x Abu Dhabi, UAESaturday 22 July 2017

On the road back home

The National Rehabilitation Centre offers those with drug and alcohol problems a chance to transform their lives. Helena Frith Powell reports on how a new facility is helping the fight against addiction in the UAE.

Storm before the calm: detoxification process takes between 10 and 12 days.
Storm before the calm: detoxification process takes between 10 and 12 days.

The National Rehabilitation Centre offers those with drug and alcohol problems a chance to transform their lives. The new facility is helping the fight against addiction in the UAE. Hidden away behind a bakery somewhere in uptown Abu Dhabi is a building where some 20 men are quite open about their addiction to drugs and alcohol. As you approach the five-storey building, you begin to realise this is not just another office block. There is something mysterious about the silver facade. If you get within a 2 metre radius of it, a mirrored sliding hatch magically opens, almost before you even know it is there. A security guard demands to know your business and you have to surrender your ID before you are let in. The windows are all mirrors, the walls around the complex high and made of thick perspex, making it impossible to see in. The windows are barred, but rather decoratively barred, giving the place the feel more of a hotel than a hospital. If you happen to ask one of the staff members what they do there, you'll be hard pressed to get an answer. The National Rehabilitation Centre likes to keep a low profile.

It was founded in 2002 by the late Sheikh Zayed bin Sultan Al Nahyan to help the nation's addicts overcome their addictions and reintegrate into society. Since its inception it has treated 230 patients, with a success rate of around 35 per cent, close to the global average. Now it is stepping up a notch. There is a recruitment drive to attract the best doctors, researchers and psychiatrists from all over the world. A Dh250 million budget for the new centre has just been approved. It will consist of a beautifully designed dome-shaped building containing 200 rooms with en-suite bathrooms. Outside there will be landscaped gardens with fountains and places to sit in the shade. There are even plans for a swimming pool. It is scheduled for completion in 2011.

"It is a resort-style facility," explains Dr Hisham Elarabi, head of health education, research and studies at the NRC. "Our aim is to give it a non-punitive feel." Instead of being thrown in jail, patients here have their debts restructured and an all-encompassing rehab programme that includes a personal fitness trainer, acupuncture and English lessons. At the moment all this takes place in the existing NRC building which, although not a patch on the proposed one, is still not a bad place to live.

"We provide five-star accommodation," says Dr Hamad Al Ghaferi, director general of the NRC. Patients' meals are prepared by an upmarket caterer and their laundry is collected on a daily basis by a local dry- cleaning company. They all have their own bedroom and most have en-suite bathrooms. There is even a VIP section. Is one of these criteria that they have to be nationals?, I ask Dr Elarabi. "No, technically we would look after any individual who is happy to receive treatment," he says. "But I don't want to give the impression that a good way to get rid of your problems is to walk into the NRC with a bottle of beer in hand. And locals do take priority."

Because nationals take priority, there are currently no expats being treated at the NRC, although there is demand. "When I was at an embassy function the other day they asked me if they could send a patient over," says Dr Al Ghaferi. "Of course, I said we would meet him - we are a humanitarian organisation - but we don't have the room." This is one of the reasons for the new facility. Although there are no statistics available in the UAE, since its inception the centre has seen a steady increase in demand. Are there more addicts now? Or perhaps more awareness of the centre and what it offers?

"We're not sure what the reason is," says Dr Al Ghaferi, "but the problem is growing. Sheikh Zayed saw this. He was a man who was in touch with his people. He saw that there was a problem that needed addressing and acted on it. The centre was directly linked to the presidential office and so has enjoyed huge support right from the beginning." It needs huge support. If you were to go to the UK or US equivalent for treatment it would cost around $30,000 a month. Here in Abu Dhabi, as Masud Hassan, a nurse at the NRC, puts it, "everything is covered under the state health care scheme."

Dr Al Ghaferi is reluctant to be drawn on the exact cost of rehabilitating a patient but concedes that "it is a lot" and stresses that he is extremely grateful for the continued support of the NRC by Sheikh Mohammed bin Zayed, Crown Prince of Abu Dhabi, and the follow-up work of Sheikh Mansour bin Zayed. A typical patient's room at the NRC. While the greatest challenge facing most hospitals is funding, the NRC is able to focus on its patients. The greatest challenge comes at the end of the rehabilitation process, when its patients try to find work. There are not many companies that want to risk taking on a former addict. They are worried about a relapse, among other things. "In addition, a lot of our patients are school drop-outs who have been using drugs for 10 years," says Dr Elarabi. "Neither of which looks great on your CV." Both he and Dr Al Ghaferi describe finding employment for patients as increasingly difficult. "We need to create awareness among organisations that there are patients who need their help and raise awareness of their social responsibility," says Dr Elarabi.

