HEALTH

In this rehab, patients are coping well despite the pandemic

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Harnessing the power of community and regular group support may be the therapeutic relief needed to successfully thrive even during lockdown. Photo courtesy of BRIDGES OF HOPE/GIMO GOMEZ

Editor’s note: Interviews with patients were not allowed by the facility due to privacy issues.

One of the most vulnerable sectors are the drug, alcohol, gambling, and behavioral addiction patients undergoing rehab at various facilities in the Philippines. But at Bridges of Hope (BoH), the in-house clients are doing quite well today despite the challenges of the pandemic.

Guillermo “Gimo” Gomez, an internationally certified addiction professional and a senior program director at BoH, is not that surprised. He thinks that the controlled and sanitized environment BoH imposes as a matter of routine in their therapies has helped greatly to shield the addiction patients from the health vicissitudes of quarantine lockdown. It may be something the rest of us can pick up on as a way out of our suffering in these unprecedented times.

Guillermo “Gimo” Gomez, an internationally certified addiction professional and a senior program director at Bridges of Hope also teaches Jeet Kune Do at a gym outside the facility. Photo by KARL R. DE MESA

Hell is around the corner

Before he came to work for Bridges of Hope, Gomez was himself a patient at the facility. He has years of substance addiction behind him, all the way back when he took his first hit of meth as a young man in 1988. He could still clearly remember that first hit of shabu and how, in hindsight, it led to a moment of legitimate addiction.

“My head exploded that first time with a rush I couldn’t understand. I just keep on drinking alcohol to down this new overwhelming feeling,” said Gomez.

The consequent hits through the 1990s eventually got him hooked, landing him in jail in the year 2000. A series of rehab stays and relapses followed, each one lasting 18 to 22 months, each slightly better than the last, but no true management system had stuck.

There was no real rock bottom, rather for Gomez it was a series of hells that waited just around the corner. “’Hell’ for me was stealing my children’s allowance (which I just gave to my wife to give to them),” Gomez said. “Selling my children’s T.V. and selling my own clean laundry which my wife had washed. And waking up somewhere near a railway, in a shack with no electricity, no furniture, and no running water.”

Though he smiles thinking about it now, one of those hells was also Gomez hiding from his own family in 2012, who was searching for him with a rehab team from Bridges of Hope in tow. After a revolving door of stays to kick his substance addictions, Gomez exited his program at BoH and started as a volunteer for them in 2013.

He’s been working there ever since. This time, the management program had stuck.

Sleeping quarters at the Parañaque facility. Photo courtesy of BRIDGES OF HOPE/GIMO GOMEZ

First, ask for help

Since Gomez knows too well how relapses can both be easy to slide into and the hardest to climb out of, it informs his interactions with patients on a deeply compassionate level — an “I know because I’ve been there” quality absent in old school therapy paradigms.

“There are certain triggers that can bring me back to my addiction,” said Gomez. “And my program from Bridges of Hope helps me with my awareness.”

There are hundreds of DOH-accredited substance and alcohol rehab facilities in the country and seven within Metro Manila alone. Bridges of Hope is one of the few that offers a holistic variant of the 12-step program, a system which they call the Eclectic Therapeutic Community.

“The pandemic is a force of its own and should not be taken lightly. It will continue to hit anybody ‘recovering,’ much harder than it would a person free of the maladies of a mental and emotional diagnosis.”

This is an alternative to what is usually a punitive approach to therapy made famous by Alcoholics Anonymous that focuses on abstinence, known in therapy circles as the Minnesota Model of drug and alcohol management.

BoH adheres to the Therapeutic Community (TC) model. A methodology that moves away from just self-denial, acknowledging that recovery must focus on the whole person and consequently the society that he moves in — in fact, the first step listed on the BoH website’s 12 steps is asking for help: “We admitted we were powerless over our addiction — that our lives had become unmanageable.”

Recovery looks different for everyone

The “eclectic” part of the therapeutic community system is in acknowledging the uniqueness of each abuser and their history. Therefore, recovery looks different for everyone.

