1.

6 Justification
Alcohol addiction in Nyanza province has been highlighted in recent years as a problem that has crippled not only economic ventures, but also the basic family
unit. The youth are reported to have turned to alcohol abuse as a means of dealing with realities of unemployment, poverty, inadequate moral direction and lack
of education. Architecture can respond to this through the design of environments in which alcoholics can comfortably seek treatment and find support. The
provision of rehabilitation facilities that share a link with the surrounding communities reduces the stigma associated with substance abuse and encourages
addicts to seek help. Treatment facilities should incorporate vocational training in order to further dignify the treatment process and enable patients to become
productive members of society upon re-integration into family life. This study intends to examine the treatment facilities available to victims of alcoholism,
with special focus on facility design, functionality and how treatment processes are suitably accommodated within various spaces.
The study mainly assessed the services implemented on drug rehabilitation centers in Cavite. Three outofsix drug rehabilitation centers in Cavite gave their
consent to conduct the studyin theircenters. Surveyquestionnaireandinterviewoftheadministrators, program facilitatorsandpatients wereutilized to gather
necessarydata.The findingsshowed thatin termsofoperationalmanagement, all centersstrictlyfollowthestandards set byDepartment ofHealth (DOH). On
theotherhand, mostoftheprogramfacilitatorsare on-call.Intermsof administratorandprogram facilitators,theyarealwaysontimeinperformingtheirdutiesbut thecenter
could notmaintain itsemployeesdueto lack ofprovision on securityoftenure.In termsofresources, allisproperlymonitored.Theyhavedivision ofbudgetfortheir
operation. On theotherhand, two ofthecenters lack financialsupportfromNGOfortheir
trainings. Findingsfurtherrevealed that,centers established linkageswith religious groups. Everyphaseoftheiractivitiesoften involve religiousadoration. Incontrast,
thereislimited linkage with localand non-governmentagenciesin supportto thetraditionalhealingofthem patient.Intermsofphysical facility,itsprivacy andcomfort
helpsintheimmediaterecoveryofthepatient.Further, evaluation conducted by program facilitatorsisindispensablein the formulation ofindividualized
treatmentprogram.Moreover, monitoring ofpatientsisalso donethrough interaction with them. They also keep in touch with theirgraduated patients.
Keywords: Servicesimplemented, Operationalmanagement, Administration and programfacilitator, Resources, Linkages, Physicalfacility, Reception and
diagnosis, Treatmentprogram, Monitoring andevaluation, Patient
It is evident that the number of recovered patients at the psychiatric hospitals in Ghana constitutes about 30% of the total patients’ population (Osei, 2007).
These recovered patients should therefore be given the chance to live a fulfilled life, contribute economically and socially to their communities and also relieve
the government of the burden of catering for them. The role of the family, employment, hope, self-efficacy, alleviation of stigma and poverty reduction iscritical
for recovery and reintegration. Recovery and reintegration must flow concurrently (Zanker, 2006). To help reintegrate patients into the community is to have
them go through a rehabilitation process before entering the community.

Introduction
“…Buildings, spaces between them…make different lives, influence how we think,
feel, behave-how we are’.
3Many specialists of various fields, including sociologists, therapists and architects have repeatedly argued about how place and the design of its spaces
communicate with the human psyche, affect the way in which people react to their lives and how they develop. And this might be said to be rather crucial for
any individual who requires long term constant care or needs to recover from a period of physical, social and emotional instability such as the multi-faceted
break down and loss of self brought about by drug addiction. It is important to note from the outset that architecture is not a treatment, but can most
significantly become part of the healing process through the creation of spaces that foster and provide meaning to those activities utilized to achieve gradual
rehabilitation through a therapeutic environment. Light, colour and movement within a residence as well as landscape and location are essential elements of this
architectural therapy and the paper will seek to bring their relevance to the fore in the 2ndpart of this paper.

“..form and space can be insidious shapers of person and community or they can
nourish and spur development, both social and individual”.
4It is a setting which readies for social inclusion and does not bunch up people as a group of patients who simply need to take their medication or stay indoors
for a prolonged period of time but as active recipients of change and individuality. Not merely a number behind a ‘health facility’ door. Architectural design can
provide the corner stone of this individuality, with spaces built as an interactive process as opposed to ‘holding a disorder within’. As Cynthia Leibrock puts it,
even the little things in the design of a building can play their part in the psychology of the healing equation; such as the way windows reflect the sunlight in a
therapeutic community residence.

