Division of Substance Use Related and Addiction Disorders

Substance misuse is not a personality or character problem; it is a health related problem. Substance use disorder (SUD) refers to a chronic and relapsing brain disease in which an individual continues the use of substance despite its harmful consequences and spends most of the time seeking the substance. When the desired substance is not available, the individual starts having some signs and symptoms of craving and withdrawal that is a clear indication of dependence. Addiction causes metabolic changes in the brain. Genetic factors, environmental factors and life styles are important etiological factors of ADDICTION.

Globally, 1 in every 12th individual had history of illicit substance use. In Pakistan, about 8.9 million of people are affected and every year this challenging condition is increasing drastically.

ICUDDR Membership

Pakistan Institute of Living and Learning is a member of The International Consortium of Universities for Drug Demand Reduction since 2022. ICUDDR is a global consortium focusing on the transfer and adaptation of science-based knowledge regarding the prevention and treatment of substance use disorders.

Statistics of Substance Use Disorder in Pakistan

Cannabis - most commonly used

3.6 % of the adult population or four million people

Opiates, Heroine & Opium

1% of drug users

Drug users

8 % Adults / 4.6 million people use drugs in Pakistan (2013)

Drug dependents

About 8.9 million – Only 30,000 of them annually receive treatment

Non-medical use of medicines

There is a high prevalence of non-medical use of prescribed medicines
Cannabis is the most commonly used drug in Pakistan. About 3.6 % of the adult population or four million people are listed as cannabis users.
The use of opiates is higher than the global estimates in Pakistan. Among opiates, heroine and opium are used by one percent of drug users.
8 % Adults or 4.6 million people use drugs in 2013 in Pakistan.
According to an estimate, about 8.9 million people in Pakistan are drug dependent and only 30,000 individuals annually receive treatment due to short supply of treatment and special interventions.
Nationwide, there is a high prevalence of non-medical use of prescribed medicines (opioid-based painkillers, and to a lesser extent tranquillizers and sedatives) particularly among women.

International Team

Ms. Muqaddas Asif

Research Associate

Dr. Salman Shahzad

Consultant

Dr. Noor ul Zaman

Consultant

Ms. Sana Farooque

Research Associate

Mr. Majid Sain Bux

Research Assistant

Ms. Saima

Research Assistant

Ms. Kiran Iftikhar

Research Assistant

Mr. Muazaffar Ali

Research Fellow

Mr. Manoj

Research Technologist

International Collaborators

Prof. Nusrat Husain

Prof. Marie Claire

Dr. Meher Husain

Dr. Iqbal Naeem

Dr. Munazza Obaid

Objective

PILL highly believes in combining research expertise and resources to work across institutions and borders and maximize research impact.

The team of substance-related and addictive disorders division’s objective is to bring together national and international experts to inform local research evidence in evidence-based interventions for prevention and management of substance use disorder, increase awareness in the community to increase help-seeking attitude, and fight stigma linked with substance misuse.

The division team meets every week on Zoom to discuss ongoing project progress as well as to develop future research ideas to improve clinical and research practices.

The division has national and international members who are working on the following themes.

  • Research projects
  • Systematic reviews
  • Cultural adaptation of evidence-based psychological interventions
  • Publications

Research Projects

Keeping in view the increased prevalence and scarcity of psychological treatment options for SUD, Pakistan Institute of living and learning, has planned a study that aims to:

  1. Culturally adapt an existing CBT-based Motivational Interviewing and Mindfulness intervention for substance misuse in Pakistan.
  2. Test the feasibility and acceptability of the culturally adapted MI-CBT (CAMIAB) intervention in a randomized control trial (RCT).

The study will include both males and females of age 18 and above with SUD. Recruitment of participants will take place from primary care and volunteer organizations/drug rehabilitation centers across Pakistan.

