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  1. 1. PREVENTION AND REHABILITATION PROGRAM ON DRUG ADDICTS: AN EFFECTIVENESS OF ASARA SUDHAR KENDRA RANIBARI KATHMANDU (A case study) For Partial Fulfillment of the M Phil in Population Studies (Research Methods in Population Studies Pop.553) By Mukesh Mishra Submitted to Centered Department of Population Studies Faculty of Humanities and Social Science Tribhubhan University Kirtipur, Kathmandu May , 2009
  2. 2. ABSTRACT The study based on the effectiveness of treatment and rehabilitation program. The study entitled; “Prevention and Rehabilitation Program Drug Addicts: An effectiveness of Asara Sudhar Kendra.” The main objective of this study deals to explore the effectiveness of rehabilitation center in promoting health and rehabilitation program in Asara Sudhar Kendra. To achieve the objectives of this study, primary as well as secondary data have used. Primary data have colleted through the questionnaire and interview schedule for key informant, which have filled up by the residential addicts and staff of Asara. All of the residential 71 addicts have taken for the study as respondent and one staff for the key informant. Secondary data have taken from the published books of Asara and other reports and research papers. The study found that most of addicts have used drug by the pressure of their friends. Most of respondents 44 (61.97 percent) have used Ganja and 47 (66.20 percent) respondents have not limited tome in a day. They have used when they have needed. Among the respondents 36 (50.71 percent) are staying before one month ago. 63 (88.74 percent) have believed that treatment can work and 58 (81.69 percent) respondents have change in their life and 54 (76.06 percent) have satisfied from the center. Among the total respondents, 53 (74.65 percent) respondents said that they have good co-operation from the staff of Asara. They expected by excusing past mistakes from their family for their readjustment. 1. INTRODUCTION ‘Health is Wealth’, it is emerging challenges of drug abuse and addiction making great problems directly on the health of the people. The misuse and addiction of drugs is making the people’s life very short because they are suffering from various dangerous diseases like HIV and AIDS, Cancer, Hepatitis, etc. The modern world is the product of scientific thoughts and development. With the development of modern science and technology, the life has become more comfortable and luxurious. The result of modernization of world affects on the one side achievement of positive health and another side it leads to the dangerous and complicated health. Drugs are also the product of modernization and development of science and technology. Therefore, misuse of drugs leads harmful effects on health of human beings.
  3. 3. The alarming increase of drug abuse in Nepal in recent years has become a national concerned. Estimated data indicate that there are about 60 thousand drug users in Nepal, ages between 14 - 30 years and this problem is increasing among the school students (Bhusal,2063). Drug addiction is rapidly growing and it has been a major challenge to the Nepali society in the country. There is an estimated 60,000 drug users in Nepal (UNAIDS country report 2005, cited as in Journal of Home Affaires). Moreover, according to the latest National Action Plan (NAP) 2007- 2011 estimation that 8, 00,000 youths are potential drug users and these groups are also affected by HIV. Drug users are one of the Most at Risk Population (MARPS) in the country and the prevalence of HIV among them is higher than other MARPS. Recent integrated bio-behavioral surveys indicate the HIV prevalence among Injecting Drug Users (IDUs) to be 51.6 percent in Kathmandu, 31.7 percent in Eastern Terai districts, 11.7 percent in the Western Terai district and 21.7 in Pokhara (New Era/SACTS, 2005). According to the survey of Drug users 2063 there are 46,309 drug users found, out of them 42,954 are male and 3,356 are female drug users. Following areas are most critical areas for drug abuse. This study also showed that is in the table no. 1. Table no 1, Districts wise drug abuse 2004 Districts Kathmandu Kaski Jhapa Sunsari Rupandehi Chitawan Morang Parsa Other valley places No 17,458 5,112 3,523 3,186 2,588 2,017 1,316 1,301 9,274 Source: Journal, 2064, The table no. 2 shows that the no. of drug users are increasing day by day. In 1978 only 50 person are drug user which no. is increase 5oo in 1980, and 150,000 in 2006. It means very dangerous situation of the country because youth are victim by drugs who are the main pillar of nation. Table no.2 Drug abuse1978-2006 Year 1978 1980 1981 1985 1986 1987 2002 2006 No. 50 500 1,000 15,000 20,000 25,000 60,000 1,50,000 Asara Darpan, 2063 We will be estimated that if this ratio is growing, the number of drug abusers in the country will be 2.25 million reached in 2020 A.D. The calamitous problem of drug abuse cannot be efficiently overcome unless the various agencies such as governmental and non-governmental organization in the different disciplines are prepared to co- operate and