Each abuser will move towards management at different speeds, through different obstacles, hence being open to what works for one person might not work for another because each brain’s infrastructure and development is unique — a set of stimuli may be a big dopamine hit for somebody, yet that same amount may be nothing to the next person.

“Some brains are just stronger and have better synaptic systems,” said Gomez. “It's like the circuit breaker in your house. With a high amperage ceiling, no matter what the current fluctuation is, if it's a good breaker, it's not going to flip. Others pop much more easily.”

The TC orientation also recognizes that relapses do occur, viewing them as learning opportunities rather than chances to intensify punishment.

“In the eclectic model we try to understand the person's feelings and thought processes,” said Gomez. “The old therapy model, like the one I experienced as a patient in the 1990s, would just simply address everyone’s addiction the same way. They tell you… you know you took the substances, you're addicted to it, whether you accept it or not, here's the punishment. I'm going to hit you, give you such a horrible experience that by the time you come out your brain will go ‘one plus one equals pain!’”

BoH’s biggest center is the one in Los Baños, Laguna that houses up to 50 clients. It has a land size of 900 sqm, and an activity space spanning 700 sqm that includes a swimming pool. At the seven BoH rehab facilities in the country, patients are encouraged to accept that going through the program will take time. That everyone advances at their own pace. Each center has a staff of around 20 people composed of nurses, counsellors, psychometricians, and administration managers like Gomez.

Aside from taking responsibility for one’s behavior, the emphasis on shared, communal liability means that recovery at BoH is viewed as a gradual and always ongoing process of cognitive change overseen by clinical interventions. Full recovery is the high ideal, but the truth is that it’s an ongoing, daily process.

Healing and relaxing geothermal (hot spring) pool at the Los Baños facility. Photo courtesy of BRIDGES OF HOPE/GIMO GOMEZ

Virus safety inside the rehab facility

Robert Ty, Executive Director at BoH BF Paranaque, says that their hundreds of in-house rehab patients have been fairly cushioned from the ravages of COVID-19. This is due to the controlled and highly sanitized environment of their facilities and in no small part because the residents are already in a quite benign “quarantine” of their own.

Ty said, “With the family culture fostered between our staff members and directorate levels we’ve been prepared to ‘sacrifice’ to respect and follow the protocols which demand time away from families and friends in exchange for the safety of our clients.”

“They are actually not experiencing stress as we are outside, in the natural environment,” said Gomez. “Our program is quite effective in shielding patients from the normal mental or emotional tensions of a lockdown.”

It’s a state of multi-layered safety only reached however through the sacrifice of medical and administrative staff. Converting buffer zone structures for quarantine before patients and staff go into the main facility has been the order of the day, as well as a buying bender on disinfection equipment like ion guns, fog machines, and hypochloric acid disseminators.

Relapses are the hardest

According to Gomez, it’s not the in-house patients they’re worried about but rather those who are at the end of their treatment and about to go back to real life. Among this group are those who have pulled out of the 12-step program early, leaving their treatment unfinished — these have proven the most vulnerable and suffered the most relapses.

Those who decide not to be monitored in their last and final stages of reintegration with the consent of their families have definitely faltered. A common denominator in this group, for both substance or non-substance cases, is a failure to adjust to the new, unseen factors of the pandemic. Gambling and drug addicts discover how intense being lonely in quarantine is. Casinos and bars are closed, and the usual ways of scoring meth or other illegal substances have been restricted by the curfew hours, lack of public transport options, and simply a shortage in product because the transport supply chain is broken.

Each abuser will move towards management at different speeds, through different obstacles, hence being open to what works for one person might not work for another because each brain’s infrastructure and development is unique — a set of stimuli may be a big dopamine hit for somebody, yet that same amount may be nothing to the next person.

Coupled with the fear of catching the virus, the pandemic can bring down an already damaged willpower and self-esteem. “The pandemic is a force of its own and should not be taken lightly,” said Gomez. “It will continue to hit anybody ‘recovering,’ much harder than it would a person free of the maladies of a mental and emotional diagnosis.”

