Final Thesis Life Stories of Young Drug Users of High Soci

Life Stories of Young Drug Users in
Bangladesh:
A Qualitative Research to explore Drug related
behaviors among young People of high socio
economic status
Independent study report submitted in partial fulfilment
for the degree of Masters of Public Health
Dr. Md. Salim Reza

Address: 10/5 Prominent Housing Ltd,
3 P. C. Culture Road; Mohammadpur,
Dhaka-1207; Bangladesh
Email: ddurjoy@yahoo.co.uk
Technical Supervisors:
1. Dr. Tasnim Azim <tasnim@icddrb.org>,
2. Dr. Sabina Faiz Rashid <sabina@bracuniversity.ac.bd>
James P Grant School of Public Health
BRAC University
66 Mohakhali, Dhaka 1212
January 2006
Table of Contents
1. Executive Summary ...…………………………………………………………..6
2. Introduction ……………………………………………………………………..10
3. Objective ……………………………………………………………………….14
3.1 Overall Objective ……………………………………………………………..14
3.2 Specific Objective……………………………………………………………...15
4. Methodology ……………………………………………………………………15
4.1 Description of the research design…………………………………………15
4.2 Study Site………………………………………………………………………15
4.3 Sample………………. …………………………………………………………18
4.4 Data Collection Tools …..……………………………………………………19
4.5 Methods of analysis ……………………………………………………20
5. Findings/Results………………………………………………………………..21
5.1 Socio-demographic characteristics of the clients…………………………..21
5.2 Hopes and dreams of the young drug users of high socioeconomic status before their
drug addiction …………………………………………………………………..22
5.3 Young drug users’ perspective of drug use………………………………27
5.3.1 Reasons for starting drug use ……………………………….27
Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 2

5.3.2 Access/ sources of drugs……………………………………..32
5.3.3 First experience of having drug………………………………33
5.3.4 Exposure to different type of drugs…………………………..35
5.3.5 Sources of money to buy drugs………………………………37
5.3.6 Factors related to relapse of drugs……………………………38
5.4 Health of young drug users of high socioeconomic status…………….41
5.4.1 Level of awareness on drug related behaviors……………….41
5.4.2 Health seeking behavior pattern of young drug users………..42
5.4.3 Factors those can help the drug users to quit drugs…………..43
5.4.4 Drug users’ expectations from health service providers regarding treatment
5.4.5 Plans for the future after rehabilitation……………………….45
5.5 Health providers’ perspective of drug use among young people of high socio
economic status……………………………………………………………………..46
5.5.1 Reasons behind starting of drugs……………………………46
5.5.2 Factors related to relapse of drugs…………………………..48
5.5.3 Role of the family/society to help the drug users to quit drugs.50
5.6 Health providers’ role in treatment and rehabilitation of drug users…. 50
5.6.1 Lines of management and treatment of the new & review clients
5.6.2 Common difficulties in managing the clients…………………53
5.6.3 Programs of the clinic for the clients & family regarding treatment and
rehabilitation- ………………………………………………………… 54

6. Discussion …………………….……………………………………...55
7. Conclusion ……………………………………………………………………..64
8. Citations………………………………………………………………………...66
9. Acknowledgement ……………………………………………………………..68
10. Appendices……………………………………………………………………. 69
1. Guideline Questionnaire for In depth interview of Young Drug Users…..70
2. Guideline Questionnaire for In depth interview of the health staffs……...81
3. Observation checklist for the clinic……………………………………….82

Abbreviations
AIDS Acquired Immunodeficiency Syndrome
HIV Human Immunodeficiency Virus
HS Heroin Smoker
IDU Injecting Drug User
MARPs Most at Risk Populations
MoH Ministry of Health
NASROB National Assessment of the Situation and Response to
Opioid/Opiate Use in Bangladesh
NEP Needle Exchange Program
NGO Non- government Organization
RSA Rapid Situation Assessment
SNS Sharing Network Study
STI Sexually Transmitted Infection
WHO World Health Organization

Executive Summary
It is no exaggeration of the fact that innumerable people are becoming hooked-up into drug day
by day throughout the world. Drug abuse is an alarming problem in Bangladesh where there are
1.7 million drug abusers (Salek SA, 1999). An ever-growing menace of drug addiction is
affecting not only the younger generation, but also the society as a whole. Drug use shortens life
expectancy, decreases productivity, increases absenteeism from workplace and schools, and is
linked to higher cost of medical care, accidents, crime, and high-risk sexual behavior (Mahbubur
Rahman et al, 2000).
The focus of my research study is on young drug users of high socio economic status with
special focus on drug related behaviors. A qualitative research was done to explore the life
stories of the young people There are a huge number of clinics and private hospitals in
Bangladesh, which provide treatment to mainly clients from well off socio-economic
backgrounds. To my knowledge no research has been conducted on well-off clients, on their
perceptions and experiences of drug use. So I planned to carry out a qualitative research focusing
on the young drug users of the upper middle class or elite society to understand their reason of
drug use, perception of HIV-related risk and behaviors, pattern of drug use and other social
factors related to drug addiction including their perceptions of the treatment, facility, and health
providers.
I conducted my study in ‘D’- A treatment and rehabilitation center of the drug abused located at
Iqbal Road in Mohammadpur area of Dhaka city in Bangladesh. The reason behind this was,
most of the cases the sons of the upper middle classes and higher socio-economic classes got
admitted there to seek treatment and rehabilitation in drug abuse. So it will be easy for me to find
out my respondents there to complete my research on time. I carried out a minimum ten in depth

interviews of drug users and a minimum of five representatives of the facility staff. I also
conducted four observations of the health facility: one in the morning and one in the afternoon
for two days to observe the activities of the health facility and also their client management skill.
In total, 10 clients were interviewed during my study. All of them were male and the mean age
was 26 years with a range of 21-32 yrs. The monthly family income range of my respondents
was Tk. 30,001-500,000 and the range of pocket money they received per month was Tk. 1,000-
15,000.
Seven of my respondents shared that they had plans and hopes and ambitions about their future
before drug addiction. But the rest 3 were very much confused about their future. The main
reason came behind this was frustration due to family instability. It also inhibited them to build a
good relationship with their parents, relatives and the society. However, according to the
respondents, the situation changed when they became addicted to drugs. Most of them became
irregular in their study due to drug use. Only 2 could complete post graduation and one could
complete under graduation. The rest of the respondents could complete higher secondary level of
school and became irregular in their study in the under graduate level.
Different reasons had been come out from the discussions with the drug users behind starting of
drugs like meeting and hanging out with peers in social gatherings, which led to pressures to
conform, curiosity and part of enjoying life, family instability, mental anxiety, and boredom and
passing the leisure time. Some of the respondents gave multiple reasons, whereas others gave
only one or two reasons. The results showed that 3 of my respondents had started drug due to
frustration from family instability, 2 to enjoy the life, 2 from curiosity, 2 to follow their mentors’
life, and 1 to pass the leisure time.

During our discussion it was found that drugs were easily accessible and available. They were
used to collect it from the different spots in the cities. The mobile phone network with the drug
dwellers made the life easy for the drug users to get access to the drugs. The drug users could get
involvement in the drug dwelling due to their financial stability. The health staffs also had given
emphasis on easy availability of drugs in all over Bangladesh as one of the main reasons to start
and relapse of drugs among the drug users.
The starting substances were Gaza & Phensydil in most of the respondents. Very few started
with alcohol, Pethidine, and capsule/tablet. Then they switched over different types of drugs. But
the ultimate drug of choice was heroin for majority of my respondents. Few used to take
Phensydil, Pethidine, and Yaba. Low cost, high euphoria, easy availability, non-availability of
Phensydil and other drugs tended them to switch over heroin.
In the initial stage of drug addiction, most of the drug users could manage money from their
pocket allowance. But at the late stage when they started to take extra doses to get their desired
feelings they needed extra money. Then to manage the money for buying the drugs they started
telling lie to their parents, selling household goods, stealing money from the wallet of their
parents, and selling their favorite items like computer, wrist watch, music system etc. They also
got involved in drug dwelling and local politics to manage the money.
My study showed that most of my respondents had more than one sexual partners or girl friends.
Among them more than half respondents regularly visit the sex workers. While sex with their girl
friends they never used condoms. But they tried to use condoms when they planned for having
sex with the sex workers. They also granted that sometimes they failed to use condoms while sex
with them. All of my respondents could tell me about the causes and route of transmission of
HIV/AIDS. But their sexual behaviors do not match with their knowledge on HIV/AIDS.

In public health practice, the saying goes: prevention is better than cure. It would be much more
cost-effective and socially beneficial if the epidemic of substance/ drug abuse in Bangladesh
could be managed by preventive interventions specifically targeted at the adolescents, based on
their knowledge base and mindset. Law enforcement groups, member of the parliament, local
government, local clubs along with the elite groups of the society, local NGOs should work
together to stop drug dwelling in their locality. Govt. should pass strong law even life penalty or
prison to death for the drug traffickers.
To create public awareness and also to inform the young and adults about the side effects of
different type of drugs Govt. NGOs, donor agencies will work together to launch a massive
campaign. HIV/AIDS awareness program can be initiated in the school based education with due
regard to cultural context.
No condom no sex program can be initiated among the sex workers to reduce the transmission of
STI/HIV/AIDS in the general population.
Serological surveillance should cover the whole population not only the specific group of people.
Drug treatment and rehabilitations centers should follow a specific guideline to management and
treatment of drug users. WHO & MoH can take the initiative on urgent basis. The clinics will
also conduct awareness sessions on drug related risk behaviors like HIV/AIDS, unprotected sex,
selection of multiple partner, needle sharing etc from their center.

Introduction
Bangladesh has been a transit and recipient country for illicit drugs for decades. Drug abuse is an
alarming problem in Bangladesh where there are 1.7 million drug abusers (Salek SA, 1999)
Among drug abusers, injecting drug use has the potential to turn a slow HIV epidemic into an
explosive and devastating one, as was observed in Thailand and northern India. Drug use
shortens life expectancy, decreases productivity, increases absenteeism from workplace and
schools, and is linked to higher cost of medical care, accidents, crime, and high-risk sexual
behavior (Mahbubur Rahman et al, 2000)
From an epidemiological perspective, the HIV epidemic in Bangladesh is evolving worsened by
its porous borders with India and Myanmar. Studies conducted with Injecting Drug Users (IDUs)
show an increase in the prevalence rate from 1.4 per cent up to 4.9% per cent over the last three
years in one locality in central Bangladesh. Results also show that HIV among IDUs is
approaching a concentrated epidemic level nationwide. (Aus Aid Fact Sheet, 2005)
Bangladesh, with a population of 136 million, is estimated to have approximately 7,500 adults
and children living with HIV. (NASP, unpublished data). However, since the first case was
detected in 1989, till December 2004, only 465 cases were officially reported at the end of 2004.
Of these, 87 had developed AIDS, and 44 had died. Significant underreporting of cases occurs
because of the country’s limited Voluntary Counseling and Testing capacity. The social stigma
attached to the disease is a further impediment (World Bank Fact Sheet, 2005).
IDUs in Bangladesh are reported to be one of the most at risk populations (MARPs) and
vulnerable to HIV/AIDS and other blood borne diseases. The sixth round of HIV serological and
behavioral surveillance shows that the prevalence of HIV has raised to 4.9% among IDUs in

central Bangladesh, which is just 0.1% below the threshold of a concentrated epidemic. The
same survey shows that every year roughly 10 to 20 percent of drug users are new injectors,
which means that drug use is spreading in Bangladesh like other south Asian countries. Five
successive rounds of Bangladesh’s behavioral surveillance show high levels of needle and
syringe sharing among IDUs and other high-risk behaviors (i.e. sharing equipment and drugs),
low levels of risk perception/knowledge on HIV transmission, and low rates of condom use
(GOB 6th Round Technical Report, 2004-2005))
The Sharing Network Study (SNS) also found that the number of IDUs in Dhaka and the
surrounding area is steadily increasing as heroin smokers (HS) switch to Buprenorphine
(Tidijesic) injection quite frequently due to increased cost and decreased availability of heroin.
(6) The National Assessment of Situation and Response to Opioid/Opiate use in Bangladesh
(NASROB; August- November 2001) study showed that most of the IDUs have an age range
between 15 to 52 years, which means they belong to a sexually active group, i.e. they have
regular sexual partners, they buy sex from both men and women, they sell blood and also they
are extremely mobile across cities (Shah Ehsan Habib, 2005).
IDUs are not an isolated group of people. They are connected to the general population through
their sexual partners. The interaction between high-risk groups in Hai Phong, Vietnam shows
that the halves of the sex partner among the street sex workers are IDUs. 50% of the IDUs had
spouse or girl friend as their regular partners and 47% of IDUs go to the sex workers. 40% of
street sex workers also take injecting drug. NASROB study showed that 9% of the heroin
smokers and 12% of current IDUs have had sex with their drug using partners and most
interestingly only 4% IDUs and 9% HSs used a condom in those encounters. As injecting drug