“…The power of a healing environment comes from the design details that empower
Patients to take responsibility for their own health’.
5 Before delving into how building design can interconnect with the healing process
and activities in providing healing for individuals with long term recurring drug
addiction problems, one must provide a detailed outlook of the approach that can
serve this type of architecture-drug addiction rehabilitation approach. And this is the
concept, or rather the healing principle of the therapeutic community, a relatively
3Christopher Day ‘Spirit and Place’ pg 5
4Christopher Day ‘Spirit and Place’ pg 111
5Cynthia Leibrock ‘Design Details for Health’ Preface
Today, drug dependency is undeniably one of the major problems around the globe. This kind of somewhat called disorder commonly results to suicide, mental
illness and Violence that can lead to heinous crimes or worst - death. It does not only affect the drug Dependent and his families but also the society in a way
that it threatens everyone’s security and life. Drug dependency refers to a state where in an individual can only function effectively with the help of his/her
substance of abuse (LeMoaland Koob, 2006). American Psychiatric European Scientific Journal February2015 /SPECIAL/edition vol.3 ISSN:1857 – 7881
(Print)e - ISSN1857- 7431141Association (1994) emphasized the three stages of drug use such as: occasional/controlled or Social use; drug abuse; and drug
addiction. Introduction of excessive amount of drugs in the human body cause an abnormal state of physical and psychological dependence. Physical
dependence occurs when an intense physical disturbance or with drawal syndrome upon drug usage wasdis continued while psychological dependence is a
chronic, compulsive, lossofselfcontroland over-poweringdesiresand craving to useone’ssubstance ofabuse(Soriano,2002).InthePhilippines, the emphasisof
combating drugrelated problemsisusuallythroughtheestablishmentand operation of agenciessuch asDangerousDrug Board,
PhilippineDrugEnforcementAgency,National Bureau of Investigation, PhilippineNationalPolice andotherlawenforcementagencieschargedwiththe
enforcementofdrugrelated
laws. However, intervention, treatmentand rehabilitation ofdrugdependentsareslightlygiven emphasisand funding. Thisstatementis supported byUnited Nations
InternationalDrugControlProgramme(UNDCP), emphasizingthatdrugdependencyisoneofthemajorproblemsofalmostallsocietiesand thatshould also beaddressed
through givingmoreemphasison appropriateintervention strategies, treatmentand rehabilitation ofdrug
dependents.Becauseofthehugenegativeeffectsofdrugdependency, intervention and rehabilitationprograms were made available by differentstates.These
rehabilitation centersparticularlyprivate rehabilitationcenters,exist forthosewhocan affordto undergosuchtreatment. Accordingto theNationalSurveyon
DrugUseand Health in 2006, 23.6 millionAmericansneeded treatmentfor drugaddiction andonly 4millionreceivedthat treatment.
Ofthat figure,only2.5millionreceivedtreatment at aspecialtytreatment facilitysuchasahospital, drugoralcoholrehabilitationcenterora mentalhealthcenter.The
remainder receivedtreatmentthroughself-help groups, jail, privatedoctors, orothermethods (The Importance ofDrugRehabilitation, 2013).
Manyofthedrugdependentsthink thatthey canovercome theaddictionandgetback to normallivesbythemselvesbutitwasproven thatdependentsneed help and
professional assistanceto get backintheirnormal lives(Drug and Abuse, 2013). Rehabilitationcentersaretheinstitutionsthat give servicetothesedrug dependents
andare responsible incorrectingtheirover-allbehaviourasoneofthemain purposesofthe existence ofdrug rehabilitationcentresistobreakthe cycle ofdependency (The
Importance ofDrugRehabilitation, 2013).
Due to increasing number of institutions that cater treatment and rehabilitation of drug Dependents, this study was conceptualized to assess the services
implemented in elected Public and private rehabilitation centers.In contemporary society, the full-fledged impact of modernization and globalization, which has
led to free movement of people, goods and money across the countries of the world, can be witnessed. This has also opened the economic opportunities
among the individuals and the communities in the society, which has become the new of life. Society has changed over the years and activities of the
people have undergone changes. Even the substances used for inebriation have changed corresponding with the dynamics of society. Traditionally used drugs,
marijuana and cannabis, have been replaced by modern synthetic drugs. The proliferation of pharmaceutical industries, which manufactures narcotic drugs, has
directly and indirectly encouraged the use and the abuse of the drugs due to the easy access in the market. The epidemic of illicit drug users in the global
society has increased significantly and simultaneously drug use associated crimes as well in the society.A drug is a biological substance, synthetic or
natural, that is taken primarily for non-dietary needs, and it is a substance, which affects the functioning of mind and body or both. Globally according to
UNODC estimate, in 2009 between, 149 and 272 people or 3.3% to 6.1% of the population aged 15-64 has used illicit substance once in previous year.
Cannabis and Amphetamine Type Stimulants [ATS] are two important drugs which are commonly used world-wide.(World Drug Report,2010;pg.123)
Within Asia, ATS ranks as the main drug abuse in Thailand, Japan, Republic of Korea, Philippines and also China, Myanmar and Indonesia are in
the second rank according to United Nations of Development Countries [UNODC] in 2004. Heroin, Cocaine and other drugs kill around 0.2 million people
each year and causes health problems with incurable diseases. (Changing Drug abuse patterns and law enforcement strategies;pg.-134) The European-
Monitoring Center for Drug and Drug Addiction [EMCDDA] defines the problem of Drug use as injecting drug use as ‘injecting drug use or long
duration regular use of opium, cocaine and amphetamines.’ World Health Organization [WHO] defines Drug Addiction as a ‘disease’ and the
