essay on drug addiction in pakistan

Causes of Drug Addiction in Pakistan- How to Deal with Them

Drug addiction in Pakistan is a pressing issue with multifaceted causes. Socioeconomic factors like poverty, lack of education, and unemployment contribute, alongside accessibility to drugs and peer pressure. To address this, Pakistan needs comprehensive strategies focusing on education, rehabilitation, and community support. Raising awareness, improving access to treatment, and implementing stricter drug control measures are essential steps in combating this problem.

Drug addiction is a serious problem that has been plaguing Pakistan for years and its effects are felt through loss of life, increased medical costs, and strained relationships in communities. Everyday lives of young people especially have been devastated by substance abuse. A major contributing factor to this vexing issue is the lack of awareness among youth about drug addiction, its causes and consequences. It's important to educate our society on the causes of drug addiction in order to address them properly. In this blog post, we'll discuss three main causes-social environment, economic difficulties, and access to drugs as well as ways that can be taken to reduce their impact on our society.

10 Major causes of drug addiction in Pakistan!!

1-availability of drugs at cheap prices.

Drug addiction is a growing problem in Pakistan, affecting individuals and families alike. One major factor contributing to the issue is the availability of drugs at cheap prices. While this may seem like a solution for those struggling with addiction, it only perpetuates the cycle of dependency and the negative effects that come with it. Access to affordable, quality healthcare and addiction treatment is essential in combatting this epidemic and helping individuals overcome their addiction for good. It's time for a change and for society to prioritize the well-being of those affected by drug addiction.

2-Family Issues

Families are the bedrock of society. They offer support, love, and a sense of belonging that cannot be found elsewhere. However, family issues can arise that threaten to unravel these bonds. One such issue is drug addiction in Pakistan. It affects not only the individual but also the whole family. The sense of helplessness and despair that envelops families can be overwhelming.

It is crucial to address the root cause of the addiction and seek professional help. Families can support their loved ones by providing love, understanding, and unwavering support throughout the journey to recovery.

3-Support from Authority

Substance abuse in Pakistan is a serious concern that affects countless individuals and families. While many may feel alone in their struggles with addiction, it is important to remember that support is available. One valuable source of support comes from authority figures such as government officials and religious leaders who can offer guidance and resources to those in need. It is heartening to see the efforts being made by these figures to address substance abuse through awareness campaigns and treatment centers.

Their recognition of this issue highlights the importance of community and societal support in battling addiction. By standing together and providing support, we can make a difference in the lives of those affected by substance abuse in Pakistan.

View More: Various Health Stress Of Unemployment In Pakistan

4-Peer Pressure

Peer Pressure is a force that can be hard to resist, especially when it comes to substance abuse in Pakistan. Young individuals are often surrounded by friends and peers who are experimenting with drugs or alcohol, and they may feel the need to conform in order to fit in and be accepted. However, the consequences of substance abuse can be devastating, both for the individual and for their families. It's important for young people to learn how to say no to peer pressure and make wise decisions about their own health and well-being. By being proactive and seeking support from trusted adults and professionals, they can overcome peer pressure and stay on a positive path toward a bright future.

5-Mental illness

Mental illness is a topic that has been widely discussed, but widely misunderstood. In Pakistan, mental health awareness is still in its infancy, and one issue that has arisen is the high rate of heroin addiction. Despite the detrimental effects that heroin has on lives, people continue to use it as a coping mechanism for their mental illnesses.

It's important to address and understand the root causes of addiction in order to prevent it from taking hold in future generations. Mental health needs to be a priority not only in Pakistan but around the world, as we strive to create a healthier and more empathetic society.

6-Socio-cultural Aspects

Socio-cultural aspects often play a significant role in shaping the norms and values of a community, including how they deal with issues like addiction. In Pakistan, heroin addiction is a growing problem, and examining the influence of socio-cultural factors can help us understand why. For example, the social stigma surrounding addiction may discourage people from seeking help or discussing the issue.

Additionally, cultural beliefs about masculinity and honor can prevent men from admitting to their struggles with addiction. Overall, tackling heroin addiction in Pakistan will require a nuanced understanding of the socio-cultural factors at play, and a willingness to work within those frameworks to create meaningful change.

7-Toxic Relationship

Toxic relationships come in many forms, but one particularly harmful factor can be substance use disorders. When one partner is struggling with addiction, it can completely alter the dynamic of the relationship and cause irrevocable damage. This can lead to codependency, enabling, and an overall imbalance of power.

The toxicity of the relationship can spread beyond just the addicted partner, infiltrating every aspect of both individuals' lives and causing ongoing pain and turmoil. It's important to recognize the signs of a toxic relationship and seek help before substance use disorders worsen and further damage the relationship.

8-Study Pressure

As students, we all deal with a lot of pressure when it comes to studying. The constant deadlines, exams, and expectations can take a toll on our mental health and well-being. Unfortunately, for some, this pressure can lead to substance use disorders. When students turn to drugs or alcohol to cope with study pressure, it can quickly spiral out of control and result in serious addiction issues. It's important for us to recognize the signs of substance use disorders and seek help before it's too late. Whether it's talking to a friend, or a teacher, or seeking professional help, don't be afraid to ask for assistance when the pressure of studying becomes too much to handle. Remember, your health and well-being always come first!

Genetics is a fascinating field that explores how our DNA influences who we are, from our physical traits to our susceptibility to certain diseases. While much of the research in genetics has focused on understanding these biological mechanisms, researchers are also exploring the ways that genetics intersects with culture and society. For example, in Pakistan, the organization Narcotics Anonymous is using knowledge about genetics to help prevent addiction.

By understanding the genetic factors that make some people more prone to addiction, they are able to provide more targeted support and treatment to those in need. This is just one of many examples of how the cutting-edge research in genetics is having practical, real-world applications that are improving the lives of people around the globe.

10-Environmental Factors

Environmental factors play a crucial role in the development of drug addiction in Pakistan. In a country where poverty, unemployment , illiteracy, and political instability are prevalent, people are more prone to becoming vulnerable to drug addiction. Additionally, environmental factors such as peer pressure, exposure to drugs, family history of drug use, and lack of access to effective treatments also contribute significantly to the opioid crisis in the country.

Environmental risks can be avoided through the implementation of public policies that are aimed at reducing poverty, improving education, and creating job opportunities to enable people to access better living conditions, making it less likely for them to become victims of drug addiction.

Drug Addiction Treatment

Drug addiction is a global issue that affects millions of people around the world. While addiction treatment options are available, the challenge lies in providing access to those who need it the most. In Pakistan, addiction treatment is gaining momentum as more and more individuals seek help to overcome their dependence. From private rehabilitation centers to government-run programs, the options for addiction treatment in Pakistan are vast and varied.

While the road to recovery can be difficult, the success stories are endless, and the benefits of seeking help make all the difference in the lives of those struggling with addiction. With continued efforts towards awareness, education, and access to treatment, we can make a significant impact in the fight against drug addiction in Pakistan.

By understanding the causes of drug addiction in Pakistan, we can work on ways to help those afflicted by this problem. We must prioritize the education of both adults and children, support laws to restrict drug accessibility, provide treatments for addicts, and make communities available for support. Taking an active part in tackling this issue is essential for society's overall well-being.

As individuals or groups, we can sponsor organizations committed to helping those struggling with substance abuse, volunteer our time and resources to share information and advice about avoiding these problems, or even visit rehabilitation centers ourselves to help addicts in their recovery journey. Therefore, let us start taking practical steps that will bring about positive change in our society and provide a healthier future for everyone.

