Rehabilitation of drug-addicted persons: the experience of the Nav-Chetna Center in India

Sections

ABSTRACT
Introduction
Development of a programme to cope with drug abuse
Treatment approach
Treatment management
Yoga therapy
Asanas (body postures)
Reintegration into the community
Results

Details

Author: K. SHARMA , V. SHUKLA
Pages: 43 to 49
Creation Date: 1988/01/01

Rehabilitation of drug-addicted persons: the experience of the Nav-Chetna Center in India

K. SHARMA Director
V. SHUKLA Chief Clinical Psychologist Nav-Chetna Drug De-addiction and Rehabilitation Center, Varanasi, India

ABSTRACT

The Nav-Chetna Drug De-addiction and Rehabilitation Center, Varanasi, India, was established in December 1985. It provides out-patient and residential rehabilitation services, medical treatment, counselling, educational and vocational guidance, yoga therapy and after care.

Drug-dependent persons under rehabilitation treatment at the Center are encouraged and helped to promote personal development, to build up and strengthen their initiative and confidence and to bring about improvements in their maturation, attitude and behaviour to overcome drug addiction. This is accomplished through a therapeutic-oriented programme, which creates conditions that optimize the natural tendency of the individual to self-actualize and eventually stabilize. Yoga plays a crucial role in this programme at both pre- and post-clinical stages. It offers a new avenue for positive mental and physical health and helps to free individuals from drug dependency and its associated problems.

Introduction

Drug abuse and its associated problems have reached alarming proportions in parts of India. Individuals of all socio-economic strata and age groups and from urban and rural areas are increasingly affected by drug abuse.

Before 1985, there was a serious lack of facilities for the treatment and rehabilitation of addicted persons. In response to this situation, the Nav-Chetna Drug De-addiction and Rehabilitation Center was established, in City Varanasi, in December 1985, sponsored initially by the Kashi Club.

Development of a programme to cope with drug abuse

In the early days of its operations in 1985, the Center provided counselling services to occasional and moderate drug-dependent persons, and promoted drug awareness education for the general public.

In early 1987, the Nav-Chetna Center began to offer clinical treatment on an out-patient basis. In April 1987, the Center provided full-fledged residential rehabilitation, supported by a grant from the Ministry of Welfare of India, making all requisite services available in one institution, including detoxification, medical care, counselling, educational and vocational guidance, yoga therapy and after-care.

Treatment approach

Motivation to abandon drug addiction is perhaps the single most important factor for successful rehabilitation. Law enforcement and educational and clinical treatment alone, and a variety of programmes involving these approaches, have not been sufficient to stop drug abuse. In order for drug abuse programmes to be effective, they must provide a non-chemical alternative that can offset at least some of the motivations to abuse drugs.

Everyone who comes to the Center is accepted and, depending upon individual motivation, treatment is started. Building up motivation is important in treatment management and, certainly, in preventing recidivism.

Treatment management

Most drug-addicted persons who visit the Center are required to undergo a detoxification process for about six days. Then individual and group therapy and counselling sessions begin, followed by bio-energetic exercise classes. Individuals are handled carefully and monitored around the clock by personnel who are well-acquainted with the characteristics of those requiring drug abuse treatment.

The approach of the Nav-Chetna Drug De-addiction and Rehabilitation Center is to build up individual motivation and initiative, to promote personal development and to bring about improvements in maturation, attitudes and behaviour through a therapeutic-oriented programme. The key to this approach lies in creating physical and psychological conditions that optimize the natural tendency of the individuals, system to self-actualize and eventually stabilize.

In individual therapy, the drug-dependent person is encouraged and helped to modify her or his attitudes and behaviour and to build and strengthen initiative and confidence to overcome the drug addiction problem.

In group therapy, various subjects are discussed; new ideas are generated; morale is boosted; individuals are encouraged to talk freely about drug dependency; and yoga exercises are organized. In this way, by providing effective medical and therapeutic aversion programmes, the Center can tackle many of the problems that prolong drug dependency. To the extent possible, groups are formed of individuals residing in the same area, so that they can continue to be mutually supportive after leaving the Center.

The Center recognizes that the family has a significant role to play in successful drug rehabilitation- Therefore, after the initial detoxification phase of treatment, family therapy is started. Family members visit the Center daily for about one month and every other day for another month.

