Psychotherapist, military psychologist Azad Isazade talks about war trauma and drug addiction, one of the worst scourges of our time.
Doctor, as far as I know, you work closely with people suffering from war-related trauma.
It was a big project with the involvement of international organizations, governmental and non-governmental organizations, individual psychologists. It started in October, but we were not allowed across the frontline at first, so we were able to go there only in November, after the war ended.
Did you find people in need of psychological aid yourself, or did they find you?
Let me start by saying that our team consisted mainly of young psychologists. I was in the First World War and worked with refugees at that time, I had experience in this area. It was difficult to find a psychologist back then. Over the past 30 years, Azerbaijan has produced a number of well-educated psychologists, but young people have little experience working with trauma. So, we first conducted relevant trainings and selected 4 regions: Ganja, Goranboy, Tartar, Agdam. Although Ganja is far from the frontline, it was subjected to missile strikes and missiles hit several places. Our team consisted of 28-30 psychologists; there were also social workers and physicians. One group worked in each region, and I coordinated the work between them. In Ganja, people who had been affected by the missile strikes were accommodated in a dormitory. Our team worked with them there too. Working in Ganja was technically very comfortable, and there are local psychologists there. In other regions, it was more problematic. We went from village to village, one by one. We also talked to school administrations and used school buildings as headquarters. Our main target group was children and mothers. We divided the children into age groups: child psychologists worked with young children, other psychologists worked with teenagers and adults. Our work consisted of two stages, examination and psychological rehabilitation. As part of the program, we conducted intervention for about three thousand children and their mothers; ten interventions for each child and each mother. We also conducted interventions for at least nine thousand people—one intervention per person, or rather, examination and one intervention.
Nine thousand—were those people with minor trauma?
If we saw during the examination that the trauma was too severe, we included the person in the other group. Still, it was impossible physically to see everyone. We did not group the families of the martyrs in any way: we worked with them individually—mainly I and other adult psychologists. International organizations are a little more sensitive when it comes to providing help to the military. There is indeed a logic to this: we could restore soldiers’ health and they would be sent back to fight. Therefore, international organizations try not to fund projects in this area. But after finishing our main job, we fulfilled our civic duty and met with veterans. We talked to them and tried to resolve their various issues. I should also point out that this was not a single project, but several parallel projects. Some were funded by government agencies, such as Asan Service.
What about Yashat?
Yashat joined us later. For example, there was a project of the Ministry of Labor and Social Protection. As part of such projects, we also met specifically with veterans. Some pharmaceutical companies provided us with free medication. My main profession is a doctor, I am a psychotherapist and I have a degree in military psychology. That is, I have the right to prescribe medication. Sometimes we even gave out drugs, because many people in the village could not afford them. Although there are no psychologists in big cities and district centers there, it is possible to find a neuropathologist, a psychiatrist, or a psychotherapist. Buses do not run in the villages, and a person in need of medical help has to get a taxi. The villages we visited were mainly frontline villages, 200-300 meters away from the frontline. It is true that the frontline moved significantly and there was no more danger, but the fact is that the people there have lived in war conditions for years. For example, a stone wall was built on the side of the village looking at the frontline for protection against sniper bullets and shells, and a shelter was dug in each yard.
Was this the case in all the frontline villages, or just in one?
In all the villages, in every yard, every school, every polyclinic… There were as many shelters, sandbag fortifications and so on as many houses and yards there were in the village. When danger came, people hid there. Moreover, most of the people living in those villages are children of the children who saw the First Karabakh War, and most of them are IDPs. They fled their villages and settled in the villages that were not occupied. Imagine living through the first war as a child, suffering trauma, becoming a refugee, growing up, getting married, having a child… and that child is now going through the same trauma. This is a chronic, long-term trauma.
Did you encounter more trauma in children or in adults? Maybe children forget easier, they can distract themselves with games and so on.
Children get scared more often and easily, they feel lost more easily, they have no experience of self-rescue, they do not know where to run, what to do. Therefore, children’s traumas were more associated with panic. For example, a child ran away from home. Everyone hid in the shelter, and the child wasn’t there, he or she ran away in fear. After the father hid the whole family in the shelter, he started looking and found the child at the other end of the village. This is the kind of children’s traumas we came across. They don’t forget these traumas, but with children, it as if gets pushed deep down and does not manifest itself at the first stage: you talk to them and see no symptoms. Trauma is different in men. Men keep everything inside, because they see sharing it with someone or crying as something shameful, and the pain hardens inside. Women, on the other hand, let their emotions out, even if a little bit, because they cry and scream, but they still react to every little sound, reliving a traumatic situation in their mind. That is, traumas are different, but the results are similar.
