PRACTICAL INITIATIVES

For The Bohol Tribune

In This Our Journey

NESTOR MANIEBO PESTELOS

Starting this week, we have heard practical initiatives on how to cope with more than 100, 000 illegal drug users and pushers who have surrendered to police authorities for fear to end up as corpses in the current deadly war launched by the Duterte administration.

Aside from news about gruesome killings which readers have been used to during the past few weeks, the scene has brightened up with actual initiatives either proposed or put on the ground to respond to the need for surrenderees to pass through a systematic process of diagnosis, counselling and for others, a more intensive treatment and recovery process.

For Bohol, a meeting is being held at this time while we are writing this column today, 04 August, by the Provincial Anti-Drug Council (PADAC) presided by Gov. Edgar Chatto. The meeting seeks  to finalize details on how to operationalize in two weeks’ time a Counseling and Rehabilitation Center.

The facility will be located at the Oak Brook Building near the St. Joseph Cathedral and will be staffed by a doctor, social worker, nurse and clerk, according to Dave Charles Responte, who posted the early news about the meeting on Facebook along with picures taken by Ric Obedencio.

A long way to go to cope with the 30,000 identified drug addicts and pushers who have surrendered the past few weeks, but a significant initial step to provide a contact point where drug abuse victims can be categorized and provided initial counselling and advice for referral and treatment.

As described by the FB posting, the facility looks like an Outreach and Drop-In Center (ODIC), which is a sort of half-way house to a regular drug rehab center. We hope it will happen soon and made operational so municipal LGUs and private sector entities can learn how to establish and operate one. In previous columns, based on the experience of health ministries and local governments in other countries, we have noted such facility is quite important to serve as information, diagnostic and referral centers for drug addiction cases.

In our own estimate, such facility, if it will use an existing building or office, will cost only around Php 350,000 to maintain in a year for a staff of three and other office requirements. Most LGUs can afford such cost. In fact, the facility can require payment for its services to make it sustainable.

With such huge number of drug users, however, which may reach more than 30,000, building such facilities as a counselling and drop-in centers will not be sufficient to cope with the need to provide comprehensive treatment and post-treatment services. In fact, we need more than one drug rehabilitation and mental hospital as planned to be located in the Municipality of Carlos P. Garcia under the draft Development Framework of the Province of Bohol.

It looks like we need to launch a vigorous advocacy and marketing campaign so that the private sector, including the existing drug rehab centers in other regions, will find it attractive to establish branches here in the province where they can be assured of substantial support from the Government and other stakeholders, such as the business community, who will be among those affected adversely if hundreds of illegal drug users remain untreated.

Meanwhile, let us study some practical initiatives either proposed or launched in some areas of the country to cope with the overwhelming number of surrenderees expected to reach more than 150,000 by this month.

Fr. Fernando Po, drug awareness guru and development advocate, called our attention early this week about an initiative championed by ex-drug addict–turned-Congressman, Arnolfo Teves, Jr. of Negros Oriental.

Congressman Teves proposes that:

-Public high school classrooms be used as rehabilitation centers from 5 pm to 8 p.m. because classrooms are no longer in use at this time. He says this is the time when an addict’s day normally starts, when the addict has the most cravings for drugs.

-Around 50 drug dependents to stay in a classroom and their rehabilitation program to be conducted by two primary counselors, two secondary counselors, and two volunteers.

-Participants to attend 8 am-to-9 am meetings at barangay covered courts.

-An optional physical therapy session, which may include a game of basketball or a session of zumba, to follow from 9 am to 10 am.

-The daily rehabilitation program to be implemented in the span of 8 to 12 weeks.

If approved by the Duterte administration, he plans to coordinate with different local government units. He says his proposed rehabilitation program would only cost the government Php 2,500 per drug dependent.

In Iloilo City, Mayor Jed Patrick Mabilog said the city government would allocate Php 5 million initially from its peace and order fund to establish drop-in centers to address the needs of surrenderees with mild and moderate addiction. He said those with severe cases will be referred to the Department of Health.

Mayor Mabilog noted that most families cannot afford the cost of treatment, which may last from three to six months. In the Western Visayas region, treatment cost, excluding medicines, ranges from Php 10,000 monthly in government centers and Php 25,000 to Php 60,000 monthly in private facilities.

The drop-in center, to be established in each of the city’s six districts, will employ a psychologist, a nurse, three peer facilitators and a record custodian or utility person. Clients will be provided periodic drug testing, spiritual and psycho-social counseling, vitamins and post-care follow-up for a period of one year.

For the national government, Pres. Duterte announced in last night’s meeting with volunteers in the recent elections that he would convert military camps into drug rehab facilities complete with doctors, nurses, and social workers. He did not indicate a time frame for this remarkable plan.

In a press conference in Jaro, Iloilo City last 05 July, Health Secretary Paulyn Ubial announced that all regional offices have been ordered “to really prioritize community-based rehabilitation centers.” She said that not all drug dependents have to be residential or have to be committed to a facility.

According to her, the DOH treatment and rehabilitation centers have been trained to establish community-based centers and what is now needed is getting the cooperation of local government units.

