11th International Nursing Conference - mypnaa.orgmypnaa.org/resources/Documents/Presentations/PNAAEstacioFin.pdf · 11th International Nursing Conference ... The Philippine Drug

11th InternationalNursingConference

NursingInnovations:BridgingtheChasm26January2018BlueLeafFilipinas

NursingInnovations:BridgingtheChasm26January2018BlueLeafFilipinas

ThePhilippineDrugCrisis:Biomedical,PsychologicalandSocio-CulturalPerspectives

LEONARDOR.ESTACIOJR.,UNIVERSITYOFTHEPHILIPPINESMANILA

Outline

• HowseriousisthedrugprobleminthePhilippines• Whathasbeenthestateresponseanditsoutcome?• Whatstillneedstobedonetosolvetheproblem?

• HowseriousisthedrugprobleminthePhilippines?

• Archipelago < 1,840 kilometers• 7,107 islands and islets• 3 main islands: Luzon, Visayas

and Mindanao• 42,036 barangays (villages) –

the smallest political unit • Current Population: 103.3 M (2016)• Religion: Christian (80% catholics,

15% protestants), Islam and others ( 5%)

ThePhilippinesIslands/RepublicofthePhilippines

PDEAAnnualReport,2015

MarijuanaPlantations(20provinces)

SmugglingSites(14sites)

ClandestineMethLaboratories(21sites)

InternationalDrugSyndicates(3bigsyndicates– Bamboo;Hongkong; SunYeeOnTriads)

FOUR CRITICAL ENTRY POINTS

v Seaports

v Airports

vMailsandParcelSystems

v PhilippineCoastlines

NationalBureauofInvestigationpersonneldisplayhundreds ofplasticbagscontainingkilosofshabu,partofaP6.4-billion($125.4million)shipmentseizedfromawarehouseinValenzuelaCity,onMay27,2017,basedonatipfromChineseauthorities.PhotobyMARIANNEBERMUDEZ/PhilippineDailyInquirer)

Drugaffectedbarangays(42,036),PDEA2016

Affected 20,872(49.65)

Unaffected 21,164(50.35)

Particulars Price(inPhP)

Shabu (gram) 1,200-15,000($25- $312.5)

Marijuana

DriedLeaves(gram)

18-300($.38-$6.25)

Plants(piece) 150-400($3.12-$8.33)

Cocaine(grams)

3,600-7,000($75-$145.83)

Ecstacy(piece) 1,200-3,000($25-$62)

1sachet=PhP250– 1000($5- $20)

1kilo=PhP5M– 25M($100k- $500k)

Nationality Number Classification

Pusher,15

Chinese 25 Possessor,10

Pusher,1

Nigerian 2 Possessor,1

Taiwanese 1 Possessor

Uganda 1 Possessor

Venezuela 1 Courier

American 1 Possessor

Mexican 1 Pusher

Pakistani 1 Pusher

Liberian 1 Pusher

SaudiArabian

1 Possessor

HK 1 Pusher

Japanese 1 Possessor

Total 38 Pusher,20Possessor,17Courier,1

PublicOfficialsArrested

Elected 65

LawEnforcers 32

GovernmentEmployees

104

Use ofMinors

17year olds 117

16 59

15 35

14 12

11 3

• Archipelago < 1,840 kilometers• 7,107 islands and islets• 3 main islands: Luzon, Visayas

and Mindanao• 42,036 barangays (villages) –

the smallest political unit • Current Population: 103.3 M (2016)• Religion: Christian (80% catholics,

15% protestants), Islam and others ( 5%)

Indangerofbeinga“narco-state…narcotizedstate”

• Whathasbeenthestateresponse?

RA 9165Comprehensive Dangerous Drugs Act of 2002

• “Safeguardtheintegrityofitsterritoryandthewell-beingofitscitizenry...fromtheharmfuleffectsofdangerousdrugs”

• “Pursueanintensiveandunrelentingcampaignagainstthetraffickinganduseofdangerousdrugs andothersimilarsubstances”

• Providemechanismsormeasurestoreintegrateintosociety individualswhohavefallenvictimstodrugabuseordangerousdrugdependencethroughsustainableprogramsoftreatmentandrehabilitation


ØSection 11. Possession of Dangerous Drugs. - The penalty of lifeimprisonment to death and a fine ranging from Five hundred thousandpesos (P500,000.00) to Ten million pesos (P10,000,000.00) shall be imposedupon any person, who, unless authorized by law, shall possess anydangerous drug in the following quantities, regardless of the degree ofpurity thereof:

• (1) 10 grams or more of opium; morphine; heroin; cocaine or cocaine hydrochloride; 10 grams or more ofmarijuana resin or marijuana resin oil;

• (2) 50 grams or more of methamphetamine hydrochloride or "shabu";

• (3) 500 grams or more of marijuana; and• (4) 10 grams or more of other dangerous drugs such as, but not limited to, methylenedioxymethamphetamine

(MDA) or "ecstasy", paramethoxyamphetamine (PMA), trimethoxyamphetamine (TMA), lysergic acid diethylamine(LSD), gamma hydroxyamphetamine (GHB), and those similarly designed or newly introduced drugs and theirderivatives, without having any therapeutic value or if the quantity possessed is far beyond therapeuticrequirements, as determined and promulgated by the Board in accordance to Section 93, Article XI of this Act.


ØSection15.UseofDangerousDrugs.ØApersonapprehendedorarrested,whoisfoundtobepositiveforuseofanydangerousdrug,afteraconfirmatorytest,shallbeimposedapenaltyofaminimumofsix(6)monthsrehabilitationinagovernmentcenterforthefirstoffense...