users are often clients of sex workers, thus transmission of HIV infection from the former to the
later group is quite likely. Based on assumed sexual network dynamics, the eventual spread of
HIV infection to the general population is well predicted, and this may largely be triggered from
within the infected IDU population like many other countries of the world.
The focus of my research study is on young drug users of high socio economic status with
special focus on drug related behaviors. However, before I go on to discuss my broader and
specific research objectives and methodology, I will review some of the literature available on
the demographic and drug use characteristics, health status, and HIV-related risk behavior among
drug users in Bangladesh.
A cross sectional study was carried out on 253 male hospitalized drug addicts, admitted into the
Central Drug Addiction Treatment Hospital, Tejgaon, Dhaka (the only government hospital in
Bangladesh). The study result showed that 88% of the addicts were heterosexual and 7% of them
were found bisexual. 87% of the addicts have multiple sex partners and most of them (72%) did
not use condoms. As indicators of a drug habit, starting drug, choice of drug, period of addiction,
sharing of needles etc. were included. The study showed that only 8% of the addicts were taken a
single drug and the remaining 92% took multiple drugs. The drug addicts who used mostly
injection (87%) shared needles. Regarding socio-economic characteristics, young adults (79%),
secondary educated (46%), low-mid income (60%), businessmen (46%) and married people
(60%) were found highly involved in addiction (Sk. Nazrul Islam et al, 2000).
Another research was conducted in the same venue among 196 drug users between October 1998
and February 1999. The research showed that 64% of the respondents had a history of HIV-

related high-risk behavior. Among them 58% had unprotected sexual intercourse, 12% were
IDUs. Logistic regression model revealed that lower education, taking drugs in groups and
higher age were associated with high-risk sexual behaviors. From this study it can be said that
high prevalence of needle sharing (54%), group practice (79%) and unprotected sex (87%)
among the IDUs- key factors for a major HIV outbreak-are widespread in Bangladesh.
(Mahbubur Rahman et al, 2000).
Bangladesh is a low HIV prevalence country, with buprenorphine injectors having the highest
prevalence of HIV at 2.5% as of 1999. Using National HIV Behavioral Surveillance data, the
impact of a needle exchange program (NEP) on sharing behavior among injecting drug users in
two cities was measured. Results showed positive changes that varied with the different settings.
Those who reported utilizing the NEP were compared with those who did not. Differences in
Dhaka were significant for the average proportion of needles shared but not for the proportion of
men who ever shared in the last week. In Rajshahi, where professional injectors were the norm,
the impact of an NEP was greater and affected both the proportion of needles shared as well as
the proportion of men never sharing. Behavioral surveillance methods have the potential to
measure intervention impact through comparative analysis in certain settings. (Jenkin C et al,
(2001).
National HIV Serological Surveillance, 2004-2005, Bangladesh through their sixth round
technical report showed that first time HIV cases was detected in IDUs outside Central City A
from Southeast-D and Northwest F1. The geographical coverage of IDUs in surveillance has also
increased dramatically over the rounds. During 1st round only one city was covered but in the 6th
round it was 17 cities.

Relevance of the study
Most of the studies however have focused on clients/IDUs of low or middle socio-economic
classes, but a huge gap exists regarding information and characteristics of richer and well off
clients who are also part of the needle sharing network and at risk of infecting or being infected
by HIV/AIDS.
There are a huge number of clinics and private hospitals in Bangladesh, which provide treatment
to mainly clients from well off socio-economic backgrounds. To my knowledge no research has
been conducted on well-off clients, on their perceptions and experiences of drug use. I carried
out a qualitative research focusing on the young drug users of the upper middle class or elite
society to understand their reason of drug use, perception of HIV-related risk and behaviors,
pattern of drug use and other social factors related to drug addiction including their perceptions
of the treatment, facility, and health providers.
Objective
General objectives:
To explore and understand drug related behaviors of young drug users from high socio economic
status
Specific objectives:
1. To understand the nature of drug use pattern among the young drug users.
2. To know about the different types of drugs they usually take
3. To explore the reasons given for drug addiction (i.e. explore reasons given for starting
drug use – peer pressure, emotional & social trauma, etc)

4. To assess the level of awareness regarding STI/HIV/AIDS among the drug users
5. To investigate access/source of drugs (i.e. where are young clients getting access to
various drugs).
6. To understand the perceptions of treatment from both the service providers and clients
perspectives
7. To assess drug related behaviors of young drug users (i.e. sexual behavior, risky
behavior.
Methodology
Type of Study:
A qualitative study had been done to explore drug related risk behaviors among young people of
high socio economic status.
Study site:
I had a plan to carry out my study in two different clinics of Dhaka city of Bangladesh. One of
them was situated at Kamal Ataturk Avenue in Gulshan area of Dhaka city, which is known as
the one of the most elite zones of the city and another one was situated at Iqbal road in
Mohammadpur area of the same city that was known as the area of upper middle class society.
There were two main reasons to choose those clinics. The first reason was- most of the cases the
sons or daughters of the elite groups of the society got admitted there for treatment of drug
abuse. Another reason was- no research had been done before there focusing on these groups.
My technical adviser also suggested me to work on those clinics so that we could get new
information from that untouched population that will also help me to strengthen my study

objectives. But while taking with the authority of the first clinic, I came to know that they need
consent from the parents or guardians of the individual clients to ensure their participation in this
type of research study and it would take several days to weeks. But to time constrain I did not
take the risk to conduct my study there. Then I talked with the authority of the second clinic
explaining them the objectives of my research study and they agreed to conduct my study there
though they take few days to give me the permission. They also kept my promise that I would
not disclose the name of my respondents, their family status, and position in the society
anywhere in the study and even not to discuss with the third party. I think I faced this type of
problem due to the sensitivity of my research topic and the study population. But the Chairperson
of the clinic who is also the counselor of that clinic told me that if I wanted to use the name of
their clinic in my thesis paper they would not mind for that. But due to some ethical region I was
not using the original name of the clinic and also the name of the respondents of my study.
Besides this, Dr. Tasnim Azim, my technical supergviser and one of my relatives those had a
good relationship with the Chairperson of that clinic helped me a lot to motivate them about my
research and getting access to that clinic. Then I was able to start my work there.
‘D’- A treatment and rehabilitation center of the drug abused located at Iqbal Road in
Mohammadpur area of Dhaka city in Bangladesh. Most of the cases the sons of the upper middle
classes and higher socio-economic classes got admitted there to seek treatment and rehabilitation
in drug abuse. The clinic mainly ran two types of programs for the drug users. One program
mainly dealt with the new cases. The new cases meant those clients who had got admitted in
their clinic for the first time. The duration of this program was 60 days and it consisted of both
treatment and rehabilitation component. Another program dealt with the review cases. The

review cases meant those clients who had received treatment and rehabilitation from that clinic
before but they relapsed the drug again. The duration of that program was 30 days and mainly
gave focus on rehabilitation issues.
The clinic was established here in 1999. Now about 14 persons were working for that clinic.
Among them 13 persons are ex drug users. So they could easily understand the problems of their
clients and also could manage them efficiently. The clinic had only 30 beds in its indoor
department and the health staff of the clinic only allowed those clients who were self-motivated
and wanted to give up drugs willingly. The structure of the staff position of that clinic were as
follows-
Sl. No. Name Designation

1 Rajib Chairperson & Counselor
2 Momen Director & Counselor
3 Shibli Director & Counselor
4 Wasim Director & Counselor
5 Alam Medical Officer
6 Qayum Clinic Manager
7 Robin Program Officer
8 Sohel Program Assistant
9 Titu Program Assistant
10 Unzum Program Assistant
11 Victor Program Assistant
12 Maheen Account Officer
13 Nazim Volunteer
14 Dipu Volunteer
Before starting my research, I had a meeting with the Chairperson of that clinic. The main
objectives of that meeting were to describe him about my research plan & guide line

questionnaire for in depth interviews of the clients and health staffs, selection of the clients and
health staffs, to make a plan with that clinic to conduct my study there, to make an appointment
of the individual clients and health staffs. I also tried to build up my rapport with the health staffs
and the clients of that clinic to get the maximum co-operation for them by introducing myself
and describing them about my research proposal. I also ensured them that all the information
they would give would be kept confidential; no names would be recorded only ID numbers
would be used. I also told them that there would be no risks as far as I knew and no benefits from
participating in that study.
Sample:
In a WHO guideline Stimson, Fitch and Rhodes (1998) notes, undertaking research on drug use
is a difficult task. Therefore, in many situations sampling frames may be incomplete or simply
non- existent. There are no set rules on how large or small the samples should be; the selection of
the respondents should continue until it reaches the point of saturation. This is based on the
rationale that no more new information is being discovered by the researcher and all sorces
related to potential variation among the target population have been explored.
As my research was qualitative in nature I carried out a minimum ten in depth interviews of drug
users and a minimum of five representatives of the facility staff.
Data Collection Tools:
• In depth interviews – I conducted ten interviews with the clients from the upper middle class
and upper class society to get their perceptions about the drug addiction, STI/HIV/AIDS and
other HIV-related sexual behaviors. I also conducted five in depth interviews with the health

staffs working there. I had interviewed the clinic manager, one program officer, two program
assistant, and one volunteer.
• Observation – I conducted four observations of the health facility: one in the morning and
one in the afternoon for two days to observe the activities of the health facility and also their
client management skill.
Data collection process:
• Data collection- Data collection was done from 4th December to up to 1st of January.
Data was collected following the appointment of the respondents. While conducting the
first in depth interview I found that it took more than four hour to complete one person.
Then I sat with one of the Director of that clinic and rescheduled my plan to cover my
study within that limited time frame. Even I conducted my research on the weekly
holidays so that I could talk to my clients for enough time and get more information from
them.
• Study population: As my target group was young drug users of high economic class I
tried to take the young people those age would be with in 18-32 during my research
period. Due to some ethical issue I tried to take the people not those are not less than 18
years old. In case of drug users I tried to take those cases that were taking drugs for not
less than 2 years before coming to that clinic. Regarding socio economic issues I tried to
focus on the young people of high society. To include them I set up the criteria that the
average monthly income of the family of my respondents would not less than 30,000
Bangladeshi Taka per month. I tried to follow the criteria of socio-economic status by
Gonoshastho, Bangladesh to select my target group of high society.

• The questionnaire- I conducted my in depth interviews with the clients and the health
staffs following a guideline questionnaire so that I did not miss any of my point during
my conversation and note taking. The questionnaire covered the socio-demographic
characteristics, details’ of the clients drug taking experiences, knowledge on HIV/AIDS,
their expectations from the clinic and family etc (See Appendices). I also followed a
separate guideline questionnaire while talking with the health staffs of that clinic and a
observation check list while conducted the observation of the clinic.(See Appendices)
• Informed consent- for all of the above data collection procedures, informed consent was
obtained from the participants. They were first explained the purpose and nature of the
study and their rights to refusal.
Data analysis:
To maximize the exploratory nature of this study and to utilize my time efficiently, each
evening after the day’s activities I reviewed the data collected, coded and organized the material
and data produced. The review of data collected every day guided me to focus on specific
questions in my in-depth interviews. Qualitative data was analyzed through coding and decoding
of the data. The reason for using this kind of analysis was being the fact that there have been a
lot of gray areas in every aspect of the whole program, which was explored through qualitative
research. Coding and decoding allowed me to stratify different aspects, look in-depth into each
of them and then construct a holistic picture. Then I booked the last three weeks allotted for draft
and final write-up of the research report.

