Substance abuse and addiction is the story of almost every household in Pakistan. It has exempted no one, not even the educated and especially not the young. Karachi becomes the most tragic city, when it is ranked second in ABCD 2018 Cannabis Index. For readers, it may seem that many lives are, or have been, in squander; however, Charles Frazier in his “Cold Mountain” says: “[No] matter what a waste one has made of one’s life, it is ever possible to find some path to redemption, however partial.”
Such an example is true among us in Karachi – through the life story of Muhammad Ali. His journey from battling substance abuse for 12 years to becoming an addiction therapist at AAS Recovery Center (ARC) is truly inspirational and hopeful to those directly or indirectly battling with addiction.
It all began in the sixth grade with smoking because of curiosity and maintaining a ‘cool’ self-image. It became a need for calming emotional disturbances due to family conflicts. During the summer in grade eight, through a mutual social contact, he was introduced to hashish (hash), which was again out of curiosity but then became a means for escaping from his negative feelings towards family, relationships, adjustments, and pressure in general. At the same time, he wanted to push himself to his limits and prove the power and control he was able to have over himself. From tasting the substance for the first time, this led to consuming it every weekend with friends.
This went on till the time of Matriculation and continued through the university years. With every next educational stage came a sense of more autonomy, such as driving his car and having an ever expanding social circle. On the other hand, rebelliousness increased too – now it was not only hash during weekends but sometimes alcohol as well. Parents began to show concern, but it was ignored, as Ali, with his extraordinary intellect, fulfilled their basic demand of attaining good grades, and there were no further grounds for the family to interfere in his independent life.
However, the family arranged for Ali a job in Saudi Arabia, where he went during his last year of BBA undergraduate, leaving it incomplete. They thought it would help Ali get away from addiction. Nevertheless, he found similar substances in Saudi Arabia and continued his addiction. According to Ali, he craved for it, which made him constantly take it without thinking, as he could not understand his desire for it.
After a year, he came back to Karachi and at the age of 21 initiated a small event management business. It was a success, as he had corporate clients, and a good amount of revenue was coming in. Unfortunately, it was not to last long because during one such event, Ali was introduced to heroin. When he tasted it for the first time, it was a thrilling experience. The biggest advantage was that it neither needed to be placed inside a cigarette to be smoked, nor it smelled. Just a sniff and one was instantly high. He then replaced hash with heroin during weekends, but this only increased the desire to get high. Unable to wait for, he moved on from a weekly to daily base heroine.
As a result, Ali spent all his money on buying good quality heroin and gradually became dependent on it. He was unable to function without it, be it mentally, physically, or spiritually. Everything became muddled, and he was unable to manage anything to the extent that his finances deteriorated and business was neglected. His physical symptoms were noticed by the family. When asked as to what was going on, he gave an excuse of being ill. When Ali tried to leave heroin, he experienced withdrawal, which gave him body aches everywhere to the point of being unable to function. At this point he realized that he has gone too far – he had become enslaved to the drug, after which he finally decided to take treatment.
He visited top notch psychologists and psychiatrists in Karachi and went through 10 to 15 days of detoxification. Unfortunately, this did not work for him, because they gave him consistent instructions as to what to do and what not to do. He felt an experiential gap between him and the professionals – they could not understand each other, which resulted in five relapses.
Fortunately, someone informed Ali about rehabilitation, in which he enrolled himself. He came across a special programme called the 12-step programme of Narcotics Anonymous (NA) and Alcohol Anonymous (AA) designed by former addicts in America back in 1953 (see Illustration #1). It is based on a disease model, which assumes addiction to be an illness, the origin of which lies within the individuals themselves. It believes addiction to either exist or not, that there is no control over the intake of substance, and it is irreversible.
His counsellor in rehabilitation, an ex-addict, was also treated through this programme and guided Ali through its steps.
Ali could experientially relate to his counsellor, which was the contributing reason for his recovery, but was at first unable to understand the NA steps. When relapsed for the sixth time, he knew something was internally wrong with him. It dawned on him that for years he had been trying to control the substances by reducing the use from daily to weekly basis, replacing heroin with hash or hash with alcohol. When he stopped all the substance abuse head-on, that is when positive changes came, as it was replaced with counselling. Through counselling, he consciously understood his cravings, learned about their management and the importance of analyzing life events leading to addictions, such as trauma, childhood glitches and family conflicts.
During this time, Ali went through an agonizing acute withdrawal phase for two weeks, in which he was locked in a ward and given medicines to pass through this phase. This is the key phase, as relapse rate is high, because the pain becomes unbearable to the extent of praying for death or to be put down. Then came thirty months of post-acute withdrawal phase, in which there were fewer physical symptoms but more emotional and psychological ones, such as being stress sensitive.