American Psychiatric Association defines drug abuse as the „illicit consumption of any naturally occurring of pharmaceutical substance for the purpose of
changing the way, in which a person feels, thinks or behaves without understanding or taking into consideration the damaging physical and mental side
effects that are caused.(World Drug Report,2012;pg.125-126).Drug Abuse is a global phenomena and it is also abused in India. India is a diverse nation and is
like many other nations afflicted by drug abuse and drug addiction among the youths in the society. Drugs like opium and cannabis were traditionally used by
the people, which are taken as a pain reliever by the people. „Ganja was consumed to worship Hindu God, Lord Shiva, during the festival of „Shivratri‟
in India.(B. Sundas, 2011;pg.50). According to a nation-wide survey spread over 13 states by a NGO, in collaboration with the Ministry of Women and Child
Development found that 32.1% children below the age of 18had tasted bhang, ganja, heroin or other forms of narcotics. (P. Mehta, 2011) In 2008, 5.3
million Indians aged 12 and older had abused cocaine in any form and 1.1 million had abused LSD at least once in the year. In 2008,453,000 Indians aged 12
and older had abused Heroin at least once in the year. In 2008,25.8 million Indians aged 12 and older had abused marijuana at least once in the year. In
2008,850,000 Indians aged 12 and older had abused methamphetamine at least once in the year.(Ibid,pg. 34-40).Northeast has been challenged by serious
problem of Drug use by the youth. Nagaland and Manipur are the two states in Manipur are the two states in North-East India, which has the
highest prevalence of Intravenous Drugs (IDUs). Even cultivation of opium is done in Manipur, Nagaland and Arunachal Pradesh, and supplied to other
parts of India. These are the easy routes of drug trafficking across the common borders of Myanmar and the three North-eastern States of India (Manipur,
Mizoram and Nagaland). There is illicit cultivation of opium and cannabis, the heroin and the amphetamines, and the pharmaceuticals are used as illicit
drugs and trafficked in the North-east India. (Drug used in Northeastern States, India;pg.xiv) IRA-International Journal of Management & Social
SciencesSikkim is one of the North-eastern States of India and is connected with other seven states of the northeast via Siliguri. It is sparsely populated, with lot
of social changes going on because of its merger with the Indian Union in 1975. It is also witnessing problems related with modernization and
urbanization. One of the glowing problems faced by the society of Sikkim due to modernization is of Drug Abuse and its prevalence among the youth
is very high due to the availability and easy access.The phenomenon of drug addiction to the people is not a new issue worldwide. This issue has brought
awareness to humanitarian, religious, and governmental agencies. The challenge of resolving drug addiction is commonly seen as an issue faced by Developing
countries. Drug addiction is one of the main and unsolved problem in Somalia. There is no Facility which provides full their recovery.
Drugs are chemicals that affect the body and brain. Different drugs can have different effects. Some effects of drugs include health consequences that
are long-lasting and permanent. They can even continue after a person has stopped taking the substance.
There are a few ways a person can take drugs, including injection, inhalation and ingestion. The effects of the drug on the body can depend on how the
drug is delivered. For example, the injection of drugs directly into the bloodstream has an immediate impact, while ingestion has a delayed effect. But
all misused drugs affect the brain. They cause large amounts of dopamine, a neurotransmitter that helps regulate our emotions, motivation and feelings
of pleasure, to flood the brain and produce a “high.” Eventually, drugs can change how the brain works and interfere with a person’s ability to make
choices, leading to intense cravings and compulsive drug use. Over time, this behavior can turn into a substance dependency, or drug addiction.
Today, more than 7 million people suffer from an illicit drug disorder, and one in four deaths results from illicit drug use. In fact, more deaths, illnesses
and disabilities are associated with drug abuse than any other preventable health condition. People suffering from drug and alcohol addiction also have
a higher risk of unintentional injuries, accidents and domestic violence incidents.
Substance use disorders are associated with a wide range of short- and long-term health effects. They can vary depending on the type of drug, how
much and how often it’s taken and the person’s general health. Overall, the effects of drug abuse and dependence can be far-reaching. They can
impact almost every organ in the human body.
The most severe health consequences of drug abuse is death. Deaths related to synthetic opioids and heroin have seen the sharpest rise. In
the past 12 months, 212,000 people aged 12 or older have used heroin for the first time. Every day, more than 90 Americans die after
overdosing on opioids.
The centre has been involved in: Assessing magnitude of addiction problem in the country Providing clinical care to patients – outpatient, inpatient and
community based -through daily OPD, specialty clinics, ward and community clinics in urban-slums of Delhi Health education& prevention of addictive
disorders in the country Capacity building & human resourcedevelopment – including training of several categories of staff Documentation, publication of
resource material and creation of database Establishment and development of laboratory services to detect drugs of abuse in body fluids and health damage
Research Following is a brief overview of recent contributions: Development of Models of Care Capacity Building Collaborative research with
National/International agenciesOral Substitution Treatment (OST) using oral morphine, buprenorphine, buprenorphine & naloxone and methadonePolicy and
Planning

