LET’S pretend, for a moment, that the issue of extra-judicial killings is not threatening to define the Duterte administration’s campaign against illegal drugs.
Let us instead focus on what to do with the many who have fallen prey to the drug menace and found themselves hooked to a habit that has destroyed their lives, frustrated their families, squandered their resources—and, for some, led them to a life of crime.
The business of rehabilitating drug dependents has been an old one, but it has taken center stage anew with the thousands of drug users who have surrendered during the first two months of President Rodrigo Duterte’s rule.
Photos of drug dependents who have surrendered and who are cramped in our already-crowded jails have circulated social media, raising the issue of where they will be made to stay and how they could be effectively reformed into productive members of society again.
There is also the question of drug dependents belonging to middle-class and affluent families who, it appears, have yet to be reached by Duterte’s war on drugs.
There have been proposals to build more drug rehabilitation centers to accommodate the growing number of drug dependents who have surfaced. Some big names in business have offered to do their share. Putting up more centers through public-private partnerships has been raised.
But what is it like to establish—and run—a drug rehabilitation center?
Junjun Gonzales and Ces Casas Gonzales, who have been in the business of providing treatment to those with substance-related disorders since 2004, among others, say that the top issue in running a rehabilitation center is not how many people you can take on, but how strictly you comply with quality standards.
The husband-and-wife team assists Junjun’s father, Rudin Gonzales Jr., in running The One Algon Place, a fishpond property-turned-rehab center in Barangay Mamatin, Cabuyao, Laguna.
“We have seen drug dependents from all walks of life come in for treatment, sometimes voluntarily, more often not,” Junjun said.
According to Ces, when they began in 2004, there were about 77 rehab centers across the country. “Soon after, the Department of Health issued its accreditation standards, and the number of centers dwindled,” she said.
What the law says
The treatment and rehabilitation of drug dependents in the Philippines is governed by Republic Act 9165, otherwise known as the Dangerous Drugs Act of 2002. Article VIII of the law outlines the provisions under voluntary submission and compulsory confinement of drug dependents in rehabilitation centers.
Among the salient points of the law:
Voluntary submission to confinement, treatment and rehabilitation may be done by the drug dependent himself/herself or through a parent, spouse, guardian or relative within the fourth degree of consanguinity or affinity;
Application shall be made to the Dangerous Drugs Board, which would in turn bring the matter to the attention of the court.
The court will then order the indivudual to be tested by a Department of Health-accredited physician who will issue a certification that the applicant is a drug dependent. With this, the court will order the applicant to undergo treatment and rehabilitation in a center designated by the DDB for a period of not less than six months.
Upon certification by the accredited doctor, the court orders the release of the drug dependent on the condition that he or she report to the DoH for after-care and follow-up treatment for a period not exceeding 18 months. After this period, the dependent may be certified rehabilitated and discharged by the court.
Judicial and medical records will be confidential.
Compulsory confinement of a drug dependent is also allowed. The Dangerous Drugs Board or any of its representatives may file the petition for confinement of any person determined to be dependent on dangerous drugs before a Regional Trial Court.
The parent, spouse, guardian or any relative within the fourth degree of consanguinity of any person confined through voluntary submission or compulsory submission program shall be charged a certain percentage of the cost of treatment and rehabilitation. Guidelines for the cost sharing will be determined by the economic status of the family.
The treatment and rehabilitation centers for drug dependents shall be operated, maintained and managed by the Department of Health.
A family enterprise
Junjun’s father Rudin, the fourth of 10 children, was born poor but persevered in his studies and became a steel trader. His business took him to many places around the world, but also exposed him—through the children of friends, associates, and people in his network—to the ills of drug abuse. When Rudin was diagnosed with a debilitating muscle disease, he decided he would start an advocacy. He started The One Algon Place—with Algon standing for Almendral and Gonzales, the last names of his parents.
Junjun and Ces, who now help in the day-to-day operations of the center, say that the most important part is providing the “student”—what they call the drug dependents put under their care—with treatment in four aspects: biological, psychological, social and spiritual.
To be sure, the care is not cheap. Aside from the maintenance of facilities, the center has to pay for medical doctors and other DoH-accredited practitioners, licensed psychologists, house parents (psychiatric caregivers).
Payment scheme is in brackets depending on the financial capacity of the “student.”