At the age of twenty-six, Ali was finally out of treatment. He picked up the pieces of his life by religiously following the NA and aftercare programmes, along with attending counselling sessions. When there was no substance contact for five months, it felt almost surreal to live a life without narcotics. He gradually gained confidence in himself and improved relationships with his family members. Finally, Ali completed his Bachelor’s degree, found a good circle of friends and got a job in an advertising agency.
At some function, Ali met a man, who shared his own life story of addiction and offered to send Ali to the UK to become a trained therapist, after which Ali could return and work for him as a therapist. Ali travelled to the UK and became a certified Humanistic Integrative Counsellor. He visited rehabilitation centers there and in other parts of the world to study and understand the rehab system.
His counsellor advised him not to be involved in a marital relationship for at least four years, after which both the counsellor and the client would decide, if he was ready or not. The major reason for this was Ali’s financial instability as well as his need to be psychologically strong enough to handle the stresses of marriage.
After four years of no relapses, Ali had gained enough self-confidence. He remembered people being fearful of him thinking that no sane person would give away their daughter to an addict. On the contrary, God had other plans.
A proposal of marriage was accepted and before the engagement, Ali went to his counsellor to share the good news. His counsellor asked in wonder, whether he had shared his past with his future spouse. Ali uneasily said that naturally not. With difficulty he was finally able to get a partner, and exposing his past could jeopardize his future. On hearing this, the counsellor reminded him of the 12 steps programme’s core concept, which was honesty. The consequence of dishonesty could be harsh – if the girl would find out from a third source about Ali’s past, then there would be severe mistrust in the relationship. Besides, Ali was asked, whether he trusted God and after that himself, to which Ali responded in affirmation, which struck a chord and gave him a newfound confidence to share his past with his future wife.
The next moment, he called her and shared everything over the phone, giving her the choice to annul the relationship, if she wished so. At first, she closed the line with a simple ‘ok’ in the end, which was strange to Ali, who thought that maybe this was it. However, the very next day, he got a call from her – she admitted she was blessed to wed a person, who was trustworthy and would gladly spend the rest of her life with him.
Now being a father of a three-year-old daughter, he and his spouse are trying to be functional parents through open communication about reality at an early age, because tomorrow she will have to survive on her own, and with that comes protection of the self, physically or psychologically, from dangers. To do this, currently, the mother, who wisely understands all this, is teaching her daughter about good touch and bad touch. By the age of six years, Ali plans to communicate openly to his daughter about his past addictions and teach her to identify and defend herself against various types of abuses, which can be verbal, intellectual, physical, emotional, and spiritual. This will lead to his daughter having secure self-esteem and being comfortable in her own skin. For her to grow up as a healthy adult, there must be a conscious understanding of her boundaries and a strong trust bond between her and parents.
If, God forbid, his daughter does get into trouble, the parents will be there to help and she will have in her the groundwork for a secured self, which will make the recovery much easier. For Ali, all this is crucial, because he believes that the taboos preventing open communication with children have become detrimental in the twenty-first century and have thus ruined many lives.
When questioned about the spiritual aspect of his recovery, Ali said that for him spirituality is based on trust, belief, and faith in God. He takes life one day at a time asking: “What good things should I do today?” He has consciously chosen not to do drugs, to be honest, pray five times a day, get out of his self-centeredness, and give as much as he can to his family and people in general. When asked about the motivation behind such choices, he said he wishes to attain Heaven and have a sense of inner fulfillment in this world by just placing a smile on others.
This led to a query of how Ali, as a therapist, tends to counsel the spiritual element of his clients in addiction. His approach is to teach the client how to relive their life by sharing basic universal principles of a good life. Examples are positive approaches to themselves, caring about their family, being truthful, and becoming an altruistic human being. These are very basic concepts of maintaining a healthy life – his clients can choose to excel in some or all, depending on their capacity.
Twelve Steps of Narcotics Anonymous
- We admitted that we were powerless over our addiction — that our lives had become unmanageable.
- We came to believe that a power greater than ourselves could restore us to sanity.
- We made a decision to turn our will and our lives over to the care of God as we understood Him.
- We made a searching and fearless moral inventory of ourselves.
- We admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
- We were entirely ready to have God remove all these defects of character.
- We humbly asked Him to remove our shortcomings.
- We made a list of all persons we had harmed and became willing to make amends to them all.
- We made direct amends to such people wherever possible, except when to do so would injure them or others.
- We continued to take personal inventory, and when we were wrong promptly admitted it.
- We sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.
- Having had a spiritual awakening as the result of these steps, we tried to carry this message to addicts, and to practice these principles in all our affairs.
