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Sober talk: 'Asia's meth is going to be the number one cause of human suffering'

Source : SIFY
Last Updated: Wed, May 15, 2013 12:01 hrs

​The Cabin, a revisionist Thai rehab, is in India to update people on the scale and severity of Substance Use Disorder [addiction]. The Cabin tariff is about 12,000 dollars a month for a modern teakwood room – one room to a person. In Part III of an in-depth interview, The Cabin Programme Director Alastair Mordey and Clinical Consultant Prem Kumar Shanmugam assess the challenges that addiction is likely to pose in the days ahead.

Part I:
Food addiction will abound in India over the next 20 years



Part II: The 12 Steps might die if we don’t revise them

Q: What brought The Cabin to India?

A:
I met leading American rehab people recently and they asked me how we've done what we do overseas. Do you use interventionists – you know, middlemen – to go out and catch people and families and extricate them into treatment? No, we don’t use them. We came out to a developing country to set up a rehab like the one we have.

I went and dug every new oil well. I got on the plane and went to the top three cities in the Far East. I did conducted tours of hospitals. I met doctors. I drummed up support. That's how we did it. We find that we now have to do it at another level.

Now we know all this brain disease research and it's been taken the wrong way by insurers and people who have another agenda – to eliminate rehabs and treatment. They want it all to be in the hands of the white coats, which is not fair. They have their place and so do the people who treat psychologically. The addicts have their place and are central to how it works.

We need to go around in the Asia-Pacific, which is where we are. We will drive things in this region. We will go around and raise awareness, educate. At the same time it is a social good. It is the best marketing tool you can use.

When I am on tour I don't need to talk about The Cabin. Because what is being said is so interesting that people want to know who you are and where you are anyway. It is everything. It helps business grow; we'll probably be a player in the Asia-Pacific region and it is social good. It needs to be done. It needs Roadshows like this. It needs findings from all over the world.

A top Euro scientist said recently, in a brilliant presentation where he broke down the DSM-5, 90 percent plus of the treatment centres in America and Britain do not work on the new scientific research findings. Even 12 Step centres who have always said it is a disease now realise they don't really believe it is a disease.

They want it to be a symbolic disease; they don't want it to be a real disease. It is amazing. Forget India and Thailand, most treatment in the West is not taking in account the findings on this disease and the developing treatment models that show why it is too big a shift.

They are like oil tankers. They can't turn around in the water. They've got 60 board members who are all old stalwarts of AA and who do not want to see a new treatment method. They just want to keep doing the same encounter therapy, the same shame-based treatment. They don't want to bother with writing a new treatment programme. That is the only thing I can put it down to.

Q: India is therefore important to change things.

A:
I think India can get up to speed faster than the West because it doesn't have a big ship that it can't turn around in the water. It is like The Cabin. We're three years old. Two years into treatment, when ASAM released their document, I rewrote the whole treatment programme according to ASAM criteria.

I did it in six months. They are not going to do that. Hazelden [the world's biggest 12 Step treatment centre] are not going to do that. Hazelden are wonderful and brilliant but they can't do that. India can. [Prem] There is a need. I landed in Delhi and switched on my phone. I get call from someone seeking treatment for their son.

He saw our brochure apparently and said his son and his friend's son need help. [Alastair] he gets mobbed wherever he goes. In Oman, we had families coming to the hotel. Desperate upper middle-class families and doctors.

Very well meaning, excellent doctors who can't do it all. They detox people and then what. It was the same in Malaysia. [Prem] I admitted a person into treatment two days ago. He went to The Priory and left after a week. He has come to The Cabin now. He couldn't cope with The Priory. He says they charged him 1000 pounds a day.

He had to wash his own clothes apparently and you have to carry your own food plate. So there's a shame thing there. [Alastair] Culturally that is not going to work with upper middle-class Indians either. You've got to be realistic. You've got to think.

At some of these exclusive Arizona rehabs in the southwest, which is where a lot of the rehabs are in the US, they shame people. Westerners can handle it because we are very confrontational culturally. For example, what they did with Britain's foremost comedian – an icon in England. He could handle it because he is a comedian and an actor.

He had to wash his own clothes apparently and you have to carry your own food plate. So there's a shame thing there. [Alastair] Culturally that is not going to work with upper middle-class Indians either. You've got to be realistic. You've got to think.

At some of these exclusive Arizona rehabs in the southwest, which is where a lot of the rehabs are in the US, they shame people. Westerners can handle it because we are very confrontational culturally. For example, what they did with Britain's foremost comedian – an icon in England. He could handle it because he is a comedian and an actor.

He and the person he was in treatment with had to carry a sack all day long with 'My Shit' written on it, because they had failed to offload their problems in the group. Can you imagine a damaged, sensitive, upper middle-class Indian being able to cope with that? I don’t think so. I can't. I don't like it. If I relapsed now I wouldn't want to go to one of those hardcore 12-Step very famous very expensive American rehabs.

I want to be treated decently. That type of treatment has had its day although it is still the dominant model in the US.

Q: The quality of counsellors is an important and integral part of treatment. In India, people start their own rehabs soon after they leave a rehab after a few months in treatment. They inherit money or land and start a rehab in a small space. They don't understand the concept of space in a rehab. I've realised that you need physical space to treat a mental illness like addiction. The other issue is that none of these people are trained; their recoveries are not measurable nor have they been tested. How does it work with The Cabin?

A:
I’m sure you've seen that most people are sly. [Prem} Counselling is scientific and clinical. It's not talk. You need to have the basic skills to be a good counsellor. Therapy is very wide. You can have a degree in psychology but addiction therapy itself is very specialised and vast.

