- Drug Treatment and Rehabilitation Act 1983 - Drug was issued
as a security threat Ministry of Home Affairs - Facility Pusat
Serenti (One Stop Centre) - National Antidrugs Agency Act -
Fasiliti Pusat Serenti (rebranded as PUSPEN [Pusat Pemulihan
Penagihan Narkotik] in 2009) -Enforcement Division was established
in 2007 - Transformation of Treatment and Rehabilitation at AADK -
Drug Dependency treated as a chronic relapsing disease (Patient)
1983 2004 -Drugs as a social problem -- Department of Social
Welfare - Facility Pusat Insaf Diri -Drugs as a social problem --
Department of Social Welfare - Facility Pusat Insaf Diri 1975 2010
onwards 2 Evolving government policies towards Treatment and
Rehabilitation of Drug Dependency
Slide 3
Category of Drug Dependents 20112012DECREASE (%) New Drug
Dependents 6,9565,270-24.24 Repeat Drug Dependents 4,2383,745-11.63
Total11,1949015-19.50 Total no of registered drug dependents since
1988 till 2012 are 345,234 individuals COMPARISON STATISTICS OF
DRUG DEPENDENTS 2011 AND 2012
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?
Slide 6
Success Rate 75% ? 50% ? 20% ? 10% ? Success Rate 75% ? 50% ?
20% ? 10% ? Compulsory Treatment Reluctant & Resistant Clients
Problems in the DRCs Compulsory Treatment Reluctant & Resistant
Clients Problems in the DRCs Treatment Services Programs in DRCs
and those undergoing Supervision Treatment Services Programs in
DRCs and those undergoing Supervision Parents, Families Stigmatized
Residents criminalized (records) Parents, Families Stigmatized
Residents criminalized (records) Changes Impact of New drugs on
Clients Need for Clinical Approach Changes Impact of New drugs on
Clients Need for Clinical Approach Why NADA needs to Transform? GTP
& NKRA Concept of 1Malaysia GTP & NKRA Concept of 1Malaysia
Success Rate 75% ? 50% ? 20% ? 10% ? Success Rate 75% ? 50% ? 20% ?
10% ? Compulsory Treatment Reluctant & Resistant Clients
Problems in the DRCs Compulsory Treatment Reluctant & Resistant
Clients Problems in the DRCs Treatment Services Programs in DRCs
and those undergoing Supervision Treatment Services Programs in
DRCs and those undergoing Supervision Parents, Families Stigmatized
Residents criminalized (records) Parents, Families Stigmatized
Residents criminalized (records) Changes Impact of New drugs on
Clients Need for Clinical Approach Changes Impact of New drugs on
Clients Need for Clinical Approach
Slide 7
OBJECTIVE 2 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 CURE AND CARE 1 MALAYSIA
CLINIC 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
Slide 8
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
Slide 9
AADK DAERAH 9 AKTA PENAGIH DADAH (RAWATAN DAN PEMULIHAN) 1983
INSTITUTION BASED COMMUNITY BASED
Slide 10
Return of clients as socially funcional individuals Provide a
holistic approach in treatment and rehabilitation Treat Drug
Dependents as patients 10 Treatment and Rehabilitation
Strategy
Slide 11
Treatment Wards Registration Office Sg. Besi Psychiatrist/
Medical Officers
Slide 12
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
Slide 13
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 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 CLINICAL SERVICES 22 VOCATIONAL TRAINING
AND JOB PLACEMENT 33 Skill Training Business Job Placement Skill
