case study about drug abuse in the philippines

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Health Hum Rights
• v.24(1); 2022 Jun

The Politics of Drug Rehabilitation in the Philippines

Gideon lasco.

Senior lecturer in the Department of Anthropology, University of the Philippines Diliman, and a research fellow at the Ateneo de Manila University’s Development Studies Program, Quezon City, Philippines.

Lee Edson Yarcia

Senior lecturer in medical jurisprudence and constitutional law at the College of Law, University of the Philippines Diliman, Manila, Philippines, and a drug policy expert at the United Nations Joint Programme for the Protection and Promotion of Human Rights in the Philippines.

The international consensus to end compulsory drug treatments and close forced rehabilitation facilities needs urgent transformation to country policies. In the Philippines, as with other countries in Asia, rehabilitation can be compulsory and is seen as the humane alternative to the “war on drugs.” In this paper, we present the landscape of rehabilitation and narrate the ways in which people who use drugs are forced to undergo treatment. We unpack the politics behind rehabilitation and explain the sociocultural foundations that support compulsory treatment. We argue that a transition to a human rights-based approach, including voluntary alternatives in community settings, is possible by capitalizing on the reforms that are, unwittingly, the result of the “war on drugs.”

This paper analyzes the Philippines as a case study of how politics and populism have framed the understanding and implementation of drug rehabilitation, particularly in an unstable democracy with a long history of authoritarianism and oligarchic patrimonialism. 1 The Philippines has taken global center stage since the Duterte administration’s launch of a “war on drugs” in 2016, with much attention and concern focused on extrajudicial killings—numbering at least several thousand—in connection with this campaign. 2

Less critically examined, however, is how this period—during which drugs have been at the forefront of political and public discourse—has shaped compulsory drug interventions in the country. Compulsory treatment in the Philippines occurs inside spectacular “mega rehabilitation centers” and in the context of a growing number of public and private drug treatment facilities. 3 During the height of the “war on drugs,” the police conducted door-to-door searches in order to compel people who use drugs to “surrender”—effectively a form of forced apprehension—and undergo “voluntary” rehabilitation. 4 Philippine drug courts continued ordering people who use drugs to undergo rehabilitation in government centers or inside jails, with rehabilitation considered a penalty under the national drug law. 5 In recent years, promising community-based programs have operated in parallel with compulsory detention and involuntary treatment, but difficulties have arisen in implementing a fully autonomy-respecting system given the punitive legal environment for people whose lives include drugs. 6

In this case study, we argue that long-standing perceptions on drugs in the Philippines have created an uncritical acceptance that people who use drugs require “rehab” and, consequently, a permissive political environment for compulsory detention and involuntary treatment. Moreover, we argue that the punitive drug regime has reinforced similarly pernicious attitudes by presenting forced “rehab” as the humane and acceptable alternative to extrajudicial killings. To support our findings, we present figurations of “rehab” in the country over the past six years, from the Duterte administration’s statements and programs to the policy pronouncements of those who are running to succeed him in the 2022 elections. We explain this fixation on treating people who use drugs as either criminals or patients—in both cases deemed as without full autonomy to make informed and moral personal decisions—as a product of exploited populism in a predominantly Catholic country. Drawing from international human rights obligations in relation to drug policy, we conclude by identifying critical leverage points and structural factors that drug policy reformists in unstable democracies can maneuver toward a public health-centered framework that respects full patient autonomy and human dignity.

The drug rehabilitation landscape in the Philippines

Duterte’s election to the highest post in the country was premised on a relentless and sustained fight against criminality, illegal drugs, and corruption. 7 On his first day in office, Duterte appointed his former city police chief Ronald dela Rosa to implement his “war on drugs” to fulfill his campaign promise of eliminating illegal drugs in three to six months. 8 As noted by the Office of the United Nations High Commissioner for Human Rights, between July 1, 2016, and November 27, 2017, there was a staggering average of nearly 40 deaths per day as a result of drug operations by the police and from homicides perpetrated by unidentified persons. 9 The prosecutor of the International Criminal Court subsequently requested authorization to open an investigation in the Philippines after finding reasonable basis to believe that the crime against humanity of murder was being committed in the context of the government’s “war on drugs.” 10

Against the backdrop of extrajudicial killings apparently perpetrated pursuant to an official state policy of the Philippines, the drug rehabilitation landscape in the Philippines was changing in light of the threat to life and liberty of people who use drugs. 11 The 2016 statistics of the Philippine Dangerous Drugs Board (DDB) showed that 6,079 individuals were admitted to residential and outpatient facilities nationwide for rehabilitation. 12 A year later, the data showed a decrease in admission to 4,045 individuals, equivalent to a 33% reduction. 13 This substantial drop in admissions is understandable in light of the threat to life and liberty of people who are identified to be using drugs. In 2018, a significant 34.55% increase in admission was reported, largely due to a court-directed policy that allowed for plea bargaining by persons charged with criminal cases, which made up 24.89% of the 5,447 admissions for the year. 14 The 2019 data showed increasing admissions due to plea bargaining agreements, but an overall slight decrease of 4.04% in total admissions was observed, attributed to individuals’ “voluntary submission” to community-based drug rehabilitation. 15 Figure 1 shows the number of persons who use drugs who were admitted to rehabilitation facilities from 2016 to 2019. Close to the end of Duterte’s term, a total of 55 treatment and rehabilitation facilities were operating, up from 31 centers before the start of his presidency. 16

Number of admissions in rehabilitation facilities (residential and outpatient) during the Duterte administration

In November 2016, Duterte inaugurated a 10-hectare compound, dubbed a “mega rehab center,” designed to house as many as 10,000 persons who “surrendered” and would undergo treatment. 17 According to the compound’s chief medical officer, Nelson Dancel, a typical day in the center starts at 5:30 a.m., when residents are required to do a series of physical exercises similar to those required in the army, followed by activities meant to teach the concepts of self-acceptance, self-development, and self-formation. 18 For recreation, the mega rehab center boasts basketball and volleyball courts, chess boards, and musical instruments, with television reserved as a privilege for more senior residents. 19 Dancel explains that escapes are a natural occurrence since some residents feel homesick or worry about their families; individuals who attempt to escape but fail are segregated from other residents, but Dancel is quick to clarify that they are not in solitary confinement. 20 If violations are severe, residents receive extra physical work, such as exercises or additional chores. 21

A year after the center’s inauguration, the DDB described it as a mistake. 22 Only 400 people were treated in the 75,000-hectare property, leading the DDB chief to push for community-based interventions. 23

Nevertheless, the protocols in the mega rehab center reflect typical programs in drug treatment and rehabilitation centers nationwide. Guided by the Manual of Operations for Drug Abuse Treatment and Rehabilitation Centers , which sets the minimum standards for this type of facility, the Department of Health accredits rehabilitation centers—both government and nongovernment owned or operated—based on their compliance with these prescribed uniform standards. 24 Notably, the manual enumerates the prescribed services, which are replicated here for a fuller appreciation of the mandated programs in rehabilitation centers:

• Medical service provides comprehensive health care services ranging from routine physical examination and screening procedure for diagnosis, treatment and follow-up of illnesses and other medical problems.
• Psychiatric service provides therapy to drug abusers with behavioural and psychiatric disorders through, among others, chemotherapy, individual and group psychotherapy, family therapy and occupational therapy conducted by a psychiatric team. A psychiatric team shall include a psychiatrist, psychologist and social worker. This may include an occupational therapist and para-professional worker.
• Psychological service assists the team in the assessment, diagnosis and management of drug dependents through psychological testing and evaluation as well as in conducting therapy/counselling to patients and their families.
• Social service assists the drug dependents help themselves cope [with] their problems, facilitate and/or promote their interpersonal relationship and adjustment to the demands of a treatment program with the end view of helping the drug dependents’ physical, social, moral and spiritual development.
• Spiritual and religious services include the development of moral and spiritual values of the drug dependent. It has been noted that the spiritual foundation of patients has been very weak that this could not provide support to them to enable them to cope with their problems and conflicts. Strengthening the spiritual foundation would involve, among others, reorientation of moral values, spiritual renewal, bible study and other charismatic sessions. It aims to bring them closer to God and better relate to their fellowmen. Various religious and civic organizations can be contacted to provide services. Spiritual counselling shall be helpful in aiding and resolution of individual and family problems.
• Referral service involves the process of identifying accurately the problems of the patient and sending him to the agency that can provide the appropriate services.
• Sports and recreation services provide facilities for sports and recreation to offer patients the opportunity to engage in constructive activities and to establish peer relationship as an alternative to drug abuse. The emphasis in all activities should be on developing the discipline necessary to improve skills and on gaining respect for good physical health.
• Residential/house care service includes provision of basic foods, clothing and shelter.
• Aftercare and follow-up services provided to the patient after the primary rehabilitation program. Aftercare activities can be viewed as the first line of defence against relapse. The activities include attending self-help programs like Narcotics Anonymous (NA) /Alcoholic Anonymous (AA) meetings, regular follow-up at treatment Center, individual and group counsellings sponsor/sponsee meetings, alumni association meetings, etc. This is for a period not exceeding eighteen (18) months and should be undertaken by the appropriate Center personnel. 25

The manual further provides optional additional services, which may include placement service for work opportunities, volunteer service opportunities to assist the rehabilitation center, and educational opportunities. 26 Centers are mandated to contribute effectively to the goals of the Comprehensive Dangerous Drugs Act of 2002, which expresses the state policy of pursuing “an intensive and unrelenting campaign against the trafficking and use of dangerous drugs and other similar substances [including provision of] effective mechanisms or measures to re-integrate into society individuals who have fallen victims to drug abuse or dangerous drugs through sustainable programs of treatment and rehabilitation.” 27

Presently, people who use drugs undergo drug treatment and rehabilitation programs and services following the guidelines set under Board Regulation No. 7 of 2019 by the DDB. Under this regulation, a verified application must be filed to the DDB to access a treatment and rehabilitation program. The application may be made by the person who uses drugs or by parents, spouses, guardians, or relatives within the fourth degree of consanguinity. 28 Upon recommendation by an accredited physician, “taking into consideration his/her level of drug dependency and the potential danger he/she may pose to himself/herself, his/her family and the community,” the DDB shall file a petition to the appropriate court for the confinement of the person for treatment and rehabilitation. 29 The court shall then order the person to undergo a drug dependency examination by an accredited physician, and, if certified to be drug dependent, “he/she shall be ordered by the court to undergo treatment and rehabilitation in a center designated by the Board for a period of not less than six (6) months.” Notably, the examination is conducted by physicians accredited by the Department of Health, with reference to the clinical parameters of drug dependency under the International Classification of Diseases, 10th revision. 30

Modes of compulsion in drug treatment and rehabilitation during Duterte’s administration

Under the Duterte administration, persons who use drugs may be compelled to undergo drug rehabilitation through three major modes: first, through a police and law enforcement-directed door-to-door search and “request to surrender” campaign known as Oplan Tokhang; second, through court-mandated rehabilitation of people arrested for drug use; and third, through family-initiated admission without the consent of the person who uses drugs. The second and third modes are not unique to the Duterte administration, but a significant increase in arrests have been noted in the past six years, leading to congestion in jails. 31

On the day of his appointment as chief of the Philippine National Police, dela Rosa issued a circular entitled PNP Anti-Illegal Drugs Campaign Plan – Project “Double Barrel,” where he ordered the police “to clear all drug affected barangays across the country.” 32 The international community was shocked by this policy’s aftermath, with the Office of the United Nations High Commissioner for Human Rights reporting 5,601 killed based on information from the Philippine Drug Enforcement Agency; government data mentions 16,355 “homicide cases under investigation” as accomplishments in the fight against illegal drugs, while 20,322 deaths are reported from drug operations by police and homicides perpetrated by unidentified persons. 33 Less visible in the international public discourse is the plight of 223,780 persons arrested for drug-related cases, which led to massive congestion in jails—85% to 90% of those incarcerated are there for drug-related offenses. 34

The police have also conducted house-to-house visitations, which do not require search or arrest warrants, to “encourage voluntary surrender” to the government for drug-related acts. 35 Refusal leads to an immediate case build-up and “negation,” a term appearing in the aforementioned circular that could be interpreted by the police as permission to kill. 36 The DDB has noted “unprecedented responses from both law enforcement and the public,” including “voluntary surrender of self-confessed drug personalities nationwide.” 37 Under Board Regulation No. 3 of 2016, a “surrenderer” shall subscribe to an affidavit of undertaking and waiver that authorizes a medical examination and drug test; and if the individual in question is not engaged in trafficking or sale and is just using drugs, they shall state in the affidavit that “he/she shall undergo voluntary treatment and rehabilitation.” 38

