Decoding the Harm Reduction approach through the journey of former substance users who have become “bridges of hope,” leading youth back to their communities.
Addiction treatment doesn't always start in treatment centers but can begin in small community spaces, such as a corner of Ban Mae Kasa community in Mae Sot District, Tak Province. “Kavee Kaenchanthong” A 37-year-old farmer currently serving as a “gateway” for active substance users. He volunteers with the Give Hope group in Tak Province, providing support and hope to families seeking to bring their children back home. He relies on a personal strength that official systems or health workers may not reach, which is “understanding” as a former user himself, and “trust” from peers within the same cycle.
Before reaching this point, Kavee endured the storm of addiction. His initial reason for using substances differed from many; it was not youthful recklessness or peer curiosity. In his youth, he was even part of a group opposing drug use. However, at age 32, as the family’s pillar, caring for a sick father and supporting a sibling’s education, the daily hard labor led him to use substances to relieve exhaustion.
At that time, Kavee worked in a sugarcane factory, sometimes from 5 a.m. until 11 p.m., occasionally working overnight without returning home. A coworker introduced him to “opium” claiming it eased aches and pains without causing addiction and that drug tests wouldn't detect it. Kavee admitted that it did relieve his body pains temporarily, but once the effect wore off, the pain returned stronger, compelling him to continue using, trapping him in addiction.
“At first, I was careless, thinking at my age I couldn’t get addicted. I tried quitting for 2-3 days, but when a friend brought it again, I used it.”
Due to the complicated process of smoking opium, after about 7-8 months, Kavee switched to “heroin” because it was easier and faster. However, its stronger effects gradually consumed his life more deeply. Though he worked more, his earnings went toward buying heroin. On days without use, he suffered severe withdrawal symptoms, deteriorating health, unable to work or even live normally, constantly worrying about where to get money for drugs.
“As the strongest person in the family, bearing responsibility for my sibling, home, father, and mother, I initially thought it helped me keep working. Opium helped relieve aches to rest, but heroin helped me work faster. The problem was when I ran out, I had to find more; without it, I couldn’t work.”
His addiction affected not only himself but also his family, leading to missed car payments he never missed before. Fortunately, his family never looked at him with disdain but warned him, with his mother constantly urging him to turn his life around while there was still time.
“I was disappointed in myself, but withdrawal symptoms were unbearably painful with no relief—writhing in pain, stomach cramps, muscle and joint aches everywhere.”
Out of compassion for his family, Kavee tried to quit many times—20 to 30 attempts—hesitant to seek hospital treatment, fearing the stigma of being labeled a “drug addict,” which could ruin his record and career. Yet the torment of withdrawal forced him back into use, caught in a vicious cycle, though he always held hope of quitting until his body could no longer endure. Then, his family again became the reason he agreed to seek treatment. “I had researched and found that Thanyarak Hospital in Chiang Mai offered addiction treatment. When I told my mother, that night she called my sibling to take me there immediately. It was October 17, 2024, a day I remember clearly. While hospitalized, I reflected on everything and regretted ever getting involved with drugs; if I hadn’t, I wouldn’t be in this situation.” Kavee began treatment with
“methadone,”
an opium and heroin derivative substitute. Over 14 days, the methadone dose was gradually reduced. Then, for another 14 days, he was moved to another ward to adjust his behavior, engaging in activities like sports and music to interact with others. Nearly a month of treatment pulled him out of the drug cycle, restoring Kavee to his former self as “the family’s pillar”
and opening a new role as “a community pillar” helping other substance users. From “substance user” to “helper” After breaking free from addiction, Kavee wanted others, especially friends and youth in his community, to succeed as well. He became a volunteer, leveraging his local roots, fluency in users’ language, and understanding of their fears, shame, and withdrawal pains, gradually breaking down barriers and encouraging them to enter treatment voluntarily.
Kavee advances community assistance through the Harm Reduction approach, starting by visiting substance users and families, distributing clean needles to reduce disease risks. He understands many users aren’t ready for immediate treatment and explains to families that while not endorsing continued use, at least using clean equipment prevents diseases like tuberculosis, hepatitis, or HIV, which would add physical burdens and costs.
Through consistent engagement, he persuades users toward treatment, provides emotional support during relapses, and when ready, coordinates with hospitals, even volunteering to transport them if families cannot.
“Some still use needles and are not ready or willing to quit, and forcing them backfires. At least they should use clean equipment to avoid infections. If they’re not ready to quit today, they can live without contracting diseases or viruses.” To date, Kavee has continued methadone treatment for two years while actively guiding community members into treatment. Proudly, he says he has helped return five to six youth to their parents. “Families want their loving children back. When they return, the joy and smiles of parents make me forget my fatigue.”
