What's a day like inside a private drug rehab center?

MANILA, Philippines – Three months into office and President Rodrigo Duterte’s war on drugs shows no signs of letting up.

The number of drug personalities falling into the hands of authorities – either arrested, surrendered, or killed – continues to increase. As of Tuesday, September 13, data from the Philippine National Police (PNP) showed that 16,607 drug suspects have been arrested while 1,491 have been killed in legitimate operations. 

Meanwhile, 710,961 individuals have voluntarily surrendered under PNP’s Project TokHang. Of this number, 52,744 are drug pushers while an overwhelming 658,217 have admitted to being drug users. 

There is no shortage of proposals on how government should proceed with the drug treatment and rehabilitation of drug users who surrendered. Yet, surrenderees have been engaging in various activities in an effort to "change.”

For instance, some participated in Zumba sessions in their local barangays (villages) while others just signed a statement vowing to stay away from illegal drugs.

Ideally, however, the appropriate intervention should be based on an individual's level of drug dependency. (READ: War on drugs: Rehabilitation must be more than a knee-jerk reaction) 

According to the Dangerous Drugs Board (DDB), a drug user should go through the Drug Dependency Examination (DDE) conducted by an accredited physician. It is in this exam that a user's level can be determined: (1) experimenter, (2) social recreational user, (3) habitual user, (4) drug abuser, and (5) drug dependent.

While individuals falling under levels 1 to 3 can be treated in out-patient centers where they can undergo counseling, those found to be on the 4th and 5th levels have to be admitted in residential treatment and rehabilitation centers (TRCs). 

There are various rehabilitation programs implemented across 44 residential TRCs in the Philippines. Only 15 are government-owned while 26 are privately managed. 

What happens in a day inside a private rehabilitation center? We visited Bridges of Hope, a rehabilitation center tucked in a quiet Quezon City neighborhood.

Simulated, self-sustaining

Situated at the end of a road in Quezon City, Bridges of Hope, a big white house, does not look like a temporary home of people suffering from drug addiction. 

It is one of 28 privately-managed residential TRCs that can accommodate 20 individuals at a time with separate wings for males and females. The residents’ ages range from 15 to 65. 

According to program director Guillermo Gomez, Bridges of Hope “tries to simulate a structured life” under its “eclectic therapeutic community modality.” 

The residents’ day starts at 6 in the morning. After exercising, they shower and take care of personal hygiene. Gomez explained that residents are encouraged to dress up well even if they're not going anywhere to emphasize “self-love and self-care.”

After eating breakfast, the residents huddle for the morning meeting where they talk about the day’s agenda. The agenda often includes deciding on who will take care of certain chores inside the center.

According to Gomez, residents are grouped into several departments and work to keep their minds occupied.

For example, the maintenance department takes care of fixing broken home furniture, while the stocks department looks after the food and non-food supplies inside the center.

Residents assigned to the kitchen department take care of cooking meals. They are, however, assisted by staff as they are not allowed to use knives.

“Values such as being responsible and being humble are instilled in the respective departments,” Gomez explained. “Since their ages are varied, it is not unusual that a 44-year-old will take commands from an 18-year-old. That’s difficult but they do that.”

After lunch, group therapy is conducted to “negate violence” among the residents. It's not uncommon for tension to rise among the residents too because they are, after all, human beings.  

Since violence has no place in the culture of a treatment center, Gomez said that group therapy paves the way for “feelings to be expressed” in a civil manner. 

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For example, if one did something bad to another resident and did not apologize, a “case” can be filed in relation to that incident. The group then takes up the complaint during their therapy session.

“Everybody is trained to express their feelings,” Gomez explained. “The therapy promotes a discussion. Not to retaliate, but to express feelings.”

Several other activities such as bible studies, journal writing, and art therapies are also conducted, depending on the day.  

“Everything is simulated here and it is a self-sustaining community,” Gomez said. “But of course in the beginning, residents have a hard time complying, but eventually, they learn to embrace it and love it.” 

On weekends, residents get to relax a little bit more. They wake up later than usual and read books. They also write letters to their families. At night, the residents vote on what movie to watch. 

On Mondays, they go back to regular programming which, according to Gomez, can be difficult for a drug dependent. 

