Community Support Key to Kicking Drugs

PENANG, Sep 23 (IPS) - Looking at Abdullah Mohd Isa today, it's hard to imagine that he was hooked on drugs for 10 years, injecting himself with diluted opium in desperation. Smiling and shirtless inside his home, he now looks the picture of health.
These days, he runs a drop-in centre that is helping a small therapeutic community of recovering drug addicts around the fishing village of Teluk Bahang in northwest Penang to kick the habit the holistic way.
But it is an uphill struggle. Even after 25 years of staying clean from drugs, Abdullah himself admits that he is still a ''recovering addict''. ''There is no cure for addiction--recovery takes a life-time,'' he says.
In a community of 70 heroin addicts, Abdullah has worked with 57 of them. After a few years, 25 of them made a clean recovery while 32 were put on the drug buprenorphine, used in drug substitution therapy to treat addicts. Out of these 32, 12 are leading fairly normal lives.
Abdullah seems pleased with the success rate of the holistic method, which involves the larger community, religious institutions, and the local police in the recovery process. ''Our treatment is oriented towards taking them away from artificial highs,'' he says.
As Abdullah speaks, a gaunt-looking man walks into his house along with a couple of Abdullah's assistants. His name is Ibrahim and he is a long-time addict. After three stints at government rehabilitation centres, relapsing each time soon after, Ibrahim has just decided to put himself under the supervision of Abdullah's team.
''This time, I want to turn over a new leaf. My two children, aged 22 and 24, are getting married soon and I fear I will bring shame to the family if I am still addicted,'' says the 57-year-old.
Although each stint at a rehab centre typically lasts just over a year, Ibrahim, now a divorcee, says ''it felt like 10 years''.
''I just couldn't stand it (the craving) and thought I would just take a little bit after coming out. By the third day (after coming out of the centre), I was hooked again,'' he says.
''They may be physically healed when they come out of the (government-run) centres, but mentally they are not,'' observes Abdullah.
Once they are released from these centres, recovering addicts are vulnerable to the temptation or cravings.
Addicts obtain illegal drugs from pushers on the streets. For Johari Mohamad, 41, the treasurer of the Teluk Bahang fishermen's association, and now Abdullah's right-hand man, the reason for this availability is obvious: ''If there is no corruption, there will be no drugs''. Other addicts resort to abusing legitimate drugs with , which to satisfy their craving.
Abdullah's methods are different from the usual way of treating addicts in Malaysia. Those nabbed by police are charged in court within 14 days if they test positive for drugs. Many are sent to one of 28 government-run rehabilitation centres.
Over 9,000 addicts, 98 percent of them male and 70 percent of them ethnic Malay, are confined at these government-run centres that dot the country.
Addicts typically spend just over a year at these rehab centres, first going 'cold-turkey' in a two-week detoxification programme and then receiving counselling and religious instruction. Civics courses to instil patriotism and training in skills like haircutting, woodwork, tailoring, and landscaping are part of the plan.
Each inmate receives individual counselling twice a month, according to a source familiar with one of these centres. Group counselling is carried out once a month in batches of about 10 inmates at a time.
For all the effort, only a small minority actually kick the habit.
Last year, Health Minister Chua Soi Lek conceded that despite the government spending 50 million ringgit (13 million US dollars) annually on its drug rehabilitation programmes at these centres, the number of drug addicts detected each year has not shown any sign of abating.
''In fact, anecdotal reports say that up to 70 percent of drug users who left the centres went back to drugs again,'' the minister said.
Even within the camps, some addicts crave tobacco and manage to smuggle in supplies. Occasionally, their stockpile is discovered and confiscated and this leads to unhappiness that sometimes triggers disturbances inside the camps, says Abdullah.
Critics question the government centres' methods. ''It's very regimented,'' recalls a source who researched rehabilitation centres some years ago. He remembers being startled by a smart salute from one of the inmates and believes strong regimentation and ineffective counselling contributes to high relapse rates.
Some say the centres should not be judged too harshly as the rehab success rates in more developed countries are not that high either.
One counsellor defended the counselling methods used: ''Counselling is just a tool, one aspect of helping them. It gives them an idea how to solve their problems. But it is up to the addicts to solve them''.
The relapse rates used to be a lot worse-- some say as high as 99 relapses for every 100 cases.
Abdullah's holistic method has caught the attention of the National Drug Agency, which has enlisted help from recovering addicts to provide fresh ideas on how the camps should be run.
Now the relapse rate has fallen to around 70-80 percent, says Abdullah, largely due to aftercare support such as drop-in centres, the 12-step therapy, and religious counselling.
Despite the best efforts, more than half of the more than 30,000 drug addicts detected nationwide every year are repeat or relapse cases. Officially, the reasons that addicts give for falling into the habit are peer pressure, curiosity and gratification or pleasure.
But there could be larger forces at work. The areas with the highest number of cases detected - Penang (20 percent), Kuala Lumpur (16 percent), Johor (13 percent), Perak (10 percent) and Selangor (8 percent)--are the most industrialised in Malaysia.
Not only are these areas with money, they are also within easy reach of the 'Golden Triangle' countries of Thailand, Burma and Laos which play a key role in global trafficking.
The break-up of the family unit as a result of industrialisation and rural-urban migration may have fuelled alienation, says physician Jeyakumar Devaraj, who has treated addicts in the past. The lack of recreational spaces and cramped low-income housing in urban areas may also be contributory factors, he said.
''Addiction is symptomatic of a larger problem. Our society is already dysfunctional and it is not in a position to help these addicts,'' he said.
A surgeon in a private hospital in Penang, for his part, argues that ''addiction should be decriminalised and addicts should be treated as patients not criminals''.
Frustrated by the low success rates, the government is now introducing methadone treatment for addicts, though critics say this is not without problems.
''I heard from a friend who is a doctor that he wanted to stop methadone treatment because some of the addicts were mixing it into cocktails and will do anything to get the next fix,'' a doctor in Kuala Lumpur told IPS. ''They are so dependent and overwhelmed''.
Devaraj believes that for drug addiction to be controlled, addicts need therapeutic communities where people accept them, where they are given jobs while they readjust to society
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