  4. 4. co-ordinate their effort depending upon the aspects in which they can become most effective. In their situation, the study on the effectiveness of rehabilitation centre in promoting health of drug users in Kathmandu will be meaningful. 1.1 Statement of the Problem Drugs are organic or inorganic chemical substances, which affect in the body process and functioning of organism and may change or modify one or more behaviors while in taking them. Drug abuse is one of the burning problems of the worldwide. It has affected to the young generation especially. Drug addiction is the major critical problem in the family, society and the whole nation. Besides this, it is a social cancer and diffuses slow poison to its members. Drug addiction is a habitual use of drugs. It is the state of periodic or chronic intoxication produced by repeated consumption of drug natural or synthetic (WHO). About 20 million peoples are victim by drugs all over the world. In the Nepalese context 1,50,000 people are victim (Narconun 2064). Injecting Drug Users (IDUs) are highly population in Kathmandu valley. In fact, drug addiction is treatable and recovery is possible. There are many treatments and rehabilitation centre for drug addict, which work with drug addict, and drug related field, especially in Kathmandu valley. ASARA Sudhar Kendra is only one NGO, which is run by the support of government.” Until now, there are no any studies in this topic so researcher interested to research in this topic. It will be helpful to conduct the additional facilities in the organization. 1.2The Objective of the Study The general objectives of the study is to explore the effectiveness of rehabilitation centre in promoting health and rehabilitation program in Asara Sudhar Kendra, Kathmandu and the following are the specific objectiveness of this study. a. To find out the existing socio- demographic characteristics of drug addicts in Asara. b. To investigate the techniques used in rehabilitation program for drug addicts. c. To explore the benefits achieved by the clients. 1.3Significance of the Study
  5. 5. Drug addiction is a treatable diseases but not a crime itself. Therefore, treatment is necessary to end this compulsive behavior and then the related problems will be diminished. The rehabilitation centers provide opportunities to drug addicts by encouraging self-esteem, by developing communication between parents and children’s by providing public awareness etc. The study will helpful in the following areas: a. The issues of this study will serve as guidelines for health planners, health policy makers, community health workers to formulate plan, policies, and improving the levels of knowledge and awareness towards this problem. b. The recommendation of this study will be useful the curriculum developer for the inclusion of drug education in the school curriculum and college curriculum. 1.4 Definition of the Terms Used; Drug: Any substances that, when taken into the living organism, may modify one or more of its functions (WHO). Drug abuse: It is defined as self-administration of drug for non- medical reasons, in quantities and frequencies which may impair an individual’s ability to function effectively, and which may result in social, physical, or emotional harm (Park, K. 18th edition). Drug Addiction: Drug addiction is the state of periodic or chronic intoxication produced by repeated consumption of drug, natural or synthetic. Rehabilitation: It is a process of treatment consists of different activities to promote the physical, social and mental health of the addicts. It helps to create the favorable situation for the adjusting clients to home and community. NGN: Naulo-Ghumti Nepal, an NGO provides facilities for counseling and residential treatment, vocational training, and harm reduction and outreach programmes. Cannabis: It is the Latin word from hemp; mild hallucinogen and widely grown in Nepal. Hippies: Individuals following away of life based on renunciation of maternal things and believing it possible to achieve deep insight into life through use of drug. 2. REVIEW OF RELATED LITERATURE The literature search is a very significant step in the research process. It gives general guidelines to the researcher. It helps the researcher to gain knowledge about related field. A literature review is the presentation, classification and evaluation of what other