According to the most recent data from the Bureau of Jail Management and Penology, there are now 80,162 persons deprived of liberty detained for violation of the national drug law. 39 On November 8, 2021, the bureau signed a memorandum of agreement with the DDB so that such persons who have signed a plea bargain and who are classified as “low risk” or “moderate risk” for drug dependence may undergo court-mandated treatment and rehabilitation while in jail. 40

Long-standing perception on drug rehabilitation: “Save the user, jail the pusher”

The above policies and programs cannot be disentangled from the long-standing perception—characterized by some scholars as a “moral panic”—that people who use drugs are “addicts” and societal villains. 41 This prohibitionist paradigm, which is perhaps best summed up by the popular slogan “save the user, jail the pusher,” has been reflected in various institutions throughout past half century, from the Catholic Church to broadcast and print media. 42 Essentially, this part-moralistic, part-medicalized view forges divisions between “pushers” and “addicts” who are a menace to society and “users” (often depicted as young people) who need to be “saved.” As the Catholic Bishops’ Conference of the Philippines wrote in a pastoral letter that coincided with Ferdinand Marcos’ ascendancy:

A country whose youths are mental and physical wrecks will be hopelessly doomed to ignominy unredeemable until, if that is possible, a new and strong breed will rise up from the ruins. These are the worst saboteurs and are worthy of the highest punishments. For they destroy the youth, the hope of the land. 43

Rehabilitation centers figure in this narrative as sites where this “salvation” and “healing” can take place. In the words of a Catholic leader touting the church’s rehabilitation program, “Everybody needs healing. These drug addicts, they’ve been wounded very much and what they need is someone who can help them.” 44 Indeed, many such programs are affiliated with religious organizations; those who are not nonetheless orient themselves around the same themes of healing, redemption, and salvation. 45

Duterte’s punitive approach to drugs has arguably made rehabilitation an even more socially and politically viable position—an alternative to the extrajudicial killings that allows individuals and institutions to continue being seen as “tough” on drugs while also satisfying civil society’s clamor for human rights.

Notably, however, drug treatment and rehabilitation remains largely compulsory in the Philippines, with evidence-based initiatives in some communities seen as the exception to general forced treatments that often have little or no scientific basis. As reported by the United Nations Office on Drugs and Crime and UNAIDS, the Philippines continues to detain people who use drugs in closed settings, often against their will, without sufficient human rights safeguards and forces them to undergo rehabilitation for an average duration of ten months. 46 Government data show severe over crowding and substandard compulsory facilities, as well as little evidence supporting the use of spiritual or religious interventions. 47 People who use drugs are coerced to undergo treatment in order to “cure” themselves of their addiction.

A number of episodes during the Duterte administration are illustrative. In response to the first few months of Duterte’s drug war, for instance, the Catholic bishops remonstrated in another pastoral letter:

Our hearts reach out in love and compassion to our sons and daughters suffering from drug dependence and addiction. Drug addicts are children of God equal in dignity with the sober ones. Drug addicts are sick brethren in need of healing deserving of new life. They are patients begging for recovery. They may have behaved as scum and rubbish but the saving love of Jesus Christ is first and foremost for them. No man or woman is ever so unworthy of God’s love. 48

As criticism mounted, including from the political opposition, Duterte at one point appointed Vice President Leni Robredo—the highest-ranking member of the opposition—as chair of the Inter-Agency Committee on Anti-Illegal Drugs. Although her tenure was short-lived—17 days—her report, which she published months after, is reflective of her view. 49

Finally, the campaign for Duterte’s successor in the May 2022 elections—still underway at the time of writing—is also reflective of the same view. Virtually all the major candidates have expressed support for an “intensified” anti-drug campaign while vowing to respect human rights and promote a “public health” approach. Invariably, however, their idea of what constitutes “public health” includes scaling up the same rehabilitation paradigm that dichotomizes between killing and “rehab.”

Tellingly, when the leading candidate—Ferdinand Marcos Jr.—was accused by Duterte as using cocaine, his opponents lost no time in calling out the contradictions in Duterte’s drug war—while also calling on Marcos to be punished, as expressed in this tweet by Leody de Guzman, standard-bearer of the progressive left:

Tiyak, kilalang kilala ni Duterte kung sino ang supplier ng kandidatong ‘yan na nagpapasok ng cocaine sa bansa. ‘Yan dapat ang pokusan para mahuli at matigil na. Kaysa itsismis lang, ipahuli na ang kandidatong ‘yan para ipa-rehab. [For sure, Duterte knows who the supplier is of that candidate who trafficks cocaine in the country. That should be the focus so that he can be arrested and stopped. Instead of rumor-mongering, the candidate should be arrested and placed in rehab.] 50

For her part, Robredo has hewed close to the same discourse she raised as chair of the Inter-Agency Committee on Anti-Illegal Drugs:

In my belief, once DDB sits as the chair of DDB, its plan will not be just “kill, kill, kill” but the plan will be more comprehensive—heavy on prevention, heavy on rehabilitation. 51

These political discourses reflect and reinforce the moral panic on drugs that sees rehabilitation as the humane (and only) way to “save the user,” precluding other initiatives such as harm reduction and decriminalization, which—notably—none of the candidates have mentioned.

Drug rehabilitation and populism

What can explain the subscription to the “save the user” narrative that has led to uncritical support for “rehabilitation” as it is (mis)understood by the Philippine public?

As discussed above, previous scholars have used the literature on “moral panic” to explain the long-standing vilification of drugs in the country. Drawing on the literature on penal and medical populisms, more recent scholarship has implicated political actors in reflecting and reinforcing public attitudes about drugs, portraying these actors as “moral entrepreneurs” who simplify, spectularize, and forge divisions between “addicts” and the virtuous public. 52

Missing in these accounts, however, is the nuance regarding what people view as the rightful solution to the “problem.” Survey after survey has shown that Filipinos favor a strong approach to drugs—even approving of the “drug war”—despite the fact that they disapprove of the killings, suggestive that far from a monolithic dichotomy between supporting or opposing a draconian approach to drugs, people are divided on what particular draconian approach to take: either drug addicts deserve to be killed or drug addicts should be sent to compulsory rehabilitation.

Less emphasized in the scholarship is how Philippine drug policy has followed global drug policy flows; most notably, as Christopher Hobson notes, “among all the possible wrongdoing and bad things that exist in the world, it is slightly counterintuitive that drugs are the only one to be labelled as ‘evil’ in international law.” 53 Indeed, the first drug war in the 1970s coincided with the Nixon-era war on drugs and global commitments to the “drug problem,” leading to the establishment of DDB in 1972 and inaugurating a trend of increasingly punitive drug laws. The parallels in high incarceration rates in the United States and the Philippines and similar institutional configurations (e.g., a Philippine Drug Enforcement Agency patterned after a similarly named agency in the United States) speak of how this international—and particularly American—influence continues to have an impact on drug policy in the country. 54

However, it must be pointed out that even as “Western democracies” and even international organizations are moving away from this approach, the Philippines and other countries in the region have steadfastly adhered to it (with notable exceptions such as Malaysia), suggesting that such an approach has been indigenized, likely enabled by a cultural environment that emphasizes “Asian values” such as conformity and social control, as well as the enduring valance of drugs as a populist trope in the region. 55

Because they do not specifically address the question of why a particular form of rehabilitation has gained uncritical popular and political acceptance, these explanations are at best partial and would require corroboration through cultural histories and contemporary ethnographic accounts of rehabilitation today. However, they suffice to furnish a historical context to the figurations of rehabilitation in today’s political discourse that in turn perpetuate popular perceptions.

Compulsory rehabilitation in the Philippines an urgent human rights issue

There is a dangerous tendency for reform advocates to condemn extrajudicial killings and due process rights violations as human rights concerns, while supporting rehabilitation as an acceptable alternative. As we have observed, the motivations behind gross human rights violations and forcing people to treatment are the same: the dehumanization of people who use drugs and the removal of their autonomy to decide on the treatment approaches that respond to their felt needs. Drug policies in the Philippines remain to be “substance-centric, moralistic, and medicalized.” 56 Present drug policy from the Department of Health does not recognize non-pathological use, as substance use is classified as mild, moderate, or severe and, in any case, as requiring medical or psychological interventions. 57 Because treatments are compulsory in nature, the right to health, which includes access to voluntary and evidence-based services, is breached. 58

Relatedly, drug testing has been transformed into a diagnostic and prosecutorial tool for treating people who use drugs. 59 A positive random drug test is enough justification to remove students from school or to terminate employment of otherwise productive employees and to force them to undergo rehabilitation. 60 Notably, random drug testing in schools violate students’ right to privacy and is inconsistent with international guidelines on the rights of children in relation to obligations arising from the human rights of particular groups. 61

As a result, in 2015, countries from Asia and the Pacific committed to facilitate the transition away from compulsory centers toward an “evidence-informed system of voluntary community-based treatment and services that are aligned with international guidelines and principles of drug dependence treatment, drug use and human rights.” 62 Seven years after, however, the transition has yet to happen.

Moving forward: Transitioning to voluntary alternatives

Despite the problematics of drug rehabilitation in the Philippines being strongly determined by political and popular approaches to drug issues, recent developments suggest that a changing paradigm is not beyond the range of possibilities.

In the first place, the DDB has recognized the failures of closed settings in its approach to rehabilitation. The public admission that the mega rehab center was a mistake because it uproots people who use drugs from their families and the policy shift toward more community-based interventions are important concessions made as the country transitions to a more public health-based framework. More citations on community-based approaches appear in the DDB’s recent issuances that provide guidance to local government units on general interventions and programs. 63 Prior to Duterte’s time, rehabilitation programs were effectively available only in closed settings. Notably, the country has not closed down compulsory rehabilitation facilities and appears to be far from doing so. Nevertheless, at the close of Duterte’s term, we note a promising dent in the number of admissions in closed settings in favor of community-based programs.

This palpable shift in policy can be attributed largely to the work of civil society organizations, human rights groups, and academic institutions that are more sensitized to drug issues and more critical of the political discourses employed in the wake of Duterte’s war on drugs. Many of these groups still embrace a decidedly “drug-free” paradigm, but they can nonetheless serve as entry points for interrogating rehabilitation as it is practiced and understood in the Philippines today. Policy officials, too, have learned important lessons from the drug war, leading them to revise the national guidelines on rehabilitation.

Similarly, as one of the authors notes in another work, “there has been a proliferation of drug war-related researches, from the documentation of its ‘lived experiences’ to policy analyses.” 64 The academic interest in drug issues has included narratives of rehabilitation and case studies on community rehabilitation, all of which can contribute to a local evidence base for alternative interventions. Academic networks have been formed, and publications that problematize the drug war have allowed for dialogues nudging policy makers toward reform.

Second, although, as mentioned above, presidential politics have largely embraced the killings-versus-rehabilitation binary, lawmakers have in fact filed harm reduction bills and similar initiatives. 65 These legislative initiatives—though still unlikely to prosper at this stage—nonetheless represent a sea change from previous times and may signal more openness in the future. This is an important step to challenge the binary framework and to introduce a genuine option that promotes autonomy, human dignity, and health.

Nevertheless, legislative change is necessary. We can no longer avoid and delay the conversation on decriminalization of drug use, as it is apparent that the courts—supposedly the champions of human dignity—have become agents for compulsory rehabilitation. In the Philippines, people are ordered to undergo rehabilitation or face imprisonment. People arrested for drug-related offenses bargain for a lesser penalty, which includes rehabilitation. Jails are now formally considered centers for rehabilitation, putting into question the capacity of these institutions to provide the standards necessary for genuine health programs. 66

Third, despite the defiant tone that government officials have struck in terms of Duterte’s possible trial before the International Criminal Court, international pressure has been effective in forcing government officials to reform policies that address drug-related concerns. For example, the United Nations Joint Programme for Human Rights in the Philippines has become an important platform for introducing human rights-based approaches to drug control. Among other things, it calls for the improvement of prison conditions and development of community-based programs. If it is to make further progress in the country, however, the joint program must implement the international consensus on ending compulsory rehabilitation and invest in a transition toward voluntary services, following the consensus from the Third Regional Consultation on Compulsory Centres for Drug Users in Asia and the Pacific, and further accommodating the recommendations from the United Nations Office on Drugs and Crime and UNAIDS on adopting voluntary community-based services as the framework for drug-related programs and interventions. 67

One caveat about international pressure, though, is that it might perpetuate policies that can be framed by populist politicians as “colonial interventions,” especially given the backdrop of how human rights and concerns over the drug war were cast by local politicians as “Western” or “colonial” impositions. 68 This goes to show that beyond “decolonizing drug policy,” drug reform must also move toward decolonizing harm reduction. 69 It is important that attempts to reshape rehabilitation be based on the perspectives of people who use drugs. Thus, international support must not be merely a transplantation of practices from abroad but a genuine privileging of the voices of the communities whose lives involve drugs. Crucial to this project is empowering local actors (e.g., academics and advocates) who can then provide local scholarship and offer localized, culturally sensitive communications efforts that can be more difficult to delegitimize. 70

Finally, the long-standing support for forced rehabilitation ultimately rests on how people who use drugs are perceived by the public and leaders, both political and religious. Thus, any attempt to reform must involve careful thinking as to how public attitudes can be changed. The narratives that inform policies negatively portray people who use drugs, and moral leaders (predominantly Catholic) have provided the justifications for a draconian approach to drugs, including the removal of personal autonomy in decisions affecting one’s life and health. Admittedly, this sociocultural foundation that supports compulsory rehabilitation is the hardest to break. However, cultural values such as the importance of family can be important themes in counter-narratives that can support family- and community-based approaches. Similarly, amplifying narratives from people who use drugs themselves can illuminate the lived realities of drug rehabilitation for the general public. More fundamentally, however, we need to deepen our understanding of the paradigms that inform the rigid binary to be able to transition to a framework that fully embraces human rights and public health.

