MANUAL ON MINIMUM STANDARDS OF

CARE IN ADDICTION TREATMENT CENTRES

CONTENTS

Chapter 1 - Introduction

Chapter 2 – About the Scheme

Chapter 3 – Drug Awareness and Counselling Centres

Chapter 4 – Treatment-cum-rehabilitation centres

Chapter 5 - De-addiction camps

Chapter 6 – Workplace prevention programme

Chapter 7 – Code of ethics for staff and rights of clients

List of References
Annexures 1- 35
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CHAPTER 1

MINIMUM STANDARDS OF CARE IN THE FIELD OF

ADDICTION TREATMENT / PREVENTION
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CHAPTER 2
ABOUT THE SCHEME

The government believes in addressing the problem of addiction in its totality. This includes
prevention efforts, creating awareness, early identification, treatment and rehabilitation,
sustained follow-up care, and also involving and mobilising the community. The non-
governmental organisations have been given the responsibility to deal with this issue, and
financial support is given to the NGOs for providing out patient and in-patient treatment
facilities.

The aims and objectives of the scheme for prevention of alcoholism and substance abuse
are

• To create awareness about the ill-effects of alcoholism and substance abuse to the
individual, the family and the society at large.
• To develop culture-specific models for the prevention of addiction and treatment and
rehabilitation of addicts.
• To evolve and provide a whole range of community based services for the
identification, motivation, detoxification, counselling, after care and rehabilitation of addicts.
To promote community participation and public cooperation in the reduction of demand for
dependence-producing substances.
• To promote collective initiatives and self-help endeavours among individuals and groups
vulnerable to addiction.
• To establish appropriate linkages between voluntary agencies, working in the field of
addiction and government organisations.
• To support activities of non-governmental organisations, working in the areas of prevention
of addiction and rehabilitation of addicts.

Eligibility conditions for assistance

The following organisations / institutions are eligible for assistance under this scheme.

1. A society registered under the Societies' Registration Act, 1860 (XXI of 1860) or any
relevant Act of the State Governments / Union Territory or under any State law relating to
registration of charitable societies.
2. A registered public Trust
3. A Company established under Section 25 of the Companies Act, 1958
4. An organisation / institution fully funded or managed by Government
5. An organisation or institution which has been approved by the Ministry of Social Justice and
Empowerment.
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In addition, the organisation registered under Societies Act to have the following characteristics.
a) It should have a properly constituted managing body with its powers, duties and
responsibilities clearly defined and laid down in writing.
b) It should have resources and facilities and experience for undertaking the programme.
c) It is not run for profit to any individual or a body of individuals.
d) It should ordinarily have existed for a period of three years.
e) Its financial position should be sound.

Application and Sanction – Annexure 1

1. To get financial assistance under the scheme, an Organisation / Institution, should apply in
the proforma prescribed along with the relevant documents in duplicate on the first of April
to the Ministry of Social Justice and Empowerment, Government of India, New Delhi and a
copy to be sent to State Social Welfare Department.
2. Grant will ordinarily be released in two instalments.
3. The first installment constituting half of the amount of the "Recurring" grant sanctioned in
the previous year will be considered for release based on the following documents.
a) Budget estimate of the financial year in question.
b) Un-audited accounts of the previous financial year

c) List of staff employed in the previous financial year (indicating the names of staff,
designation, qualifications, date of joining and date of leaving etc.)
d) Half-yearly Progress Report of the previous financial year.
e) Rent Agreement for the financial year for which the grant has been applied.

4. The second installment will be considered based on the following documents.

a) Audited Statements of Accounts for the previous financial year (Receipt & Payments
Account and Balance Sheet)
b) Utilisation Certificate, if not submitted earlier
c) The list of staff for the financial year for which grant has been applied (indicating the
names, designations, qualifications, date of appointment, date of leaving etc.)
d) Half-yearly Progress Reports upto September of the concerned financial year.
e) Rent Agreement for the complete financial year, if not submitted earlier.
f) Utilisation Certificate from Chartered Accountants for the first installment.

Submission of Reports - Annexure - Format of reports

Half-yearly reports to be submitted as prescribed by the Ministry of Social Justice and Empowerment
(twice a year) in the month of October and April - two copies to be submitted to the State
Government and one copy to Ministry of Social Justice and Empowerment, Government of India,
Shastri Bhavan, New Delhi.

Extent of Assistance
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The quantum of assistance shall not be more than 90% of the approved expenditure. In case of the
seven North Eastern States, Sikkim and J & K, the quantum of assistance will be 95% of the total
admissible expenditure. The balance of the approved expenditure shall have to be borne by the
implementing

agency out of its own resources. The Universities, Schools of Social Work and such other institutions
of higher learning will be eligible for 100% reimbursement of approved expenditure.

Services under the scheme

Under the scheme, financial assistance is given for two major services provided by non-
governmental organizations –
1) Drug awareness and Counselling Centres – Out-patient
2) Treatment-cum-Rehabilitation Centres – Inpatient
The treatment-cum-rehabilitation centre will ordinarily have 15 bedded or 30 bedded facility. In
exceptional and rare cases, the reputed centres under the Scheme may be allowed to establish 50
bedded facility after scrutiny. The Scheme also states that while a period of one month may
generally be required for a substance abuser to undergo various phases of detoxification and
psychological therapy, a provision for extension of stay will be made for a maximum period of
another month in deserving cases. The after care / follow-up services are to be provided on an
ongoing basis in an out-patient set up.

The treatment-cum-rehabilitation centres are eligible to apply for grant-in-aid to conduct treatment
camps in rural and semi-urban areas. Additional grant is provided to conduct treatment camps for
recurring expenses.

Hence, the minimum standards specified in this manual conform to the scheme specified by the
government of India.

