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These unhealthy emotions have affected his family life by causing conflicts with his family. Among patients who were previously able to gain employment after treatment, two patients reported relapsing due to work stresses. For instance, a private rehab patient admitted that the inability to meet personal expectations or lacking the necessary work skills have resulted in fatigue and frustration. Another private rehab patient also reported that drugs were used for the purpose of releasing tension by escaping from reality for a short time. A patient admitted using drugs as a way of coping when he was unable to resolve work issues.

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Furthermore, more students believed that private rehab centres were more effective than government rehab centres. The current findings were in contrast to earlier findings by Low et al., , whose survey found that most youths in Peninsular Malaysia had little awareness about drug rehab services in 1995. However, a possible explanation for the difference could be that compared to youths in 1995, the youths of today have easier access to information about drug rehab services through wider internet coverage and availability of electronic resources. These resources include e-books, official websites of registered drug rehab centres and online pamphlets. Eight rehab patients and three staff reported that NADA/AADK officers, who were often the first point of contact for drug users caught for drug abuse or voluntarily admitted treatment, were strong sources of encouragement to enter rehab. As shown in the sample quotes below, patients who received emotional support from the NADA officers generally found the treatment process a positive experience.

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Past studies (Nielsen, 1996; Boys, Marsden & Strang, 2001) have shown that adolescents who were unable to perform according to high parental and teacher expectations were at higher risk of using drugs to cope. This finding was also supported by Cloward and Ohlin’s strain theory, which proposed that young people were more likely to engage in drug abuse when there is a significant difference between personal aspirations and perceived opportunities for achievement. In these circumstances, drugs were often used as a coping mechanism to manage stress connected to academic failure, or the desire to achieve more within a short period. A diverse range of responses from university students, drug rehab patients and rehab staff were collected from the survey and interview components of this study.

Females were less likely to perceive help-seeking and avoidance, self-change and social activity as effective relapse prevention strategies. A study by Kauffman, Silver and Poulin found that females had a significant tendency to attribute biological predisposition, family history and environmental stress as reasons for drug abuse. However, lack of willpower and poor moral character were perceived equally by both genders to be contributory factors of drug abuse.

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Another student did not find the exhibitions useful and was doubtful whether students would take the time to go through the exhibition items. Moreover, this student felt that drug prevention information was often dispensed from a general perspective using uninteresting videos and lectures. Thirty-nine students reported that early prevention was extremely beneficial to them.

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The findings indicated a good understanding about common drug types such as cannabis and heroin among the student cohort in 1995, but less familiarity with drugs like hashish and amphetamines. Additionally, they were not knowledgeable about the effects of drugs on the individual such as physical health risks and mental health side effects. Welche Wirkung hat CBD? Educators had a good understanding about general knowledge questions such as information on drug sources and agencies that provided assistance, but had difficulties identifying the uses of different drugs and their terminologies. The parents also had a fair level of knowledge about drugs and were able to identify common drug types.

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Two rehab staff (i.e., one government and private rehab staff respectively) also viewed that vocational workshops would be a favourite among patients. The government rehab staff explained that vocational training was popular because employment skills were highly relevant and beneficial to the patients after completing treatment. Moreover, another staff reported that efforts were made to ensure that the job skills that were taught in the private rehab centre. There were five patients who reported entering treatment through voluntary admission.

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A government rehab patient reported that his work performance and attendance was impacted due to the physical and mental effects of drugs. The patient further elaborated that the use of drugs like opioids resulted in drowsiness and clouded mental functioning, which led to declining work performance and attendance. However, there were times when stimulants were taken to increase work performance, resulting in a temporary surge of energy. However, the downside of using stimulants was that extreme exhaustion would set in when its effect subsides and repeated use could lead to feelings of hostility and paranoia.

Due to the impact of drug abuse on drug users, their family and community, there is a growing need to shift the mindset and treatment approach from the traditional CBT and individual-based interventions to a more interpersonal and systemic approach . The growth and development of network-based or couple-oriented therapies would also provide service users (i.e., drug rehab patients, family members and close social networks) with a wider range of evidence-based methods to treat and cope with drug abuse and relapse. The experience of persistent pain among some individuals is also a lesser discussed factor leading to the misuse of illicit drugs and overuse of prescribed medication. For instance, a study by Jamison, Kauffman and Katz on 248 patients receiving methadone maintenance therapy at three centres revealed that 61.3% of patients reported experiencing chronic pain. The varying degrees of functional impairment experienced as a result of the level of pain severity have led some patients to self-medicate with psychoactive drugs.