Please book an appointment with the best Psychiatrist in Lahore , Karachi, Islamabad, and all major cities of Pakistan through InstaCare , or call our helpline at 03171777509 to find a verified doctor for your disease.

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Frequently Asked Questions

How can we deal with the drug addiction problem.

Dealing with drug addiction requires a multifaceted approach. Education and awareness campaigns can prevent initial drug use. Accessible rehabilitation and treatment centers are crucial for recovery. Community support and counseling play a vital role in rehabilitation. Additionally, enforcing strict drug control measures and addressing underlying socioeconomic issues are key to combating the problem effectively.

What are the causes and solutions of drug abuse?

Causes of drug abuse often include peer pressure, stress, trauma, and easy access to drugs. Solutions involve prevention through education and awareness programs, improved mental health support, rehabilitation and treatment facilities, stricter drug control measures, and addressing underlying socioeconomic issues like unemployment and poverty. Combating drug abuse requires a holistic approach.

What kind of drug addiction is in Pakistan?

In Pakistan, drug addiction primarily involves opioids, including heroin and prescription painkillers. The country faces a significant challenge with opioid abuse due to factors like accessibility, poverty, and lack of education. Addressing this issue requires a comprehensive approach, including education, treatment, and stricter drug control measures.

What are the social issues related to drug abuse?

Drug abuse leads to various social issues, including strained relationships, family breakdowns, and increased crime rates. It contributes to the spread of infectious diseases like HIV/AIDS. Drug-related accidents and violence are common, affecting not only users but also their communities. Drug abuse can exacerbate poverty and hinder socioeconomic development.

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Drug Abuse in Pakistan

Genetic Factors and DRD2 Enhancer Variant rs12364283

• Living reference work entry
• First Online: 04 May 2022
• Cite this living reference work entry

• Shagufta Jabeen 3 ,
• Uzma Abdullah 4 ,
• Muhammad Sheeraz Ahmad 4 ,
• Muhammad Mobeen Zafar 4 ,
• Julia K. Pinsonneault 5 ,
• Wolfgang Sadee 6 &
• Ghazala Kaukab Raja 4  

36 Accesses

Drug addiction is a major health issue still growing across the world including Pakistan. Associated physico-mental health issues, large direct health costs, negative social impact, and increasing death rates render drug addiction a global epidemic. Among addictive drugs, the illicit opioid heroin has spread at a high rate in different parts of the world, especially in Pakistan. Heroin addiction is considered a complex disorder involving interplay of genetic and environmental factors. A number of genetic markers have been identified and candidate genes declared for opioid addiction. Genome-wide association studies (GWAS) have revealed only a few single nucleotide polymorphisms (SNPs) in candidate genes associated with increased risk of drug addiction, while epidemiological and genetic studies estimate genetic factors to account for a substantial risk for opioid use disorder (OUD) (Deak and Johnson, Psychol Med 51:2189–2200, 2021). Targeted genetic association studies with candidate genes further highlight potential genetic factors in OUD but often fail to be replicated in diverse populations. A key gene in the dopamine pathway, the dopamine D2 receptor ( DRD2 ), harbors regulatory variants, i.e., two intronic SNPs (rs1076560 and rs2283265; involved in mRNA splicing) and the enhancer SNP rs12364283 have been identified as potential risk markers of psychiatric/addictive disorders. This book chapter focuses on OUD, specifically heroin addiction, reviewing distribution among ethnic groups in Pakistan and assessing genetic variation in candidate genes such as DRD2 in world and Pakistani populations.

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Abbreviations

Brain-derived neurotrophic factor

Catechol- O -methyltransferase

Dopamine transporter

Dopamine receptor D2

Gamma-aminobutyric acid receptor subunit gamma-2

Genome-wide association studies

Human immunodeficiency virus

Hypothalamic-pituitary-adrenal

Serotonin receptor 1B

Internal ribosome entry site

κ-opioid receptor

Linkage disequilibrium

Minor allele frequency

Monoamine oxidase A

mu opioid receptor

Nerve growth factor-β subunit

National Institute on Drug Abuse

Opioid receptor kappa 1

Opioid receptor mu 1

Opioid use disorder

Prodynorphin

Proenkephalin

Period circadian protein

Proopiomelanocortin

Single nucleotide polymorphisms

Substance use disorder

Tryptophan hydroxylase 2

United Nations Development Programme

United Nations Office on Drugs and Crime

Variable number tandem repeat

Ventral tegmental area

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Islamabad Model College for Boys, Islamabad, Pakistan

Shagufta Jabeen

University Institute of Biochemistry and Biotechnology, Pir Mehr Ali Shah Arid Agriculture University Rawalpindi, Rawalpindi, Pakistan

Uzma Abdullah, Muhammad Sheeraz Ahmad, Muhammad Mobeen Zafar & Ghazala Kaukab Raja

The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

Julia K. Pinsonneault

The Ohio State University, Columbus, OH, USA

Wolfgang Sadee

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Vinood B. Patel

Dept of Nutrition & Dietetics, King's College London, London, UK

Victor R. Preedy

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Jabeen, S. et al. (2022). Drug Abuse in Pakistan. In: Patel, V.B., Preedy, V.R. (eds) Handbook of Substance Misuse and Addictions. Springer, Cham. https://doi.org/10.1007/978-3-030-67928-6_145-1

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An exploratory research on the role of family in youth's drug addiction

Sobia masood.

a Department of Behavioral Sciences , Fatima Jinnah Women University , Rawalpindi, Pakistan

Najam Us Sahar

Most of the researches in Pakistan are concerned with the aetiological factors of drug addiction among the youth. However, few studies seek to explore the social aspects of this phenomenon. The present study aimed to explore the role of family, the influence of parental involvement, and communication styles in youth's drug addiction in a qualitative manner. Twenty drug addicts (age range 18–28 years) were taken as a sample from drug rehabilitation centres in Rawalpindi and Islamabad, Pakistan. A structured interview guide was administered comprising questions related to the individual's habits, relationship with family and friends, and modes of communication within the family. Case profiles of the participants were also taken. The rehabilitation centres offered family therapy and the researcher, as a non-participant, observed these sessions as part of the analysis. The demographic information revealed that majority of the participants were poly-substance abusers (80%) and the significant reasons for starting drugs were the company of peers and curiosity. The thematic analysis revealed parental involvement and emotional expressiveness as two major components in family communication. It was found that parents were concerned about their children, but were not assertive in the implementation of family rules. It was also found that the major life decisions of the participants were taken by their parents, which is a characteristic of collectivist Pakistani society.

1.  Introduction

Drug abuse is a prevalent problem among Pakistan's youth, who account for 28% of the whole population of Pakistan (Niaz, Siddiqui, Hassan, Ahmed, & Akhtar, 2005 ; Royen & Sathar, 2013 ; United Nations Office on Drugs and Crime [UNODC] ( 2013 )). According to the recent report by UNODC and Pakistan Bureau of Statistics in 2013, an estimated 6.45 million of the population in Pakistan use drugs on an annual basis with cannabis being the most commonly used drug.

Among the youth population, nearly 25% are involved in some form of drug abuse. Among the youngest drug users, between the ages of 15 and 19 years, the most commonly used drug is cannabis. Compared to other national estimates, opiate use is very high with one million people using heroin or opium. The use of ‘Sheesha’ 1 with cannabis (charas) and other drugs is a new emerging trend and is being abused by both males and females, mostly from the upper socio-economic strata living in the posh areas of cities (Ministry of Narcotics Control, Islamabad, Year Book, 2012 ).

