The Story of Miguel and Harm Reduction

Miguel is not his real name — but this is his real story.


He had been in and out of rehabilitation centers both here in the Philippines and internationally. Eventually, he and his family decided on a center that operated on the philosophy of harm reduction. That center was PCSAM, the Philippine Center for Substance Abuse Management, the precursor to what NoBox is today.

We interviewed him as someone who had gone through these experiences firsthand, as someone we’d worked with, and as a friend.

Below is our conversation:

How was the experience like, with your first few rehabilitation centers?

Harsh. One of my most terrible experiences in life. They try to help you by confronting the behavior of drug addicts, like that we’re sneaky, we always have reasons, blah blah blah. They make you confront it by making you accept things, like punishments. Like cleaning the porch with a toothbrush, or washing dishes for fifty people. They have four to five people in a panel scream at you, called “blasting”— “ADIK! HINDI KA NAGBAGO!”

They call punishments learning experiences. Do the dishes, clean the bathroom, you’re last in line for 5 days.

It’s a lot of screaming. It’s a lot of, there’s something inherently wrong with you, you’re f*cked up, you’re broken, and it’s called tough love.

What if you don’t like what they’re doing to you?

The others who have been there longer are tasked to subdue you. If you don’t listen, they’ll handcuff you. [They do this] because when you’re defiant, when “the natives are restless,” the others might follow.

But at some point, what’s the point?

How long did you have to stay?

It’s a year and a half program. Some people don’t know what they’re getting into. If you get pulled out, the deposit of PhP150,000 stays. They don’t want pullouts because it’ll make the program look bad. It’ll stir up emotions among the residents, the inmates.

What did you think of it? Did it work?

It may have helped some people, but not me. A few things I learned from rehab, um… I can wash dishes really fast. I can toothbrush your freaking garahe. It didn’t teach me anything. But it built up resentment, made me feel shitty, and made me hate the people who put me in there.

I escaped. I left [my guard] while I was pissing. Then my parents pulled me out of the program.

Can you tell us about PCSAM?

PCSAM was the Philippine Center for Substance Abuse Management. PCSAM was founded on the philosophy of Harm Reduction, and provided services with that framework. It was NoBox before NoBox, when we still offered residential stay-in services.

PCSAM was different. It was so different from all the others. I was treated well as a person.

They really individualize it. My case was studied and hinimay, versus “fall in line, soldier!” They really get to know you. They wanted to know what my interests were. Why are you now clean? Why are you now tapering? Why are you now not destroying your life? They wanted to know.

When you find out the person you are, and you get to know who you are, and you accept it, then from there, sorry to use a cliché, but the possibilities are endless.

By treating a person as a person, he becomes one.

How did you find it? What did you think?

I was happy. It was open door. I was like, if I didn’t like this, I could leave. But a week later, I felt empowered and respected. And I respected them! I could see that they wanted to help. These people, they’re there, that’s their job, that’s their advocacy.

I’d go to mass every day. I brought weights from my house, exercise kami. There was a basketball half court. Mentally and physically, it was therapeutic. We were never negative or planning an escape. Here it was like, we were all just trying to work towards bettering ourselves. 

And if at midnight we were hungry, we’d just go downstairs to cook!

We barely had time to get bored. It was uppity up, positive. We weren’t bumming or sullen or what. The thought of escape was stupid. It was so okay here! Why leave? A few weeks became months. And things just went uphill from there.

How was the interaction like with the PCSAM team?

There was no punishment! We brought weed in there, and shabu. [Inez] just like… thought about it, and eight hours later, talked to us. Like, hey guys, we’re supposed to be open here. Don’t smoke jutes naman in the freakin’ place, ‘diba? She didn’t raise her voice or give us sanctions. And we never did it again! We hardcore drug addicts never did it again. Nahiya kami.

What was harm reduction treatment like?

They really tailored it for me.

They ask you what your commitment is, what your goals are. I said I wanted to stay clean for a year.

They gave me strategies, like, “Let’s pretend you relapse. What did you wish you didn’t do?” So I learned, I’d leave my credit cards, my watch, my wallet. That’s one thing that helped me. And always use protection. Condom. Always.

They helped draw things out of you instead of yelling it in your face. Whatever you wanted to fix, they helped you out. They encouraged making it realistic, but stretch yourself. 

When you’re an addict, people usually don’t support you. But sa kanila, “You wanna make a film? Let’s make a film!” That was a first. I participated in Cinemalaya! Then we watched the films in CCP!

I was treated as a person. There’s things out there. Once you discover that, then you start bringing yourself towards that.

That’s what I never learned with the other rehabs. With harm reduction, I started protecting myself and others. We talked about practicality, what’s realistic, strategies, finding and discovering myself. And I had a goal. And it’s not about quitting drugs. I wanted to live a different life. For example, smoking. Smoking was getting in the way of my athletics, so I let go of smoking!
Your heart is better, your mind is better, you become a person again. That you want to be, that you didn’t know you could be.

How are you doing now?

I got lucky! I’m now doing something about my life. Not because I’m forced to, but because I deserve it.

Once you’re empowered to have a choice — because addicts have always been told what to do — and you’re treated like a person, you want to give that same respect to yourself.

Harm reduction skills are like buying a DVD that you can replay. The lessons are there, you can apply them anytime.

I was putting myself in sexual situations, and I could have gotten AIDS. I could have overdosed five times over if I didn’t know these strategies. Jail, hepa, being institutionalized — these never happened to me. I knew how to keep safe.

Harm reduction works! I relapsed twice. But from seven or five days, it became two or three. I’d leave my cellphone and wallet and credit cards at home. I wouldn’t go near the casino because I knew I’d get carried away. I wouldn’t call girls anymore. Condoms always. I’d let my parents and girlfriend know I was okay, when before I used to turn my phone off. I used a lot less this time. And after relapse, which was a lot shorter, I went right back to work!

You can make your own decisions na pag harm red.

It saved my life.

If there’s anything you could say to someone who’s thinking of treatment?

Give harm reduction a try. Give it a month. If you can’t after a month, go back and do your thing. You’ve been doing this thing 10 years and you’re unhappy. But here are small things that you can do. Just try it.