Drug Addiction in Bangladesh: A bird’s eye view

 Drug Addiction in Bangladesh: A bird’s eye view

1. INTRODUCTION 

Many people around us do not understand why individuals become addicted to drugs or how drugs change the brain to foster compulsive drug abuse. They mistakenly view drug abuse and addiction as strictly a social problem and may characterize those who take drugs as morally weak. One very common belief is that drug abusers should be able to just stop taking drugs if they are only willing to change their behavior. But this is not the case in reality. What people often underestimate is the complexity of drug addiction—that it is a disease that impacts the brain and because of that, stopping drug abuse is not simply a matter of willpower of any individual. Due to scientific advances we now know much more about how exactly drugs work in the brain, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and resume their productive lives.

    

Drug abuse and addiction are a major burden to society. Estimates of the total overall costs of drug abuse in the United States—including health- and crime-related costs as well as losses in productivity—exceed half a trillion dollars annually. Though there are no dependable data, yet we may assume that in Bangladesh the over-all total cost of drug abuse is in terms of billion takas. Staggering as these numbers are, however, they do not fully describe the breadth of deleterious public health—and safety—implications, which include family disintegration, loss of employment, failure in school and drop out, domestic violence, child abuse, and other crimes.

2. WHAT ADDICTION MEANS

Addiction is a chronic, often relapsing brain disease that causes compulsive drug seeking and use despite harmful consequences to the individual who is addicted and to those around them. Drug addiction is a brain disease because the abuse of drugs leads to changes in the structure and function of the brain. Although it is true that for most people the initial decision to take drugs is voluntary due to curiosity, peer influence or other reasons, over time the changes in the brain caused by repeated drug abuse can affect a person’s self control and ability to make sound decisions, and at the same time send intense impulses to take drugs.

It is because of these changes in the brain that it is so challenging for a person who is addicted to stop abusing drugs. Fortunately, there are treatments that help people to counteract addiction’s powerful disruptive effects and regain control. Research shows that combining addiction treatment medications, if available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches that are tailored to each patient’s drug abuse patterns and any co-occurring medical, psychiatric, and social problems can lead to sustained recovery and a life without drug abuse.

3. DRUGS AND THE BRAIN:

Drugs are chemicals that tap into the brain’s communication system and disrupt the way nerve cells normally send, receive, and process information. There are at least two ways that drugs are able to do this: (1) by imitating the brain’s natural chemical messengers, and/or (2) by over stimulating the “reward circuit” of the brain.

Some drugs, such as marijuana and heroin, have a similar structure to chemical messengers, called neurotransmitters, which are naturally produced by the brain. Because of this similarity, these drugs are able to “fool” the brain’s receptors and activate nerve cells to send abnormal messages.
Other drugs, such as cocaine or methamphetamine, can cause the nerve cells to release abnormally large amounts of natural neurotransmitters, or prevent the normal recycling of these brain chemicals, which is needed to shut off the signal between neurons. This disruption produces a greatly amplified message that ultimately disrupts normal communication patterns.
Nearly all drugs, directly or indirectly, target the brain’s reward system by flooding the circuit with dopamine. Dopamine is a neurotransmitter present in regions of the brain that control movement, emotion, motivation, and feelings of pleasure. The over stimulation of this system, which normally responds to natural behaviors that are linked to survival (eating, spending time with loved ones, etc.), produces euphoric effects in response to the drugs. This reaction sets in motion a pattern that “teaches” people to repeat the behavior of abusing drugs. 

As a person continues to abuse drugs, the brain adapts to the overwhelming surges in dopamine by producing less dopamine or by reducing the number of dopamine receptors in the reward circuit. As a result, dopamine’s impact on the reward circuit is lessened, reducing the abuser’s ability to enjoy the drugs and the things that previously brought pleasure. This decrease compels those addicted to drugs to keep abusing drugs in order to attempt to bring their dopamine function back to normal. And, they may now require larger amounts of the drug than they first did to achieve the dopamine high—an effect known astolerance. Long-term abuse causes changes in other brain chemical systems and circuits as well. Glutamate is a neurotransmitter that influences the reward circuit and the ability to learn. When the optimal concentration of glutamate is altered by drug abuse, the brain attempts to compensate, which can impair cognitive function. Drugs of abuse facilitate nonconscious (conditioned) learning, which leads the user to experience uncontrollable cravings when they see a place or person they associate with the drug experience, even when the drug itself is not available. Brain imaging studies of drug-addicted individuals show changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Together, these changes can drive an abuser to seek out and take drugs compulsively despite adverse consequences—in other words, to become addicted to drugs.