In the Philippines, owing to a long history of penal populism, moral panic around drugs, and long-standing moralistic views of people who use them, “drug rehabilitation” is seen as a humane and acceptable alternative to the “drug problem,” and this has been reflected in (and reinforced by) contemporary political discourse. However, as we have shown in this paper, there is very little difference between jails and rehabilitation centers in terms of both philosophy and practice; in fact, jails are now centers for compulsory treatment. Those who seek to reform this untenable status quo need to capitalize on recent policy reforms, informed by a vibrant civil society and supported by the international community, to end the era of forced rehabilitation, with local actors and stakeholders empowered to take the lead.

As the Philippines undertakes a change of leadership, advocates in the country and elsewhere must recognize the need to go beyond addressing killings and insist on a discussion about what kind of rehabilitation should exist—and for whom—and about how to genuinely expand our responses to drug-related issues in a way that goes beyond criminal and medical frameworks. Institutions that have been sensitized to what is at stake with drug policy in the country can be potential allies in this move, but it must be accompanied by international attention beyond the killings—as well as a recognition that “decolonizing drug policy” also entails decolonizing the ways we have sought to reform it. 71 Lessons learned from the Philippines are likely relevant for neighboring countries and thus for drug policy and human rights advocacy around the world.

Just how big is the drug problem in the Philippines anyway?

PhD candidate in Medical Anthropology, Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam

Disclosure statement

For his research on drug use in the Philippines, Gideon Lasco received funding from the University of Amsterdam's Global Health Research Priority Area.

View all partners

“Hitler massacred three million Jews … there’s three million drug addicts. There are. I’d be happy to slaughter them.”

These words, spoken by Filipino President Rodrigo Duterte in September, have become notorious worldwide.

Duterte has since apologised for the reference to the Holocaust. But alongside continued concern about the extrajudicial killings in the Philippines drug war, questions remain about whether there are actually three million drug users in the country – and whether they are addicts.

If true, drug users would represent 3% of the nation’s population – even higher than Thailand’s 1.8% (based on a recent estimate of 1.2 million), or Indonesia’s 1.8% based on an official (but questionable) estimate of 4.5 million .

Are there really three million “drug addicts” in the Philippines?

The official statistics show a much lower figure. In 2015, the Philippine Dangerous Drugs Board estimated a total of 1.8 million drug users . Of this number, 859,150 were thought to be users of shabu or crystal methamphetamine – the drug of particular concern in the country.

The term “user” was defined in the report as someone who had used drugs at least once in the past year. Of all drug users, 85% reported using at least once monthly and 50% cited weekly use. Thus the number of drug “abusers” or “addicts” is necessarily lower than that.

Still, we can’t dismiss Duterte’s claims on the sole basis of the 2015 survey or previous ones, given the variability of their results.

In 2005, the drugs board reported five million regular users of methamphetamine alone - amounting to a prevalence of 6% of the country. This prompted the UN Office on Drugs and Crime to suggest that the Philippines has the “the world’s highest methamphetamine prevalence rate” at the time.

But just three years later, the prevalence was reported to be only 1.9% .

Given the poor quality of the reports themselves (the 2008 report cites Wikipedia as reference), it’s unclear whether they reflect actual changes, or merely methodological flaws.

Duterte’s philosophy of drug use

While Duterte’s figures cannot be definitively dismissed, his view of drug users can be. His use of the term adik (addict) - a word that has very negative connotations in the Philippines - is in line with his conviction that users of illicit drugs, particularly methamphetamines, are beyond redemption.

He has claimed, for instance, that the continuous use of shabu would “ shrink the brain ”, making users “ no longer viable as human beings in this planet ”. Based on these statements, and contrary to his own government’s official stance and efforts , Duterte seems to think rehabilitation is not an option.

Numerous studies present a far more complex picture. While methamphetamine has indeed been demonstrated to cause damage to neurons and the brain’s white matter , various therapies, such as cognitive-behavioural therapy and to a lesser extent, pharmacotherapy , have shown promise as forms of rehabilitation.

What’s more, alternative models of dealing with substance abuse, including those that employ demand-reduction and harm-reduction frameworks , strongly suggest that drug use is embedded in, and in part determined by, users’ social and physical environment .

My own ethnographic research among young drug users in a poor urban community in the Philippines resonates with these perspectives. Caught in an informal economy where income opportunities are scarce and living conditions are harsh, shabu allows the youths to stay awake and work at night, gives them energy, alleviates their hunger, and provides them with moments of euphoria amid their difficult lives.

While some of them exhibit signs of addiction (they have gaunt, hollowed-out faces, for instance), most remain functional. And while some of them admit to resorting to crime (such as stealing mobile phones), the only crime most commit is taking drugs.

Educational and economic opportunities, I found, can help them move away from drug use – and prevent many others from using drugs in the first place.

A widely held view

Duterte’s philosophy of drug use is shared by many Filipinos, and has common since the very beginning of the “war on drugs” in the early 1970s. In 1972, Filipino bishops described drug users as “mental and physical wrecks”, calling them “worst saboteurs” who were “worthy of the highest punishments”.

In 1988, the Philippine Supreme Court, foreshadowing Duterte’s assertions, wrote in one of its decisions that it was:

Common knowledge that drug addicts become useless if not dangerous members of society and in some instances turn up to be among the living dead.

In many towns and cities in the Philippines, anti-drug posters (with messages like “Get high on God, not on drugs”) are displayed prominently, as if to demonstrate public’s resolve to get rid of what they see as society’s great menace.

These sentiments underwrite the widespread support that Duterte’s war on drugs enjoys. And although a majority of Filipinos think drug suspects should not be killed , many see the extrajudicial killings as a necessary evil to get rid of the far worse menace of drug addicts and the criminality associated with them.

In light of this attitude, what must be most urgently addressed is the lack of understanding about drug use and the dearth of information about the true extent and nature of drug use in the country. That means scholarly and journalistic investigations that fill these gaps must be communicated effectively to the public.

Otherwise, the official discourse and popular understandings of drug use will remain unchallenged - and the “three million addicts” in the Philippines will all be deserving of the “highest punishment” in the eyes of their fellow Filipinos.

• War on Drugs
• Philippines
• Rodrigo Duterte
• Methamphetamine
• Philippine war on drugs
• Global perspectives

Deputy Social Media Producer

Research Fellow /Senior Research Fellow – Implementation Science

Associate Professor, Occupational Therapy

GRAINS RESEARCH AND DEVELOPMENT CORPORATION CHAIRPERSON

Faculty of Law - Academic Appointment Opportunities

• Share full article

Advertisement

Supported by

Court Finds Evidence of Crimes Against Humanity in the Philippines

The International Criminal Court has released its latest report on President Rodrigo Duterte’s bloody war on drugs.

By Jason Gutierrez

MANILA — The International Criminal Court issued a preliminary report on Tuesday in which it said there was evidence to show crimes against humanity had been committed in the Philippines under President Rodrigo Duterte , whose bloody drug war has left thousands dead since 2016.

The report was issued by Fatou Bensouda, the chief prosecutor of the I.C.C. It found there was “a reasonable basis to believe that the crimes against humanity of murder, torture and the infliction of serious physical injury and mental harm” had taken place.

The court will decide in the coming months whether to open a full investigation. The Philippines officially withdrew from the I.C.C. last year after multiple complaints were filed against Mr. Duterte.

According to the Philippine National Police, roughly 8,000 people accused of being involved in the illegal drug trade have been slain since Mr. Duterte launched his bloody war on drugs. Rights groups have reported higher numbers, and said the violence has continued even as the country remains under a coronavirus lockdown announced in March.

The latest incident took place last month, when Vincent Adia, 27, was shot three times by unidentified vigilantes on the streets of a town outside of Manila. Bystanders and witnesses took Mr. Adia to a hospital, where a gunman walked in and shot in him twice, killing him in front of a stunned and terrified hospital staff.

Mr. Duterte has denied any connection to the killings, attributing them to hit men belonging to rival gangs intent on eliminating each other. But his denials backfired in 2018 when three policemen were convicted of killing Kian Loyd delos Santos, a 17-year-old boy who was mistakenly identified as a drug dealer.

Surveillance video showed the police taking the teenager away before he was found dead moments later in what the police said was a shootout. The killing ignited widespread public anger and forced Mr. Duterte to temporarily freeze the drug war.

Cristina Palabay, head of the Filipino rights group Karapatan, said on Tuesday that the I.C.C. report confirmed what was known all along.

“The complaints against Duterte at the I.C.C. remain a very important and viable venue in pursuing justice and accountability, despite the Philippines’ withdrawal,” Ms. Palabay said.

While the I.C.C. cannot force Mr. Duterte to appear before the court in The Hague, Ms. Palabay said the preliminary report is significant in the fight for human rights in the Philippines.

Etta Rosales, the former chairwoman of the Philippines’ Commission on Human Rights, welcomed the new findings, and stressed that the report was a triumph in the effort to hold Mr. Duterte and his government accountable.

“We have repeatedly warned Mr. Duterte that he would eventually face the law,” Ms. Rosales said. “He will be made accountable for all the spilled blood. Time is catching up with him.”

“Let this be an example of how no one is above the law,” she added.

Mr. Duterte has frequently ridiculed Ms. Bensouda, the I.C.C. prosecutor, and angrily rejected the investigation. In March 2019, he withdrew the Philippines as a signatory to the Rome Statute, the international treaty behind the I.C.C.

Ms. Bensouda’s office investigated allegations that unidentified assailants had “carried out thousands of unlawful killings” in the Philippines, and that Mr. Duterte and senior members of his police had “promoted and encouraged the killing of suspected or purported drug users.”

Last week, Senator Leila de Lima, an outspoken critic of Mr. Duterte, called his war on drugs “a machine of unjust deaths.”

Community-Based Drug Rehabilitation in the Philippines Proving Successful and Cost-Effective

When people think about drug treatment, images of incarceration and mandatory inpatient treatment often come to mind. However, the understanding of drug use has changed in the past decade, and today, there is greater recognition that most users are low-to-moderate risk and can be treated without taking them away from their homes or work.

In fact, treatment must be available, accessible, and appropriate, according to the first principle of the “International Standards for the Treatment of Drug Use Disorders” by the World Health Organization and the United Nations Office of Drugs and Crime.

During the past decade, more countries have shifted toward community-based drug rehabilitation (CBDR). CBDR is a holistic process that incorporates prevention and health promotion, screening and assessment, drug treatment, wraparound family and community services, and aftercare programs closest to where people are.

In the Philippines, CBDR emerged in 2016 on the heels of the aggressive case finding that elicited more than 1.2 million potential clients . The Dangerous Drugs Board declared that a great majority of clients could be treated in their respective local government units (LGUs).

As the country had no history of CBDR, there was a lack of documentation on CBDR’s implementation and impact. To fill this gap, the URC-led  USAID Expanding Access to Community-Based Drug Rehabilitation Program in the Philippines  (USAID RenewHealth) project conducted case studies of 12 LGUs in the Philippines (seven in Metro Manila with five in Regions 4, 7, 8, and 10) to determine the costs, benefits, barriers, and enablers in implementing CBDR.

Barriers to and Enablers of CBDR

Common barriers to CBDR implementation are inadequate resources and limited facilities and equipment. Having dedicated funds for CBDR is important, and the results of the USAID RenewHealth case studies showed that LGUs invest anywhere from 0.04% to 0.53% of their annual budgets for CBDR activities.

The majority of LGUs do not have permanent CBDR staff and rely on volunteers to implement the program. However, some LGUs have hired full-time personnel to deliver or implement CBDR. The findings showed that ratios of CBDR staff members to clients ranged from 1:25 to 1:92, with an average ratio of one staff member to 45 clients.

