Suthasinee Klui-Ngern has developed an interactive treatment method for youths with drug addiction problems. She trains former drug users, who have completed her program, to counsel newcomers and replicate her program by starting further treatment centers; in this fashion her approach is spreading rapidly in eastern Thailand.
The New Idea
Suthasinee Klui-Ngern has established a center where young Thais with drug addiction problems can live during the time of their treatment and return for support as they need it. In several ways her approach differs from government and Buddhist treatment centers, which are the two dominant drug-treatment models in Thailand: Her system uses no medication of any sort to treat addictions, it does not remove patients from the realities of their lives in order to affect treatment, and it takes specific aim at recidivism. Treatment is individually tailored to each person, with the aim being to discover the real roots of the drug use, such as low self-esteem or family problems, in order to treat the causes, and not just the symptoms of the addiction. Her goal is to arrive at a truly permanent cure. The center is characterized by a family-like atmosphere where peer counseling plays a key part in treatment. Patients become comfortable enough to explore why they have become addicted: Moreover, Suthasinee's policy that they can return whenever they need to even after the formal treatment period is over assures them that the most important goal is not to fall into their old patterns after they leave. Her center provides the context, and allows the time, for patients to modify their behavior and learn how to choose drug-free lives. For many of her clients, whose ages range from 9 to 27 years, resuming their education is a major issue; and Suthasinee has created a process to assist them to receive vocational education or to participate in one of Thailand's two open universities (courses by correspondence).
The Thai government estimates that there are over 1 million addicts in the country, or approximately two percent of the population, and that the industry is worth approximately 69 million Baht per year (roughly US$ 2.75 billion). Government figures appear, however, to underestimate the extent of the problem by an extremely wide margin in comparison to what can be seen at the village level. Suthasinee estimates that some 80 percent of the youth in Yasothon province, where she now works have drug addiction problems, and even the government acknowledges that the problem can be found everywhere in the country. The current scourge is amphetamines, which are used by everyone from factory workers to students; government analysts estimate that half of the 230,000 truck drivers in the country use them to stay awake, and over 70,000 students admitted to using them in a survey some years ago. The abuse of inhaled substances, cocaine and "ecstasy" are common problems, as heroin also continues to be.
The two prevalent methods of treatment for drug addiction in Thailand are the use of medication at the government's centers and a process that combines traditional herbal medicines with prayer and discipline under the supervision of Buddhist monks. Suthasinee has found that neither method succeeds in curing the person of the addiction completely. Government centers constantly face budget cuts and cannot meet the need for drug rehabilitation services. The Buddhist centers tend to be formal and somewhat out of touch with the lives of today's Thai youth and thus difficult contexts in which to speak about the causes of an addiction. Further, when patients enter government or Buddhist treatment centers, they typically leave their daily lives behind in order to undergo treatment, only to return later to the same situations and pressures that led them to use drugs in the first place. While these two types of treatment often halt physical addictions temporarily, relapse into addiction is a common outcome where the initial causes remain unexplored.
Suthasinee sees the problems of addicted youths as being far more pervasive than a need to be withdrawn from their drugs: she looks at multiple factors, including lack of support from the family, a missing sense of self-worth, reduced religious identification and the influence of the media. Insofar as Thailand has a generally dynamic and growing economy with many apparent opportunities for its youth, the use of drugs cannot easily be attributed to a sense of malaise or pessimism about a promising future. The same economic dynamism, however, places pressures on the family unit such as the movement, repeated worldwide, of increasing numbers of women into the workforce. And growing affluence contributes in its own way to the problem, as young people have the time and means to experiment with drugs.
Suthasinee's strategy reflects three major emphases. First, her treatment process is individualized, taking into account each patient's psychological makeup and personal situation. Second, the major therapeutic tool is peer counseling by rehabilitated drug users; Suthasinee feels that their participation creates positive reinforcement for both parties, as former drug users bring an intimate understanding of the causes, problems and feelings of addiction and current drug users see before them a living example of how they can turn their lives around. Finally, Suthasinee's approach assists each client to plan for his or her future.
