Community Clinics to Provide Comprehensive Care For Substance Abusers

Twenty- two year old Gary lives with his family in a remote district in St. Catherine. Like a lot of young man his age, Gary is addicted to marijuana.
Sometimes, smoking the drug makes him “go off” as the neighbours like to say, resulting in erratic and even violent behaviour.
Gary’s aunt took him to a clinic in Spanish Town to seek treatment for his condition, but that was only once. The cost of transportation and the time and effort it would take to seek regular rehabilitation to help Gary kick the six-year old habit is just too much for the family, and there are no other drug rehabilitation facilities in their parish. This is just one of the difficulties faced, not only by Gary and his family, but also by the thousands of other substance abusers and their families across the island. Research shows that there are some187, 000 persons, who need professional care for substance abuse, but there are very little, or limited services available. “Also, it is a fact that there are very limited services available for adolescents or women,” says Michael Tucker, Executive Director of the National Council on Drug Abuse (NCDA). It is in response to this need that the NCDA, in partnership with the National Health Fund, the Ministry of Health, non-governmental organizations, the church and medical personnel, has taken an integrated approach to fighting drug abuse at the community level, by providing much needed treatment and rehabilitation services by way of care clinics.
The pilot project, which has been extended to 10 communities, will take a comprehensive approach, so that the clinics will not only serve substance abusers, but also persons living with HIV/AIDS, victims of trauma and violence, and children with delinquent behaviours and their parents.
The clinics, which are hosted at care centres provided by the NCDA’s partners, are a critical part of the Council’s plan to extend treatment services and to collaborate with agencies that provide social services. Clinical support will be provided by the Department of Community Health and Psychiatry at the University of the West Indies, while the NCDA will provide technical support.
Speaking at the recent launch of the project, Mr. Tucker explains that the care clinics will provide targeted interventions and programmes and referral services, which will include parenting skills, professional counselling intervention and support. There will also be general support for community members, who are having problems, and a counsellor development programme addressing substance abuse, HIV/AIDS, and crime and violence.
A life-skills programme is being offered that is geared at improving self-esteem and emotional intelligence to help beneficiaries to better focus to succeed at studies and pursue meaningful careers. “This comprehensive intervention is designed to teach adolescents techniques to reduce high risk behaviours, reduce academic failure, while enhancing self esteem and protective skills,” Mr. Tucker outlines, noting that some cases of violence among students in school and poor performance can be linked to the use of drugs by these students.
Some aspects of the life skills component include coping, decision-making and problem-solving skills; conflict resolution; anger management; resisting peer pressure; expressing feelings and taking responsibility for one’s actions. Meanwhile, the referral service will be offered when problems encountered at the clinic cannot be dealt with at that level, and the appropriate institution that can deal with the nature of that problem will be recommended. Mr. Tucker informs that training will be provided for the officers working in the centres in areas such as treatment and rehabilitation, to ensure that the minimum standard of care is enforced. Stressing the importance of operating a comprehensive intervention programme for children, adolescents and their families at the community level, Mr. Tucker says that several different agencies are working with communities in different areas, but this presents a fragmented approach to the problem.
“With the establishment of community clinics and services, collaboration and convergence among the agencies could be developed to address the total person and their problems,” he points out.
The project has sought to make the link between substance abuse and other problems such as HIV/AIDS because of the direct correlation between drug use and illicit activities to obtain money to support the habit. “Whether it is substance abuse, violence and aggression, sexual promiscuity, and HIV/AIDS, we are all aware that these behaviours share common contributing factors,” he points out. A 2001 Ministry of Health report found that one out of every 12 persons with HIV/AIDS has used crack cocaine, while further research done by the Department of Psychiatry and Community Health, has indicated that the drug-using population among at risk groups (commercial sex workers, etc.) have an even higher incidence of HIV/AIDS.
“Therefore, we know that the relationship between substance use and abuse cannot be ignored, as it is one of the significant and growing realities that we face. Any effort made to treat and care for substance abusers will have a direct and positive impact in reducing the spread of HIV/AIDS,” Mr. Tucker states.
The breakdown of the family and poor parenting, he notes further, are linked to negative effects such as depression, promiscuity, behavioural problems, experimenting with drugs, attempting suicide, and becoming parents at an early age. “This is exacerbated by the tremendous financial burden now at the feet of the inexperienced, immature mothers and fathers, who lack proper role models, have limited education and training and opportunities, and often exist in a cycle of poverty,” he says.
Meanwhile, Head of Psychiatry in the Department of Community Health and Psychiatry at the UWI, Dr. Wendel Abel, says the abuse of drugs in Jamaica, especially alcohol and marijuana, is of particular concern, as these are acceptable, affordable and easily available.
“The grim reality is that there are limited services available to children and adolescents with mental health and substance abuse problems,” he says, noting that there are three child guidance clinics in Kingston, one in St. Catherine, one in Manchester, two in Montego Bay, one in St. Ann, and one in St. Mary. Clearly, he points out, these services are inadequate and in many parts of the island, such services are not available to persons. “So, this initiative is an initiative whose time has come,” Dr. Abel says, while commending the NCDA.
The National Health Fund, has extended well-needed financial assistance to this critical programme, through a grant of $11.8 million.
Public Relations Manager at the NHF, Rosemarie Lee, says that drug abuse is a major problem in many Jamaican communities. She notes that, “as a country, we have paid a high price through untreated drug abuse, mainly through the direct and indirect cost of ongoing crime to finance substance abuse habits.”
She cites a study of clients brought before the drug court, which indicates that 32.6 per cent of these abusers committed simple larceny offences, to support their habit.
“Any programme that is aimed at the prevention of this problem of drug abuse is worthy of funding. It is our view that one of the most effective ways to assist those who have fallen prey to this negative habit is through a programme of support at the community level,” she says.
The communities targeted under the NCDA programme are based on numerous requests and records of high incidence and concentration of substance abusers and problems with substance abuse in those communities. “With the partners that we have on board, we are assured of success and impact from this programme, and therefore, we hope to replicate this programme throughout the island,” Mr. Tucker assures.
The care centres open under the progamme are: . Stella Maris Foundation, 1 Grants Pen Road, Kingston, telephone: 941-2000-1.. Boulevard Baptist Church, 2 Washington Boulevard, Kingston. Telephone: 925-5329.. Maverley Gospel Hall, 100