Promoting and Broadening the Horizons of UNODC Drug Prevention Methodologies for Working with Adolescents, Youth and Families in Uzbekistan

Every morning, Dr. Lilia Muzaffarova walks to work at the Tashkent City Narcological Dispensary. During her walk regardless of the season, Lilia admires the beauty of nature, which she loves very much, and also gazes into the faces of passers-by, some - happy, some - sad and full of worries, which makes her mind wonder how many people she can help to find harmony in their families today. Dr. Muzaffarova is the Head of the adolescent department of the narcological dispensary, she works on diagnosis, treatment and prevention of drug addiction among youngsters and adolescents which makes her well-aware that any family, regardless of their financial status or education, can face the problem of addiction.

Since 2008, Dr. Muzaffarova has been regularly participating in UNODC workshops focusing on health-related responses. These workshops fall within the framework of Subprogramme 3 "Drug Dependence Prevention, Treatment and HIV Prevention" of the UNODC Programme for Central Asia2015-2021, as well as UNODC Global Projects GLOK01 “Prevention of drug use, HIV/AIDS and crime among young people through family skills training programmes in low- and middle-income countries” and GLOJ71 "Treating drug dependence and its health consequences: Treatnet II". Such workshops included training on programmes for the prevention of drug use among adolescents and young people through strengthening family relationships, as well as 14 courses of the Universal Treatment Curriculum for Substance Use Disorders (UTC) and successful application of the learned methods and skills, adapting them to different formats, audiences, expanding the coverage and achieving positive results. She also willingly teaches her colleagues the skills she has acquired through trainings.

An Unexpected Effect During a Pandemic

During a conversation, Dr. Muzaffarova told us more about her practice during the pandemic: "At the beginning of the spread of COVID-19, many patients experienced panic attacks, conflicts began in families due to an unusually long stay together, people felt confused, parents did not know how to interact with children, it was difficult for them to find time and energy to help children adapt to studying online, there was quite a lot of internal stress, mood disorders, depressive states, there were even suicidal tendencies".

As a national trainer for the Strengthening Families Programme (SFP 10-14) and the UNODC Strong Families Programme that teach family skills, positive parenting, communication skills, stress relief relaxation techniques, conflict detection and resolution, Lilia realized in time that the methods from drug prevention programmes work well in the new stressful situation caused by the pandemic, where everyone was forced to be in confined spaces. Adolescents demonstrated behavioral disorders, fathers experienced stress due to worries on feeding their families, not being able to leave the house, and mothers were torn between everyday life, work and children studying from home. Using online platforms available to clients: Zoom, WhatsApp, Telegram, and just audio messages, Dr. Muzaffarova adapted her work to the online mode. Since the start of the pandemic, Lilia has held various sessions for 1,470 teenagers and their families, according to her report. "The majority of my patients were parents who felt lost due to not knowing how to improve relationships with children, conduct explanatory work, how to be confident and build “the family shield”, be understanding to each other, feel united, and create a positive emotional environment". Dr. Muzaffarova highly appreciated UNODC-introduced new tools specifically related to caregiving and parenting under COVID-19.

"In March and April, probably the most stressful period, it was clearly visible that the parents who participated in the Strong Families programme were better able to cope with the situation, applying the acquired skills and asked facilitators of the programme to help their relatives and friends with the issues they were facing," says Lilia. "The peculiarity of adolescence is that at this time the worry about sick parents or depression from the loss of loved ones often manifests itself in behaviour disorder: depression in adolescents takes the shape of aggression, rebellion, withdrawal, and refusal to study. That was the time we all, including school psychologists, were forced to open the UNODC manuals and refresh our memory on the principles of differential diagnosis". An essential advantage of the UNODC programme, according to Dr. Muzaffarova, is its scientific validity, conciseness, efficiency, interactivity, and versatility, which makes it possible to expand the scope of its application.