The manual has been divided into Five main areas. The minimum standards for each of these
areas are presented:
1. Drug awareness and counselling centres
2. Treatment–cum-rehabilitation centres
3. De-addiction camps
4. Workplace prevention programme
5. Code of ethics for staff and rights of clients
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CHAPTER 3

DRUG AWARENESS AND COUNSELLING CENTRES

Drug awareness and counselling centres function as out-patient units and offer the following
services. The centres are staffed by counsellors / social workers / psychologists / sociologists /
recovering addicts with two years of sobriety.
• Awareness building in the community
• Screening and motivating clients to take help
• Referral services
• Follow-up services
Activities for awareness building in the community
Awareness programmes need to be organised in the neighbourhood in educational institutions,
industries, slums and social welfare organisations to sensitise about the impact of addiction and the
need to take professional help to treat addiction.

The awareness programmes are to be organised in the local language. Audio visual aids like OHPs,
slides and films may be used. Innovative methods like street plays, puppet shows, seminars, group
discussions are to be included.

Minimum criteria Records required

Awareness programme register to be maintained

by the project-in-charge – Annexure 3

• Details of programmes conducted with feedback

One awareness programme per week from 5 people for each programme.

• Copy of the article published / details of the

programme telecast / broadcast.
One article on addiction or the treatment
services available to appear in daily newspaper,
magazine or mass media (television, radio)
once in six months.

Minimum criteria Records required

External evaluation of the awareness Awareness programme register – evaluation

programme by a professional in the field of report to be maintained by project-in-charge –
addiction once a year. Annexure 3

Availability of educational materials for different Prevention programme manual to be maintained by

groups. project-in-charge – content and type of programme for
each target group is described and recorded –
Annexure 4.
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Activities for screening and motivating clients to take help

• Assessment of addiction through personal interviews (with clients and family members) and
through use of standardized tests
• Providing counselling to motivate the addict to enter treatment
• Delivering services according to the schedule / timetable to offer individual counselling, group
therapy and family counselling for the patients and their families on a regular basis.

Minimum criteria Records required

Intake form to be completed on the very first day Intake Form which has demographic details, addiction
of meeting the client. history and prior medical history to be filled by
counsellor – Annexure 5.

Assessment to be made before referral by using Assessment forms to be completed by the counsellor –
standardised questionnaires. Annexure 6 – Suggested Tests.
SMAST / MALT for alcoholism
DAST for drug addiction

Providing counselling every time he visits the Case history form which covers family, marital,
centre until he is motivated to take help from a occupational and financial history with counselling
government hospital or a nearby de-addiction notes to be maintained by the counsellor – Annexure 7
centre.
Case history to be completed within a week / four
sessions with the client.

Meeting family members / support persons within

4 sessions.

Objective and content of each of the services Therapy Manual to be prepared by the project-in-
provided (counselling, group therapy, family charge – Annexure 8.
counselling, follow-up) to be described.

Activities related to referral services and follow-up

• Identification of both government and non-governmental agencies, working in the field of

addiction and networking with them on a regular basis.

• Referring clients after motivation to other centres for detoxification / treatment.

• If referred to the government hospitals, maintaining regular contact with the client during
detoxification and providing follow-up services after completion of detoxification.

Minimum criteria Records required

Networking with government and non-governmental Network Directory with names, addresses, phone
organisations working in the field of addiction in the numbers, admission criteria, time of admission,
location where the centre is situated. contact persons and any other relevant information to
be maintained by project- in-charge – Annexure 9

If a client is referred to a government organisation, Case history form to include visits to government
two visits to be made by the counsellor every week hospitals to be recorded by the counsellor – Annexure
until discharge. 7

Organise a minimum of two group meetings every Group therapy record form to be maintained by
week for clients who have undergone detoxification. the counsellor – Annexure 10

On completion of detoxification, follow-up is to be Follow-up card which has details of counselling

maintained. notes, home visits and letters written to be maintained
by the counsellor – Annexure 11
- One counselling session every week during the
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first three months

- One session every month from the third month till

he completes one year.

- One session every two months for one more year

till he achieves two years of sobriety.

Failure to report for follow-up visits for two months

to be followed up with two letters and one home
visit for the patient and one letter to the family /
significant person.

Minimum criteria Records required

Drinking / drug taking history and improvements Follow-up card with details of whole person
made to be recorded. recovery to be maintained by the counsellor –
Annexure 11
Whole person recovery to be assessed twice a year
and recorded.

Maintaining letter of endorsement from clients for Endorsement letter from each patientto be
receiving free counselling services maintained by the project-in-charge – Annexure 12
- at the time of referral
and
- at the time of follow-up on completion
of 3 months from clients referred to
government organisations

Half-yearly report with details of patients to be Half-yearly report to be maintained by Project-in-

maintained charge to be sent to the funding agencies – Annexure
13.

The physical aspects of the centre

• The centre should be located in a reasonably quiet locality.
• The built in area should be at least 1000 sq.ft. in case of metros and 1500 sq.ft. in case of
small towns and villages
The centre should be properly ventilated, well-lit and maintained in a clean manner. It should have
toilet facilities, drinking water facilities and telephone facility.
• The centre should be easily accessible through public conveyance.
• The following facilities should be available.
i) reception, enquiry / registration counter / waiting space with seating
arrangements for a minimum 5 persons
ii) cubicles / rooms for providing individual counselling, group therapy and
family counselling.
iii) space to store records of patients to ensure confidentiality
and a system of easy retrieval
• Addiction related educational material such as posters to be prominently displayed at strategic
points
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• Information pamphlets, hand outs and other educational materials in the vernacular to be made
freely available for the public
• The centre to have slide projector / overhead projector to conduct awareness programmes.

