CHAPTER II

REVIEW OF RELATED LITERATURE

Community-Based Drug Rehabilitation Program

A community-based rehabilitation program is a type of crime prevention since

it reduces the rampant drug trade in the Philippines and promotes reformation for
drug addicts who willingly turn themselves in to the authorities so they can rejoin
society and contribute. Outpatient care predominates in community-based treatment.
This method of dealing with drug users and dependence acknowledges the
complexity of drug use. In order to be effective and produce long-lasting results, it
offers consumer and societal participation.

The Dangerous Drugs Board (2016) of the Philippines reported that 90% of
those who have voluntarily surrendered could be treated in the community. But, the
Philippines, like the other countries within Asia, has utilized mandatory residential
management in resolving the drug usage difficulties. In the given prodigious amount
of surrendered individuals, the communities provided their options consist of different
civic service (e.g., cleaning, remodeling, tree planting, gardening), recreational
activities (e.g., sports activities, Zumba, yoga, psychotherapy, and religious
development (e.g., bible study, prayer groups) (Hechanova et al., 2018).

Eradication of the drug menace is the centerpiece program of the Duterte

administration. The President claims there are more than 4 million drug users in the
country. The police used the “tok tok-hangyo” or “knock and appeal” approach, to
encourage drug users, pushers and others involved to surrender and stop their
illegal activities. The nationwide response was overwhelming as 1,176,523, pushers
and users submitted voluntarily to authorities. Without a national blueprint on how to
deal with this problem, Local Governments are left to craft their own programs to
help their constituents. The Transformational Rehabilitation Plan Community-Based
Approach to Drug Prevention and Moral Recovery Program, a 3-Phases modular
approach was implemented with a general objective to enable the participant to
 11

understand the process of healing and recovery from their old lifestyles and embrace
the new life for the future (Mazo, 2017).
Although addiction is a difficult, demanding, and frustrating affliction, good
treatment can help those who battle it live happier, healthier lives. Better outcomes
are attainable when a wide range of therapy alternatives are offered and catered to
the needs of the individual. Unfortunately, the majority of people who require
specialized drug abuse therapy do not get it. Just about 11% of those who needed
substance addiction treatment obtained it, according to a report by the Substance
Abuse and Mental Health Services Administration (SAMHSA).
Relapse is frequent despite the possibility of effectiveness in addiction therapy
due to the nature of addiction. It can be challenging for a person to manage the
stresses of daily life in a healthy way, even after receiving treatment. The skills you
acquired throughout recovery can be reinforced by taking part in an addiction
aftercare program, which will help you keep your sobriety. People who have battled
addiction are aware of how lonely and isolated it can be, especially after your
treatment program concludes. With aftercare as a base, you can establish or expand
a strong social network of people who can assist you in maintaining healthy
behaviors and lifestyle improvements (Patterson, 2023).
Recent studies on community-based and behavioral approaches to
addressing substance use highlight the importance of establishing evidence of
effectiveness (Curtis et al., 2017; Giesbrecht & Haydon, 2009; Hechanova et al.,
2019; Sy & Hechanova, 2020).
Community-Based Development Treatment (CBDT) includes providing
holistic care for recovering drug users from screening and assessment,
treatment, provision of skills training, as well as access to health and wellness
programs, livelihood opportunities, and social services within the locality (UNODC,
2014).
The CBDT approach recognizes the complexity of substance use behaviors
as a health condition that has biological, social, and psychological dimensions
(UNODC, 2014). Given this, it considers the contextual and cultural realities of
the target participants as well as enables involvement of community and family
members to ensure sustained recovery Hechanova et al., 2018, UNODC,
2014). This mode of treatment is supported by recent studies demonstrating
 12

