Decoding the Harm Reduction approach from former substance users who have become a "Bridge of Hope" to bring youth back to the community, providing a path to reintegration.
Substance addiction treatment does not always begin in formal rehab centers; it can start in small community spaces, such as a corner of Ban Mae Kasa community in Mae Sot District, Tak Province. "Kawi Kaenchanthong" A 37-year-old farmer currently serving as a "Gateway" for active substance users. He volunteers with the Give Hope team of Tak Province, acting as a pillar of support and hope in his community to guide youth back to their families, utilizing personal assets that government agencies or public health officials might not reach — namely, "understanding" as a former substance user himself, and "trust" from peers within the same circle.
Before reaching this point, Kawi had struggled through the storm of addiction. His reason for substance use differed from many others; it did not begin with youthful recklessness or peer pressure. In fact, as a youth, he was part of a group opposing drug use. However, at 32, as the family’s main support, caring for an ill father and a studying younger sibling, the daily hard labor led him to use substances to relieve fatigue.
At that time, Kawi worked at a sugarcane factory, sometimes from 5 a.m. until 11 p.m., occasionally working through the night without returning home. Colleagues introduced him to "opium" claiming it relieved pain without causing addiction or positive drug tests. Kawi admitted it initially eased his body aches, but when the effect wore off, the pain intensified, forcing repeated use and leading to addiction.
"At first, I was careless, thinking at my age I couldn't get addicted and could quit anytime. I managed to quit for two or three days but relapsed when friends offered it again."
Since opium smoking was complicated, after about seven to eight months, Kawi switched to "heroin" which was easier and faster to use. However, its stronger effects led his use to spiral from relieving work fatigue to consuming his life. He was heavily addicted for two years. Although he worked more, his income was spent entirely on heroin. Without the drug, he suffered withdrawal, poor health, and could barely live, thinking daily only about how to get money to buy drugs.
"As the strongest person, bearing responsibilities for my younger sibling, home, father, and mother, I thought drugs would help me keep going. But it wasn’t like that. Opium helped with pain after work, but when I switched to heroin, it was to work faster. The problem was when the heroin ran out, I had to find more to keep working; without it, I couldn’t work."
His addiction affected not only himself but also his family, who depended on him. Even reliable car payments were missed. Fortunately, his family never looked at him with disgust and kept encouraging him. His mother repeatedly told him it was not too late to change.
"I was disappointed in myself, but withdrawal was agonizing—nothing could help. I writhed in pain all over my body, joints, and bones."
Feeling pity for his family, Kawi tried to quit many times on his own—20 to 30 attempts—but feared going to a hospital for treatment, worried about the stigma of being labeled "a drug addict" and how it would affect his record and career. Yet, the withdrawal pain forced him back into use repeatedly. He always hoped to quit until his health failed. Then, his family became the reason he agreed to seek treatment.
"I had researched that Thanyarak Hospital in Chiang Mai offers drug treatment. When I told my mother, she immediately called my sibling to take me there on the night of 17 October 2024. I clearly remember that day. While in the hospital, I reflected and thought I shouldn’t have gotten involved with drugs; if I hadn’t, I wouldn’t be here now."
Kawi began treatment using "methadone," an opiate substitute. Over 14 days, the methadone dosage was gradually reduced. For the next 14 days, he was transferred to another ward to adjust his behavior through activities like sports and music to encourage social interaction.
After nearly a month, he was freed from the drug cycle and slowly became his former self again, a "pillar of the family," and took on a new role as "a pillar of the community" helping other substance users.
Once free from addiction, Kawi wanted others, especially friends and youth in his community, to succeed. He volunteered, leveraging his local knowledge and understanding of the language and fears of substance users—the shame and pain of quitting—to break down barriers and encourage them to enter treatment voluntarily.
"They are all afraid—afraid we are police informants, afraid information will be reported to authorities. But with me, they trust somewhat because I tell them I won’t send anyone to jail; I know jail only causes more suffering."
Kawi continues helping his community following the Harm Reduction approach, first by knocking on doors to talk with substance users and their families, distributing clean needles to prevent disease transmission. He understands many users are not ready for immediate treatment. He explains to families that this does not encourage ongoing drug use but, at least, using clean equipment reduces risks until they are ready for rehab, avoiding additional health burdens like tuberculosis, hepatitis, or HIV.
Through consistent conversations, he persuades users to accept treatment, supports them during relapses, reducing psychological harm, and when they are ready, coordinates with hospitals and even volunteers to transport them if families cannot.
"Some needle users aren’t ready or willing to quit yet. Forcing them makes it worse. At least, we provide clean equipment to prevent infections. If they can’t quit now, at least they can live without catching diseases or viruses."
