The AIPC Integrated Rehabilitation Centre for Addicts (IRCA) would provide composite/integrated services for the rehabilitation of the substance dependent person. The structure of IRCAs is as given below:
The IRCAs would be responsible for the following services:
1. Preventive Education and Awareness Generation
Preventive Education and Awareness Generation programme should address specific target groups (vulnerable and at risk groups) in their neighbourhood, educational institutions, workplace, slums and social welfare organizations with the purpose of sensitising the community about the impact of addiction, and the need to take professional help to treat..
The programme needs to specifically focus on children and youth, in and outside educational institutions. The programme should start at the school level addressing adolescent groups and continue with college students. Parents/teachers should be sensitised to develop skills to understand
the psychology of the youth and to help them keep away from substance abuse. The high-risk groups like commercial sex workers, mobile population like tourists and truck drivers, children of alcoholics and drug addicts, children of HIV affected parents, street children, prisoners and school dropouts, should be specifically addressed.
The awareness programme should be appropriate to the local culture and in the local language. Utilization of audio visual aids such as OHPs, slides, CDs, Power Point, films, etc and use of innovative methods like street plays, puppet shows, seminars, group discussions are to be included. People holding positions of respect and credibility like Panchayat leaders, school/college Principals/teachers/Lecturers, should be associated with the programmes.
2. Identification of substance dependent persons for motivational counselling
This would require assessing the problem related to addiction and motivating the addict to avail the services at IRCA. It would envisage total recovery of the addicted person leading to his socio economic rehabilitation through an appropriate combination of individual counselling, group therapy, yoga, exposure to self-help/support groups, and introduction to other recovering addicts. It would also include support and care to families of the addicted person.
3. Detoxification and Whole Person Recovery (WPR)
The IRCA would aim at enabling the addict to achieve total abstinence and improve the quality of their lives by helping them to:
- Identify areas of necessary change
- Become aware of risk factors leading to relapse and evolve positive coping skills Strengthen inter-personal relationships
- Develop a healthy work ethic
- Sustain their recovery through follow-up services
Detoxification services would be provided for safe and ethical management of withdrawal symptoms. The addict would be helped to overcome the desire to use drugs even when he is in situations, which were once tempting.
WPR would indicate that a person who has acquired life skills stays drug free and develops an interest in healthy living. It provides for the whole range of community based services for the identification, motivation, counselling, de-addiction, after care and rehabilitation for Whole Person Recovery (WPR) of addicts to make a person drug free, crime free and gainfully employed. The key elements of WPR include:
- Commitment to a drug and alcohol free life
- Adaptation to work and responsibility
- Social re-integration
- Personal growth and self acceptance
- Acceptance of higher values
For people striving to WPR, four factors, popularly known as the Four Keys to Change are necessary. These are:
- Practical guidance on what needs to be done
- Caring encouragement for one’s effort a powerful “fuel”for motivating recovery
- Successful role models who have achieved the goal
- A peer learning group working together towards that goal.
4. Referral services
Addicts showing deviant behavioural symptoms like violence, depression, suicidal thoughts, etc., should be assessed and referred to a psychiatric hospital immediately for availing specialized psychiatric services. For allied and opportunistic medical manifestations such as tuberculosis, hepatitis C, STDs, AIDS, etc., referral should be made for appropriate medical interventions which would, inter-alia, include services of other specialists, hospitals and testing laboratories, run/controlled/aided/accredited by the Union or State Governments such as National Aids Control Organization (NACO) and de-addiction hospitals set up by the Ministry of Health and Family Welfare including also other institutional networks established in the field of social defence focusing on the target groups covered under this scheme. There should be a system of inter-linkage of care givers and care-giving institutions to ensure effective handling of the social defence issues.
5. After-care and Follow-up
After care and follow up are essential components of addiction treatment subsequent to the discharge of the client from the IRCA. The outcome of therapy depends largely on the effectiveness of the follow-up efforts towards the whole person recovery (WPR) of the addict, and his reintegration into the community. As an after-care plan, alternative methods for clients who have not recovered should be devised. Adequate after care and follow-up would help in reducing relapse.
6. Care and support to families for co-dependence and rehabilitation.
The IRCA would have a well-defined program for the family members especially for co-dependence and ensuring the social reintegration of the addict/family. This includes counselling, relapse prevention, self-help programme, and reaching out to the families of the addicts through regular home visits. The focus would be to make the families understand that addiction is a disease, and help them develop a caring attitude towards the addicts. The thrust would to help the addicts as well as their families deal with their negative emotions and improve their quality of life.
The primary objective of the IRCA is the total rehabilitation of the addict after having been treated for drug dependence. To facilitate the self-sustainability of the addict/dependent family members, an IRCA would avail of the services available through various schemes/programmes of the Govt/State through effective networking.
Rehabilitation activities may include relevant vocational training utilising local resources. It would also involve identification and networking with government recognized vocational centres to refer recovering/recovered addicts for training. The Centre would also maintain a network directory of specialized services.
8. Period of stay
While a fixed period cannot be prescribed for the treatment of all the addicts, as the period of treatment will differ with type and severity of addiction (whether alcohol or drugs) and between individual addicts, a period of one month would generally be required for an addict to undergo the various phases of counselling, detoxification, de-addiction and psychological recovery. However longer or shorter periods of stay may be required, in certain cases, depending upon individual circumstances, for after-care of the addicts, particularly in case of Therapeutic Community model to take care of co-dependence in the family members, psychological rehabilitation of the addict through yoga, meditation, spiritual inputs etc. The period of stay, in no circumstances, should exceed two months. If keeping an addict for a period of more than one month is necessary in view of the local or case-specific situation, consent to this effect should be obtained by the Organization from a district level committee consisting of the Civil Surgeon, the District Welfare Officer and a representative of the NGO. While doing so, the interest of the clients being served by the centre shall be kept into mind without compromising on the basic components of the programme.
An IRCA will ordinarily have a 15-bedded facility to cope with the clients at any given time. Centres with bed capacity of 30 and 50 may also be sanctioned by the Ministry in special cases on recommendations of the State Governments or an authority designated by the Government and on the basis of the credibility and performance of the NGO during the previous three years. The number of beds in any 15 and 30-bedded centres may be increased to 20 and 40 beds respectively in urban areas and the North-East, if there is a consistently higher occupancy for the last two years. Grant- in- Aid would be enhanced for an additional post of Nurse/Ward boy with a proportionate increase in entitlements for medicines and kitchen expenditure. Prior approval of the Ministry would be necessary in all such cases.
10. Food for the Inmates
An IRCA shall provide wholesome food (breakfast, lunch and dinner) to the patients. The inmates shall be provided food free of charge. For this purpose, recurring grant @ Rs. 75/- per day per person for wholesome food of 3 meals a day for all the inmates, would be provided to the organization which would be duly accounted for on actual basis while submitting utilisation certificate for that year. It must be ensured by the organization that food of the same quality, as per fixed diet chart approved by the district level committee mentioned in para 188.8.131.52 above, is provided to all the inmates irrespective of their economic status.
FINANCIAL ASSISTANCE NEEDED
The financial norms for setting up /maintenance of a 15-bedded, 30-bedded and 50-bedded IRCAs are at Appendices-II, III and IV, respectively.
An IRCA in Sansad Adarsh Gram Yojna (SAGY)
An IRCA may be located in the village provided there is incidence of alcoholism and drug abuse in the village and in adjoining areas and there is a felt need for rehabilitating the affected persons. The IRCA can be set up provided an eligible NGO is willing to locate the project in Adarsh Gram or the Gram Panchayat is willing to set up and run the centre.