Addiction defined and quantified?

Addiction is a chronic, debilitating condition which affects people from a broad spectrum of
society. Those addicted to alcohol often suffer extreme physical, psychological, emotional,
economic, and social pain. Erickson (2014) provides us with the following definition of
addiction. “Addiction is seen as a maladaptive pattern of drug use, leading to impairment or
distress, presenting as three or more of the following in a 12-month period:
tolerance to the drug's actions
withdrawal
drug is used more than intended
there is an inability to control drug use
effort is expended to obtain the drug
important activities are replaced by drug use
drug use continues despite knowledge of a persistent physical or psychological
problem”
Source: Erickson, C., (2014) Exploding Drug Myths, Addiction Science Research and
Education Centre
Addiction has severe negative consequences and can be difficult to overcome. Tabor Lodge
Addiction and Housing Services Limited deliver a number of programs to those with
addiction problems.
Intervention methods include residential treatment programs, extended treatment programs,
family programs, cognitive behavioural therapies and aftercare programs. The extended
treatment programs delivered by Tabor Lodge follow the Supportive Housing model. This
model delivers transitional housing, counselling and support services to people in recovery
from substance use problems once they have completed a primary treatment program in a
residential setting (Crawford 2007). The extended treatment programs of Fellowship House
and Renewal offered by Tabor Lodge focuses on stabilisation and the development of a long
term support network that the individual can utilise. This is a vital element of recovery,
helping the person develop the skills to function in society.
Expected Outcome of the Thesis Project
Design Elements on how to deal with the buildings built psychologically for such kind persons Research study on psychologically based built architecture
Recovery - a journey of happiness Nurturing relationships Positive substitutes for addiction Building Psycho social Rehabilitation Service

 Learning to recover wards suffering from mental disability of varying degrees and Types

The public attitude is twofold – who are addict people? One part think they are criminals, and the other calls them patients. Overcoming drug addiction is a
complex process, after treatment and improvement in symptoms addiction people need rehabilitation services. These services often combine treatment (often
required for program admission), independent living and social skills training, psychological support to clients and their families, housing, vocational
rehabilitation and employment, social support and network enhancement and access to leisure activities.
Adiction, especially drug adiction, is a very present part of our society.Conventional rehab clinics deal with the medical aspects of quitting drugs. Having to
deal with the issue of relapse among the pacients that have accomplished the rehab treatment, specialists noticed the need for a post-rehab program. Such a
program consists of psychological counceling in a secure enviroment where former drug users can integrate themselfs in a healthy community.Such a place
takes form in a social rehabilitation center, that takes part in preventing relapse for former drug users. Centers like this started appearing all over the world
around 10 years ago, countries like the Netherlands and Switzerland being among the first to develop such a program.
Rehabilitation is a term use for the processes of medical or psycho therapeutic treatment, for dependency on substances like street drugs, prescribed
drugs,alcohol etc. Addictions expose people to health hazards and psychological problems and they found to suffer from general inability to adjust with the
social norms.
Consequently they isolate themselves or worse, the society treats them like an outcast or antisocial creature. Rehab provides treatments for depression
and other physical and mental disorders. Medication and counseling are two important treatment aspects which are as important as medications. Interaction with
experts and sharing between inmates and ex-addicts will help them to rebuild their lost confidence and hope. Religious retreat units are also working in the field
of rehabilitation, but they use spiritual wisdom as a major counseling element.
It is not easy to create a space for people like this. They need our help and support. Rehabilitation centre cannot be designed by putting up the
requirements in a line diagram or bubble zoning. When we approach a design problem like this, our aim should be providing a comfortable and patient friendly
environment for treatment and rehabilitation facilities, which means using the potential of architecture to enhance the experience of space and helps the patients
to reintegrate back to the society.We have to create a space with meaning, which helps the patients to build their lost social behavior back
Drug abuse is a prevalent problem among Somalian youth, who account for 70% of the whole population of Somalia.
Availability of substances such as cannabis is determined culturally. The community and government influence and decide which drugs should be controlled
and how. Under Pakistani law, shop owners cannot legally sell drugs, even cigarettes, to individuals below 18 years of age, but people tend to find ways to get
around the law. In a number of studies of substance abuse in the developing world, drug use has been characterized by the use of low-priced and accessible
drugs, such as cannabis, alcohol, and tobacco, and volatiles, such as glue
The effects of substance abuse have far-reaching consequences. They not only affect the user him/herself, but also their families, and society as a whole. The
work sector loses able-bodied individuals, which in turn affects the economy. The family's role in the development of substance abuse is unique as the family
simultaneously suffers from the direct consequences of the abuse, while also holding the potential to be one of the most powerful protective influences against
it.
In supporting efforts to control drug-related problems in the country, the rehabilitation centres in Pakistan mostly focus on culturally adapted rehabilitation
techniques. Common therapies used in rehabilitation centres include a modified version of the Alcoholics Anonymous treatment and family therapy. Most of
these rehabilitation centres are present in the urban areas and they recruit psychologists and psychiatrists to work in these facilities.
Multiple drug use among young people is now a widespread phenomenon prevalent in almost all sections of society. A large number of young people, both
male and female, experiment with a variety of illegal substances such as cannabis products (such as Hash/Hashish and marijuana), Ketamine, 2 cocaine, and
heroin. Drug abuse among the youth of Pakistan is becoming a major issue, and identifying the family dynamics and interfamily communication styles that may
influence a youth to turn to drugs is the target of this article.
Family dynamics
Pakistan is a collectivistic culture in which the family is given priority as social and financial support is coveted. Family is the core for need fulfilment. This is
why joint families prevail in which grandparents, parents, children, and their uncles and aunts all live together. Members make major life decisions with the
approval from elders of the family as they are the primary support network.
Family dynamics can be defined as the way a family is structured including the individual interpersonal roles played by the members within the family unit.
Family dynamics is the basis for all individuals to learn how to cope with the challenges they might face in later life. Parental support and unconditional
positive regard strengthen self-esteem and self-confidence, and their absence reduces them.
Drug abuse is often referred to as a family issue because of the serious negative consequences of addiction and because the importance of recovery affects not
only the substance abuser, but also all the members of the family. Therefore a focus on the role of families is critical in understanding and preventing the
destructive intergenerational cycle of substance abuse and addiction.
The objective of this study was to explore the role of family, the influence of parental involvement, and communication styles in youth drug addiction.
Methodology

