In order to find out what treatment was available for addicts in the Philippines, I talked with a friend who went through treatment himself, became a member of a 12-step fellowship, worked in rehabilitation centers and got his second college degree in social work in order to help others. We spoke in person at a restaurant in Cavite Province.
Congratulations on finishing your degree. I understand this is not your first.
No, my first one was in business management. But then I got the call to get into social work. I wanted to be able to do more than I could as simply a member of the fellowship. My prior interest was just in counseling, but I was told that a degree in social work would give me more options than a degree in counseling. Actually, the course changed me. I used to think of social work as just disaster relief, but it’s much more than that. It centers in social functioning for individuals and then helping and empowering a community. Actually, part of it is pushing for reforms on a bigger scale, not only locally and nationally. It opened my mind and made me look deeper into myself.
Here government agencies are not very well supported by the local and national government. For example, here in this city, I was devastated to learn that people can’t get help if they’re not registered to vote.
So if you need food to feed your family you have to be a voter first?
They don’t give out food, but they give out educational assistance and medical assistance and so on to people with disabilities, senior citizens, and indigents. I don’t know if this is true, but I heard that even the government hospital here requires a voter’s certificate. But I would have to verify that. I have seen even the barangays [local districts] require a certificate before they dole out any kind of assistance. It’s very political. I am sure there are ways to get around it, but that’s the rule.
I’ve heard also about vote buying.
That’s a way of life here. People love the election period because they get freebies, like rice, tee-shirts and money. If one group gets caught, it just means local police are siding with their opponents. Last night there was a raid on people who were suspected of vote buying. The police found envelopes containing 200 pesos [$4] each, a total of 75,000 pesos [$1,442]. The police supported the other side, another political family.
Vote buying has always been a part of Filipino culture, which for a social worker is very sad. The patronage system seems to be really ingrained. The culture emphasizes putting your family first, excluding the good of the whole. So if this particular politician gives something to my family, that’s who I’ll vote for, even if he’s extremely corrupt. How can you change that? I don’t know where to start. We have a lot of work to do as social workers besides helping those in need. Changing the political system is probably a pipe dream, and yet, something’s got to give.
So how has social work expanded your thinking?
If I am going to help people empower themselves, the system they find themselves in is a big part of that. Social workers work in agencies. If the system is really corrupt, the agency is rendered ineffective. I was thinking of going to work in the private sector, for a foundation, but that can also be difficult. At a government job I’d have a better chance of making a difference, but they don’t pay much. A supervisor gets about 40,00 pesos [$764] a month. That’s not too bad, but still… I have family obligations. What I really want to do is work with addicts.
You worked in a rehab in Hong Kong, right?
Back in 2010, I worked in a 12-step rehab in Hong Kong. It was a small-time operation on a ferry which had been converted into a sort of yacht. The first deck was sleeping room, the second deck was the counseling rooms and a private area and on the third deck we had an open area which can be used for dining or other activities. I think the boat could accommodate ten residents, but the most I remember having was about six. The price was two thousand Hong Kong dollars a day—roughly 12,000 pesos or $240—with a month’s charge payable in advance.
That’s a lot.
Right. The residents were mostly expats. The facility didn’t skimp on food. If a place calls itself a retreat for recovering people—kind of a resort—rather than a rehab, it doesn’t need a lot of government licenses and permits. You just show that you have good plumbing and sanitary control and that the kitchen is approved. So you can see the big difference. Here a lot of facilities call themselves retreats rather than rehabs.
There are different kinds, right?
There are 12-step facilities which don’t lock the patients in and one I know of that does. That one has a very good success rate, from what I’ve observed. I think the minimum stay there is three months. ’I’m the product of a 12-step rehab which does not lock people up. The first day of my stay there we watched a movie in a mall. We went outside to fellowship meetings and stayed at the facility during the day.
One thing that’s important is building trust. In my experience, 12-step program sessions with the counselors are kept confidential. With other programs it may be different.
For readers who may not be familiar, can you go through the steps and explain/tell me what happens with a recovering addict?
Basically, the first three steps are just an admission that you have a problem and that you can’t fix it yourself, that you have to ask for help, and that you have the willingness to go through the program so that you can find relief from your addiction. The next six go through your past and find out what really is inside you as a person—what’s wrong and what’s right. The idea is to find out the root of the problem and solve it and make amends. So you clean house.
The goal is a personality change?
The goal is a spiritual awakening. A personality change is the by‑product. And then the last three steps are just the maintenance steps so you can continue to develop yourself spiritually. That’s my take on the steps.
