DOH to pilot cognitive behavioral therapy as drug rehab method

Cognitive behavioral therapy (CBT) will be introduced as a rehabilitation technique for female drug dependents for the first time in the Philippines. The program will be conducted by the Dangerous Drugs Board (DDB), the Department of Health (DOH), and Women and Reforms (WAR), an NGO of experts on gender-based CBT.

DDB, DOH, DSWD, and NGO Women and Reforms will pilot cognitive behavioral therapy in drug rehabilitation programs for women in Bicutan. pic.twitter.com/iPlLXYbzHI

— Rie Takumi (@rie_takumi) May 11, 2017

If successful in its test run at the DOH Treatment and Rehabilitation Center (DOH-TRC) in Bicutan, the gender-based program will be replicated in other female-specific facilities and integrated into the DOH's community-based treatment and rehabilitation programs.

"With the CBT program for women, we will integrate it once it is successful with the piloting in Bicutan TRC," Health Usec. Roger Tong An affirmed at a press briefing in Makati on Thursday.

"We will integrate it with our community-based clinic together with our community clinic. This includes even the rural health unit and barangay health stations," he continued.

Sec. Benjamin Reyes, DDB Chairman, said gender- and age-based therapy has been a long time coming and shows the country's dedication to a holistic campaign against illegal drugs.

"It's actually a long overdue program. We wanted to really provide gender and age-specific therapies and programs in our treatment and rehab. As we have been saying all along, our campaign is really a balanced campaign, it's not limited to the enforcement side," Reyes said.

What is CBT?

CBT is an evidence-based and goal-oriented approach to therapy that was originally conceived to treat depression.

"[It's] a focused approach that helps users understand and recognize specific situations in which they are prone to engage in addictive behavior," Mary Ann Evans Smith of WAR explained.

It is a type of talking therapy that aims to change a patient's cognitive patterns through functional analysis and modify their behavior through skills training.

"[In functional analysis] both the therapist and the patient work together to identify circumstances, thoughts, and feelings that the patient experiences before and after she or he uses illicit substances," Smith elaborated. "Maiintindihan na nila ngayon kung bakit they are in a risky situation."

"In skills training, this is the next step where the patient will begin to unlearn old, destructive habits and come up with new and healthier ways to replace these old habits," she added.

Part of this training involves identifying the intra- and interpersonal issues and other underlying reasons that motivated the drug use and to help patients get out of drug-using lifestyles.

"Kailangan po nila ng tulong but they don't know," Smith pointed out. "Chronic involvement in a drug-using lifestyle, even if the user once had effective strategies to deal with stress and challenges at once point... nawala na po talaga. And this is treatable po."

Why is it female-specific?

While there are more male drug dependents than females, the DDB stated that the number of female patients admitted to TRCs increased from 332 in 2014, to 361 in 2015, and 431 in 2016.

In addition to this, the smaller population of female patients would also make it easier for the understaffed Bicutan TRC to carry out the program.

"[One staff member per 25 patients] is the ideal, but right now we have [a ratio of] 1:50," Reyes stated. "It's a fairly inexpensive program. It's more therapeutic, one-on-one, and I think it can work."

The DDB hopes that running the program with women will improve women's access services to fix the gender imbalance in in-patient care, as seven males for every one female need access to services, but only 14 males for every one female are accepted to facilities.

"Unfortunately, in our in-patient rehab facilities right now, one female for every 14 males," Reyes said. "There's a huge gap that we need to address as far as the gender imbalance is concerned."

Sequestering women, WAR added, would also remove distractions "from being around members of the opposite sex" and allow patients "to feel more comfortable or focused as they recover around peers of the same sex" and related gender-specific experiences.

"Women have special needs in substance abuse treatment," Smith said. "Just as each patient needs [are] unique, treatment programs must be tailored to address those particular needs."

LGBT-specific therapy is also offered by WAR to address "a unique set of factors that can contribute to their addiction disorder and hinder recovery."

How will it work?

Fifteen health professionals underwent a three-day seminar with Zoe Louise Watson of WAR and are scheduled to complete a gender-sensitivity course before applying for certification.

"[Pagkatapos] mag-exam itong mga nag-training, 15 sila. So hopefully within one month, after they are certified by the US, pupwede nang mag-start ang program," said DOH-TRC Bicutan Center Director Dr. Marvin Diokno.

"The other day, we started the gender sensitivity training. We're very specific on how women, the youth also, and the families," Smith added. "We'll need more time before it gets implemented kasi yung mga technique minsan, yung lalaki na technique ang nagagamit, 'di ba, 'cause you're so used to it."

If all trainees pass their certification in a month, a group of patients Bicutan will undergo CBT for a month in addition to the standard therapeutic community (TC) or participative, group-based treatment that the other half will continue to receive without CBT.

"Halimbawa, 100 yun. Yung 50 percent merong CBT, yung 50 percent wala. Pagkatapos, i-evaluate nila. May mga parameters sila na gagawin na yun bang programa na may CBT is more effective kesa dun sa wala," Diokno explained.

After a month of treatment, patients who have undergone CBT and TC and patients who only received TC will be assessed.

"'Pag nakita na, evidence-based, na talagang mas kapakakinabang yun ang dadalhin sa ibang lugar," Diokno said. "One month muna tapos i-evaluate."

If proven to be effective, CBT will be integrated in the rehabilitation program of other female-centered facilities in Cebu; Malinao, Albay; Bataan; and La Union.

Diokno believes the program could be implemented as early as June if all professionals receive certification within a month.

"Kung certified na sila, that's the time na magiistart na sila ng CBT," he said. "Yung exam, within one month, dapat nakakuha na sila. June ang target. [Pero] kung halimbawa, certified na sila nitong 15, pupwede na silang makapag-start ng program." — BM, GMA News