Phrae Sirisakdamkoeng: Within the humanity… of drug users

Let us look at drug users through the doctoral research of Phrae Sirisakdamkoeng. When they violate all norms set by society, they have to hold onto other values instead to stay within the community. They have to talk to themselves and to God, adjust to their sins without throwing away their religion, when a drug user is more than a “druggie”, but also another human being.

  • When a drug user violates all the main norms of the law, health and religious morals, they have to find other values to hold onto and stay with the community, and those are family relationships.
  • The community doesn’t look at them just from the dimension of being a drug user, but also sees them as children, relatives or friends that grew up in the community.
  • This study leads to an answer in terms of policies on harm reduction and using the community as a base for taking care of drug users.

The attitude of Thai society to drug users is still negative and it is difficult to see how it can be otherwise. The cannabis movement that’s starting to slowly see concrete results is just an exception.

It is hard when Thai society has been inculcated with thoughts, beliefs, and views on drugs and drug users for a long time as we see today. When the spotlight shines on drug users, what people see are druggies, a social burden, criminals, and so on. It is as superficial as that, with no other dimensions for understanding at all.

The PhD dissertation of Phrae Sirisakdamkoeng on ‘Muslims’ Lives in “Drug Dens”: A Southern Community’s Negotiated Normality in Thailand’ tries to look at drug users from a more human dimension, rather than just a one-dimensional completely black character in the drama of life. Drug users well know that they are sinful and not pure according to religious teachings, so they need to find other norms to be able to live in the community and manage some form of relationship that still allows them to relate and see the humanity inside them.

Nevertheless, even though the dissertation mentions religion, this is not something that occurs with any one religion. The use of drugs and intoxication from drugs in every religion is considered sinful. They may be sinners, but they are human.

What was the starting point that made you interested in this topic?

I went to work with the Aids Access Foundation. They wanted to tell the stories of HIV-infected patients in the southern provinces who have a different status compared to patients in other regions, since patients in the three southern provinces were often infected from husbands who injected drugs. They have knowledge about HIV, but they didn’t think it could be passed on within the family. Also, that fact that Islam allows 4 wives means that in some families there is more than 1 wife. The spread of the HIV virus then takes a different form from other places, and the book Under the Hijab’s Shadow was born.

The question when I collected field data was, why are drugs so widespread? I went into the community to interview those infected, and they say that there are a lot of narcotic drugs. The question I had for the people living there is, are they worried about violence? They said that violence is already a normal thing, and that they’re more worried about the drugs that are widespread in the area. This was the origin of my wish to know about this, what is it like, just how bad is it and why do the people here choose to do drugs.

But in the end when I conducted the study, I didn’t choose the southern provinces, because of the problems related to security. So I chose an area with mostly Muslims. The next question is, it’s known that Muslims are religiously strict, so why can’t they deal with drugs? Since we have always believed that religious beliefs will be a protection against all bad things.

So did you get an answer as to why drugs are so widespread even though people are religiously strict?

In the end I didn’t get an answer for that because further along there were various dimensions that appeared to me. When I designed the research methodology, there was only the question of why drugs are still widespread when people are religiously strict. One expression we always hear from people in the area or related to it: ‘wherever there’s a mosque, there’s drugs’. It sounds like Muslim communities have drugs, but actually that’s not it. There are drugs everywhere. Buddhist communities also can’t prevent drugs, because there are many other factors.

We, as people who aren’t related to drugs, perceive drug users as dangerous. The second question of the research is, when so many people are using drugs, then how do they live together with others in society?

When you say many, how many is that?

When I did Under the Hijab’s Shadow, I would ask them how, when they say it is a big problem, should I describe it? People would answer that 60-70% of the men in the village use at least one type of drug. Light drugs would be cannabis or kratom. The heavy drugs are heroin and methamphetamine, which involve a high percentage. 

With women, when I was doing field work there were rumours that they also use drugs. I tried to find out that if only a small number of male drug users are accepted by society, women are accepted even less. Trying to find a woman drug addict who would agree to be interviewed was very difficult, as they are stigmatised. But in the end I did find some women that were happy to talk to us. In the dissertation there is a little about women as well.

What do they do to be able to stay in the community?

