روانشناسی اعتیاد در جمهوری اسلامی ایران: مکانیزم مقابله ای ناسازگار - پروژه ققنوس ایران

Toronto Conference 31 May- 02 June 2019

By
Dr. Farrokh Sedighdeilami

April 2019

Introduction

For most of history, Addiction has been considered both as a sinful conduct and even a disease.

In recent decades, it has also been viewed as just maladaptive behaviour. People use the term loosely in their everyday language. Unfortunately, most people do so without knowing precisely what addiction means. Informally, addiction may be viewed as a problem behaviour that has two functions; it can both produce pleasure and provide relief from discomfort. The costs of such maladaptive behvaiours will eventually outweigh the benefits. In fact, addiction can be seen as a maladaptive behaviour that has negative and destructive consequences for addicts, their families, and society as a whole. According to the Diagnostic and Statistical Manual-5^th Edition (American Psychiatric Association, 2013), substance-related and addictive disorder is a “cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems.” In the DSM-5 this is formally termed substance use disorder.1 In general; substance use disorder refers to recurrent use of a specific substance (e.g., heroin, cocaine, opium, amphetamines) that leads to adverse consequences. Unfortunately, in most cases the recurrent substance abuse can result in a failure to fulfill a person’s obligation toward him/herself, family, and society.

It should be noted that from a psychological point of view there is no single explanation of addiction, as there are various factors, such as family, life style, environment, thoughts, feelings, and society that determine addictive behaviours.

The aim of this paper is to briefly explore the meaning of addiction in the Islamic Republic of Iran.

The Islamic Republic of Iran Drug Addiction

The Islamic regime in Iran is facing a drug use crisis with record numbers of young Iranians, including women, becoming addicted daily. The official data published in 2015 revealed that the number of young women in Iran suffering from addiction has doubled since 2007.2

After the Revolution the Islamic regime maintained the belief that addiction represented a refusal to follow a moral code of conduct imposed by the regime. Government agencies consider addiction to drugs a freely chosen behaviour which is irresponsible and evil, as are behaviours such as drinking alcohol.

The Public Drug Control Policy of the Islamic regime has clearly failed. The regime policy not only failed to eradicate addiction, it has not even been able to reduce the rate of addiction in the country. In spite of their propaganda addiction has been increasing at an alarming rate. By 2012, Iran was the world’s fourth highest importer of pseudoephedrine, the main chemical used in the production of crystal meth (United Nations Office on Drugs & Crime-UNODC).3 In October 2015, Mr. Mosavi, the director of public health in Fars province, reported that children as young as 11 years of age suffer from substance abuse in Iran.4 At the same time another official, Mr. Zeidvand announced that between “100000 to 150000” individuals are being added to the number of addicts per year in Iran. During the same interview he reported that the number of Iranian students suffering from addiction has doubled, and that between 70 to 80 thousand students are currently using drugs.5 More recent data shows that the number of addicts has doubled in six years.6 During the same year data from a survey by a Drug Control Organization showed that 2.8 million Iranians “regularly consuming drugs.” At the same time Mr. Saied Safetyman from the Expediency Council told the official IRNA that the real figure was probably higher, as the relatives of addicts have not been counted by the survey.7 An internal report on Iran’s Budgetary issues in dealing with drug addiction estimated the number of addicts as high as 10 million.8

As noted previously, the Islamic government considers addiction a freely chosen and morally wrong behaviour. Therefore, from this perspective, harsh punishments including capital punishment are considered the most appropriate way to deal with this social problem. Relapse is considered as evidence to support its perspective about addicted individuals and its harsh punishment. The Islamic regime receives huge funding from the United Nations Office on Drugs and Crime (UNODC) to prevent drug addiction. This fund is provided by several European countries. These donors should be reminded that if they do not want to be complicit with the Islamic regime in human right abuses, they should make their financial support conditional on abolishing capital punishment for drug offenders. They cannot, on the one hand condemn the Islamic regime for the increasing number of executions, and on the other hand provide financial support to a regime which has no respect for human dignity and has executed thousands of people for drug offences, with the lie that the regime only uses capital punishment for serious traffickers.      

Here it is important to remind the readers that the Islamic regime is also using drug prosecutions in part to arrest, torture, and execute political dissidents, who are opposed to the Islamic regime and its barbaric policies.

One clear example of this involves Zahra Bahrami, an Iranian-Dutch woman who was arrested in 2009 for her participation in protests against Ahmadi Nejad’s allegedly rigged re-election. After her arrest and charges for protesting, she was later charged with possession of a large amount of opium and cocaine and was executed in 2011.

Human behaviours can be explained in terms of a reciprocal interaction among cognitive, behavioural, and environmental determinants. Therefore, people have the opportunity  

to influence their destiny. Unfortunately, in the Islamic Republic of Iran, people have a very limited self-direction, as the regime wants people to see themselves as powerless objects and pacifists who are controlled by the government and not free agents who can become whomever they wish. 