CBT involves numerous treatment elements including motivational and cognitive elements and skill-building interventions. It has shown excellent effectiveness in the treatment of substance misuse both as a mono-therapy and as a combination of treatments. Motivational interviewing is a promising option to enhance engagement and adherence whereas, mindfulness-based relapse prevention (MBRP) reduces the risk and severity of relapse by enabling individuals to cope with cravings. There is little research as well as the availability of these evidence-based treatments in Pakistan.

CMAP Plus study aims to test a culturally adapt CMAP Plus Intervention for self-harm in people with SUD. For intervention adaption, we have conducted focus groups with health professionals and service users to explore their views on how to adapt existing interventions for people with SUD who have a history of self-harm. CMAP Plus intervention is an extension of existing problem-solving intervention that will incorporate motivational Interviewing and mindfulness practices along with CBT techniques to manage substance use-related difficulties and prevent relapse.

Currently, we are in the adaptation stage, after this, we will test the CMAP Plus intervention with 80 participants aged 18 and above with SUD who also have a history of self-harm. This project will be conducted across five cities including Karachi, Lahore, Rawalpindi, Peshawar, and Quetta Pakistan. Participants will receive 12 one-to-one sessions on a weekly basis and learn problem-solving skills to reduce the reoccurrence of self-harm episodes and prevent relapse.

We along with the collaboration of Prof. Marie-Clarie Marie-Claire, Van Hout is Professor of Public Health Policy and Practice at the Public Health Institute, Liverpool John Moores University, UK and United Nations Office on Drug and Crime have started a joint research project on parenting interventions the for prevention of substance use.

The project called “Strong Families Programme” is currently in the ethics approval process and will be launched soon.

Suicide and substance use both contribute significantly to the global burden of mortality and morbidity. We are conducting a qualitative research project to explore the perspectives of close relatives or friends of deceased persons on the actual reasons for the use of substances and reasons for suicide. The aim is to better understand the role of substance use (particularly, alcohol and drug use) in the overall lifestyles and suicides of deceased men in Pakistan.

The study has been approved by the National Bioethics Committee of Pakistan and we have started interviews. On average interview lasts between 60-90 minutes. We are aiming to interview up to 20 participants. The study findings will be shared with potential stakeholders, participants, community leaders, and mental health professionals. We will also share summary of findings in local languages.

Systematic Reviews

Cultural adaptation of evidence-based psychological interventions

Our team is dedicated to working on translations and cultural adaptation of evidence-based psychological interventions specifically for substance use disorder.

Our process of cultural adaptation generally follows an initial translation of the manual in the Urdu language by two bilingual experts followed by a rapid qualitative assessment by potential stakeholders and field experts and then manuals are further adapted according to suggestions obtained from qualitative assessment keeping in view simplification of language or use of lay terms and culturally relevant pictures. Adapted manuals are then run with experts, service users, and other potential stakeholders through Public and Patient Involvement and Engagement events. Any revisions suggested are made and pilot tested with a small group of participants. Currently, the team is adapting the following interventions.

  • CBT- Based Problem-Solving
  • Motivational Interviewing and CBT
  • Mindfulness-based Relapse Prevention
  • Strong Families

Trainings and Workshops

Certificate in Management of Substance Use Disorder

Pakistan Institute of Living and Learning in collaboration with Global Manchester Foundation, UK has developed a certificate course program in Management of Substance Use Disorder for professionals who want to peruse in the field of Addictionology.

The aim of this course program is to enable general practitioners, nurses, social workers and community health workers etc. to recognize, screen and provide basic physical and psychological help to people suffering from SUD. The first batch of this program from October 2019- March-2020 has included a group of 9 health professionals (Psychologists, psychiatrists and general practitioners) who have passed the exam successfully.

According to program participants, this program will lead to improved knowledge and skills in health and social care settings that will strengthen workforce in this specialty. We are hoping to start the next batch of this course in October 2022 in collaboration with the Centre for Clinical Psychology, University of the Punjab. For further updates keep visiting our webpage.