You've got to have a degree to be a good addiction therapist. And then you have to go for certification. We do that. I sit on the board of accreditation in Singapore. It is called the Asia Pacific Certification Board [APCB]. We are trying to form one in Delhi. It's free. You don't have to pay for it but you have to be accredited.

All our therapists at The Cabin are accredited and they go through training all the while. I train them once a month. Everyone is kept up to speed. [Alastair] We are having everyone retrained, re-accredited locally by APCB. Most of the counsellors are coming to us with western accreditations too. When they come to The Cabin there is always a continuing professional development.

There are other big accrediting bodies in Asia that are usually UN-driven. For instance, the Colombo Plan of the UN. We have Filipino and Mandarin speaking counselors. Prem speaks Indian languages and Japanese. The Asian continent is covered well in our multi-cultural staff.

Q: What would I need to do, say, to be accredited as a counsellor?

A:
Let's say you want to be a drugs and alcohol counsellor in India. Your skills need to be improved; you want to get up to Western standards. You will need to contact the APCB.

Q: What would the APCB do?

A:
[Prem] First, you need to sit for an exam. There's a course you need to study; 12 core functions of an addiction counsellor. All our therapists at The Cabin have gone through that. The course might take you five months after which you sit for an exam. You can study the course online but you will still need to take the exam at the centre.

[Alastair] First, Prem will get the APCB going in Delhi. Then, he will come to India to train people. You and the others interested can come and take your first training. And then you will join the federation for minimum fees. This way the Indian APCB federation is born because they have some actual counsellors on the ground.

Q: What length of recovery is a good place to start? It can't be that people just leave rehabs and begin work as counsellors, like they do in India. I believe Hazelden looks at eight years of recovery before they take anyone on as counsellor.

A:
At The Cabin I prefer that people have at least two years of recovery but that is negotiable. I will meet with them; I will see how psychologically healthy they are. How good their behavioural health is. You can have excellent behaviour with one year of recovery. I know top addictionologists with 20 years clean time who earn a million dollars. I wouldn't hire them for a dollar.

I would pick a driven young man and train him. That is what The Cabin is. The Cabin is full of them. What else is The Cabin? It is not trees and cabins. It is counsellors. Everyone on the staff has a role to play, even the kitchen staff. The kitchen staff is Thai, lovely, sensitive, and caring.

Q: What are the three big challenges in the treatment of Substance Use Disorder?

A:
Let’s look at the world first, then Asia and finally India. The main issue in addiction – and this is true of America, Britain, India or Thailand – is that it is a brain disease. Explaining that to people is a challenge. It's not that it might be, it might not be or I don't agree. I'm sorry it is a brain disease. It has certain symptoms and therefore certain treatments.

We strongly contend that behavioural therapy of various types, whether AA-based, CBT-based or whatever, have to happen along with the medical model. You can't just medicate people. If we are not very very careful and very very clever, the medical industry that is not particularly sympathetic to anything other than its own profits will take over.

If we don't get cleverer and meet them on their own ground, they will take over by saying this is a brain disease and you need outpatient treatment and I'm a doctor. You need to come to me and me only. We need to go into their territory and say it is a medical problem but not just a doctor and outpatient one.

If we don't do that now, rehabs will die. Inpatient treatment will die. The addicts helping addicts model will die. Ironically, the people who seem to least understand this is Hazelden and the 12 Step-based models. They are so confident that their models will survive.

Q: They are the ones most affected.

A:
They will be if they don't stop saying we know best. We are addicts, we know everything. Come to us. They have to stop being so arrogant.

Q: Is Hazelden the Titanic of addiction treatment?

A:
It could turn out to be the Titanic if it's not very careful. It is so confident that everyone is listening to them or bowing to them. They are not seeing the big money coming in through the back door. The big money has got all the research. I'm saying it is research that backs Hazelden. Wake up Hazelden, it backs you up.

Q: What are the other two challenges?

A:
Then we come to the parts of the world where treatment of addiction is not so well understood or practiced – most countries outside of the Anglo-Saxon English-speaking world. These places have the opportunity to develop this new science-based approach that is not 12-Step based.

Even if they are 12-Step based, they are in a position to bring revisions. They can have the best of everything. They can look around and pick the right models but they don't have anything. They have an open palette and they can paint whatever they want.

The big challenge of the 21st Century is going to be the big populations of India and China, the Asia-Pacific region. What it does with its addiction problem that is already dwarfing the West. One country in Southeast Asia dwarfs Colombia's decades of cocaine production and warfare.

Myanmar's production of methamphetamine has already dwarfed Colombia's cocaine. The markets in China and Thailand are already dwarfing that. It really is going to become the number one cause of human suffering. A comet hitting the earth would scarcely be more important.

It is the biggest issue for Homo sapiens. If you bring in the food addictions of big populations – with more fatty food and in a way more developed food – there are a lot of things that stimulate the reward system in the brain and create addicts.

Computer games are going to stay in people's reward circuitry and create the disease. Fatty food is going to create the disease in billions more people. We are going to have an awful lot more addicts coming now into treatment.

An epidemic of addiction is coming. We've got to get on this one and have a treatment system that doesn't sound medieval.

[Concluded]

Also by the author:

Sober talk: 'The 12 Steps might die if we don't revise them'

Sober talk: 'Food addiction will abound in India in the next 20 years'


Karnataka, a way ahead

Ten ways India can make China respect it

New India, new police

Rajiv Gandhi and the muddlemen of Indian defence

Silly Vijender, sillier state

Vijay Simha is an independent journalist and sobriety campaigner based out of New Delhi. His most recent journalism assignment was as executive editor with The Financial World, New Delhi, and tehelka.com.

He was a guest on Season 1 of the popular Indian TV show Satyamev Jayate, hosted by Aamir Khan.

Vijay blogs here and may be contacted at vijsimha@gmail.com.


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