Ø Ifapprehendedusinganydangerousdrugforthesecondtime,he/sheshallsufferthepenaltyofimprisonmentrangingfromsix(6)yearsandone(1)daytotwelve(12)yearsandafine rangingfromFiftythousandpesos(P50,000.00)toTwohundredthousandpesos(P200,000.00):

ØProvided, ThatthisSectionshallnotbeapplicablewherethepersontestedisalsofoundtohaveinhis/herpossessionsuchquantityofanydangerousdrugprovidedforunderSection11ofthisAct,inwhichcasetheprovisionsstatedthereinshallapply.


ØArticle8section54:Ø“A drug dependent voluntarily submits or any person who violates Section15 of this Act may, by himself/herself or through his/her parent, spouse,guardian or relative within the fourth degree of consanguinity or affinity,apply to the Board or its duly recognized representative, for treatment andrehabilitationof the drug dependency.”

Change is Coming…

President Duterte’s 1st Policy Statement on the War on Drugs

“We will not stop until the last drug lord …and the last pusher have surrendered orare put either behind bars or below theground, if they so wish…” [PresidentDuterte, Sona, July 25, 2016]

ChangeisComing…PresidentDuterte’swarondrugsstrategy

Operation Double Barrelc/o the PhilippineNational Police

“WewillcallitCampaignPlanDoubleBarrel…

“Onetouchofthebarrel,twotriggerswillbesetoff.There’sabarrelthatwilltargetfromabove,thehigh-valuetargets.Andthere’sabarrelthatwilltargetfrombelow,thestreet-levelpersonalities…”

[Ronald“Bato”DelaRosa,Duterte’spickforPNPchief,June29]

OPLAN DOUBLE BARREL (July 2016 to Jan 2017)

• Oplan HighValueTarget(HVT)ØDrugsyndicates,druglordsandtheircohorts[includingpolicescalawagsandcelebrities]

• Oplan TokhangØStreet-levelpushersanddrugusers

OPLANTOKHANG

Groups of policemen go house-to-house and talk tohomeowners to inform them about the government’scampaign against illicit drugs, asking drug-using householdmembers to surrender to authorities and undergo treatmentand rehabilitation…

• Whathasbeentheoutcome?

Oplan Tokhang

OperationDoubleBarrelReloaded(JanuarytoOct2017)

1,266,966: totalnumberofsurrenderees (April2017)Ø 88,940pushersØ 1,178,026users

“Happy Problem”• TheLGUs,however,wereunpreparedtohandletheinfluxof‘voluntarysurrenderees’.

• Theydidnothaveestablishedprogramsandnotallcanbeplacedinresidentialfacilities.

Classification Residential Non-residential

Total

GO 15 1 16NGO 26 2 28Total 41 3 44

Year Total2015 5,4022014 4,3922013 3,2662012 2,7442011 3,040

NumberofAdmissionsinBoth

DOHAccreditedTreatmentandRehabilitationCenters,July2016

The Challenge

• With the Oplan Double Barrel Campaign of the Duterteadministration, a million have voluntary surrendered to thecommunities for treatment and rehabilitation

• With only 44 existing treatment centers nationwide, there isa need to improve the treatment policy of thegovernment…

The Policy Response• ExecutiveOrder#4series2016,ProvidingfortheEstablishmentandSupportofDrugAbuseTreatmentandRehabilitationCentersThroughoutthePhilippines

• DDBBoardRegulationNo.3,GuidelinesonHandlingVoluntarySurrenderofDrugPersonalities

• DDBBoardRegulationNo.4,Seriesof2016,entitled“OPLANSAGIP– GuidelinesonVoluntarilySurrenderofDrugUsersandDependentsandMonitoringMechanismofBarangayAnti-DrugAbuseCampaigns.”

• AdministrativeOrder0018seriesof2017(DOH)GuidelinesforCommunity-BasedTreatmentandSupportServicesforPersonsWhoUseDrugsinPrimaryHealthCareSettings

upublishme.com

1.5BMegarehabcenterfor10,000patientsinNuevaEcija,donor,ChinesebillionaireHuangRulun,Nov2016

Philstar.com

Drug recoveryresidentsoftheMegaDATRCassemblesfortheirdailyformationbeforelunchtime.JonathanCellona,ABS-CBNNews

RehabinthetimeofdrugwarPatrickQuintos,ABS-CBNNewsPostedatJun28201708:42AM|UpdatedasofJun28201711:15PM

The"graduates"taketheiroathbeforeagovernmentofficer, withhopesofanewlifeleavingbehind themegacentertheyspentthepastsixmonthsin.PHOTOBYCRISSANSANO,INTERAKSYON

53‘graduate’fromNuevaEcija‘megarehab’centerByCrisSansano,InterAksyonAugust6,2017,1:26PM

OPLANSAGIP

• Mandated Local Government Units (LGUs) through their Anti-Drug AbuseCouncils (ADACs) to facilitate the establishment of community-based treatmentand rehabilitation services and interventions to surrenderers found to be oflow-risk or having mild substance use disorder.

• Based on statistics, this comprise at least 90% of drug users.

OathofCommitment Zumba

Sports SpiritualFellowship

MedicalCheck-Up/Drug-Testing Tumba?!

The New Problem?!

Zumba Simba Tumba?!

Therapeutic Community Eclectic 12 Steps

Facilitation

Interventions in the community

Interventions in treatment centers

Outcome/Effect??

Outcome/Effect??

“DoyousupportornotsupportthecampaignagainstillegaldrugsoftheadministrationofPresidentDuterte?”

