Advocating an altruistic and holistic approach to addiction treatment
DR. Alfonso “Ponch” Villaroman was on his way to becoming a surgeon, but thanks to “a series of fortunate events,” as he puts it, he found the path toward Addiction Medicine, which to date has made him Chief of the Department of Health Treatment and Rehabilitation Center (DoHTRC).
He admits he had a vague career plan when he was choosing specialties. Whereas surgeons then could easily dream of becoming a chief surgeon at a hospital, becoming the top doctor at a rehabilitation center seemed more unlikely. Why? In the early days, doctors were of the belief that treating any addiction — especially drug addiction — was best left with law enforcers since it is not a disease but a “malady of society.”
Nevertheless, Villaroman had been drawn to the challenges of mental health, choosing, in fact, a Bachelor of Science in Psychology degree from the University of Santo Tomas as his pre-med course. And when his residency exposed him to addiction treatment in 1994, he never looked back.
“It’s about finding your niche, and this is my niche. I could have earned five times more as a surgeon, pero natali ako sa gobyerno. At nag enjoy din ako,” the 61-year-old doctor shared with a good-natured laugh during a sit-down interview with The Sunday Times Magazine at DoH-TRC in Bicutan, Taguig.
In the mid-’90s, Villaroman joined the National Bureau of Investigation since government-operated drug treatment centers were still operated by either the NBI or the Philippine National Police back then.
But with the amendment of Republic Act 9165 or the Comprehensive Dangerous Drugs Act of 2002, drug treatment centers operated by the government were finally transferred to the Department of Health.
“As early as then, the government already saw addiction as a medical problem or health problem that needed to be addressed,” Villaroman conveyed.
First assigned to a NBI in Tagaytay, he soon worked at East Avenue Medical Center’s central screening unit for drug dependence before eventually transferring to Bicutan’s main treatment facility.
From then, Villaroman rose up the ranks and, from Medical Officer 3, became Division Chief, then Chief Health Program Officer, finally assuming the center’s directorship in 2016.
Somewhere along the way, Villaroman also made time to become one of 33 founding members of the Philippine College of Addiction Medicine, comprised of the country’s most competent doctors in addiction treatment and rehabilitation.
“Ang pinaka importante dito, nagkaroon na tayo ng evidencebased, scientific, researchbacked, cutting-edge and modern, so to say, methods treating patients with addiction problems.”
A humble leader who would rather focus on educating the public about addiction rehabilitation than going into his stellar and storied career, Villaroman enthused about the positive evolution of treatment in the Philippines.
“Right now, we’re probably even ahead of other countries in Asia. I compared all treatment modalities in the region, and all are either handled by the police or military and consider drug dependence as a crime regardless.
“Sophistication-wise, with modern technology, probably we’re behind. But when it comes to treatment theory, philosophy, I think we’re ahead because we use scientific methods,” the expert proudly noted, adding that soon the center will be offering the first residency training program in addiction medicine in Asia.
So how exactly did the Philippines adopt a better system of addiction rehabilitation? Why should substance and alcohol-dependent Filipinos seek help without fear? And where is the country headed when it comes to the fight against addiction?
All these and more the hardworking and grounded Dr. Ponch — as his loyal staff would call him — answers in this interview.
The punday Times MagazineW How do you define addiction?
Addiction is very complex because there are too many things involved. Despite repeatedly getting in trouble with the law, you still use drugs. Despite knowing you will die because you’re getting sick from using drugs, you still use them.
What addiction treatment method, specifically drug dependency, was practiced when you first entered this field? How did it change?
The treatment for drug dependents was more draconian than anything else because, like I said, they saw addiction not as an illness but as a malady of society. The victims of which were people that needed correction and character discipline.
The pathway to treatment used to be arduous, like a boot camp. But as we went on, studies were made abroad, and we discovered that this brain disease can be treated.
Nagkaroon ng paradigm shift towards the disease and the principle in treatment — you have an illness, you try to find ways to correct them. The approach suddenly became bio-psychosocial, and there was a need to capacitate people who did the treatment.
Again, addiction treatment is very mental and very cerebral. It does not involve the doctor alone. There is a staff with you — psychologists, nurses, social workers, door managers, and house parents. But the most important member of this group is the patient. The family is also part of the team, but the patient is more important.
So when you make a treatment plan, you keep the patient in mind. You just don’t tell them what to do — that’s not treatment. That’s puppeteering a person to hope for recovery. It never works.
Those are just elements of recovery. We have programs that are no longer confrontational. Whereas before, talagang confrontational na sinisigawan ka, now, we have shifted to more humanistic, more logical means.
How can addiction treatment help patients?
Recovery should not be a painful process. Recovery should not be fraught with barriers and layers. Recovery should be something where you gain an education and a skill. Recovery should be a process where your selfesteem is elevated so you can go back more confidently and heal relationships. But most importantly, recovery should be fun. That’s my mantra here.