  6. 6. researchers have written on a particular subject. Similarly literature, studies on drugs field has been reviewed on various grounds to provide its relevant concepts, and its significance in the world on Nepalese context overall the purpose of this chapter is to review briefly the different existing view of experts on this field and to lay out a frame work for the present study. 2.1 Theoretical Literature Park, (1991) he had explained that the rehabilitation of former drug user, regardless of age, is in most cases a long and difficult process. Relapses are very frequent. Success of the treatment necessitates the adoption of mature and realistic attitude by the local community and the avoidance of panic, moral condemnation and discrimination .Facilities for national training and sometimes the provision of sheltered work opportunities are useful in rehabilitation and help to prevent relapse. 2.2 Empirical Literature Bhandari, (1988) conducted a case study on Kathmandu Valley on ‘Drug Abuse in Nepal. The study area was Kathmandu valley by DAPAN. He had done case study in the topic “Drug Abuse in Nepal”. He designed the study to collect interpretation on drug abuse in Kathmandu valley to examine relationship between drug abuse and selected socio economic characteristics of the drug abuse. The study found that heroin was the number one drug used by the addicts in Kathmandu. The peer pressure was found to be the leading causes of drug abuse among addicts. The study revealed the average frequency of drug intake that was to be 2.4 percent per head and smoke was the primary method of drug administration. 3. METHODOLOGY This study focused on the prevention and rehabilitation program run by Asara Sudhar Kendra on Drug Addicts. The nature of the study is quantitative and descriptive and the source of data primary as well as secondary. Secondary source are related books journals and so on. 3.1 Introduction of the study area Asara Sudhar Kendra is located at Ranibari in Kathmandu. It had established in B.S. 2054 with force of Nepal police. After that, it had registered as a Non–governmental organization in 19th of Magh 2055. This organization was running by the support of
  7. 7. government also. According to the published book of Asara the populations of drug dependence are heterogeneous. The majority of the populations are 21 to 30 years persons and their educational status is found. They are literate and illiterate. The majority of drug users are literate, which numbers are 655 in the year 062 -064 and then S.L.C. completed 417 numbers in the year 062 – until 064 Ashad (Asara Darpan, 2064). 31.1 The purpose of this organization To reliance the victimized society by organizing awareness program on the bad effect of drugs. To help control the carrying and use of drugs by decreasing the criminal activities caused by drugs. To teach them to be self- help by involving them in skill- oriented activities. Various kinds of treatment methods have been brought into practice to revive those youths, the important power of the societies, who are in the wrong path being away from their duties. To provide them mental and Physical Health; To bring about emotional change; For the sake of family and social co –ordination: To make them self-help and self- confidents 3.2 Tools of Data Collection Using questionnaire collected the primary data both open and closed ended. The questionnaire prepared to cover the residential clients. It divided into four main broad areas: Socio-demographic situation, Drug used related behaviors, Responses of residential addicts. The secondary data also used to fulfill the objectives of the study book and journals 4. ANALYSIS AND INTERPRETATION OF DATA This chapter deals with the collected information in an organized and analyzed form. Analysis and interpretation of data is an important process in every research. In the data processing, the filled questionnaire schedules are carefully checked to remove the possible error and inconsistencies in the raw data. After editing the raw data, necessary data are presented in the text, in the form of table, percentage and figure. Finally, the data are interpreted according to the need of study. This chapter is divided into three main parts: Socio- demographic status of respondents; Drug use related behaviors of respondents; Response of residential addicts 4.1 Socio-demographic Status of Respondents In this topic, socio-demographic characteristics of residential clients have been
  8. 8. interpreted. Every study required socio-demographic characteristics of respondents because every problem concerns with socio–demographic status of the society. Addiction is the part of the social illness. So, needed to discuss the social dimensions for the findings of any research. In this topic, the prevalence of the use of drugs among respondents is based on gender, age, education, occupational status and caste etc. This section is sub divided into different headings: 4.1.1 Distribution of the Respondents by Age and Sex Groups Sex composition is the important factor for drug addiction. But in this study all were male because this center is not for female crisis. The table no. 3 shows that the youth, of the age group of 20 -24 formed the larger number of