You had to deal with so many different traumas simultaneously over a short period of time.
First, I would like to thank the organizations and people who are implementing this project, because it was not a short period time. We started in November, returned home to Baku in July, we worked in these regions for eight or nine months in winter and summer, in cold and heat. Of course, everyone was allowed to visit home for two or three days, we took turns. There was a psychologist who brought his wife and baby with him, and the five- or six-month-old baby stayed with us. We set this condition from the beginning: we couldn’t go back and forth. We spent at least two or three weeks in one village. After we were done in the village, one or two people stayed there to finish the work, to work more individually with children with severe traumas, with severe cases, and the main group went to the next village.
What were the most difficult cases?
The most severe cases were people with suicidal thoughts, aggression, depression, stuttering, etc. There were children who suffered from enuresis, that is, loss of bladder control. There were those who became incontinent because of fear. For me personally, the most difficult cases were the mothers of martyrs. You can give some hope to other people, you can say, “Everything will be fine” and so on, but with the parents of martyrs…. Just imagine, there you have a martyr’s father, missing a leg… He is a refugee, he lost his first son in the First Karabakh War, his second son was killed in this war, and his third son is fighting right now, wounded and still serving in the army. What should I tell him? Or twin boys who were born on the same day and became martyrs on the same day—what about their parents? There was a village where two or three families of martyrs lived. In another village, there were nine such families. After working with them, I saw that even with all my professional and life experience that thickened my skin, I couldn’t take it. Fortunately, we worked in face masks, so they did not see our expressions and tears.
What did you say to those families? Because from personal experience, it is very difficult to say something to someone who has lost a loved one. “God rest his soul”, “May the earth lie light upon him”—expressions like these are extremely meaningless in the face of human loss.
You can’t do anything with words alone, you have to use some specific methods. This is probably manipulation, but it is a positive manipulation. We all manipulate each other anyway. The biggest manipulators are our children. A five-year-old can have us wrapped around their finger. For example, my grandson. I know it’s a manipulation, but it’s sweet, I can’t resist it. In every village, we first invited all the women, including mothers of martyrs, into a hall. Everyone in the village knew them, and when those women came in, the front row stood and gave up their seats, and the community treated them with particular respect. It was clear that they were in mourning, they did not smile, their steps were heavier. After everyone sat down, we introduced ourselves. We didn’t tell anyone, “Come and talk to us about your pain.” We talked about emotions, about stress. About fifteen or twenty minutes later, I said, ladies, keep talking to my colleagues, and I’ll go to the next room; I am a doctor, so if anyone has anything to say, if you want to speak one on one, come to me, and if there are mothers of martyrs and veterans among you, I am going to see them out of turn. I would go and sit down, and then they would come one by one, they were ready. I listened to them, they listened to me. We discussed what to do, the future of our grandchildren and other children. But there were also difficult cases of mothers who had no children left. Then again, the very fact that we came to the village and paid attention to them already had a positive effect on people. There were such remote villages that no one had come there before us. Now there were people coming to the village from Baku: several cars, several people. The executive authorities gave their permission and a venue was given specifically for our purposes. This gave them confidence. We listened not only to people’s psychological problems, but also to their social, financial, and construction problems. Our social workers registered such problems and gave the lists to the executive authorities. I don’t know if those problems have been resolved or not. We did not have the chance to take a broad interest in such issues. But again, at least someone listened to them and heard their pain. The main point here is not to lie, not to say things like “I will take care of this”. I told them we would send their complaints to the relevant agencies, and whether they would be solved or not, or when it would happen, it was not up to us. However, when we visited some villages again, we could see that some issues had been addressed, at least in part.
The culture of seeking psychological help in Azerbaijan is still in its infancy. Even educated people do not trust psychologists very much, they still treat them as “doctors for psychos”. I imagine that if this is the case in Baku, this insecurity in rural areas must be twice as bad. From this point of view, what was the level of interest and participation of the people you worked with?
