Chiang Mai, Thailand (CNN) — Kneeling beside a gutter within a walled compound adjoining a complex of golden-roofed temples, 50 men in red pajamas with the word "overcome" on the back are sweating under the midday sun.
The temple herbalist dispenses shots of a thick, brown liquid that his assistant pours down their throats. They swallow with a wince. In the background, recovering patients are banging on cymbals and tambourines.
The music stops and the kneeling men gulp large cups of water and begin vomiting into the gutter. An Irishman, whose features belie years of drug abuse, is retching on all fours next to a Thai teenager who is shaking from meth withdrawal symptoms.
This is Thamkrabok, a Buddhist monastery located 140 kilometers (86 miles) north of Bangkok, which specializes in treating drug addiction.
"We usually have around 50 drug addicts and alcoholics, including about 10 Westerners," says Mae Chee Katrisha, a British ex-heroin addict-turned-Buddhist nun, who is in charge of foreign patients.
In recent years, prior to travel restrictions imposed due to the Covid-19 crisis, Thailand has become a leading destination for addicts from all over the world.
Some undergo radical detoxes like the one offered at Thamkrabok; others choose to head to a luxury rehab in the country's jungle-clad northern mountains. The facilities offer a relatively inexpensive alternative to Western treatments. But some experts warn that detoxing in a tropical setting far from home can be dangerous and increases the risk of relapse.
Secret recipe for detox
Thamkrabok is a sprawling complex of white-pillared temples, oversized Buddha statues made of black lava stone and small cottages used to house monks and nuns.
Founded in the late 1950s by local nun Luang Poh Yaai and her two nephews, the monastery soon turned to treating addictions. "The government had just criminalized the use of opium and local farmers were showing up at the monastery asking for help to wean themselves off it," recalls Vichit Akkachitto, the vice abbot of Thamkrabok.
Peter Suparo is a British monk who first came to the monastery in 2002.
One of the first foreigners to make his way to Thamkrabok in the 1970s was a US Vietnam war veteran called Gordon, who ordained as a monk and took care of the handful of Western patients who started streaming into its gates, after hearing -- usually through word of mouth -- about the radical rehab offered there.
In the 1990s, organizations in the UK and Australia began to send drug users to the monastery. "Today, most people find out about us online," says Akkachitto.
Foreign patients have to commit to spending at least seven days at Thamkrabok. Apart from basic food costs -- around $20 a day -- they don't have to pay for anything.
"Whereas the locals are mostly addicted to crystal meth and yaba (pills containing meth and caffeine), foreigners take a mix of heroin, cocaine, meth and alcohol," says Peter Suparo, a British monk who first came to the monastery in 2002 and has been living there on and off since. "We are also seeing more and more fentanyl and other synthetic opioids users, especially from the US and Canada."
Detoxing can be a dangerous process, especially for alcoholics who risk a seizure or a heart attack and meth addicts who often suffer from paranoia and severe anxiety.
To avoid any issues, Thamkrabok requires all of its alcoholic patients to have undergone detoxing in a hospital setting before arriving at the monastery, allowing them to focus on controlling their urges through prayer and meditation.
Every morning, they are enlisted in a series of work-related activities. Some sweep the grounds; others make bricks and assemble wooden tables. Around midday, they head to a rudimentary steam bath, which emits a powerful scent of citronella. Then it is time for the purging ceremony.
"The vomiting helps expel toxins in the body," explains Suparo. "We have found this helps a lot with the withdrawal symptoms." The emetic potion is made of 108 herbs, sourced locally, according to Achurwon Moi, the temple herbalist. Its recipe is a jealously guarded secret.
The emetic potion is only a small part of the treatment. "The most crucial element is the Sacca, an oath patients take on their first day at the monastery," says Akkachitto.
Kneeling in front of a golden altar as incense smoke swirls around them, new patients swear to never take drugs again and bow three times under a senior monk's watchful eye. "This oath is sacred and cannot be broken, which is why patients only get one go at our rehab," adds the vice abbot.
Detoxing in Thailand
Founded in the late 1950s, Thamkrabok offers radical detoxes for addicts.
Worldwide, the medical tourism industry is worth $11 billion in 2017, according to a report by the World Travel & Tourism Council. Thailand was the fifth biggest market, behind the US, France, Turkey and Belgium, earning $589 million in 2017, the report said.
Rehab centers represent only a fraction of this income, but their number is growing rapidly. So far, four centers have obtained a special license introduced in 2011. The two-year process, overseen by the Ministry of Public Health, requires the center to prove it has qualified staff, meets safety and hygiene standards and provides annual training.
Alongside the private centers catering to Western addicts, the Thai government runs a network of compulsory drug treatment facilities, called Thanyarak, which are often run by the army and focus heavily on physical exercise and vocational training, according to James Windle, an academic at University College Cork.
Around 600 kilometers from Thamkrabok, the town of Chiang Mai, an ancient royal capital set in the mountains of northern Thailand, has also become a hub for recovering drug addicts and alcoholics.
Chiang Mai now houses around 500 beds in around 30 treatment centers, estimates Alastair Mordey, who runs a local rehab center called Alpha Sober Living.
The Cabin was one of Chiang Mai's first private rehab centers. Peter Maplethorpe is one of the four founding partners.
The Cabin was one of the first private rehab centers to open in Chiang Mai. "When we started 10 years ago, we only had eight beds," recalls Peter Maplethorpe, one of the four founding partners.