2.2.1. Demographic data sheet

A demographic data sheet was used to collect data regarding the age, family income, family system, siblings, marital status, family system, familial illnesses, as
well as data regarding the substance abused, frequency of abuse, relapses, and the beginning of the addiction (Table 1).
Table 1.
Frequency and Percentage of participants demographic variables (age, education, marital status, family system, birth order, occupation, mother, and
father).

Variable Label Frequency (f) Percentage (%)

Age 18–22 years 3 15.0

23–28 years 17 85.0

Education Uneducated 2 10.0

Up to fifth grade 5 25.0

Up to tenth grade 9 45.0

College level 4 20.0

Marital status Single/unmarried 9 45.0

Married 8 40.0

Separated/divorced 2 10.0

Widowed 1 5.0

Family system Joint 15 75.0

Nuclear 5 25.0

A structured interview guide was constructed consisting of questions referring to the individual's habits, relationship with family and friends, modes of
communication within the family as well as the social aspects of their lives. The interview guide was adapted and extended from the Family Functioning Style
Scale by Deal, Trivette, and Dunst (1988) and Dunst, Trivette, and Deal (1988).
2.2.3. Observation technique
It was a practice in the rehabilitation centres to hold family therapy sessions. The family therapy sessions were conducted by three consultant psychologists of
the facility, at different times, and were attended by three to five members of the participant's family, which included the parents and spouses. Consent was
obtained from the psychologists and the attending family members for the researcher to attend the sessions herself as a non-participant observer. The data
collected from therapy sessions were in the form of field notes.
Additionally, informal discussions were held with the participants, the psychologists, and some of the family members present in the facility during the
preliminary study. These discussions helped the researcher in rapport-building and in understanding the setting of the session.
The researcher made case profiles of the individuals which helped in formulating a comprehensive picture of the particular individual and in the corroboration
of the information collected in the focus group discussions during the family therapy sessions (Table 2).
Table 2.
Frequency and percentage of participants according to demographic variables of drug use, duration of drug use, single substance or multiple
substance abuse, number of treatments, and reasons for starting drugs.

2.3. Procedure
Data were collected from rehabilitation centres which were sanctioned by the Anti-Narcotics Force of Pakistan in the vicinity of Islamabad and Rawalpindi.
Some government and private institutions offer family therapy along with rehabilitation of drug addicts which is why these specific centres were selected. The
interviews took a minimum of 30–40 minutes each. The data were collected over a period of four weeks in the form of notes. Research ethics were followed as
the researcher took consent from the participant in the form of signatures on a consent form.
The data collected were then translated from the native language, Urdu, into English. The themes were generated based on the common responses by
participants.
The researcher used the interpretive paradigm to code the verbatim responses collected from the participants. A master code sheet was created on the basis of
themes identified in Family Functioning Style scale (Dunst et al., 1988). The researcher continued to code the responses while conducting interviews and
observing the interaction between family members during the sessions. Consensus was reached through committee approach during analysis.
Coding was applied to the responses pertaining to communication styles, social relationships, and family dynamics. Subcategorization was done based upon the
patients' responses and then counterchecked with the psychologists and families. The coding was then subjected to a peer review process which involved the
researchers and two anthropologists in order to facilitate inter-coder reliability. (Table 3)
Table 3.
Case studies.
Go to:

