SKATING ON THIN ICE

With An Estimated One Million Drug Users And Addicts In The Country, There
Is An Urgent Need To Revamp Thailand'S Treatment And Rehabilitation Programmes

'Addicted to meth? Expect to help yourself!"

This statement from a distressed mother, whose 14-year-old daughter has
been battling drug addiction for several months, speaks a thousand words
about what can be expected in the treatment of drug abuse in this country.
And she insisted that after attempts at several drug treatment and
rehabilitation centres in Bangkok, her daughter still cannot kick the
habit. The reason is not that she cannot afford to pay for the treatment,
but for her, there is nowhere she can find the help she and her daughter need.

An overview of the country's drug treatment programmes conducted by a
psychiatrist for the United States Embassy in Bangkok has for the first
time highlighted how the country's overall approach is outdated. Existing
national and private programmes were developed for the treatment of opium
and heroin addiction, which included in-patient care, medication and often
moral and religious sessions that aimed to reform the addicts.

With the overcrowding of the facilities since the explosion in drug abuse
four years ago, mostly among youths, and the lack of trained health
professionals, the current treatment approach is to process as many addicts
as possible-a "better some treatment than nothing at all" approach.

With an estimated one million drug users and addicts in the country,
according to a study commissioned by the Narcotics Control Board, this
approach has clearly failed. Under the Narcotics Act BE 2522, all hospitals
under the responsibility of the Ministry of Public Health must provide drug
treatment. Currently there are a total of 516 such facilities nationwide
including state-run hospitals in Bangkok, and provincial and community
hospitals. The total number of beds available is 1,670.

There are only five specialised drug treatment facilities which provide
both treatment and rehabilitation, operated by the ministry in the four
regions and Bangkok-two each in the North and South located in Chiang Mai
and Mae Hong Son, and Songkhla and Pattani respectively, one in the east in
Khon Kaen, and Thanyarak hospital in Nonthaburi. The provincial drug
treatment centres each have a capacity of 200 beds, while Thanyarak has 670
beds. The Bangkok Metropolitan Administration operates 39 facilities.

An official at the ministry said that over the past three years the private
sector has shown interest in drug treatment, especially high-end hospitals,
which charge anything from a few thousand to over 100,000 baht per case.
There were only 10 private medical facilities which provided drug treatment
just three years ago, now there are 79, mostly in Bangkok.

The official stressed that all private facilities must seek authorisation
from the ministry. Both modern and traditional medical units are qualified
to apply with proof of a medical license issued by the Medical Council. A
detailed outline of the treatment and rehabilitation programme must also be
provided with the application.

Last fiscal year, a total of 86,603 people received treatment at facilities
run by the ministry; about 70 percent were addicted to opium and heroin.
About 80 percent of the 86,603 were treated as out-patients.

These figures indicate that state-run facilities are primarily attended by
"traditional" (opium and heroin) addicts, while the demand today is for
treatment for addiction to synthetic drugs, such as ecstasy, speed and
prescription tranquillisers. The official admitted that private facilities
may be better equipped with financial and human resources, and the role of
the ministry was to make sure they do not take advantage of the mostly
well-to-do addicts.

Dr Phanuphong Chitasombat, a leading private psychiatrist involved in the
effort to revamp Thailand's treatment and rehabilitation programmes, in
conjunction with other Thai and US experts, said he was confident that a
new approach will take shape, albeit slowly.

The launch of a model treatment centre in Bangkok and a few other provinces
nationwide is expected to be announced by the Ministry of Public Health
before year's end. And Thai and US drug experts are currently working on a
model training programme for Thai health professionals.

"To treat the symptoms of meth addiction is not difficult, it's beating the
craving that is hard, and only individual determination, support from
family members and friends, and professional counselling can help," he said.

"In the past, we thought that treatment should only be administered when a
person hits rock-bottom, but now we understand the aim and the
responsibility of health professionals is to help build confidence and
determination to avoid drugs in the first place or not use drugs again," he
said. "In the case of synthetic drugs, addiction is all in the head."

After studying treatment programmes in the US, Dr Phanupong and his team
are working on how to adapt methods in Thailand. In the US, group treatment
is known to be effective in some areas, but the doctor commented that Thai
people may not feel comfortable in a group. The two key factors which he
thought might work in Thailand are to operate on an out-patient basis, so
that addicts feel they can still live a normal life during treatment, and
to encourage the greater involvement of the immediate family.