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This opinion was supported another student who recommended that students be encouraged to participate actively as the knowledge gained by students involve input from facilitators, their peers and themselves. Other paper-based media that were cited by24 students as the preferred medium for sharing drug information were brochures, pamphlets and posters. According to a student , brochures, pamphlets and posters are easily read because brief summaries of important facts are presented creatively. Another student also preferred using brochures and pamphlets to share information because they are light and can be mass distributed to a large number of people within a short time.

This would ensure that only individuals with high levels of passion and commitment, and the ability to cope with challenges are employed to reduce employee turnover rates. There have been reports by patients that drug withdrawal management under medical supervision was not available to patients in smaller-scale facilities. These facilities often did not have on-site medical officers and the rehab staff lacked training on managing drug withdrawal symptoms. The rehab staff also viewed that treatment services should be properly coordinated since drug abuse treatment is a collaborative effort. The programme co-ordinator needs to establish links and networks between key experts to enable organisation of joint assessment and case reviews.

Parents, guardians and family (72.5%) were rated as the most commonly sought resource across all grade levels and gender, followed by teachers or counsellors (67.3%) and the television (53.0%) . From the research evidences above, it can be surmised that findings related to the prevalence of a drug abuse progression trend is inconclusive across different drug user samples. It would be of interest to examine whether a progressive trend in drug use exists within the sample of rehab patients in the current study.

Feedback from students about drug abuse issues (e.g., factors for drug abuse and relapse and effective relapse prevention strategies) can help educators and programme developers to gauge the effectiveness of past educational programmes. Thematic findings from rehab patients and staff were triangulated in response to Research Question 10. Major similarities in themes were found between patients’ and staff’s responses on favourable treatment components (i.e., group counselling, vocational workshops, spiritual studies and recreational activities).

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The differences found between public perceptions and statistical data however, indicates a need for caution when using the statistical data to interpret actual availability and commonality of drugs. For instance, users of heroin and morphine were more likely to require rehab as compared to users who recreationally use ecstasy and cannabis (Nutt, King, Saulsbury & Blakemore, 2007). The utilisation of spiritual teachings as the main foundation of treatment was essential to the patients who chose to enter the private rehab centre. Six out of 15 private rehab patients viewed the spiritual studies component as an important step towards healing and recuperating from the effects of drug abuse.

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Another sub-theme found in staff responses about management issues was the need to increase staffing. A senior government rehab staff viewed that the existing staff was lacking expertise in the area of counselling and religious teaching. The senior staff further elaborated that the lack of commitment among the younger staff was also an issue and a reason for high employee turnovers. Nevertheless, the senior staff remarked that there should be stricter criteria in selecting rehab staff such as having the proper counselling qualifications or demonstrates interest and passion in working with drug rehabilitation. However, they should have the intention of upgrading their knowledge and skill sets.

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However, it was difficult to assess the levels of knowledge retained from past drug prevention education. Despite past exposure to drug prevention education, some students reported that they lacked familiarity with the legal names of drugs. Research like Corazza et al. suggested that young people may be more familiar with drugs promoted using attractive street names or popular brand names.

When this happens, it is essential that treatment providers communicate to patients that drug relapse should be viewed as an opportunity to learn which strategies and plans were effective or ineffective. As mentioned earlier, a benefit of this framework is each action and strategy that is taken towards behaviour change is recorded. Thus, patients are able to select effective behaviour change strategies used in the previous cycle and continue moving towards their treatment goal. Printed books were also less popular among the younger generation due to the need for quick information. Moreover, the students observed that printed books on drug abuse were often limited and costly.

Razali and Madon stated that reduced levels of control from parents and the authorities during the transition into college and university provide adolescents and young adults with the freedom to satisfy their curiosity about drugs. Additionally, more adolescents were experimenting with drugs for personal enjoyment without considering the consequences. Once they experienced the thrill, pleasure and comfort in drug abuse, it was more likely that drug abuse behaviour would be repeated until it became a habit (Razali & Madon, 2016). Due to constant changes in the field of drug abuse research, there is a need to continuously study the phenomenon of drug abuse and relapse to uphold relevance.