3. Results
The numerical data regarding the demographic characteristics showed that the majority of the participants (85%) were within the age range of 23–28 years; 45%
were unmarried, 40% were married, 10% were separated or divorced, and 5% were widowed. It was found that majority of the participants (75%) lived in a
joint family system, while 25% lived in a nuclear family system. The majority of the participants (45%) were educated up to and above the tenth grade, and all
the participants were living with their parents. According to the demographics, both parents of the majority (60%) of the participants were alive.
The drug-related questions revealed that the majority of the participants (80%) were poly-substance abusers, and 45% had been abusing drugs for over 10 years.
A relapse ratio was estimated by the number of treatments received by individuals from various facilities. Of the participants, 65% had received treatments 1–5
times, 30% were being treated for the first time, and 5% had received treatments 19 times, indicating a high rate of relapse which can be linked to dysfunction
within the family that can be seen in the following analysis. One respondent, who had relapsed three times and was in the facility for his fourth treatment, stated
that he had relapsed because of fights with his father.
Referring to the reasons which caused the participants to become involved in substance abuse, 50% cited a single reason while the other 50% stated multiple
reasons, of which the company of peers (indicating peer pressure), curiosity, and stress were commonly cited.

3.1. Thematic analysis

In analyzing the responses and information provided by the participants and verified by family members and psychologists during family therapy sessions, the
following themes and related subcategories presented themselves.

3.1.1. Parental involvement

This theme contains information about family dynamics in terms of functions performed by all members, as well as information concerning family cohesion,
communication patterns, familial support, decision-making, parental control, and supervision, among other topics.
Spending time with family members. Spending time with family is important. The majority of participants (80%) stated that they communicated frequently with
their parents on a regular basis, i.e. every day, and whenever they had time to do so. As one respondent specifically stated:

LIST OF ABBREVIATIONS AND ACRONYMS

NIH - National Institutes of Health
NIAA - National Institute of Alcohol Abuse and Alcoholism
SPSS - Statistical Package for Social Sciences
WHO - World Health Organization
NACADA - National Agency Campaign Against Drug Abuse
UNODC - United Nations Office of Drug Abuse and Crime
PPS - Probability Proportionate to size
SOS - Safe our souls
1. 3 Purpose of the Study
The study was to investigate the prevalence of relapse and factors that influence this
relapse among alcoholics in rehabilitation centers in Nairobi, Kenya. The independent
variables in this study included :personal, family, institutional and community domains.
The dependent variable was alcoholic relapse.

1.5 Research Questions of the Study

The study sought to answer these research questions:
i) What is the prevalence of relapse among alcoholics in selected
rehabilitation centre in Nairobi?
ii) Which personal factors contribute to relapse among alcoholics in
rehabilitation centers in Nairobi?
iii) Which family factors contribute to relapse among alcoholics in
rehabilitation centers in Nairobi?
iv) Which social factors contribute to relapse among alcoholics in
rehabilitation centers in, Nairobi?
v) Which institutional factors influence relapse among alcoholics in
rehabilitation centers in, Nairobi?
vi) Which demographic factors contribute to relapse among alcoholics
in rehabilitation centers in, Nairobi?

OBJETIVOS
Design a Physical Rehabilitation Center in the district of La Molina, which includes the most
high standards of care, with state-of-the-art technology and a
equipment that responds to the needs of the user.

Determine the characteristics of disabled people, emphasizing the

limitations that these have to be able to fully integrate in the community, all this to
through knowledge of the data obtained on the subject.
Evaluate the existing infrastructure in physical rehabilitation centers in our country and
how it negatively or positively affects people with disabilities.
Establish the general design guidelines for a Physical Rehabilitation Center for
people with disabilities, evaluating the regulations as the basic requirements that
allow the effective rehabilitation of patients.

ANALYTICAL FRAMEWORK:
The analytical framework of the present study includes a discussion on research questions and the Purpose of the study followed by the objectives, the research
design, sampling procedure and analysis and Interpretation of data.

Research Questions:
Objectives of the Study:
The present study was undertaken on the following objectives:
 To know the different categories of drug addicted people in Sikkim.
 To find out different causes of drug addiction among the people in Sikkim
 To explore the socio-economic factors leading to drug addiction.
 To study the socio-economic conditions of the drug addicted people in Sikkim; and,
 To explain the social relations of de-addicted people.
Purpose of the study
This study therefore filled the gap by examining the effectiveness of programs offered in rehabilitation centers in relation to behavior modification of drug addicts by establishing how
drug rehabilitation programs can be improved to help bring about effective treatment.
Justification of the study
Drug abuse and addiction are a threat to the survival of the society. Therefore the increasing rate of drug problem in the society is a concern to all people. Through rehabilitation
programs, people who are addicted to drugs can be assisted to change their behavior. However, it is only effective programs that can bring about behavior change. Understanding the
effectiveness of the rehabilitation programs used could be achieved through an empirical study in which the strengths and the weakness are identified and analyzed. This can be able
to inform the service providers on areas that need to be improved to enhance their ability in bringing about behavior change. It is for this reason that this study on the evaluation of
effectiveness of current existing rehabilitation program was found justified.
Scope and limitations
References
1. World Drug Report (2007) UNODC. 36.

