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.
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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)
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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
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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
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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.
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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.
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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.
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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?
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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.
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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.
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12. E ffective Treatment Plan
 Individualized
 Flexible
 Realistic
 Simple
 Useful
 Solution focused
 Clear
 Responsive to changes and progress
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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.
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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
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17. “ E vidence-B as ed” Practice
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18. “ E vidence-bas ed” : S cience
 Empirically
validated evidence, meaning
evidence that is based on information gained
through:
 Directobservation
 Experience
 Experiments
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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
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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
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21. Why E vidence-B as ed Practices ?
 Question:
 Why do we need to know and care about EBPs?
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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)
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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.
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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.
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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
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27. E B Ps We’ll C over
 Cognitive-behavioral therapy
 Motivational approaches
 Certain family approaches
 Therapeutic community
 Contingency management
 Pharmacotherapy for opioid dependence
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