Findings
5.1 Socio-demographic characteristics of the Clients:
The general characteristics of the clients were shown in the table below. In total, 10 clients were
interviewed during my study. All of them were male and the mean age was 26 years with a range
of 21-32 yrs. Among ten of my clients, 7 could complete higher secondary level of education, 1
was under graduated, and the rest 2 were post graduated. Those were graduated or post-
graduated were married and the rest 7 were unmarried. The monthly family income range of my
respondents was Tk. 30,001-500,000 and the range of pocket money they received per month was
Tk. 1,000-15,000.
Name Age(Yrs) Education Marital Status Monthly Income of Pocket money
&Sex the family (Tk) per month (Tk)
Abir 24(M) HSC Unmarried 100,001-250,000 15,000
Rahat 25(M) HSC Unmarried 250,001- 500,000 6,000
Sumon 25(M) HSC Unmarried 30,001- 50,000 3,000
Hamid 32(M) Bachelor Married 30,001- 50,000 4,000
Amir 24(M) HSC Unmarried 50,001- 100,000 3,000
Simon 23(M) HSC Unmarried 50,001- 100,000 1,500
Taufique 31(M) Masters Married 100,001-250,000 5,000
Asad 21(M) HSC Unmarried 100,001-250,000 4,500
Rabbi 26(M) HSC Unmarried 30,001- 50,000 1,000
Radit 30(M) Masters Married 50,001- 100,000 5,000

5.2 Hopes and dreams of the young drug users before starting drug :
Study and future plan-
Seven of my respondents shared that they had plans and hopes and ambitions about their future.
They also claimed that they were serious about their study and the result was also very good as
well. Taufique said…
“From my childhood, I was very much serious about my study. I was the only son of my parents.
So I have got all the love and affections from my parents and relatives. I was always under close
supervision of my parents. I wanted to be a reputed businessman like my father even more
successful man than him. I felt myself as a happy and optimistic man.”
Radit said… “ I had completed my masters degree from Dhaka University. I was a member of the
first division football league and played football for different reputed clubs of Dhaka. I had
earned a lot of money but I did not spoil the money on addiction, bating like other players. I
joined in a reputed company as a marketing officer after my post graduation. I always thought
that I need not much money to pass my life. So I tried to maintain a problem free life. I always
founded myself as a happy man.”
Rabbi said. “My family was a joint family with cultural background. I was also the member of a
cultural organization and was involved in all type of cultural activities like singing song,
recitation of poem, reading books etc. So we had the common friends on cultural backgrounds. I
was passing a happy life with my family.”
Hamid said….

“My parents and relatives liked me a lot because I was very calm and quiet and also serious in
my study. My relatives used to gave my example to their sons.”
Three of my respondents were very much confused about their future. The main reason came
behind this was frustration due to family instability. It also inhibited them to build a good
relationship with their parents, relatives and the society.
Asad said. “I felt very much in secured in my family. Nobody took care about my opinion. I had
no privacy. I had to do what ever my family wants. I had to change my school five times before
my SSC and it created a great problem to adjust me in the new places. My only brother is 12
years senior to me. He was doing business with my father. Both of them had no timetable. Even I
could not see them for 4-5 days. They used to come back home when I went to bed and in the
morning when I went to school in the morning they were sleeping. But they tried to control me
and impose their decision to me. I could not agreed with them always and it brought family
tension in my family. I always wanted love and affection from them, to share my feelings with
them. But they had no time to understand me. That’s why I decided that I would not be a business
man like them.”
Simon said. “ I was brought up in my grandmothers house and I knew her as my mother at a
certain age. But one day my parents came and my grandmother told me that these are your
parents. They were abroad for a long time. No body told me about that even they never talked to
me over phone. Then they took me with them and admitted me in a residential school. In the
parents’ day, my friends’ parents used to come to see them. But my parents never came to see

me. Then one day my grandmother came and took me to her. I came to know that my parents had
got separations. When my grandmother died, I became alone and frustrated about my life.”
Amir said. “ I thought my family was just wearing a musk in the society. But inside there was
always unhappiness, cruelty, and quarrel. Always we had a unrest in our family. I came to know
that my parents had no relation of husband and wife for a long time when they were quarreling
one day. I lost my respect for them and became frustrated day by day.”
However, according to the respondents, the situation changed when they became addicted to
drugs. Most of them became irregular in their study due to drug use. Out of ten respondents,
only 2 could complete post graduation and one could complete under graduation. The rest of the
respondents could complete higher secondary level of school and became irregular in their study
in the under graduate level. They felt to understand that they have lost the valuable times of their
life due to drug use but failed to come back in the right track. They were frustrated and not being
able to complete their studies and that often lead to a cycle of abuse as many that could not stop
taking drugs because their self esteem was affected. Amir said………
“I scored star mark in SSC and HSC. I did believe that I could do everything alone. I always
wanted to be a desperate man and hoped that everyone will follow me. I was a lyricist, music
composer in my school life and tried to spend most of the time with music. I was also fond of
traveling by road and boat. I wanted to be a computer engineer in future. I got admitted in the
university but could not continue my study due to drug. What I am now? Just simply HSC pass.”

Sumon said… “ I had step mother & brother. My father spent enough time with them. I have
seen my mother crying and it put me under frustration. I did not like to go to the university. I
used to fly away from the university on regular basis and spent my time with the friends. I was
very fond of video games, music and gossiping with friends. Gradually I became involved with
the local area politics and different type of illegal matters (taking funds for the local club, drug
dwelling) with my friends.”
Relationship with family, relatives and society-
Of the 10 drug users, 7 had said that they had a good relationship with their parents, relatives,
friends, and others of the society before starting drugs and was very fond of passing hours with
them. 2 of my respondent said that they were very much introverted from their childhood and
liked to pass most of their times alone at home even before starting drug. But they started to pass
most of the time with their friends when they had got some friends in their locality. Most
interestingly, in these two cases, they had more senior friends and they found themselves
psychologically mature enough from the friends of their same age. But it was not clear to me that
why they had more senior friends and why they liked to pass their leisure time with them. They
also could not explain it to me. But they told me that Amir said like this. “ I had a lot of senior
friends in my locality. I used to pass more time with them by playing football or cricket, roaming
with them outside our area, sharing my feelings. So I started to behave like them, think like them.
So, when I met with my friends in the school or colleges I found that they could not take
decisions from their own or felt very much confused to take decision in any normal life activities.
But due to my exposure with the seniors I could easily mange those problems than them.”

It was also found that in these two cases they were from a broken family and they did not like to
share their feelings with their family members. Simon said...
“I was very much introverted and different from others from my childhood. I never accepted
anything that seems to be illegal and unethical to me. Gradually I found myself alone in my
family.”
But after starting drugs they started avoiding their parents and relatives and liked to pass most of
the time with few of their friends those were also addicted. They also liked to confine themselves
in their own world whenever they were at home.
Plan for the leisure time-
All of my respondents used to pass their leisure time by listening music, reading books, playing
football, cricket, badminton etc, and gossiping with their friends before starting drug. It was
come to our discussion that they all liked to pass their most of the leisure time gossiping with
their friends. They used to discuss about the current national and international issues, fashions,
sports, girl friends, planning for their future, and also tried to follow some of their seniors who
were looking smart and handsome like the heroes of the film. Rahat said….
“My friends acted as a tonic for me. I couldn’t spend a single day without meeting them.”
Sumon said. “To meet my friends I even left my school and went to the TSC. To escape from the
family I came back at 4 pm in home so that they could understand that I was coming from school.
Then I took my meal and also left the home to meet my friends. Gradually I started to come back
home very late at night.”

Radit said, “As I was a footballer, practicing football spent most of my time. Besides this, I had a
very few friends whom I met after my office or practice session. I also liked to see the sports
channel in the TV during my leisure period.”
Rabbi told, “I passed my time by doing music, reading different type of books, playing chase and
organizing different kinds of cultural activities.”
It was also found that after starting drug they were very much busy to manage the drugs and
passing most of the time with the drugs. The interesting findings were, they liked to pass their
times with their friends discussing about the different types of experiences after taking drug,
planning for the ways to manage the money to buy the drug for the next time, listening music,
and sleeping. Only two of my respondents said that he never liked to pass time with his friends
after taking drugs rather than keeping themselves alone and watching TV. But all of them has
said that they always tried to maintain a good reputation within their family so that they could
not understand that they had started taking drug.
5.3 Young drug users’ perspective of the drug use:
5.3.1 Reasons behind starting of drugs-
Before starting this topic I would like to draw a table here containing the name of different type
of drug, their composition and other relevant issues.

Name of the Period of Name of the Composition of the Name of the
respondents drug use Drug(s) they drug/ Synonyms drug(s) are
(Yrs) Started first Continuing now
Asad 6 Whisky Alcohol Heroin
Amir 10 Gaza Same Gaza+ Heroin+
Phensydil
Rabbi 10 Phensydil Cough syrup Heroin+ Yaba
(Codeine+
promethazine+
ephedrine)
Sumon 13 Gaza Cannabis/ Marijuana Phensydil +
Heroin
Rahat 7 Gaza Cannabis/ Marijuana/ Heroin
Abir 10 Cap. Analgesic (Morphine Phensydil +
Spasmoproxyvan derivatives) Heroin
Hamid 8 Pethidine Analgesic & Sedative Pethidine
(Morphine
derivatives)
Taufique 15 Phensydil Cough syrup Phensydil
Simon 7 Phensydil Cough syrup Pethidine+ Yaba*
Radit 2 Phensydil Cough syrup Phensydil
* Yaba- Amphetamine group of medicine
Different reasons had been come out from the discussions with the drug users behind starting of
drugs like meeting and hanging out with peers in social gatherings, which led to pressures to
conform, curiosity and part of enjoying life, family instability, mental anxiety, and boredom and
passing the leisure time. Some of the respondents gave multiple reasons, whereas others gave
only one or two reasons. The results showed that 3 of my respondents had started drug due to
frustration from family instability, 2 to enjoy the life, 2 from curiosity, 2 to follow their mentors’
life, and 1 to pass the leisure time.

Peer pressure and ‘wanting to fit in’-
Two of the respondents, told me that they have seen that those were taking drugs were passing
happy moments among them like doing songs, discussing different interesting topics, planning
for go outside for sight seeing, talking with girls smartly etc. Also they told me that they wanted
to show their friends that they could do whatever their friends could do. They wanted to be a part
of their fellows, and tried to keep the leadership among the friends so that their friends would
respect their opinion while taking any decisions among them. Amir said…
“In the university, I have seen my seniors taking drugs and passing happy moments among them.
They were also looking very smart and handsome like the heroes. I wanted to be like them and
wanted to enjoy my life like them. Then one day some of my friends decided to take Gaza
(Marijuana. I have heard from one of my friends about where it was available. I collected it from
that place along with that friend. But none of us knew how to prepare that. I also saw the seniors
before to make it in front of us. Then I tried to make it and was able to make that though it was
not appropriately made like the seniors. Then we shared that among our friends.”
Rabbi said. “ Few of my friends were used to take Gaza during our gathering. They also told me
to try for a once. Then one day I could not refuse them and took it from them.”
Hamid told me like this. “ One of my friends was used to take Pethidine and told me about that. I
discouraged him to take that because I was very afraid of taking drug. But I could not avoid his
company. He requested me so many times to take for only one time. I refused him repeatedly. But
one day, what happened to me, in absence of his family members at home, I took that from him.”

Boredom and curiosity-
To pass the leisure time one of our respondents started to take drugs. Abir said….
“When I was studying in India, we have different types of friends from the different parts of the
world. I have heard about the name of Cap. Spasmoproxyvan from them. But I did not care.
During one Eid vacation, I could not come back to Bangladesh. I was thinking about how could I
pass those times? Then to pass the idle hours I started that drug.”
Two respondents said that they have started taking drugs from the curiosity. Asad said…
“Some of my friends were taking Gaza while gossiping or passing the lazy hours. One day I took
it from them just from the curiosity.”
Rahat said. “When I was in hostel, on of my used to take Gaza everyday during his leisure
period. I scolded him a lot for that practice. But I had seen my senior brothers who were taking
alcohol or Gaza passed their leisure time with happy mood. So from curiosity, I took gaza from
my friend.”
Family instability-
The role of family instability was also found to be a reason behind starting drug use. Three of my
respondents had said that they have started to take drugs due to mental pressure as a result of
family instability. One of these respondents, Simon said…
“I have seen my senior friends to take Phensydil. They offered me several times but I refused
them. One day I had a quarrel with my parents about to send me abroad because I could not
accept their ignorance to me any more. Then I came back to our club and requested my friends
to give me that drug. I took the full bottle at a time.”