“The problem with suffering from addiction is that the brain doesn’t want the pleasure to stop so the pleasure from the weekend may carry over to Monday,” he explained. “For a recovering drug dependent, that’s a hard thing to do. They don’t want the weekend to end.”

Throughout the day, as needed, residents can consult counselors, social workers, and doctors, especially when they are having a hard time.

“The people here, such as doctors and social workers, can guide them [to deal] with what they’re feeling,” Gomez said. “They can help in identifying attitudes and certain behaviors that come with the feeling.”

The length of the rehabilitation program depends on the progress of an individual. It may take as short as 6 months to one year. 

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Dealing with families

Unlike other rehabilitation centers, Bridges of Hope emphasizes the role of families in the treatment of drug users and drug dependents. 

Their involvement and commitment, Gomez said, is vital to the “success” of their kin’s program. According to the Department of Health (DOH), the current relapse rate in the Philippines stands at 20%.

Prior to admission, Bridges of Hope conducts a preliminary interview with the family of a potential resident to determine if they are really supportive and in favor of rehabilitation.

“Usually in the preliminary interview with the family, we challenge them already,” he explained. “It hurts to accept that the person fell into substance abuse so there’s a certain level of denial. So [in the interview] we have to break that already and we try to see if the family is also ready.”

The acceptance by the family of a member’s drug problem is important because they are supposed to be the source of support of a rehabilitated user who completes the program.

“We also ask [families], ‘What's your plan after rehabilitation?’ because if you're just gonna have the person rehabilitated and then there’s no plan once he goes out, it will be a problem,” Gomez explained.

“You have to remember, people suffering from substance abuse also suffer from low self-esteem and low self-confidence so they need the tools to build themselves back up so that they don't go back.”

Rehabilitation, he insisted, cannot be just a place for a family to “deposit” a drug dependent to eradicate the problem. 

“[Rehabilitation] has to be a place seen as a way to provide an opportunity to the recovering drug dependent to think how to stop,” Gomez said. “[A family]’s participation is integral because once we’re done, we’re not there anymore to see or hear.”

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Families of residents are also educated about how to handle stigma that comes with involvement with illegal drugs. 

In some cases, the heavy burden on their shoulders can affect the rehabilitation process of a family member.

“The family is the one suffering more while the resident is inside the facility,” Gomez said. 

“You will see parents not wanting to know what’s happening with their child or they’ll pull out their child, but we tell them that the fact that they opted for treatment instead of leaving the person to die, they already stood up against stigma and can be better with it,” he added.  

Private and government rehab centers

Not every drug user and drug dependent can afford the services of a private rehabilitation center, considering that the average sum needed to be admitted is at least P30,000 ($642) a month. This excludes expenses for medication.

Individuals suffering from drug addiction can also be treated in government-owned TRCs which, unfortunately, differ from the privately-owned ones. 

For one, budget and logistics issues affect government’s rehabilitation programs. In fact, according to the DDB, inadequate resources hinder the effective implementation of programs. (READ: Rising number of users seeking drug rehab is a 'happy problem' but…)

But as the anti-illegal drug campaign of Duterte continues, several initiatives are in the pipeline to improve rehabilitation programs.

The 2016 budget of the DOH allots over P900 million ($19.2 million) for TRCs. The health department also plans to build 4 centers with 2,000-bed capacities.

TRCs in every legislative district and 8 regions have also been proposed while Duterte, in his first State of the Nation Address (SONA), said the Armed Forces of the Philippines (AFP) can facilitate the preparation of military camps and facilities for drug rehabilitation. 

There are proposed bills that seek to expand the coverage of the Philippine Health Insurance Corporation (PhilHealth) to also benefit members seeking rehabilitation.

DOH spokesperson Eric Tayag estimated that only around 1%-10% of "drug surrenderees" will need to be admitted to residential TRCs. 

Given the 658,217 drug users who voluntarily surrendered, government will have to take care of attending to the health needs of from 6,582 to 65,821 Filipinos suffering from drug addiction. Rappler.com

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Jodesz Gavilan

Jodesz Gavilan is a writer and researcher for Rappler and its investigative arm, Newsbreak. She covers human rights and also hosts the weekly podcast Newsbreak: Beyond the Stories. She joined Rappler in 2014 after obtaining her journalism degree from the University of the Philippines.