I completely agree, people say something like, “I’m not a psycho to see a psychologist.” I have been in this profession for more than 30 years, and I have to say that this stigma is slowly disappearing. It is true that it has not yet reached the European level, but it is declining. According to my personal theory, the reason is in the family. In Eastern countries, the family is a broad concept. When we say family, we mean grandmothers, grandfathers, uncles, aunts, uncles—a very large group of people. Within this large family, there used to be an expert for every specific type of problem. If it was love matters, I would tell my cousin to go and give a note to the girl I was interested in and to tell her I loved her. If someone wanted to beat me up, I would gather my uncles and cousins, and they would protect me. When it came to money, you had a father, but if there was a distance between you and your father, you could turn to your uncle—when it came to sexual issues too. When a teenage girl began menstruating, her mother usually wouldn’t say anything to her, keep her distance. The girl would be taught by her aunt instead. When does a psychological problem arise? I have a problem and I can’t find a way out: I do not have any guidance, and I do not have any experience because it is my first time. This becomes a psychological problem over time. And when there is an expert in every problem in the family, sometimes the issue does not turn into a psychological problem. This is neither good nor bad. And, of course, all families are different. With some families, you are better off without their advice. But still, as there were such experts in the family, there was no need to see a psychologist. Now the scale of families has shrunk, and we have small families. Everyone is in Baku, in the cities, although the situation is changing in the villages as well. A small family consists of a mother, father and one or two children. Everyone has a job, they work, study and so on. The grandfather stays in the village, one uncle is on the other side of the city, another uncle is in the neighboring city. Thus, there is a need for a psychologist. Until the late 1980s, there was no psychology faculty in Azerbaijan at all. If you wanted to become a psychologist, you went to study in Moscow, St. Petersburg or Kyiv. There were only a few of them. In the late 1980s, psychology faculties were opened at Baku State University and pedagogical institutes. Now 50-60-70 psychologists graduate every year, while the first psychologists became established a long time ago and wrote scholarly works.
I remember that only Agabey Sultanov was well-known in Azerbaijan in this field.
And he was a psychiatrist. Psychiatrists and psychotherapists took over psychologist’s work. In the 1990s, after the first war, we found only two or three psychologists to involve in our work with IDPs. The bulk of work was done by psychiatrists. But now it is the other way around, in fact, I was the only psychiatrist on the team, and the other twenty-eight were psychologists. Attitudes towards this craft are also changing. Now psychologists appear on TV, people see and recognize them. People say, oh, a psychologist, a specialist has come to my village directly from Baku, I should go and see what they say, because when else would I get the change to find a psychologist in the region?! Of course, there were those who complained, “Why didn’t they prescribe me medication?”. But they still came. They saw that we were working with children. They saw that we worked for several weeks and were in the village every day. Little by little, they began to trust us. They would come and say, “Doctor, examine me, I don’t sleep well.” Teachers would come and say they were irritable and asked for help. Slowly, the news spread that we could really help.
Doctor, as far as I know, a group of Turkish specialists worked in parallel with you. Was their help effective? Or rather, let me generalize my question a little. War is almost the same everywhere, people have the same fears, go through the same things. Is it important to know the specifics and sensibilities of the place when helping them, or does professionalism make up for everything?
In Barda, I met an excellent professional named Selma among Turkish psychologists. She had come through the World Health Organization. She had worked in Syria, Iraq and other regions. She had experience of talking to such people, and her approach to the problem was very interesting. She also got acquainted with our team. At one stage, the organization also joined the project, and temporary psychological aid stations were set up in certain areas, where people living in the district center were received. But there was a language problem. Most of the psychologists were specialists who had studied at BSU and had contacts with Azerbaijan at some point. But they had little experience in this area. They came there and worked, but… That is, some work was being done, but it is difficult to say that their work was very effective. As I said, they had little experience, there was a language barrier. But, for example, their work in the district centers freed us from that work, so we could go to the villages more often, because we knew that someone was working in the district center. We also visited remote villages where they could not go.
According to statistics, there were few PTSD-related suicides after the war. Is that really so? Have you encountered suicidal tendencies or suicide cases in the process of your work?