A Psychological Approach to Addiction in Iran

There are different models of addiction in Psychology, such as learning/psychosocial and cognitive/emotional models. According to the learning model, a variety of components such as exposure to drugs, availability, and self-perceived needs, contribute to the acquisition of problem behaviour (drug abuse). This model states that drugs have reinforcing properties which are related to the past experiences of relieving emotions such as anxiety. The tension reduction from the drug abuse brings relief which acts as a reinforcement.  With each reinforcement the substance abuse becomes stronger and the likelihood of the occurrence of maladaptive behaviour is increased. Psychosocial models tend to relate emotional problems to the consequences of such social factors, such as poverty and discrimination. However, they cannot explain the great variations in the abilities of people to deal with and manage the problems, such as economic hardship. Among various models, a psychoanalytic model seems more applicable and useful in explaining addiction in Iran today. From a contemporary psychoanalytic point of view, addiction is seen as a defense mechanism. Addicted individuals abuse drugs to protect themselves from overwhelming feelings of depression, anxiety, boredom, guilt, shame, abuse, emptiness, violence, social isolation, poverty, etc. In fact, it seems that addicts in Iran are trying to treat themselves as they are unable to regulate and manage factors, such as their own affects, self-esteem, and self-care. When the life of addicts in Iran is looked at carefully, we come to the conclusion that negative emotions (e.g., depression and anxiety) may not be the result of substance abuse, but rather its cause. In fact, negative affective states are precursors, and not the consequence of, substance abuse. Today in Iran, substance use is reinforced by its ability to reduce stress, tension, anxiety, anger, and depression. In fact, addicts use substances as medications to reduce their levels of stress, anxiety, and other unpleasant emotions, and to elevate their mood. There are many risk factors that presently put Iranians, especially young ones, at risk for addiction. Some of those risk factors include: injustice and inequality, lack of freedom and security, no respect for human dignity, lack of adequate access to education and health care, no sense of belonging, discrimination, unemployment, underemployment, economic hardship, etc. In my opinion these are risk factors and not the direct cause of addiction in Iran. The main issue is that when illicit drugs are used to deal with daily life stressors (e.g., risk factors mentioned above), the addict never develops appropriate/positive coping mechanisms, which I believe is the main cause of addiction in Iran.

Hope for a Better Future: Toward No Substance Abuse

It seems that the co-occurrence of depression, anxiety disorder, and other psychological problems with substance abuse are pervasive in Iran. This is a very important issue to consider, as it can have significant clinical implications. If the co-occurrence of psychological disorders and substance abuse is not recognized by professionals in treating addicts, the treatment impact and prognosis will likely be poor. In my opinion, stress, lack of support, and no future planning are the most important factors in explaining relapses among recovering addicts in Iran. Through careful observation and collection of information, it is possible to determine when relapse is likely to occur for addicted individuals. The events or situations that tend to provoke relapse should be investigated. Risk factors such as unemployment, underemployment, financial hardship, and easy access to drugs are all factors that can provoke relapse. After finding out the exact reasons, every effort must be made to eliminate relapse by dealing with these factors. By discovering these factors, it is possible to develop very effective plans for assisting the addicts and preventing their relapse. Social support should be included as part of the resources that could be used at this stage. Professional aid provided by a multidisciplinary team (including a physician, nurse, psychologist and social worker) should also be implemented. The public policy developed toward substance abuse prevention and treatment in Iran should have clarity, be comprehensive and explicit, reflect reality, and should generate research findings to support its concepts. Different prevention and intervention programs should be developed and put in place to evaluate their effectiveness. Prevention especially must be addressed. Prevention policies should be based on a number of issues such as availability of drugs, public support, and actions that can be taken to minimize the adverse consequences (e.g., harm minimization) of substance abuse. From a psychological perspective, I believe that social support is one of the most important factors in prevention programs, to promote the idea that alternative opportunities are available for stress reduction without recourse to various harmful drugs.        

In short, to work on one of the biggest social problems in Iran (addiction) a system-based approach is needed. A system-based approach in which drug addicts and professionals play an essential and necessary role along with the government, private agencies and society to alter the vicious cycle of addiction. Those who can help in this matter should not be exempt from this system-based approach because of ideological ‘nonsense.’ Only after this can we be sure that we are able to interrupt the cycle and prevent young Iranians from becoming some of the most drug addicted individuals in the world.

In light of the above, best practice of prevention and intervention programs will be discussed in a series of upcoming papers.

Endnotes

• Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association, 2013).
• Monavar Khalaj, “Rise in Young Women Drug Addicts Triggers Alarm in Iran,” Financial Times, January 02, 2015.
• United Nations Office on Drugs and Crime (UNODC), World Drug Report 2013 (New York: United Nations, 2012).
• Voice of America (Persian, October 05, 2015).
• Voice of America (Persian, October 05, 2015).
• Bethan Mckernan, “Number of Drug Addicts in Iran ‘Doubles’ in Six Years,” The Independent, June 26, 2017.
• Bethan Mckernan, “Number of Drug Addicts in Iran ‘Doubles’ in Six Years,” The Independent, June 26, 2017.
• Iranian Students’ News Agency (ISNA): https://www.isna.ir/news/92062012883/ (in Persian).