In bio-energetic exercises, individuals are urged to recite, as loudly as possible, their resolution not to resort to drugs again. This results in a loosening of abdominal muscles and in a feeling of relaxation.

Physically, addiction is a recurring disorder; socially, it carries a stigma; and, professionally, it impairs productivity. Thus, rehabilitation efforts at the Nav-Chetna Center concentrate on reintegration in society in roles that are more satisfying than those assumed during drug dependency.

Yoga therapy

When addicts stop using drugs, their rapidly improving physical health should not be regarded as the main criterion to judge their real condition. A craving for drugs does not automatically stop after detoxification.[1] The post detoxification period requires constant adjustment and the removal of distractions in order to achieve co-ordination of mind, body and senses. Yoga, as a system for rejuvenation, becomes a natural ally, offering a systematic method of achieving this goal in a relatively short period of time.

Yoga therapy satisfies the aim of drug rehabilitation by bringing about a holistic development in mental and physical health and in social behaviour. The metabolic and breath rates and cardiac output markedly decrease with yoga therapy. Such results indicate the achievement of a state of rest even deeper than that during deep sleep. The danger of relapse naturally decreases with increased stability, satisfaction and awareness.

The principal aim of yoga is to help a person overcome physical discomfort and emotional tensions by training her or him to forget unpleasant experiences and to face stressful situations boldly. The mind experiences more base-line autonomous pleasures and no longer remains dependent on an external agent. Thus, yoga offers new avenues for the promotion of positive health and protection against stressful events.

Yoga has a crucial role in pre- and post-clinical rehabilitation programmes at Nav-Chetna. It helps to considerably reduce recidivism. There is a fundamental inconsistency between drug taking and yoga; an individual can do one or the other, but not both.

The package of tailored programmes of yoga therapeutic exercises being provided in the Center are described below.*

Asanas (body postures)

Shavasana

Shavasanais a relaxation exercise. It helps bring progressive muscle relaxation [2] , balance nervous system overactivity and reduce restlessness [[3] , [4] , [5] ].

*All of the Asanas, breathing and purification exercises mentioned below should be done under the guidance of a qualified instructor.

Arshmatsyendrasana and matsyendrasana

These asanashelp alleviate indigestion and loss of appetite [5] and indirectly help offset abdominal problems and the craving for drugs.

Sarvangasana

This asana has a very beneficial effect on the endocrine glands, toning up the whole nervous system and increasing considerably the strength of the brain and nerves. It is a rejuvenation exercise.

Shirshasana

Shirshana is a yoga "head stand". It sends a rich flow of refreshing blood to the brain, relaxing the mind and body and improving concentration, body metabolism and brain functioning. It has been observed that, during this posture, there is sudden spurt of blood volume to brain (about 3-5 times the normal rate); this sudden spurt helps to stabilize the protein metabolism of the brain, thus inducing an increased production of beta-endorphine [6] .

Pranayama (breathing)

Pranayama ,derived from prana (the life breath) and ayama (pause), constitutes the yoga science of breath control. The reciprocal relationship between emotions and breathing is well-established; when one becomes excited, the respiratory rate is faster and vice versa.

Nadi-shodhana

Nadi-shodhana helps concentration by increasing amino-acid levels in the brain, as could be detected in the blood flow from the brain [7] . It gives stability to otherwise restless ex-addicts and, after prolonged regular use, results in an increase in alpha-wave activity, along with a reduction of blood pressure, as well as in emotional stability.

Bharmari

The bharmari exercise helps to relieve the tension of mind and strengthen veins and the tissues of the brain.

Bhastrika

A large amount of fresh air is supplied to the body by the bhastrika pranayama .At the same time, carbon dioxide is driven off, When practised regularly, this exercise results in an increase in the oxygen/carbon dioxide ratio and a decrease in the presence of nor-adrenaline metabolites in the urine; the body is relaxed and the mind alert [8] .

Kriyas (purification exercises)

Purification exercises (kriyas) help solve symptomatic conditions (e.g. watering from eyes and nose, insomnia) that ex-addicts have to live with for quite some time and help to restore the normal sleep cycle.

Neti

In sutra neti ,a cotton thread is passed through a nostril and brought out through mouth; then it is repeated with the other nostril.

In jal neti ,lukewarm salted water is passed through one nostril and brought out through the other one; this is repeated with both nostrils.

Dhauti

Dhauti is the process of gradually swallowing a muslin surgical cloth (7 m x 8 cm) soaked in salt water and then taking it out slowly.

