Alcoholics Anonymous

Imaduddin Ahmed | The Friday Times

Sadaqat clinics fill a neglected niche in the medical world

“Why are you running ads on curing alcoholism when alcohol is banned in the Land of the Pure,” wrote in one inquisitive reader. Why indeed? I decide to set up an appointment with Dr Sadaqat Ali, project director of the Sadaqat Clinic, to find out.

I am invited to the flagship institution of Sadaqat Clinic, Willing Ways, in Gulberg, Lahore. Formally dressed and sitting in an upright manner, Dr Sadaqat looks every bit the sober professional. And it appears that the impression has truth to it. Apparently Dr Sadaqat doesn’t drink himself: “I’ve never tasted alcohol. I never had an ambition to. I think it is a drug and I will take it when a doctor proscribes it.”

I’ve been impressed by the courage to advertise treatment for something that is supposedly a taboo in society. Is it driven by a desire to see a more open society? Dr Sadaqat laughs and tells me that alcohol consumption is hardly ever punished by the state; that it is easily obtainable from non-Muslim bootleggers and that patients never come to him apprehensive that they will be caught for drinking or abusing other drugs. Nor does he feel strongly that prohibition should be lifted: “Alcohol is alcohol, whether it comes from Murree Brewery or it is imported,” he says, “I don’t mind about it being legalised, but awareness should be raised that it is not a good way to alleviate anxieties.”

Dr Sadaqat’s transition from general practice to treating addicts came during the Mujahideen war against the USSR, at a time when Professor Alfred McCoy of the University of Wisconsin-Madison states that Pakistani intelligence operated hundreds of heroin laboratories. The UN Drug Programme estimated that Pakistan’s heroin addicted population exploded from negligible in 1979 to 1.3 million by 1985.

It was in this setting, in 1980, that a friend who could not afford to go abroad for treatment, or find a willing specialist to treat his addiction within Pakistan, pleaded with Dr Sadaqat to treat him. The Dow Medical College graduate followed his “common sense” and detoxified his friend by keeping him in isolation in his own house for 15 days. Delighted with his success – his friend never relapsed – Dr Sadaqat related the story in his column in the Pakistan Times in an article titled ‘Heroin addiction is spreading like a Jungle Fire.’ The rest, as they say, is history. Dr Sadaqat got more requests from friends and family of drug addicts and started restructuring his practice in Shadbagh, Lahore. Due to demand, Sadaqat clinics opened up in Karachi and Murree and now the Sadaqat clinics collectively treat at least 90 patients at any one time.

In 1991, Dr Sadaqat was invited to share his experiences at the Hazelden Graduate School of Addiction Studies in Minnesota, a leading research institute in the field, where he then enrolled in an 18 month training programme and earned his diploma in addiction psychiatry. The methodology used subsequently in Sadaqat clinics is based on the ‘Minnesota model’ and Dr Sadaqat personally trains all the doctors, psychiatrists and psychologists employed in his clinics.

Patients will take residency in the clinic for an average of three months, are withdrawn from their drug of choice and administered substitutes by doctors if needed, go through group therapy and follow a 12 step programme in which they acknowledge they have a problem – the hallmark of the treatment – receive personal counselling, listen to lectures and are encouraged to take up yoga and go for walks in the evenings. Meanwhile the patient’s family is also counselled.

The biggest hurdle to getting treatment, Dr Sadaqat explains, is unwillingness on the patient’s part: not for fear of being caught, but denial that he has a problem or that he can solve the problem by himself. About 90% of the patients in his clinics are brought in by their families. He believes that family support is vital to the rehabilitation of an addict and advocates “tough-love” the clinic counsels families on how to prepare their loved-ones for admission into the hospital. Once the patient has been brought in, he will sign an agreement stating that he consents to admission and that if later he wants to leave, he shouldnn’t be allowed to.

Almost all Sadaqat clinics patients are Muslim and over 90% are men, 30-60 years of age from highly educated and elite backgrounds. Dr Sadaqat says that a lot of alcoholics are “top-notch achievers” bureaucrats, businessmen “who know the pleasure of success” and turn to alcohol. This latter demographic is a function of the cost of treatment at the clinics: they don’t do pro-bono cases and the treatment for three months of a middle class patient at the Lahore Sabzbagh Clinic is about Rs 90,000, including meals, room and medicines. Treatment at the flagship Lahore Willing Ways clinic, which only employs postgraduate doctors, psychiatrists and psychologists, is a lot more expensive, but Dr Sadaqat isn’t willing to disclose the exact cost. He says alcoholics in his clinics tend to be older than heroin addicts, mostly men aged between 15-30, and who are yet to achieve glory.

Dr Sadaqat claims the typical success rate of treatment centres that follow the Minnesota model: roughly 50% of patients stay sober after their first treatment and 25% more stay sober after multiple treatments. 25%, on the other hand, will continue to relapse into their addiction.

Estimates put the number of drug addicts in Pakistan at around 4-5 million, many of whom are without family support or the financial resources to pay for services offered by the Sadaqat clinics. But if the clinics are only treating 90 patients at any one time, I’m sure that there’s a good number of people who can afford his services and have the family support to back the patient. The question we should really be asking then is: why aren’t there more privately run addiction centres in Pakistan?

Alcoholism

Between 40% and 60% of alcoholism cases are related to genetic factors
Between 10-20% male drinkers abuse alcohol
The risk for alcoholism in sons of alcoholic fathers is 25% n Alcoholism reduces life expectancy by 10 to 12 years
About 10% to 35% of heavy drinkers develop alcoholic hepatitis
Even when people with alcoholism experience withdrawal symptoms, they nearly always deny the problem, leaving it to relatives to take the first steps towards encouraging treatment. Denial may be an important warning signal for alcoholism
– Excerpted from Reuters Health

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