This is a prospective six months follow up study on drug addicts after treatment and rehabilitation. The main concern is to find out during this critical period, whether the

addicts were able to stay off drugs or fall back to drugs and what happened during the

process

Foong Kin, Foong Kin

Navaratnam, V.

English

Repository@USM

RESEARCH REPORT SERIES NO. 31A FOLLOW-UP STUDY ON DRUG ADDICTS AFTERTREATMENT AND REHABILITATIONV. NAVARATNAMFOONG KINPUSAT PENYELIDIKAN DADAH DAN UBAT-UBATAN(CENTRE FOR DRUG RESEARCH)UNIVERSITI SAINS MALAYSIA1996COPYRIGHT © 1996 PUSAT PENYELIDIKAN DADAH DAN UBAT-UBATANUNIVERSITI SAINS MALAYSIA -" 'ALL RIGHT RESERVED.NO PART OF THIS PUBLICATION MAY BE REPRODUCED ORTRANSMITTED IN ANY FORM OR BY ANY MEANS, ELECTRONIC ORMECHANICAL, INCLUDING PHOTOCOPY, RECORDING, OR ANYINFORMATION STORAGE AND RETRIEVAL SYSTEM, WITHOUTPERMISSION IN WRITING FROM THE AUTHOR(S).ACKNOWLEDGEMENTThis study has been completed with the kind cooperation and assistance of manypersons ofwhorn only some have been mentioned here:1. Y.A.B. Dato' Seri (Dr.) Mahathir Mohamad, Prime Minister, and Chairmanofthe National Security Council.2. Y.B. Dato' Megat Junid b. Megat Ayob, Deputy Minister, Ministry of HomeAffairs.Pusat Penyelidikan Dadah dan Ubat-Ubatan*(Centre for Drug Research)Universiti Sains MalaysiaMinden, Pulau PinangMalaysia3.4.Y.B. Dato' Ishak T. Kechik, Vice Chancellor, Universiti Sains Malaysia, fOt::his continued support and for providing the facilities essential for this study.Y.Bhg. Dato Yaakob bin Mohamad Amin, Director-General, Agensi DadahKebangsaan, Ministry of Home Affairs.5. Encik Ramli Abdul Rahman, Director, Treatment and RehabilitationDivision, Agensi Dadah Kebangsaan, Ministry of Home Affairs.ISBN - 967 - 9979 - 41 - 56. Puan Laily Ibrahim, Treatment and Rehabilitation Division, Ministry ofHome Affairs.* U.N.lI.F.N.GO. Research and Training Centre7. The Commandants and staff of Pusat Serenti Bukit Mertajam, Pusat SerentiKarangan and Pusat Serenti Besut;8. Penang State Drug Treatment and Rehabilitation Department/Aftercare andits officers.9. The fieldwork, statistical, computer and secretarial staff of the Centre forDrug Research for. their tireless effort during the study and in thepreparation of the report.ii iii5.8 Criminal Involvement5.9 Case Studies Of Selected Addicts5.10 Analysis Of Case StudiesCHAPTER 6 PARTIAL RELAPSE6.1 Introduction6.2 Patterns Of Partial Relapse6.3 Duration Until Reversion To Drug Use After Treatment-~6.4 Frequency Of Drug Use6.5 Reasons For Drug Use6.6 Abstinence Factors6.7 Employment6.8 Case Studies Of Selected Addicts6.9 Analysis Of Case StudiesCHAPTER 7 ABSTINENCE7.1 Introduction7.2 Cigarette And Alcohol Use7.3 Duration Until Reversion After Treatment7.4 Frequency Of Cigarette And Alcohol Use7.5 Reasons For Cigarette And Alcohol Usc7.6 Abstinence FactorsivPage6264707272727476767979828586868688888890REFERENCESPUBLICATIONS OF THE CENTRE FOR DRUG RESEARCHv120123LIST OF TABLES PagePage Table 3.3 Time Until First Use After Treatment Among Those WhoReported Any Posttreatment Use of Each Drug TypeTable 1.1 Distribution of Subjects by Reasons for Failure to (Only Cases Who Completed Follow-Up) 35Locate Subject 7Table 3.4 Frequency of Posttreatment Drug Use at The Last Point ofTable 2.1 Demographic Charactertistics of Respondents 10 Contact / the Last Point of Use (Only Cases Who CompletedFollow-up) 36Table 2.2 Living Arrangements of Respondents 11Table 3.5 Employment Status At The Beginning of Follow-Up 38Table 2.3 Childhood of Respondents 12Table 4.1 Number of Follow-Up Months Completed and Their ReasonsTable 2.4 Distribution of Respondents by Number of Siblings 13 for Dropping Out 40Table 2.5 Vocational and Employment Background of Respondents 15 Table 4.2 Duration Until