Study of drug treatment modalities and approaches in Pakistan

ENGLISH :
This study was conducted in six major cities of the country: Quetta, Karachi, Lahore, Faisalabad, Peshawar, and Rawalpindi/Islamabad. The institutions assessed included nine government-run facilities situated within departments of psychiatry at teaching hospitals, three prisons and eight private or NGO-run facilities. Additionally, three focus group discussions were held with eighteen clients regarding their perceptions about treatment and recovery. More than half of treatment services are located among the private sector and NGOs. Most of the NGOs are restrained by finances and are largely dependent on donors for programme funding and provision of services. They have yet to develop the capacity for financial management and self-sustainability of their programmes. Regulation and monitoring of NGOs' activities and quality of service delivery by a government body has been an issue of long debate and remains unresolved. Most of the drug treatment organizations are following no particular model, but rather have adopted into their programme's tools and components from various modalities. Some of the modalities highlighted were related to self-help groups (e.g., Narcotics Anonymous), therapeutic communities and/or community-based outreach and outpatient, non-residential rehabilitation. All the government-run facilities located within teaching hospitals are essentially providing short term medical detoxification as the main intervention for drug treatment. Some institutions, especially those in Karachi, are providing these services on an outpatient basis only. The majority of government-run centres allow a maximum stay of up to two weeks for the clients. Most of the government-run facilities were initially supported and developed with the financial assistance of the UN Fund for Drug Abuse Control (UNFDAC). Currently, many of these facilities do not have sufficient funds for treatment programmes. The government-run facilities within the departments of psychiatry in hospitals, due to their orientation as medical facilities are limited in the scope and nature of interventions they can provide. The prisons do not have personnel who either have the orientation or training to deal with problems related to drug dependence beyond the medical intervention for acute withdrawal syndrome. Prisons were found to have the largest numbers of drug addicts, at any given time, of any institution in the country. Prison drug addicts constitute between 20 and 40 percent of the total prison population Most prison addicts languish in custody for prolonged periods and receive extremely limited drug-related care. The District Jail in Peshawar was the only prison identified as having a programme for drug addicts, run by a local NGO, utilizing concepts of self-help and those of the Narcotics Anonymous programme. (From the author' s abstract)