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 (United Nations International Children's Emergency Fund, as cited in Sherman, Plitt, Hassan, Cheng, & Zafar, 2005 ).

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.

1.1. 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.

According to the findings of Bahr, Maughan, Marcos, and Li's ( 1998 ) study, the parent–adolescent bond has indirect effects through religiosity, and family drug use. It was found that among family variables the two major variables were for bond to mother, followed by family drug problem. Bond to father, parental monitoring, and family aggression were relatively weak predictors of adolescent drug use. Since the bond to mother is stronger, adolescents feel closer to them and share their daily life routine, thus communicating frequently with their mothers. In Pakistani society a strong bond to mother is observed as fathers are seen as the authority figure. Poor communication within the family unit affects an individual's indulgence in drug abuse.

The findings from Manley, Searight, Skitka, Russo, and Schudy's ( 1991 ) study found that the families of adolescent drug abusers were more reserved in their expression of thoughts and feelings. As fathers in Pakistani society are responsible for discipline, they are seen as less warm and as such communicating on a one-on-one basis can prove to be a little difficult. Out of the many conflicts within a family, the lack of problem-solving abilities, interactions, and communication are related to further addiction (Hosseinbor, Bakshani, & Shakiba, 2012 ; Sajida, Zia, & Irfan, 2008 ).

The objective of this study was to explore the role of family, the influence of parental involvement, and communication styles in youth drug addiction.

2.  Methodology

2.1. participants.

The participants included in the study were substance abusers seeking treatment from validated rehabilitation centres. The participants were selected through purposive sampling technique from rehabilitation centres which were offering family therapy sessions, and where the clients were residing in the facilities for a minimum of three months in order to facilitate detoxification. All the participants were males between the ages of 18 and 28 years old and were being treated in various drug rehabilitation centres in Rawalpindi and Islamabad, Pakistan.

The present research was conducted on 20 individuals who had an understanding of their dependency. A preliminary study was conducted which helped in building rapport with the participants. It also helped the researcher in identifying the inclusion and exclusion criteria. Participants were excluded from the study if they were in an active phase of mental disorders such as bipolar disorder, depression, or stable schizophrenia.

The facilities from which the data were collected were offering family therapy sessions conducted by trained psychologists. These sessions were attended by immediate family members of the individuals admitted for substance abuse. The family members included in the therapy sessions were mostly the parents and wives of the clients. These sessions were attended by the researcher with permission from the facility as well as the family members.

2.2. Instruments

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 ).

Note: ( N  = 20).

2.2.2. Interview guide

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 ).

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 )

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:

Whenever I get the time I talk to my parents

Only 20% of the participants stated that they seldom communicated with their parents. A majority (70%) of the participants stated that they spent more time with their mothers rather than their fathers, e.g. a respondent stated:

My mother liked spending time with me. My father didn't.

Over half (55%) of the participants stated that they were closer to their mother than their father, which can be explained through the cultural context as in Pakistan fathers are reserved in their affections towards their children.

Mode of communication with parents . Another sub-theme was the mode of communication with parents, 55% of the participants stated that they communicated with both parents on a one-on-one basis. In relation to communicating with the father, 15% stated that they did communicate with their father on one-on-one basis, but also used another family member as mediator (usually the mother). One of the reasons given by the participants was that the fathers were not willing to listen to the individuals; hence they approached the mother, e.g. a respondent stated:

My father never bothered to listen to what I had to say. So I told my mother my opinion and she later conveyed it to my father.

This statement explored the problems in family communication which was further explored and the following reasons were reported by the participants. One of the reported barriers to effective communication is the refusal to talk. Though the parents were not reported to ignore their children, 60% of the participants reported that when they were angry, the parents stopped communication in order to avoid further conflict.

When I became angry while being intoxicated, my parents stopped talking to me.

The reasons given for arguments were not agreeing on certain things and being beaten, along with siblings, by the father, e.g. a respondent stated:

Yes, when my father used to beat me and my siblings, my mother used to scream at him to top hitting us.

Out of the total participants, 65% reported no incidence of arguments involving yelling with parents. However, 35% of them reported frequent arguments with fathers. Moreover, they reported their fathers yelling at them frequently. During an interview, a respondent stated:

Frequently, my father used to yell at me, hit and scream at me

Range of issues being discussed with parents . All the participants were aware of the prescribed family rules such as mobility, social circles, and expenditures; hence the breaking of the rules incited the parents' disapproval. This can be connected to the parents' attempt at controlling the negative behaviour of the participants. Almost all the participants agreed upon the activities disliked by their parents such as the use of drugs, coming home late, not listening to their parents' advice, spending money on drugs, selection of friends, refusal to go to school, and poor academic performance. However, it was found that these rules were not put into practice because the parents were not assertive in their implementation.

My parents don't like my friends. They tell me to leave them.

Most of the participants reported a consensus on major decisions such as choice of life partner, career, and academics. Seventy per cent of the participants agreed that their parents knew how they felt and thought about any given situation.

They're parents. Of course they know what I'm thinking and feeling. They can always tell

Pertaining to the communication links between the individuals and their family, 50% of the participants stated that they could discuss anything with both their parents. They were given the freedom to express their opinions and their advice was sought. Only 15% of the participants stressed that they discussed issues more with their father than their mother, another 15% of the participants stated that they used to discuss their problems with both of the parents before being involved in substance abuse, but afterwards they were more comfortable discussing their problems with an elder sibling (usually a brother) as evident from the following statement:

I can discuss every problem with my parents. I don't because then they'll get worried. So I go to my elder brother for guidance.

Referring to the parents' approval of the friends of the participants, a majority of the participants (65%) stated that their parents did not approve of their peers as they feared that their children would get into bad habits such as substance abuse.

My father never liked my friends. He was afraid I would get into bad habits like substance abuse or drinking alcohol.

Pertaining to parents' knowledge of their whereabouts, 75% of the participants reported that their parents were aware.

Yes, my father knew where I was. He had spies everywhere. He used to drop by when I least expected him to, to check up on me.

Of the participants, 15% stated that their parents had no idea about their child's social life. A respondent, upon being asked about his parent's knowledge of his whereabouts, reported:

No. Only when I needed money from them did I tell them where I was going. Otherwise no one knew where I was or with whom.

The choice of selecting their own life partner is an important aspect where communication discrepancies can be brought to the surface. It can also be one of the major causes of drug addiction as reported by participants. In a collective culture like Pakistan, life partner selection is mostly done by the family as the family provides financial, social, and moral support. This is why most people prefer arranged marriages. In the present study, out of the 40% of married participants, two-thirds of them had arranged marriages. One of the advantages of an arranged marriage is social compatibility, where both families work together to keep harmony. Of the total participants, 75% reported that their opinion on family issues were held in regard and respected. They stated that their parents were ultimately responsible for making all the decisions.

All participants were focused on their future goals, which included quitting drugs, getting married, reuniting with their spouses, and finding secure jobs to support their families. The decision-making is influenced by family support and it is this social support which helps in future planning.

Emotional expression . In this section the participants reported the characteristics of their communication styles with their families. The data within this section help in exploring the gaps perceived by the participants in communicating with their families which could possibly lead to conflict and may provide insight into their addiction.

Using profanities . Sixty per cent of the participants admitted to using profane language generally, which is one of the common characteristics of problematic communication style. Thirty-five per cent of them admitted to using profane language with their family, but only under the influence of drugs or alcohol, e.g. a respondent stated:

Yes [I curse] sometimes. When I was under the influence of drugs I used to curse.

