Rehab centers: Safe havens for addicts

JAKARTA (JP): Psychiatrist Al Bachri Husin established Wisma Adiksi (Addiction House) in late 1998 using his own money because he witnessed an overwhelming upsurge in the number of drug abusers that existing health facilities simply could not cope with.

A shortage of facilities for post-detox patients and rehabilitation centers, as well as an environment which was far from supportive, were other reasons why Al Bachri, or Al to his friends, set up his own institute. A previous failure in running a similar clinic convinced the doctor that the facility should be run professionally and profitably without becoming a commercial enterprise and sacrificing its original altruistic goals.

Residents who come from various backgrounds pay Rp 3 million per month -- a much lower fee compared to many other rehabilitation centers. "If there were no operational costs, I would have made the facility free of charge," he said.

The Addiction House is located at Jl. Jati Indah I No. 23, Pangkalan Jati, Pondok Labu in South Jakarta. It brings together drug abusers within a community under a special program to encourage them to heal one another. Applying the therapeutic community (TC) approach, rehabilitation efforts are the focus of the Wisma's program.

The treatment methodology is also integrated with the well- known "Twelve Steps" for drug addicts, as well as religious counseling for residents. A number of professionals are involved: psychiatrists, educators, social workers and religious teachers. Even former addicts are hired to take care of the Wisma's daily operations.

The program consists of the primary phase for three to four months, the senior phase for two to three months, reentry phase I for three to four months and reentry phase II for two to three months.

The emphasis in the first phase is on recuperating through individual and group therapy aimed at instilling discipline, awareness of the problem and responsibility and honesty toward oneself. The phases that follow are geared toward helping residents make the transition and reintegration into "normal life" in their family and the community.

In the later stages, residents are assisted in planning for an independent future. At this stage, family members are involved so they will be more supportive of the residents.

Nearly 200 people have been treated in the Wisma, with 65 percent of them having been declared "cured." "I don't guarantee that everyone will be cured, but at least this method works better than the previous one that I used," Al said.

Chilam, a former addict now working as a staff member at the Wisma, agreed. "I feel that my life changed for the better after I entered the Wisma," he said.

In Bogor, West Java, there is the Wijaya Kusuma Sports Campus, a rehabilitation center run on the principle of the therapeutic community. It is the only rehabilitation center with an on-site 24-hour doctor.

There are now 23 residents participating in the primary program and 12 residents in the reentry program in its facility on Jl. Hang Lekir, South Jakarta.

Wijaya Kusuma Sports Campus has eight staff members for the primary and four for the reentry program to prepare residents to reintegrate with society when they leave. More than 15 addicts have successful finished the program.

The center was established in October 1999 by Dr. Mohammad Sarengat, the fastest runner at the 1962 Asian Games who won gold and bronze medals). His motive for opening the center was personal because his own son, Andung Sarengat, was then a drug addict.

Andung was at the time treated at a rehabilitation center in Kuala Lumpur. He was later trained in the six-week program for substance abuse counselor training at Kusuma Wicitra. He is now the program manager of the Reentry House at Wijaya Kusuma.

"The basic program of Wijaya Kusuma is therapeutic community, with sports being supplementary," said Andung.

"This is not a place where we force people to do sports. At Wijaya Kusuma we can play basketball, soccer and all kinds of sports and have fun," he added.

What exactly is the TC approach that is being used by a number of rehab centers such as Titian Respati, Terracota and Yayasan Sinar Indonesia (Yasin). The rehabilitation program is a four to six- month resident treatment designed to address the behavioral and emotional issues of drug dependency.

Residents move through four progressive phases of treatment with the option of continuing treatment for a period of one year.

Therapeutic community treatment also offers group support to family members who wish to be involved. Both group and individual therapy is provided and is geared toward addressing the unique treatment plan of each resident.

Groups are formed to discuss issues in life, concerns and coping strategies. Treatment is further complemented by a variety of leisure and learning activities including management, sports, horticulture and art therapy.

Except in emergencies, residents do not engage in any off-site communication during the first three months of care. After this initial orientation period, communication resumes where desired and visits by family members to the center may be arranged.

Therapeutic community treatment offers long-term residential care which is based on the belief that addiction is an acquired lifestyle.

Users suffering from chronic or severe addictions are offered an alternative lifestyle where values and attitudes are explored and challenged in an atmosphere of self-help and mutual support. Treatment addresses the individual in a holistic fashion and is premised on the belief that change is most effective when it is "experienced and shared".

"However, therapeutic community treatment does not involve physical contact," said Andung Sarengat.

Also in Bogor, there is Wisma Afiat, a facility opened two years ago by the Muhammadiyah Islamic organization. It is still a pilot project of approaching drug addiction through the Islamic concept of daily life and behavior.

Psychiatrist Fuadi Yatim, who is the director of the facility, said incoming residents were first given physical examinations. "The magnitude of damage caused by drug use simply cannot be emphasized enough. Drugs destroy these children's livers, hearts, lungs, often fatally," he said.

After the physicals, newcomers are taken off drugs, known as detoxification, for up to a week. This is where it often hurts the most, Fuadi's deputy Izfan said. "They are in so much pain as they go through sakau (withdrawal)," he said.

To ease the pain, the newcomers are given pain killers, sleeping pills and other medication. At the end of this period, the youths are again given physical and laboratory examinations.

"Then we go on to the spirituality approach," Fuadi said. "These youths have been living so far away from what Islam teaches us, which is why we try to bring them back."

The youths are encouraged to perform the shalat (prayers), read the Koran and dzikir. They are awakened at night to say the tahajud prayers and to take a predawn meal before fasting every Monday and Thursday.

"That is actually our criteria for recovery," Izfan said. "If the youths can stop smoking altogether, pray and fast, then insya Allah (by the grace of Allah), they will be fine."

Both Fuadi and Izfan spoke strongly against smoking. "That is the gateway to this vice (drug addiction or alcoholism)," Izfan said.

"Something that damages your health is haram (religiously unlawful or forbidden), and smoking is that," Fuadi said.

Fuadi and Izfan agreed on the importance of the therapeutic community concept but feel that the approach has yet to target the real root of the problem -- which is a lifestyle that is far from pious. "TC, for instance, builds up the residents' confidence to the point of defying them," Fuadi said.

Fuadi and Izfan, however, believe the importance of a total change encompassing not only the residents but also the other family members, is the key to recovery. "How can we ask the youths to behave Islamically, to fast and to read the Koran when their parents do not do the same thing?" Fuadi said.

So far, Wisma Afiat has treated more than 100 youths and has a success rate of 70 percent. "Some 30 percent of them came back because they relapsed," Izfan said.

Fuadi and Izfan believe helping drug addicts is another form of da'wa (spreading the teachings of Islam). "They're our brothers and sisters, and they need help," Fuadi said. (Deka Kurniawan/Nuraini Razak/Santi W.E. Soekanto)