Field Guide Demand Reduction - 2017
Field Guide Demand Reduction - 2017
Field Guide Demand Reduction - 2017
SECOND EDITION
BRIAN MORALES
CHARLOTTE SISSON
BILL MCGLYNN
MARIA SKIRK
JULLION COOPER
ALAN PIRACHA
SECOND EDITION
The First Edition of the FIELD GUIDE Over the last year, my team has worked
to Drug Demand Reduction Program diligently to fulfill this expanded
Development was originally created to mission and reach out globally. The
orient and inform US Embassy personnel Second Edition of the FIELD GUIDE
as they faced a range of issues related to to Drug Demand Reduction Program
substance use. Development is presented in the spirit
of unifying and fostering connection
With greater reflection, it became clear among the growing demand reduction
to the Drug Demand Reduction team community worldwide. Its primary
in the Bureau of International Narcotics purpose is to inform all demand reduction
and Law Enforcement Affairs (INL) that professionals -- both organizationally and
the FIELD GUIDE to Drug Demand individually -- across a spectrum of drug
Reduction Program Development had demand reduction challenges. A highly
both a broader mission to fulfill and a informed demand reduction community
far larger audience to reach than that of can better develop and implement
exclusively US Embassy personnel. evidence-based solutions.
FOREWORD
Brian A. Morales, Division Director
Global Drug Demand Reduction Programs
Office of Policy, Planning and Coordination
Bureau of International Narcotics and Law Enforcement Affairs
U.S. Department of State
Washington, D.C.
April 2017
The audience for the Second Edition threats emerging, including very young
of the FIELD GUIDE to Drug Demand children being identified with substance
Program Development includes U.S. use disorders, increases in availability
Embassy personnel and additionally, of new psychoactive substances, and
the increasingly wide range of demand evidence of toxic adulterants in seized
reduction-focused individuals and drugs in three continents which has
organizations, including: triggered a need for enhanced public
health responses and emergency alerts
1.
The scientific community of at local levels.
researchers in the field of substance
use prevention and treatment of While the scope of the problem has
substance use disorders; expanded, so too has the range of
solutions. Policymakers, program
2. Professionals involved in the providers, and service professionals
development of demand-reduction have an expanding menu of innovative
related technologies, such as brain approaches and successful outcomes
imaging and substance screening; from which to craft informed and
comprehensive responses, including
3. Representatives from governments
global prevention and treatment
and intergovernmental organizations
protocols for children, breakthrough
tasked with the development,
testing technologies for tracking
implementation, and evaluation
adulterants, enhanced training and
of demand reduction policies and
workforce development options,
programs;
and evidence-based prevention and
treatment program options shown to be
4. Non-governmental organizations
effective across diverse cultures.
with whom partnerships are essential
for the achievement of demand
The FIELD GUIDE to Drug Demand
reductions policy goals; and
Program Development, to be produced
annually, welcomes its broad-based
5. Public health practitioners worldwide,
readership. We look forward to
who seek greater knowledge, skills
highlighting issues, focusing efforts,
and credentials to address substance
inviting your collaboration, strengthening
use and related disorders among
partnerships, increasing participation,
children, adolescents, adults, and
and fostering unity and understanding
families.
among the ever-widening global demand
In the last decade, the scope and reduction community.
complexity of drug demand reduction
challenges have increased, with new
ACKNOWLEDGEMENTS
INTRODUCTION 19
PART 4 APPENDICES
PART 5 REFERENCES
References 282
PORTFOLIO
➭ Management of the Drug Demand Reduction (DDR) Team
➭ International Consortium of Universities Drug Demand Reduction (ICUDDR)
➭ Mapping Treatment Capacity
➭ Strategic Planning and Communication Products
Brian Morales is the Division Director for Global Drug Demand Reduction Programs in
INL’s Office of Policy, Planning and Coordination (INL/PC). He has worked on the issue
of drug demand reduction for eight years, covering programs throughout the world.
One of his most notable achievements was the establishment of the International
Society of Substance Use Prevention and Treatment Professionals (ISSUP) in July 2015,
bringing together the global treatment and prevention workforce into an association
that promotes professionalization through training and credentialing. In March 2016,
he collaborated with international partners to launch the International Consortium of
Universities for Drug Demand Reduction (ICUDDR) to promote academic study around
the world in the field of addiction science. Prior to INL/PC, he covered Afghanistan
counter-narcotics issues and also served in the Bureau of Western Hemisphere Affairs
at the U.S. Mission to the Organization of American States. Brian earned his Bachelor
of Science in Foreign Service (2001) and a Master of Arts in Latin American Studies
(2004), both from Georgetown University.
PORTFOLIO
➭ Alternatives to Incarceration Curricula Development, Credentialing,
ISSUP-3, Mapping Treatment Capacity, Humphrey Fellowship,
Colombo Plan
➭ Special Populations: Women, Trafficking in Persons, Child Soldiers
➭ Intranasal Naloxone Trial, Toxic Adulterants
➭ Evaluation: Pakistan
➭ Country Programs: Mexico, Indonesia
Charlotte Sisson joined the team in February 2016 as the Team Lead for Drug Demand
Reduction. She brings over 16 years of drug policy experience from working at the
White House Office of National Drug Control Policy in the areas of drug supply and
demand reduction. She earned her undergraduate degree from Virginia Tech in
Liberal Arts and Sciences concentrating in Economics, Political Science and French and
received a Master’s Degree in International Policy and Practice from George Washington
University in 2001. Over the past year Charlotte has integrated herself into the team
working to oversee an intranasal naloxone study being conducted by UNODC and
WHO. She is currently pursuing efforts to begin the development of a new curriculum
aimed at building partnerships to increase access to treatment between public health
and criminal justice systems.
Bill is an experienced U.S. State Department professional. From 2008 to 2011, Bill was
INL’s Principal Deputy Assistant Secretary. In other assignments, he served as Deputy
U.S. Permanent Representative to the Organization of American States and in the U.S.
embassies in Haiti, Gabon, the European Union, Austria, and Portugal. Bill received his
undergraduate degree in 1976 from the University of Virginia, studied law at William
and Mary, and was a member of the Executive Education program at Princeton (1995-
1996). Bill has been working on drug demand reduction programs in Africa, Asia, and
Latin America. As part of the drug demand reduction team, Bill has been instrumental in
working with the African Union on establishing indicators as part of an epidemiological
project funded by INL.
Maria Skirk joined the Drug Demand Reduction team in July 2015, covering the
Universal Prevention Curriculum (UPC) development and training. She also supports
the work of professionalizing the demand reduction workforce in Afghanistan and
Pakistan. Her previous work at the U.S. Department of State includes creating and
managing strategic communication campaigns and involvement in YSEALI (the Young
Southeast Asian Leaders Initiative), YALI (the Young African Leaders Initiative), and
forging partnerships with the private sector to strengthen the Department’s ability to
engage with youth communities around the world. Maria first joined the Department
as a Presidential Management Fellow in 2011, which included a rotation at the U.S.
Embassy in Jakarta. She has a Masters Degree in International Affairs from the George
Washington University, is a native speaker of Lithuanian, and is conversational in Spanish
and Russian.
Jullion Cooper joined the DDR team in February 2017. He is a Foreign Service
Officer with a B.A. in Criminal Justice from the University of Delaware and an M.A. in
International Relations from Johns Hopkins' School of Advanced International Studies.
Before joining the Department, Jullion assisted HIV+ incarcerated individuals in the
Boston area with re-adjusting to life outside of prison. During his tenure at the U.S.
Consulate in Guangzhou, he aided U.S. citizens in distress, promoted LGBT civil society
and vetted prospective Chinese citizens for tourist visas. During the next year he will
lead efforts in the Western Hemisphere working with the Colombo Plan, the United
Nations Office on Drugs and Crime and the Organization of American States to increase
the number of treatment professionals in the region. Jullion is an asset to the drug
demand reduction team speaking fluent Chinese, Spanish, Catalan and Italian, and is
working on Hebrew and Haitian Creole proficiency.
Alan joined the drug demand reduction team in early 2017 and covers the development
of the advanced Universal Treatment Curriculum, Myanmar, and special population
issues for children and countering violent extremism. Alan previously worked in several
other capacities at the State Department, including in INL’s Afghanistan and Pakistan
office where he covered multilateral engagement for justice sector issues, including
efforts that supported demand reduction programming in Afghanistan. Alan brings a
wealth of background having served as the Niger Desk Officer at the State Department
and working in the Office of the Chief of Protocol and Bureau of Overseas Building
Operations. He completed his Master of Arts in public diplomacy at American University
and his undergraduate education in political science and film production at Bowling
Green State University.
For over three years, Sadie Thimsen Nora Reyes works with U.S. Embassy
worked in the field of global drug in the Dominican Republic, and has
demand reduction in the Bureau an International Business degree
of International Narcotics and Law from Northeastern University. As
Enforcement Affairs as a Foreign Affairs Program Assistant, she is responsible
Officer. Sadie served as the office’s lead for supporting INL projects; in 2016
on the Universal Treatment Curriculum she began working on drug demand
development and dissemination. She reduction. During her rotation with
also oversaw the drug-free communities INL/PC she learned about evidence-
grant to the Community Anti-Drug based programs, and attended
Coalitions of America (CADCA), which planning meetings to observe how INL/
works with communities in over 20 PC effective elaborates strategies to
countries around the world to prevent align initiatives in the field. Soon after
drug use based on community needs. her training, a three year project with
In addition to a Masters of Public UNODC was funded to implement the
Administration from the George “Strong Families” program. Future
Washington University, Sadie attended projects for which INL/PC continues
Virginia Commonwealth University, to provide advice include: mapping
where she studied International of treatment centers, coordinating the
Addiction Science and also received UPC/UTC trainings, and implementing
a Graduate Certificate in Addiction community coalition trainings.
Studies from Eastern Washington
University. In 2015, Sadie obtained her
credentials as an International Certified
Addiction Professional I (ICAP I) at the
launch of ISSUP in Bangkok, Thailand.
Mary “Trina” Bolton works with Robert Weiss served on the demand
U.S. Embassies, other bureaus, and reduction team from June to
external partners to manage people- September. He worked on organizing
to-people sports exchanges for the ISSUP-2 event, providing an
delegations around the world in her opportunity to collaborate with several
role as a program officer for the U.S. international organizations and plan a
Department of State’s Sports Diplomacy major conference, participating in the
Division. Trina focuses on the ESPN ISSUP Board of Trustees meeting in
“Global Sports Mentoring Program” Geneva, Switzerland and conducting
to empower women, as well as the an advance mission to Campinas,
“Sport for Community” program on Brazil. He also conducted research on
disability rights, sports and sustainability vulnerable, marginalized populations
projects. During Trina’s January to April exposed to drug use. Working in the
2016 detail in INL, she maintained Bureau of Consular Affairs on the issue
partnerships with UNODC, the Colombo of International Child Abductions, his
Plan, and CADCA with an emphasis time in INL/PC helped him understand
on disseminating the UTC. Building how drug use can become a problem in
on her INL experience, Trina has since families where the children are victims
encouraged international sports alumni of international abductions and face
to create healthy alternative sports critical risk-factors.
opportunities for youth who are most
vulnerable to substance use.
