For Salma, 25, the most difficult stage of her illness was her family denying her the right to drug addiction treatment. For a long time, they refused to have her admitted to a rehabilitation clinic, or allow her to visit a specialized physician. It took time before they came to the decision to allow her to begin her tough journey to recovery. [h2]To Rehab[/h2] With her frail physique and dark hair, Salma recalls her painful story from within a private rehabilitation clinic, located in the first settlement in New Cairo. She traces the problems that would eventually lead to her addiction, to her childhood which was overshadowed by her parents’ troubled relationship. Eventually, they divorced, and remarried different people; and with the new families, came new family members, while Salma and her brother were largely pushed to the curb. As a socially awkward teenager, lacking the confidence for fruitful interactions, she found solace in drugs at the age of 17. Though she began with only cigarettes, that progressed into hashish, eventually culminating in an opium addiction. When her father found out about her addiction, and her secret marriage to a friend who shared her addiction, the reaction was vicious. “They locked me up in the house, and refused to send me for treatment in a specialized clinic, fearing the scandal that would ensue,” Salma tells Raseef22. “It was only when the relatives of my brother’s ex-fiancée found out about my addiction, and pressured my family with the scandal, that my family came to their senses, and realized I must receive treatment. They feared for their children’s future,” Salma continues with a sigh. [h2]The Big Picture[/h2] Salma is just one of thousands of girls and women suffering from drug addiction in Egypt. Their families do not support their treatment, and choose to deny and hide it, for fear of stigma and scandal. Globally, a third of drug users worldwide are women, but only fifth of drug addiction patients are women, according to a report from the International Narcotics Control Board (INCB) in 2016. The same report also indicated that women are more vulnerable to “depression, anxiety, trauma, and victimization,” compared to men. Women often consume drugs as a coping or escape mechanism for these problems. “[There] is evidence that women are significantly more likely, than men, to be prescribed narcotics and antianxiety [sic] medications,” according to the report. In addition, in comparison with men, women represent a greater ratio of people who abuse medically prescribed sedatives and painkillers for non-medical purposes. There are no accurate statistics in Egypt of the number of female drug addicts, nor on their response to treatment. Tamer Hosni, an addiction treatment specialist in the Anti-Addiction Fund in the Cabinet, has his own estimates. He suggests the percentage of female drug users in Egypt are at approximately 27% of the total drug users. Salma successfully completed her rehabilitation, and now participates in support groups and Narcotics Anonymous (NA) meetings. Recently, she resumed her studies. However, though her journey to and through rehabilitation was a struggle, Salma is a comparatively fortunate example, compared to the many women who continue to suffer the hurdles of addiction without their families’ blessings to seek help, nor any other outlets from which they can seek support. [h2]Addiction is Not an Exclusively Male Phenomenon[/h2] In the 1980s and 1990s, it was commonly believed that addiction was a male-dominated issue, according to Tamer Hosni. Thousands of women, as a result, were discouraged from confronting their illness, and social reintegration. This assumption was particularly upheld in television dramas and films, where drug-addict women were portrayed as deviant and abnormal, often connecting sexual promiscuity to drugs. Due to the social pressure, hundreds of families chose to ignore the conditions of their female members, instead of treating it. Thana, 23, is a nurse who, resorted to Tramadol, a powerful painkiller, in a bid to increase her productivity- a practice that many Egyptians follow. Soon, she began experiencing one of the drug’s most severe side-effects: she started having violent seizures, often ending up on the floor, with several scars on her face. She recounts to Raseef22 that, following increasing seizure incidents in the hospital and on the streets, she wanted to seek help for her condition. Upon learning that the treatment would require her to remain at the facility for three months, her family objected and did now allow the treatment. Her addiction and its side-got worse. Many women like Thana enter the cycle of drug addiction through painkillers, or Tramadol, as several addiction specialists suggest. One woman became addicted to Tramadol after her husband brought it to her once to help with her gallbladder pain. Another woman asked a pharmacist for an over-the-counter painkiller. The pharmacist