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Table of Contents
PERSONAL REFLECTIONS
Year : 2018  |  Volume : 16  |  Issue : 3  |  Page : 283-286

The impact of addiction on Afghan youths


Associated Professor, Department of Psychology, Faculty of Psychology and Educational Sciences, Kabul University, Kabul, Afghanistan

Date of Web Publication30-Nov-2018

Correspondence Address:
Sataruddin Sediqi
Associate Professor, Department of Psychology and Dean of Faculty of Psychology and Educational Sciences, Kabul University, Kabul
Afghanistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INTV.INTV_28_18

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  Abstract 


Drug addiction is a problem in many countries, affecting many lives, damaging the addicted individual and affecting their families and communities. In underdeveloped countries, such as Afghanistan, there are often no appropriate systems for rehabilitating drug addicted people. Most hospitals tend to use detoxification as the main treatment programme, and there remains a large gap between demand and treatment services. In this case study, the author discusses the possibilities for dealing with the various causes of substance abuse and recommends solutions.

Keywords: Adolescent development, childhood adversity, public outreach programmes, substance abuse and culture


How to cite this article:
Sediqi S. The impact of addiction on Afghan youths. Intervention 2018;16:283-6

How to cite this URL:
Sediqi S. The impact of addiction on Afghan youths. Intervention [serial online] 2018 [cited 2018 Dec 13];16:283-6. Available from: http://www.interventionjournal.org/text.asp?2018/16/3/283/246428




  Introduction Top


Drug addiction is a destructive phenomenon, which has existed in different societies since ancient times. There have also been claims of positive effects, as well as adverse, depending on use. Historical evidence suggests that drugs have been used to treat illnesses, relieve pain, eliminate psychological stress, depression and sadness and time to enjoy pleasure. Today, however, use of drugs among people in distress to manage their suffering often leads to addiction, loss of home, family and eventually early death (World Health Organization, 2012).

In Afghanistan today, recent reports indicate that the use of illicit substances is increasing among young people in urban areas (Cottler et al., 2014; United Nations Office of Drugs and Crime, 2017). Although there are some epidemiological studies indicating this increase, studies that seek to understand the origins of the problem and the needs of the sufferers are scarce (Cottler et al., 2014). Afghan government efforts have so far centred on hospital-based medical intervention, with little follow-up (Government of Islamic Republic of Afghanistan (GOIRA) & Ministry of Public Health (MoPH), 2015).

Noting that ideas regarding the possible psychological, social and economic roots of this problem in Afghanistan (in general) and Kabul (in particular) have not so far been published. Therefore, the Faculty of Psychology and Educational Science of Kabul University decided to launch a small exploratory study of homeless substance users in the 6th District of Kabul with the hope that it would yield useful information to follow-up. I was one of the researchers on this study.

We went to an area of the city where homeless substance users congregate to learn whether any would agree to be interviewed on: their life history, source(s) of addiction, attempts to stop and their views of what might be helpful to them. The study yielded 15 interviews or case studies, which are currently being analysed for useful patterns.

In this personal reflection, I have isolated the narrative of one particular youngster whose circumstances I found particularly moving and significant. The narrative reveals a nexus between early parental death, poverty, Afghan traditions, cross-border migration and lack of services in Afghanistan today. After recounting this youngster’s story, I will discuss this single case from a biopsychosocial perspective and will then make some recommendations for psychosocial, economic and educational services that might prevent these tragic circumstances or mitigate their effects in the future.


  Contacting potential participants Top


I had understood that addicts are shunned and persecuted by others in society, not only because they are seen as ‘dirty’, but also because addiction is contrary to Islam, and so, they are generally fearful of harm from outsiders. Not to frighten them, I came into the area informally dressed in traditional men’s clothing that was not new and a shawl to keep warm. The addicts could assume that I was one of them.

After some days in the area, I finally came into contact with potential participants and introduced myself as a professor at the Department of Psychology, Faculty of Psychology and Education Science at the University of Kabul. I explained the purpose of the study, stated that I want to learn from and about them, so that we can try to find better ways to help. I had one in-depth interview with each and took hand written notes. All respondents agreed to participate and understood that there would be no benefit to them from participating.

I used a life course interview approach asking about where they grew up, and how it was that they became addicted and how they came to be living ‘rough’.


