THESIS SYNOPSI SYNOPSIS S
DE ADDICTION CENTER INTRODUCTION: Substance use disorder is best conceptualized as a chronic, noncommunicable disease. The disorder requires a comprehensie treatment, deliered b! trained pro"essionals, belon#in# to arious disciplines, disciplines, in a ariet! o" settin#s. In India, The dru# dependence treatment sector is still deelopin# and under#oin# re$nement. re$nement. The treatment serices "or substance use disorder in India are deliered b! three ma%or pla!ers&. The $rst ma%or pla!er is the Non'oernmental Or#anization (N'O) sector. There are around *+ dru# dependence treatment treatment centers throu#hout the countr!, hich are bein# run b! N'Os, supported b! the inistr! o" Social /ustice and Empoerment, 'oernment 'oernment o" India (S/E, 01). 2nother ma%or #roup is the priate sector3 man! doctors includin# a lar#e number o" ps!chiatrists are proidin# serices to people "or substance use related problems. The third ma%or #roup is the #oernment de-addiction centres 0 (4526s7). The inistr! o" Health and 8amil! 9el"are (OH:89), 'oernment 'oernment o" India, has established about &00 dru# dependence treatment centers (or 4526s7 as the! are called) throu#hout the len#th and breadth o" the countr! (Panda, 0;). ost o" these #oernment centers are associated ith either #eneral hospitals at the district leels or ith departments o" Ps!chiatr! at certain medical colle#es.
HISTORY OF DRUG USE: The Hindu m!tholo#! sa!s that durin# 2mrith anthan , one o" the <&* /eels= that the ocean deliered as Varuni- The 'oddess o" 9ine. 9ine.
5000 BC : The Sumerian people used the
Smo>in# o" 6annabis is >non in India since 0 ?6.
The code o" Hammurabi Hammurabi (&;@0-&;A ?6) is the oldest >non "orm "orm o" le#al code code , that had re#ulator! proisions and #uidelines "or preentin# preentin# 2lcohol 2buse.
Bin# Hammurabi
5000 BC : The Sumerian people used the
Smo>in# o" 6annabis is >non in India since 0 ?6.
The code o" Hammurabi Hammurabi (&;@0-&;A ?6) is the oldest >non "orm "orm o" le#al code code , that had re#ulator! proisions and #uidelines "or preentin# preentin# 2lcohol 2buse.
Bin# Hammurabi
?! the middle o" SiCteenth 6entur!, dru#s li>e 6ocaine, Tobacco and Hallucino#ens ere introduced "rom "rom 2merica to Europe , in eCchan#e o" 9ine , 6annabis and Narcotics. ?! the late &@ th 6entur! 6ocaine >its ere readil! aailable in the estern estern orld.
6ocaine Bit Harrison 2ct (&@&*)D made the possession o" Narcotics ithout a prescription a criminal oence.
DEFENITIONS: Drug ue: is simpl! the in#estion o" substanceFsubstances ithout eCperiencin# eCperiencin# an! ne#atie consequences. It ma! be social use, li>e in parties3 recreational recreational or eCperimental eCperimental use, dietar! practice or ma!be reli#ious ritual. Drug A!ue: the use o" an! substance "or purposes other than medical and scienti$c, includin# use ithout prescription, in eCcessie dose leels, oer an un%usti$ed period o" time. Addi"#i$n: is de$ned as the repeated use o" the substanceFdru#s to the eCtent that the user is periodicall! or toCicall! intoCicated, shos a compulsion to ta>e the pre"erred pre"erred substance or substances, has #reat diGculties in olunteerin#, ceasin# or modi"!in# substance use, and eChibits determination determination to obtain ps!choactie substances b! almost an! means. De%enden"e: is de$ned as,
OVERARCHING ISSUES AND &RINCI&'ES There are certain oerarchin# issues and principles hich must be adhered to "or proidin# the serices. 2ll the 'oernment 5e-addiction centers should strie to achiee the "olloin#D 'i"ening ( A""redi#a#i$n D Ideall! a s!stem should be in place hich proides certi$cation or accreditation to a 'oernment 5e-2ddiction centre as an authorized substance use treatment centre. This issue has been discussed elsehere in the mono#raph. 8or this purpose, the senior mana#ement o" the centre F hospital should ta>e the necessar! steps.
