Extreme measures

24 January 2005

Drink and Drugs News

The Buddhist monks of Thamkrabok Monastery in Thailand offer a gruelling programme of detox that relies on grim determination and spiritual belief. Is it a viable treatment option for British addicts?

Up in the mountains 120 km north of Bangkok, a community of monks offers an extreme programme of detoxification to those who cannot give up any other way.

From the minute they enter the community and change into the regulation pyjamas, the guests are signing up to an agreement to purge their bodies of drugs and their minds of addiction.

It’s not an easy choice. Detox the Thamkrabok Monastery way is about taking a ‘secret recipe’ dark herbal liquid, followed by buckets of water that will make the new visitor vomit again and again, in full view of the monastery staff and patients. This is the beginning of a programme of ‘herbal detoxification’ that continues for the next five days, eased only by afternoon saunas with lemon grass and eucalyptus, support and counselling from the monks – and as much sleep as the withdrawing body can accept.

The Buddhist monastery attracts diverse reactions, because it is so different in its approach to anything we are used to in the West. The treatment is certainly extreme, but for many who have come out the other side drug free, it is the miracle cure they thought they would never find. The chanting and rituals add to the spiritual journey, it is suggested; the harsh vomiting regime replacing the daily ritual associated with drug-taking.

Mike Sarson set up the East-West Detox charitable trust in Reading, to send British patients out to Thailand. A former NHS drugs counsellor, Sarson has thrown his energies behind the programme, believing that combining eastern and western philosophies can provide a ‘holistic programme of natural, herbal detoxification and rehabilitation’.

The treatment at Thamkrabok is not new. Since 1957, the monastery’s monks have provided detox treatment for native Thai addicts. Treatment was harsh and uncompromising – and there are hints that the regime is still much stricter for natives of a country where drug trafficking carries the death penalty. ‘There is possibly more control exerted upon Thais’, says East-West’s literature. Westerners are called guests, and are not punished for struggling with treatment, and there is definitely an attempt to cushion the blow of a regime that would be considered spartan by the standards of any rehabilitation centre in the UK. There is a standard rule for all guests wherever they come from, however: if they are unable to live in the monastery without resorting to their old drugs, they must leave immediately.

For some, the regime is just too tough, as seen recently in newspaper headlines reporting that Pete Doherty, ex singer with The Libertines had very publicly checked in – and even more publicly checked out, to lick his wounds (and take heroin, according to the newspapers) in a Bangkok hotel. Many others struggle on and make it to the other side. Some are so inspired that they become assistants at the monastery, supporting the new arrivals and helping with the chores.

Sarson can provide contact details of many success stories from people who have emerged transformed, and their grateful relatives.

‘For some, the regime is just too tough, as seen recently in newspaper headlines reporting that Pete Doherty, ex singer with The Libertines had very publicly checked in – and even more publicly checked out...

Some are so inspired that they become assistants at the monastery, supporting the new arrivals and helping with the chores.'

Julia from Berkshire sent her daughter to Thamkrabok in desperation, after a three-year drug addiction, including a two-year methadone prescription. Admitting that she was ‘petrified of sending [her] daughter to Thailand… didn’t they have the death penalty for possessing drugs!’, she was convinced by Sarson’s ‘passion and belief’ about the treatment. Taking her daughter along to see him produced the moment of conviction that seems to convince patients that this experience will be different. It’s about taking control of one’s actions and their consequences, says Sarson, and participating in the monastery’s Buddhist way of life.

Julia’s daughter believed that she could ‘take the opportunity to confront herself in order to reorganise her life’, as the East-West literature suggests. She succeeded, is still clean two years later, and has since gone back to work at the monastery as a volunteer.

Many of the Western visitors find the Buddhist cultivation of one’s inner light extremely motivating, and with it the chanting, meditation and rituals. Ceremony is considered extremely important to declaring that you are serious about completing detox, and includes ‘Sajja’ – ‘a solemn declaration… a sacred act that will connect you with your willpower and with something beyond’.

After the first phase of treatment you can get a little paper with a ‘sacred word’ on it, called ‘Kahtah’. The syllables have no particular meaning, but the function ‘purely energetic’. If you learn them by heart, eat the paper after seven days, then repeat the word constantly when you meditate, ‘you can use it as a snow-plough to keep your road clean’.
The symbolism is everything. ‘If you use this very powerful tool well, it will grow and become an effective support mechanism in your life,’ says the monastery.

The ‘journey’ at Thamkrabok represents ‘travelling to a new life’ and appeals to many people for its offer of recreating inner strength and belief in oneself, after a period of feeling utterly demoralised.

