COMMUNITY- BASED- TREATMENT And REHABILITATION for Drug Users and Recovering Drug Dependents SONIA H. CARREON, RSW,MPA HEAD, AFTERCARE AND MSWS

Training Contents WHAT IS COMMUNITY-BASED TREATMENT? II COMMUNITY – BASED TREATMENT APROACH 1 Philosophy of the community-based approach 2 Service Delivery 3 Components and roles of community-based approach 3.1 Community (including outreach) 3.2 Community health centers 3.3 Social support services and NGOs 3.4 Law enforcement III. INTERVENTIONS 1. Screening and Assessment Screening questionnaires suitable for use in a community setting (by WHO & UNODC)1. ASSIST IV. THE OUT PATIENT THE COMMUNITY-BASED AFTERCARE PROGRAM: A MULTI- SECTORAL APPROACH

Training Objectives: 1. Participants would enhance their knowledge and skills on Community-Based Treatment (OPD and the Community- Based Aftercare Program for Recovering Drug Dependents: A Multi- Sectoral Team Approach) 2. Strengthen close coordination among community service providers; 3. Services for Drug Users and Recovering Drug dependents shall be integrated into existing health and Social Service; to be accessible to clients in the community.

4. Strengthen and provide necessary knowledge and skills for the MADAC/ BADAC and line agencies for fast implementation of the Community-Base OPD and Aftercare Treatment.

5. Aimed at helping practitioners in the health, social work and law enforcement sectors implement community-based Treatment. Encourage the line agencies to promote the comprehensive approach, taking into account different needs(Health, Education, Employment, housing, and other socio-psychosocial, spiritual aspects).

Drug use disorders are health conditions that can affect any individual, family and community. Yet People tend to keep away from the necessary services due to misperceptions, fears of social and legal consequences, and discrimination.

On the other hand, if they get help, people suffering from drug use disorders can and do manage their condition, recover and lead happy, productive, and full lives.

Community-Based Interventions This program is based on the joint program of the United Nation Organization on Drug and Crime (UNODC) together with WHO that promotes a health-oriented approach to drug dependence.

WHAT IS COMMUNITY- BASED- TREATMENT for Drug Users and Recovering Drug Dependents?

LAW ENFORMENT, HEALTH SECTORS SOCIAL SECTORS It is a multi-sectoral approach involving LAW ENFORMENT, HEALTH SECTORS SOCIAL SECTORS will produce the most effective response in terms of reducing drug use and providing needed services to persons affected by drug use in the community. Adopted from the Guidance for Community-Based Treatment and Care Services for People affected by Drug Use and Dependence in Southeast Asia (United Nations Office on Drugs and Crime (UNODC))

to work harmoniously to implement community-based Treatment. Continuation……………… It aimed to encourage an integrated service delivery from practitioners from - Health Sectors - Social Sectors - Law enforcement Sectors to work harmoniously to implement community-based Treatment.

“Working together can have a positive impact on the future of youth in your community” From: Community action on drug abuse prevention

How these sectors work harmoniously to implement community-based Treatment. - Health Sectors - Social Sectors - Law enforcement Sectors

Problems from getting INTOXICATED - SOCIAL in nature Health problem Family, friends Law Hangover Feeling sick, vomiting Stomach pains and problems Head injuries from falls Other accidents and injuries Drowning Accidental overdose Arguments Fighting Neglecting children Violence at home Sexual assault Child abuse Being intoxicated Doing damage to things Drink driving Assaulting people Accidental killing Drug possession offences

Problems from REGULAR or EXESSIVE Health problem Family, friends Law Brain and nerve damage Mental health problems Heart disease, diabetes, cancer Infectious diseases Sleep and dental problems Family problems Marriage problems Work problems Neglected children No food in the house Drug possession offences Drink driving offences Not paying bills Sex work Drug dealing

Philosophy of the community-based approach “To ensure a holistic approach to treatment and care of drug users with the intensity of essential care varied according to the nature and complexity of the problems experienced by the individual” The approach is broadly based on the World Health Organization Pyramid of Mental Health Services (See Figure 1).

Figure 1. Service organization pyramid for substance use disorder treatment and care

Benefits from community-based interventions

There is active patient involvement ; Close linkages and collaboration between service providers in the community; The process usually starts and is sustained within the community where the drug user and his/her family lives ; There is active patient involvement ;

Increase community support for people with drug problems and promote supportive public opinions and health policy. Help reduce discrimination and social marginalization; reducing the stigma of drug use ; It promotes a paradigm change within society to acknowledge drug dependence as a multi-factorial disorder.