Ø88%supportthewarondrugscampaign

PulseAsiaSurvey,September24to30, 2017;1,200respondents


“DoyoubelieveornotbelievethatextrajudicialkillingsorEJKarehappeningintheimplementationofthecampaignagainstillegaldrugs?”

Ø73%believesthatEJKsarehappening


“WhatshouldtheleadersoftheCatholicChurchdoaboutthecampaignagainstillegaldrugs?”

Ø 58percentwouldlikeChurchleadershelptherehabilitationofdrugaddicts

Ø 46percentwantedChurchleaderstoobserveormonitorthecampaignagainstillegaldrugs

Ø 40percentsaidChurchleadersshouldreleasestatementexpressingconcernaboutthedeathsassociatedwiththecampaign.

Ø 28percentsaidtheChurchleadershipshouldassistinlitigationofabusivelawenforcers

Ø 13percentsaidtheyshouldnotinterferewiththegovernment’sdrugwar

• Response to the drug problem from the academe

MetroManila&neighboringprovincesdrug-using young

Reducethenumberofdrug-using young

PHASEI:BaselineStudy

Assessthecharacteristics,dynamics, consequencesandimplicationsofdrug-useon thebehavioralhealthandsocial

behaviorofyoungpopulations inMetro-Manila

PHASEII:Intervention/PostInterventionStudy

BasedontheresultsofPhase1,design, testandevaluateacollaborative,multi-sectoral,

community-directed interventionprogramtoreducetheincidenceof

druguseintheselectedcommunities

ParticipatingPartnersNationalGovernment

Agencies

DepartmentofHealth

DangerousDrugsBoard

NGOResidentialTRCs

Lord’sAgapeRecoveryCenter,Inc.

HealingPathFoundation,

Inc.

Out-Patient

MakatiAnti-DrugAbuseCouncil

Taguig Anti-DrugAbuseCouncil

GOResidentialTRCs

MarikinaRehabilitation

Center

DOHTRC-Bicutan

DOHTRC-Bataan

DOHTRC-Dagupan

DOHTRC-Tagaytay

Sourcesofdata

DrugUsersinRehabilitation

DrugUsersintheCommunity

ParentsandStakeholders

• Clientsadmittedintreatment&rehabilitationcenters(TRCs)

• Self-administeredquestionnaireforquantitativedataandFGDsforqualitativedata

• Voluntarysurrenderersinthecommunity

• Self-administeredquestionnaireapproachforquantitativedata

• Parents,directorsandstafffromTRCs,andofficialsinthecommunity

• In-depthinterviewsforqualitativedata

DrugUsersinRehabilitation

SAMPLE

475centerclientsaged10-35yearsandcurrentlyadmittedatselectedtreatmentandrehabilitationcenters(TRCs)

DATACOLLECTIONMETHOD

Self-administeredquestionnaireapproachforquantitativedataandfocusgroupdiscussionsforqualitativedata

DrugUsersintheCommunity

SAMPLE

44clientsaged10-65yearsoldfromabarangayinMarikinaCitywhovoluntarilysurrenderedunderthePhilippineNationalPolice’sOPLANTokhang

DATACOLLECTIONMETHOD

Self-administeredquestionnaireapproachforquantitativedataandinterviewsforqualitativedata

TheDrugUsingPopulationinRehabilitationandintheCommunity

InRehabilitation

Gender

65.3

29.4

5.3

25-35y/o

15-24y/o

10-14y/o

Age

85.6

10.6

3.8

Males Females LGBT1.1

10.4

13.5

24.3

50.7

Widowed

Separated

Married

Live-in

Single

CivilStatus

MeanAge:26.6y/o

Gender

46.5

23.3

30.2

36-65y/o

25-35y/o

15-24y/o

Age

79.5

15.9

4.5

Males Females LGBT2.3

9.3

25.6

16.3

46.5

Widowed

Separated

Married

Live-in

Single

CivilStatus

MeanAge:33.7y/o

InCommunity

RespondentProfile

Educational Attainment %NoFormalEducation .4Elementary 17.3HighSchool 47.8College 28.2Vocational 6.3

Occupation %Employed 67.2Unemployed 32.8

Religion %RomanCatholic 81.0Born-AgainChristian 8.0Iglesia ni Kristo 4.4Islam 1.3Others 3.8No Religion 1.3

Educational Attainment %Elementary 40.9HighSchool 59.1

Occupation %Employed 70.5Unemployed 27.3

Religion %RomanCatholic 86.0Born-AgainChristian 7.0Iglesia ni Kristo 4.7Others 2.3

InRehabilitation InCommunity

SocioeconomicStatus

1.7

50.3

43.6

4.4

VeryPoor

SlightlyPoor

JustRight

Rich

PerceivedSES

75

20.5

4.5

PHP0toPHP10,000

PHP10,001toPHP20,000

PHP20,001toPHP30,000

AverageMonthlyIncome


Respondentsfrombothsettingsreportedhavinglowsocioeconomicstatuses.

Adverse Childhood Experiences (ACEs)• Thisstudyalsoexploredtheadversechildhoodexperiencesthattherespondentsmighthavehad.

• ACEsareclassifiedaseventsthatcouldpossiblybetraumaticwhichcouldhaveanegativeeffectonhealthandwell-beingofapersoninthelongrun(Sacks,Murphey,&Moore,2014)

• StudiesshowedthatchildrenwhohavebeenexposedtodifferentACEsaremorelikelytodeveloplethalhealthconditions,experiencedifficultyinlearning,anddevelopbehavioralproblems(AmericanAcademyofPediatrics2014).

