Therapy for Substance Use Disorder in Developing World Communities

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It has been presented with clear evidence by substance abuse policymakers that global public health objectives cannot be achieved without addressing the broad spectrum of mental health issues. The policymakers suggested that there is a dire need for improvement to access rehab treatment for substance abuse in developing nations. Though it is difficult to measure the precise numbers of substance abuse prevalence in these countries due to the lack of resources to conduct national surveys, addiction is still recognised as an ever-increasing problem. For example, 34% of low-and middle-income nations don’t have a substance use disorder policy because the resources are severely limited. Also, according to the six World Health Organisation (WHO) regions, the background information regarding the prevalence of substance abuse in the countries is provided in Table 1 mentioned in this article.

Table 1. Background Information of the Regions by World Health Organisation (WHO)

The Americans Alcoholics Anonymous (AA), a self-help group managed by recovering alcoholics, was first established its presence in 1947 in Brazil. And by the end of 1997, they gathered 1,20,000 members in 5700 active groups.
Similarly, in Trinidad and Tobago, Alcoholics Anonymous and Narcotics Anonymous consist of 110 existing local drug rehab centres, but the number of active ones is unknown. In these groups, both open and closed meetings were held for the addicts.
Africa
Nigeria ranked third in the continent when the 1-year prevalence rates of cocaine (0.7%) and opioid use (0.7%) were calculated. On the other hand, in Tanzania and Kenya, high rates of substance use have been reported among inpatient psychiatric patients. Also, based on the alcohol consumption per drinker in the World Health Organisation-defined Africa E region, countries including Ethiopia, Kenya, and South Africa reported similar health outcomes (16.6 L), which is higher than that for the United States, Canada, and Cuba (14.3 L).
As far as the national alcohol policies are concerned, the beverage alcohol industry collaborated with governments to issue them in much of sub-Saharan Africa, including countries like Botswana, Uganda, Lesotho, and Malawi. The policy documents from these countries drafted the national symposia attended by the government representatives and the beverage industry, similar to policymaking documents across countries, also reflecting the industry’s dominance. In addition, underfunding and migration of potential researchers to the private sector or other countries in Nigeria have stunted the scope of improvement in growing alcohol issues.
Europe Alcohol dependence has garnered serious attention in Russia. For example, a 1998 study declares that one of the biggest factors threatening the country’s current transition towards a functioning democracy is alcoholism. And even today, alcoholism is considered a natural disaster, affecting the Russian population. Also, the Russian population using heroin and other opiates annually constitutes 2%. And despite the increased regulation by the government on the supply and demand of alcohol, structural barriers to treating methadone and buprenorphine addiction or maintenance of treatment programs remain. Russia also lacks a systematic research approach to the availability of treatment services. 

Because the poorest nations already allocated the smallest portion of their already strained public budgets to mental health, the developing countries are making underinvestment in mental health care, paying inadequate attention to substance use disorder. And because of this underutilisation of mental health services in resource-poor settings, people associate stigma with their condition and hesitate to seek treatment. However, further explanation has been called for an investigation by WHO. In addition, the unequal distribution of resources within the countries and the inefficient care services have also attracted scholars’ attention.
Though inadequate treatment for substance use disorder is a massive public health problem plaguing developing countries at an increasing rate, the practical and feasible treatment options will shed some light to bridge the treatment gap. Hence, today’s article will review the current literature on substance use treatment in the developing world to inform future program development and research.

Methods

According to the 2011 United Nations Development Programme, a nation with a high, medium, or low Human Development Index (HDI) is defined as a developing country. Thus, for the purpose of this review, studies conducted in countries with very high HDIs were excluded. The findings in this review are as follows. First, we review the limited prior literature investigating the treatment modalities in various developing countries. Next, we review papers, presenting comprehensive overviews of treatment models within a single country. Subsequent reports are categorised by treatment approach, where a single treatment or intervention is described. 

Subsequent papers, many of which describe a single treatment. Also, a separate section is given to alcoholics anonymous in this paper, based on treatment approaches due to the substantial body of literature on this model. Finally, those articles were reviewed, which are service-related. 

Common Therapies Used for Substance Use Disorder

Substance abuse treatment or addiction help usually consists of a combination of individual and group therapies to help people recover successfully and ensure long-term sobriety. A few effective techniques that most rehab centres use for addiction treatment include:

Individual, Group and Family Therapy

All these three therapies usually occur under the supervision of the therapist. They ensure a peer-supported and safe environment for patients to share their struggles. While in individual treatment, the interaction occurs between the patient and the therapist; family therapy requires the participation of a family member or anyone significant in the patient’s life.

Cognitive Behavioural Therapy (CBT)

A part of psychotherapy, CBT, aims to change negative thought patterns into positive ones by teaching the patients coping skills, using problem-solving skills, developing self-confidence, and gaining a better understanding of others’ behaviours. Also, CBT is focused on the present and is goal-oriented.

Contingency Management (CM)

Effective in treating addiction o various substances, such as alcohol, marijuana, opioids, and stimulants, the contingency management approach is used to encourage or reinforce sobriety. In this method, patients are rewarded with materialistic things as motivation for their improved behaviours, such as maintaining sobriety.

Dialectical Behavioural Therapy (DBT)

DBT is a sub-category of CBT and teaches clients to regulate their intense emotions and reduce self-destructive behaviours due to alcohol or drug dependence. The central focal points of DBT include mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, which are mainly used to treat borderline personality disorders. DBT also helps reduce cravings, help patients avoid triggering situations, learn healthy coping skills, and avoid opportunities to relapse.

12-Step Facilitation

A kind of after-therapy, 12-step facilitation program is run by recovering addicts who aim to promote continued abstinence by engaging people in meaningful activities. Self-help groups like Alcoholics Anonymous and Narcotics Anonymous usually host meetings held at 12-step programs.

Conclusion

Substance use disorder has always been a rising concern worldwide, which people need to address to live a happy, fulfilling life. But multiple countries still don’t have the resources or policies to combat alcoholism. However, choosing the right treatment option can help people recover. Multiple rehab therapies for addiction help, such as cognitive-behavioural therapy, dialectical behavioural therapy, contingency management, or a group, are there to help people struggling with severe addiction. Also, rehab treatment for substance abuse ensures long-term sobriety compared to the failed attempts to cut back and come back crawling again. If you or someone from your family suffers from substance abuse, it is time to check out the rehab services near you. Go out there and contact the treatment centres to attain sobriety.

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