how culturally-adapted substance use interventions show more evidence of

effectiveness than non-adapted interventions (e.g. Robleset al., 2018).
The United Nations Office on Drugs and Crime guidelines for CBDT
emphasize that programs geared towards curtailing and preventing substance
use behaviors in communities need to be both evidence-based as well as culturally
appropriate (UNODC, 2014). However, literature on CBDT in the fields of
psychology, medicine, social work, and health demonstrate varying development
considerations and effects based on age (Burns et al., 2017; Evanset al., 2013;
Fosteret al., 2016; Gfroereret al., 2003), gender (Greenfieldet al., 2007; Niv & Hser,
2007; Possick & Itzick, 2018) and educational attainment (Saueret al., 2018;
Schepiset al., 2018).
For example, previous studies have observed different behavioral patterns
among males and females in relation to drug recovery (Fattore & Melis, 2016).
Several studies have found that women, specifically, tended to demonstrate
better drug recovery behaviors when involved in women-only treatment groups
rather than mixed-gender (male and female) treatment groups (Possick & Itzick,
2018; Greenfield et al., 2007) whereas other studies found no significant
differences (Niv & Hser, 2007).
Also, participants in CBDT programs are adults whose ages span a wide
range. Studies suggest that an individual’s age can have an impact on the
trajectory of substance use behaviors and recovery (Burns et al., 2017). For
example, older adults tended to relapse when faced with temptations to drink
or use substances and when coping with negative emotions, whereas younger
adults tended to relapse in either positive or negative emotional states (Ramo
& Brown, 2008). This implies that there is a wider variety in terms of the
possible triggers of relapse for younger adults, which suggests that they could be
more at-risk in this respect.
Similarly, there are conflicting findings as to how education impacts the
trajectory of substance use behavior and recovery. O’Shea and Salzer (2019) found
that those with higher levels of educational attainment tended to experience
poorer recovery outcomes due to a lack of interventions focusing on self-stigma
and demoralization, while Schepis and colleagues (2018), as well as Sauer
and colleagues (2018), found that lower levels of educational attainment
predicted poorer recovery outcomes as a result of lack of resources.
 13

Thus, despite the emphasis on ensuring CBDT programs’ evidence of

effectiveness as well as cultural appropriateness, there seems to be a need to
nuance the impact of these programs based on variations in participants’
demographic profile. Doing so will help ensure the effectiveness of CBDTs at
the community and individual levels.

Relationship with the Family

In the rehabilitation from drug addiction, family support is essential, according

to the earlier study by Dumanguing et al. (2021). Every member of the family
receives their basic emotional requirements from their family. Contrarily, it is
discovered that having a dysfunctional family is one of the causes of a person
engaging in such behavior that results in drug addiction. The family, which was the
main and most important socialization agent and, if both its structure and function
were intact, could provide the individual with a sense of belonging and security, both
essential for social integration.
Moreover, every element of family life is profoundly affected by a family
member's drug use, including the entire family. The common inclination to control
and manage the issue was nearly always found to produce more issues than it
resolved, and it frequently put families in the uncomfortable situation of having to
exclude the drug user, whether temporarily or permanently (Barnard, 2005).
Rehabilitation is a complex process that may cause considerable difficulty for
the members of the family, who may experience guilt, anxiety, and criticism as a
result of the addict's behavior. These conflicts may focus family attention on the real
problems experienced by the addict and can lead them to become more open toward
the addict member. The family, however, can also be argued to have the power to
help the recovering addict member increase his social capital, assisting him in doing
so and assisting him in overcoming the challenges his addiction caused in the past
and which he must now overcome while reentering the normative, noncriminal
society (Cheung & Cheung, 2000).
However, because of their own experiences, the recovering addict's family
members frequently lack confidence in the process' genuineness, which makes it
difficult for them to remain hopeful (Cheung & Cheung, 2000). Only if the former
addict demonstrates himself over an extended period of time can his family
 14

members, who often have more knowledge of the addiction problem than the addict
himself, change their opinion of him (Beach et al., 1996). Oftentimes, recovering
addicts who relapse are not willing to take responsibility for their behavior and failure,
and they may blame others for not helping them in the process.
It is well recognized that drug treatment programs significantly contribute to
lowering future drug use and, consequently, criminal participation. But, one cannot
overlook the full context in which the patient is being treated, particularly the most
important agency of all, the family. The family plays a significant role in the
development of addiction, making it crucial to comprehend and manage rehabilitation
and reintegration (Giddeon, 2007).
In a study conducted by (Norizan,2015.), results showed the non material
support expected by the drug addicts. The non-material support that addicts require
from their family members in order to recover from addiction includes the continuous
support for their recovery (59.2 percent). For them, the support of their family during
their recovery is [Link] acceptance (38.8%) and Love (37%) are also two of
the most crucial forms of assistance that addicts undergoing rehabilitation programs
expect. Also, addicts expect their families to show them that they care by paying
close attention to them and their development (25.9 %). All of these expectations, if
given by the families of addicts, will positively affect the addicts fighting their
addiction. Addicts' families should consider that addicts must be given the
opportunity to prove their worth in rehabilitation, and should get enough support in all
areas during their rehabilitation process. According to the data analysis, every addict
has more than one dream to share with their families. There are two broad
categories which can be separated into two large categories which comprise material
and nonmaterial hopes. In the context of material, most of the drug addicts expect
that they can provide financial support (57.4 percent) to their [Link] addicts
hope that they can be employed and have enough money to support themselves and
their families. While the non-material form of hope that the addicts want to offer their
families is that they can make them happy. This is due to the feelings of guilt after
abandoning their families. After struggling with addiction for so long, addicts also
desire to improve and become better [Link] be loved and accepted by their
families, they want to set a good example for them and play a significant part in their
lives. They seek to restore family ties to rebuild their relationships. Norizan et al.
(2015) discovered that families have a big impact on addicts' lives and that the
 15