• Alcoholismandinjectionofillegaldrugshaveastrongrelationshipwithadversechildhoodexperiences(Felitti,2003)

AdverseChildhoodExperiences(Abuse)

Therewererespondentswhoexperiencedabuse(physical,verbal,andsexual)whilegrowingup.

Greenfont– Significantlyhigherat95%confidence level

Thepercentageofsurrenderers (57%)whoexperiencedphysicalabuseweresignificantlyhigherthanthoseinrehabilitation.

In Rehabilitation InCommunity

PhysicalAbuse Never 62% 43%Yes 38% 57%

VerbalAbuse Never 46% 55%Yes 54% 46%

SexualAbuse Never 82% 91%Yes 18% 9%

Severalrespondentshavereportedgrowingupwithsomeonewhoabusesalcoholanddrugs.


AlcoholAbuseintheFamily No 61% 57%Yes 39% 43%

DrugAbuseintheFamily No 72% 57%Yes 28% 43%

PsychDisorderintheFamily No 89% 86%Yes 11% 14%

IncidenceofSuicideintheFamily

No 90% 96%

Yes 10% 5%

IncarcerationofFamilyMember

No 78% 71%Yes 22% 30%

AdverseChildhoodExperiences

Nosignificantdifferencesbetweenresults fromthetwosettingswerefound

• Presenceofdrugabuseinthefamilyishigherinfemalesthanmales.• Onlyfewreportedhavingafamilymemberwithpsychologicaldisorderandwho

attempted/committedsuicide.

Somerespondentsgrewupinachaoticenvironmentandhaveseparatedparents.

AdverseChildhoodExperiences



DiscordintheFamily No 68% 75%Yes 32% 23%

SeparatedParents No 64% 68%Yes 36% 30%

OFWParents None 72% 86%Yes 28% 9%

FosterHome/Institution

No 95% 91%Yes 5% 9%

Adopted No 96% 93%Yes 4% 7%

• Higherincidenceofseparatedparentsamongyoungeragegroup.• Onlyfewexperiencedlivinginafosterhomeorwereadopted.

InSum:

• Demographics:• Majorityaremale,inmostproductiveyearsoftheirlives(25-35y.o.),single,mostlyhighschooleducated,employed,comesfromlowincomefamilies

• Socialization• Exposedtoadversechildhoodexperiences,variousformsofabuse,drug-usingfamilymembers

FactorsleadingtoDrugUse

About45%and34%ofrespondentsfromrehabcentersandthecommunity,respectively,startedtheirdrug-usingactivitiesbetweentheagesof15to19yearsold.

DrugUseOnset

RehabilitationPatients

VoluntarySurrenderers

AgeofOnset

5-9y/o 1% 0%10-14y/o 34% 7%15-19y/o 45% 34%20-24y/o 13% 16%25-29y/o 5% 14%30-34y/o 1% 11%35-39y/o 0% 2%

Morethan39y/o 0% 9%

Morevoluntarysurrenderers reporteddruguseonsetatalateragethanrehabilitationpatients.


Topdrugseverusedforpatientsandsurrenderers aremethamphetamine/shabu andcannabis/marijuana

DrugsEverUsed

InRehabilitation Total AgeGroup10-14y/o 15-24y/o 25-35y/o

DrugUsed

Methamphetamine 89% 56% 86% 93%Marijuana 81% 92% 86% 78%Cocaine 17% 20% 18% 17%Ecstasy 11% 0% 14% 10%Inhalants 9% 20% 12% 7%PsilocybinMushrooms 3% 0% 7% 2%

Heroin/Morphine 3% 4% 5% 2%Others 6% 0% 6% 7%


InCommunity Total AgeGroup15-24 y/o 25-35y/o 36-65 y/o

DrugUsedMethamphetamine 89% 31% 30% 70%

Marijuana 50% 69% 70% 30%

Syrup 2% 0% 0% 5%

AgeofOnset(%)7-14y/o 15-24y/o 25-34y/o

Nicotine 41 37 22Alcohol 25 38* 52*Marijuana 18 13 4Shabu 11 11 22

Nicotine(36%)andalcohol(34%)arethetopsubstancesthatwerefirsttried

FirstEverTriedDrugs(TRC)

5 types of shabu (Estacio, 2003)

Ø 1. “Makapuno”, a first class shabu; unadulterated; Ø 2. “Market”, tastes like makapuno and genuine-tasting; widely

peddled in the market;Ø 3. “Brownies”, made from the residue of makapuno; tastes like

gelatin; Ø 4. “Lasang tiki-tiki”, tastes like tiki-tiki, the most popular

vitamins for babies in the 1960s and 1970s; gives an effect similar to that of market;

Ø 5. “Lasang papaitan”, bitter-tasting shabu; smells like a piece of rubber; prepared as a buffer and sold only when there is short supply of market and lasang tiki-tiki;

Ø 6. “Semi-lahar (s.l.) or hopeless case”, the worst kind; tastes like ash and the effect is nil, “hopeless”; adulterated with alum or salt

Mainreasonsforinitialdruguseamongpatientswerecuriosity,peerinfluence,experimentation,andpersonalproblems.