Reversion to Drug Use After TreatmentAmong Those Who Dropped-Out 42Table 2.6 Cannabis Use 17Table 4.3 Frequency of Drug Use at Last Point of ContactTable 2.7 Heroin Use 18 (Drop-out Cases) 45Table 2.8 Main Reasons for Initial Drug Use 20 Table 4.4 Reasons for Drug Use (Drop-Out Cases) 47Table 2.9 Duration of Time Before Realizing Addiction 21 Table 4.5 Employment Status at The First Point of Contact(Drop-out Cases) 48Table 2.10 What Happened After Realizing Addiction 22Table 4.6 Employment Status at The Last Point of ContactTable 2.11 Activities Involved to Support Habit 24 (Drop-out Cases) 49Table 2.12 Distribution of Respondents by Criminal Background 25 Table 5.1 Patterns of Relapse 51Table 2.13 Treatment History 27 Table 5.2 Duration Until Reversion to Drug use After TreatmentAmong Cases Who Relapsed 54Table 3.1 Duration Until First Use After Treatment Among Those WhoReported Any Posttreatment Use Of Each Drug Type 31 Table 5.3 Frequency of Drug Use at the Last Point of Contact / TheLast Point of Use for Cases who Relapsed 56Table 3.2 Frequency of Posttreatment Drug Use of Those Who ReportedAny Drug Use at The Last Point of Known Drug Use 32 Table 5.4 Reasons for Heroin Use (Relapse Cases) 59vi viiPagePageTable 5.5 Employment Status at The Beginning of Follow-UpTable 8.2 Distribution of Respondents by Frequency of Posttreatment(Relapse Cases) 61Alcohol Use 104Table 5.6 Employment Status at The Last Point of ContactTable 8.3 Distribution of Respondents by Time Until Posttreatment(Relapse Cases) 63Cannabis Use 106Table 6.1 Pattern of Partial Relapse 73Table 8.4 Distribution of Respondents by Frequency of PosttreatmentCannabis Uwse 107Table 6.2 Duration Until Reversion to Drug Use After Treatment 75Among Partial Relapse CasesTable 8.5 Distribution of Respondents by Time Until PosttreatmentHeroin Use 108Table 6.3 Frequency of Drug Use at The Last Point of Use for Cases 77Who SlippedTable 8.6 Distribution of Respondents by Frequency of PosttreatmentHeroin Use 109Table 6.4 Reasons for Reversion to Drug Use (Cases Who Slipped) 78 Table 8.7 Distribution of Respondents by Status of Drug UseTable 6.5 Employment Status at The Beginning of Follow-UpPosttreatment and Age 111(Cases Who Slipped) 80 Table 8.8 Distribution of Respondents by Status of Drug UseTable 6.6 Employment Status at The End of Follow-UpPosttreatment and Marital Status 112(Cases Who Slipped) 81 Table 8.9 Distribution of Respondents by Status of Drug UseTable 7.1 Cigarette and Alcohol Use of Abstinence Cases 87Posttreatment and Level of Education Attainment 113Table 7.2 Duration Until Reversion After Treatment 89Table 8.10 Distribution of Respondents by Status of Drug UsePosttreatment and Factors Associated With Their Return toTable 7.3 Abstinence Factors 91Drug Use 114Table 7.4 Employment Status at The Beginning of Follow-Up(Abstinence Cases) 93Table 7.5 Employment Status at The End of Follow-Up(Abstinence Cases) 95Table 8.1 Distribution of Respondents by Time Until PosttreatmentAlcohol Use 103viiiixRINGKASANPengenalanIni adalah satu kajian susulan prospektif ke atas penagih-penagih selepas rawatan danpem~lih~. Tujuan utama ialah untuk mengetahui sarna ada penagih-penagih ini dapatmen~a~1 .dadah atau kembali semula ke daJam perangkap dadah dalam jangmasa yanggentmg 1m dan apa yang berlaku di daJam proses tersebut.MetodologiSeramai 56 orang responden berjaya dihubungi dan 42 orang daripada mereka berjayamenamatkan susulah selama 6 bulan itu. Pengumpulan data terdiri daripada enamtemubual mendalam di mana setiap responden ditemubual setiap bulan selama enambulan. Kaedah ini berbentuk kualitatif.Penemuan-Penemuan••••Kebanyakan mereka yang "slipped", pada awalnya mula minum alkohol keranamengikut mereka, alkohol bukan dadah dan adalah sangat biasa sebagai