An additional challenge cited was participant attrition due to conflicting schedules. A number of LGUs have addressed this concern by delivering CBDR programs on weekends or after work. LGUs also reported difficulties in obtaining the participation and cooperation of clients’ families. Key informants highlighted the importance of engaging the family.

Another barrier cited was community officials’ lack of cooperation. Not every official prioritizes CBDR and some still see drug use as a personal failure or don’t believe in rehabilitating drug offenders.

A key enabler cited by program managers was a strong service delivery network with collaboration between anti-drug abuse personnel, law enforcers, health workers, social workers, the Bureau of Jail Management and Penology, and courts. Other LGUs cited the importance of having civil society and international partners as enablers for CBDR. For example, faith-based organizations and non-government organizations volunteer to help with CBDR programs.

CBDR Costs and Savings

Overall, the USAID RenewHealth study found that CBDR provided great value in comparison to inpatient treatment in a government residential facility.

Human resources account for 48% of total CBDR program costs for all LGUs. The next highest expenses were testing kits, equipment, furniture, and supplies (see Figure 1). Other costs were for facility repairs and maintenance, meetings, other medical costs, training for program staff, and prevention programs in schools.

Even though CBDR requires funding, program managers recognized that its costs were relatively low compared to inpatient treatment. The cost of CBDR for low-risk clients was 12% of the cost of inpatient treatment. The cost of 15 CBDR sessions (for moderate-risk clients) was 16% of the cost of four months of inpatient treatment. And 24 CBDR sessions (for persons deprived of liberty) cost 16% of a six-month inpatient program. In general, the cost of inpatient treatment was 6-8 times the cost of CBDR (see Figure 2).

Positive Outcomes of CBDR

Beyond savings, both clients and program implementers shared a number of positive outcomes of CBDR. An LGU representative saw the program as providing a one-stop shop to support and address the clients’ needs and help them stop illicit drug use. He said, “Some clients want to stop but do not know how and where to start — the program opens an opportunity for them to act on their drug dependence.”

The positive impact was validated by Karding, a graduate of CBDR, who described her journey after becoming addicted to drugs.

“I lost my family and was imprisoned,” Karding said. “When I was released, I thought I could recover on my own. But I found myself still tempted to use. Our barangay suggested I attend, and I tried it. The facilitator was good, and I learned a lot from each of the 15 modules and took lessons to heart. I learned the bad effects of drugs, tips to avoid drug use, my triggers. I eventually was reconciled with my family and found a new job. CBDR was such a big part of my recovery.”

Service providers shared that their clients not only stopped drug use but also changed for the better. “Our clients now have a better outlook in life, are less irritable, and are less hot-headed,” one LGU representative said. “Before, they had frequent fights with their wives, but this has since been reduced.”

Other CBDR program successes reported by program managers and service providers included:

• Helping reunite and strengthen bonds within families. “The program helped a family member realize that it is not only the clients who have issues but there are other causes of drug use within the family,” said one service provider;
• Helping clients find employment and start small businesses;
• Addressing clients’ health needs through referral to health services and facilities; and
• Reducing stigma and discrimination in communities. “Without our CBDR program, clients will still feel ashamed and the community will still think they cannot change,” said one program manager.

Although CBDR is still in its infancy in the Philippines, the study emphasizes the importance of investing in and sustaining its implementation. The study has also shown how important it is to take a holistic approach to address the needs of PWUDs. The adage “it takes a village to raise a child” appears to be just as true for drug recovery.

“The general perception of a person who uses drugs is that they are mentally challenged and need to undergo rehabilitation in a facility. But not all of them needs to be ‘checked-in.’ Depending on the severity of drug use, some clients can stay home to their families and earn a living while eliminating drug use. CBDR gives them a chance to live.” — Lito, CBDR program manager, National Capital Region

The shift to CBDR in Southeast Asia

Malaysia has transformed a third of its compulsory facilities into outpatient Cure and Care facilities.

In Cambodia, health centers provide CBDR; in Myanmar and Laos provide CBDR through district hospitals.

Vietnam provides voluntary treatment through community or home-based outpatient programs and methadone clinics.

Indonesia implements CBDR through nongovernmental organizations in community health centers, public hospitals, psychiatric hospitals, and prisons.

In Thailand civil society organizations provide CBDR in temples and mosques.

Source: “Compulsory Drug Treatment and Rehabilitation in East and Southeast Asia,” United Nations Office on Drugs and Crime. (2022).

USAID RenewHealth - Expanding Access to Community-Based Drug Rehabilitation in the Philippines

Learn more about the project.

Community Health

Learn more about our expertise.

Philippines

Learn more about our work.

Annals of Global Health

• Download PDF (English) XML (English)
• Alt. Display

Expert Consensus Documents, Recommendations, and White Papers

The manila declaration on the drug problem in the philippines.

• Nymia Simbulan
• Leonardo Estacio
• Carissa Dioquino-Maligaso
• Teodoro Herbosa
• Mellissa Withers

When Philippine President Rodrigo R. Duterte assumed office in 2016, his government launched an unprecedented campaign against illegal drugs. The drug problem in the Philippines has primarily been viewed as an issue of law enforcement and criminality, and the government has focused on implementing a policy of criminalization and punishment. The escalation of human rights violations has caught the attention of groups in the Philippines as well as the international community. The Global Health Program of the Association of Pacific Rim Universities (APRU), a non-profit network of 50 universities in the Pacific Rim, held its 2017 annual conference in Manila. A special half-day workshop was held on illicit drug abuse in the Philippines which convened 167 participants from 10 economies and 21 disciplines. The goal of the workshop was to collaboratively develop a policy statement describing the best way to address the drug problem in the Philippines, taking into consideration a public health and human rights approach to the issue. The policy statement is presented here.

When Philippine President Rodrigo R. Duterte assumed office on June 30, 2016, his government launched an unprecedented campaign against illegal drugs. He promised to solve the illegal drug problem in the country, which, according to him, was wreaking havoc on the lives of many Filipino families and destroying the future of the Filipino youth. He declared a “war on drugs” targeting users, peddlers, producers and suppliers, and called for the Philippine criminal justice system to put an end to the drug menace [ 1 ].

According to the Dangerous Drugs Board (DDB) (the government agency mandated to formulate policies on illegal drugs in the Philippines), there are 1.8 million current drug users in the Philippines, and 4.8 million Filipinos report having used illegal drugs at least once in their lives [ 2 ]. More than three-quarters of drug users are adults (91%), males (87%), and have reached high school (80%). More than two-thirds (67%) are employed [ 2 ]. The most commonly used drug in the Philippines is a variant of methamphetamine called shabu or “poor man’s cocaine.” According to a 2012 United Nations report, the Philippines had the highest rate of methamphetamine abuse among countries in East Asia; about 2.2% of Filipinos between the ages 16–64 years were methamphetamines users.

The drug problem in the Philippines has primarily been viewed as an issue of law enforcement and criminality, and the government has focused on implementing a policy of criminalization and punishment. This is evidenced by the fact that since the start of the “war on drugs,” the Duterte government has utilized punitive measures and has mobilized the Philippine National Police (PNP) and local government units nationwide. With orders from the President, law enforcement agents have engaged in extensive door-to-door operations. One such operation in Manila in August 2017 aimed to “shock and awe” drug dealers and resulted in the killing of 32 people by police in one night [ 3 ].

On the basis of mere suspicion of drug use and/or drug dealing, and criminal record, police forces have arrested, detained, and even killed men, women and children in the course of these operations. Male urban poor residents in Metro Manila and other key cities of the country have been especially targeted [ 4 ]. During the first six months of the Duterte Presidency (July 2016–January 2017), the PNP conducted 43,593 operations that covered 5.6 million houses, resulting in the arrest of 53,025 “drug personalities,” and a reported 1,189,462 persons “surrendering” to authorities, including 79,349 drug dealers and 1,110,113 drug users [ 5 ]. Government figures show that during the first six months of Duterte’s presidency, more than 7,000 individuals accused of drug dealing or drug use were killed in the Philippines, both from legitimate police and vigilante-style operations. Almost 2,555, or a little over a third of people suspected to be involved in drugs, have been killed in gun battles with police in anti-drug operations [ 5 , 6 ]. Community activists estimate that the death toll has now reached 13,000 [ 7 ]. The killings by police are widely believed to be staged in order to qualify for the cash rewards offered to policeman for killing suspected drug dealers. Apart from the killings, the recorded number of “surrenderees” resulting in mass incarceration has overwhelmed the Philippine penal system, which does not have sufficient facilities to cope with the population upsurge. Consequently, detainees have to stay in overcrowded, unhygienic conditions unfit for humans [ 8 ].

The escalation of human rights violations, particularly the increase in killings, both state-perpetrated and vigilante-style, has caught the attention of various groups and sectors in society including the international community. Both police officers and community members have reported fear of being targeted if they fail to support the state-sanctioned killings [ 9 ]. After widespread protests by human rights groups, Duterte called for police to shoot human rights activists who are “obstructing justice.” Human Rights organizations, such as Human Rights Watch and Amnesty International, have said that Duterte’s instigation of unlawful police violence and the incitement of vigilante killings may amount to crimes against humanity, violating international law [ 10 , 11 ]. The European Union found that human rights have deteriorated significantly since Duterte assumed power, saying “The Philippine government needs to ensure that the fight against drug crimes is conducted within the law, including the right to due process and safeguarding of the basic human rights of citizens of the Philippines, including the right to life, and that it respects the proportionality principle [ 12 ].” Despite the fact that, in October 2017, Duterte ordered the police to end all operations in the war on drugs, doubts remain as to whether the state-sanctioned killings will stop [ 13 ]. Duterte assigned the Philippine Drug Enforcement Agency (PDEA) to be the sole anti-drug enforcement agency.

Duterte’s war on drugs is morally and legally unjustifiable and has created large-scale human rights violations; and is also counterproductive in addressing the drug problem. International human rights groups and even the United Nations have acknowledged that the country’s drug problem cannot be resolved using a punitive approach, and the imposition of criminal sanctions and that drug users should not be viewed and treated as criminals [ 14 ]. Those critical of the government’s policy towards the illegal drug problem have emphasized that the drug issue should be viewed as a public health problem using a rights-based approach (RBA). This was affirmed by UN Secretary General Ban Ki Moon on the 2015 International Day Against Drug Abuse and Illegal Trafficking when he stated, “…We should increase the focus on public health, prevention, treatment and care, as well as on economic, social and cultural strategies [ 15 ].” The United Nations Human Rights Council released a joint statement in September 2017, which states that the human rights situation in the Philippines continued to cause serious concern. The Council urged the government of the Philippines to “take all necessary measures to bring these killings to an end and cooperate with the international community to pursue appropriate investigations into these incidents, in keeping with the universal principles of democratic accountability and the rule of law [ 16 ].” In October 2017, the Philippines Dangerous Drug Board (DDB) released a new proposal for an anti-drug approach that protects the life of the people. The declaration includes an implicit recognition of the public health aspect of illegal drug use, “which recognizes that the drug problem as both social and psychological [ 16 ].”

Workshop on Illicit Drug Abuse in the Philippines

The Association of Pacific Rim Universities (APRU) is a non-profit network of 50 leading research universities in the Pacific Rim region, representing 16 economies, 120,000 faculty members and approximately two million students. Launched in 2007, the APRU Global Health Program (GHP) includes approximately 1,000 faculty, students, and researchers who are actively engaged in global health work. The main objective of the GHP is to advance global health research, education and training in the Pacific Rim, as APRU member institutions respond to global and regional health challenges. Each year, about 300 APRU GHP members gather at the annual global health conference, which is hosted by a rotating member university. In 2017, the University of the Philippines in Manila hosted the conference and included a special half-day workshop on illicit drug abuse in the Philippines.

Held on the first day of the annual APRU GHP conference, the workshop convened 167 university professors, students, university administrators, government officials, and employees of non-governmental organizations (NGO), from 21 disciplines, including anthropology, Asian studies, communication, dentistry, development, education, environmental health, ethics, international relations, law, library and information science, medicine, nutrition, nursing, occupational health, pharmaceutical science, physical therapy, political science, psychology, public health, and women’s studies. The participants came from 10 economies: Australia, China, Hong Kong, Indonesia, Japan, Mexico, Nepal, the Philippines, Thailand, and the US. The special workshop was intended to provide a venue for health professionals and workers, academics, researchers, students, health rights advocates, and policy makers to: 1) give an overview on the character and state of the drug problem in the Philippines, including the social and public health implications of the problem and the approaches being used by the government in the Philippines; 2) learn from the experiences of other countries in the handling of the drug and substance abuse problem; and 3) identify appropriate methods and strategies, and the role of the health sector in addressing the problem in the country. The overall goal of the workshop was to collaboratively develop a policy statement describing the best way to address this problem in a matnner that could be disseminated to all the participants and key policymakers both in the Philippines, as well as globally.

