Global Problem
- 1. Th e C olom b o P lan As ian C e ntre for C e rtification and E d u cation of Ad d iction P rofe s s ionals Training S e rie s C O N TIN U U M O F C AR E S AM P LE R M O D U LE S C u rricu lae 1,6,7 Junjun Abella MAC.,RGC.,NCAC I
- 2. The Global Problem 149–272 million people used illicit substances at least once in 2009 Source: UNODC. (2011). World drug report 2011. New York: United Nations. 1.2
- 3. S ubs tance-Related Dis orders — DS M-IV-TR ( new terminologies ) Substance-Related Disorders Substance Use Disorders Substance Dependence Substance Abuse Substance-Induced Disorders Substance Intoxication Substance Withdrawal Substance-Induced Mental Disorders *( in place of the terms‘ addiction, abuse, dependence) 1.3
- 4. S ubs tance Us e Dis orders Includes the categories “Harmful Use” and “Dependence Syndrome” of the World Health Organization’s International Classification of Diseases (ICD)-10 1.4
- 5. The Global Problem Globalconsequences of SUDs are far- reaching and include: Higher rates of hepatitis and tuberculosis Lost productivity Injuries and deaths from automobile and other accidents Overdose deaths Suicides Violence 1.5
- 6. The Global Problem 15–39 million “problem drug users” “Problem drug use” was determined based on: The number of people reported to be dependent on a substance The number who injected substances The number reporting long duration of use of opioids, amphetamines, or cocaine Source: UNODC. (2011). World drug report 2011. New York: United Nations. 1.6
- 7. The Global Problem 11–21 million people injected drugs in 2009 About 18 percent of those who inject drugs are HIV positive About 50 percent of those who inject drugs are infected with the hepatitis C virus Source: UNODC. (2011). World drug report 2011. New York: United Nations. 1.7
- 8. The Global Problem Only 12–30% of those who have SUDs receive any treatment for them What percentage level of treatment for a disease is acceptable ? Source: UNODC. (2010). World drug report 2010. New York: United Nations. 1.8
- 9. Philippine s ituation Approximately 1.7 million SUD about 37,000 access treatment annually 2.17% vs Global norm of 12-30% What is the acceptable level? 1.9
- 10. The Global Problem “There continues to be an enormous unmet need for drug use prevention, treatment, care and support, particularly in developing countries.” —Yuri Fedotov, Executive Director, UNODC Source: UNODC. (2011). World drug report 2011 (p. 9). New York: United Nations. 1.10
- 11. THE UNIVERSAL DECLARATION OF HUMAN RIGHTS Article 25. (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control. (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection. 1.11
- 12. E ffective Treatment Plan Individualized Flexible Realistic Simple Useful Solution focused Clear Responsive to changes and progress 1.12
- 13. E vidence-bas ed Practices (E B P): Definition Practices for which the evidence is strongest and most accepted—and that are most likely to have significant impact on improving care Source: U.S. National Quality Forum. (2007). National voluntary consensus standards for the treatment of substance use conditions: Evidence-based treatment practices (abridged version). Washington, DC: Author. 1.13
- 14. E B P Definition: “ Improving C are” Substandard SUD treatment was common “Substandard” was defined as treatment that was not: Safe Effective Patient-centered Timely Efficient Equitable (fair) Source: McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A. et al. (2003). The quality of health care delivered to adults in the United States. New England Journal 1.14 of Medicine 348.
- 15. E B P Definition: “ Improved C are” Only 10 percent of people with alcohol use disorders received recommended care, resulting in increased mortality and morbidity Source: McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A. et al. (2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine 348. 1.15
- 16. E B P Definition: Practices Practices are sets of techniques and approaches that may include elements from more than one counseling theory 1.16
- 17. “ E vidence-B as ed” Practice 1.17
- 18. “ E vidence-bas ed” : S cience Empirically validated evidence, meaning evidence that is based on information gained through: Directobservation Experience Experiments 1.18
- 19. “ E vidence-bas ed” : C linical and Financial Feas ibility Ina real-life treatment setting, not just in a research setting, implementing the practice is: Reasonable Achievable Economically possible 1.19
- 20. “ E vidence-bas ed” : C linical E xpertis e Counselors implementing a practice have basic counseling skills, can connect with clients, and have been trained in the use of the specific practice Photo credit: Family Health International, Hanoi, Vietnam 1.20
- 21. Why E vidence-B as ed Practices ? Question: Why do we need to know and care about EBPs? 1.21
- 22. E B Ps Improve Outcomes EBPs have been shown to improve treatment outcomes Source: World Health Organization (WHO) and UNODC. (2008). Principles of drug dependence treatment: Discussion paper. (http://www.unodc.org/documents/eastasiaandpacific//china/UNODC-WHO-Principles-of- 1.22 Drug-Dependence-Treatment.pdf)
- 23. WHO and United Nations Office on Drugs and C rime “Evidence-based good practice and accumulated scientific knowledge on the nature of drug dependence should guide interventions and investments in drug dependency treatment. The high quality of standards required for approval of pharmacological or psychosocial interventions in all the other medical disciplines should be applied to the field of drug dependence.” Source: World Health Organization and UNODC (2008). Principles of drug dependence treatment: Discussion paper. (http://www.unodc.org/documents/eastasiaandpacific//china/UNODC-WHO-Principles-of-Drug-Dependence-Treatment.pdf) 1.23
- 24. Recommended E B Ps Source: U.S. National Quality Forum. (2007). National voluntary consensus standards for the treatment of substance use conditions: Evidence-based treatment practices: A consensus report. Washington, DC: Author. 1.24
- 25. Practices Not Recommended Acupuncture, relaxation therapy, education, drug testing, detoxification as stand-alone treatments Individual psychodynamic therapy Unstructured group therapy Confrontation as the main approach to treatment Discharge from treatment in response to relapse Source: U.S. National Quality Forum. (2004). Evidence-based treatment practices for substance use disorders: Workshop proceedings. Washington, DC: Author. 1.25
- 26. Important to Know An empathic, supportive approach may be just as important as the specific practices used A counselor’s ability to engage and develop a helping relationship with a client is critical 1.26
- 27. E B Ps We’ll C over Cognitive-behavioral therapy Motivational approaches Certain family approaches Therapeutic community Contingency management Pharmacotherapy for opioid dependence 1.27