The rehab trap

Nischal Niraula delves beyond the needles, pins and powder as he looks into the lives of recovering drug users, whose intentions are to kick the habit, but sadly it’s easier said than done

Sandeep (name changed on request) wakes up with what he describes as “a pleasant hangover” from excessive use of drugs the previous day — his head and body feathery light, so light that his feet refuse to support the weight of his body when he tries stepping out of bed. “My feet wobble as I collapse to the floor making myself laugh in the process,” he laughs as he recalls the absurd scenario.He then proceeds to light up a cigarette, or preferably marijuana if he happens to have some, while enjoying TV comfortably in his couch.However, as the day progresses, the toxins start getting flushed out his body putting him in a state of unease. That’s when he starts getting drenched in his own sweat, suffers a runny nose along with teary eyes. Then he gets nauseous and starts vomiting while also suffering from acute diarrhoea — symptoms of what he calls withdrawals.He takes a fix every time he has enough money (Rs 1,200 to Rs 1,600) for the same.“During withdrawals, all your orifices start flowing with fluids with just your ears being the exception,” he shares.Sandeep, 28, has been injecting a mix of phenergan, diazepam and norphine for about 12 years now.Struggle for salvationSandeep realises the grave aftermaths of excessive drug use. “I know I am hurting myself physically and mentally while crushing my family emotionally,” he admits. But “now, the drugs have become more of a need than a want”.He wishes to end his drug use and move on with his life as a functional member of society but it’s easier said than done.According to Prem Dhital, Psychiatrist at the Upkar Rehabilitation Centre, Dhakaltar such chronic users don’t necessarily use their choice of drug for mere pleasure, but do so because their body craves the chemicals.“The textbook definition of addiction is the unwanted use of drugs. Such users continue using drugs to avoid withdrawals,” continues Dhital, “Withdrawals can be extremely painful on all three levels — physical, psychological and emotional.”Withdrawls can last for about a month depending on the choice of drug, frequency of use and dosage.As per Dhital, it’s the fear of withdrawals that often keeps users from quitting drugs for good. To tackle withdrawal problems faced by their clients, the centre has hired Dr Suresh Gautam, who provides alternative medications to users providing them the needed relief during their sick phases.“Some scream in anguish, some faint and some go into vivid hallucinations,” illustrates Dr Gautam.“We’ve seen our clients bantering like madmen.”The healing procedure commences with a rescue operation whereby the users are picked in a van (without their consent or knowledge) and taken into the centre after receiving a letter of consent from the user’s parents. The user (referred to as ‘client’ by rehabilitation centres) is then detoxified using alternative medicines like lorazepam, diazepam and clonazepam among others. The detoxification period varies as per the user’s choice of chemical, frequency of usage and the amount of dosage.After clearing out the toxins, clients are provided counselling where the psychologist discusses the issues that might be triggering the client to use drugs.He adds that reminding their clients about the times they made their parents cry often brings tears to their eyes because at the end of the day, they’re human like us. Work therapy follows the counselling phase. The clients are given basic tasks such as kitchen duties or gardening aimed towards educating them on importance of work and time. If the client wishes, they can also indulge in training sessions such as aluminium wielding or lighting.According to Pravin Shiwakoti, Managing Director of Upkar, such trainings make their clients independent.“While we don’t yet have the provision to train them for a high-skilled job, we are trying our best to make our clients self-dependent trying to enlist them into the workforce,” he shares.Then, the psychologist listens to the family’s perspective. The psychologist sits together with the client and their family where the client confesses to their misdeeds seeking forgiveness.“The meeting can be emotionally draining for both clients and their families. The confession stage helps rekindle the loving parent-child bond,” shares Dhital. “Despite the anger, your heart is bound to melt if your child confesses to his/her wrongdoings with teary eyes.”These are the typical steps followed by a rehabilitation centre to straighten their clients, but do they actually work? A recovering addict Charlie (name changed on request) in his early 30s has a mixed opinion regarding the issue. According to Charlie who has been in rehabs about 10 times now, the rehab centre is a transit point rather than the destination for a recovering addict.“If you genuinely want to get clean, you need to ensure that the first time you go to a rehab will be your last,” advises Charlie. “In a rehab, you get acquainted with all kinds of users. You may be a brown sugar user, but meeting an intravenous (IV) addict might open your mind to different drugs.”While most of the rehab centres preach love and care treatment devoid of torture, both Charlie and Sandeep claim to have been subjected to torments. “In one of the rehabs, we had an isolation box which is roughly the size of a dog kennel. I was shoved inside the box along with seven other people which was utterly painful and suffocating,” recalls Charlie.“I was made to dig a hole of my size using a spoon and fork,” shares Sandeep. In another instance, Sandeep’s punishment entailed him to fill a bucket with water using nothing but a spoon.Sandeep and Charlie unanimously believe that rehab centres in Nepal are money oriented with minimal focus on the welfare of the users.“Here, the rehabs use fear to leash the addicts,” opines Sandeep.The severity of the issue can be realised looking at the figures. As per Basanta Kunwar, Executive Director and South East Asian Coordinator of Narconon International, there are about 200,000- 250,000 narcotic users in Nepal and the number is increasing by 25,000 every year. Kunwar states that there are about 150 rehabilitation centres in the nation and they are able to accommodate a total of 4,000 inmates at a time.“There are certain approaches to treatments in rehabilitation centres such as the Narcotic Anonymous approach, the spiritual approach and holistic approach among others,” informs Kunwar, “There are only a few rehabs here that apply such standard programmes to treat their clients.”It is due to lack of proper application that makes people operating the rehab centres to resort to tortures with mundane tasks to keep clients occupied. While Kunwar condemns the use of such torture on users, he acknowledges that sometimes the fits thrown by the clients could provoke operators to use force which might come off as torture. He shares that such users are unable to confront members of society due to lack of self-esteem and self-worth and end up blaming the society rather than rectifying their errors.There also exists a severe lack of government intervention when it comes to rehabilitating users. “To mitigate the problem of drug addiction amongst the youth, you can prevent the youth from using drugs, rehabilitate the current users, or catch the drug dealers,” continues Kunwar, “However, our government’s focus is incriminating the dealers rather than prevention or rehabilitation.”