Drug traffickers smuggling opiates have fulled rises in drug addiction throughout central Asia. Treatments for addicts are generally poor, but one doctor boasts success rates of almost 90%. Tom Parfitt travels to Kyrgyzstan to find out how he does it. Standing with heads thrown back and arms outstretched, four men in white tunics quiver uncontrollably under the light of bright arc lamps. Eyes closed, bodies arched, they mutter and groan, pouring with sweat. Each seems locked in a trance, as if battling an inner demon.
This startling scene is the climax of a 30-day treatment programme to cure drug addicts devised by Jenishbek Nazaraliev, a respected doctor in Kyrgyzstan. As the men in white squirm and judder under the lights, a team of experts led by Nazaraliev circles around them. They lean close to the heads of their trembling patients.
“Free yourself from the devil inside you”, cries one, poking his patient and tugging his hair. “Go on! Go on! Go on! You are full of power. There is no force on Earth that can outperform you and make you take drugs.” Another doctor's voice rises to a crescendo. “You're a strong man, charged with energy. Push it out!”
Finally, the four patients—all heroin addicts—collapse exhausted on to soft mats that lie behind them, and are scooped up by waiting orderlies who take them to beds in an ante room.
Moments after the treatment has finished, Nazaraliev sinks into an armchair in his office, wiping perspiration from his shaven head with a handkerchief, and talks to The Lancet. “What you have just witnessed is what we call stress-energetic psychotherapy, or SEPT”, he explains. “The aim is to make the patients get rid of their psychological dependency on drugs.”
“Drug addiction has inhibited the production of endorphins in their bodies. At the end of our treatment programme they go through this unique stress therapy, which is when we switch on the endorphins again.”
During the past 3 years, addicts using heroin and other opiates have become a huge concern in the former Soviet states of central Asia: Turkmenistan, Tajikistan, Uzbekistan, Kazakhstan, and Kyrgyzstan.
The UN Office on Drugs and Crime (UNODC) reported earlier this year a burgeoning drug addiction and AIDS crisis in the region, as traffickers increasingly choose to smuggle Afghan opium and heroin through central Asia to markets in Russia and Europe. The Taliban briefly stifled opium poppy production before they were ousted from power in 2001, but since their demise, the trade has started again. In May, Kyrgyz prime minister Nikolai Tanayev warned: “The increase in drug trafficking through our country has led to a rapid growth of drug abuse via injections, which threatens a catastrophic rise of HIV and hepatitis cases.”
In the west, treatment of drug addiction focuses on a combination of medications to suppress withdrawal syndrome and drug-craving, along with behavioural therapies. But although the UN is supporting pilot programmes to introduce these treatments in Kyrgyzstan, methadone remains illegal in other central Asian countries.
“Treatment facilities are not very well developed”, says Mirzakhid Sultanov, UNODC project coordinator for drug treatment services for intravenous users in central Asia. “There is a network of ‘narcological dispensaries’ across the region that focus on pharmacological treatment but they are under-funded and the treatment process is very poorly managed.”
According to Sultanov, there are only a few rehabilitation clinics in central Asia, and access to psychotherapy, counselling, and other newer treatment methods is very limited. One honourable exception is the state-run National Applied Research Centre for Drug Addiction Problems in Pavlodar, Kazakhstan, where doctors have developed a holistic approach to curing addiction using social rehabilitation as well as medication. Elsewhere, state-provided services are sparse and some addicts—at least, those who can afford it—have turned to the less conventional methods practiced by Nazaraliev in Kyrgyzstan.
Nazaraliev also uses conventional medications but the crowning glory of his treatment is “stress therapy”.