Managing as a whole person: the role of spirituality - Mohamad Hussain Habil, Malaysia

Began describing patient's he'd seen who had been jailed with chain to his leg for years to stop smoking.  With recommendation of Iman the beat an adolescent who smoked. This was the religious approach for addiction in the past, discipline, imprisonment, shame etc but now there is a new growing awareness.

Rational of the Mosque MT program
-to support the government mission for expansion and upscaling of MMT and greater impact on HIV/Aids prevalence
To provide platform for research opportunities, training program, etc


SEDAR (spiritual enhancement and drug rehabilitation)program
- pilot project, started in May 2009
- now have 40 patients
all male , 20-50
Majority are heroin dependent
BRI - brief religious intervention
Iman and religious expert deal with psycho spiritual counselling and health workers/doctor to help patient



Treatment Concept
positive addiction through 1 ritual (prayer and fasting ) to overcome craving and negative addiction
proses pembersihan diri (purification) "repent"
Overcoming selfish brain phenomena through spirituality
bring in concept of Bismilla to over come abstinence violation and efects
bring in mindfulness
Approach
work together with mosque officials
-BRI - individual and group activities, talk and discussions about religious ritual, Jemah - group work and group prayer in mosque

6500 mosques  
Most of the time they are not fully utilized

Views from ulamak, views from health practitioners, community participations (including police)
Medical intervention
BRI sessions - religious counselling
Individual sessin
Methadone taken in the mosque in front of the pharmacist
One year retention - 80%
Urine negative - nearly 100% in 6 month
Drug use reduction better in mosque than clinics
Sexual risk behaviour reduced more in mosque than in clinic
Quality of life indicators same for both groups
Spiritual Improvement scale - both had same results

Even smokers are stigmatized, so stigmatization with heroin addiction is truly major. Plan is to treat smoking in mosque now too.

Research to Reality (translational process)
-training oman/religious counsellor in addiction
upscale to 2500 mosques
waiting for grants from JAWI/JAKIM
mosque and bri for smoking and heroin but could also be used for behavioural addiction
New research tool for taqwa (THIM and the validity study being conducted in Iran and Malaysia
Heuristic to better research design


Conclusion
-possibilities of having addiction clinic in mosque
-spiritual religious program for treating addiction
early hopeful result which need to be supported by more systematic research

(These are my rough notes and slides photographed during the presentation. I provide this as an indication of the depth and breadth of study and apologize for any errors. I would recommend anyone interested go to the source for further clarity and information - W.HAY

Integrated Therapeutic Community - Gregory Bunt, MD

(These are my rough notes. I apologize for any errors but hope they give a gist of the remarkable material presented and the exciting successes with therapeutic communities in the treatment of addiction - W.Hay)
International Society of Addiction Medicine, Kuala Lumpur, 2013
Gregory Bunt, MD
Medical Diretor , Daytop Village
Clinical Assistant Professor of Psychiatry
NYU School of Medicine
 
Attended the first training program in Addiction Psychiatry in US started by Dr. Marc Gallanter
Therapeutic communites began for psychiatry in UK by Mawxell Jones in the 1940-50s.  In US - really began in the 1970's because of the heroin epidemic, following Vietman and the youth revolution
Synannon, Daytop Village, Phoenix House
In New York, a priest and a psychiatrist recognized the heroin epidemic was out of control, people dying, lots of crime, saw the model and brought back to New York. This was Daytop Village. This resulted in good effects and was translated to other settings. Europe. Latin America and Asia.
Pres. Nixon hired Dupont and Jaffre who saw that the therapeutic community worked with result that federal funding was available for therapeutic communities.  They expanded.The deficiency was that there were no medical professionals or psychiatrists.
In the 1980's we got funding for the outpatient treatment. This created the New York Model, an integrated system for those with medical, psychiatric and drug addiction. Many got into the therapeutic communities in the 90's . They were in the residential component for a year and could rebuild their lives, leaving the community with employment and housing.  They came in with no social skills, no employment and no housing.
Daytop International was formed and began developing programs in Europe then in late 90's to Asia and Latin America and expanded globally. The issue is always what support the local and federal governments will provide for the treatment programs.  In the last decade there has been diminished interest in continuum of care. Even though the cost is very low, $100, and want to place people in outpatients but that is not satisfactory for severe addicts. There will be an escalation in drug addiction, synthetic drugs, and prescription drugs, so there will clearly be this need for continuum of care as the alternative is only prison which are overcrowded and long term psychiatric facilities which are too expensive. If we can get the message out this particular model will be so important