Expanding Horizons

Dr. Muzaffarova has 10 years of teaching experience at the Department of Narcology, Adolescent Psychopathology and Psychotherapy of the Tashkent Institute for Advanced Medical Education. Based on her experience as an adolescent narcologist, Lilia highlights the importance of the methods promoted by the UNODC workshops, which make it possible to have broader perspective, understand the essence of the problem, develop effective methods and involve all family members, which is extremely important while working with adolescents. It should be emphasized that these methods are successfully adapted to different ages and the local context, especially in the year declared by the President of the Republic of Uzbekistan as the year of support to young people. The main goal of prevention is the development of a harmonious, happy personality, which requires a warm family environment.

"I also take part in work with representatives of the mahalla (community), young parents, as well as those who are planning to build a family, in which I include such elements as teaching family skills, conflict resolution skills, and also share information on the stages of personality development starting from birth and the ways parents can affect a child’s life. It helps me to achieve positive results upfront. People begin to think more about the responsibility of parenting, to reflect and work on mistakes".

Understanding family habits, the origin of stress and its consequences have proven to be effective even with young adults, such as university students. Due to strict discipline and environmental conditions, stress-creating factors can sometimes lead to substance use. Dr. Muzaffarova skillfully adapts the knowledge gained from the UNODC workshops, bringing it into the shape personalized for the target audience.

Dr. Muzaffarova also works part-time in a private clinic, where she also successfully integrates the studied approaches into the treatment practice.

In addition to her main work, Lilia is the head of the international charity society "Eastern Woman" ("Sharq Ayoli"), where she supervises the "Happy Family" project in her free time, in which she also uses elements from UNODC programmes.

Dr. Muzaffarova can be called an invisible hero and a champion in promoting UNODC evidence-based and cost-effective initiatives on drug addiction prevention and treatment in Uzbekistan.

A True Story

Once upon a time, there lived a teenager suffering from substance abuse, being in remission. However, the pandemic started, and due to the restrictions imposed, his father who at the time was in another country could not come back. The whole situation caused a relapse, but the teenager could not go to the treatment facility since the traffic in the city was strictly limited. Psychotherapy had to be carried out online with the teenager and his mother, helping her communicate with him in such a difficult period. It undoubtedly helped the adolescent avoid breaking down and wait for his father, who flew back home with the first chance. However, due to the stress experienced, the father experienced panic attacks, so he joined our sessions on building a "family shield", how to talk about his feelings, and how to enjoy life with the whole family. Family members wrote letters to each other, where they shared experiences that they could not tell directly. After the therapy was over, they initiated new father-son leisure activities that strengthened their bond - they began to learn a language together and made a habit of jogging. All the family skills taught by the programme helped them get out of the crisis, demonstrating that timely psychological assistance can not only help overcome the crisis, but also strengthen the family bonds.

Personal Experience

At some point in 2020, Dr. Muzaffarova also fell ill with COVID-19, and for health reasons, she was forced to spend three months at home, when she felt the need to apply the techniques from the UNODC courses in her own family. "It was a unique experience, and I could feel the effect first-hand".

Of course, my profession forced me to work online while on vacation, but it was then that I realized how my helping others helps myself. Programmes such as "Strong Families" and "Family UNited" that save, that change, that help - this is what inspires and grants me the energy to move on."

 

UNODC helps mental health workers of Kazakhstan to stay safe during COVID – 19 pandemic

Pandemics and health emergencies like the current COVID-10 outbreak, can cost many lives and pose additional risks to the global economy and overall security and stability. Ensuring continued access to health care during a pandemic, including services for people who use drugs and treatment of drug use disorders, are key not only to protect the health of populations, but also key to security and stability.

Drug use disorders are frequently accompanied by somatic conditions such as HIV/AIDS, hepatitis B and/or C and tuberculosis, lung or cardiovascular disease, stroke, cancer and injuries and traumas among others. Moreover, people with drug use disorders, especially those who inject drugs, may have a compromised immune system. Finally, stigma and discrimination linked to drug use and drug use disorders often result in limited access to basic resources such as housing, employment, health care and social support. For all these reasons, it may be more difficult for people who use drugs and with drug use disorders to protect themselves and they may be particularly at risk of developing COVID-19.