Ongoing trafficking of heroin, cocaine, and methamphetamine, as well as other drugs, are fueling
the health and safety problems of countries worldwide and there are troubling indications of
an expansion of drug supply via the internet, including via the anonymous online marketplace
known as the "dark net."
The “hijacking” of the brain occurs as a result of substance use which causes a “cascade
of neuro-adaptive changes” that include the creation and strengthening of new memory
connections in different brain circuits.
The reward and inhibitory control circuits are shown in the figure below.
The reward systems become more dominant and the inhibitory control systems become compromised in addiction.
Key: PFC – prefrontal cortex; ACG – anterior cingulate gyrus; OFC – orbitofrontal cortex; SCC – subcallosal cortex;
NAc – nucleus accumbens; VP – ventral pallidum; Hipp – hippocampus; Amyg – amygdala
society at large has the courage to look at with gene variants influencing temperament
the suffering of children and adolescents at and personality traits. On the other, in
risk, to see the difficulties of young adults developing countries, those same factors
affected by substance use disorders with are further complicated by issues such as
compassion and openness. exposure to extreme poverty, degraded
neighborhoods, displacement, exploitation,
Society recognizes the risk-conditions violence, hunger and work overload, which
affecting the vulnerable populations in contribute to aggravate the risk condition
both western developed countries and low- and participate in the pathogenesis of drug
income or developing countries. On one use disorders.
side, in developed countries, neglect and
abuse, lack of bonding to family, impaired It is becoming clearer that the issue is not
parent-child attachment, lack of engagement whether to permit or to prohibit drugs; it
in school, household dysfunction, social is not about adopting liberal or repressive
exclusion, isolation and early onset of policies, but rather to build a comprehensive
mental health problems are concurring to evidence based response to the variety of
the etiology of the disease, in combination
Drug Production
Public Security
The largest number of consumers
of drugs by volume are found outside of Persons who use drugs are perpetrators of
U.S. borders. Afghanistan, Iran and Pakistan theft, violence, and community deterioration
are the largest consumers of opiates in the as a consequence of their need to acquire
world, for example. Cultivation, trafficking funding to sustain their drug use.
and production are fueled significantly by
local and regional markets. While the U.S. Other Organized Criminal Enterprises: Drug
market represents high profits for traffickers, use also helps fuel a number of trans-national
the convenient markets closer to the source threats, including trans-national organized
Drug use results in lost employment A top priority of INL’s Drug Demand
productivity and diminished cognitive Reduction program is professionalizing staff,
abilities which are difficult to quantify, but which consists primarily of training, testing,
ultimately compounds a country’s ability to and credentialing treatment and prevention
become economically stable. workers. This program is fairly advanced,
with 32 countries participating in the project
in 2016, and expanding interest from
Social Impact European countries and U.S. universities to
take part in the coming years.
The social impact of drug use in developing
countries can be profound. Children of A second top priority is the professionalization
persons with substance use disorders of treatment services. INL funded the
commonly neglect and abuse their children. establishment of International Treatment
The childrens’ protective factors are Standards which were released in 2016 at
destroyed while their risk factors to become the 59th Commission of Narcotic Drugs
drug users themselves (environmental + (CND). These Standards will eventually lead
genetic) are high. Research demonstrates to the development of an international
a high correlation between drug users quality assurance system which can license
and their parents. In this way, the cycle of treatment facilities.
drugs and violence is replicated in future
generations, damaging the social fabric of
the local community.
DR. OLAJUMOKE their jobs and health. During her fellowship year, Dr. Koyejo
seeks to increase her knowledge of research, addiction
“JUMMY” prevention, treatment, and rehabilitation. She hopes to learn
more about cognitive behavioral therapy and telepsychiatry
KOYEJO in the treatment of substance use disorders, and to acquire
skills in outpatient drug abuse treatment and rehabilitation.
Nigeria
Dr. Koyejo also wishes to improve her public speaking and
media technology skills.
OCAÑA-GORDILLO
address Ecuador’s drug problems. During her fellowship,
Ms. Ocaña-Gordillo would like to improve her research skills,
Quito, Ecuador especially in epidemiology and biostatistics. She plans to
use her new research skills to conduct studies that lead to a
greater understanding of heroin and opioid use in Ecuador.
Ultimately, she wants to use this information to develop
more effective treatment and prevention programs and
policies to reduce adolescent substance abuse.
Daruish Osmani, MD
Kabul, Afghanistan
Dr. Hnin Aye was exposed to the drug demand field during her
undergraduate studies at the Yangon Mental Health Hospital.
Upon her graduation as a medical doctor, she pursued her post
graduate studies in psychiatry. Presently, she is a consultant
psychiatrist with the Ministry of Health and Sports, Myanmar.
Reema Samman,
Masters in Applied Psychology
Pakistan
There are numerous systems which exist sometimes sleepy, sense of well-being or
for classifying psychoactive substances. For euphoria.
the purpose of this drug demand reduction
• Hallucinogens produce a spectrum of
primer, we are presenting four main classes,
vivid sensory distortions and markedly
or types, of psychoactive substances:
alter mood and thinking.
Stimulants; Opioids (sometimes called
narcotics); Depressants; and Hallucinogens. This classification system is intended as
a general guide, and some psychoactive
These four classes are based on the
substances, do not fit neatly into the basic
substance’s primary effects on the Central
categories. For example, marijuana may be
Nervous System (CNS).
somewhat sedating or relaxing at low doses
• Stimulants increase the activity of the but may have some hallucinogenic effects
CNS. They tend to increase heart rate and at high doses. Miraa (khat) can induce mild
breathing and offer a sense of excited euphoria and excitement at low doses but
euphoria. at higher doses it can also induce manic
• Opioids selectively depress the CNS. behaviors and hyperactivity. Dissociative
These analgesics reduce pain and tend to anesthetics (or PCP) can have hallucinogenic
induce sleep. effects but can also have depressant or
stimulant effects. Inhalants generally have
• Depressants decrease the activity of
depressant effects but can also have
the CNS. They tend to decrease heart
stimulant or hallucinogenic effects.
rate and breathing and offer a relaxed,
Opioids
Stimulants Depressants Hallucinogens
(narcotics)
Mescaline
Amphetamine Morphine Barbiturates
Peyote
Demerol
Gamma-Hydroxybutyrate
Nicotine, Caffeine Mushrooms
(GHB); Rohypnol
For the purpose of this drug demand reduction primer, we are presenting four main classes, or types, of
psychoactive substances that are based on the substance’s primary effects on the central nervous system (CNS).
The classification system is intended as a general guide, and some psychoactive substances, such as marijuana,
do not fit neatly into the basic categories.
receptors. Meanwhile, the communication is not turning off, because the dopamine has not
been returned to the sending cell. So, dopamine continues to be released, and the receptors
are flooded. This flooding of dopamine produces cocaine’s euphoric effects.
Brain with
Healthy brain chronic cocaine use
Red=High levels of dopamine receptors
Source: National Institute on Drug Abuse. (2007). Science & Practice Perspectives, 3(2).
The decrease in dopamine receptors can actually be seen on brain scans. The slide shows
PET scans of a healthy brain and the brain of a person who has used cocaine chronically.
The scan illustrates how dopamine receptors have been depleted over time. The red spots
in the healthy brain on the left are dopamine receptors. In the brain of the person who
uses cocaine, on the right, hardly any dopamine receptors are visible.
Diseased Brain /
Healthy brain
Cocaine Abuser
LOW HIGH
This accompanying graphic compares scan images to show visible brain metabolism
differences between a healthy brain and the brain of someone who uses cocaine.
This image is only an example of how the brain can recover from drug use. In this example
we see a brain of a healthy person on the far left. When we compare the image in the
middle to the healthy brain on the left you can see that the middle brain image of a
person who has been not using methamphetamine for a month has much less activity
with very little red and yellow. With a longer duration of drug abstinence, 14 months later
it can be seen that this brain has more red and yellow and looks more like the brain of
a healthy person. These images are important in that they suggest that there is hope for
brain recovery after substance use disorder.
1 2 3 4
RECREATIONAL OCCASIONAL REGULAR ADDICTIVE
USE USE USE USE
Vulnerability Protection
Intrapersonal: Intrapersonal:
• Irritable temperament • Easy temperament, easy to soothe
• Inability to regulate emotions • Cooperative behaviour
• Aggressive tendencies • Happy demeanour
• Low intelligence • Average intelligence
• High sensation seeking • Early reader
• Athletic ability
Interpersonal: Interpersonal:
(relationships with family and peers) (relationships with family and peers)
• Resistance to rules • Warm supportive parenting
• Arguing with parents • Parent involvement in child’s activities
• Harsh discipline • Parents know child’s friends
• Domestic violence • Friends who resist drugs
• Maternal depression • Involvement in school activities or clubs
• Parental substance abuse
• Association with deviant peers
Environmental: Environmental:
• Classroom mismanagement • Safe adequate housing
• Lack of safe places to play • Sidewalks and streetlights
• Drug dealing on streets • Community policing
• Adults who are publically intoxicated • Clean well-resourced schools
• Infestation by rodents • Parks and recreation equipment
Preventive interventions encompass the full Preventive interventions and policies aim to
range of programs and policies to address prevent or delay the onset of drug use
these factors by: and progression to disorders. These are
important goals, especially as the onset and
• Identifying malleable risk and protective progression of drug use are preventable
factors for substance use, causes of:
Source: U.S. National Quality Forum. (2007). National voluntary consensus standards for
the treatment of substance use conditions: Evidence-based treatment practices (abridged
version). Washington, DC: Author.
Screening
Severe Risk or
No or Low Risk Moderate Risk Ac6ve
Addic6on
Assessment
No Further Brief
and Primary
Interven6on Interven6on
Treatment
2.1
Screening identifies individuals as having: No or low risk of an SUD;
Moderate risk of an SUD; or Severe risk or active addiction
Case Management
mental disorders, trauma, family therapy).
Case Management
• An integral part of treatment
2.1
FIELD GUIDE | 2016 - 2017 75
MONITORING AND EVALUATION:
Evaluations can be conducted over the course of intervention development from planning,
through early development, to full-blown implementation, and after the program is over. In
reality, all prevention intervention stages should be evaluated because you learn valuable
information to improve the program.
Conception Completion
A full monitoring and evaluation system would include all of the components in the Figure
below.