Our goal is to maintain them sober, to keep them sober for the longest period possible. Whether they become sober forever, it’s not an assurance basta importante sa amin, kung ano man ang mangyari sa inyo, nandito pa rin kami to intervene and help you. That’s the essence of addiction treatment.
And there is no bigger satisfaction you can get pag na-elevate mo yung pagkalugmok ng isang tao sa drugs, when you give him back his chance to earn money, to have a relationship with his family and God.
For those not familiar with this medical specialty, what makes it even more challenging to treat?
Addiction is different from any other disease. If I have tuberculosis and I take the medicine, I’ll get well even if I don’t want to get well.
In addiction, it’s different — you have to want to get well. And there lies the challenge, how do you make a person want to get well?
One, addiction treatment should be something where a patient comes in and he or she hears problems.
Here, you not only get reassurance, counseling and other things that you need. You’re also given the skills for surviving. Like you go to school, you attend a technical course, for example. We have TESDA [Technical Education and Skills Development Authority] and K-12 schools here. That’s why we also have ALS [Alternative Learning System] school here. Kasi importante ma-arm sila with education.
You have to improve their self-esteem. If you give them employment or skill, their self-esteem is elevated. Plus, you deal with people in a nonconfrontational way.
Why are a lot of patients addicted to drugs still afraid to come here?
Because humans fear the unknown. What’s the first thing you do? You show them everything and assure them that no harm can come to them.
What does modern treatment look like, and when can we say a person is already healed from addiction?
We have patients here from all walks of life. Walang pinipili ang droga — the effect is the same. When you become dependent, the vortex is the same, traveled by each patient.
Ang purpose naman ng mga programs ay dudurugin namin ang dating pagkatao, titibagin namin and then, with the patient, help them build themselves up again.
We treat them how to be normal. In Gestalt psychology, people are given a set of behaviors deemed normal, and he is made to act out that behavior daily.
For example, waking up early, exercising, cleaning your bed, brushing your teeth, washing your face, having breakfast and then talking, and discussing the upcoming day. Whenever they do these — nagiging part na ng personality nila yan.
You see, with addicts, especially drug dependents, when they wake up, the first thing they think about is where will they get their drugs?
It’s an exaggerated scenario, but that’s basically how the psyche of an addict will work because he’s conditioned to be that.
Because those who use drugs develop tolerance so there will come a point when you have to take drugs just to feel normal. That’s tolerance.
Basically, recovery is different in pace but similar in phase. So they have to go through all of that.
We’ve heard of relapse among patients. Why does it happen, and what does it indicate?
The problem with relapse is sometimes because of the cravings. And what triggers cravings? People, places and things that you were used to when using drugs or other substances. So you have to break that cycle. You have to get new people in your environment and acquaintances, and you have to avoid a place where you know you will get a hit.
But more importantly, if you cannot avoid it, you relate. You talk about it. That’s why you have groups. Putting them all together will probably increase your chance significantly of picking up again.
But for me relapse, it doesn’t happen overnight — it takes a series of lapses, and eventually, you get into the relapse mode.
You don’t become an addict overnight, you don’t get well overnight.
If a patient relapses and comes back, for me, that’s a success. Why? Because he came back, because he knows that if he comes back, there’s a chance for him to get well.
When do you fail in treatment in addiction?
Dalawa lang naman yun, pag namatay ka or nasira ulo mo na hindi ka na pwede gumaling. Pero hangga’t buhay ka, pwede ka gumaling. So he held on to that lifeline, no matter what happens.
What are the challenges of leading a facility in the Department of Health Treatment and Rehabilitation Center?
First, motivating the staff to do their job because this is a very thankless job. Second, probably the budget. We understand what the government gives us and we try to make do with what we have, we really try and nagagawa naman namin and the government naman is not selfish. Pag humingi kami, they also provide.
But the biggest challenge for me is to change the mindset of people, not only the government but also the general public.
Since starting this advocacy, do you feel the general perception has somehow changed toward drug addiction?
I would believe so. A lot of people now listen with the help of social media, the help of tri-media. Noong araw kasi, hindi naman tayo in the limelight. We were brought in the limelight during [former President Rodrigo] Duterte’s administration, which was a good thing for us because it gave us the chance to prove our mettle. Duterte was right, dahil sa ginawa nya, napakaraming humingi ng tulong.
People had the initiative na magpakita, magpaggamot. When they come, we start reassuring, motivating and empowering them. That was the positive effect for us. We cannot do any intervention if they are not here.
What’s your biggest dream for the center?
I would want a very beautiful and efficient pipeline for managing/treating patients from the community down to the center and back to be fully established. We’ll get there. How long? I don’t know. Will we be alive? Probably not but we will get there slowly.