Training Business Job Placement Early Recovery Relapse Prevention
Sosial Support Family Development Spiritual and Religious
programmes Counseling Self Management Outing/Excursion Sports and
Recreational Activities Early Recovery Relapse Prevention Sosial
Support Family Development Spiritual and Religious programmes
Counseling Self Management Outing/Excursion Sports and Recreational
Activities PSYCHOSOCIAL 11 13 PROGRAMME PROVIDED
Slide 14
Bkt. Mertajam 15/10/10 Bkt. Mertajam 15/10/10 Kota Bharu
15/10/10 Kota Bharu 15/10/10 Papar 01/11/10 Papar 01/11/10 Tampin
04/04/11 Tampin 04/04/11 Sg. Besi 01/07/10 Kuching 15/10/10 Tampoi
15/10/10 Tampoi 15/10/10 Jerantut 01/07/11 Jerantut 01/07/11
Karangan 01/05/12 Karangan 01/05/12 Bachok 1/8/12 Bachok 1/8/12
TOTAL NO OF CURE & CARE CLINICS - 11 CLINICS TOTAL NO OF MINI
C&C : 4 CLINICS (BESUT, KINTA, MIRI & KENINGAU) : INPATIENT
479 CLIENTS : OUTPATIENT 525 CLIENTS : OPERATIONAL SINCE 15 NOV
2011 TOTAL NO OF MINI C&C : 4 CLINICS (BESUT, KINTA, MIRI &
KENINGAU) : INPATIENT 479 CLIENTS : OUTPATIENT 525 CLIENTS :
OPERATIONAL SINCE 15 NOV 2011 Tampin 04/04/11 Tampin 04/04/11
Dengkil 07/01/13 Dengkil 07/01/13 (TILL April 2013)
Distribution
Slide 15
C&C CLINICCAPACITY CLIENT REFERRAL & ADVOCACY TOTAL
INPATIENTOUTPATIENT SG.BESI150135747216 KOTA BHARU50 4213105 BKT
MERTAJAM403551894 TAMPOI100612164 KUCHING30197026 PAPAR40203225
TAMPIN755492111257 JERANTUT100774586 KARANGAN100 590159
BACHOK201516031 DENGKIL1002514039 CURRENT NO ( 30 Apr 2013)
5913641471102 ACCUMULATIVE JAN - APR 2013 1449127822484975
ACCUMULATIVE 2012 50433854386912766 ACCUMULATIVE 2011
3028225940809367 ACCUMULATIVE 2010 6667721171555 ACCUMULATIVE
2010-2013 1018681631031428663 PERCENTAGE OF INCREASE OF CLIENTS
FROM 2011 TO 2012 } INPATIENT : 66% OUTPATIENT : 71 % 15 STATISTIC
OF CLIENTS
Slide 16
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 Focus on medical, psychiatric & clinical
treatment Treatment-based services only 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, arsonNo incidence of
violence or arson
Slide 17
FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH
Slide 18
YEAR TYPE OF SERVICE TOTAL NO OF CLIENTS DISCHAR GED CLIENT
STATUS ENTRY TO COMPULSORY CENTRE UNDERGO REHABILITATION IN
COMMUNITY PRISONCOMPLIANT NOT ABLE TO BE TRACED* 2010 Inpatient560
30.54%152.68%30.54%45581.25%8114.46% Outpatient294
00.00%51.70%10.34%27894.56%103.40% 2011 Inpatient2590
361.39%2037.84%271.04%181970.23%45517.57% Outpatient1600
110.69%1298.06%80.50%95959.94%50431.50% 2012 Inpatient3230
491.52%2718.39%491.52%215366.66%88527.40% Outpatient2527
240.95%50720.06%50.20%136754.10%63225.01% TOTAL10,8011231.14%
113010.46% 930.86%703165.10%256723.77% OUTCOME RESULTS OF CLIENTS
DISCHARGED FROM CURE & CARE CLINICS (2010-2012)
Slide 19
94.4% 90% 61% Reduced by 37.1% Injecting drug use 46% to 8.9%
Confident of not using drugs in the near future Clients satisfied
with services Ready to recommend the clinic to family and friends
OUTCOME STUDY AT C&C CLINIC
Slide 20
Drug use history Substance 30 days BEFORE first visit to
C&C Past 30 days Heroin67.1%4.8% Benzos; Dormi, Clona, Valium,
Xanax 12%2.0% Syabu, Meth, Ice13.9%2.1% Pil Kuda3.3%2.2% 3 or more
substances in the same day 10.8%1.7% OUTCOME STUDY AT C&C
CLINIC