gave her a sedative medication, and after taking several doses of the drug, she became addicted. Female addicts often suffer from their families’ denial of their illness, according to Ahmed Abou el-Azayem, psychiatrist and addiction treatment consultant, and head of the Arab Federation of NGO for Drug Prevention (AFNDP). This denial results in delaying the necessary treatment steps, and thereby increases the difficulty of treatment and the risk of relapsing after rehabilitation. This sense of denial is motivated by fear of the stigma surrounding female addicts in conservative societies. Society is generally more accepting to the types of behavior associated with addiction when they come from a man. Women within the addiction community in Egypt, are exposed to sexual harassment, which often leads to trauma, complicating their recovery, according to Abou el-Azayem. Even if a woman is successfully treated, society does not easily excuse past trespasses, he notes. This reflects socially in avoiding sincere relationships, including marriage, with recovered addicts; in many cases, the presence of a female addict in the family alone is enough to warrant calling off a marriage into the family. And that, in itself, becomes another source of pressure on the families, who then transfer it unto their female family members. [h2]Women’s Day[/h2] Female addicts and their families often seek alternative, more discrete forms of treatment. Some resort to drug addiction counseling over the phone, or hotlines for addiction issues—which cannot replace the rehabilitation programs needed to properly recover from an addiction. “The highest percentage of callers are women,” says Amany Falah, a telephone counsellor on a governmental addiction hotline, tells Raseef22. The hotline receives complaints and inquiries from callers all over Egypt. “Most of their inquiries are about issues related to their families, and their parents’ genuine fear over their reputation,” Falah added. Others seek out hospitals that guarantee confidentiality. Nowadays in Egypt, there are 18 free public hospitals specialized in mental illness and addiction treatment, the most renowned of which is Abbasiya Mental Hospital and Asylum, a 68-acre property that was previously a royal palace, before it was converted into Egypt’s first psychiatric institution in 1883. The average number of male patients admitted to public rehabilitation clinics is a 100 per week. As for female patients, the numbers are extremely low. Many are embarrassed by the prospect of attending sessions with men, leading the General Secretariat of Mental Health to allocate a day for women only in public clinics. According to the former director of the Addiction Treatment Unit at the hospital, Abdel Rahman Hamad, the average number of female patients rose to 40 per week since the women’s day was designated. Hamad highlights the gravity of addiction for women, noting that it develops more rapidly than in men. Further, the social pressure associated with the stigma of addiction makes it more difficult to persevere during treatment, and make women more vulnerable to relapse after being treated. [h2]The Blame Game[/h2] Nadia considers herself lucky to have had her immediate family’s support throughout her experience with addiction. Her extended family, however, were silence about it, and luckily abstained from pointing fingers at her, although it was clear that they were secretly judging her. In her opinion, the most difficult aspect of addiction for women is the culture of "silence" they find themselves forced into—one that nurtures fear of discrimination and stigmatization. The predominant reaction in Egyptian society is to silence the female addicts, and to blame them. "It is your fault!" is the same approach to any woman who experiences what society deems "improper, or a taboo." So it is the reaction to women who are the victims of sexual harassment, of rape, and women who experience psychological or mental disorders. Reducing stigma requires time, and communal efforts, Nadia believes. A good place to start, she suggests, would be the religious rhetoric, which affects people from a wide range of social backgrounds. She further stresses the urgency of providing a safe environment where women can freely discuss their addiction. The unlicensed therapeutic centers should to be closed, she says, and treatment at public hospitals should operate under complete confidentiality. Today, Nadia has fully recovered from drug addiction; she works as a mentor, helping addicts during their rehabilitation journey. Along with her colleagues, she is working on changing the assumptions women have, and on encouraging them to take care of themselves. Mostly, she hopes women would learn to resist social stigmas, and have the support they need to avoid and prevent relapse. *Names of women interviewed have been changed to protect their identity.
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