Asian Social Science
It has been noted that many drug addicts relapse to drug use after discharged from successful treatment and rehabilitation programs. Thus it is imperative and timely to address the issues that prompt relapsed addiction. 400 drug addicts on relapse cases were selected from eight drug rehabilitation centres throughout Peninsular Malaysia to examine factors influences the relapsed addiction to drug use.
Consistent with previous research, self-efficacy, family support, community support and employers support were identified as main factors that influenced the relapsed addictions tendency amongst addicts.
Suggestions to curb relapsed addiction to drugs were discussed in relation to the findings. Keywords: Relapse, Addiction, Drug, Malaysia 1. Introduction The close geographical propinquity to Myanmar, Laos and Thailand (Golden Triangle) and other Southeast Asian countries that produces illicit drugs has intensify drug use in Malaysia. The illicit drug use been well thought-out as major social intimidation in Malaysia.
The government, on February 19, 1983, declared drug as national disaster and endeavor with stringent law enforcement together with rehabilitation programs for addicts. Indeed the government through various agencies has put in action strategies to impede drug use, parallel to the mission of attaining a drug-free society by 2015. Nevertheless, even with the country’s stringent enforcement policy, there has been a sizeable ascends in the number of fresh and relapsed drug users (National Anti-Drug Agency (NADA), 2009).
NADA entrusted by the Malaysian government to sculpt mechanisms to handle the drug crisis and in particular to trim down relapsed addiction rate. Based on the statistics by NADA (2009), the number of detained drug addicts from January to December 2007 and 2008 were 14,489 and 12,352 respectively. Perhaps, the addiction trend that was recorded by NADA is some sort of a relief to all concern. In 2007, the detained fresh and relapsed addicts were 6,679 and 7,810 respectively.
Among the detained drug addicts in 2008, 5,939 (48%) were fresh addicts while 6,413 (52%) were relapsed addicts. Interestingly, in 2008 the statistics revealed a decline of percentages in total number of detained addicts (15%), new addicts (11%) and relapsed addicts (18%) compared to the reported statistics in 2007. Nevertheless, careful observation on the statistics revealed an increase in the number of detained relapsed addicts compared to new drug addicts between 2008 and 2007.
Generally, it is well understood that the number of drug addicts should reduce dramatically upon successful completion of treatments or rehabilitation program. However, the reported data explicates that most of the drug addicts failed to sustain the free of drug lifestyle after they have been discharged from rehabilitation treatment program. Mohamad Hussain and Mustafa (2001) reported that there are evidence of 90% relapsed cases among heroin addicts within six months after been discharged from the Serenti rehabilitation centres.
It also had been found that 40% of the addicts pine for heroin after a month of abstinence. Surprisingly, Serenti rehabilitation centers have relapsed inmates who have followed the rehabilitation sessions for more than five times. Moreover, Habil, (2001) contended that more than 70 percent of those attending drug rehabilitation centres would probably relapse. Reid, Kamarulzaman, and Sran (2007) alleged that though some of the programs had been successful, about 70 to 90 per cent of addicts who underwent rehabilitation probably 37 Vol. 5, No. 12
Asian Social Science return to the habit within first year after been discharged if they are compelled and detained at the rehabilitation centres. In any event, the rate of relapse among addicts is of great concern to both governmental and non-governmental bodies. Thus, this research was initiated to examine the factors contributing to relapsed addiction tendency amongst drug addicts in Malaysia. Indeed this study is significant and timely to fight against drug addictions to the root while achieving the nation’s ambition to reach the zero drugs by 2015. . Factors Contributing to Relapse among Drug Addicts Relapse is a formidable challenge in the treatment of all behavior disorders (Witkiewitz & Marlatt, 2004). Several authors have described relapse as complex, dynamic and unpredictable (Buhringer, 2000; Donovan, 1996; Marlatt, 1996). Whereas according to Mahmood (1996), relapsed addiction means, usage, intake or misuse of psychoactive substances after one had received drug addiction treatment and rehabilitation, physically and psychologically.
To Rasmussen (2000), relapse occurred because of the building up of additional crisis such as to look trivially on certain problem, stress, weak or failed forecast, the pessimistic thinking that all issue cannot be resolved and immature actions. Relapsed addicts also confused and overreact due to the inability to think clearly, unable to manage feelings and emotions, the difficulty to remember things, unable to control their feelings and easily angered. Various studies have examined the effects of psychosocial factors towards relapse among drug and alcohol dependence.
