Bhutan: Safeguarding youth from the perils of drug use
The increasing use of drugs by the youth in Bhutan is a major concern for government agencies and civil society organizations. According to the 'National Baseline Assessment (NBA) on drugs and controlled substance use (2009)' carried out by the Bhutan Narcotics Control Agency (BNCA) and UNODC, the mean age at the onset of alcohol use was 16 years in 14 districts of the country, where surveys were carried out. A school specific survey carried out in 60 schools as part of the NBA also revealed some of the drug use trends among students.
Use of tobacco, alcohol and solvents were reported by students from classes VI onwards with an increasing trend among those in the higher classes. Both sexes reported drug use, with more male than female students. More than 60 percent of the male students from classes IX-X and XI-XII reportedly had friends using cannabis, alcohol or solvents (sniffing), while about one-third of the female students said so. Drug use-related problems in the family were reported by one-fourth of the students from higher classes. 2 percent of male students from classes XI-XII responded that using alcohol was a smart thing to do. Similarly, yielding to friends' requests to use drugs was viewed as important by a higher proportion of male students as compared to females.
UNODC interviewed Ms. Yandey Penjor, Executive Director of the Bhutan Youth Development Fund (YDF), one of the first NGOs in the country which started addressing substance use among the youth. She is also a member of the Bhutan Narcotics Control Agency, representing civil society. In her interview, Ms. Penjor shares her insights on the issue and YDF's experience in dealing with this same, the challenges they face and their association with UNODC.
1. What is the drug use situation in Bhutan?
In Bhutan, we have a very large youth population. Over 60% of our youth are below 25 years of age. The issue with drug and alcohol dependence is mainly a problem among the youth and with a large youth population, it becomes a very big concern. And going by the number of youth who use our services, I feel the problem is on the rise.
The problem is more concentrated in urban areas and we feel that rural - urban migration is one reason for this. If you visit rural areas, you normally find only old people in the villages. All the young people are either in school or they have migrated to urban centres - for employment and also better quality of life, I suppose. We also have a lot of marijuana growing wild, which our youth are abusing now. Another concern is that many of our school children are experimenting with and using drugs. Alcohol is also a big problem, since the youth abuse alcohol and also use it as a cover up for their drug habits. This is because if you are caught using drugs, you are taken to prison, but it is not so for alcohol. Most of those whom we treat in our rehabilitation centres are poly drug users.
The good thing is that services in the country have been enhanced over the years. Earlier we just had one drop in centre (DIC), but we now have drug rehabilitation centres for both men and women, and also 3 - 4 DICs run by YDF and the Bhutan Narcotics Control Agency (BNCA). Established by the Government of Bhutan in 2005, the BNCA is mandated to play a supervisory, monitoring and regulatory role. Bhutan's Narcotic Drugs, Psychotropic Substances and Substance Abuse (NDPSSA) Act was also ratified by the Parliament in the same year. We have a Narcotics Control Board and a Secretariat, through which UNODC has been associated with us.
2. When and why did YDF start working on substance use?
The Bhutan Youth Development Fund (YDF) was established in 1999. We initially started by focusing on helping children from low income families and giving them access to education, through scholarships and so on. We were also conducting youth leadership building programmes, building youth facilities, etc. It was a few years later that we felt the need to address drug and alcohol dependence among the youth. So, we started working in this area in 2002, when a self help group requested us to support them. While the group was providing the services though a DIC, we helped them with networking, fundraising and capacity development. The NGO then shut down in 2005 and there was a yearlong gap. Around the same time, there was a big demand for a drug rehabilitation centre. A lot of people who needed these services were going to facilities in the region like India, and it was turning out to be quite expensive. Many people would come to our office asking for financial support. So, in partnership with the Bhutan Narcotics Control Agency (BNCA), we established a rehab centre for male drug users. By then we also had with us some peer counselors who had the capacity to run a rehab centre. We also requested UNODC for help, and through the BNCA, UNODC became closely involved with the establishment of the rehab centre.
3. Please talk about UNODC's association with YDF and how it has helped address drug use In Bhutan.
Our first contact with UNODC was through their regional project on HIV prevention among drug users, when we were supporting the self help group which started the DIC. Later, we got assistance from UNODC through the BNCA and we continue to get UNODC's support for our rehab centres as well as DICs, mainly for capacity development. One of the biggest gains out of our association with UNODC has been the capacity development of our peer counselors. This has been very helpful as lack of capacity is our main challenge. The other gain was also the capacity development of personnel to do surveys.