These days Almaty-based Republican Mental Health Centre, one of UNODC’s primary national counterparts in Kazakhstan, and its Pavlodar-based affiliation are at the coronavirus frontline providing emergency medical help to people with the mental health problems and drug use disorders – the most dysfunctional in the epidemiological sense population. Their health conditions most of the time are aggravated with the proneness to vagrancy, failure to comply with quarantine measures, and numerous contacts with people.

On the wake of the pandemic in Kazakhstan in August this year and following the urgent request from the Republican Mental Health Centre, United Nations Office on Drugs and Crime (UNODC) Programme office in the Republic of Kazakhstan, purchased personal protection equipment and bactericidal equipment for the “dirty zone” for the total amount of  12 000 US dollars. Two global UNODC programmes – “UNODC-WHO joint programme on drug dependence treatment and care” and “HIV/AIDS prevention, treatment, care and support for people who use drugs and people in prison settings” – have provided funding for this timely initiative. 

”In order to ensure the safety of medical workers who are at the coronavirus frontline now, proving emergency medical help to people with the mental health problems and drug use disorders, and to prevent the spread of COVID-19 in clinical departments, we organized separate, isolation units in the “dirty zone”  where newly arrived patients are waiting for the results of their COVID-19 tests”, said Mr. Nikolay Negay, head of the Republican Mental Health Centre. 

“We do not stop treatment of people in dirty zones thus reusable anti-plague suits, medical goggles, gloves and masks, shoe covers, and bactericidal irradiators-re-circulators will serve as a good protection to our medical workers”, he highlighted.

As elsewhere, in Kazakhstan the situation has become more complicated with regard to access to harm reduction and drug treatment programmes, and it has become more difficult for people who use drugs to receive health-retention services as the healthcare system is more focused on combating COVID-19. Although respondents of the UNODC ROCA produced report “Brief overview of COVID-19 impact on drug use situation as well as on the operations of the drug treatment services and harm reduction programmes in Central Asia”  report reduced overdose cases, it should be predicted that in the shortest term, the use of synthetic drugs, poor quality substances, and mixed substances may lead to serious consequences for the somatic and mental health of PWUD. Consequently, the demand for healthcare services may increase significantly among this population group in Kazakhstan.

Countries reported widespread disruption of many kinds of critical mental health services:

Over 60% reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%).

67% saw disruptions to counseling and psychotherapy; 65% to critical harm reduction services; and 45% to opioid agonist maintenance treatment for opioid dependence.

More than a third (35%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures; severe substance use withdrawal syndromes; and delirium, often a sign of a serious underlying medical condition.

30% reported disruptions to access for medications for mental, neurological and substance use disorders.

Around three-quarters reported at least partial disruptions to school and workplace mental health services (78% and 75% respectively).

“The Impact of COVID – 19 on mental, neurological and substance use services: result of a rapid assessment”, WHO, 2020

The support was provided within the framework of Sub-programme 3 - “Drug prevention, treatment and reintegration and HIV prevention” of the UNODC Programme for Central Asia 2015-2020 and UNODC Global Project GLOK32 “UNODC-WHO Joint Programme on drug dependence treatment and care”.

The Regional Mission to Central Asia of the United Nations Office on Drugs and Crime (UNODC) is organizing a regional online training for national assessors experts on the use of UNODC/WHO-designed insights

The five-day regional online training on the skills of UNODC/WHO assessment experts on quality drug treatment has begun on 12 October 2020. The aim of the training is to strengthen institutional support to ensure the successful implementation of the UNODC/WHO drug treatment services in Central Asia and to promote a scientific approach to the quality of drug treatment and drug care services.