The workshop included presentations from three speakers and was moderated by Dr. Carissa Paz Dioquino-Maligaso, head of the National Poison Management and Control Center in the Philippines. The first speaker was Dr. Benjamin P. Reyes, Undersecretary of the Philippine Dangerous Drugs Board, who spoke about “the State of the Philippine Drug and Substance Abuse Problem in the Philippines.” The second speaker was Dr. Joselito Pascual, a medical specialist from the Department of Psychiatry and Behavioral Medicine, at the University of the Philippines General Hospital in Manila. His talk was titled “Psychotropic Drugs and Mental Health.” The final speaker was Patrick Loius B. Angeles, a Policy and Research Officer of the NoBox Transitions Foundation, whose talk was titled “Approaches to Addressing the Drug and Substance Abuse Problem: Learning from the Experiences of Other Countries.” Based on the presentations, a draft of the Manila Declaration on the Drug Problem in the Philippines was drafted by the co-authors of this paper. The statement was then sent to the workshop participants for review and comments. The comments were reviewed and incorporated into the final version, which is presented below.

Declaration

“Manila Statement on the Drug Problem in the Philippines”

Gathering in this workshop with a common issue and concern – the drug problem in the Philippines and its consequences and how it can be addressed and solved in the best way possible;

Recognizing that the drug problem in the Philippines is a complex and multi-faceted problem that includes not only criminal justice issues but also public health issues and with various approaches that can be used in order to solve such;

We call for drug control policies and strategies that incorporate evidence-based, socially acceptable, cost-effective, and rights-based approaches that are designed to minimize, if not to eliminate, the adverse health, psychological, social, economic and criminal justice consequences of drug abuse towards the goal of attaining a society that is free from crime and drug and substance abuse;

Recognizing, further, that drug dependency and co-dependency, as consequences of drug abuse, are mental and behavioral health problems, and that in some areas in the Philippines injecting drug use comorbidities such as the spread of HIV and AIDS are also apparent, and that current prevention and treatment interventions are not quite adequate to prevent mental disorders, HIV/AIDS and other co-morbid diseases among people who use drugs;

Affirming that the primacy of the sanctity/value of human life and the value of human dignity, social protection of the victims of drug abuse and illegal drugs trade must be our primary concern;

And that all health, psycho-social, socio-economic and rights-related interventions leading to the reduction or elimination of the adverse health, economic and social consequences of drug abuse and other related co-morbidities such as HIV/AIDS should be considered in all plans and actions toward the control, prevention and treatment of drug and substance abuse;

As a community of health professionals, experts, academics, researchers, students and health advocates, we call on the Philippine government to address the root causes of the illegal drug problem in the Philippines utilizing the aforementioned affirmations . We assert that the drug problem in the country is but a symptom of deeper structural ills rooted in social inequality and injustice, lack of economic and social opportunities, and powerlessness among the Filipino people. Genuine solutions to the drug problem will only be realized with the fulfillment and enjoyment of human rights, allowing them to live in dignity deserving of human beings. As members of educational, scientific and health institutions of the country, being rich and valuable sources of human, material and technological resources, we affirm our commitment to contribute to solving this social ill that the Philippine government has considered to be a major obstacle in the attainment of national development.

The statement of insights and affirmations on the drug problem in the Philippines is a declaration that is readily applicable to other countries in Asia where approaches to the problem of drug abuse are largely harsh, violent and punitive.

As a community of scholars, health professionals, academics, and researchers, we reiterate our conviction that the drug problem in the Philippines is multi-dimensional in character and deeply rooted in the structural causes of poverty, inequality and powerlessness of the Filipino people. Contrary to the government’s position of treating the issues as a problem of criminality and lawlessness, the drug problem must be addressed using a holistic and rights-based approach, requiring the mobilization and involvement of all stakeholders. This is the message and the challenge which we, as members of the Association of Pacific Rim Universities, want to relay to the leaders, policymakers, healthcare professionals, and human rights advocates in the region; we must all work together to protect and promote health and well being of all populations in our region.

Competing Interests

The authors have no competing interests to declare.

Xu M. Human Rights and Duterte’s War on Drugs. Council on Foreign Relations ; 16 December, 2016. https://www.cfr.org/interview/human-rights-and-dutertes-war-drugs . Accessed December 20, 2017.  

Gavilan J. Duterte’s War on Drugs: The first 6 months. Rappler ; 2016. https://www.rappler.com/newsbreak/rich-media/rodrigo-duterte-war-on-drugs-2016 . Accessed January 18, 2018.  

Holmes O. Human rights group slams Philippines president Duterte’s threat to kill them. The Guardian ; 17 August, 2017. https://www.theguardian.com/world/2017/aug/17/human-rights-watch-philippines-president-duterte-threat . Accessed January 18, 2018.  

Almendral A. On patrol with police as Philippines battles drugs. New York Times ; 2016. 21 December 2017. https://www.nytimes.com/2016/12/21/world/asia/on-patrol-with-police-as-philippines-wages-war-on-drugs.html . Accessed January 18, 2018.  

Bueza M. In Numbers: The Philippines’ ‘war on drugs.’ Rappler ; 13 September 2017. https://www.rappler.com/newsbreak/iq/145814-numbers-statistics-philippines-war-drugs . Accessed January 18, 2018.  

Mogato M and Baldwin C. Special Report: Police Describe Kill Rewards, Staged Crime Scenes in Duterte’s Drug War. Reuters ; 18 April, 2017. https://www.reuters.com/article/us-philippines-duterte-police-specialrep-idUSKBN17K1F4 . Accessed January 18, 2018.  

Al Jazeera. Thousands demand end to killings in Duterte’s drug war; 21 August, 2017. https://www.aljazeera.com/news/2017/08/thousands-demand-killings-duterte-drug-war-170821124440845.html Published 2017. Accessed January 18, 2018.  

Worley W. Harrowing photos from inside Filipino jail show reality of Rodrigo Duterte’s brutal war on drugs. The Independent ; 30 July, 2016. https://www.independent.co.uk/news/world/asia/filipino-philippines-prison-jail-presidentrodrigo-duterte-war-on-drugs-a7164006.html . Accessed January 18, 2018.  

Baldwin C, Marshall ARC and Sagolj D. Police Rack Up an Almost Perfectly Deadly Record in Philippine Drug War. Reuters ; 5 December, 2016. https://www.reuters.com/investigates/special-report/philippines-duterte-police/ . Accessed January 20, 2018.  

Amnesty International. Philippines: The police’s murderous war on the poor; 31 January, 2017. https://www.amnesty.org/en/latest/news/2017/01/philippines-the-police-murderous-war-on-the-poor/ . Accessed January 18,2018.  

Human Rights Watch. Philippines: Duterte threatens human rights community; 17 August, 2017. https://www.hrw.org/news/2017/08/17/philippines-duterte-threatens-human-rights-community . Accessed January 18, 2018.  

Andadolu News Agency. EU: Human rights worsened with Duterte’s drug war. Al Jazeera ; 24 October, 2017. www.aljazeera.com/news/2017/10/eu-human-rights-worsened-duterte-drug-war-171024064212027.html . Accessed January 18, 2018.  

Holmes O. Rodrigo Duterte pulls Philippine police out of brutal war on drugs. Reuters ; 2017b. 11 October, 2018 https://www.theguardian.com/world/2017/oct/12/philippines-rodrigo-duterte-police-war-drugs . Accessed January 18, 2018.  

International Drug Policy Consortium. A Public Health Approach to Drug Use in Asia; 2016. https://fileserver.idpc.net/library/Drug-decriminalisation-in-Asia_ENGLISH-FINAL.pdf . Accessed April 5, 2018.  

United Nations Secretary-General. Secretary-General’s message on International Day Against Drug Abuse and Illicit Trafficking; 26 June, 2015. https://www.un.org/sg/en/content/sg/statement/2015-06-26/secretary-generals-message-international-day-against-drug-abuse-and . Accessed January 18, 2018.  

Kine P. Philippine Drug Board Urges New Focus To Drug Campaign. Human Rights Watch ; 30 October, 2017. https://www.hrw.org/news/2017/10/30/philippine-drug-board-urges-new-focus-drug-campaign . Accessed January 18, 2018.  

• Open access
• Published: 16 April 2024

Navigating drug use, cessation, and recovery: a retrospective case notes review among sexual minority men at a community-based service in Singapore

• Tzy Hyi Wah 1 ,
• Adeline Jia Xin Ong 1 ,
• Kuhanesan N. C. Naidu 1 , 2 , 3 ,
• Syaza Hanafi 1 ,
• Kelvin Tan 1 ,
• Alaric Tan 1 ,
• Tricia Jia Jing Ong 1 ,
• Eleanor Ong 1 , 2 ,
• Daniel Weng Siong Ho 1 ,
• Mythily Subramaniam 1 , 2 , 4 ,
• Maha Yewtuck See 1 &
• Rayner Kay Jin Tan 1 , 2  

Substance Abuse Treatment, Prevention, and Policy volume  19 , Article number:  23 ( 2024 ) Cite this article

101 Accesses

Metrics details

In Singapore, where drug use is a highly stigmatized and criminalized issue, there is limited understanding of the challenges faced by individuals, particularly sexual minority men, in their journey towards recovery from substance dependence or addiction. This qualitative study aimed to investigate the driving forces behind drug use, the factors contributing to drug cessation, and the elements influencing the recovery process.

Data were extracted from clinical records provided by   The Greenhouse Community Services Limited between January 2020 to May 2022. These records encompassed information from four distinct forms: the intake assessment, progress notes, case closing summary, and the care plan review. Thematic analysis was employed to identify and categorize recurring themes within the data.

Data from beneficiaries ( n = 125) were analyzed and yielded a series of themes related to facilitators of drug use, motivations to cease drug use, and managing one’s ongoing recovery. Within the facilitators of drug use, two sub-themes were identified: (a) addressing trauma and triggers and (b) managing emotions. Additionally, managing one’s recovery was marked by four significant sub-themes: (a) uncovering personal identities, (b) losing motivation and drive, (c) overcoming obstacles, and (d) preparing for aftercare.

Conclusions

The study contributes valuable insights into the dynamics of ongoing recovery management, offering potential avenues for interventions that could enhance support for individuals in their journey to overcome substance dependence. Enhancing psychoeducation and fostering peer support have the potential to facilitate the recovery process. Clearly, a holistic approach is needed to address these complex issues that cuts across our societies.

In public health, recovery models of substance use, and addiction are pivotal in eliciting effective treatment outcomes [ 28 ]. Recovery from substance use and addiction involves a complex process of psychological healing and transformation, where an individual overcomes substance dependence and achieves a state of improved psychological, social, and physical health [ 7 , 54 ]. However, recovery models vary widely, each with its perspective on addiction recovery. For example, the Transtheoretical Model proposes five stages of substance use recovery that individuals experience, namely pre-contemplation, contemplation, preparation, action, and maintenance. Notably, the process of complete recovery is often assumed to be difficult and does not occur the same way with everyone [ 40 ]. Whereas the Recovery-Oriented Systems of Care framework focuses on systems of care that supports long-term recovery, with a continuum of services (i.e., treatment recovery support and community reintegration, [ 1 ]. Despite the diversity of perspectives on addiction recovery, scholars agree that the recovery trajectory is often non-linear, implicated by other biopsychosocial factors, and where there is no one-size-fits-all approach. Different individuals may require different strategies and support systems based on their unique circumstances and needs, that require continuous self-reflection, personal growth, and adaptation [ 17 , 31 , 53 ].

We note that the extant literature in addiction recovery narratives emphasizes the importance of adopting a holistic model that encapsulates individual motivations on recovery, developing healthier coping strategies, sustaining interpersonal relationships, and forging therapeutic alliances to facilitate recovery outcomes [ 10 , 11 , 47 ]. Despite this notion, measurements of addiction recovery outcomes often rely on recidivism data and/or drug tests [ 43 ]. These can be attributed to several reasons. First, an objective measurement, where recidivism and drug use tests provide quantifiable data that can be readily collected and analyzed. It offers concrete evidence of whether an individual has abstained from drug use, making it easier to assess progress and outcomes [ 30 ]. Second, standardization, where these assessments enable standardized measurements across different individuals and settings, reflecting the essential uniformity needed for research and policy evaluation (i.e., comparisons and generalizability of findings, [ 15 ]. Third and most importantly, legal and regulatory requirements, where court systems require drug testing as a condition of parole, probation, or participation in specific treatment regimes. Compliance with these requirements is monitored via drug test results [ 2 ]. While the reliance on recidivism data and/or drug tests provides valuable information, it is essential to recognize that these measures do not capture the entirety of the recovery process and risk oversimplifying the complexities surrounding addiction recovery. For example, underestimating drug substitution, a commonly held practice among individuals in drug use recovery, or disregarding past psychological trauma could motivate them to engage with drugs [ 46 , 51 ]. To address this limitation, clinicians and researchers advocate for more comprehensive approaches to recovery measurement that combine objective data with self-reported assessments, qualitative interviews, and measures of personal growth [ 29 , 48 ].

