Side Event- Evidence-Based Treatment as an Integral Part of the Health System

Chair: Welcome, thanks for coming to this meaningful side event.

Spain: The collaboration between the organisations is a good example of collaboration between the government and civil society. They were both created in a similar period. Addictions constitute a public health problem all over the world. In Spain, since the 80s, drug policies are based on evidence of effectiveness and are respectful of human rights. For the Spanish Government, basing ourselves on the evidence has been of great importance in all areas of social action. In a context of increasing certainty, several organisations have been emphasing the need to inform the programmes related to drug abuse addictions. The aim is to regulate the services that have a direct impact on people’s lives and health. Significant programmes have been made in the standards for people with problematic use of drugs and to facilitate their development. We are able to boost regulation based on evidence and protect the quality of life of people who have problems with drugs. It is clear in some countries that available treatment from health services with problematic use presents difficulties that compromise accessibility, quality and assurance of attention received. In this context, it is crucial  to work in different aspects of improvement to move towards a reference framework that informs drug policies. We need definition of standards and aspects relating to structure and functioning of treatment services and the need of legal frameworks. The scientific evidence approach is of vital importance and the adoption of the International Standards is based on consensus. I will share with you a project funded by Sapsin through UNODC about seized assets from drug trafficking. It will be developed in 2020 and supports countries from Latin America who are in the process of moving towards the adoption of regulatory legal frameworks which ensure the quality of treatment to use drugs. These have been adapted to every country. Multilateral organisations and other initiatives that work towards that improve the situation. This project will result in use of resources, technical support and funding of the programme. We are aware that our project is ambitious, but it will be worth it to provide the tools that help them guide the development of policies in environments of evidence and multilateral cooperation of human rights and addiction as an illness.

UNODC: Consider the title. If this was 20 years ago, someone would say that the community is not evidence-based. Evidence-based is a pharmacological intervention which is based on science. It is an integral health system- they are doing something outside the towns to have a drug free programme away from the health system. I have noted it is a miracle- a complete change in perspectives who are now promoting evidence-based systems responding to the needs of the patient. When we speak about science, we are doing research together showing how much we are interested in having data- showing what is effective on the basis of science. In the last year, I was working in Italy in the public health system in a concrete way. The patient and family are not understanding whether its public or private as the care is so integrated. However, distortion in the system means that you deal with the problem in different districts of town. I have provided you with two articles- if you inject cocaine, it is very addictive. If you do it in an empty cage then you will be addicted. If you put other things in with the rat, he does not become addicted. Now this article, says that there is clinical application. If there is social interaction, there is a decrease in addiction rate and a change is the part of the brain. The application of the environment is effective in changing. A strong component is the issue of spirituality. Psychotherapy and spirituality has positive effects and results.

Projecto Hombre: We are an NGO created in 1985 with ECOSOC status. We Bring together 27 organisations, focusing on drug prevention and treatment. We ensure a common methodology. We provide quality information for analysis of substance use problems. We are governed by transparent and rigorous principles and show commitment with the study of addiction. Information comes from internal data which collects infomation related to people who attended the service. The Survey name is EiropASI. We dedicate ourselves to accompanying people with addiction problems. We must pay attention to what is happening in society, how environments and circumstances affect it. It also aims to regulate rigorous information on the profile of people with addiction problems. This involves work of the National Evolution Committee in cooperation and data analysis is done externally. The annual report from this data shows the problem of abuse not linked to specific groups, but throughout society. You can find it in difference ages, social status etc. This means that is it relevant to develop a  joint response. The report provides information on drug use, data and people attending. The 2 substances which cause most demand are alcohol and cocaine. Few people have taken some other toxic substance. The importance of developing preventing tasks and ensuring the availability of treatment resources is vital. The report also provides information on other aspects of people involved in the development of substance use syndrome such as medical status, employment, family relations.

World Federation of Therapeutic Communities: Funders – FEBRACT, Government de Sao Paolo, Programa Recomeco. We are able to see the development of this community which started having programmes. After some years, this community with help, developed more technical treatment. Many did not have any data at the start. We are developing an online monitoring system which allows us to have access to all activities for example, referring patients through local health services, treatment follow up and all the financial reporting. Outcomes: select first sample of 9000 patients 2017-2020. The online monitoring system started being used in 2017. the sample composed of mostly of males between 30-50 years. 37% of participants reached the conclusion of the programme. To measure improvement during treatment, we developed qualified release to prevent relapse through house and self-support. At the release, more than 70% have a home and have money to support themselves working. One of most important findings, is that we found people who participate at least in activites are more likely to have QR. We are still improving and enhancing programmes, offering more activities help to reach better outcomes. There is a 12 month follow up with all people attending the service – In the first database, there are more than 44,000 contacts. Preliminary outcomes: 55% reach abstinence, 65% working, 80% better family bond.

Turkish Green Crescent: Before, we focused mainly on prevention but because of the big need in Turkey, we work on rehabilitation too. We made some attempts before, but the attempts were not successful. We need to be careful about establishing a system that is sustainable. We work on best practice around world. We visited 10 centre around the world and we work with local professionals. We did some tests in centres in big cities. Now we have 50 councelling centres around Turkey. There are 5 services. psychotherapy, group psychotherapy, family, social work. All the workshops are free. The main focus is to work with the evidence based model. We publish work and now we have reached 25 published articles in journals. This week, we are planning to publish all 25 in English next wek. Substance abuse is growing in turkey. Psychotherapy treatment is needed which is why we established centres. Showed video- After this campaign, many came to centres. In one of our papers, we worked with data 554 participants and implemented questionaires to 155 who dropped out. We used BAPisoft. As long as they are in the service centre they benefit more. We also focused on the relationship with family as a strong factor to prevent addition. There are so many services we provide and also job replacement. As long as they are in the service, the rehabilitation works very well. Interviewing techniques have been effective in maintining treatment and the use of substances decreased. Many were satisfied with the service they received. The treatment programme applied has an effect on the treatment of the clients.

World Federation of Therapeutic Communties: Addictive disorder emerges from a complex set of behaviours. The Model for evidence-based programmes looks at the risks and needs of clients and preferences of clients backed by research and clinical expertise. Addictive behaviours can be linked to internal, external, environment, belief systems. Triggers of disorder- dealing with a process of beliefs, thoughts, urges, cravings. Evidence based practices for adolescent and children show that not much research has been done on this and that there are differences. With children, we are mostly looking at prescribing practices, family edcucation and support services. We are also coordinating with teachers and families. Additions continue and result in increased levels. Even if daily use is stabilised, some will need to continue to use drugs for maintenance. Addiction is a brain disease and causes long-lasting brain changes caused. There are many different reasons for relapse. Longer activng drugs have longer period of toxicity such a cocaine and methamphetamine. We also know that compiance rates are no worse for addiction illness that for chronic illness. Abstinence rates are 50% or higher from who we have been seeing. Relapse should be viewed in the context of recovery and in law. We know that there is stigma attached to people after recovery too. Reducing stigma is not easy but with my colleagues, we know that anything is possible and they will continue to do great work on this.

 

 

 

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