PROJECT PTOPOSAL: PILOTING ON COMMUNITY BASED PARTICIPATORY DRUG DE-ADDICTION AND HIV HARM REDUCTION PROGRAM

PILOTING ON COMMUNITY BASED PARTICIPATORY DRUG
DE-ADDICTION AND HIV HARM REDUCTION PROGRAM

CAPTER-1: INTRODUCTION

A. History:

As with other South Asian nations Bangladesh has a long history of illicit drug use, particularly of opium and cannabis. Before 1948, Bangladesh was a part of an undivided India and therefore much of its history mirrors eastern India, particularly Bengal. From the time of British colonisation until 1984 it was possible to purchase opium from government controlled vendors (Ray 1998). Cannabis has been widely used in Bangladesh society for many years and was often not perceived as a drug of abuse (Kabir 1998). In the late 1970s consumption of opium was strictly restricted and the scheme of compulsory registration identified about 1,600 chronic opium addicts (Spencer and Navaratnam 1981). Since 1987 production of cannabis has been banned and most is now smuggled across the Indian border (Hossain 2000). Until the mid 1980s the drugs of use, among the young, were cannabis, local wine and prescribed tablets (Mandrax and Prodrom). Heroin, generally called brown sugar, did not appear until the mid to late 1980s. It had low potency and became the drug of choice (Ray 1998) among the lower socio-economic sector and some students (Kabir 1998). In 1991, the majority of drug users in treatment indicated heroin as their drug of choice, followed by pethidine. At this time the level of education and affluence tended to influence drug-taking practices; 15% of the poor injected compared to 42% of the more affluent (Gibney 1999). At the same time as heroin addiction increased, a shortage in supplies emerged as a result of law enforcement activities. As a result drug users turned to the pharmaceutical buprenorphine from India (Habib 2000, Hossaine 2000). The emerging popularity of buprenorphine (commonly know as Tidegesic) stems from its cheapness, availability, longevity of effect and as a result of some pharmacies promoting the drug as a way of treating heroin addiction (Kabir 1998). By the mid 1990s individuals dependent on buprenorphine started to appear in treatment centres (Ray 1998).


B. Current situation:

Bangladesh is surrounded by one of the largest drug producing regions in the world. While it is not a significant producer of narcotics, opium cultivation near the Myanmar border, albeit small, has been detected in some districts. In 1999, 90 acres of poppy fields were destroyed by the army (Narcotics 2001, Henry 1999) and 28 kilograms of heroin and 2.3 metric tons of cannabis were seized. The drug Phensidyl (a cough syrup containing codeine) has become increasingly popular among drug users. In 2000, 140,000 bottles were seized by law enforcement officials (International 2000). Phensidyl is readily available and remains the most visible illicit drug: it requires no prescription and is easily accessed by many illegal traders in various parts of the country (Habib 2001).

In 1996, a Rapid Situation Assessment (RSA) of the drug use in three major cities (Dhaka, Rajshahi and Chittagong) was conducted; 1,750 participants were selected at random. The results of this survey reported the most commonly used drugs in descending order were cannabis, cough syrup (codeine based), sedatives and heroin. For those surveyed in treatment centres the most commonly used drugs in descending order were heroin, codeine, cough syrup, buprenorphine, cannabis and sedatives (Ray 1998). Among all the participants the life time use of selected drugs show cannabis at 25.8%; cough syrup at 11.3% with heroin and buprenorphine, 2.9% and 0.5% respectively (Ray 1998). However, a recent study in Dhaka showed buprenorphine as the most commonly used drug among users (70%) (Mallick and Gomes 2000). It is widely agreed among experts that there is increasing evidence of the widespread use and availability of illicit drugs (Ahmed 1999; Habib 2001; Ray 1998; Hossain and Ahmed 1999; Malibubur 1999).

In the northern part of the country, drug use, including injecting, has been reported in the cities of Coxes Bazar, Chittagong, Jessore, Khuna, Rajshahi and Chapainawabganj and drug use is common in several areas of the capital, Dhaka (Jenkins 1999a; Begg 1999). While drug use is mainly confined to the urban centres it has also been reported in several rural areas and villages (Ray 1998; Jenkins 1999a).

In 1998, a study was undertaken to assess the vulnerability of an estimated 200,000 street children (aged between 5- 14 years) living in the metropolitan area of Dhaka.