4. WHY SOME PEOPLE BECOME ADDICTED, WHILE OTHERS DO NOT

No single factor can predict whether or not a person will become addicted to drugs. Risk for addiction is influenced by a person’s biology, social environment, and age or stage of development. The more risk factors an individual has, the greater the chance that taking drugs can lead to addiction. For example:

i) Biology. The genes that people are born with––in combination with environmental influences––account for about half of their addiction vulnerability. Additionally, gender, ethnicity, and the presence of other mental disorders may influence risk for drug abuse and addiction.

ii) Environment. A person’s environment includes many different influences––from family and friends to socioeconomic status and quality of life in general. Factors such as peer pressure, physical and sexual abuse, stress, and parental involvement can greatly influence the course of drug abuse and addiction in a person’s life.

iii) Development. Genetic and environmental factors interact with critical developmental stages in a person’s life to affect addiction vulnerability, and adolescents experience a double challenge. Although taking drugs at any age can lead to addiction, the earlier that drug use begins, the more likely it is to progress to more serious abuse. And because adolescents’ brains are still developing in the areas that govern decisionmaking, judgment, and self-control, they are especially prone to risk-taking behaviors, including trying drugs of abuse.

5. TYPES OF DRUGS FOUND IN BANGLADESH

In different regions of Bangladesh there are many drugs which are in use by the abusers. However there are three main types of drugs available in use in Bangladesh. 

Opium

a) Heroin

b) Phensidyl

c) Tidijesic

d) Pethidine

e) Opium

Cannabis

a) Ganja

b) Chorosh

c) Bhang

Sleeping pill

a) Tranquilizer

b) Seduxene (Diazapam)

6.  DIFFERENT SURVEYS REVEAL SOME FINDINGS WHICH MAY BE PRESENTED AS UNDER

i.  Some generalized opinions of survey respondents-

Most of the respondents of the different surveys expressed that they initially started abusing drugs due to-

·                Curiosity

·                Encouragement from friends

·                Frustration from family matters

·                To get immediate relief from tension

·                Easy availability to drugs

·                Persons from all Occupations: doctors, teachers, students, service-holders, businessmen etc. are victims of drug abuse

      ii.   Reasons for being addicted to drugs-

·                Easy access to drugs

·                Unemployment problem

·                Economic insolvency

·                Surrounding environment

·                Estranged in love

·                Mental stress due to family problem

·                Mental stress from other sources

     iii.   Sources of money for buying drugs-

·                From own income

·                From pocket money

·                Loan from friends or family members

·                Collect money by criminal activities like hijacking, extortion etc.

     iv.   Where from respondents collect drugs-

·                Specific sellers in the locality

·                Drug smugglers in town

·                Houses near border area

·                Drug smugglers in border crossing points

·                Spots beside lanes/roads

      v.   Respondents view on negative effects of drugs-

·                Physical impatience

·                Insomnia

·                Inadequacy in Sense of perception

·                Increased head-ache

·                Feeling dizzy until taking drugs

·                Hallucination syndromes

·                Decreased working capability

·                Decreased mental stability

·                Sexual problem

·                Inability to concentrate

·                Abnormal behavior

·                Loss of humanity and

·                Inability to assess

·                Lack of discipline in daily life

    vi.    Respondents view on behavioral changes of drug abusers

·                Tendency of hijacking

·                Tendency of Extortion

·                Tendency of stealing, robbery

·                Less respect for law and order situation

·                Less respect to elders

·                Increased personal and family expenditure

·                Loss of interest in education

·                Change in morality

7. PREVENTION IS THE KEY

Drug addiction is a preventable disease. Results from research have shown that prevention programs that involve families, schools, communities, and the media are effective in reducing drug abuse. Although many events and cultural factors affect drug abuse trends, when youths perceive drug abuse as harmful, they reduce their drug taking. It is necessary, therefore, to help youth and the general public to understand the risks of drug abuse, and for teachers, parents, and healthcare professionals to keep sending the message that drug addiction can be prevented if a person never abuses drugs.

