30 participants attended the study. Their mean age was 30±5 years. Six were illiterate (20%), 15(50%) primary school, and 5(16.6%) diploma certificate. 15(50%) were married, 10(30%) got divorce and 5(16.6%) were single.We derived multiple categories from our analysis and identified multiple relationships between categories. women’ experience of Ups and downs of drug rehab was constructed by two main concepts, the need for emancipation ( the deviated path, Compulsion to drug abuse, Acquaintance with God, A supportive family) and Sinking factors( Unassisting mates, Pro-addictive family, Unawareness of assisting bodies, Woman’s lack of authority, Ineffective opportunities) (Table 1).
A. The need for emancipation:
Research has shown that one of the main categories is the “need for emancipation”, which consists of three sub-categories: “being exhausted of the status quo, feeling threatened, reaching the end of the line, and compulsive abuse.” Threats are: fear of major changes in lifestyle, fear of complications of physical deprivation, fear of criticism and rejection due to addiction, fear of losing the current status, fear of failure in rehab, embarrassment, destroying the inner religious beliefs, and fear of family pressure to continue the emancipation path were among the threatening factors in making the decision to rehabilitate in participants. Participant No. 24 stated, for example:
“I decided to put it away whatever it takes. Admittedly, I was accustomed to this kind of life, when I decided to overtake it, I was really alone. My husband used drug, too. He didn’t pay any attention to me. So, I had to solve it myself and decided to come to the rehab camp.”
The deviated path: the conditions that led to being fed up of the status quo, and reaching a dead end were noticeable with subcategories as: feeling worthless, not realizing the realities of life, the lack of attraction of life and dissatisfaction with it, the worthlessness of the drugs, the feeling of being harmful for others (the family), the numerous rehabs and its consequences, physical complications of the drugs and the risk of being rejected from the family. In this regard, participant no. 8 states:
“…When I look back, I see that I sacrificed two lives for drugs. I did not see my children and my husband at all. I was a black stain…When I refrained, I had a runny nose; I had pain in my body and hands. I could not move at all, I was very nervous and aggressive. I was uncontrollable; I was at the end of the rope. I felt the real danger that I may be rejected by my parents. I felt that it was the time. I really had to quit. I had to discontinue using drugs.”
Abnormal behaviors for acquiring drugs, like prostitution, theft, lying and the resulting psychological and social consequences such as pregnancy, runaway, self-harm and suicide were among the factors influencing the sense of dissatisfaction from the status quo and the decision to rehabilitate. Participant no. 18 says:
“I robbed and was a prostitute to gain money for the drugs. I was a rough sleeper. I said to myself: I cannot live like this. I have to die or find a way out. I harmed myself. I have committed suicide four times, I hated myself. You know what I’m saying? I’ve been at the end. It was so late for me that I never even got to the middle of it.”
Compulsion to drug abuse: For the participants of this study, factors like compulsion, persistent obsession over the preparation, storage and usage of drugs, and attempts to procure drugs by violation of ethical and legal norms reflected the conditions that made them exhausted. Participant no. 4, who had a history of drug injection, says:
“Opium was no longer effective. I got into cracks, heroin and crystal. Eventually, these didn’t work either, and I got into injection. My body did not respond anymore. I was permanently drinking, smoking or injecting. That made me think it’s the time to quit. It was enough. I was tired of all of it.”
Acquaintance with God: At the pinnacle of helplessness, “God’s grace” was a resort for returning to life, as participant no. 21 puts it:
“I liked to get rid of the fear of rape by men who came to my home to give me drugs. I wish my mother did not leave me alone that day in the garden to get drugs. I wish that after 10 times in the rehab camps, I wasn’t tempted again. These wishes have been memories for years; and with those same wishes, I will go again to quit. God’s remorse is my hope for perseverance.”
A supportive family: Some participants feel good about family support and encouragement. It is impossible to deal with problems in the physical, mental, therapeutic, and financial areas without family support. Participant no. 11 talks about this unparalleled source of hope:
“At my first course (in rehab camp) my dad and family came to meet me. I kissed my parent’s hands for the first time. They told me we want to keep you here for two courses because we love you. Oh, they told me they loved me. I said, if you want, I’ll stay. When I came back to my room I was laughing. My roommates thought I was nuts. They said: ‘you are told to stay here for two courses and you laugh!?’ I completed my ‘First Step’. My first honesty was that I raised my hand and said I am an addict. Second, I was finally proud of my parents whereas I used to lie that they were dead. I accept them as they are. I depend on them to stay healthy”.
