To help teen drug abusers in Thailand overcome addiction, Jurairat Swatdiparp has established a residential rehabilitation center that inspires life changes through peer counseling, group therapy, and involvement in community activities.
The New Idea
A former probation officer, Jurairat has seen hundreds of people of all ages struggle with drug addition, finding only temporary relief in Thailand's existing public and private rehabilitation programs. Building on her experience with addicts and exposure to alternative rehabilitation programs in the United States, Jurairat has designed a treatment model that helps pre-teen and teen addicts turn their lives around–permanently. The first of its kind in Thailand, the model has attracted attention nationwide for its success in treating addiction, its integration of addicts into the broader community, and its reliance on recovered addicts for ongoing management of the center. Residents spend a minimum of eighteen months in treatment, during which time they gain stability from peers, learn marketable skills, contribute to the center's daily operations, and participate in community activities. A strict daily regimen balances opportunities for psychological healing with pursuit of external objectives, and fosters a supportive environment among peers. In addition, residents' frequent interaction with the community dissolves prejudice toward drug users and inspires a nurturing relationship between community members and the center's residents. Through three primary strategies for spreading her idea, Jurairat expects to see her treatment model, or elements of it, reach communities nationwide.
Use of illegal drugs–especially amphetamines–by Thai youth has escalated in recent years. A study conducted in 1999 by ABAC, a leading Bangkok-based academic institution, revealed that 12.4 percent of Thai students ages twelve to twenty-two are habitual drug users or recovering users, a statistic representing a 40 percent jump from 1995. Of the roughly 40,000 drug users currently receiving formal treatment in Thailand, 50 percent are children and youth. The scale of the problem is increasing, and medical professionals, social workers, policy makers, and parents are struggling to find preventive and corrective solutions that are effective and cost-efficient.
Drug rehabilitation programs in Thailand are typically run by the state, by Buddhist monks, or by the military. In Jurairat's experience, many are ineffective, primarily because they treat the symptom of the problem–drug use–while ignoring the fundamental problems that cause drug use. Most programs isolate the addict from real life responsibilities, an approach that may prove therapeutic in the short-term, but rarely results in a lasting cure, as addicts become less able to balance internal needs with the demands and pressures of the external world. Most programs do not make effective use of peer and family involvement in the patient's recovery, an oversight Jurairat sees as critical. Following a brief treatment period, individuals are typically returned to the same complicated lives that inspired their addiction in the first place. In rare cases, they forge lives free from chemical dependence; more frequently, though, they resume old habits.
The Thai public is not well-informed about the nature and causes of drug abuse among the nation's children and teenagers. Negative public perception of drug abusers compounds the problem. Paradoxically, to escape the social isolation they feel, addicts retreat further into a world of addiction and, in many instances, resort of criminal behavior to support their drug dependence.
Jurairat initially focused her efforts on building a broad base of support from the hosting community. She identified those individuals whose support and endorsement would be key in dispelling criticism from more skeptical community members. Then, over a period of months, she visited them regularly, telling them of her experiences with drug addicts and encouraging their support of the center's activities. She talked to the town's monks, enlisting their help in teaching the boys. From community doctors she secured free medical care for the center's residents. She found a volunteer to teach English as part of the center's non-formal education curriculum.In establishing the center, Jurairat collaborated closely with Ashoka Fellow Suwanee Juboonsong, an appointee to the prestigious Associate Judges of Thailand, a national network of laypeople who assist the juvenile courts in recommending actions in cases of criminal misconduct. Now, the majority of the center's residents are referred by the court system–on the recommendation of Associate Judges–often with the courts assuming some of the cost of treatment. In some cases, though, desperate families find the center through word of mouth or the media. Families who can pay the full monthly fee of 3000 baht (roughly $60) do so, while those of more meager means pay only what they can afford.