They used profanities in conversations with their friends as well as in response to situations. The rest of the participants denied using profane language.

Being good listeners & speakers . All participants agreed that they were good listeners with whom family and friends could discuss various problems. They also felt that they were good speakers, being clear in their expression and maintaining eye contact. However, it was observed that 15% of the respondents mumbled while conversing with the researcher.

Assertiveness . A majority of the participants reported themselves to be assertive and expressive; however, discrepancies were found amongst the statements given by the participants pertaining to communication with their parents and friends. The participants stated outright that they were assertive, that they were able to say ‘no’ to a decision taken by their family, and that they took responsibility for their actions. However, upon conversing with the researcher, some participants negated this statement. As recorded, a participant, upon being asked if he expressed his feelings in regard to a given situation, stated:

No. My parents make all the decisions.

Expression of negative emotions and arguments . Ten per cent of the participants stated that they used drugs as a means to express themselves. They viewed substance abuse as an escape from reality. Upon being asked how they expressed their negative emotions, most of the participants (80%) stated that they yelled and shouted.

Presenting Nervous Tics . Forty-five per cent of the participants reported nervous tics such as nail biting, smoothing hands over their lips, and playing with their hair. This might be due to the side effects of the drugs or the medication used in the treatment. One of the reasons stated by a participant was that because he used heroin in panni (silver paper), the skin under his nails blackened and thus biting his nails became a habit.

Yes, I used to bite my nails. That was when I used to use heroin in panni. The skin under my nails used to be blackened hence I bit my nails out of habit.

The aforementioned analysis revealed parental involvement and emotional expressiveness as two major components in family communication. It has been further revealed that culture plays an important role in family dynamics with reference to the major life decisions being taken. Another aspect identified was the presence of physical abuse in the family. With reference to the communication style, it has been noted that the elements of respect and emotional expressiveness have been present. This will be further discussed in the following section.

4.  Discussion

It was found by the researchers that all the participants unanimously agreed in their communication styles stating that they were assertive, good listeners, and future-oriented. However, it was found that there were discrepancies among the participants' views and the observations of the researcher and the psychologists involved in their rehabilitation. The participants sometimes refused to make eye contact and were not clear in their verbal expression, i.e. they mumbled answers, which may be due to the effect of the medications they are given for their treatment.

It is the understanding of the researcher, as well as the consulted psychologists, that these discrepancies can be attributed to denial. In the case of drug abuse, impaired insight causes what is referred to as ‘denial’. Denial of addiction is a common, if not a core, feature of most substance-use disorders and has been conceptualized as a psychological phenomenon (Rinn, Desai, Rosenblatt, & Gastfriend, 2002 ). The first step of treatment is the confrontation of this denial, as reported by the psychologists.

The findings of the present research are consistent with previous researches which stated that the family of a drug addict plays an important role as the causal or aetiological factor for the addiction itself. The main problem reported was with authoritarian fathers and submissive mothers, as well as lack of communication between parents and children, particularly with their fathers and during conflicts. This has been reflected in the thematic analysis under the subsection of spending time with family members. It can be inferred from other studies that authoritarian parents, who are highly demanding but less responsive, tend to make demands on their children but not respond well to their needs. It can also be inferred that due to this parenting style a communication gap can develop among the family which prohibits direct communication, especially the expression of anger (Verdejo-Garcia, Rivas-Perez, Vilar-Lopez, & Perez-Garcia, 2007 ).

Parental monitoring has been associated with elements of parental control such as imposing rules and restrictions on children's activities and associations (Borawski, Ievers-Landis, Lovegreen, & Trapl, 2003 ; Nash, McQueen, & Bray, 2005 ). Monitoring of adolescents' behaviour, which includes tracking and surveillance, is an essential parenting skill. A large amount of studies show that well-monitored youths are less involved in delinquency and other norm-breaking behaviours (Cleveland, Feinberg, Osgood, & Moody, 2012 ; Stattin & Kerr, 2000 ). The findings of the present study are in contradiction with the findings of the aforementioned studies as 75% of the participants stated that their parents were aware of their whereabouts, and yet, the participants were still involved in norm-breaking behaviours. One of the possible reasons for this can be the lessened mobility restrictions on males in Pakistani culture.

It was observed by the researcher and the psychologists that dysfunction within the family of an addict was the leading cause of relapse. Lavee and Altus ( 2001 ) also noted that individuals in a dysfunctional family were at a higher risk of relapse than those who were not. It was found by the researcher that most of the participants (65%) who had relapsed did so because of the problems they faced within their family, for example communicating directly with the fathers who were unwilling to listen and talk to their sons. This, in the case of 35% of the participants, resulted in frequent arguments with their fathers which involved yelling.

In addition to the family being the aetiological factor in addiction, it was found paradoxically to be part of the cure as well. Repeated admissions to the rehabilitation centres show continued family support since the families were willing to invest emotionally and financially in the improvement of their sons. In Pakistan choice and financial liability are on parent's part, so this practice can be used as an indicator of family support in the treatment.

Since the family plays an integral part in the rehabilitation process, the centres included the component of family therapy into the treatment programme. This will help to integrate the family and improve communication between the individuals as well as encourage families to show their support to the addict. Through their support the family can lessen environmental stressors such as peer pressure and help the addict.

It can be stated that if parents and significant others identify the signs of addiction at an early stage, the family can stage an intervention and potentially stop the behaviour before it becomes worse. The importance of communication between the parents (especially fathers) and children is stressed as it may be the key link in the detection and prevention of self-destructive acts.

4.1. Conclusion

The current study provides an insight into the role played by family in youth's drug addiction. It found that parental involvement and emotional expressiveness were two of the major themes identified.

4.2. Limitations and suggestions

The present study aimed to explore the role of family in youth drug addiction, but there are a few limitations of the study that must be taken into consideration.

First is the time limit. The researcher did not have ample time to conduct the study on a larger number of participants because of the short time period supplied for this project. Due to this shortage of time, the time spent on one-on-one session with the participants was limited. Hence unstructured interviews and a deeper exploration into the problems stated by the participants were not possible.

The present study is focused only on the role of parents in youth addiction, not taking into consideration the role of siblings or peers of the addicted. However, the researcher believes that if the study were to be conducted in a longitudinal manner, more aetiological factors would come to light for addiction with respect to Pakistan. Other areas of interest as well as other factors, bio-socio-cultural factors, remain to be explored as well as their contribution to addiction among youth.

1. An oriental tobacco pipe with a long flexible tube connected to a container where the smoke is cooled by passing through water.

2. Ketamine – commonly used as a safe, effective, anesthetic agent, but misused as a club drug.

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Drug Addiction in Pakistan: A step towards alleviation of sufferings

2021, JSZMC

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IntroductionDrug is any substance (other than food) which by its chemical nature affects the structure or functioning of living organism (Danial et al. 1980; Kosten et al. 1987). According to World Health Organization drug abuse is the consumption of a drug apart from medical need or in the unnecessary quantities. Drug addiction is the compulsive use of a drug in greater amount than is used in ordinary therapeutic and is harmful to individual or society or to both (Jaffe 1975; Bozarth 1987; Smith W Ausubel 1958). Addiction is an inveterate, often reverting disease which causes compulsive drug use, in spite of harmful effects to the individual as well to those around the addicted one. Although, in the initial stage, most of the people voluntary decide to take drugs, but with the passage of time the brain changes challenge the addict's ability to resist against the impulses which urge them to take drug (NIDA 2011).Since long, Pakistan has suffered from the consequences of illegiti...