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The use of drugs as a coping mechanism against stress is also prominent among university students, in which some are also working to pay for school fees or making ends meet. Findings from Western literature show that the reasons for drug abuse have changed since the 1990s and similar trends are found in Malaysia since an increasing number of college and university students are juggling studies and work to maintain a more comfortable lifestyle . Based on the account of a government rehab staff, halfway houses were established during the last restructuring of the drug rehab system for the benefit of patients who were homeless and unemployed upon completing treatment. A deeper look into after-care services provided in Malaysia revealed that these services were mostly offered by halfway houses under the care of private organisations such as PENGASIH and PEMADAM.

This patient felt that improving the group relationship through effective communication will enable treatment providers to adapt treatment plans accordingly to the different circumstances of each patient for better treatment outcomes. One government rehab staff felt that a major limitation in regards to the health and safety procedures during treatment admission was the health contamination risks. The staff reported facing health hazards when undiagnosed drug users were brought into the centre. As most drug users only receive a medical examination after admission into treatment, the staff faced the potential risk of exposure to transmittable diseases such as HIV and tuberculosis.

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Another patient also reported being confident of not relapsing because he intended to continue serving the centre as an employee and working closely with the church in order to receive continuous guidance and supervision. A patient was feeling confident as he was focused on building a secure future such as having detailed plans to start up his own workshop or business upon leaving the centre besides having past aspirations of serving the church as a pastor. Furthermore, another staff reported that based on his experience with relapsed patients, after-care monitoring and services was essential since most patients are able to cope on their own for an average of three to four months post-treatment.

Opiate derivatives were perceived as less commonly abused and available with a rank of 7. This perception was supported as there were no users registered in the 2013 to 2015 statistics and patients’ drug use history. Understanding gender differences in students’ perception about drug abuse and drug relapse issues has important implications towards tailoring content for drug prevention programmes in schools, college and university. By understanding patterns in perception according to gender, it will enable drug educators and counsellors to emphasise different points about drug abuse, relapse and prevention according to the school environment (i.e., girls’ school, boys’ school and mixed gender school). Six private rehab patients also reported feeling uncertain about the probability of not relapsing.

This finding strongly supports the role of positive social networks in patients’ ability to recover from drug addiction. BCT is a manual-based behavioural and psychological treatment that recently gained a comeback in the UK . It is an evidence-based couple therapy intervention for drug users and their spouse or partners and consists of four phases of treatment, which are divided into 12–20 weekly couple sessions (Geel, 2016; Ruff, McComb, Coker & Sprenkle, 2010). The first phase is engagement, whereby the therapist will obtain the client’s consent to contact their spouse or partner and invite them to attend a joint interview (Ruff, McComb, Coker & Sprenkle, 2010). An assessment of the couple’s suitability for BCT is then conducted in terms of motivation, commitment and goals . The second phase focuses on managing drug abuse, whereby the couple will be tasked with keeping a diary of daily drug abuse, urges and lapses, attendance in 12-step programmes or recovery meetings and methods to maintain abstinence .

Internet websites and blogs were equally popular mediums for seeking and sharing information, simply because they were viewed by students as more credible and reliable avenues (Schmierbach & Oeldorf-Hirsch, 2012). A private rehab staff also viewed that improving security within the rehab centre was important. The staff described efforts by the management to upgrade security by building stronger gates with a stricter security system to ensure that private rehab patients were not endangered within the centre grounds. Furthermore, it was disclosed that the gates would also help prevent new patients from escaping when they were unable to withstand drug urges and the loss of freedom. In addition, the enforced security would also enable staff to monitor visitors entering and leaving the centre, especially acquaintances who may be drug dealers.

This suggestion was similarly found at college and university level, in which 28 students viewed that students should be educated on drug abuse and relapse topics using visual and interactive learning styles. Two students proposed organising video and filmmaking competitions to showcase the impact of drug abuse and present drug prevention messages using creative concepts. Fourteen students viewed debates and student dialogues as a form of discourse that would allow an exchange of insightful ideas between fellow students in secondary schools, public and private universities. Two students particularly felt that university students should lead by organising dialogues and forums during drug prevention campaigns because they are educated and should be sufficiently matured to do so. In Malaysia, NADA has played an active role in educating the young about drug abuse through drug prevention programmes conducted at all levels encompassing pre-school , primary school as well as colleges and universities (NADA, 2010; 2012).