Kunjal

Kunjal involves drinking and then vomiting salted lukewarm water. This helps in cases of dyspepsia by regulating the normal peristaltic movements of the intestines and removing excessive gastric acid.

Nauli

Nauli removes the impurities in the lining of the intestines; it also alleviates constipation, obesity and dyspepsia. The liver, spleen and glands are influenced positively, and the stomach remains light and the appetite increases, promoting physical and mental alertness. Apart from relieving some of the physical problems of an ex-addict, nauli imparts a sense of cleanliness. Hence, the thought or sight of drugs brings aversion, and the exercise helps the individual to stay drug free.

Reintegration into the community

The qualified staff of the Center continues to keep in touch with those concerned in order to sustain the resolve not to return to drugs. A former drug-dependent person discharged from the treatment and physical rehabilita- tion process who does not receive any further assistance, particularly with respect to employment, encounters considerable difficulties in maintaining a drug-free life. Thus, great emphasis is placed at the Nav-Chetna Center on the importance of vocational training and education. If rehabilitation efforts do not focus on genuine social alternatives, vocational guidance and job placement, post-care success is limited.

At the Nav-Chetna Center, high priority is given to on-the-job vocational apprenticeships in various crafts, under the supervision of master craftspersons. At present, four skill programmes are offered: (a) carpet and drugget weaving; (b) silk and handlooms; (c) ready-made garments; and (d) other handicrafts made from stone, wood and brass.

Successful training in these activities results in good trade skills and afford considerable employment and self-employment prospects. The Center, through yet another novel scheme in the country for the self-employment of former addicts, has established a network with financial institutions in order to obtain loans for persons who have acquired such skills.

In order to promote public awareness of drug rehabilitation programmes, and in an effort to bring them within close proximity of those who need them, Nav-Chetna has undertaken community-supported, voluntary de-addiction camps in all the parts of the region, These camps provide at least an opportunity to establish contacts with other previously drug-dependent persons within a cultural setting.

Results

During the period 1986-1988, about 1,700 persons underwent treatment for drug addiction at the Nav-Chetna Center. At first, drug-dependent persons in the initial programme of family counselling could not manage to overcome problems of restlessness and a craving for drugs. The result was a considerably high number of relapses.

Afterwards, when a regular system of pre-detoxification yoga was started, a considerable reduction of drug abuse and a high motivation was observed in the population. In some cases, there was abstinence from drugs. In fact, participants were found to be more relaxed and energized. Many found their drug addiction experience to be unpleasant. Life became more fulfilling with the daily practice of yoga; almost all stopped engaging in drug-selling activities, changed their attitudes and even discouraged others from abusing drugs. When detoxification began, individuals were already highly motivated, determined and spirited to the extent that even withdrawal symptoms did not last for more than two days.

In the post-detoxification period, yoga therapy augmented the process of physical and psychological integration produced by pre-yoga. Moreover, the motivation that was built up during pre-detoxification was transformed into greater self-confidence and initiative, inspiring former addicts to take up regular work, continue studies, confront unsolved problems, establish new social ties and contacts and help others and extending meaningful co-operation at the Center.

References

01

A. Wikler, "Implication of a conditioning theory for research and treatment", in Opiate Addiction: Origins and Treatment , S. Fisher and A. M. Freedman, eds. (Washington, D.C., Winston and Sons, 1973).

02

E. Hewitt, "Variations of responses of muscles and intestines", Annals of Internal Medicine , vol. 12, 1979.

03

J. F. Beary, H. Benson and H. K. Hmehuk, "A simple psychophysiologic technique which elicits the nypometabolic changes of the relaxation response", Psychosomatic Medicine , vol. 30, No. 6 (1974).

04

E. Rossi, "The cerebral hemispheres in analytical psychology", Journal of Analytical Psychology . No. 22, 1978.

05

J. P. Henry, "Relaxation methods", Psychosomatic Medicine , vol. 40, No. 4 (1978).

06

G. L. Singh and B. Neki, "Physiological and biochemical changes in young healthy volunteers after regular yogic practices", Indian Journal of Medical Research , vol. 4, No. 63 (1980), pp. 120-124.

07

G. D. Dutt, Pranayama and Health (New York, Anchor Books, 1981).

08

T. M. Srinivasan, "Electrophysiological correlates during yogic practices", The Yoga Review , vol. I, 1981, pp. 165-173.