addicts. The second large group is 25– 29 years of age group and third one is 15–19 years of age group. Overall, it indicates that the drug addiction in the recent year, it has much affected the younger generation. Table no 3: Distribution of the Respondents by Age and Sex Groups Age Group 15-19 20-24 25-29 30-34 35+ Total Number 14 20 17 9 11 71 Percent 19.2 28.2 23.9 12.7 15.5 100.0 Source: Field survey 2008 4.1.2 Distribution of Respondents by Ethnicity/Caste Grouping The population of Nepal is composed of multi ethnic and caste groups. The distribution of the addicts according to ethnicity caste is shown in the table no. 4. The highest no. of drug addict are Rai/Limbu 14(19.2. percent), among 71 .Chhetri , Gorung are13(18.31 percent) and 12(16.9 percent) respectively. Similarly , Magar and Newar equal 11/11 (15.5 percent) and Brahmin only 10(14.1 percent). Table no 4: Distribution of Respondents by Ethnicity/ Caste Grouping Caste/ Brahmin Magar Newar Gurung Chhetri Rai/Limbu Total Ethnicity Number 10 11 11 12 13 14 71 percent 14.1 15.5 15.5 16.9 18.31 19.2 100.0 Source; Field survey 2008 4.1.3 Distribution of Respondents by Religion Religion has great impact in the life of people or human behaviors. Their beliefs, values and practices are guided by the religion they are following. Mostly, Nepal is a multi religious country; most of the Nepalese people follow their religion. Some time religion
  9. 9. also encourage to use drug. The table no. 5 indicates that the higher number of drug addicts 48 (67.61 percent), were from Hindu religion followed by Buddhist 19(26.76 percent) and Christian religion 3 (4.22 percent) and one (1.41 percent) is other religion. :Table no 5: Distribution of Respondents by Religion Religion Hindu Buddhist Christian Other Total No. 48 19 3 1 71 Percent 67.61 26.76 4.22 1.41 100.0 Source; Field survey 2008 4.1.4 Educational Status of Respondents Education is most important factor, which can change the behaviors of human beings. Curiosity of teenagers is the main cause of drug addiction. In this study, all of the respondents had found literate with different categories: Table no. 6 shows that 33(46.47 percent) were attained higher education. Then lower secondary level finished respondents were 25 (35.2 percent) and 13 (18.32 percent) respondents were primary level Table no 6: Educational Status of Respondents Education Primary Lower secondary Higher education Total Number 13 25 33 71 Percent 18.82 35.2 46.47 100.0 Source; Field survey 2008. 4.2 Drug Use Related Behavior of Respondents In this topic, drug use related behavior of respondent have been interpreted. According to objective it is necessary to know the drug use related behavior of respondent so in this topic divided in different part. These are as follows. 4.2.1 Reason for Taking Drug for the First Time Table no 7: Reason for Taking Drug for the First Time Reasons peer curiosity For Love/Tragedy Unemployment Others Total pressures enjoying No. 36 15 8 4 2 6 71 Percent 50.71 21.13 11.26 5.64 2.82 8.45 100. 0 Source; Field survey 2008 The majority of drug addicts take drug in the first time by the peer pressures (table 7). They were influence by their school friends mostly. So, family should know about their
  10. 10. children friends what they do. In addition, most of addicts were used drug to fulfill their curiosity. Key informant also said the most cause of addiction of their family support by money and friend’s circle. Therefore, school should conduct program about curiosity of drug and rehabilitation center conduct anti-drug program in the school and community. 4.2.2 Accompanied Person for Starting Using Drug; Table no 8: Accompanied Person for Starting Using Drug S.N. Accompanied Number Percent 1 Friends 58 81.69 2 Own self 11 15.49 3 Others 2 2.82 Total 71 100.0 Source; Field survey 2008 It is important to find out the person who accompanied to respondents at the first for using drug. Table no. 8 indicates that the most of respondents 58 (81.69 percent) had been accompanied by their friends. Among the total 11 (15.49 percent) respondents had initiated using drugs own self for the first time? Others accompanied Left two (2.82 percent) respondents. It reveled that friends are the main causative agent that play main role for starting using drug. 4.2.3 Name of the Drug Taken for the First Time There are different types of drugs available in a market. So, availability of different types of drugs may determine for taking drug. Table no. 9 indicates that the majority of the respondents 44(61.97 percent) used ‘Ganja’ for the first time .Then 20 (28.17 percent) respondents used others types of drugs and Teddies and Heroin were used one (1.41 percent) respondents. Left five (07.04 percent respondents were used Brown Sugar. It was revealed that the ‘Ganja’ was preferred by the most of the addict for the first time because it is easily available than other drugs. Therefore, starting is mostly from ‘Ganja’. Table no 9: Name of the first time taking drug by Respondent Kind of Ganja Brown Heroin Teddies Others Total Drugs Sugar NO. 44 5 1 1 20 71 Percent 61.97 7.04 1.41 1.41 28.17 100.0 Source; Field survey 2008 4.2.4 Management of Money for Buying Drug Table no 10: Management of money for buying drug