However, having failed multiple times to quit on his own, Kavee knows the journey is difficult and often not a one-time success. Many he helps relapse even after treatment.
Yet, he never gives up and encourages families not to lose hope, reminding them that if a relapse occurs, he is ready to bring them back to treatment, because as long as there is life and connection to care, there is always a way out.
“Harm Reduction literally means reducing the harm from drug use, aiming toward cessation. They’re human beings, not monsters, once good people. Even if we can’t help them quit immediately, improving their health is a success. Sometimes, we talk and encourage them—if they quit, great; if not, we take it step by step together.”
From Tak Province southward to another part of Thailand, Songkhla Province,
“Robet Lae Rod,”
a 55-year-old fisherman, also used substances to cope with work. Unlike Kavee, Robet used substances to create “another world,” escaping childhood wounds, hardships, and eventually realizing that this alternate world was unreal and slowly destroyed his relationships with loved ones.
Robet recounted his childhood: his mother died soon after his birth; he grew up with a harsh stepmother; only completed grade 6; began fishing as a child; lost his stepmother at 14; his father left for another family; grew up without adult guidance; sometimes went hungry; was abandoned by a lover; and often thought of ending his life.
Robet began using “heroin” initially to forget pain temporarily and to work longer. It worked, so usage increased, leading to addiction and use of other substances like cannabis, yaba, and ice.
“When I’m worried or stressed, drugs are my companion, helping me forget, become detached, and sleep. Some days I work from 8 a.m. until 10 p.m., much longer than usual. When my body can’t keep up, I need stimulants.”
Despite using substances, Robet maintained work and a loving family. Though others warned his wife about potential harm, he believed many users are not dangerous. In over ten years of marriage, he never harmed her. When craving drugs, he would isolate himself quietly in the forest. “It depends on one’s personality. If you’re aggressive, even without drugs you’re angry. If you’re already aggressive and add drugs, it worsens because it mixes with cravings.” Though he sustained life, substance use damaged Robet’s physical health and brought stigma from others. Seeing himself and his wife age, he resolved to live their remaining years together as long as possible.
“I thought about my wife’s future if I kept using. I realized heroin wasn’t what I loved; it was an illusion. What I truly love is my wife and family. So, I committed to quitting. When I told her, she gave me a chance but said I must succeed for our future. That was the right moment because she gave me hope; otherwise, I wouldn’t be here now.”
Robet entered methadone treatment, gradually reducing substance use from spending 500 baht per session to 200 baht, freeing more money for living expenses. Though not fully clean yet, he believes he can continue reducing until he quits, driven by encouragement from those around him.
Robet treasures a book titled
“Train Your Brain to Quit”
which he reads daily to remind himself of his determination. The book’s greatest impact was not methods but positive encouragement to think optimistically and not dwell on painful past experiences.
“It tells you to think positively. If you see flowers, think only of flowers. I try to think of beautiful things, which really helps me forget. If I want to plant a tree, it says to go do it, and when planting, compare it to using drugs—which is better?”
The book also taught Robet that even after treatment, victory over addiction is not guaranteed. Treatment clears toxins, but returning to the same social environment risks relapse. Thus, Robet encourages fellow users to enter treatment, offers support, uses positive language, and educates the community to reduce stigma. A nonjudgmental community is vital to prevent users from feeling isolated and returning to addiction. “I explained to village elders that when they see kids using drugs, they get scared and chase them away, not knowing the kids’ true nature. Being chased angers the kids, who haven’t done anything wrong yet. That’s a society judging prematurely, which fuels resentment. So, I tell the kids not to be angry; I understand their feelings.”
Today, Robet openly shares his addiction story sincerely, without shame, hoping others will see him and seek treatment and to warn those who have never used drugs to avoid that path.
Not far from Songkhla, in Trang Province,
“Duean” (pseudonym),
a 50-year-old former sex worker, also used substances to endure daily life and work, easing the pain of a life she did not choose.
Duean admitted that in her youth, she was rebellious, disobedient, and enjoyed nightlife. At 19, she and friends were lured by a waitress to work in Hat Yai. After eating food given by the woman, they woke locked in a room guarded by many, told they had been sold for 1,500 baht each.