majority of them aspired to live better lives once their addictions were conquered.
Support from parents, spouses, and other family members can help addicts in their
rehabilitation process as they battle addiction.

Socio-economic Status

Being a drug addict is a trademark for a person who engages with it; even if
they change for the better, society will have feedback on them no matter what, as the
study of Dumaguing et al. (2021) shows the stigma, mistrust, and loss of
self-discipline were a few difficulties. To satisfy one's hunger, others admitted to living
a life of crime. The negative consequences of drugs and their stigma lead to
instability in socioeconomic standing. The voice that kept on hammering at their soul
and mind, pleading with them to stop and start a new life, but they had no idea where
to start.

The purpose of rehabilitation, in Mack's opinion (2020), rehabilitation should

be successful reintegration of many ex-offenders, correctional programs in Australia
place a strong emphasis on education and vocational training as a method of
rehabilitation. Similarly, Cunnington (2020) claims that job and education initiatives
are the doors to effective social and economic flexibility. Rehabilitation and
restorative programs should equip inmates with the essential skills and information to
assist them integrate back into society after they are released while preparing them
to do so. However, in the current society, education is deemed as very vital and
eventually influences the job one [Link] likelihood of landing a well-paying job is
slim for those with limited schooling and low literacy levels after release. Having a
job is a factor in criminal disorder. Companies are reluctant to recruit applicants with
a criminal [Link] companies won't hire ex-offenders, the person may choose
to commit crimes again, which raises the recidivism rate. Recidivism can be
decreased by programs that assist people with criminal records in finding
employment. Frequently, these programs also assist the participants in finding stable
housing and other means of subsistence.
 16

The Costs of Stigma

Stigma influences how drug users are treated, contributing to policies like
severe abstinence requirements or clients being discharged from treatment as
"failures," where victim blaming is frequent and moral judgements about the "weak
wills" of those who are seen to have "chosen" drug use. Incarceration stigma is
represented through a punishment rather than rehabilitation attitude to drug use, a
perception of drug users as "criminals," zero tolerance for any use (or relapse), and
a scorn for therapeutic methods or sympathy for persons with drug addictions (Harm,
2001).

Current statistics published by the Bureau of Justice Statistics (BJS) highlight

correctional populations within the United States. The statistics provided by BJS for
2012 show an astonishing ‘‘6,937,600 offenders were under the supervision of adult
correctional systems at year end 2012 (Glaze and Herberman, 2013). Furthermore, it
has been estimated that 1 in every 35 adult is under the heavy hand of the criminal
justice system and its web of sticky fingers; showing that 2.9 % of all adult residents
were on probation or parole—both ‘hidden barriers’ and ‘forms of invisible
punishments’ (Petersilia, 2005) compared to the rough statistic of 1 in every 108
adult that was incarcerated in the largest penal system in the world. The vast
majority (90 %) of those who have been convicted of felonies in the United States
are men. Schmitt et al. (2010) estimate that the working age ex-felon population in
the U.S. is between 12.3 and 13.9 million (or approximately 1 in 15 working aged
adults). Besides having a felony conviction, up to 70 % of offenders are high school
drop-outs (Freeman 1992; Travis 2004) and a disproportionate number are minority
individuals (Wheeler et al. 2011).

