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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 treatment Sanwal 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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  • 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

  • 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.

  • 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)

  • 4

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

  • 5

    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

  • 6

    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

  • 7

    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

  • 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

  • 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)

  • 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

  • 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

  • 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

  • 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

  • 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

  • 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.

  • 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.

  • 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