satubentuk kesukaan dan beristirehat. Sebab mereka "slipped" ialah perasaan bosan.pengaruli. kawan dan keinginan.Kombinasi berbagai faktor sepelii sokongan keluarga yang kuat, menjauhipenagih-penagih dadah atau menjauhi tarikan dadah, bergaul dengan bukan. penagih. kesedaran diri, mempunyai pekerjaan, kecekalan hati dan aktiviti-aktivitibermanfaat untuk memenuhi masa membantu penagih-penagih untuk menjauhidadah.Merokok adalah biasa dan kebanyakan kes kembali merokok dengan cepat.Kebanyakan daripada mereka yang tercicir, yang menagih semula dan yang"slipped" mula menggunakan alkohol tidak lama selepas rawatan.Penemuan-penemuan utama kajian ini adalah: Cadangan••••••Sebilangan besar penagih-penagih tidak dapat dikesan selepas mereka tamatrawatan dan pemulihan.25% tercicir daripada kajian. Khususnya keciciran ini disebabkan olehpenggunaan dadah.39.2% daripada mereka yang dikaji menagih semula sementara 17.9% "slipped".Hanya 17.9% berupaya menjauhi dadah di dalam jangkamasa enam bulan ini.Mereka yang menagih semula boleh dibahagikan kepada dua kumpulan: merekayang kembali menggunakan dadah sebaik sahaja ke1uar dari Pusat Serenti danmereka y~ng ~enggunakan dadah semula beberapa bulan kemudian. iaitu selepascuba menJauhl dadah tetapi gaga!.Sebab utama yang dikenalpasti untuk penagihan semula ialah bergaul dengankawau-kawan penagih, perasaan bosan, keinginan untuk dadah dan tekananemosi.xKeseluruhan program rawatan dan pemulihan perIu dinilai semula. Elemen "coping" danpencegahan penagihan semula perlu digabungkan ke dalam program. Keluarga perludiberi didikan tentang penagihan, pemulihan, pencegahan penagihan semula danbagaimana untuk menguruskan penagih-penagih. Sebelum mereka kembali semula kepangkuan masyarakat, rancangan perIu diatur susun dengan penagih-penagih yang telahpulih dan keluarga mereka. Kerajaan perIu membenteras dan menangani bekalan dadahyang senang diperolehi dengan lebih serius lagi. Menyertai kumpulan bantu-diri, aktiviti-aktiviti rekreasi dan bimbingan daripada bekas-bekas penagih adalah penting.XlSUMMARY OF FINDINGSIntroductionThis is a prospective six months follow·up study on drug addicts after treatment andrehabilitation. The main concern is to find out during this critical period, whether theaddicts were able to stay off drugs or fall back to drugs and what happened during theprocess.MethodologyFifty six respondents were contacted and 42 of them managed to complete the six-monthfollow-up. Data collection consists of six in-depth interviews where the respondentswere interviewed monthly for six months. The approach is mainly qualitative.Findings••••The majority of those who slipped first started to consume alcohol because tothem alcohol is not a drug and is something very common as a form of enjoymentand relaxation. The reasons for their slips were boredom, friend's invitation andcraving.A combination of various factors such as strong family support, avoiding drugaddicts or the temptations, mixing with non-addicts, self-realization, having a job,determination and beneficial activities to fill their time helped the addicts toabstain from drugs.Cigarette smoking is rather common and most of the cases returned to cigarettesmoking rather immediately.Majority of those who dropped-out, relapsed or slipped, started alcohol use soonafter treatment.The major findings in this study were: Recommendations••••••Quite a number of the addicts cannot be traced after completing treatment andrehabilitation.25% dropped-out of the study. The reason for dropping out was mainly due todrug use.39.2% of those follow-up were re-addicted while 17.9% "slipped"Only 17.9% managed to abstain from drugs· during the six months follow~.upperiod.Those who relapsed can be divided into two groups: those who returned to drugsrather