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Opium poppy is contemplating a cash crop across the globe, which is cultivated in almost every region of the world and also in many areas of Pakistan, especially in Baluchistan, Federally Administered Tribal Area (FATA) and Khyber Pukhtunkwa (KP). In the heydays of Soviet-Afghan war the cultivation of opium as a cash crop was initiated in Pakistani areas adjacent to that of Afghanistan. In the 1980s the opium poppy was grew in the Khyber Pakhtunkhwa, Federally administrated tribal areas (FATA), Kohistan, and Kala Dhaka and even in Punjab and in Baluchistan. The covert operation in Afghanistan against Soviet led by the CIA has converted the Borderland of Pakistan and Afghanistan into the world top illicit drug producer. The region supplied 60 percent of United States heroin demand. A shadow economy of opium was developed in the country and Pakistan became a major opium producer. The U.S drug enforcement agency (DEA) identified 40 major illicit drug dealer syndicates. The capabilities of the local population are deprived by the opium ban in opium growing areas of Pakistan to meet their traditional socioeconomic needs.

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Rising trend of substance abuse in Pakistan: a study of sociodemographic profiles of patients admitted to rehabilitation centres

Affiliation.

• 1 Department of Biosciences, COMSATS, Institute of Information Technology, Islamabad, Pakistan. Electronic address: [email protected].
• PMID: 30616031
• DOI: 10.1016/j.puhe.2018.10.020

Objectives: In Pakistan, the prevalence of drug addiction is increasing at an alarming rate. However, the risk factors, which are increasing vulnerability towards addiction, remain largely elusive. The major objective of this investigation was to study the sociodemographic variables common in addicted patients in order to identify vulnerable cohorts and risk factors, which increase predisposition towards substance abuse.

Study design: This is a multi-site cross-sectional survey-based study.

Methods: In this study, 102 male addicted patients admitted to drug rehabilitation centres of the Islamabad/Rawalpindi and fulfilling Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for dependence, were interviewed with the help of a structured questionnaire.

Results: A total of 102 male patients participated in the survey. Participants mean age was 28.4 years (±9.8), whereas 14% were aged between 15 and 20 years. A large number of respondents (35%) initiated drug abuse in the teenage years. Majority of the subjects were skilled (60%) and had secondary education (47%), whereas 8% of the patients were students. Heroin was the most abused substance (48%) followed by cannabis (28%). The mean duration of substance abuse was between 1 and 5 years, whereas a significant fraction of subjects (8%) had more than 16 years of duration of abuse. Family disputes and peer pressure were the most common reasons for initiation of substance abuse. A significant fraction of patients (46%) reported to suffer from comorbid depression.

Conclusions: The growing trend of abuse in highly addictive substances such as heroin in teenagers and in the skilled and educated stratum of society is of great concern and demands immediate preventive measures from the policymakers.

Keywords: Epidemiology; Heroin; Pakistan; Substance abuse.

Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Publication types

• Multicenter Study
• Cross-Sectional Studies
• Pakistan / epidemiology
• Patient Admission
• Risk Factors
• Socioeconomic Factors
• Substance Abuse Treatment Centers
• Substance-Related Disorders / epidemiology*
• Substance-Related Disorders / rehabilitation
• Surveys and Questionnaires
• Young Adult

Causes of Drug Addiction in Pakistan- How to Deal with Them?

Drug addiction is an alarmingly increasing issue in Pakistan, with both local and imported drugs contributing to this problem. A range of social, cultural, and economic factors are responsible for the prevalence of drug addiction in the country. It is essential to take measures to address the causes in order to prevent drug addiction from becoming an even bigger problem in the country.

Table of Content

Highlights:

• Drug addiction is a complicated neurobiological disorder that affects a person’s brain and behavior, resulting in a person’s inability to resist the urge to use drugs.
• The most common causes of drug addiction in Pakistan are family issues, mental illness, Peer pressure, toxic relationships, etc. 
• To prevent or minimize drug addiction, it is necessary to eradicate the cause and then focus on the mental education of those affected and guide them to seek help if drug usage gets out of control or causes problems.

The effects of drugs on your body and mind might change your feelings, thoughts, and behaviors. People use drugs in many different ways and for many various reasons. When something is used frequently to the point where you crave it and become dependent on it, you are said to be addicted. If you are addicted, you might use the drug even when it is harmful. Drug addiction is simply a trap; once you get into it, it’s too difficult to come out of it. 

Scientifically speaking, drug addiction is a complex neurobiological disorder, which affects a person’s brain and behavior in a way that they lose the ability to resist the urge to use drugs. 

9 Significant Causes of Drug Addiction in Pakistan:

The common causes of drug addiction in Pakistan are given below: 

 1:Availability of Drugs at Cheap Prices:

According to some experts, cheap and easy drug access is the leading cause of its increasing rate in Pakistan. Drugs are available in high amounts in our country.   

2: Family Issues:

In Pakistan, family issues are a significant source of stress for many kids, and they start taking drugs. Their mental health suffers from parental disputes, poverty, conflicts with siblings, etc. Teens who are unhappy in their homes may use drugs as an escape from reality. They enjoy temporary pleasure because it sends them to the stars. However, as they land back on Earth, reality strikes, and they yearn to return to where the drug had taken them. Their dependency begins here.

Also Read: Drug Addiction In Pakistani Youth

3: Support from Authority:

The leading cause of Pakistan’s alarming rise in drug use is that those in positions of authority, wealth, and control give them constant support. Pakistan is now both an importer and an exporter of drugs. “Pakistan’s illegal drug trade is believed to generate $2 billion a year. Pakistan is the most heroin-addicted country, per capita, in the world,” expressed David Browne.

 4: Peer Pressure:

The issue of peer pressure is real. Teens try to fit in with society by bowing down to others. Peer pressure to use drugs can contribute to drug use and perhaps result in addiction. Peer social standards may also put pressure on individuals. For instance, even in the absence of specific peer pressure, a person may feel pressure to drink if they observe that their friends spend a lot of time consuming such drinks.

 5: Mental illness:

People with moderate, severe, or even subclinical mental problems use narcotics as a sort of self-medication. According to studies, individuals who suffer from different mental illnesses, including anxiety , depression, or post-traumatic stress disorder (PTSD), may turn to drugs or alcohol as a kind of self-medication.

6: Socio-cultural Aspects: 

You are more likely to develop a drug addiction if one or two drug users are in your social network. Because any organization’s shared values and beliefs always direct its members’ behavior and activities, socio-cultural influences significantly impact the development of addiction. If alcohol or drug use in that culture is ordinary, members of a culture become more prone to addiction. Keep your guard up, decline any offers of drugs, and confidently leave whenever they approach you.

 7: Toxic Relationship:

Most people associate toxic relations with romantic connections, although they can also exist in friendships, workplace partnerships, and family interactions. Drug addiction can result from toxic relationships. Because of an unhealthy relationship with someone, you might use drugs or alcohol to hide or deal with painful emotions.

8: Study Pressure:

The study pressure causes a lot of stress. They keep looking for quick cuts, but they never succeed. They become depressed after failing an exam. Therefore, they might use a drug to make them feel better. You are more likely to use a particular drug if you notice that it improves your mood and performance.

 Read Also: Harmful Effects of Drugs.

9: Genetics:

Your genetic makeup could make you more prone to addiction. A particular substance affects your body and mind in the same way that it influenced your forefathers. You have a significantly higher likelihood of developing a drug addiction if your parents or their parents used drugs in the past.