  Case of Khan Aqa Top


I became acquainted with a youngster of 18 years that, for the purposes of this article and the study, he has been called Khan Aqa (an alias), with his full consent. He also agreed that his information could be used for an individual case study. Khan grew up in poverty, with his parents and two younger brothers. His father suffered from an untreatable, fatal disease, dying when Khan was 13 years old. His mother was unable to work outside the home because the elders of the family were conservative believers in ‘purdah’, a regional custom that requires the complete seclusion of girls and women after puberty. So, Khan Aqa had from the time his father got sick when he was about 8 years, gone out to work each day with his father, earning what he could as a shoe-shine boy while his father sold goods in the street.

When his father died, as Khan was the oldest male, he was obliged to pay for his father’s funeral expenses and then to serve as the exclusive wage earner for himself, his mother and brothers. At first, he continued working as a shoeshine boy as he had done beside his father, in their old spot. He remembers feeling overwhelmed, terribly sad and very frightened. His father had been his constant companion, now he was alone with all of these responsibilities and no one to share them.

Soon he realised that in addition to his other worries, his income was insufficient. He had not had enough money to pay for his father’s funeral, and so the family had to borrow money. He was then required to earn enough to feed his family, pay the debts and pay rent for the family home. Because of his meagre income, he, his mother and brothers often went hungry. He describes how the debtors came around to the house, threatening Khan and his mother. He was terrified. He asked his family members what to do and they suggested that he go to Iran, where he might be able to earn more, through factory or construction work, so that he could both feed his family and pay off their debts. It took some time for the family to make the arrangements with the smugglers and labour traffickers who arrange for these migrations. He knew he had a large responsibility to fulfil, but hoped that he could manage. He set off on a truck with a large group of other boys. Khan Aqa was fourteen years old.

In Iran, Khan Aqa worked very hard. He sent half of his earnings to his family in Afghanistan and used the rest of the money for his daily expenses, including rent for his room, food and paying the contractors who hired him. He had to work long hours at hard labour and his body often ached. He was under pressure from the supervisor at the worksite to work harder, be more productive or he would be sacked, sent home owing more money still! He felt increasingly frightened and very sad, as he missed his family. He missed his father most of all. He prayed, hoping to hear his father’s comfort and wisdom. The pain did not subside, neither in his body nor in his heart. He began to have difficulty sleeping and had violent, incomprehensible dreams.

He shared a room with a few other boys. One of them saw how he suffered and introduced him to drug taking, suggesting that the drugs would help him to feel better and to work faster. At first, the drugs did help! Using drugs made him feel comfortable and relaxed − relieved his sadness and helped him work more quickly. After some time, he spent almost all of his earnings on drugs, saving less and less to send home. He stopped communicating with his mother and brothers. To be able to afford his habit, and thinking he might get more money to send home, he began to sell drugs.

Six months after his last contact with his family, he was caught selling drugs and was deported from Iran. He returned then to his family, who had borrowed more money and were in terrible straits. Why had he stopped sending money to them? They sent him back to the streets immediately, so that he could help his younger brothers and earn for the family again. Out in the streets, he was miserable, frightened and very sick as he was experiencing withdrawal. Soon he found the drugs he needed to feel better again. At home, he was caught in the act of taking drugs. His mother became very angry but did not throw him out of the house. Instead, she made him swear to Allah that he would never use drugs again. She believed that this would be enough, as she did not really understand that addiction was a disease. It did not occur to her that her son might need treatment.

Khan Aqa could not stop using drugs. Instead, he got involved in a robbery to obtain money to buy drugs and perhaps to get more money for his family. Then he was asked to leave his family home. Sent out alone to live under the bridge with the other addicts, Khan became even more depressed. He stated that he tried to get treatment, but all the (few) available treatment centres for drug addicts were full. He is still waiting on a waiting list for treatment.

I supported him in his search for treatment. For the first time since his father died, he can feel that he is not alone, frustrated and helpless, with no one to turn to. He tells me he is thinking of starting treatment as soon as he is given a place in a treatment programme. However, it seems difficult for him to do this, but at least he is able to discuss his fears with me now. I believe that I have helped him to make the decision to accept treatment and live without using drugs. I believe that, if I assure him that I will be there when he returns, he will take the decision to go when a bed is available.


