1. TRANSFORMATION JOURNEY OF TREATMENT AND REHABILITATION
PROGRAMS IN MALAYSIA:
COMPULSORY OPEN ACCESS SERVICES
CURE & CARE
DR. SANGEETH KAUR
NATIONAL ANTI DRUGS AGENCY
MINISTRY OF HOME AFFAIRS
MALAYSIA

2. Evolving government policies towards Treatment and Rehabilitation of Drug Dependency
Drugs as a social problem
- Department of Social Welfare
- Facility – Pusat Insaf Diri
1975
- Drug Treatment and Rehabilitation Act 1983
- Drug was issued as a security threat
Ministry of Home Affairs
- Facility – Pusat Serenti (One Stop Centre)
- National Antidrugs Agency Act
- Fasiliti – Pusat Serenti (rebranded as PUSPEN [Pusat Pemulihan Penagihan Narkotik] in 2009)
-Enforcement Division was established in 2007
- Transformation of Treatment and Rehabilitation at AADK
- Drug Dependency treated as a chronic relapsing disease (Patient)
1983
2004
2010
onwards

3. COMPARISON STATISTICS OF DRUG DEPENDENTS 2011 AND 2012
Total no of registered drug dependents since 1988 till 2012 are 345,234 individuals
Category of Drug Dependents
2011
2012
DECREASE (%)
New Drug Dependents
6,956
5,270
-24.24
Repeat Drug Dependents
4,238
3,745
-11.63
Total
11,194
9015
-19.50

4. PROFILE OF DRUG DEPENDENTS 2012
/ 48.3%
/ 31.3%
/ 12%
Adults, 29.85%
98 % drug dependents are male
77.4% between the ages of 18-44
91.6% use traditional drugs like heroin/ morphine/ marijuana
Youth,
66.88%
Teenagers, 3.29%

5. Treatment Scenario in Malaysia
Compulsory Treatment
Provided for drug dependants
since 1983
Drug Rehabilitation Centers (DRC) &
Supervision in the Community
22 DRCs – capacity of 7,000 residents
Supervision - 55,000 estimated in the community How can N.A.D.A take care of the
massive numbers in the community?

6. Why NADA needs to Transform?
Success Rate
75% ?
50% ?
20% ?
10% ?
Compulsory Treatment
Reluctant & Resistant Clients
Problems in the DRCs
Treatment Services
Programs in DRCs and those undergoing Supervision
Parents, Families
Stigmatized
Residents – criminalized (records)
Changes
Impact of New drugs on Clients
Need for Clinical Approach
Success Rate
75% ?
50% ?
20% ?
10% ?
Compulsory Treatment
Reluctant & Resistant Clients
Problems in the DRCs
Treatment Services
Programs in DRCs and those undergoing Supervision
Parents, Families
Stigmatized
Residents – criminalized (records)
Changes
Impact of New drugs on Clients
Need for Clinical Approach
Stakeholders
GTP & NKRA
Concept of 1Malaysia

7. OBJECTIVE
In response to the growing drug problem and its complexity and realizing that the existing strategies are not achieving the intended effects / targets, NADA has shifted its approach from INSTITUTIONALISED rehabilitation to an open approach, OPEN ACCESS SERVICES, by setting up THE CURE AND CARE 1 MALAYSIA CLINIC or better known as C&C 1MALAYSIA CLINIC.
This is a paradigm shift for NADA to transform its treatment and rehabilitation services to all its clients in the country. 2
NADA MALAYSIA

8. COMPULSORY REHABILITATION OPEN ACCESS AMBULATORY VOLUNTARY CENTRES
Major Developments since 2010 in terms of the extension of voluntary community based treatment
COMPULSORY REHABILITATION
OPEN ACCESS AMBULATORY VOLUNTARY CENTRES
19 CURE & CARE REHABILITATION CENTRES
11 CURE & CARE 1MALAYSIA CLINICS