Kawi has continued methadone treatment for two years while actively guiding community members into rehab. Proudly, he has helped return 5 to 6 youths to their parents.
"Families want their lovely children back. When the children return, the family is joyful. Seeing their smiles makes all my efforts worthwhile."
However, knowing from his own repeated failed attempts, Kawi understands recovery is difficult and may not happen immediately. Many he helps relapse even after treatment.
He never gives up and encourages families not to lose hope, reminding them that whenever someone struggles, he is ready to bring them back to treatment. As long as there is life and connection to care, there is always a way out of the cycle.
"Harm Reduction literally means reducing harm from substance use, aiming up to quitting. They are human, not monsters, once good people. Even if we can’t make them quit immediately, improving their health is a success. Sometimes we talk to encourage them; if they quit, great; if not, we take it step by step, supporting each other along the way."
From Tak Province down south to another part of Thailand, Songkhla Province, "Robert Laerod" a 55-year-old fisherman, also used drugs to help with work. Unlike Kawi, Robert used substances to create an "alternate world" to escape childhood wounds and hardships. Eventually, he realized that world was false and destructive, costing him relationships with loved ones.
Robert shared that his mother died shortly after his birth. Raised by his father and stepmother, he completed only primary grade 6. As a boy, he began fishing for hire. At 14, his stepmother died, and his father left for a new partner, leaving him without adult guidance. He faced hunger, abandonment by lovers, and despair, even contemplating ending his life several times.
Robert began using "heroin" initially to forget pain and to work longer. His use escalated and expanded to other substances, including marijuana, methamphetamine, and crystal meth.
"When stressed or troubled, drugs were my companion, helping me forget my worries, drifting away from myself temporarily, and helping me sleep. On some days, I worked from 8 a.m. until 4 a.m., relying on drugs to keep going."
Despite drug use, Robert maintained a family with his wife and child. Though others warned his wife of potential harm, Robert believed that many drug users are not dangerous. Over ten years of marriage, he never harmed her and, when craving drugs, preferred to be alone in the forest to avoid others.
"It depends on personality. Aggressive people tend to be aggressive whether or not they use drugs. If an aggressive person uses drugs, it worsens because it mixes with their irritability."
Though able to continue life, drug use harmed Robert’s physical health and caused stigma from outsiders. Seeing himself and his wife aging, he resolved to spend his remaining life with her as long as possible.
"I thought about my wife—if I keep using drugs, how would she manage? I realized heroin isn’t what I love; it’s just an illusion. What I truly love is my wife and family. So, I committed to quitting. When I told my wife, she gave me a chance but said I must succeed for our future. That made me realize this was the right path because she gave me a chance; otherwise, I wouldn’t be here."
Robert entered methadone treatment, gradually reducing drug use. His spending on drugs decreased from 500 baht per session to 200, leaving more for living expenses. Although not yet fully abstinent, he believes he will reduce use further and eventually quit. The most important motivation is encouragement and kind words from those around him.
Robert treasures a book titled "Train Your Brain to Quit Using" which he reads daily to remind himself. The book’s most impactful message was not methods to quit but positive encouragement to think positively and not dwell on past pain.
"It tells you to think positively. If you see flowers, think only of flowers. I try to focus on beautiful things, which helps me forget. If you want to plant trees, just do it. Comparing planting trees to using drugs, which is better?"
The book also taught Robert that even after treatment, relapse can happen. Treatment helps clear the body’s toxins, but returning to old social environments risks relapse.
Therefore, Robert encourages other substance users to enter treatment, offers support, uses positive language, and educates the community to reduce stigma. A non-judgmental community is vital so users do not feel isolated and return to addiction.
"I explained to village elders that when they see drug-using youth, they get scared and chase them away. But I know the child’s character well. When rejected, the child becomes angry and resentful, though they have done nothing wrong. This kind of society increases bitterness and resentment. I try to tell them to understand and not be angry."
Today, Robert openly shares his substance use experience honestly without shame, hoping to inspire others to seek treatment and warn those who have never used drugs not to enter this cycle.
Not far from Songkhla, in Trang Province, "Duen" (pseudonym) a 50-year-old former sex worker, also used substances to cope with daily life and work, alleviating the pain from a profession and life she did not choose.
Duen admitted that during her youth, she was rebellious, disobeying her parents and enjoying nightlife. At 19, she and friends were lured by a waitress in Bangkok to work in Hat Yai.
They were tricked into eating food that rendered them unconscious. Upon awakening in a locked room guarded by many, they were told they had been sold for 1,500 baht each.
"I was shocked and wanted to escape but couldn’t. Guards were everywhere. That evening, they ordered us to put on makeup and clothes; I realized we were to provide sexual services."