Notably, Mumola (1999) found that more than half of those who are
incarcerated were under the influence when they offended (SAMHSA 2013). Given
that the Bureau of Justice Statistics (2004) estimates that more than 700,000
prisoners are released each year, it is critical to address what has been termed
‘‘collateral damage’’ associated with being labeled an offender (Holzer et al. 2003;
Beckett 2011).
 17

Extant research on the social reintegration of offenders focuses on problems

of labeling (Luoma et al. 2007; Anderson 1991; Anderson and Ripullo 1996; White et
al. 2012) as well as challenges offenders face in gaining employment. Anderson and
Ripullo (1996) argue for a humane social campaign to de-stigmatize addiction
(Soyez and Broekaert 2003; Visher et al. 2004). Once a person is labeled deviant,
especially if that involves having a drug and offender record, it is challenging to find
employment—especially during economic downturns (Petersilia 2005; Sampson and
Raudenbush 2004; Visher and Travis 2005; Visher and Courtney 2007). The current
work explores how employers perceive the experience of hiring ex-offenders, most of
whom are recovering drug addicts, as well as how a drug treatment facility prepares
individuals for re-entry into the workforce.

Shaming, Reintegration, and Labeling

Those seeking treatment for substance misuse worry that they will be
stigmatized when they return to their old habits starting a career (Link et al. 1997;
Harris and Keller 2005; Gunnison and Helfgott 2011). Importantly, some addicts go to
rehab in the hopes that they will be accepted as normal, respectable members of
society; however, they end up feeling even more stigmatized than they did before
going to rehab (Radcliffe and Stevens 2008). According to Jock Young (1999) in The
Exclusive Society, "the meanings given to behavior become recognized as an
objective truth, a thing of solidarity instead of an arbitrary product of human
fabrication" (97).

Likewise, the application of the label of ‘felon’ creates what some call a
‘hidden barrier’ (Petersilia 1999, 2003) and impedes the mobility and life
opportunities of those labeled through the life cycle. Offenders face negative
consequences that ensue from acts labeled deviant by society that continues to
‘punish’ them even after their sentence and punishment(s) has[ve] been served. The
need to redefine what "successful treatment" and "successful punishment" mean to
those trying to "reclaim their lives" is even more challenging, but the ambiguous and
overlapping nature of these terms calls for scholars and researchers to be extremely
critical of "success" and its application to treatment methods and systems that
 18

include punishment through gulags among many other barbaric means of punishing
people.

According to Ferrell et al. (2008:25), "ideas don't just appear out of thin air;
they occur in specific locations, at specific times, and in specific cultural and
economic settings. These concepts, when placed in a "deviant" or "criminal" context,
lead society's members to categorize or condemn particular behaviors and activities.
It has been contested inside. The social construction of the meanings and rules of
"illegality" and "deviance" is allegedly broken, twisted, and other "unorthodox"
criminological circles believe twisted and patched. The elite or those in positions of
power in the US have reified and legitimized these social structures (see Ferrell et al.
2008; Currie 2009).

According to Australian criminologist John Braithwaite (1989), the way we

perceive crime is out of date. The nature of the deed, recognizing a clear distinction
between behavior and action, with action being given its significance through social
construction while behavior is considered as essentially physical. When shaming
marginalizes offenders towards criminal subcultures (e.g. drug using subcultures) it
is causing dissatisfaction for both individuals and society. Yet when it is both effective
and "bounded by ceremonies to reintegrate the offender back into the community of
responsible people," shame has the power to reduce crime (Braithwaite 1989:4).

Economic Barriers Drug Surrenderees Face

The term ‘‘collateral damage’’ has historically been used as a euphemism for
civilian casualties during war; however, researchers have begun to apply this
concept to being labeled an offender (Holzer et al. 2003; Chiricos et al. 2007). Laird
(2013) contends that after being classified as an offender, people face severe
employment obstacles, legal constraints, bias, and restrictions on their civil rights. A
history of incarceration is thought to diminish employment opportunities by 15–30%.
Historically, certain occupations have been closed to offenders including those that
have contact with children, certain health occupations, and employment with
organizations providing security (Holzer et al. 2004; Gunnison and Helfgott 2011).
Additionally, under the premise of "negligent hiring," companies may be held
 19

accountable for the illegal conduct of their workers in many states. Significantly, 72%
of careless hiring by businesses has been lost cases where the average settlement
exceeded 1.6 million (Glynn 1988; Connerley et al. 2011).