Role of Family in Addiction
When asked about the role of family in causing and maintaining addiction in an addict’s life, Ali stated that contributing factors are such traumatic behaviors towards the child as verbal and physical aggression, rejection, handing them over to relatives, and replacing emotions with material goods. Likewise, parents themselves are not aware of the psychological distresses in their surroundings, which is subconsciously transferred to children through wrong parenting skills. If children grow in such stressful environment, they look for escape in habits that could help them replace this tension with instant pleasure. It is crucial for parents to have an open communication with children from a young age and teach them self-protection. We are not able to keep children under 24-hours surveillance, as they are on their own when they go to school or visit a friend.
The above-mentioned strategy is an early preventive step that families can take. However, if the loved ones are already trapped in addiction or are undergoing rehabilitation, their goal should be to make their environment healthy.
According to Ali, there are two types of people in an addict’s life, who indirectly maintain their substance intake:
- Provoker, who triggers the addict’s distress through such unpleasant means as criticisms, taunts, and blames. Statements, such as ‘you will never be good enough’ or ‘it is because of you that we are in trouble”, can provoke an addict.
- Enabler, who indirectly facilitates addictive behavior through such statements as ‘my child is absolutely fine and everyone is just out to get him/her’ or ‘give him/her what he/she wants’.
A healthy environment would entail striking a balance. This balance should refrain from demeaning statements and have a constructive, solution-oriented approach towards the addict, while at the same time maintaining boundaries and holding them accountable for wrong actions. If a child stays out late at night, he should be answerable, and if he demands high amounts of cash, it should not be handed without questions.
In AAS rehabilitation, Ali conducts family counselling, educating the Enabler and/or Provoker in the addict’s environment. However, his main concern is to make the addict understand their family dynamics, because in most cases, families do not change their behaviour, as they are not going through the rigorous process of therapies and rehabilitation, which addicts are required to do. This is not to say that they do not have a crucial role to play, but the fact remains that they only have a one-hour surface-level awareness, while an addict is counseled to have an in-depth understanding of themselves, their past, their suffering and their treatment. The goal of Ali as a therapist is to break the cycle of ignorance within the addict, which could save the next generation from a similar suffering.
Description of AAS and Its Sub-Programmes
Alleviate Addiction Suffering (AAS) was formed in 2000 as a private non-profit organization in Karachi and Lahore. They provide addiction treatment services to individuals from underprivileged backgrounds.
Their daughter programme AAS Recovery Center (ARC) provides rehabilitation facilities for the privileged class. Having the resources to do so, most of them used to travel abroad to obtain exclusive services; therefore, a state-of-the-art residential center was designed in their native environment, which provides comfortable and luxurious accommodations.
AAS in general offers services for all types of addiction from chemical abuse (alcohol, heroin, cocaine) to non-chemical abuse (gambling, sex, prescriptive drugs). Core services are treatment, rehabilitation, and aftercare.
The first stage is detoxification and withdrawal (acute & post-acute), if the case is of chemical abuse. For example, a heroin addict will be made to leave the substance through alternate medicines, which would be slowly tapered off. The target is to complete the medicinal procedure within two to three weeks.
The rehabilitation phase consists of 90 days primary care, in which the process of reintegrating the individual into society begins through counselling and therapy. This includes the 12-step programme along with constructive activities supporting recovery, such as recreational activities, vocational training, group therapies, psychoeducation and many more. The reintegration method has two styles. One is the in-patient style, in which the patient stays in the rehabilitation center for three months without going home. The other is out-patient/weekend style, in which patient is sent home during the weekends and spends five days in rehabilitation after the primary core.
The last phase is the aftercare which lasts for six to nine months, during which therapy continues and strategies are made to prevent relapses. The patient is asked to stay away from four situations that trigger the craving, namely: hunger, anger, loneliness, and tiredness (HALT concept). The chances of relapse are always unpredictable, though it is important that the patient does not stop the therapy till the time both therapist and the client have agreed to a full recovery, thus terminating the process.
The community is welcome to support AAS financially through charity, Zakat or any means possible. Non-financial support is also welcomed by using all the means to spread awareness with AAS – addiction has turned into an epidemic given the recent statistics in ABCD 2018 Cannabis Index.
According to Ali, the addiction issues will only get worse with time, mainly due to family mindsets in comorbidity with normalization of addiction through media. He states that films have played an integral role by showing characters in distress, who immediately resort to alcohol, substances abuse, or addictive behaviours as a means of coping. If previously the media promoted acceptability of smoking and alcohol, then now it has normalized drugs to the extent that some countries have legalized such substances as marijuana and hash in controlled form. Some Pakistanis also find this acceptable in their homes. In the privileged class, alcohol has become a norm, and it is not a cause of concern, if children consume it.
In the face of all of these social dynamics, Ali’s message to the youth of Pakistan is loud and clear: “Don’t do drugs!”
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