 i) Prevention Strategies for Schools-

Drugs threaten our nation's youth. The average age of initial drug use has been dropping.  Drug abuse can lead to physical problems, emotional damage, and a decline in educational achievement and productivity. Efforts to fight drug abuse must occur in the schools since they provide a major influence in transmitting values, standards, and information to children. This government should be more focused on the extent of drug abuse among youth, why drug abuse occurs, the effects of drug abuse, what schools can do to combat the problem, prevention programs, what teachers and principals can do, and future needs for drug abuse prevention programs.

Teenage drug use is in the rise in Bangladesh while addiction in poor sections is also spreading wildly.

Metropolitan cities and some other towns of Bangladesh show a steady growth of drug abuse.

ii) Drug Abuse and Its Effects-

Studies show peer pressure plays the largest role in causing children to begin using drugs (Englander-Golden, 1984); Towers, 1987)  Acceptance by peers becomes especially important when children leave high schools and begin college life. At this critical age, "adolescents seem to be either unwilling or unable to successfully resist peer pressure in drug abuse situations" (Englander-Golden, 1984).

Other reasons for taking drugs include the constant exposure to stress from various sources besides frustration or depressive illness leads to drug dependence. Often simple pleasure serves as a motive. The user may feel good after taking drugs but may be unable to enjoy activities such as hobbies and sports.

Drugs produce many effects, including distortion of memory, perceptions, and sensation. For example, cocaine and amphetamines give users a false sense of performing at a high level when on the drug. So-called designer drugs, chemical variations of illegal drugs, have caused brain damage and death (Towers, 1987).

Frequent drug users skip school or arrive late to class. Regular drug users are twice as likely as their classmates to receive low grades. Continued drug use can cause memory gaps and also lead to decreased physical endurance (Wagner, 1984). Marijuana users often develop sinusitis, pharyngitis, bronchitis, and emphysema within a year of beginning use (Wagner, 1984).

Experimenting with drugs, particularly at a young age, often leads to dependence (Towers, 1987). Those dependent on drugs sometimes support their habits by stealing, selling drugs to others, and less solvent females may resent to immoral activities to finance drug taking.

iii) What Schools Can Do -

Early intervention and prevention activities should characterize a school's drug abuse program (Towers, 1987). School administrators should determine the extent of the drug problem within their jurisdiction before initiating a new intervention program. This can be accomplished by an anonymous survey of students and consultation with local law enforcement officials. Collaborative plans should be made with parents, school boards, treatment agencies, and concerned groups within the community to ensure successful programs.

School authorities should be more focus on drug abuse issues. They must develop their internal policies and regulations to deter the drug problem within their jurisdiction including notifying the parents or police. Monitoring measures should be implemented to eliminate drugs from school premises and school functions. A comprehensive drug curriculum from Class-6 through grade 12 is needed. Teachers should receive appropriate training to participate in the program.

School systems generally combine two approaches to preventing drug abuse (Lachance, 1985). One emphasizes discipline - what school personnel should do when drug abuse or peddling is encountered at the school. The other concerns education - instructing students about drugs and helping them develop skills and attitudes that will keep them away from drugs.

iv) What Teachers and Educators Can Do-

Teachers exert a significant influence on students' attitudes, knowledge, and opinions. They can complement a drug abuse awareness program by incorporating drug abuse prevention strategies into their subject at any grade level (Towers, 1987). For example, teachers can structure activities that require students to rethink about the fatal consequence of experimenting with drugs.  This classroom practice will increase the students' ability to say ‘No’ to peer pressure. Office of the DG Narcotics can play a pivotal role by providing prevention ideas that can be incorporated into school awareness programs in both curricula and extra-curricula.