In Conclusion  

Of course, none of these risk factors guarantees that a person will develop a substance abuse disorder. There are different reasons for drug addiction in Pakistan. To stop or minimize it, we have to eradicate its causes, then focus on the mental education of the affected ones and guide them to get assistance if the drug usage is out of control or causing issues. The chances of full recovery are higher the sooner people seek support. 

Addiction psychiatrists are trained professionals that consult with patients to identify the causes of their drug or alcohol addiction. They can prescribe medication to manage withdrawal symptoms and treat underlying or co-occurring mental health issues, if necessary.

You can book an appointment with the top psychiatrists in Lahore through Marham by calling at Marham helpline: 0311-1222398 or by online booking facility through the website or Marham mobile app.

1. How can you prevent drug addiction?

Engaging in prevention programs and creating awareness among the masses can help prevent drug addiction in youth.

2. How does drug addiction affect you mentally?

In some cases, recreational drug use can cause long-term mental health problems. For example, taking it can cause depression or schizophrenia. Or, it may trigger feelings similar to those already experienced as part of a mental health problem.

3.Can drugs cause infertility in females?

Illegal drugs, such as marijuana and cocaine, can seriously affect fertility and make ovulation more difficult.

He is a biotechnologist, microbiology researcher and a passionate content writer who loves to generate creative content and enlighten others with his authentic research.

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An essay on drug addiction with outline and quotations

 2nd year. FSc part 2, ICS part 2, FA part 2 and BA students can see this excellent essay on Drug Addiction and learn it for their exams. The essay is given with outlines and quotations. You can save this essay as a pdf file if you want. 

The essay covers 300 - 400 words and you can skip some sentences if you want to keep it to 200 words limit.

Drug Addiction Essay with outlines and quotations

The essay has been written for the help of the students of grade 10 to grade 12. Anyhow this essay can be used for any exam as it is an excellent essay. You can see a list of related essays topics here.

An essay on abuses and effects of drug addiction

1. Introduction and definitions

2. Kinds of Drugs

3. Drug Addiction in Pakistan

4. Causes and factors behind drug addiction

5. Personal and social effects of Drug addiction

6. Prevention of drug abuses

7. Conclusion

Addiction is an adaptation. It’s not you–it’s the cage you live in - Johann Hari

We don’t choose to be addicted; what we choose to do is deny our pain - Anonymous

There’s not a drug on earth that can make life meaningful - Anonymous

You can get the monkey off your back, but the circus never leaves town - Anne Lamott

Addicts are addicted to their drugs, and their families are addicted to hope -  Fredrik Backman

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Drug Abuse in Youth of Pakistan English Notes Chapter 19

Drug Abuse in Youth of Pakistan English Notes Chapter 19 for boards of kpk, sindh, punjab and fbise .

Drug Abuse in Youth of Pakistan English Notes Chapter 19 2024

What is the central idea of the essay ‘drug abuse in youth of pakistan, analyze the pattern of writing and the order of arranging paragraphs in the essay ‘drug abuse in youth of pakistan, why are the educated youth resorting to drug abuse explain it in five lines., compare and contrast college’s life with that of school’s. highlight the points of similarities and differences in light of the essay., what should be the role of parents in managing the future goals of their children, what role can academia play in the control of drug abuse, how important is a healthy relationship between parents and children for the overall development of a child, why should the use of soft drugs be controlled what is the “gateway” to, whom for is the writer using the term ‘this nexus’ in the essay ‘drug abuse in youth of pakistan’ and why.

Read more: School Vs Education English Class 11 Notes Chapter 16

Summarize the role of parents, educators, government administration and society at large in the eradication of drug abuse in the light of the text of the lesson ‘Drug Abuse in Youth of Pakistan.’

Drug abuse is one of the greatest threats to our society that is making the youth drug addicts. Various reasons are there for the youth to be caught in the web of drug abuse such as academic pressure, parents’ over-expectation, lack of proper counselling and easy availability of drugs at educational institutions. In order to keep our youth away from the dangers of drug abuse, parents, educators, government administration and society has to join hands together. With respect to the parent’s role, they should create a friendly environment at home and must not put extra pressure on their children that may lead to stress and anxiety. Rather, they should help and guide them towards their future goals.

Teachers, educators, and educational institutions must come forward to fight the evil of drug abuse by arranging conferences and contests, launching awareness campaigns, proper counselling sessions and through extracurricular activities including sports and games that help students feel a sense of relief from the extra burden of studies. Government administration needs to look into this affair seriously and immediately.

The law enforcement agencies must keep an eye on the activities of drug dealers at educational institutions. Mass media must be used for creating awareness among the public with respect to the damaging effects on the social, mental, emotional and physical well-being of individuals. In the nutshell, every segment of the society has to play a constructive role in eradicating the menace of drug addiction to have a progressive society.

Read more: Chapter 15 University Days English Class 11 Notes

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When Prison and Mental Illness Amount to a Death Sentence

The downward spiral of one inmate, Markus Johnson, shows the larger failures of the nation’s prisons to care for the mentally ill.

Supported by

By Glenn Thrush

Photographs by Carlos Javier Ortiz

Glenn Thrush spent more than a year reporting this article, interviewing close to 50 people and reviewing court-obtained body-camera footage and more than 1,500 pages of documents.

• Published May 5, 2024 Updated May 7, 2024

Markus Johnson slumped naked against the wall of his cell, skin flecked with pepper spray, his face a mask of puzzlement, exhaustion and resignation. Four men in black tactical gear pinned him, his face to the concrete, to cuff his hands behind his back.

He did not resist. He couldn’t. He was so gravely dehydrated he would be dead by their next shift change.

Listen to this article with reporter commentary

“I didn’t do anything,” Mr. Johnson moaned as they pressed a shield between his shoulders.

It was 1:19 p.m. on Sept. 6, 2019, in the Danville Correctional Center, a medium-security prison a few hours south of Chicago. Mr. Johnson, 21 and serving a short sentence for gun possession, was in the throes of a mental collapse that had gone largely untreated, but hardly unwatched.

He had entered in good health, with hopes of using the time to gain work skills. But for the previous three weeks, Mr. Johnson, who suffered from bipolar disorder and schizophrenia, had refused to eat or take his medication. Most dangerous of all, he had stealthily stopped drinking water, hastening the physical collapse that often accompanies full-scale mental crises.

Mr. Johnson’s horrific downward spiral, which has not been previously reported, represents the larger failures of the nation’s prisons to care for the mentally ill. Many seriously ill people receive no treatment . For those who do, the outcome is often determined by the vigilance and commitment of individual supervisors and frontline staff, which vary greatly from system to system, prison to prison, and even shift to shift.

The country’s jails and prisons have become its largest provider of inpatient mental health treatment, with 10 times as many seriously mentally ill people now held behind bars as in hospitals. Estimating the population of incarcerated people with major psychological problems is difficult, but the number is likely 200,000 to 300,000, experts say.

Many of these institutions remain ill-equipped to handle such a task, and the burden often falls on prison staff and health care personnel who struggle with the dual roles of jailer and caregiver in a high-stress, dangerous, often dehumanizing environment.

In 2021, Joshua McLemore , a 29-year-old with schizophrenia held for weeks in an isolation cell in Jackson County, Ind., died of organ failure resulting from a “refusal to eat or drink,” according to an autopsy. In April, New York City agreed to pay $28 million to settle a lawsuit filed by the family of Nicholas Feliciano, a young man with a history of mental illness who suffered severe brain damage after attempting to hang himself on Rikers Island — as correctional officers stood by.