Dr Al Ghaferi stresses the importance of patients finding work. "If they don't we may lose them," he says. "Work is not only a means of supporting themselves but also crucial to their self-esteem." Without a job, the likelihood of a recovering addict relapsing is much greater, although Dr Elarabi says relapse is common. "Addiction is a chronic disease like diabetes and hypertension and there will be relapses. Few things in the world are sure, but relapses are and so are taxes, at least in some parts of the world."

To lessen the risk of relapses, NRC patients are not simply thrown into the outside world once they have been through the treatment process. Their exposure to real life begins slowly with carefully monitored visits to friends and family before they move to a halfway house where they get used to relying on themselves again and living alone. Some might argue that if you take drugs or become an alcoholic you have only yourself to blame, and they ask why the state should pay thousands of dirhams to wean you off. For example, can you compare a patient who has cancer with a person who is ill due to something he or she has voluntarily taken?

"Even though drug addiction is a choice, we believe it is a disorder choice," says Dr Elarabi. "Yes it is a choice to go and drink but we firmly believe that data supports the theory that these are choices affected by cultural or genetic aspects. If you look at the Chinese, they have a gene deficiency which means they have a lower level of tolerance to alcohol than other races, which means they can't consume excessive amounts of alcohol. Consequently they get drunk very quickly and don't build up a tolerance. This is proof of the genetic influence, along with the fact that alcoholism runs through families."

But, Dr Elarabi concedes, across any drug addiction, be it alcohol or heroin, genetics only increase the risk. "You could have the genes that are coded for addiction but they are not switched on," he adds. "So genes don't mean it is inevitable but it means the risk factor is higher and you are more susceptible to triggers like peer pressure, low self-esteem and other environmental conditions." Dr Elarabi is also keen to stress the importance to society at large of a drug rehabilitation centre. "We are concerned with the burden of the disease and the consequences of addiction, which are not limited to the health of the individual but could also result in several other issues such as child neglect, abuse, the breaking of family bonds and more. The cost of all that cannot be measured."

So what kind of people in the UAE end up at the NRC? Are they often those from poor backgrounds? The general perception is that problems flourish at the extreme ends of society. The theory behind it is that the very poor feel they have nothing to lose and the very rich believe they are omnipotent and can handle anything. "Drugs are used to fill a gap," says Dr Elarabi. "We tend to see patients from those two very different spectrums of society but remember that this disease can afflict anyone regardless of their social standing."

He also thinks that some people may get involved in drugs in part because they do have everything. "They get bored and look for new highs," he says, adding that the role of parents is crucial. "In some of these rich families the children are brought up by the nanny. The parents are not involved. What people forget is that parenting is a full-time job and if they are not doing that job then there will be cracks."

Over 70 per cent of the patients at the NRC are alcoholics. Half of them are there purely for alcohol addiction, the remainder are addicted to another substance, too. Alcohol is easy to get hold of, even for a Muslim, and due to the UAE's geography it is extremely vulnerable to drug traffickers. It is not only close to the world's major production zones, but has open sea and land borders. In fact it has become a transit hub for areas of high use. "The multi-cultural aspect of our society and our location encourages drugs," says Dr Al Ghaferi. "It is one negative price of modernisation."

With the new location, Dr Al Ghaferi plans to establish a centre of excellence to fight drug and alcohol addiction and to provide research as well as treatment. He also plans to open satellite clinics across the region. "This is a problem for the whole region and not just Abu Dhabi," he says, "If there were clinics in other places I think we would get a huge response from people who are unable or unwilling to come here. The NRC is not here for the short term but for the good of the nation in the long term."

Patients arrive at the clinic, having been referred either by a hospital or the police, or they come voluntarily. All undergo medical and psychiatric testing to assess their suitability. There are rules of entry: for example, patients cannot be involved in a legal process or be under the age of 18 (the new centre will have a facility for adolescents). Until now, the centre has catered mostly to men; there is an out-patient service for females, but the new centre will also include rooms for women.

