Teamwork between Dr. Antoine Boustany, left, and Sister Jean-Marc, right, guides the center’s patients and staff. (photo: Marilyn Raschka)
Mrs. Mona Hrawi, Lebanon’s First Lady with Archbishop Pablo Puente, Papal Nuncio to Lebanon at the inauguration of the center. (photo: Marilyn Raschka)
Chores, such as hanging out the laundry, are part of the rehabilitation program that involves everyone. (photo: Marilyn Raschka)
The names of Lebanons drug pushers are internationally known: chaos, fear, desperation, escapism and the disintegration of family and society. These agents operated freely among fighters and civilians from the beginning of the countrys civil war in 1975.
Before the 15-and-a-half-year conflict Lebanon was unique in that it produced and exported drugs but didnt have a serious abuse problem. The cannabis (hashish) fields were discreetly hidden behind facades of corn. Deep inside were landing strips used to fly the processed hashish out of Lebanon. But there was no hiding a drug abuse problem. It simply didnt exist.
As state authority fell into the hands of militias, the big growers no longer feared the government. Small farmers learned quickly that the economic benefits of a hashish crop outstripped those of potatoes or sugar beets. No education or experience was needed to qualify as a middle man or smuggler of hashish. The drug business provided a quick economic fix for hundreds of once law abiding citizens.
The power of the militias grew, and so did the need for something stronger than hashish; the link between the war and the use of drugs was established. At first fighters used stimulants to stay awake. Later, drugs helped them face, and then forget, the atrocities they suffered and committed against rival militias and innocent civilians. Militiamen admit that they didnt know which drug they were given but say, It made us courageous.
Meanwhile, the terrified population sought safety not only in corridors and basements but in bottles of pills.
Legal drugs were looted from government warehouses, pharmacies and Red Cross centers. Illegal drugs confiscated by the government also fell into militia hands. As border control became lax, smuggling increased and the flow of contraband drugs flourished.
Turkey and Iran provided the Lebanese with the know-how for the growing and processing of opium. Convincing the hashish growers to switch took only a couple of taps on the calculator to demonstrate the greater profit.
Drugs became cheap, available and in high demand as the violence reached deeper and deeper into every corner of the fractured society. It is estimated that, out of a population of about 3 million 20,000 Lebanese struggle with drug dependence today.
The plea for a center to treat drug addicts and alcoholics came from Dr. Antoine Boustany, a Lebanese psychiatrist trained in Paris. After conducting an extensive study of the problem, Boustany contacted the Sisters of the Sacred Heart congregation in Lebanon and convinced them to support the project. Together they approached the Pontifical Mission for financial assistance in building the center. About $400,000 was designated, and in January 1989 construction of a three-story extension to St. Charles Hospital began. Located in a suburb of Beirut, the hospital is owned and run by the order.
The Specialized Medical Center, the first of its kind in Lebanon, was inaugurated last March. The 30-bed facility includes a group therapy section, a library, a workout room and dining areas. Its 2,000-square meter area also accommodates a conference room and Boustanys clinic. Patients rooms have private baths, built-in AM/FM radios and a paging system. A grape arbor and flower gardens filled with roses and oleander bushes frame the vista from the hillside location overlooking Beirut. Unbreakable glass rather than bars on windows and doors allows the patients to enjoy the view and avoids the feel of a stereotypical drug treatment center.
Potential patients are met and screened by Sister Jean-Marc, the centers director whose training in France focused on treatment of drug addicts and psychiatric cases. Most of those coming to request treatment are accompanied by family members whose questions about the program give Sister Jean-Marc the chance to explain the centers purpose and procedures. This session also allows her to make basic observations which she passes on to Boustany. In the second screening, Boustany determines the patients level of motivation.
If he is not sufficiently motivated, treating him will be a waste of time, Boustany explains. Addicts learn that when drug dependency hits a high level, the habit becomes very expensive. So they seek treatment to return to what we call the honeymoon period, when only a small, affordable dose produces the desired effect.