9. (RAWATAN DAN PEMULIHAN)
AKTA PENAGIH DADAH
(RAWATAN DAN PEMULIHAN)
1983
INSTITUTION BASED
COMMUNITY BASED
AADK
DAERAH

10. Treat Drug Dependents as patients
Treatment and Rehabilitation Strategy
Return of clients as socially funcional individuals
Provide a holistic approach in treatment and rehabilitation
Treat Drug Dependents as patients

11. Cure & Care 1 Malaysia Clinic
TRANSFORMASI
Cure & Care 1 Malaysia Clinic
Registration Office– Sg. Besi
Psychiatrist/ Medical Officers
Treatment Wards

12. CONCEPT OPEN ACCESS SERVICES
Voluntarism or Walk-in
Support from parents or family
Referral
Outreach / Motivate
No Legal Implications
No Pre-conditions
No stigma
Private and Confidential
Options for clients
Community-based Program
Clients as patients
Any Malaysian, irrespective of age, race, gender or locality can walk in voluntarily either on their own or with his/her family members (with special preference for youths or young people) to seek treatment at the C&C Clinic.
Support from parents and family members are vital in ensuring clients undergo the full course of treatment.
Clients are also referred by their employers, significant others, schools or institutions of higher learning or concerned friends
NADA officers and NGOs are involved in outreach programs to motivate and encourage clients to come forward voluntarily.
The concepts of being non-judgmental or no pre-conditions, no legal implications and supportive of the clients motivation to change are the strengths in developing this model for the needs of the clients.
Clients and their families do not face the problem of stigma when seeking treatment at the C&C Clinics as compared to the compulsory treatment centres.
All records of clients are treated as private and confidential and are not revealed to the public so as to ensure the identity of clients and their families.
Clients are given the options to choose either the inpatient or outpatient programs as some of them have obligations or commitment to their families.

13. 2 1 3 PROGRAMME PROVIDED PSYCHOSOCIAL CLINICAL SERVICES
VOCATIONAL TRAINING AND JOB PLACEMENT 3
Early Recovery
Relapse Prevention
Sosial Support
Family Development
Spiritual and Religious programmes
Counseling
Self Management
Outing/Excursion
Sports and Recreational Activities
Medical Detoxification
MAT with Methadone/Suboxone
Psychiatric Management
HIV/HEP/TB/STI Management
Inhalan Management
Alcohol and Nikotin Management
Immunisation
Infectious Disease Screening
INH Prophylaxis
Skill Training
Business
Job Placement

14. TOTAL NO OF MINI C&C : 4 CLINICS (BESUT, KINTA, MIRI & KENINGAU)
Distribution
Karangan
01/05/12
Kota Bharu
15/10/10
Papar
01/11/10
Bkt. Mertajam
15/10/10
Bachok
1/8/12
Kuching 15/10/10
Dengkil
07/01/13
Jerantut
01/07/11
TOTAL NO
OF CURE & CARE
CLINICS
- 11 CLINICS
Sg. Besi 01/07/10
Tampoi
15/10/10
Tampin
04/04/11
Tampin
04/04/11
TOTAL NO OF MINI C&C : 4 CLINICS (BESUT, KINTA, MIRI & KENINGAU)
: INPATIENT – CLIENTS
: OUTPATIENT – CLIENTS
: OPERATIONAL SINCE – 15 NOV 2011
(TILL April 2013)

15. STATISTIC OF CLIENTS ACCUMULATIVE 2012 ACCUMULATIVE 2011
C&C CLINIC
CAPACITY
CLIENT
REFERRAL & ADVOCACY
TOTAL
INPATIENT
OUTPATIENT
SG.BESI
150
135 74 7
216
KOTA BHARU 50 42 13
105
BKT MERTAJAM 40 35 51 8 94
TAMPOI
100 61 2 1 64
KUCHING 30 19 26
PAPAR 20 3 25
TAMPIN 75 54 92
111
257
JERANTUT 77 4 5 86
KARANGAN 59
159
BACHOK 15 16 31
DENGKIL 14 39
CURRENT NO ( 30 Apr 2013)
591
364
147
1102
ACCUMULATIVE JAN - APR 2013
1449
1278
2248
4975
ACCUMULATIVE 2012
5043
3854
3869
12766
ACCUMULATIVE 2011
3028
2259
4080
9367
ACCUMULATIVE 2010
666
772
117
1555
ACCUMULATIVE
10186
8163
10314
28663
PERCENTAGE OF INCREASE OF CLIENTS FROM 2011 TO } INPATIENT : 66% OUTPATIENT : 71 %

