This brief article is meant for counselors, family members, and those suffering from addictions. By addictions, I mean both behavioral, such as gambling, and substance abuse, such as alcohol and drugs. I will only consider three areas of addiction treatment, as I consider these three crucial to favorable outcomes.
As an American Addiction Specialist since 1979, I have worked in Singapore in that capacity for the better part of 5 years between 2005 and 2011. Prior to full time work there, I presented several addiction workshops in Singapore between 1998 and 2001. I was employed by both the National Institute of Mental Health (IMH) in their National Addictions Management Services (NAMS) as their Principal Therapist, and with WE CARE Community Services, a Voluntary Welfare Organization (VWO), as their Program Director. (At that time NAMS was known as Community Addictions Management Program (CAMP).
We Care was registered as an independent charity in 2005, however it maintained an extremely close connection with CAMP (IMH) using much of their equipment and personnel until 2007 which it became entirely independent of IMH. It was the first of its kind in Singapore, and perhaps in all of Southeast Asia, that devoted its entire programming to the treatment and in the service of those suffering from addictions and their families.
This was no minor accomplishment, given the atmosphere surrounding addiction treatment in Singapore.
Addiction treatment in Southeast Asia, as understood in the West, was in its infancy. Thanks to the visionary leadership of Dr. Muni Winslow and support from Professors Tan Chorh Chuan, Wong Kim Eng, and Kua Ee Keok, addiction treatment is securing a legitimate place in Singapore medical and psychological treatment.
Education:
Many people addressing addictive diseases have little to no education in this speciality. This is particularly true with counseling based in local churches or in more general practice counseling agencies.
It is also true that for many addicts, general practitioners are the first professionals sought out when things become difficult for the addict. They are often asked to prescribe, in particular, benzodiazepines and sleeping medications. Both can be addictive in themselves but they may also be used to relieve the anxiety of other addictive problems such as gambling, shopping, or internet addiction. You then end up with two addictions.
I do think the educational program, Window on Addictions, produced by Promises, a local private agency, under the direction of Dr. Winslow, is a good place to start for a brief, but thorough education. There are many other workshops offered by the National Council of Social Service, (NCSS) throughout the year; and there is an International Conference on addictions every two years in Singapore. The 2nd Asia Pacific Behavioral & Addiction Medicine (APBAM) will be held in Singapore from 1st to 3rd November 2012.
Family members and even addicts are often able to attend these events. Contact WE CARE for further information. They can also suggest and provide reading material. Individuals reading this article might also suggest that various organizations they belong to might invite in a speaker to talk about addictions to their group. Again, contact WE CARE or IMH, or even look on the Internet.
Be aware that without knowing about addictive diseases, both the well meaning professional and loving family member is likely to engage in behavior that is counter-productive to recovery and only foster a continuation of the problem. Traditional approaches to these problems do not work. For example, it is a well known practice for families and even churches and agencies to “bail out” compulsive gamblers from debt, especially if the gambler has gotten into the grips of the loan shark.
Family work
Addiction is a family disease. I have often 
found that it is extremely difficult to engage family members in the recovery process. As a result, by not being involved, they often sabotage the addict’s recovery process. Some of this is due to ignorance regarding addictions, and some due to the structure of the Asian family.
Many professionals have been trained at least superficially in family therapy; however, one not only needs to understand addictions, but also needs to understand the particular structure of the family in the ethnic group being served. Often a Western model is learned which has little relevance to the Singaporean Asian populations.
I do think that the free groups at WE CARE are very helpful in educating families. Also, there are public education groups occasionally offered throughout Singapore. I would contact IMH or WE CARE for information about these programs.
Lastly, many suffering from addictive diseases have co-occurring disorders, especially trauma. By trauma I mean substantial psychological distress often caused by sexual abuse, violence, or medical issues. Trauma needs to be addressed and treated at the same time as the addiction. Occasionally, two professionals working closely as a team are able to do this; however, it is probably more productive to have only one therapist, if possible.
The 12 STEPS
For those of you who are not familiar with the term “Twelve Steps”, it refers to free self-support groups who use a particular format to address and recover from addictions. We are now so fortunate to have many of these groups in Singapore. Again, contact WE CARE for island wide references to all these groups. There are also groups for family members as was mentioned earlier. Professionals should be familiar with their format and philosophy and refer their clients to these groups.
It is important to understand that addiction requires a deep and profound psychological change in the addict for a lasting, successful, and happy recovery. Addiction is not just about being free of the substance or behavior.
Singapore has come a long way in the past ten years in addressing addiction treatment and recovery issues. A new program opened at Changi General Hospital with a fine staff under the leadership of Dr. Andrew Peh Lai Huat, providing both inpatient and outpatient care in addition to the programs at IMH, WE CARE, halfway houses, and other agencies in Singapore who now have trained addiction therapists on staff.
Addiction treatment is difficult to sell as most still believe it is a moral wrong or something that the weak-willed do. Families see the impact on their lives of their loved one’s addiction, but either choose to conceal the devastation, or exclude the family member from family involvement. Families often give money, time, and other personal resources, hoping with all their love and attention that the addict will see the error of his ways and stop the behavior.
Counselors often apply tried and true psychological techniques when working with addicts and are dismayed that they never seem to work. Everyone gets tired of the relapses and all the effort going into what seems like a bottomless pit. Often counselors believe that addicts are simply untreatable. Thus, education is the first absolute for all wishing to understand addiction both professionally and personally.
Hopefully, in the near future, Singapore will launch a national campaign addressing addictions as a treatable family disease.
CONTACT RESOURCES:
WE CARE Community Services, www.wecare.org.sg
Tel : 6471-5346
National Addictions Management Services, www.nams.org.sg
Tel : 6732-6837
Promises Pte Ltd, www.promises.com.sg
Tel : 6397-7309
Changi General Hospital, www.cgh.com.sg
Tel : 6788-8833
Copyright © 2012 by Marge Nixon, LCSW
Marjorie Nixon is a Licensed Clinical Social Worker from the Untied States. she specializes in the treatment of addictions and provides program development and training in this specialty. Between 2005 and 2011 she worked in Singapore in the field of addictions.