immediately after rehabilitation and those who fall back to drug use severalmonths later after attempting to stay away from drugs without success.The main reasons identified for relapse were mixing with addict-friends, boredom,craving for drugs and emotional pressure.xiiThe whole treatment and rehabilitation programme needs to be reviewed. The copingelement and relapse prevention need to be incorporated into the programme. Familiesalso need to be educated about addiction, rehabilitation, relapse prevention and how tohandle the addicts. Plans need to be worked out with the rehabilitated addicts and theirfamily before they return to the larger community. The problem of easy availability ofdrugs must be dealt with seriously by the Government. Joining self-help groups,recreational activities and guidance from senior recovering addicts are important.xiiiCHAPTER 1INTRODUCTION AND BACKGROUND OF STUDY1.1 INTRODUCTIONDrug addiction is a serious problem worldwide and Malaysia is no exception. Althoughwe have ibeen battling with the problem for years, the number of drug dependents in thecountry remains large and drug abuse remains a serious problem.From 1970 till October 1991, the Malaysian Government has registered a total of 159,275addicts, out of which approximately 100,000 are still active addicts (Anti Dadah TaskForce, 1991). Considering the high number of existing active addicts, treatment andrehabilitation plays an important role. Pervasive drug abuse impedes the social economicdevelopment of the country.Drug addiction, drug pushing and trafficking is associated with corruption, increasedcriminal activities, violence, intimidation, prostitution etc. If drug addicts are not treated,the number of addicts will soon multiply and the situation become worse.Since the introduction of institutional rehabilitation in 1975 and from then till December1991, 34,583 drug addicts have undergone institutional rehabilitation (ADTF 1991).However, the number who returns to drugs after treatment and rehabilitation remains ratherhigh. Almost seventy percent of those who can be traced returned to drugs after dischargedfrom treatment centres and the rates for those that cannot be traced were assumed to behigher (Navaratnam et a1. 1989).The major problem in treatment of drug abuse is therefore, preventing relapse once theindividual has ceased using the drug for a period of time. The problem of relapse remainsan important challenge. In order to deal with the problem better and to achieve a morefavourable result of treatment, we need to understand why these individuals went back todrugs after treatment and especially what happened to them after treatment so thattreatment efforts are not wasted.Although we have some knowledge on the relapse rates and causes of relapse, very little isknown about the centrally important issue of what happens to addicts after they leavetreatment. No study have ever been done to follow these addicts to find out what actuallyhappened to them after discharged. Were they able to get stable employment? Did theymanage to stay away from drugs?' What caused them to go back to drugs? If they managedto abstain from drugs, what were the factors that helped them to do so?

Since the introduction of institutional rehabilitation in 1975 and from then till December 1991, 34,583 drug addicts have undergone institutional rehabilitation (ADTF

the Malaysian Government has registered a total of 159,275 addicts, out of which approximately 100,000 are still active addicts (Anti Dadah Task Force,

A Follow-Up Study On Drug Addicts After Treatment And Rehabilitation.

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A Follow-Up Study On Drug Addicts After Treatment And Rehabilitation.

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