A 'Rapid Situation and Response Assessment (RSRA) of Drugs and HIV' in Bhutan was first done by UNODC. The National Baseline Assessment and also the 'Drug use situation and responses in schools and communities - A Rapid Assessment in Phuentsholing, Bhutan' was also done by BNCA together with UNODC. These studies have helped both the BNCA and the YDF to provide more efficient services. The RSRA and the other studies helped us understand which districts in the country are facing this problem to a larger extent, so that we could strengthen service provisions there. They have also guided us in establishing DICs in the country, as we know where they are most needed. We also know which spots in urban centres should have DICs. The studies also helped us in mobilizing resources, since we had evidence that this was a problem which needed to be addressed.
I think we need to look more closely at drug use among school children, even though I am aware that the national survey did cover a lot of schools. We also need to know more about the accessibility of drugs and about our legislation and the legal services to address this problem. Drug and alcohol abuse among women and girls is another area that should be studied.
4. How has your journey been over the years? What are the challenges you had to face?
It has been a slow and gradual evolution for us. Initially, when we re-started as a DIC in May 2007 we were very cautious. We made sure we had all the people in place such as the counselors, peer counselors and also an expert from UNODC. We did all the ground work with the help of UNODC and the BNCA, such as preparing the guidelines and protocols, after which we established the centre. It is very important to have the necessary guidelines and standard operating procedures in place, because the rehab staff face different situations and may not always know how to handle them. It is important for them to have a guidebook they can refer to, where it clearly mentions what steps should be taken. So, we started with one rehab centre for male drug users and a year later decided to open one for females. We also do a lot of advocacy and prevention through education, and in the future we feel that we need to build a proper rehab centre.
Right now, the rehab centres are in rented spaces, so their capacity is very limited. We can only handle 12 clients at a time, who stay there for three months and we always have many waiting in line, especially in the male rehab centre. The capacity of the female rehab centre is 8, and we have 7 or 6 or even 4 women sometimes. It is never filled to its capacity. We are trying to find out why, because it is not as though girls are not abusing alcohol and drugs. Our outreach workers say that it is very difficult for women to join a rehab as they find it difficult to be away from their families for three months.
One of our biggest challenges is the shortage of specialized people such as counselors, psychologists and psychiatrists. In Bhutan right now, we just have 2 or 3 psychiatrists in the whole country. So we have to ask the Ministry of Health to send the psychiatrist to our centre at least once a week or something like that. Our peer counselors are not equipped to deal with certain problems, and I think that will remain a challenge for some time. Some of our peer counselors have gone on to study in the areas of addiction counseling. So when they come back after a couple of years, we will hopefully have our own trained staff. Right now we get a lot of volunteers from the USA and Europe who come for a few months to work with and guide our peer counselors.
Another challenge is, of course, the resource constraint. It is quite expensive to provide these services as we don't charge the clients that much, just a nominal amount of Ngultrum (Nu.) 1500 (youth) - 2000 (adult) per month. The per capita cost actually works out to over Nu. 30,000. We also pay for the rent, salaries of peer counselors, meals etc. We have been very fortunate so far, thanks to some good donors who have contributed to the programme, but we definitely need to find a more sustainable way of helping and providing these services. Most clients are from middle class and lower middle class backgrounds and they can't access services if they are high priced.
5. What are the areas you would like to strengthen and what do you see as your next steps?
We definitely need to expand provision of services, especially rehab services. As I mentioned earlier, we are trying very hard to get resources to establish a better rehab centre with greater capacity and improved services. The Government has been very kind and given us land on lease. Our dream is to have an integrated centre which will not only provide therapeutic services, but also livelihood skills like carpentry or farming so that when the recovering drug users go back to society, they have some skills to find employment. We also need psychiatrists to work in the centre. Otherwise, every time the staff has a problem, they have to run to the hospital. This takes a lot of time and we need to respond very quickly to situations.
UNODC, as part of its regional project on 'Prevention of transmission of HIV among drug users in SAARC Countries,' presently provides technical assistance in running the DICs, the rehab centres and building capacities of the staff. This is possible thanks to support from AusAID and the Japan Drug Abuse Prevention Centre (JDAPC).
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 Around USD 583