Job description of staff

Project in charge-cum-senior counsellor (one post)

¾ Responsibilities as a Project In charge

• Coordinating and managing the counselling centre
• Taking care of administrative responsibilities of the centre – attendance, allocation of job and
disciplinary action.
• Preparing Half-yearly / Annual report and application forms for grant purposes.
• Liaisoning with government and non-governmental organisations working in the field of
addiction.
• Checking whether the records are maintained properly.
• Supervising and providing guidance to counsellors
• Organising case discussions
• Organising training programmes for counsellors

¾ Responsibilities as a senior counsellor

• Assessing problem areas of clients
• Collecting case history both from the client and significant persons
• Visiting governmental and non-governmental agencies to support the client in treatment.
• Conducting group therapy for clients
• Providing counselling for family members
• Providing follow-up counselling
• Maintaining individual case records of patients seen
• Conducting awareness programmes

Counsellors (Two posts)

• Motivating the client to take help
• Assessing problem areas of clients
• Collecting case history both from the client and significant persons
• Visiting governmental and non-governmental agencies to support the client in treatment and
escorting him for admission to other organisations.
• Conducting group therapy for clients
• Providing counselling for family members
• Providing follow-up counselling
• Conducting awareness programmes
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• Maintaining records
Training of counselling staff
• Orientation of one month duration to be provided to new staff on counselling, conducting group
and family therapy.
• Updating and training through refresher courses to be provided to existing staff at least twice
a year – to attend one training conducted by Regional Resource Training Centre by each staff.
• Professionals from other counselling centres to be encouraged to visit the centre once a year
and share their experiences. Similarly, staff to visit other counselling centres once a year and
learn from their experiences.
• Case discussions to be conducted once a week to ensure quality of service delivery.
Accountant-cum-clerk (one post)

¾ As an Accountant
• Writing main account / petty cash account and preparing monthly expenditure statement
• Disbursement of cash for salaries and incidental expenditure.
• Assisting the Chartered Accountants in preparing Balance Sheet and liaisoning with project
coordinator regarding funds
• Maintaining asset register

¾ As a clerk
• Receiving phone calls and playing the role of a receptionist
• Maintaining attendance, leave letters
• Maintaining records for telephone calls, stationery and electricity.
• Getting stationery and cleaning items for the centre
• Visiting post office, bank and shops as and when needed

Sweeper / Peon (one post)

• Cleaning the entire centre including bathrooms
• Maintaining the garden or space available around the centre
• Visiting post office and shops as and when needed
• Paying electricity and telephone bills
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CHAPTER 4
TREATMENT–CUM- REHABILITATION CENTRES

The treatment-cum-rehabilitation centres aim to help the addicts to

¾ achieve total abstinence

¾ improve the quality of their lives by helping them to

- identify and deal with personality defects
- become aware of risk factors for relapse and develop positive coping skills
- strengthen inter-personal relationships
- develop healthy work ethics

¾ sustain their recovery through follow-up services

As prescribed by the grant-in-aid scheme, both medical and psychological services are provided on
an in-patient basis. The after care / follow-up services are provided on an out-patient basis.
Medical care is provided by physician / psychiatrist and nurses. Psychological care is provided by
social worker, psychologist, sociologist or a recovering person with a minimum of two years of
sobriety.
The treatment–cum- rehabilitation centres are to provide the following services
• Awareness building
• Screening and motivating clients to take help
• Detoxification and medical care
• Psychological therapy
• After-care / follow-up

Activities related to awareness building and screening / motivating clients has been described in the
earlier chapter (pages 6-7).

Activities related to detoxification and medical care

• Detoxification services to be provided to make the withdrawal period safe and comfortable.
• Other related medical and psychiatric disorders (diabetes / hypertension / depression, suicidal
thoughts etc.) are to be treated. Services of other specialists, hospitals and testing laboratories
can be used to ensure appropriate care.
• Medical care to be provided during the follow-up as well.

Minimum criteria Records required

Admission Register with basic details about patients to Admission Register to be maintained by the
be maintained. counsellor / Nurse - Annexure 14

Prescribing medicines to minimise withdrawal symptoms Medical manual which describes protocols (based
and to deal with related medical and psychiatric on research or in keeping with accepted practice)
problems. for prescribing medicines to be maintained by the
Medical Officer

Medicines essential for detoxification and other related Stock Register to be maintained and checked by
medical emergencies to be made available at all items the nurse once in 15 days - Annexure 15
 12

and to be checked for quantity and availability once a

month.

Providing essential medicines free of cost for a period of Endorsement Register for providing free
one month. medication to be maintained by the project
director – Annexure 16

Medical history to be obtained on the day of admission. Medical case sheet to be filled by medical officer
– Annexure 17
Medical complaints of patients, prescription of
medicines / reasons for change of medicines to be
recorded by the medical officer.

In case of any untoward incident like fits, delirium or

accident, the patient to be monitored on an half hourly
basis till he gets back to normalcy.

For hypertensive patients, blood pressure to be Blood pressure chart to be maintained by the
checked everyday till discharge nurse – Annexure 18

For diabetic patients, urine sugar to be checked Diabetic chart to be maintained by the nurse –
everyday. If need be, blood test to be conducted at Annexure 19
least once in ten days.

Temperature to be recorded for patients running Temperature chart to be maintained by the nurse
temperature, until normal temperature is recorded for a – Annexure 20
minimum of two days.

In case of any medical/ psychiatric problem beyond the Medical case sheet– the need for referral and
scope of the detoxification centre referral should be medical / psychiatric problems exhibited by the
made within 2 days. client to be recorded by the physician – Annexure
17.
Violent patients need to be assessed and transferred if
necessary to a psychiatry unit. Medical assistance directory of various
specialists / hospitals to be maintained by the
project director - Annexure 21

Essential equipment to be checked for maintenance Equipment maintenance register to be

once in 15 days – ECG machine, Oxygen cylinder, maintained by the nurse and signed by the Medical
suction apparatus, BP apparatus, weighing machine and Officer. – Annexure 22.
urine sugar testing material.

Medical care to be given to discharged patients for a Follow up records to be maintained and updated
minimum of 2 years by the Medical Officer – Annexure 23.

Activities for psychological services:

• Assessing the problems related to addiction and motivating the addict to participate actively in
the treatment.

• Providing psycho-social treatment for the total recovery of the addict through individual
counselling, group therapy, re-education and yoga. Treatment plan to include exposure to AA/
NA meetings and introduction to other recovering addicts.

• Providing psychological care to families and support persons of the addict.