While the study found many of the children were the victims of exploitation, harassment and abuse (including sexual) it also found that some were addicted to injectable drugs and other substances. Awareness on HIV/AIDS issues was reported to be poor among this group (Milky 1999).

C. Drug taking practices and risk factors:

While the most popular routes for taking drugs is reported as ingesting or inhalation (Malibubur 1999) injecting does appear to be gaining popularity (Hossaine and Ahmed 1999). The injecting of drugs is believed to have commenced in 1990 (Hossaine 2000) and data recorded in treatment centres reports an increase in the rate of injecting from 6% in 1993 to 17% in 1995 (Ray 1998). The time frame from using different types of drugs before switching over to injectables ranges from six to fifteen years (Jenkins 1999a; Mallick and Gomes 2000). In 1996, a study in Rajshahi reported the injecting of sedatives as widespread (78%), followed by buprenorphine (21%) (Habib 2001). The behavioural surveillance study of 1998-99 showed that for those who injected, the drug of choice was buprenorphine which was frequently mixed in a cocktail of substances including diazepam, promethazine hydrochloride and chlorpheniramine. A recent study also reported that 29% of participants injected a cocktail of drugs (Hussaine, 2000; Mallick and Gomes 2000). Heroin was used by only 2% of participants, and was usually dissolved in lemon juice before injecting (Hussaine, 2000). One study shows that 90% of all injectors had once smoked heroin (Begg 1999).

Reports of drawing up blood in the syringe in order to dilute the drug and front or back loading (moving the drug from one syringe to another) occurs, even though in small numbers (<10%) (Jenkins 2001, Mallick and Gomes 2000). In 2000, a study in Dhaka reported the average number of injections per day was two and the sites of injecting varied; 26% injected into the vein, 56% into muscle and the rest (18%) used both the vein and the muscle (Mallick and Gomes 2000). Another earlier study reported that 59% always injected into the vein (Jenkins 1999b).

In the city of Rajshani most IDUs used the services of a professional injector in an adda: an adda is a place where IDUs gather to inject and where the drugs and the professional injector can be found. While the same practice is likely to occur in Dhaka it is not as common (Hussaine 2000; Jenkins 1999b) It has been suggested the professional injectors are able to maintain business through a good supply of drugs, connections to wholesalers and by providing the injecting services. In 1999, in Rajshani an estimated 50 adda injectors operated and there were an estimated 94 addas in the city. These facilities are often located in disused buildings and lane ways but some also operate in hotel rooms (Hossaine 2000). For a small additional cost, people can ask to be injected at their homes. In one study it was reported up to 90 persons a day used a single adda injector, often for multiple injections. Being an adda injector was not exclusively the domain of men as several women had also become involved (Jenkins 1999a).
Reports suggest an adda injector will use the same needle for 20-50 people and that it is not unusual for it to be used for 2-3 days. (SHEAS, 1996). Studies in the late 1990s reported widespread sharing of needles among all IDUs (60% - 90%) and that professional injectors did not sterilise their needles and syringes (Hossaine 2000; Begg 1999; Ashaful 1999). The sharing of injecting equipment has also been documented among street children (Gibney 1999). Among professional injectors it has been observed that a needle is only changed when it becomes blunt and glass syringes are rarely changed or discarded (Hossaine 2000). New needles add an expense that few poor IDUs can afford thus explaining the reasons for the widespread sharing (Jenkins 1999a) and why some people have been known to use syringes rejected by hospitals (SHEAS 1996). It costs an average of three Taka (US$0.05) to buy a disposable syringe and needle. There are regulations in place requiring a prescription to buy such equipment but this is often ignored. It is not difficult to find a needle and syringe in most parts of the country (P.S. Mallick personal communication 2001). Cleaning of needles by those who shared their needles is nearly always inadequate. Some methods included using cotton or paper to clean the needle or using distilled water (Mallick and Gomes 2000). Some IDUs used saliva to clean their needles believing this would destroy any poisons found in the blood (SHEAS 1996).

