Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand

Transcription

1 Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand Thai drug situation UNODC Guideline A rural northern Thai examples TC vs Community based treatment Sanwal Jantip, Sutas Chua-nam, Apinun Aramrattana, MD, PhD Southeast Asia HIV Addiction Technology Transfer Center, Faculty of Medicine, Chiang Mai University

2 Household Survey Trends: Ever users: Estimated Numbers ( x 1,000) War on Drugs since 2003 Source: ACSAN, ONCB, 2012 Methamphetamine tablets(ya Ba), Marihuana, and Kratom are the most common drugs used with Ice epidemics emerging. Source: The Office of Narcotic Control Board (ONCB)

3 Estimated number of ATS users in Thailand, 2011: 910, % High >26 Meth. Induced Psychosis patients increased after the epidemics 12.0 % Moderate 86.6 % Low Risk Scores Longer duration of MA use led to heavier drinking patterns and higher depression prevalence. High Sexually Transmitted Infection especially among female MA users. WHO-ASSIST Score among ATS ever users, Household Survey, Only about 12 % of MA ever -users would need treatment. Source: The Office of Narcotic Control Board (ONCB)

4 Community -Based Drug Treatment & Care Approa The Optimal Mix and Coordination o 4

5 Community -Based Drug Treatment & Care: 12 Principles The Optimal Mix and Coordination o 1 No Wrong Door PWUD can enter the service system a 2 Delivery of Services in the Community 3 Minimal Disruption of Social Links 4 Integrated into Existing Services 5 Involve & Build on Community Res 6 Participation of PWUD, Families & 5

6 Community -Based Drug Treatment & Care: 12 Principles The Optimal Mix and Coordination o 7 Taking into Account Different Need 8 Close Collaboration between Secto 9 Evidence -Based Interventions 10 Informed & Voluntary Participation 11 Respect for Human Rights & Dign 12 Accept Relapse as a Part of the P 6

7 Components of a Community -Based Approac 1 2 Community organizations including NGOs Help identify drug users Refer to primary health services when required Offer preventive education & health promotion Delivery of basic support, reintegration & rehabilitation services Primary health services are provided in the health centers specialist health services in hospita 3 Education, Vocational & Skill Trainings are offered by social welfare agenc 7

8 Thai Health System for Substance Use Problems: Primary Health Care provide health promotion, prevention, linkage to comprehensive, continuing & holistic health care. BI + MI + Treatment Centers, Psychiatric Hospitals Hospitals SBIRT: Primary Health Centers, District Hospitals Community & Family care Community-based services for drug users

9 Community-based Management:- In an initial stage - Relied on existing primary health care resources - > 1 million village health volunteers nationwide BI + MI + Treatment Centers, Psychiatric Hospitals - almost 10,000 health centers at sub-district level - almost 800 district hospitals - Bridging with other local resources - leaders, justice volunteers, NGOs District Health System (DHS) Hospitals - polices, social workers, school teachers, monks, etc SBIRT: Primary Health Centers, District Hospitals Community & Family care Community-based services for drug users

10 Pilot areas: Chiang Mai, 2009 Kuanpahk Sub-district, - Rural area in Chiang Mai - 10 villages, 1,285 households - 4,919 populations - traditional agricultural community Community problems: - young alcohol & substance users - risky sexual behaviors - aggression & violence - failed rehab. camps

11 Pilot areas: Chiang Mai, 2009 Community care strategies: - no legal processes for users - family-involvement at the beginning - health- & future-oriented - supportive environments - community involvements - religious & spiritual guidance

12 Pilot areas: Chiang Mai, 2009 Community care components: - legal advice and assurance - family counseling - custodial care volunteer - regular random urine tests - regular home-visits - family and community activities for kids - collaboration with the district hospital

13 Results: at September 2016 Year No. treated Successfully Recovered On-going care Total Success: Urine negative for 12 months

14 Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand TC vs UNODC Guideline What Is a Therapeutic Community(TC)? A TC is a structured method and environment for changing human behavior in the context of community life and responsibility. Structure and social organization of the TC Role of staff & Role of the patient(s) Treatment tools used via the social structure Work as therapy Mutual self-help Peers as role models Staff as rationale authorities

15 Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand TC vs UNODC Guideline The TC Approach to Treatment bio-psycho-social approaches with multi-dimensional model, a structural environment with constant attention to negative behavior change, socially acceptable rules as the norm, acceptance of personal responsibility for their individual actions and positive peer modeling; aiming at supporting necessary change in drug user life in order to become healthy and productive citizens in community.

16 Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand Summary TC & UNODC CBTx both are aimed at drug user behavioral changes under structural environment. TC provide an in-house social structure/environment while CBTx provide a community based structure/environment. TC utilize strong peer supports under authority assistance while CBTx utilize strong community supports under strong community leadership. CBTx could be a excellent after-care program for TC clients recovery.

17 Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand A rural northern Thai examples TC vs UNODC Guideline Thank you very much Q & A