She compares the community-based drug rehabilitation approach to a parole program wherein a drug addict who surrenders reports to his or her barangay officials everyday.

"We do random drug test, any time that they report, they can be tested. If they test positive, they have to undergo screening by our doctors, and if need be, they have to be committed to facilities. Not all who surrender will be automatically committed to a facility," she explained.

The DOH head said that the program also includes after-care, with government continuing to support a "graduate" of the treatment and rehabilitation center even after he or she returns to the community. She disclosed that the community-based drug rehabilitation approach was pilot-tested in Davao City years ago.

It is expected that the community-based drug rehabilitation approach will be replicated throughout the country through the DOH regional offices in collaboration with local government units.

The health secretary said scaling up the program would entail the training of LGU and barangay officials who will facilitate community-based rehabilitation services. DOH will tap LGUs and non-governmental organizations to help in assisting patients who may not be accommodated by existing treatment and rehabilitation centers. Private facilities can expand to admit some of the patients, but government will pay for residential treatment.

For the long term, DOH will convert some facilities into treatment and rehabilitation centers soon, in collaboration with LGUs. The DOH will shoulder the centers' operating expenses, and LGUs will provide the personnel.

The report says the health department's Health Facilities Enhancement Program has a P26.87 billion allocation in the 2016 budget. Of this amount, P18.96 billion is for the construction, expansion, rehabilitation, and repair of health facilities, including dangerous drug abuse treatment and rehabilitation centers.

Meanwhile, the killing continues. More and more drug users and pushers, out of fear, are swelling the ranks of surrenderees from day to day. It’s about time the practical initiatives which have been proposed are planned, funded and implemented.

Otherwise the war against illegal drugs will just be a grand horror show for our country and the whole world. For comments, email npestelos@gmail.com.

NMP/04 Aug. 2016/9.41 p.m.

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FROM SURRENDER TO RECOVERY

        For The Bohol Tribune

In This Our Journey

NESTOR MANIEBO PESTELOS

Judging from Facebook posting and emails from friends and colleagues, keen public attention has shifted from the rampant killings going on in Bohol and the country as a whole to concern about what to do with the hundreds of drug users  who have surrendered to the police and turned over to their respective families.

In Bohol, some 23,000 surrenderees were reported as of this week,  but no plan has been announced so far on how to handle this number of drug users so that they can be given appropriate treatment to prevent them from reverting to their old ways. The same waiting-game situation seems to exist in other provinces. Aside from the announcement by Pres. Duterte that military camps will be used as drug rehabilitation centers, no detailed plan has been presented yet at national and sub-national levels.

 It is obvious that making drug users sign a pledge not to sell or use drugs will be ineffective if steps are not taken to provide them adequate psychological inputs or the necessary treatment protocol to ensure that brain damage which results from repeated drug use will not lead to their committing crimes or anti-social acts.

In previous columns, I have reported on suggestions given by drug addiction professionals who attended a series of consultations we have arranged on how to deal with this increasing number of drug users turning themselves in to police authorities. Just based on common sense, drug abuse therapy being not our field of specialization, we have suggested the need for assessment of each drug user’s status to determine appropriate intervention required.

Now we continue to report on feedbacks or suggestions received from our friends through FB and email as response to our appeal for more information on how to deal with surrenderees, a matter of concern to LGUs, civil society organizations and many individual families in the province.

We have posted on FB and make available through individual emails to friends in Government and NGOs, including faith-based organizations and academic institutions, a summary of suggestions given by friends and development colleagues.

I have reprinted in full the strategy proposed by Miriam Peguit-Cue, Chairperson, Professional Regulatory Board of Psychology, Professional Regulation Commission (PRC), and made it available to others through social media and emails. In last week’s column, however, I dealt only with the section on recovery supports, where she talked about what could be done at community and family levels.

I assumed that her recommendations on what to do at national and provincial levels were read by those concerned for possible inclusion in the strategy being formulated on how to deal with the 23,000 drug users and pushers virtually given provisional amnesty by the police and the national government.  

In an earlier email dated 14 July 2016, Miriam Cue, who is also consulting psychologist at the New Day Recovery Center (NDRC) in Davao City, gave a list of what could be done at municipal level while waiting for a national program to be put in place to complement the current drive to plush out drug users and pushers and get them to pledge to change their ways.

1.       Information drive. Conduct advocacy campaign to build awareness and concern. Destigmatize addiction and mental health issues. Help local residents understand that these people [drug users] need help, not condemnation to enlist their support.  Work out a platform to build a real therapeutic community where community members help each other and all those who surrendered towards wholeness and wellness. 

2.       Mapping. Identify the community's treatment capacity.  Identify and determine the needed resources and what can be provided by the LGU and the community itself in terms of treatment services and psycho-social support. She says they have  few "graduates" of NDRC who are now in recovery, and have reintegrated themselves into the community. They can be trained them to become support buddies and recovery coaches.