Today, The Cabin is licensed and can host 120 patients. Set on expansive grounds at the foot of rolling hills covered in jungle, it has several swimming pools, a modern gym with personal trainers and a spa. Residents can take Thai boxing, yoga or meditation classes. On weekends, they can go on elephant rides or learn how to cook Thai food.
"Most of our clients are high-functioning individuals who lost their way," says Mike Miller, one of the head therapists. Many patients work in finance or have their own companies, he says. The Cabin regularly gets celebrities: the singer Pete Doherty was briefly a guest.
Patients come from all over the world, including the United States. They treat the same addictions as at Thamkrabok: cocaine, heroin, methamphetamine and alcohol. Here too, synthetic opioids are a growing problem, reflecting increasing consumption trends in North America.
The Cabin is split into five villages, catering to women, young men, older men, LGBT+ members and Muslims. The program for young men focuses on physical activities and has a module about video game addiction. The one for LGBT+ members discusses chemsex -- sexual activity engaged in while under the influence of stimulant drugs -- and trauma related to homophobia. The one for Muslims provides culturally and religiously informed therapy, as well as halal meals.
A separate unit is devoted to healthcare professionals. "They are usually addicted to self-prescribed pills," explains Alexandria Barley, who is in charge of the program. They also have a lot to lose, such as their medical license, and are not used to sitting in the patient's chair." They need a quick, personalized and discreet treatment protocol.
At The Cabin, patients start with detoxing, which can take from three days to two weeks, depending on the substance. They are allowed sleeping pills, tranquilizers and substitution treatments during this phase.
Once abstinence has been achieved, they are enrolled in group and one-on-one therapy. "We use cognitive-behavioural therapy, as well as trauma management tools such as EMDR (a desensitization technique based on rapid eye movements)," says Paula Shields, who is in charge of the program for women. "We try to understand the underlying causes of addiction, not just free the patients from their substance of choice."
Addicts are mostly drawn to rehab in Thailand by the variety of options on offer, says Alastair Mordey, who runs a local rehab center called Alpha Sober Living. In their home countries, treatment is often limited to a substitution program with methadone or to a 12-step abstinence program based on the Alcoholics Anonymous philosophy, which is based on Christian beliefs, says Maplethorpe, from The Cabin. Price is another selling point. A month-long stay at The Cabin costs $14,900. Comparable facilities in the US can cost as much as $50,000.
Christopher Castellaw went to a licensed addiction treatment center on Koh Chang island to treat his heavy drinking addiction.
Christopher Castellaw, a 37-year-old Colorado native who had been drinking heavily for 20 years spent two months at Dara, a licensed addiction treatment center on the island of Koh Chang. His life started to spiral out of control three years ago. "More or less at the same time, I found out my dad had amyotrophic lateral sclerosis (a progressive nervous system disease that causes loss of muscle control), I broke up with my fiancée and I lost my job," he recalls. "My drinking became an all-day activity."
He says he would get through 15 cans of malt liquor a day. "I would tell my family and work colleagues I had forgotten something in my car or was going out for a cigarette and sneak in a few drinks," he says. Soon, he was turning up drunk to work and pushing his friends away.
As his father's health worsened, he decided he needed to make a change and started researching rehabs, stumbling upon Dara. "The cost was a major draw," he says. "But I also liked the fact that they offered a holistic approach, combining meditation, therapy and physical exercise."
At Dara, he felt challenged, "both physically and mentally" and was able to work through the issues behind his drinking, he says. After eight weeks in Thailand, he headed home and enrolled in a course to become an addiction counselor. He has now been sober for eight months.
No drugs, no phones
Thamkrabok is known for its radical "cold turkey" detoxes. Upon arrival at the monastery, patients are searched. Any drugs found are confiscated. Patients are not given substitution treatments, like methadone or buprenorphine, nor any medication to ease their withdrawal symptoms, such as sleeping pills or tranquilizers. They also have to hand in their mobile phones and money. To purchase food, they are given vouchers which can only be used in the monastery cafeteria.
Most patients have already been through several rehabs at home and relapsed. "Many of our patients are long-term addicts, who have tried everything and are determined to get better," says Suparo. Out of 65 patients surveyed in 2010 by the British-run East West Organization, 60% were still clean one year after they visited Thamkrabok.
Luke Barker, a former meth addict from Australia, came to the monastery four years ago.
But experts worry that addicts seeking out treatment on the other side of the world might be setting themselves up for failure. "Once they get back home, they will be re-exposed to the same contexts and triggers that spurred their addiction in the first place, increasing their risk of relapsing," believes Judith Grisel, an addiction specialist from Pennsylvania's Bucknell University.
She also worries about the lack of data on the new forms of therapy which are being used at Thai rehab centers. "There is strong evidence the 12-step program works, whereas we have very little information on the success rates of other treatments, such as specialized programs for young men or trauma therapy," she says.
As for the boot camp approach practiced at Thamkrabok, Grisel believes it can help some addicts take responsibility for their actions, but she also warns against an approach lacking compassion: "When you're recovering from substance abuse, you need to feel understood and cared for."
Some patients choose to stay at Thamkrabok after their recovery. There are currently around 10 foreign monks living at the monastery.
Luke Barker, a former meth addict from Australia, is one of them. He arrived at the monastery four years ago and was planning to be ordained as a monk. "I had been to rehab back home, but instead of trying to wean me off the drugs, they just replaced them with medication," he sighs. "At one point, I was taking seven pills a day and still craving the meth."
In Thailand, he managed to get off the drugs and found a form of serenity. "The Sacca really helped," he says. "It is like a promise you make to yourself, like a belief. It is very powerful."