Standards on programme structure
Minimum criteria Records required
 13

A schedule / timetable to be developed and followed. Therapy manual to be prepared and

maintained by the senior counsellor – Annexure
24.
Rules that need to be adhered to by the clients – e.g. Therapy manual – Annexure 24.
waking time, recreation time.
Issues that warrant disciplinary actions - e.g. missing
sessions, trying to abuse drugs inside the centre and the
disciplinary measures that can be taken.

Patients to complete treatment within the prescribed Admission register to be maintained by the
period. Drop out or extension of treatment beyond the nurse / counsellor – Annexure 14
one month period to be recorded with reasons.

Standards on counselling:
Minimum criteria Required Records
Record of patients' attendance to psychological Attendance Register to be maintained by the
therapy sessions. counsellor – Annexure 25

Case history to be completed within two weeks Case history form to be completed by the
through counselling sessions with client and family counsellor – Annexure 7
members.

During the one-month programme, at least 8

counselling sessions to be provided. Each session
to last for at least half-an-hour to forty five minutes
and main issues recorded in brief.

There should be visible improvement in the mental Case history form to be completed by the
condition of the client from first week to counsellor – Annexure 7.
subsequent weeks. Insufficient improvement
should be discussed with other team members or
the consultant psychiatrist, recorded and
appropriate action initiated.

Issues such as HIV positive status, extra marital Case history form to be completed by the
affairs, legal problems, marital separation, counsellor – Annexure 7.
gambling or traumatic childhood experiences
should be handled with extra efforts.

Treatment plans to be specifically recorded keeping Case history form to be completed by the
in mind the whole person recovery. counsellor – Annexure 7.

Standards on re-educative lectures:

Minimum criteria Required Records
Three educative sessions to be conducted each week. Therapy Manual to be maintained by the senior
The contents of the re-education lectures to be counsellor – Anenxure 24
documented and followed to ensure uniformity.
Basic issues such as disease concept, addiction
related damage, relapse, overcoming personality
defects, methods to stay sober, AA/NA principles and
HIV-AIDS to be covered.

Standards on group therapy:

Minimum criteria Records required
5 sessions per week and each session to be Therapy Manual to be maintained by the senior
conducted for at least one hour. counsellor – Anenxure 24
 14

Each group to have a maximum of 15 and a minimum

of 5 clients.

Groups to be divided based on languages the patient

speaks comfortably

Issues related to damage due to addiction,

symptoms of addiction, powerlessness and
unmanageability, breakdown of values and character
defects to be discussed.

Observation of individual patient during the group Group therapy record to be maintained by the
therapy sessions to be recorded once a week. counsellor conducting the group therapy session –
Annexure 10.

Activities for the family programme:

The addiction treatment centre should have programmes for the family members including
significant persons. The goals of the programme are to help them understand addiction as a disease
and in turn develop a caring attitude towards the addict. Another goal is to help them deal with their
negative emotions and improve their quality of lives.
Standards for the family programme
Minimum criteria Records required

Four counselling sessions for family members to be Case history form to be maintained by the
provided (either individual or combined sessions). counsellor – Annexure 7.

Through the sessions, to help the family members

to achieve personal recovery by becoming aware of
their enabling behaviour, negative traits and
develop methods to deal with their feelings of
shame, guilt, anger and resentment.

Minimum criteria Records required

One educative session to be conducted each week. Therapy Manual to be maintained by the senior
counsellor – Anenxure 24
The contents of the re-education lectures to be
recorded and followed to ensure uniformity.

Basic issues such as the objectives of the treatment

programme, medications given, the disease process,
relapse, recovery, impact of addiction on the family to
be provided.

Other Issues related to psychological services

Minimum criteria Required records

Identity card with registration number to be given to Identity card to be issued by the counsellor –
the patient at the time of discharge. Annexure 26.

A letter of endorsement from the patient that he Letter of Endorsement signed by the patient
received free treatment maintained by the counsellor – Annexure 27.
 15

A manual which provides information about the vision Administrative manual to be prepared by the
of the organisation, members of the society, facilities project-in-charge – Annexure 28.
and functions of the centre to be available and
updated every year. Organisation chart to be
included.

Half-yearly report with details of patients to be Half-yearly report to be maintained by Project-

maintained in-charge to be sent to the funding agencies –
Annexure 29

After - care / follow-up and rehabilitation services

After- care and rehabilitation are essential components of addiction treatment. The outcome of
therapy depends largely on the effectiveness of the follow-up efforts towards the patient’s re-
integration into the community to attain whole person recovery. Rehabilitation through vocational
training to facilitate income generation can be part of the services by the Addiction Treatment
Centre. After care / follow-up services are provided on an out-patient basis.

Activities for aftercare and rehabilitation of the patient and family

• A clearly defined after care programme (counselling, relapse prevention programme, self-help
programme, reaching out to patients through home visits) to be made available with focus on
the whole person recovery of the individual.
• Procedures to be clearly laid out for relapsed patients to address relapse issues (in both
detoxification and counselling services)
• After- care plans of alternative methods for patients who have not recovered have to be
explored and support to their family members to be ensured.

Minimum criteria Records required

Patient to be prepared for discharge with focus on short- Case History – recovery plans to be
term and long-term goals - e.g. developing work ethics, maintained by the counsellor – Annexure 7
improving inter-personal relationships and financial
management.

Regular follow-up services to be provided on completion of Follow-up card which has details of
treatment. counselling notes, home visits and letters
written to be maintained by the counsellor –
- One counselling session every fifteen days during the Annexure 11
first three months

- One session every month from the third month till he

completes one year.

- One session every two months for one more year till he
achieves two years of sobriety.

Failure to report for visits for two months to be followed up

with two letters and one home visit for the patient and one
letter to the family / significant person.

Drinking / drug taking history and improvements made to Follow up card to be updated by the
be recorded in every visit. counsellor – Annexure 11

Whole person recovery to be assessed twice a year and

 16

recorded.

Minimum criteria Records required

Patients completing one or more years of sobriety to be Congratulatory letter signed by the
encouraged by sending a congratulatory letter. counsellor / project-in-charge – Annexure 30

Relapse has to be dealt with specific input to increase the Therapy Manual - Annexure 24.
understanding and coping mechanism of the addict – four
counselling sessions.