4.1
• Parties to the Single Convention need not • This category of drugs includes heroin
require that the label under which a drug and are considered to have "particularly
in Schedule II is offered for sale. Most dangerous properties" in comparison to
commonly known substances include: other drugs
Substances of 1971
Narcotic Schedule
DevelopmentDevelopment
and dissemination
and dissemination
of international
of international psychosocial, Development
behavioural andand medication-assisted
dissemination of treatment, as
international
standards for
standards
the treatment
for theoftreatment
drug use of
disorders
drug use disorders appropriate and in accordance
standards with treatment
for the national legislation,
of drug asusewell as
disorders
rehabilitation, social reintegration and recovery support programmes,
The Commission
TheonCommission
Narcotic Drugs,
on Narcotic Drugs, including for peopleThe in the prison system
Commission and those
on Narcotic recently released
Drugs,
from prison, giving special attention to the specific needs of women,
Recalling the Single
Recalling
Convention
the SingleonConvention
Narcotic Drugs
on Narcotic
of 1961Drugsas of 1961 as Recalling the Single Convention on Narcotic Drugs of 1961 as
children and young people,
amended by the amended
1972 byProtocol,
the 1972
1 the Protocol,
Convention
1 theonConvention
Psychotropic on Psychotropic amended by the 1972 Protocol, 1 the Convention on Psychotropic
Substances of 1971 2 and the
Substances of United
1971 and
2 Nations
the United
Convention
Nationsagainst
Convention
Illicit against Illicit Stressing Substances
that, as withofany other
1971 2 andhealth disorder,
the United the development
Nations Convention against Illicit
Traffic in Narcotic
Traffic
Drugs
in Narcotic
and Psychotropic
Drugs andSubstances
Psychotropicof 1988,
Substances
3 of 1988, 3 of standards forTraffictheintreatment of drug
Narcotic Drugs and use disorders Substances
Psychotropic should beof 1988, 3
consistent with applicable human rights obligations,
Stressing, in particular,
Stressing, article
in particular,
38 of the
article
196138 Convention
of the 1961asConvention as Stressing, in particular, article 38 of the 1961 Convention as
amended, according
amended, to which
according
partiesto to
which
the Convention
parties to theshall
Convention
take all shall take all Emphasizing
amended,the need to ensure
according non-discriminatory
to which access to shall take all
parties to the Convention
practicable measures
practicable
for the
measures
preventionfor the
of the
prevention
abuse ofofdrugs,
the abuse
and for
of drugs, and for adequate, effective and scientific
practicable measures evidence-based
for the prevention treatment of drug
of the abuse of drugs, and for
the provision of
theearly
provision
identification,
of early identification,
treatment, education,
treatment,aftercare,
education, aftercare, use disorders, the
including
provisionfor people
of earlyaffected by suchtreatment,
identification, disorders education,
in the aftercare,
rehabilitation and
rehabilitation
social reintegration
and social of reintegration
the personsofinvolved
the persons
and involved and prison system rehabilitation
and other closed settings, in accordance with national
and social reintegration of the persons involved and
shall coordinate
shall
theircoordinate
efforts and their
promote
effortsthe
andtraining
promoteof the
personnel
traininginof personnel in legislation, shall coordinate their efforts and promote the training of personnel in
drug treatment,drugaftercare,
treatment,rehabilitation
aftercare, and
rehabilitation
social reint
andegration
social of
reint egration of Convinced drug of treatment, aftercare,
the importance of rehabilitation and social reint egration of
providing comprehensive,
abusers of drugs,
abusers of drugs, abuserstherapies
integrated treatment of drugs, aimed at preventing relapse to those
Bearing in mindBearing in mindDeclaration
the Political the Political
and Declaration
Plan of Action
and Plan
on of Action on affected by substanceBearing
use dependence
in mind the andPolitical
disorders, in order toand
Declaration ensure
Plan of Action on
International International
Cooperation towards
Cooperationan Integrated
towards anandIntegrated
Balancedand Balanced that all peopleInternational
have access Cooperation
to effective towards
treatmentanandIntegrated
supportiveand Balanced
Strategy to Counter
Strategytheto World
CounterDrug
the Problem,
World Drug4 in Problem,
which Member
4 in which Member services that Strategy
promote to their
Counter the World Drug Problem, 4 inthewhich Member
recovery, and also convinced of
States reiterated
Statestheir
reiterated
commitment
their commitment
to promoting,to developing,
promoting, developing, effectiveness ofStates
holisticreiterated
approaches undercommitment
their which services to and support developing,
promoting,
reviewing or strengthening
reviewing or effective,
strengthening
comprehensive,
effective, comprehensive,
integrated drugintegrated drug are provided that are tailored
reviewing to fit individuals’
or strengthening andcomprehensive,
effective, families’ needs,integrated drug
demand reduction
demand
programmes,
reduction based
programmes,
on scientific
basedevidence,
on scientific
as part
evidence, as part and of promotingdemand the active participation
reduction programmes, and based
involvement of those
on scientific evidence, as part
of a comprehensive,
of a comprehensive,
balanced and integrated
balanced andapproach
integrated
to both
approach
supply to both supply affected by substance use disorders, balanced and integrated approach to both supply
of a comprehensive,
and demand reduction,
and demand reduction, Welcoming andthedemand
ongoingreduction,
work of the United Nations Office on
Recalling the Recalling
Declaration
theonDeclaration
the Guidingon Principles
the Guiding
of Principles
Drug of Drug Drugs and Crime Recalling
and the World Health Organization
the Declaration in raising
on the Guiding Principles of Drug
Demand Reduction,
Demand
5 Reduction, 5 awareness of drug
Demand use Reduction,
disorders 5as a public health concern and i n
providing technical assistance to Member States to improve the
Welcoming theWelcoming
outcome document
the outcome
of the
document
United Nations
of the United
summitNations summit quality and ensure the Welcoming the of
availability outcome document
and increase of the
access United Nations summit
to effective
for the adoption
for the
of the
adoption
post-2015
of thedevelopment
post-2015 agenda,
development
entitled
agenda, entitled fortreatment
practices for the the adoption
of drug ofusethe post-2015 development agenda, entitled
disorders,
“Transforming “Transforming
our world: theour 2030
world: Agenda
the 2030
for Agenda
Sustainable
for Sustainable “Transforming our world: the 2030 Agenda for Sustainable
Development”,Development”,
6 6 Noting with appreciation6 the work of the United Nations Office
Development”,
on Drugs and Crime and the World Health Organization in developing
AcknowledgingAcknowledging
that drug use that
dependence
drug useand
dependence
disorders and
are adisorders are a Acknowledging
the international standards for the that drug of
treatment usedrug
dependence and disorders are a
use disorders,
complex, multifactorial
complex, multifactorial
health disorderhealth
of a disorder
chronic and
of a relapsing
chronic and relapsing complex, of
which is a compendium multifactorial health disorder
scientific evidence-based of a chronic and relapsing
recommendations
nature with psychosocial
nature with causes
psychosocial
and consequences,
causes and consequences,
which can be which can be that reflect best treatment practices for possible use in Member States, which can be
nature with psychosocial causes and consequences,
prevented and treated,
prevented and treated, as appropriate,prevented
and whichand treated,
is to be updated and improved as additional
Convinced of Convinced
the importance
of theofimportance
a multisectoral
of a multisectoral
and fully and fully scientific data is collected, including
Convinced of thethrough field testing,
importance of a multisectoral and fully
coordinated approach
coordinatedunder
approach
which under
government
which agencies,
governmentnon- agencies, non- 1. coordinated
Encourages approachStates
all Member under which government
to consider expanding theagencies, non-
governmental organizations
governmental andorganizations
other relevant
and stakeholders
other relevantcooperate,
stakeholders cooperate, coverage and governmental
improving the organizations
quality ofand other
drug relevant stakeholders
treatment systems, cooperate,
as appropriate as
andappropriate
in accordance
and in
with
accordance
national legislation,
with national
to support
legislation, to support as appropriate
interventions and and inonaccordance
policies based scientific with national
evidence, legislation,
using the to support
the developmentthe development
of policies of and policies
programmes
and programmes
that promote that promote the development
scientific evidence-based of policies
international standards and
for theprogrammes
treatment of that promote
drug use disorders developed by the United Nations Office on Drugs
1 Ibid., vol. 976,1 No.
Ibid.,
14152.
vol. 976, No. 14152. and Crime and the World
1 Ibid., Health
vol. 976, Organization, as appropriate and in
No. 14152.
2 Ibid., vol. 1019,
2 Ibid.,
No. 14956.
vol. 1019, No. 14956. accordance with national
2 Ibid., legislation
vol. 1019, and the international drug control
No. 14956.
conventions; 3
3 Ibid., vol. 1582,
3 Ibid.,
No. 27627.
vol. 1582, No. 27627. Ibid., vol. 1582, No. 27627.
4 See Official Records
4 See Official
of the Economic
Records ofand theSocial
Economic
Council,
and Social
2009, Council, 2009, 2. Requests the United
4 See Official Nations
Records of the Office
Economic on and
Drugs and Council,
Social Crime, in2009,
Supplement No.Supplement
8 (E/2009/28),
No.chap.
8 (E/2009/28),
I, sect. C. chap. I, sect. C. collaboration with the World
Supplement No. 8Health Organization
(E/2009/28), and C.
chap. I, sect. other relevant
5 General Assembly
5 General
resolution
Assembly
S-20/3,
resolution
annex. S-20/3, annex. stakeholders,5 as appropriate, to develop initiatives
General Assembly resolution S-20/3, annex. to support the
6 General Assembly
6 General
resolution
Assembly
70/1. resolution 70/1. dissemination6 of the international
General standards
Assembly resolution for the treatment of drug
70/1.
use disorders;
1 1 1
2
Secretary William R. Brownfield. At this most in large part to the effective United States
recent CND meeting, a key issue for the U.S. collaboration with the International Narcotics
government was international controlling of Control Board (INCB). The CND action is
fentanyl precursor chemicals. After robust a critical step in helping to reduce opioid-
U.S. government advocacy efforts with related overdoses in the United States
the 53 members of the CND, the United because it will require nearly 200 countries
States secured a unanimous vote of the 51 to control the production and export of
members present in favor of international these chemicals, which in turn will make it
control under the UN Convention against harder for criminal organizations to acquire,
Traffic in Narcotic Drugs and Psychotropic produce, and traffic illicit fentanyl into the
Substances (1988 Convention) of two United States. By voting unanimously to
precursor chemicals – ANPP and NPP – control fentanyl precursors, the international
essential to the manufacture of illicit fentanyl community demonstrated its ability to act
and fentanyl-related compounds. The quickly to prevent the spread of a drug-
process leading to this vote occurred in related public health crisis to other countries.
