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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 treatmentSanwal Jantip, Sutas Chua-nam,
Apinun Aramrattana, MD, PhD Southeast Asia HIV Addiction Technology Transfer Center,Faculty of Medicine, Chiang Mai University
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Methamphetamine tablets(Ya Ba), Marihuana, and Kratom are the most common drugs used
with Ice epidemics emerging.
Source: ACSAN, ONCB, 2012
Household Survey Trends: Ever users: 2001-2016
Estimated Numbers ( x 1,000)
Source: The Office of Narcotic Control Board (ONCB)
War on Drugs since 2003
Chart1
20012001200120012001200120012001
20032003200320032003200320032003
20072007200720072007200720072007
20112011201120112011201120112011
20162016201620162016201620162016
Marihuana
Kratom leaf
Yaba tablet
Ice
Inhalants
Opium
Ecstasy
Heroin
5425
2106
3492
1
934
907
360
274
2019
1160
1094
1
478
324
120
193
1506
1078
789
42
261
229
124
151
2441
1233
902
134
211
167
88
134
1113
1602
1061
174
155
88
54
63
Sheet1
20012003200720112016
Marihuana54252019150624411113
Kratom leaf21061160107812331602
Yaba tablet349210947899021061
Ice1142134174
Inhalants934478261211155
Opium90732422916788
Ecstasy3601201248854
Heroin27419315113463
To resize chart data range, drag lower right corner of range.
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Estimated number of ATS users in Thailand, 2011: 910,361
>26
4-26
0-3
Risk Scores
1.4 %High
12.0 % Moderate
86.6 % Low
Longer duration of MA use led to heavier drinking
patterns and higher depression prevalence.
High Sexually Transmitted Infection especially
among female MA users.
Meth. Induced Psychosis patients increased after the
epidemics
WHO-ASSIST Score among ATS ever users, Household Survey, 2011.Only about 12 % of MA ‘ever’-users would need treatment.
Source: The Office of Narcotic Control Board (ONCB)
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The Optimal Mix and Coordination o Community-Based Drug Treatment & Care Approa
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1 No Wrong Door2 Delivery of Services in the Community3 Minimal Disruption of Social Links4 Integrated into Existing Services5 Involve & Build on Community Res6 Participation of PWUD, Families &
PWUD can enter the service system a
Community-Based Drug Treatment & Care: 12 PrinciplesThe Optimal Mix and Coordination o
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7 Taking into Account Different Need8 Close Collaboration between Secto9 Evidence-Based Interventions10 Informed & Voluntary Participation11 Respect for Human Rights & Dign12 Accept Relapse as a Part of the P
Community-Based Drug Treatment & Care: 12 PrinciplesThe Optimal Mix and Coordination o
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Components of a Community-Based Approac
1 2
3
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 servicesare provided in the health centers specialist health services in hospita
Education, Vocational & Skill Trainingsare offered by social welfare agenc
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BI+MI+CBT: @General Hospitals
BI + MI + Refer: @Drug Treatment Centers, Psychiatric Hospitals
Thai Health System for Substance Use Problems:Primary Health Care provide health promotion, prevention,
linkage to comprehensive, continuing & holistic health care.
Community-based services for drug users
SBIRT: Primary Health Care @Health Centers, District Hospitals
Community & Family care
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BI+MI+CBT: @General Hospitals
BI + MI + Refer: @Drug Treatment Centers, Psychiatric Hospitals
Community-based Management:- In an initial stage- Relied on existing primary health care resources
- > 1 million village health volunteers nationwide- almost 10,000 health centers at sub-district level- almost 800 district hospitals
- Bridging with other local resources- leaders, justice volunteers, NGOs- polices, social workers, school teachers, monks, etc
Community-based services for drug users
SBIRT: Primary Health Care @Health Centers, District Hospitals
Community & Family care
District Health System (DHS)
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Pilot areas: Chiang Mai, 2009
Kuanpahk Sub-district, - Rural area in Chiang Mai- 10 villages, 1,285 households- 4,919 populations- traditional agricultural communityCommunity problems: - young alcohol & substance users- risky sexual behaviors- aggression & violence- failed rehab. camps
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Community care strategies:
- no legal processes for users
- family-involvement at the beginning
- health- & future-oriented
- supportive environments
- community involvements
- religious & spiritual guidance
Pilot areas: Chiang Mai, 2009
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Pilot areas: Chiang Mai, 2009Community 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
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Results: at September 2016Year No.
treatedSuccessfully Recovered
On-going care
2010 47 45 22011 47 42 52012 1 1 02013 7 5 22014 10 6 42015 3 0 32016 9 0 9Total 124 99 25
Success: Urine negative for 12 months
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Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand
• TC vs UNODC GuidelineWhat 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 TCRole of staff & Role of the patient(s)
Treatment tools used via the social structure Work as therapy Mutual self-helpPeers as role models Staff as rationale authorities
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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.
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Therapeutic Community within Community-Based Program for methamphetamine users in rural Thailand• SummaryTC & 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.
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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
Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Thai Health System for Substance Use Problems:� Primary Health Care provide health promotion, prevention, linkage to comprehensive, continuing & holistic health care. Community-based Management:- In an initial stage�- Relied on existing primary health care resources� - > 1 million village health volunteers nationwide� - almost 10,000 health centers at sub-district level� - almost 800 district hospitals �- Bridging with other local resources� - leaders, justice volunteers, NGOs� - polices, social workers, school teachers, monks, etcSlide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17