2. Hubbard RL, Craddock SG, Flynn PM, Anderson J, Etheridge RM (1998) Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS).
Psychology of Addictive Behaviors 11:291-298.

3. Benjamin KR(2003) Control of landmark events in meiosis by the CDK Cdc28 and the meiosis-specific kinase Ime2. Genes Dev 17: 1524-1539.

4. Bruner (2008) Learning Theory in Education. Simply Psychology.

5. Sacks S, Banks S, Mc Kendrick K, Sacks JY (2008) Modified therapeutic community for co-occurring disorders: A summary of four studies. J Subst Abuse Treat 34: 112-122.

6. World Drug Report (2009) UNODC.

 7. Mugenda O, Mugenda G (2003) Research methods, quantitative and qualitative Approaches. Acts press, Nairobi.

8. Rhodes T, Singer M (1998) The social structural production of HIV risk among injecting drug users. Social Science & Medicine pp: 1-19.

9. Suzanne M, Jessie MK, Nora HM, PsyD GKP, Jacquelyn CC, et al. (2002) HIV-Positive Women Report More Lifetime Partner Violence: Findings From a Voluntary Counseling and
Testing Clinic in Dar es Salaam, Tanzania. American Journal of Public Health 92: 1-8.

10. World Drug Report (2004) UNODC.

11. Nathaniel-James DA, Frith CD (2002) The role of the dorsolateral prefrontal cortex: evidence from the effects of contextual constraint in a sentence completion task. Neuroimage 16:
1094-1102.

12. Poulin C, Elliott D (1997) Alcohol, tobacco and cannabis use among Nova Scotia adolescents: implications for prevention and harm reduction. CMAJ 156: 1387-1393.

13. Hibbel B, Anderson B, Bjarnason T, Kokkeri A, Morgan M, et al. (1995) Alcohol and other drug use among medical students in 26 European countries. The European schools project
on alcohol and other drugs (ESPAD) study, Stockholm, Council of Europe.

14. Raymond GM (2008) Behavior Modification: Principles and Procedures. (5th Edn) Cengage learning.

15. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327: 557-560.

16. Fatoye FO, Morakinyo O (2002) Substance use amongst secondary school students in rural and urban communities in south western Nigeria. East Afr Med J 79: 299-305.

17. Leslie C,EskinE, NobleWS (2002) The Spectrum Kernel: A String Kernel For Svm Protein Classification. Pacific Symposium on Biocomputing 7: 566-575.

18. Kendel B, Yamaguchi K (1985) Developmental patterns of the use of legal, illegal and medically prescribed psychotropic drugs from adolescence to young adulthood. In: Jones CL,
Battes RJ (Eds) Etiology of drug abuse: Implications for prevention, DHHS.

19. NACADA (2004) Building Bridges: Advisors as Architects for the Future.

20. Mpabulungi L, Muula AS (2004) Tobacco use among high shool students in Kampala, Uganda: questionnaire study. Croat Med J 45: 80-83.

21. Siringi S, Waihenya K (2001) Drug abuse rife as government braces for narcotics war in Kenyan schools.

22. Kwamanga DH, Odhiambo JA, Amukoye EI (2003) Prevalence and risk factors of smoking among secondary school students in Nairobi. East Afr Med J 80: 207-212.

23. Kanyesigye K, Basiraha R, Ampaire A, Wabwire G, Muchura S, et al. (1997) Prevalence of smoking among medical students of Makerere University, Kampala, Uganda. Tobacco:
The Growing Epidemic pp: 924-926.

24. http://africacheck.org/reports/flawed-survey-claims-a-third-of-south-africans-are-drug-users/

25. Orodho J (2005) Techniques of writing research proposals and Reports in education and Social Sciences. Masola Publishers, Nairobi.

26. Mgendi C (1998) Corruption and drugs in Kenya. Africa Recovery 12: 1- 9.

27. Lukwiya M (2000) Cigarette smoking among secondary school students in Jinja District. Proceedings of the 9th UNACOH Annual Scientific Conference, Kampala.

28. Bratter E, Kolodny C, Deep C (1984) Surviving Your Adolescence. Boston: Little Brown.

29. Siringi S (2003) Kenya: Alarm Over Drugs: Nacada Study Cites Rampant Drug Abuse in Schools and Universities. Daily nation.

30. Van Etten ML, Neumark YD, Anthony JC (1999) Male-female differences in the earliest stages of drug involvement. Addiction 94: 1413-1419.

31. Cloninger R (1983) Genetic and environmental factors in the development of alcoholism. J of PsychTreat and Eval 280: 487-496.

32. Croen LG, Woesner M, Hermann M, Reichgott M (1997) A longitudinal study of substance use and abuse in a single class of medical students. ERIC 72: 376-381.

