KARACHI, Aug 2 What started out 10 years ago as a bit of fun has now become the biggest challenge 25-year-old Sobia (name changed to protect privacy) has ever faced in her life. Currently admitted to the KPT/ Karwan-e-Hayat Psychiatric Care and Rehabilitation Centre, Keamari, she is undergoing treatment for drug addiction for the fifth time in three years.

The desire to overcome her addiction notwithstanding, she sees little hope for better prospects.

“I want to quit drugs for good and embark upon a career but my family does not support me,” she says bitterly. “My parents want to kick me out of the house.” While admitting that drugs are part of the problem, she adds that “perhaps my relationships with men irritate them”.

Sobia lives in the upper-class DHA locality and dropped out of school during her O-Levels. The drugs which she has been using for recreational purposes since she was 15-years-old include hashish (charas), Ecstasy, Ketamine, cocaine, Lysergic Acid Diethylamide (known as LSD or 'acid') and various methamphetamines.

Over the past decade or so, the use of these so-called 'recreational drugs' has become relatively common amongst the elite of the city. Once viewed as a problem restricted to the economically-challenged sections of society, substance abuse and drug addiction now appears to be a widespread phenomenon, although the substances in question vary.

“My father drinks alcohol and my brother is also hooked on these drugs,” says Sobia. “I ended up being addicted to them.” The reason, she says, is not only because they are easily available but also because she and others like her command sufficient financial resources. “I never paid for my drugs since I got them from either my brother or friends,” she tells Dawn. “They could buy them quite easily.”

The world of which Sobia speaks is well-known to the Karwan-e-Hayat Centre. While most of the patients there are from lower-income groups, the doctors in the rehabilitation department say that they also get patients from well-to-do areas, and point out that recreational drug abuse is on the rise.

“There is no doubt that children from educated and well-off families are now getting more and more into drugs,” informs Dr Sheema Nadeem, who works at the centre. “Initially, it is the result of peer pressure at parties where such drugs are used openly. These substances — though greatly damaging in the long term — can momentarily provide boundless energy, euphoria and an increased sexual appetite. But the initial high gives way to negative emotional and physical after-effects, so many young people then turn to sedatives and anti-depressants.”

These observations are endorsed by Dr Uzma Ambreen, a psychiatrist who runs a clinic in Clifton. The doctor receives about two dozen cases a month of patients from all over Karachi, who have a history of drug abuse and are aged between 13 and 26 years.

“Initially, the parents of such youngsters come to us citing some other problems,” she explains. “Generally, it is either a decline in school grades or an inexplicable change in behaviour that forces parents to seek medical help for their children. It is during the investigations that we come to know about the use of drugs.”

Usage condoned

Dr Ambreen believes that part of the problem is a shift in societal attitudes, particularly in the upper class, that now condones alcohol and hashish as 'acceptable'. With the use of these substances having been normalised, young people have little reservations about experimenting with higher-class and more dangerous drugs. The choice of drugs appears to depend on economic capacity. “Ecstasy and cocaine are expensive, so their use is restricted to the posh areas; but hashish is cheap and is easily available everywhere,” she observes. “The victims of hard recreational drugs are usually young people in elite co-education schools. Although I do get female patients, they are far fewer in number as compared to males.”

At the Aga Khan University Hospital, Dr Ehsanullah Syed, a child and adolescent psychiatrist, also receives about 10 new cases of teenagers with a drug history every month. “The use of recreational drugs is definitely increasing,” he says. “Eighty per cent of such patients are boys, and the most commonly abused substances include alcohol, hashish — which is usually smoked — and Ecstasy, which comes in the form of pills. Very often, parents remain unaware that their child is taking drugs. Some parents fail to recognise the problem altogether.”

Drug facts

While heroin, cocaine and marijuana fall in the organic category, Ecstasy, methamphetamines, Ketamine and LSD are synthetic drugs which are produced through chemical synthesis. Synthetic drugs are psychoactive substances produced in laboratories, and as with most drugs, sustained usage may give rise to physical dependency or addiction.

Information gathered from various sources suggests that Ecstasy — commonly known as 'E' — is the most commonly used amongst the synthetic drugs. Smuggled into the country and sold by dealers who meet their clients at pre-arranged locations, pure Ecstasy and cocaine are often cut with other substances such as sedatives, in order to increase the dealers' profits. For the end-user, one pill of Ecstasy costs between Rs1,000 and Rs1,200 depending upon the type and quantity of the contaminants.

Cocaine, which resembles a fine white powder, is usually adulterated with substances such as baking powder and one gram of it costs between Rs12,000 and Rs15,000. Ketamine, an anaesthetic used in human and veterinary medicine, is a prescription drug found commonly in drug stores.

“Each drug gives a different sort of high,” says Sobia. “With Ecstasy I feel happy and super-confident while LSD causes hallucinations. These substances give more pleasure when taken with booze. Since I've been taking them for so long, I now have a high tolerance level and have so far not experienced any side-effects.”

Indeed what the users often do not know is that these recreational drugs can cause serious and long-lasting damage. Doctors say that Ecstasy, for example, is in some ways even more damaging than heroin since it can cause sudden death. Taken as it is in the heated atmosphere of a party, it can lead to severe dehydration, high blood pressure and heart or kidney failure. Frequent use of the substance can damage the brain cells and may affect memory. And after the high is over, users often experience depression and find themselves taking more drugs to counteract that.

The physical effects of cocaine include constricted peripheral blood vessels, dilated pupils and increased temperature, heart rate and blood pressure. The duration of cocaine's immediate euphoric effects, which include hyper-stimulation, reduced fatigue and mental clarity, depends on the route of administration.

“With an increasing number of heroin addicts, the trend of consuming recreational drugs among youth of well-to-do families is worrisome. Though the government puts the total number of drug addicts in the country at five million, one can say with confidence that this is pretty much an under-estimation and the actual number must be around 10 million,” says Dr Ajmal Kazmi, who heads the Karwan-e-Hayat centre.

High relapse rate

The relapse rate of substance abuse patients is disturbingly high, sometimes going up to 50 per cent. Most doctors agree that the major reasons for this are the lack of family support, and the lack of motivation on part of the drug user.

“Basically, the factors that led them towards drug abuse and addiction do not change,” Dr Ehsanullah Syed points out. “Patients do not complete the full treatment and fail to report again after some time. In many cases, I feel that parents do cooperate and are truly concerned, which is why they seek help for their children. But there are other social factors at play that are, unfortunately, not under their control.”

According to the doctor, the substance abuse relapse rate at his AKUH clinic is as high as 50 per cent.

“Addiction is a disease,” says Wakeel Ahmed, a drug abuse counsellor at Willing Ways, a health facility that provides help in dealing with addictions of different types. “Drug addiction is no different,” he comments. “Every drug has a different level of addictiveness and the time it takes for a person to get hooked may vary. But once that happens, patients need not just detoxification but also rehabilitation. And that is not possible unless the family is involved. The writ of the family has to be restored and that is why we hold a series of sessions with the family before admitting a patient to the centre.”

Medical experts maintain that in the case of young and educated patients in particular, parents need to be much more involved in and aware of their children's activities. Early warning signals can come in the form of anything from behavioural changes to demands for increased pocket-money. If these danger signs are missed, substance abuse can lead to serious mental and physical damage, and even death by either suicide or accident.