Coming Clean in the Bangkok Post 13-02-2011
Vince Cullen
Coming clean
Wat Tham Krabok in Sara Buri has one of the world's most gruelling and transformative drug treatment programmes
- Published: 13/02/2011 at 12:00 AM
- Newspaper section: Spectrum
Phra Sayan looks at a 16-year-old patient checking into the rehabilitation programme. Though surrounded by members of his family, the boy looks unhappy and scared. "What drug are you addicted to?" The boy keeps his head down, and replies: "Ice."
CONTENTIOUS PAST: Dormitories that once housed 30,000 Hmong refugees have fallen into disuse.
His mother explains that after he was caught stealing from the family to fund his crystal methamphetamine habit, he started stealing from neighbours. Once they were wise to him, he stole from strangers. There is more at stake than a drug habit, she implies; they're afraid that without intervention, the boy might embark on a life of drug use, crime and, as likely, prison.
Tham Krabok Monastery takes in anyone with an addiction _ men, women, Thai and foreign, from rock musicians such as Pete Doherty and Christy Dignam to poor hilltribe villagers from the North _ and the treatment and accommodation are free. Only meals must be paid for. Mobile phones, valuables and unnecessary personal belongings are deposited in a safe on arrival. Patients' families can stay on the grounds for free, but outside contact with patients in the first five days is not allowed. One reason for this is that patients going through withdrawal and detoxification often beg to be taken away. Seeing their loved ones in distress, families may feel compelled to agree before the treatment's benefits can take hold.
There are four rules before patients can be admitted: They must be here of their own volition; they must be able to prove their identity; they must be willing to commit to at least 15 days of treatment and commit to the sajja, or vows; and they must swear to never take drugs again.
CLEANSING: Detoxification from drug addiction can be gruelling.
The 16 year old is one of three new admissions to the monastery during a visit by Spectrum. We are allowed to observe their indoctrination ceremony, the oath they repeat. The sajja is serious. The terms are eternal, and breaking them is considered a breach _ patients aren't allowed treatment in the inner compound a second time if they relapse. All patients swear to abstain from illegal drugs, some swear to abstain from alcohol (forever, or for a set time frame), some from prescription drugs, some are even here to stop smoking.
Patients are milling around, doing chores, sweeping the temple grounds or cleaning. There are many signs that point to tough previous lives _ gang tattoos, scars, bruises, faces in bandages. Some had to reach the nadir of their dependencies, the proverbial or literal gutter, where drugs were undermining their characters and ruining all facets of their lives, before they realised they had to make a clean break.
Unlike the many expensive luxury rehab clinics in Thailand (see sidebar), conditions here are rudimentary. Patients sleep in plain dormitories; men and women are separated, as are Thais and foreigners, but there is little personal privacy. Nor is there hot water, or air conditioning, although there are a few concessions to comfort. There are communal television screenings, and smoking is allowed for those who haven't vowed abstinence.
At 4pm the vomiting begins. Patients kneel over a gutter and drink 25ml of the medicine. After a few minutes they drink diluted tea and induce vomiting. This is meant to purge toxins from the body, and it is a violent process. Some patients look dazed and weakened, vomit dripping from their mouths, as others who have passed the initial five-day vomiting period look on and sing and play music in support. It's a surreal scene. One boy of the dozen or so who are vomiting is another ice addict from Ayutthaya, only 14 years old, the minimum age for admittance (the maximum is 45). One is a pale foreign man. One is a teenage girl.
This scene must be repeated for everyone during the five-day detox period, after which the vomiting becomes voluntary. Combined with the regular saunas, scented with lemongrass and other herbs, and the bitter traditional tea, many toxins are purged. The rest of a patient's stay covers the recovery and rehabilitation period; saunas and teas continue so the body and mind can start to repair themselves and find balance.
THE FOREIGN PATIENTS
THE FIRST STEP: Three new patients take vows to remain drug free, above right.
BELOW: The traditional medicine that induces vomiting. It is given in both liquid, ‘ya tad nam’, and pill, ‘ya tad med’, form.
RIGHT: Phra Vichit holding a ‘dok ngieuw’ flower, one of over 100 ingredients in the traditional medicine.