When we think of drug users and how they live in society, or how people in society live with drug users, we have major norms in society such as the law. We think that drug users are a group that breaks the law. Second are religious principles, since we know that all religions prohibit drugs. The third is that drug users are breaking norms on health because you’re hurting yourself by consuming substances that are poisonous to the body. Drug users today are considered to be patients. So when we set the research topic, it was not good, because we used our own norms to look at whether they really go against these norms or not and how they live with others. If we don’t establish these norms, we wouldn’t have the question of ‘how do they live with others’, since they are also normal people. Later on we found that this research question also stigmatised them.

What we went to find was how they live with others and found that in reality society doesn’t have just these norms but the society of the community also many other norms whose value they uphold. It doesn’t have to be just these three norms; there are other values that the community has.

The community where we conducted the research isn’t very strict religiously. They are happy to break the law in every way. If people outside the community are asked, they would say it’s because these people aren’t religiously strict, helping each other so well when anyone comes to investigate. This leads to the spread of drugs. The question is what is strict and what is not strict, and law violations exist in every community, not just this one.

We went to see in the community how drug users live. While society stigmatises them as illegal, what do people in the same community think of them? When we walked into the community it seemed quite peaceful. They can live together, and drug users walk here and there. Do people in the community know who uses drugs? They all know. Then what allows them to live side by side, since we always think that drug users are dangerous? They may steal from us, rob us, because they want money to buy drugs, or they may go crazy and hurt us.

However, if we’re asking whether people in the community are scared of drug users, or if they think like this of drug users, we found after collecting some data that they don’t see drug users as just simply drug users. They still see drug users as their children, their grandchildren, their friends, as people who grew up in the community and have seen since they were small. When we look at them, we will see drug users as drug users, but we won’t see their humanity in other dimensions. This is an important point. People in the community said that yes, they are addicted to drugs but they’re still our children, our relatives. Then what will we do?

There were many things showing us that drug users are important to them in one way or another, either as neighbours, siblings, friends, children. They can’t simply be cut off. Calling in the police to arrest them they can’t do either because there is just a relationship that is more than that of drug users.

The first answer we found was because they don’t hold onto mainstream norms but hold onto the importance of family. The fact that drug users stay in the community and people in the community hold onto the value of family is important. What does holding onto these norms lead to? The results are that drug users have to be careful. They know they’re in this kind of community, this kind of relationship, and these relationships make them safe.

From one angle, do drug users see the value in this? They see it, because drug users here choose to use drugs that don’t lead to madness. For example, if sedatives are used in a large amount, users will hallucinate. People often say that you’ll be unable to recognise brothers, sisters and friends. It is likely that users will physically harm them. Or taking a lot of methamphetamine and not sleeping for many days will cause the user to hallucinate, go crazy and hurt others. They know what would happen afterwards if they act like this, so it becomes something like a prohibition of this community against using this kind of drug or overdosing on methamphetamine, because they won’t recognise their friends and family.

Not being able to recognise people in their family means they don’t dare to use the drugs, because they will soon not be able to control themselves and may harm their relatives. They choose not to do it, because if they do harm their relatives, there will be problems with their family relationships. Or heroin is a drug found in this community. They know that if they use heroin they will need to increase the dose. More consumption means more money. When more money is needed, where will they find that money? They have to steal, rob. They say that to avoid having to increase the amount of heroin used, they use methadone which they receive from the hospital instead. Methadone has a long-lasting effect, which means that if you use it now, you’re OK for the whole day and don’t want to use any other drug. So it reduces drug use.

The next issue is that they know that stealing may be something that is still acceptable, but robbery or physically assault is unacceptable in the community. To rob a relative is a serious offence. In the community they say that there’s never been a robbery, rape, or murder by drug users; there’s never been one. When we asked drug users why there aren’t any crimes like these, they say how could they do it? You’ll take money from relatives by robbing them? They’re our relatives you know. All of this places a value on being in a family.

What are the results? The results are that drug users can live without being hated. If a drug user were to rob or murder someone in the community, there wouldn’t be a place for them. Not violating the rules of family relations allows them to live in the community, while at the same time the community can still accept them within the dimension of being family.

Do they make efforts to quit?

Of course they do. I think everyone who has been addicted has been through the feelings of wanting to quit because drug addiction has its own cycle. At the start people know it and use it, use it a lot, then become addicted. When they are heavily addicted, their physical condition will worsen. Everyone knows that their body can’t go on anymore. It’s a period where they feel guilty and have to find a way to quit. The important thing is that many people use religion as a pathway, such as dawah, or proselytizing.

