Making Recovery Less Lonely: Building Belonging into Community-Based Drug Rehabilitation

Community-Based Drug Rehabilitation (CBDR) programs in the Philippines continue to face a major challenge: many participants do not complete treatment. Among moderate-risk persons who use drugs (PWUDs), 56% do not finish the program.

This is often seen as an issue of attendance or discipline. But the challenge is more complex. Many clients face practical barriers such as work, limited time, transportation difficulties, and family responsibilities. At the same time, many also experience recovery as a lonely and difficult process. Stigma, judgment, and limited support from others can make it harder for them to keep attending sessions and stay committed to treatment.

This was the challenge that the Ka’Damayan Toolkit was created to address.

Ka’Damayan comes from the Filipino word kadamay, meaning “companion.” The name reflects the behavioral idea behind the toolkit: people are more likely to continue recovery when support and peer connection are made visible and easy to practice within the program.

To translate this idea into practice, AHA! Behavioral Design®, in partnership with the USAID RenewHealth project implemented by University Research Co., LLC, co-created the toolkit with PWUDs, treatment facilitators, and local government staff across eight city government offices. 

The team developed simple, low-cost tools that could be integrated into existing CBDR sessions. These included Recovery Tokens and Belonging Cues, which were designed to help clients recognize progress, encourage one another, and sustain participation together.

After development, the tools were embedded into routine CBDR sessions and assessed through a pre–post intervention study across two CBDR sites, involving 14 persons who use drugs (PWUDs) who used the tools during two consecutive sessions. One site introduced the intervention during orientation, while the other introduced it midway through the program, allowing the team to observe changes across different stages of implementation.

Pre- and post-intervention measures assessed participants’ intentions, attitudes, subjective norms, and perceived behavioral control related to two peer-support behaviors: celebrating the recovery progress of fellow PWUDs and discussing session assignments with peers. These findings were supplemented by qualitative observations of peer-initiated support and comparisons with the sites’ historical attendance and dropout trends.

The results showed that strengthening belonging can help improve participation and reduce dropout. In two pilot sites, dropout decreased from the historical rate of 56% to 21%. Among participants who were exposed to the tools for two consecutive sessions, 100% completed the program.

The change was also visible in how clients behaved during the program. Clients began initiating make-up classes, inviting absent peers to return, and celebrating recovery milestones together. These actions showed that recovery was becoming less dependent on facilitators alone. Clients were beginning to take ownership of their own progress and support the progress of others.

This result shows that treatment completion cannot rely on individual discipline alone. While personal commitment is important, people are more likely to stay engaged when they feel supported, recognized, and connected to others.

These findings should be interpreted as preliminary. Due to project timeline and budget constraints, the study was limited to two sites, did not include treatment and control groups, and could not test the tools across the full treatment cycle. The intervention also could not be introduced at the start of treatment in both sites, limiting the team’s ability to attribute observed changes solely to the tools.

Nevertheless, the implication for treatment implementers and facilitators is practical: CBDR participation can be strengthened through low-cost tools embedded into routine sessions. Ka’Damayan shows that adherence may be supported when programs are designed around shared progress, peer reinforcement, and visible belonging, making recovery support a practical part of service delivery.

Building on this initial evidence, Ka’Damayan offers a direction for how LGUs can rethink future CBDR programs. Rather than treating adherence primarily as a matter of individual motivation, programs can be designed so that social support, visible progress, and timely reinforcement are built into the entire KKDK journey — from enrollment and orientation to module delivery and treatment completion. Future testing can examine how facilitators, families, and co-clients can work as coordinated sources of support, positioning Ka’Damayan as a foundation for more connected, responsive, and behaviorally informed CBDR service delivery.