Nalini was a 17-year-old Advanced Level student of a leading school in Colombo. She was studious and was a school prefect. During the past few months, her mother noticed that she was not spending time on her studies and was always going out with other students. She frequently asked for money from her parents. Her worried mother checked her room one day and her worst fears were confirmed. There was paraphernalia suggesting Nalini was addicted to drugs!
The shocked parents took Nalini to a doctor. Her road to full recovery was not easy but seven months later she almost fully recovered. Her parents admitted her to a new school and constantly watched over her movements and encouraged her in her studies. She excelled in her studies and gained entry to a university.
Unfortunately, stories of some children addicted to drugs have not ended so well.
Addiction
Drug addiction or drug dependence is considered a chronic disease, characterised by compulsive, or uncontrollable, drug seeking and use despite its harmful consequences and changes in the brain, which can be long lasting. The changes in the brain can lead to the harmful behaviour seen in people who use drugs. Drug addiction is also a disease where relapsing ocurrs. ( Relapse is the return to drug use after an attempt to stop).
Drug dependence can be treated, but it is not easy. An addicted person cannot simply stop using drugs for a few days and be cured. Most patients need long-term or repeated care to stop using drugs completely and regain their normal lives.
Rehabilitation of a drug dependent person will help him to stop using drugs and stay drug-free. This will make him a productive person for the family, employer and society.
Treatment
In many treatment programs medically assisted detoxification is the first stage of treatment. Treatment may be voluntary or involuntary. Drug use during treatment must be monitored continuously.
Behavioural counselling and evaluation and long-term follow-up to prevent a relapse are necessary. Follow-up care may include community- or family-based recovery support systems.
When considering rehabilitation, it is important to remember that no single method of treatment is right for everyone. Counselling and other behavioural therapies are the most commonly used forms of treatment.
Although addicts need to have quick access to treatment ,effective treatment should address all of the patient’s needs, not just his or her drug use. Treatment should also address other possible mental disorders.
There is no hard and fast rule about a residential period of rehabilitation. Receiving treatment as long as necessary is critical. When combined with behavioural therapies, medication is often an important part of treatment.
Treatment plans have to be reviewed often and modified to fit the patient’s changing needs.
Treatment programs should examine and test patients for substance use disorders such as HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases. It is necessary to teach them symptoms and signs of these illnesses.
Detoxification
They may need psychiatric evaluation for co-occurring mental health issues such as depression and anxiety.
Medication can help suppress unpleasant withdrawal symptoms during detoxification. Detoxification is only the first step in the process. Patients who do not receive any further treatment after detoxification usually resume their drug use. One study of treatment facilities found that medications were used in almost 80 percent of detoxifications.
To manage withdrawal symptoms, prevent relapse and treat co-occurring conditions medication can be used.
Patients can use medication to help re-establish normal brain function and decrease craving for drugs. Medications are available for treatment of opioid (heroin, prescription pain relievers), tobacco (nicotine), and alcohol addiction.
People who use more than one drug, need treatment for all of the substances they use.
There are many options that have been successful in treating drug addiction.
A range of care options with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed.
Behavioural therapies are used to treat drug addiction. These help patients to modify their attitudes and behaviour related to drug use, increase healthy life skills and persist with other forms of treatment, such as medication.
Patients can receive treatment in many different settings with various approaches. Treatment can be either outpatient behavioural treatment or inpatient (residential) treatment.
Residential treatment
In outpatient behavioural therapy, treatment is sometimes intensive at first. Patients have to attend multiple outpatient sessions each week. After completing intensive treatment, patients can commence regular outpatient treatment. This may be for a few hours per week to help sustain their recovery.
In-patient or residential treatment is perhaps more effective than outpatient treatment especially for those with more severe problems (including co-occurring disorders). Residential treatment facilities offer 24-hour structured and intensive care, which include safe housing and medical attention.
Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free and crime-free lifestyle after treatment.
Wherever possible, the residential programs incorporate activities and experiences consistent with normal lifestyles.
The clients will have a formal treatment program during week days and less structured activities in the evenings and on weekends.
Daily activities include individual and group counselling sessions, educational programs, care and maintenance of the centre, work projects such as landscaping, creative pursuits such as pottery, welding work, carpentry and drama, stress management activities like muscle relaxation, meditation and recreation. Television and news papers are available for residents.
In Sri Lanka, the National Dangerous Drugs Control Board (NDDCB) operates four residential rehabilitation centres for drug abusers. Those centres are in Colombo (Thalangama), Kandy, Galle and Urapola (Nittambuwa). These centres provide individual and family counselling to the drug dependents, including mental relaxation programs, physical exercises, detoxification treatments, indoor and outdoor activities, educational and vocational training, psychotherapy, other skills and motivation to develop healthy lifestyles.
The centres of the NDDCB consist of counselling rooms, office buildings, vocational training units, kitchen and dining hall(s).
These are in easily accessible and free locations. The centres provides basic but clean and hygienic accommodation, a balanced diet, in-door and out-door recreational facilities, a group of friendly and trained staff.
The treatment program consists of medical attention, counselling, behavioural therapy, vocational training, in-door and out-door recreational activities. The treatment needs of each person are assessed individually.
Under the Treatment and Rehabilitation Act No. 54 of 2007, the Prisoners Diversion Scheme (PDS) was initiated in association with the Department of Prisons.
It is an exclusive treatment program for prisoners imprisoned for drug related offences. These specially designed treatment programs are now conducted at Kalutara, Weerawila, Pallekele, Anuradhapura, Pallansena, Thaldena, Meethirigala, Kandewatta and Watareka Prisons.
The Commissioner General of Rehabilitation has been conducting drug treatment and rehabilitation programs since 2013 in Kandakaduwa in the Polonnaruwa district.
Rehab centres
Parliament passed a Bill to make provision for the treatment and rehabilitation of drug dependant persons in November 2007.
According to the Act, the Minister on the recommendation of the National Dangerous Drug Control Board (NDDCB) may, by Order published in the Gazette, designate any place or building to be a Treatment and Rehabilitation Centre for the care and rehabilitation of drug dependant persons.
Any person may on his own behalf or on behalf of anybody corporate or unincorporated apply to the NDDCB for a license to establish in the premises to be specified in the application, a private Treatment Centre for the care and rehabilitation of drug dependant persons.
To provide rehabilitation to an estimated 200,000 to 250,000 drug addicts in Sri Lanka is a costly and time-consuming endeavour.
But it is necessary that the Government and civil organisations should receive funds and be more efficient and dedicated to provide rehabilitation services to drug dependant persons. We will continue see children such as Nalini as long as narcotic drugs such as heroin, cannabis (Ganja) and cocaine are found in the market. It is essential the authorities take steps to control the availability of drugs.