The establishment of needle and syringe programs (NSP) from May 1998 has shown some behavioural changes. Results from a recent study between two surveys show the overall sharing of needles in Dhaka appears to have been reduced from 93% to 75% of people ever sharing in the last week. In Rajshahi the reduction is from 96% to 55% (Jenkins 2001). The government recognises that NSP clearly impacts on the proportion of injections shared (Government of Bangladesh 2001).

D. Prevalence and profile:

The number of drug users has been estimated to be between 100,000 to 1.7 million (Ray 1998; Rhaman 2000; Narcotics 2001; WHO 2001). In the early 1990s it was estimated that there were 100,000 heroin users in the country but this figure is likely to have lessened as buprenorphine has become the favoured drug (Hossaine 2000). It has been estimated there could be 20,000 to 25,000 IDUs in the country (Hossaine 2000; Jenkins 1999a; Wodak 2001). In the capital Dhaka, reports suggest there are 7,650 injectors and at least 11,000 heroin users (Begg 1999). In northern Bangladesh there are an estimated 12,000 to 15,000 injectors, most of whom are found in the cities of Rajshahi and Chapainwabganj (Jenkins 1999b). However, these figures are disputed by others: a Rapid Situation Assessment (RSA) in 2000 found there was no more than 2,000 IDUs in Rajshahi and 1,000 IDUs in Chapainawabgonj (Mallick and Rabbani 2000).

The majority of drug users, and those who inject, are reported to be male with less than 2.5% females (Government of Bangladesh 2001; Hossaine 2000; Begg 1999). The number of female drug users could be greater but reaching out to this sector of the community is difficult when most are very hesitant to identify themselves as IDUs (Begg 1999). One outreach program in Dhaka has contact with about 40 female IDUs most of whom are also sex workers (Begg and Nizam 1999). In one southern city a survey found 14% of street female sex workers injected drugs and in the brothels 6% stated they were IDUs. Among male IDUs a high proportion paid for sex. A survey in various cities has shown that half to three-quarters of male injectors paid for sex and close to one in ten bought sex from men or transvestites; less than 25% used a condom the last time they paid for sex (MAP 2001).

In 1986, HIV was first detected in a foreign drug trafficker and in 1989 the first case of HIV in a citizen of Bangladesh was recorded (Gibney 1999; Hussaine 2000). While the HIV prevalence levels have remained relatively low there has been a sizeable increase since 1989 (Gibney 1999). As of December 2000 the total number of HIV/AIDS cases was 157 (127 males, 30 females). Between December 1999 and December 2000 the number of identified HIV infections was 31 cases, the highest number in a single year. A breakdown of the transmission route is not available but it is likely the majority are sexually acquired (Department of Virology 2001). In 1999 an estimated 7,500 adults and children lived with HIV infection (UNAIDS 2000) but in 2000 this increased to 13,000 (WHO 2001). It has been calculated that the annual number of AIDS cases was 1,100 in 2000 which will rise to 1,700 by 2005 (WHO 2001). A sero-surveillance of 1998-1999 reported that among IDUs coming into detoxification centres, 2.5% were found to be HIV positive and among the 880 surveyed the rate of needle and syringe sharing was about 90% (Hussaine 2000).

A follow up survey for the second national expanded HIV surveillance in mid 2000 reported that of the 418 participants from a central NSP, 6 people (1.4%) were found to be HIV positive (Government of Bangladesh 2001). The low levels of HIV infection in the two rounds of surveillance have yet to be fully explained considering widespread sharing of needles was still occurring. Studies have shown that Hepatitis C can be found in 25% of IDUs: this was associated with the sharing of needles and the longer duration of drug injecting (Shirin 2000). Surveys conducted on IDUs have shown a wide age range (15 to 70 years) with the average age being 30 to 35 years (Mallick and Gomes 2000; Hossaine 2000, Hussaine 2000). Many have poor education and unskilled occupations, a substantial number are married, and the majority had previously been to jail, mostly for drug offences (Begg 1999; Jenkin 1999b; Hussaine 2000; Habib 2000) A recent study found most family members were aware of the users drug using behaviour (Habib 2001). Use of commercial sex workers, particularly among the unmarried, was fairly common and the use of condoms was generally very low; condoms are rarely a consideration and are seen as mainly for family planning (SHEAS 1996; Jenkins 1999b; Malibubur 1999; Ashaful 1999; Hussaine 2000; Mallick and Gomes 2000). Many sex workers were aware of colleagues having sex with drug users without condoms (Gibney 1999). A 1997 study showed 21% of IDUs donated their blood and many did so as a way to raise money (Jenkins 1999a). This is clearly a problem when none of the blood banks test the blood for HIV (Begg, 1999).