C$)%a#i!i*i#+ ,i#h ei#ing hea*#h er.i"e /ra)e,$r D 9hile plannin# and implementin# substance use treatment serices, it is essential to ensure that these serices are compatible ith the eCistin# health care delier! s!stem. 2 situation is aoided herein certain policies and procedures o" the 5e-2ddiction centre are at odds ith the policies and procedures o" the associated hospital. Seni#i.i#+ and ada%#a!i*i#+ #$ *$"a* "u*#ureD It should also be noted that the policies and procedures at a 'oernment 5e-2ddiction centre are sensitie to the local cultural scenario. 8or this, it is important that patients and their care-#iers are inoled not onl! in the process o" clinical decision ma>in# at an indiidual leel, but their inolement should also be sou#ht "or ma>in# policies and procedures o" the clinic. &r$)$#ing er.i"e u#i*i1a#i$n: 2ll eorts must be made to ensure that the serices on oer are adequatel! utilized b! those in need. ist o" serices and "acilities aailable should be prominentl! displa!ed. 2dditionall!, opportunities "or increasin# the isibilit! o" the centre amon# the masses (throu#h adertisements in local media, local eents etc.) should also be eCplored. A %a#ien#-/riend*+ a#)$%hereD 2ll the serices on oer should be made aailable to all sections o" the societ! ithout an! discrimination. 2ll eorts must be made to ensure priac! and con$dentialit! o" the patients and their "amilies. No procedure hoeer ell-intended should be carried out ithout the eCplicit consent o" the patient. Sa"et! and securit! o" the patients, their attendants and sta should receie the topmost priorit!. Ong$ing e2$r# /$r i)%r$.e)en# D 9hile the standards listed in this chapter (and the subsequent ones) should be seen as 4minimum7 standards, a centre need not stop a"ter achiein# them. There should ala!s be an on#oin# process at or> to brin# about improement in
serices as per the #roin# eCperience, chan#in# needs and deelopments in the $eld. S+#e) /$r a""$un#a!i*i#+D Internal monitorin# s!stems should be deeloped hich ensure accountabilit! at each leel. These internal s!stems should be lin>ed ith the national s!stems "or monitorin# and ealuation (described in another chapter).
THE 3ISSION AND THE VISION Providing quality service with utmost dedication, commitment Sharing skills, knowledge and expertise. Thereby equipping professionals to spread the concept of care. Creating awareness so that more and more people make sensible choices and the number of new drug users comes down This positive social change to be felt at the family level peer level community level
OB4ECTIVES Providing accurate information Clarifying myths and misconceptions ffering methods for early identification, providing motivation, etc !quipping trainees with the necessary skills to become effective trainers
SCO&E J2
place to #ie immense scope to man! lost souls ho desperatel! need to come out o" 5ru#-2ddiction and become normal persons ith their on indiidualit!.
JIt basicall! understands people about their lon# term behaioral obseration and proides them eectie treatments. JThis sel" reliant 5e-2ddiction 6entre pronounces to its patients, the need o" becomin# a sel" reliant and a complete human bein#.
SE'F RE'IANCE &. PO9EK(Electricit!) eectiel! usin# Solar Ener#!) 0. 6OOBIN' '2S +. 92STE 2N2'EENT *. 6LTIM2TION (e#Fpulse) Plant (?io-8ertilizers) A. 8LN5 'ENEK2TION "ertilizers , 2#ri.Produce and . PKO6LKENENT o" "ood materials
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Solar Poer (b! -
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?io-#as Plant ?io-#as Plant ?i-Product o" ?io 'as ar>etin# o" biosurplus Solar Ener#! 6ultiation (Or#anic)
3ETHODO'OGY 6 &'AN: A7 Research:
J5ru# use and addiction 5ru# and 5ru# use 2 pharmaceutical preparation or a naturall! occurrin# substance used primaril! to brin# about a chan#e in the eCistin# process or state (ph!siolo#ical, ps!cholo#ical or biochemical) can be called a dru# 9hen dru#s are used to treat an illness, preent a disease and improe health condition, it is termed dru# use. 5ru# abuse and 2ddiction Inta>e o" dru#s "or reasons other than medical in a manner that aects ph!sical or mental "unctionin# is termed dru# abuse. 2n! abuse can lead to addiction. Tolerance re"ers to a condition here the user needs more and more o" the dru# to eCperience the same eect. Smaller quantities, hich ere suGcient earlier, are no lon#er eectie and the user is "orced to increase the amount o" dru# inta>e. 5ependence This can be ph!sical and ps!cholo#ical . The person becomes dependent and starts "eelin# uncom"ortable in the absence o" the dru#. 9ithdraal s!mptoms 9hen the dru# inta>e is stopped, ithdraal s!mptoms are eCperienced. Ph!sical dependence #ies rise to ithdraals such as tremors and omitin#. Ps!cholo#ical dependence causes ithdraal s!mptoms li>e restlessness or depression. The intensit! o" ithdraal s!mptoms depends on
the ph!sical condition o" the user, t!pe o" dru# abused, the amount o" dru# inta>e and the duration o" abuse. 6lassi$cation o" 2ddictie 5ru#sD Q a. b. c. d. e. ". #.
Narcotic 2nal#esics Stimulants 5epressants Hallucino#ens 6annabis Q Molatile Solents Other dru#s o" abuse.