33. Haworth A (1982) A preliminary report on self-reported drug use among students in Zambia. Bull Narc 34: 45-60.

34. Guy LR (1981) Educational Research: competencies for analysis and application. Charles Mairill Publishing Company Bell A, Howell Company Columbus, Toronto, London.

35. Dhadphale M, Mengech HN, Syme D, Acuda SW (1982) Drug abuse among secondary school students in Kenya: a preliminary survey. East Afr Med J 59: 152-156.

METHODS
This cross-sectional study was conducted in 2009 in 20 cities of Isfahan Province. Study population was high school students aged 14–18 years. The required
sample size (considering α = 0.05) was calculated as 6489 students, which was increased to 7137 students with consideration of the dropout rate of 10%.
Because there is a difference in student population of the cities of the province and also to provide possibility of generalization of the results, multi-stage
random sampling was applied after determining the proportion of each city in supplying the sample size. To determine the denominator, all students who were
studying at high schools of the province were summed up which was 227,127 students. High school student population of each city in cities and villages were
determined and the proportion of students each city to the whole province was determined. This proportion was multiplied by the sample size, and sample size
of each city was determined. After determining the sample size of each city, sample size of urban and rural areas of each city was determined. To determine the
sample size in high schools, a list containing names of all high schools was prepared. About 20–30% of high schools (depending on the number of high schools
in each city) were selected randomly. The total sample of each city was divided by the selected school, and the sample size in each school was determined. Due
to lack of a significant difference between male and female population of the schools, the gender proportion was considered equal. Using the list of students
names (using random number table or odd/even numbers) the number of students was determined and the questionnaires were filled out.
To collect the information, proficient examiners were selected, involved people were trained, and data were collected under the supervision of the observer.
Coordination was made with the education organization to implement the study. Experienced personnel of the education organization and Health Centers of the
cities were recruited to help collect data in a 1-day workshop about the method of collecting data and determining the sample size. To achieve an equal
approach in data collection and control of confounding variables by the interviewers, a uniform training workshop was held for 8 h in 1-day. A 1-day workshop
for 6 h was held to ascertain meticulous questioning by the observers. Besides these training workshops, a guideline was issued to the interviewers to unify the
data collection. In this guideline, it was explained why filling out the questionnaire carefully and completely, and avoiding unanswered questions and
emphasizing confidentiality of the information were important. To fill out the questionnaires, first students were briefed about how to answer the questions by
the interviewers. Then, the questionnaire was completed by the students. Each student had 20–30 min to complete the questionnaire and after that the
questionnaires were gathered and delivered to the researcher.

REFERENCES
1. Sadeghi M, Ahmadi M, Farhoudian A, Jafari F, Vassel MY. Overview of the Status of Research on Drug Dependence and Abuse in Iran. Spec Issue Addict
Stud. 2012;12:27–35. [Google Scholar]
2. Sarami AA, Naderi H. Comparison between participants and non-participants in terms of knowledge and attitude towards drug abuse. Humanity Soc Sci
J. 2009;4:76–82. [Google Scholar]
3. Donev GP, Kragelj LZ, editors. Lage, Germany: Hans Jacobs Publishing Company; 2007. Health Promotion and Disease Prevention. [Google Scholar]
4. Khushabi K, Moradi S, Habib M. Risk and protective factors of drug abuse in high school students. Iran J Psychiatry Clin Psychol. 2012;17:313–23. [Google
Scholar]
5. Fayaz-Bakhsh A, Babashahy S, Jarrahi L, Rafiei S. Comparison of the knowledge, attitude and practice of Iranian college students about tobacco use in
comparison to their American and Chinese counterparts. Int J Prev Med. 2011;2:139–44. [PMC free article] [PubMed] [Google Scholar]
6. Farhadinasab A, Allahverdipour H, Bashirian S, Mahjoub H. Lifetime pattern of substance abuse, parental support, religiosity, and locus of control in
adolescent and young male users. Iran J Public Health. 2008;37:88–95. [Google Scholar]
7. Ahmadi J, Hasani M. Prevalence of substance use among Iranian high school students. Addict Behav. 2003;28:375–9. [PubMed] [Google Scholar]
8. Rezaei AM, Delavar A, Najafi M. Development and validation of the questionnaire to assess the attitude of 3rd grade middle school and high school students
toward drugs. Drug Abuse Stud Q. 2012;6:37–54.[Google Scholar]
9. Allahverdipour H, Heidarnia A, Kazemnegad A, Shafii F, Azad Fallah P, Mirzaei E. Status of drug abuse among students and merging self-control factor
with EPPM model. Yazd Univ Med Sci J. 2005;13:24–5.[Google Scholar]
10. Moradi A, Orayzi HR, Rezaei DS, Ahmadi DA. Assessment of dependency of male high school students of Faridan and its related factors in 2005-
2006. Journal of Psychological Studies. 2008;4:9–34.[Google Scholar]
11. Khavari Z, Heidari P, Heidari M, Montazeri M. Prevalence of Alcohol and Psychoactive substance in High School Students of Mehriz in Yazd. Toloue
Behdasht. 2009;8:33. [Google Scholar]