eISSN 2550-2042 MALAYSIAN JOURNAL FOR ISLAMIC STUDIES VOL 3, BIL 1 2019

MANZIL VERSES AND TRANQUILIZING EFFECT IN OPIATE DEPENDENTS Samhani Ismail1, Rohayah Husain2, Syed Hadzrullathfi Syed Omar3, Nasir Mohamad4

Abstract This review article discusses the practicality of Manzil Verses recitation in managing opiate dependency among drug users. Opiate addiction is an alarming public health issue and leads to a variety of social problems such as communicable diseases, financial burden and defects in cognition and behaviors. Drug treatment and rehabilitation in Malaysia is implemented under the purview of the National Drug Agency and the Prison Department, Ministry of Home Affairs. Scientifically, the Manzil Verses act as a form of rhythmic therapy by calming the senses, cognition and palpitations. Thus, this article aimed to discuss the potential of Manzil Verses in terms of their tranquilization effect among those with opiate addiction. Keywords: Manzil Verses; Opiate Addiction; Spiritual Therapies; Quranic Rhythmic Therapy, Relaxation

Introduction

Opiate dependency refers to the chronic consumption of opiates resulting from chronic use. Opiate abuse afflicts society and causes an enormous financial burden in addition to compromising national health. In addition, it is associated with communicable disease transmission. The abnormalities which produce addiction are wide-ranging, complex and long- lasting, and may involve the interaction of environmental effects such as stress and psychological conditioning (Kosten et al., 2002).

The cognitive deficit model of drug addiction proposes that individuals who develop addictive disorders suffer from abnormalities in the prefrontal cortex (PFC), reducing their ability to use judgment and predisposing them to compulsive drug-taking behavior (Volkow et al.,

1Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Terengganu, Malaysia, [email protected] 2 Faculty of Medicine, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu, Terengganu, Malaysia, [email protected] 3Faculty of Islamic Contemporary Studies, UniSZA Gong Badak, Terengganu, Malaysia, [email protected] 4Centre for Research in Addiction, UniSZA Gong Badak, Terengganu, Malaysia, [email protected]

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2011). This neuroadaptation in the brain reward system caused by chronic opiate exposure is manifested in searching for opiates in order to suppress the manifestations of opiate withdrawal. In general, individuals with long-term consumption consistently demonstrate neuropsychological impairments of executive (inhibitory) control, working memory and decision making (Yucel et al., 2007). Neurotoxicity may also be characterized by symptoms such as severe pain, tremors, seizures, confusion and hallucinations (Kozlov et al., 2011).

Methadone Maintenance Therapy (MMT/TGM) is the most widely applied therapy to reduce neurogenic manifestations, emphasizing abstinence, reduced cravings and blocking the euphoric effects of illicit opiate (Krambeer, L.L et al., 2001). Methadone gives better treatment retention rates than buprenorphine (Whelan et a., 2012), but patients enrolled in MMT may become physically dependent and even experience methadone withdrawal symptoms (Brands et al., 2014). In order to achieve stability, dependent individuals require opiates to feel normal, and they must be delivered consistently to avoid the presence of withdrawal signs and symptoms. Unfortunately, relapse is common and retention rate of MMT is inversely proportionate to time (Mohamad et al., 2010). It compromises the effectiveness of MMT program in promoting harm reduction activity. The complexity of opiate dependence manifestations requires robust models for therapeutic approaches. This includes psychological, spiritual and social treatments to develop the sustainability of MMT clients.

This paper aims to review the basis and importance of the Manzil Verses recitation activities. which may be suited to be a non-opioid substitutional therapy in opiate dependents in Malaysia.

The adverse effects of the Benzodiazepine as therapeutic agent for opiate user

Benzodiazepines are among the most widely prescribed psychotropic agents in treating opiate users for its sedative-hypnosis effects (Dundee, 1992). Four of benzodiazepines - alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium) and Iorazepam (Ativan) - are the top prescribed current medications. Benzodiazepines are a „minor tranquilizer‟ and an alternative to barbiturates.