Following the launch of the International Standards for the Treatment of Drug Disorders, WHO/UN/UN resolution 59/4 by the Commission on Drugs (which calls for the development and dissemination of international standards for the treatment of drug-related disorders) and urges UNODC to support a systematic process of national adaptation and the adoption of national quality standards for accreditation of services under national law), the need for new globally applicable tools based on a coherent distribution strategy has been proposed to ensure a qualified and effective response to drug-related disorders around the world.

The development of such standards for the quality of drug treatment services is necessary to be able to evaluate best practices based on scientific and ethical principles. Quality standards also help to ensure that quality standards and opportunities for drug addicts are maintained by the health system for anyone with any other chronic disease.

A regional online refresher course for national assessor experts and other national experts involved in the development of national quality standards will focus on the following actions related to the continued implementation of quality standards in Central Asia:

  • Presentation of achievements in Central Asia based on the results of pilot initiatives;
  • Update on WHO/UNODC International Standards 2020 and a new set of service quality control tools from UNODC/WHO and Consensus Standards.
  • Discussion of quality control standards with an emphasis on what is currently lacking in Central Asia.
  • Focus on how to evaluate and plan improvements.
  • Identify the changes needed in each country after pilot projects and the next steps to adopt international quality standards and develop national quality standards

Ms. Ashita Mittal, UNODC Regional Representative for Central Asia, stressed that "these standards must be globally applicable and consistent with the International Standards for the Treatment of Disorders Caused by UNODC and WHO, as well as to support politicians, health service managers and practitioners to enhance their capacity to provide quality services for drug treatment and care for drug addicts." She also took the opportunity to thank national partners for their commitment to implementing UNODC quality standards and tools by establishing working groups to adapt and test UNODC quality standards and tools for drug treatment services in 2019.

This training is part of UNODC's GLOBAL GLOJ71 Project "Treatment of Drug Addiction and Its Health Effects: Treatnet II"

UNODC Regional Office for Central Asia Organizes Online Regional Training for Assessors on UNODC-WHO Quality Assurance Mechanisms/Tools for Drug Use Disorder Treatment

Five-day online regional refresher training for assessors on UNODC-WHO quality assurance (QA) tools for drug dependency treatment launched on 12 October 2020. The purpose of the training is to consolidate the institutional support to ensure the successful implementation of the UNODC-WHO QA mechanism of drug treatment services in Central Asia and promote the scientific understanding of quality drug use disorder treatment and care services.

For the five days, the participants from Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan will have a unique opportunity to discuss important issues related to the development and institutionalization of a drug treatment services QA mechanism to improve the quality of drug use disorder treatment in Central Asia.

Following the launch of UNODC-WHO International Standards of Treatment of drug use disorders and the approval of resolution 59/4 by the Commission on Narcotic Drugs (which calls for the development and dissemination of International Standards for Treatment of Drug Use Disorders and urges UNODC to support a systematic process of national adaptation and the adoption of national QA standards for the accreditation of services in accordance with national legislation), the need for new globally applicable tools based on an agreed dissemination strategy was proposed in order to ensure a qualified and effective response to drug use disorders around the world.

The development of such quality standards on drug use disorder treatment services is necessary in order to evaluate good practices informed by science and ethical principles. The quality standards also help to guarantee the same quality standards and opportunities for drug-dependent people that are provided by the health system for any other chronic disease.

The online regional refresher training for the national expert assessors and other experts involved in the development of national QA standards will focus on following actions related to continuing introducing QA standards in Central Asian countries:

  • Reflections on the achievements in Central Asia based on the findings of pilot initiatives
  • Updates on ‘International Standards’ WHO-UNODC 2020 and new UNODC-WHO Services QA Toolkit and the Consensus Standards.
  • Run-through on QA Standards areas with a focus on what is currently missing in Central Asia.
  • Focus on assessment methods and improvement planning.
  • Identifying changes required in each country following the pilots and next steps in adopting the International QA Standards and developing National QA Standards.