JThe G$.ern)en# De-Addi"#i$n Cen#er: Fun"#i$ning in India 2bout &00 dru# dependence treatment centers (or 5e-2ddiction 6enters 4526s7) hae been established b! The inistr! o" Health and 8amil! 9el"are (OH:89), 'oernment o" India. 9hile most o" these #oernment centers are associated ith either #eneral hospitals at the district leels (district hospitals or ciil hospitals), some hae also been attached ith departments o" Ps!chiatr! at certain medical colle#es. It is noteorth! that the Lnion Health inistr!s contribution has been lar#el! limited to proidin# one-time #rants "or construction F re"urbishment o" the buildin#s. Onl! a "e centers (about *0, mainl! those in the north-eastern states o" the countr!) receie recurrent #rants "rom the union health ministr!. ost others hae been dependent on the state #oernments "or the recurrin# eCpenditure (on sta salaries, supplies etc.). It is understandable that the state 'oernments ma! hae ar!in# de#rees o" health priorities3 consequentl! the "unds proided b! the state #oernments hae also been ariable in nature. 9hile so "ar, there is no re#ular s!stem in place to ealuate the "unctionin# o" these centers, the inistr! o" Health and 8amil! 9el"are has been ta>in# steps to conduct ealuation eCercises, mainl! throu#h N55T6, 2IIS and throu#h NIH2NS, ?an#alore. In the !ear 00 an ealuation eCercise as underta>en ith support "rom the 9orld Health Or#anization (India). 2#ain in 01 in response to a parliamentar! quer! another ealuation eCercise as underta>en. The $ndin#s o" the ealuation eCercise do not paint an encoura#in# picture. The $ndin#s (see boC) hae reealed that there is a lar#e amount o" ariabilit! in the "unctionin# o" 'oernment de-addiction centers. Thou#h, it must be understood that in li#ht o" the "actors mentioned aboe, it should not come as a surprise. The or#anization o" health s!stems in arious states and ariabilit! o" the aailable resources there should be some 4minimum standards o" serices aailable at these de-addiction centers. It must be understood that 4inimum ma! not mean 4Optimum and certainl! does not mean 4 Ideal. Een a"ter adoption o" minimum standards there ma! be scope "or eCpansion o" scale and improement in the qualit! o" serices. Hoeer, at the least, all centers must aspire to achiee and to proide minimum standards o" care as su##ested in the subsequent chapters o" this mono#raph.
B7 Observations:
The use o" dru#s has a Histor! o" more than thousands o" !ears li>e use o" Opium in A?6 b! Sumerians , 6annabis "rom 0?6 in India , Tobacco and 6ocaine "rom &th centur! in LS2 etc . Een introduction o" the idea o" deaddiction as introduced b! >in# Hammurabi in 0nd millennium ?e"ore 6hrist. The Harrissons Narcotics 2ct &@&* en#endered it as a criminal oence to >eep dru#s in hand ithout an! prescription. 2ccordin# to 9orld 5ru# Keport 0&0 about 0+ million people, or A per cent o" the orlds adult population, are estimated to hae used an illicit dru# at least once in 0&.&-&+ per cent o" dru# users continue to be problem users. The prealence o" HIM (0 per cent), hepatitis 6 (*.; per cent) and hepatitis ? (&*. per cent) amon# in%ectin# dru# users continues to add to the #lobal burden o" disease. 2nnual prealence o" the use o" alcohol is *0 per cent (the use o" alcohol bein# le#al in most countries), hich is ei#ht times hi#her than annual prealence o" illicit dru# use (A. per cent).2pproCimatel! & in eer! & deaths amon# adults is attributed to illicit dru# use
India is located close to the ma%or illicit opium #roin# areas o" the orld, ith<'olden 6rescent= on the Northest and <'olden Trian#le= on the NorthEast. icit substances (alcohol and tobacco) are the most commonl! used substances. 2mon# the illicit substances , cannabis and opiates are the most "requentl! used ones.
