Setting up Treatment in Thailand
From Granite Buildings to Tropical Climes – Martin Peters reflects on the challenges for the sector and the very real benefits of working in Thailand in a treatment environment unfettered by ‘tradition’.
I am often asked how I ended up working in Thailand…
My journey has been somewhat different from many clinicians in the field of addiction who have, because of their own personal experience with drugs or alcohol, chosen a path that allows them to “give back” by working in the field. My journey began 21 years ago in a run-down Victorian psychiatric hospital in the southwest of England, where I was working as a nursing assistant to support my training.
The drive to empty the hospitals and return long-term psychiatric patients to their communities was in full swing, and I probably entered the mental health field during one of its most dramatic periods of change. Only now, particularly in the area of addiction, is the field catching up, after years of being stuck in traditional models of care and entrenched beliefs.
For many years, the field of addiction has been preoccupied with questions like “is addiction a disease?” and “how do we treat it? To the first question, my reply is “does it matter? What we do know, from experience – both personal and professional – is that addiction causes chaos and dysfunction, destroys lives, and for many results in premature death or significant physical damage. Anyone who has worked or lived with, loved or treated an addict sees and feels the pain, and the label matters little.
More to the point are “how can we approach treatment differently?” and “how do we engage the client to seek treatment?” This is the route to moving forward, not diagnostic labels. That is not to dismiss the importance of DSM or other diagnostic tools to define addiction (my MHP background wouldn’t allow that), but sometimes we do get distracted in trying to fit individuals into generic criteria boxes, when what we really need to be doing is getting down to engaging them in treatment.
For many people, being labelled an addict or alcoholic gets in the way of their acceptance of the fact that they have a problem. It is often a barrier for an individual to seek treatment, despite all the evidence pointing to the fact that their addiction is dominating their life.
As treatment providers, we need to be able to offer our clients hope, and a clear path to recovery that doesn’t punish or shame the individual. The journey for every person is different, with many challenges along the way. Treatment does not need to be medically modeled, but needs to encompass the four core aspects of the biological, physical, social and spiritual if it is to be effective. When I was given the opportunity to reshape, reorganise and redefine treatment at DARA in 2011, my experiences from the mental health field, as well as the addiction field, had considerable influence on my planning.
Creating an environment that is safe, warm and caring is paramount – a place where the client can “be comfortable while feeling uncomfortable”. It’s important clients get space and privacy so they can reflect in peace. I believe that treating clients with dignity and respect, and providing comfortable surroundings, improves the efficacy of treatment and encourages them to stay in treatment longer than the standard four weeks.
The programme also needs to offer the “hope of reconnection”. How many clients do we see who are living on the fringes of society or their families due to their addiction? To bring them back into an environment that regards them as a person rather than an addict is an element of treatment that I firmly believe in.
As noted earlier, this approach needs to address the four fundamentals of the biological, physical, social and spiritual, so we can identify the deficits and work with the client to address them. The approaches of CBT, Schema and DBT are an excellent basis for clients to start to build their tool kit and lay a foundation, as are the 12 Steps, although many clients are unwilling to take that approach.
Consequently we offer two separate programmes so that those with an aversion to the Steps do not need to undertake them. Nevertheless, as my good friend and colleague Roland Williams often says, “the Steps are guidelines for good living” and even I, a person not in the fellowship, wholeheartedly agree that they are just as relevant to someone without an addiction who is on a quest for a healthier life.
We also recognise the importance of engaging the family, and identifying the client’s support network, for without this we would not be addressing a fundamental element of the recovery plan and ignoring the importance of “connectivity”. These programmes, as we have learned from our time in the field, also need to be “fun,” and certainly not seen as a punishment. Re-integrating clients back into the community through off-site activities is a fundamental part of our approach to treatment, giving them new experiences and observing how they react to these challenges when they are back in the world without alcohol or drugs.
We also recognise the importance of exercise and nutrition, and all clients receive individual exercise plans and nutritional advice. One-on-one and group work with the PT staff allows clients to build their social, physical and teamwork skills. Clients, in my experience, need to experience a sense of belonging if they are to buy into treatment, and there is no difference between treating depression and addiction in that respect, so we have to push them to have new experiences, and make breakthroughs. Of course, learning new skills and working on solution-focused objectives are exceptionally important. We also have to understand that the majority of our clients do have co-occurring disorders, and we have to be mindful of this in our treatment planning and psychiatric reviews, including medication appraisal and management. As a centre we’ve embraced change, introducing EHR, which enables the clinician to spend more time with the client and less on the paperwork. We also hold regular training in relevant areas such as confidentiality, cultural awareness, customer service, and patient rights, to name a few. Like all healthcare providers, we will need to continue to make changes, tough as they may be, so that we do not remain stuck doing things as they have always been done before. As an industry, it is a good time for all of us to embrace ideas from various fields and professions to improve the quality of life of our clients and reintegrate them into society. Fundamental approaches like group and individual therapy are exceptionally important, as are the evidence-based approaches of CBT, DBT, mindfulness and relapse prevention, but we must not lose sight of the social aspects of treatment, and recovery/discharge planning, which can make the difference between a solid outcome and a shaky one.
Treatment is still relatively new to Asia, and therefore not beset by “tradition”. This has allowed treatment centres such as DARA to offer quality programmes with a different twist – at very competitive prices, one area that as an industry I believe we have lost sight of. Because our organisation, and our programme, was built from a clinician-led model, it is important that we never lose sight of why we came into the field. That is one of the reasons I have been delighted to remain working in Thailand for the past 10 years, particularly in the fields of mental health and addiction, which remain areas of rapid change and development.
Today, I spend my reflective time looking out over the sea through a tropical forest, rather than cold granite walls and a looming clock tower, and am grateful to be a part of something that is changing lives, including my own.