Moos (2007) contended that psychological factors are supposition to contribute to relapse among drug addicts after abstinence. Consistently, anxiety has been linked to increased relapse risk among marijuana addicts (Arendt et al. , 2007; White et al. , 2004). Other relapse promoting factor is self-efficacy, defined as a degree to which an individual feels confident and capable performing a certain behavior in a specific situational context (Bandura, 1977).
As described in the cognitive-behavioral model of relapse (Marlatt, Bear & Quigley, 1995), high levels of self-efficacy are predictive of improved alcoholism treatment outcomes (Brown et al. , 1995; Greenfield et. al. , 2000; Rychtarik, Prue, Rapp & King, 1992). The situation is different from the results of research done on 60 alcoholics, which found that individuals who have high self-efficacy after going through rehabilitation treatment, are most unlikely to be addicted again (Allsop, Saunders & Phillips, 2000).
Chuah (1990), in his research found that drug addicts who have low self-efficacy would be back to addiction after their release from getting treatment and rehabilitation. Other previous studies have also point out that improvement in self-esteem positively lead to success in rehabilitation programs and it assist in curbing drug addictions (Graham et al. , 1997; Mahmood, 1995; Mahmood et al. ,1998; Mahmood et al. , 1999). Attitude and poor knowledge on drug abuse been reported to be contributing factor of relapsed addictions among drug addicts (Abdullah & Iran, 1997).
Besides, less support from family members and the community by large towards former addicts highly promote the relapsed addiction tendency after treatment (Brown et al. , 1995; Miller et al. ,1999; Miller, 1992; Moos & King, 1997). Research by Mohd Taib, Rusli and Mohd Khairi (2000) on family communication patterns amongst addicts’ family and non addicts’ family, showed weak communication patterns and less effective interactions amongst former addicts’ family is one of the high probable factors toward drug addiction.
Indeed, family support is much needed to ensure the rehabilitation process success and issues like “don’t care attitude” and ostracizing former addicts would only failed the rehabilitation process and in the long run caused the former addicts to relapse (Daley & Marlatt, 1992). Amongst other factors that have been associated with relapsed addiction are peer pressures especially from the old friends who still use drugs. Mahmood, et al. (1999) found 50% of old friends influenced former addicts to pick up the drug taking habit after they were discharged from rehabilitation centres.
The research also showed that 76% of the old friends assist rehabilitated individuals to get the needed supply of drugs. These situations further induced the relapsed addiction amongst former addicts who has been getting rehabilitation treatments. However, the above research is different from findings by Chuah (1990). He found peers support could help former addicts from not getting back to the old habit. He concluded that high emotional and spiritual support will indirectly increase the addicts’ self confidence and decrease the risk towards relapsed addiction.
Gregoire and Snively (2001) reported that addicts who have discharged from rehabilitation centres and living in drug-free social environments could be linked with higher abstinence rates and low in relapse of drug use. Mc Coy and Lai (1997), on the other hand, associates inability to get jobs amongst former addicts who were discharged from rehabilitation centres coupled with lack of financial supports, caused the addicts to go back to addictions. Yunos (1995) asserted that employers always took advantage on the former addicts by paying low salaries without aking into consideration their qualifications and experience, causing dissatisfactions amongst the former addicts that eventually caused them to quit their jobs. Yahya & Mahmood, (2002), found that the treatment and rehabilitation programs being conducted in any country would faced various challenges. The effectiveness of drug rehabilitation programs also one of the factors, associated with relapsed addictions amongst addicts. This is because some researchers found drug rehabilitation programs conducted on addicts are less effective to jolt them to awake (Mokhtar, 1997, Wellish & Prondergast, 1995).
Many research found that the traditional treatment and rehabilitation models failed to help in reducing relapse addiction to drug use (Habil, 2001; 38 Asian Social Science December, 2009 Mahmud Mazlan, Schottenfeld & Chawarski, 2006; Mohamad & Mustafa, 2001; Mahmood, Md Shuaib Che Din and Ismail Ishak, 1998; McLellan, 2002; Nestler, 2002; O’Brien, 2006 ; Reid, 2007). Though, sufficient rehabilitation programs are in place, prevention of relapse to drug will pass its best if physiology and psychology strength of addicts faint in due time.