To investigate the presence of gender differences in university students’ perceptions about factors for drug abuse and relapse, as well as relapse prevention strategies. In most rehab centres, treatment approach and services vary according to staff expertise, resources and client groups although most adopt the eclectic approach, which combines multiple therapeutic frameworks in treatment delivery (Winters, Botzet & Fahnhorst, 2011). Thus, it is important that treatment providers identify the cause of initiation, maintenance and relapse in drug abuse, drug use history and patterns of use for each patient. Furthermore, patients should be referred to centres that meet their treatment needs rather than its occupancy rate. Illicit drugs are loosely classified based upon their effects on the nervous system.

Although the Internet provides greater access to a wider source of information, it can be dangerous because adolescents and young adults can easily order drugs online (Gijsbers & Whelan, 2004). The Internet is an ideal site to conduct illicit drug transactions due to the ease of anonymity . Some drugs such as marijuana and ecstasy have been sold on the net as herbal supplements (Forman, Marlowe & McLellan, 2006), which have led adolescents to purchase illegal drugs unwittingly. Furthermore, Tam and Foo reported that in Malaysia, underground websites were used by drug suppliers to keep in contact with buyers to promote new designer drugs and ensure continuous transactions. Nevertheless, two studies (Parker, Aldridge & Egginton, 2001; Parker, Williams & Aldridge, 2002) from the UK argued that aggressive drug dealing does not occur only on the Internet. According to Parker, Aldridge and Egginton , most drug users obtain supplies through social networks and ‘friends-of-friends’ chains.

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This finding was similar to Prediction 1, whereby it was predicted that female students were significantly more likely to perceive social activity, change and help-seeking strategies as effective. However, the current findings were contrary to Cirakoglu and Isin , whose Turkish female participants were less likely to view help-seeking, social activity and self-change as effective relapse prevention strategies. In the following sections, the research findings are presented and discussed in response to the research questions.

The fifth limitation as suggested by 3 students was a severe lacking of support services. A student remarked that despite the usefulness of counselling programmes, there were no counsellors available in school to explain about drug abuse and methods of overcoming drug addiction. Another student felt that there was insufficient support and motivation from the government in regards to the organisation of drug prevention education and activities in schools. Forty-eight students also reported preferred sharing information using face-to-face communication via prevention education to provide students with awareness and early exposure to avoid drug abuse.

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Newspaper and magazines were the second most preferred information medium among 225 (48.9%) students. Internet resources such as blogs and websites were in third place, with 199 (43.3%) students reportedly using it to learn about rehab services whilst brochures, pamphlets and posters were the fourth most preferred resource among 147 (32.0%) students. To examine university students’ perceptions about commonly abused and easily accessible drug types. You’ll even be able to get uncommon premium Southeast Asian strains that you just can’t get at many vendors.

According to a government rehab staff , these services were catered to patients who were left homeless after completing drug rehabilitation. Temporary shelters were setup for these patients while they searched for jobs and earned sufficient money to rent outside accommodations. A plus point of this shelter was that it provided services to patients of various ethnicities and thus, gave patients the opportunity to interact and support each other.

However, a student highlighted a need for greater access to books on psychiatry and drug abuse in libraries and bookstores. The CCC, which is a private rehabilitation centre, places more emphasis on spiritual studies and improving patients’ mental well-being. However, CCC patients also learn vocational skills aimed at post-treatment employment and participate in recreational activities to help rebuild their physical vitality. The current study was conducted using a mixed method approach, which involved collecting, analysing, and integrating quantitative and qualitative components in a single study. The combination of both quantitative and qualitative components provides a better understanding of research problems than either approach alone (Creswell & Plano Clark, 2011).

This student further noted that the real-life perspective of dealing with drug abuse from the patient and treatment providers’ view would have more impact as compared to countless motivational speeches. Fifty-eight students felt that college and university students would also benefit from field visits to drug rehab centres. Four students reported that field visits to rehab centres were an eye-opening experience as it allowed them to understand the reasons why some individuals got involved in drug abuse and what motivated them to deal with the addiction.