Benzodiazepines act by inducing the conformational changes of GABA to make it more efficacious. This mechanism is termed allosteric, as diazepines bind at a site distinct from the agonist GABA receptor and then enhance the affinity of the most prominent inhibitory 13 eISSN 2550-2042 MALAYSIAN JOURNAL FOR ISLAMIC STUDIES VOL 3, BIL 1 2019 neurotransmitter GABA. Activation of this benzodiazepine-GABA-chloride ionophor complex will then produce therapeutic anxiolytic effects in opiate users, making them sedated and relax. Molecularly, irrespective of actions on receptor kinetics, benzodiazepines have been documented to increase the conductance of individual GABAA receptors. Campo-Soria et al. (2006) proposed the action of benzodiazepines which alter the sensitivity of GABAA receptor by shifting the equilibrium between R and R* where more receptors in high-affinity open state, the sensitivity to GABA- mediated activation would be increased. Thus, they are known as anxiolytic agents, hypnotist, anticonvulsant and muscle relaxant.

Unfortunately, with long-term high-dose use of benzodiazepines, there is an apparent decrease in the efficacy of GABAA receptors, presumably understood as a mechanism of tolerance. Activation of benzodiazepine-GABA-chloride ionophor complex also mediates many side effects and possibly dependence along with withdrawal. When high doses of benzodiazepines are abruptly discontinued, this “down-regulated” state of inhibitory transmission is unmasked, and may cause withdrawal symptoms such as anxiety, insomnia, autonomic hyperactivity and possibly seizures (Williams et al., 2001). Benzodiazepines are revealed to carry risk of dependence (Bramness, J. G. Kornor, H., 2007), withdrawal and cause impairment in several cognitive domains as well. Long- term treatment with benzodiazepines has been reported to alter visuospatial ability, speed of processing and verbal learning of patients. In fact, although cognitive dysfunction improves after benzodiazepine withdrawn, patients may not return to levels of functioning matching the benzodiazepine-free control (Steward, 2005).

Development of physiologic dependence brought by benzodiazepines is predictable and proportional to the amount of benzodiazepines exposure (dose x duration of treatment). Benzodiazepines actually carry a very low of risk of acute toxicity. But they are usually used with other type of medications. Pharmacokinetic drug interactions may occur, leading to enhanced efficacy and inevitably side effects as reported as psychomotor retardation includes drowsiness, poor concentration, ataxia, dysarthria, motor incoordination, diplopia, muscle weakness, vertigo, mental confusion; memory impairment such as amnesia; paradoxical disinhibition that increase excitement, irritability, aggression, hostility and impulsivity and some antisocial behaviors such as depression and emotional blunting those emerge suicidal ideation resulted from reduction in central monoamine activity; causing adverse effect in pregnancy as benzodiazepines are able to cross the placenta and are classified as teratogens, which may lead to development of dependency in the

14 eISSN 2550-2042 MALAYSIAN JOURNAL FOR ISLAMIC STUDIES VOL 3, BIL 1 2019 fetus, tolerance, short term withdrawal symptoms and protracted withdrawal symptoms (Longo, 2000).

The same goes for insomnia, which is a common sequel of opiate abuse in early abstinence or protracted withdrawal at early treatment, and which can be treated by benzodiazepines. Patients notice relief from insomnia, but its efficacy gradually decreases and patients developed tolerance as an adverse effect. Tolerance towards the sedative effect of benzodiazepines has been widely reported in both animals and humans (Willems, Gorgels, Voshaar, Mulder, & Lucassen, 2013). The development of tolerance towards the effects of benzodiazepines raises the expectation that long- term use of this drug requires the dose to increase over time to achieve the same effects. Conversely, research involving a retrospective study among American long-term benzodiazepine recipients showed that there is no increase in benzodiazepine dosage over time (Wastila L, 2003).