Radit told me like this. “I had seen some of my friends to take Phensydil. But I was not interested
about that. One day I had heard that my brother and father were not ready to accept the
relationship of mine with my cousin. But I loved him so much and could see me without her. Due
to this family problem and mental anxiety, I came to meet my friends to pass some moments with
them so that I could get relief from the mental pressure. When I saw them to take Phensydil, I
also tried a little amount to forget my sorrows.”
‘Mentors’ and Drug-
Everybody in his life gets a mentor whom he like best and try to follow him and all of his
activities. The mentor can be his father, brother, cousin, friend and others. During my study, I
have found two respondents who started drug only to follow their mentors.
Amir held like this…“I had a cousin and I liked him so much. I wanted to be like him and tried
to follow all of his activities. He was used to take Phensydil. I requested him to give me that. He
refused me at first. But after repetitive request he gave me a little amount from his bottle.
Whenever I was with him I was taking a small amount from his bottle. Gradually I became
dependent on it.”
Sumon said, “ I had a cousin. I tried to follow all of his activities so that I could see me like him
in the near future. I had seen him to take Gaza. He also used to give money to buy Gaza and
cigarettes from a shop near to our market. From him I came to know about Gaza and started
taking that.”
It was found from the interviews that friends are playing a vital role to provoke the respondents
for taking drugs. Most of the cases the respondents have heard about the different types of drugs

and their effects on body and mind from their friends. And these leaded them to take the drug
only from curiosity, to pass the leisure moment, to face the mental pressure on them and others.
5.3.2 Access/ sources of drugs:
Drugs (Gaza, Phensydil, Heroin, Pethidine, Morphine, Yaba, Tidigesic etc) are sold in different
areas of all cities in Bangladesh. It was found from the discussions with the respondents that
drugs are easily available in all the districts of Bangladesh. Usually these places are known as
‘Spots’ to the drug users and drug dwellers. All of the ten respondents said that they have been
collecting or buying drugs from those spots in the initial stage of their starting drugs. They come
to know about those spots from their friends. At first, friends showed them the places where the
different types of drugs are available. But later on they could easily collected drug by
themselves. But when they became known to the drug dwellers, they started to contact with the
dwellers over mobile phone (give me an example or a quote to elaborate. The drug dwellers
supplied the all type of drugs according to their need to a specific place like in front of market
(Metro shopping mall, Rapa plaza, Gulshan –1 market etc), in the local cultural club or the local
offices of the political parties, and even at home. To avoid the risk of police harassment and
other unavoidable circumstances the drug users prefer this way to collect drugs. One of my
respondents said like this…
“I had seen the poor people with the dirty cloths were collecting and taking drugs from the same
spots. I did not like to see me like their stage. So I called the drug dwellers over mobile phone
and they supplied it to me at my convenient places. It was hassle free and risk free.”
Two of my respondents, Rahat and Simon, said that they became involved in the local political
parties and were used to work for them. During election period they used to earn a lot of money

to organize the procession, meeting, and to seek votes for the party. So they had an influence in
their localities. The drug dwellers of that areas were used to supply the drugs to them on regular
basis at free of cost so that they can run their business in that locality without any problem from
them.
Two of my respondents, Rahat & Simon, accredited that they were also involved in the drug
dwelling. They invested money in this business and controlled the business in their locality. So
they have always a good access to the drug they need. Simon said….
“I was the only agent of ‘Yaba’ in my area. I need not to think about the money to buy the drugs.
I can easily manage my drugs from my profit.”
Another way of collecting drugs was investing money as an advance to the drug dwellers. One
respondent was involved in this type of business. Asad said…
“I invested Tk.10, 000 on every week. In return they ensure the availability of the drugs on time
and of course it was free. They return the money after doing the business. Sometimes they failed
to return the money. I that case I balanced the money by taking the drugs free from them.”
5.3.3 First experience of having drug:
The young drug users could not forget their first experiences of having drugs. Among 10
respondents, nine had expressed me about their happy moments after taking the drug which ever
they took. They also mentioned about increased concentration on their study and listening music,
extra energy for doing work, increased thirst for tea and cigarettes, good feelings for roaming
here and there by rickshaw or even walk, passing time gossiping without feeling tired etc. Radit
uttered his experiences like this…

“I felt like that I was flying in another world or galaxy. The sounds were coming from far away. I
was moving to a black hole. I could separate the every scale of my music.”
Amir informed me about his experiences…
“I was feeling very much happy in the very first day. The experiences were something different. If
I put my head in the right side of my shoulder, I could put it like that for several minutes and I
could not say how long I was on that position. I had seen a lot of stars while lying down on the
ground. I could think more, got extra energy to do any type of works. I passed that night without
sleeping just gossiping with my friends.”
However, not all respondents had a positive experience when they first experimented with drugs.
Only one respondent, Asad described about his mixed feelings while taking alcohol. He told me
like that… “I was feeling nice to walk, taking more cigarettes but I got headache and chest
tightness at the same time. I would not prefer anything, which causes harm to my feelings and
would control me. I took drug for feelings. I need ‘Feelings’. Even if you offered me ten bottles of
alcohol and one puriya/pata heroin, I would prefer the next one. Heroin helped me to
concentrate in any type of activities but alcohol did not. Heroin gave me the feelings of flying in
the sky, showed me the colors those I had never seen before. It was totally different experiences.
That’s why I changed my drug and was continuing with that before coming to this clinic”
Though the experiences were something different for the injecting drug users, they said that they
had some experiences for them to try the drug for the next time. Shahid told me about his first
feelings after taking Pethidine…………. “At first I could not get up from the chair. My friends

were gossiping and taking tea, cigarettes. I felt sleepy and numbness of my whole body. I could
not take part with them. Then after two hours, I became normal like wake up from the sleep. I felt
very fresh and energetic.”
From the above discussions, we can say that the first experiences of taking drugs played a
significant role for the drug users to try the same drug for the next time and gradually they
became dependent on that. They claimed about different types of experiences (flying in the sky,
moving to black hole, saw different type of color for the first time in their life, could separate the
different scales of music, got more energy and concentration in work, increased thirst for tea &
cigarettes etc) which they never got before when they were not taking drugs and they also told
that it was not possible for them to feel such type of experiences without drug.
5.3.4 Exposure to different type of drugs:
The starting substances were Phensydil for 4 of my respondents. 3 started with Ganza, 1 with
alcohol, 1 with Pethidine and 1 with capsule. Then they switched over different types of drugs.
But the ultimate drug of choice was heroin for 2 of my respondents. 2 of them were continuing
with Phensydil, 1 with Pethidine, 2 with heroin & Phensydil, 1 with heroin & Yaba, 1 with
heroin & Phensydil & Ganza, and 1 with Pethidine & Yaba.
As I discussed earlier, peer pressure plays a vital role in influencing friends to try different types
of drugs. Some are also motivated by curiosity, particularly when they see their friends
experiment to get new feelings. It was also confirmed by Sumon, one of the respondents while
talking about exposure to different type of drugs.

“I started with Ganza. One day, one of my friends threw me a challenge that two corks of
Phensydil would make my life measurable and I would be not able to digest that. I took the
challenge and gradually became fond of it. ‘One puriya of brown sugar(Heroin) will give you the
feelings ten bottles of Phensydil’- after four years of taking Phensydil, another friend’s comment
again provoked me to take the taste of Heroin. Now I was used to take heroin before getting
admitted in this clinic.”
Initially, most of my respondents started to take a single drug, which was easily available to
them, or they can mange it easily from their friends or from the spots. Then they switched over to
different types of drugs to get a different type of feelings. From the discussion with the
respondents, I found that the Most of the cases the train was like this- Cigarettes-ÆCannabis
(Ganza)-Æ Sleeping pill -Æ Alcohol-Æ Charos-Æ Afim-Æ Phensydil-Æ Heroin-Æ Yaba
(Amphetamine)-Æ Ice (High dose Amphetamine)-Æ Cocaine-Æ LSD-Æ Pethidine-Æ
Morphine.
Discussions reveal that the young drug users were very afraid of taking injecting drugs. This may
explain why that I only got two respondents during my study who were taking injecting drugs. It
was found that the respondents were also curious about the new drugs, which come to the
market. They usually tried all of these and finally selected one (Phensydil/ Heroin/ Pethidine) or
mixture of two or three drugs (Gaza+ Phensydil+ Heroin/ Heroin+ Yaba) which gave them their
desired feelings. And to get the same feelings they gradually started to increase the doses of their
preferred drugs.
Besides this, the wide variety of drugs and the need or pressure to explore new kinds of drugs
had a great impact on changing the drug use pattern. Amir expressed his experiences like this…

“My friends suggested me for Heroin for different type of feelings with less amount of money. As
Phensydil became more expensive and I was looking for a new test I tried Heroin and liked it so
much. Then I switched over to Heroin.”
5.3.5 Sources of money to buy the drugs:
According to my respondents, they usually spent Tk. 50-200 per day to buy the drug at their
initial stage of addiction. But gradually it became Tk. 500-2000 per day at the late stage. Two of
my respondents were self employed and tried to manage the money for buying drugs from their
own income because they need not to help their family. They sometimes borrowed money from
their friends or took advance from the office to meet the urgent need. The two respondents who
were engaged in drug dwelling could manage money from that business. But rest of the cases the
respondents tried to manage money from their monthly pocket allowance. At the late stage when
they became more dependent and increased the doses of drugs they tried to manage the money
by giving different type of excuse to their family like to buy the books, fees for the university,
photocopy for the assignment etc. One of my respondents told me even about bating in pools to
manage the money for buying drugs.
At the late stage of addiction, the drug users started to show some physical signs like body ache,
insomnia, vomiting, and diarrhoea if they did not have the drug on time. They became more
violent and irritated even they started to behave very rudely with their parents, relatives, and
friends. They did not want to show these symptoms to their families and friends. So they became
desperate to manage the money by any means. They started to steal money from the house, sell
the valuable household items. Even they started to sell their favourite items which was seem to

be the part of their life like computer, music system, guitar, wrist watch, ornaments etc. They
also started to borrow money from their relatives and friends giving them different type of
excuses.
Rabbi said. “I told my uncle to give me some money to buy a mobile phone and not to tell my
family because for the third time I have lost my mobile. They will be angry if they heard about
that. I also could not want money from them to buy a new one.”
Asad said. “I took money from my friend to meet some emergency need. They believed me and
gave the money. I tried to return their money always. But if I failed, I tried to avoid them.”
One of my respondents, Rahat become desperate when his family came to know about his
addiction and denied to give him money. He told me like this…
“I attempted to kill my mother with a scissor when she refused to give me enough money for
buying the drugs.”
At this stage the parents of the drug users come to know that their sons/daughters were become
drug addicted. Then they took different attempts about their children so that they could lead a
drug free life like before. The parents firstly met the doctors in their chambers those mainly deal
with the drug users. They tried to follow their prescription and advice for their children. They
also came into contact with the other parents with same type of problems in those chambers.
They also followed their advice and sent their children to different detoxification and rehab
center. Sometimes the doctors also referred their patients to the rehab centers.
5.3.6 Factors related to relapse of drugs:
Very interestingly, different factors had been come out from our discussion on relapse of drugs.
The drug users said that they were determined to stop using drugs, particularly when they felt

increasingly isolated from their society and they felt they were losing their families trust, and
their friends started to avoid their company, and even when their lovers could not relay to them.
They tried to get rid of drugs for a week or month and wanted to prove their family, friends and
society that they are now living a normal life like before. But the damages those have already
done in their images are very difficult to regain. Then they become very much frustrated and
started to take drug again.
The main reasons those were come from our discussions are family instability, failure in love,
lack of trust of family members on them, enough leisure time, peer pressure, frustration on life,
mental anxiety, lack of planning for future career, even only enjoy the life like a king. The first
experiences of having drugs had also a strong relationship with the relapse of drugs. I can put
two/three examples in favor of the factors related to relapse of drugs, which had come to our
discussion with my respondents. Amir told me like that…
“I married my cousin without the concern of our parents when I passed higher secondary school
certificate. They did not accept us. They never talked to my wife, did not take meal together. They
gave me a bond that if I can establish myself then they will accept us. Then I moved to India to
complete my study. Phensydil was easily available there. I continue to take drug because of
mental anxiety and to forget the behavior of my parents to my wife”
Hamid expressed…“My outlook did not match with my peers in the college. It inhibits me to go
to the college regularly. Then I relapsed again to pass the leisure time and also from the
frustration.”
Asad uttered like this. “My movement was very much restricted when I was first discharged from
another clinic. I tried to go back to the normal life. I was fond of cricket. I went to play cricket

