The high and low ends of rehab tourism in Thailand
Thailand is known for its medical tourism industry, with travelers coming here for everything from dental surgery to sex changes. But an increasing number of visitors are coming to the kingdom in search of a solution to addiction-related issues, a niche that has been dubbed "rehab tourism."
The rehabilitation industry is growing steadily and many former addicts cite a trip to a centre in Thailand as being a major factor behind getting clean and, more importantly, staying clean.
Thailand is a country of enormous disparity, where the wealthy enjoy opulent luxury while the poor subside on a handful of baht a day; nowhere is this more apparent than in the detox and treatment options available for addicts.
For those with a limited budget, Buddhist temples that typically offer treatment of a spiritual rather than medical nature provide the only available escape from addiction.
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If money is no object, upmarket rehabilitation programs can cost in excess of US$30,000 per month. A number of exclusive and luxurious retreats welcome wealthy addicts from all over the world who come to kick their respective habits.
Yet some of the most basic Buddhism-based treatment methods are also popular with foreigners.
The 'Vomiting Temple'
Tham Krabok temple has attracted notoriety in the Western media for a regime that includes enforced daily vomiting sessions. A recent BBC story even suggested that Tham Krabok had a higher success rate than Britain’s National Health Service.
Even though English musician Pete Doherty famously failed to get clean here, and was not overly enamoured with the standard of treatment he received, there are a number of success stories.
Counsellor Hans Derix credits Tham Krabok with helping him to end a 13-year addiction to cocaine.
“I went to rehab in Holland but I relapsed after about six or seven months and my parents, who spend a lot of time in Thailand, heard about Tham Krabok and they knew that I was interested in meditation so they thought it would be perfect for me," he says.
"In the beginning I was a bit hesitant because the program is four weeks max and I thought ‘what can I do in four weeks?’ but the idea grew on me and I decided to go.”
Tham Krabok is often referred to as simply "the vomiting temple" because everyone is forced to partake in a daily ceremony which involves ingesting a drink specifically brewed to induce vomiting. The abbot of the temple famously refuses to divulge the mixture's contents.
For Derix this was the most difficult part of the treatment.
“The detoxification ritual, the medicine which they give you every day at around 6 p.m., that’s the hardest part that everybody struggles with. The first five days are tough, it is seven days minimum and they take all of your belongings, your clothes, your passport and your money so you have no possessions. You basically sign up for seven days.”
Tham Krabok is located about 130 kilometers north of Bangkok, between Saraburi and Phraputthabat, and has been offering drug detoxification services for over 50 years. The major appeal to addicts is that it charges a pittance for residential treatment but its punitive approach is enough to deter many from ever entering the program in the first place.
Successes and failures
Rock singer Doherty was a reluctant guest who claimed he was emotionally blackmailed into going to Tham Krabok by his desperate mother. Here is an excerpt from an online diary entry he wrote during his brief stay: "I had a [expletive] breakdown. But there is no way out. I've signed in for a week and they're adamant they won't give my passport or money back."
A few days of the Tham Krabok regime was all Doherty, a notorious addict, could reportedly handle and he soon checked himself out, allegedly to go looking for drugs.
Derix completed three and a half weeks at Tham Krabok, an unusually long stay, and has remained drug-free ever since. His stay in Thailand made an enormous impression and he returned a few years later looking to set up a treatment centre of his own.
These ideas never came to fruition but instead he found employment as a mindfulness and meditation counsellor at The Cabin in Chiang Mai.
Upmarket treatment centers such as The Cabin provide a much softer option for recovering addicts.
“We focus much more on the treatment side," says Derix. "There is the 12 Steps program, there is cognitive behavioural therapy, physical fitness and mindfulness, there is more focus on looking at the mind and the roots of the cravings.
"The minimum stay at Tham Krabok is seven days whereas at The Cabin it is four weeks and people can stay up to four months,” he says.
The Cabin reportedly takes in 15 foreigners per month, which works out to about 180 per year. A spokesperson at Tham Krabok said they get about 120 foreigners a year, "although the peak time is between August and December when we normally have around 20 foreigners here at any one time."
"I think this is because people tend to party during the summer months and then when summer ends they start to realize that maybe they have a problem," said the spokesperson. "We get people from all over the world but the most common countries are probably the United States, U.K., Ireland and Australia."
At Tham Krabok, addicts are forced to take a vow of abstinence and if they break it they are not allowed to return. The temple looks at its treatment program as a once-in-a-lifetime opportunity so addicts are only allowed one attempt to get clean there.
Because of this, figures are not available as to the relapse rate amongst addicts who are treated at Tham Krabok. While some like Derix will use the experience as a catalyst to permanently turn their lives around, for others the rehabilitation they receive will ultimately not stand the test of time.
'You can’t follow people for the rest of their lives'
Alastair Mordey is a certified and accredited addiction counsellor who has worked in treatment services for over a decade. He is responsible for putting the program at The Cabin into place.
“We have a multidisciplinary team of doctors, psychiatrists and clinical psychologists," he says. "People will always respect medical professionals but when it comes to counselling, it’s worth its weight in gold if a counsellor is a recovering addict, which most of ours are.
"You still have to be good at what you do, otherwise it makes no difference whether you are a recovering addict or not, but ideally what you want is good counsellors who are also recovering addicts."
Mordey also believes that detoxification is only a small step on the path towards recovery; The Cabin uses mentors and role models to try and help secure the long-term well-being of its clients.
“There’s no effective research as to what percentage of former addicts relapse," he says.
"You can’t follow people for the rest of their lives, so all the evidence we have is anecdotal, but addiction appears to be a chronically relapsing condition that most people never get out of. If an addict sees a counsellor in front of them who has been clean for 10 years that is the most cogent imagery they can have, the most powerful thing which will mean something to them."
Although The Cabin does deal with detoxification it does so in conjunction with a local hospital. The primary purpose of this rural retreat just outside of Chiang Mai is not to get addicts clean but to help them stay clean.
To do this they employ a series of innovative methods, as Mordey explains, “We’ve taken the 12 Steps which is the traditional treatment method in Britain and the United States and combined it with cognitive behavioral therapy, a modern psychological therapy which is used in treatment of depression and mental health disorders."
Mordey, a recovering addict himself, adheres to the following philosophy which he has implemented at The Cabin: “When addicts are willing to receive treatment their rehabilitation is facilitated by care and mentoring and a more loving approach; the idea that they are not guilty and it’s not their fault, that they have a condition or disorder, seems to allow them a mental space to get a grip."
This sympathetic style is in contrast to the more disciplinarian approach favoured by Tham Krabok whose website proclaims that: "In Buddhism we believe that one is totally responsible for one's actions and their consequences. Therefore he must get the chance of confronting himself, in order to reorganize his life. This is one of the reasons why the withdrawal in Tham Krabok is a ‘cold withdrawal’."
While traditional Thai treatment centres such as Tham Krabok and modern Western-style facilities like The Cabin might appear to be polar opposites, they do have one thing in common -- a purportedly far- higher-than-average success rate.
A choice between the two contrasting types of establishment is one that few addicts will ever have to make for the simple reason that a stay at The Cabin costs US $12,000 per month, which is well below the standard industry rate but significantly more that Tham Krabok which only expects people to contribute 200 baht a day.
Thailand is not a destination that is traditionally associated with abstinence, but people from all walks of life are starting to look to the country as a possible sanctuary from, and solution to, their problems with addiction.