ReasonsforInitialUse


Curiosity 50% 40% 48% 52%Couldnotsaynotofriends 44% 64% 42% 44%Justwanttoexperiment/try 38% 32% 40% 38%Familyproblems 33% 36% 30% 34%Lovelife problems 23% 12% 18% 27%Nothingtodo 22% 24% 26% 20%Imitatedmyfriend 15% 16% 21% 12%Relievebodypain 9% 4% 6% 11%Financialproblems 8% 0% 3% 11%Workproblems 6% 0% 3% 8%Schoolproblems 4% 4% 4% 5%Friendproblems 4% 0% 4% 4%Spiritualproblems 3% 4% 1% 5%Couldnotsaytofamilymember 3% 8% 5% 2%Greenfont– Significantlyhigherat95%confidence level

ThesewerealsothetopreasonsthatcameoutfromtheDDB2008HouseholdSurvey

Whatmakesdrugattractive?(Estacio,2003)

• “Gamot sa problema atkalungkutan”(problemanddepressionhealer);• “Gamot sa kagutuman atkahirapan”(hungerandpovertyhealer);• “Gamot sa pagkabagot”(healerofboredom);• “Gamot sa antok atpagkapagod”(anti-sleepinessandanti-stressmedicine);

• “Pampagana sa pagkain,seks atdiskusyon”(appetizerforeating,sexanddiscussion);

• “Pampatalino”(intelligenceenhancer).

ØTheperceivedgamot (medical/healing)propertiesofthedruginducesonetofirsttryandthentocontinuedrugus

Mainreasonsforinitialdruguseamongsurrenderers werepeerinfluenceandcuriosity.

ReasonsforInitialUse

InCommunity Total AgeGroup15-25y/o 25-35y/o 36-655y/o

Peer Influence 55% 62% 70% 40%Curiosity 39% 54% 20% 40%FamilyProblem 16% 8% 20% 15%Nothingtodo 14% 15% 20% 10%Treatmentofbody pain 11% 8% 30% 5%Community influence 5% 8% 0% 5%RomanticProblem 5% 0% 20% 0%Occupational/Schoolproblem 5% 0% 20% 0%Familyinfluence 3% 0% 0% 5%Problemwithfriends 3% 0% 10% 0%Financialproblems 3% 0% 0% 5%

Primaryreasonsforcontinuedusearealsoescapefromproblemandpeerpressure.

ReasonsforContinuedUse


Iforgetmyproblems 56% 43% 55% 57%Icouldnotsaynotofriends 43% 57% 35% 45%Familyproblems 33% 26% 27% 36%Igetbored 31% 26% 32% 31%Nothingtodo/Forpastime 29% 13% 40% 25%Romantic problems 28% 13% 20% 32%Financialproblems 13% 4% 8% 16%Workproblems 7% 0% 5% 9%Friendproblems 6% 0% 8% 6%Needitformyillness 6% 13% 5% 6%


• Somerespondentsmentionedfamilyproblemswhichwasansweredmorebyfemalesthanmales.

• Therewerethosewhowerejustboredorhadnothingtodo.Thisresponsewasmorecommonamongtheyouth.

• Romanticproblemsarementionedmorebyfemalesandyoungeradults.

Greenfont– Significantlyhigherat95%confidence levelBluefont– Significantly higherat95%confidence levelamongagegroups

Primaryreasonsforcontinueduseareescapefromproblemandinabilitytorefusefriends.

ReasonsforContinuedUse

In Community Total AgeGroup15-24y/o 25-35y/o 36-65y/o

I cannotsaynotofriends 23% 31% 20% 20%Iforgetallmyproblems 18% 23% 30% 10%Treatmentforbodypain 14% 8% 10% 20%Familyproblem 11% 8% 10% 10%It boosts self-esteem 11% 8% 20% 10%Occupational/Schoolproblems 5% 0% 10% 5%Cannotsaynotofamily 2% 0% 10% 0%Problemwithfriends 2% 0% 10% 0%Financialproblems 9% 0% 0% 15%Romanticproblems 2% 0% 10% 0%


• Surrendererswerelessinfluencedbyvariousproblemsintheirdecisiontocontinueusingdrugs.

• Themiddle-agedgroup(25-35y/o)weretheoneswhotypicallyfacedproblemsthatwereinfluentialincontinuingtheirdrug-use.

Whatwasthereasonbehindyour

continueduse?

Bicutan(n=248)

Tagaytay(n=81)

Dagupan(n=107)

CamSur(n=78)

Albay(n=29)

CDO(n=84)

Total(627)

FamilyProblems 69 16 14 12 6 12 129

PersonalProblems 38 15 15 11 4 10 93

PeerPressure 77 28 44 20 11 29 209

Likeditalready 74 19 40 50 14 36 233

Others 25 12 14 2 2 5 60

Primaryreasonsforcontinueduseareescapefromproblemandinabilitytorefusefriends.

Followupstudyof10TRCs,Estacioet.al.,2017

Whatmakesdrugattractive?

lVarious tama include:

lMagandang tama:tamang gisingtamang kuwentotamang sekstamang gawatamang tulog

lVarious tama include:

lMasamang tama: − tamang hinala− tamang away − tamang praning− tamang lowbat− tamang flash-back

Drugs, whether licit or illicit, are, in general, addictive

=============================================• “’Ever since pharmacology and psychiatry became accepted as

modern medical discipline…chemists and physicians,psychologists and psychiatrists, politicians and pharmaceuticalmanufacturers, all have searched, in vain of course, for non-addictive drugs to relieve pain, to induce sleep, and to stimulatewakefulness” (Thomas Szasz, 1985)

ContinuumofDrugUse,PathwaytoAddiction

AddictionCompulsive Drug Use

Intensive Drug Use

Casual Drug Use

Experimental Drug Use

Circumstantial Drug Use Motivational Toxicity

From Bozarth (1990); terms described on the continuum were suggested by Jaffe (1975).