Once admitted, each boy meets with a staff member for an initial consultation, which results in a treatment plan tailored to meet his specific needs. The plan establishes milestones and sets periodic progress check-in dates. Now at maximum capacity, the center is home to sixty-three boys–most between eleven and seventeen years old–who stay for a minimum of eighteen months. Strict house rules accompany a prescribed daily regimen. By learning discipline from their environment, residents begin to apply structure to their internal lives. They awaken at six, exercise, take a shower, and convene for breakfast at nine and for a morning meeting just afterwards. Facilitated by the staff member on duty, typically a recovered addict himself, the morning meeting establishes objectives for the day. From nine until noon, residents perform chores around the center or work in the garden or on other projects. At noon, they rest for thirty minutes, eat lunch (prepared by the kitchen team), then break into study groups. Older residents resume work in the late afternoon, after which time they play football or another sport. They take another shower, and assemble for dinner at six, followed by a period of relaxation (typically includes watching television or a movie). At eight, they break into small groups for group therapy. Again facilitated by a staff member, these one-hour meetings review the day's activities and provide a sometimes emotional forum for residents to share personal challenges and extend mutual support to peers. Following the session, residents break for a snack, then spend at least thirty minutes recording their thoughts in a diary. At ten, lights go out.
Jurairat calls on recovered addicts, themselves former residents, to play a key role in managing the center's daily activities, working closely with residents, and coordinating outreach and prevention programs in the community. In the past two years, Jurairat has trained groups of three to four former residents to assume staff positions. This provides a career opportunity for some recovered addicts while, at the same time, strengthening the center. Because staff have lived through addiction, they establish a brotherly, yet firm, rapport with residents. Furthermore, they don't treat the work as just another job. As know they owe their lives to the center, they are dedicated to its mission. Now in its second year of operation, the center is successful in treating drug addiction. A team of dedicated, skilled staff members manages the center, and it is financially self-supporting. Residents grow most of the vegetables and fruits they eat, and sell leftover produce to the community.
While Jurairat plans to maintain general oversight of the center, she is increasingly turning her attention to spreading the treatment model throughout the country, a task she intends to approach in three ways. First, she plans to establish additional centers in Thailand, starting with a center in the south, for which she has already secured land and initial funding. This approach is greatly aided by the ongoing support of the Associate Judges of Thailand, a national network. Second, she plans to share lessons learned by teaching in formal rehabilitation programs. Third, she plans to develop a more formal program to aid in training visitors to the center, who currently include health care workers and representatives from the Ministry of Public Health and from civil society and youth organizations.
Born near the Thai-Malay border, Jurairat grew up in a Muslim family living in a predominantly Buddhist country. Early on, she developed an interest in the cultural influences that shape people–an interest she pursued through academic research, graduating with a master's degree in sociology in 1987.
Curious about people on society's fringes, Jurairat took a post after graduation as a probation officer. There, her duties ran the gamut from conducting diagnostic interviews with criminal offenders to providing family counseling to administering urine tests to determine recent drug use. The work left her exhausted and often at odds with the existing system, as she saw clear needs and sometimes clear solutions, but was required by official mandate to pass offenders through designated channels. Despite her growing frustration, the work furnished the very best exposure to the nature and causes of addiction, as drugs played at least a supporting role in just about every story she heard. Jurairat learned the slang of the drug world, and saw first hand urine swapping and other tactics used by addicts to avoid arrest. Most importantly, she learned from criminal offenders that addicts want to overcome addiction but cannot do so on their own. This lesson would be reinforced several years later, as Jurairat poured endless hours into helping her younger brother stop using heroin, on which he had become dependent at age nineteen.
Following two years as a probation officer, Jurairat volunteered to head the first state-run drug rehabilitation home for child delinquents, begun in 1991. While she felt that she was the best person for the task, she knew she lacked expertise in treatment methods and organizational management. She appealed to the U.S. Embassy to sponsor her participation in exposure trips to rehabilitation programs in the United States, for periods of between two weeks and eight months for three consecutive years. These trips, which included site visits to private and government centers in New York State, proved instrumental in shaping Jurairat's vision of a treatment model that would work in Thailand. Thus, when conflicts over philosophy and management of the state rehabilitation center reached a head in 1998, she joined with Ashoka Fellow Suwanee Juboonsong in launching a private residential center. Located in the town of Petchaboon in northern Thailand, the center is now in its second year of operation.