“I was terrified, wanted to escape but couldn’t. They controlled us constantly. That evening, they ordered us to dress and apply makeup; I knew we had to provide sexual services.” This work forced Duean to use multiple substances—ice, yaba, glue, cannabis, occasional heroin, and mysterious “sex stimulant pills” that employers compelled her to use to work without resistance or embarrassment. Addiction became a condition to work daily; even when sick, she had to comply or lose access to drugs, facing beatings and wage deductions. “It made me happy, forget all sorrow and sadness, enjoy every day. When serving clients, I didn’t think about happiness, just the money. But when the drug wore off, I felt terrible again, wondering how they’d force me next.”
Duean was trapped in a 23-year cycle of violence, control, and pain, using drugs to cope until one day, after being abused by an employer while working away from home, she sought help from a waitress who successfully rescued her.
“She was like an angel who pulled me out. Without her, I don’t know if I’d be alive or dead or when I’d see my parents again.”
After escaping, Duean started a new life with her mother in Trang, hiding her past from the community. Nevertheless, the trauma caused panic disorder, and she has not fully quit drugs, using them sporadically but trying to control usage.
“Drugs are like a mother; they attract me, help me not stress, make me happy, like I was just born again, free from worries, and obedient to commands.” Though she has not yet fully left drugs, Duean now volunteers as a frontline worker building trust with 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 Kavee, Robet,
and Duean,
there is agreement that successful quitting doesn’t always begin with forced treatment, which risks relapse. Instead, a system allowing users to gradually reduce harm is preferable,
“understanding”
their goals and
“willingness”
to quit on their own, following Harm Reduction principles.
This approach benefits not only users but also public health efforts. Sakina Suwan, an experienced psychiatric and addiction nurse and head of the psychiatric and drug addiction unit at Chana Hospital in Songkhla Province, has worked in addiction treatment for 20 years and views addiction as a chronic disease similar to diabetes or hypertension, calling it a “brain addiction disease” because users seek happiness from substances and cannot quit easily. The disease is complex and often does not follow textbook patterns, with most patients not seeking treatment themselves; professionals must reach out first. “Substance users and their families are the best textbooks. When asked why they used drugs, they often say curiosity, peer influence, or fun. But when we explore family, living conditions, and environment, these factors shape personalities that face problems without proper coping skills, leading them to use drugs as a solution.” For Sakina, treating addiction isn’t one-size-fits-all; it requires individualized care because each patient has different tolerance and reasons for use. Polysubstance use causes varied symptoms and behavioral problems. Being a “chronic disease” means treatment is challenging and can be disheartening for staff. “As a therapist, the ultimate goal is helping patients quit drugs. Early in my career, I was happy to see patients succeed, but after two to three years, seeing relapses made me feel burned out.”
Sakina learned that Harm Reduction helps prevent burnout, providing gradual steps for both users and workers toward the shared goal of quitting.
The first step is engaging patients indirectly through networks to build understanding and willingness for treatment among patients, families, and communities. Next, staff assess physical and mental health, screen for complications or psychosis, and address these immediately. Treatment involves methadone to gradually reduce drug use. “Some think methadone means immediate cure, but Harm Reduction aims to reduce risks, such as cravings that might lead to theft if users lack money. We help patients stay safe even if still using, with small goals like reducing from multiple drugs to one, then just methadone. This approach eases public health workload with short- and long-term targets.”
Sakina believes addiction treatment has advanced greatly since she started, with more understanding, agencies, and projects supporting patients, such as community rehabilitation centers (CBTx) that address economic pressures causing relapse when patients return to jobless communities.
Beyond economics, community attitudes matter. Stigma and reluctance to accept users make reintegration difficult. Sakina stresses educating communities to reduce fear and provide accurate information rather than reinforcing stereotypes of drug users as violent.
From her experience, not all users are dangerous; danger arises with coexisting psychiatric symptoms. Actual numbers of violent patients are lower than perceived. For example, in Chana Hospital’s area, among thousands of users, about 500 enter treatment, with only around 32 categorized as violent or aggressive. “Users often cannot care for themselves because drugs diminish their abilities. When most people say, ‘That’s your problem,’ no one helps, and users resort to harmful solutions. Unresolved, these issues become family, community, and eventually national problems.” Sakina believes that if society stops stigmatizing and sees addiction as a shared problem, Thailand’s drug problem can be successfully addressed.
“Marginalizing users perpetuates the problem. When society values and embraces them, we can collaboratively solve it. Right now, everyone is in the middle, pushing these people out, so the problem persists because they are not valued—like the saying, ‘If it’s not your child, you don’t care.’”
The path to recovery for substance users is not just treatment but understanding, opportunity, and valuing humanity above all. When hope fills the heart and the body heals, lives once consumed by addiction can always begin anew.
