Pubdate: Wed, 05 Oct 2005
Source: Philippine Daily Inquirer (Philippines)
Copyright: 2005 Philippine Daily Inquirer
Contact:  http://www.inquirer.net/
Details: http://www.mapinc.org/media/1073
Author: Michael Tan
Bookmark: http://www.mapinc.org/meth.htm (Methamphetamine)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)
Bookmark: http://www.mapinc.org/prison.htm (Incarceration)

PINOY KASI : REHAB

MENTION "rehab," and many Filipinos will think of drug dependents sent
into a center. There are some expectations of a cure here, but more
often rehab is seen as detention under harsh and Spartan conditions.
All said, rehab is seen as punishment and imprisonment.

These perceptions of rehab are not unfounded. Many of our drug rehab
centers work on the assumption that drug dependents are hardened,
selfish people who need to be taught discipline so they can overcome
their drug habit. Methods often parallel those of military camps and
jails, stripping a person of his (most dependents are male, so I'll
use male pronouns) "ego" through various methods, from shaving the
head to group shaming sessions, regimented schedules and, of course,
well-guarded centers with high walls.

No doubt, there have been many success stories. But there are also
stories of failure, of shuttling in and out of rehab, accompanied by
harrowing accounts of dehumanization. Several rehab "alumni" I've
talked with use the term "zombie" to describe their new identities
inside rehab and narrate how at night they would pace back and forth,
back and forth, how escaping became an obsession. Those who have tried
to escape still relive that experience over and over again in their
dreams, long after they're out of rehab.

Punitive

Our approaches to rehab for drug dependents reflects a cultural
mind-set, which looks at many of our problems as being caused by a
"lack of values," a "weak personality" or a "lack of self-control."
It's not just for drugs that we tend to blame the victim. We have the
same mind-set for obese people, for those who smoke or drink, or who
are compulsive gamblers.

When my partner got seriously hooked on "shabu" ["crack"] and
disappeared, his own relatives goaded me to get the police into the
picture and to look for the most harsh rehab center. Their reasoning
was that force was the only way to get a "cure." "Have him beaten up
- -- that's the best cure," suggested one of his uncles.

I resisted that "get-tough" option, and a major reason was that many
years ago, I lost a cousin to one of these rehab centers known for
their "discipline" and shaming tactics. He learned to maneuver his way
to get out of the center through bribes, through feigning recovery and
through outright escapes. One night, he got out on his own and within
two days, he was dead. To this day it isn't clear if it was an
overdose, or a reaction -- or he just gave up on the world. They'd
succeeded quite well in breaking down his defiance, but that also
meant crushing his spirit.

My skepticism about punitive methods isn't based on that one personal
case. "Clinical Work with Substance Abusing Clients," edited by
Shulasmith Straussner, reviews many reports on drug rehabilitation and
concludes that there is little "to justify the punitive, authoritarian
and coercive tactics that appear in the counseling styles of some
clinicians."

Freedom

There are humanist rehabilitation methods that give primary value to
the dignity of the individual, helping them to first recognize they
have a problem, and then to see how they can harness their own
strengths to overcome the problem.

I know it's difficult to imagine an "addict" as having any dignity,
but that, precisely, is the danger of authoritarian approaches. After
taking away what's left of a person's humanity, an authoritarian
counselor will claim: "You see what animals they are?"

It's not surprising some of the rehab "graduates" become more defiant,
more cynical, more spiteful of their families and of the world.
"Cures" are maintained by medicines to control all their anger and
bitterness. I've seen too many of them tamed indeed, but at the cost
of turning them into mere listless shadows of their once vibrant selves.

The humanist methods do recognize the importance of discipline, of
bringing some sense into a drug dependent's life, with more structured
schedules. There are restrictions, too. For example, cell phones are
not allowed within the rehab center and there may even be a complete
"ban" on visitors, but this is meant to create space for the drug
dependent, to think things through without feeling pressured by family.

What's important is that each step of the rehab process is negotiated,
the dependent "forced" to confront himself and his life, and
understand why there are restrictions on his freedom. When he feels
capable, he can negotiate for more freedoms and explain why he
deserves that much more space.

Nonsense, some of you might scoff especially because of that word
"freedom." Yet, I am totally convinced that it is this freedom that's
the key to sustained recovery. The world outside the rehab center is
just fraught with so many risks. One drug dependent told me you do not
have to go more than one kilometer anywhere within Metro Manila to
find a drug den or a drug dealer, and I can believe him.

What does this mean for our drug problem? A drug dependent "beaten"
into conformity will easily be overwhelmed by the real world outside.
Without walls, without guards, it becomes all too easy to succumb to
temptation. On the other hand, a person who has tasted freedom even
while in rehab will remember how hard it was to earn each small
freedom, and will ask himself if it's worth throwing everything out
after having gone so far.

A column isn't a place to discuss the humanist methods here, but it is
important we begin to talk of alternatives in rehab. I speak from the
heart, of experiences with my own partner in the last few months, of
stints in the hospital, in rehab and the uneasy and often turbulent
life outside of the rehab center. We've been to hell and back, many
times, to the point where I've declared the best I can hope for is to
stop hoping. Yet, I believe it would have been worse to use punitive
methods because short of hiring guardian angels, there is no way to
keep watch 24 hours a day, 7 days a week over someone who behaves only
because of fear of punishment.

These days, when we drop in at family reunions, my partner's relatives
look at him and compliment him on how healthy he looks. They're
cynical, but they marvel as well, knowing he wasn't "beaten" into
recovery. If for that alone, I'm glad we chose the path less taken.

Voices Unheard

Tomorrow night, Oct. 6, join the Philippine Center for Substance Abuse
Management (PCSAM) for a night of advocacy at the Penguin Cafe in
Malate, Manila, starting at 8:30. Admission is free for a night of
sharing on alternative approaches to substance abuse. There will be a
short film, "Hear Amanda," by Cinemalaya awardee Lawrence Fajardo,
followed by readings and acoustic music. The Pinikpikan band will
perform. Admission is free, but you pay for food and drinks, which
goes to Penguin. It's a night for voices unheard, exploring how drug
rehab can be made truly rehabilitating. 
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