Drug Abuse Treatment and Rehabilitation - United Nations Office on

143 Pages·2003·1.24 MB·English

D r u g A b u s e Tr e a t m e n t To o l k i t
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A Implementation Guide
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United Nations publication
Sales No. E.03.XI.II
ISBN 92-1-148160-0

UNITED NATIONS OFFICE ON DRUGS AND CRIME
Vienna
Drug Abuse Treatment
and Rehabilitation:
a Practical Planning
and Implementation Guide
UNITED NATIONS
New York, 2003
The Office for Drug Control and Crime Prevention became the United Nations Office on Drugs and Crime
on 1 October 2002.
UNITED NATIONS PUBLICATION
Sales No. E.03.XI.II
ISBN 92-1-148160-0
The designations employed and the presentation of the material in this publication do not imply the expres-
sion of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal
status of any country, territory, city or area, or of its authorities, or the delimitation of any frontiers or
boundaries.
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Acknowledgements
The present text of Drug Abuse Treatment and Rehabilitation: a Practical Planning and Implementation Guide was
commissioned by the Demand Reduction Section of the United Nations International Drug Control Programme
(UNDCP). For their contributions to the preparation of the Guide, UNDCP would like to express its gratitude to
the following:
• The consultant project team: Dr. John Marsden, National Addiction Centre, Institute of Psychiatry, United
Kingdom of Great Britain and Northern Ireland; Dr. Robert Ali, Drug and Alcohol Services Council, Adelaide,
South Australia; Dr. Michael Farrell, National Addiction Centre, Institute of Psychiatry, United Kingdom; and
Dr. Manit Srisurapanont, Department of Psychiatry, Chiang Mai University, Thailand, who drafted and edited
the Guide;
(cid:127) The treatment and rehabilitation experts who, together with the staff of the UNDCP Demand Reduction
Section and the project team, participated in an advisory group meeting in February 2001: Dr. Alfred Bamiso
Makanjuola, Nigeria; Dr. Victor Capoccia, United States of America; Dr. Augusto Perez Gomez, Colombia; and
Dr. Nadeem-Ur-Rehman, Pakistan;
(cid:127) Experts from around the world who contributed their experiences in planning and implementing treatment and
rehabilitation programmes. Such experiences are described in the many boxes contained in the Guide;
(cid:127) Drug demand reduction experts and focal points at UNDCP regional and country offices who provided feed-
back and, in particular, staff at the Regional Office in Mexico, which coordinated pilot testing in Central
America;
(cid:127) Members of the Central American Demand Reduction Experts Network from Costa Rica, El Salvador,
Guatemala, Honduras, Nicaragua and Panama participating in the project “Integral Subregional Project on
Structure Generation for Prevention, Rehabilitation and Social Reinsertion” (AD/CAM/00/F17), who pilot-
tested the Guidein their respective countries;
(cid:127) Members of the Demand Reduction Experts Group participating in the project “Treatment and Rehabilitation
Centre for Drug Abusers in Tuxtla Gutiérrez, Chiapas, Mexico” (AD/MEX/01/F84), who pilot-tested the Guide;
(cid:127) The treatment and rehabilitation expert of the project “Drug Demand Reduction Programme for Guyana”
(AD/GUY/99/C08) and the staff of the Georgetown Public Hospital Corporation Psychiatric Unit, who pilot-
tested the Guidein Guyana;
(cid:127) Members of the Eastern African Demand Reduction Experts Network, who kindly provided feedback;
(cid:127) Staff of the UNDCP Legal Advisory Programme who provided inputs and feedback on the legal framework for
treatment;
(cid:127) International experts in treatment and rehabilitation who reviewed the final draft of the Guide and provided
valuable feedback: Dr. Virginia Carver, Canada; Dr. Anna McG. Chisman, Inter-American Drug Abuse Control
Commission of the Organization of American States; Dr. Maristela Monteiro, World Health Organization
(WHO); Dr. Augusto Perez Gomez, Colombia; and Dr. Gerard M. Schippers, the Netherlands.
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I. INTRODUCTION
A. Cultural settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I.1
B. Resource constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I.1
C. Principles underpinning the Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I.1
D. How the Guidewas constructed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I.2
E. Purpose and structure of the Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I.2
F. How to use the Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I.3
II. DEVELOPING A STRATEGIC FRAMEWORK FOR TREATMENT
A. Strategic definitions and principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.1
B. Legal and regulatory background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.5
C. Developing and implementing an effective treatment strategy . . . . . . . . . . . . . . . . . . . . . . . . .II.10
III. ASSESSING TREATMENT NEEDS
A. Nature of a needs assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .III.1
B. Designing and conducting a needs assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .III.3
C. Estimating the size of the population in need . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .III.5
IV. EFFECTIVE TREATMENT AND REHABILITATION SERVICES
A. Elements of a comprehensive treatment system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV.1
B. Accessing information about effective treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV.6
V. DEVELOPING AND IMPLEMENTING TREATMENT SERVICES
A. Involving the community and integrating drug abuse treatment in primary care . . . . . . . . . . . . .V.2
B. Developing a new treatment service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.3
C. Treatment programme operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.9
VI. EFFECTIVE INTEGRATION OF TREATMENT SERVICES
A. Definition and characteristics of an integrated treatment system . . . . . . . . . . . . . . . . . . . . . . .VI.1
B. Operating the system: client assessment processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.6
VII. MONITORING TREATMENT ACTIVITY AND OUTCOME
A. Purpose of monitoring treatment activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.1
B. Elements of a performance and outcome monitoring system . . . . . . . . . . . . . . . . . . . . . . . . .VII.3
C. Managing information and communicating results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.10
Annexes
I. People with specific treatment needs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I.1