Spiritual well-being is an important aspect of human well-being which integrates and regulates the internal power that leads to intimacy with God, self, society and environment. One of primary concerns in opiate dependents is lack of spiritual well-being as spiritual awakening may protects individuals from taking drugs, and impact in decrease of substance abuse (Noormohammadi, Nikfarjam, Deris, & Parvin, 2017). Therefore, regarding the uncontrolled adverse effects afflicted by usage of therapeutic drugs and their substitutions, the recitation of Manzil Verses is humbly proposed. It is a form of spiritual practice inherited from long history of Islamic civilization and empowerment, which rooted in , from the Holy recitation, called Manzil Verses. Perhaps it can fix the symptomatic withdrawal of anxiety and agitation in opiate dependents without adverse effects.

Manzil Verses; a proposed spiritual approach in treating opiate dependency Manzil Verses is a collection of Quranic verses and short chapters arranged by Maulana Zakaria Kandahlawi, a scholar of hadith and has been used by number of Muslim scholars and auliyas. It contains a collection of Quranic verses taught by the Prophet Muhammad (p.b.u.h) to his companions as means of treatment from diseases as well as spiritual protection from magic and devil disturbance, as well as other harmful things. Hence, chanting the Manzil Verses is believed to be a substitution therapy among opiate dependents that can relieve those suffering symptoms.

The Manzil Verses include the following verses of the Quran:

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Al-Fatihah (chapter 1): verses 1 to 7 • Surah Al-Baqarah (chapter 2): verses 1 to 5, 163, 255 to 257, and 284 to 286 • Surah Al-Imran (chapter 3): verses 18, 26 and 27 • Surah Al-A'araf (chapter 7): verses 54 to 56 • Surah Al-Isra‟ (chapter 17): verses 110 and 111 • Surah Al-Mukminun (chapter 23): verses 115 to 118 • Surah Al-Saffaat (chapter 37): verses 1 to 11 • Surah Al-Rahman (chapter 55): verses 33 to 40 • Surah Al-Hashr (chapter 59): verses 21 to 24 • Surah Al-Jin (chapter 72): verses 1 to 4 • Surah Al-Kafirun (chapter 109): verses 1 to 6 • Surah Al-Ikhlas (chapter 112): verses 1 to 4 • Surah Al-Falaq (chapter 113): verses 1 to 5 • Surah Al-Nas (chapter 114): verses 1 to 6

According to The Weapon of Pious by Al-Allamah Sheikh Haji Hussein Qadri, whoever reads these compiled verses daily or night will find peace and be protected from destruction and thieves, robbers and so on for the day and evening, with the permission of Allah. In addition, a reader of these texts will be protected from the dangers of demons and wild animals. It is also said that the Manzil Verses offer healing properties for a hundred diseases, including mental disorders, agitation, and symptomatic withdrawal of opiate addiction (Sidek, 2013).

Manzil Verses can be recited by the opiate dependent themselves and also chanted by man of healer as a sound therapy. This may be performed once or twice a day, in the latter case once in the morning and once in the evening. Regular recitation and auditory stimulation using these verses will definitely strengthen one‟s psychospirituality. The reciter should be seated properly, covering their body, and recite or listen with a proper heart while remembering Allah. He is also advised to pray his intention before starting on reciting Manzil Verses, whether to get serenity or tranquility or to heal their physical bodies.

