Sunday Times 2
Dealing with drug addiction: Educating professionals
View(s):By Tay Bian How
United Nations Office on Drugs and Crime reports that a total of 246 million people, or one out of 20 people between the ages of 15 and 64 years, used an illicit drug in 2013. Approximately one out of ten people who use illicit drugs is suffering from a drug use disorder. Almost half of those with drug dependence inject drugs of which more than 10% are living with HIV. Given this information, substance use disorders is a major global health problem that places a heavy burden on affected individuals and their families.
There are also significant costs to society including loss of productivity, security challenges, crime, increased health care costs, and a myriad of negative social consequences. Furthermore, caring for individuals with substance use disorders places a heavy burden on public health systems of countries. In view of this, improving treatment systems and making them the best they can be, would undoubtedly benefit not only the affected individuals, but their families, communities and the whole society in which they live.
As all countries commemorate the International Day Against Drug Abuse and Illicit Trafficking on 26 June, the Colombo Plan International Centre for Credentialing and Education of Addiction Professionals (ICCE) Director Tay Bian How recommends that drug demand reduction interventions, particularly relating to prevention and treatment be supported by evidence-based practices. Evidence-based practice (EBP) entails making decisions about how to provide or promote health care by integrating best practices with practitioner expertise and other resources, as well as taking into consideration the characteristics, state, needs, values and preferences of those who will be affected. This is done in a manner that is compatible with the environmental and organisational contexts.
Over the years, many countries have practised treatment interventions based on the premise that drug dependence is a moral failure, a social problem, a character pathology and a guilty behaviour to be punished. So it is common to hear of physical torture, shaming techniques, verbal abuse and compulsory detention in rehabilitation centres.
White and Miller (2007) underscored that treatment for substance use disorders in the United States took a peculiar turn in the mid-20th century. There arose a widespread belief that addiction treatment required the use of fairly aggressive confrontational strategies to break down pernicious defense mechanisms that were presumed to accompany substance use disorders. 1970s.
An example published in the front page of the January 13, 1983 Wall Street Journal, described a physician-led intervention with a corporate executive:
They called a surprise meeting, surrounded him with colleagues critical of his work and threatened to fire him if he didn’t seek help quickly. When the executive tried to deny that he had a drinking problem, the medical director . . . came down hard. “Shut up and listen,” he said. “Alcoholics are liars, so we don’t want to hear what you have to say” (Greenberger, 1983).
Aggressive verbal communication including abusive language in contrast to therapeutic traditions does not work. However, there is a scientific understanding of the brain mechanisms that play the central role in the development and persistence of the behavioural signs and symptoms of substance use disorders. After many years of medical research, we now have a very good understanding of drug dependence as a complex multifactorial biological and behavioural disorder. These scientific advances are making it possible for us to develop treatments that help normalize brain functioning of affected individuals and support them in changing their behaviour. Offering treatments based on the scientific evidence is now helping millions of affected individuals regain control over their lives and initiate a productive life in recovery.
Treatment for substance use disorders has steadily evolved over time. Research on treatment and recovery has become more rigorous and science-based. We now have a better understanding of what works in treatment and recovery. The goals of treatment must include the reduction of intensity of substance use, improve the functioning and well-being of the affected individual and prevent future harm by decreasing the risk of complications and reoccurrence. In addition, treatment interventions should be consistent with UN Declaration of Human Rights and existing UN Conventions, designed to promote individual and society safety, and promote personal autonomy.
Finding what works in prevention has been a challenge. Many approaches, which have been popular for example “scare tactics”, campaigns, information only approaches and testimonials of recovering persons have been found to be ineffective in rigorous research. UNODC published recently the International Standards on Drug Use Prevention that documented twenty years of research in effective drug use prevention strategies and interventions.
The International Standards on Drug Use Prevention, makes the following recommendations on prevention interventions and policies:
Age-related developmental periods whereby interventions and policies are specific towards different developmental periods of an individual from infancy to adolescence and adulthood. Prevention interventions must begin as early as before child birth.
Setting in which the intervention and policy is implemented such as family, school, workplace or community.
Target population in accordance with their vulnerability of substance use.
Hence, prevention or treatment interventions that are based on the common adage, “one size fits all” does not work! In prevention, we see that different target groups in different settings require different approaches, while in treatment every person is unique and requires different clinical needs. Prevention and treatment staff need to be multidisciplinary and professionally trained to render quality services. In addition, they should adhere to a Code of Ethics particularly non-maleficence (do no harm) towards their clients, co-workers, and community.
Responding to the dearth of adequately-trained addiction professionals on evidence-based practices worldwide, the Colombo Plan International Centre for Credentialing and Education of Addiction Professionals (ICCE) was formed on 16 February 2009 with a mandate to train, expand and professionalise the drug demand reduction workforce world wide. To ensure the highest standard of quality to its beneficiaries, ICCE is equipped with a team of highly-trained and qualified professionals from across the globe, including South and South East Asia, Central Asia and Africa. The ICCE Team is also equipped with a wealth of knowledge regarding the cultural, religious and linguistic needs of their global beneficiaries.
With the increasing prevalence of substance use, it is imperative that countries adopt a paradigm shift relating to the initiative of professionalising their drug demand reduction workforce to implement evidence-based practices.
In the process of professionalising the related workforce, ICCE with experts in the field, have developed science-based training manuals in prevention, treatment and recovery to train addiction professionals. The Universal Treatment Curriculum for Substance Use Disorders (UTC) and Universal Prevention Curriculum for Substance Use (UPC) training series are currently being implemented in 47 countries. In addition to the training of trainers in these countries, ICCE also design internationally-recognised credentialing of addiction professionals. Credentialing adds legitimacy to an extremely significant role in addressing substance use as well as being part of the process of professionalisation. Validation of a professional’s knowledge, skill, and competency is conducted through various testing, trainings, and education, all of which provide the basis for the ICCE credentialing process. Professional’s are also required to renew their credentials every two to three years with required number of continuing education hours.
As ICCE has achieved seven years of service to member countries and beyond and has credentialed a total of 468 addiction professionals.
(The writer is a Director at the Colombo Plan’s International Centre for Credentialing and Education of Addiction Professionals.)