8G O'DEN C RESCENT9 AND 8G O'DEN T RIANG'E9
In India , the abuse o" alcohol , tobacco and cannabis is not entirel! ne . 9ith the introduction o" neer dru#s and medical remedies, hich o"ten contained cocaine or heroin deriaties, ere "reel! distributed ithout prescription. 2rticle *; o" the 6onstitution o" India directs the State
s and dru#s hich are in%urious to health.= The same principle o" preentin# use o" dru#s eCcept "or medicinal use as also adopted in the three international conentions on dru# related matters, iz., Sin#le 6onention on Narcotic 5ru#s, &@&6onention on Ps!chotropic Substances, &@;& and The LN 6onention a#ainst Illicit TraGc in Narcotic 5ru#s and Ps!chotropic Substances, [email protected] has si#ned and rati$ed these three conentions. 8olloin# the 6onention on Ps!chotropic Substances (&@;&) The 'oernment o" India, inistr! o" Health and 8amil! 9el"are in &@; appointed an eCpert committee to eCamine the problem o" 5ru# 5e-2ddiction and su##est "uture #uidelines. The report o" committee as submitted in &@;;.The Plannin# 6ommission and the 6entral 6ouncil o" Health inisters reieed this report in &@;@.The recommendations o" the report emphasized the need to eole appropriate strate#ies and to brin# about better coordination amon# dierent inistries and 5epartments or>in# in this area. The 5ru# 5e-addiction Pro#ram o" the inistr! o" Health : 8amil! 9el"are as started in &@1A-1 hich #ot modi$ed as scheme in &@@* and once a#ain reised in &@@@.The scope o" the scheme as enlar#ed to include assistance to
State 'oernmentsFLnion Territories "or deelopin# 5e- addiction 6enters in identi$ed medical colle#esFdistrict-leel hospitals.
C7 U NDERSTANDING :
To create aareness about the ill-eects o" alcoholism and substance abuse to the indiidual, the "amil! and the societ! at lar#e. To deelop culture-speci$c models "or the preention o" addiction and treatment and rehabilitation o" addicts. To eole and proide a hole ran#e o" communit! based serices "or the identi$cation, motiation, detoCi$cation, counselin#, a"ter care and rehabilitation o" addicts To promote communit! participation and public cooperation in the reduction o" demand "or dependence-producin# substances. To promote collectie initiaties and sel"-help endeaors amon# indiiduals and #roups ulnerable to addiction. To establish appropriate lin>a#es beteen oluntar! a#encies, or>in# in the $eld o" addiction and #oernment or#anizations. To support actiities o" non-#oernmental or#anizations, or>in# in the areas o" preention o" addiction and rehabilitation o" addicts.
The actiities to reduce the dru# use related problems in the countr! could be broadl! diided into to arms D Supply reduction and Demand reduction . •
•
The supply reduction actiities hich aim at reducin# the aailabilit! o" illicit dru#s ithin the countr! come under the inistr! o" Home 2airs, ith 5epartment o" Keenue as the nodal a#enc!. The demand reduction actiities "ocus upon the aareness buildin# , treatment and rehabilitation o" dru# usin# patients.
These actiities are run b! a#encies under the inistr! o" Health and 8amil! 9el"are, and the inistr! o" Social /ustice and Empoerment.
The inistr! o" Health : 8amil! 9el"are is mainl! inoled in proidin# treatment serices to the addicts hereas the inistr! o" Social /ustice : Empoerment deals ith other aspects o" the problem li>e aareness creation, counselin# and rehabilitation. Lnion Health inistr!s contribution has been
lar#el! limited to proidin# one-time #rants "or construction F re"urbishment o" the buildin#s. Onl! a "e centers (about *+, those in the north-eastern states o" the countr!) receie recurrent #rants "rom the union health ministr!. Implemented b! the inistr! o" Social /ustice and empoerment , the non#oernmental or#anizations hae been entrusted ith the responsibilit! "or delier! o" serices and the inistr! bears substantial $nancial responsibilit! (@R o" the prescribed #rant amount).In case o" the seen North Eastern States, Si>>im and / : B, the quantum o" assistance ill be @AR o" the total eCpenditure. The balance o" the approed eCpenditure shall hae to be borne b! the implementin# a#enc! out o" its on resources.
D7 Analyze :
2nal!zin# the basic serices, the enironment surroundin#s, the le#ac! o" eCistin# de addiction centers, etc.. Regi#ra#i$n 2t a minimum leel all patients attendin# de-addiction treatment serices should be re#istered in a dedicated re#ister and should receie a unique re#istration number. This serice is lin>ed to record maintenance and thus patients7 unique re#istration number should be reected in all the records o" the patient. 9hile most hospitals (o" hich the de-addiction centers are a part) are eCpected to hae a central re#istration s!stem, the deaddiction re#istration number should be e%ara#e "rom the hospital re#istration as this ould be important "or monitorin# and ealuation purpose.
