PROPOSED STRATEGY BY NOTED PSYCHOLOGIST FROM BACLAYON, BOHOL - MIRIAM P. CUE

We meant to present this in our column for next week, but we think this proposed strategy from noted Psychologist Miriam P. Cue cannot wait that long.

She could not make it to the consultation with drug addiction professionals we scheduled last week, but she was kind enough to email her thoughts as response to our appeal for ideas on how to handle the situation of having hundreds of drug users waiting for some kind of treatment or counselling.

I have known her for more than two years for her work and that of her colleagues at the New Day Recovery Center (NDRC) in Davao City as part of our study of selected drug rehab centers in Visayas and Mindanao. This initiative was undertaken prior to the establishment of Bohol's first drug rehab center.

Over the past several years, she has given us valuable advice on how to deal with the serious drug addiction problem in our province. Miriam P. Cue from Baclayon, Bohol is one of the country's internationally-known drug addiction professional.

Her credentials is impeccable: Chairperson, Professional Regulatory Board of Psychology at the Professional Regulation Commission (PRC); Clinical Psychologist and Psychotherapist at NDRC Davao and internationally-known trainer of recovery coaches and other drug addiction professionals.

Her proposed strategy will be a valuable input to all sectors in Bohol and other provinces who are now preoccupied on how to handle a critical situation resulting from the surrender of thousands of drug users throughout the country.

Here is her proposed strategy in response to our appeal for assistance to determine a cost-effective approach in handling the surrenderees contained in her email dated 16 July 2016:

Following your brilliant ideas, I would say, your goals are clearly defined, but for the project to work, I would like to suggest this strategy for your consideration:

1. Organization of the "Response Management Team" in partnership with the provincial and local government, the Department of Health, the Church, HEIs and religious-civic groups in Bohol. We all need to work together on this with a Hub and Spokes" strategy to make things work. The hub could be the provincial government as central provincial bureau or headquarters with a designated point person like you to orchestrate things. Every municipality or community should have its own coordinator and point person. Policies and guidelines also need to be established right from the start to avoid if not minimize confusion.

2. Mapping of Treatment Capabilities and Resources.

a. Treatment Professionals and Certified Specialists - We need to know available resources in the province who have the credentials and experience in SUD (Substance Use Disorder) treatment - psychiatrists, clinical psychologists and mental health nurses, clinical social workers and doctors trained in addiction medicine, guidance counselors, etc....

It is important you identify them so you would know whom to tap and where to send referrals.. Given our professional regulatory laws, we need to identify those who are registered and those who are not). We need to identify potential recovery coaches as well...

We can give specialized training courses to those whose education, experience and exposure to the neuroscience, psychology and treatment of SUD and related disorders are relatively limited.

b. Volunteers. We need to map out / identify the service-volunteers - professionals, para professionals and professional groups who can help us address the problem. Cluster the volunteers according to their specific profession, education, experience, affiliation and location so we can train them in areas where they can be most effective or where they can give their best efforts and contribution.

c Facilities. How many treatment facilities do we have in the province? Where are they located? How are these facilities run? Are there any available government owned facilities we can use for this "emergency" situation? How safe and secure are these facilities? Any private individuals who are willing to rent out or volunteer facilities they are not using in response to this overwhelming problem?

d. Financial Support and Resources - how much can the province and the local government units allocate for this this purpose, particularly for training and treatment? Are there any institutions and caring citizens we can identify for possible funding support?
e. Establish Directory of Treatment Capabilities: Resources and Services...

3. Client Registration, Intake and Screening. This should be done as soon as possible so we can start triaging (sorting out those who surrendered according to their distinct problems -addiction severity and related legal and financial issues- and allocating treatment resources according to priorities).

Those who have committed heinous crimes, or those who present potential danger or threat to themselves and/or society must be institutionalized now.

Student help and support should be limited to registration/registration intake and they should not be made to feel obliged to help like asking for their involvement in this project as a class requirement. Please spare them the trauma...

And for student volunteers, debriefing should be done every after work in the field at the end of the day. The story might be more different however for medical clerks who are expected to be more mature.

For this purpose, I suggest we tap municipal health clinics/centers, and the social welfare offices for the task. Training support can be provided if necessary... School Guidance Counselors and Psychology teachers can also help in the effort to make our beloved province drug free...

4. Psychoeducation - This should be provided to all those who care - LGU officials, volunteers, support groups for them to understand the nature of addiction and the economics of the drug trade business. We need to fight social stigma first and awaken interest among people to help and serve. The "I couldn't care less attitude" you are describing in your column Nes could be symptomatic of the social stigma and lack of real understanding about the problem.

5. Capacity Building for the Treatment Professionals, Clinicians and Service-Volunteers/Providers. I can help you prepare the training curricula for the different clusters...As Global Master Trainer under the Colombo Plan International Center for the Certification and Education of Addiction Professionals and the US Department of State Bureau of Narcotics and Law Enforcement Affairs, I believe I can help..

I already have the commitment of the ICCE Director of Colombo Plan to conduct the Training of Trainers (TOT) here in Manila early next month with the funding support of the US INL through the Director of the Global Demand Reduction Program.

If there is any interested doctor, psychologist or social worker experienced in SUD treatment you would like to endorse as potential trainer for Bohol, please send endorsement and CV ASAP so I can submit his papers to Colombo Plan.for consideration and inclusion in the TOT training.

If you cannot endorse one right now, I will ensure training in Bohol after the TOT I have organized here in Manila. This problem affects all regions in the country, so I hope you realize why we need to work this out on a national scale with the Department of Health and the Professional Regulation Commission who regulates practice of the professions.

