Treatment for addicts, malpractice or not?

Treatment for addicts, malpractice or not?

David and Joyce Djaelani Gordon, Directors, Yayasan Harapan
Permata Hati Kita, Ciawi

Recently The Jakarta Post ran an article titled "If doctors
hurt but not heal: It's malpractice."

As regards the detoxification and treatment of addicts at the
present time, there are those whose methods and conduct -- if
reviewed by a board of inquiry -- could be considered as
malpractice.

Most of this article, however, is not specifically directed at
malpractice but addresses medical common sense, while encouraging
better approaches to detoxification and recovery, adding
stratagem to harm reduction, and sensitizing professionals. In
this case, it means that hospitals, institutions and those in the
medical and therapeutic fields, and communities must learn more
about intervention, detoxification, drug abuse, the world of drug
addiction and addicts, HIV/AIDS and Hepatitis C.

The grounds for allegations of malpractice concerning the
detoxification, treatment and recovery processes generally
concern the discovery of facts that some "professional or
institution" is knowingly making the same mistakes over and over
again with patients (and their families) by using incorrect and
or incomplete procedures and methods.

Malpractice includes imparting false information and advice
for reasons of ignorance, arrogance or inadequate knowledge --
overmedicating a patient during the detoxification process;
continuing to prescribe medication on an ongoing basis for
patients without employing a proper system of evaluation,
monitoring, and therapy; or using "the addicted and recovery
community" to enhance one's personal wealth and status.

The foundation of all medical practice is helping others, and
assisting those who are sick and suffering towards healing. In
recovery from drug abuse or addiction, detoxification constitutes
the first part of the recovery process only. A true "recovery"
means physical, mental, emotional and spiritual recovery. Medical
common sense also recognizes that there are four stages that
encompass the process of treatment and recovery.

Controversy mostly concerns what is meant by proper and
improper methods and treatments in the detoxification process.
Yet for most drug abusers and addicts, "detoxification" is far
easier and safer than most realize.

When the symptoms of the abuser or addict are treated through
the detoxification process, the generally used method is "the
standard medical model", meaning a heavily medicated
detoxification process. It means they treat the symptoms of
withdrawal with heavy medication, while mostly neglecting to
treat the mental, emotional and spiritual individuality of the
abuser, the person within.

Therefore, they only address the first stage detoxification,
the physical portion of recovery. One stage recovery,
detoxification only, is rarely successful.

At Yayasan Kita, for instance, we have always used a natural
method of detoxification. Over 250 mostly young males and females
have successfully completed the detoxification process with no
adverse side or after affects. Only a tiny bit of medication is
used and vitamins for withdrawals, and only when necessary.

Detoxification from putaw (heroin) and shabu-shabu (crystal
methamphetamine) is relatively uncomplicated when individuals or
institutions understand the detoxification procedure, understand
the addict and addiction, and realize most of those seeking
detoxification are young people who are easily assisted through
the detoxification process. After three to six days, the most
difficult part of withdrawal (sakaw) is over with.

The mental cravings of second stage recovery are far more
difficult to deal with than the detoxification withdrawal pains
and discomforts of first stage recovery. Furthermore, it is not
the getting-off drugs that is considered the main problem in the
recovery process. The more difficult problem is staying off
drugs!

It is malpractice today for a recovery facility or center,
hospital or other body to treat any drug abuser or addict for
anything related to detoxification, recovery or general health
issues without providing testing for HIV/AIDS and Hepatitis C, as
well as quality information regarding these two highly prevalent
diseases. This is especially true if the drug abuser is an IDU
(injecting drug user).

HIV/AIDS and Hepatitis C are both raging throughout the
addicted community. If drug abusers or addicts are treated by
professionals for anything related to drug abuse today, they
should be given factual information about drug abuse and the
viruses, and provided with harm and risk reduction counseling
along with referrals for ongoing support and assistance, and
given the option (a suggested must) of being tested for the
viruses.

Testing must be carried out with the full understanding of why
they need to be tested. Written consent from the drug abuser,
guardian, or family member is also essential. With blood testing,
information, counseling, consent and confidentially are always
primary factors.

At any point when and where addicts and their families show up
for help, professionals must give responsible information and
assistance. Qualified professionals realize most addicts relapse
after intervention and treatment, usually several times or more,
and by not providing accurate information on how to avoid HIV and
Hepatitis C today can mean sending addicts home unprepared and
open to infection with a life threatening or deadly virus.

The foundation of Harm Reduction is based upon personal
involvement, giving quality time and information, and caring.
Harm Reduction as regards the drug-abuse community means focused
education, ongoing counseling, outreach into the community,
confronting human rights issues, family counseling and
involvement, self-support groups, treatment and hospitalization,
and directly addressing HIV/AIDS and Hepatitis C.

Harm Reduction realizes that without knowing they may be
infected with HIV/AIDS and/or Hepatitis C after treatment, when
they return home they often return to their "old ways and
patterns of life (relapse)", thus continuing to spread the
viruses further into the drug-abuse community and general
population.

Harm Reduction methods are responsible and sensible methods
that intervene and build bridges of learning, action, and
protection for almost everyone in the war against drug abuse and
the viruses.

Sensitizing the professional (centers and institutions) means
a conscious elevation of maturity, sense of responsibility and
integrity in facing both a national crisis and a human crisis.

Today there are three to four million addicts throughout the
country. Many are beginning to seek help for detoxification and
treatment. As professionals, we cannot truly help if we do not
fully understand addicts and addiction, the recovery process, the
viruses, or exploit these people for personal gain or fame. We
cannot help very much if we only see a person as a drug abuser,
thereby forgetting that he or she is someone's child, our brother
or sister, a member of our own family.