Ms. Ashita Mittal, UNODC Regional Representative for Central Asia, highlighted “that these standards need to be globally applicable and aligned with the UNODC-WHO International Standards for Treatment of Drug Use Disorders and serve the purpose of supporting policymakers, treatment services managers and practitioners to improve their capacity to deliver quality drug use disorder treatment and care services”. She also used this opportunity to thank the national counterparts for their commitment to introduce UNODC QA standards and tools by supporting the establishment of Working Groups on adaptation and piloting of the 2019 version of the UNODC QA standards and tools for drug treatment services.

This training is organized within the framework of UNODC global project GLOJ71 “Treating drug dependence and its health consequences: Treatnet II”.

Motivational Interviewing Course: Assisting Patients in Making Sustainable Positive Lifestyle Changes

We invite you to register for this free webinar-based training course on Motivational Interviewing (MI). The three week long series is presented by Igor Koutsenok, MD, MS, Professor of Psychiatry at the University of California San Diego, Department of Psychiatry.

Igor Koutsenok ISSUP Motivational Interviewing

Motivational Interviewing is an essential, client-centered, counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. We are absolutely thrilled to bring you this skills-building opportunity presented by a recognized expert in the field of MI.

The course consists of four sessions to be held during June 2020 (see course descriptions and session dates below).

We highly encourage registration for all sessions.

Course Description

This is a training in evidence-based clinical methods of motivational interviewing (MI). After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building therapeutic relationships in clients’ outcomes. Integration of MI with other treatment modalities will be considered.     

Course Objectives

The goal is to provide knowledge and practical skill training for various practitioners on effective ways to enhance motivation of patients with substance use disorders that require significant behavioral changes to initiate and sustain positive and healthy behavioral choices. Skill building, and experiential training will be emphasized throughout the course by exercises to develop a therapeutic alliance with patients, assess patient needs, level of engagement in treatment process, structure treatment sessions, select appropriate interventions, and assist patient in maintaining motivation for a sustainable behavioral change.

Participants will learn the basic and advanced skills in motivational interviewing and strategies for engaging patients in collaborative relationship in treatment process and assist them in achieving sustainable positive behavioral changes. The course will:

  1. Help participants to acquire a systemic perspective of motivational interviewing and other motivational enhancement strategies;
  2. Build necessary clinical skills and attitudes to implement new strategies in working with ambivalent patients.

Learning Outcomes

Upon completion of the course, every participant will be able to:

  1. Describe all the aspects of the spirit of MI
  2. Explain the differences between MI and other counselling strategies
  3. Demonstrate the ability to respond to clients with reflective listening statements
  4. Identify change talk within client speech
  5. Generate open questions designed to elicit change talk
  6. Generate MI-consistent responses to client resistant statements
  7. Differentiate commitment language from other forms of change talk
  8. Provide and empathetic summary statements collecting change talk

Course Content, Dates & Registration

Session 1: Thursday June 4th 2020

Motivational Interviewing: Basic Understanding

After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.  

Learning outcomes:

  • Introduction: Motivation and behavioral change in addiction medicine
  • Review of the concepts of Ambivalence, Stages of change, the righting reflex, limits of persuasion.
  • Spirit of MI
  • Expressing empathy
  • Roadblocks to communication
  • Four Processes in MI

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar Recording 

Slide Deck

Session 2: Thursday June 11th 2020

Fundamental Skills in MI - OARS

This session will focus on Fundamental Skills in MI (OARS), providing practical exercises to help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Participants will learn strategies for engaging patients in a collaborative relationship in the treatment process and assist them in achieving sustainable positive behavioral changes. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.    