Anna, 26, is from Macau. She is in her third month here, wearing the white robes of a mae shee (nun). She explains that she was first introduced to drugs in Thailand, smiling at the irony of it. "Thailand is like a party paradise for young people," she says. "I went to the full moon party
[on Koh Phangan] when I was 15, and tried drugs there. When I went back home, I wasn't scared any more to try various drugs because I'd experienced them before. And now I'm back in Thailand, where it all began."
Roger, 30, from Switzerland, is in his sixth day of the treatment, the first day free of the mandatory vomiting. "I was in and out of treatment for six months in Switzerland," he says. "It wasn't effective, because you still have your underlying problems, and the urge to relapse is too great. Here it's different; it's all about balance. Six days here have served me far better than six months of treatment at home."
Roger's words don't seem to be wishful thinking; the force of his words is evident in his demeanour. Like Anna and Kevin, a 32-year-old Australian who has also ordained and stayed for several months, he seems quite at ease with himself, able to reconcile his past with the fact that his future is again hopeful.
Will he go back to driving trucks when he goes back home?
HEARTS AND CRAFTS: The lakeside crafts workshop offers a way for drug addicts to keep their minds busy.
"I don't know," he admits. "My job and that lifestyle were part of the problem."
Anna is equally honest when asked what she'll do when she returns home. "I have no idea," she says simply. Part of a patient's vow is not only to refrain from illegal drug use, but to refrain from any action that might contribute to drug use in others. Working in the Macau casinos, for example, may help contribute to other societal problems besides gambling.
Kevin is more disposed to returning to his former job on a drilling rig, although he admits his new appreciation for nature is at odds with the profession.
For Kevin, the vows of his ordination forbid him from taking transport or operating machinery, yet one of his jobs here is to repair the many machines and vehicles in the compound. Lay workers run or drive the machines he repairs; he can keep his vows and still use his mechanical expertise to help the monastery.
The patients willing to speak to outsiders seem unburdened. The future is a distant worry; they seem happy to focus on recovery, on appreciating the moment, on helping others in the same way they were helped by others.
Aren't there conflicts among patients, or those who don't participate in the chores, or who are disruptive?
''Sometimes,'' Kevin admits. ''Mostly they only think they can't cope with the conditions, but start helping out later.''
''If one isn't helping out,'' adds Anna, ''the others will let him know.''
Many addicts became addicted in the first place by trying to self-medicate other conditions such as attention deficit disorder or bipolar disorder. The treatment doesn't deal with these conditions individually, which is why Buddhist principles are such an important part of the treatment, reducing desires and encouraging balance and stability.
Some patients suffering from bipolar disorder have been able to function here without medication for the first time in years, says Phra Vichit, one of the monks at the monastery.
Not that there is any proselytising _ patients are encouraged to adapt the dhamma talks to fit their individual religious beliefs. Roger says dhamma isn't as much a part of the treatment for foreigners as it is for Thais. But it is also possible that he doesn't recognise the lay language, lifestyle and common-sense guidelines to be Buddhist principles.
THE GOOD AND BAD
NATURAL REMEDIES: Above, herbs for the medicine given as part of the detoxification treatment at Wat Tham Krabok, and right herbs for the sauna.
These days, Tham Krabok, having treated 100,000 addicts, is reverentially known in Thailand through books, songs and films. Ruang Khong Nam Phu (The Story of Nam Phu) is the tale of Wongmueang Nanthakh wang, son of novelist Suwannee Sukhontha, who died of a heroin overdose at the age of 18. His letters from Tham Krabok are a moving description of the torments of addiction.
In 1975, the temple's abbot, Phra Chamroon Parnchand, was given the Magsaysay Award, which honours greatness of spirit and transformative leadership and has informally been called Asia's Nobel Peace Prize.
But the Tham Krabok Monastery hasn't always been in the news for the right reasons. It once housed Hmong refugees for a number of years until their resettlement in 2004-2005. This was a politically hot issue as the shelter was seen as giving encouragement to other political refugees as well as ''economic migrants''.
FIRM HAND: The current abbot, Phra Ajarn Boonsong Tanajaro.
Among the more than 30,000 refugees were possibly drug dealers or fugitives on the run, and there were reports of crimes such as human and drugs trafficking, and also counter-claims that some northern drug gangs, who were losing clients and dealers to sobriety, were trying to undermine the monastery's reputation.
Tham Krabok was once reprimanded by the government for building a statue of HM the King without permission; once for encroaching on forest territory; and in 1989 it closed its doors for several months for not having the requisite licence to treat addictions.