Maintenance of a directory and networking with Net working Directory to be maintained by

specialised services – vocational training, job placement, the project-in-charge – Annexure 31
referral to half way home / after-care centre.

In case of a Vocational Rehabilitation Section at the Addiction

Treatment Centre
• Culturally relevant vocational training to be considered, utilising local resources and the
marketability of the products - e.g. candle making, tailoring, carpentry and mat weaving.
Mobilizing resources and networking with other agencies to be utilised.
• Content of the vocational course to be clearly laid out and followed meticulously. The unit to
be operated on an out patient basis.
• Training provided at the vocational centre to be recognised by government organisations or at
the end of the training, trainees to be able to write exams conducted by government
organisation.
Standards for vocational rehabilitation unit
Minimum criteria Records required
Education, skills and prior work experience of patient Assessment Form to be maintained by the
to be assessed before initiating him into vocational vocational instructor – Annexure 32
training.

To monitor regularity of attendance, register to be Attendance Register to be maintained by the

maintained. vocational instructor.

The performance of the patient to be assessed every Work performance assessment form to be
third month. maintained by the vocational instructor– Annexure
33.
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The environment and physical aspects of the treatment –cum-rehabilitation setting

• The centre should be located in a reasonably quiet locality.

• The built in area should be at least 2000 sq.ft. in case of metros and 3000 sq.ft. in case of
small towns and villages to house 15 patients and 3000 sq.ft. in case of metros and 4000 sq.ft.
in case of small towns and villages to house 30 patients
• The centre should be properly ventilated, well-lit and maintained in a clean manner. Water to
be made available.
• Facilities at the centre
⇒ Waiting space with seating arrangements for a minimum 5 persons
⇒ Reception, enquiry and registration counters
⇒ Cubicles / rooms for consultation for physical examination
⇒ Nursing Station with facilities to store drugs, linen, and records of patients
⇒ Facilities with privacy for providing individual counselling, group therapy, re-educative
lectures, family classes. They should be airy with comfortable seating on floor mats/ chairs.
Blackboard, chalk and other material to be provided.
⇒ Recreational facilities such as books for reading, indoor(carrom, chess) / outdoor games, radio
and television.

Requirement in a ward
• The maximum number of beds in a ward should not be more than 15 and there should
be a minimum of 1 foot distance between the beds (cots optional)
• Mattresses and pillows should be provided for each patient. Bed linen to be changed at
least once a week
• Each patient to be provided with a locker / storage space to store personal belongings
• There should be one bathroom for ten patients and one toilet for five patients. Open
toilets to be discouraged

Others
• Space to be provided to store records of patients to ensure confidentiality and a system of
easy retrieval. Computerisation of case histories to be considered and implemented.
• Addiction related educational material such as posters to be prominently displayed at strategic
points.
• Information pamphlets, hand outs and other educational materials in the vernacular to be made
freely available for the public
• The centre to have slide projector / overhead projector to conduct awareness programmes.

Job responsibilities of Medical Officer / Psychiatrist (One part- time post):

• Assessing clients with regard to their physical / mental condition and providing treatment
for their medical and psychiatric problems.
 18

• Prescribing medication during detoxification, follow up and relapses and handling all medical
emergencies e.g. DT, fits and acute psychotic episodes
• Liaiasoning with specialists in psychiatry, internal medicine, neurology, pathology and bio-
chemistry for referral in case of further treatment.
• Maintaining all records of detoxification, emergencies and follow up of patients
• Participating in the case discussion with the counsellors to plan the treatment and recovery
of individual patients.
• Contributing to awareness building and preventive education programmes.

Training for general physician / psychiatrist

• Exposure to new trends regarding kinds of drugs abused, medical and psychiatric problems,
new medicines/ methodologies available for the treatment of addiction through participation
in training programmes and conferences once a year

Nurses (Two posts):

• Minimal history taking on admission
• Dealing with emergencies and assisting the Medical Officer
• Giving medication and injections;
• Maintaining all registers and records of patients in detoxification (e.g. blood pressure and
urine sugar)
• Supervising the functioning of ward boys, sweepers
Training of Nurses
• A mock emergency drill to be carried out once every three months to deal with issues like
breathlessness, acute psychotic episode, convulsions and cardiac arrest. The drill will be guided
by the medical officer.
• New nurses will be given training for a period of one week with information on drug addiction,
about psychiatric problems, effects of psychiatric medicines and day to day management of the
centre.
Ward boys (One post):
• Assisting the nurses in the detoxification unit
• Attending to the personal hygiene of bed- ridden patients
• Escorting the patients to labs or other specialists
• Monitoring the visitors and checking patients for possession of drugs
• Conducting physical exercises for the patients
• Cleaning of the detoxification centre including toilets
Job responsibilities of Project Director (One post)

¾ Responsibilities as a Project In charge

• Coordinating and managing the treatment and rehabilitation centre
• Taking care of administrative responsibilities of the centre – appointment of staff, attendance,
allocation of job and disciplinary action.
 19

• Preparing Half-yearly / Annual report and application forms for grant purposes.
• Checking whether the records are maintained properly.
• Liaisoning with government and non-governmental organisations working in the field of
addiction.

¾ Responsibilities as a senior counsellor

• Supervising and providing guidance to counsellors
• Organising case discussion
• Organising training programmes for counsellors
• Assessing problem areas of clients
• Collecting case history both from the client and significant persons
• Conducting group therapy for clients
• Providing counselling for family members
• Providing follow-up counselling
• Maintaining individual case records of patients seen
• Conducting awareness programmes

Counselling staff (Three posts)

• Functioning in a team to coordinate activities and receive feedback from other team
members.
• Counselling to incorporate assessment, motivation, building rapport, counselling families
and significant others and planning treatment strategies from admission to follow-up.
• Conducting re-educative classes, family therapy and group therapy.
• Recording and documentation of the patient's treatment processes.
• Conducting awareness programmes in the community.
• Net working with government and non-governmental agencies.