record-setting speed – four months – due
3. AlsoDevelopment
requests the Unitedand dissemination
Nations Office of on international
Drugs and disseminate theDevelopment
international standards for the treatment
and dissemination of of drug use
international
standards
Crime, in collaboration withfor
the the
Worldtreatment of drug use
Health Organization and disorders
other disorders; standards for the treatment of drug use disorders
relevant stakeholders, as appropriate, to provide Member States, upon 10. Invites Member States and other donors to consider
request, with technical Theand
Commission on Narcotic
capacity-building Drugs, in support of
assistance The Commission
providing extrabudgetary resources foron the
Narcotic Drugs,
purposes described above,
their efforts to implement practices consistent with those international in accordance with the rules and
Recalling the Single Convention on Narcotic Drugs of 1961 as Recalling theprocedures of the United
Single Convention Nations. Drugs of 1961 as
on Narcotic
standards for the treatment of drug use disorders,1as appropriate and in
amended by the 1972 Protocol, the Convention on Psychotropic amended by the 1972 Protocol, 1 the Convention on Psychotropic
accordance with national legislation;
Substances of 1971 2 and the United Nations Convention against Illicit Substances of 1971 2 and the United Nations Convention against Illicit
4. Encouragesin Narcotic
Traffic MemberDrugs and Psychotropic
States to considerSubstancesinitiatingof 1988, 3 Traffic in Narcotic Drugs and Psychotropic Substances of 1988, 3
systematic processes of national adaptation of the international
Stressing, in particular, article 38 of the 1961 Convention as Stressing, in particular, article 38 of the 1961 Convention as
standards for the treatment of drug use disorders and the adoption of
amended, according to which parties to the Convention shall take all amended, according to which parties to the Convention shall take all
national standards for the accreditation of services, in accordance with
practicable measures for the prevention of the abuse of drugs, and for practicable measures for the prevention of the abuse of drugs, and for
national legislation, to ensure a qualified and effective response to
the provision of early identification, treatment, education, aftercare, the provision of early identification, treatment, education, aftercare,
drug use disorders, and requests the United Nations Office on Drugs
rehabilitation and social reintegration of the persons involved and rehabilitation and social reintegration of the persons involved and
and Crime, in collaboration with the World Health Organization and
shall coordinate their efforts and promote the training of personnel in shall coordinate their efforts and promote the training of personnel in
other relevant stakeholders, as appropriate, to assist Member States in
drug treatment, aftercare, rehabilitation and social reint egration of drug treatment, aftercare, rehabilitation and social reint egration of
those processes, upon request;
abusers of drugs, abusers of drugs,
5. Invites the World Health Organization, within its mandate,
Bearing in mind the Political Declaration and Plan of Action on Bearing in mind the Political Declaration and Plan of Action on
to support the United Nations Office on Drugs and Cr ime in assisting
International Cooperation towards an Integrated and Balanced International Cooperation towards an Integrated and Balanced
Member States, upon request, in the process of national adaptation of
Strategy to Counter the World Drug Problem, 4 in which Member Strategy to Counter the World Drug Problem, 4 in which Member
those international standards for the treatment of drug use disorders to
States reiterated their commitment to promoting, developing, States reiterated their commitment to promoting, developing,
ensure effective responses to drug use disorders as part of a
reviewing or strengthening effective, comprehensive, integrated drug reviewing or strengthening effective, comprehensive, integrated drug
comprehensive approach;
demand reduction programmes, based on scientific evidence, as part demand reduction programmes, based on scientific evidence, as part
6. of a Member
Invites comprehensive,
States, balanced
through and integrated
bilateral, approach
regional and to both supply of a comprehensive, balanced and integrated approach to both supply
and demand reduction,
international cooperation, as appropriate, to collaborate in the and demand reduction,
implementation of Recalling
practices,theconsistent
Declarationwith on thethe Guiding
international
Principles of Drug Recalling the Declaration on the Guiding Principles of Drug
standards for the treatment
Demand of drug5use disorders through the exchange
Reduction, Demand Reduction, 5
of information and the provision of assistance, including technical
Welcoming
assistance, upon request, with the outcome
a view document their
to enhancing of theability
UnitedtoNations summit Welcoming the outcome document of the United Nations summit
implement the for the adoption
international of theforpost-2015
standards the treatment development
of drug useagenda, entitled for the adoption of the post-2015 development agenda, entitled
“Transforming
disorders, as appropriate and in our world:with
accordance thenational
2030 leAgenda
gislation;for Sustainable “Transforming our world: the 2030 Agenda for Sustainable
Development”, 6 Development”, 6
7. Encourages Member States to provide input to the United
Nations Office onAcknowledging
Drugs and Crime that drug andusethedependence and disorders are a
World Health Acknowledging that drug use dependence and disorders are a
Organization complex,
on a regular multifactorial
basis, inhealth disorder with
accordance of a national
chronic and relapsing complex, multifactorial health disorder of a chronic and relapsing
legislation, based on consultations with relevant stakeholders such a s which can be
nature with psychosocial causes and consequences, nature with psychosocial causes and consequences, which can be
scientists, drugprevented and treated,
treatment practitioners and non -governmental prevented and treated,
organizations, and invites the United
Convinced of the Nations
importanceOfficeof ona Drugs and
multisectoral and fully Convinced of the importance of a multisectoral and fully
Crime and thecoordinated
World Health approach underto which
Organization use thatgovernment
input, in theagencies, non- coordinated approach under which government agencies, non-
context of their respective procedures, to regularly update the
governmental organizations and other relevant stakeholders cooperate, governmental organizations and other relevant stakeholders cooperate,
international standards for the
as appropriate andtreatment of drug
in accordance withuse disorders,
national in
legislation, to support as appropriate and in accordance with national legislation, to support
close collaboration
the with Member States,
development to reflect
of policies andthe programmes
most effective that promote the development of policies and programmes that promote
practices;
8. Invites the
1 Ibid., vol.United Nations
976, No. 14152.Office on Drugs and Crime to 1 Ibid., vol. 976, No. 14152.
support Member States, upon request, in improving the knowledge of
2 Ibid., vol. 1019, No. 14956. 2 Ibid., vol. 1019, No. 14956.
their policymakers, as well as the capacity of their practitioners and
3 Ibid., vol. 1582, No. 27627. 3 Ibid., vol. 1582, No. 27627.
researchers working in the area of treatment of drug use disorders,
of Official
through the useSee Records ofstandards
the Economic andtreatment
Social Council, 2009, See Official Records of the Economic and Social Council, 2009,
4 4
the international for the of drug
use disorders, Supplement No. 8 (E/2009/28),
where appropriate chap. I,and
and applicable sect.consistent
C. with Supplement No. 8 (E/2009/28), chap. I, sect. C.
5 General Assembly resolution S-20/3, annex. 5 General Assembly resolution S-20/3, annex.
national legislation;
6 General Assembly resolution 70/1. 6 General Assembly resolution 70/1.
9. Also invites the United Nations Office on Drugs and Crime
to continue coordinating efforts with other relevant United Nations
1 1
organizations, in particular the World Health Organization, to
3 4
Short-term Inpatient
Outreach Outpatient
or Residential
Programs Treatment Setting
Treatment
Screening Brief
Long-term
Interventions
Residential
& Referral to
Treatment
Treatment (SBIRT)
Routine screening Refers to care in a
in non-specialized therapeutic facility in
settings can support which patients spend
the early identification up to 24 hours for an
of individuals extended period of
experiencing problems time, usually between
related to their drug 6 and 24 months.
use and provide brief
interventions which
may help to prevent
the escalation of drug
use towards drug use
disorders.
Family-oriented treatment
approaches have been found
effective to improve engagement
with treatment, reduce drug use, and
improve participation in aftercare
when compared to care focused on
the individual patient.
Special Populations
Evidence-based pharmacological
interventions: Medications (i.e.
Includes the treatment of pregnant methadone, buprenorphine,
women, treatment of newborn naltrexone, etc.) can be very helpful
infants passively exposed to opioids in managing a variety of drug-related
in utero, children and adolescents disorders such as treatment of drug
with substance use disorders, and intoxication and overdose, drug
withdrawal, drug use disorder, and
treatment in criminal justice settings.
treatment of psychiatric complications
related to drug use.
President Donald Trump meets with New Jersey Gov. Chris Christie during an opioid and drug abuse
listening session on Wednesday, March 29, 2017, in the Cabinet Room of the White House in Washington.
President Trump has appointed Governor Christie to lead the President’s Commission on Combating Drug
Addiction and the Opioid Crisis.
o Video: https://www.whitehouse.gov/featured-videos/
video/2017/03/29/president-trump-hosts-opioid-and-drug-
abuse-listening-session
o Video: https://www.whitehouse.gov/featured-videos/
video/2017/03/29/32917-white-house-press-briefing
Department of Agriculture
1 Department of Health and
5 Human Services
• U.S. Forest Service
• Administration for Children
and Families
Court Services and Offender • Centers for Disease Control
2 Supervision Agency (CSOSA) for and Prevention
the District of Columbia
• Centers for Medicare &
• Drug Interdiction and Medicaid Services
Counterdrug Activities/
OPTEMPO • Health Resources and Services
Administration
• Defense Health Program
• Indian Health Service
Colombo Plan
Drug Advisory Program (DAP)
Colombo Plan is
Head-quartered
in Colombo, Sri Lanka
The Colombo Plan for Cooperative Economic and supply reduction solutions in the region
and Social Development in Asia and the since its inception in 1973. DAP has assisted
Pacific, established in 1951, is one of the its member states and non-member states to
oldest intergovernmental organisations in formulate effective policy and craft practical
Asia-Pacific with the goal of achieving socio- solutions through innovative science-based
economic progress in its member countries. approaches, and strong and grass-roots
partnerships.
The Colombo Plan Drug Advisory Programme
(DAP) was established to address the DAP is relevant and innovative in delivering
growing concerns surrounding drug use in effective interventions. It is the first ever to:
the region. It has spearheaded drug demand
ICCE Curriculum Development Process, which includes the Universal Prevention Curriculum (UPC),
the Universal Treatment Curriculum (UTC), and Specialized Curricula, consists of seven phases.