with my friends. They did not like and told me to stop that. But how long I could stop that. I need
some amusement also. One day they beat me when I went to play without their concern. They
could not keep trust on me. Then I revolt- even I did good things my family did not trust me. So
why I should be good? Then I started to take drug again.”
Failure in the sexual activity without drug was found very common to my respondents. They told
me that it was also a reason not to give up drugs. The drug users had established a strong
relationship between sex and drug. Nine of my respondents believed that drug had made their
sexual life more pleasant. Without drug they could not think about their sexual life. In this issue,
they had come into a single platform. Nine of my clients believed that drugs increases the sexual
power and if they leave drugs they will be not able to fulfill the demands of their sexual partners.
To meet the sexual need they used to visit the sex workers on regular basis. Friends also had
played an important role here to introduce their friends to the sex workers. I will quote some of
their comments here to describe their attitude….
“Drugs increase the duration of sexual intercourse. During detoxification phase, I met with my
girl friend but could not satisfy her. It also slipped me to take heroin again.”
Taufique said, “ I tried to leave Phensydil for several times. But I had found that without taking
that I could not perform my sexual activities for a long time like before with my wife. My wife did
not tell me anything but I could understand that. I have examined that after taking Phensydil I
got back the same power. Now I am annoyed about my sexual life. I did not know after getting
discharge from the clinic and leaving the drug I would be able to satisfy my wife or not. The

clinic authority could take some initiatives regarding those issues so that I could have sex like
before.”
Hamid thought that… “The addiction of sex is more than drug and only drug can fulfill that
desire by increasing the duration of sex. Sometimes I feel that without drug I can not enjoy my
sexual life.”
5.4 Health of young drug users of high socioeconomic status:
5.4.1 Level of awareness on drug related behaviors-
Drug related behaviors among young drug users had covered some simple but important and
relevant issues in my study. I tried to focus on drug use pattern especially focusing on injecting
drug users and sharing of needles, knowledge of young drug users on HIV/AIDS related issues,
sexual behavior (CSW, MSM, anal sex), partner selection (single/multiple), use of condoms,
STI, blood donation etc.
All of my respondents had some knowledge on causes and mode of transmission of HIV/AIDS.
They came to know from mass media, billboard, magazines etc. They believed that only
injecting drug users who share needles are at risk of transmission of HIV/AIDS. Having said that
however, it is important to state here at this is a critical point – close relations and trust with
friends meant that often-risky behavior such as sharing needles with them was not considered
harmful…. as my other eight respondents did not use injecting drugs in their life they feel that
they are not at risk of HIV/AIDS.

Two of my respondents had the exposure to injecting drug. Among them one had shared needles
with their friends. The logic behind this was… “They were my close friends and I knew them
very well. I was sure about them that they were not suffering from HIV/AIDS. But I developed
jaundice and then stopped to share needles with them.”
Another one was using disposable syringe and destroyed it after taking Pethidine for one time.
Seven of my respondents had more than one girl friend. It is very interesting that they kept full
trust on their girl friends and never used condoms while having sex with them. They believed
that their partners were not at risk of HIV/AIDS so that they could carry it from them. They also
denied having any STI with them.
Among these seven clients, four of them visited the sex workers on regular basis. They used to
take condoms whenever they went to them. But sometimes they failed to use that. It is a common
picture for all of my four clients. They had agreed that they were at risk of STI/HIV/AIDS as
they did not use condoms always while meeting with the CSWs. But they argued that they had
no signs and symptoms of STI/HIV/AIDS in their body.
Amir said… “I was in hallucination and also could not manage time to use the condom. I was
very much worried to have sex without condom but the situation did not allow me.”
Only two of my respondents had donated blood. They had screened their blood before donating it
to others. They were not denied from the Red Crescent Society to donate blood after screening.

5.4.2 Health seeking behavior pattern of young drug users-
The young drug users always had a deep intend into their mind to quit drugs. They tried on their
own way to get rid of drugs. They could manage it for a week and even for a month. According
to them, they again come in contact with drugs due to some unavoidable circumstances. The
drug users could not bear the mental pressure like others. But what happens at last? They become
helpless after taking drugs for a long time. They got some physical and mental ill health due to
their addiction. They surrendered to their parents or to the fellow friends to get rid of the drugs. It
was found from the discussions with the respondents it was found that no one among them had
the access to the doctors or to the clinics by their own interest or initiatives. Most of the cases the
parents took the main responsibility to bring them to the drug detoxification and rehabilitation
center. In only one case, friends had taken the responsibility to bring the client to the clinic.
According to the clinic authority it is very rare where the friends had done all the arrangements
in the clinic for their friend so that he could quit drugs. His wife brought one of the respondents
to the clinic. One came with his sister.
Six of my respondents had the experiences for several times (3-8 times) to get admitted in the
different clinics before coming to the study site (clinic). According to them, all the clinics
mainly dealt their clients only with medicine. They only tried to detoxify them from the clinic.
They have no rehabilitation program like this center. That’s why they felt no encouragement
from their mind to quit drugs. Then again after 2-3 month, they started to take drug.
For the other four respondents, it was the very first time they had got admitted in this clinic.
5.4.3 Factors those can help the drug users to quit drugs-

The drug users believed that they had created a lot of suffering to their families. Their family had
lost their position in the society only for them. They also wanted to rebuild their reputation in
their families, relatives and in the society. They could understand from the clinic that if they
realized these problems from their heart then it will be easy for them to quit drugs. Besides this
they deserved that their family would rely on them and would not behave with them like before
when they were taking drugs. They also realized that they still had some good friends those are
not drug addict and hope for the best for them. They would get mental support from them. More
over the after care program of the clinic would also help them to quit drugs. All of the
respondents have focused on these issues invariably. One of the respondents had added the
employment opportunity; one had talked about avoiding the emotions in addition to the above
factors.
5.4.4 Expectations of drug users from the health service providers regarding treatment and
rehabilitation-
Simon’s expectations from the clinic were as follows. “I want to see my life without drug. I will
prove my family that I can continue my life without drugs. I want to see everyone happy.”
This was not only his expectation from the clinic. Those (four clients) were admitted for the first
time in this clinic had the same expectations from the clinic. They also thought that individual
counseling with the counselor on regular basis after recovery period might have a great impact to
change their attitudes. They had also given emphasis on arrangement of cultural program in the
clinic in every week for their mental refreshment.

But those (Three clients) were got admitted for the second times in the clinic had some other
expectations. Hamid said… “This clinic had provided me the guideline to keep me in the right
track. But I failed to follow their instruction. This was my fault. I had slipped again and again.
Now my target is to keep me drug free for at least one year. Then I will go abroad to establish
me.”
All of the respondents irrespective of new and old, had told me about the positive impact of
sharing individual feelings with the fellows, physical and mental support from the fellows and
health staffs during detoxification phase, classes on different issues related to drugs, house work
etc. during their treatment and rehabilitation phase to give up drugs.
5.4.5 Plan for the future after getting rid of drugs-
The clients who could accept the program of the clinic had the same feelings to do something for
their future career as well as for their families. I have talked with 10 clients of the clinic. Among
them those were student (7 in numbers) and could not complete their under graduate level had
shown their deep interest to complete their study. They also wanted to show them as a successful
man of the society in the near future. They wanted to rebuild their reputation with in the family,
relatives and in the society. Rahat said….
“Drug can give you enjoyment for a very short period not for ever. If you ever taken the program
of the clinic then the life with drug will be more painful for you and your mind as well.”
Those were in service or doing business (3 in numbers) wanted to establish themselves in their
respective field. Alamgir was crying and told me that….

………“I have a girl. Today it is her first birth day. But I am here. I don’t want these type of
events in my life again. Besides this, I have to do something for my family”
5.5 Health providers’ perspective of drug use among young people of high socio economic
status:
5.5.1 Reasons behind starting of drugs-
Before going to the findings, in a table, I want to show here the background information on the
health providers whom I interviewed.
Name of the Age How long in How long Position & Job description
health staff (Yrs) this clinic in this
(Yrs) field (Yrs)
Qayum 40 6 11 Clinic Manager- Co-ordinate the

program dept, client service dept, and
center management
Robin 34 5 5.5 Program Officer- Client management,
Counseling & motivation, conduct
classes on drug related issues like
relapse of drug, family support,
slogans of the clinic etc.
Sohel 32 2.5 3.5 Program Assistant- Case management,
logistics supply to the clients,
marketing for the clinic, Counseling &
motivation, conduct classes on drug
related issues.
Titu 34 3 - Program Assistant- Observation of the
clients’ behavior, sharing feelings,
Counseling & motivation, conduct

classes on drug related issues.
Nazim 31 15 days - Volunteer- Client management during
withdrawal phase, Counseling &
motivation, conduct session on drug
related issues like anger management,
slogans of the clinic, surrender to the
program of the clinic etc
I have already discussed about the reasons behind starting of drugs. It was from the young drug
users’ perspective. Talking to the health staffs (Five in numbers) of the clinic I had got some
interesting findings those seemed to be more general and would be applicable for all the young
drug users of high socio-economic status in our country as they always deal with the same type
of clients of different parts of the country.
Nazim expressed his experiences like this… “The drug users faced the same type of mental or
social problem like others. Others could solve their problem by their own away but the drug
users could not. Why? That means they were coward and could not face the problem. So they
took drugs to keep themselves confined on them or kept them away from the problems. Besides
this the first feelings of drugs had a very important role to continue or take the drug again. Some
take it as a fashion. But gradually he became dependent on that.”
Titu believed that... “Most of the cases the clients felt very loneliness in their life. They didn’t get
any amusement from their family. To avoid the loneliness and also to get the amusement they
started drug. Drugs took that place very soon. They could spend their time by confining
themselves in their own world and also by getting amusement from drugs.”

Titu also said the reason that. “A very little portion took drug from the curiosity. They wanted to
show their friends those were already taking drugs that I was also the part of your group.”
Qayum had focused on family problem as one of the main reason to start drug. He shared his
experiences of one client in his life. “All of the relatives of a young people knew that he was the
member of that family where his mother had extra marital affairs. It had a great negative impact
on his mind and life. He tried to forget this or got under frustration. Then he started to take
drug.”
Qayum also told about enjoyment of life… “Somebody enjoyed doing small crime with his
friends. Gradually he got involved in a big crime and being arrested by the police. This made a
gap with his family and tended to be more closure to his friends resulting in continuing of
drugs.”
Wealth is also a main cause of addiction among the high socio economic group. He uttered,
“Young people from the high socioeconomic status had enough money. He could go abroad,
could do whatever he liked, and could buy what ever he wanted. But did not enjoy his life. He
then along with his friends started drugs, crimes, and illegal sex to enjoy his life.”
Robin had given emphasis on over controlling of parents to the children. Bindings of the family
tended the young people to break the laws. Then he tried to revolt and started to do all illegal
things.
5.5.2 Factors related to relapse of drugs-
First dose does the damage- this is one of the slogans of my study site (clinic). The clinic has
designed their program to manage their clients keeping this slogan in their mind and also trying
to transmit this message to all the drug users. But still they are getting the relapsed cases in their

clinic. Now I will try to figure out the factors related to relapse of drugs and of course it will
come from the health service providers’ sites.
The health providers thought that if anybody could not surrender to the program of the clinic or
follow up the programs after recovery had more prone to relapse. They should avoid bad
company, bad boundaries and others those were taught in the sessions.
Nazim said about mental weakness of the clients’ to face the problems as a reason for relapse of
drug. He told… “Some clients tried to take the mental pressure. They did not share with any
body. At last they could not able to fight with them and slipped.”
Qayum shared his experiences like this… “Some clients got admitted in the clinic under pressure
of their parents and relatives. They were not motivated about themselves to quit drugs. So they
passed the time in the clinic and never tried to surrender to the programs of the clinic. Then after
discharging from the clinic they again started the drugs.”
Sohel told about lack of planning for the future and family support as the reasons for relapse. He
expressed like that… “Some could not feel interest with his life due to lack of planning for their
lives. Besides this, they could not forget the feelings and company of drugs very soon. So they
need extra care and love with passions from the family. If they didn’t get family support at that
period there were every possibility of relapse.”
Robin talked about lack of plan for the leisure period. He said… “Some clients saw that all of
their friends are passing their times by taking drugs. But after getting discharge from the clinic
they could not get involved in any activities. So they had a lot of leisure time. They started to feel
bore and took drug again to pass the lazy hours.”