Slide 21
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% Health status, needs and access OUTCOME STUDY
AT C&C CLINIC
Slide 22
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 2 nd 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
Slide 23
20112010 Example text METHADONE MAINTENANCE PROGRAMME CCSC 1024
CCRC 0 Klinik C&C 0 Jumlah 1024 CCSC 1380 CCRC 21 Klinik
C&C 351 Jumlah 1647 2012 CCSC 1530 CCRC 40 Klinik C&C 1735
Jumlah 3305 936 (67.8%) clients employed in 2012 compared to 543
(53%) clients in 2011. OUTCOME STUDY AT C&C CLINIC
Slide 24
56.3% Helped maintain jobs 42.7% Helped get into government
support services 54.3% Continued education 77.6% Improved family
relations 72.1% Obtained permanent homes 75.9% Prevented arrest
into prisons OUTCOME STUDY AT C&C CLINIC
Slide 25
73.8% Prevented admission into Compulsory DRCs 78.3% Helped
family or friends to get treatment and rehabilitation 76.7% Access
to medical care 94.9% Very satisfied with the methadone maintenance
programme 94.4% Reduced drug cravings 65.4% Obtained skill training
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C OLEH UNIVERSITI MALAYA
OUTCOME STUDY AT C&C CLINIC
Slide 26
CRIME HISTORY InstitutionBEFORE C&CSince coming to the
C&C Lock-up3.500.57 Prison1.060 PUSPEN0.610 Average number of
times inpatients and outpatients have been sent to prison, lock up,
or PUSPEN KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU
OUTCOME STUDY AT C&C CLINIC
Slide 27
Mental Health KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA
BHARU OUTCOME STUDY AT C&C CLINIC
Slide 28
1.UNODC (United Nation Office of Drug And Crime) 2.UNAIDS 3.WHO
4.IDPC (International Drug Policy Consortium) 5.Pengiktirafan
daripada Negara Luar 28 Drug Issues and Priorities for Southeast
Asia 24 th IFNGO Conference, Kuala Lumpur Gary Lewis Regional
Representative, UNODC 8 November 2011 Drug Issues and Priorities
for Southeast Asia 24 th IFNGO Conference, Kuala Lumpur Gary Lewis
Regional Representative, UNODC 8 November 2011 Positive example:
Malaysias Cure and Care 1 Malaysia Clinics (Gary Lewis. Regional
Representative, UNODC) Commendation by Mr. Andrew Marshall,
Journalist from Al-Jazeera
Slide 29
AFTERCARE SERVICES AFTERCARE Options for Aftercare Services
after discharge from C&C Clinic : as outpatient with the same
C&C Clinic or other facility; or CCSC (Cure & Care Service
Centres); or CCH (Community Caring House) CCVC (Cure & Care
Vocational Centre) vocational skills training TransCC Transitional
Cure&Care facility Outpatient CCSC CCH CCVC TransCC NADA
District Offices
Slide 30
NADA VISIONS AND TARGETS People Targets Capacity Building
Training for officers, partners, volunteers Process Targets
Engaging Strategic Partners and Smart Partners Strategy Targets
Scaling up of Community-based services /programs Outcome Targets
Better outcome and success rate in treatment & rehabilitation
Nations Targets Healthier people, drug-free country
Slide 31
By 2015 STRATEGIC PLANNING FOR COMMUNITY-BASED SERVICES /
PROGRAMS CCH / MOBILE UNITS C&C 1MALAYSIA CLINIC CCSC What are
N.A.D.As Future Plans? By 2015
Slide 32
STRATEGIC PLAN (2011 2015) No. of Compulsory Rehab. Centers
(CCRC) (4) No. of CCSC 98 No. of CCH 96 2015CCSC 2015CCH 2015
C&C 1Malaysia Clinic No. of C&C 1Malaysia Clinics (18)