Now licensed with the Thanyarak Institute under the Public Health Ministry, it seems eager to build on the very positive reputation it has with clinics in the West.
Most of the 50 patients here now are Thai, but there are eight foreigners, who have come from all over the world. Twenty foreigners were treated in January. Some find Tham Krabok through internet searches, many are referred by other treatment programmes, some have had their journeys here subsidised by the UK's National Health Service or other national health services, because the high success rate makes the distance and expense worthwhile.
One outside study that followed treated patients after their release pointed to a 70% non-relapse rate after one year _ not a perfect success rate but better than most treatment programmes in the world. Kevin estimates that more than 90% complete the gruelling programme.
The monks themselves make no such claims, except to say that those who keep their sajja will necessarily stay clean. They emphasise that the determination must come from within; no outside push, no statistic, no replacement crutch will be effective unless the patients have the will and strength to overcome their problems. And learning and abiding by Buddhist principles is one of the best ways of overcoming desire and greed.
''The craving will never go away,'' says the current abbot, Phra Ajarn Boonsong Tanajaro. ''But you can learn to live with it.'' He sniffs the air. ''Like I can smell food cooking. Of course I feel hunger. But I can focus on my vows and not be distracted.'' The drug addict must also find a source of internal conviction to keep his or her cravings manageable.
Oxford University once asked for a sample of the medicine to analyse, but the monastery declined. Perhaps the reason the recipe for the medicine is a closely guarded secret is that seeing a stark list of ingredients might detract from the rest of the rehabilitation programme. If people discover the medicine is just a combination of herbs, some may feel it is another crutch, such as the methadone used in many treatments around the world.
''Our medicine gets flushed out in a day,'' says Ajarn Boonsong. ''What stays is the sajja. That is the most important part of the treatment. The cure is not the medicine, it's faith.''
One patient who came to Tham Krabok, the abbot explains, had been on methadone _ used to compensate for heroin dependency in clinical treatment _ for 13 years. ''It's a chemical, unnatural,'' he says. For recovery, patients need to achieve a natural balance and inner strength, otherwise they are only supplanting one dependency for another. Here the emphasis is on being able to live independently; not running from problems, desires and dependencies but being able to face them, recognise them for what they are and learn to coexist with them.
The monks accommodate most of my requests; I'm allowed into the inner treatment compound (known as ''the Hey''), can speak to the monks, to those patients who are willing to be spoken to, to inspect the facilities, to ask what I want to know. They stop short at letting me try the medicine. It would involve preparation and vow-taking. ''When you come again, you can try it,'' says Phra Vichit.
''But believe me,'' warns Anna, ''it's not pleasant.''
Anna later shows me the crafts workshop by the reservoir. ''This is my favourite place,'' she says. The view is beautiful and the scene is tranquil as the sun begins to set, casting long shadows, dust motes filtering the light. Ceramics are made here, or crafts, or paintings. For addicts, work with the hands helps focus the moment, Anna explains. ''You are nowhere except with the art you're making.''
HONOUR ROLL: List of the 100,000 patients treated at Tham Krabok since 1959. Currently 50 are being treated, though the facility can accommodate up to 200.
For Thais from poor villages, who have no trade to return to, the arts and crafts represent a new and sustainable skill, something that is possible to market. And some patients have returned to their villages and sold their crafts at markets, or opened small galleries.
Wat Tham Krabok treats more than addictions; the monastery rehabilitates lives, giving people and society another chance, by helping those who need it most.
Wat Tham Krabok closes to new admissions on March 16 for the annual April 'tudong' walking pilgrimage, and reopens in May. Visit www.thamkrabok-monastery.org.
The rise of luxury rehab centres in Thailand
There are at least a half dozen "five-star" or "luxurious" treatment centres in Thailand to help people come off addictions to alcohol, prescription or illegal drugs, sex or even smoking, which cost up to 30,000 baht a day.
In Thailand, the Thanyarak Institute, a treatment facility in its own right and also the body under the Public Health Ministry that deals with substance abuse treatment, has licensed some 1,000 hospitals, clinics and individuals around the country to treat those with chemical dependencies. Wat Thamkrabok is licensed with the institute, which confirmed that the detox medicine used at the monastery _ containing over 100 herbs _ had been screened for illegal or harmful ingredients and cleared for use.