E. Government responses to illicit drug problems:

In the Narcotics Control Act, 1990, there is provision for the establishment of narcotic addiction treatment centres and when it is deemed treatment is necessary the person is directed to a competent physician or a treatment centre (Ray 1998). However, detoxification and rehabilitation programs are scarce in the country and few drug users have the resources to attend them. As occurs in most countries of the world recidivism is high for those receiving treatment. A 1998-99 study showed 90% of the participants who had made attempts to stop drug use had failed (Hussaine, 2000). It has been suggested that the drug prohibition laws enacted under the Narcotics Act of 1990 are not an effective strategy for harm reduction (Habib 2000). The government does not view drug addiction as a high priority issue and it is seen as a self-created problem (Hossain and Ahmed 1999). If a person is found in possession of heroin, cocaine and coca derivatives, and the quantity does not exceed 25 grams, imprisonment will not be less than two years and not exceed 10 years. If the quantity exceeds 25 grams the penalty can be the death sentence or life imprisonment. For possession of pethidine, morphine or tetrahyrocannabinol, if the quantity does not exceed 10 grams, imprisonment will be no less than two years and no more than 10 years. If the quantity exceeds this amount the penalty is a death sentence or life imprisonment. There are various A class narcotics which is where buprenorphine is likely to be classified. Being in possession of this drug is also likely to incur a severe penalty. The penalty is an imprisonment of not less than two years and no more than 15 years: the possession amount is not specified (Rahman 1990). There is usually no provision for arrested drug users to be sent to drug treatment centre. The only option appears to be prison (P.S Mallick, personal communication 2001).
The Department of Narcotics Control has recently initiated a community level of coordination to streamline the activities of the non-governmental organizations (NGOs) to strengthen existing and future drug prevention activities in the country (Ahmed 2001). There are four government de-addiction centres in the country with a total of 55 beds (Ray 1998).

The traditional approach to treating drug users is in the psychiatric units of hospitals. The shortage of beds results in few being able to receive treatment. Other problems include physicians being discouraged from offering their services to treatment centres because they can lose their seniority if they are not properly released by the Ministry of Health and placed under the Department of Narcotic Control (Hossain and Ahmed 1999).

The two models of treatment are the ashram model, run by non-medical social activists, and the medical hospital model run by medical professionals. Most drug users are serviced by government health care facilities and at the Dhaka centre people stay for four weeks. There is only one program designed to cater for female drug users (Hossain and Ahmed 1999) Only one government- run detoxification centre exists in Dhaka, which has 40 beds and charges a nominal fee (Begg 1999). Many drug users have tried various ways to stop their drug use and a study shows 68% had been in prison at least once. However, even here drug injecting occurs (Jenkins 2001).

F. Government response to drug use and HIV:

The government is aware of the link between HIV/AIDS and drug use as has been shown in the two sero-surveillance surveys. It has been acknowledge NSP can play a role in reducing the amount of needle sharing and impact upon HIV transmission.

However, there are reports of IDUs being arrested for carrying syringes and needles even though no ‘paraphernalia laws’ exist (Begg 1999; Hussaine 2000). Substitution therapy is currently not available. Information about HIV/AIDS which directly targets drug users is reported to be unavailable.

G. National AIDS policy:

The Ministry of Health and Family Welfare produced a National HIV/AIDS Policy which received approval by the cabinet in 1998. In the policy there is a special focus on IDU and approval of harm reduction as a useful strategy. However, the Ministry of Home Affairs, whose focus includes narcotic laws, does not approve of harm reduction believing such a policy cannot supersede the law of the land. As a result of these contradictions serious threats from the Narcotics Department and police have emerged with this policy. In recent times the Narcotics Department has indicated they acknowledge the existence of NSP and at this stage have tended to ignore the operations of such programs.