  Reflections on this case study Top


I chose to present this case study because it illustrates several interlocking and longstanding problems facing Afghanistan today and links them to the crisis of increasing drug addiction. In doing so, it presents the opportunity to make recommendations for change. These problems include cultural traditions, lack of services to poor families who lose a breadwinner, child labour, lack of educational opportunities and services for street working children and economic migration (Cottler et al., 2014; ICF International, 2008; United Nations Office of Drugs and Crime, 2017; World Health Organization, 2012). It also presented me, as a psychologist, with the opportunity to discuss the factors related to child development and psychosocial wellbeing, factors not often included in existing papers on drug addiction in Afghanistan.

The word for adolescence in Afghanistan is ‘nawajawan’ or newly young, and refers to the onset of puberty, with its physical and sexual maturation. At the same time, modern science now tells us that not only does the physical body experience enormous growth in adolescence, but so does the mind. The prefrontal cortex, the part of the brain responsible for logical decision-making, complex thought and reason also experiences a spurt in activity (Kuther, 2017). Socially, people in this age group know that they will soon have to take their place as adults, in this case, in Afghanistan today in an uncertain world. They can become preoccupied with their place in the world, with their ability to grow up successfully, get married, earn a living and, in the case of boys, take on the responsibilities of a man in their society. Their same sex parent, as well as their best friend, take on new importance as they begin to think of an adult future. Their newfound capacity to question, to think independently and to develop new skills and ideas is what makes adolescents the hope for the future of any society (Kuther, 2017; Gupta, 2018).

Khan Aqa loses his father precisely at this developmental moment. His father has been his constant companion and suddenly he is alone, without both his caregiver and best friend, and with all of the family responsibilities on his young shoulders. His mother seems unable to protect him, and his family members simply demand that he take over the responsibilities. Even the funeral is his responsibility. There is no space for him to grieve, to cry, to mourn for this loss with his family. So, he has lost not only his father, his companion in the daily struggle of working in the street, but also his childhood, and any hope he may have had for a future life. Because of these dramatic demands on Khan, we can think of his bereavement and subsequent grief as complicated and traumatic, because they are accompanied by such drastic circumstances. Had the family been inclined to treat him as a child, allow him to grieve and to provide support, he might have been able to overcome the loss, turn to his mother and brothers for support and over time to move forward. Instead, he finds himself alone, bearing adult responsibilities he cannot meet and terrified by the consequences of failure (Layne, Kaplow, Oosterhoff, Hill, & Pynoos, 2017). It is also important to note that these difficulties are exacerbated by the fact that his rapidly growing body is starving, when it needs food the most (Kuther, 2017). He denies any feelings of anger and, typically for an adolescent suffering from complex bereavement, can blame only himself, turning the rage against the others who appear to have failed to protect him in any way, against himself (Paiman & Khan, 2017; Layne et al., 2017). He might have become suicidal at this moment had a way out not appeared, in which he is given to smugglers for illegal underage labour in Iran. We see his adolescent self, having some moments of hope and developmental resilience kick in when he is first sent to Iran, as he imagines being able to succeed there and earn enough to be able to both eat enough and to support his family (Bragin, 2012). However, the circumstances of child and adolescent labourers in Iran is difficult, especially for smuggled and trafficked adolescents, such as Khan, who have no legal rights and no family to protect them (Buil, Vanore, Majididi, Kuschminder, Marchand, & Siegel, 2014).The fact that he then fell victim to drug abuse to ease his physical and mental pain is not surprising. Without any emotional support, it is clear that he had no real way out. However, it appears a hopeful sign that he can accept my outreach and see me as friend.

The psychosocial way forward for this boy is engagement in a comprehensive programme that not only addresses his substance abuse but creates an ongoing group connection with others, so that he can begin to feel human connection again. Outreach to his family is also required, with psychoeducation not only about his addiction, but also about adolescent development. Family counselling might help the extended family to begin to consider whether helping these boys, who have lost their father, to grow into men might be more beneficial than increasing demands. Such a programme would also have to have an economic development component to help, so that families could be able to afford such support.

However, in contemporary Afghanistan, there are few if any comprehensive programmes for adolescents and their families who work in the streets, and little that is done to support families where the wage earner has died. Further, the drug treatment programmes that do exist provide medical treatment only and do not address adolescent developmental needs. This may be due to the lack of public awareness and inter-ministerial coordination that connects the daily life problems of poor Afghans to the problems of substance abuse (GOIRA & MoPH, 2015; United Nations Office of Drugs and Crime, 2017).

Therefore, I am using this case illustration as a ‘jumping off point’ to propose the following comprehensive recommendations.