Motivational Strength

Lapag[Pooling of Resources]

Iskor[Buying Shabu]

Batak[Shabu-taking]

Low Bat[Re-charging/Sustaining]

Tama[Hit/Tripping]

Vicious Cycle of Shabu-Taking in an Urban Poor Community (Estacio, 2003)

Otherfactorsforcontinuedusewereintensecravingsandincreasedself-perception

• Participants continuallyseekthe‘high’and‘goodfeeling’

“...hindi naman agad agad nawawalayung cravingse.Ako oneyearna ko maycravingparin ako,magccrave ngmagccrave,magrerelapse ka lang,yungmga yun.”- Malepatient,31yrs.Old

• Evenifsomeareawareoftheilleffects,theycontinueusingbecausetheirbodiescraveforthedrug’seffects.

• There is a higher sense of self. They seethemselves greater than who they are inreality

“Unang-una,sa shabu -- kungwari,sabihin natinang kaligayahan mo sa buhay isibibigay niya saiyo 100%na saya,pakiramdam,sa pagkatao mo,feelingmo supermanka. Ikaw magaling.Pakiramdam mo kayamo na lahat.Tapos,samahan mo pangmga bagay nakakapagpasayasa iyo,halimbawa,sex.Pakiramdam ngpanalo.Isama mo ang shabu sa pakiramdam ngpanalo,sobrang sarap nun.Iyong ang minsan hinahanapnamin.”- Malepatient,28yrs.old

CRAVINGS SELF-PERCEPTIONANDCONFIDENCE

Reasonsforrelapse,TRC(Estacio,et.al.,2015)

Total(%)Sex(%) AgeGroup(%)

Male Female 10-14y/o 15-24y/o 25-35y/oInfluenceoffriends 40 41 37 50 35 41Problemswithself 23 22 29 17 26 21Familyproblem 15 15 11 17 17 15Lovelife 10 9 23* 0 8 12Environment 10 11 6 17 8 11Gotusedtodrugs 9 10 3 0 15* 7Workproblems 3 3 6 0 1 5Financialproblems 2 2 0 0 1 2

• Sometriedstoppingtheirdrug-usingbehaviorontheirownbutmanyhavefailed• Topreasonscitedareinfluenceoffriendsandproblemsthatlieswithinthemselves• Morefemalesmentionedlovelifeasreasonforfailuretostopdruguse• Whilemoreyouthmentionedthattheyjustgotusedwithit

AddictionTheories

QUESTIONS YES NO

“Doyouusedrugsmostlytomakebadfeelingslikeboredom,loneliness,orapathygoaway?”“Doyouusedrugsmostlybecauseyouwanttogethigh?”“Doyouusedrugsmostlybecauseofcravings?”“Doyoufindyourselfgettingreadytotakedrugswithoutthinkingaboutit?”“Doyouimpulsivelytakedrugs?”

Drugs, whether licit or illicit, are, in general, addictive

Addiction-likeBehavior(Newton,delaGarza,et,al,2009):ØNegativeReinforcement-NR(“PainAvoidance”)ØPositiveReinforcement-PR(“PleasureSeeking”)ØIncentiveSalience-IS(“Craving”)ØStimulusResponseLearning-SRL(“Habits”)ØInhibitoryControlDysfunction-ICD(“Impulsivity”)

InSum• DrugUse

• Startedearly(10-19y.o.)• Shabu andmarijuanaasdrugsofchoice• Alcoholandtobacco(cigarette)useatanearlyage

• Reasonsfor1st use• Curiosity,peerinfluence,experimentation,familyproblem,lovelife,boredom,financialproblem,school/workrelatedproblem

• Relievebodypain• Reasonsforcontinueduse

• Escape/forgetproblems,peerpressure,boredom,lovelife,financial,work• Relievebodypain,boostself-esteem• Likeditalready;cravings• Relievebodypain• Boostself-esteem

• Reasonsforrelapse• Sometriedstoppingtheirdrug-usingbehaviorontheirownbutmanyhavefailed• Topreasonscitedareinfluenceoffriendsandproblemsthatlieswithinthemselves• Morefemalesmentionedlovelifeasreasonforfailuretostopdruguse• Whilemoreyouthmentionedthattheyjustgotusedwithit

Severity,Consequences,andEffectsofDrugUse

SeverityofDrugUse

17%

57%

26%

RehabilitationPatients*

Mild Moderate Severe

*Adruguseseverityscalewasdeveloped toassessseveritylevel**TheDrugAbuseScreeningTest20(DAST-20)wasutilizedtoassessseveritylevel

21%

58%

21%

VoluntarySurrenderers**

Mild Moderate Severe

68%53% 49%

21% 18% 16% 15% 9% 4% 2% 1% 1%

Deviantactivitiescommittedbyrehabilitationpatients

Rehabilitationpatientsdidmoreillegalorimmoralactscomparedtovoluntarysurrenderers.

18%

9%7%

2%

7%

Sellinghouseholdappliancesor

gadgets

DrugPushing Stealing Physicallyharmotherpeople

Extortion

Deviantactivitiescommittedbyvoluntarysurrenderers

Morethanhalfofthesurrenderers (64%)didnotcommitanydeviantact.

EffectsofDrugUseonPhysicalHealth(TRConly)

Ailments %Withoutailments 54Withailments 46BodyPain 6Fever 5SkinDisease 5Cough 5Headache 4Psychosis 3Colds 3Tuberculosis 3LungAilment 3MemoryLoss 3HigBloodPressure 2Ulcer 2UTI 2Others 6

Almosthalfoftherespondentshaveexperienceddepression,anxietyanddifficultycontrollingtheirtemperforthepast12months.