Whether or not Buddhism comes naturally, Thamkrabok opens its doors to everyone, no matter what their religion or belief system. The treatment has attracted criticism on different levels – but it has also inspired devotion in those who thank the monks for showing them an alternative way of life and a route to self-discovery.

For Mike Sarson of East-West Detox, the pressing priority is to find tangible support to provide new facilities at Thamkrabok. British visitors pay for their
own travel and that of an accompanying counsellor, insurance, counselling support and a contribution towards accommodation and food (amounting to ‘a fraction of most western conventional treatments’, he says). But there are buildings and equipment to maintain, and a new wing under construction, all of which require funds.

Sarson is hoping that the Maudsley National Addiction Centre and Oxford Brookes University will proceed with an evaluation of the treatment, against more conventional programmes, but is concerned that the research is stalling from lack of funding – ‘buttons compared to the amount currently being spent on drug and alcohol treatment’.

But he continues to campaign for support to offer the treatment more widely and remains optimistic:

‘Innovative methods such as ours can offer more choice, save lots of money and achieve very positive outcomes,’ he says.

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Dr Chris Ford is a GP in North West London. DDN asked for her opinion of the treatment at Thamkrabok

I’ve had a couple of patients who have been to the monastery. The last person I saw was a businesswoman who’d got a real alcohol problem and she thought it was the best thing since sliced bread. She said she would talk to other patients about it, if anyone who wanted to go.

I think it’s great if people want to go down that line. What worries me is the follow up. Having been an on-off smoker all my life, I know that addiction is a long-term disease, a chronic elapsing condition and I don’t know any treatment that works as a one-off.

Twelve steps treatment can be long term; people are recommended to 12 step groups forever. I think the Sajja is partly trying to do that, but can you do that with just having been there a few days? I know detox is one of the difficult bits, but we always regard detox as a beginning point and not an end stage. So the question mark for me is
around the follow up. What happens when you have to come back to your own environment?

We do know that rehab and detox work for a proportion of people in this country. I can’t get enough funding to get as many patients as I want to go down that line. It could be seen as a cheap option to send them off to Thailand for a few days. But it’s horses for courses. I think the drugs field is too narrow on the whole – we don’t use all the tools. So for the right people, it’s a useful addition to the toolbox.

One problem would seem to be that those on methadone maintenance have to get down to 5mls before they go. That’s the difficult bit. If they can do that, they can probably do the last 5mls. As far as I can see, being in general practice and managing drug users, it’s a nice option if somebody can go and pay for it themselves and want to give it a go, but nothing more than that.

Whether the addiction’s smoking, alcohol, eating – I’d love to wake up in the morning, chew tablets and all would be cured, but life’s not like that.

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Dr Vanessa Crawford visited Thamkrabok for a 24-hour period, when on holiday in Thailand.

‘I was given the opportunity to take my own vow (sajja), something that is said to be far more important than the medication. The taking of the vow instills a sense of strength and it was clear from talking to Phra Hans (a Swiss monk) and one of the service users that it is very important in the recovery process.

The medicine is drunk from a small glass, in one swallow. Drinking large volumes of water is rather counter-intuitive to me, but the aim is to fill the stomach to a level of discomfort, nausea and then induce vomiting. The subjective experience varies for everyone but certainly at one stage I could feel my head and shoulders sensing themselves being lifted upwards.

It is not possible to know the importance of the medication in the detoxification. I think not having the knowledge of its content adds to its magic. The overall experience of Thamkrabok was very uplifting for me; it does not rely on a specific religious belief.

I have a great respect for the treatment offered there; there is nothing sinister about it, no enforced religion, rather a collective wisdom to guide people. It is clearly not for everyone – those who find physical symptoms of withdrawal particularly difficult may struggle with this programme. Those who need to be on regular medication cannot be treated. There is good medical support, with visiting doctors and a nearby hospital. It is very clear that Phra Hans knows when the limits of Thamkrabok, in terms of medical and psychiatric problem management, have been reached. The peer and volunteer support is excellent, there are activities, but equally individuals have a lot of time to fill and this really is important for them to learn to manage periods of unscheduled time. The magic of a foreign country, the calmness of the surroundings, the positive wisdom of Buddhism and the importance of being entrusted with a vow all add to the chances of success. As with any detoxification a solid aftercare plan is essential to follow up after the four-week period of detoxification.

Dr Vanessa Crawford, Consultant Psychiatrist/Clinical Director, East London and the City Specialist

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The original article can be seen at http://www.drinkanddrugs.net/features/jan2405/extrememeasures.pdf