Training of counselling staff

• Orientation of one month duration to be provided to new staff on counselling, conducting group
and family therapy.
• Updating and training through refresher courses to be provided to existing staff at least twice
a year – to attend one training conducted by Regional Resource Training Centre by each staff.

• Professionals from other addiction treatment centres to be encouraged to visit the centre once a
year and share their experiences. Similarly, staff to visit other treatment centres once a year
and learn from their experiences.
• Case discussions to be conducted once a week to ensure quality of service delivery.

Yoga/ other therapists (One post)

 20

• Conducting physical exercises / yoga for the patients

• Conducting meditation and classes on spirituality

Accountant-cum-clerk (one post)

¾ As an Accountant
• Writing main account / petty cash account and preparing monthly expenditure statement
• Disbursement of cash for salaries and incidental expenditure.
• Assisting the Chartered Accountants in preparing Balance Sheet and liaiasoning with project
coordinator regarding funds
• Maintaining asset register

¾ As a clerk
• Receiving phone calls and playing the role of a receptionist
• Maintaining attendance, leave letters
• Maintaining records for telephone calls, stationery and electricity.
• Getting stationery and cleaning items for the centre
• Visiting post office, bank and shops as and when needed

Sweeper / Peon (Two posts)

• Cleaning the entire centre including bathrooms
• Maintaining the garden or space available around the centre
• Visiting post office and shops as and when needed
• Paying electricity and telephone bills
 21

CHAPTER 5
DE-ADDICTION CAMPS
An organisation running a Treatment–cum-rehabilitation Centre may organise De- addiction camps in
areas prone to drug abuse especially in rural / semi urban areas.
The camp approach has many benefits
- Treatment is cost effective because existing facilities available in the community are made
use of.
- The local community is involved in organising the camp, hence, they provide support to the
addict in recovery and they also get sensitised regarding the impact of addiction.
- Sustained involvement of the community promotes collective initiative towards prevention
of addiction.

Activities for conducting de-addiction camps

• Creating an awareness in the community about the problems associated with drinking and drug
addiction and the need for appropriate treatment.
• Prior to conducting the camp, a local host organisation has to be identified from the
community. The host organisation could be any non-governmental organisation, providing
health care / education / rural upliftment / micro credit system. The host organisation should
have credibility and be trusted by the community. The host organisation should be
involved in providing infrastructure such as accommodation for conducting the camp,
organising meals for the patients and treatment staff, and mobilising local support persons.
• Involving the community in identification, intervention and providing support during recovery.
Identification of addicts to be done through multiple contacts – formal / informal leaders, local
physicians, community workers, teachers etc.
• Treatment to include detoxification and psychological therapy for the patients and therapy for
family members for a period of 15 days by conducting a camp at the community itself. On
completion of camp, to provide follow-up care for a minimum period of one year.
• To sustain the momentum built at the time of the camp, meaningful activities to be conducted
on an ongoing basis.

Standards on services
Minimum criteria Records required
To involve the community, identification of a host organisation Profile of Host organisation to be
and sensitizing them about the impact of addiction and the maintained by the counsellor – Annexure
need for treatment. 34.

Two programmes to be organised prior to the camp at the

community.

Identification of patients through community network - formal

/ informal leaders, panchayat leaders, families of addicts,
Youth Associations, teachers, Mahila Mandal Workers,
Religious Leaders and health workers / recovering addicts.

Through personal contact or by distribution of pamphlets,

making people aware of the camp programme.
 22

The selection criteria to be clearly defined and followed-up. Camp Manual to be developed and
maintained by the counsellor.

Providing detoxification and dealing with addiction related Medical case sheet to be maintained by
illnesses. the medical officer – Annexure 17.

Identification and creating linkages for medical services to Net work directory to be maintained by
handle emergencies during detoxification, during follow up and the project-in-charge – Annexure 9.
relapses through local resources such as physicians, hospitals
and primary health centres.

Developing a structured programme for a duration of 15 days Camp Manual to be maintained by the
with the focus on medical care as well as providing support to project-in-charge – Annexure 36.
improve the quality of life.

Providing a minimum of 8 re-educative sessions for patients, 8

group therapy sessions and 4 individual counselling sessions.

To provide support to the family, conducting five sessions for Camp Manual to be maintained by the
families with components of re-educative sessions, group project-in-charge – Annexure 36.
therapy, and counselling.

To sustain the recovery, conducting one follow-up meeting at Follow-up card – Annexure 11.
the camp site every month for a period of one year.

Activities for creating awareness in the community

• Formal and informal methods that include community participation such as dramas,
competitions, pantomime shows, street plays and folk media to be organised depending on the
target audience.
• Messages to be sensitively designed so as not to arouse any undue scare, curiosity or
experimentation with alcohol and drugs
• The language, content and style of message to be culture-specific according to the target
groups to be addressed
• Education against alcohol and drug abuse to incorporate contents of socially healthy alternative
life styles
Refer Chapter 2 for minimum criteria and records required (Pages 6-7).

Staff required to conduct a camp

• A minimum of three counsellors, one nurse and a ward boy are required for 25 patients.
• Physician and other support persons from the camp site to be utilised.

Training of staff
‰ The treatment staff to be placed in a treatment centre that already conducts de-addiction
camps to understand and observe the camp approach
‰ Training to include methods to mobilise and work with the community
‰ Specific training on pantomime shows, street plays and folk media to be included.
 23

CHAPTER 6
WORKPLACE PREVENTION PROGRAMME

Addiction, especially addiction to alcohol is a major problem in industries. According to some of the
studies conducted, 7-10% of the work force may have problems related to alcohol / drug use. It
creates problems for the employer, managers, union office bearers and supervisors. Some of the
problems faced are unpredictable absenteeism upsetting production plans, accidents leaving an
unpleasant impact, constant worry over product quality and deteriorating discipline in the
department.

A comprehensive strategy against the spread of alcohol and drug abuse includes building awareness,
training supervisors / managers on the impact of addiction and offering treatment services. The
scheme by the government of India encourages and gives grants to non-governmental
organisations to undertake work place prevention programmes in urban areas. The programme is
focussed towards promoting health, maintaining safety and improving work performance.