• Almosthalfofthemalerespondentsreportedhavingexperienceddepression,anxietyanddifficultymanaginganger

• Anxietyishighestamongfemalesthandepressionandangermanagementissues

Sex

Males Females LGBT

Depression 42.90% 28.60% 50.00%Anxiety 48.60% 42.90% 0%

AngerManagement 48.60% 14.30% 0%

Self-HarmBehaviors

TOTALSex

Males Females LGBT

Thoughtsofharmingselfand/orharmedselfinanyway 20.00% 0.00% 0.00%

Suicidalthoughtsand/orattempts 5.70% 14.30% 50.00%

Prevalenceofsuicidalthoughts 3.30% 0.00% 0.00%

• Moremales(20%)havethoughtsandbehaviorsofself-harm• 14.30%offemalerespondentsreportedsuicidalthoughtsorattempts• Participantsage15-24yearsolddonothaveanincidenceofanyself-harmbehaviors

• Agebracketof25-35yearsoldhavemorereportofself-harmbehaviors

• Mostclaimedtohaveparanoiawhileundertheinfluenceandaftereffectshavewornoff

• Usersofdowners likerugbyexperiencedhallucinationsand,toanextent,extra-sensoryperception(ESP).

• Someexperiencedauditoryhallucinations,whichtheycall bulong.

Paranoia,hallucinations,anxiety,anddepressionaseffectsofdruguse

EffectsonSocialRelationshipsandOtherAspectsofSocialLife(TRCOnly)

• Socialrelationships,especiallywithfamily,weregreatlyaffectedduetodruguse

• Drugusealsoaffectedabilitytoworkand/orgotoschool

• Majority(88%)committedcrimesthatnotonlyaffectedthehouseholdbutalsothecommunity

• Commonactsincludesellinghouseholditems,drugpushing,andstealing

• Maybeoneofthereasonsfortheviewpointthatdrugabuseisacrime.

EffectsonSocialRelationship– Community(TRCOnly)

Consequences of Drug Use

• Physicalhealth• Mentalhealth• Socialrelationships(family,peers,intimatepartner)• Otheraspectsofsociallife(education,work,etc);

TreatmentProvidedandItsEfficacyandEffectiveness(TRCOnly)

TRCBICUTAN

TRCBATAAN

TRCILO-ILO

TreatmentServicesandFacilities

ü Participantsgenerallyfindtheircurrenttreatmentprogramaseffective.

ü Topservicesofferedthatareperceivedtobeeffectivearespiritualcounsellingandtherapeuticcommunity.

• UseofspiritualapproachintreatmentØmosteffectiveapproachamongallinterventionsoffered.

• FamilytherapyØ strengthenedfamilybondingandsocialsupport

StrengthsofTreatment

• EducationalandTechnicalSkillsTrainingProgramsØ AlternativeLearningSystem(ALS)Ø LivelihoodTraining(in-houseandotherproviders)Ø Personaldevelopmenttraining

• Aftercareserviceswaseitherabsentornotsustained• Facilitieswerelackingorneedsrepairorimprovement.• Overpopulationofclients• Treatmentnotindividualized,holisticandprogrammatic• Staffworkfoundnotsatisfactoryandskillstrainingwereneededtoimprovetheirperformance

WeaknessesofTreatment

Typesoftreatmentinterventionsandeffects

Thetreatmentenvironment:Ø administeredsocializedpayments;Ø employedTC,eclectic,spiritualmodels;Ø withvariousservices;Ø effective(spiritual,TC);Ø over-allsatisfactionrating:averageØ strength(spiritual,familytherapy,educationalandtechnicalskillsenhancement);Ø weakness(lackofaftercareservices,facilitiesthatneedrepair,overcrowding,needformorecompetentandhighly-trainedstaff)

ViewsonDrugUsebyStakeholdersandFamilyMembers

• ASACRIME:Drugusehasbeenviewedasacrime becauseofthenatureofriskybehaviorsassociatedwithit.

• ASASPIRITUALISSUE:Theparticipantsbelievedthatthedruguser’spoorspiritualityledthemtodruguse.

ViewsonDrugUsebyStakeholdersandFamilyMembers

• ASADISEASE:Mostcenteradministratorsvieweddruguseasachronicrelapsingbraindisease.

• ASAMULTI-FACETEDISSUE: Environment,personalitytraits,psychological,andpsychosocial-environmentalfactors areconsideredaspredisposingfactortodruguseaswellastheuser’sfamilyhistory.

ViewsofTreatmentProvidersandParentson

DrugUse

AsaCrime

Multi-Faceted

BrainDiseaseAsaSin

ProfileofVoluntarySurrenderers

BaselinestudyofVoluntarySurrenderers

Majorityofthesurrenderers (91%)triedtostoptheirdrugactivities.

9%

62%

18%

2%9%

AttemptstoStopDid not stop 1-3 times

4-10 times More than 10 times

Not Ascertain

Regardlessoftheirattemptstoultimatelystopdruguse,only1ofthesurrendererssoughtrehabilitation.

Majorityofcommunityrespondentsweredrugusers(91%)whovoluntarilysurrendered(82%).

91%

2%5%2%

PresentParticipation

User Pusher User-Pusher Not Ascertain

82%

18%

TypeofSurrender

Voluntary Forced

Whydidthedrugusers/pusherssurrender?

