University of California
Type of paper: Thesis/Dissertation Chapter
Drug Abuse and Treatment Centers in Afghanistan
The issue of narcotic drugs production and consumption is worsening in Afghanistan which threatens the security and hinders the development. Afghanistan as the largest opium-producing country in the world produces 94% of the world’s opiates and thus has 920,000 illicit drug users. Ministry of Counter Narcotics (MCN) and many other major organizations such as International Narcotics and Law Enforcement Affairs (INL), UNODC and Colombo Plan aim to eliminate opium and illicit drugs’ cultivation, production, trafficking and addiction in Afghanistan through different programs.
As an example, INL has taken actions to decrease drug demand by establishing treatment centers in many provinces of Afghanistan. Specifically, this paper aims to analyze interventions in drug addicts’ lives by Nejat as a male and Sanga Amaj as a female drug treatment center from an ethical point of view. Throughout the intervention, these two centers have overlooked issues related to women, social stigmatization and problems of forced treatment.
Despite its deficiencies, intervention by Nejat and Sanga Amaj significantly contributes to drug abusers’ human rights and also the security and development of Afghanistan and thus benefits both individuals and the society. First of all, Sanga Amaj and Nejat promote the Human Right to Health by providing access to drug treatment and also aiming to decrease and prevent negative health consequences of drug abuse. Right to health is the economic, social and cultural right of everyone to the highest attainable standard of mental and physical health.
Sanga Amaj and Nejat help drug users to lead healthy lives by decreasing the “mental and physical health problems,” that drug usage poses to their lives. HIV Aids, Hepatitis B, social exclusion and suicides among drug users are some of the main examples of physical and psychological harms of drug usage mainly among injecting addicts. According to an HIV report in Afghanistan, “almost all the known cases of HIV infection in Afghanistan today are due to injecting drug use”, thus drug use treatment will save a great number of injecting drug users’ lives.
Besides, treating drug users, a socially excluded and marginalized group affected by drug addiction, and bringing them back to live ‘normal’ and healthy lives in their societies like everyone else help them overcome the psychological problems posed by addiction. Usually, drug abusers live in hostile and unclean places like under bridges and garbage piles that are unhealthy habitats and cause varieties of other diseases especially caused by bacteria.
By providing treatment facilities to drug abusers and thus eliminating and preventing all these health disadvantages, Sanga Amaj and Nejat support health well-being of the society overall. Secondly, Sanga Amaj and Nejat contribute to promote the security in individuals’ lives which promotes the security of everyone and of the country. The diseases that develop in relation to drug abuse (HIV, Hepatitis and other diseases including mental disorders) are all a threat not only in drugs users’ lives but also to individual, national and human health and financial security.
Besides, according to studies, drug consumption causes “poverty, violence and criminal behavior” in a certain society which poses severe economical and social insecurity not only to drug users’ lives but also their families and the society. Many road and domestic accidents, drug crimes, and death because of overdose are due to drug usage. Such as, it is common that drug abusers commit crimes such as they steal money for buying drugs. Besides, insecurity and disorder due to drug trafficking and crimes becomes the bases for corruption, insecurity and illegal drug smuggling and poverty in society which affects everyone.
Thus, these treatment centers’ intervention promotes the protection of drug users’ rights by facilitating treatment and preventing them from these crimes while leading them to health, social and economical security. Nejat and Sanga Amaj also add to human resources and productivity and play a positive role for the development of drug abusers and other citizens’ lives and thus for a sustainable development of Afghanistan. First of all, intervention in drug abusers’ lives causes them to lead much more productive lives than before because drug abusers are unproductive both in school and labor.
Drug abuse “incurs social costs in the form of loss of productivity and family income, violence, security problems, traffic and workplace accidents, and links with corruption” and loss of productivity and corruption affects the development of a country and its all citizens negatively. “Much HIV-related mortality occurs in adults in their productive age”, which causes loss in an individual’s life, and also the prosperity of their families, and the country.
When drug users get treatment, they go in societies and lead much more productive lives which not only benefit them but also the society and its other citizens. Thus, by decreasing drug usage, a harmful factor of drugs users’ lives and also of the society and thus decreasing the level of health issues, violence, crimes and poverty, Sanga Amaj and Nejat are actually promoting the well being of the citizens as human beings and leads them and their societies to development. In addition to all these, treatment centers, specifically, Sanga Amaj highly contributes in promoting children’s rights. 0,000 of this drug-abusing populace are children who are usually born from or breastfed by addicted mothers, get addicted due to second hand smoke in families with addicted members, or are given opium or drugs directly for ailments or more working hours.
As a doctor states, “If a child cries, they give him opium, if he can’t sleep, they use opium, if an infant coughs, opium,” a child is fed opium frequently which makes them addicted. These children while growing up then have to find a way to get opium or drugs. It usually leads them to crimes, such as, stealing at an early age, or leads them to being abused, especially sexual abuse.