Training treatment practitioners from Argentina, Global workshop to address SUD in Children,
Brazil, Chile, Paraguay, and Peru on the CHILD Washington, DC - July 2016
Curriculum series - December, 2016
The PROCCER Model includes the following The PROCCER program promotes the
components that may be specifically tailored assurance that prevention and treatment
to meet the needs and capacity of each service providers operating in participating
member state: member states have the necessary
competencies, knowledge, and aptitudes
➩ Conduct a diagnostic (institutional to provide the appropriate interventions.
mapping; assessment of PROCCER has been executed in Central
institutional, human resource, and America, Mexico, South America, and the
user profiles and country training
needs; and legal assessment);
Main Building
UNODC operates in all regions of the world, Under the Drug Demand Reduction pillar
through an extensive network of field offices of work, the UNODC assists countries in
to assist Member States in responding to the implementation of evidence-based drug
world drug problem and dealing with crime, use prevention strategies and treatment
corruption and terrorism. UNODC’s pillars of programmes for drug dependence.
action that guide its work programme cover: The approach is health-centric and is
fundamentally based on respect for human
(a) field-based technical cooperation rights, social protection and cohesion. The
projects to enhance the capacity of aim of prevention is to support and promote
Member States to counteract illicit science- based approaches that target
drugs, crime, and terrorism; individual and environmental vulnerabilities
to risky behaviors at different developmental
(b) research and analytic work to increase
stages of growth and in different social
knowledge and understanding of
settings (the school, the family, the
drugs and crime issues and expand
workplace and the community). Moreover,
the evidence base for policy and
UNODC works with Member States to
operational decisions; and
implement treatment, care and rehabilitation
(c) normative work to assist States in the interventions for people affected by
ratification and implementation of substance use disorders. Such interventions
the relevant international treaties, the are integrated into a public health approach
development of domestic legislation and offer the population affected nothing
on drugs, crime and terrorism, and the less than the highest standards of medical
provision of secretariat and substantive care available for persons with a chronic
services to the treaty-based and health condition. UNODC operates joint
governing bodies.20 programmes on drug dependence treatment
with the WHO.22
It reports to and receives its mandate from
the Commission on Narcotic Drugs (CND), The Office also promotes the integration
which is the central policy-making body for of drug and HIV prevention, treatment,
drug related matters within the UN system, care and support into mainstream health
and the Commission on Crime Prevention and social welfare systems to ensure that
and Criminal Justice (CCPCJ) which is prevention, treatment, care and rehabilitation
the UN system’s central body covering programmes are accessible to all who need
crime prevention and criminal justice them.23
policy. Through its drug mandate UNODC
encourages a balanced approach between
drug supply and drug demand reduction
activities.21
PAHO is the specialized international health PAHO wears two institutional hats: it is
agency for the Americas. It works with the specialized health agency of the Inter-
countries throughout the region to improve American System and also serves as Regional
and protect people's health. PAHO engages Office for the Americas of the World Health
in technical cooperation with its member Organization (WHO), the specialized health
countries to fight communicable and non- agency of the United Nations. From its
communicable diseases and their causes, to Washington, D.C., headquarters, 27 country
strengthen health systems, and to respond offices and three specialized centers in
to emergencies and disasters. PAHO is the region, PAHO promotes evidenced-
committed to ensuring that all people have based decision-making to improve and
access to the health care they need, when promote health as a driver of sustainable
they need it, with quality and without fear of development.
falling into poverty. Through its work, PAHO
promotes and supports the right of everyone
to good health. Specialized Training for Professionals
of the Public Health System to
To advance these goals, PAHO promotes Address Substance Use Disorders
technical cooperation between countries and
works in partnership with ministries of health In the interest of public health, social health,
and other government agencies, civil society and social security, PAHO is collaborating
organizations, other international agencies, with OAS/CICAD, UNODC, and WHO
universities, social security agencies, to develop a Specialized Training for
community groups, and other partners. Professionals of the Public Health System.
PAHO promotes the inclusion of health in This initiative includes the training curricula
all public policies and the engagement of for the professions of medical doctor,
all sectors in efforts to ensure that people psychiatrist, nurse, psychologist, and social
live longer, healthier lives, with good health worker, which have been identified by the
as their most valuable resource. Under Central American OAS Member States
the leadership of its 52 member countries as those professionals most requiring this
and territories, PAHO sets regional health training to provide guidance on how to
priorities and mobilizes action to address identify and address substance use disorders
health problems that respect no borders within the public health system.
and that, in many cases, jeopardize the
sustainability of health systems.
The program was finally revised in 2002 In 2009, INL developed the Universal
when international demand reduction was Treatment Curriculum (UTC) through a
included for the first time in the President’s contract with Alvarez and Associates and
National Security Presidential Directive their subcontractor JBS.
(NSPD# 25) on International Drug Control
Policy. A key objective of that policy urged In 2013, Applied Prevention Sciences,
the Secretary of State to “expand U.S. International (APSI) began the development
international demand reduction assistance of a new curriculum for prevention, known
and information sharing programs in key as the Universal Prevention Curriculum
source and transit countries.” A related (UPC). INL has oriented a significant part
priority, addressed by ONDCP at a March of its centrally–managed program to focus
2002 inter-agency strategic review session on on workforce development through the
demand reduction, involved incorporating dissemination of these curricula along with a
the President’s new goals and priorities credentialing process for demand reduction
for demand reduction into the international professionals.
program.
In the coming years, INL will also support
In the mid-2000s INL supported UNODC the development of an international quality
in developing the TreatNet curriculum and assurance system to support the inspection
OAS/CICAD in developing a specialized of treatment and prevention programs.
curriculum for their PROCCER model.
INL’s program to address substance use use. As a result, law enforcement resources
around the world has a broad-reaching impact become stretched, courts are overwhelmed
on a number of foreign policy and domestic with cases, and prisons overflow with drug
objectives. Drug use around the world is the offenders. International drug demand
primary driver of drug production, to include reduction programming has a direct role
cultivation, production, and trafficking. in improving public security. INL’s demand
The United States does not consume the reduction program in South Africa had a
majority of the illicit drugs in the world. recidivism (rearrest) rate of 20%, compared
Many middle income and low income to 80% which was the national rate. In
states are developing significant drug using Thailand, the demand reduction program
populations which also fuel drug production. saw a reduction in arrest rates by 87% six
Proof of this broad foreign consumer base months post-treatment, while the figure was
can be found in the thousands of treatment 85% in Colombia.
centers found in countries like Mexico and
Brazil. INL’s demand reduction programming Drug use also fuels other organized criminal
has been documented to impact supply enterprises, such as transnational organized
reduction by reducing drug dealing among crime, corruption, money laundering,
high risk Brazilian Youth by 32% and by 25% cybercrime, border security, and trafficking
in Peru. in persons. INL’s demand reduction
programming contributes in addressing
International Drug Demand Reduction these cross cutting issues. Interventions to
programming is also a direct and impactful provide treatment and rehabilitation services
strategy for reducing HIV/AIDS, hepatitis to members of criminal gangs resulted in a
and other communicable diseases. The 70% reduction of drug use, 83% reduction in
most effective way to eliminate intravenous past-month felonies, and 75% reduction in
drug use (IDU) is to stop drug use altogether. arrests and incarcerations by gang members.
Outcome evaluations of INL-supported
drug treatment programs documented a Another dimension of drug use is its impact
66% and 85% reduction in IDU in Thailand on the national security and stability of
and Vietnam, respectively. Additionally, some states. Illicit drugs have been used
mental health disorders are initiated by insurgencies to force unwilling or hesitant
or exacerbated by drug use. Treating combatants (e.g. child soldiers in Liberia
substance use disorders can treat mental and Uganda, suicide bombers in Pakistan
health disorders, improving quality of life and Afghanistan) to commit horrific attacks.
measures and reducing associated violence. Marginalized, economically deprived,
INL’s demand reduction program decreased homeless and persons already suffering from
suicide attempts among women by 64% in substance use disorders are all vulnerable for
Afghanistan. recruitment by these insurgent and terrorist
groups.
Demand reduction programs can also
address challenges with public security International demand reduction is
caused by drug use. Theft, violence, and also valuable in supporting economic
the deterioration of communities around development. Drug use has a quantifiable
the globe are often caused by substance economic loss for society. The aggregated
Global Drug Demand Reduction Programs,Office of Policy, Planning and Coordination,Bureau of International
Narcotics and Law Enforcement Affairs, U.S. Department of State
01 02 03 04
To date, the UTC Basic Series and UPC Coordinator’s Series have been disseminated in 63
countries:
Europe Georgia
• The UTC Advanced Series and UPC Recognizing the limited curriculum worldwide
Implementer’s Series will be piloted in to train treatment professionals, INL
2017. assembled a panel of curriculum developers
who were researchers, university faculty,
• In 2016, The INL-funded Colombo
and practitioners to develop the Universal
Plan ICCE implemented nearly 112
Treatment Curriculum for Substance Use
initiatives benefitting about 1,570 drug
Diorder (UTC).
demand reduction professionals.
The UTC provides the most comprehensive
• ICCE is in the process of credentialing
educational materials for substance use
regional and national-level trainers
treatment professionals, covering a broad
around the world as well as 500
spectrum of topics from physiology and
The Basic Level UTC consists of eight courses that cover the
broad spectrum of addiction treatment, while the Advanced Level
UTC is a set of 14 courses, which is currently being developed to
provide a more comprehensive and theoretical foundation in the
clinical practice of substance use disorder treatment. Each course
for both these levels consists of a Trainer and Participant Manual.
In 2013, UNODC released the International Series one (8 courses) is developed for
Standards on Drug Use Prevention, prevention program supervisors, government
consolidating the existing global research staff, and university staff and students,
on effective and ineffective prevention focusing on the full range of prevention
interventions. science.
INL commissioned a new training package, Series two (6-8 courses for each track, 50+
the Universal Prevention Curriculum (UPC) courses in all) is developed for prevention
to disseminate these evidence-based implementers. Each setting (e.g. school
prevention practices using the International prevention, family prevention, media, and
Standards as a foundation. workplace) represents an independent track
with 6-8 courses sharing knowledge and
This curriculum covers all of the prevention building skills for prevention workers in the
settings – family, school, environmental, field. This curriculum is under development
media, workplace, delivery systems, and and will be fully completed during 2017.
research in two series:
Credentialing
Treatment Credentialing
Prevention Credentialing
ICCE also offers a prevention examination and credentialing process leading to a level one or
level two credential called the International Credentialed Prevention Specialists (ICPS).
Presently, ICCE is developing two credentials for specialists who are involved in drug
prevention, that is, ICPS l and ICPS ll. Similar to the ICAP credentials, ICCE determined
the eligibility criteria for these two levels of credentials to be implemented in the region.
PTC will also manage the two levels of ICPS examinations.
• INL supported UNODC assembling a panel of leading treatment experts and developed
the International Standards for Substance Use Treatment. These treatment standards
synthesize the 70+ years of scientific research in the field of addiction science and
produce universal standards reflecting the latest research of effective practices as well
as identifying ineffective practices.
• The standards, released at the 2016 CND, are being used to develop universal quality
standards for treatment programs, irrespective of a country’s level of economic
development or cultural context. For example, all treatment programs should have
trained staff, offer services that are evidence-based and do no harm and avoid further
stigmatizing clients, and adhere to a code of ethics.
The goal of Program Area #3 is continuous country profiles with national data,
support to the International Society of and 8) encourage the establishment of
Substance Use Prevention and Treatment national chapters.
Professionals (ISSUP) and to drug-free
community coalitions, in order to unite c) Hold a global ISSUP workshop every
professionals and grassroots organizers in year.
the field, allowing for innovation and sharing
d) Support a meeting of the ISSUP
of best practices.
Board of Trustees and participate
This program area is built on the knowledge in the governance structure of the
that: organization.
• Since 2012, INL has supported the • Ghana: 8 coalitions in Accra and
establishment of 209 community South Eastern Region
coalitions to reach programming in
25 countries in 2017 with 6,300 active • Guatemala: 5 coalitions in the
members around the world through Departments of Sacatepéquez and
grantee, Community Anti-Drug Quetzaltenango
Coalitions of America (CADCA).