This work forced Duen to use various substances—ice, methamphetamine, glue, marijuana, and sometimes heroin—as well as unknown "sex stimulant drugs" her employers forced her to take to work without resistance or shame. Eventually, addiction became a condition for working daily, even when ill, as refusal meant no drugs and beatings or wage deductions. "It made me happy, forgetting all suffering and sadness, feeling fun every day. When taking clients, I didn’t think if I was happy, just that I earned money. But when the drug wore off, I felt terrible, wondering what abuse I’d face next." Trapped in a cycle of violence and control for over 23 years, Duen finally escaped after being severely abused while working away from home. She sought help from a waitress, who helped her flee.
"She was like an angel who saved me. Without her, I don’t know if I’d be alive or dead now or how long I’d stay there. Would I ever see my parents again?"
After escaping, Duen began a new life with her mother in Trang, hiding her past from the community. However, the trauma caused panic attacks, and she could not fully quit drugs. She admitted to still using substances occasionally but tries to control and minimize use.
"Drugs are like a mother, attracting me and relieving stress and giving happiness. It feels like being newly born from a mother's womb, free from stress and able to comply with any command."
Though not yet fully recovered, Duen volunteers as a frontline worker building trust with substance users, encouraging voluntary treatment especially among youth, men who have sex with men, and former sex workers. Over six years, she has helped more than 50 people.
From the experiences of Kawi, Robert,
and
Duen, they agree that successful quitting does not start by forcing users into treatment immediately, as this risks relapse. Instead, systems should allow users to gradually reduce harm from drugs, "understand" their goals and be "willing" to quit on their own, following the Harm Reduction approach. This approach benefits not only users but also public health efforts. Sakina Suwan, an experienced professional nurse, head of the Psychiatry and Substance Abuse Department at Chana Hospital, Songkhla,
with 20 years in addiction treatment, views drug addiction as a chronic disease like diabetes or hypertension, calling it "brain addiction disease"—using substances to feel pleasure and being unable to quit. Yet it is more complex, as symptoms and causes don’t always match textbooks, and most patients do not voluntarily seek treatment; professionals must reach out first.
"Substance users and their families are the best textbooks. When asked why they started drugs, they often say curiosity or peer influence. But deeper interviews reveal family, living conditions, and environment influence their identities leading to drug use. For example, living in drug-using environments or upbringing that leaves them unable to cope with problems properly, so they resort to drugs." For Sakina, treating drug addiction isn’t one-size-fits-all. Each individual has different tolerance and reasons for use. Poly-substance users show different symptoms and behavioral issues. Being a
"chronic disease"
means treatment is difficult and can demoralize staff.
"As a therapist, the ultimate goal is to help patients quit drugs. Early on, seeing patients quit was joyful. But in years two or three, seeing relapses can cause burnout." Sakina learned that Harm Reduction helps prevent burnout by providing gradual steps for users and staff toward the same goal—quitting drugs. The first step involves users not directly entering treatment but through networks engaging patients, families, and communities to open their hearts and willingly enter treatment.
Next, staff assess patients’ physical and mental health for complications or psychosis and address these immediately. Treatment includes methadone to gradually reduce drug use.
"Some may think methadone should cure immediately, but Harm Reduction focuses on reducing various risks. First, it helps reduce cravings that might otherwise lead to theft. It keeps patients safer even if they still use drugs. Goals can be small, like reducing from multiple drugs to one, then to methadone only. Harm Reduction eases public health workload with short- and long-term goals."
Sakina sees current substance treatment systems have advanced since she began, with more understanding and programs supporting patients, like the CBTx community rehabilitation center. This addresses economic pressures that otherwise cause relapse after treatment due to lack of jobs.
Beyond economics, stigma and prejudice in communities hinder reintegration. Sakina stresses that community education is essential to reduce fear and spread accurate information, not just reinforce stereotypes of drug users as violent.
From her experience, not all users are dangerous; danger arises with coexisting mental symptoms. Actual violent patients are fewer than perceived. At Chana Hospital, among thousands of users, about 500 enter treatment, and only around 32 are violent or aggressive.
"Users often can’t care for themselves due to drug effects. When society says, ‘It’s your problem,’ no one helps, and they solve problems wrongly, leading to family, community, and national issues."
Sakina believes society must stop stigmatizing and see substance use as a collective issue to overcome, which will drive Thailand’s success in combating drug problems.
"Labeling users as outcasts perpetuates the problem. When society values and embraces them, they become central and supported. But currently, society pushes them aside, so the problem remains because people don’t see their worth, like the saying, ‘You don’t care unless it’s your own child.’"
The journey to reclaim the lives of substance users is not simply treatment but requires understanding, opportunity, and seeing their humanity above all. When hope fills the heart and the body heals, lives once consumed by drugs can always begin anew.