In addition, lack of multiple long term treatment modalities, social intervention and additional pharmacological treatment could abet relapse. Hence, relapse to drug use after extended periods of abstinence remains as most intricate clinical problem and research issue in the treatment of drug addiction (Miller et al. , 1999; O’Brien, 2006; Sinha & Li, 2007). Individuals involved in recovery and the treatment of recovering individuals recognize that sustaining a clean and sober life is perhaps significantly more difficult than eliminating the use of the drug.
There is a high degree of consensus in the field that relapse is a common element in the recovery process. Nevertheless, examination of factors which contributes to relapse is indispensable to develop successful interventions in curbing future relapse to drug-taking behavior (Donovan, 1996; O’Brien, 2006, Sinha & Li, 2007). The present study intended to identify the extent that self-efficacy; support from peers, family, employers, community; and programme effectiveness at drug rehabilitation centres influences the relapsed addiction amongst drug addicts.
The findings of this research is advantageous to the government, namely the Home Ministry, NADA, social workers, drug counselors, psychologist and other human services in particular, Malaysia and other regions in general. 3. Method The primary data was obtained through a survey using self-administered questionnaire. Items from established instruments were adopted and modified appropriately to suit the objectives of the study. The instrument consists of five parts. The first part of the questionnaire collected the demographic information of the respondents.
Second part consist 42 items developed by Marlatt and Gordon, (1985) to measure the tendencies of relapsed addiction among the addicts. The items specifically measures three dimensions; negative emotion, interpersonal conflict and social pressure. Part 3, 4 and 5 obtained information pertaining to self-efficacy, sosial-environment factors (support form peer, family, employer, and community) and rehabilitation programme effectiveness respectively. Self-efficacy was measured using 15 items developed by Sherer and Maddux (1982) while 5 items from Abdullah and Iran (1991) was employed to measure attitude towards drug abuse. 0 items developed by Procidano and Heller (1983) used to measure peer and family support.
12 items created by the researchers to measure employer and community support. The program effectiveness at drug rehabilitation centres was measured using 26 items developed by Bahaman, et al. (2003). The respondents were asked to respond on a scale ranging from strongly disagree (1) to strongly agree (4). From the analysis, it was identified that the Cronbach alpha of all constructs exceeds Nunnally’s (1978) recommended threshold value of 0. 7. Thus, the instrument used in this study showed a good level in terms of reliability.
The respondents were chosen by systematic sampling procedure. 400 questionnaires were personally distributed to the relapsed addicts who are undergoing treatments and rehabilitations in eight Narcotics Rehabilitation Centres in Peninsular Malaysia. Counselors from the respective centres help to disseminate and collect the survey. High response rate (100%) for this study is due to high degree of cooperation by the respondents and the centres’ counselors. In addition, the drop and pick method utilized in this survey was very effective.
The data were analyzed using SPSS Version 15. 4. Findings and Discussion 4. Respondents’ background Majority of the respondents (86%) involved in this research were aged 30 years and above. 80% of them were Malays and Muslims and in terms of marital status, 65% were single. From the data on educational level, 91% of the respondents were holding Sijil Pelajaran Malaysia (Malaysian Certificate of Education, equivalent to O’levels). About 47% of them used to work as temporary workers. 4. 2 Factors promoted relapsed addiction amongst drug addicts in Malaysia. Respondents perceptions on all factors contributing to relapsed addiction were categorized as low, moderate and high based on the possible score range.
Table 1 shows the summary of the findings. About 97 percent of the respondents indicated moderate to high level of agreement on attitude towards drug abuse. 68 percent of the respondents agreed to moderate level of self-efficacy. In short, the findings showed that respondents received moderate to high level of support from peers (99 percent) and family (96 percent) in their endeavor towards free from drug use. On the other hand respondents reported that they received low to moderate level of support from employers (98 percent) and community (94 percent) on the whole.
About 99 percent of the respondents indicated moderate to high level of satisfactory with the rehabilitation programme at the respective centres. Table 2 displays the Pearson’s correlation coefficients between the research variables which indicate the strength of relationship between the seven factors with respect to perceived tendency of relapsed addiction to drug use. Out of seven factors identified to promoting relapsed addiction, only four factors showed significant correlation at the 0. 05 level. The factor with the highest correlation to tendency of relapsed addiction to drug use is self-efficacy (r= . 790, p