This is a process where men travel to various villages to invite people back into the religion. They don’t invite people of different religions, but people of the same religion to sit and converse on religious beliefs and talk about religion. They may go on a dawah for 3 days, 7 days, 10 days or 100 days; it’s up to them. It’s one of the ways drug users choose to abandon or quit drugs.

This means when they’re at a dawah, they don’t use drugs. So don’t they get withdrawal symptoms?

They do get withdrawal symptoms, but they use religion to treat them, such as praying to God, and taking a shower. During the process many people said that, that period of time caused him to feel that he can quit drugs. Mentally, they feel that their bodies are purer. Many people also choose to be treated in a religious rehabilitation centre, it depends on what they choose. Some people choose the method of making an oath to God that they will quit. In Arabic it’s called tawba.

Are there causes to revoke their oath?

There’re many interpretation issues here, because people ask if it’s okay to make an oath many times that they’re going to quit. Some drug users say it’s okay. When they repent, they have to say they will quit. Then they return to drugs, then they can repent again. Religious leaders say they can make an oath only once in life that they’re going to quit, otherwise God will not accept it. There are various interpretations, depending on how the leaders explain it.

Being a drug user is probably already bad enough, but what about HIV-infected drug users? Will that increase problems in their life?

Generally, when someone is infected with HIV, it’s their right to tell others or not tell others about it, so it’s not certain how much the community knows. We didn’t focus on it, but as far as we’ve seen, many people choose not to tell their family and friends in the community.

There was one person who was infected with HIV and also a heavy drug user. He also steals. We called him Karim in the dissertation. He used drugs since he was a teenager. Originally his family had a good status, and his parents brought him up while giving him everything. In his house there were 2 sons; one is a drug addict, and the other is a drug addict and a drug seller. Karim has used drugs for a long time and became infected with HIV. It was a great pain for Karim when he found out he was infected. Karim was already married. If one were to ask if he loved his wife, he does, but his wife asked him to quit drugs many times and Karim refused. But when he found he was infected, he had his wife leave the house to stay with somebody else and to not have anything to do with him again.

He felt that using drugs was already bad enough, to be infected was even worse. With the love he had, he wasn’t going to hold her back anymore. He tried to get her out of his life. His wife also loved him, but in the end left and remarried. More than 10 years after his wife left him, Karim still hasn’t remarried because he still loves his wife.

After he found out he was infected, he had people at his house separate their plates and cutlery even though he knew that they couldn’t catch it through these things. He protected in every possible way his family from to being close to an infected person, even though he knew it doesn’t spread that way; but he felt that it was the only responsibility he could take towards his family.

In his own family, after his mother died, his older sister who he was very close to, showed him that she did not hate him at all. His sister strictly ordered her children not to ever show signs of hatred towards him. Karim has two duties, which are to look after his sick father and to look after his sister’s children. His sister’s children were brought up by him. Everyone made life normal out of their love for him, but he was still using drugs. Karim was the person who explained that he doesn’t have the courage to meet his religious teachers. He feels ashamed. When he was heavily addicted, he stole everything.

As a Muslim, how do drug users talk to themselves and to God?

Almost all the drug users we interviewed studied religion at school or the house of religious teachers. They know that drugs are against the principles. Do they feel guilty? They always do, but it’s an addiction. You don’t need to be a Muslim, Buddhists also know that it’s against religious principles. All drug users have to fight against themselves with guilty consciences. Many people said they don’t have the courage to look their religious teachers in the face. They would shun them and go by a different way. Some people said that many times when they used the drug they would cry that they would end up in hell. Many are ashamed to go and pray in the mosque because they think they’re dirty from the drugs.

Tawba or taking an oath is to speak to their God, accepting that they’ve sinned. If possible, they would like to redeem themselves. There was one person that tried to quit and went to work with the Ozone Foundation. He said that every Friday he wanted to go to pray because he knew he had sinned. Praying allows him to stay on the path of his religion. When he prayed in the community’s mosque he would be looked at. Sometime people would ask him if he was about to die so he came to pray close to going to the graveyard. It was a way to chase him out. He was stigmatised, and no one accepted him back into his religion. That’s why he worked with the Ozone group in another province. Every weekend he tries to return home, but he has to finish praying on Friday first so that he doesn’t have to pray at home since other mosques don’t know that he’s a drug user even though the best way for Muslims is to pray at their local mosques. Every time he goes to pray is to go to negotiate, to talk to his God, because it is his attempt to get closer to God.