3.        Outreach Services. Make contact. Build linkages. Reach out to the clients and identify essential support services in the locality. Establish directory of resources and services. Connect client, support groups and service provider(s). Identify local resources we can tap and facilities we can use for outpatient treatment.

4.       Client Registration and triaging, including the screening and assessment of those who surrendered. We already translated ASSIST (a screening tool for alcohol, smoking and substance use) into the vernacular (local dialect) to facilitate more efficient and effective use. We need to triage the client population to determine the type of treatment they need.

For those considered to be in the low to moderate risk and addiction severity, brief intervention will be provided. Those found to be of high risk and addiction severity will be subjected to more thorough assessment using the Addiction Severity Index (ASI) which we are also translating for trained workers to use. She says she will conduct the training myself.

5.       Expand Brief Intervention in the Primary Care Setting. Many of those who surrendered may not require intensive treatment or psychosocial report in a residential or outpatient facility.  Many will only require brief interventions. Nurses and other medical professionals in the municipal health clinic can be trained on screening and intervention... Young entry psychologists and counselors can be trained and enlisted to assist with the case loads. Consider to enlist and engage volunteers from the church and civic-religious organizations to build on the momentum of these people who are seeking change.

6.       Capacity building of workers and volunteers to provide brief intervention, coping skills training, coaching and guidance, psycho-education, and support to families. This will be provided by NDRCs trained clinical staff with me and Jay coordinating things.

Separate trainings should be provided for those involved in a) primary care (case managers, counselors and clinicians);  b) screening, assessment and brief intervention (nurses, social workers and other professional volunteers);  c) psychoeducation and information drive (teachers, church workers and other volunteers) and d)  for recovery coaches as well.

I think this proposed actions are doable at municipal or city levels if there is sufficient political will and available funding to carry out the specific activities required. Perhaps, with Miriam’s support, a pilot project in several municipalities can be implemented and documented to formulate the tools and approaches and the various systems required to cope with the overwhelming number of surrenderees that we have all over the country today.

Our resource person, who is originally from Baclayon, recommends the holding of a conference “to unify professional trainers, clinicians and service providers along with concerned government bodies towards one direction... one end.”

I think this recommendation can be done as a national initiative if the Government will identify the lead agency for this  program to address the overwhelming number of identified drug users waiting for interventions either by way of counselling or outright rehabilitation program.

Meanwhile, a network of 7 drug rehab centers in the Visayas and Mindanao will hold a conference in Bohol on 01 August, Monday, to formulate strategies to work effectively with LGUs and other sectors in addressing the recovery needs of the surrenderees. Also in the agenda are matters related to the operations of the FARM It Works Balay Kahayag (FITWBK) Chemical Dependency Treatment Center jointly managed by Rene Francisco of It Works Chemical Dependency Treatment Center in Ozamis City and Jimmy Clemente of Family and Recovery Management (FARM) center in Minglanilla, Cebu.

I continue to receive feedbacks from friends mostly through Facebook encouraging us to go on with this journey to help address the challenge of having this great number of identified and self-confessed drug users in our midst.

We all lack resources but I think we need not wait for the big program to come to be able for us to help. What we need at this stage will be a mobile team trained to work with drug users and their families, help establish family bonding, facilitate assessment of the drug user’s condition and help provide appropriate services and interventions towards recovery.

Perhaps the drug rehab centers, the Government, as well as bilateral and multilateral donors, can help relevant Government agencies and NGOs recruit and train such mobile teams as initial efforts to move the current process from surrender to recovery.

  

For comments, email: npestelos@gmail.com.

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FINDING A REASON TO CARE

For The Bohol Tribune

In This Our Journey

NESTOR MANIEBO PESTELOS

In last week’s column, we reported the recommendations presented during consultations with drug addiction professionals on how to address this disturbing phenomenon brought about by the unrelenting campaign against drug users and pushers launched by the new administration. It was just a personal initiative with the modest aim to gather ideas on how to deal with what could develop into a major crisis.

As expected, only a few responded to our personal invitation.

We were quite heartened, however, with the quality of the sharing done in this small café named Crescencia, by the road in Poblacion, Baclayon, where incidentally dozens of drug users under rehabilitation gather every Wednesday night for their weekly sharing of experiences and reflections.

I summarized in my last column what I heard during this series of meetings with friends  inspired actually by our group’s reading of the Biblical passage on the Good Samaritan in our action group meeting (AGM), a regular activity of the Brotherhood of Christian Businessmen and Professionals (BCBP) which I joined in 2015 as part of efforts to go back to my faith after years of doubt and skepticism. But that’s another story.

Brod  Irwyn Lumuthang and his wife, Sis Joy, who are our AGM facilitators, encouraged us to put into writing what could be done about having so many identified drug users left in the custody of their respective families waiting for further action by counselling or rehabilitation. Somebody joked that if they revert to the old ways of using or in some cases, actually selling drugs, bullets would surely come as their way of salvation.

A grim joke, but newspaper pictures of bloodied bodies by the road, in isolated places in some remote barangays, in crowded buses and terminals, all tend to show what could be expected if drug users and pushers return to their old ways. Effective psychological warfare images, but they may overshadow more caring and humanitarian ways to address drug addiction problems.

