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. - ---