  11. 11. Management From Parents Self From Friends Others Total Process NO. 33 27 6 5 71 Percent 46.47 38.04 8.45 7.04 100.0 Source; Field survey 2008 Money needed for buying drugs. So, it is a more essential and responsible factor. Without money, they cannot get drug. So, they had managed money through different process. It shows most of drug addicts were managed their money from their parents and themselves. They are managing by other sources. Stealing or robbery, by lying, etc. may be the other source of their money management process. It means they can do anything to collect money for buying drugs (Table 10). 4.3Services Related Behavior The study had taken the entire residential addict as respondents. In this topic various behavior regarding to the staying, changes, relationship with the staff etc. are discussed. Rehabilitation is the main aspect of treatment after the 10 days detoxification period, it is followed by rehabilitation It consists of different process such as counseling, group therapy, meditation, spiritual classes relapse prevention class, entertainment program, sports competition with inter rehabilitation center etc. by key informant of Asara. The main aim of rehabilitation in the center is to engage the respondents in different planned activities for preventing thinking about drug. 4.3.1 Believing of Respondent about treatment can work Most of respondents were believed treatment could work. Definitely, treatment can work and an addict may change into a normal person. The respondents 63(88.74) percent were believed treatment can work but left eight (11.26 percent) respondents were not believing that the treatment change the behavior. It revealed that the respondent who were not believed they may be more severe stages of respondents. 4.3.2 Change in Feelings after coming for the Treatment in the Center Here 58 (81.69 percent) respondents had got change in their life after coming treatment and left 13 (18.31 percent) respondents had not change their life after coming in the rehabilitation center for treatment. Changes in feelings by the respondents are as follows: The table no. 11, shows that the respondents 41(70.68 percent) felt that they had new life. The respondents 10 (17.24 percent) were realized that they felt pleasure after coming at
  12. 12. the center for treatment. Left seven (12.08 percent) respondents accepted that they had some changes with painful feeling Table no 11: Change in Feelings after coming for the treatment in the center Feelings Got new life Pleasure Pain Total No. 41 10 7 71 Percent 70.68 17.24 12.08 100.0 Source; Field survey 2008 4.3.3 Most Favorable Program of Asara to the Respondents There are different types of program have been conducted in the center for drug addicts. The respondents like different types of program for their adjustment. The respondents put their views for the favorable program. The table no.12 shows that the larger number of respondents 15(21.14 percent) liked encounter program, the respondents 14(19.65 percent) are like Yoga and Counseling. 12 (16.91 percent) are like input classes and out of 10 (14.11 percent) are want entertainment program. Majority of respondents expected counseling, encounter, entertainment program and input class because of they wanted to forget the drugs and involve in difference types of program. Table no 12: Most Favorable Program of Asara to the Respondents Program Encounter Yoga Counseling Input Entertainment Ask me Total class No. 15 14 14 12 10 6 71 Percent 21.14 19.64 19.64 16.91 14.11 8.45 100.0 Source; Field survey 2008 5. SUMMARY, CONCLUSION 5.1 Summary In the modern era of 21st century, drug dependency has been diagnosed as a complex nature. The sign and symptoms of drug dependency are completely visible, diagnosable and treatable. The traditional misconception that ‘drug dependents are criminal persons as well as asocial problem. Drug dependents are neither criminals nor social problem. This is a physiological problem of addiction. Drug dependents are ill person having physical problems, social inter-personal adjustment problems, physiological problems and spiritual problems, which have infected a large number of the youth. Kathmandu Valley is the most drug-affected area in mid region of Nepal. The 17,458 persons are affected in Kathmandu valley (The Nepalese Journal for Drug Control,
