Reasons for Using An Integrative Approach to Addiction Problem in Afghanistan

Esmael Darman

M.D., M.S., Clinical & Counseling Psychology

January, 2010

Reading about drug and alcohol addiction has always amazed me. A sense of curiosity during my adolescence and the prevalence of drug addiction in my country and its socio-economic, socio-cultural, and negative health-related impact on the contemporary Afghanistan have been one of my concerns as I entered the medical field. It was during that period that I realized that drug addiction was simply a universal plight, affecting all societies, races, and the majorities and minorities in one way or another. Even the stigma attached to drug addiction looks relatively worldwide.

Fortunately, however, we now have a huge amount of information regarding drug addiction and its related problems thanks to a variety of studies and the extensive data that have been collected on the subject so far. These comprehensive data also indicate the complexity of drug addiction and its implications and consequences.

Apart from its universality, drug addiction appears to impinge on all aspects of a person’s life and the systems he or she is connected with.  As a result, researchers have not only focused their efforts on collecting data about the type of drug/drugs used among different populations and the biological effects of using or being dependent on drugs, but they have also tried to shed more light on social, economic, and even cultural effects of drug addiction throughout life span and from one generation to another. For instance, we now know that using drugs bring changes, sometimes permanently, to the neurotransmitter levels, by over-bombarding the brain’s reward neurochemical system, the pleasure, gratification, and relief mechanisms, and by sidelining the body’s normal levels of endorphins. Some studies have also implicated genes as one of the major factors behind substance abuse and dependence.

A medical approach to drug addiction has also resulted in developing some treatment strategies and introduction of some medications, for example Methadone. Nevertheless, a growing need to address a wider range of addiction-related problems, a DSM introduction that has described addiction as a chronic, relapsing disorder, the increasing number of people with substance abuse and dependence disorders, and several other major issues have forced the health systems in a large number of countries, especially in the United States, to develop other therapeutic measures looking from a continuing care perspective, taking into account the comorbid psychiatric and medical problems more seriously, assessing patients in a more systematic manner, and introducing other treatment methods such as cognitive-behavioral therapy, marital and family therapies, behavioral couples therapy, AA, network therapy, etc, in a bid to offer better, more effective services.

An Afghan drug user

These treatment methods can be promising in the long run and I believe an integrative approach will obviously be more successful compared to any one of the treatment methods used alone. However, I think the application of such approaches in a different setting, i.e. in a country like Afghanistan, which is the largest opium producer in the world with populations having much lower socio-economic status and healthcare system, requires cross-cultural studies to reveal some important aspects of the problem in that country. For example, Edward Khantzian’s notion, which indicates that the selection of drugs among addicts is not random as it is the result of an interaction between the psychopharmacologic action of the drug and the dominant painful feelings with which they struggle, makes me think about the difference between drug selection in the United States and Afghanistan. For instance, cocaine and methamphetamines are widely used in the U.S., while heroin and opium are popular among Afghan drug addicts.

It seems that a surge in instances of drug addiction over the past one or two decades in Afghanistan has a direct connection with the war and trauma and the drug-dependent individuals use opium and heroin for their “powerful muting action” to prevent further frustration, pain, and aggression. Recently, there has also been an increasing tendency toward using even more purified forms of opium. Therefore, I think the drug problem in Afghanistan clearly requires some large-scale studies, but the amount of data acquired so far in the U.S. and some other countries will help such a project to a large extent.

Photo: Firouz Mashouf (