H. Non-government responses to drug use and HIV:

In 1999, the SHAKTI project CARE-Bangladesh (NGO) operated seven drop in centres in Dhaka, which are open six hours per day, six days per week and offer needles and basic primary health care for drug users (Begg 1999). A NSP has been set up at a professional injector site in Rajshahi, reaching approximately 10-20% of the local IDUs. In 1999, SHAKTI was estimated to have access to 3,500 IDUs; peer educators distributed two new syringes and six needles every other day, per person at their drop in centres (Jenkins 2001). About 90,000 needles and syringes per month are exchanged at the DIC with a reported high return (>80%) (Wodak 2001). As there is no incinerator in Bangladesh, there has been no other option for NGOs but to burn collected needles and syringes at the drop in centres in the open air (Begg 1999). CARE-Bangladesh also has programs in Rajshahi and in early 2001 they set up a program in Chapai Nawabgonj which reaches 200 IDUs. In this latest project they have trained five adda educators who are current drug users. Their role is to educate other IDUs and professional drug injectors on STD/HIV issues and to exchange old needles and syringes for new ones (CARE-Bangladesh 2001). It has been reported there are nine NGOs focused on drug demand reduction with a total of 190 beds between them for in-patient treatment (Ray 1998).


Estimated number of drug users : 100,000 - 1.7 million
Estimated number of IDUs : 20,000 - 25,000
Drugs used : cannabis, cough syrup, buprenorphine, sedatives, heroin, codeine
Drugs injected : sedatives, buprenorphine, heroin, drug cocktails
Estimated number of HIV infection : 2.5% of IDUs in detoxification centres among IDUs are HIV +

J. Life, the proposing NGO:

Like-mindedness and the urge to achieve a common goal aided by knowledge, skill and experience is that has given birth to NGO life. It is an organization committed to all out development of the society and its approach to development is a people oriented one. Life believes in an integrated approach, which included both humans and materials aspects of development. For any development effort to be meaningful it must integrated both human material components of development organically. In other words, our scope of activity encompasses the whole gamut of development issues obtaining in Bangladesh.

Our motto is to build self-confidence and capabilities in human races by development critical consciousness in them or other words, humanize them. We do not believe in relief or loan as an end in itself. Hence we are for building adequate human infrastructure as a prerequisite for introducing material imputes within any community. For the task, empowerment of community and person is the most desired intervention by “Safe Life”. Also community based solution is the dream as that will be the utmost sustainable development of a community or the person. Participatory methodology of development is the most important technique in which “Safe life” believes. The primary beneficiaries of the “Safe Life” development approaches are the most vulnerable sections of the rural and urban population especially the landless poor, children and women groups. It is a national organizational its jurisdiction of activities spread all over the country.

Life is a non-profit, voluntary non-Government organization working for the uplift of the people in Bangladesh since decades. Life’s main objective is to uplift the social condition of the poorest of the poor living mostly in rural areas as well as in the urban centers of Bangladesh. As because poverty is responsible from the social and natural environment conditioning the lives of the people Life include in its activities and ambitions program for developing the natural and social environment around the people habits. Achieving household food security, to ensure fundamental rights for the population accepted and ratified by the UN and Bangladesh constitution, structural poverty alleviation, community actions to stop drug abuse, harm reduction of the drug abuse, detoxification and rehabilitation of the drug abusers, health and nutrition including the issues relating HIV/AIDS, environmental protection and regeneration, improvement in women's status, increasing people's participation in the public institution, increasing people's capacity to gain and exercise democratic and human rights etc. are among the important mottos of the NGO Life.

In recent years, along with other interventions, Life is working on the drug abusers to refrain them from abusing drugs through mainly community based participatory awareness raising, advocacy and other holistic approaches. However, from the experiences of Life it is now evident that only the awareness program is not sufficient to restrict the massive damage of the community and persons made by the drug abuse and the dimension of the drug related program has be widened by establishing drug abuse detoxification and rehabilitation centers to intervene the already addict population, to save their lives and to stop any more propagation of the addiction by them.


