About half of those referred for treatment do not comply
Of the more than 500 people the Royal Bhutan Police referred for compulsory treatment, the Bhutan Narcotics Control Authority (BNCA) has put about 12 individuals, all male on residential treatment at Serbithang.
The rest are provided treatment as outpatients. BNCA has started providing compulsory treatment since last month from a rented building in Serbithang.
Royal Bhutan Police referred 366 adults and 122 persons below the age of 18 years last year for compulsory treatment to the authority.
BNCA’s deputy chief programme officer, Dorji Tshering said that clients referred are screened and assessed if they have high, moderate, or low risk of getting dependent on controlled substances.
It was learnt that the clients are referred for compulsory treatment only if they are found dependent on controlled substances. Otherwise, they are referred to drop-in centres for counselling.
Based on the severity of the abuse of drugs, an individual is recommended for the treatment.
The Treatment Assessment Panel (TAP) assesses the severity of a person’s substance use and provides intervention. TAP consists of clinical experts, professional counsellor, an addiction professional, legal officers and BNCA officials.
Two kinds of programmes are catered to clients referred for the treatment.
First, is the residential treatment programme where individuals have to stay at the rehabilitation centre for treatment while in the second, the outpatient programme, individuals are provided counselling, said Dorji Tshering.
“Sometimes, people try drugs for the first time and end up getting referred. For these individuals, we conduct outpatient counselling and they are not necessarily referred for residential compulsory treatment.”
Besides considering the state of health and mind of the client, the panel also assesses the recovery capital of the client, he said. “It looks at the family support and the kind of environment the client is in. If the client is in a better condition and has the support of the family, we don’t refer them for residential treatment. We provide counselling from office here in Thimphu.”
He said that the two kinds of compulsory treatment programmes although similar differ in the way they are carried out. In the outpatient programme, the client will spend about two hours in counselling whereas in the residential programme, the client will be following a planned schedule.
“Those people who are dependent on controlled substances or more likely to get dependent are referred for residential programme,” Dorji Tshering said.
BNCA officials said that in the past when clients were required by the law to undergo compulsory treatment, they were referred to the two existing voluntary centres.
Last year, clients were referred most for abuse of cannabis. Other drugs include pharmaceutical drugs such as Tramadol, Spasmoproxyvon, Nitrosun 10 and thinner, among others.
There are eight drop-in centres, and five TAPs in the country today.
If an adult is referred for the first time, he or she has to go through compulsory treatment for three months. After the completion of treatment, if he or she abuses drugs and is caught again, the tenure of the treatment is extended, BNCA officials said.
Dorji Tshering said that last year, 90 percent of those referred were male. “Female cases are rare and youth as young as 12 years old are also referred for treatment.”
He said that they have also noted a rising trend of youth abusing thinner.
The biggest challenge is non-compliance to treatment from the clients. “When we try to contact the clients, they either don’t respond or switch off their phones. They don’t come for help.” About half of those referred have not complied for the treatment.
Human resource was another challenge in providing effective service delivery. “As the concept of addiction is fairly new in the country, there is lack of experts or professionals in addiction. The counsellors are trained in basics only.”
BNCA today has about 28 counsellors at Serbithang, drop-in centres and at its office. The authority is also planning on proposing to construct a compulsory treatment centre in the 12th Plan.
However, he said that a structured programme design is being worked out for counsellors to help improve service delivery.
The stigma to substance abuse also deters people who require help from coming forward. “Drug abusers are viewed negatively and people label them either as somebody who is incompetent or someone insignificant,” Dorji Tshering said.
This, he said, is because people are still unaware about addiction. “People do not know that addiction is a chronic brain disease and those addicted require help. Addiction is not because of the character or personality of a person.”
After treatment, clients are observed for about two to three months. If a client relapses after treatment, the client will again be referred for compulsory treatment. “If the client doesn’t comply, then we have no choice but to report it to police.”