The scheme has listed two types of interventions:

1. A 15 or 30 bedded treatment cum rehabilitation centre to be established by the industry /
enterprise. Financial assistance upto 25% of the expenditure for setting up such a centre shall
be provided by the Ministry. Only an industry with a minimum strength of 500 workers will be
eligible for assistance.
2. A treatment cum rehabilitation centre (15 / 30 bedded) run by an NGO taking up work place
prevention programmes as part of its activities. Additional funding of 25% to be provided to
employ staff such as counsellors / community workers / part time medical officer.

Activities related to workplace prevention programme

• To create awareness among the employees about the impact of use and abuse of alcohol /
drugs in relation to the quality of work.
• To create awareness among the families of employees about the impact of use and abuse of
alcohol / drugs in relation to health, finances and general well being.
• To educate and change the attitude towards use of alcohol and drugs and promote healthy
leisure time activities.
• To conduct awareness programmes for the management as well as union office bearers
regarding the impact of addiction and the need to develop a policy.
• To conduct training programmes for supervisors / managers to identify early phase addicts
through poor job performance.
• To collect data regarding absenteeism, accidents, poor job performance among the employees
and relating them to use and abuse of alcohol.
• To identify, refer and treat workers with problems of addiction.

Functions of the programme

 24

Minimum criteria Records required

To conduct one programme a month on creating Awareness programme register - Annexure 3
awareness about the impact of addiction – lecture,
film shows and puppet show.

To conduct one programme every six months for Awareness programme register - Annexure 3
families of employees on the impact of addiction
To conduct one programme every two months to Awareness programme register - Annexure 3
supervisors / managers on early identification of
problem employees

To conduct one programme every six months to Awareness programme register - Annexure 3
management / union office bearers on the need to
have a policy to deal with addiction.

To help the industries to collect data regarding

absenteeism and poor quality of work and the use
and abuse of alcohol.

To treat patients referred by industries as and when Register for patients referred by industries –
needed. Annexure 35.

Training of staff
‰ The counsellors or community workers should have undergone at least one week training in an
organisation that conducts such workplace prevention programmes.
 25

CHAPTER 7
CODE OF ETHICS FOR STAFF AND RIGHTS OF CLIENTS

Access to addiction treatment services without prejudice

• Services are available irrespective of religion, caste, political belief of all clients.
• Services are available irrespective of the particular drug(s) abused (e.g. alcohol, ganja, brown
sugar) or routes of administration (e.g. intravenous).
• Services are available irrespective of history of prior treatment
• Services are available irrespective of the patient's ability to pay or employment status.
• Exclusion criteria for admission to be clearly stated e.g. medical complications / psychiatric
problems.
• Expulsion criteria to be clearly defined – e.g. being violent and abusing drugs / alcohol on the
premises.

Code of ethics for staff

The primary obligation of all staff is to ensure quality of services to clients in treatment. The
relationship between the staff and the client is a special one and it is essential that staff have both
the maturity and the ability to handle the responsibility entrusted to them.

• Conduct oneself as a mature individual and a positive role model by not using alcohol / tobacco
/ other drugs.
• Respect client by treating him with dignity.
• No sexual relationship of any kind with client.
• No physical restraint to be used to detain or restrain patients who are in normal physical and
mental condition. No corporal punishment of any kind may be used for any misbehaviour of the
client. No locking up or tying of any patient for any reason.
• No denial of food as a means of punishment.
• Not to make use of / exploit the client for the personal gains of a staff member / organisation.
• Recognize the best interest of the client and refer him if necessary to another agency or a
professional for further help.
• No photographic, audio, video or other similar identifiable recording is made of
patients without their prior informed consent. If done for research / training, the purpose has to
be explained and consent obtained.
• Maintain all client information in the strictest confidence. Information about the patient or his
progress in treatment not to be divulged to any individual or authority without the
patient's consent.
• No discrimination made against a HIV–AIDS patient regarding admission or in providing any
other services.
(Reference: Modified based on CHASP Standards)

Clients rights at the addiction treatment centre

 26

All clients and their family members have the right to the following:
• A supportive drug-free environment
• To dignity, respect and safety.
• To be fully informed of the nature and content of the treatment as well as the risks and
benefits to be expected of treatment. To be made aware of conditions and restrictions
prescribed in the centre before admission.
• To wear their own clothes in keeping with local customs and traditions
• To have contact with, and visits from, family or support persons while in treatment.
• To have confidentiality of information regarding participation in the programme and of all
treatment records.
• To have permission to get discharged from the programme due to personal reasons at any time
without physical or psychological harassment.
• Access to the project-in-charge or management to air out grievances / register complaints about
the treatment or the staff.
(Reference: Modified based on CHASP Standards)
 27

LIST OF REFERENCES

Bureau of Indian standards, New Delhi 1996 Indian standard – Quality management for hospital
services (for 30 bedded hospital) – guidelines – Part 4
Hospital support services - ICS 11.020

The Community Health Accreditation and Manual of standards for community and other primary
Standards Program (CHASP), Australia health care services (3rd Edn.).
1993
European federation of therapeutic communities Standards for residential treatment services staff code of
(EFTC) ethics

John Ovretviet Evaluating health interventions – An introduction to

1997 evaluation of health treatments, services, policies and
organisational interventions - Open University Press,
Buckingham, Philadephia.

Ministry of Social Justice and Empowerment, Scheme for prevention of alcoholism and substance
Government of India, New Delhi (DRUGS) abuse
1999

National workshops for medical superintendents Minimum standards of care in mental hospitals – National
of mental hospitals and state health secretaries Institute of Mental Health and Neuro Sciences (Deemed
2000 University), Bangalore 560 029

Shanthi Ranganathan The empowered community – A paradigm shift in the

1996 treatment of alcoholism – sponsored by Ministry of
Welfare, Government of India, New Delhi – pp 17-36.