It is well documented that the effectiveness of recital of these verses depends on the sincerity and earnest devotion of reader as well as determination deep rooted belief in Allah. Allah‟s name and His true holy words hold barakah, or the unseen blessing benefits and abundant value from Allah. Since opiate dependents represent with many psychological imbalances including

16 eISSN 2550-2042 MALAYSIAN JOURNAL FOR ISLAMIC STUDIES VOL 3, BIL 1 2019 agitation, anxiety and insomnia (Mohamad et al., 2012). Thus, Manzil Verses recitation is believed to give a tranquilizing effect and bring the hope of recovery from withdrawal agony. Additionally, listening to rhythmic sound has a strong scientific basis and is widely used clinically such as in stroke patients (Kim et al., 2014), improving gait velocity, cadence, stride length and stride symmetry (Thaut, McIntosh, & Hoemberg, 2015), recovery from brain injury (Bradt, Magee, Dileo, Wheeler, & McGilloway, 2010) and in Parkinson Disease (Bella et al., 2017; Murgia et al., 2015). Rhythm also helps with speech and language fluency, articulation and intelligibility (Katongo & Ndhlovu, 2015), cognitive enhancement (Samhani & Reza, 2017), and memory and executive functions (Kraus, 2015). Additionally, effects are seen in terms of improving language skills (Arntson, It, It, & Grove, 2013), rehabilitation of aphasia (Cortese, Riganello, Arcuri, Pignataro, & Buglione, 2015), and improved emotion expression and emotion memory (Samhani, Begum, et al., 2018).

Quran recitation has proven healing effect

It is based on some basic construct that Manzil Verses is one of the Quranic recitation healing promoted by Prophet Muhammad (p.b.u.h). In , anything causes inebriation is considered intoxicant and all intoxicants are prohibited. Opiate and other recreational drugs bring disastrous effects on both mind and body of its users. Although during the early usage stage, this drug can allay pain and suffering, soon users will end up in vicious cycle of depression, dependence and addiction (Donnelly, 2013). Indeed, long term use of opioids will change the brain‟s reward system yielding in excessive noradrenaline in brain, anxiety, aches and pain depending variability on genetics, length of exposure, and amount of used that contributes to spiritual imbalance. There is no drug of mood enhancers can be prescribed to addicts but the Holy Quran does.

Quranic recitation has an effect on the therapy and relaxation to individuals achieved by listening and/or reciting to the words of the Quran, even without understanding its meaning (Tumiran et al., 2013). Elkadi‟s study showed that certain Quranic concepts are very effective in helping patients to eliminate negative emotions, a major immune suppressive factor which is always present in patients with chronic illness (Elkadi 2006). Samhani‟s study showed that acoustical stimulation of the Fatihah Chapter recitation, termed the Quantitative Verse, provides cognitive and psychoacoustical effects that eliminate negative emotions and improving emotional and speech fluency (Samhani, Husain, et al., 2018). Chanting the Quranic verses indeed brings tranquilization

17 eISSN 2550-2042 MALAYSIAN JOURNAL FOR ISLAMIC STUDIES VOL 3, BIL 1 2019 in mood and emotion in opiate dependents, because the Holy Quran itself is a „mukjizat‟ granted with therapeutic effects for those who recite, listen, near, see, and practice it (Chapter Fussilat: 44).

There is consensus that rhythm is crucial to music, indeed therapist also agree that rhythm is equally so for the Holy Quran. The rhythmic quality of sound is recognized by human brain whether it belong to the subject‟s native culture (Patel, 2003). The melodious sound of Holy Quran has therapeutic effects which address the emotion, cognition and even social needs of individual (Tumiran et al., 2013). It is worth noting that in Islamic history, the fierce character of Umar al- Khattab, the Prophet Muhammad‟s companion, was turned into gentle and delicate man after he first heard verses of the Holy Quran recited by his sister, which indicates the cognitive restructuring ability bestowed in the Holy Quran. Since Quranic recitation and listening are able to increase levels of inner peace, Manzil Verses therefore is beneficial to treat symptomatic withdrawal of psychological restlessness of opiate dependence.