B. Sinking factors
Although participants of the study managed to change, most of them failed to return to their normal lives, and in response, they refer to the following as failure factors: “lack of support by family members, lack of awareness of community support services, financial dependency, lack of discretion among women, ineffectiveness of drug rehab camps.
Unassisting mates: Most of the participants lacked family support during rehab. Participant no. 14 says:
“My family did not help me at all. They did not trust me anymore. They looked at me with hatred. My children and my husband still do not want to see me. It affected me. It made me firmer to use drugs. They wanted me as an addicted person who listened to whatever they said. They did not want to help me. I used drugs, I harmed everyone, I destroyed everything. They did not help me to quit because they could force me. They took me wherever they wanted. They did everything to me: physical abuse, sexual abuse, rational and mental abuse.”
Pro-addictive family: The availability and general use of drugs at home were another major threat to the temptation to use drugs and was effective on the determination to quit. Participant no. 17 talks about this factor:
“I didn’t know what to do. Drugs were found at my mom’s home, and also at my dad’s home, or my sister’s. When I went to my home, my husband used drugs in front of me. I had to use, too. I could not refrain, I had a big temptation. I did not want to use it, but I used while crying.”
Unawareness of assisting bodies: Lack of awareness of existing community support services or lack of special rehab centers for women were among the most threatening factors in quitting mentioned by the participants. For example, participant no. 20 says:
“I was exhausted. I was doing everything to quit. I did not know what to do, until one day I was desperately sitting in front of the TV, and I saw a program about rehab centers. I thought that these centers were for men only. It was very late for me. Now that I think, I see that if I went to the rehab camp only on opium, the desired result would have come very sooner than when I used several drugs.”
Woman’s lack of authority: In terms of quitting, most of the participants not only lacked financial resources, but also were living as a woman under the supervision of a father, husband, brother or partner. These conditions largely made them fail to quit drugs. These women, even if they had financial resources, had to inevitably stay with their fathers or husbands. Any time their father/husband wanted, the women had to leave the camp. Participant no. 11 says:
“… After 20 times that my husband was taken to the rehab camp, my dad once brought me there to quit. However, my husband gave him 400.000 Tomans to bring me back. My husband wanted me to be an addict, so that I may not think of divorce or making him quit drugs. He gave me subsistence and I had no options for quitting. I was a woman and needed food and a shelter”
Ineffective opportunities: Addicted women participating in the study had gone to rehab camps several times. But they left there more disappointed each time than the last. The high costs of staying in the camp, lack of permission to leave or reenter the camp, not meeting children, the absence of a doctor or counselor, lack of physical space and adequate food, and sometimes violent behaviors were factors of ineffectiveness of rehab camps. Participant no. 22 states:
“… The first time at the camp, they were about to beat me. If someone had a pain and was mourning, they shouted at her or slapped her. I was afraid of the addicts; I was afraid of their looks. It was not good. For example, when eating food, the servants prepared salads but they ate it at the office. They didn’t give any to the addicts. I cried like children; I said if my mom was here, she prepared me salads.”
Also, participant no. 16 talks about conditions of a rehab camp:
“I’m already a postmenopausal woman. I have hypertension and diabetes. I have to take my medicines. But here they did not allow me to my take them. One of the women had a bad cold and they did not allow her to take an acetaminophen. They take you out only if you die. It is my last time here.”
Only a few addicted women are able to benefit from outpatient addiction quitting facilities. The cost of these centers is prohibiting for these women. These conditions, along with getting under the control of men/partners, deprive them of the use of these services. In this regard, participant no. 4 says:
“I went to the camp about 7 to 8 times, but it did not pay off. The last time in the camp, one of the women said: ‘go to the rehab center of Dr. X. He was a professional doctor. But, I could not afford the money they wanted. I tried a lot. I’m not worth more than 50.000 Tomans. I wish there was some rehab centers for free. I’m exhausted. I’m fed up with trying in vain to quit.”