In having this overwhelming number of surrenderees, with Bohol, for instance, having 22,000 now and still counting, there’s no way you can go by the insane solution of just killing all of them to get rid of the problem; no way you can go shooting them down  like they are stray dogs, those who would revert to the old ways, for sheer lack of guns and bullets, not to mention the lack of bounty money to spread around and the various paper forms to fill to justify the killing and to have probably an official receipt of each killing required to collect the bounty. What a cruel country we have become to imagine this could happen at all!

I reported in last week’s column what the consultation participants shared with us during the meeting. For the benefit of LGUs and NGOs who are interested to access more information about services which can be used to formulate a strategy or simply to decide on what to do about these hundreds of identified drug users now in the custody of their respective families , let me give here some names and contact numberst: Jimmy Clemente, 0998 888 1559; Alain Alino, 0917 325 0252; Rene Francisco, 0918 908 8237; Epoy Jiffy Laroya, 0907 350 5041.

They run a network of around ten or more drug rehab centers in the Visayas and Mindanao and have announced their intention to adjust their admission fees and modify treatment procedures to cope with the thousands of drug users and pushers now identified and obviously pardoned but needing a systematic program of counselling and treatment.

Alain Alino visited Bohol last week to meet with government officers tasked to plan the government’s drug rehab center. He said he also accompanied them to the FARM It Works Balay Kahayag (FITWBK) drug rehab center in Laya, Baclayon to see first-hand what is being done in the facility.

Rene Francisco went around the province last week-end to look for venues for possible tent cities, his proposed strategy to cope with hundreds who have no access to treatment services. He is expected to attend a conference this weekend in Iloilo City  to discuss his recommended strategy.

For his part, Jimmy Clemente, is organizing what he calls a “Unity Conference” among drug abuse professionals from various drug rehabilitation centers this week-end in Iloilo City to be able to identify  collaborative approaches regarding drug rehabilitation which can be presented later to target LGUs and other agencies.

Meanwhile, Miriam P. Cue, noted psychologist originally from my adopted town, Baclayon, emailed last 18 July her proposed strategy since she could not make it to the consultation meeting on account of her usually tight work schedule at the New Day Rehabilitation Center in Davao City and her engagements with international organizations.

We meant to present her proposed strategy in this week’s column but we decided to post the entire strategy in our Facebook pages and blogs last week to make her ideas available to as many people as possible. It is timely to do so because provincial governments and the Municipal LGUs all over the country are preparing their respective plans on how to handle the situation of having hundreds of drug users waiting for some kind of treatment or counselling and I believe that her ideas will be quite useful at this time. 

I have known her for more than two years for her work and that of her colleagues at the New Day Recovery Center (NDRC) in Davao City as part of our study of selected drug rehab centers in Visayas and Mindanao. This field research was undertaken prior to the establishment of Bohol's first drug rehab center managed since November last year by the It Works Chemical Dependency Treatment Center of Ozamis City and the Family and Recovery Management (FARM) center of Minglanilla, Cebu.

Miriam P. Cue from Baclayon, Bohol is one of the country's internationally-known drug addiction professional. She is always eager to lend her expertise to the Government and other sectors interested to be involved in this quite unique problem in Bohol and in the country where drug users and pushers have been identified, turning themselves in to police authorities, their numbers growing by leaps and bounds from day to day.

Her credentials is impeccable: Chairperson, Professional Regulatory Board of Psychology at the Professional Regulation Commission (PRC); Clinical Psychologist and Psychotherapist at NDRC Davao and internationally-known trainer of recovery coaches and other drug addiction professionals.I believe that her proposed strategy will be quite a valuable input to all sectors in Bohol and other provinces who are now preoccupied on how to handle a critical situation resulting from the surrender of thousands of drug users needing a systematic treatment program.

I have provided copies of her proposed strategy to government offices and NGOs who may be interested to implement her ideas. For this column, however, I will limit myself to the last section of her paper because I think it is something in which most of us who are not drug addiction professionals can assist.   Here is that portion of her paper she categorizes as Recovery Supports:

“a. Working with Clients through non-clinical services that are used with treatment to support     

individual clients in their recovery goals. This can be done by peers and self-help groups.

“b. Working with families through Community Based Programs. The families of all those

surrendered in particular, need to be educated and provided the appropriate supports.    

Many of them could be suffering from social stigma now. They may not know what to do

anymore,  with their confusion... their co-dependencies and their involvement with the

clients.

    

“These families were already affected before these users/peddlers surrendered; and these   

users/peddlers will go back to their families after treatment and/or intervention. Build and foster health, resilience, wellness and quality of life through the transition of  individual clients  and client families within the network of families and recovery partners in the community.

“These families and recovery partners play a very critical role in recovery and they can also be tapped for essential supports to our rehabilitation efforts. 

“Seek help from the DOH, establish linkages with the Church and various church/faith groups, with the DDB and other government institutions, with UNODC, with rehabilitation centers and facilities, SUD [Substance Use Disorder] treatment professionals and other treatment-providers outside Bohol for needed supports.

