Program meets clinical — It is standard practice for Program to consult with Clinical on a regular basis to ensure the best possible approach for each resident’s recovery. Photo shows Trainee Gie, Counselor Nell Bayaban, Head of Resident Development Peejo Balinghasay, Deputy Director for Clinical Lyn Simbulan, and Clinical Head Mai Bucong in one such meeting.

James was admitted to SELF on August 8, 2007 at the age of 33 years old due to methamphetamine dependence. He had started taking drugs at the age of 16 years old.

About eight years prior to his admission, James was brought to the Makati Medical Center for detoxification and for his diabetes which he inherited from his late father. He stayed for three weeks and from there went straight to a 60-day rehab program. After that James stayed sober but only for a short period of time.

Background

James is the eldest in a family of four children and both of their parents ran their own RTW business. When his father died from alcoholism and diabetes, it was James’ mother who raised them while continuing with the family business. As a child James was the helpful one. He was always there for his family until he learned to go out with negative friends when he reached high school. Like other curious adolescents James started with alcohol and liked it. This was followed by occasional puffs of marijuana which he also liked. Eventually he fell in with a group of gangs who taught him to use and sell shabu (methamphetamine).
It was around this time that James started having conflicts with his family and with the school and thus began his transfer from one school to another.  Nothing changed, however, and he continued to use drugs until he got married in 2002. At first, he thought that the marriage would help him straighten out as they immediately had a child. However, he began feeling stressed out from the heavy demands of managing his own RTW line. At this time his relationship with his wife also soured due to her demanding attitude. This prompted his heavy drug taking. So aside from job related stress he and his wife would also fight not only because of their relationship but also because of his drug taking. At first he did well in business but he eventually went bankrupt due to his drug taking and his wife’s expensive lifestyle. This eventually led to their separation, making him more depressed and drug dependent. At this point James’ mother, seeing how his son was destroying his own life and his family’s future, looked for a rehab program where he could be helped.

Initial Intervention

Upon admission James was given the routine drug test and was found positive for methamphetamine. He was very shy yet cooperative with his point persons. For the first few days he was made to settle down to manage his withdrawal symptoms. He was also put under close monitoring due to his diabetes for which he was also given maintenance medicines at that time. James’ orientation process took place after a week when he was briefed about the TC process and the house rules. He critiqued the rules based on his previous experience in the short term rehab program, but he listened anyway and participated in the process. Following this, he was welcomed to the TC program.

A month after joining the TC, the results of his clinical assessments came out and James was diagnosed with anti-social personality disorder (aggressive type) along with depression. At this time medication was not recommended though he was put under strict monitoring. It took James another two weeks to fully adjust to the fast-paced environment, but he showed exemplary performance when it came to group activities and was receptive during counseling sessions.

On his fifth month James began exhibiting stubborn, sneaky and arrogant behavior so he was subjected to the normal intensity of the TC confrontation process. Despite this, he started to lose concern for his medical condition and began eating foods that he knew he should avoid. In one confrontation process he admitted feeling angry towards his family for bringing him to treatment and holding grudges against them. He was so negative during that time that he felt there was no reason for him to be in rehab. He claimed that he could handle himself already and his family must pull him out. As a result he was placed in reflection status to give him time to consider his behavior. While sitting in reflection he tried to manipulate the people around him with any means available. When he was eventually put on working reflection status after not taking his reflection seriously, he tried to capture everyone’s attention through his work. He also started using his medical condition to manipulate his co-residents. He often used it as an excuse for his behavior because he knew that it was his family’s soft spot.

It was around this time that the psychiatrist recommended that James be given medication for depression. He was placed under a regime of 5 mg of Lexapro (antidepressant) to be taken at bedtime. This was increased to 10 mg after a month when James started embracing the rigorous process of self-discovery upon learning of his mother’s firm decision not to pull him out from the program in a letter.

Breakthroughs

On his eighth month, James started to show interest in his recovery process. Although he still got occasional confrontations for sneaky and non-caring behavior, he managed to pick up the pieces and make the necessary shift in disposition. With consistency and trust he finally earned his much delayed case defense interview in preparation for his family dialogue. In this process he was able to disclose his innermost issues and identify the areas that he wished to resolve with his family.

On May 31, 2008, James faced his family for the first time after being admitted to the TC. The family dialogue turned out to be very therapeutic as James’s family was able to achieve healing and forgiveness not only with regard to him but also for each and every family member who apparently had issues with one another. Following this, James was promoted to the Senior phase and his family was able to visit regularly and have him out for his probational days-off.

At this time James was also entrusted with additional responsibilities as he became an officer of the house. Although there are times when he still gets overwhelmed with things around him, he continuously pushes himself to do better and avails of regular counseling. This allows him to open up his feelings and thoughts about what disturbs him. He has also learned to use group sessions to help himself feel better.

Turning Point

At the end of his Senior phase, James challenged himself to pursue peace with his wife by having dialogues with her to promote harmony for the sake of their two children. At first the dialogue became a powerful motivation as it would allow him to see his kids on a regular basis. However, when he was promoted to the Reentry phase and began seeing them regularly, conflicts started to resurface as old issues came out again.

This time it was not only between him and his wife; his immediate family was also having conflicts due to his wife’s demanding behavior. The idea of mediating between them in this crucial point of his process stressed James out and unaware his old behaviors resurfaced.

At this time he exhibited marked symptoms of attention deficit disorder (ADD) for which he was given additional medicine — Risperdal 0.5 mg. Later on this was shifted to Abilify 0.5 mg due to his diabetes.

With this James went on a time-out status so he could ponder what was happening to him. After almost two weeks of reflection he succeeded in shifting from feeling depressed to a readiness to face his challenges as he requested for a dialogue with his mother and siblings.

With frequent family intervention and coaching from his Reentry counselor, James started to reflect and study the effects of his own behavior on his recovery process. As he gained sufficient emotional and moral support, he decided to face his reality and cooperated with the court case filed by his wife. In the process James was able to express his concerns and fought for his rights to their two children. From time to time James would encounter difficulty in facing his legal battles, but he has consistently chosen to face them with a sober mind.

These events in his life prompted James to extend his recovery inside the facility. As soon as he finished his Reentry phase, James applied for the Self Practicum Internship Program and worked for six months as Evaluation and Motivation Unit (EMU) Officer. This line of work has not been easy for James as he went through a lot during his probationary term. However, he has kept a strong rapport with peers in his support group and has learned to set his priorities despite the pressures of the job. He has also honed his leadership and management skills and remained steadfast and consistent in his newly found growth. With these developments his medication was adjusted; Lexapro has been discontinued, 0.5 mg Abilify maintained.

In September 2010 James marched with his peers and marked his formal graduation from the program. Unlike the rest who chose to work or study outside, James has opted to stay on at SELF to give back what he has learned from the program. He had the option to work in the family RTW business, but James was firm in his choice to stay with the program and work as EMU Officer for four days a week as his commitment to his own recovery.

By Lyn Simbulan
Deputy Director for Clinical