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Drug rehabilitation centers under pressure

June 18, 2009 By: Ikon Bali Category: Dokumentasi

by Anissa S. Febrina

During her bleak past – seven hard years as a drug addict – Dania (not her real name) tried all kinds of drugs. She also tried all types of rehabilitation centers.

“The one place I haven’t been to is prison,” said the 35-year-old, who confessed to having her well-off family bail her out to escape the authorities when she was arrested back in 2005.

“There was some agreement and my parents told the officer that they would send me to rehab instead.”

Now, addicts like Dania no longer have to make any such “agreement”, as the Supreme Court has advised judges to send convicted drug users to rehabilitation centers instead of prisons.

In its memo, the Supreme Court proposed rehabilitation centers that could be appointed to help drug addicts, including the National Narcotics Agency’s centers across the country, drug addiction hospitals, the Social Affairs Ministry’s rehabilitation centers, psychiatric hospitals and private hospitals or rehabilitation centers.

The widespread and apparently uncontrolled use of drugs inside prisons and the rising number of people imprisoned for drug-related crimes have been given as the reasons behind the policy.

Currently, around 60 percent of those in Indonesian prisons, or about 40,000 inmates, are drug users.

The policy has been welcomed by those working in the drug area, such as Joyce Gordon from Yakita, a foundation that operates rehab centers in several provinces. .

“It is a step forward in separating drug users from dealers,” Joyce said of the policy. “The first are people who need treatment, while the latter are criminals.”

But – and there is always a but – there is still a lot of work to be done. It isn’t simply a matter of sending drug addicts to appointed centers, if those centers are not ready to take them.

The question of how they will handle a sharp increase in the patients gets even trickier given their funding is almost non-existent.

And then there is the matter of the standard of care.

“The quality and approach taken by rehab centers vary and there are no standards or indicators to measure the success of the treatment,” Joyce pointed out.

When talking about these centers, it is certainly difficult to classify them according to their approach, let alone start to define the success of any one approach. When it comes to working with drug abusers, quality depends on more than fancy buildings or modern infrastructure.

And that “quality” a recovering drug addict needs is intangible.

“All the rehabs that I’ve been in have fed me well. But the last one really got to me. Or is it because I’m growing older?” Dania said.

The last one that is working for her, she added, places the emphasis on rebuilding her self-esteem, which was wrecked from five years of unemployment.

“Some friends I met at the first one, a pesantren [Islamic boarding school], have never relapsed. But I guess that depends on your personality.”

Some centers choose a religious approach and completely ban any kind of methadone treatment, and others combine detoxification with group counseling. Only a very few provide a comprehensive rehabilitation program.

The Drug Rehabilitation Unit in Pondok Pinang, South Jakarta, is one that claims to combine supervised methadone therapy with a re-entry program for its in- and outpatients.

“We provide counselors and doctors here. And we have daily sessions for inpatients,” said Muhammad Iqbal, a former drug user who works as a counselor at the center, which can accommodate up to 50 people.

Aside from the two-hour sessions in the morning and late afternoon, inpatients at the unit find ways to kill time, whether watching TV, listening to the radio, playing the guitar or just lying around on their beds.

Kedhaton Parahita in Sentul, Bogor, managed by Father Lambertus Somar, adopts a therapeutic community approach involving psychiatrists, psychologists and patients’ family members.

One of the oldest rehabilitation approaches draws on religious values and rituals to help addicts.

Recovering addicts staying at the Suryalaya Islamic boarding school in West Java are directed to shift their focus to religious activities while being isolated from the outside world.

The religious center that Dania stayed in for two months was of a similar kind.

“They wake you up before dawn, bathe with cold water in cold weather and ask you to pray and recite the Koran all day,” Dania recalled. At places like that, she said, a junkie has no choice but to “enjoy” cravings, as no kinds of legal drugs are allowed.

Another center in South Jakarta’s Karang Tengah, the Fan Campus, offers a blend of detoxification as the first step, with a flexible re-entry program, in which patients can spend most of their time outside the center.

“What defines the success of the centers is how well one’s life can be restored,” said Temi, a counselor.

And who determines that?

“We should have a standardized indicator of what defines a good rehab center, especially if we want this program to support the fight against drug abuse,” Joyce of Yakita said.

While sending drug users to prison cannot help, sending them to rehab centers could be promising – if the quality is assured, that is.

Currently, the only standard for rehabilitation centers, issued by the Health Ministry in 2002, only vaguely defines a “good” center. It stipulates that a center should feed its patients three times a day and provide health and recreational services as well as physical, mental and social guidance.

It also stipulates the need for a reintegration program and aftercare, without providing details or evaluative indicators.

Setting quality aside, there is still much to be done in the logistics of implementing the policy.

“Most of the centers are located in Java,” Joyce pointed out. “What will happen to a convicted drug user in Sorong?”

It will be a question of who will be sent where and whether some jurisdictions have the required centers to take in convicted drug users.

According to compiled data from the Health Ministry and the Social Affairs Ministry, there are only 22 accredited private rehab centers and two religious ones with several branches, most of which are located in Java. On top of that, there are more than 70 hospitals and psychiatric hospitals in provinces across the country.

But even government-owned clinics seem to be ill-prepared to welcome convicted drug users, and cost is a big part of it, according to Juenas Sitepu from the Social Affairs Ministry.

“It’s expensive to cover the cost of treatment for drug users, such as medication and doctor’s fees,” Juenas said. “We have not allocated much for treatment in this year’s state budget.”

It is indeed expensive to care for recovering drug addicts. The monthly operating cost per head for an established medium to large center ranges from Rp 2 million to Rp 4 million.

“If we do take in convicted drug addicts, we have to rely on funding from international donors. We can sometimes cross-subsidize, but that depends on our own financial condition,” said Joyce, who started working with penitentiaries long before the new policy was officially endorsed by the government.

Meanwhile, small centers like Fan Campus said that they were not ready to take in those sent by judges into their care.

“We are too small to be able to cross-subsidize them,” said Temi, which leaves the question of how drug users will get the help they need to prevent them ending up back in prison.

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