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The future of treatment in developing countries. Isidore S. Obot Department of Psychology, University of Uyo Centre for Research and Information on Substance Abuse Uyo, NIGERIA. Outline. Prevalence of substance use disorders Problems Availability of treatment The challenges

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the future of treatment in developing countries

The future of treatment in developing countries

Isidore S. Obot

Department of Psychology, University of Uyo

Centre for Research and Information on Substance Abuse

Uyo, NIGERIA

outline
Outline
  • Prevalence of substance use disorders
  • Problems
  • Availability of treatment
  • The challenges
  • Delivering effective interventions
sources of data

Sources of data

World Health Organization Atlas projects - MH Atlas and SUD atlas

WHO GISAH

GBD data

Published literature

Informal survey

UNODC information system

alcohol trauma and crime in south africa
Alcohol, trauma and crime in South Africa

In 2002, 46% of non-natural deaths involved persons with BACs equal to or greater than 0.05g/100 ml

In 2003, for all causes of deaths 49% had positive BACs (mean of 0.18g/100ml)

39% of trauma patients in Cape Town, Durban and Port Elizabeth had BACs equal to or greater than 0.05/100ml

In Cape Town 70% of domestic violence cases are alcohol related

Daily average of persons driving under influence increased from 1.8% in 2002 to 2.1% in 2003.

Drinking strongly linked to rape, property crimes and weapons-related offences

slide7
Alcohol related mortality in South Africa
  • Mortuary-based (x32) system on non-natural deaths (e.g. homicide, suicide, transport related)
  • Also assess Blood Alcohol Concentrations (BAC): 0.05 gm/100ml (legal limit for driving)
  • Among adolescents - 70% male - leading causes of death:
    • Homicide (36.8%)
    • Transport collisions (33.2%)
  • 34.7% had +ve BACs
  • Over 80% with +ve BACs were over .05 gm/100ml (legal limit for driving)
  • Highest number of BAC +ve cases aged 17-19 years

Source:National Injury Mortality Surveillance System (NIMSS) – MRC/UNISA , 2001

alcohol related problems in nigeria
Alcohol-related problems in Nigeria

A disproportionate part of total admissions to tertiary hospitals linked to alcohol

presenting as acute intoxication, delirium tremens, alcoholic psychosis, polyneuropathy and liver damage

Higher prevalence of pathological liver functioning in Nigeria compared to Germany with higher level of alcohol consumption

One of the highest rates of road traffic accidents in the world. Role of alcohol not clearly established.

Unintentional injuries accounted for highest proportion (28%) of male alcohol related deaths in 2002

2.6% of disease burden attributable to alcohol

slide9
Primary drugs of abuse among people in treatment for drug problems in different regions of the world, 2002

Source: UNODC (2004)

primary drugs of abuse in treatment population
Primary drugs of abuse in treatment population

In most countries cannabis mentioned in 50-100% of new admissions

Khat – 75% in Ethiopia

Methaqualone – 43% in Namibia and 24% in South Africa

Cocaine – 72% in Sao Tome & Principe

Opiates (mostly heroin) – Mauritius

Inhalants – 35% in Cameroon; 21% in Kenya

Source: UNODC, WDR, 2004

some findings from who atlas projects

SOME FINDINGS FROM WHO ATLAS PROJECTS

Mental Health Atlas (2005)

Substance Use Atlas (2004)

slide12
Presence of substance abuse policy(Written document containing goals pf prevention and treatment activities related to use, abuse [of] and dependence [on] alcohol, prescription and non-prescription (including illicit) drugs)
the future of treatment what experts in four countries say are the major challenges

The future of treatment: What experts in four countries say are the major challenges

Brazil

1. Lack of qualified professionals

2. Poor quality of treatment

3. Stigma among professionals (at primary care level)

China

1. Discrimination

2. Denial

3. Low level of affordability of treatment

the future of treatment what experts in four countries say are the major challenges1

The future of treatment: What experts in four countries say are the major challenges

India

1. Lack of resources – trained manpower; high cost of pharmacotherapy and treatment

Lack of sensitization

Negative attitudes to people with SUD and therapeutic nihilism

South Africa

Limited resources

Perception that substance abuse is not a psychiatric issue

Stigma

other challenges
Other challenges

Cultural and moral attitudes which affect social acceptability

Delayed onset of treatment due to poor accessibility

Drug diversion

Lack of data on treatment and rehabilitation

slide26

Facing and dealing with the emerging threats of increased drug abuse and associated health and security problems:STRATEGIES

does the future lie in sbi experiences from brazil and south africa

Does the future lie in SBI? Experiences from Brazil and South Africa

There is hope that widespread adoption of SBI will have impact on alcohol problems in developing countries

WHO has funded projects in Brazil and South Africa

One seems like a success; the other not quite so

There are structural and organizational issues to address, e.g. competing priorities in the clinic, who should carry out the screening, etc.

unodc treatnet project
UNODC Treatnet project
  • International network of drug dependence treatment and rehabilitation resource centres
  • Initiated in 2005 to deliver and disseminate a variety of effective drug dependence treatment and rehabilitation
  • 4 priority areas - community based treatment, treatment and rehabilitation in prisons, role of drug treatment in HIV/AIDS prevention and care, reintegration and rehabilitation
  • Network of resource centres, trainers, multipliers
  • Many partners -- ILO, RWJF, EMCDDA, UNIADS, NIDA, CICAD
suggested package of care in low income settings

Suggested package of care in low income settings

Opportunistic screening

Start with brief advice to extended interventions

Community based treatment of withdrawal (detoxification)

Structured relapse prevention

Pharmacotherapy

Follow up and monitoring in the community

Preventive interventions

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