A SECOND CHANCE
Talisay City’s outpatient rehab center gives drug dependents unlimited chances to seek help Cooperation of agencies and government offices secret to success of rehabilitation program
In the Talisay City Hall, in a room barely 40 square meters in size, broken lives are mended and made whole again.
A chair; a place to meet and talk; white boards for tracking sobriety, but also for imparting valuable lessons on life are the simple tools the Talisay City Outpatient Rehab and Aftercare Program use to help drug dependents get clean and start over.
“We're doing the same things they're doing in rehab, but on an outpatient basis. Normal rehab is residential, but we believe recovery is basically in the real world,” said Dr. Rey Cesar Bautista, head of the Talisay City Health Office's Rural Health Unit 1.
The idea was born in 2012 in the Talisay City Health Office under Dr. Lino Alanzado and the social welfare office under Felipa Solana, and the program started in 2013, he said.
Under the program run jointly by the two offices, the City Health takes care of the manpower, while the social welfare office provides the funding and social services.
“The program is based on the premise that drug addiction is a health problem. It is not a problem of morality. Drug addiction is a chronic and relapsing brain disease. That is a scientific fact recognized by the World Health Organization, so the treatment should be medical,” he said.
Treatment period
The treatment program is three months. Why 90 days?
“Methamphetamine addiction destroys the dopamine regulatory center of the brain. So if you can have an addict off the drug for 90 days, there's a big chance he will continue to stay sober. The relapse rate will be lower,” Bautista said.
“The pathology of addiction is that with the constant use of drugs, you've already forgotten how to have fun in life without the drugs because the basic chemical regulatory system in your brain already went haywire due to the use of artificial means (to feel good). In our experience, it takes a minimum of 90 days to restore the normal chemical balance,” he said.
The 90 days is just to stabilize the brain. They still have not been cured, he said.
Republic Act 9165 or the Comprehensive Dangerous Drugs Act of 2002 mandates at least six months of intensive residential care and 18 months of aftercare.
“But we don't have the luxury of putting them in a place. So we just tried this 90-day program. Once they enroll, we start counting the number of days they stop using drugs,” he said, pointing to a chart on a white board on one wall of the room.
Of the more than 50 people currently undergoing the program, some have been sober for as long as two years and 10 months, determined by the results of the drug tests they are subjected to twice weekly. If a person tests positive on the drug test, he goes back to Day 1 on the monitoring chart.
Cost-effective
Bautista said this is where the budget of the City Health Office goes: to the P40 drug tests. At twice a week, this would total just P320 a month, which is more cost-effective than sending an addict to a rehab center at P8,000 to P25,000/month, “achieving the same effect, which is to monitor their sobriety.”
“Our original mission was to help those coming from the government rehab centers in Argao and Eversley in the 18 months of aftercare. But the others did not go to the rehab center anymore. They came straight here,” he said.
Cebu's two government-run rehab centers are the Department of Health's Treatment and Rehabilitation Centers in Argao town (for males) and in the Eversley Childs Sanitarium compound in Mandaue City (for females).
Coleen Enajada, social welfare officer 2 of the Talisay City social welfare office, said her office provides funding for the medicines not available in the City Health Office and subsidy for those needing residential rehabilitation, which it has been doing even before President Rodrigo Duterte's administration began its war on drugs.
There first
Talisay City, Cebu is one of the five pilot areas in Central Visayas (the others being Cebu and LapuLapu cities and Minglanilla town in Cebu, and Dumaguete City in Negros Oriental) for the Department of Social Welfare and Development (DSWD) 7's first program for recovered drug dependents: the Strategies Toward Acceptance, Reintegration and Transformation of Poor Recovering Drug Dependents (Start).
Talisay City's success under Start may be due to the fact that the city's own program pre-dated Start, which began only in late 2014. Bautista said it had already cultivated a network that made it easy for the City Health Office to call on the parties needed to make its rehab program work.
“If a parent comes to seek help for a child, and the child is violent and refuses to come to the center for the assessment, we go to their house. We have close coordination with the Philippine National Police. They escort us there,” Bautista said.
If Bautista assesses the person to be in Stage 4 of drug addiction, he has the person committed to either the government-run center in Argao town or either of Talisay's two privately run rehab centers.
Another advantage of Talisay City is that it has a Department of Health (DOH)-accredited physician in the person of Dr. Bautista who can diagnose drug addiction.
“According to Republic Act 9165, before you enter rehab, you need to be examined by a DOH-accredited physician in the treatment of drug abuse. There were only 118 of us nationwide in 2013,” he said. The doctor conducts the Drug Dependency Exam, the evaluation of whether
a person needs rehab.
Talisay's outpatient program accepts Stage 1-3 addicts. Most of the addicts seeking help there voluntarily walked in, some because they had tested positive for drugs at work and their companies would not let them return to work if they had not been rehabilitated.