The decision to enter the program is made by the addict himself. He is under no obligation to stay. Only his determination to kick the habit keeps him there.
The initial step is to deal with the addicts first fear: withdrawal from the drug. Biological treatment minimizes these symptoms and within four to six days detoxification is close to complete.
Boustany pursues his main goal in the second phase of treatment, which is to define the patients relationship to the drug. The question of why and to what extent the person has come to rely on drugs or alcohol is probed. Crucial to many cases, family relations are brought out into the open in one-on-one sessions with Boustany. A social worker makes regular calls on a family while its son or daughter is in the center to discover why normally strong ties have weakened. Boustany says that often the family, as well as the patient, needs counselling.
Socially condemned and misunderstood, drug and alcohol abuse brings shame on the family as well as the user. An anxious family group is often gathered outside Boustanys office seeking support and guidance.
In addition to psychiatric therapy by Boustany or a staff psychologist, a battery of internationally-used personality tests is used to reach the root causes of drug or alcohol dependency. These tests, translated into Arabic by the staff, have no social or cultural dimensions and have proved very successful.
The third step in the centers holistic approach to treatment introduces the patients to group therapy. Conversation comes easy to the Lebanese, and these sessions not only bring to the surface many of the patients problems; they also establish strong bonds within the group. Patients openly discuss their addiction. One traces his reliance on drugs to migraine headaches. Another used them to escape financial problems and a third admits he began just for fun.
Although their drug abuse histories differ, the addicts share the desire to find a way to a drug-free future. Helping them in this goal is the centers group therapy leader, Denise Barakat, who trained at Walter Reed Hospital in Bethesda, Md.
There is no one profile to the people who are treated at the center. They vary in age, background and religious affiliation. In the first month the center was open, a doctor, a businessman and a near illiterate laborer were among the 21 people treated.
The workout room, or ergotherapie, as the sign reads in French, is an important component in the patients holistic treatment. Sister Jean-Marc explains: Their bodies have absorbed the drug and here is where they work it out. Highly motivated by physical exercise, patients find their ability to concentrate on mental activities begins to return to normal.
The three-week program at the Specialized Medical Center begins with detoxification. Then, with psychiatric help, the patient learns to face his problems without relying on drugs or alcohol and together with the staff discovers the basis for the dependency. As logical and orderly as this sounds, the programs success is sometimes threatened by the patient at the end of detoxification.
As soon as his body is cleaned of drugs or alcohol, he is convinced he is well enough to leave, Boustany said. Fortunately, most of these patients respond to additional therapy and continue with the program.
Even after treatment, the road to full recovery is filled with dangers. Our big problem, said Boustany, is to keep our patients from returning to addiction. They need to develop physical and psychological independence and that means they must stay far away from any temptation.
For 23 fortunate men, a place like this exists. Located in the foothills of the Lebanese mountains are two rehabilitation centers for ex-addicts on the mend. The association that staffs and sponsors this program is called Mother of Light and was founded in 1989. Each naziil, Arabic for lodger, has a companion who acts as a big brother and lends support and guidance. Some of these companions are themselves rehabilitated drug addicts.
To help these young men put order back into their lives, each naziil is assigned a daily schedule of house-cleaning, cooking, dish-washing, laundry and/or gardening.
Theres much to do outside the house as well. Land has been cleared and planted with beans, cucumbers and squash. Carefully pruned fruit trees blossom with apples and cherries and a new chicken coop will soon have occupants. Another goal of this program is to provide the young men with vocational training.
Daily problems are solved by discussion and consensus. More serious questions are handled in a kind of rap session led by a volunteer from the association. Topics range from the literalness of biblical stories to the difference between love and friendship.
The lodgers stay in the program for at least a year. Unlike the newly detoxified addicts, these men will come far enough in their rehabilitation to know how much farther they still have to go.
The excellence of this program is best said in the words of Boustany.
When anyone asks me, How can I help you? I tell them, support this program.
Marilyn Raschka is a freelance journalist living and working in Beirut.