A great number of drug addicts sell their bodies or work as prostitutes to get money. For example, many male children become “dancing boys” who usually dance in front of men and are used by them for sexual purposes and thus get little money or drugs in return. It increases sexual slavery of children, social crimes against them and also exploits their lives and thus deepens the issue even more. Sanga Amaj as a children’s treatment center provides treatment facilities which help in promoting children’s rights to healthy and ‘normal’ lives.
It plays a good role in preventing the devastating consequences of child drug abuse and thus has a big hand in supporting children’s rights. On the other hand, not only the treatment facilities available for drug users are insufficient compared to the level of drug consumption but also it is unevenly distributed between men and women and also different provinces. According to DW report of 2013, around 1. 3 million of population in Afghanistan is addicted to drugs. The existent services are adequate for only 10,000 addicts every year so the remainder of the addicts do not have access to treatment facilities.
The drug abusers without services are mainly women who have only 2 treatment centers around the country and the drug users in provinces without centers as most of the centers are located in Kabul while some provinces do not have even one. For example, Sanga Amaj as one of the only two women’s residential treatment centers among the 40 treatment centers overall has 20 beds while Nejat as one of the many treatment centers for male drug users provides structured treatment with 50 beds available . Thus, as though Sanga Amaj has successfully treated 400 women with having only 15 relapses, it is much less compared to the number of women drug users.
Additionally, these treatment centers are located only in some main provinces such as Kabul while leaving other provinces without centers. This proportion of facilities has created an uneven distribution of facilities among people in different provinces and also among male and female drug abusers. Traditional drug treatment programs have been designed to treat male addicts and fail to address the needs of women leading to inequity. Basically, 120,000 of the drug users in Afghanistan are women which might be less than the real number as most of them are reluctant to reveal their addiction.
As UNODC reports, “Drug use among women and children is extremely difficult to estimate in Afghan society as it is easier to conceal and most often occurs in the home”, women make a big part of this populace but have remained invisible. Besides, most addicted women are from rural areas where they “consume opium on a regular basis to cure their illnesses” while the only two residential treatment centers available for them are located in big cities, leaving out women in the rest of 34 provinces demanding treatment.
Men have more treatment centers than women though it is easier for them to travel from one province to another and despite the fact that many women are not addicted by their choice. They are forced by members of family, especially by husbands, and thus do not have the autonomy to decide about their addiction or undergoing treatment. As Shinkai Zahin claims, “Woman addicts were ignored by both the Afghan government and international donors,” women’s needs have been overlooked.
As every woman, man, youth and child has the equal human right to the highest attainable standard of physical and mental health, at this point women drug users’ right to health is undermined by discrimination. The social stigma of drug abuse creates an environment where society overlooks the external reasons of drug addiction and instead blames and ill-treats the drug abusers and leads to forced treatments. Initially, drug usage is considered disgraceful and drug users as the ones who perform this shameful act are degraded though it is usually unemployment, poverty, sickness, depression, violence, migration, imprisonment, etc. hat leads to addiction. Putting all the blame on the drug abusers leads to their ill treatment, being marginalized and negative psychological effects. Therefore, drug usage turns into “shameful secret” for drug users and they are socially condemned such as many of drug users especially male are beaten and sometimes they are forcefully imprisoned or brought to treatment centers. As “The right to health is an inclusive right” and “contains freedom”, forced treatment which is against a drug users’ will is a form of degradation and violates his/her right of decision-making.
Moreover, the treatment process is a difficult, painful and cruel process and sometimes drug abusers are dehumanized during the process. Treatment includes withdrawal effects and drug detoxification which is extremely painful and if the clients resist, they are tied to beds for hours to days. Sometimes, drug users who cannot endure these pains die during the treatment, try to commit suicide or run away. These cases are against the key aspects of Right to Health defined by the UN high commissioner that right to health should be free from non-consensual medical treatment, torture and other cruel, inhumane or degrading treatment or punishment.
Some drug users claim that forced treatment violates their liberty and forces them to quit, deal with the withdrawal, and give up what they call “the intense feeling of pleasure”. A former heroin addict states, “The War on Drugs isn’t a “War on Drugs”, it’s a war on personal liberty and a war on one’s ownership of their body”, so forcing treatment is degrading them and their human rights. Therefore, considering drug usage a crime or shameful act and thus enforcing treatment on unwilling drug abusers cannot be justified based on their individual human rights.
To conclude, Sanga Amaj and Nejat as two major treatment centers benefits drug users and Afghanistan in many ways through their intervention in drug users’ lives. It ensures their human right to health, security and development and also children’s rights in many ways. Thus, it advantages not only the drug users but also their societies. Besides, though the treatment facilities provided is not sufficient and also is unevenly distributed among places and genders, based on cost-benefit analysis their intervention still is justified as it does more good than harm.
Having less or insufficient treatment facilities is better than not having at all and in the same way treating some women is better than none. Instead, ending the social stereotypes about drug users and also men and women, and also preventing forced treatments while providing more counseling can make the intervention more sufficient. Besides, building more centers for females and rural areas is a better way to maintain equality.