Transcript what is working in prevention - United Nations Office on Drugs and

THEMATIC PROGRAMME
Addressing
health and human development vulnerabilities
in the context of drugs and crime
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UNEXPLORED TERRITORY
NO ONE’S LAND
Discrimination
Stigma
Ignorance
Prejudice
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DRUG USERS AND DRUG DEPENDENT PERSONS
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DRUG USERS
AND DRUG DEPENDENT PERSONS
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PERSONS WHO HAVE COMMITTED AN OFFENSE
IN PRISON SETTING
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PERSONS WHO
HAVE
COMMITTED
AN OFFENSE
IN PRISON
SETTING
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PERSONS VULNERABLE TO HUMAN TRAFFICKING
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PERSONS VULNERABLE TO HUMAN TRAFFICKING
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UNODC has
the unique position
to ameliorate
the condition of…
Victims of crime:
- Drug users
- Vulnerable to HIV
- Vulnerable to
human trafficking
and violence
Perpetuators of crime:
- Offenders
- Convicted offenders
UNCONDITIONED RIGHT TO HEALTH
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Vulnerabilities relating to drug use and dependence
Political Declaration 2009
Paragraphs 20, 21, 22, 23
Prevention of drug use, treatment of drug dependence,
rehabilitation and reintegration
Prevention of health and social consequences of drug use
HIV prevention, treatment care and support
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Health at the center stage of the drug control system
(A.M. Costa, 2009)
Supply reduction
Demand reduction
To protect the health of people,
particularly the most vulnerable,
from the dangerous effects of drug use
and from drug use disorders
HEALTH CARE
To reduce drug-related diseases
and social consequences
Harm reduction
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Vulnerabilities in prison setting
United Nations Standard Minimum Rules
for the Treatment of Prisoners (ECOSOC resolution 1984/47)
Art. 12 : The right of everyone to the enjoyment of the highest attainable
standard of physical and mental health. Those who are imprisoned retain
this fundamental right
Resolution 2004/28: United Nations standards and norms
in crime prevention and criminal justice (E/RES/2004/28)
Art. 9: Prisoners shall have access to the health services
without discrimination on the grounds of their legal situation.
The United Nations General Assembly Special Session 1998
prisoners as an important group for activities to reduce demand
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Vulnerabilities in prison setting
Commission on Crime Prevention and Criminal Justice
2009
Thematic debate:
Penal reform and reduction of prison overcrowding
Improving health conditions in prison
Reducing overcrowding
Stopping of reducing the use of alcohol and drugs
Improving sanitation
Providing food
Promoting exercise
Preventing TB – HIV infections
Preventing mental health disorders
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Vulnerabilities in the context of human trafficking
United Nations Convention Against
Transnational Organized Crime (Annex II, Article 6)
Protection of victims of trafficking in persons
Para 3
(c) medical, psychological and material assistance
mental health promotion
substance abuse prevention
(a) housing
(d) education-training opportunities
employment
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Ministry of Health
Ministry of Interior
Ministry of Justice
UNODC
health and human development
WHO
UNDP
UNICEF
UNAIDS
ILO
IOM
A MULTI-DISCIPLINARY APPROACH
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Do we have consolidated evidence
concerning the effectiveness of
prevention of drug use,
treatment of drug dependence
and prevention and treatment of HIV?
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WHAT IS NOT WORKING IN PREVENTION
scare tactics and moralistic appeals
curricula that rely solely on information about drugs and their dangers
curricula that only work to promote self-esteem and emotional well-being
single shot assemblies
testimonials by former addicts
counseling in peer-group context
recreation and community service activities
Levine et al. 1999
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WHAT IS WORKING IN PREVENTION
training in resistance skills
normative education
life skills: communication
life skills: decision making
life skills: emotional communication
life skills: impulse control
life skills: self esteem
trained teachers
interactive methods / reliable information
Faggiano et al., Cochrane 2005
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WHAT IS WORKING IN PREVENTION
Supervising and monitoring skills
Caring, trusting relationships between parents and children
Warm child rearing style
Communication of positive family values
Setting age appropriate limits, rules and consequences
Praising children appropriately for their behavior and
accomplishments
Structured family life including having meals together
Parents involvement in the lives of their children
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WHAT IS NOT WORKING IN TREATMENT
Prison
Punishment
Pure re-education
Working alone
Spirituality alone
Individual psychotherapy alone
Detoxification without after-care
Short-term therapy
Symptoms therapy
Treatment without assessment
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WHAT IS WORKING IN TREATMENT
Brief intervention
Motivational interviewing
Cognitive-behavioural therapy
Contingency therapy
Family therapy
Vocational training
Self help 12 step
Therapeutic community method
Long term opioid-agonists
Slow release opioid-antagonists
Medications for psychiatric comorbidity
Integrated pharmacological and psychosocial therapy
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WHAT IS NOT WORKING IN HIV PREVENTION