In the Singaporean context, drug use narratives are rarely explored [ 49 ]. Thus, there is a paucity of research on drug use recovery among individuals and the support systems found in community services. This may be attributed to harsh criminal penalties that create barriers for individuals to participate in related research or access healthcare resources provided by community services [ 13 ]. For example, the Misuse of Drugs Act criminalizes the possession and use of narcotics, including fines of up to S$20,000 to a maximum of a 10-year jail term. Additionally, the legislation mandates the death penalty or life imprisonment for trafficking in banned substances in quantities over predetermined thresholds [ 37 ]. Moreover, individuals who used or are suspected of using drugs may be subjected to investigations by law enforcement, and those who have been charged with drug use offenses could be placed under the Drug Supervision Scheme or sent to the Drug Rehabilitation Centre, which is part of the Singapore Prison Services [ 12 ].

Recreational drug use is more prevalent in sexual minority men compared to the general population [ 22 , 41 , 42 ]. Past studies have attributed this to issues relating to minority stress owing to one’s minority sexual orientation [ 16 , 39 ]. Furthermore, research on drug use among gay men and other men who have sex with men have tended to focus on the risk factors associated with substance use, or how sexualised substance use may place them at greater risk for HIV and other sexually transmitted infections [ 18 , 23 , 50 ]. While some past work in Singapore has begun to detail how trauma and context serve to underpin substance use and dependence [ 48 ], to our knowledge, little to no published work has focused on the recovery journey and narratives of this population.

Present study

To our knowledge, there is little to no published work that has formally evaluated the effectiveness of drug recovery services in Singapore. Furthermore, more research is needed on the narratives of sexual minority men undergoing recovery from drug use. This is especially salient given that the law criminalising sex between men, Section 377A of the Penal Code, was only repealed in November 2022. In light of these gaps, our study broadly explored trajectories and factors associated with drug use and the challenges individuals face in sustaining abstinence from drug use among a sample of substance use treatment-experienced clients in Singapore, who comprise largely sexual minority men. By amplifying the voices of those who have triumphed over substance use challenges, we aspire to contribute valuable insights that can inform support systems, interventions, and public health initiatives tailored to the specific needs of sexual minority men in Singapore. In this study, we extracted clinical case notes to examine the factors that motivate drug use, drug cessation, and recovery outcomes.

Data extraction

Retrospectively, the clinical case notes were provided by The Greenhouse Community Services Limited ("The Greenhouse) between 2020 to 2022. The Greenhouse is a community-based, charitable organization that provides peer support and substance use recovery services for sexual minorities in Singapore. Clients at The Greenhouse undergo a voluntary treatment program comprising a series of counselling sessions, engagement in a peer support programme, as well as group-based therapy and support groups. The clinical notes included from 4 different forms: intake assessment , progress notes (PN), case closing summary (CCS), and care plan review (CPR). These forms were completed in English language by licensed counsellors.

All clients who initially arrive at The Greenhouse would fill in the intake assessment form. Thereafter, they can choose to attend various in-house programs, such as group therapy, individual counselling, or peer support – whichever best suits the client’s recovery needs. The intake assessment form contained information on client’s background, chief concerns (CC), and a brief trauma description. Responses gathered from the CC section were guided by three items: what brings you here today? , how can we help you? , and what is your treatment goal? . CC data were used to uncover the themes associated with drug use motivation and client’s motivation toward recovery.

Further, PN and CCS were made available only to clients who decided to attend in-house counselling programs. PN, in particular, contained information about client’s recovery struggles, recovery goals, coping strategies employed to deal with drug use temptations, and personal milestones during recovery. Besides, CCS data provided a succinct summary of the client’s recovery journey and their anticipated needs for continued clinical care. Notably, CPR data is made available to clients who wish to review their recovery progress after completing or terminating their participation in the in-house programs. These included post-program information on the client’s protective and risk factors for drug use and a review of current recovery progression.

Data analysis

A thematic analysis was conducted to code and analyze the clinical case notes following Braun and Clarke’s (2006) six-step framework. In the first step of familiarization with data, our researchers sought to read through all the clinical case notes from participants to get a stronger sense of the data. In the second step, the research team started initial coding of the clinical case notes without any pre-existing framework and starting developing categories of similar codes. It was at this stage when codes like ‘self-security’, ‘setting healthy boundaries’, and ‘fears and worries’ were generated. In the third step of searching for themes, we then sought to further categorise our codes and generated broader narratives that reflected and aligned with participants’ recovery journeys, which generated phrases like ‘factors influencing drug use’. Weekly meetings were held to explore different categories and themes from the data. In the fourth and fifth steps of reviewing and defining themes, we then continued to gather more data and codes and compared this to the broader framework of themes that we had generated to ensure that the themes made sense, and that the data supported the themes. While theme descriptions were developed, the team concurrently consulted extant literature to refine these themes [ 9 ]. This was when we generated two separate, higher-order themes of ‘factors influencing and stopping drug use’ (Table 2 ), and managing one’s recovery (Table 3 ). In the final step, we then reporting our findings in this manuscript [ 8 ]. Besides, a case study method was adopted to better illustrate an in-depth appreciation of an individual’s recovery progress. A case study was selected based on the completeness of the clinical data (i.e., no missing information in PN, CC, CCS, CPR) and a case that best signifies the recovery process of The Greenhouse's clients [ 44 ].

Reflexivity and positionality

Qualitative research studies rely significantly on the nuanced judgement of the researcher. Therefore, we acknowledged that reflexivity and the constant need to consciously critique and evaluate one’s work is critical in generating unbiased qualitative data [ 4 ]. The clinical data for this study were obtained from a team of trained counsellors (with clinical supervision) at The Greenhouse. The data were subsequently analyzed by two research assistants (RAs) who then worked with counsellors to develop the findings of this study. Both RAs were undergraduates with psychological and/or life sciences research experiences. Therefore, the research team’s diversity contributed fresh perspectives to the study. Additionally, the collaborative relationship between stakeholders allowed for better comprehension of expression or content from the clinical notes with an understanding of terminologies, sensitivities, and concerns around individuals in addiction recovery. Conversely, this bore limitations on the scope of data generated and analyzed in the study because the clinical notes obtained were based on the counsellors’ interpretation of the CCS, trauma, and concerns that may simplify the recovery narratives. Therefore, to preserve the originality and validity of the clinical notes, multiple discussions and reviews were held among a diverse team of researchers Fig. 1 .

Client’s recovery process

Ethics approval

This study was approved by the National University of Singapore Institutional Review Board (Reference: NUS-IRB-2022-457). Participants provided written documented consent for the use of their data for research purposes during their intake to the community-based program.

Clients’ demographics

Table 1 illustrates a summary of the clients’ demographic characteristics obtained from ( n = 125) intake assessment forms. Majority of the clients identified as sexual minority men, held Singapore citizenship, and were between the ages of 30 to 39. Further, most have obtained a bachelor’s degree and are of Chinese ethnicity. Additionally, clients reported identifying with various religious affiliations, where a large proportion are Free Thinkers . While most clients live with their families, do not have HIV, and have never been incarcerated, many have had a substance use history and used four types of substances (polydrug use) on average. Overall, most clients sought treatment via community treatment programs, where 35.2% attended individual counselling after intake assessment was completed. Notably, most clients reported abstinence as their recovery goal.

Factors facilitating drug use

Across clients, the two themes found to significantly influence their decisions to use drugs are illustrated in Table 2 , which include ‘managing trauma and trauma triggers’, and ‘managing feelings and emotions’. Generally, the reasons for drug use are individual focused, where clients are unable to cope with their past traumas, trauma triggers, and their associated emotions. For example, clinicians made a brief note on specific factors that potentially threaten a client’s sobriety: “ family related, sex, triggers, trauma .” This was an example of clients having to manage trauma and trauma triggers, with specific indications that the client faced issues around managing their own family relationships, their relationship between sex and drugs, dealing and navigating triggers for trauma and substance use, as well as trauma underpinning their substance use.

Motivations to cease using drugs

Conversely, the desire to improve the quality of current relationships tended to motivate clients to cease their drug use. As illustrated by clinical excerpts, “ problems making friends and having close friends ”, these factors led clients to abstain from drugs. Besides, friendships, relationships among family members were strong motivators for ceasing drug use. Further, a clinician noted the detrimental effects of drugs on a family as a client mentioned how using drugs have negatively impacted his relationship with his loved ones: “ Affected r/s (relationship) with [partner] … He hates the effect of using [drugs]. Miss out a lot in [loved ones’] life… Does not want to lose family. ”

Managing one’s ongoing recovery

Table 3 illustrates some themes in the recovery process that were highlighted by clients in general and in the selected case study. Supplementary Table 1 provides descriptions of each category and theme. Drawing from the case study, the client’s recovery progress started with themselves by uncovering personal narratives. This included their experiences with the multiple identities they possess, such as being a son, a husband, and a partner. Further, losing motivation and drive for recovery surfaced when they experienced circumstances that threatened the client’s reason for sustaining abstinence. This included feelings of loneliness, because no one understands their situation; hopelessness, because they do not see how abstinence is possible; and a lack of belonging because clients were unable to feel as though they were part of a social group, because appearing as an individual recovering from drug use was perceived to be unacceptable.

Taken together with external stressors (i.e., work and relationship tensions), the themes of losing motivation were identified as risk factors that facilitated relapse, self-doubt about one’s recovery outcomes, and discouraged clients from pursuing recovery. As the client identified obstacles and setbacks to recovery, he was able to work them through with his counsellor and incorporated the skills learnt from counselling into his everyday life. Notably, feelings of discrimination were a significant theme that stood out as an obstacle in the recovery process.

Towards the end of counselling, the counsellor and client in the case study shifted the sessions’ focus toward re-evaluating values and goals, specifically, plans that the client had for aftercare. At this instance, the clinician noted that the client expressed fear about the end of counselling. Following this, the client was empowered to co-design their termination activity. Other clients expressed their desire to contribute back to The Greenhouse by serving as peer supporters. Supplementary Table 2 further illustrates the comprehensive progress of notes attained for the case study.

The present study is the first to explore factors that facilitated drug use, motivated ceasing one’s drug use, and managing one’s ongoing recovery among clients who utilized community services at The Greenhouse in Singapore. Of note was that the trajectory around managing one’s recovery tended to transverse several subthemes, from uncovering personal identities, losing motivation and drive toward recovery, overcoming struggles, to preparing for aftercare (Figure 1). As noted in previous literature, clients may regress to earlier stages of recovery when they experience a relapse [ 4 , 40 ]. Consistent with our case study, the client struggled to work through his personal identity, relationship strains, and other external stressors. Therefore, clients tend to be more vulnerable to potential relapse as they navigate through the first three stages of recovery.

As illustrated in Table 2 , one of the prominent motivations that drove continued drug use was to manage one’s feelings and emotions. A reason why clients could be more prone to relapse was that they relied on drugs as a maladaptive coping strategy, including avoidance coping strategies aimed at reducing or avoiding immediate distressing experiences [ 14 ]. Consistent with alcohol use literature, evidence suggests that individuals who rely on avoidance coping strategies are more likely to engage in problematic drinking behaviors [ 52 ]. Generally, reasons for clients to engage in drug use vary from being bored to managing anger, guilt, and shame. For sexual minority clients, the intersectionality of their identity becomes particularly crucial in understanding how these motivations manifest. The lived experiences of being a sexual minority can contribute to heightened psychological distress due to minority stressors, potentially influencing substance use patterns [ 35 , 36 ]. Stigma related to sexual minority identity, as identified in our case study, emerges not only as a motivator for seeking recovery but also as a significant threat to the recovery process. Clients grapple with internalized, enacted, or anticipated stigmatized labels, such as being a person who uses drugs or a sexual minority, adding an additional layer of complexity to their recovery journey. Hence, rendering these individuals at greater risk of substance use and dependence [ 48 , 49 ].