• Honduras: 7 coalitions in the
• CADCA was able to work with in-country Department of Cortez
partners to secure commitments and
• Kyrgyzstan: 7 coalitions in 3
resources from local, regional and
regions of the country
national governments to support the
development of anti-drug community • Mexico: 35 coalitions in 12 states
coalitions through the “Training
of Leaders” DDR programs. The • Peru: 60 coalitions in 9 provinces
collaboration with local and national
• Philippines: 16 coalitions in country
governments led to an increase in the
number of community coalitions in • Tajikistan: 15 coalitions throughout
country. In addition, the expansion the country
of coalitions under this modality led
to the establishment of several new • In 2017, CADCA will expand the
networks of community coalitions and Training of Leaders strategy in Brazil,
the strengthening of some existing Kenya, Senegal and South Africa.
networks in the following countries:
Five overarching organizing categories are denoted and populations are listed in alphabetical
order as each population is important. Items in italics notes that they are sub-categories of a
larger category (see medical conditions as an example).
Border Populations
• Eating Disorders
4. DISLOCATION/DISPLACEMENT
FROM HOME ENVIRONMENT
Conflict-affected/Displaced/Forced
Migration/Refugees
Criminal-justice involved
• Incarcerated
• Post-incarcerated
• Active duty
The Guiding the Recovery of Women In 2016, site visits were conducted in Brazil,
(GROW), a 10-course series that trains Argentina, Peru, Ecuador, South Africa, and
counselors on treating women with substance Sri Lanka to test the toxic adulterants in illicit
use disorders was fully disseminated in Peru. drugs. Quick tests are also being developed
using a number of different advanced
technologies, depending upon the molecule
Children for phenacitin, levamisole, and aminopyrine.
Criminal Justice
PROJECT NAME/
GOALS/FIT WITH LARGER STRATEGIC OBJECTIVES & IMPACT
DESCRIPTION
Impact - Prevent initial on-set of drug use and reduce drug use
among youth.
5. Toxic Drug Addresses National Drug Control Strategy Funding Priority: Expand
Adulterant global prevention and treatment initiatives through cooperation
Study with the UN, OAS, and Colombo Plan. Addresses Department Key
Attribution: Science, Technology and Innovation.
6. Technical Indonesian Stakeholder’s Meeting (Jan. 2016) and support for the
Assistance International Society of Substance Use Prevention and Treatment
Professionals (ISSUP)
PROJECT NAME/
GOALS/FIT WITH LARGER STRATEGIC OBJECTIVES & IMPACT
DESCRIPTION
12. UNODC Addresses National Drug Control Strategy Funding Priority: Expand
Technical Seminar global prevention and treatment initiatives through cooperation
on Drug Research with the UN, OAS, and Colombo Plan. Addresses Department Key
and Evaluation Attribution: Gender Equality/Women’s Empowerment - Secondary.
Impact – More national drug policies and prevention/treatment
program decisions based on evidence and science, as opposed to
ideology or misinformation. Support for USG positions at UNGASS.
PROJECT NAME/
GOALS/FIT WITH LARGER STRATEGIC OBJECTIVES & IMPACT
DESCRIPTION
14. Drug-Free Addresses National Drug Control Strategy Funding Priority: Drug
Community Free Communities Support Program. Addresses Department Key
Coalitions Attribution: Gender Equality/Women’s Empowerment - Secondary.
Also addresses INL Funding Priorities: CACI, WACSI, CARSI, and
CBSI.
Impact - Prevent initial on-set of drug use and reduce drug use
among youth.
PROJECT NAME/
GOALS/FIT WITH LARGER STRATEGIC OBJECTIVES & IMPACT
DESCRIPTION
Self-care
(Informal)
• Assessment
• Case management
Specialized drug • Treatment planning
dependence • Detoxification
treatment
• Psychosocial interventions
• Medication-assisted treatment
• Relapse prevention
• Housing
Long-term • Vocational training
residential • Protected environment
services
• Life skills training
• Ongoing therapeutic support
Given the multiple needs of people drop-in) services with defined referral
affected by drug use disorders ideally a mechanisms to the actual clinical treatment
wide range of medical and social services services and the accompanying social
should be available “under one roof.” services.
Such an integrated service provision could
be described as a “one-stop-shop” that Policy makers can be supportive in setting
improves accessibility to comprehensive up networks and one-stop-shops, especially
drug dependence treatment and care with a view to the facilitation of coordination
services.27 between different sectors that need to come
together to allow for the implementation of
In order to ensure access, there should be a full package of services.
always a low-threshold entry level (outreach,
As it will not always be possible to set up UNODC has published a good practice
a one-stop-shop for the treatment of drug document on community-based drug
use disorders, a network of services at the dependence treatment28 and a guidance
municipality/community level that works note29 on the same topic, which provide
in close coordination and with established examples from around the world and
referral mechanisms is another option. detailed practical guidance on the elements
of a community-based treatment network.
Partners for the delivery of community- To make sure patients are linked and referred
based treatment are in the health services to the appropriate services that meet their
such as primary health care, specialized drug needs, case management is an essential
treatment services, hospitals and clinics and component. Case managers work with the
social services (access to housing and shelter, client, other members of the treatment
food vouchers, etc.). In a community-based team, and other services or organisations, to
network, broad partnerships can be formed select the mix of interventions and support.
not only between different services from Case management ensures that the network
the public health and public social sector of referral and other ancillary support
but also with other community stakeholders services become accessible and are utilized
such as:
MODEL OF COMMUNITY-BASED TREATMENT AND CARE FOR PEOPLE WHO USE DRUGS
AND ARE AFFECTED BY DRUG USE DISORDERS
Continuum of care
A continuum of care from outreach, basic and of course recovery itself. Also there is
support and reduction of the negative a possible reduction in the frequency and
consequences associated with drug use to intensity in which such services are used by
social reintegration, is necessary in order people in recovery. In any case, such services
to support people with drug use disorders (like any other drug dependence treatment
in their recovery process. Such services can service outside of emergency situations)
be called “sustained recovery management should be voluntary and have the aim to
services”; some of these services might be be non-disruptive for the person in recovery.
similar to the services offered in a functional There are a variety of definitions for what is
community-based drug dependence meant by recovery, for example “Recovery
treatment and care network, but the emphasis is a continuum process and experience
is stronger on rehabilitation, reintegration through which individuals, families, and
II. Assessments o Rapid assessment survey of the drug use situation, capacity
and needs
o Prevention evaluations
o Treatment evaluations
o Accreditation of Programs
VII. Continuum of Care o Recovery services: peer support groups, halfway houses,
Support vocational training
o Crisis Intervention
o Accreditation of Programs
Thank you for participating in the Bureau for International Narcotics and Law Enforcement
(INL) survey on global drug demand reduction. The survey is intended to provide a
preliminary review of the addiction prevention and treatment system. You will be asked
less than 30 questions about relevant partner-government policies and research.
2. Please provide the partner-government point of contact who assisted with responding to
this survey. Include the name, title, ministry/department, e-mail, and phone number.
3. Does the country have a National Drug Control Strategy? Key Definitions: National Drug
Control Strategies are a country’s efforts to address the prevention and treatment of
abuse of narcotic drugs or psychotropic substances in addition to supply reduction efforts,
including drug trafficking, money laundering and even efforts to combat organized crime.
4. Is the country drafting a National Drug Control Strategy? Key Definitions: National Drug
Control Strategies are a country’s efforts to address the prevention and treatment of
abuse of narcotic drugs or psychotropic substances in addition to supply reduction efforts,
including drug trafficking, money laundering and even efforts to combat organized crime.
5. Which of the following drug demand reduction activities are included in the national drug
control strategic guidance:
a. Prevention
b. Education/Awareness
c. Early Identification/Screening
d. Aftercare/Rehabilitation
e. Alternatives to Incarceration Reintegration/Recovery
6. What government agency, department, or ministry has the lead responsibility for drug
demand reduction efforts in the country? If a lead agency has not been designated, enter
"None Designated"
11. Is there a drug demand reduction coordinating body, structure, group or stakeholders that
meet regularly?
13. Has the country conducted a national drug use prevalence survey in the past 7 years?
If formal evaluations have not been conducted, e-mail any national drug assessments
to demandreduction@state.gov Key Definitions: National Drug Use Surveys adhere to
a rigorous methodology and will provide nation-wide drug use data figures for a given
period of time (e.g. past year use, lifetime use).
14. For each national drug use prevalence survey, please enter the Publishing Date, Title, and
Author below. If electronic versions of the evaluations are available, please e-mail them
to demandreduction@state.gov Key Definitions: Drug Use Surveys adhere to a rigorous
methodology and will provide nation-wide drug use data figures for a given period of time
(e.g. past year use, lifetime use). Multiple lines of text
15. Which states/provinces have had a drug use survey in the past 7 years? Write "None" if a
formal survey has not been conducted. Enter the name of each state/province on a separate
line in the space below. Include the Publishing Date, Title, and Author when possible.
(Example: Montana; January 1, 2017; "Drug Use in Montana"; Doe, John.) If electronic
versions of the evaluations are available, please e-mail them to demandreduction@
state.gov If formal evaluations have not been conducted, e-mail any state/province drug
assessments to demandreduction@state.gov Key Definitions: Drug Use Surveys adhere to
a rigorous methodology and will provide drug use data figures for a given period of time
(e.g. past year use, lifetime use).
17. Which of the following populations with special clinical needs have had a drug use survey
in the past 7 years? If formal evaluations have not been conducted, select "None" and
e-mail any city drug assessments to demandreduction@state.gov Key Definitions: Drug
Use Surveys adhere to a rigorous methodology and will provide drug use data figures for
a given period of time (e.g. past year use, lifetime use).
a. Women
b. Adolescents (ages 13-18)
c. Children (under age 12)
d. Rural Populations
e. Low Income Populations
f. Users at risk of recruitment for violent extremism
g. Gangs
h. Refugees
i. Users of opioid drugs
j. Users in the Criminal Justice System
k. Culturally Distinct Populations (Indigenous)
l. LGBT
m. Peoples with Physical Disability and Chronic Pain Management
n. Homeless Populations
o. Child Soldiers
p. Trafficking victims
q. Sex workers
r. People living with HIV+, Hep B & C, TB
s. None
18. Does the country have a designated national drug observatory? Key Definitions: A national
drug observatory is a research center that can be housed within a government agency,
academic institution, or private organization which has a mandate to research drug use
patterns over time. They conduct surveys, rapid assessments, and more extensive research
studies. An example of an observatory could be the U.S. Center for Disease Control (CDC).
22. Does the government offer a national drug prevention license/credential for individuals?
23. Does the government offer a national license/credential for treatment specialists?
26. Does the government have standardized evaluation forms for addiction treatment
programs?