“Not all may need treatment. Some of them may only need psycho-social support in their efforts to find acceptance, amnesty, redemption and reintegration.

“Please realize as well that SUD treatment for the parolees, and/or probationers (whatever you call these offenders) differ from the treatment of those who have not been in conflict with the law and/or those in jail or in prison. Their freedom may be curtailed but they still have greater access to drugs and alcohol than those who are incarcerated, hence, the greater potential for relapse and recidivism. 

“Many of the "surrenderees" may have a co-occurring anti-social personality disorder, or a conduct disorder (for those below 18); many of them may be spiritually empty and financially impoverished.

“Securing their basic needs such as food and shelter, re-examining their values, helping them see the meaning of their life and purpose in this world, and providing more intensive psychotherapy among other treatment strategies to address the co-occuring problem, should help them reintegrate into society.”

Those of us who are not drug addiction professionals will find in this portion of the proposed strategy justification to get more involved. No special qualification required to help facilitate services to reach these drug users, most of them may not need a rehabilitation center to recover. We need not be psychologists, psychiatrists and social workers, as well as doctors and nurses, to assume a role in the current crisis to cope with having thousands of self-confessed drug addicts in our midst, some of them are close friends and relatives.

We need only to find a reason to care. For comments, email: npestelos@gmail.com

###NMP/21 July 2016/1.06 p.m. 

PROPOSED STRATEGY BY NOTED PSYCHOLOGIST FROM BACLAYON, BOHOL - MIRIAM P. CUE

We meant to present this in our column for next week, but we think this proposed strategy from noted Psychologist Miriam P. Cue cannot wait that long.

She could not make it to the consultation with drug addiction professionals we scheduled last week, but she was kind enough to email her thoughts as response to our appeal for ideas on how to handle the situation of having hundreds of drug users waiting for some kind of treatment or counselling.

I have known her for more than two years for her work and that of her colleagues at the New Day Recovery Center (NDRC) in Davao City as part of our study of selected drug rehab centers in Visayas and Mindanao. This initiative was undertaken prior to the establishment of Bohol's first drug rehab center.

Over the past several years, she has given us valuable advice on how to deal with the serious drug addiction problem in our province. Miriam P. Cue from Baclayon, Bohol is one of the country's internationally-known drug addiction professional.

Her credentials is impeccable: Chairperson, Professional Regulatory Board of Psychology at the Professional Regulation Commission (PRC); Clinical Psychologist and Psychotherapist at NDRC Davao and internationally-known trainer of recovery coaches and other drug addiction professionals.

Her proposed strategy will be a valuable input to all sectors in Bohol and other provinces who are now preoccupied on how to handle a critical situation resulting from the surrender of thousands of drug users throughout the country.

Here is her proposed strategy in response to our appeal for assistance to determine a cost-effective approach in handling the surrenderees contained in her email dated 16 July 2016:

Following your brilliant ideas, I would say, your goals are clearly defined, but for the project to work, I would like to suggest this strategy for your consideration:

1. Organization of the "Response Management Team" in partnership with the provincial and local government, the Department of Health, the Church, HEIs and religious-civic groups in Bohol. We all need to work together on this with a Hub and Spokes" strategy to make things work. The hub could be the provincial government as central provincial bureau or headquarters with a designated point person like you to orchestrate things. Every municipality or community should have its own coordinator and point person. Policies and guidelines also need to be established right from the start to avoid if not minimize confusion.

2. Mapping of Treatment Capabilities and Resources.

a. Treatment Professionals and Certified Specialists - We need to know available resources in the province who have the credentials and experience in SUD (Substance Use Disorder) treatment - psychiatrists, clinical psychologists and mental health nurses, clinical social workers and doctors trained in addiction medicine, guidance counselors, etc....

It is important you identify them so you would know whom to tap and where to send referrals.. Given our professional regulatory laws, we need to identify those who are registered and those who are not). We need to identify potential recovery coaches as well...

We can give specialized training courses to those whose education, experience and exposure to the neuroscience, psychology and treatment of SUD and related disorders are relatively limited.

b. Volunteers. We need to map out / identify the service-volunteers - professionals, para professionals and professional groups who can help us address the problem. Cluster the volunteers according to their specific profession, education, experience, affiliation and location so we can train them in areas where they can be most effective or where they can give their best efforts and contribution.

c Facilities. How many treatment facilities do we have in the province? Where are they located? How are these facilities run? Are there any available government owned facilities we can use for this "emergency" situation? How safe and secure are these facilities? Any private individuals who are willing to rent out or volunteer facilities they are not using in response to this overwhelming problem?

d. Financial Support and Resources - how much can the province and the local government units allocate for this this purpose, particularly for training and treatment? Are there any institutions and caring citizens we can identify for possible funding support?
e. Establish Directory of Treatment Capabilities: Resources and Services...

3. Client Registration, Intake and Screening. This should be done as soon as possible so we can start triaging (sorting out those who surrendered according to their distinct problems -addiction severity and related legal and financial issues- and allocating treatment resources according to priorities).