Outpatient services 'ien the dearth o" the specialist medical human resources in the countr!, the de-addiction serices ould hae to be proided b! doctors ho ma! be either 'eneral 5ut! edical OGcers ('5Os) or medical specialists F ph!sicians. 9hile these doctors ma! encounter man! patients ith substance use disorders in their routine 4#eneral7 clinics, such patients should be re"erred to F encoura#ed to attend, the eCclusie and dedicated outpatient clinic "or substance use disorders. Thus all hospitals ith 'oernment 5e-2ddiction centres should oer an eCclusie outpatient 5e-addiction clinic. The eCpected patient load ould determine the "requenc! o" this 5e-addiction outpatient clinic3 it ma! ar! "rom dail! (i.e. on all or>in# da!s) to onceFticeFthrice a ee>. 8olloin# serices should be aailable in a 5e-addiction centre at outpatient leelD
Assessment: 2ll patients should under#o clinical assessment (i.e. histor! ta>in# and eCamination) b! a trained and competent doctor. The assessment should be #eared at ma>in# a clinical diagnosis (as per the I65-& or 5S-IM #uidelines) as ell as "ormulatin# a treatment / intervention plan. 8or the purpose, adequate in"rastructure should be aailable ensurin# com"ort and priac! "or the patients. Counseling / psychosocial interventions / psycho-education D 2ll patients (and their attendants, i" aailable and onl! i" the patients a#ree
to inole them) assessed b! the trained doctor, should receie 6ounselin# F ps!chosocial interentions F ps!cho-education, as per the clinical needs. 8or this purpose it ould be necessar! to inole a trained medical social or>er F counselor F ps!cholo#ist. Treatment prescriptionD Eer! patient should receie a prescription o" the treatment adised to him. I" the procedures "or dispensin# inoles a dispensin# slip, that ma! also be proided to the patient. The outpatient serices should hae proisions "or both the ne patients as ell as "or the old patients on "ollo-up.
In-%a#ien# #rea#)en# Patients ho require in-patient treatment should be admitted in a dedicated ard hich is e"*ui.e*+ meant "or this purpose. Thus, each hospital ith a #oernment de-addiction centre should hae an eCclusie, &-bedded de-addiction ard. 9hile the duration o" the in-patient treatment ma! ar! as per the indiidual needs o" the patients, all eorts must be made to proide the in-patient treatment "or an adequate len#th o" time. 5urin# the in-patient sta!, "olloin# serices should be made aailable to the patientD 2ssessment b! the doctor(s)D 2t least once per da! durin# the mornin# rounds.
2ailabilit! o" nursin# careD round the cloc>
2ailabilit! o" emer#enc! care (on call doctor)D round the cloc>
Psychosocial interventions
edicines O 8or treatment o" ithdraal s!mptoms O 8or mana#ement o" associated conditions F s!mptoms
8ood
0* hours assistance b! a b!-stander
8acilit! to meet isitors durin# the speci$ed isitin# hours
2ccess to "acilities "or recreationD nespapers, teleision (i" aailable), indoor #ames
9hile there ma! be certain restrictions durin# the inpatient sta! (i.e. restrictions on brin#in# certain items inside the ard F restrictions on moements outside the ard etc.), the hole treatment should be proided onl! ith the eCplicit in"ormed consent o" the patient. The patient should hae a ri#ht to leae treatment (a#ainst medical adice i.e. 22), an! time o" the da!.
Di%ening $/ )edi"ine Pharmacotherap! pla!s the central role in the treatment o" substance use disorders. 2ll the patients see>in# treatment "rom de-addiction centers should hae access to the "olloin# medications "ree o"
cost "rom the dispensar!. In addition, the centre should strie to also ma>e aailable medications listed as 4Other medications7, thou#h the! hae not been put on the essential list.
E)ergen"+ Ser.i"e In those de-addiction centers hich are a part o" the #eneral hospital, the emer#enc! de-addiction serices ma! be proided b! the emer#enc! department o" the hospital. 9hile most such emer#enc! set-ups hae proision o" doctors F nurses and necessar! supplies, these should be #eared toards proidin# emer#enc! serices related to substance use disorders. The emer#enc! set-ups should be #eared to handle emer#enc! situations commonl! encountered in the area o" substance use disorders iz. acute intoCication F oerdose, ithdraal s!ndromes, aderse dru# reactions etc. 'a!$ra#$r+ er.i"e 2ll the de-addiction centers should hae access to basic laborator! serices. It is not necessar! that these serices be established eCclusiel! "or de-addiction patients but these serices ma! be incorporated ith laborator! serices o" the #eneral hospital. Speci$call!, the "acilities "or the "olloin# inesti#ations should be made aailableD Koutine Hiero#ram i.e. Hb, T6, 56, ESK, Platelets ier "unction tests i.e. Serum ?ilirubin , 2ST, 2T, Serum 2l>aline Phosphatase , -'T
Koutine biochemistr!D ?lood Su#ar, ?lood Lrea, Serum 6reatinine, Koutine Lrine chemistr!
HIM screenin#D through linkages with associated ICTC
6hest U ra!