27. How many people have been trained to inspect addiction treatment programs?
28. Does the government provide national accreditation of treatment programs? Choice
What are the three most active non-governmental organizations in the country supporting
efforts to reduce drug demand? Include organization name, address, and contact information
if available. (Example: Communities to Prevent Addiction (CPA); St. Paul, MN; 555-555-5555;
John Doe, Director; doej@cpa-org.net) Key Definitions: Non governmental organizations
may include churches, community based efforts, schools and educational providers such as
universities and medical drop in centers engage in and supporting the reduction of drug
50 MISSIONS
to
30 COUNTRIES
in 2016
in an effort to deliver
programmatic services,
support Embassy personnel,
participate in national and
regional events, and complete
assessments of emerging issues.
The following pages summarize
the missions.
1. Montreal, Canada
INL Addresses ISAM Annual Meeting: INL presented at the joint meeting of the International
Society of Addiction Medicine (ISAM) and the Canadian Society of Addiction Medicine (CSAM),
inviting members to partner with INL and participate in its programs, including joining the
International Society of Substance Use Professionals (ISSUP). (October 20)
2. Washington, D.C.
U.S. Interagency Coordination on Demand Reduction: The White House Office of National
Drug Control Policy (ONDCP) and INL co-hosted the U.S. Interagency Working Group on
International Demand Reduction four times throughout the year. Interagency representatives
from the Department of State, National Institute of Drug Abuse, Department of Health and
Human Services, Drug Enforcement Administration, Department of Defense, and U.S. Agency
for International Development shared their agencies’ current efforts and explored how to
coordinate their efforts in the field.
3. Washington, D.C.
INL Organizes Drug Demand Reduction Study Tour for the Colombian Government:
Embassy Bogota collaborated with INL’s Demand Reduction team to organize a study tour for
Colombian National and Local Government officials to conduct site visits related to substance
use treatment and prevention programming in Washington, D.C., New York, and Los Angeles.
The Colombian delegation began the visit with a day-long familiarization of substance use
prevention, where top experts were flown in from across the U.S. to share the latest advances
in family, school, workplace, media, community, and environment-based prevention as well as
monitoring and evaluation. (April 6)
5. Washington, D.C.
SAMHSA Hosts National Meeting to Explore UTC: The U.S. Department of Health and
Human Services’ (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA),
and their Center for Substance Abuse Treatment (CSAT) hosted a national meeting to explore
the applicability of the INL-supported Universal Treatment Curriculum. Representatives from
several U.S. universities and federal partners, including INL and the Addiction Technology
Transfer Center (ATTC), explored the applicability of the materials and how best to make
these available nationally. University of South Florida reiterated its commitment to serve as a
coordinating center in disseminating the materials with universities. Community colleges were
discussed as a potential vehicle for dissemination. (September 28)
6. Baltimore, Maryland
SAMHSA Addiction Technology Transfer Center (ATTC) Meeting: INL provided a presentation
at the ATTC meeting to share the opportunities for sharing international products in the U.S.
Additionally, delegates were invited to participate in ISSUP-3 workshop in Cancun, Mexico.
(April 11-12)
8. Chicago, Illinois
Expanding Treatment Opportunities in the Criminal Justice System: INL led a mission
with ONDCP, the Organization of American States’ (OAS) Inter-American Drug Abuse Control
Commission (CICAD), and a representative from the Supreme Court of India to explore how to
implement alternatives to incarceration through criminal justice system. The NGO, Treatment
Alternatives for Safe Communities (TASC), shared their model of building collaborative system
with law enforcement, health professionals, and legal professionals to advance a public health
approach for treating those with substance use disorders. (September 13-16)
1) Promote the field of addiction science as an independent and multidisciplinary field and
encourage other universities to develop addiction studies programs;
3) Collect training data on students for purposes of research and evaluation; and
This university consortium on addiction studies is the first of its kind and will facilitate the
sustainable dissemination of INL’s curriculum. As part of ICUDDR, universities in the United
States and Europe will form their own regional consortium and operate without INL funding,
complementing INL efforts in Asia, Africa, and Latin America. (March 29-31)
INL Adapts Innovative Rural Treatment Modality for Afghanistan: Afghanistan drug demand
reduction stakeholders met in Male, Maldives to shape the development of evidence-based
prevention, treatment and recovery programs for rural communities. The first three days of
the meeting involved international experts briefing Afghanistan’s ministries of Public Health,
Counternarcotics, Women’s Affairs and Education on the newly established globalframework
and related training. The final two days involved interactive discussions with rural community
leaders, NGO demand reduction implementers, and the Ministry of Rural Rehabilitation and
Development. Community leaders learned about drug use in rural Afghanistan, discussed their
village’s experience with substance use, and explored the feasibility of conducting the pilot
study in their communities. (August 15-19)
EAST ASIA
GUEST
AUTHORS
Richard Meich
Isadore Obot
Matthew Kiefer
Brian Morales
Melody Heaps
Michal Miovsky
Roger Peters
Richard Spoth
A powerful tool for demand reduction is Surveys of youth in school are a cost-effective
knowledge of a country’s level of youth and straightforward way to monitor and
alcohol, tobacco, and other drug use. document youth drug use at the national
Scientific documentation of the rise of a new level. Monitoring the Future is a school-
drug or increasing use of an existing one can based, scientific, nationally-representative
provide a strong rationale for a country to survey that has interviewed approximately
allocate resources to drug prevention and 40,000 youth age 13 to 17 in about 400
treatment, as well as to help prioritize the schools for each of the past 42 years. It
drugs to target. Scientific documentation includes questions on a wide variety of drugs,
of a decrease in drug use can provide including alcohol, tobacco, illegal drugs,
strong evidence for the effectiveness and and prescription drug abuse. Results from
on-going need of a specific national policy/ the survey have in the past directly informed
intervention that reduces drug use. national U.S. drug policy and continue to do
so today.
MONITORING
THE FUTURE SURVEY
We conduct the Monitoring the Future study, which is a survey of the behaviors,
attitudes, and values of American secondary school students. Each year, a total
of approximately 50,000 8th, 10th and 12th grade students are surveyed.
MTF is the gold standard for national, school-based surveys of student drug
use.
MTF has provided annual, national U.S. estimates of student drug use for
more than 40 years.
A survey is administered to students in schools- by far the most cost-
efficient method to produce valid estimates of in-country, student drug use.
Ever year MTF surveys about 40,000 students in about 400 schools.
MTF surveys students in 8th grade (age 13-14), 10th grade (age 15-16), and
12th grade (age 17-18).
Includes questions on a wide variety of drugs, including alcohol, tobacco,
illegal drugs, and prescription drug abuse.
Includes questions on important predictors of drug use, including perceived
risk, disapproval and perceived availability.
See: http://monitoringthefuture.org for more information, including
publications.
Matthew Kiefer
Author Bio: Matthew Kiefer is the manager of the Lions Quest Educational Programs
for the Lions Clubs International Foundation. Matt joined Lions Quest in 2007 and has
overseen the program’s growth to more than 90 countries. As manager, he oversees
all aspects of program development and implementation. Prior to joining Lions Quest,
Matt worked as a program director for Amigos de las Americas, managing youth
development projects in Panama and Mexico.
Social and emotional learning (SEL) involves In their “Lessons from Prevention Research,”
the process through which children, the National Institute for Drug Abuse
adolescents, and adults acquire and identified school-based prevention programs
effectively apply the knowledge, attitudes, as a key part of a comprehensive prevention
and skills necessary to understand and strategy. Specifically, prevention programs
manage emotions, set and achieve positive for elementary and middle school students
goals, feel and show empathy for others, should target improvements in academic
establish and maintain positive relationships, and social emotional skills. Key skills include:
and make responsible decisions. The
Brian Morales
Division Director of Global Drug Demand Reduction Programs
Office of Policy, Planning and Coordination
Bureau of International Narcotics and Law Enforcement Affairs
U.S. Department of State
Thom Browne
Thom Browne is an internationally recognized expert in the field of drug demand
reduction. He is currently President and CEO of Rubicon Global Enterprises which
provides global technical assistance on drug prevention, treatment, recovery, and
criminal justice issues. He is also currently serving as the Chief Executive Officer of the
Colombo Plan Secretariat. His expertise builds on a foundation of over three decades
of experience within the US State Department, where he served as Deputy Director of
the Office of Anti-Crime Programs within the Bureau of International Narcotics and Law
Enforcement Affairs, as well as within the US Department of Justice, where he served as
a Senior Program Analyst within the Drug Enforcement Administration. Mr. Browne was
recognized in 2014 by the US Secretary of State as a finalist for the Samuel J. Heyman
Service to America Medal career achievement award, the highest possible recognition
for excellence and inspiration of public service by any Federal employee.
Diluents are basically inert substances added to provide bulk that are relatively cheap and
in low doses relatively safe (e.g., sugars such as lactose and mannitol).
“Cutting” of Drugs:
Nineteenth Century to the Early Twenty-first Century
Phenacetin – is an analgesic and fever general use after it was linked to bladder
reducer. It is increasingly being found as the cancer, kidney failure, and renal failure. The
primary adulterant in crack cocaine samples, ban was later revoked, but its legal use is
and more recently cocaine hydrochloride. highly restricted because of the danger it
Phenacetin was introduced in 1887 and was poses.
principally used as an analgesic/synthetic
fever reducer. It was widely used until the Levamisole – is a pharmaceutical veterinary
third quarter of the twentieth century as a de-wormer. It was once used in North
remedy for fever and pain. The U.S. Food and America for rheumatoid arthritis and as
Drug Administration, however, ordered the an adjuvant therapy in the treatment of
withdrawal of drugs containing phenacetin in colorectal cancer. It is no longer available
November 1983, owing to its carcinogenicity for human use but is available in the United
and kidney toxicity. Phenacetin reduces States and South America for veterinary
bone marrow and also induces hemolytic administration. As a cocaine adulterant,
anemia, a disorder in which red blood cells levamisole is dangerous primarily because
are destroyed prematurely, affecting oxygen it suppresses the body’s immune system
transfer and cognitive impairment. Other (massive reduction of white blood cells)
countries officially banned phenacetin from affecting the body’s defense mechanism
making it less resistant to infections, a
A growing number of children around the world are the victims of drug-
trafficking and drug use within their families, friends and communities. The
Child Intervention for Living Drug-Free (CHILD) Curriculum responds to
this expanding threat against an innocent population and is an important
focus of INL’s international drug demand reduction efforts. A range of
verifiable toxicological test data have enabled INL to document alarming
levels of substance exposure in infants, elementary school age and
children up to 12 years old. Previous studies of the effects of substances
on children have traditionally focused on in utero drug exposure or on
the social impact of family and community substance use. This evidence
of continued drug exposure post-delivery and identification of child
substance use disorder among the very young is a unique and important
contribution to the field of substance use disorder treatment.