AND HEALTH CARE
Information alone
Counselling alone
Demonization
Panic dissemination
Stigma and marginalization
Denial
Violation of privacy
Lack of medical care
Punishment for drug dependent individuals
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WHAT IS WORKING IN HIV PREVENTION
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WHAT IS WORKING IN DRUG USERS HEALTH CARE
reliable information and counseling
low-threshold pharmacological interventions
(example opioid-agonists and antagonist drugs) easily accessible
adequate social assistance for marginalized drug dependents
vaccination programs against Hepatitis to all drug abusers
medication and emergency kits for management of overdoses
in appropriate places
availability of measures to prevent acute consequences
of stimulants abuse (free water…)
appropriate interventions in emergency rooms
well-equipped street-workers and peer outreach workers units
measures to prevent car and workplace accidents
social assistance for children of drug dependent individuals
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help low and middle income countries
to build
a community-based continuum of care
through the ‘normal’ health
and social services system
for the vulnerable populations
at all the stages
of their problematic conditions
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social support
to families
life skills
programs
and vocational
training
high-threshold
treatment
centres
low-threshold
treatment
centres
strengthening
family
program
educational activities
alternative jobs
sustainable livelihood
A continuum
of care
recovery-oriented
outreach
interventions
HIV/AIDS
Hepatitis TBC
prevention
and treatment
health and social
care in prison
health and social
care for vulnerable
to human trafficking
health care and
mental health
treatment
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1) Advocacy/ethical approach
2) Training, science-based practice dissemination
3) Low cost treatment/health care centers/prevention
4) Data collection / evaluation and research
5) Adaptation to regional country needs /ownership
6) Guidelines and therapeutic tools
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Life Skills Training during Junior High School
Up to 56% reduction in drug use by 12th grade
45
40
35
30
25
20
15
10
5
0
Marijuana
Hallucinogens
Narcotics
Control
Life
Skills
Botvin et al., 2000
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NTORS,
Gossop et al.,
2003
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NTORS,
Gossop et al.,
2003
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Woody et al.,
2008
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Comer et al., 2006
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Combination of Olanzapine With Opioid-Agonists in the Treatment
of Heroin-Addicted Patients Affected by Comorbid Schizophrenia
Spectrum Disorders
Gerra et al.,
2007
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Results suggest that adding any psychosocial support
to maintenance treatments improve the number of participants
abstinent at follow up (20% increase at 48 weeks)
3,000
Abstinent subjects
associated treatment
single treatment
48 weeks
Amato et al., 2004, Cochrane Database Syst Rev.
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Countries Worldwide with Treatment UNODC Activities
Treatnet II
CAM-H90
EU-UNODC, Focus on Treatment
EU-UNODC
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Countries Worldwide with IDU/HIV UNODC Activities
Russia, Romania, Estonia, Latvia, Lithuania, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Ukraine, Moldova, Egypt,
Palestine, Lebanon, Pakistan, Afghanistan, Nepal, Iran, India, Sri Lanka, Bangladesh, Bhutan, Thailand, Laos, Myanmar, China,
Cambodia, Vietnam, Indonesia, Kenya, Mauritius, Brazil, Argentina, Paraguay, Costa Rica, Maldives, UAE, Yemen, South Africa
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Countries Worldwide with HIV UNODC Activities in Prisons
Algeria, Benin, Morocco, Namibia, Mozambique, Sudan, Swaziland, Togo, Zambia, Kenya, Latvia, Lithuania, Estonia, Russia, Romania,
Egypt, Lebanon, Jordan, Palestine, Azerbaijan, Uzbekistan, Kyrgyzstan, Turkmenistan, Kazakhstan, Pakistan, Afghanistan, Bangladesh,
Cambodia, Nepal, Iran, India, Malaysia, Maldives, Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras,
Nicaragua, Panama, Bolivia, Ecuador, Peru
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INTEGRATION IN REGIONAL PROGRAMS?
Anti-trafficking
action
Anti-corruption
action
Alternative development
action
25% of police
positive for drugs
Building
criminal justice system
Anti-money laundering
action
Anti-terrorism
action
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(1997)
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Universal access to treatment of drug dependence
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Sustainable Livelihoods:
A broader vision
Social Support and Integration
enabling Prevention
of Illicit Drug Use, HIV Epidemic and Crime
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Area of work
Activity
Prevention of drug use
Establishment and validation of family skills
training programmes
Prevention of drug use
Prevention of drug use
Drug dependence
treatment and
rehabilitation
Prevention of HIV and
AIDS among drug users, in
prison settings and as it
relates to the trafficking in
persons
Adapting and mainstreaming evidence-based
drug education curriculum in schools
Developing and establishing workplace
prevention programmes in public and private
companies
Funding
requirements
(million US dollars)
10.0
3.0
3.0
31.0
UNODC-WHO Joint Action Programme on Drug
Dependence Treatment
70.0
UNODC obligations towards UNAIDS UBW 20082009 and 2010-2011, Universal access by 2010,
MDG 6 by 2015
2009-2011
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