CBDR Portal

Webinar Series FAQs

Treatment Planning
Is there a standard for effective treatment?

There are four criteria for an effective treatment. These are symptom reduction, improvement of functioning, prevention of complications and respect for human rights.

Globally, what are the evidence-based treatments that have been used for drug dependents?

Here are some of the interventions with very good evidence of effectiveness. Cognitive behavioral therapy which has been found to be very effective. Both in groups and individual. Motivational interviewing and motivational enhancement therapy with different specifications. Another option is the twelve-step model particularly for recovery management and Medication assisted therapy.

From the presentation, are the evidence-based interventions that over time might not be considered as evidence-based anymore, or may not be efficient?

Science is constantly developing. What we know works now will most likely continue to be working. But at this point, we have some interesting scientific discoveries that could add to our tools.

Why do individuals go back to using drugs?

Using drugs is a condition that is chronic. Meaning, it will probably last for the rest of their lives. With tendency to recur, to get worse. If it gets worse, we will intensify treatment, we will put the person back to normal. And we’ll continue relapse prevention.

What will be the use of manualized treatment models or programs if we individualize the treatment for PWUDs?

You cannot manualize treatment completely because people are different. When we use manuals, it gives you a pattern and some sequence of treatment steps. Manualized treatment is typically used for groups not individuals, although it can be used for individuals but typically is used in group settings.

For low risk or those who are mild dependents, can group community interventions work?

Difficult to answer because the definition of mild and not mild dependency has to be established. Even with mild severity of problem, people are still very different. Need more information to answer this question.

How we deal with clients who are resistant to undergo treatment?

Resistance is a normal human behavior. It takes two to resist. When working with a client, and the client is becoming defensive or resistant, it means you did something to make him defensive. It is a good thing because it gives a signal not to it again. Change your strategy. Shift something. Change something. Because otherwise if you continue what you are doing, the client will continue being defensive and resistant.

Could you recommend some community-based treatment plans for the Philippines?

Difficult to answer because information like what are the communities like, its traditions and cultural or religious specifics are need to make responsible recommendations.

Up to what extent are we extending treatment to a relapsing patient, knowing we have exhausted all our efforts to help them?

Extend options for as long as the client is alive. Do not discard any client even if the client doesn’t seem to be very effective, or compliant. Your expectations will probably change if you see that the client is not capable of maintaining recovery. Consider some of the harm reduction strategies. Do whatever it takes to keep the client functional and alive.

Are there ethical considerations for developing a treatment plan?

Absolutely. Like any other profession, everything we do must follow basic ethical fundamental rules. Ethical considerations in addiction medicine and in mental health and behavioral health are very gray. If you as a professional want to do something and you wanted to know whether it is ethical or not, ask yourself two questions—Do I want my children to know about it? Do you want it to be published in the newspaper tomorrow morning? If one or both answers are no, you’re doing something unethical. Don’t do it.

How do we form and sustain recovery support system to prevent relapses of our PWUDs?

Building a recovery-oriented system of care means having to depart from the acute care model. If the approach to the chronic condition is from the acute care philosophy, you have 30 days in patient to detox. After that the patient is on his own. This will not be effective because this is not a recover- oriented system of care.

What is your perspective on mandatory treatment for drug use?

People who use drugs should not be considered for prosecution. This is a public health problem. They should be offered effective, attractive, available and accessible treatment. The drug use itself should not be considered a crime.

Is the therapeutic community approach effective both in community based and in in-patient rehab?

The 12 step approaches have been particularly good at supporting people who are committed for mutual care. Those in communities are really designed to assist people who have significant problems in living skills. In our experience, therapeutic communities are really reserved for those who are most troubled and finding that they don’t have a significant number of life skills to support themselves in recovery.

We look into programs with evidences that has been used in other countries. In the DDB board regulation, therapeutic community is one. Hazelden Minnesota model is one. And the various faith-based models were also allowed. As long as it conforms with the effective treatment principles published by the UNODC and USAID, then it is accepted by the Dangerous Drugs Board.

If this voluntary, it does not matter who will bring the PWUD to confinement and treatment center. However, if it is court mandated, the decision falls on the court.

What if the PWUD is found positive on random testing or there is a case of relapse?

The service provider will decide if another assessment is needed or another program intervention should be given. The CBDR service provider should know how to manage the case of the PWUD.

What if the admission to inpatient and outpatient treatment and rehabilitation centers were suspended?

The suspension is a decision made by the DOH. However, there is the need to adopt with the new norm. Going online may be an option. There are also other methodologies to utilize. There is a DOH helpline. The important thing to do is for the provider to touch based with their clients and provide them options.

What are the options for a drug dependent who has been in and out of rehabilitation and goes back to illegal drug use?

Option 1 – They need to be reassessed to evaluate if they need more intensive care. Beyond treatment, it is also important to check what the other risks and needs are. For example they may be living in a home with drug use or have family using drugs, etc.
Option 2 – not to respond; the question needs more info like what kind of rehab did person already went through.
There are many answers to this question but a good start is to identify the person’s level of risk and look into the kind of treatment he/she is receiving. Oftentimes, there is a mismatch to the level of risk vis a vis the intervention being given.

Funds for Treatment
Just like in ordinary hospitalization, is there a Philhealth support for payment of treatment for high risk PWUD?

Getting Philhealth support is currently in progress. The detox package for drug dependents was already presented. The proposed package will be provided to patients before admission especially for those who underwent withdrawal treatment. Another treatment package is being developed to support rehabilitation programs.

Reinforcement approach have been used in countries where you would not expect it to occur. For example, in China they’ve used contingency management for increasing likelihood of people coming to and staying in treatment. In terms of the moderate risk group, being there, supporting, commenting and praising people for doing well is rewarding in its own right. It doesn’t have to be tangible goods. It can also be emotional support as well.