I. OBJECTIVES:
The objectives of the program are as follows:

1. To establish a fellowship of recovering addicts living in a healthy atmosphere, helping fellow addicts and their families recover from addiction.
2. To disseminate knowledge of basic facts about drug abuse, addiction, the Twelve Steps Program of Narcotics Anonymous and the recovery process.
3. To provide an environment in which addicts review their lifestyle, develop healthy attitudes, demonstrate sobriety and form good habits in daily life and work.
4. To provide an environment in which addicts acquire sufficient skill training, education and other preparatory knowledge that will lead to constructive and gainful employment.
5. To enable recovering addicts to make a full and active positive contribution to family and society, living a happy drug free and crime free life, who are constructively and gainfully employed, motivating others to stay off drugs or to get off drugs. Special emphasis is on high-risk youngsters of the nearby slums.
6. To provide drug prevention, motivational and training assistance for young drug addicts and high-risk youngsters, especially those from poor and/or dysfunctional families.
7. To create awareness and educating the people about the ill effects of alcoholism and substance abuse on the individual, family and the society at large.
8. To evolve culture-specific models for the prevention of the alcoholism and substance and the treatment and rehabilitation of addicts.
9. To provide for the whole range of community based services for the identification, motivation, counseling, de-addiction, after care and rehabilitation of addicts.
10. To promote collective initiatives and self help endeavors among individuals and groups vulnerable to addiction are found at risk.
11. To establish appropriate linkage between Government interventions and voluntary efforts in the field of prohibition and substance abuse prevention.
12. To increase community participation and public co-operation in the reduction of demand for dependence-producing substances. Creating Awareness

J. Activities:

Life’s target group will be the poor and young addicts of the local area but people come for treatment from all over Bangladesh. Those who come to Life pay according to the family means; as a result many of those who come for assistance pay little or nothing. The activities of Life will cover all aspects of drug addiction treatment and after care rehabilitation for male addicts, including prevention and awareness activities. These activities can be grouped into the following main forms of service provision:

(i) Identification of addicts.
(ii) Awareness building
(iii) Motivational counseling
(iv) Preventive education
(v) Screening of abuses-addicts
(vi) Detoxification / De-addiction
(vii) Formation of Self Help Groups
(viii) Vocational rehabilitation
(ix) After care and re integration into the social main stream.

Program components:

I. Production and Dissemination of Educative and Publicity Material
a) Posters/Flash Cards/Flannel Charts/Flip Charts
b) Pamphlets/Brochures/Leaflets
c) Hoardings/Panels/Banners
d) Booklets/Periodicals etc.
II. Community Participation Programs

a) Corner meetings/Workshops/Conferences
b) Essay/Debate/Slogans/Drama/One Act Play Competitions
c) Pantomime Shows/Street Plays/Folk Media, etc.

III. Training Camps for Voluntary Workers

IV. Any Other Activity for Awareness building programme against drug/alcoholism
V. Residential Treatment/ Rehabilitation:
The principles of Narcotics Anonymous 12 Step Program form the basis of this program of treatment and rehabilitation/habilitation. The importance of structure, work production, exercise, prayer and relaxation is acknowledged and these are all essential elements in this holistic program.
VI. Awareness, Prevention, Demand and Harm Reduction:
This is comprised of:

i) A series of meetings that all Life residents participate in on a daily basis.
ii) The Children's Program that is focused on removing 'at-risk' children from potential drug abuse situations.
iii) An important educational service for addicts, their families and the general community.
iv) Aftercare and Halfway House with Skill Training and Income Generation: This incorporates a range of post rehabilitation meetings and also a strong support network (Life based) to assist with the continued recovery of the addict. Additionally the aftercare service provides participants with the option to obtain skill training and to contribute to the income generation of the program.

VII. Community Outreach Project: With the program, Life will operate community based participatory detoxification and de-addiction centers in the vulnerable most places of Bangladesh where no or less similar programs are available. In those areas, Life will contact and communicate with the local actors including Government, NGO and local elites. The community committees, local government members, local elites and cultural leaders will be involved in the establishment of the community detoxification and de-addiction centers (CDD), collection of the drug abusers and retaining them in the centers till detoxification, then to handover them to the their families for de-addiction processes and in need to transfer more resistant cases to the Life drug rehabilitation center in Dhaka for better management.

VIII. HIV/AIDS Awareness program:
The HIV/AIDS issues for drug addicts in Bangladesh are extremely pressing. The links between intravenous drug use, prostitution and unsafe sex are strong. Life is already in preliminary discussion with local NGOs regarding the possibility of collaborating on a project which targets this issue and the ever increasing 'at risk' population. This program will be existing as a cross cutting issue in all Life drug and substance abuse programs. The necessary components will be the screening, counseling and life skills for HIV/AIDS among the drug abusers and their families wherever necessary.


