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Community Based Treatment Programme Community Clinic, Trilokpuri, New Delhi
(Faculty in-charge: Dr. Anju Dhawan)
‘Community Clinic, Trilokpuri, New Delhi’ was started in December 2003 as part of community drug abuse treatment services of the National Drug Dependence Treatment Centre (NDDTC). In the past, community deaddiction services were provided at community clinics in Pandav Nagar and Sagarpur, New Delhi. The clinic was started to develop a model for low-cost, low-threshold treatment through availability of limited manpower and resources.
Initially, a needs assessment survey was conducted. Awareness in the community was spread through locally acceptable methods such as drum announcements, information in the cable television and meetings with local leaders.
Why community based treatment?
Community based treatment and prevention approach is a key strategy to reach alcohol/drug affected individuals, afflicted families and vulnerable groups who may not be able to avail these facilities on account of difficulty in access, social stigma and host of other factors. The advantage of community-based treatment is that treatment is available at the doorstep and flexibility can be maintained in delivery of services. It also facilitates family and community participation.
Treatment goals The goals of these services are:
Staff Team
The community clinic is being managed by a qualified and committed multidisciplinary team. The clinical staff includes faculty in charge (currently Dr Anju Dhawan), senior resident and junior resident doctor (pursuing MD, psychiatry), two staff nurses and a Medical Social Service Officer (MSSO). The ancillary staff includes medical record peon, an orderly and a guard and support staff.
The doctors are available on two days in a week (Tuesday and Thursday) and the Medical Social Service Officer (MSSO) is available for three days per week. The other staff is available on all six working days.
The clinical staff assesses the new patients attending the clinic and formulates a management plan with immediate, short-term and long-term goals and objectives. Screening for the co-morbid medical illnesses is performed. Patients are referred to the nearest multi-specialty hospital for investigations for co-morbid physical illness, if required. In follow-up visits, patients are evaluated regularly and feedback is taken from the family members as well. In a few cases requiring admission, referral to NDDTC for admission is made.
The Medical Social Services Officers are trained in psychosocial interventions including brief intervention, motivation enhancement, relapse prevention and family interventions. Home visits are made as and when required. The staff nurses in the Community Clinic, Trilokpuri dispense medications to the patient, participate in psychosocial rehabilitation and provide support and care to patient and family members.
People served / catchment area The catchment area of ‘Community Clinic, Trilokpuri, New Delhi’ includes the area in the radius of 5 kilometers. The patients and family members from these areas can seek advice and treatment for drug / alcohol problems at ‘Community Clinic, Trilokpuri’
Activities that have been carried out so far
Profile of patients
On an average each month approximately 2000 patient visits are made in ‘Community Clinic, Trilokpuri New Delhi’, that includes around 20 new patients and rest are follow up cases. Approximately 70 patients visit daily. The majority of the follow up patients are Opioid dependent patients receiving agonist maintenance treatment (also known as Oral Substitution Treatment – OST). For this purpose various pharmacological options are used: buprenorphine, buprenorphine-naloxone, Slow Release Oral Morphine (SROM) etc. There are some opioid dependent patients on Antagonist maintenance (Naltrexone) as well. Patients with Alcohol dependence are also treated using appropriate combination of psychosocial services and long-term medications (such as Disulfiram).
Services and facilities available Ø Alcohol Dependence o Outpatient detoxification (using benzodiazepines) o Inpatient detoxification at NDDTC (referral) o Long term pharmacotherapy § Deterrent medication: Disulfiram (dispensed free of cost) § Anticraving medication: Acamprosate (to be purchased by patient), Naltrexone o Psychosocial interventions Ø Opioid Dependence o Outpatient detoxification o Inpatient detoxification at NDDTC (referral) o Long term pharmacotherapy (Free of cost) § Agonist maintenance: Buprenorphine (directly observed therapy), Morphine SR (directly observed therapy), Buprenorphine-naloxone § Antagonist: Naltrexone (directly observed therapy) o Psychosocial interventions Ø Nicotine Dependence o Nicotine replacement therapy: Nicotine gum (to be purchased by patient) o Bupropion and nortryptilline (to be purchased by patient) o Psychosocial interventions Ø Other drugs (benzodiazepine, inhalants, cannabis, etc.) o Outpatient detoxification o Inpatient detoxification at NDDTC (referral) o Psychosocial interventions Ø HIV/AIDS o Pre and post test counseling o Referral to nearest centre for testing (HIV, CD4, etc.) and antiretroviral medication (ART) o Counseling and behavioral interventions with focus on harm reduction, condom usage and other safer practices Ø Non pharmacological interventions o Instillation of hope o Psychoeducation o Motivational enhancement therapy o Relapse prevention therapy o Alternative therapies: Yoga Ø Family interventions o Psychoeducation o Family counseling Ø Social/community interventions o Door to door contacts for bringing treatment non-seekers or treatment dropouts o Occupational rehabilitation facilities. Attempts are also made sometimes to facilitate provision of small financial help in the form of micro-credit to the needy patients. o School based awareness o Interactions with NGOs, local authorities (bank, post office, etc.), community leaders, etc. Ø Other activities
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Training of doctors from government dispensaries Research (publications/presentations) § Data collection for a multi centre study on Oral Substitution Treatment with Buprenorphine funded by United Nations Office on Drugs and Crime, Regional Office for South Asia, New Delhi. Draft report submitted to UNODC (ROSA) § Data collection for PhD dissertation of Renu Agastya on “Study of Psychological and Familial Variables in Drug Abusing Adolescents Adolescent: A Descriptive Study of Users and Non-Users” § Rao Ravindra, Dhawan A, Sapra N. Opioid maintenance therapy with Slow Release Oral Morphine (SROM) – Experience from India. Journal of Substance Use 2005; 10(5): 259-261. § Paper on Experience with Morphine Maintenance presented at Workshop on Practical Approaches to the Use of Opioid Substitution Treatment with Antiretroviral Medication for the Effective Treatment of Both HIV and Heroin Addiction, organized by Adelaide University on 28th –30th August 2006 at Kuala Lumpu
Mobile Clinic, Nand Nagari, New Delhi
(Faculty in-charge: Dr. S. Jhanjee)
As a part of its community based treatment program, NDDTC is also running a mobile clinic at Sundar Nagari, in New Delhi. This area is inhabited largely by people from the lower socio-economic strata.
The clinic has been launched based on the philosophy that services for substance use disorders should be made available to the drug users closer to their doorsteps. In this clinic the staff commutes in a vehicle and assessment and treatment services for opioid dependent patients are provided to them with a low threshold approach. Those who require a higher intensity treatment are offered appropriate referral services. Though recently launched, the clinic is already providing services to about 50 opioid dependent patients.
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