E6'
2dditional serices (i" possible)D Lltrasound abdomen, Lrine screenin# "or dru#s
&+"h$$"ia* in#er.en#i$n 2ll centers should be equipped ith "acilities to proide ps!chosocial interentions at both the leels o" careD Outpatient and In-patient and in both the settin#sD in #roup settin#s and in indiidual settin#s. 8amil! members must also be inoled in ps!chosocial interentions as much as possible. 9hile the specialized ps!chotherapies ma! be out-o"-scope "or most o" the centres, trained manpoer and other "acilities must be aailable "or the "olloin# ps!chosocial sericesD ?asic ps!cho-education about the nature o" illness, important o" treatment adherence Votiation Enhancement VKeduction o" hi#h-ris> behaior V?rie" Interentions VKelapse Preention
V6ounselin# "or occupational rehabilitation
Re/erra* ( C$nu*#a#i$n ( 'inage 9hile a comprehensie treatment pro#ram should address multiple needs o" the patient, no sin#le de-addiction centre alone can proide all the serices a patient requires. 6onsequentl!, it is imperatie "or the centers to establish and maintain re"erral and consultation lin>a#es ith other "acilities and serices. The important ones areD Genera* and %e"ia*i1ed )edi"a* er.i"e D "or associated comorbidities. Since the de-addiction centers are a part o" the #eneral hospital, it is eCpected that man! o" the specialist medical serices ould be aailable. 8or an! associated s!mptoms F medical condition, appropriate re"erral or consultation "rom the concerned specialit! must be sou#ht. This is especiall! important "or conditions li>e HIMF2I5S (lin>a#es ith 2KT centre), Tuberculosis (lin>a#e ith 5OTS centre) and ps!chiatric conditions (lin>a#e ith nearest ps!chiatric "acilit! or 5istrict ental Health Pro#ram 5HP). &ara)edi"a* #a2 u"h a ASHA; Hea*#h ,$rer; AN3; Angan,adi ,$rer e#"76D These are the paramedical stas that are usuall! eCpected to be in close touch ith the communit!. I" these sta members come across out-o"-treatment dru# users in the communit!, the! can motiate the dru# users to see> treatment at the 'oernment 5e-addiction centre and proide re"erral. NGO in #he *$"a*i#+ D It is ell >non that most substance users are unable to access treatment serices "or a ariet! o" reasons. I" there are N'Os in the localit! or>in# ith substance users the centre should strie "or establishin# lin>a#es ith them, so that N'Os could identi"! the out-o"-treatment dru# users in the communit! and encoura#e them to see> help at the 'oernment 5e-addiction centre. Similarl! a"ter the earl! phase o" treatment is oer "rom the 'oernment 5e-addiction centre, N'Os could help the patient in social F occupational rehabilitation
Re"$rd 3ain#enan"e: aintenance o" clinical records is a er! important aspect o" the "unctionin# o" the centre. It is not onl! necessar! "or adequate clinical care o" a patient at the individual leel, but it is also necessar! "or monitorin# and ealuation purpose at the program leel. The "olloin# records should be maintained b! a centreD ndividual patients !le D This should be traceable b! a unique re#istration number. 2 s!stem should so deelop that, once the patient is admitted and dischar#ed, hisFher in-patient treatment record is also incorporated in the out-patient $le. Thus upon pic>in#-up a patients $le, one should be able to assess the entire treatment histor! and pro#ress o" the patient in a chronolo#ical order. 2t each instance o" patients7 "ollo-up in OP5, the $le should be retrieed, presented to the clinical sta (doctor F counselor), in hich necessar! clinical notes should be entered. 2ll the records related to the patient (Inesti#ation reports etc.) should be attached to the $le.
Drug Abuse "onitoring System #DA"S$ pro%orma D 2t eer! instance o" $rst re#istration in the de-addiction clinic, the doctor F counselor should $ll up this pro"orma . Periodicall!, these pro"ormas ould be collected b! a desi#nated central F re#ional centre, and ould be used to anal!ze the pro$le o" patients see>in# treatment. "edication dispensing records D These should be maintained er! strin#entl! since some o" the medications used "or treatment possess abuse liabilit! and ris> o" diersion. 2 s!stem should be deeloped hich ould ma>e each unit o" medicine enterin# into the stores accounted "or. 2"ter dispensin#, the patients should be as>ed to si#n the receipt o" the medications.