The luxury rehab centres we contacted are another matter; none of them are directly licensed with the Thanyarak Institute to do clinical detox, although many of them work in conjunction with licensed hospitals, physicians and psychiatrists, who can prescribe the drugs or offer clinical services needed by patients. Many provide counselling and post-detox or "wellness" programmes to help patients recover and re-integrate.
Channah Thailand, one of the most expensive clinics (US$20,000, or 620,000 baht a month) and known to have treated some very high-profile patients from around the world, was the subject of some British tabloid stories, one implicating former boss in Simon Gunn taking illegal drugs. Mr Gunn later resigned, and Channah has changed its name to Alcohol Rehab Thailand, based on Koh Chang.
The Channah website was still operating last week, offering "alcohol and drug rehab treatment". However, the site was taken down on Thursday after we talked to Wade Dupuis, the CEO of Alcohol Rehab Thailand. The Channah Thailand website now redirects to Alcohol Rehab Thailand.
Mr Dupuis said the company was in the process of rebranding itself to treat alcohol dependency only and was "presently in the process of [satisfying] our licensing requirements" through the Thanyarak Institute. He said that because of a "zero tolerance" rule for staff members, Mr Gunn has no further connection with the centre, either as a director, member or investor, nor is that likely to change in the future.
According to Mr Dupuis, "We do not have full-time medical doctors on staff as we do not do detox on site.
"Any emergency medical treatment is done through the Bangkok Hospital group."
Under the arrangement, Bangkok Hospital Pattaya undertakes pre-admittance medical treatment (such as medical detox and prescription of medicine), and Alcohol Rehab Thailand focuses on non-medical aspects of treatment.
Neil Maniquiz of Bangkok Hospital Pattaya said that both Channah Thailand and Alcohol Rehab Thailand were treatment facilities that worked with the hospital.
Peter Maplethorpe, director of the Cabin, Chiang Mai, said his facility didn't need to be licensed, as it didn't prescribe medication. Medication and physical check-ups were conducted by Dr Suttipan Takkapaijit, a licensed psychiatrist and staff member at Chiang Mai Ram Hospital.
Adrian Crump, one of the owners, added that there was "no available licence for drug and alcohol rehabilitation until recently", a view shared by Mr Dupuis of Alcohol Rehab. The Cabin costs $12,000 for a 28-day stay.
One rehabilitation centre we contacted, ProCounselling, said it wasn't yet a fully operational facility and didn't yet have a base of operations, even though it has an operational website and an online entry on an international list of treatment centres. It was currently looking for a base, "probably in the North", and would provide one-on-one support and counselling services "in the next few months".
Another recently opened facility, Safe Havens in Bangkok ("We know what alcoholism and drug addiction is ... and how to treat it", its website states), said they had instructions not to answer our questions.
Archie Glikakis, responsible for public relations for Breathing Space in Chiang Mai, said "you don't need a licence to operate a wellness centre". While Breathing Space was "not certified to do clinical detox", it had a licensed physician and a licensed psychiatrist on its staff.
Breathing Space costs $30,000 for a two-month programme and provides a range of activities and services including treatment of co-occurring disorders and "elephant-assisted therapy".
WHAT'S IN A LICENCE?
According to the Thanyarak Institute, in 1979 the government assigned the Public Health Ministry to take care of drug rehab facilities all over the country. In 2009, a new act came out and the ministry divided rehab facilities into three categories:
1. Government-owned facilities (hospitals, health centres, special clinics).
2. Privately owned facilities (private clinics, hospitals, temples).
3. Rehabilitation facilities that don't use medicine in treatment, including counselling services and clinics that only offer psychological treatment.
If the clinic is only treating alcoholism, and not hard drugs such as heroin, the rules are more relaxed. Any clinic that treats drug addiction needs a licence (category 1 or 2), required to get methadone from the Food and Drug Association, the sole distributor of it in Thailand.
To get a licence, clinics file applications directly to the director-general of Medical Services Department. They will send out a team to evaluate the facility and issue a licence if it's approved. Quality control in all three categories is done yearly for government-owned facilities, and randomly a few times a year for privately owned places.
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About the author
Writer: Ezra Kyrill Erker
Position: Writer
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Those who speak truth
and give gentle encouragement,
contending with no-one,
these do I call great beings.
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A DHAMMAPADA for CONTEMPLATION