I have been through the steps four times, not including twice when I did the Back to Basics program, which goes through the steps 1 to 9 really fast, like in a day or over a weekend. I think the rationale behind that is to jumpstart your recovery.
What’s the difference between the 12-step facilities and the others?
I guess the difference is in the client’s willingness to change. The 12-step people stay there because they want to stay there, and they have a choice to either stay or walk out. When I went in I was already very willing. In the other kinds of facilities most of the patients do not even realize they have a problem. If you ask them, they say they don’t.
Some are put in there by a court order and some—why—because their families put them there?
The families might put them in there, but a lot of rehabs require a court order.
I took the group part of my practicum in a therapeutic community, or TC. It was a bit of a culture shock since I am a product of a 12-step rehab. There the minimum stay is a year.
In some TCs. there may be less shaming than in others, but there’s still a lot of ego-busting going on. I don’t know if I would have recovered in that kind of environment. I think their attrition rate is a lot higher than most 12-step communities, but that may just be my bias.
Again, for our readers, can you explain what’s going on with the shaming and ego-deflation?
Almost all of that is based on correcting behavior. So peers are encouraged to confront other clients for even the slightest misbehavior, like dragging your chair when you get up from the table instead of picking it up with both hands. Then you’re confronted. If you leave clothes on your bed, you’re confronted. There are consequences—punishments—for that. Sometimes the clients themselves have a choice of what consequences they think their actions deserve, but most of the time they don’t.
So what happens if you leave clothes on your bed?
You have to clean part of an area or write announcements on the board, tasks like that. But for more severe infractions there are worse punishments. There are seven basic no-nos like sexual activity—even just holding hands–or running away or of course using drugs or alcohol. For those you’re isolated for the rest of the day or the rest of the week. Eventually you’re confronted, but most of the time you just sit there watching the others. No one is allowed to talk to you. And of course you’re trashed by a group of peers who each tell you off.
Now, let’s get into the supposed good results of shaming or the heavy criticism. What’s the intended result? To break down someone’s ego? Don’t addicts already have a problem with low self-esteem?
I think “criticism” is a better term, yes. It’s meant to make you realize that you are not the most important person in the universe and that you should contribute to society and follow society’s rules. Addicts have low self-esteem but are also very self-centered. For a lot of people it takes two, three, four times—that’s about four years—before it sinks in. I’ve never met anyone who went into a TC just once and reformed. It normally it takes two or three times. There are programs I’ve heard about where “Face the wall” is the most common consequence. That’s for a minor infraction. That’s the culture here. I don’t think that would work in the States.
No, not for a day. What do you suppose is the difference here? Asian cultures are called “shame cultures,” as opposed to “guilt cultures.”
Back in the States people know their rights and are not afraid to voice their concerns. Here we’re more subservient, and we normally try to avoid confrontation. So it takes a while to root out what the obvious matters are. Some people have been in the system for so long that they are actually getting to the root of their being.
And you’re subjected to this for a year?
Yes, but at about nine months you’re slowly reintegrated and allowed to go home with a chaperone. On the first weekend for about twelve hours, then the next three times for 24 hours, the next three times for a couple of days until you finish your year.
And so the chaperone comes with you?
Yes, for the first few times. If it’s decided that you can do it on your own, then you’re allowed. A lot of people don’t come back after that—about 50 percent.
I wonder why.
The staff are graduates of the system—the facility director, the program director and the counselors and the peer counselors or peer coaches—all of them have been through the system, so they are very practiced in the techniques they’re using. When I was in rehab I was full of bullshit, but I had a counselor who made me face up to that.
What makes the difference is the client’s willingness to work the program and the choice of programs. In my case, I don’t know how much a difference it would have made if I’d been in a different facility or maybe I say that because I do get where they are coming from.
I think the weakness of the therapeutic community I worked in was that there was only one social worker. She was fairly new when I left. None of the treatment programs I saw had a strong family program. We say addiction is a family disease, so you have to include the family in the treatment.
So the program consists of shaming and what else?
Ego-busting and lectures on coping tools like anger management or how to plan your life. They also have individual sessions. One particular session that I like is where the clients are encouraged to dump their guilt without consequences. During these huddles their peer coaches (who act as their counselors) are present and they, in turn discuss among themselves about the things that went on in that session. Well, let’s just say everything there is everybody’s business.
Why don’t you tell me about someone you helped in your social worker guise?