The Messenger (sallallaahu alayhi wasallam) said, "There is no-one who is afflicted by distress and grief, and says: O Allah, I am Your slave, son of Your male and female slaves, my forelock is in Your hand, Your command over me is forever executed and Your decree over me is just. I ask You by every name belonging to You which You have named Yourself with, or revealed in Your Book, or You taught to any of Your creation, or You have preserved in the knowledge of the Unseen with You, that You make the Qur'an the harvest of my heart and that light of my chest, and a departure for my sorrow and a release for my anxiety, but Allah will take away his distress and grief, and replace it with joy," (Ahmad 1/391).

Manzil Verses is a way of Sufism Healing

Islam is a complete way of life and provides a practical model of stress reduction and self-healing that offers a complete system of healing and skills including deep mindfulness, social-emotional self-care, self-affirmation, patience, deep breathing, and systematic contemplation of healing insights, supplication, prayer and turning to Creator (Loizzo et al., 2010). In fact, prayers, supplications or invocations are considered in Islam as the most appropriate actions for treating diseases and afflictions. Prayer in Islam involves a passionate appeal to the God. The efficacy of prayer as a way of medication lies in God‟s Words; that is, the Holy Quran (Akanni, 2013). However, there are many other words of prayer recommended by Prophet Muhammad (p.b.u.h). One of them is Manzil Verses. In this case, Manzil Verses also acts as Ruqyah. Ruqyah is

18 eISSN 2550-2042 MALAYSIAN JOURNAL FOR ISLAMIC STUDIES VOL 3, BIL 1 2019 commonly translated in English as "incantation" which carries a negative meaning, since the word incantation is usually associated with magic, spells, and witchcraft. However, Ruqyah in Islam is the recitation of Qur'an, seeking refuge, remembrance and supplications that are used as a means of treating sicknesses and other problems.

During the recitation of the verses, the reciter must remain present and full of heart throughout the zikr process. Empty performance of zikr with the tongue continuously chanting without conscious should be avoided. This act, known as contemplation, is the pillar of zikr practice in which disciples must remember Allah in each their exhalation or breath, whereby the mind and thoughts are not influenced by other than Allah (Syed Omar et al., 2011). From the Sufi perspective, when performing this action, one‟s energies are concentrated and gathered all the energy from all the sources and they work both ways; physically and metaphysically. That is, if there is any illness or weakness in individuals caused by opiate usage, this means the source of energy (heart) has been destroyed, which then is not able to direct the energies towards organs (Wilcox, 1995). Sufism works to obliterate the ego, compared to psychotherapy works that aims to increase the ego and building ego strength. Sufism concentrates on diminishing the socially constructed self, until it gradually disappeared. The ultimate desire of every reciter is union with the Beloved God, the complete obliteration of self in God which requires an absence of ego (Al- Haqqani, 2004).

Neuroscience-psycho-spiritual perspectives

Human brain generates different oscillations at different frequencies during various states of consciousness level. The Manzil Verses contains piece of the Holy Quran verses which of exogenous rhythmic stimulation that can lock and synchronize of reciter‟s/listener‟s brainwaves. This action has been linked to a strong emotional state that may influence cognitive intelligence and memory sharpness. It has been found that listening to the Holy Quran gives such a calming and relaxing effect, irrespective of listener‟s native language or culture, and even without perceiving its meaning, because of its distinctive rhythm. The global auto correlated power in theta frequency band has shown that The Holy Quran has a relaxing effect as shown by the recurring rising and descending prototypes of power in delta and theta in the global, frontal and temporal brain regions during listening to Quran recitation (Reza et al., 2010). Another study has suggested that natural „music‟ of Quran is able to tranquilize and relax people and eliminate mental stress (Khan et al., 2010).

