Substance Use Disorders A Manual for Paramedical Personnel

National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi

Supported by
World Health Organization (India) and
Ministry of Health & Family Welfare, Government of India

Print Edition

 

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DEBASISH PANDA

Telefax : 23061447
e-mail : debasish.panda@nic.in

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JOINT SECRETARY
MINISTRY OF HEALTH & FAMILY WELFARE GOVERNMENT OF INDIA
NIRMAN BHAVAN, NEW DELHI-110108

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Acknowledgements

No work of any merit is possible without contributions from several ends. We wish to express our sincere gratitude to all those who made this work possible.

First and foremost, we would like to express our sincere thanks to the World Health Organisation (India) for the generous funding support to develop this manual. We also acknowledge the Drug De-Addiction Programme (DDAP) at the Ministry of Health and Family Welfare, Government of India, for their support and encouragement. A special mention has to be made of Joint Secretary, Mr. Debashish Panda for his interest and involvement. We would like to acknowledge the financial support extended by Ministry of Finance, Department of Revenue for reprint and distribution of this manual.

Acknowledgements are also due to the Director and the Dean, All India Institute of Medical Sciences for permitting us to carry out this work.

We also wish to express our deep appreciation and gratitude to Professor Rajat Ray, Chief, National Drug Dependence Treatment Centre (NDDTC) for being the guide and the source of encouragement.

We are grateful to all the contributors who undertook the mission of bringing this manual out on a war footing. Special thanks are due to each and every one of them.

Rakesh Lal Atul Ambekar

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Awareness of available interventions

In order to ensure a complete understanding of the treatment approach and possible interventions the para-medical staff should apprise themselves of all available interventions. While they might not be required to administer these treatments on their own, an understanding of the issues involved would be of paramount importance in continuing patient care. The treatment for drug abuse/dependence might mean:

·  Use of medicines to prevent withdrawal symptoms (Detoxification)

·  Use of medicines to minimise/prevent craving

·  Drug-free’ follow-up at the out-patient

·  Medicines to be used for Long-term (Medication maintenance)

·  Formation of self-help groups

·  Motivation enhancement/ relapse prevention sessions

·  Socio-occupational rehabilitation
Current immediate challenges
In order to facilitate preparedness, the para- medical staff involved in the treatment of drug users should be aware of the common challenges. Some of these are:
Too few drug users are attracted to treatment Too few accept treatment
Too few stay in treatment

 

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PSYCHOSOCIAL INTERVENTIONS FOR SUBSTANCE USE PROBLEMS

Deepak Yadav

National Drug Dependence Treatment Centre, All India Institute of medical Sciences, New Delhi

Substance use is a Bio-psychosocial illness and Psychosocial intervention forms an important part of treatment . The current chapter focuses on some of the very important issues related to non medical management of this disorder. These are:

·  Concept of stages of change

·  Enhancingmotivationtoseekhelp

·  Referral(establishingreferrallinkages,preparingresourcedirectoryetc.)

·  Psycho-education to patient and family about the illness, its treatment and the
recovery process

·  Rehabilitation:Social,Occupational,Financial

·  Addressingstigmaanddiscrimination
The role of paramedical staff worker in providing help for substance use disorders has beenillustratedthroughahypotheticalstory“Thestoryof Sunil.”

Psychosocial Intervention: The concept

Psychosocial intervention comprises of a range of non-medical interventions that are aimed at motivating an individual to seek treatment for alcohol and drug use, improving retention in treatment and compliance to pharmacotherapy. It also focuses on improving quality of life, reducing high-risk behavior and developing skills to cope with factors leading to relapse. Rehabilitation, reintegration with society, counselling and educating the family members about the nature of disease and role of family in treatment are also issues which are addressed during psychosocial intervention.

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Concept of Change

Generally it is believed that
change is an event (something
static) rather than a process.
“It is difficult for an individual
to bring about change in
habits, behaviour or life style.”
This was the laymen’s understanding about the individuals suffering from problematic drug or alcohol use. However, with the development of stage of change model by James Prochaska and Carlo DiClemente about four decades back, a new understanding in the field of behaviour change emerged. According to this theory:

·  The behaviour change does not happen in one step. Rather, people tend to progress through different stages on their way to successful change.

·  The rate/pace of progress through each stage varies from individual to individual.

·  In each of the stages, a person has to grapple with a different set of issues and tasks that relate to changing behaviour.
The Stages of Change
As per this model an individual in the change process goes through following stages:

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So expecting behaviour change by simply telling someone, that he or she must stop using alcohol or drugs or to seek treatment is rather naive (and perhaps counterproductive) because they are not ready to change

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· They are acceptable to the communities and their advices are often given serious attention by the communities.

What can the Health Workers and Health Volunteers do for Substance Use?

Role in Primary Prevention

 

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Assessment of Community needs (for example if the heath workers finds out that most adolescents in the community start with inhalant use, than the awareness building measures for inhalant use can be instituted)

Identification of high risk individuals.
Counseling and education of such individuals.
Handling crisis situations in the families.
Providing moral support.
Organizing and participating IEC/ Awareness programmes for various groups

such as high risk groups and schools.
Linkages & Coordination with governmental health systems and non-

governmental organization.
Creation and operationalizing self help groups.

Secondary Prevention

The health workers and health volunteers can help in early diagnosis (case finding / screening) and treatment of cases including referrals to appropriate treatment Centres. Various Screening Tools are available for identifying people who may be addicted to alcohol or substances. The health workers can be trained to use these tools.

Through their routine work, they can keep a follow up of cases on treatment and prevent lapses/ relapses.

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Community Mobilization: Through this process, the communities take required steps to bring people together to facilitate a program. The health workers can be instrumental in community mobilization by enlisting support from local, religious and opinion leaders of the communities.

Role in Tertiary Prevention

Tertiary prevention activities attempt to reduce disabilities through rehabilitation and thus help the person to return to the highest level of functioning.

The health workers and health volunteers can play an important role in the rehabilitation and disability limitation efforts by:

·  Helping the patient to identify substance abuse behavior and its consequences.

·  Offering constant support to the patients.

·  Helping the patient to realize her/ his strength to overcome her/ his
problem.

·  Encouraging the patients to participate in treatment programme and
continue.

·  Referring the patients to appropriate agencies and organizations for seeking
economic support for starting some vocation.

·  Minimizing the stigmatization and discrimination against the patient by the
community.

·  Working in close liaison with governmental and non-governmental

organizations for rehabilitation of the patients.

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Conclusions

In brief, despite their existing workload, the health workers and health volunteers can be of vital importance in prevention, treatment and control of substance use in rural and urban areas. They can be pillars of all community based de-addiction programmes.

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