Those who have committed heinous crimes, or those who present potential danger or threat to themselves and/or society must be institutionalized now.

Student help and support should be limited to registration/registration intake and they should not be made to feel obliged to help like asking for their involvement in this project as a class requirement. Please spare them the trauma...

And for student volunteers, debriefing should be done every after work in the field at the end of the day. The story might be more different however for medical clerks who are expected to be more mature.

For this purpose, I suggest we tap municipal health clinics/centers, and the social welfare offices for the task. Training support can be provided if necessary... School Guidance Counselors and Psychology teachers can also help in the effort to make our beloved province drug free...

4. Psychoeducation - This should be provided to all those who care - LGU officials, volunteers, support groups for them to understand the nature of addiction and the economics of the drug trade business. We need to fight social stigma first and awaken interest among people to help and serve. The "I couldn't care less attitude" you are describing in your column Nes could be symptomatic of the social stigma and lack of real understanding about the problem.

5. Capacity Building for the Treatment Professionals, Clinicians and Service-Volunteers/Providers. I can help you prepare the training curricula for the different clusters...As Global Master Trainer under the Colombo Plan International Center for the Certification and Education of Addiction Professionals and the US Department of State Bureau of Narcotics and Law Enforcement Affairs, I believe I can help..

I already have the commitment of the ICCE Director of Colombo Plan to conduct the Training of Trainers (TOT) here in Manila early next month with the funding support of the US INL through the Director of the Global Demand Reduction Program.

If there is any interested doctor, psychologist or social worker experienced in SUD treatment you would like to endorse as potential trainer for Bohol, please send endorsement and CV ASAP so I can submit his papers to Colombo Plan.for consideration and inclusion in the TOT training.

If you cannot endorse one right now, I will ensure training in Bohol after the TOT I have organized here in Manila. This problem affects all regions in the country, so I hope you realize why we need to work this out on a national scale with the Department of Health and the Professional Regulation Commission who regulates practice of the professions.

6. Further Assessment of those found to be of high risk and addiction severity after screening (strategy # 2). Identify and determine severity of problem for those with a co-occurring psychiatric condition or other mental disorders, those with co-occurring health problems or medical conditions, those with serious legal problems, employment concerns and financial problems, and those with limited education and mental capacities... We need all these information for treatment planning.

7. Client Referral, Treatment and Rehabilitation in the Continuum of Care. This I would like to discuss separately. How long and intensive the treatment and primary care will be, whether residential / in-patient, or outpatient, will depend on client case diagnosis, client motivation and recovery capital. Unless we have the assessment findings, we cannot really say it is good only for 30 days, 3 months, 6 months, I8 months, or forever (as in custodial care)... Certainly, those with co-occurring disorders need specialized services like pharmacotherapy and psychotherapy, and longer-term treatment.

7. Recovery Supports:

a. Working with Clients through non-clinical services that are used with treatment to support individual clients in their recovery goals. This can be done by peers and self-help groups.

b. Working with Families through Community Based Programs. The families of all those who surrendered in particular, need to be educated and provided the appropriate supports. Many of them could be suffering from social stigma now. They may not know what to do anymore, with their confusion... their co-dependencies and their involvement with the clients.

These families were already affected before these users/peddlers surrendered; and these users/peddlers will go back to their families after treatment and/or intervention. Build and foster health, resilience, wellness and quality of life through the transition of individual clients and client families within the network of families and recovery partners in the community..

These families and recovery partners play a very critical role in recovery... and they can also be tapped for essential supports to our rehabilitation efforts.

Seek help from the DOH, establish linkages.with the Church and various church/faith groups, with the DDB and other government institutions, with UNODC, with rehabilitation centers and facilities, SUD treatment professionals and other treatment-providers outside Bohol for needed supports...

Not all may need treatment. Some of them may only need psycho-social support in their efforts to find acceptance, amnesty, redemption and reintegration.

Please realize as well that SUD treatment for the parolees, and/or probationers (whatever you call these offenders) differ from the treatment of those who have not been in conflict with the law and/or those in jail or in prison. Their freedom may be curtailed but they still have greater access to drugs and alcohol than those who are incarcerated, hence, the greater potential for relapse and recidivism.

Many of the "surrenderees" may have a co-occurring anti-social personality disorder, or a conduct disorder (for those below 18); many of them may be spiritually empty and financially impoverished. Securing their basic needs such as food and shelter, re-examining their values, helping them see the meaning of their life and purpose in this world, and providing more intensive psychotherapy among other treatment strategies to address the co-occuring problem, should help them reintegrate into society.

I hope these thoughts will be of help. Of course, I am coming from the perspective of a psychologist who has been exposed to SUD counseling and treatment for 40 years now.

7. Recovery Supports:

a. Working with Clients through non-clinical services that are used with treatment to support individual clients in their recovery goals. This can be done by peers and self-help groups.

b. Working with Families through Community Based Programs. The families of all those who surrendered in particular, need to be educated and provided the appropriate supports. Many of them could be suffering from social stigma now. They may not know what to do anymore, with their confusion... their co-dependencies and their involvement with the clients.