RISK AND PROTECTIVE FACTORS FOR YOUNG PEOPLE AND DRUGS

Level Risk factors Protective factors

Community Availability of drugs Cultures of cooperation
Poverty Stability and connectedness
Transitions and mobility in schooling and community Good relationship with an adult outside the family
Low neighborhood attachments and community disorganization Opportunities for meaningful contribution
School Detachment from school and poor relationships in school A sense of belonging and ‘fitting in’
Positive achievements and evaluations at school
Academic failure, especially in middle years
Early and persistent antisocial behavior and bullying Having someone outside your family who believes in you
Low parental interest in education
Attendance at pre-school
Family History of problematic alcohol and drug use A sense of connectedness to family
Inappropriate family management Feeling loved and respected
Family contact Proactive problem solving and minimal conflict during infancy
Alcohol/drugs interfere with family
Maintenance of family rituals Warm relationship with at least one parent
Harsh/coercive or inconsistent parenting Absence of divorce during adolescence
Marital instability or conflict
Favorable parent attitudes towards risk-taking behaviors
A ‘good fit’ between parents and child
Individual/peer Constitutional factors: alienation, rebelliousness, hyperactivity, novelty seeking Temperament/activity level, social responsively, autonomy
Development of special talents, hobbies and zest for life
Seeing peers take drugs
Friends engaging in problem behavior Work success during adolescence
Favorable attitudes towards problem behavior High intelligence (not paired with sensitive temperament)
Early initiation of the problem behavior



Time Chart
Sl. # Activity MONTHS
1 2 3 4 5 6 7 8 9 10 11 12
1. Preparatory: i) Reviewing secondary literature ii) visiting similar facilities iii) consultation with resource persons/experts iv) communication with donor, Government and other stakeholders etc. v) Recruiting vi) Renting the premises vii) Arrangement of the logistics

2. Establishment and commencement of operation of drug
de-addiction center
Identification of addicts

Awareness building

Motivational counseling

Preventive education

Screening of abuses-addicts

Detoxification / De-addiction

Formation of Self Help Groups


Vocational rehabilitation



After care and re integration into the
social main stream.

3. Production and Dissemination of Educative and Publicity Material
a)Posters/FlashCards/Flannel Charts/Flip Charts

b) Pamphlets/Brochures/Leaflets

c) Hoardings/Panels/Banners

d) Booklets/Periodicals etc.




4. Community Participation Programs

a)Corner meetings/Workshops/Conferences




b) Essay/Debate/Slogans/Drama/One Act Play Competitions


c) Pantomime Shows/Street Plays/Folk Media, etc.




5. Training Camps for Voluntary Workers
6. Any Other Activity for Awareness building programme against drug/alcoholism
7. Residential Treatment/ Rehabilitation:
8. Awareness, Prevention, Demand and Harm Reduction
9. Community Outreach Project:
• operate community based participatory detoxification and de-addiction centers in the vulnerable most places of Bangladesh where no or less similar programs are available. In those areas,
• Life will contact and communicate with the local actors including Government, NGO and local elites.
• The community committees, local government members, local elites and cultural leaders will be involved in the establishment of the community detoxification and de-addiction centers (CDD),
• collection of the drug abusers and retaining them in the centers till detoxification,
• Handover them to the their families for de-addiction processes and
• Transfer more resistant cases to the Life drug rehabilitation center in Dhaka for better management.














CHAPTER-II: BUDGET
SECTION: 1. NORMS FOR SETTING UP OF DRUG AWARENESS AND COUNSELING CENTERS

(Expenditure in Tk..)

S.No Name of the Post No. of posts Monthly exp. Yearly exp Minimum qualifications
A. RECURRING EXPENDITURE (ESTT.)
1. Project In charge-cum
Senior Counselor 1 15000 180000 A masters in psychology or sociology with minimum experience of 3 years in Addiction counseling in a Drug De-addiction centre or a experiential counseling
(recovered addict) with 2 years of sobriety. Preference will be given to the persons who have acquired specific qualifications in the field of addiction counseling.