<6
DESIGN :
E6 Cae S#udie TT> Hospital o" 5ru# 5e 2ddiction , 6hennai Hope Trust 2lcohol and dru# de-addiction center , H!derabad F6 Buine &r$"e A business process is a collection of linked tasks which find their end in the delivery of a service or product to a client. A business process has also been defined as a set of activities and tasks that, once completed, will accomplish an organizational goal. i. In-patient care Serices 5etoC 6omprehensie medical 2ssessment Ps!chiatric assessment Orientation 5ail! Yo#a and editation ind"ulness trainin# Indiidual counselin# 5ail! 22FN2 meetin#s Input sessions Emotional ana#ement 'roup sessions 2udio and ideo input 8amil! Interentions and meetin#s Ps!cholo#ical Interentions Ps!chiatric help Kelapse Preention Ps!cho Education ECternal Support a>in# 'oals 6ommunication ECercises ii. Out- patient care serices arital counselin# Parental #uidance (teena#e, adolescence, behaior issues) Pre- and post-sur#er! counselin# 'rie" counselin# 6onict mana#ement 6?T "or anCiet! and depression
6?T "or mood disorders ind"ulness and meditation trainin# iii. Online Patients 6are The sessions are ta>en b! our eCperienced and quali$ed therapists ho are equipped to handle issues such asD addictions anCiet! depression bipolar relationship issues adolescence parental problems other emotional problems
G6 =IREFRA3E: =ire /ra)e re%reen# #he !ui*# /$r) in ,hi"h $n*+ *ine and .er#i"e are re%reen#ed 7Here a !ai" e#"hed i#e %*an i h$,n7
H6 DESIGN CONCE&TS:
5esi#nin# an enironment "or rehabilitatin# dru# addicts needs sensitiit! and a better understandin# o" their situation. Here the issues o" primar! concern areD
6an our architecture contribute to this healin# processW - ith the qualit! o" our outer space helpin# to modi"! our inner ps!cholo#ical space and ith the help o" nature 6an our desi#n enhance human interaction and reduce the isolationW
9hile discussin# the brie" ith the clients, the clients eCplained the importance o" bein# connected "or the patients there. ?ein# isolated increases their depression and their crain#. There"ore the desi#n attempts to create as much transparenc!, openness and uidit! o" space to help in the healin#, correctin# process.
2 small, enclosed landscaped amphitheatre in the 6entre, breathes li#ht and %o! into the buildin# hile helpin# the inmates to connect ith each other and the sta there. The buildin# is "unctionall! eas! to monitor ith onl! one controlled entrance. The increased isibilit! because o" the transparenc! ma>es this superision easier. 2 balance has been struc> beteen a sense o" "reedom and disciplinar! control. This architecture attempts at raisin# a sense o" belon#in# and sharin# beteen the users and there"ore indirectl! causin# recoeries. >6 DEVE'O& 7
DESIGN HANDOVER :
The 5esi#n Handoer is the sta#e here client and the desi#ner (architect) si#n the 5esi#n Trans"er 2#reement and the desi#ner trans"ers the $nished desi#n $les to the client.
46 CO33UNICATE:
2n essential communication shall be made beteen the architect and the client on the basic "acilitations , buildin# desi#n , landscape "eatures etc.. hich are important "or an eectie produce. ?6 3ONITOR: Clear observation and checking the progress or quality of the structure over the constructional period of time and thus ; keep under a systematic review of it..
'6 VISUA' DESIGN: Graphic/Visual design is the process of visual communication, and problem-solving through the use of type, space, image and color. he field is considered a subset of visual communication and communication design, but sometimes the term !graphic design! is used interchangeably with these due to overlapping skills involved.
@6 DE&'OY: 36 USABI'ITY TEST:
Usability Inspetion testing is a technique used in user-centered interaction design to evaluate a product by testing it on users. his can be seen as an irreplaceable usability practice, since it gives direct input on how real users use the system."#$ his is in contrast with usability inspection methods where e%perts use different methods to evaluate a user interface without involving users. N6 VERIFICATION:
The eri$cation o" the Lsabilit! test is done in this process . 2 positie result in the conclusion o" the eri$cation can proe the the mental "eelin# o" an admitted patient , his collaboration ith the surroundin#s and the qualitatie proisional requirements. O6
DESIGN UA'ITY CHEC?:
The Xualit! or Standard o" the desi#n ill be reieed. It ould be "urther made clear that the basic standards o" the buildin# are compatible "or the #ien site and climatic conditions. &6 A&&ROVA':