In 2010, with INL’s support, child substance In the Southern Cone region of South
exposure and substance use disorder was America, crack cocaine is so abundant that
documented. Children from newborns it now sells for as little as one US dollar
through 12 years old were observed to be per dosage unit (e.g., a rock like substance
dependent on opioids like heroin and opium. weighing approximately ten milligrams which
Many children were found to be prenatally is smoked). Widely available on the streets,
opioid-exposed and then exposed to opioids crack is attracting thousands of children, who
throughout their childhood with parents are turning to the stimulant as an alternative
giving them opioids to prevent withdrawal, to the glue and solvents that many children
stave off hunger and control their children’s living in street-life circumstances have
behavior. INL and its partners provided the traditionally used. Surges in the use of crack
first scientific evidence that children were cocaine within Southern Cone countries
exposed to extremely high levels of opioids are resulting in urban “cracolandias”
from first-hand (e.g., parents blowing opium (cracklands) where hundreds of users gather
smoke in their faces), second-hand (e.g., to smoke the drug and where children are
breathing the air where their parents are frequently used as runners or decoys to
smoking opium) and even tertiary level avoid law enforcement. Fifty-four treatment
exposure (e.g., touching walls, floors and providers, representing eight regions within
toys with opioid residue and then placing Brazil, were surveyed in 2012 about crack
their hands in their mouths). In some cases
• Providers currently work within treatment systems that are targeted to address the
needs of adult or adolescent substance users; age-appropriate services simply do not
exist as part of the substance use disorder treatment infrastructure.
• Even for countries that recognize the urgency of establishing age-specific substance
use disorder treatment services for very young to pre-adolescent children, a lack of
evidence-based training materials and professional training opportunities has left most
treatment providers unprepared to effectively address the unique needs of this highly
vulnerable and growing population.
• Treatment providers are increasingly being challenged by the broad array of complex
social, cultural, legal, and political settings in which they must reach out to intervene
with substance-using children.
• Children must be identified and engaged within social service settings, school
classrooms, street shelters, hospital emergency wards, open-air drug markets, child
labor markets, opium dens, urban “cracklands,” and a multitude of juvenile court
systems which often ignore the basic rights of children or fail to protect them while in
custody.
• Treatment outreach requires practitioners to follow-up with children over long periods,
even years, and demands interaction with caregivers or other individuals within the
community who are extremely fearful and highly resistant to intervention strategies.
To address the growing evidence of child such treatment teams, INL engaged an
substance use disorder and to support internationally recognized panel of experts
treatment providers in meeting the to work together over eighteen months to
challenges, INL advanced a partnership develop a comprehensive evidence-based-
with leading universities to implement and training curriculum that would offer practical
evaluate global child-substance use disorder tools and skills to prepare dedicated
prevention and treatment protocols, with a providers who are working on the front lines
longer range intention of developing multiple with children around the world.
child-substance use disorder treatment
training teams. As a first step in assembling The INL expert panel was spearheaded by
Hendree E. Jones, Ph.D., author of INL’s
The Child Intervention for Living Drug-Free ‘how-to” method for the development and
(CHILD) Curriculum represents an important implementation of effective interventions.
first step in response to child substance Looking ahead, as treatment providers begin
use and its attendant suffering in countries to put into place a more skilled and highly
around the world. This Curriculum offers trained workforce to respond to substance-
treatment providers a tangible evidence- using children, additional evidence-based
based tool that significantly enhances their instruments and guidelines for designing,
capacity to address the needs of substance- implementing, and evaluating effective
using children and their caregivers. It offers interventions will likely be required.
highly diverse communities a straight forward
The participants, trainers and Colombo Plan support staff at the CHILD Curriculuum training
held in Dhaka, Bangladesh in August 2015
Opioids
Opioids include powerful drugs derived and can quickly trigger the disorder when
from the poppy plant that have been used used improperly.
for centuries to relieve pain. They include
opium, heroin, morphine, and codeine. In Route of administration
addition, this group includes substances
Oral (tablets, liquid preparations) or injecting
that are also agonists of the opioid
receptors in the brain, but that have been Medical use
produced synthetically, such as methadone,
Morphine, codeine, oxycodone and fentanyl
buprenorphine, hydrocodone, oxycodone,
are used in the treatment of pain related
hydromorphone, and fentanyl. This section
to illnesses (e.g. cancer) and medical and
discusses opioids in general, whilst a
dental procedures. Codeine is used in cough
separate section is devoted solely to heroin
syrups. Methadone and buprenorphine are
that is the most commonly abused and most
used in the long-acting maintenance therapy
rapidly acting of the opioids.
of opioid dependence.
The brain itself produces endogenous
opioids – endorphins-that have an important
Expected effects of non-medical use
role in the natural relief or modulation of pain Opioids tend to induce euphoria by affecting
and are very important for survival. Opioids the brain regions that mediate reward. Users
attach to specific proteins called opioid generally report feeling warm, drowsy,
receptors, which are found on the surface of and content. Opioids relieve stress and
brain cells, in spinal cord, in gastrointestinal discomfort by creating a relaxed detachment
tract and in many other organs. When from pain, desires, and activity.
opioid drugs attach to opioid receptors,
they block painful stimuli transmission and Acute consequences
pain perception in the brain. Nausea and vomiting; confusion; slowed
breathing; constipation; blurred or
Even centuries after their discovery, opioids double vision; pinpoint” pupils; dizziness,
are still the most effective pain relievers faintness, floating feeling, light-headedness;
available to physicians for treating pain. uncoordinated muscle movements, rigid
When used as directed by a physician, muscles; rash, hives, itching; facial flushing;
opioids are safe and generally do not result dry mouth; weakness; agitation; headache;
in a drug use disorder. However, opioids also appetite loss; memory loss. Opioids also
possess very strong reinforcing properties tend to produce drowsiness, reduce heart
Synthetic cannabinoids are usually added to • Distorted sense of body (feeling either
plant material by soaking or spraying, but weighed down or weightless);
in some cases their solid form (crystalline
powder) was added to plant material. They • Loss of sense of reality; melding past
are sold as ‘Spice Gold’, ‘Spice Silver’, ‘Spice experiences with present;
Diamond’, ‘K2’, ‘Bliss’, ‘Black Mamba’,
• Preoccupation with trivial thoughts,
‘Bombay Blue’, ‘Blaze’, ‘Genie’, ‘Zohai’,
experiences, or objects;
‘JWH -018, -073, -250’, ’Kronic’, ‘Yucatan
Fire’, ‘Skunk’, ‘Moon Rocks’, ‘Mr. Smiley’. • Intense emotions;
They are usually smoked, but oral use has
also been reported. • Altered sense of time and self;
As the name implies, these substances are Other side effects include: headache,
inhaled in a variety of ways: sniffing fumes confusion; nausea and vomiting; drowsiness;
directly from the container; spraying aerosols slurred speech; lack of coordination;
directly into the nose or mouth; placing an
inhalant-soaked rag in the mouth; inhaling
• Clandestine laboratories
Use of No Yes
Psychodynamic
Techniques
Abuse
Problem with the term: Although “abuse” Replacement or Substitution Therapy
is a clinical diagnosis in the DSMI-5 and Problem with the terms: This implies that
ICD10, it is stigmatizing because: (1) it treatment medications such as buprenorphine
negates the fact that addictive disorders are are equal to street drugs like heroin. The
a medical condition; (2) it blames the illness term suggests a lateral move from illegal
solely on the individual with the illness, addiction to legal addiction, and this does
ignoring environmental and genetic factors, not accurately characterize the true nature
as well as the ability of substances to alter of the treatment. The essence of addiction
brain chemistry; (3) it absolves those selling is uncontrollable compulsive behavior. The
and promoting addictive substances of any first goal of addiction treatment is to stop
wrong doing; and (4) it feeds into the stigma this dangerous addictive behavior. With
experienced not only by individuals with successful buprenorphine therapy, as part
addictive disorders, but also family members of a comprehensive treatment plan, the
and the addiction treatment field. dangerous addictive behavior is stopped
not replaced.
Preferred terminology: Misuse, harmful use,
inappropriate use, hazardous use, problem Preferred terminology: Treatment,
use, risky use. medication-assisted treatment, medication.
37. Kähnert, H. (2002) Evaluation of the 44. O’Leary, ME; Hancox, JC (May 2010).
Lions-Quest Program “Erwachsen “Role of voltage-gated sodium,
Werden” (German Version of ‘Skills for potassium and calcium channels in the
Adolesence’). University of Bielefield. development of cocaine-associated
cardiac arrhythmias”. British Journal of
38. Salazar, F., Luna Jiménez, M., Barreto Clinical Pharmacology 69 (5): 427–42.
Castro, G. (2015). Implementación y
Adaptación del Programa Lions Quest 45. Jared A. Jaffe; Kimmel, PL (2006).
(Leones Educando) en Perú, Paraguay, “Chronic Nephropathies of Cocaine
y Colombia. Presentation at the annual and Heroin Abuse: A Critical Review”.
meeting of the Socidrogalcohol, Clinical Journal of the American Society
Logroño, Spain. of Nephrology (American Society of
Nephrology) 1 (4): 655–67.
39. Maalouf, W., Stojanovic M., Kiefer,
M., Campello, G., Heikkila H., Ziad, 46. Vasica G, Tennant CC (2002). “Cocaine
E. (2016, October). Lions Quest Skills use and cardiovascular complications”.
for Adolescence in South East Europe: Med. J. Aust. 177 (5): 260–2.
case-control changes across students
exposed to this life skills based 47. Lowinson, Joyce, H; Ruiz, Pedro;
program. Poster session presented at Millman, Robert B. (2004). Substance
the annual meeting of the European abuse: a comprehensive textbook (4th
Society for Prevention Research, Berlin, ed.). Lippincott Williams & Wilkins. p.
Germany. 204.
81. Magill M., Ray L. A. (2009) Cognitive- 87. Adopted from “Substance Abuse
behavioural treatment with adult Treatment: Group Therapy”(2005).
alcohol and illicit drug users: a meta- Treatment Improvement Protocol (TIP)
analysis of randomized controlled Series, No. 41. Center for Substance
trials. Journal of Studies on Alcohol Abuse Treatment. Rockville (MD):
and Drugs; 70: 516–527. Substance Abuse and Mental Health
Services Administration (US)
72. Tajikistan
73. Afghanistan
74. Pakistan
75. India
76. Nepal
77. Bhutan
78. Bangladesh
81. Burma
82. Laos
83. Vietnam
84. Cambodia
61
60
62
59
58
51 54 56 63 57
52 55
70 95
64
53
67 69 71
2 50 93 96
68 72 92
7 8 10 9 49 94
73
15 3 74
16 75 78
6 81 83
48 82
17 4 5 85 91
47 83
76 84
77
19 41
45 44 66
14 12 11 13 40 79
23 46
18 39 65
24 43 42 37 80 89 97 101
38
36
20 25
30 33 88 99
35 87 90
21 98
86
27 32 34
22 100
31
28 29
26