Treatment lasts six months and costs between LE3,500 and 12,000 depending on the number of people sharing a bedroom and their ability to pay. Of the average 1,200 addicts that go through Freedom’s programme each year, the centre can afford to treat only 300 at a discount and 100 free of charge. As for outside funding, Al-Kharrat explains that it’s pretty much a blanket policy of international agencies never to fund treatment, only prevention.

The recovery approach offered by Freedom is still inspired by the Twelve Steps, combined with therapy and education. And here’s the kicker. Since 2000, Freedom has also trained people to become professional addiction workers. Many of the centre’s former addicts, like Sherif, have thus trained to become specialists working in the same programme.

Through Freedom’s training arm, known as the International Substance Abuse Addiction Centre of Studies, or ISSACS, hundreds of professional addiction workers have received training and are now qualified to work in drug-rehabilitation facilities around the region. In Egypt alone, nearly 60 centres for narcotics-related treatment, outreach, or counselling exist. All are operated by graduates of ISSACS.

This is quite a revolution. Before the 1990s, the medical community in Egypt had no concept of a group-based therapeutic approach to addiction. Even today, the Ministry of Health does not recognise addiction treatment as an independent branch of healthcare.

For government health officials, the idea of helping a former addict through rehabilitation is too un-medical, so to speak. It is not what doctors do. Serious facilities lock addicts in a ward, give them prescription drugs to get them off street drugs, and release them only upon doctors’ orders. They don’t have facilities that look like summer camps, and they don’t allow addicts to leave if they change their mind. Treatment minus coercion just doesn’t make sense to the mainstream medical community in this country.

At Freedom, the idea of a patient, in the sense of someone who should take his medicine and do what the doctor says, doesn’t apply. Addicts are not seen as patients, but rather as willing guests. They are expected to form bonds, friendships, and learn how to look at themselves and the world in a different way. They are also free to leave if they choose. The Freedom programme aims to build trust, not negate it, as the mainstream medical approach tends to do.

When Al-Kharrat explained his method to the mental health officials inspecting his facility, they simply didn’t get it. Either you confine addicts to a ward and lock the door, he was told, or you have no business dealing with them.

After some negotiations, it was agreed that Freedom would operate under a convalescence home licence. The irony here, Al-Kharrat said, is that most government-approved addiction treatment facilities are run by doctors with no real training in this specialisation.

This is why Al-Kharrat’s work is as much about advocacy as it is about rehabilitation. He contends that people who work with addicts should be trained and licensed to deal with addiction. They should have their own syndicate, their own regulations, and their own regulatory bodies. As a member of the Shura Council he has submitted a bill to that effect and is hopeful that it will become law. If so, the treatment of addiction in Egypt will finally be recognised as the specialised field it is.

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