Any teacher who believes a student is abusing drugs should take actions. Signs that may indicate drug abuse include redness around the eyes, dramatically changed appearance such as dirty hair, dilated pupils, reduced motivation, slurred speech, short attention span, changes in school attendance, falling grades, and uncompleted assignments (Towers, 1987; Wagner, 1984). The first step when suspecting drug abuse is to notify the appropriate school committee if one exists. Otherwise, the teacher should express concern to the student and to the parents, citing observed behaviors (Towers, 1987). Students who have been abusing drugs should be referred to professionals for help.

In addition, teachers must inform students that they disapprove of drug abuse (Towers, 1987). Presently most of the teachers remain quiet or at least discusses among themselves when they suspect any drug abuse by any of their students. I am so sorry to accept the fact that I am also not taking up the suspicion cases either to the parents or to the university authorities or the police. I am reluctant to inform the parents as the family reaction may be painful for all the parties. I cannot inform the university authorities as there is no such cell or office to handle or rehabilitate drug addicted students. Informing the police is impossible for me as generally teachers look at their students as sons and daughters. The absence of proactiveness to prevent addictions gives the impression of approval or unconcern. Students should be told that they will be reported to proper authorities if they come to school in possession of drugs or under their influence. But what is very important is to open a unit/cell/office in various educational institutions specially in Dhaka and Chittagong where there are more cases of drug afflicted students. The narcotics department should start initiative or at least start writing to various educational institutions reported to have a sizeable number of drug addicted students.

Intervention strategies must be supported by the school authorities. Head of academic institutions need to provide opportunities for teachers to meet for discussions about drug use and how they can fight the problem. They must inform students and parents that teachers have been authorized to communicate their concern. School authorities should designate professionals to counsel students as and when necessary. Finally, head of schools or somebody authorized by him should follow up with students and/or parents after school personnel have intervened addiction cases.

v) Using Social influence to resist drug abuse-  

As drugs in the long run turns to a social crisis, social influence is the panacea to prevent drug abuse or addiction. Awareness programs that were run 5 years ago do not hold effectiveness now. Awareness programs that focused only on drug information have been shown to be of questionable value. Seminars and workshops are no longer effective enough to arrest this fast-spreading epidemic social disease. Research reviews indicate the two most promising prevention approaches are :

a). The social influences model- it teaches skills to opinion leaders of the society for resisting drug use.

b) The personal and social skills approach expands the social influences model to include skills in problem solving, assertiveness, and conversation as well as strategies for reducing stress.

Both approaches have led to significant reductions in drug abuse. Preliminary evidence suggests these approaches also work to reduce the use of drugs.

"Saying No" may be one example of a drug abuse prevention program that emphasizes teaching students to resist peer pressure by understanding and practicing reasons for not taking drugs. The approach should be targeted to class-8 school students up to the first year of university. This strategic awareness program should use methods such as role modeling, videotaped practice, and assertiveness training to help students learn how to refuse drugs. The Narcotics Department may organize "Just Say No to Drugs" clubs in different educational institutions that are reported to have reported to have substantial number of addicted students. The Dept. of Narcotics should offer booklets, pins, and T-shirts so that the members of the clubs find that the clubs give them a reason and way to say no to drugs. Such initiative of the narcotics department is sure to be sponsored and supported by the corporate houses and affluent sections of the society.

vi)  Future Needs-

It is very unfortunate that still there is an absence of an all out war against this deadly social evil called addiction. Surveys say that as in the case of Pakistan, Myanmar, Thailand, India, Bangladesh is becoming the breeding ground of addiction and drug abuse. Most organizations having addicts do not have any data base about their members who have already fallen victim of addiction. These organizations neither collect information on the awareness programs against drug abuse nor do they organize any awareness programs themselves for their victims. A database is needed about the status of drug abusers in each school, college, university those are under threat of addiction. So that prevention strategies for those individual institutions can be formulated and put to implementation. The prevention models that have shown promise need further research to be used in Bangladesh.

