THERAPEUTIC COMMUNITY IN THAILAND. Dr. Viroj Veerachai President of Thai Therapeutic Communities Association

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1 THERAPEUTIC COMMUNITY IN THAILAND Dr. Viroj Veerachai President of Thai Therapeutic Communities Association

2 Establishment of Thanyarak Therapeutic Community The establishment of Thanyarak T.C. began when seven professional staffs and one ex-addict from the hospital with the support from the United Swedish Foundation of Sweden (UNISWED) studying and training in T.C. at Daytop Sweden in November 1985 March After which, they started to run a T.C. program with 11 residents with funding by UNISWED and After a one-year trial, the program came out quite satisfactory.

3 Thanyarak Therapeutic Community 1 was opened in February Then, Thanyarak Therapeutic Community 2, 3 and female were established in 1989, 1890 and 1990 respectively.

4 Then, 6 branches of Thanyarak Institute started TC program: 1.Thanyarak Chaingmai Hospital 2. Thanyarak Maehongson Hospital 3. Thanayarak Udonthani Hospital 4. Thanyarak Khan Kaen Hospital 5. Thanyarak Pattani Hospital 6. Thanyarak Songkhla.Hospital

5 The program is composed of four main phrases 1. Induction Stage: includes preparation, orientation and motivation of the new individual residents to enable them to create self- determination of their actual lives. This period takes an average of 15 days. 2. T.C. Treatment Stage : includes various therapeutic approaches in psycho-social aspects. The main functioning process of this period composes of two major parts : therapeutic groups and working groups. Group Therapy utilizes mainly the principles of Transactional Analysis and Gestalt therapy. Work therapy depends upon the nature of group process. This period takes an average of 1 year. 3. Re-entry stage : prepares graduated residents from T.C. program to be able to re-integrate into the society. Work practices outside the T.C.center at two-week period with evaluation are provided for each individual. This period takes approximately 6 months. Before graduation from the T.C. programs, every resident should be pre-occupied by regular jobs.

6 The program is composed of four main phrases 4. After-care Stage : takes care every graduates of the T.C. centers for a period of a least 5 years. Every exresident shall be requested to keep contact with the T.C. centers by any means at any appropriate occasions. After-care programs include supportive psychotherapy, problem-solving advice, family association, as well as follow-up for individual progress in drug habit, social and behavioral functions and job placement. 5. Half-way house : provides food and lodging facilities for those ex-residents of T.C. s programs who have no families to live with, no home to reside, or who are not ready yet to re-integrate into society. Programs in this half-way house are rather similar to Re-entry phase, but the residents will have to take care and manage themselves in more responsibility manner

7 Statistical Study of Thanyarak at the end 1996 At the end of March 1996, 120 *162 residents still remain in the residential 100 T.C. program, (151 males,11 females). * 161 (155 males, 6 females) have 80 graduated. * 98 (94 males, 4 females) still remain 60 abstinent from drug (followed up 5 years) and are occupied by regular jobs (60.86% abstinent) 40 * 7 died from AIDS (4.35%) * 3 males died from cirrhosis of liver (1.84%) 20 * 1 male died from car accident (0.62%) * 1 male died from murder (0.62%) 0 Number % N = 161 Abstinent Relapse Death

8 FAST model the evolution of rehabilitation for substance users in Thailand. For past two decades in Thailand major changes occurred regarding the drug situation, as follows; 1. Main drug of abuse was methamphetamine, or Yaba (>70% ) 2. Most of methamphetamine abusers were young (> 50% were in years of age ), unemployed ( >50%) and had loweducation levels 3. The volume of abuser is high (data in 2011; >1.2 million cases or 19:1000). 4. Most patients are diagnosed as drug abusers, with mental health problem and disorders such as psychosis, depressions and anxiety. 5. Concept of brain addiction in worldwide treatment program for stimulant abusers

9 FAST model Shorten down the period from 1 ½ year to 4 months Enhance family to treatment process because the age of users became teenager. Alternatives treatment : As a diagnosis addressed the mental illness such as depression or Cognitive impairment ( Cognitive behavior therapy for depression and Cognitive training) Self help and Therapeutic Community are still being the core modality of rehabilitation.

10 Motivation Interviewing (MI) and Cognitive Behavior Therapy (CBT) in TC Session 1 : Be aware of negative feeling Session 2 : Be aware of negative thinking Session 3 : Behavior shaping tools Session 4 : Learning of thought Session 5 : Thought changes Session 6 : Problem Solving I Session 7 : Problem Solving II Session 8 : We can have our own choice to get win!

11 Cognitive training for Cognitive impairment Assessment the patient with the MOCA MOCA score < 25 Provide Cognitive training MOCA score >25 No need to receive cognitive training MOCA score < 17 MOCA score = Intensive Cognitive Group Cognitive training Group

12 Cognitive training programs Arousal module Orientation Activity Level of Stimulation Activity Initiation and Perceptual-motor activity Training module Memory Attention Executive Function Visual perception and Visuoconstructional Language Relaxation module Yoga Meditation Physical relaxing

13 Intensive Cognitive training For the patients who have score < 17. The occupational Therapist will assess the patient dysfunction and look after which part do they need specific intervention. The occupational Therapist provide intervention individually. Practice Executive Function Practice Visuospatial Function

14 Specific treatment for women There are complicated issues of women are includes: They are jobless or their job involve sex industry. A lot of trauma and failure relationship. Domestic violence. Children caring or Unwanted pregnancy. Low self esteem, Depression, Anxiety. The appropriate program should be addressed We provide the vocational training to change their attitude to work and enhance self esteem as well as group therapy to reduce trauma and recover relationship.

15 Drug treatment facilities in Thailand Public health ministry treatment center Non-Public health ministry treatment center Provincial General Hospital 92 Ministry of Defense:- rehabilitation camp 50 District Community Hospital 733 Ministry of Defense:- hospital 5 Subdistrict Health Promoting Hospital 10,616 Ministry of Interior:- territory defense camp 46 Department of Medical Services 7+3 Royal Thai Police 2 Department of Mental health 13 Ministry of Justice Total 11,464 Buddhist temples / Islam Mosque 19/13 Bangkok Metropolitan Administration 68 University hospitals 6 Private clinics, hospitals and rehabilitation centers Grand total 11,930 ( Residential services 98 ) Data from nationwide public health provincial offices on Dec 31, 2015

16 Thai Therapeutic Communities Association In 2013, TTC was officially established. We hoped that TTC will play a vital role in TC development in Thailand. Our members from all sectors join hands to contribute of sharing knowledge and experience for the quality TC rehabilitation. It is the collaboration among PMNIDAT, Department of Juvenile Observation and Protection, Department of Probation, Department of Correction and The private rehab center such as Rebirth center foundation, House of compassion, Pianpitak Drug Free House and Tulakarn Chalernprakiat Hospital Foundation.

17 Purpose of TCC To be the center of knowledge exchanging between members To support standard development of academic knowledge in TC rehabilitation To be the center of international and region information exchanging To cooperate with Government agency and private sector.

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