Update

Integrating HIV/AIDS Prevention Program and the Therapeutic Community

Like quitting chemical abuse and learning to remain sober, practicing safe sex and healthy lifestyle to prevent the spread of HIV/AIDS require a change in attitude and sustained motivation. Influencing behavioral and attitudinal change and providing the motivation to practice new and adaptive behavior require sustained effort and favorable social condition. When the prevalence of HIV/AIDS infection is tied to the prevalence of drug abuse, particularly I.V. drug use, it is unreasonable to have a public health policy that addresses one issue in isolation of the other. The attitude and behaviors related to drug abuse and their psychosocial and health consequences on the individual and society are intricately related to high-risk behaviors that spawn the spread of HIV infection. And very often, drug users who are aware of their seropositive status, given their morbid and reckless disposition, are likely to continue their behavioral acting out at their health’s expense and others’ unless appropriate help is made available.

The therapeutic community (TC) has been an effective treatment approach to addiction. It’s treatment philosophy and practices are based on the assumption that addiction is a disorder of the whole person. Because of the pervasive negative effects of addiction not only on the person’s body and mind but on his total health as well as well being, an effective treatment approach must include comprehensive strategies. Treatment interventions must include techniques to shape behavior and attitude, resolve psychosocial issues, address criminal behavior, and rectify social and vocational skills deficits. In addition, treatment must take place in a safe and disciplined environment that provides social support and encourage the enhancement of social and civic responsibilities.

The TC’s focus on modifying self-destructive behavior and attacking negative attitudes that put drug users in constant high-risk behavior, provide a framework that encompasses the treatment of drug abuse and HIV/AIDS prevention as integral program.  The social setting of the TC and its highly structured and safe treatment environment provide the necessary social and emotional support for recovery and for any serious efforts to personal change. Because of the shared social and psychological goals related to achieving drug-free and healthy lifestyle, drug abuse treatment and HIV/AIDS prevention strategies can be harmoniously integrated into a comprehensive program using a therapeutic community model. The proposed model is relevant to the conditions in several Asian countries that are grappling with the dual problems of drug abuse and rapid spread of HIV/AIDS in their societies.

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APON, A Premier TC in Bangladesh

Brother Ronald Drahozal is an American missionary who has lived in Bangladesh for over forty years. He speaks Bangla and has adopted many of the customs of the local people. He is beloved and respected by residents of his community of recovering addicts and street children. Housed in a cramped rented house in the center of Dhaka, his fledgeling program has grown to over a hundered residents. Ashokti Punorbashon  Nibash, which means "addiction rehabilitation residence" or APON for short, has a very humble beginning and totally reliant on faith and hardwork to meet its needs as it provides rehabilitative services to a growing number of clients from all strata of society.  Brother Ronald has a vision of APON as a self-sufficient therapeutic community and an oasis of hope for recovering addicts in a country that is empoverished and lacking the necessary and effective drug treatment infrastructure. 

Equipped with his experiences from his visits to Nepal's Freedom House TC and St. Joseph Rehabilitation Center in Calcutta and a ten-day Colombo Plan sponsored training on the TC for the prisons in Bangladesh, he gradually built APON as a credible TC since its founding in 1994. Although APON continues to struggle for financial survival and to meet the pressures to accommodate increasing demands for bed space from addicts of all walks of life, it thrives and has produced ex-addict graduates of the program. Living among the grown-ups are the street children or the "bazaar kids" who slept in the open spaces of the bazaars prior to their admission to APON. Many of them  used drugs and committed all sorts of crimes to survive in the streets. Except for a few straight staff that handle executive functions, most of APON''s staff are ex-addicts.

APON has built a reputation as a premier drug program through hardwork and dedication by its founder and director, Bro. Ronald. He lives and works in APON's congested center, among residents who come from all sorts of background, from  the best homes and those neglected and forgotten by society.    

You can contact APON through e-mail at apon@citechco.net

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LOGROS TC: The Jewel of the Ecuadorian Prison TC Program

Unbeknownst to many prison officials that have come and gone in the often tumultuous history of the Ecuadorian prison system, Logros stands as a testament of will and heart among a "chosen" social rehabilitation staff of the Direccion Nacional Rehabilitacion Social (DNRS). In the face of tremendous odds and the often corrupt prison system, Dr. Joselo Alban, a psychologist working for the prison, started in 1997 a small TC within the huge Guayaquil prison. From six prisoners operating in a small isolated cell, he went on to build the biggest and successful TC to date in Ecuadorian prison system with more than one-hundred prisoners as TC residents.

The miracle in this place is not apprarent until you speak to Dr. Alban, a tall man but humble and self-effacing. I remember him as a participant in the first TC training by Daytop under INL funding in 1997 not because he stood out in the group but rather for his "too-good-to-be-true" action plan that he has drawn and implemented quietly. It was brazen in scope and ambitious in intent to take place under the noses of the then prison administration. Dr. Alban had a vision and he did not brag but acted decisively. I couldn't help but feel proud that a quiet man like him would listen to all that was said in that training and did exactly what was envisioned effectively and quietly. 

There is virtue in speaking less and doing more, it works in his case. His success is so complete, and yet he continues to do his work quietly. It comes not as a surprise that few of the top officials of the prison have ever heard or visited his TC. Here are the amazing things about Logros: It has no guards posted inside its facilities. The residents police themselves the TC way, with responsible concern and strict TC code of conduct. There are one hundred ten residents when I last visited the place with only five social rehabilitation staff including Dr. Alban. The place runs itself and the residents progress up to as high as a program counselor. Dr. Alban runs a tight ship, and residents get demoted for any serious behavior infractions and work their way back up again. The TC hierarchy is in place and the senior members help in running the place and in conducting therapeutic activities. There have been several well-coordinated riots and strikes by inmates in most of the Ecuadorian prisons, but never in Logros, which shares space with the rest of the prison. Logros is housed in one of the prison pavilions and adjacent to the other prison pavilions. But it is distinctly different from the run-down and decrepit prison environment around it. Instead, it has clean and painted walls, polished floors, air conditioned group therapy rooms and classrooms. Residents sleep in bunk beds neatly organized and tucked in. No, Logros does not get special budget allocations from the prison system. It raises its own funds to purchase equipment and furnitures it needs for its activities. It runs a little store inside the prison, a workshop to make cabinets, and arts and crafts it sells to the public. The money it makes goes to the upkeep and maintenance and different improvement projects. 

In managing cases, Logros follows the usual treatment protocol, complete with treatment plan for each member and a strict admission procedure and interview process.  As freely as any drug abusing prisoner motivated enough to join in, in a heart beat anyone can be thrown out of the place for breaking any of the cardinal rules of no drugs, no sex, and no violence. Most residents respect these rules, the staff, and the house they helped build.            

You may contact Logros through Dr. Joselo Alban at joselojimm03@hotmail.com

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