Robin also argued that lack of knowledge of family to keep support for the drug users was also a
main reason to relapse. He said… “Family or society has the feelings that the drug users could
not come back to the normal life. It strikes them and provoked them to take drug again. Family
sometimes gave them extra freedom, provided them what ever they wanted. So they could
manage extra money easily from them. With that money, they got nothing to do then again start
to take drugs.”
5.5.3 Role of the family/society to help the drug users to quit drugs-
Family support could help a client to quit drug. If the client saw that the family members were
behaving with him like before; could not keep trust on him, tried to keep everything under lock
& key- it created a negative impact on his mind. He started to think about like that- “I am not
addicted now but my family does not keep trust on me. So I need not to be a good man.” Then he
slipped.
In general health providers worried about clients who had a habit for more than 8-10 years, as
these clients were much mire difficult to bring back on the right track. In addition, health
providers pointed to the importance of family support. This is because the client was in a wrong
track. So it will take time to change his behavior. The family should provide him social and
mental support. They should not blame him for what he had not done. It created anger on his
mind. Then he thought to start drug again.
5.6 Health providers’ role in treatment and rehabilitation of drug abuser:
5. 6.1 Lines of management and treatment of the new & review clients-
Programs of the clinic:

The clinic mainly ran two types of programs for the drug users. One program mainly dealt with
the new cases. The new cases meant those clients who had got admitted in their clinic for the
first time. The duration of this program was 60 days and it consisted of both treatment and
rehabilitation component. Another program dealt with the review cases. The review cases meant
those clients who had received treatment and rehabilitation from that clinic before but they
relapsed the drug again. The duration of that program was 30 days and mainly gave focus on
rehabilitation issues.
Procedures for admitting clients:
After getting admitted in the clinic the clinic authority firstly checked the whole body and
beddings of the clients to ensure that they had no drugs with them even any cigarettes. Then they
filled up the history sheets of the clients. After that the clients were introduced with their fellows
by a staff or another fellow. Then they were sent to the in house department where they got the
opportunity to live with the review (old) cases. The reasons behind this to keep them with the
review cases were to ensure their help and motivation during the withdrawal period of the
clients.
Treatment during withdrawal period:
During the withdrawal period, the clients mainly suffered from body ache, excessive sweating,
insomnia, vomiting, fever, and diarrhoea. In those cases the fellows or health staffs massage their
body, help them to take shower and also tried to motivate and counsel them so that they could
easily manage those types of problems. In case of severe diarrhoea or chronic insomnia the clinic
provided oral saline and sedatives after consultation with the medical officer of that clinic. It
usually took 5-7 days to recover from the withdrawal period.

Motivation & Counseling:
After the management of the withdrawal period, the clinic authority tried to involve them in
different types of works of the clinic. The clinic has four units. Unit- 4 for cleaning the clinic,
Unit- 3 for kitchen, Unit-2 for organizing the classes, and Unit-1 for management of the clients
with motivation and medicine. The clinic involved the new cases in the unit-4 then gradually 3,
2, and 1 according to their performance.
‘T’, one of the health staff, put his comment like this………..
“We have seen that the drug users always try to keep themselves away from works,
responsibilities. So we try to involve them in different type of works so that they can feel interest
to different type of works. Then we gradually we try to build up their responsibility.”
Through their works and weekly evaluation, the clinic observed the clients. Then they tried to
focus on the issues they need help. Then they helped them to take the initiatives to improve
themselves, wherever they had the lacking. By this way, the clinic tried to rectify their clients.
In the mean time, the clinic also arranged individual counseling sessions, group counseling
sessions, feelings sharing sessions. They organized different type of classes focusing on drug
related issues like management of anger, factors related to relapse of drugs etc.
The clients were used to fill up an inventory sheet to assess their achievement from the program
of the clinic per day. They were the self-evaluator there. They tried to give marks on their works
and take the initiatives to improve themselves in those fields they have lacking. Besides this,
they also had to fill up a weekly evaluation sheet and discussed in the open forum to get the feed
back from their fellows and also from the health providers so that they can improved themselves
in those respected fields they had still some gaps to surrender to the program.

During observing and spending time in the clinic, I noticed that emphasis is given on managing
the patient through counseling without giving them any medicines. The health staffs of the clinic
alleged that they are well known about the initial problems of the drug users after leaving the
drugs. They also thought that in 5% cases the problems are physical and the rest are
psychological. So they tried to manage the patient with counseling and motivation. From my
own experience during my previous work in medical college and different clinics in Dhaka &
Chittagong, I found the difference of that clinic from other clinics in Bangladesh. In those clinics
and hospitals, I had seen to give emphasis on detoxification of the drug users by using different
types of medicines. It could not motivate the drug users to get rid of drugs. As a result, the
relapse rate is very high in those clinics. It is not only the experiences of mine but the health
staffs of that clinic and also the clients who had got admitted several times in different type of
detoxification center claimed like that.
Health staff, the past drug users – ‘empathy for clients’:
A key advantage of this clinic is that most of the care givers (all the health workers interviewed
by me) and all other staff, except for one counselor, were drug users in their recent past. Thus,
there is a certain level of empathy in treatment and care given to the clients. So they could
easily understand the problems of the clients and could manage them according to their need.
The clients also felt free to share their problems and feelings with them. It is very important for
drug users.
5.6.2 Common difficulties in managing the clients-

The clients did not want to stay in the clinic for a long period like 60 days. The drug users are
mentally very weak. They could realize that they have to stay in the clinic for their benefit but
sometimes felt that they had to leave the place. They felt like that they were in the custody. Then
they tried to motivate their parents and even gave threat to them to start drugs again after
discharging from the clinic. So, the parents also requested the clinic authority to discharge their
children. The clinic took extra initiative and motivation program for those types of clients even
for their guardians.
Some clients tried to break the rules of the center like cigarette sharing, late in the class, did not
wake up early in the morning, shouting, telling a lie etc.
‘S’ said………. “During the initial stage of the treatment the clients are most vulnerable both in
mentally and physically. If you listen to them, share their feelings, motivate them then they will
cooperate with you. If you tried to give pressure, they tend to be more violent and will break the
rules.”
5.6.3 Programs of the clinic for the clients & family regarding treatment and rehabilitation-
Program on sex recovery-
I have already discussed that the drug users strongly believed that there is a strong co-relation
between sex and drugs. Drug increases the sexual desire and also the duration of intercourse. So
they became worried about their sexual life after getting discharge from the clinic. The clinic was
also concerned about this issue. So they conducted a 3-day Sex & Recovery session focusing on
this. They also counseled their partners to help them on that stage because it is very temporary.
The clinic had a plan to conduct a session on drug related risk behaviors. They were still
working on it and promised me to start it very soon.

Program on Family Support:
The counselor and all of the health workers shared their hopes that the family would provide
mental and social support to their children after getting discharged from the clinic. In order to
facilitate this process, the clinic has also organized a program that provides counseling sessions
for the parents or guardians about their responsibilities to their children at home and outside.
Said uttered like this… “The parents of a drug addict are also co addict. They have suffered a
lot. So they are angry and hopeless about their children. We try to motivate them so that they can
provide mental support to them. We expect that they will try to understand the feelings of their
children, will behave softly with them, and will not give hem mental pressure.”
The clinic management staff claimed that they provide re assurance to their clients that they
would try and provide as much support as they can even after 10 years of discharge of the client.
The clinic staff also claimed to be available…if clients or family wanted to talk to them over the
phone. But in return they expected self-motivation and self-realization from them.
Discussions
Drug addiction severely affects human life. It is being addressed as a national, societal and health
problem in Bangladesh. It was assumed that drug addiction is the common problem in low or
middle income families of our country where poverty, unemployment, lack of education, crime,
violence, frustration about life is very common. The researches those were done before in our
country also had given focus on these groups of people. But during my recent study in one of the
reputed drug treatment and rehabilitation center in our country with the young drug users of high
socioeconomic status, it would be worth exploit, why the member of a high socioeconomic status

who get all the opportunities to lead a happy and meaningful life, were getting addicted with too
many different types of drugs. It meant that drug addiction had already invaded every fabric of
the community.
It was found in my study that the people who was got admitted to drug use in the clinic had
negative impact on their individual as well as social life. Out of my 10 respondents, very few
could complete their post graduation and under graduation. But most of them could complete
their higher secondary level of education. All of them got admitted in the under graduate level
but they claimed could not complete their study due to drug which had kept them very frustrated.
While talking with them these issues came repeatedly and they could not come into a decision
about their future career plan as because drug had already taken away several years from their
life. Their parents and relatives still could not believe that they will be able to come back to the
drug free life. The parents of the drug users had taken several steps, spent lot of money so that
they could return back to the normal life. They lost ‘face’ and position in the society due to their
children. Even though their children could not give up the drugs. As a result the drug users
became isolated from their family, friends and relatives and got involved different types of small
(Stealing, telling lie, selling goods) and large crimes (drug dwelling, local politics etc.). The
impact of drug on their personal, family, social, and national level had not been evaluated before
as no qualitative or quantitative research had been done focusing on these issues in our country.
The results showed that my respondents had started drug due to frustration from family
instability, to enjoy the life, from curiosity, to follow their mentors of life, and also to pass the
leisure time. One study showed that more than 80% of the addicts started taking drugs out of
self-curiosity and on a friend’s incitement. Frustration from unemployment, family instability,
poverty etc. also contributed to addiction. (Sk. Nazrul Islam et al, 2000). Another study showed

that 63% cases the addicts started drug from friends’ pressure, 7% from own curiosity, 4% from
family conflict, 4% due to failure in love, and 4% started drug just for fun. (Shah Ehsan Habib,
2005). Both of the study was conducted among the low and middle-income group of people in
two different big cities in our country. From the above discussion I could say that the factors
influencing initial drug use among the people of high socio economic status matches the other
studies, which was done before among low and middle-income group of people. Only poverty
and unemployment did not come out here.
From the in depth interviews with my respondents, it was found that drugs were easily accessible
and available. They were used to collect it from the different spots in the cities. Even if they went
to the new places for sight seeing they could mange the drugs from that place though they had to
spend more money and time. The mobile phone network with the drug dwellers made the life
easy for the drug users to get access to the drugs. The drug users could get involvement in the
drug dwelling due to their financial stability. They need not to think about the money to buy the
drugs up to a certain stage. The health staffs also had given emphasis on easy availability of
drugs in all over Bangladesh as one of the main reasons to start and relapse of drugs among the
drug users. A study that was done in Rangpur city had also mentioned about the different
popular spots of that city where the regular drug users met with the drug dwellers (Shah Ehsan
Habib, 2005). If we want to save our children from drugs we should stop drug dwelling in our
country on urgent basis. Law enforcement groups, member of the parliament, local government,
local clubs along with the elite groups of the society, local NGOs should work together to stop
drug dwelling in their locality. Govt. should pass strong law even life penalty or prison to death
for the drug traffickers.