8. FIGHTING DRUG ABUSE

Efforts at fighting drug abuse are dictated by the attitudes of the public and their perceptions of drug's dangers. These attitudes may be framed by personal experience, media portrayals, news events, or drug education. Approaches to combating the drug problem have traditionally focused on reducing both supply and demand.

i) Supply Reduction-

The policy of supply reduction aims to decrease the available amount of a drug and make its cost prohibitively high due to the short supply. One strategy for supply reduction is the passage and enforcement of strict laws that govern the prescribing of narcotic drugs. Other strategies are aimed at disrupting drug trafficking. Other attempts to disrupt the flow of drugs involve the seizure of clandestine labs, arrest and conviction of drug dealers and middlemen, and international efforts to break up drug cartels and organized crime distribution networks. Eradication of crops may be a strategy to reduce supply of drugs. Some attempts at reducing drug production by creating more lucrative markets for nondrug crops in drug-producing areas also have been made.

 ii) Reduction of Demand for Drugs-

Attempts to reduce the demand for drugs mainly involve education and treatment. For the most part, responsibility for education falls to schools and educational institutions and for treatment to local public hospitals or private treatment centers. Other drug laws attempt to reduce the demand for drugs by imposing stiff penalties for drug possession, manufacture, and trafficking. Drug testing in public but it has resulted in increased public awareness.

9. RECOMMENDATIONS 

From surveys it has been found that many people, especially the youths are eager to get rid of drugs. But unfortunately they can hardly find any way out. The departments of narcotics control, police, BDR etc. are only working in sporadic ways in vain to combat this social crisis- addiction. According to the discussion with the concerned people such as drug abusers, guardians, teachers, policemen and related persons in the drug business, it is clear that awareness programs for behavioral modification of the abusers is not enough to check the spread of drug taking and drug trafficking in Bangladesh. Discussing with the concerned people, the following recommendations are presented for consideration to control widespread drug abuse.

Concerned authorities should be reshuffled to create adequate linkage with society and other stake holders. Adequate manpower and equipment should be arranged for the dept. of Narcotics as well as customs, police and other law enforcers involved in drug control. Rewards may be declared for good performers of narcotics control dept, customs, police and other law enforcers but exemplary punishment should be given to the beneficiaries of drug business. It is obvious that, drugs business would fall rapidly if border-crossing areas can be checked properly. Awareness programs should be developed and implemented in thana, upazilla, and district level to inform the public about the fatal consequences of addiction and drug abuse. Leaders of social institutions like schools, colleges, clubs etc. should be involved so that they come forward to build resistance against drugs.

The NGOs can play a great role throughout the country, especially in the awareness and rehabilitation processes. It is observed by many of the addicts that, the rehabilitation procedures and prevailing costs are high and cumbersome. Presently the number of NGOs involved in campaign against drugs are hand count few.

Most of the addicts sought treatment to wipe out the negative effects of drugs.

10. CONCLUSION

When a disease breaks out like an epidemic in all segments of the society, it indicates a social change. Throughout Bangladesh this symptom has been observed. It is not only the youth that are under threat of drugs. Addiction has also grabbed the social leaders. Even the teachers and physicians who are supposed to guide the society are also getting addicted. Law enforcing agencies and other concerned authorities are in most cases either refraining from their job or failing to do it effectively enough to control the crisis. Thus number of addicts is increasing everyday and has total to a few million throughout thecountry. Addicts are found in schools, colleges, universities among teachers, engineers, doctors, lawyers and even in the law enforcers. The number of addicts in medical colleges and hospital areas and some border areas are incredible for valid reasons. This is high in medical college and hospital areas due to the easy availability in the drug stores. Number of addicts is high in border areas due to the availability of smuggled drugs from neighboring countries. Undoubtedly this is not only an awesome situation but an alarming one also.

I believe that the pictures in other cities and towns are more or less the same. Most surveys focuses mainly on the youth and middle class members of the society. But in the last few years, we have observed a massive use of drugs in several towns of the country, almost all of the users were poor. So the condition is severe everywhere in the country. The situation is even worse in some border regions of the country.

Every disease has a cure. We must come out of this one way deadly game. Some ‘entry barriers’ and ‘exit points’ are given in the recommendation. But those are not enough. A more intensive research, action program, and social mobilization are needed. It is also needed to strengthen family and social values and religious ethics in order to maintain a stable and drug-free society.

We believe that there is a lot to do to stop this social malaise now before another dangerous symptom appears which is AIDS.