Drug rehab, an unglamorous yet vital part of drug-free campaign

Andrei Simanjuntak ,  Denpasar   |  Tue, 07/01/2008 10:25 AM  |  Opinion

The affliction of drug addiction, with its poisonous impact on new layers of the Indonesian younger generation and the consequent rapid spread of HIV/AIDS among intravenous drug users, is perhaps not news.

Media and public service announcements with city billboards depicting scary skull and cross-bones, probably designed to frighten children against drugs, have helped alert and alarm the public.

The slogan "Say No To Drugs", both in its English or Indonesian version, has become familiar, at youth functions from rock concerts to rave parties, or plastered on walls and vehicles in towns and countrysides all over Indonesia.

What needs to be understood, however, is that dissemination of information on the dangers of drugs comes under the heading of prevention, which is only part of the overall strategy to combat drug addiction. Prevention is a means to reach those who have not fallen into drug abuse and the support system around them, such as parents and teachers.

It is through prevention that public awareness of drug addiction has been raised, hopefully with fewer people getting themselves hooked on drugs as a result. Prevention is the most "visible" aspect of the campaign against illegal drugs, because its message is continuously before the public.

Another equally important aspect that is often overlooked is the rehabilitation of individuals already deeply buried in addiction. The attempt to stop using drugs is a very difficult process. Many drug addicts end up relapsing back into drug use, if they are not professionally supported.

In the rehabilitation process former addicts are guided and assisted in regaining social skills and self-esteem, which are severely impaired, if not lost, after years of drug abuse. They are also furnished with knowledge on the nature of addiction and skills to nurture and maintain a drug-free lifestyle.

Rehabilitation centers are a necessary part of social welfare services as they serve as "one-stop-shops" where drug addicts can undergo a healing process and hopefully be rehabilitated and become productive members of society.

Prevention and rehabilitation should go hand in hand, with the former as an effort to curtail the number of people falling into addiction, and the latter to help turn those damaged by drugs back into positive roles in society. If addicts are left untreated, one can only imagine the negative repercussions with society having to cope with so many dysfunctional people.

Unfortunately, in Indonesia as in many other countries, public opinion is less than enthusiastic about rehabilitation.

There are two reasons for this lack of enthusiasm when it comes to drug rehabilitation: high costs and low success rates. The average cost of care for residential or outpatient treatment, for programs ranging from 28 days to a year, is quite high.

The typical program fee in a private drug treatment center in Indonesia is approximately Rp 2 million (US$216) to Rp 4 million ($433) per month. This is quite exorbitant considering that addicts come more and more come from low-income families. This is small change compared to treatment costs in western countries such as the United States, where rehabilitation centers may charge up to $30,000 per month.

The second unfortunate fact is that this high cost doesn't necessarily reflect an equally impressive result in terms of non-recidivism. This social enterprise is therefore less likely to find donors and philanthropists rushing to its aid.

The criteria for success is hard to determine in the drug rehabilitation world, and difficult to standardize. For example, if a patient completes the program in a center, can that be counted already as a success? How many years of staying clean from drugs after discharge from the program is considered a "success"? What if a patient manages to stay clean for five years after a program, but then relapses into active addiction, can the center be held responsible for this so that a previous "success" point can be withdrawn for this patient?

Almost every treatment center has its own yardstick, often devised to project a favorable outcome to the public. However, as a general rule of thumb in the therapeutic community, albeit unsupported by credible and continuous research, a 30 percent success rate, meaning patients achieving a significant amount of clean time after discharge, is already quite good.

While high costs and low success rates may question the effectiveness of drug rehabilitation, it would be negligent on the part of society to completely dismiss this branch of social services. The negative impact of drug abuse can be found in almost every province in the country. The effort to develop the expertise and resources to build a rehabilitation center in every province therefore becomes more pressing.

Active drug users cause expensive damage to society, mostly through crime. They also breed more users, by introducing the destructive habit to others through social contacts. If the government has proposals for building correctional centers specifically for drug cases (because they happen to be the largest group of criminal inmates), why not funnel the funding into building government sponsored rehabilitation centers in the provinces as well?

The answer is that currently there is not enough support and awareness expressed by the public on the need for more drug treatment centers. On the prevention front, many agencies around the country such as the government's National Narcotics Agency (BNN) have taken part in campaigns with admirable enthusiasm, as demonstrated by the familiar slogan "Say No To Drugs."

But on the largely overlooked other side of the "war against drugs" coin, rehabilitation services that promote a healthy, new lifestyle totally abstinent from all drugs are not as much appreciated or supported.

Quite a stark contrast to the ubiquities presence of the HIV/AIDS campaign in public health institutions, both government and private. Funding flows freely into the effort to combat this pandemic on all fronts, including advocacy, education, and providing medicines for the infected.

In the midst of this worldwide concern (on HIV/AIDS), sometimes the public forgets that one of the main causes of the rapid spread of HIV infection is intravenous drug use. Therefore, drug rehabilitation as a social service component needs to be supported and more widely available to the public if we are to instigate a comprehensive, all-out effort to eliminate the negative impact of chemical dependence in Indonesia. Then, perhaps a "drug-free Indonesia" will be translated from a slogan into reality.

The writer is a drug therapist based in Bali. He also can be reached at andreism@gmail.com

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