Learning outcomes:

  • Open and closed ended questions
  • Affirmations
  • Summaries
  • Rowing with OARS

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar recording

Session 3: Thursday June 18th 2020

Fundamental Skills in MI Continued

This third session will continue to focus on MI fundamentals, with a focus on more advanced skills and the integration of MI with other strategies and treatment modalities. Research evidence will be reviewed for the efficacy of MI and for the importance of building therapeutic relationship in clients’ outcomes.       

Learning outcomes:

  • Recognition and responding to change talk and sustain talk
  • Forming reflections
  • Levels of reflections
  • Recognizing readiness
  • Initial and intermediate planning
  • Integration with other skills and strategies

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar recording 

Session 4: Friday June 19th 2020

The fourth and final session will continue to build on MI Fundamentals covered in Session 3, increasing your knowledge of advanced MI skills.

Time: 9am Pacific / 12pm Eastern / 5pm London

Duration: 1 hour

Webinar recording 

We look forward to you joining us for these virtual sessions! Please contact info [at] issup [dot] net if you have any questions.

About Professor Koutsenok

Dr. Igor Koutsenok is а Professor of Psychiatry at the University of California San Diego, Director of the Center for Addiction Research, Training and Application, Director of the SAMHSA PEPFAR International Addiction Technology Transfer Center-Ukraine, and a co-director of the SAMHSA PEPFAR South East Asia Addiction Technology Transfer Center. He is also a Vice-President of the International Consortium of Universities on Drug Demand Reduction.

In 1983 he graduated as a medical doctor from the National Medical University in Kiev, (Ukraine). In 1986, he completed his psychiatry residency training and received degree as psychiatrist from the Medical University in Sofia (Bulgaria). In 1993-1996 he received a degree in addiction psychiatry at the University of London, Department of Addictive Behavior and Psychological Medicine at St. Georges Hospital Medical School. In 1996, he was recruited by the University of California San Diego, School of Medicine, Department of Psychiatry and since then he serves as faculty member of the Department. In 2013-2016 he served as Chief of Prevention, Treatment, and Rehabilitation at the United Nations Office on Drugs and Crime, United Nations Office in Vienna.

Over the last 25 years Dr. Koutsenok led the design and implementation of multiple training and technical assistance programs for mental health and addiction treatment practitioners, primary health care and social work practitioners, criminal justice professionals in the United States and around the world. He is also directing the UCSD Summer Clinical Institute - the second longest running Summer Institute in the United States (over 40 years). Dr. Koutsenok is also a member of the International Motivational Interviewing Network of Trainers (MINT). 

For many years, Dr. Koutsenok taught general and addiction psychiatry to medical students, psychiatry residents, psychology trainees, social workers, criminal justice professionals, and policy makers around the world. He is a recipient of numerous national and international awards. He has authored and co-authored over 50 scientific publications, one monograph, and contributed to 4 book. Dr. Koutsenok has been invited as a presenter and trainer to hundreds of conferences and workshops in the USA and more than 40 countries around the world. He is a proud father of three.

WEBINAR: Cary Hopkins Eyles on Authentic Self-Care for Addiction Professionals

This webinar focuses on the issue of self-care for addiction professionals and was delivered by ICUDDR Deputy Director Cary Hopkins Eyles.

Many of us are drawn to work in the field of substance use disorders due to our history, family, and personal traits, such as compassion and empathy. While these can be great assets, they can also be detrimental to us personally.

In this webinar, Cary explains how to identify healthy and unhealthy traits, how we can care for ourselves, and what authentic self-care looks like.

Cary has worked in the field of substance use disorders for 18 years. She is passionate about helping professionals in this field to take care of themselves so they can thrive and help those in need. Cary has worked in direct care in non-profit in the U.S., has run Residential, Outpatient, and Criminal Justice treatment programs, and has trained and mentored other substance use professionals. She is now the Deputy Director for the International Consortium of Universities for Drug Demand Reduction (ICUDDR) and supports the development of addiction studies programs around the world. She is a global trainer in the Universal Treatment Curriculum (UTC).

Recorded on 13 March 2020

Cary Hopkins Eyles