Pretreatment Drug use Characteristics and Experiences among Patients in a Voluntary Substance Abuse Treatment Center in Malaysia: A Mixed-Methods Approach

Abstract

Background Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers (CDDCs). Following criticism over human right violations in CDDCs, Malaysia has begun to transition towards voluntary drug treatment centers known as Cure & Care (C&C) Centers. To best serve the needs of regional C&Cs, data on drug use are essential among patients accessing treatment. Using a mixed methods approach, we examined pre-treatment drug use characteristics and experiences with addiction treatment among C&C patients in Kelantan – a religiously conservative state in Northeast Malaysia with high prevalence of drug use but where limited data are available on drug use patterns. Methods A mixed methods study utilizing surveys (N=96) and semi-structured interviews (N=20) was conducted among a convenience sample of inpatients and outpatients at the Pengkalan Chepa C&C Center in Kelantan. Results Survey results showed 89.6% of participants met screening criteria for moderate to severe addiction severity. Nearly 90% reported lifetime illicit amphetamine (syabu, meth, ice, and pil kuda) use followed by alcohol (60.4%) and opioids (52.1%). Qualitative results pointed to the powerful influence of peer networks in drug initiation and relapse, and the positive effect of the C&C on drug rehabilitation. Conclusions The drug use profile of the Kelantan C&C enrollees shows extensive pre-treatment amphetamine use, polysubstance use, and injection drug use including high-risk behaviors such as sharing needles, syringes and containers. Evidence points to the need for integration of social support-oriented practices and behavioral interventions into the rehabilitation of drug users in this region.

Assessment of an Innovative Voluntary Substance Abuse Treatment Program Designed to Replace Compulsory Drug Detention Centers in Malaysia

“…Recent qualitative (Ghani et al, 2015) and mixed methods (Krishnan et al, 2016) research has described satisfaction with the various components of the new C&Cs (e.g., psychosocial counseling, recreational and vocational training activities, staffing and social support, healthcare access and utilization and religious instruction). Now the quantitative findings of this study are the first empirical insights into the impact of these relatively new evidence-based drug treatment strategies in Malaysia, as the country begins to transition away from CDDCs toward voluntary treatment for people with substance use disorders.…”

“…Two of the principles underlying this new model of care are that the complexity of drug dependence requires that a wide array of evidence-based interventions be offered and that individualized and holistic care is necessary to reduce the risk for relapse. To that end, C&C centers now provide an array of services alongside MAT, including some onsite medical care (Al-Darraji et al, 2014) as well as rehabilitative activities that may include MAT, psychosocial interventions, religious/spiritual programs, psychiatric counseling, recreational activities (group games, hiking trips, artistic activities, dance and musical therapy), and vocational training provided in both group and one-on-one sessions (Ghani et al, 2015; Krishnan et al, 2016). After undergoing a comprehensive intake by trained C&C counseling staff, patients select which activities may be most relevant to their situation based on type and severity of addiction and social and legal situation.…”

“…AADK opened its first C&C site near Kuala Lumpur in Sungai Besi and its second site in October 2010 in Kota Bharu (Ghani et al, 2015; Krishnan et al, 2016), the capital of the conservative northeastern state of Kelantan. Despite high rates of stimulant use reported in this region (UNAIDS & WHO, 2004), there are limited data on people who use drugs in this region, and particularly on treatment outcomes among stimulant users accessing treatment in Malaysia.…”

Confronting the HIV, Tuberculosis, Addiction, and Incarceration Syndemic in Southeast Asia: Lessons Learned from Malaysia

“…Consequently, several United Nations agencies called for their immediate closure (Amon et al 2013; Amon et al 2014) due to a lack of evidenced-based addiction treatment and medical care including for HIV and TB (Fu et al 2012). Recent data from Malaysia suggest that transforming CDDCs to voluntary treatment centers is feasible, acceptable to patients, provides evidence-based treatments, and attracts patients who might not be involved with the criminal justice system (Ghani et al 2015; Khan et al 2015; Krishnan et al 2016), and is markedly more effective in curbing relapse (Wegman et al, under review). Nevertheless, the question of whether to maintain CDDCs remains contentious and, for as long as the drug laws and policies remain as they are, criminalization will continue to be the mainstay of the response despite the progress of public health interventions in recent years.…”

Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review

“…Prior research suggests drug users in one’s social network act as dysfunctional role models (4, 5), reinforce risky drug use behaviors (6, 7), increase likelihood of engaging in sexual risk behaviors (8–14), and consequently lead to poor HIV treatment outcomes (15). Conversely, self-reported condom use is strongly associated with positive norms using condoms among social network members (12) and social support increases engagement in needle exchange (16, 17) and addiction treatment programs (18, 19).…”