These families were already affected before these users/peddlers surrendered; and these users/peddlers will go back to their families after treatment and/or intervention.

Build and foster health, resilience, wellness and quality of life through the transition of individual clients and client families within the network of families and recovery partners in the community..These families and recovery partners play a very critical role in recovery... and they can also be tapped for essential supports to our rehabilitation efforts.

Seek help from the DOH, establish linkages.with the Church and various church/faith groups, with the DDB and other government institutions, with UNODC, with rehabilitation centers and facilities, SUD treatment professionals and other treatment-providers outside Bohol for needed supports...

Not all may need treatment. Some of them may only need psycho-social support in their efforts to find acceptance, amnesty, redemption and reintegration.

Please realize as well that SUD treatment for the parolees, and/or probationers (whatever you call these offenders) differ from the treatment of those who have not been in conflict with the law and/or those in jail or in prison. Their freedom may be curtailed but they still have greater access to drugs and alcohol than those who are incarcerated, hence, the greater potential for relapse and recidivism.

Many of the "surrenderees" may have a co-occurring anti-social personality disorder, or a conduct disorder (for those below 18); many of them may be spiritually empty and financially impoverished. Securing their basic needs such as food and shelter, re-examining their values, helping them see the meaning of their life and purpose in this world, and providing more intensive psychotherapy among other treatment strategies to address the co-occuring problem, should help them reintegrate into society.

I hope these thoughts will be of help. Of course, I am coming from the perspective of a psychologist who has been exposed to SUD counseling and treatment for 40 years now.

Your partner for a better world,
Miriam P. Cue, PhD, RPsy, RPm, RGC, ICAP-II, MAC

Chairperson, Professional Regulatory Board of Psychology
Professional Regulation Commission

Registered Psychologist (Lic # 000001)
Registered Psychometrician (Lic # 000001)
Registered Guidance Counselor (Lic # 0002011)
PAP Certified Clinical Psychologist
PAP Certified Counseling Psychologist
PAP Certified Assessment Psychologist
PAP Certified I/O Psychologist
Internationally Accredited Addiction Professional (CP-ICCE)
Global Master Trainer in the Universal Treatment Curriculum for Substance Use Disorder
Master Addiction Counselor (NADAC - USA)

Consulting Psychologist/Retainer
New Day Recovery Center (Davao City)

Note: Much thanks for this comprehensive and valuable contribution to our quest for an effective strategy. We will make this available to as many people as possible.

WHERE DO WE GO FROM HERE?

For The Bohol Tribune

In This Our Journey

NESTOR MANIEBO PESTELOS

As everyone knows, the number of so-called surrenderees, a term adapted widely by the media to refer to drug users who signed with government and police authorities not to use illegal chemical substances again, soared to staggering proportion early in the week all over the country. In Bohol alone, the number reported increased from something around 3,000 to 4,600 during the weekend and then to 6,000 climbing to 9,000 at the start of this week.

My initial response was to go find a cave elsewhere and bring my family to hole in there until the imagined holocaust trips over. When I look around, however, in-between reading Facebook posts, I realized there was no panic at all about the situation.

Everything appears normal. Facebook reflects, at least as far our network is concerned, shown on public mode, that people are mostly having fun, celebrating birthdays and anniversaries, feasting and cavorting on the white-sand beach, admiring sunsets and the vast expanse of the sea around us as though seeing these natural wonders for the first time, enjoying life to the hilt despite the grim possibility of a crime rise in our midst as a result of untreated mental condition arising from repeated drug use.

My two sons, Gabe and Odoni, both in their twenties, would come home past midnight as usual and I suppose, despite all these drug buy-bust operations ending up in quite gory bloody scenes in the bush, crowded bus, busy street and all, everything is as normal as can be in our beloved Bohol. Hence, more blessings, oh Lord. Everything is A-OK, bless our leaders in all sectors, government and non-government that because of their deafening silence about it all, everything must be alright under the new regime.

In the popular imagination, at least, everything is just OK and so why bother. Enjoy your beer and make San Miguel richer and happier! I must be in the wrong planet, worrying about it all. Anyway, for whatever it is worth, I am sharing some advice from friends, old and newly-found ones, on what could be a good strategy to cope with a situation that we have 9,000 drug users outside some form of a rehabilitation or counselling process.

And so here it is, how a personal quest unfolded during the week which I am sharing not for any dramatic value (read: gossip!) but to raise key issues that could somehow result in a response to a potentially risky situation which can scar us for life emotionally and otherwise.

13 July, Sunday. We had our Action Group Meeting (AGM) with our cluster of brods and sis from the organization I joined in 2015, the Brotherhood of Christian Businessmen and Professionals (BCBP) held at Crescencia Café at my in-laws’ place in Baclayon. As is the practice during such small-group meetings, we chose a passage from the Bible, pick up a phase and then individually share our thoughts with the other group members.

The assigned passage for this AGM was Luke 10:25-37, a popular one, known by many cathechists and Bible Study Groups the world over as “The Parable of the Good Samaritan.”