Enable people with drug-related problems to have improved access to a range of quality services from education, information and drug counselling, to assistance in stopping or reducing drug use and avoiding the harmful health and social consequences of drug use, Treatment provided in the community is less invasive than other treatments, fostering independence of the client; more accessible and affordable.

COMMUNITY-BASED TREATMENT AND CARE SERVICE DELIVERY

Community- Based Treatment and Rehabilitation Program Intake, Screening and Assessment ADMISSION? Yes = TRC No = for OPD/ community Based AFTERCARE treatment MADAC/ BADAC Client/ Drug abuser Surrenders DOH-TRC or Hospital if client needs detoxification, or other health complications due to drug use Discharged from In-patient

“The journeys of the people who are affected by drug use and dependence through the treatment and rehabilitation system begin and end in the community”

SOCIAL WORKERS ARE CASE MANAGERS IN MUNICIPAL SWD TO CONDUCT PSYCHOSOCIAL COUNSELLING, SOCIAL WORK INTERVENTIONS, NETWORKING AND REFERRALS

THREE MAJOR COMPONENTS Community organizations including NGOs help identify drug users, conduct basic screening of drug problems and refer to primary health services when required; focus on preventive education; health promotion and on the delivery of basic support; reintegration and rehabilitation services

Primary health services health care services act as an interface between families and community programs on the one hand and hospitals. Social Welfare Agencies, and NGOs provide Social Services , offer education, vocational and skills training, income generation opportunities, micro-credits, etc.

Model of community-based treatment and care for people who are affected by drug use and dependence

Components and roles of community-based approach

1. Community (COM. Org.)(including outreach) Major tasks: Awareness raising’, public education and health promotion, highlighting the complexity of drug use behaviors and consequences. Role of Community-based workers Help identify drug users, conduct preliminary screening interviews and basic needs assessment of the user and his/her family and together devise an ‘action plan.’

2. Community health centers Roles: They provide basic health care to drug abusers

Roles: The health center offers a good opportunity for brief counselling, which is appropriate for people who do not have severe problems such as clients for OPD.

Provide screening for substance use problems and associated health conditions, and provide basic primary health services. Refer clients with complex problems of psychiatric comorbidity, polydrug use or serious medical problems to hospitals. Offers basic education and brief counselling on risks of drug-related problems, working in tandem with community organizations, outreach workers and families.

Assessment guide for social workers or CO Team

Key activities of Health and Social Workers and Other Community Health Team • Provide advocacies and education to the community; • Provide sensitivity training on drug use to partner agencies; • Collaborate with stakeholders in the community (including law enforcement) in conducting preliminary screening for drug and alcohol use; • Collaborate with other organizations working with people who are affected by drug use and dependence and HIV, and providing rehabilitation training;

relapse prevention when indicated Continuation………… • Provide psychosocial counselling to people affected by drug use and dependence and their families • Provide rehabilitation services such as life skills and vocational training • Support mutual-help and support groups for people affected by drug use and dependence • Provide home visits and home-based care when required and help support non- pharmacological withdrawal and relapse prevention when indicated

Law enforcement There are fundamental differences between drug dependence treatment and law enforcement procedures. In the context of law enforcement, illicit drug use is regarded as criminal behavior.

A positive paradigm of community-based care can occur when police recognize the value of a health approach to drug use and dependence. - Police attitude towards drug dependence treatment will change once drug dependence is recognized as a chronic health disorder having negative health and social impact with many contributing factors, the required response will also be understood as a long term health intervention.

Promoting treatment for drug dependence as an alternative to punishment will provide support for an effective approach with a continuum of care.

A community-based approach allows for careful screening and assessment of the nature and severity of drug problems and allows the police to use a range of strategies to deal with people affected by drug use and dependence;

SUGGESTED THERAPY SERVICES

Social Behavior and Network Therapy (SBNT) The basic principle of the approach is to encourage a change of social network, from one that is supportive of drug use to one that is supportive of abstinence. Access to welfare supports, together with encouragement from friends, partners, children, parents and other significant individuals is commonly involved in the pathway out of drug use disorders.