CURE & CARE
Evolving government policies towards
Treatment and Rehabilitation of Drug
Dependency
1975
-Drugs as a social problem
-- Department of Social Welfare
- Facility – Pusat Insaf Diri
- Drug Treatment and Rehabilitation Act 1983
1983
- Drug was issued as a security threat
Ministry of Home Affairs
- Facility – Pusat Serenti (One Stop Centre)
- National Antidrugs Agency Act
2004
- Fasiliti – Pusat Serenti (rebranded as PUSPEN [Pusat Pemulihan
Penagihan Narkotik] in 2009)
-Enforcement Division was established in 2007
2010
onwards
- Transformation of Treatment and Rehabilitation at AADK
- Drug Dependency treated as a chronic relapsing disease (Patient)
2
COMPARISON STATISTICS OF DRUG DEPENDENTS
2011 AND 2012
Total no of registered drug dependents since
1988 till 2012 are 345,234 individuals
Category of Drug
Dependents
2011
2012
DECREASE (%)
New Drug
Dependents
6,956
5,270
-24.24
Repeat Drug
Dependents
4,238
3,745
-11.63
Total
11,194
9015
-19.50
Number
5,000
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
4,354 / 48.3%
0%
12%
2,820 / 31.3%
31
5
3
13
6
1%
9%
1,090 / 12%
689
3
0%
1
MELAYU
CINA
78%
INDIA
Malay
PRIBUMI
SABAH
PRIBUMI
SARAWAK
Type of Drug
≥ 50 TAHUN
974
744
Age when detected
45-49 TAHUN
Adults, 29.85%
964
40-44 TAHUN
1,317
35-39 TAHUN
1,611
30-34 TAHUN
Youth,
1,577
25-29 TAHUN
1,506
19-24 TAHUN
66.88%
271
16-18 TAHUN
13-15 TAHUN
24
< 13 TAHUN
0
0
Teenagers, 3.29%
500
1,000
1,500
No of drug dependents
2,000
Treatment Scenario in Malaysia
Compulsory Treatment
• Provided for drug dependants
since 1983
• Drug Rehabilitation Centers (DRC) &
Supervision in the Community
• 22 DRCs – capacity of 7,000 residents
• Supervision - 55,000 estimated in the community
How can N.A.D.A take care of the
massive numbers in the community?
Why NADA needs to Transform?
Success
SuccessRate
Rate
75%
75%??
50%
50%??
20%
20%??
10%
10%??
Treatment
Treatment
Compulsory
Compulsory
Services
Services
Treatment
Treatment
Programs
Programsinin
Reluctant
Reluctant &&
DRCs and
andthose
those
Resistant
ResistantClients
Clients DRCs
undergoing
undergoing
Problems
in
the
Problems in the
Supervision
Supervision
DRCs
DRCs
Parents,
Parents,
Families
Families
Stigmatized
Stigmatized
Residents
Residents––
criminalized
criminalized
(records)
(records)
Changes
Changes
Impact
ImpactofofNew
New
drugs
drugson
onClients
Clients
Need
Needfor
forClinical
Clinical
Approach
Approach
GTP & NKRA
Concept of
1Malaysia
OBJECTIVE
 In response to the growing drug problem and its
complexity and realizing that the existing strategies are not
achieving the intended effects / targets, NADA has shifted
its approach from INSTITUTIONALISED rehabilitation to an
open approach, OPEN ACCESS SERVICES, by setting up THE
2 CARE 1 MALAYSIA CLINIC
CURE AND
or better known
as C&C 1MALAYSIA CLINIC.
 This is a paradigm shift for NADA to transform its
treatment and rehabilitation services to all its clients in the
country.
NADA MALAYSIA
Major Developments since 2010 in terms of the extension of voluntary community
