Kinder, Gentler Treatment TAGAYTAY'S CHILLY weather and laidback lifestyle may be perfect for soothing the frazzled nerves of urbanites, but if you're a drug user trying to kick the habit in an overcrowded government rehabilitation center, all that may be lost on you. At any given time, the National Bureau of Investigation (NBI)'s Treatment and Rehabilitation Center there can have as many as 400 "residents," when ideally it should have just 150. Still, says psychiatrist Alfonso Villaroman, who visits the center periodically, they do try to maintain "a family setting in a treatment milieu." Villaroman helps the center administer a "therapeutic community" where residents are taught "responsibility, love for each other, and awareness of environment." Their program, Villaroman stresses, is "not come-what-may, rather it is scientific." But it's a program that some people just cannot imagine for their loved ones. To them, the Therapeutic Community approach practiced at the NBI center could seem harrowing, since it looks at addiction as an attitude problem that requires breaking down and rebuilding through humiliation and aggressive confrontation. It's actually one of the two predominant approaches to substance abuse treatment programs in this country. The other is the 12-step program patterned after the Minnesota Model, which sees addiction as a life-long disease that can only be contained by surrendering to a "higher power." This program compels drug users to attend lifetime support group meetings in the manner of Alcoholics Anonymous. Even that, however, was too much for social psychologist Ma. Inez Feria Jorge, who 10 years ago learned that someone she loved had become hooked on drugs. So she launched a personal quest for drug addiction treatment, and finally found what she was looking for in the United States. And for the last two years, she has been practicing what she calls the "harm-reduction" technique at the Philippine Center for Substance Abuse Management (PCSAM) in Cubao, Quezon City. Jorge, who is PCSAM's executive director, says harm reduction looks at the drug user as a human being with all his/her complexities. "You have respect for the person and also the understanding that he or she has the capability to make decisions and choices," she explains. "Sometimes, they may not be the decisions you would necessarily agree with. But it's very important at the start to get their story and understand it from their perspective." Indeed, what differentiates PCSAM's approach compared to the 12-step program and the Therapeutic Community is that it is wholly client-driven, not program-driven. Drug use is understood in the particular context of the person's life. Jorge says treatment can never be a "one-size-fits-all" deal, which is partly why she says the program that they offer is more a "rediscovery of oneself," and one that is not necessarily dependent on a set timeframe. Of the 20 or so clients they've had so far (mostly males, in their 20s to early 30s), one stayed at the center for 10 months. Another was there for just a month, then came back for a couple of weeks. But she says many were there for six months on average. Typically, Jorge says, the length of the program presumes a stay-in arrangement. But since it is made as much the responsibility of the drug user as that of the counselor, the treatment becomes personalized and often results in a less extended stay. Jorge says the treatment duration is sometimes difficult to explain to the families. "When people call us, two questions lang 'yan: how long and how much," she says. " Families understandably want answers — quick fix, quick solutions. It's tempting to say, sige two, three months. But when you look at it from the clinical point of view, that's not how it works." PCSAM would really rather have clients opt to be outpatients. This liberates clients from the stigma of being under "rehab." Besides, Jorge says, the "real test" is being outside where the drug user is able to study or to work — while regularly going to PCSAM. This entails a lot of strategizing with individual clients on what plan of action will work. Hence, a great deal of the work that PCSAM counselors and staff do requires intense involvement in terms of time and effort in getting to know the person and finding out what's going on in his or her life — knowing what they want in their lives, which direction they want to go, and the goals they wish to achieve. "We're basically there to guide them, not to dictate to them," Jorge says, pleased that clients have been appreciative of the fact that they are being listened to. Harm reduction also means avoiding the labeling of clients as drug addicts. While this approach seems helpful in some programs, Jorge believes it isn't necessary. "Sometimes, it's so sad when they are made to identify themselves as such," she says. "When they have problems, they cannot cope with them. We've actually heard some of them say, 'kasi addict ako.' (The label) becomes limiting already." Treatment at PCSAM, however, can be costly, given its complement of professionally trained counselors and psychotherapists, and a 24-hour nursing staff. That, and the fact that few people have heard about it, could help explain why more drug users are seeking treatment at the NBI center in Tagaytay. But Jorge herself says that center-based rehabilitation — PCSAM included — is rather passive. Thus, she sees PCSAM eventually going into community-based intervention. Instead of waiting for people to come to them, PCSAM would be going to where the drug users are, and helping families deal with the situation, particularly in terms of interacting with their drug abusing loved ones in a non-judgmental and humane way. "Rehabilitation centers, we'd probably need them for more intensive treatment," she says. "But a community-based approach will allow us to reach more people in need." — Alecks P. Pabico, with additional reporting by Vinia Datinguinoo