6. Further Assessment of those found to be of high risk and addiction severity after screening (strategy # 2). Identify and determine severity of problem for those with a co-occurring psychiatric condition or other mental disorders, those with co-occurring health problems or medical conditions, those with serious legal problems, employment concerns and financial problems, and those with limited education and mental capacities... We need all these information for treatment planning.

7. Client Referral, Treatment and Rehabilitation in the Continuum of Care. This I would like to discuss separately. How long and intensive the treatment and primary care will be, whether residential / in-patient, or outpatient, will depend on client case diagnosis, client motivation and recovery capital. Unless we have the assessment findings, we cannot really say it is good only for 30 days, 3 months, 6 months, I8 months, or forever (as in custodial care)... Certainly, those with co-occurring disorders need specialized services like pharmacotherapy and psychotherapy, and longer-term treatment.

7. Recovery Supports:

a. Working with Clients through non-clinical services that are used with treatment to support individual clients in their recovery goals. This can be done by peers and self-help groups.

b. Working with Families through Community Based Programs. The families of all those who surrendered in particular, need to be educated and provided the appropriate supports. Many of them could be suffering from social stigma now. They may not know what to do anymore, with their confusion... their co-dependencies and their involvement with the clients.

These families were already affected before these users/peddlers surrendered; and these users/peddlers will go back to their families after treatment and/or intervention. Build and foster health, resilience, wellness and quality of life through the transition of individual clients and client families within the network of families and recovery partners in the community..

These families and recovery partners play a very critical role in recovery... and they can also be tapped for essential supports to our rehabilitation efforts.

Seek help from the DOH, establish linkages.with the Church and various church/faith groups, with the DDB and other government institutions, with UNODC, with rehabilitation centers and facilities, SUD treatment professionals and other treatment-providers outside Bohol for needed supports...

Not all may need treatment. Some of them may only need psycho-social support in their efforts to find acceptance, amnesty, redemption and reintegration.

Please realize as well that SUD treatment for the parolees, and/or probationers (whatever you call these offenders) differ from the treatment of those who have not been in conflict with the law and/or those in jail or in prison. Their freedom may be curtailed but they still have greater access to drugs and alcohol than those who are incarcerated, hence, the greater potential for relapse and recidivism.

Many of the "surrenderees" may have a co-occurring anti-social personality disorder, or a conduct disorder (for those below 18); many of them may be spiritually empty and financially impoverished. Securing their basic needs such as food and shelter, re-examining their values, helping them see the meaning of their life and purpose in this world, and providing more intensive psychotherapy among other treatment strategies to address the co-occuring problem, should help them reintegrate into society.

I hope these thoughts will be of help. Of course, I am coming from the perspective of a psychologist who has been exposed to SUD counseling and treatment for 40 years now.

7. Recovery Supports:

a. Working with Clients through non-clinical services that are used with treatment to support individual clients in their recovery goals. This can be done by peers and self-help groups.

b. Working with Families through Community Based Programs. The families of all those who surrendered in particular, need to be educated and provided the appropriate supports. Many of them could be suffering from social stigma now. They may not know what to do anymore, with their confusion... their co-dependencies and their involvement with the clients.

These families were already affected before these users/peddlers surrendered; and these users/peddlers will go back to their families after treatment and/or intervention.

Build and foster health, resilience, wellness and quality of life through the transition of individual clients and client families within the network of families and recovery partners in the community..These families and recovery partners play a very critical role in recovery... and they can also be tapped for essential supports to our rehabilitation efforts.

Seek help from the DOH, establish linkages.with the Church and various church/faith groups, with the DDB and other government institutions, with UNODC, with rehabilitation centers and facilities, SUD treatment professionals and other treatment-providers outside Bohol for needed supports...

Not all may need treatment. Some of them may only need psycho-social support in their efforts to find acceptance, amnesty, redemption and reintegration.

Please realize as well that SUD treatment for the parolees, and/or probationers (whatever you call these offenders) differ from the treatment of those who have not been in conflict with the law and/or those in jail or in prison. Their freedom may be curtailed but they still have greater access to drugs and alcohol than those who are incarcerated, hence, the greater potential for relapse and recidivism.

Many of the "surrenderees" may have a co-occurring anti-social personality disorder, or a conduct disorder (for those below 18); many of them may be spiritually empty and financially impoverished. Securing their basic needs such as food and shelter, re-examining their values, helping them see the meaning of their life and purpose in this world, and providing more intensive psychotherapy among other treatment strategies to address the co-occuring problem, should help them reintegrate into society.

I hope these thoughts will be of help. Of course, I am coming from the perspective of a psychologist who has been exposed to SUD counseling and treatment for 40 years now.

Your partner for a better world,
Miriam P. Cue, PhD, RPsy, RPm, RGC, ICAP-II, MAC

Chairperson, Professional Regulatory Board of Psychology
Professional Regulation Commission

Registered Psychologist (Lic # 000001)
Registered Psychometrician (Lic # 000001)
Registered Guidance Counselor (Lic # 0002011)
PAP Certified Clinical Psychologist
PAP Certified Counseling Psychologist
PAP Certified Assessment Psychologist
PAP Certified I/O Psychologist
Internationally Accredited Addiction Professional (CP-ICCE)
Global Master Trainer in the Universal Treatment Curriculum for Substance Use Disorder
Master Addiction Counselor (NADAC - USA)

Consulting Psychologist/Retainer
New Day Recovery Center (Davao City)

Note: Much thanks for this comprehensive and valuable contribution to our quest for an effective strategy. We will make this available to as many people as possible.