The approal o" desi#n #ets $nalized b! the end o" the eri$cation and desi#n qualit! chec>. Once approed , its the permission to start buildin# the the structure. DETAI'ED CASESTUDIES
7 TT? HOS&ITA' FOR DE ADDICTION &eneral 'eatures: '$"a#i$n : Chennai F$unded : 0 Area : @7@ A"re Addre : ; IV 3ain R$ad; Indira Nagar; Chennai; Ta)i* Nadu -000<07 India7 Fa"i*i#a#ed F$r : Re"$.er+ $/ %a#ien# /r$) A*"$h$*i" ; 'i"i# and i**i"i# Drug Addi"#i$n7 A""$))$da#i$n /$r : A*)$# 0 %a#ien# in-%a#ien#6
Bai" /a"i*i#ie %r$.ided in #he h$%i#a* 5etoCi$cation unit 'eneral ards Special rooms 8amil! ards 6anteen Pharmac! Kecreation center F #!mnasium The T.T. Kan#anathan 6linical Kesearch 8oundation as "ounded in &@1 ith a desire to help people stru##lin# speci$call! ith addiction to alcohol. Since then, it has eCpanded to a A bed treatment "acilit! in &@1; and has helped oer 0, indiiduals ith alcohol addiction and dru# addiction. The TTB Hospitals ision is to rehabilitate patients throu#h in-house treatment and also "ocus on helpin# patients "amilies realize that addiction is a serious problem. Patients receie the help the! need $rst throu#h detoCi$cation, and ps!cholo#ical therap!, hich consists o" both indiidual and #roup therap!. The TTB Hospital also has
a unique part o" the pro#ram hich requires "amilies to participate in therap! "or &* da!s. 2"ter completion o" the 0A da! pro#ram , patients can continue counselin# multiple times a month "or 0-+ !ears to help ith the pro#ress o" liin# a more health! li"e. O""u%a#i$na* Ser.i"e %r$.ided: Tai*$ring C$)%u#er "$ure
&a"age er.i"e
<7 H$%e Tru# A*"$h$* and drug de-addi"#i$n "en#er ; H+dera!ad &eneral 'eatures: '$"a#i$n : H+dera!ad F$unded : <00 Area : 75 A"re Addre : H$%e Tru# ; &*$# N$7 @; R$ad N$7 ;4u!i*ee Hi**; &hae >;H+dera!ad - 500 0>>;Te*angana; India7 Fa"i*i#a#ed F$r : Re"$.er+ $/ %a#ien# /r$) A*"$h$*i" ; 'i"i# and i**i"i# Drug Addi"#i$n7 A""$))$da#i$n /$r : A*)$# %a#ien# in-%a#ien#6
Hope Trust is one o" the 2sias leadin# treatment "acilit! "or addictions alcoholism, dru# abuse, #amblin# and dual dia#nosis. Hope Trust rehab
has earned an international reputation "or its commitment toard sa"e, con$dential and eectie treatment. 6lients and their "amilies "rom all oer the orld come here "or treatment. The abstinence based recoer! pro#ram is &0 Step oriented, ith 6?T, Yo#a, meditation and eCpert medical and ps!chiatric inputs. Inpatient and outpatient options oer intensie pro#rams includin# relapse preention and "ollo-ups. The 8amil! Support Pro#ram proides constructie support and care "or the hole "amil!. Hope Trust is aGliated ith leadin# treatment proiders orldide and or>s ith seeral or#anizations and #oernment a#encies in India and abroad7 Fa"i*i#ie Hope Trusts "acilities are housed in serene and upmar>et area to ma>e !our sta! com"ortable, and "ruit"ul. 9e hae ell appointed bedrooms, entertainment, recreational and $tness "acilities to help !ou ith recoer! ithout "eelin# remoed "rom !our dail! actiities. KelaCin# enironments that ill help !ou "ocus on #ettin# better, happil!Z &. Spacious air-conditioned rooms 0. 2ttached bathrooms ith hot ater +. 6osmopolitan Indian Me# F Non-Me# enu *. odern air-conditioned class room : seminar hall A. Table Tennis, TM oun#es, Indoor 'ames . aundr! Serice ;. Koo"top sit out 1. '!m 1. Kecreation spaces ocation Hope Trust is located in pollution-"ree and serene enirons o" /ubillee Hills at H!derabad, India. It is in close proCimit! to to ma%or corporate hospitals and a ps!chiatric institute. H!derabad is a modern, tourist"riendl! cit!, ell connected b! road, rail and air to the rest o" the countr!. It has hi#h qualit! and economical medical "acilities. The "elloships o" 2lcoholics 2non!mous, Narcotics 2non!mous and 2l2non hae stron# presence here, proidin# support "or lon#-term recoer!. Hope Trust clients attend these meetin#s re#ularl! durin# and a"ter their sta! at the treatment centers. SITE INFO: '$"a#i$n : Tri.andru) ; ?era*a ; India Area : A*#i#ude :
4udgeunnu ; Thiru.a**a) ; >7 A"re @00 /ee# a%%r /r$) ea *e.e*
SITE &HOTOS
(ntrance to )udge*unnu %rom Thiruvallam-+arumam road
&hat Road
&hat Road ,
Rea"hing Hi**#
%$Vi**age in #he .a**e+
Hi**#$% rea"hed
En#ran"e #$ #he %r$%$ed i#e
&r$%$ed i#e I
&r$%$ed i#e II
&r$%$ed Si#e III
eni#h $/ #he Si#e
&an$ra)i" .ie, /r$) #he hi**#
%$'uh Greener+ Ar$und
The "i#+ +*ine
?ara)ana Ri.er $,ing ar$und #he hi**
Terrain Te#ure
Terrain - 'a#era#e $i*
&r$i)i#+ #$ Air%$r#
Vie, /r$) Ara!ian Sea
The Sune#