based treatment
COMPULSORY
REHABILITATION
OPEN ACCESS
AMBULATORY
VOLUNTARY
CENTRES
19 CURE & CARE
REHABILITATION
CENTRES
11 CURE & CARE
1MALAYSIA
CLINICS
AKTA PENAGIH DADAH
(RAWATAN DAN PEMULIHAN)
1983
INSTITUTION BASED
COMMUNITY BASED
AADK
DAERAH
9
Treatment and Rehabilitation Strategy
Provide a holistic
approach in treatment
and rehabilitation
Return of clients as
socially funcional
individuals
Treat Drug Dependents as
patients
10
Registration Office– Sg. Besi
Psychiatrist/ Medical Officers
Treatment Wards
CONCEPT
OPEN ACCESS SERVICES
 Voluntarism or Walk-in
 Support from parents or
family
 Referral
 Outreach / Motivate
 No Legal Implications
 No Pre-conditions
 No stigma
 Private and Confidential
 Options for clients
 Community-based
Program
 Clients as patients
PROGRAMME PROVIDED
1
•
•
•
•
•
•
•
•
•
2
PSYCHOSOCIAL
Early Recovery
Relapse Prevention
Sosial Support
Family Development
Spiritual and Religious
programmes
Counseling
Self Management
Outing/Excursion
Sports and Recreational
Activities
•
•
•
•
•
•
•
•
•
3
CLINICAL SERVICES
Medical Detoxification
MAT with
Methadone/Suboxone
Psychiatric Management
HIV/HEP/TB/STI
Management
Inhalan Management
Alcohol and Nikotin
Management
Immunisation
Infectious Disease
Screening
INH Prophylaxis
•
•
•
VOCATIONAL TRAINING
AND JOB PLACEMENT
Skill Training
Business
Job Placement
13
Distribution
Karangan
01/05/12
Kota Bharu
15/10/10
Papar
01/11/10
Bachok
1/8/12
Bkt. Mertajam
15/10/10
Dengkil
07/01/13
Kuching
15/10/10
Jerantut
01/07/11
Sg. Besi
01/07/10
Tampin
04/04/11
Tampoi
15/10/10
TOTAL NO
OF CURE & CARE
CLINICS
- 11 CLINICS
TOTAL NO OF MINI C&C : 4 CLINICS (BESUT, KINTA, MIRI & KENINGAU)
: INPATIENT
– 479 CLIENTS
(TILL April
: OUTPATIENT
– 525 CLIENTS
2013)
: OPERATIONAL SINCE – 15 NOV 2011
STATISTIC OF CLIENTS
CLIENT
C&C CLINIC
CAPACITY
SG.BESI
150
KOTA BHARU
50
BKT MERTAJAM
40
TAMPOI
100
KUCHING
30
PAPAR
40
TAMPIN
75
JERANTUT
100
KARANGAN
100
BACHOK
20
DENGKIL
100
CURRENT NO ( 30 Apr 2013)
ACCUMULATIVE JAN - APR 2013
ACCUMULATIVE 2012
ACCUMULATIVE 2011
ACCUMULATIVE 2010
ACCUMULATIVE
2010-2013
INPATIENT
OUTPATIENT
135
50
35
61
19
20
54
77
100
15
25
74
42
51
2
7
3
92
4
59
16
14
REFERRAL
&
ADVOCACY
7
13
8
1
0
2
111
5
0
0
0
591
364
147
1102
1449
1278
2248
4975
5043
3854
3869
12766
3028
2259
4080
9367
666
772
117
1555
10186
8163
10314
28663
PERCENTAGE OF INCREASE OF CLIENTS FROM 2011 TO 2012 } INPATIENT : 66%
OUTPATIENT : 71 %
TOTAL
216
105
94
64
26
25
257
86
159
31
39
15
DRC VS. C&C CLINIC
DRUG REHAB. CENTERS
C&C CLINIC
Compulsory Treatment & Admission through
the Law; Criminal Records; Stigma
Open Access Services – Voluntary Admission;
Considered as Patients
Treatment-based services only
Focus on medical, psychiatric & clinical
treatment
Treatment for opiate-based addicts; all males
and separate for women
Treatment for all substance abusers (opiate,
ATS, inhalant) – males, females & adolescent
are separated
Treatment Duration – 2 years