16.  DRC VS. C&C CLINIC C&C CLINIC DRUG REHAB. CENTERS
Compulsory Treatment & Admission through the Law; Criminal Records; Stigma
Open Access Services – Voluntary Admission; Considered as Patients
Focus on medical, psychiatric & clinical treatment
Treatment-based services only
Treatment for opiate-based addicts; all males and separate for women
Treatment for all substance abusers (opiate, ATS, inhalant) – males, females & adolescent are separated
Treatment Duration – 2 years
Treatment duration – 1-3 months (inpatient), 4-6 months (outpatient)
Capacity for residents in DRCs – 7,350
Number of clients that accessed services at 8 C&C Clinics – 9,041
Cost of food – RM8.00 x 30 days x 12 months /person = RM 2,880
Cost of food – RM8.00 x 30 x 3 months = RM720.00
Loss of Property caused by violence, arson
No incidence of violence or arson

17. FUN, EFFECTIVE & EASY TO IMPLEMENT APPROACH

18. OUTCOME RESULTS OF CLIENTS DISCHARGED FROM CURE & CARE CLINICS (2010-2012)
YEAR
TYPE OF SERVICE
TOTAL NO OF CLIENTS DISCHARGED
CLIENT STATUS
ENTRY TO COMPULSORY CENTRE
UNDERGO REHABILITATION IN COMMUNITY
PRISON
COMPLIANT
NOT ABLE TO BE TRACED*
2010
Inpatient
560 3
0.54% 15
2.68%
455
81.25% 81
14.46%
Outpatient
294
0.00% 5
1.70% 1
0.34%
278
94.56% 10
3.40%
2011
2590 36
1.39%
203
7.84% 27
1.04%
1819
70.23%
17.57%
1600 11
0.69%
129
8.06% 8
0.50%
959
59.94%
504
31.50%
2012
3230 49
1.52%
271
8.39%
2153
66.66%
885
27.40%
2527 24
0.95%
507
20.06%
0.20%
1367
54.10%
632
25.01%
TOTAL
10,801
123
1.14%
1130
10.46% 93
0.86%
7031
65.10%
2567
23.77%

19. OUTCOME STUDY AT C&C CLINIC
Injecting drug use 46% to 8.9%
Reduced by 37.1%
Confident of not using drugs in the near future
61%
Clients satisfied with services
94.4%
Ready to recommend the clinic to family and friends
90%

20. OUTCOME STUDY AT C&C CLINIC 30 days BEFORE first visit to C&C
Drug use history
Substance
30 days BEFORE first visit to C&C
Past 30 days
Heroin
67.1%
4.8%
Benzos; Dormi, Clona, Valium, Xanax
12%
2.0%
Syabu, Meth, Ice
13.9%
2.1%
Pil Kuda
3.3%
2.2%
3 or more substances in the same day
10.8%
1.7%

21. OUTCOME STUDY AT C&C CLINIC
Health status, needs and access
In general, how satisfied are you with the medical attention you receive for your health problems (other than drug addiction) at the Cure and Care Clinic?
Satisfied 69.3%
Very satisfied 23.9%
Not very satisfied 5.6%
To standardize boxes/ tables
To include Simple intro plz Objective of study, Methodlogy

22. OUTCOME STUDY AT C&C CLINIC
Qualitative analysis: Opinions and feedback on C&C program and services.
Overall, happy with the C&C concept
C&C encourages voluntary and ambulatory care and rehabilitation
MMT is seen as a stabilizer giving 2nd chance
Programs offered by C&C were well received
Good support from C&C staff, Counselors and Medical Team