More than 50% of readers expressed the willingness to read more printed books provided the bookstores or libraries were closer to their homes (Chaudhry & Low, 2009). A government rehab patient reported that since the centre was located at a road intersection, it consisted of only a block of building with limited landed space surrounding it. Therefore, the grounds were rather cramped and there was insufficient space to conduct outdoor activities such as morning exercises. The thematic findings indicated that there were major similarities between patients’ and staff’s responses about favourable treatment components.

The staff further elaborated that tailored counselling should be applied to patients who faced public discrimination such as patients diagnosed with HIV or had homosexual preferences. Patients who have faced years of discrimination require special care and attention as their hardships may have caused them despair and the loss of will to live. The rehab staff or counsellors need be a source of non-judgemental support to these patients. The treatment programme in the private rehab centre was conducted using two language modes (i.e., the Malay and English language). However, a patient of Indian ethnicity voiced his concern that there were a few Indian patients, including himself, who only understood a basic level of Malay and English. These patients were more comfortable using their mother tongue language, which was Tamil.

In contrast with findings from the rehab patient sample, ketamine was recorded as the fourth commonly abused drug but there was no record of amphetamine use for comparison. The 2015 drug statistics however, listed amphetamine and ketamine as the fourth and fifth commonly abused drug, respectively. In the opinion of another staff who was a qualified counsellor, it was essential that the option of individual counselling be made available in addition to the usual routine of group counselling. The option of such a combination was important in managing patients who have difficulties voicing out issues within a large group setting. This staff personally felt that he had sufficient time to allocate to each patient and in keeping track of their individual progress since the schedule of counselling sessions were largely managed by the counsellor himself. As seen in the quote below, the staff suggested that patients select jobs that would keep them physically active to avoid boredom, which was viewed as a reason for drug relapse.

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As mentioned earlier, the experience of drug abuse and relapse are as varied as the individuals who perceive or experience them. Thus, the current study attempted to gain insight of this issue from the view of university students without drug abuse experience, drug rehab patients and the rehab staff. Data from the three sample groups were coded and analysed using the constant comparison method, in which data was compared against each other . This progressed to comparisons between their interpretations, which were translated into codes and categories. A noted code and category was then compared with others, in terms of its differences and commonalities. Additionally, the research concepts in this study were progressively developed since grounded theory is a complex iterative process.

Heckman, Dykstra and Collins’ study also indicated that students who have prior exposure to drug abuse during college were more aware of the negative impact of drug abuse. Further measurements of physical and mental health indicated that there was a decrease in affective well-being among students during the semester due to stress from academic pressures. Gender-wise, male college students were more at-risk of drug abuse as a stress-coping measure as compared to female college students. Comparatively, the positive expectancies for marijuana decreased among male students from other courses, but remained constant for male students in the drugs and behaviour course. A possible explanation for this was that male students in the drugs and behaviour course received in-depth exposure to various types of drugs that were viewed as more harmful than marijuana as compared to students in other classes.

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Another student noted that conducting these classes using a workshop format would be more enlightening. Two students also called for more opportunities to conduct student dialogues with youth leaders and field experts. A student stated that dialogues could encourage students to openly discuss drug abuse topics, which may be considered taboo in some communities.

Thirdly, rehab programmes should create a family-oriented atmosphere since Malaysia is a collectivistic country. Patients would be able to relate and communicate better with treatment providers, whom they view as family. Although rehab patients in Malaysia are accorded the opportunity to engage in therapeutic activities like gardening and arts and craft, the current range of rehab activities that would allow cultural immersion in rehab centres are comparatively limited. Although the patient satisfaction rating by patients were at the higher continuum of the rating scale, it is a fact that most treatment outcomes are defined by the professionals and may differ from those of importance to the patients. Even though patients are fully aware of the treatment objectives and expected treatment outcomes, this slight discrepancy could result in less satisfactory treatment ratings (Bond & Thomas, 1991). Thus, patients’ satisfaction rating was consistently lower than perceived ratings of rehab staff in the pilot and actual surveys.

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A similar predicament was experienced by the private rehab patients, who subsequently stayed on as staff. A staff who was previously a patient , disclosed that he decided to work for the rehab centre and church because there were less work opportunities due to his increasing age. In fact, most patients end up staying and working at the rehab centre or helping the church due to a lack of options although it was acknowledged that helping other drug users was meaningful work. Another staff , who was also previously a patient, reported feeling a sense of discontinuity upon leaving the centre as he was not given information on other potential directions to seek work with employers who would be interested in their work skills.

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