• Surveyandpersonalinterviews[n=40]

CLASSIFICATION Freq %

User 34 85.0

Pusher 1 2.5

User-Pusher 5 12.5

TypeofParticipation Freq %

Voluntary 32 80.0

Forced 8 20.0

ReasonsforVOLUNTARYSurrender(n=32) %

Liketoberehabilitated/treated 46.9

Afraid ofthefuturewithdrugs 37.5Afraidof being killed 31.3Afraidformyfamily 31.3

Wanttocontributetogovernmentcampaignagainstdrugs 25.0Afraidofbeingjailed 21.9WanttoobeyGod 21.9Persuadedbyfamily 18.8

Myfriendsalsosurrendered 15.6Others 12.5

ReasonsforFORCEDSurrender(n=8)

BecauseofOplan Tokhang

Adviceofpastor

Persuadedbyfamily

Influenceoffriends

Based on the the macro and micro data/situation, • What can we find?• What can we conclude?• What can we propose as an improved response?

SummaryofFindings

• The Philippines has a serious drug problem; to the credit of PresidentDuterte the danger of us turning into a narco-statewas prevented

• Despite the issue on EJK/DUI, 88% or more than majority of thepopulation approve of the war on drugs campaign of the presentadministration (social ambivalence)

• On the other hand, 73 % agree that EJK/ is happening and are drug-related

• The WOD campaign is quite strong in law enforcement and not sostrong in demand reduction despite the enacted treatment policies

• The Filipino mindset strongly favors the criminalist and moralistapproach to the drug problem

DrugUsersinRehabvs.Community

• Intermsofreasonsforinitialuse,bothusersinrehabilitationandinthecommunitystatedpeerpressureandcuriosity.

• Bothalsocontinuedtousedrugsduetopeerpressure andasameanstoescapefromproblemsandcravings(likingthedrugs).

• DrugusersfrombothgroupsexperiencedsomeformACEs,butvaries.However,bothdrugandalcoholabusivefamilymembersplayedinfluentialrolesinthedrugusingbehaviors

DrugUsersinRehabvs.Community

• Inbothsettings,morethanhalfoftherespondentsweremoderateusers.

• Moreusersinrehabilitationcentershavecommitteddeviantacts.Mostcommoninbothsettingsissellinghouseholdappliancesanditems.

REHABILITATION COMMUNITYMild 17% 21%

Moderate 57% 58%Severe 26% 21%

StrengthsandWeaknessesofTreatmentinTreatmentandRehabilitationCenters• Over-all,treatmentstrengthwasonspiritualapproach andeducationalandtechnicalskillstraining.

• Treatmentwasfoundtobeweakintermsofthefollowing:lackofaftercareservices,facilitiesthatneedrepair,overcrowding,andneedformorecompetentandhighly-trainedstaff

Conclusions

• ThedrugprobleminthePhilippineshasatransnationalcharacter,thus,difficulttograpplewith;

• TheFilipinopeoplearesociallyambivalentwithregardstotheWODcampaignofthecurrentadministration.WhilemorethanmajoritysupporttheWODcampaign,thesamenumberagreethatEJKishappening

• Thepolicyandprogramapproachofthestaterethedrugproblemismoreinformedbyacriminalistandmoralistperspectiveandlessofthemultifactorialapproach

Conclusions

• Evidenceshowsthatthedrugproblemisnotjustaproblemofthedruganddrug-takingitselfbutmoresoaproblemofphysical,mentalhealth,andsocialrelations

Treatment Interventions and Outcomes

Zumba Simba Tumba?

Therapeutic Community Eclectic 12 Steps

Facilitation

Interventions in the community

Interventions in treatment centers

Minimal effect; low effectivity

Moderate effectivity;

can be improved

Recommendations

• Policywise,ashift:ØFromcriminalist-moralist tohumanist-transformativeapproachØFromeclectictomoreholistictypeoftreatment

ØAddresshealth,psychological,social,economicneedsØFromcentralizedtoindividualizedtreatment

ØEachonehadreasonswhytheywentintodrugsandthustreatmentshouldbefocusedattheindividuallevel

ØFromcenter-basedtocommunity-basedtreatmentØBecauseitismorecost-effective,manageable,practicalandsustainableinthelongrun

ØTreatmentcenterscannotaccommodateasmanydrugusers,thus,theyshouldonlycatertoorspecializeinseverecases

Recommendations

• Programwise:Ø1. Enhancing one’s spirituality may be the answer.ØThis is perhaps, the most culturally appropriate way of handling cases ofdrug addiction.

ØA lot of testimonies (e.g., one center administrator-partner) have beenheard about former drug addicts turning into more positive ways ofhandling their lives because of a renewed relationshipwith God.

ØAs many drug users admitted that they find it hard to control their drughabits, an external locus of control (e.g., God, faith) may be necessary tomotivate and strengthen their desire to be rehabilitated.

Recommendations

• Programwise:Ø2. Increasing family support may also be necessary.ØThis is especially true for Filipinos who value their family, often,more than themselves.

ØThis would mean, however, that therapeutic mechanisms shouldfocus or at least involved the family of the drug user, as this studyshowed that many problems of drug-using populations arise fromthe family.

Recommendations

• Programwise:• 3.Providinggoodorbettervenuesforpeer-bonding.• Sports,livelihood,scholarshipsandotherinterestingandproductivemechanismsareneededtodiverttheattentionofyoungpeopleawayfromdrugs.

• Butoutcomemeasuresshouldbeemployedtogettheeffect.

“….Thedrugsituationinthecountryisatitsworstthatitdamagesnotonlytheperson,butthesanctityandsolidarityofthefamilyaswellastheintegrityandprogressofthecountry…..”(PresidentDuterte)

Thanksforlistening….Let’s drinktothat!