23. OUTCOME STUDY AT C&C CLINIC
METHADONE MAINTENANCE PROGRAMME
2010
2011
2012
CCSC
1024
CCRC
Klinik C&C
Jumlah
CCSC
1380
CCRC 21
Klinik C&C
351
Jumlah
1647
CCSC
1530
CCRC 40
Klinik C&C
1735
Jumlah
3305
936 (67.8%) clients employed in 2012 compared to 543 (53%) clients in 2011.
Example text

24. OUTCOME STUDY AT C&C CLINIC
56.3%
Helped maintain jobs
42.7%
Helped get into government support services
54.3%
Continued education
77.6%
Improved family relations
72.1%
Obtained permanent homes
75.9%
Prevented arrest into prisons

25. OUTCOME STUDY AT C&C CLINIC
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C OLEH UNIVERSITI MALAYA
OUTCOME STUDY AT C&C CLINIC
73.8%
Prevented admission into Compulsory DRCs
78.3%%
Helped family or friends to get treatment and rehabilitation
76.7%
Access to medical care
94.9%
Very satisfied with the methadone maintenance programme
94.4%
Reduced drug cravings
65.4%
Obtained skill training

26. OUTCOME STUDY AT C&C CLINIC
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU
CRIME HISTORY
Average number of times inpatients and outpatients have been sent to prison, lock up, or PUSPEN
Institution
BEFORE C&C
Since coming to the C&C
Lock-up
3.50
0.57
Prison
1.06
PUSPEN
0.61
Mansur

27. OUTCOME STUDY AT C&C CLINIC
KAJIAN KEBERKESANAN PROGRAM KLINIK C&C KOTA BHARU
Mental Health
Farrah

28. PENGIKTIRAFAN ANTARABANGSA
Drug Issues and Priorities for Southeast Asia
24th IFNGO Conference, Kuala Lumpur
Gary Lewis
Regional Representative, UNODC
8 November 2011
UNODC (United Nation Office of Drug And Crime)
UNAIDS
WHO
IDPC (International Drug Policy Consortium)
Pengiktirafan daripada Negara Luar
Positive example: Malaysia’s
Cure and Care 1 Malaysia Clinics
(Gary Lewis. Regional Representative, UNODC)
Commendation by Mr. Andrew Marshall,
Journalist from Al-Jazeera 28

29. AFTERCARE AFTERCARE SERVICES Outpatient CCSC
Options for Aftercare Services after discharge from C&C Clinic :
as outpatient with the same C&C Clinic or other facility; or
CCSC (Cure & Care Service Centres); or
CCH (Community Caring House)
CCVC (Cure & Care Vocational Centre) – vocational skills training
TransCC – Transitional Cure&Care facility
CCSC
CCH
CCVC
TransCC
The Options for aftercare 1.Cure & Care 1Malaysia Clinic
1. Cure & Care Service Centre (CCSC)
2. Caring Community House (CCH)
3. Cure & Care Vocasional Centre (CCVC)
4. TranCC – Transitional Cure & Care facility
NADA District Offices

30. NADA VISIONS AND TARGETS Strategy Targets Process Targets
Nation’s Targets
Healthier people, drug-free country
Strategy Targets
Scaling up of Community-based services /programs
Outcome Targets
Better outcome and success rate in treatment & rehabilitation
Process Targets
Engaging Strategic Partners and Smart Partners
People Targets
Capacity Building – Training for officers, partners, volunteers

31. STRATEGIC PLANNING FOR COMMUNITY-BASED SERVICES / PROGRAMS
What are N.A.D.A’s Future Plans? By
2015 By
2015
C&C 1MALAYSIA CLINIC
CCH / MOBILE
UNITS
CCSC

32. No. of Compulsory Rehab. Centers (CCRC) No. of C&C 1Malaysia Clinics
STRATEGIC PLAN (2011 – 2015)
2015
C&C 1Malaysia Clinic
2015
CCSC
2015
CCH
No. of Compulsory Rehab. Centers (CCRC)
(4)
No. of CCSC – 98
No. of CCH – 96
No. of C&C 1Malaysia Clinics
(18)

33. THANK YOU
TERIMA KASIH
We Care, We Serve