5.05 a.m. There was a loud bang followed by total darkness. Now I have a flashlight and lighted candle-in-a-glass jar near this laptop. I am thinking there must be a message there, the brown out happening as I review the passage from the Bible by my side.

But I refuse to be distracted by any further thought. To continue: I chose this sentence from the assigned text: “Love your neighbor as you love yourself,” and used it as the basis for my sharing.

After the meeting, during dinner, the conversation turned to this matter about the surrenderees. All of a sudden, the whole room was overwhelmed with excited voices from the dozen or so members indicating keen interest on the subject by our Action Group which I took it to mean this must be a popular sentiment, that many people would like to share their bit to do something about the situation.

Our couple leaders, Irwyn and Joy Lumuthang, stayed behind to discuss the issue some more and before they left, they said they would bring the matter to the attention of the Chapter President, Jun Navarro. I immediately set to work putting flesh to the ideas which had been thrown around before, drafted a concept and named it the Good Samaritan Project, no doubt inspired by the Biblical selection for the day.

Let me directly quote pertinent portions of the draft concept so that readers may also share their thoughts with us or their neighbors, whoever they conceive them to be.

Overall Goal

To ensure that each surrenderee is provided a comprehensive package of services from pre-treatment to full recovery.

Specific Objectives

a.       To establish a baseline data on the condition of each surrenderee which will serve as basis for treatment and post-treatment interventions;

b.      To ensure systematic provision of counselling and other services with the full cooperation and assistance of the family and the local community;

c.       To monitor regularly the progress of each client and adjust inputs accordingly;

d.      To document outstanding cases of full recovery and successful integration with both the family and the community.

Strategy

To achieve its objectives, the project will adopt an implementation strategy with the following features:

a)      Partnership with all key sectors with specific inputs to deliver;

b)      Mobilization of volunteers who will be organized into teams assigned to specific cluster of target clients in specific location and linked to specific focal person in the project management committee;

c)      Organization of families of clients to ensure spiritual and other support to target clients.

d)      Designation of a pilot area where implementation approaches can be tested based on current organizational capability, existence of willing partners, and affordability.

Key Activities

-Link up with drug rehab centers in nearby regions and consult them if they can help conduct a systematic diagnosis of those arrested and those who surrendered to determine a) who can be treated at home; b) those who must be treated in a drug rehab facility; and (c) those whose mental conditions has worsened due to long period of drug use and must be committed to a mental hospital instead.

-Recruit and train volunteers who can serve as counsellors for both drug abuse victims and their respective families;

-Train nursing, psychology and/or social work or social science students and their teachers on the use of diagnostic tools so that the diagnosis could be done on a massive scale simultaneously to cover more than 4,600 surrenderees;

-Formulate and implement a short-term orientation or basic skills training course for all the volunteers who are willing to do this work;

-Liaise with partner drug rehab centers and institutions and seek their advice on how to fast-tract treatment at substantially lower costs;

-Organize an interim core team who will assist in mobilizing support from all sectors (Government, Church and faith-based organizations; private sector; civil society organizations, academic institutions, etc.

-Get an updated list of surrenderees and all relevant data about them for planning purposes.

Note: This is a tentative list. More can be added.

Organization and Management

Details will be provided in accordance with the role to be undertaken by the organization, whether as proponent/implementation agency or one of the partner agencies.

I used this project concept as basic document to discuss with others from various organizations who shared the same concern with us.

Due to limited space, I will just summarize here what have been given to us during the discussion or through the internet:

From Rene Francisco, CEO of FARM It Chemical Dependency Center in Bohol who has had eighteen years’ experience in rehabilitation work.  He suggested a 45-day program for those who need rehabilitation. In coordination with LGUs and other institutions, old unutilized buildings can be used to serve as rehab centers. In the absence of these old structures in the municipality, having the surrenderers in tent cities could be an alternative structure. He is ready to work with a network of drug rehab centers in Cebu and Mindanao who can provide

training to rehab workers and volunteers in Bohol.

Alain Alinio who is from the FARM Drug Rehab Center in Cebu and also a network of such facilities in Visayas and Mindanao has discussed their proposal with representatives of the Provincial Government and will be willing to offer terms, too, for doing rehabilitation work with the surrenderees.

Fr. Clarito Rara also attended the meeting last 15 July in Baclayon. He has had 17 years of experience in counselling drug abuse victims in a military camp at the Veterans Hospital in Houston, Texas. He has since returned to Bohol and runs a counselling clinics in one of the parishes. He is willing to be part of the planning and implementation team to address the critical problem regarding the surrenderees.

Bel Jayco of the International Learning Center in Cortez says she can mobilize social workers who can help in documenting cases and provide auxiliary work in the various centers. She also says she can liaise with the government to be partner in this venture.

Today, Saturday, I will go around with Rene Francisco to visit some structures in the municipalities that can serve as rehab centers for this growing number of drug users being identified each day.

We will come up with a detailed project design next week for presentation with the Government, the Church and other key sectors wanting to do something about the need to extent rehabilitation services to the drug users who have surrendered these past few weeks. For comments: Email: npestelos@gmail.com