Somebody in Bracket A pays, for instance, anywhere between P45,000 and P80,000 a month, not including the cost of doctors and medicines. Bracket B is P35,000 to P40,000. Bracket C, P15,000 to P25,000 a month. A “student” who falls under Bracket D does not have to pay anything at all.
“Ideally, for every 25 paying students, we can take one for free,” according to Ces. Of course she concedes the fees are lower for government-run centers.
“We don’t really think of what we do as a business. The aim is just to make our operations sustainable. We get people who can pay and then, give some back, too,” according to Junjun.
The Gonzaleses say The One Algon Place has two licenses: first, as a drug treatment and rehabilitation center, and second as a psychiatric facility.
“Sure, there is treatment for drug addicition,” says Ces. “But what about those who are drug addicts AND who also suffer from mental problems?” Many of the rehabilitation centers only cover drug addicition.
Standards are key
The Dangerous Drugs Board has issued a manual of operations for drug abuse treatment, serving as “standard reference material to aid administrators and practitioners in the management and operations of the different drug treatment and rehabilitation centers in the Philippines.”
The manual, available online, presents the minimum standards for facilities, services and resources recommended by the DoH. These will be used as a basis of accreditation of treatment and rehabilitation centers in the country.
The requirements vary, depending on whether the center is non-residential (outpatient) or a residential (in-patient) center.
For a non-residential center, there has to be one part-time DoH-accredited physician, one licensed nurse, one part-time licensed social worker/psychologist, and one clerk.
For residential centers, there must be one center program director or administrator, one on-call DoH-accredited physician, one on-call licensed dentist, one licensed nurse/midwife for every 50 patients, one licensed social worker for every 50 patients, one licensed psychologist for every 50 patients, one clerk for every 100 patients and four non-professional staff for every 100 patients.
The manual also itemizes the equipment and instruments needed for either the outpatient or in-patient center. The center must exclusively be for the treatment and rehabilitation of drug dependents. Outpatient centers should be at least 25 square meters for the business area, consultation examination and treatment, toilet with lavatory and a multi-purpose area.
Meanwhile, in-patient centers must have an area of at least 400 square meters for 30 patients.
Size should be adequate for intended use, the building should meet construction and safety standards, must have one bathroom/toilet/lavatory for every 10 patients, and kitchen and dining area should be clear. For those with bedrooms, beds should at least be 1 meter apart. If a double-decked bed is used, there must be at least one meter between the ceiling and the upper bed. The same one-meter distance requirement holds between the upper and lower beds.
Among the services to be provided by drug treatment and rehabilitation centers are medical, psychiatric, psychological, social service, spiritual and religious service, referral service, sports and recreation, residential and house care, and after-care and follow-up.
Additional services include placement series, volunteer services, educational opportunities.
Therapeutic activities include psychotherapy, counselling, individual therapy, group therapy, family therapy, community work projects, sheltered workshops, and social reintegration.
As good as new—almost
Ces and Junjun would be the first to admit that a drug dependent cannot be restored fully to one’s original state, despite the most earnest of rehabilitation work. “When a person becomes addicted, the anatomy changes,” he says. “It’s like a mirror, or a glass. You can try to put them back together, but there will always be that imperfection when you look more closely.”
The most difficult part of the process, they say, is treating somebody who does not wish to be treated. Often, their “students” have to be picked up against their wishes.
It could also be difficult for the men and women who work at the center. Despite the fact that the professional and non-professional staff received ample training for their jobs, it could be difficult, at times, to isolate themselves from the issues confronting the students they deal with. Often, they find parallels between the students’ lives and their personal situations.
But there are success stories that push them to try harder, every day, One former “student” was a woman, abandoned as a baby by her parents, grew up in the slums picking garbage for a living, and who ended up in drugs and prostitution. She was introduced to the center by her foreigner boyfriend who was himself a student there.
To be sure, the process was never smooth. The woman tried to escape rehabilitation a few times—but always returned. These days, Ces says, she remains in touch with them, and has made a living supplying soaps and other products to motel chains and other establishments she had dealt with in her life before rehab.
Not all rehabilitation centers are created equal. Some existing ones barely comply with the requirements and place emphasis on housing a specific number of patients instead of giving them the quality they need. Others look upon treatment and rehab as an advocacy—a calling to respond to as a way of fulfilling a role in society.
Whatever their view, the fact is that establishing a rehabilitation center is no joke. It’s one thing to build the structure, and quite another to run it from day to day. That takes more than just sweeping declarations about fighting the war on drugs. It takes, instead, painstaking commitment, affirmed day after day.