The first experience of having drugs seemed to be more pleasant for all of my respondents. The
health staffs also mentioned that. They told me that the drug users tried to give up drugs. But the
addiction to pleasure with drug use makes it difficult for many to stop. It tended them to take
drug again. That’s why the clinic always tried to motivate them to avoid the bad companies (BC)
and bad boundaries (BB). Bad companies means the people who were always used to take drugs
and the bad boundaries means the areas where the drugs were sold or the places the drug users
were used to take drugs. Because it was not possible to wipe up the memory of the first
experiences of having drugs from their mind. But some initiatives like this could be taken to
keep them away from the drugs.
The starting substances were Ganza & Phensydil in most of the respondents. Very few started
with alcohol, Pethidine, and capsule/tablet. Then they switched over different types of drugs. But
the ultimate drug of choice was heroin for majority of my respondents. Few used to take
Phensydil, Pethidine, and Yaba. Low cost, high euphoria, easy availability, non-availability of
Phensydil and other drugs tended them to switch over heroin. But the effects of stopping heroin
is much more harder that any other drug. So, once who started heroin could hardly come back
from that and gradually they need to increase their dose to get their desired feelings. The results
of my study showed that 4 of my respondents were used to take single drug and the rest 6 were
taking multiple drugs. My respondents expressed to me that they would like ‘feelings’. They
tried with that which gave them more feelings. As the time was passing out the doses of drugs
were also increasing. The drug users also came into contact with different types of drugs that
were coming into the market. And finally they tried to choice a drug or combination of more than
one, which can fulfill their desire. A study that was done in Central drug addiction treatment

center at Dhaka (in 1999) showed the similarity that 60% of the drug users started with Ganza,
23% with Phensydil, 15% with heroin and only 2% with injection. The ultimate drug of choice is
heroin for 60%, Phensydil for 23%, injection for 7%, and cannabis for 7%. The same study
showed that 93% of them are multiple drug users (Sk. Nazrul Islam et al, 2000). Another study
that was done at Rangpur (in 2005) also showed that the main drugs for addiction was heroin for
76% of the drug users. My findings and that of two other studies reveal that heroin is the most
popular drug of choice in both high and low or middle income groups of people and it is very
much alarming for the public health professionals because of its serious social, mental, and
physical consequences. Every drug had its serious side effects in the body. But the consequences
of heroin smokers by physical, mental, and social are very crucial and irreversible in the late
cases. Health communication (BCC) can play a vital role here. We can use mass media,
newspapers, and billboards to create public awareness on the consequences of different types of
drugs in the body and mind and also in the familial or societal level. Govt., private agencies,
NGOs, and donor agencies should work together to get the highest achievement of the program.
In the initial stage of drug addiction, most of the drug users could manage money from their
pocket allowance. As the members of high-income families they were used to get a handsome
amount for that. The range for the pocket allowance was Tk.1500-6000 per month. Besides this
they could take extra money from their parents whenever it was necessary. But at the late stage
when they started to take extra doses to get their desired feelings they needed extra money. Then
to manage the money for buying the drugs they started telling lie to their parents, selling
household goods, stealing money from the wallet of their parents, and selling their favourite
items like computer, wrist watch, music system etc. They also got involved in drug dwelling and
local politics to manage the money. None of my respondents were involved in large crimes like

kidnapping, robbery, pick pocketing those were very common in the lower income groups. Close
supervision from the family to their children on educational activities, leisure activities, spending
time with them, building trust with them can keep their children away from drugs or bad
companies. As one study found that close family connection and relation stops youth from
indulging in risky behaviors (Talukdar et. al, 2005). This study was took part in WHO 25
country with same focus on adolescents about risky behaviors and protective factors.
Mentally the drug users are very vulnerable. They cannot take any pressure on their mind. Any
type of mental pressure provokes them to take drug. From our study it was found that lack of
trust of family members, family instability, failure in love, frustration on life, lack of planning
for the future, enough leisure time, failure in sex were the factors behind relapsing of drug.
Family and friends should take the main responsibility here. Their mental support and love could
help them (drug users) from relapse of drugs. The drug rehabilitation centers those were working
in this sector should take sessions for the parents of the drug users so that they can understand
their role for their children and take necessary steps while they will be at home after getting
discharge from the clinics. Govt. should establish drug rehabilitation center in every medical
college hospital so that the drug users who could not afford the treatment cost of the private
sectors could easily get access those centers for their treatment and rehabilitation. We should not
forget that drug addiction is not a problem of high socioeconomic class but also for the low and
middle-income families those present the major portion of the society. The Govt. should develop
a guideline for the treatment and rehabilitation of the drug users and an effective monitoring
team will supervise the activities to ensure that every center irrespective of public or private was
following the same guideline. The guideline will also cover the roles of family, friends, relatives

and society to the drug users and should behave with them like that they could never go back to
the drug.
Drug users are not an isolated group of people. They are connected to the general population
through their sexual partners. My study showed that most of my respondents had more than one
sexual partners or girl friends. Among them more than half respondents regularly visit the sex
workers. While sex with their girl friends they never used condoms. But they tried to use
condoms when they planned for having sex with the sex workers. They also granted that
sometimes they failed to use condoms while sex with thm. All of my respondents could tell me
about the causes and route of transmission of HIV/AIDS. But their sexual behaviors do not
match with their knowledge on HIV/AIDS. The study that was conducted in Dhaka also had the
similar picture. The study showed that 88% of the drug addicts were heterosexual and 7.1% were
bisexual. 75% of the drug addicts have more than one sexual partner. Among them 29.5% were
CSWs, 18.7% were residential sex workers, and 43.1% were both commercial and residential sex
workers. 75% of the drug addicts did not use condom at all, 20.3% are occasional user, and only
4.6% are regular user of condoms. 60% of the drug addicts were suffering from STIs (Sk. Nazrul
Islam et al, 2000). Another study also showed that 76.8% of the unmarried drug users had sex
with the CSWs and only 12.7% cases they had used condoms (Shah Ehsan Habib, 2005). From
the above discussions it was found that drug addicts have multiple sex partners and unprotected
sex were very common which could spread sexual diseases. Unprotected heterosexual sex
accounts for most of the HIV spread in developing countries. HIV infection is spreading
specially in Southeast Asia and sub- Saharan Africa. In Southeast Asia, the HIV epidemic is
dominated by India followed by Thailand and Myanmar (Mann JM et al, 1998). Trafficking
between India, Bangladesh, Myanmar and Thailand is extremely high, which can easily spread

the HIV infection among the people of this country. Because of sharing of needles, multiple sex
partners, unprotected sex practices, and use of immunosuppressive morphine derivatives, drug
users are at high risk of HIV infection. The sixth round technical report of NASROB showed
that, in Central A-1, 7.1% of the IDU tested positive for HIV. This was the highest prevalence
recorded for HIV so far amongst all vulnerable population groups sampled. Central- A2 recorded
1.3% HIV positive. To make these sites comparable to the previous years, both Central A-1 and
Central A-2 were combined together and termed as Central- A. This combined site showed HIV
prevalence at 4.9%, which is close to a concentrated epidemic. For the first time during the 6th
round HIV was detected in cities other than Central-A (Dhaka Division) and these were
Southeast-D (Chittagong Division) and Northeast- A1 (Sylhet Division). The HIV prevalence
was 0.6% and 2.0% respectively. No HIV was detected in the other sites. Among heroin
smokers, two (0.5%) tested positive for HIV in Central-A. Active syphilis rate varied from as
low as 0 to as high as 9.2% among IDU in different sites and the highest rate was recorded in
Southeast- H1. Active syphilis rate for heroin smokers was comparable to that of IDU in the
same region. HIV was remained below 1% for sex workers in all rounds except among the casual
female sex workers in Northwest- K1 (Rajshahi Division), where the HIV prevalence was 2% in
the 5th round and 1.7% in the 6th round. Altering their sexual behavior, no condom no sex
program among the sexual workers, needle syringe exchange program among IDUs can control
the epidemic of HIV infection in Bangladesh.
The drug users believed that they could give up drugs whenever they want. This type of belief
provokes them to relapse again and again. They could manage themselves by their own way but
for a very short period then they relapsed again. At last when the drugs took the upper hand and

they could not manage themselves without drugs they surrendered to their guardians. Then the
guardians take the initiatives to bring their children in the clinic. But if they did not get proper
treatment then they again started the drug. The clinic staffs had set their program keeping the
mentality of drug users in their mind. They believed that 5% cases the problems of the drug users
are physical but the rest 95% are mental. So they try to motivate them by involving them in
different type of works to increase their confidence level and responsibility. Then they tried to
focus on different issues where the drug users need help. They arranged group counseling,
individual counseling, and feelings sharing sessions to know their problems. And also by
observing their works they decided to arrange psychotherapy session. Through these programs
the clinic prepared their clients to face the world without drug. In the mean time the drug users
tried to surrender to the programs of the clinic and they got self-motivation and self-realization to
change their life and wanted to be a new man with out drug. I thought this type of program had a
very good implication on the drug users. Because if anyone does not want to change himself no
one can change him.
The clinic did not keep any sessions focusing on drug related behaviors and their consequences
on life. If they could convey the message on negative impact of needle sharing, unprotected sex,
multiple partners, and STI/HIV/AIDS among the drug users then the risk of transmission of HIV
would be very much reduced. Besides this, the clinic could provide enough time for individual
counseling, arrange cultural show on weekly basis, go out for walking or playing outdoor games
everyday with close supervision, improve the accommodation facilities, show different types of
documentary on the life of drug users or drug related risk behaviors, and improve the diet for the
better management of their clients.

Conclusion
The finding of this study suggests that easy availability and accessibility to drug has made the
young people of our country most vulnerable to drug addiction irrespective of high, middle and
low socio economic status. Al though poverty and unemployment have not come into our
discussion as the reasons behind starting of drugs among the young people of high socio-
economic group but lack of plan for the leisure time, and free flow of money to their hand have
provoked them to enjoy their life by taking drugs, doing small crimes and having illegal sex.
Their exposures to different type of drugs and popularity of heroin among them is also triggering
their chance to move for injecting drugs as the Sharing Network Study has shown that heroin
smokers are switching to Bupreonorphine injection quite frequently due to increase cost and
decrease availability of heroin. It is also alarming that at the late stage of addiction when their
family came to know about their addiction the drug users had faced the shortness of money that
leaded them to perform small crimes. If it proceeds like that then they can be involved in large
crimes in the near future that have a serious negative impact in our social security. Their
inadequate knowledge on HIV/AIDS, irregular use of condoms, selection of multiple sexual and
regular visits to the sex workers are also increasing their chance of spreading STI/HIV/AIDS to
the wider group of populations. It was also found from the study that most of the cases the
addiction has started at the adolescent age and cigarette has played the vital role to go for further
addiction in all cases. That means the addiction of the drug is gradually engulfing the society
from the womb to tomb irrespective of high and low-income groups. We all are at risk now.
In public health practice, the saying goes: prevention is better than cure. It would be much more
cost-effective and socially beneficial if the epidemic of substance/ drug abuse in Bangladesh

could be managed by preventive interventions specifically targeted at the adolescents, based on
their knowledge base and mindset. However, very little information is available on this issue in
Bangladesh. To bridge this knowledge gap, BRAC, a national NGO, and the Central Treatment
Centre for Drug Addicts (CTC), Government of Bangladesh, initiated a joint study to explore the
knowledge, attitudes and perceptions of the school going adolescents on substance/drug abuse.
World Health Organization (WHO) funded the study, and it was expected that the insight gained
from it would help them in designing a preventive campaign for school-age adolescents (Syed
Masud Ahmed et al, 2005).
Law enforcement groups, member of the parliament, local government, local clubs along with
the elite groups of the society, local NGOs should work together to stop drug dwelling in their
locality. Govt. should pass strong law even life penalty or prison to death for the drug traffickers.
To create public awareness and also to inform the young and adults about the side effects of
different type of drugs Govt. NGOs, donor agencies will work together to launch a massive
campaign.
HIV/AIDS awareness program can be initiated in the school based education with due regard to
cultural context.
No condom no sex program can be initiated among the sex workers to reduce the transmission of
STI/HIV/AIDS in the general population.
Serological surveillance should cover the whole population not only the specific group of people.
Drug treatment and rehabilitations centers should follow a specific guideline to management and
treatment of drug users. WHO & MoH can take the initiative on urgent basis. The clinics will
also conduct awareness sessions on drug related risk behaviors like HIV/AIDS, unprotected sex,
selection of multiple partner, needle sharing etc from their center.

Citations
AusAid Fact Sheet for the HIV status in Bangladesh. Retrieved 31st October, 2005, from
http://www.ausaid.gov.au/country/country/htm
GOB Sixth Round Technical Report, National HIV serological surveillance, 2004-2005
Bangladesh
Jenkins C et al, (2001); Measuring the impact of needle exchange programs among injecting
drug users through the National Behavioural Surveillance in Bangladesh; AIDS Education
Preview. Oct 2001; 13(5):452-61]
Mahbubur Rahman et al, (2000); HIV-related risk behaviors among drug users in Bangladesh;
Dept. of General Medicine and Clinical Epidemiology, Kyoto University Graduate School of
Medicine; International Journal of STD & AIDS (Volume 11, December 2000); P. 827-828.
Salek SA (1999); Role of mass media in control of drug abuse. Bangladesh Narcotics Control
Board, Ministry of Home Affairs, Dhaka, Bangladesh, June 1999: 15-20
Shah Ehsan Habib (2005). Drug use and potential spread of AIDS- A Rapid Situation Assessment
in Rangpur, HIV Programme, CARE Bangladesh, Dhaka.
Sk. Nazrul Islam et al, (2000); Sexual life style, drug habit and socio-demographic status of drug
addicts in Bangladesh; Institution of Nutrition and food science, Department of Pharmacy,
University of Dhaka, Dhaka, Bangladesh; Public Health (2000) 114, 389-392].