This, he said will require "air-tight counselling" from the health
professionals working closely with the family members. "Meth" or ice, as it
is known, is the chemical methamphetamine. Known in Thai as ya ba (crazy
drug) it has become the drug of choice, particularly among students over
the past four years. The name change from ya ma, which literally means
"horse drug" and implied horsepower, does not appear to deter youngsters
from experimenting with the drug. "If it had any impact, we would not be
seeing an increase in addiction," commented Dr Phanupong. Even though the
past three years have seen a clear interest in developing drug
rehabilitation and treatment units in private hospitals, the subject is
still stigmatised, particularly among so-called high-society users. Drug
abuse is hidden under the wide-ranging "addiction treatment" banner, which
also includes treatment of nicotine, alcohol and food addiction. These
small clinics within big hospitals also treat patients prone to violent
behaviour, some associated with drug addiction.

The cost of drug treatment in these private hospitals is out of reach for
most of the estimated one million users, especially when compared to the
few hundred to few thousand baht that state facilities charge. Some wealthy
families are known to send their children with addiction problems to
Singapore and as far as Europe and the US to secure professional help.

Generally, the treatment for addiction to meth and other synthetically
generated drugs involves professional counselling to treat the physical
symptoms resulting from drug abuse.

Meth addiction fuels paranoia and eventually leads to irrational violent
behaviour, heart attacks, strokes, chest pain and kidney malfunction.
Prolonged use of meth can lead to lack of appetite and malnutrition. Dr
Phanuphong said Thai doctors were familiar with the treatment of these
symptoms and that the medication required is already available in the
country. It is the counselling services that need to be developed.

Currently there are 300 to 400 psychiatrists in the country, most are by
necessity involved in the treatment of those hospitalised with serious
mental illness or providing psychiatric medication in out-patient settings,
read the report to the US Embassy.

Dr Phanuphong said he was uncertain how many health professionals would be
interested in the new, specialised training, which not only treats users
and addicts but also helps families to cope. There is no set model for
treatment but a so-called psychosocial approach, such as education,
information on the impact of abuse on mental and physical health and
motivation to change behaviour, is becoming the accepted approach.

Dr Phanuphong said that it was most crucial for the treatment programme and
the modern training for health professionals to be recognised at the
highest level of authority to be instituted as national policy.

The Chuan Leekpai government has been supportive but there is uncertainty
with the forthcoming elections later this year, whether the next man in
power will be as supportive. For now the only option for people like the
addicted 14-year-old girl and her mother is to face up to the addiction and
see each other through. A drop of love and understanding will certainly
help. "If parents take time to care for their children, there is little
chance for addiction to drugs," said the official at the ministry of health.

TREATMENT FOR DRUG ADDICTION IN THAILAND (Sidebar)

Dr Anggoon Patarakorn, psychiatrist and head of the Detoxification
Department of Thanyarak Hospital has revealed the following information for
the interest of the public:

Sixty percent of the department's patients are addicted to meth, 30 percent
to heroin, and 10 percent to other substances.

Thanyarak Hospital has 670 beds, and treats approximately 19,000 patients
per year. The population ratio between the In-Patient Department (IPD) and
the Out-Patient Department (OPD) is 1:1.

There are four steps to treatment at the hospital:

1) Pre-Admission-Patients and relatives come in to discuss the addiction
and possible treatment with doctors.

2) Detoxification-In-house patients take 14 days, while out-patients take
21 days.

3) Rehabilitation-This step can be separated into occupational and
psychological therapy, and can be divided into four phases:

3.1 Motivational period-Seven to 30 days. If a patient is ready to leave
after seven days, he will be released, but if not, he must stay until he is.

3.2 Therapeutic Community (TC)-Group therapy with other addicts lasts about
a year. Patients are trained professionally to enhance their prospects for
employment.

3.3 Re-entry Period-Six months. Patients are counselled to successfully
rejoin society.

3.4 Dismissal

4) After-Care-Follow-up periods depend on the length of treatment. For
example, if a patient is a part of TC, the follow-up period will last up to
five years.

Treatment for IPD patients and OPD patients is similar, but admitted
patients are exposed to stronger medication, as it is easier to monitor them.

Treatment costs depend on the patients' addiction, and range from around
400 to 500 baht. Those who are admitted into TC spend an extra 100 baht per
month. How does the hospital survive? Patients are put to work and produce
marketable products.

The synthetic drug methadone is used to treat heroin addiction cases, in
which the doseage will gradually be decreased. When methadone is used, the
withdrawal symptoms and physical pain are massively reduced.

Anti-depressants are used to help meth addicts. Stimulant medications are
given in the morning to keep the patients awake, and in the evening,
sedative anti-depressants are taken. These anti-depressants help the
patients to re-adjust to normal life cycles-waking up in the morning and
going to bed at night.

Replacement treatments are used for addiction to alcohol, sleeping pills,
and heroin.

On the whole, treatment in Thailand is not yet sufficient, because it lacks
psychosocial treatment. Addicts may be medically cured, but their
circumstances and surroundings are difficult to change.

Thanyarak Hospital is run by the state, and is located on Vibhavadi Rangsit
Road, Pathum Thani. Call 531-0080 for more information.