Mr. Johnson’s mother has filed a wrongful-death suit against the state and Wexford Health Sources, a for-profit health care contractor in Illinois prisons. The New York Times reviewed more than 1,500 pages of reports, along with depositions taken from those involved. Together, they reveal a cascade of missteps, missed opportunities, potential breaches of protocol and, at times, lapses in common sense.

Prison officials and Wexford staff took few steps to intervene even after it became clear that Mr. Johnson, who had been hospitalized repeatedly for similar episodes and recovered, had refused to take medication. Most notably, they did not transfer him to a state prison facility that provides more intensive mental health treatment than is available at regular prisons, records show.

The quality of medical care was also questionable, said Mr. Johnson’s lawyers, Sarah Grady and Howard Kaplan, a married legal team in Chicago. Mr. Johnson lost 50 to 60 pounds during three weeks in solitary confinement, but officials did not initiate interventions like intravenous feedings or transfer him to a non-prison hospital.

And they did not take the most basic step — dialing 911 — until it was too late.

There have been many attempts to improve the quality of mental health treatment in jails and prisons by putting care on par with punishment — including a major effort in Chicago . But improvements have proved difficult to enact and harder to sustain, hampered by funding and staffing shortages.

Lawyers representing the state corrections department, Wexford and staff members who worked at Danville declined to comment on Mr. Johnson’s death, citing the unresolved litigation. In their interviews with state police investigators, and in depositions, employees defended their professionalism and adherence to procedure, while citing problems with high staff turnover, difficult work conditions, limited resources and shortcomings of co-workers.

But some expressed a sense of resignation about the fate of Mr. Johnson and others like him.

Prisoners have “much better chances in a hospital, but that’s not their situation,” said a senior member of Wexford’s health care team in a deposition.

“I didn’t put them in prison,” he added. “They are in there for a reason.”

Markus Mison Johnson was born on March 1, 1998, to a mother who believed she was not capable of caring for him.

Days after his birth, he was taken in by Lisa Barker Johnson, a foster mother in her 30s who lived in Zion, Ill., a working-class city halfway between Chicago and Milwaukee. Markus eventually became one of four children she adopted from different families.

The Johnson house is a lively split level, with nieces, nephews, grandchildren and neighbors’ children, family keepsakes, video screens and juice boxes. Ms. Johnson sits at its center on a kitchen chair, chin resting on her hand as children wander over to share their thoughts, or to tug on her T-shirt to ask her to be their bathroom buddy.

From the start, her bond with Markus was particularly powerful, in part because the two looked so much alike, with distinctive dimpled smiles. Many neighbors assumed he was her biological son. The middle name she chose for him was intended to convey that message.

“Mison is short for ‘my son,’” she said standing over his modest footstone grave last summer.

He was happy at home. School was different. His grades were good, but he was intensely shy and was diagnosed with attention deficit hyperactivity disorder in elementary school.

That was around the time the bullying began. His sisters were fierce defenders, but they could only do so much. He did the best he could, developing a quick, taunting tongue.

These experiences filled him with a powerful yearning to fit in.

It was not to be.

When he was around 15, he called 911 in a panic, telling the dispatcher he saw two men standing near the small park next to his house threatening to abduct children playing there. The officers who responded found nothing out of the ordinary, and rang the Johnsons’ doorbell.

He later told his mother he had heard a voice telling him to “protect the kids.”

He was hospitalized for the first time at 16, and given medications that stabilized him for stretches of time. But the crises would strike every six months or so, often triggered by his decision to stop taking his medication.

His family became adept at reading signs he was “getting sick.” He would put on his tan Timberlands and a heavy winter coat, no matter the season, and perch on the edge of his bed as if bracing for battle. Sometimes, he would cook his own food, paranoid that someone might poison him.

He graduated six months early, on the dean’s list, but was rudderless, and hanging out with younger boys, often paying their way.

His mother pointed out the perils of buying friendship.

“I don’t care,” he said. “At least I’ll be popular for a minute.”

Zion’s inviting green grid of Bible-named streets belies the reality that it is a rough, unforgiving place to grow up. Family members say Markus wanted desperately to prove he was tough, and emulated his younger, reckless group of friends.

Like many of them, he obtained a pistol. He used it to hold up a convenience store clerk for $425 in January 2017, according to police records. He cut a plea deal for two years of probation, and never explained to his family what had made him do it.

But he kept getting into violent confrontations. In late July 2018, he was arrested in a neighbor’s garage with a handgun he later admitted was his. He was still on probation for the robbery, and his public defender negotiated a plea deal that would send him to state prison until January 2020.

An inpatient mental health system

Around 40 percent of the about 1.8 million people in local, state and federal jails and prison suffer from at least one mental illness, and many of these people have concurrent issues with substance abuse, according to recent Justice Department estimates.

Psychological problems, often exacerbated by drug use, often lead to significant medical problems resulting from a lack of hygiene or access to good health care.

“When you suffer depression in the outside world, it’s hard to concentrate, you have reduced energy, your sleep is disrupted, you have a very gloomy outlook, so you stop taking care of yourself,” said Robert L. Trestman , a Virginia Tech medical school professor who has worked on state prison mental health reforms.

The paradox is that prison is often the only place where sick people have access to even minimal care.

But the harsh work environment, remote location of many prisons, and low pay have led to severe shortages of corrections staff and the unwillingness of doctors, nurses and counselors to work with the incarcerated mentally ill.

In the early 2000s, prisoners’ rights lawyers filed a class-action lawsuit against Illinois claiming “deliberate indifference” to the plight of about 5,000 mentally ill prisoners locked in segregated units and denied treatment and medication.

In 2014, the parties reached a settlement that included minimum staffing mandates, revamped screening protocols, restrictions on the use of solitary confinement and the allocation of about $100 million to double capacity in the system’s specialized mental health units.

Yet within six months of the deal, Pablo Stewart, an independent monitor chosen to oversee its enforcement, declared the system to be in a state of emergency.

Over the years, some significant improvements have been made. But Dr. Stewart’s final report , drafted in 2022, gave the system failing marks for its medication and staffing policies and reliance on solitary confinement “crisis watch” cells.

Ms. Grady, one of Mr. Johnson’s lawyers, cited an additional problem: a lack of coordination between corrections staff and Wexford’s professionals, beyond dutifully filling out dozens of mandated status reports.

“Markus Johnson was basically documented to death,” she said.

‘I’m just trying to keep my head up’

Mr. Johnson was not exactly looking forward to prison. But he saw it as an opportunity to learn a trade so he could start a family when he got out.

On Dec. 18, 2018, he arrived at a processing center in Joliet, where he sat for an intake interview. He was coherent and cooperative, well-groomed and maintained eye contact. He was taking his medication, not suicidal and had a hearty appetite. He was listed as 5 feet 6 inches tall and 256 pounds.

Mr. Johnson described his mood as “go with the flow.”

A few days later, after arriving in Danville, he offered a less settled assessment during a telehealth visit with a Wexford psychiatrist, Dr. Nitin Thapar. Mr. Johnson admitted to being plagued by feelings of worthlessness, hopelessness and “constant uncontrollable worrying” that affected his sleep.

He told Dr. Thapar he had heard voices in the past — but not now — telling him he was a failure, and warning that people were out to get him.