Drawing from the case study, feelings of loneliness and hopelessness appeared as prominent themes that were identified when the client lost motivation and drive for recovery. Loneliness as a subjective experience is associated with poor physical and psychological health outcomes [ 45 ]. Further, the general excerpts and case study identified feeling lonely as a risk factor for drug use relapse. This aligns with the extant literature investigating the relationship between loneliness and drug use and found that loneliness is a significant risk factor for drug use [ 21 , 26 ]. Nevertheless, this relationship could be moderated by the type of coping styles employed by individuals [ 34 ]. Conversely, hopelessness increases when clients face a series of adverse events and believe that recovery is impossible. When revisiting the qualitative data, the theme of hopelessness is identified in the earlier stages of recovery. Further, feelings of hopelessness were identified in our case study, where the client navigated through a breakup, worsened familial tensions, and managed feelings of inefficacy.

Moreover, for sexual minority clients, hopelessness takes on a distinctive dimension, influenced by adverse events and the overarching belief that recovery may be an insurmountable feat. It is crucial to acknowledge the role of being a sexual minority within this dynamic, as the added layers of stigma and societal pressures may intensify feelings of hopelessness. Therefore, our study accentuates the need for a more nuanced exploration of how being a sexual minority intersects with emotional states like loneliness and hopelessness, shedding light on the distinct factors that contribute to the recovery challenges faced by this marginalized population.

Notably, this study identified the significance of social belonging , pertinent to the recovery process, specifically in the aftercare phase. A sense of belonging refers to an individual’s perception of relatedness to a social group [ 33 ]. While true belonging demands authenticity and courage from individuals to show up as themselves, it could be extremely challenging for individuals in recovery from drug use in drug-free societies to achieve [ 9 ]. A potential explanation would be that belonging is enmeshed within the broader socio-political landscape that highly stigmatizes drug use [ 3 ]. For clients at The Greenhouse, commonly stigmatized labels that were internalized, enacted, or anticipated include being a person who used drugs, sexual minority, or living with HIV. Interestingly, stigma was identified as a motivator for clients to seek recovery and a threat to a client’s recovery process. For clients who expressed their desires to reconnect with others who do not engage in drug use, being able to show up as an individual in recovery could be a vulnerable and uncomfortable experience. To make matters worse (since drug use is highly stigmatized in Singapore), clients often face social rejection from loved ones who do not engage in drug use. Therefore, the social pressure to fit into the drug-free narrative and the desire to reconnect with others could have motivated clients to seek out drug recovery services [ 5 ]. With that in mind, a client’s desire for social belonging can further hinder his/her recovery process especially in the Singaporean context, where harsh criminal penalties create barriers for individuals access healthcare resources provided by community services [ 13 ]. This fear of once again having to experience rejection from their loved ones and social network could be bolstered and demoralize clients from working toward recovery. Conversely, re-engaging in substance use behaviors could reinforce a client’s sense of belonging. For example, intimacy could be achieved with sexualized drug use, or as a way of socially engaging with peers [ 48 , 49 ]. Overall, clients who are caught in between social connections who both engage or do not engage in drug use will have to eventually choose between going through recovery or not, which potentially risks losing valuable relationships.

More importantly, our qualitative data supported the notion that clients required various social groups to achieve their recovery needs. As illustrated in Table 3 , when clients completed the intake assessment, they expressed assistance-related concerns, such as guidance, non-judgmental support services, and discussions on navigating social relations. For example, clients who received validation for their recovery process reported feeling valued and confident in achieving abstinence. They subsequently indicated an interest in wanting to give back to society by becoming peer supporters towards the end of counselling sessions, further suggesting that social support serves to bolster self-confidence and empowers clients in addiction recovery. This is consistent with Hall et al.’s [ 20 ] and Ogilvie and Carson’s [ 38 ] studies that demonstrated clients who were perceived as competent in addiction recovery were less likely to relapse in the future. Similarly, the subjective perception of recovering clients could have uplifted their self-confidence, motivating them to overcome their addiction issues [ 6 ].

Moreover, a significant part of overcoming recovery struggles requires clients to internalize and work on their personal growth (i.e., self-awareness, self-esteem, and self-security) and reinforce coping skills [ 5 ]. These reframed thoughts are pertinent in helping clients increase their self-efficacy with the belief that they can sustain recovery beyond counselling [ 24 , 55 ]. As illustrated in Table 3 , general excerpts revealed that achieving a level of personal growth positively influenced the client’s recovery journey. Notably, these clients possessed the ability to acknowledge their strengths, weaknesses, values, and the awareness of maladaptive behaviors in times of distress. Clients acquired a more objective view of themselves as a result, which may in turn, increase their self-efficacy. This is consistent with Kang et al.’s [ 25 ] study which demonstrated that journey toward drug use recovery is a process of personal growth (and not just abstaining from drugs).

Lastly, psychoeducation appeared to be a significant element in counselling. As illustrated in Table 3 , psychoeducation materials were tailored based on the clients’ needs ranging from designing and attempting exposure-based experiments, and distress tolerance coping skills, to integrating healthy and sustainable habits into clients’ everyday lives. Clients are taught about their drug use tendencies, trauma symptoms, practice various coping skills, and share their struggles in addiction recovery. Thus, psychoeducation allows clients to reflect on their experiences through a psychological lens and develop appropriate tools to aid them in their recovery journey. As mentioned above, sustaining abstinence from drug use is only one of the many struggles faced by clients in recovery. This demonstrates the importance for clients to take ownership of their recovery needs and develop/re-design a variety of healthy yet sustainable skills when needed. Encouraging clients to share their struggles in addiction recovery within the psychoeducational context becomes particularly significant for sexual minority individuals. By fostering an open and supportive environment, psychoeducation can empower clients to address the specific challenges they face due to their sexual minority identity. This collaborative approach enhances the effectiveness of psychoeducation and contributes to a more inclusive and tailored recovery process.

Limitations of the present study should be noted. First, the qualitative data consisted of clinical case notes that were summarized by counsellors. This introduces inaccuracies in data interpretation and may not necessarily reflect the emotions and feelings of clients accurately. Second, our study did not uncover the influence of individual difference mechanisms on recovery (i.e., social support and stigma). This could potentially overlook unique nuances that may impact a client’s journey in recovery. Third, clients who came forth to access clinical services at The Greenhouse could likely represent a specific population within sexual minorities in addiction recovery (i.e., largely gay men, and higher education attainment). As such, the results may not be generalizable to other sexual minorities (lesbian women, transgender individuals, etc.). Furthermore, the narratives are reflective of individuals who have taken a step forward in seeking help for their substance use, and may not be generalizable to the wider population of people who use drugs. Taken together, it is recommended that future qualitative studies explore the influence of individual difference mechanisms, including a wider sexual minority population, and possibly the perspectives of primary caregivers, and the barriers they face in supporting individuals in addiction recovery. Further, it would be of clinical interest to explore the psychotherapeutic processes at play in drug use cessation and the clinical management of recovery outcomes to improve addiction services in community organizations.

Implications and future directions

With the results and limitations in mind, the strength of the present study is bolstered by its novelty in attempting to uncover factors that influence addiction recovery in the context of sexual minorities in Singapore. The study uncovered that willpower by itself is insufficient to maintain sobriety since there is a complex relationship between the motivations for drug use and drug cessation. Further, the findings revealed individuals who engage in drug use contend with realities, such as prejudice against sexual minorities and drug use behaviors, both of which impede their ability to recover. Therefore, our study demonstrated the importance of delivering holistic programs for clients in addiction recovery, specifically a model that emphasizes personal growth, social support structures, and healthy coping mechanisms to empower them to take ownership of their recovery journey.

Notably, there are further implications arising from this study that could be of relevance to the community, mental health practitioners, and policymakers. First, in communities, it is crucial to provide additional opportunities that prioritize judgement-free care for individuals in drug use recovery. Moreover, communities must confront the stigma they often attach to individuals who engage with drugs and understand that these negative connotations can pose significant barriers to those seeking recovery services. Rather than isolating or stigmatizing these individuals, friends and family members could strive to empathize with those in their recovery journey and provide social support toward recovery [ 19 , 27 , 32 ]. Second, mental health practitioners play a pivotal role in aiding individuals in drug use recovery to identify and address their struggles. Additionally, practitioners could highlight key personal growth milestones in their client’s recovery journey, which may, in turn, encourage these individuals to continue persevering through continued recovery. Importantly, this emphasizes the need for culturally competent clinicians who can provide clinical care specific to sexual minority individuals in addiction recovery. Third, from a policy perspective, recognizing the multifaceted nature of factors impacting the recovery process underscores the necessity of formulating comprehensive metrics for the identification of vulnerabilities associated with drug relapse.

In a similar vein, given the diverse range of factors influencing addiction recovery within the context of sexual minorities in Singapore, future research should explore the potential utility of non-professional modalities such as the 12-step fellowships and mutual-help groups in the communities. Understanding the role and impact of these peer support networks could offer valuable insights into tailoring effective interventions that address the unique needs of individuals in the gay men community on their journey towards recovery.

The present study is the first to explore trajectories and factors associated with drug use and the challenges individuals face in sustaining abstinence from drug use among a sample of substance use treatment-experienced clients in Singapore. It revealed several themes that is of clinical interest, specific to drug use behaviors, motivations toward drug cessation, and personal narratives surrounding one’s recovery journey. To this end, the findings could be used to review and bolster the effectiveness of existing interventional programs and organizational policies in facilitating drug use recovery in the community.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly available due to potential legal risks to participants and clients to The Greenhouse Community Services Limited but are available from the corresponding author on reasonable request.

Abbreviations

Case Closing Summary

Care Plan Review

Progress Notes

Research Assistant

Ashford RD, Brown A, Ryding R, Curtis B. Building recovery ready communities: the recovery ready ecosystem model and community framework. Addict ResTheory. 2020;28(1):1–11. https://doi.org/10.1080/16066359.2019.1571191 .

Article   Google Scholar  

Banja JD. Alcohol and drug testing of health professionals following preventable adverse events: a bad idea. Am J Bioeth. 2014;14(12):25–36. https://doi.org/10.1080/15265161.2014.964873 .

Article   PubMed   Google Scholar  

Batchelder A, Foley JD, Wirtz MR, Mayer KH, O’Cleirigh C. Substance use stigma, avoidance coping, and missed HIV appointments among MSM who use substances. AIDS Behav. 2020;25(5):1454–63. https://doi.org/10.1007/s10461-020-02982-3 .

Berger R. Now I see it, now I don’t: researcher’s position and reflexivity in qualitative research. Qual Res. 2013;15(2):219–34. https://doi.org/10.1177/1468794112468475 .

Birtel MD, Wood L, Kempa NJ. Stigma and social support in substance abuse: Implications for mental health and well-being. Psychiatry Res. 2017;252:1–8. https://doi.org/10.1016/j.psychres.2017.01.097 .

Booth BM, Russell DW, Soucek S, Laughlin PR. Social support and outcome of alcoholism treatment: an exploratory analysis. Am J Drug Alcohol Abuse. 1992;18(1):87–101. https://doi.org/10.3109/00952999209001614 .

Article   CAS   PubMed   Google Scholar  

Borkman T, Stunz A, Kaskutas LA. Developing an experiential definition of recovery: participatory research with recovering substance abusers from multiple pathways. Subst Use Misuse. 2016;51(9):1116–29. https://doi.org/10.3109/10826084.2016.1160119 .

Article   PubMed   PubMed Central   Google Scholar  

Braun V, & Clarke V.Successful qualitative research: A Practical Guide for Beginners. SAGE. 2013.

Brown B. Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience. Random House. 2021.

Browne T, Priester MA, Clone S, Iachini AL, DeHart D, Hock R. Barriers and facilitators to Substance use treatment in the Rural South: a Qualitative study. J Rural Health. 2015;32(1):92–101. https://doi.org/10.1111/jrh.12129 .

Brunelle N, Bertrand K, Landry M, Flores-Aranda J, Patenaude C, Brochu S. Recovery from substance use: Drug-dependent people’s experiences with sources that motivate them to change. Drugs-educ Prev Policy. 2015;22(3):301–7. https://doi.org/10.3109/09687637.2015.1021665 .

Central Narcotics Bureau. CNB Explains: Where Do Adult Drug Abusers Go When Caught? 2022.  https://www.cnb.gov.sg/CNBExplains/where-do-adult-drug-abusers-go-when-caught .

Chua A, Chen M, Cavailler P, Jiang L, Abdullah MR, Ng OT, Chio MT, Koe S, Tay J, Wong ML, & Chan RK. Challenges of Respondent Driven Sampling to Assess Sexual Behaviour and Estimate the Prevalence of Human Immunodeficiency Virus(HIV) and Syphilis in Men Who Have Sex with Men (MSM) in Singapore. Ann Acad Med Singapore. 2013; 42(7), 350–353. https://doi.org/10.47102/annals-acadmedsg.v42n7p350 .

Coriale G, Bilotta E, Leone L, Cosimi F, Porrari R, Rosa F, Ceccanti M. Avoidance coping strategies, alexithymia and alcohol abuse: a mediation analysis. Addict Behav. 2012;37(11):1224–9. https://doi.org/10.1016/j.addbeh.2012.05.018 .