I haven’t started practice yet. I still have to take the board exam. But I can tell you about a client who was assigned to me in the rehab. As I said, the rehab didn’t focus on the family, although in this case the family was crucial. This was an eighteen-year-old whose mother had him locked up in a rehab whenever they had a disagreement. He’d been thrown into the rehab for four years, so since he was fourteen. So I interviewed his mother and got a lot of information. The boy doesn’t do drugs, but he probably has a marginal problem with alcohol. It was clear to me that it was the father who was the drug addict and that both mother and son had been traumatized. So I wrote up a report which I believe helped change the course of the treatment. The boy blames himself for not concentrating on schoolwork, but I believe he’s dyslexic. He has ADHD as well.
That’s an example of how a social worker can change the course of a program. But in the eight weeks I worked in the therapeutic community, there was only one social worker for forty clients.
Then there was another case of an addict who was emotionally unstable and given to temper tantrums and all that. In the past his wife always gave in to his demands. During his treatment, I learned that he was never given any responsibility. Through his in-laws, he got a job as a government worker, but he didn’t show up for work regularly. He was just given a salary, which went to drugs and gambling. I interviewed his mother and his wife and explained what addition was and how they were contributing to his disease. I think they took it to heart, but the result remains to be seen.
The social worker looks at all aspects of the client’s life to determine where the problems are, why he’s back in the treatment center again and what could bring him back in the future—what needs to be changed. That includes the co-dependents, who could very well be contributing to the problem. I haven’t heard of a government facility with a family program. At least a therapeutic community will have periodic seminars about addiction which are open to the co-dependents. The 12-step rehabs have family therapy, but it’s usually aimed at improving relations between the clients and the family, their partners and their children or parents. It’s really hard for a codependent family member to admit that they have a problem as well.
Besides the 12-step and therapeutic community facilities, what options are there?
There’s also Christian recovery facilities, which incorporate Christianity with the 12 steps and other modes of therapy. They have a lot of good recovery and a good success rate. A program director for one of these facilities is setting up a fellowship now for graduates of the program. I first heard of the program when through Hospitals and Institutions outreach for the fellowship. I guess it was about three years ago that a graduate of a Christian program started an interdependent meeting of the fellowship.
You want to talk about surrenderees?
I can only talk about my own personal views on this. Our local meeting has six members who were surrenderees. Having these newcomers is good for us. So what does this mean? Well, the Duterte administration has launched an anti-drug campaign in which people who are known drug users have been forced to surrender and register themselves. A lot of local governments have been organizing community-based rehab programs. They’ve been marginally successful because a lot of people have been scared into them, but they can’t take in the huge volume of people who need help. The government drive served, among other things, to identify the extent of the problem.
As you know, in the Philippines, unlike in some enlightened places, drug use is still seen as an immoral activity. Here the disease concept of addiction is not yet generally accepted. But a lot of people are heavy users, and a lot of them really need to be in a facility, and even the less severe cases need to go through some kind of program in order to recover.
In response a lot of new programs were initiated. Some are faith-based, some are run by addiction specialists and some are without a specific approach. One town I know of set up a city-wide, 45-day program with six groups, each with 40 people or more. The addicts were encouraged to go to meetings. As far as I know, only six individuals are showing up at meetings—so perhaps actually recovering. That’s a really low rate.
Because some of these programs are not run by people with expertise in the area, a lot of the addicts still drink. When they come to meetings, it’s clear no one had told them alcohol is a drug. We tell them that even though they’re drinking they should come to meetings. If they want to stop they’re welcome. Their presence helps us. We have a saying that we only keep what we have by giving it away—by helping others. We share our experience with them, and that keeps us honest. I believe that’s how doing outreach helps us.
In the Philippines the demographics are changing, especially in Mindanao and Visayas. It used to be just the affluent or the middle class who were recovering, but now it’s those with less money as well. Our local group has been successful with those new members who are willing to work. There’s a probation officer in the social work department of a nearby town who believes in the fellowship and she refers people to us. Unfortunately, the local health and welfare authorities are apparently not interested in referring people. We have approached them and offered to make a public presentation, and we got no response. But people from two nearby towns are coming to meetings.
Why do you think the demographic is changing?
Because of the Duterte drug war. A lot of addicts are being forced to come out in the open in fear of their lives.
I was told some time ago that 12,000 people had been shot and that the police had stopped keeping records.
That number seems close to the figures I’ve seen. I suspect that records are still being kept, just not reported. Personally, I find it very sad. People don’t need to die, and an administration that does not respect human life…well, what then can we expect them to respect? I don’t understand why this drug war is popular with a lot of people. The hold it has on them seems to come from previous frustration about the drug problem and relief that something is finally being done about it. Still, I have to work within the system, both as a social worker and as a trusted servant of the fellowship.
And now this: Last Week Tonight on drug rehabs in the US (Link)