At the time he was incarcerated, the basic options for mentally ill people in Illinois prisons included placement in the general population or transfer to a special residential treatment program at the Dixon Correctional Center, west of Chicago. Mr. Johnson seemed out of immediate danger, so he was assigned to a standard two-man cell in the prison’s general population, with regular mental health counseling and medication.

Things started off well enough. “I’m just trying to keep my head up,” he wrote to his mother. “Every day I learn to be stronger & stronger.”

But his daily phone calls back home hinted at friction with other inmates. And there was not much for him to do after being turned down for a janitorial training program.

Then, in the spring of 2019, his grandmother died, sending him into a deep hole.

Dr. Thapar prescribed a new drug used to treat major depressive disorders. Its most common side effect is weight gain. Mr. Johnson stopped taking it.

On July 4, he told Dr. Thapar matter-of-factly during a telehealth check-in that he was no longer taking any of his medications. “I’ve been feeling normal, I guess,” he said. “I feel like I don’t need the medication anymore.”

Dr. Thapar said he thought that was a mistake, but accepted the decision and removed Mr. Johnson from his regular mental health caseload — instructing him to “reach out” if he needed help, records show.

The pace of calls back home slackened. Mr. Johnson spent more time in bed, and became more surly. At a group-therapy session, he sat stone silent, after showing up late.

By early August, he was telling guards he had stopped eating.

At some point, no one knows when, he had intermittently stopped drinking fluids.

‘I’m having a breakdown’

Then came the crash.

On Aug. 12, Mr. Johnson got into a fight with his older cellmate.

He was taken to a one-man disciplinary cell. A few hours later, Wexford’s on-site mental health counselor, Melanie Easton, was shocked by his disoriented condition. Mr. Johnson stared blankly, then burst into tears when asked if he had “suffered a loss in the previous six months.”

He was so unresponsive to her questions she could not finish the evaluation.

Ms. Easton ordered that he be moved to a 9-foot by 8-foot crisis cell — solitary confinement with enhanced monitoring. At this moment, a supervisor could have ticked the box for “residential treatment” on a form to transfer him to Dixon. That did not happen, according to records and depositions.

Around this time, he asked to be placed back on his medication but nothing seems to have come of it, records show.

By mid-August, he said he was visualizing “people that were not there,” according to case notes. At first, he was acting more aggressively, once flicking water at a guard through a hole in his cell door. But his energy ebbed, and he gradually migrated downward — from standing to bunk to floor.

“I’m having a breakdown,” he confided to a Wexford employee.

At the time, inmates in Illinois were required to declare an official hunger strike before prison officials would initiate protocols, including blood testing or forced feedings. But when a guard asked Mr. Johnson why he would not eat, he said he was “fasting,” as opposed to starving himself, and no action seems to have been taken.

‘Tell me this is OK!’

Lt. Matthew Morrison, one of the few people at Danville to take a personal interest in Mr. Johnson, reported seeing a white rind around his mouth in early September. He told other staff members the cell gave off “a death smell,” according to a deposition.

On Sept. 5, they moved Mr. Johnson to one of six cells adjacent to the prison’s small, bare-bones infirmary. Prison officials finally placed him on the official hunger strike protocol without his consent.

Mr. Morrison, in his deposition, said he was troubled by the inaction of the Wexford staff, and the lack of urgency exhibited by the medical director, Dr. Justin Young.

On Sept. 5, Mr. Morrison approached Dr. Young to express his concerns, and the doctor agreed to order blood and urine tests. But Dr. Young lived in Chicago, and was on site at the prison about four times a week, according to Mr. Kaplan. Friday, Sept. 6, 2019, was not one of those days.

Mr. Morrison arrived at work that morning, expecting to find Mr. Johnson’s testing underway. A Wexford nurse told him Dr. Young believed the tests could wait.

Mr. Morrison, stunned, asked her to call Dr. Young.

“He’s good till Monday,” Dr. Young responded, according to Mr. Morrison.

“Come on, come on, look at this guy! You tell me this is OK!” the officer responded.

Eventually, Justin Duprey, a licensed nurse practitioner and the most senior Wexford employee on duty that day, authorized the test himself.

Mr. Morrison, thinking he had averted a disaster, entered the cell and implored Mr. Johnson into taking the tests. He refused.

So prison officials obtained approval to remove him forcibly from his cell.

‘Oh, my God’

What happened next is documented in video taken from cameras held by officers on the extraction team and obtained by The Times through a court order.

Mr. Johnson is scarcely recognizable as the neatly groomed 21-year-old captured in a cellphone picture a few months earlier. His skin is ashen, eyes fixed on the middle distance. He might be 40. Or 60.

At first, he places his hands forward through the hole in his cell door to be cuffed. This is against procedure, the officers shout. His hands must be in back.

He will not, or cannot, comply. He wanders to the rear of his cell and falls hard. Two blasts of pepper spray barely elicit a reaction. The leader of the tactical team later said he found it unusual and unnerving.

The next video is in the medical unit. A shield is pressed to his chest. He is in agony, begging for them to stop, as two nurses attempt to insert a catheter.

Then they move him, half-conscious and limp, onto a wheelchair for the blood draw.

For the next 20 minutes, the Wexford nurse performing the procedure, Angelica Wachtor, jabs hands and arms to find a vessel that will hold shape. She winces with each puncture, tries to comfort him, and grows increasingly rattled.

“Oh, my God,” she mutters, and asks why help is not on the way.

She did not request assistance or discuss calling 911, records indicate.

“Can you please stop — it’s burning real bad,” Mr. Johnson said.

Soon after, a member of the tactical team reminds Ms. Wachtor to take Mr. Johnson’s vitals before taking him back to his cell. She would later tell Dr. Young she had been unable to able to obtain his blood pressure.

“You good?” one of the team members asks as they are preparing to leave.

“Yeah, I’ll have to be,” she replies in the recording.

Officers lifted him back onto his bunk, leaving him unconscious and naked except for a covering draped over his groin. His expressionless face is visible through the window on the cell door as it closes.

‘Cardiac arrest.’

Mr. Duprey, the nurse practitioner, had been sitting inside his office after corrections staff ordered him to shelter for his own protection, he said. When he emerged, he found Ms. Wachtor sobbing, and after a delay, he was let into the cell. Finding no pulse, Mr. Duprey asked a prison employee to call 911 so Mr. Johnson could be taken to a local emergency room.

The Wexford staff initiated CPR. It did not work.

At 3:38 p.m., the paramedics declared Markus Mison Johnson dead.

Afterward, a senior official at Danville called the Johnson family to say he had died of “cardiac arrest.”

Lisa Johnson pressed for more information, but none was initially forthcoming. She would soon receive a box hastily crammed with his possessions: uneaten snacks, notebooks, an inspirational memoir by a man who had served 20 years at Leavenworth.

Later, Shiping Bao, the coroner who examined his body, determined Mr. Johnson had died of severe dehydration. He told the state police it “was one of the driest bodies he had ever seen.”

For a long time, Ms. Johnson blamed herself. She says that her biggest mistake was assuming that the state, with all its resources, would provide a level of care comparable to what she had been able to provide her son.

She had stopped accepting foster care children while she was raising Markus and his siblings. But as the months dragged on, she decided her once-boisterous house had become oppressively still, and let local agencies know she was available again.

“It is good to have children around,” she said. “It was too quiet around here.”

Read by Glenn Thrush

Audio produced by Jack D’Isidoro .

Glenn Thrush covers the Department of Justice. He joined The Times in 2017 after working for Politico, Newsday, Bloomberg News, The New York Daily News, The Birmingham Post-Herald and City Limits. More about Glenn Thrush

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