We have. Unfortunately, this is a natural process. I saw an unbelievable figure in an article about the US military. Reportedly, after 20 years of the US military presence in Afghanistan, there were allegedly 60,000 suicides among those serving there. I didn’t exactly believe it, I looked for other sources and could not find any, but there are indeed such cases. Alright, say that is one zero too many. 6,000 suicides among US veterans… Their social issues are resolved, they have insurance, they get psychological aid, there are various institutions, rehabilitation centers, etc., and professionals work with people returning from the war. However, if this problem persists there, clearly, it exists here as well. In fact, there are fewer suicide attempts in eastern and southern countries. The mindset factor, the family factor again, and so on maintains their effect. Sometimes I hear that we are oblivious and neglectful. This is not neglect. Sometimes our dismissive attitude saves us: “Oh, nevermind, it will be alright!” We do not get hung up on any problems of today or yesterday. In the East, our outlook is influenced by N factors, and there are fewer suicides. Perhaps this is the effect of Islam, which considers suicide a sin before God. But the number is not so low, and it is gradually increasing. It is not just about the war, in general. It has not yet reached a critical level, but it is growing. Of course, we also encounter suicidal tendencies and cases among ex-military and veterans. I did not count, but according to official media reports, about 15-17 people killed themselves.
Considering the size of the country, this is not a small number for Azerbaijan.
No, it isn’t. There have been 200 suicides in Armenia. Victory and defeat also affect the dynamic of such cases. I, an Azerbaijani, was wounded, but at least we won. It saves me. I was one of the losers in the First Karabakh War. I still remember how that stress affected me. Maybe working with IDPs at that time, trying to rehabilitate them psychosocially saved me. But there is a problem, and the first of them is the lack of statistics. This is the work of the police, and real statistics can be obtained from the information available to them. Other such cases remain obscure. There are not only fatal cases, but also suicide attempts. Or a person committed suicide, but the family hid it and had it registered as a natural death. Therefore, we cannot obtain complete statistics. Forms of suicide also vary depending on age groups, social groups and regions, and there is no center to study them. One basic thing: work should be carried out to prevent not only suicide in general, but also each particular form of it, and it should be studied.
Here are two examples. There was a suicidology center in the former Soviet Union. Suicide by vinegar essence poisoning was common at that time. People drank 60-70% vinegar essence and it burned their stomach. Doctors and psychologists proposed to reduce the percentage of over-the-counter essences to 15-20% to prevent this type of suicide, so that at least a person cannot burn their insides or kill themselves. They could not get rid of the idea of suicide itself, so they made it difficult. Suicide has this specific nature—it becomes fashionable. A few years ago, it became fashionable to jump off a bridge that was even called the suicide bridge. One person wanted to jump off it, and then others started repeating it. After the execution of Saddam Hussein, 7-8 people hanged themselves in Azerbaijan, but not because of Saddam Hussein. At that time, the number of suicides by hanging in Muslim countries also grew. They watched it on TV and saw that it was possible to kill oneself this way. Then for a while we had suicide attempts by self-immolation. Someone set themselves on fire, it gets into the press… But I must say here that the reason here is not because this information gets out thought the press, through journalists. Even if such news is not published in the press, we still hear it. The form of suicides varies from region to region, and the reasons vary. For example, there may be differences between urban and rural areas. We also have risk groups: adolescents and the age group of 60-70 years. Older people think, well, my life is over, diseases have started, I should not be a burden to my children and so on. Teenagers are maximalists. Every summer, after university entrance exams, there are several suicide attempts or suicides that result in death. A teenager goes to the tutor for three or four years, and the parent puts pressure on him, saying, “Such-and-such’s kid has been accepted, but you haven’t.” Thus, for a teenager under pressure, not being accepted to the university means the end of life: that’s it, it’s all over, I should kill myself. And this idea will seem so funny later to the person. So what? You were not accepted this year, but you may be next year. And not everyone has to get a higher education. Or love. They fall in love for the first time but get rejected, and again, that’s is, life is over. After we grow up, we realize that we fell in love today, but I can forget it tomorrow and I can love someone else again after a while. And life is not just about love. These are peculiarities of suicide, and we cannot work with suicide cases on a regular basis. There must be centers that do this. Special rehabilitation centers should be established under state medical institutions or by commercial and non-governmental organizations, where people prone to suicidal ideations should receive therapy in specially designated places, and psychologists, sociologists and psychiatrists should work together. This also requires funding.
You mentioned the winner-loser syndrome a while ago, and said that you talked to mothers of martyrs. “Long live the Motherland!”—how comforting is the sentence? Is it even comforting in reality?