Bautista estimates that the city's aftercare center has helped 200 people since 2013, of whom about 100 show up during reunions.
“We are using these recovering drug dependents as recovery coaches. They share about what they went through,” he said.
“We believe in recycling,” he joked.
Recovery program
The Talisay City's program involves activities from 8 a.m. to 5 p.m. The social welfare office provides for the lunch.
On Day 1, the drug dependent says his name, the drug he is addicted to, and then the other people in the room (around 4050 per session) clap for him, signifying that he is not alone.
There are 12-step fellowship meetings for long-term sobriety. During these meetings, the drug addicts share their issues and how they dealt with them.
The 12-step program is a program of Narcotics Anonymous for recovery from the effects of addiction. It is founded on the premise that recovery takes place one day at a time under the guidance of a higher power, which refers to anybody who you believe can help you, Bautista said. But for that higher power to work, you would have to practice the 12 steps.
“We teach them coping skills, telling them it's okay to not be okay. They write in their journals. They hear lectures on why they became addicts. They are taught the physiology of addiction,” he said.
Physical fitness is part of the program, and they currently have yoga classes, with the yoga instructors first subjected to a drug test by Bautista to ensure that they are not drug users.
There are also meetings for the co-dependents, like their parents and spouses or partners.
All these are given free, including the drug tests.
Work
“Because of the Start program, if they are clean for 90 days, we can give them cash for work,” Bautista said. “The reason we give them work is to give them an idea what it is like to work. It is to give them structure. They learn to wake up early. It is not our job to give them livelihood.”
The work program is dependent on their continued sobriety. Those who relapse are removed from the cash-for-work program. Cash-for-work programs typically run from 22 days to three months.
As for finding more permanent jobs after rehab, he said that usually, they were able to find work on their own. “They have become productive members of society.”
Enajada said Talisay's social welfare office provides livelihood training to the drug dependents and capital to their co-dependents. The Talisay City Livelihood Training Center, registered with the Technical Education and Skills Development Authority, offers training in welding, housekeeping, culinary arts, beauty care, carpentry and plumbing.
“That's the strength of Talisay's aftercare program. The social welfare office, City Health and the rest of the agencies are marching to the same rhythm. There is a convergence of interests,” said Bautista, who gave credit to Talisay City Mayor Eduardo Gullas for his strong support for the rehab program.
The center does not track the addicts after they leave the center, but Bautista said that sometimes they can find out through the grapevine that a person is on the verge of a relapse because of discernible behavioral patterns like lying about his whereabouts.
“We immediately intervene. We do counseling, telling them, ‘Do you really want to go back to your old life?' We give them an unlimited number of chances to come back,” Bautista said.
Tokhang
Talisay's orientation is not geared toward the mass surrenderers under the Philippine National Police's ( PNP) Project Tokhang, but to help people who want to be treated, Bautista said.
Tokhang is the project to knock on the doors of homes of suspected drug users and pushers to persuade them to surrender. But most of those who surrendered did so out of fear of being killed by police if they did not acquiesce. They were made to sign Voluntary Surrender Forms.
The city's Tokhang surrenderers are still being processed by the barangays where, Bautista said, it was even difficult to make them attend barangay meetings. He knows this because he sends his recovering drug users to these surrenderers' meetings to inspire them.
What the center has now are minors apprehended during buybusts. Instead of bringing them to prison, the PNP brought them to Bautista.
“You cannot force an addict to stop using,” he said. The deci-
sion to change would have to be voluntary so he would succeed in rehabilitation.
Asked to share success stories, Bautista said, “Each and every one of them is a miracle.”
He spoke of a 16-year-old boy they brought to the Vicente Sotto Memorial Medical Center six months ago for treatment of his psychosis due to drug use. Discharged from the hospital two days later, he surprised Bautista by showing up to share about his experiences and to thank him for his help.
He's been clean for six months and has returned to school. The DSWD gave him a scholarship. What's more, Bautista said, “In- stead of second year high school, he was even accelerated to fourth year because he is intelligent.”
Other recovering addicts have studied counseling and made it a vocation to help others, he said. Under the trees
Talisay City's outpatient rehab and aftercare program shows how determination to proceed can carry a program forward even with a small budget.
The room the center is using is new, Bautista said. But the lack of a room in the past did not deter them from pursuing their mission.
“We used to have our sessions under the trees. Or we went to the church (the Sto. Niño Parish under Fr. Jonas Mejares) and used an open space there. That's the other thing here. The Catholic Church here in (Barangay) Mohon is very cooperative.”
As for manpower, Bautista said that aside from himself, Enajada and some other staff from the City Health office, “the manpower I use are the people I am helping, which is very effective.”
Bautista urged drug dependents who want to talk to someone to call Talisay City's helpline at (032) 491-4731.
Like the other services at Talisay's aftercare center, he said, this is also free.