2. Accountant-cum-Clerk
(Part-time) 1 7000 84000 A graduate with experience of accounts work

3. Counselor/Community
Worker/Social Worker 2 10000 240000 A Masters in psychology or sociology with minimum experience of 2 years in Addiction counseling in a Drug De-addiction centre or a experiential counselor
(recovered addict) with 2 years of sobriety. Preference will be given to the persons who have acquired specific qualifications in the field of addiction counseling.

4. Sweeper/Peon 1 2500 30000

TOTAL A 34,500 414000


B. RECURRING EXPENDITURE (OTHER THAN ESTT.)

1 Rent 30000 360,000
2. Contingencies
(Water, electricity, telephone, stationery, etc.) 10000 120,000
3. Publicity 15000 180,000
4. Transport 10000 120,000
TOTAL B 65,000 780,000
TOTAL A AND B 15, 60,000

C. NON RECURRING EXPENDITURE

(Admissible once only during the setting up of the Centre)

Furniture, Almirah, Computer and accessories, Bedsheets etc. 250,000


A+B+C= BDT 1810000


SECTION: 2. NORMS FOR SETTING UP OF 50-BEDDED REHABILITATION-CUM-
TREATMENT CENTRES


S.No Name of the Post No. of posts Monthly exp. Yearly exp Minimum qualifications
A. RECURRING EXPENDITURE (ESTT.)
a. Administrative
1. Project Director 1 25000 300,000 A Medical Professional or masters in psychology or sociology minimum experience of 3-5 years in directing an De-addiction and rehabilitation centre Preference will be given to the persons who have acquired specific qualifications in the field of de-addiction and detoxification protocols

2. Accountant-cum-Clerk
(Part-time) 1 7000 84,000 A graduate with experience of accounts work

3. Sweeper/Chowkidar 2* 5000 60,000

b. Medical
1. Medical Officer 1 15000 180,000 M.B.B.S. or equivalent Degree recognized by the Bangladesh Medical & Dental Council, should have 2-3 years experience in management of drug addicts.

2. Counsellor / Social
Worker/Psychologist 7* 70000 840,000 A Masters in psychology or sociology with minimum experience of 2 years in Addiction counseling in a Drug De-addiction centre or a experiential counselor (recovered addict) with 2 years of sobriety. Preference will be given to the persons who have acquired specific qualifications in the field of addiction counseling.
Preference will be given to candidates with degree/diploma in Addiction counseling.

3. Yoga/faith based other
Therapist (Part-time) 1 6000 72000 Adequate experience in the discipline recognized

4. Nurse/Ward Boys etc. 5* 25000 300,000 Nurse: High School or equivalent with certificate in Nursing from a recognized institution.
Boy: VIII th Class Pass. Good health, mentally sound, good character preferably experienced in such centres.

TOTAL A 153000 1,836,000



B. RECURRING EXPENDITURE (OTHER THAN ESTT.)

1 Rent 40000 480,000
2. Medicines 25000 300,000
3. Transport 15000 180,000
4. Contingencies
(Water, stationery, electricity, telephone, etc.) 15000 180,000
TOTAL B 95,000 1,220,000


TOTAL A and B BDT 1836000 + 1220000 =3056000


C. NON RECURRING EXPENDITURE

(admissible once only during the setting up of the Centre)

60 beds, tables, sets of linens BDT 3,50,000
blankets, other office equipments etc.


A+B+C= BDT 3406000



SECTION: 3 NORMS FOR EXPENDITURE ON HOLDING OF DE-ADDICTION CAMPS FOR TREATMENT OF DRUG ADDICTS

(Intentions will be refer the resistant abusers to the main centre)

1. Number of Patients Not less than 25 and not more than 40


2. Duration of each camp 15 (fifteen) days

(Expenditure in Tk..)

Sl. No. Item In Rural Areas In Urban areas
1. Allowances for the staff 25000 15000
2. Medicines 10000 10000
3. Transport 8000 7000
4. Contingencies
(including rent, water, electricity, charges, hiring of beds and other essential equipments and expenses on follow-ups) 43000 42000
TOTAL 86000
74000



= BDT 75000


Total Budget:

1. SECTION 1+SECTION 2+SECTION 3= BDT 1810000+3406000+75000=

BDT 5291000 in 1 year =US $ equivalent 85000 (Approx.) ($@ BDT 62.00)


2. For 2 years, BDT 10582000= US $ equivalent 171000