Very. One mother said, “I raised my child with so many difficulties, I worked as a teacher, planted something in the yard and sold. It was as if my son could feel it, he said, mother, the day will come when you will become the most respected person in this society.” Two or three days before he became a martyr, the boy called and said goodbye to his mother, said, mom, forgive me for everything, it’s an honor for me to become a martyr.” It really comforted those mothers, it worked. They spoke through tears, and I could feel myself crumbling under the mask. During the liberation of Shusha, special forces were moving ahead because they were more professional and well-trained. The young soldiers, who were just gaining experience in the war, were sent to the second echelon to follow the vanguard and fortify the liberated positions. I did not see it myself—those who were there told me. How do they show it in the movies? They move slowly from behind one stone to another. Someone says that they already approached Shusha, that they could already see the city. Suddenly, a cry comes from behind, “Shusha! Hurrah!” and those young soldiers get up and run towards the city. If we had not gotten up at that moment, they would have trampled us, so we had to get up and run too, so that they would not be killed. They said it with a laugh. Among those kids were those who aspired to be martyred in Shusha. A wounded soldier is happy because he is wounded, and if he is dying, he is happy he is dying. This is a complicated process. You go through the initial stage, the fear, you get your first bullet, you are wounded, you lose your friend, you see the corpse, and then that fear goes away, and you say: if I die, I will die in Shusha. I am proud to become a martyr in any other place, but still if I am to become a martyr, let it be in Shusha. Maybe the root of this lies in religion to some extent. For example, it is an honor to go on a Hajj to Mecca and die there, because it means a burial in the holy land. This cannot be explained by logic, it is an emotion.
Can this be called mass psychosis? For example, the desire to become a martyr, like a Japanese kamikaze… Isn’t this a kind of psychosis?
It can be called mass psychosis, but it is more complicated. When the Japanese emperor resigned, many generals and high-ranking officers committed harakiri in front of his palace, saying that they could not protect the emperor and fulfill their duty. We have a great sense of patriotism and honor. But there is a family honor which is greater than the honor of the homeland. If someone assaulted the honor of my mother, sister, daughter, wouldn’t I kill them? I would. If they messed with my child, my family, my honor, I would kill them too. If you remember, there was a Kabardian who lost his whole family in a plane crash and found and killed the air traffic controller on duty in Switzerland. That is, it is a natural process, which is neither positive nor negative. Psychosis is a word of a slightly negative nature.
I wanted to say something else. Personally, I don’t quite understand the desire to become a martyr, to die, to kill.
Let me explain. Several people sit in the same trench. The battle goes on, a shell falls, tears a man apart. One of them sees this, gets scared and runs away. Another gets angry and rushes forward. The cause is the same, the reactions are different. The one who ran forward becomes a hero, the one who ran away becomes a deserter. We react to events depending on the individual structure of our psychology. When you slap someone, some say, “don’t slap me”, others respond with a slap. This is an individual reaction. During the Soviet era, a half-closed study related to World War II was conducted, with examinations to determine the psychological status of the heroes of the Soviet Union. It turned out that most of them had a psychasthenic personality type, that is, they like risk, adrenaline. For example, the commander gives the order “Advance!” to the whole squadron. One person thinks, well, I should wait a second or two late, so that the others go forward and I don’t get shot. A person with a psychasthenic personality goes first. The one who goes first becomes a hero and leads everyone else. When psychasthenia is pathological, a person likes to walk in risky places, for example, on the edge of a precipice. A person who is not pathological, but whose body requires adrenaline, sit in a bank and do paperwork, and when it is vacation time, they take their ropes and go mountaineering. Whether they will return or not is the question. At the very least, their body will be exhausted, cold, suffering, and so on. But they will get enough adrenaline to last them a whole year. Another person just takes a package tour, lies on a chaise longue in Antalya and does not want anything else, that is enough for them. We are all different. There was a veteran, who went through the whole war without a single wound, a single scratch in 44 days. Then the war was over, and he stood on duty in Shusha. Suddenly was an explosion somewhere, the man threw himself into a trench and broke his leg. Fortunately, this happened when he was on duty, so he received the status of a veteran.
In the documentary Human, there was an interview with two Americans who had served in Afghanistan. One says that his friend was killed right before his eyes. He followed the shooter, ran into a wide, open area, stopped when he felt the sun, and said to himself, “What am I doing? I will kill him and avenge my friend, and then someone else will come and avenge him, and so on.” He gave up the chase and returned. The other one said he loved how it felt to kill a person. So when he returned home, he fenced off his house, purchased a weapon, and prayed every day that someone would trespass on his property so that he could kill them.