Stimson et al, (1998). The Rapid Assessment and Response Guide on Injecting Drug Use, WHO:
Programme on Substance Abuse.
Syed Masud Ahmed et al, (2005). Substance and Drug Abuse: Knowledge, Attitude and
Perception of Schoolgoing Adolescents in Bangladesh; Regional Health Forum WHO South-East
Asia Region (Volume 6, Number 2)
Talukder et al, (2000). Protecting youth: Countering risk behaviour with universal protective
factors. WHO, 2000.
World Bank Fact Sheet for the HIV status in Bangladesh. Retrieved 31st October, 2005, from
http://web.worldbank.org/country/htm

Acknowledgement
I gratefully acknowledge James P. Grant School of Public Health, BRAC University, Dhaka,
Bangladesh for giving me an opportunity to undertake this study. I would like to express my
deep appreciation for all the support and guidance received throughout the MPH program from
Dr. Demissie Habte, Dr. AMR Choudhury, and Dr, Shahaduz Zaman.
I would like to thank my technical supervisors Dr. Tasnim Azim and Dr. Sabina Faiz Rashid
those amidst all their busy schedule had taken time to look at my progress of data collection and
help me with valuable advice regarding data analysis and write up.
I want to say some word of thanks to the chairperson and the Directors of my study site for
letting me be a part of their program, helping me out with necessary information.
I would like to express my sincere gratitude to my dearest family members for the support they
provided me during this MPH program and also to do this research.
Last but not the least, I would like to thank all the young drug users and health staffs of my study
site who have been so patience to take part in the in-depth interviews and shared their personal
lives and experiences with us and made this research possible.

Life Stories of Young Drug Users in Bangladesh: A Qualitative Research to Explore Drug
Related Behaviors Among Young people of High Socio Economic Status
James P. Grant School of Public Health

BRAC University, Bangladesh
Guideline Questionnaire for In Depth Interview of Young Drug Users
Informed Consent:
Hello. Assalam-u-alaikum/ Adab. I am Dr. Md. Salim Reza and I am from BRAC University. I
would like to request you to take part in a project on Life Stories of Young Drug Users in
Bangladesh: A Qualitative Research to Explore Drug Related Risk Behaviors Among Young
people of High Socio Economic Status.Before you agree to participate, please ask as many
questions as needed. If you agree to take part in this project, we shall ask you some question
about drug use and related risk behaviors. All the information you give will be kept confidential;
no names will be recorded only ID numbers will be used. There are no risks as far as we know
and no benefits from participating in this study.
You may answer only those questions you feel comfortable with. You are free to discontinue the
interview at any point. If you don’t want to participate or would like to discontinue your
participation, you will continue to receive the services provided by this institution. If you would
like to participate in this project we only need your verbal consent to maintain the privacy of
yours as well as the clinic.
3. ID No: ___/___/___/___
4. Name of the Interviewer: Dr. Md. Salim Reza__Signature with Date: ____________

Socio-demographic Issues: ID No: __/__/__/__
6. How old are you (In complete Years): _________ (Let him/her respond)
7. Sex:
a) Male……………………………… 1
b) Female……………………………….. 2
8. Have you ever attended school?
a) Yes…(Go to 8A)…………………………….. 1
b) No…………………………………………… 2
8A. Up to which level?
a) Non formal………………………………… 1
b) Mosque……………………………………… 2
c) Primary……………………………………… 3
d) Secondary…………………………………… 4
e) SSC…………………………………………. 5
f) HSC…………………………………………. 6
g) Bachelor/Masters……………………………. 7
h) Others…………….. 8
9. What is your occupation ?
a) Student………………………………..…. 1
b) Service……………………………..…… 2
c) Business………………………………..…… 3
d) Others (Specify)………………………..…… 4

ID No: __/__/__/__
10. What is the occupation of your father?
a) Service……………………………..…… 1
b) Business………………………………..…… 2
c) Others (Specify)………………………..…… 3
11. What is the occupation of your mother ?
a) Housewife………………………………..…. 1
b) Service……………………………..…… 2
c) Business………………………………..…… 3
d) Others (Specify)………………………..…… 4
12. What is the average monthly income of your family?
a) Between 15,001 - 30,000 Taka………………………... 1
b) 30,001- 50,000 Taka…………………………... 2
c) 50,001- 100,000 Taka…………………………. 3
d) 100,001- 250,000 Taka………………………... 4
e) 250,001- 500,000 Taka………………………... 5
f) More than 500,000 Taka…………………….. 6
13. How many Brothers & Sisters do you have? __________(Let him/her respond)
14. What is your position among them? __________(Let him/her respond)

ID No: __/__/__/__
15. How much money did you get as a pocket allowance from your family per month?
Tk._____________(Let him/her respond)
Social Gathering Issues:
16. Tell me about yourself. ( Study, liking, future plan, relationship with your
family/friends/others, social network etc)
17. Are you a social person? Do you consider yourself an optimistic/happy person?
18. How did you spend your leisure time?
19. How often did you meet your friends?
20. What did you do while meeting your friends?

ID No: __/__/__/__
Drug Use Issues:
21. How long you are using the drugs?
_____________________(In Months/years)__ (Let him/her respond)
22. How did you first come in contact with drugs? (Curiosity, peer pressure, social gathering
etc.)
23. What are the different types of drugs you usually take? (What did you start with, Which one
you like, what were you taking when you came here, based on liking, availability, cost etc.)
24. How did you feel while taking drugs initially?
25. How did you manage the drugs?/ Who supplied the drugs to you?

ID No: __/__/__/__
26. How much did you spend per day to buy the drugs?
27. How did you manage the money to buy the drugs? (Pocket money, family, friends, loan, pick
pocket, selling HH items etc.)
28. What are the reasons behind continuing the drugs? (Enjoyment, family problem, mental
anxiety, frustration, dependency etc.)
29. How did you feel if you did not take the drug on time?

ID No: __/__/__/__
HIV related risk behavior issues:
30. Do you have any idea about HIV/AIDS? (Cause, mode of transmission etc.)
31. Do you think there is a link between drug use & HIV/AIDS? (Why, how)
32. Do you feel you are at risk? Expand. (Sex, CSW, MSM, anal sex, IDU, multiple partner,
condom)
33. If you are at risk, why did you take those chances?

ID No: __/__/__/__
34. What would you like to do to know whether you may have HIV/AIDS?
35. Do you have boy friend/girl friend? Do you use condoms whenever you meet him/her?
(why/why not)
36. Do you have more than one sexual partner? How frequently you meet them? Do you use
condom while going to them? (Why/why not)
37. Have you ever-visited sex workers? Did you use condom? (Why/Why not)
38. Have you ever donated blood? (Why, where, any screening?)

ID No: __/__/__/__
39. Have you injected drugs? If yes, expand. (Why, what, when, how frequently, sharing, how
many, known?)
Health seeking behavior/pattern issues:
40. Who brought you to the clinic for treatment? Why?
41. How many times you have got admitted in the clinic/hospital? If more than one, Why did the
previous attempts fail?
42. What are the factors provoke you to take the drugs again after getting discharge from the
clinic?

ID No: __/__/__/__
43. What do you think about the reasons those can help you to quit drugs?
44. What are your expectations from the health service providers regarding the treatment?
45. What are your likings and disliking in the clinic regarding your treatment and rehabilitation?
After Drugs Issues:
46. How do you see your future? (With drug or not)
47. Why do you want to stop taking drug now?

ID No: __/__/__/__
48. How do you explain your relationship with your family/friends/society/others?
49. What would you like to do after you are free from drugs?
Those are all the questions I have. Thank you for participating in this survey.

Guideline Questionnaire for In Depth Interview of Health Staffs-
1. Name of the respondents:
2. Code No:
3. Address:
4. Age:
5. Sex:
6. Designation:
7. How long he/she is working in this sector?
8. How long he is working in this center?
9. Job Responsibility-
10. Who took the main responsibility to bring the patients in the clinic/hospital?
11. What are the main signs and symptoms they have had while coming to seek treatment?
12. What are the lines of treatment to manage the acute and chronic cases?
13. Which types of difficulties they commonly face to treat the patient?
14. From their perception, what are the main reasons behind the addiction of the drug users?
15. From their perception, what are the main reasons to become addicted again after
discharging from the hospital/clinic?
16. What are the expectations of the guardians from the health service providers regarding
the treatment of the drug addicts?
17. What are their (Health Provider) expectations from the drug addicts and their guardians
regarding the treatment of the drug abusers?
18. What are the factors inspired the drug abusers to take the drugs again after getting
discharge from the hospital?
19. What do you think about the reasons those may help the drug addicts to quit drug?
(Family /friends/clinic)
20. What programs do you have to aware the drug addicts about the HIV/AIDS related high-
risk behaviors (Needle sharing, Condom use, Partner selection etc.)?

Checklist For Observation of Health Facilities Regarding The Management of Drug Addicts-
1. Do they have separate Emergency/Outdoor/Indoor patient management unit?

2. Do they have any isolation unit to manage the violent/non cooperative patients?
3. Do they have any medical officer/counselor/health worker to provide 24 hours medical
services to their patients?
4. Do they have any computer database to keep the records of their patients?
5. Do they have separate units for male and female patients?
6. Do they conduct psychotherapy/group therapy/family therapy/relaxation
training/counseling session on regular basis? How frequent?
7. Do they provide balanced diet for their patients from their clinic?
8. Do they allow the guardian to bring food from the outside for the patients?
9. Do they have any activities for the recreation of the patients (Indoor games, outdoor
games, cultural night, TV, physical exercise, library, meditation, yoga etc.)?
10. Do they allow the parents to meet their sons/daughters during the detoxification phase of
treatment?
11. Do they have any parents’ day to meet with their sons/daughters during the hospital stay?
12. Do they have any program/strategy to follow up their patients after discharging from the
hospitals?
13. Do they have any program to aware the drug users about the HIV/AIDS related high-risk
behaviors (Needle sharing, multiple sexual partner, condom use etc.)

Final Thesis Life Stories of Young Drug Users of High Soci

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Final Thesis Life Stories of Young Drug Users of High Soci

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Life Stories of Young Drug Users in

Independent study report submitted in partial fulfilment

for the degree of Masters of Public Health

Dr. Md. Salim Reza

James P Grant School of Public Health

1. Executive Summary ...…………………………………………………………..6

3.1 Overall Objective ……………………………………………………………..14

3.2 Specific Objective……………………………………………………………...15

4.1 Description of the research design…………………………………………15

4.2 Study Site………………………………………………………………………15

4.3 Sample………………. …………………………………………………………18

4.4 Data Collection Tools …..……………………………………………………19

4.5 Methods of analysis ……………………………………………………20

5.1 Socio-demographic characteristics of the clients…………………………..21

drug addiction …………………………………………………………………..22

5.3 Young drug users’ perspective of drug use………………………………27

5.3.1 Reasons for starting drug use ……………………………….27

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 2

5.3.3 First experience of having drug………………………………33

5.3.4 Exposure to different type of drugs…………………………..35

5.3.5 Sources of money to buy drugs………………………………37

5.3.6 Factors related to relapse of drugs……………………………38

5.4 Health of young drug users of high socioeconomic status…………….41

5.4.1 Level of awareness on drug related behaviors……………….41

5.4.2 Health seeking behavior pattern of young drug users………..42

5.4.5 Plans for the future after rehabilitation……………………….45

5.5.1 Reasons behind starting of drugs……………………………46

5.5.2 Factors related to relapse of drugs…………………………..48

5.6 Health providers’ role in treatment and rehabilitation of drug users…. 50

5.6.2 Common difficulties in managing the clients…………………53

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 3

1. Guideline Questionnaire for In depth interview of Young Drug Users…..70

2. Guideline Questionnaire for In depth interview of the health staffs……...81

3. Observation checklist for the clinic……………………………………….82

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 4

AIDS Acquired Immunodeficiency Syndrome

HIV Human Immunodeficiency Virus

IDU Injecting Drug User

MARPs Most at Risk Populations

MoH Ministry of Health

NASROB National Assessment of the Situation and Response to

Opioid/Opiate Use in Bangladesh

NEP Needle Exchange Program

NGO Non- government Organization

RSA Rapid Situation Assessment

SNS Sharing Network Study

STI Sexually Transmitted Infection

WHO World Health Organization

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 5

Rahman et al, 2000).

backgrounds. To my knowledge no research has been conducted on well-off clients, on their

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 6

life, and 1 to pass the leisure time.

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 7

and relapse of drugs among the drug users.

Phensydil and other drugs tended them to switch over heroin.

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 8

could be managed by preventive interventions specifically targeted at the adolescents, based on

prison to death for the drug traffickers.

regard to cultural context.

STI/HIV/AIDS in the general population.

selection of multiple partner, needle sharing etc from their center.

Dr. Salim/MPH 2005/JPGSPH/Thesis/ Life stories of young drug users in Bangladesh 9