Once a patient is admitted, he will undergo a detoxification process which takes between 10 and 12 days. This is the toughest period for the patient. Although Mr Hassan says the patients at the NRC are "angels" compared with those in other countries. "We have not had one violent incident since I joined," he says. "I think it is because of the close family ties and culture here." Following detox, the patient begins his rehabilitation treatment which includes listing the issues he has to resolve (such as family, financial, or legal) as well as one-to-one sessions with psychiatrists and doctors to build a bridge between the patient and the team in order to secure the patient's trust. The patient then enters group and family therapy.

Finally, patients enter the habilitation phase where they learn skills - including computer training, English lessons and religious instruction - to help them get work when the leave the centre. Patients also have a personal trainer, as well as acupuncture, yoga and chiropractic sessions. "We try to get the patients fit and healthy, mentally as well as physically," Dr Al Ghaferi explains. "We need to improve their self-esteem and their internal spirituality. We have a mosque in the centre where they can pray and we pay great attention to those involved in teaching the patients. They need to be aware of their strength and weaknesses." Religion plays a large role in the rehabilitation process, partly because it's believed that it can stop patients from relapsing. "It is well- documented that those with a religious upbringing are less likely to take drugs," Dr Al Ghaferi says, citing a study carried out by the Free University of Amsterdam.

"My name is Ali Jalal. I am from Dubai, 37 years old and married with two daughters. But for 19 years of my life my only focus was drugs. It began when I was 13 and used to pick up other people's cigarette butts and finish them. One day a relative spotted me. He rolled me my own cigarette with hashish. At first I was sick and dizzy, but I got used to it. Then my relative started supplying me with hashish to sell to other boys. So for five years I was using it and selling it. When I was 17 I got a job in the military. During this period I started to experiment with other drugs: inhalants, heroin, sedative pills, all sorts, but I was not seriously addicted yet. My addiction really began when I was fired from my job in 1991. I started sniffing a gram of heroin a day. The police caught me and I was jailed for six months. But there are drugs in jail. Actually it was incredibly easy to get hold of drugs in or out of jail.

Once I got out I only lasted one month before I was thrown back in jail. This time they caught me selling and taking drugs so my sentence was increased to two years. I served one year and six months. I lasted just 20 days outside before I was picked up for dealing again. This life had begun to feel like the norm, jail was the inevitable consequence of it. During these years me and the group of people I took drugs with all knew we were not acceptable in society and that the only way to stay alive was to take and sell drugs.

This message was reinforced by my parents. I was a troublemaker right from the start, the only time my family had any peace was when I was in jail. The message from them was that 'Ali equals drugs and we can't do anything with him, that's his life and he can't be changed and that's all there is to it'. My life was between jail and drugs, I couldn't be part of normal society, so if I wanted a car for example I had to sell drugs to earn the money to buy it. During this period I didn't ever think about stopping; I was outside society, there was no other place for me. I couldn't live without drugs; for me it was cannabis that was the big addiction, heroin to a lesser extent. I had not had any periods of abstinence from cannabis since I started aged 13.

My next jail sentence was four years but it was reduced to two because I won a competition in jail to learn chapters of the Qur'an. When I got home I found my father's health had deteriorated dramatically since I had been inside. He was no longer the same man. This made me think that life around me was changing and that it was perhaps time to change my life. Friends had told me about the NRC so I went along.

At the beginning I lied to them and to myself, saying that I wanted to be cured of Hepatitis B and get a job, those were my stated goals. Eventually I understood that if I didn't tackle the drugs issue I would be using drugs again before long. So I re-set my goals. I needed something to keep me sober. I was here for two months. It was like a light in my darkness. I would not say I am 100 per cent cured of my addiction but I now have a commitment to others to stay off drugs. I have friends and my family. I have a wife and two daughters. Seeing them grow has helped me a lot, I have huge motivation to stay off drugs now. Just the fact that my wife agreed to marry me made me feel welcomed again in my family. She is a pharmacist and helps me to understand the bad effects of drugs which is useful for my role now.

I am committed to helping other drug users, among them close friends I knew from when I was using drugs. No one can understand when an addict is thinking like an addict. I work as a volunteer at the NRC and hope to work full-time for them in the future. And putting myself in the position of helping others helps me as well. My main message is not to kids like I was to avoid drugs, my message is to the families and the parents. They need to participate in their lives at that sensitive age, try to give them more attention and stop them from feeling isolated. The problem for these kids is that in our society we have no orientation. No one says no to the kids. The kids don't say no to themselves, then they start hating themselves and others and the isolation starts. Before long the kid will have a negative influence on other teenagers and get them to use drugs to bring them into his circle. And so it goes on."