Highlights

Workshop on Self-harm and suicide among Substance users

Dr. Joseph Meagher, Consultant Psychiatrist and Medical Leads for Addictions at University of Leeds and international collaborator of PILL visited Lahore, Pakistan in July 2018. Dr. Joseph Meagher delivered a workshop on Self-harm and suicide among Substance users at Phoenix Foundation for Research & Development that was organized in collaboration with Dr. Noor-ul-Zaman. Nearly 28 Addiction professionals attended the workshop and shared different case histories of self-harm and suicide among substance users in Pakistan.

Highlights

Workshop on Addictive Behavior in Global Perspective

Pakistan Institute of Living and Learning (PILL) in collaboration with Centre for Clinical Psychology, Punjab University, Lahore Pakistan organized a one-day workshop on Addictive Behavior in Global Perspective.

Dr. Iqbal Naeem, from Lancashire, UK facilitated the workshop. BS and MS students of University of the Punjab, Lahore participated in the workshop.

Highlights

Workshop on Alcohol and Substance Misuse

Dr. Iqbal Naeem, Consultant Psychiatrist from Lancashire, UK facilitated one-day workshop on ‘Alcohol and Substance Misuse’. A number of psychologists, rehabilitators, nurses and students attended this workshop.

Highlights

Workshop on Fundamentals of Substance Use Disorder

One-day training on Fundamental of Motivational Interviewing was organized by PILL on 11th December 2020. This training was facilitated by Global master trainers Dr Salman Shahzad, Dr. M Amjad Chaudhry, and Dr. Noor-ul-Zaman. Keeping in view Covid-19 context, the training was conducted online.

Highlights

Fundamental of Motivational Interviewing

One-day training on Fundamental of Motivational Interviewing was organized by PILL on 11th December 2020. This training was facilitated by Global master trainers Dr Salman Shahzad, Dr. M Amjad Chaudhry, and Dr. Noor-ul-Zaman. Keeping in view Covid-19 context, the training was conducted online.

Highlights

Events

World No Tobacco Day 2021

PILL SUD group organized an online seminar to participate in World No Tobacco Day activities and to spread awareness regarding on theme of the year that was, ‘the prevention of tobacco all around the globe on the day of World No Tobacco Day’. Guest Speakers of the seminar were Dr Saima Sandhu, Mr Ali Adyb, Miss Fauzia Saeed, Dr Noor ul Zaman Rafiq. Prof Zainab Zadeh, head of Child and Adolescents division at PILL gave the opening note and Mr, Ameer Bukhsh, Assistant Director gave the ending note. The role of smoking as a gateway to other substances and importance of psychotherapy in the treatment of smoking was focused. Around seventy participant including professionals and students attended and participated in this event.

Highlights

International Day Against Drug Abuse and Illicit Trafficking 2021

An online event was celebrated on International day against Drug abuse and Illicit Trafficking and Guest Speakers – Daniela Ocaña-Gordillo from Inter-American Drug Control Commission, Dr Joseph Meagher Associate Medical Director Lancashire and South Cumbria Foundation Trust, Dr Noor ul Zaman Rafiq CEO PFRD, and Dr Salman Shehzad, Associate Professor at University of Karachi were invited for talks with audience, spreading awareness on drug abuse and Illicit Trafficking.

Highlights

World No Tobacco Day 2022

Pakistan Institute of Living and Learning organized a webinar on 31st May 2022, the day that is marked as WORLD NO TOBACCO DAY. The webinar was intended to inform the general public about the hazards of tobacco use, the business practices of tobacco companies such as advertisements that are striking, and what we can do to play a role in the prevention of tobacco use.

Our guest speakers were Dr. Salman Shahzad, Clinical psychologist and Associate Professor at the University of Karachi; Dr. Noor-ul-Zaman, Chief Executive Officer at Phoenix Foundation for Research and Development; and Dr. Munazza Obaid, Assistant Professor, Dow University of Health Sciences.

In this webinar, our speakers draw the attention of participants to the widespread prevalence of tobacco use and to the negative effects of using tobacco. They also highlighted the number of immature deaths caused by tobacco use which is approximately 8 million deaths each year worldwide, including 1.2 million as the result of non-smokers being exposed to second-hand smoke.

Highlights