What do they do during month of Ramadan?

They practise fasting (sawm). They won’t take any drugs in the day, but take them at night, going by the normal fasting cycle by not consuming anything. In this village many people go to receive methadone from the hospital. The hospital normally gives out methadone from 8 am to 12 noon only, and patients must take them in front of the nurse, but the hospital understands their ways and wants to support drug users in their fasting. So this hospital allows drug users to receive their methadone after the sun sets, so that their drug-taking cycle goes with their fasting cycle.

As a religious leader they say it’s probably unacceptable. Their fasting probably isn’t accepted because to fast alongside taking drugs, what does that mean? To fast means you have to be pure, and void breaking all religious principles. Taking drugs even at night is still wrong, isn’t it? But this is the process drug users choose to attempt practise their religion. They can manage themselves only this much.

What policies will the discoveries from this work lead to that will allow drug users and non-drug users to live together?

They practise fasting (sawm). They won’t take any drugs in the day, but take them at night, going by the normal fasting cycle by not consuming anything. In this village many people go to receive methadone from the hospital. The hospital normally gives out methadone from 8 am to 12 noon only, and patients must take them in front of the nurse, but the hospital understands their ways and wants to support drug users in their fasting. So this hospital allows drug users to receive their methadone after the sun sets, so that their drug-taking cycle goes with their fasting cycle.

As a religious leader they say it’s probably unacceptable. Their fasting probably isn’t accepted because to fast alongside taking drugs, what does that mean? To fast means you have to be pure, and void breaking all religious principles. Taking drugs even at night is still wrong, isn’t it? But this is the process drug users choose to attempt practise their religion. They can manage themselves only this much.

What policies will the discoveries from this work lead to that will allow drug users and non-drug users to live together?

There are 2 issues; harm reduction from drug usage and the community as a base to look after drug addicts, in which the state has already announced a policy on community care for drugs users.

Reducing harm from drug use by distributing clean syringes, supporting addicts to substitute methadone, are subjects of great discussion in both law and religion. That’s why religious principles won’t say that it’s a principle that can be done, but Islam is good that it gives importance to the safety of the human body. So some religious leaders uphold this value, that is to make the body as safe as possible. So some religious leaders accept harm reduction from drug use from this angle.

Harm reduction from drug use is not just this, but is harm reduction for drug users and the people around them. Distributing syringes is protecting drug users from contracting HIV. Avoiding HIV infection means that people around them will be safe, but it’s not only that. If you’re with them, accept them as human beings, don’t hound them as drug users who contravene all norms. That will allow them to know how to negotiate to live together. It’s like a discovery in research. They know that if they make the community unsafe, they’re not safe, and they are much worse off.  People in the community do not accept them and hound them out of the community. Being outside the community is not safe. So people seeing drug users as children, grandchildren, as human beings and looking after them as much as they can, accepting them as much as they can, accepting them as more than just a drug addict, they feel safe to be with you and you would also feel safe to be with them as well.

Can this angle be suggested as a policy? Making drug users safe, and us safe, is harm reduction from drug use in a way that isn’t just about health. This is the first issue.

The suggestion of community care for drug users actually has many examples. Communities that accept and don’t chase away drug users and look after them as much as they can such as looking after them, warning them, seeing that they’re taking a lot of drugs and telling them to keep it down a bit, warning them as a friend or as family will reduce their drug usage or eventually they may be able to quit. Not chasing them away allows them to stay in a set of relationships and be cared for in the community.

But right now there is a misunderstanding that community care of drug users is the idea that they have to build rehabilitation centres in communities, which is not the case. Building rehabilitation centres is not community care. If you brought drug users who aren’t family members into the community, the community may be concerned. They are people who they don’t know. In the community where we went to collect data, because they know each other, they can trust people they have brought up themselves. No matter if they use drugs, they won’t hurt us, won’t steal from us. Not all drug users steal, not all of them lie. There are those who don’t lie. There are those who don’t steal. There are those who are responsible. Then people in the community are confident that the drug users won’t do anything, because they know that these people were raised here by their own hands; they see it with their own eyes; they know these people. This is community care of drug users. It means the community sees these things. It’s not building rehabilitation centres and bringing in drug users from who knows where.