CURE & CARE

Treatment Scenario in Malaysia Compulsory Treatment Provided for drug dependants since 1983 Drug Rehabilitation Centers (DRC) & Supervision in the Community 22 DRCs – capacity of 7,000 residents Supervision - 55,000 estimated in the community How can N.A.D.A take care of the massive numbers in the community?

Success Rate 75% ? 50% ? 20% ? 10% ? Success Rate 75% ? 50% ? 20% ? 10% ? Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Treatment Services Programs in DRCs and those undergoing Supervision Treatment Services Programs in DRCs and those undergoing Supervision Parents, Families Stigmatized Residents – criminalized (records) Parents, Families Stigmatized Residents – criminalized (records) Changes Impact of New drugs on Clients Need for Clinical Approach Changes Impact of New drugs on Clients Need for Clinical Approach Why NADA needs to Transform? GTP & NKRA Concept of 1Malaysia GTP & NKRA Concept of 1Malaysia Success Rate 75% ? 50% ? 20% ? 10% ? Success Rate 75% ? 50% ? 20% ? 10% ? Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Compulsory Treatment Reluctant & Resistant Clients Problems in the DRCs Treatment Services Programs in DRCs and those undergoing Supervision Treatment Services Programs in DRCs and those undergoing Supervision Parents, Families Stigmatized Residents – criminalized (records) Parents, Families Stigmatized Residents – criminalized (records) Changes Impact of New drugs on Clients Need for Clinical Approach Changes Impact of New drugs on Clients Need for Clinical Approach

??? ?..what matters most to the rakyat/people or clients …what do we want to transform ….how can we touch the hearts & souls of the people or clients with big fast results…

Treatment Wards Registration Office– Sg. Besi Psychiatrist/ Medical Officers

CONCEPT OPEN ACCESS SERVICES Voluntarism or Walk-in Support from parents or family Referral Outreach / Motivate No Legal Implications No Pre-conditions No stigma Private and Confidential Options for clients Community-based Program Clients as patients

METHADONE MAINTENANCE THERAPY REFERRAL AND ADVOCACY Public, Family dan Clients ( Hospital, Social Welfare. TRANS CC 1-3 bulan package SCOPE OF SERVICES Psychiatric Interventions Opiate Clients Temporary transit Hypnotherapy

FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH

EARLY RECOVERY RELAPSE PREVENTION SOCIAL SUPPORT GROUPS FAMILY PROGRAM COUNSELING & GUIDANCE OUTING/EXCURSIONS MEDICAL & HEALTH EDUCATION RELIGIOUS & SPIRITUAL VOCATIONAL SKILLS TRAINING PSYCHOSOCIAL

MEDICAL DETOXIFICATION METHADONE MAINTENANCE PYSYCHIATRIC INTERVENTIONS HIV/HEP/TB/STI TREATMENT INHALAN DENTAL SERVICES ALCOHOL & NICOTINE IMMUNIZATION INFECTIOUS DISEASES SCREENING CLINICAL SERVICES

DRC VS. C&C CLINIC DRUG REHAB. CENTERS C&C CLINIC Compulsory Treatment & Admission through the Law; Criminal Records; Stigma Open Access Services – Voluntary Admission; Considered as Patients Focus on medical, psychiatric & clinical treatment Treatment-based services only Treatment for opiate-based addicts; all males and separate for women Treatment for all substance abusers (opiate, ATS, inhalant) – males, females & adolescent are separated Treatment Duration – 2 years Treatment duration – 1-3 months (inpatient), 4-6 months (outpatient) Capacity for residents in DRCs – 7,350 Number of clients that accessed services at 8 C&C Clinics – 9,041 Cost of food – RM8.00 x 30 days x 12 months /person = RM 2,880 Cost of food – RM8.00 x 30 x 3 months = RM Loss of Property caused by violence, arsonNo incidence of violence or arson

C&C CLINICS CLIENTS REFERAL AND ADVOCACY TOTAL INPATIENTOUTPATIENT SG.BESI KOTA BHARU BKT MERTAJAM TAMPOI KUCHING PAPAR TAMPIN JERANTUT KARANGAN TOTAL ACCUMULATIVE TOTAL ,933 ACCUMULATIVE TOTAL ,855 OUTPUT ( NO OF CLIENTS)

OUTCOME STUDY AT C&C CLINIC

94.4% 90% 61% Reduced by 37.1% Injecting drug use 46% to 8.9% Confident of not using drugs in the near future Clients satisfied with services Ready to recommend the clinic to family and friends OUTCOME STUDY AT C&C CLINIC

Drug use history Substance 30 days BEFORE first visit to C&C Past 30 days Heroin67.1%4.8% Benzos; Dormi, Clona, Valium, Xanax 12%2.0% Syabu, Meth, Ice13.9%2.1% Pil Kuda3.3%2.2% 3 or more substances in the same day 10.8%1.7% OUTCOME STUDY AT C&C CLINIC

In general, how satisfied are you with the medical attention you receive for your health problems (other than drug addiction) at the Cure and Care Clinic? Satisfied 69.3% Very satisfied 23.9% Not very satisfied 5.6% Health status, needs and access OUTCOME STUDY AT C&C CLINIC

Qualitative analysis: Opinions and feedback on C&C program and services. Overall, happy with the C&C concept C&C encourages voluntary and ambulatory care and rehabilitation MMT is seen as a stabilizer giving 2 nd chance Programs offered by C&C were well received Good support from C&C staff, Counselors and Medical Team OUTCOME STUDY AT C&C CLINIC

Example text METHADONE MAINTENANCE PROGRAMME CCSC 1024 CCRC 0 Klinik C&C 0 Jumlah 1024 CCSC 1380 CCRC 21 Klinik C&C 351 Jumlah CCSC 1530 CCRC 40 Klinik C&C 1735 Jumlah (67.8%) clients employed in 2011 compared to 543 (53%) clients in OUTCOME STUDY AT C&C CLINIC

56.3% Helped maintain jobs 42.7% Helped get into government support services 54.3% Continued education 77.6% Improved family relations 72.1% Obtained permanent homes 75.9% Prevented arrest into prisons OUTCOME STUDY AT C&C CLINIC

73.8% Prevented admission into Compulsory DRCs 78.3% Helped family or friends to get treatment and rehabilitation 76.7% Access to medical care 94.9% Very satisfied with the methadone maintenance programme 94.4% Reduced drug cravings 65.4% Obtained skill training KAJIAN KEBERKESANAN PROGRAM KLINIK C&C OLEH UNIVERSITI MALAYA OUTCOME STUDY AT C&C CLINIC

CRIME HISTORY InstitutionBEFORE C&CSince coming to the C&C Lock-up Prison1.060 PUSPEN0.610 Average number of times inpatients and outpatients have been sent to prison, lock up, or PUSPEN KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC

Mental Health KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU OUTCOME STUDY AT C&C CLINIC

AFTERCARE SERVICES AFTERCARE Options for Aftercare Services after discharge from C&C Clinic : as outpatient with the same C&C Clinic or other facility; or CCSC (Cure & Care Service Centres); or CCH (Community Caring House) CCVC (Cure & Care Vocational Centre) – vocational skills training TransCC – Transitional Cure&Care facility Outpatient CCSC CCH CCVC TransCC NADA District Offices

We Care, We Serve