TC in drug rehab effective, but…
Therapeutic Community, TC for short, is a participative, group-based approach to treating drug addiction. It was usually residential, with clients and therapists living together, but increasingly residential units have been superseded by day units.
TC in the Philippines began in the 1970s when the then Drug Abuse Research Foundation Inc. (DARE) opened Bahay Pag-Asa for heroin addicts in Trece Martires, Cavite. It was the first Asian TC. Other residential treatment centers opened around Manila and in Baguio City. Through DARE, TC spread to Malaysia, Thailand and other Asian countries. Now there are community-based and prison-based TCs in many of these countries.
TC is adopted as a drug treatment model in many private for-profit programs in the Philippines. In the United States, large nonprofit drug programs continue to use a watered-down version of it, particularly the use of a looser social structure and selective applications of some of the traditional behavior-shaping tools. The outcome of such indiscriminate variations has been catastrophic, resulting in the breakdown of social control in many of these programs.
Government drug programs in the Philippines under the criminal justice system have applied TC in some of the jails under the Bureau of Jail Management and Penology (BJMP) and prisons of the Bureau of Corrections (BuCor), including the outpatient services for parolees and probationers by the Parole and Probation Administration (PPA). Police agencies such as the National Bureau of Investigation treatment center in Tagaytay City and the old Bicutan treatment center, formerly under the Philippine National Police, have also applied their version of TC. The latter two treatment centers, which have been absorbed by the Department of Health, together with other government centers in other cities and provinces, have implemented a variant of TC adapted to their realities.
In 1997, the PPA got funding from the US State Department’s Bureau of International Narcotics and Law Enforcement Affairs for training on TC from Daytop International. Daytop (or Drug Addicts Yield to Persuasion) is a drug addiction treatment organization based in New York City, founded in 1963, with a reported estimated success of 85 percent.
This multiagency project included the Dangerous Drugs Board, Department of Social Welfare and Development, PNP, NBI, Bucor, BJMP, Quezon City Anti-Drug Abuse Advisory Council, Parañaque Anti-Drug Abuse Council, PPA, and a few private TCs. There were study tours and internship in Daytop USA. The project lasted for years.
But after several years of trying to fit the TC model within disparate government organizations, many challenges have emerged. First, and perhaps the most serious, is the absence of a clear mandate on the status of TC as a treatment model within the agency. Second is the lack of a “standard practice” true to TC principles. Third is the lack of qualified clinical supervision and constant supply of staff with adequate training on TC. Add to this the little provision for organized training by competent trainers. And fourth, many practitioners do not have the skills to design and reorganize existing facilities for the minimum requirements of a TC program.
TC’s organizational structure and how the physical environment is organized must lend to the operational and clinical functions of TC. An important operational function is surveillance and the safety of the client population. An emotionally and physically safe environment is necessary to achieve rehabilitation. When implemented right, TC has the best tools to rehabilitate drug addicts.
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Dr. Fernando B. Perfas ([email protected]) is a New-York-based Filipino authority on Therapeutic Community and author of three books on the subject (available through Amazon). He has spent more than three decades treating drug addiction in the Philippines and many other Asian countries. He recently conducted TC seminars in Bicol.