In addition to these formal employment restrictions, unqualified drug

surrenderees must compete in a labor market with few positions available to those
with low skill levels (Freeman 1992; Holzer et al. 2006; Grogger 1996; Petersilia
2005; Sampson and Raudenbush 2004; Travis 2004; Visher and Courtney 2007). On
the other hand, criminal history records are increasingly available to non-criminal
justice users. Still, Holzer et al. (2003) found that once employers understood that
many drug surrenderees were incarcerated for non-violent drug-related offenses,
and that these offenders had sought rehabilitation, then they were more willing to
hire them (Ewald and Uggen 2012).

Social Networks and Social Environment

With respect to social networks, we can see that once again, there is a
complex interrelation between variables that make the transition from incarceration
or criminal and drug culture to the general community extremely difficult. The
majority of the drug surrenderees are parents. Mumola (2000) reported on a Bureau
of Justice Statistics survey in 1999 that revealed that approximately 721,500 parents
were incarcerated. To protect their parental rights, incarcerated parents must work
consistently against difficult barriers both while in prison and upon release to
preserve parental rights. Solomon, Gouvis and Waul (2001) reported various
challenges to successful reintegration including reunifying with families and
assuming a role of responsibility within the family structure, maintaining sobriety,
creating positive support networks and avoiding negative ones, finding stable
employment, and obtaining housing. The ex-prisoners sample also affirmed that a
critical element to their success was a readiness or resolve to change.

Baldry, McDonnell, Maplestone and Peeters (2002) described social isolation

as a “core experience” of many ex-prisoners as a result of homelessness or
unstable, unsuitable housing. Likewise, Nelson et al. (1999) reported that drug
surrenderees commonly expressed a feeling of powerlessness over their
 20

environment and a general lack of control over their own actions when asked to
predict future success and the likelihood of their return to prison. As well, they found
that prisoners returning to the community with weak or no family support were less
likely to succeed in reintegration than those with strong family support.

Sustaining Accommodations

Accommodation is a critical area that may affect successful transition into the
community and present a barrier to a more positive lifestyle. Problems finding and
sustaining stable, liveable, and affordable accommodation can impact on various
social and health-related conditions, social network and employment. Crisis
accommodation such as backpacking hostels and transient hotels may, for example,
provide a “breeding ground” for substance abuse and alcohol abuse, as well as
limiting the ex-offender’s social network to other individuals with similar backgrounds
(Rowe, 2002).

Researchers have acknowledged that drug rehabilitation may be largely

ineffective if problems related to the need for secure and affordable accommodation
are not addressed (Webster et al., 2001). Unstable and unsafe housing also
exacerbates the difficulties of drug surreenderees with histories of substance abuse
and medical health problems as these conditions are more disruptive to medical
adherence and continuation of care (Hammett et al., 2001). Nelson et al. (1999) also
indicated that those in homeless shelters were much more likely to abscond from
parole than those ex-prisoners who lived with their families upon release. Likewise,
Hirsch et al. (2002), discussed how unstable housing may disadvantage an
ex-offender in terms of maintaining employment and resuming and reunifying family
relationships including participation in child care, and in turn, how lack of income
may impact on finding and keeping stable accommodation. Ogilvie (2001) supports
the view that financial limitations can make it extraordinarily difficult for recently
released offenders to access reasonable housing.
 21

The Criminal Justice System: Legal Barriers Faced by Drug Offenders

Various legal issues may present problems for the drug surrenderees upon
release, including difficulty in accessing public benefits both in the short- and
long-term, the risk of losing access to his or her children (if not lost already), and the
difficulty (or even inability) to obtain federal financial aid to further study (Hirsch et
al., 2002). Others have identified legal barriers including laws that prohibit entry into
particular job positions, and the employer’s right to access an offender’s criminal
record in some cases (Mukamal, 2001). Corporate policy restrictions on hiring
ex-prisoners add to the difficulties of this group in reentering the workforce (Taxman,
Young, & Byrne, 2002). The observation that low skilled jobs with no provision for
benefit packages are typically restricted to drug surrenderees may, in part, be
attributed to these formal and informal restrictions (Taxman et al., 2002). Additional
problems may relate to the difficulty meeting several responsibilities required for
release, including finding employment, random drug screenings, day reporting, and
regular parole or probation-officer meetings (Buck, 2000). Other civil restrictions that
may limit full participation in the community include the right to vote and undertake
jury duty (Visher & Travis, 2003), restrictions on public housing, and public access to
criminal histories, most notably Internet-based identification of released offenders
(Taxman et al., 2002).