Durbeej N, Berman AH, Gumpert CH, Palmstierna T, Kristiansson M, Alm C. Validation of the alcohol use disorders identification test and the drug use disorders identification test in a swedish sample of suspected offenders with signs of mental health problems: results from the mental disorder, substance abuse and crime study. J Subst Abuse Treatment. 2010;39(4):364–77. https://doi.org/10.1016/j.jsat.2010.07.007 .

Flentje A, Heck NC, Brennan J, Meyer IH. The relationship between minority stress and biological outcomes: a systematic review. J Behav Med. 2019;43(5):673–94. https://doi.org/10.1007/s10865-019-00120-6 .

García E, & Arandia IR. Enactive and simondonian reflections on mental disorders. Front Psychol. 2022; 13. https://doi.org/10.3389/fpsyg.2022.938105 .

González-Baeza A, Dolengevich-Segal H, Pérez-Valero I, Cabello A, Téllez MJ, Sanz J, Pérez-Latorre L, Bernardino JI, Troya J, De La Fuente S, Bisbal O, Santos I, Arponen S, Hontañón V, Casado JL, Ryan P. Sexualized Drug Use (Chemsex) Is Associated with High-Risk Sexual Behaviors and Sexually Transmitted Infections in HIV-Positive Men Who Have Sex with Men: Data from the U-SEX GESIDA 9416 Study. Aids Patient Care STDS. 2018;32(3):112–8. https://doi.org/10.1089/apc.2017.0263 .

Grim BJ, Grim ME. Belief, Behavior, and Belonging: How Faith is Indispensable in Preventing and Recovering from Substance Abuse. J Relig Health. 2019;58(5):1713–50. https://doi.org/10.1007/s10943-019-00876-w .

Hall L, Best D, & Musgrove A. Recovery and communities. In Routledge eBooks (pp. 229–248). 2019. https://doi.org/10.4324/9780429461804-15 .

Hosseinbor M, Ardekani SMY, Bakhshani S, & Bakhshani S. Emotional and social loneliness in individuals with and without substance dependence disorder. Int J High Risk Behav Addict. 2014; 3(3). https://doi.org/10.5812/ijhrba.22688 .

Hunter L, Dargan PI, Benzie A, White JA. Recreational drug use in men who have sex with men (MSM) attending UK sexual health services is significantly higher than in non-MSM. Postgrad Med J. 2014;90(1061):133–8. https://doi.org/10.1136/postgradmedj-2012-131428 .

Íncera-Fernández D, Román-González FJ, Moreno-Guillén S, & Gámez-Guadix M. Sexualized drug use, risky sexual behaviors, and prevention strategies among gay, bisexual, and other men who have sex with men. Drugs. 2023: 1–13. https://doi.org/10.1080/09687637.2023.2225245 .

Kadden RM, Litt MD. The role of self-efficacy in the treatment of substance use disorders. Addict Behav. 2011;36(12):1120–6. https://doi.org/10.1016/j.addbeh.2011.07.032 .

Kang SK, Kim HJ, Shin S. A qualitative case study on recovery and personal growth in Korean drug addicts. J Soc Serv Res. 2018;44(3):279–90. https://doi.org/10.1080/01488376.2018.1457593 .

Kayaoğlu K, Okanlı A, Budak FK, Aslanoğlu E. The correlation between loneliness and substance use proclivity in child and adolescent substance users. J Subst Use. 2021;27(1):70–3. https://doi.org/10.1080/14659891.2021.1894495 .

Kelly SM, O’Grady KE, Schwartz RP, Peterson JA, Wilson MP, Brown BS. The relationship of social support to treatment entry and engagement: the Community Assessment Inventory. Subst Abuse. 2010;31(1):43–52. https://doi.org/10.1080/08897070903442640 .

Kim HS, Hodgins DC, García X, Ritchie EV, Musani I, McGrath DS, Von Ranson KM. A systematic review of addiction substitution in recovery: clinical lore or empirically-based? Clin Psychol Rev. 2021;89:102083. https://doi.org/10.1016/j.cpr.2021.102083 .

Laudet AB. What does recovery mean to you? Lessons from the recovery experience for research and practice. J Subst Abuse Treat. 2007;33(3):243–56. https://doi.org/10.1016/j.jsat.2007.04.014 .

Leffingwell TR, Cooney NJ, Murphy JG, Luczak SE, Rosen IG, Dougherty DM, Barnett NP. Continuous objective monitoring of alcohol use: twenty-first century measurement using transdermal sensors. Alcoholism. 2013;37(1):16–22. https://doi.org/10.1111/j.1530-0277.2012.01869.x .

Leukefeld CG, Tims FM. Relapse and recovery in drug abuse: research and practice. Int J Addict. 1989;24(3):189–201. https://doi.org/10.3109/10826088909047283 .

Luoma JB. Substance use stigma as a barrier to treatment and recovery. In Springer eBooks (pp. 1195–1215). 2010.  https://doi.org/10.1007/978-1-4419-0338-9_59 .

Mahar A, Cobigo V, Stuart H. Conceptualizing belonging. Disabil Rehabil. 2012;35(12):1026–32. https://doi.org/10.3109/09638288.2012.717584 .

Mannes ZL, Burrell LE, Bryant V, Dunne EM, Hearn LE, Whitehead NE. Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+. Aids Care-Psychol Socio-Med Aspects Aids/Hiv. 2015;28(5):598–602. https://doi.org/10.1080/09540121.2015.1120269 .

Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38. https://doi.org/10.2307/2137286 .

Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97. https://doi.org/10.1037/0033-2909.129.5.674 .

Misuse of Drugs Act 1973 - Singapore Statutes online. 1973.   https://sso.agc.gov.sg/Act/MDA1973 .

Ogilvie L, Carson J. Positive addiction recovery therapy: a pilot study. Adv Dual Diagn. 2022;15(4):196–207. https://doi.org/10.1108/add-06-2022-0018 .

Polihronakis CJ, Velez BL, Brewster ME. Bisexual men’s sexual health: a test of minority stress theory. Psychol Men Masculin. 2021;22(1):201–15. https://doi.org/10.1037/men0000304 .

Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. PubMed. 1992;47(9):1102–14. https://doi.org/10.1037/0003-066x.47.9.1102 .

Article   CAS   Google Scholar  

Sang JM, Cui Z, Sereda P, Armstrong HL, Olarewaju G, Lal A, Card KG, Roth EA, Hogg RS, Moore D, Lachowsky NJ. Longitudinal Event-Level Sexual Risk and Substance Use among Gay, Bisexual, and Other Men Who Have Sex with Men. Int J Environ Res Public Health. 2021;18(6):3183. https://doi.org/10.3390/ijerph18063183 .

Schroeder S, Bourne A, Doyle J, Hellard M, Stoové M, Pedrana A. Constructing a ‘target population’: a critical analysis of public health discourse on substance use among gay and bisexual men, 2000–2020. Int J Drug Policy. 2022;108:103808. https://doi.org/10.1016/j.drugpo.2022.103808 .

Schwartz RH. Urine testing in the detection of drugs of abuse. Arch Internal Med. 1988;148(11):2407–12. https://doi.org/10.1001/archinte.148.11.2407 .

Seawright, J., Gerring, J., Seawright, J., & Gerring, J. Case selection techniques in case study research: a menu of qualitative and quantitative options. In SAGE Publications Ltd eBooks (p. II213). 2016.   https://doi.org/10.4135/9781473915480.n31 .

Shankar A, McMunn A, Banks J, Steptoe A. Loneliness, social isolation, and behavioral and biological health indicators in older adults. Health Psychol. 2011;30(4):377–85. https://doi.org/10.1037/a0022826 .

Shapira B, Rosca P, Berkovitz R, Gorjaltsan I, Neumark Y. The switch from one substance-of-abuse to another: illicit drug substitution behaviors in a sample of high-risk drug users. PeerJ. 2020;8:e9461. https://doi.org/10.7717/peerj.9461 .

Stokes M, Schultz P, & Alpaslan A. Narrating the journey of sustained recovery from substance use disorder. Subst Abuse Treat Prev Policy. 2018; 13(1). https://doi.org/10.1186/s13011-018-0167-0 .

Tan RKJ, Phua K, Tan A, Gan DCJ, Ho LP, Ong EJ, See MLM. Exploring the role of trauma in underpinning sexualised drug use (‘chemsex’) among gay, bisexual and other men who have sex with men in Singapore. Int J Drug Policy. 2021;97:103333. https://doi.org/10.1016/j.drugpo.2021.103333 .

Tan RKJ, Wong C, Chen M, Chan YY, Ibrahim MaB, Lim OZ, Chio MT, Wong CS, Chan R, Chua LJ, Choong BCH. Chemsex among gay, bisexual, and other men who have sex with men in Singapore and the challenges ahead: a qualitative study. Int J Drug Policy. 2018;61:31–7. https://doi.org/10.1016/j.drugpo.2018.10.002 .

Tomkins A, George R, Kliner M. Sexualised drug taking among men who have sex with men: a systematic review. Perspect Public Health. 2018;139(1):23–33. https://doi.org/10.1177/1757913918778872 .

Ullman SE, Relyea M, Peter-Hagene LC, Vasquez A. Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims. Addict Behav. 2013;38(6):2219–23. https://doi.org/10.1016/j.addbeh.2013.01.027 .

Wang CDC, Anderson-White E, Jin L. Adult attachment, maladaptive coping, alcohol consumption, and drinking-related problems. Counsel Psychol Q. 2021;35(1):43–60. https://doi.org/10.1080/09515070.2021.1977914 .

Weaver B. Understanding desistance: a critical review of theories of desistance. Psychol Crime Law. 2019;25(6):641–58. https://doi.org/10.1080/1068316x.2018.1560444 .

White WL. Addiction recovery: Its definition and conceptual boundaries. J Subst Abuse Treat. 2007;33(3):229–41. https://doi.org/10.1016/j.jsat.2007.04.015 .

Yang C, Zhou Y, Cao Q, Xia M, & An J. The Relationship between Self-Control and Self-Efficacy among patients with Substance Use Disorders: Resilience and Self-Esteem as Mediators. Front Psychiatry. 2019; 10. https://doi.org/10.3389/fpsyt.2019.00388 .

Download references

Acknowledgements

We would like to thank all participants in this study. We would also like to express our gratitude to all counsellors at The Greenhouse Community Services Limited.

The work supporting the research was funded by The Majurity Trust (Grant Number: N/A). We thank The Greenhouse Community Services Limited for their support in conducting this study.

Author information

Authors and affiliations.

The Greenhouse Community Services Limited, Singapore, Singapore

Tzy Hyi Wah, Adeline Jia Xin Ong, Kuhanesan N. C. Naidu, Syaza Hanafi, Kelvin Tan, Alaric Tan, Tricia Jia Jing Ong, Eleanor Ong, Daniel Weng Siong Ho, Mythily Subramaniam, Maha Yewtuck See & Rayner Kay Jin Tan

Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, MD1 Tahir Foundation Building #10-01, Singapore, Singapore

Kuhanesan N. C. Naidu, Eleanor Ong, Mythily Subramaniam & Rayner Kay Jin Tan

Department of Psychological Medicine, National University Health System, Singapore, Singapore

Kuhanesan N. C. Naidu

Research Division, Institute of Mental Health, Singapore, Singapore

Mythily Subramaniam

You can also search for this author in PubMed   Google Scholar

Contributions

MYS, RT, AT conceptualized this study. TW, AO, SH, KT, AT, TO, EO, DH, MYS and MS acquired and managed the data for the study. TW, AO, RT, SH, KT, and AT analyzed and interpreted the data. TW, AO, TO and RT developed the first draft of the manuscript. KNCN reviewed and edited the manuscript for intellectual content. All authors reviewed the manuscript, revised it critically for important intellectual content, and approved the final version of the manuscript for submission. Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors.

Corresponding author

Correspondence to Rayner Kay Jin Tan .

Ethics declarations

Ethics approval and consent to participate, consent for publication.

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Supplementary material 1., rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Wah, T.H., Ong, A.J.X., Naidu, K.N.C. et al. Navigating drug use, cessation, and recovery: a retrospective case notes review among sexual minority men at a community-based service in Singapore. Subst Abuse Treat Prev Policy 19 , 23 (2024). https://doi.org/10.1186/s13011-024-00605-x

Download citation

Received : 16 November 2023

Accepted : 29 March 2024

Published : 16 April 2024

DOI : https://doi.org/10.1186/s13011-024-00605-x

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Substance use
• Holistic interventions
• Qualitative

Substance Abuse Treatment, Prevention, and Policy

ISSN: 1747-597X

• General enquiries: [email protected]