A Former Heroin Addict Runs A Rehab Center With A Different View Of Abstinence : Goats and Soda Sam Nugraha of Indonesia says that in his country, a smile can be a mask covering inner turmoil. So how do you get addicts to be honest?
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Why An Indonesian Rehab Center Doesn't Insist On Abstinence

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Why An Indonesian Rehab Center Doesn't Insist On Abstinence

Why An Indonesian Rehab Center Doesn't Insist On Abstinence

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NOEL KING, HOST:

Reporter Julia Simon is in our studios in New York.

Hi, Julia.

JULIA SIMON: Hey, Noel.

KING: So you are bringing us a story today that took you halfway across the world, but it actually started very close to home with your mom in California.

SIMON: Right. So my mom's an alcoholic. And growing up, my mom would go to meetings of Alcoholics Anonymous - AA - in my hometown of Los Angeles. And keeping with AA's tradition, we're going to keep my mom anonymous. Anyway, her AA groups would give these sobriety birthday cakes.

(SOUNDBITE OF ARCHIVED BROADCAST)

UNIDENTIFIED PERSON: And the rest of AA makes fun of Southern California for it.

SIMON: Right. So these cakes are mostly a Southern California thing. But they get to a bigger idea at the heart of AA, which is this emphasis on not drinking at all. In some AA groups, that can make it really hard to admit that you've relapsed.

KING: Yeah, because you go back to square one. And now you've got a cake with no candles on it, right?

SIMON: Yeah. But my mom - she was very into it. And then one night a few years ago, my mom was thrashing around in her sleep. And my dad took her to the ER, and the doctors found alcohol in her blood. It turned out that for seven years, my mom had been drinking and lying about it.

KING: That must have been a really awful feeling to find this out.

SIMON: Yeah. I was upset about the lying. And I sat down with my mom to talk about it.

(SOUNDBITE OF ARCHIVED BROADCAST)

UNIDENTIFIED PERSON: I mean, it was very disingenuous.

SIMON: But why didn't you tell anyone? We could have helped you.

UNIDENTIFIED PERSON: Because it was more important to me to keep up the illusion that I was sober. I was committed to looking like I was OK.

SIMON: My mom's the kind of person who, as she says, wants things to look good. She lied to make everything seem like it was OK. And I wondered, how do you help people like that with their addiction? I used to live in Indonesia. And there's actually a word there for this need to make everything look good. It's called malu. There are a lot of ways to translate malu. But one way is to think of malu as a mask.

(SOUNDBITE OF ARCHIVED BROADCAST)

SAM NUGRAHA: Yeah, because the culture tells us we have to be polite. When we don't know the answer, then we have to smile. When we feel threatened, we have to smile.

SIMON: This is Sam Nugraha. He's from Indonesia.

(SOUNDBITE OF ARCHIVED BROADCAST)

NUGRAHA: In our culture, we are not supposed to expose our shortcomings to other people. We are not supposed to tell our feelings.

SIMON: In the '90s, there was a lot of heroin coming into Indonesia from other parts of Southeast Asia. And Nugraha became addicted in college. He landed at a rehab program with the AA approach.

(SOUNDBITE OF ARCHIVED BROADCAST)

NUGRAHA: They always introduced themself by telling, hi, my name is X. And I'm an addict. And the group immediately responded, hi, X. Like, what's going on? (Laughter).

SIMON: Was this just, like, kind of mind-boggling to just...

NUGRAHA: Absolutely. I was scared, to be honest, because it's twisting everything that you believe.

SIMON: Nugraha called this American culture.

(SOUNDBITE OF ARCHIVED BROADCAST)

NUGRAHA: Because it's very American when people saying out loud their feelings to strangers and all that.

SIMON: But Nugraha made it through the 12 steps. He graduated from client to peer counselor, and he had this client who he really liked. This guy graduated from the program, and then he overdosed. And he died.

(SOUNDBITE OF ARCHIVED BROADCAST)

NUGRAHA: And that's actually - give me - get me thinking, what was wrong? I mean, what can prevent him from dying?

SIMON: Nugraha wondered, what if preventing people from dying was more important than keeping them sober? Nugraha decided to start his own rehab in Bogor, a city about an hour south of the capital Jakarta.

(SOUNDBITE OF ARCHIVED BROADCAST)

SIMON: Look at - who are these dogs?

NUGRAHA: These are also addicts.

(LAUGHTER)

SIMON: What are they addicted to?

NUGRAHA: Human, I suppose.

SIMON: Humans (laughter).

NUGRAHA: Yeah.

SIMON: Nugraha's rehab is called Rumah Singgah PEKA. There's therapy, job training. And clients here are not required to be completely sober.

(SOUNDBITE OF ARCHIVED BROADCAST)

NUGRAHA: We do not decide what's best for our clients. The client have to decide what's best for them.

SIMON: Do some of them keep doing heroin just, like, once a week or something?

NUGRAHA: Yeah, some of them are still using.

SIMON: The patients can't use on the premises, but Nugraha does allow them to do drugs and drink alcohol while still in the program. It's the first rehab like this in Indonesia. But it's part of a movement around the world that's sometimes called harm reduction. That can include a lot of things, like prenatal clinics for people addicted to drugs and exchanges with clean syringes. Nugraha was attacked for his approach, which includes a methadone program. But Nugraha says addiction's a disease.

(SOUNDBITE OF ARCHIVED BROADCAST)

NUGRAHA: You know, many people feel ashamed when they slip and they use again. And then they don't want to admit because it gives that feelings of, I'm being a failure. It should be like, I still need more help.

SIMON: Nugraha measures success on his patients' quality of life - how healthy they are, how their relationships are going. And this harm reduction approach is really catching on in the U.S. too.

KING: OK. So, Julia, you go across the world to Indonesia. You get in really deep on this cultural concept of malu. And then you come back to the United States, and you talk to your mom again. And you tell her about it.

SIMON: Yeah. And in the same way that the Indonesians I met are kind of adapting malu and AA, my mom is also adapting AA in her life. She still goes to AA meetings. She feels like she really gets a lot from that support. But she's also realized that there are some things about AA that no longer really work for her. Like, there's this prayer where she used to say things about herself that she didn't like.

(SOUNDBITE OF ARCHIVED BROADCAST)

UNIDENTIFIED PERSON: It feels - especially when we talk about character defects, it feels like that's all I am. You know, it was helpful till it wasn't helpful anymore.

SIMON: Yeah.

And, you know, she tells me that if she relapses, hopefully, she'll tell us. But for now, she's celebrating her sobriety by herself with no birthday cakes.

KING: Julia Simon, thank you so much.

SIMON: Thank you, Noel.

KING: That was reporter Julia Simon. And this story comes from our podcast Rough Translation. They're out with a new season now on rebels around the world.

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