That is why every war veteran needs psychological rehabilitation. They saw death, they killed people, and it became easier for them. It is very difficult for a human being to kill, to see death, but you get used to it. We need to work with these people separately.
Do we have such rehabilitation centers? Or are they thinking of building one?
Something is being done in one form or another. I for one announced that I would see veterans free of charge and at any time. They come to me and then tell the others. The doctors who had worked with me joined the process and were ready to help too. That is, we do our best. Of course, we are also looking for centers to finance this work. “Yashat” is dealing with more serious physical injuries for now. But they too do some work. For example, they organized a summer camp for the children of martyrs in Lankaran. We worked there with the children for about five weeks and returned in late August. There, too, we encountered a variety of complex conditions.
My last question about the war and we will change the subject, if you don’t mind. You said several times during our conversation that you could not control your emotions and your face mask helped you. How easy or hard is it to turn off your feelings when talking to those people?
Very hard. There is a method called supervision. This is psychological help for the psychologist. I supervised the young people who were overloaded there, and when I was overloaded, they helped me. We did this regularly to avoid the burnout syndrome. But we had to send one or two people away. They did not want to go, but we said: enough, you should go back. Some wanted to return voluntarily. There was a young lady. She had been married for about a year. She worked with us for a month or two. I told her, “You should go, go home for 3 or 4 days, then you can come back.” She said, “Doctor, if I go, I won’t come back”, and stayed with us until the end. There were moments like that.
I would like to talk a little about drug addiction, which is one of the most pressing problems of recent times. Synthetic drugs have become very common recently, and we hear about them almost every day. Let me ask you first: is drug addiction more physical or psychological?
When using drugs, first psychological dependence develops, then physical one. In the process of treatment, it is the other way around: physical dependence is eliminated first, then psychological dependence. This is a complex process: drugs accelerate the conversion of amino acids to such an extent that no food can replace it. What is physical addiction? The so-called withdrawal: a physical need. The same is true of alcoholics. Therefore, first of all, it is necessary to detox the body, remove drug toxins from the body, restore sleep patterns, relieve pain and so on. It takes about ten to fifteen days. Sometimes a little more, sometimes less. In the second stage, psychological dependence must be eliminated. I must also say that because of the effects of modern drugs the second stage can begin very quickly, in ten to fifteen days. The mood created by drugs cannot be recreated in a natural way. After drugs, we can no longer enjoy what we used to enjoy naturally. For example, there was an 18-year-old drug addict. For three years she took various drugs and spent many nights in various places where drug addicts gathered. And et she remained a virgin, although it should have been the other way around. Anything was possible in such places. If she wanted to, she would have done it, or the others would do something to her. But nothing happened. Because drugs are more interesting to them than sex.
Movies often portray drug addicts as having higher libido and higher sexual desires. So, this is not true?
This is the effect of ecstasy. The girl I was talking about was using heroin, had some dreams, saw something, nirvana and so on. I mean, it is different from natural desires. Under the influence of drugs, food we found tasty loses its taste when we stop using drugs. The person as if falls into apathy and depression. She was treated, she no longer uses, she was told not to take anything again. And she understands that she will not experience those feelings until the end of her life, that taste will not come back. Long-term work is required to overcome psychological dependence.
What kind of people, people of what disposition and character are more prone to become drug addicts, to be more addicted? Or can anyone get addicted?
The risk exists for everyone. To understand this situation, let’s simplify the problem a bit. Take alcohol. It is also a drug, only allowed by the government. Alcohol gets us into an unusual state of mind, our mood lifts, for example, we dance more freely after drinking at a wedding, and in the karaoke joint there are people who overcome their inhibitions, and sing, and so on. One likes wine, the other can’t look at wine because it gives them heartburn. Someone drinks vodka, some drink whiskey. Doses are also different. For someone, it is enough to drink a little, they perk up and do no not want to continue. Other people have to sit and drink until the bottle is empty. Because the body requires it. It is the same with drugs. Some takes heavy drugs until the body gives up, and some occasionally takes some drugs at a friend’s party. These are not drug addicts, but drug users. The effects of drugs are also different. The stronger it is, the faster it creates physical addiction.
So it has nothing to do with being weaker or stronger as a person?
Of course, weak people cannot say no to themselves. They are also more difficult to treat. But sometimes very strong people can get addicted.
Is it possible to get rid of drug addiction forever?