II. Population subgroups of drug abusers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.1
III. Example of a residential rehabilitation programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .III.1
IV. Example of a client screening form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV.1
V. Example of a triage assessment form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.1
VI. Addiction Severity Index-Lite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.1
VII. Pompidou Group-EMCDDA Treatment Demand Indicator project . . . . . . . . . . . . . . . . . . . . .VII.1
VIII. Maudsley Addiction Profile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VIII.1
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BOXES
1. Declaration on the Guiding Principles of Drug Demand Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.2
2. National drug strategic framework of Australia, 1998/99 to 2002/03 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.4
3. Services offered by the Spanish treatment and rehabilitation network . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.4
4. Legal provisions on drug treatment in Slovenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.5
5. Practical application of legislation on consumer rights to drug abuse prevention and treatment . . . . . . . . . . .II.6
6. Supported initiative of the Inter-American Drug Abuse Control Commission: standards of
care in drug abuse treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.7
7. Development of minimum standards of care for drug abuse and dependence treatment
programmes in Nicaragua . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.8
8. Minimum standards of services in India . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.8
9. UNDCP online legal library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.10
10. Developing the national drug strategy of Ireland: the power of public consultation . . . . . . . . . . . . . . . . . . .II.11
11. Renewed national treatment and rehabilitation programme of Chile . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.13
12. Community-based treatment in an Afghan refugee camp in Pakistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.14
13. The performance management framework in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.15
14. Development of performance indicators in Wales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .II.16
15. Structure of the epidemiologically-based framework for needs assessment in the
United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .III.2
16. National assessment of drug abuse in Pakistan, 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .III.4
17. Subgroups of drug abusers: major problems and main services needed . . . . . . . . . . . . . . . . . . . . . . . . . . . .III.6
18. Drug treatment and care process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV.3
19. The matrix model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV.6
20. Rehabilitation instead of incarceration in Jamaica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .IV.7
21. Community mobilization, Chiang Mai, northern Thailand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.2
22. Involvement of traditional healers in Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.2
23. Involving community health workers, Lao People's Democratic Republic . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.2
24. Royal College of General Practitioners—learning objectives for primary care workers . . . . . . . . . . . . . . . . . .V.3
25. Development of treatment services in Ireland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.4
26. Developing services for female drug abusers in Pakistan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.4
27. Identifying sources of funding in Kenya . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.5
28. Community and professional mobilization to develop a treatment centre in Mauritius . . . . . . . . . . . . . . . . . .V.5
29. Development of a National Treatment and Rehabilitation Centre in the United Arab Emirates . . . . . . . . . . . .V.6
30. Treatment centre development and management: key questions to address . . . . . . . . . . . . . . . . . . . . . . . . .V.8
31. Staff supervision system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V.10
32. Example of the elements of a treatment system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.2
33. Example of an integrated treatment system in operation: the models-of-care framework
in the United Kingdom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.3
34. Diversifying and linking services for injecting drug users: opiate substitution treatment in
Lithuania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.4
35. Example of integrated care pathways for community opiate substitution programmes . . . . . . . . . . . . . . . . .VI.5
36. From heroin to methamphetamine: the changing profile of drug problems in Thailand . . . . . . . . . . . . . . . .VI.6
37. Alcohol, Smoking and Substance Involvement Screening Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.7
38. Simple structure of an assessment process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.7
39. Eligibility criteria for community setting detoxification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.8
40. Example of a treatment link for an individual client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VI.11
41. WHO/UNDCP/EMCDDA international guidelines and workbooks for the evaluation of
treatment services and systems for psychoactive substance use disorders . . . . . . . . . . . . . . . . . . . . . . . . . .VII.2
42. Example of a minimum data set required for each client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.4
43. Community programme: twelve-month outcome report for female clients by age group . . . . . . . . . . . . . . .VII.5
44. Annual reports questionnaire—Part II (drug abuse) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.6
45. Basic description of drug use, employment and crime . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.7
46. Example of a logic model for a residential rehabilitation programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.9
47. Evaluation Instruments Bank of the European Monitoring Centre for Drugs and Drug
Addiction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.10
48. Electronic treatment data collection in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.10
49. Cochrane Database of Systematic Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .VII.11
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I
INTRODUCTION