At BoH, one of the special perks a patient earns when he completes the 12-step program is a “Lifetime Halfway Privilege.” This means you can return for a limited stay and a bed to sleep in at any of the facilities for free, no questions asked, as long as you are drug-free and there’s an available bed. Had a fight with the wife? Go back for a stay. Want to avoid your old druggie friends? Be welcome at BoH.

Gomez and Ty confess that many relapses have been avoided because a former patient opted to lie low and stay out of trouble by availing of their halfway house privilege. But since the pandemic, and for the protection of the current in-house patients, this privilege has been rescinded (with a few special exceptions), as the halfway facilities have been turned into quarantine housing for the BoH staff.

The snake in the grass

Relapses have been a reality for the early program pull-outs and a few re-integrationists who’ve finished their treatment. For the latter, it’s usually when they notice that they are simply jumping from one type of confinement to another, and they find that there’s a scarcity of work and nothing to do.

Gomez knows full well the pain a relapse brings, especially since he’s had six of them — the latest one back in 2012. “Relapses really don’t happen immediately or obviously but are slow, gradual, and unseen just like a snake in the grass gradually slithers through a field of daisies. But a relapse is the most painful thing.”

Stories of common reasons why the early BoH pullouts relapsed range from how they fell in love with the wrong person or their family refused to listen to how they needed support in fostering the best environment to prevent a backslide. But the most common one is when a patient mistakenly believes they are in control again chasing that elusive, ultimately false grail of the “functional addict.”

Gomez referred to this myth as the “Manageability Theory.” It’s akin to a pot of gold at the end of a rainbow being chased by hardcore addicts, like a magic balance struck between using substances while also being able to keep up with professional and social responsibilities.

“The effect of this fabulous, illusory state is that the drug use is effectively concealed, to a point that the user is perceived aus Functional or Normal, thereby rendering the addiction as no problem at all,” said Gomez. “This was the part that I couldn’t believe and was hardest for me to grasp during my long years of using: that I alone would not be able to stop this addiction!”

Studies have proven that relapses are harder to stop because the disease has already implanted in the brain a thick neural pathway of habit. Combine that with inherited genetic predispositions (were your parents drug abusers or alcoholics?) that make some patients more vulnerable, and the recovery-and-relapse becomes a cycle that makes it almost impossible to resist alone, sans clinical help.

Bridges of Hope patients are fairly shielded from the pandemic due to the controlled and highly sanitized environment of their facilities and in no small part because the residents are already in a quite benign “quarantine” of their own. Photo courtesy of BRIDGES OF HOPE/GIMO GOMEZ

A process, not a cure all

To combat this, Gomez and Ty strongly urge their in-house patients to finish their treatment programs but also, for those who’ve already transitioned out to the world and into the realities of the pandemic, to continue relying on their newfound support community.

Their program staff have had to work doubly hard to train the participant-families to anticipate the triggers this pandemic has brought about and that of the new normal outside. As a result, plenty of their newly released rehab patients are doing quite well, through constant case check-ups leaning on what they call “power of the group” — meaning counsellor supervised Viber, FB Messenger, and bi-monthly Zoom groups calls.

Those with a developed plan, like the proverbial 13th step homework beyond their therapy, are the best armed. They also tend to have the correct and strong support system enabling their adjustment away from BoH.

“Those who feel their family’s support, who’ve been educated on how the program works, are doing well because they see the beginning of a new life,” said Gomez. “They are our role models. With our open-arms approach many people look back on their time with us as something where they were able to stitch together a pattern of sustainable recovery. A place where they were given hope.”

To Gomez, the fact that there are newly released patients who have successfully hurdled the challenges of the pandemic and are currently managing quite well, or even better than non-rehabbed addicts, is a great sign that the community-based and compassionate system of BoH works well.

He still cautions though, that addiction recovery isn’t a one and done kind of deal— even for him, who has since found that the practice of martial arts and collaborative activity with his children are great supplements to therapy.

“Nobody really plans to become an addict. We are forever in recovery,” said Gomez.

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For inquiries, contact 0917 509 8826 for a consultation or write to a counsellor through their website.

Correction: Each of Bridges of Hope facilities has around 20 personnel instead of 9 to 12 as first stated in the article.