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Indeed, from other neuroscience perspective, Manzil Verses listening and recitation might enhance the cognitive function through the resonance of its melodious chanting that would evoke strong emotions and forming memories (Jancke 2008). Brainwave synchronization following periodic stimulation has been recognized to produce tonic and phasic synchronization in delta and theta wave ranges, showing that rhythmic entrainment on cognitive functions (Will and Berg, 2007). The central nervous system is involved in every function of all other systems, including the mind, nervous and immune system. These three areas influence each other particularly during the recovery process. What people think and feel influences other systems, as mediated by the endocrine system. Thus, activities which induce relaxation will have positive effects on the immune system and general health (Wilcox, 1995).

Opiate addiction is a chronically relapsing disorder characterized by compulsion to seek and take drugs and has been linked to dysregulation of brain regions that mediates reward and stress. The activation of the brain‟s stress system is hypothesized to lead to the key negative emotional state produced by dependence, which drives drug seeking through negative reinforcement mechanisms (Koob, 2008). This dysregulation is the responsibility of CRF (Corticotropin- Releasing-Factor), a 41 amino acid polypeptide that control hormonal, sympathetic and behavioral responses to stressors (Swanson, 1983). It is suggested that broad neurotransmitter roles for CRF systems in behavioral and autonomic responses to stress (Bale and Vale, 2004). CRF controls the pituitary adrenal responses to stress; thus, opiate withdrawal increased CRF level in the amygdala as shown by in vivo microdialysis (Weiss et al., 2001). These results suggest that CRF plays a major role in mediating negative emotional states that have motivational significance in maintaining the dependent state (Koob and Le Moal, 2005). Opiate withdrawal creates a pattern of compulsive intravenous use that induces an uneasy feeling in drug users and leads to intense intoxication, development of tolerance, escalation in intake, and profound dysphoria, physical discomfort, somatic and emotional withdrawal signs during abstinence (Koob, 2008).

Precipitated morphine withdrawal also stimulates the second arousal-stress neurotransmitter system norepinephrine to be released in the central nucleus of the amygdala and bed nucleus of the stria terminalis (Watanabe et al., 2003). The role of norepinephrine in stress-induced reinstatement follows a pattern of anxiety-like effects of acute withdrawal and dependence-induced increases in drug intake (Shaham et al., 2003). Opiate withdrawal has been shown to increase dynorphine levels in the amygdala and nucleus accumben. Dynorphine has long been hypothesized to mediate

20 eISSN 2550-2042 MALAYSIAN JOURNAL FOR ISLAMIC STUDIES VOL 3, BIL 1 2019 negative emotional states where the subsequent activation of dynorphin systems could contribute to dysphoric syndrome associated with dependence and the reduction of dopamine release (Nestler, 2005).

Stress leads to physiological changes like increased muscle tension, increased electrical activity, increased sweat production resulting in increased electrical conductivity of the skin and vasoconstriction that result in decreased blood flow to the skin, decreased skin temperature and increased heart rate. Concurrently, the Holy Quran induces relaxation, decreases the electrical conductivity and muscle tension, decreases sweat production and causes vasodilation that increases blood flow and slows the heart rate to the quiet state. These relaxation effects are achieved through the meaning of the Holy Quran and from the sound verbally echoed during Quran recitation (Elkadi, 1985). Listening to Holy Quran particularly results in more relaxing state and increased alertness. Compared to classical music, Quranic recitation gives a higher percentage of the alpha waves associated with inner peace (Zulkurnain et al., 2012). Postulating from this collection of Quranic research, we have high expectations that the Manzil Verses will offer the promising effects of relaxation, reducing stress and anxiety, serenity, and increasing cognitive performance, emotion and social relations among reciters and listeners.

Conclusion In the context of Malaysian drug treatment, drug addiction has been addressed primarily as a security issue. This proposed treatment of Manzil Verses may change the module of psychotherapy in Malaysia to be based on the Islamic perspective. In the long run, it is hoped that it shall offer a successful low-cost treatment for opiate dependents and provide a better human capital for the nation.

Acknowledgment

The publication of this article is supported by UniSZA Nic Reearch Grant Scheme (NRGS) UNISZA/NRGS/2019/RR057-1

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