In 1992, Suthasinee founded the Project for Children and Youth. When a drug-addicted youth comes to the Project, she or he is met by a project officer and a trainer. These people explain to both the individual and family members that the Project will provide for all of the material needs of the patient, who will not be allowed to have any money at all during treatment, though visits by the family are allowed at least twice a month. All drug use ceases from this moment on, and no medication is used to alleviate the symptoms of withdrawal. In severe cases, patients are sent to a hospital and return later to complete treatment. Once past this stage, the program focuses on the mental condition of the patients by involving them in music, sport, reading and concentration exercises and by assigning them responsibilities for the upkeep of the center. They become part of the "family" at the Project, where patients and counselors use informal nicknames and assume nurturing, familial relations with one other. A highlight of the treatment is a week-long rehabilitation camp in the country or forest, which provides a the setting for the counseling that is a key part of Suthasinee's work.
Over a period which usually ranges from three to six months, patients become equipped to examine the reasons for their addiction and learn how to manage their lives without drugs. Patients usually come to decisions about what they need and want to do once they leave the treatment center, and the Project helps them to carry out their plans. For example, some patients participate in drug and AIDS awareness activities in their communities. Some become counselors in the Project, while others simply return to their homes. The Project arranges for interested clients to acquire marketable skills through Thailand's Labor Development Institute, where they learn hair-cutting, for example, or dress-making, electronics or mechanical work. Sukhothaithammathiraj University, an informal university through which they can study a range of academic subjects at home, is another educational resource.
By mid-1997 Suthasinee had four full-time staff members helping her run the Project and over 100 volunteers assisting in counseling and raising public awareness of the problem of drug addiction in nineteen villages across seven districts in the Yasothon province. She plans to expand soon into neighboring provinces and realizes success will depend on involvement from the larger community. She thus trains the volunteers–often former drug addicts themselves, or teachers, professionals and sometimes family members–at her Project's treatment center, and they return to their own towns to start similar programs.
Sector by sector, Suthasinee is increasing her number of partners. She involves village leaders in gathering statistical data and information on the problems of children and youth and in setting up programs for recovering patients. She has begun to involve the media with the Project, to popularize the results of these studies; Thai national television has featured her work. Teachers in local schools are invaluable partners to her, as are the police, who often see young people at their worst. Their response can mean the difference between referring drug-addicted youths to the Project to give them a chance to change their lives, or putting them immediately in jail and on a more difficult path to recovery. Suthasinee also reaches out to establish relations with hospitals so that they will perceive her as a partner in drug rehabilitation work, rather than as a competitor; the Yasothon provincial hospital now collaborates with her to handle severe withdrawal cases.
Although recidivism rates continue to be high, and Suthasinee is currently compiling statistics on this problem, she is making a progress in attracting public support. She has received small donations for the Project from local nongovernmental organizations and has organized local arts and crafts groups in the villages to provide some funds from their profits. The fact that the Project accepts patients from all over the country is an advantage for her fundraising, because the national government's drug control, public health and social welfare departments are starting to see it as an alternative worthy of public funding.
Suthasinee was born September 1, 1959. She started doing hands-on work in the social sector in her early twenties when she went to work with village hill tribes in Mae Hong Son, where she stayed for nearly ten years. She then worked with poor children in Kanchanaburi province and later in Bangkok with slum children through the Children in Slums Foundation. It was through this organization that she was first exposed to the problems of drug addiction amongst children. When she married and moved to her husband's home town of Yasothon, she saw the increasing problem of drugs there, too, and simply decided to set about doing something about it.
Suthasinee is providing a strong example of how a young person can do important work to help others in society. It is her belief that people with drug addictions must be given chances in life in order to get themselves out of their predicament. She has been able to attract the support of both governmental and nongovernmental organizations for her work and hopes that the comprehensive nature of the approach she has developed will have lasting positive effects. She was recently chosen as the representative from Yasothon to work with the provincial government to develop policy in this area.