It is possible, but it is difficult, it takes a lot of work. And again, there is a need for special rehabilitation centers.
As far as I know, we have such places, for example, in Mashtaga, and they have 21 days’ treatment. They are released after 21 days. Is 21 days enough for full recovery?
In Soviet times, the norm was 45 days: 15 days for physical dependence, 15 days for psychological dependence, and the last 15 days for the formation of plans for future life. These 45 days included both conditioning and emotional stress therapy. But at that time, no one asked people if they wanted to be treated. And now they do, and it is not bad. It is a more modern approach. If a person does not want to be treated, no one has the right to keep him or her in a closed facility for treatment, whether the person is schizophrenic or a drug addict. The court may mandate compulsory treatment only if a person poses a threat to other people. A man was brought to the clinic, woke up in the morning and signed a form indicating that he did not want to stay there. In this case, the doctor has no right to force him to stay, they have to let him go. In the beginning, when a person is aggressive, when he is in withdrawal, he can still be coaxed: “If you go outside now while you’re in pain, you will go and take drugs, so stay, let’s relieve the pain here.” But after the pain is relieved, the person wants to leave. Therefore, psychological work is very important and should be carried out outside the clinic, not in a hospital-type environment, but in a hotel, sanatorium-type rehabilitation center. There should be a variety of entertainment, exercise equipment, television, as well as group therapy. In Italy, monasteries used to provide occupational therapy, and communes were formed around the monastery. The famous Nazaraliev (Jenishbek Nazaraliev, professor, innovator in the field of drug rehabilitation and psychiatry—Ed.) treats his patients in Kyrgyzstan in the lands around Lake Issyk-Kul, in the bosom of nature. A place far from everything, without electricity, television, telephone. It does not have to be exactly like this, but we too need special rehabilitation centers.
Are there such centers in Azerbaijan?
There are very few, and they mostly do the detox, that is, to cleansing the blood with injections. Now a group of young psychologists working with drug addiction are thinking about establishing such a center. But it also requires organizational support and funding. You can’t just set up something and keep a person there, the conditions must be up to standard.
Do social problems play a role in the growth of drug addiction? Or are social problems just an excuse?
No, they are not an excuse. Besides, marijuana use has long been popular among young people. Because they do not consider marijuana a drug, they think that they can stop at any time. They do not see the new ones, such as crystal meth, etc., as drugs. They think, well, it’s not heroin, it’s not opium, so it’s not very dangerous, and I can take it a little. They deceive themselves. And thus these things spread rapidly among young people. Serious awareness-raising activities must be carried out to prevent this. Because new types of drugs emerge very fast.
That is, the direct participation of the state here is vital, it is impossible to do without it.
The state is working, a large center has been built in Mashtaga, and the issue has been more or less resolved from a medical point of view. However, even if they start psychological assistance and awareness-raising, it is not on a sufficient scale and it is weak.
What do you think should be done? How should awareness-raising be organized?
In two directions. The number of rehabilitation centers, especially in the regions, should be increased. There should also be awareness-raising programs in schools and universities, and professional psychologists should be involved in this work. These activities should also be carried out on social media. Young people almost do not watch TV, so it is necessary to work actively and professionally on social media and other social groups. But it too requires funding. No one can do such a thing on their own. There must be programmers, there must be people who follow the social media, there must be an immediate response. There must be psychologists on duty so that we can send people somewhere at a moment’s notice. That is, there is a need for a real network, you can’t just say, “Drugs are bad, don’t drink, don’t smoke!” and think that the job is done. People, with whom I had been working for a long time and had not used drugs for years, suddenly came running to me, saying, Doctor, my vein is itching, do something, or I will go get something and shoot up. He knows I won’t give him drugs. He says, just don’t tell me what you are going to do. That person’s vein is itching, it needs to be pierced. I mixed ascorbic acid with glucose and injected. Of course, we sat down and talked later. For those people to come to me at that moment, I had to work with them for at least a year or two so that they would trust me. I once told them—I tell this to everyone: I will never forbid you from doing anything, but before you go get it and shoot up, come to me; if I can distract you, good; If I can’t, I’ll let you go, I can’t hold your hands and feet. That is, it is necessary to work with such people regularly, and they should know that there are places and people who can help soothe that itch. We sat, talked, drank tea, and he relaxed. This happened twice. I want to say that a professional should be accessible and there should be more places that make it possible.
Interview by Aygun Aslanli