What do we mean by community-based
treatment?
• Seen in the community
• Community empowerment: ensuring the community resources
and participation
• Bio-psycho social approach
• Primarily outpatient setting
• Continuum of care
• Community health and social services
Stakeholders
• Community drug action group
• Community authority
• Community leader
• Community members
• Health services
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. Community organizations
focus on preventive education and health promotion and on the
delivery of basic support, reintegration and rehabilitation services
• Screening, counseling, primary health and referral services are
provided in health centers. Patients are referred to hospitals or
clinics as required for specialized treatment of drug dependence,
infectious
diseases, or mental disorders
• Social welfare agencies and NGOs offer education, counselling,
vocational and skills training, income generation opportunities,
micro-credits, and other psychological and social support
Principles of Community Based Treatment
The nine principles of drug dependence treatment as outlined by the 2008 UNODC-WHO
discussion paper on “Principles of Drug Dependence Treatment,” provide guidance for
gradually making available treatment of quality to those in need.
Principle 1: Availability and Accessibility of Dependence Treatment: Treatment
services need to be available, accessible, affordable and evidence-based to deliver
quality care for all people in need of support.
Principle 2: Screening, Assessment, Diagnosis and Treatment-Planning:
Comprehensive assessments, diagnosis and treatment planning are the basis for
individualized treatments that address the specific needs of each patient and that will
also help to engage him/her into treatment.
Principle 3: Evidence-Informed Dependence Treatment: Evidence-based good
practice and scientific knowledge on dependence should guide interventions.
Principle 4: Dependence Treatment, Human Rights, and Patient Dignity:
Treatment interventions should comply with human rights obligations, be voluntary and
provide for the highest attainable standards of health and well-being.
Principle 5: Targeting Special Subgroups: Several groups within the larger
population of those affected by dependence require special attention including
adolescents, women (including pregnant women), individuals with co-morbid disorders
(either mental or physical), sex-workers, ethnic minorities and homeless people.
Principles of Community Based Treatment
Principle 6: Dependence Treatment and the Criminal Justice System:
Dependence should be seen as a health care condition and dependent individuals
should be treated in the health care system rather than the criminal justice system
with community-based treatment offered as an alternative to incarceration where
possible.
Principle 7: Community Involvement, Participation, and Patient
Orientation: Community-based treatment responses to drug and alcohol abuse
and dependence can promote community change, active involvement of local
stakeholders and support for community funding models.
Principle 8: Clinical Governance of Dependence Treatment Services; It is
important that treatment services have clearly defined policies, treatment
protocols, programs, procedures, definition of professional roles and responsibilities,
supervision and financial resources.
Principle 9: Treatment Systems: Policy Development, Strategic Planning
and Coordination of Services: A systematic high level policy approach to
substance use disorders and individuals in need of treatment, as a well as logical,
step-by-sep sequence that links policy to needs assessment, treatment planning,
implementation, and to monitoring and evaluation is most beneficial.
https://www.unodc.org/documents/southeastasiaandpacific/cbtx/cbtx_brief_EN.pdf
Key activities of social welfare and NGOs:
• Provide education to the community about the effects of drugs, facilitate
referral to voluntary counselling and testing
• Provide sensitivity training on drug use disorders to law enforcement,
community leaders, local authorities, teachers, parents, traffic police and
religious leaders
• Collaborate with stakeholders in the community (including law
enforcement) in
conducting preliminary screening for drug and alcohol use for people for
whom
there is community concern
• Collaborate with other organizations working with people who are affected
by
drug use and dependence
Key activities of social welfare and NGOs:
• Assist in referral to medical treatment in health centers or hospitals or
clinics as appropriate
• Provide harm reduction information to drug users, clean injecting
practices, through outreach, peer education, drop-in centers and support
groups 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
Role of Police
• Police are well placed to encourage entry into drug treatment programs
• Police have a presence 24 hours a day, seven days a week
• Police have frequent contact with all members of the community including
people who are affected by drug use and dependence
• Police often have contact with users at times of crisis when motivation for
treatment is high, such as after overdose, public dispute or family
violence, driving under the influence of alcohol, etc.
https://www.unodc.org/documents/drug-treatment/UNODC_cbtx_guidance_E
N.pdf
Multidimensional Path
Project PATHE (positive action through holistic education)
Boot camps
Wilderness program
Milieu therapy
Bangladesh
• Vocational training institute
• Addiction management and integrated care
• Shelter home for victim trafficking (Jessore)
• AM book distribution house
• Beacon point
Types of counseling
• CBT (thoughts, emotion, behavior, physical sensation
• ABC/functional analysis (antecedent, behavior, consequence)
• Motivational interviewing-MI (Express empathy, Develop discrepancy,
Avoid argumentation, Support self-efficacy)
• Contingency management (CM)- Reward or reinforced, urine test
• Community Reinforcement Approach (CRA)- more healthier, more adaptive
to meet social and emotional needs than using drug
• Social Behavior and Network Therapy (SBNT) UK, originally for treatment
of
alcohol dependence
Attributes of an effective counselor
Voluntary
Confidential
Reliable
Non-judgemental
Respectful, every client will be the same, regardless of their age, gender,
looks, social position, or financial status
Safe
Linked with other services
Basic counselling skills
• Active listening (Active listening comprises four components: attending,
paraphrasing, reflection of feeling, and summarizing)
• Processing
• Responding
• Teaching
Basic counselling skills
• Active listening (Active listening comprises four components: attending,
paraphrasing, reflection of feeling, and summarizing)
• Processing
• Responding
• Teaching
Treatment Close to Home
• Patients who travels less than one mile for treatment are 50% more likely
to complete treatment
• Patients who travel more than four miles for treatment are likely to have a
shorter stay than those who travel less than four miles.
https://pinnacletreatment.com/blog/going-local-the-advantages-of-communit
y-based-treatment/
Family inclusive practices
• Community resources service delivery- develop the skills and attitudes of
community-based treatment and care workers to take into consideration both the
needs and the value added by engaging families and children within treatment and
other services.
• Organization- develop organizational guidelines for family-sensitive policies and
practices, culturally appropriate services, processes for interacting with other
services, family-sensitive physical environments within services.
• Systems and services- build knowledge and partnerships for community
engagement and family-sensitive policies and practices across services and sectors.
• Policy- prioritize community engagement and family-sensitive practices within
policies, facilitating structures and resources, across sectors.
http://fileserver.idpc.net/library/Module%202%20The%20community-based%20drug%
20treatment%20and%20care%20approach_02Jun16.pdf
Community-Based Treatment and Rehabilitation Components
• Interviews
• Individual and Group Activities
• Seminars
• Sessions on personal growth and development
• Family dialogues and activities
• Counselling
• Testimonies
https://ddbv2.ddb.gov.ph/sidebar/301-community-based-treatment-and-reha
bilitation-resources