  13. 13. (2064) The CBS estimated in 2064/065 that there are 1, 50,000 addicts in Nepal. There are many NGOs acting in Nepal, small amount of NGOs are acting on drug abuse and related problems with regard to Nepal there is no specialized drug treatment sector in Nepal. Asara Sudhar Kendra drug rehabilitation center is a secured camp people. The socio- demographic characteristics of residential clients have been discussed. The data shows that the youth (age group 20- 24 years) forms the largest number of addicts. The larger number of respondents 48 (66.6 percent) are from Hindu religion. The data shows that the occupation of respondents attained 33(46.47 percent) in higher education. Similarly the larger number of respondents 36 (50.71percent) have started drug by their peer pressure. The majority of respondents 55 (77.46 percent) are known about their drug addiction. Most of the respondents 58 (81.69 percent) have been accompanied by their friends at the first time drug use. The majority of respondents 40 (56.34 percent) started drug use at the time 15 – 20 years. Majority of the respondents 44 (61.97 percent) have preferred ‘Ganja’ for the first time. .Now the data the majority of the respondents 63 (88.74 percent) have believed that treatment can work. The higher number of respondents 58 (81.69 percent) have been positive change in their life. It has found that 41 (70.68 percent) respondents have accepted as have a new life after coming for treatment. The higher number of respondents 66 (92.96 percent) have felt better change on their health. It has revealed that 54 (76.06 percent) respondents are satisfied with the treatment providing in the center, and 51 (71.83 percent) in the center. The larger number of respondents 53 (74.65 percent) have getting good co-operation from the center. The majority of respondents 42 (59.16 percent) have expected more helping program from the center. The higher number of respondents 15 (19.65 percent) are preferred encounter program, 14 (19.64 percent) counseling etc. All respondents wanted to involve anti-drug program in future. 5.3 Conclusions According to the findings of this study, I have concluded that socio- demographic situation of a person is an important factor for addiction of drug i.e., age, sex, marital status, occupation, caste, religion etc. Youths are more vulnerable groups because their characteristics and nature. Rai/Limbu more affected than other ethnic group because they are predominant populations in Kathmandu valley. Students are more affected than others
  14. 14. are. They used drug by their peer pressures. Most of drug addicts were youths; they had attained higher education, but not effect education for them. Therefore, the key informant says that education is not only factor for saving them from drug abuse. There are so many causes i.e., family conflict, unemployment, love etc. are also responsible factor to make addict. A parent education is also plays a vital role for improving their children (key informant).Every mother should be educated. Drug addiction largely influenced by the peer pressure, curiosity and they started at first, at the age group of (15 -20 yrs). Mainly ‘Ganja’ was preferred by most of the addicts for the first time of taking, because Ganja is easily availability in Nepal and not they use on ‘Shivaratri.’ The key informant says about the program for addicts; the school program conducted in the school from the counselor of Asara, center organized inter- rehabilitation center competition for addicts, vocational training program also provided for their social and economic adjustment. Books, poster etc published and give opportunities to write the clients to improve their feelings etc. facilities are giving from the center. The clients most stay in the center at least, 3 months by the key informant. Most of addicts used drug through oral, and after taking drug, they felt pleasure. Awareness and education are most important factor for coming treatment and rehabilitation. Most of the clients feel that, they have new life after coming for the treatment and rehabilitation. Encounter, counseling are the most important and favorable program for them. Majority of recovering addicts want to do business and to continue their further study and they have found better change in health and their rehabilitation center with their rehabilitation process. They have good relationship among their peers and good co-operation with the staff of Asara. They wanted to involve in anti-drug program after the treatment.
  15. 15. References Asara Darpan (2064). Ashra sudhar Kendra Ranibari, Maharajgang, Kathmandu Bhandari Bishnu, (1988). Drug Abuse in Nepal; A Case Study of kathmandu valley, DAPAN Bhusal Chop Lal(2057 B.S.) ‘Networking, of Drug prevention up to the Grassroots Level” The epalese Journal for Drug Control: Government of Nepal. Ministry of Home Affairs. Government of Nepal, (2007). The Nepalese Journal for Drug Control, Ministry of Home Affairs, Narcotic Control Section, Singh Durbar, Kathmandu. Narconun Nepal (2064). Park, K. (1991). Preventive and Social Medicine, 18th edition, 1167, Premnagar Road,
  16. 16. Jabalpur (India).