  Solutions and recommendations Top


  1. The Ministry of Labour, Social Affairs, Martyrs and Disabled should expand programmes to assist the families of children and adolescents working in the streets to ensure that they are available to all who need them. These programmes should include
    1. Provide all street working children with four hours per day of education and outreach to their family members
    2. Work with the Word Food Programme and other such programmes to provide food and cooking oil to street working children who attend school regularly
    3. Provide outreach to families where a street working child has lost the family breadwinner, to assess needs
      • including psychosocial support
    4. Provide home visits and counselling to widows with children who are confined to the home, reach out to family members to encourage opportunities for economic and social development
      • include provision of vocational training for widows in such areas that they can earn money without leaving the home (this can prevent the scourge of forced migration)
    5. Opportunities for adolescents to engage in group activities outside of work and school including sports, recreation and creative arts (such poetry and theatre), so that they can heal
  2. The Ministry of Higher Education should develop counselling centres at all major university centres around the country who have responsibility to promote the following activities:
    1. Create at least one day per academic year to be specified and celebrated as a day of fighting against addiction via conferences, seminars and workshops for students
    2. Conduct public awareness campaigns and programmes on counter-narcotics
    3. Insure that students and their families affected by violence, grief and loss receive group, family and individual counselling, if needed
  3. An Inter-Ministerial Committee on Substance Abuse should be established, made up of Ministry of Public Health; Ministry of Counter Narcotics; Ministry of Labour, Social Affairs, Martyrs and Disabled, Ministry of Interior; Ministry of Education and Ministry of Higher Education for the purpose of making shared decisions regarding substance-abuse-related issues in the country
  4. The Ministry of Public Health and the Ministry of Counter Narcotics should work together with the Ministry of Labour Social Affairs, Martyrs and Disabled to ensure that adequate and comprehensive treatment programmes are available to all people who do become addicted, despite these efforts.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bragin M. (2012). So that our dreams will not escape us: Learning to think together in time of war. Psychoanalytic Inquiry: A Topical Journal for Mental Health Professionals, 32(2), 115-135.  Back to cited text no. 1
    
2.
Buil C., Vanore M., Majididi N., Kuschminder K., Marchand K., Siegel M. (2014). Afghanistan migration profile. Kabul: IOM.  Back to cited text no. 2
    
3.
Cottler L. B., Ajinkya S., Goldberger B. A., Ghani M. A., Martin D. M., Hu H., Gold M. S. (2014). Prevalence of drug and alcohol use in urban Afghanistan: Epidemiological data from the Afghanistan National Urban Drug Use Study (ANUDUS). Lancet Global Health, 2(10), e592-e600. doi:10.1016/S2214-109X(14) 70290-6.  Back to cited text no. 3
    
4.
Government of Islamic Republic of Afghanistan (GOIRA) & Ministry of Public Health (MoPH). (2015). National Health Strategy: 2015–2020.Kabul, Afghanistan: Authors.  Back to cited text no. 4
    
5.
Gupta T. (2018). Psychological management of bereavement among adolescents: A case series. Journal of Indian Association for Child & Adolescent Mental Health, 14(2), 117-127.  Back to cited text no. 5
    
6.
ICF International. (2008). Child labor in Afghanistan: A four province study in Kabul, Kandahar, Nangarhar, and Balkh. Washington DC.  Back to cited text no. 6
    
7.
Kuther T. L. (2017). Lifespan development in context: A topical approach. SAGE Publications.  Back to cited text no. 7
    
8.
Layne C. M., Kaplow J. B., Oosterhoff B., Hill R. M., Pynoos R. S. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7(4), 266-285.  Back to cited text no. 8
    
9.
Paiman M. A., Khan M. M. (2017). Suicide and deliberate self-harm in Afghanistan. Asian Journal of Psychiatry, 26, 29-31.  Back to cited text no. 9
    
10.
United Nations Office of Drugs and Crime. (2017). Afghanistan synthetic drugs situation assessment. Retrieved from: https://www.unodc.org/documents/Reports/2017_Afghanistan_Synthetic_Drugs_Assessment_report.pdf.  Back to cited text no. 10
    
11.
World Health Organization. (2012). resources for the prevention and treatment of substance use disorders. Retrieved from: http://www.who.int/gho/substance_abuse/substance_abuse_indicator_book.pdf  Back to cited text no. 11
    




 

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  In this article
Abstract
Introduction
Contacting poten...
Case of Khan Aqa
Reflections on t...
Solutions and re...
References

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