Treatment duration – 1-3 months (inpatient),
4-6 months (outpatient)
Capacity for residents in DRCs – 7,350
Number of clients that accessed services at 8
C&C Clinics – 9,041
Cost of food – RM8.00 x 30 days x 12 months
/person = RM 2,880
Cost of food – RM8.00 x 30 x 3 months =
RM720.00
Loss of Property caused by violence, arson
No incidence of violence or arson
FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH
OUTCOME RESULTS OF CLIENTS DISCHARGED
FROM CURE & CARE CLINICS (2010-2012)
TOTAL NO
OF
YEAR TYPE OF SERVICE CLIENTS
DISCHAR
ENTRY TO
UNDERGO
GED
COMPULSORY REHABILITATION
CENTRE
IN COMMUNITY
CLIENT STATUS
PRISON
COMPLIANT
NOT ABLE TO BE
TRACED*
Inpatient
560
3
0.54%
15
2.68%
3
0.54%
455
81.25%
81
14.46%
Outpatient
294
0
0.00%
5
1.70%
1
0.34%
278
94.56%
10
3.40%
Inpatient
2590
36
1.39%
203
7.84%
27
1.04%
455
17.57%
Outpatient
1600
11
0.69%
129
8.06%
8
0.50%
59.94%
504
31.50%
Inpatient
3230
49
1.52%
271
8.39%
49
1.52%
2153 66.66%
885
27.40%
Outpatient
2527
24
0.95%
507
20.06%
5
0.20%
1367 54.10%
632
25.01%
123
1.14%
2010
1819 70.23%
2011
959
2012
TOTAL 10,801
1130 10.46%
93
0.86% 7031 65.10% 2567 23.77%
OUTCOME STUDY AT C&C CLINIC
• Reduced by
37.1%
• 90%
Injecting
drug use
46%
to
8.9%
Confident of
not using
drugs in the
near future
Ready to
recommend
the clinic to
family and
friends
Clients
satisfied
with services
• 61%
•
94.4%
OUTCOME STUDY AT C&C CLINIC
Drug use history
Substance
Heroin
30 days
BEFORE first
visit to C&C
Past 30
days
67.1%
4.8%
Benzos; Dormi, Clona, Valium,
Xanax
Syabu, Meth, Ice
12%
2.0%
13.9%
2.1%
Pil Kuda
3.3%
2.2%
3 or more substances in the same
day
10.8%
1.7%
OUTCOME STUDY AT C&C CLINIC
Health status, needs and access
• In general, how satisfied are you with the
medical attention you receive for your health
problems (other than drug addiction) at the
Cure and Care Clinic?
Satisfied 69.3%
Very satisfied 23.9%
Not very satisfied 5.6%
OUTCOME STUDY AT C&C CLINIC
Qualitative analysis: Opinions and feedback on C&C program
and services.
• Overall, happy with the C&C concept
• C&C encourages voluntary and ambulatory care and
rehabilitation
• MMT is seen as a stabilizer giving 2nd chance
• Programs offered by C&C were well received
• Good support from C&C staff, Counselors and Medical Team
OUTCOME STUDY AT C&C CLINIC
METHADONE MAINTENANCE PROGRAMME
2010
2011
2012
CCSC
1024
CCSC
1380
CCSC
1530
CCRC
0
CCRC
21
CCRC
40
Klinik
C&C
0
Klinik
C&C
351
Klinik
C&C
1735
Jumlah
1024
Jumlah
1647
Jumlah
3305
Example
text
936
(67.8%)
clients employed in 2012 compared to 543 (53%)
clients in 2011.
OUTCOME STUDY AT C&C CLINIC
56.3%
42.7%
54.3%
77.6%
72.1%
75.9%
• Helped maintain jobs
• Helped get into government support services
• Continued education
• Improved family relations
• Obtained permanent homes
• Prevented arrest into prisons
KAJIAN KEBERKESANAN PROGRAM
OUTCOME
AT C&C CLINIC
KLINIK
C&C STUDY
OLEH UNIVERSITI
MALAYA
73.8%
78.3%%
76.7%
94.9%
94.4%
65.4%
• Prevented admission into Compulsory DRCs
• Helped family or friends to get treatment and
rehabilitation
• Access to medical care
• Very satisfied with the methadone maintenance
programme
• Reduced drug cravings
• Obtained skill training
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU
OUTCOME STUDY AT C&C CLINIC
CRIME HISTORY
Average number of times inpatients and outpatients have been sent to
prison, lock up, or PUSPEN
Institution
BEFORE C&C
Since coming to the C&C
Lock-up
3.50
0.57
Prison
1.06
0
PUSPEN
0.61
0
OUTCOME
STUDY
KAJIAN KEBERKESANAN
PROGRAMAT
KLINIKC&C
C&C KOTACLINIC
BHARU
Mental Health
30
30 days before coming to
C&C
26
25
22
In the Previous 30 Days
20
15
11
11
10
5
0
Experienced serious depression, sadness, hoplessness, or loss of
interest
Experienced serious anxiety/tension-uptight, unreasonably worried,
inability to feel relaxed?
Drug Issues and Priorities
for Southeast Asia
24th
IFNGO Conference, Kuala
Lumpur
Gary Lewis
Regional Representative, UNODC
8 November 2011
1.
2.
3.
4.
5.
UNODC (United Nation Office of Drug
And Crime)
UNAIDS
WHO
IDPC (International Drug Policy
Consortium)
Pengiktirafan daripada Negara Luar
Positive example: Malaysia’s
Cure and Care 1 Malaysia Clinics
(Gary Lewis. Regional Representative, UNODC)
Commendation by Mr. Andrew Marshall,
Journalist from Al-Jazeera
28
AFTERCARE
Outpatient
CCSC
Options for Aftercare Services after
discharge from C&C Clinic :
CCH

as outpatient with the same C&C
Clinic or other facility; or

CCSC (Cure & Care Service Centres);
or

CCH (Community Caring House)
CCVC
AFTERCARE
SERVICES
TransCC

CCVC (Cure & Care Vocational
Centre) – vocational skills training

TransCC – Transitional Cure&Care
facility
NADA District
Offices
VISIONS AND TARGETS
NADA
Nation’s Targets
Strategy Targets
Scaling
up
Community-based
services /programs
Healthier
people,
drug-free country
of
Process Targets
Engaging
Strategic
Partners and Smart
Partners
Outcome Targets
People Targets
Capacity Building – Training
for
officers,
partners,
volunteers
Better outcome and
success
rate
in
treatment
&
rehabilitation
STRATEGIC PLANNING FOR COMMUNITY-BASED
SERVICES / PROGRAMS
By
By
2015
2015
CCSC
What are
N.A.D.A’s
Future
Plans?
STRATEGIC PLAN
(2011 – 2015)
C&C
1Malaysia
Clinic
2015
No. of Compulsory
Rehab. Centers
(CCRC)
(4)
No. of C&C
1Malaysia Clinics
(18)
CCSC
CCH
2015
2015
No. of CCSC –
98
No. of CCH – 96
We Care, We Serve