UDC 362.111:616 Indian standard – Quality management procedures for

1993 out-patient department (OPD) and emergency services –
guidelines – Part 1 upto 30 bedded hospitals – Bureau of
Indian standards, New Delhi.

UDC 658.56:658.64 Indian standard - Quality management and quality

1992 system elements – Part 2 – Guidelines for services –
Bureau of Indian standards, New Delhi.

Uwe Gunnarsen Accreditation – Accreditation of alcoholism programs

1973 (?)
WHO (?) Standards of care in substance abuse treatment –
 28

ANNEXURE 1 & 2

Applications for getting grant from Ministry of Social Justice & Empowerment,
Government of India, New Delhi

----------------------------------------------------------------------------------------------------

ANNEXURE 3
Awareness programme register

Lectures / street play / puppet show / film

1. Date and month of awareness programme
2. Target group and number of participants
3. Topics handled
4. Methodology used to impart information
5. Feed back from a minimum of 5 people with their signatures

Articles published
1. Date and month of publication
2. Name of publication
3. Title of the article

Yearly evaluation report

1. Name of the evaluator
2. Background information about the evaluator
(education, work experience, expertise in the areas of evaluation / addiction)
3. Feedback given by the evaluator
 29

ANNEXURE 4
Prevention Programme Manual
(Pamphlets prepared by NGOs and Gos to be included. For e.g. I have included TTK
Publications which are for distribution).

Available material for creating awareness

Target group Material available
Social workers / psychologists Dealing with addiction – The role of social workers /
psychologists – TTK publication – English

Doctors / Nurses Dealing with addiction - the role of the physician - TTK
publication – English

Students What every teenager should know about alcohol - TTK

Publication – English

`No' to Drugs and `Yes' to Life – TTK Publication –

English

----------------------------------------------------------------------------------------------------

ANNEXURE 5
Intake form

Socio-demographic information
Date of registration:
Name: Address &:
Telephone No:

Sex: Age:
Religion: Community:

Educational Qualification: Can read and write

In years Can only read
Cannot read and write

Occupation: Income:
Marital Status:

Living arrangements: Live with family:

Live with friends or distant relatives:
Live alone:
On the street:

Name of family member / Support person Address &:

accompanied the patient Telephone No:

Referral: Self Recovered addict

Friends Employer
Family Media
Social worker Through awareness programme
Physicians Any other
 30

Drinking / Drug History

Record all details about alcohol /drugs abused:

Drugs Age of Years Years of Specific Route of Frequency of Quantity Past

first use of use excessive type of admini- use in the used in use
use drugs stration last 30 days the last 30 if
days any

Depressants
Alcohol,
Tranquilizers,
Sedatives /
Hypnotics

Narcotic
Analgesics
Opium,
Heroin / brown
sugar,
Morphine,
Codeine,
Pentazocine ,
Buprenorphine

Cannabis
Ganja, Hash,
Charas, Bhang

Stimulants
Amphetamine
Cocaine
 31

Drugs Age of Years Years of Specific Route of Frequency of Quantity Past

first use of use excessive type of admini- use in the used in use if
use drugs stration last 30 days the last 30 any
days
Hallucinogens
LSD, PCP

Inhalants
Petrol,
Glue

Substance not
classified
Cough syrup, Anti
histamine / Anti
depressant / Anti
psychotic / Anti
cholinegic

Date of last drink / drugs taken ….. days ago

Diagnosis:
Drug dependence
Alcohol dependence
Alcohol and drug dependence

Prior treatment for addiction: Year Place of Days/months

Treatment of sobriety

Other associated psychiatric complications in the past / present

‰ Depression
‰ Suicidal ideation / attempts
‰ Confusion
‰ Aggressive outbursts
‰ Hallucinations
‰ Paranoid ideas

Physical problems (record specifically):

 32

Impression of counsellor

Denial : Mild Moderate Severe

Motivating factor for present treatment efforts:

Willingness for treatment: Unwilling /ambivalent/willing

Action taken: Referral to

If referred, name of organisation:

In case of drop out Date

Reasons for drop out Lack of Motivation

Lack of family support
Poverty, hence not able to stay
Legal problem
Unable to cope with treatment
Inadequate facilities
Any other

Signature of Counsellor:

----------------------------------------------------------------------------------------------------
ANNEXURE 6
Suggested tests for screening
Munich Alcoholism Test for diagnosing alcoholism (MALT)

About MALT

MALT was developed in Germany by Feuerlein, Ringer, Kufner and Antons (1980) as a diagnostic
instrument to distinguish alcoholics from non-alcoholics in a general population. The WHO
description of alcoholism is used as the operational definition for MALT, which consists of two parts.
The first part comprises physical examination, laboratory tests and the subject's medical history
covered through seven questions. The second part is similar to Michigan Alcoholism Screening Test
(MAST) that can be quickly and easily administered. The second part has 24 items of self
assessment scale with diagnostically relevant sub scales pertaining to drinking behaviour and
attitude towards drinking, emotional and social impairment due to alcohol and somatic complaints.
The authors stress the importance of the supplementary nature of the two components to each
other.

Administration: Self assessment scale is self administered. All statements to be answered with
True / False
 33

Scoring: The medical component items are weighted with a score of 4 and items in the self-report
component are weighted with one point each. Thus, there is a total possible high score of 52 points,
if a subject scores positively on all of the items. A score of 11 or higher is indicative of the
presence of alcoholism. With a score of between 6 and 10 points, the presence of alcoholism
should be considered.

Tick True or False

True False

My hands have been trembling a lot recently

In the morning I sometimes have the feeling of nausea
I have sometimes tried to get rid of my trembling and
nausea with alcohol
At the moment I feel miserable because of my problems
and difficulties.
It is not uncommon that I drink alcohol before lunch
After the first glass or two of alcohol I feel a craving for more
I think about alcohol a lot
I have sometimes drunk alcohol even against my Doctor's advice.
When I drink a lot of alcohol, I tend to eat little.
At work I have been criticized because of my drinking
I prefer drinking alone.
Since I have started drinking I have been in worse shape
I have often had a guilty conscience about drinking
I have tried to limit my drinking to certain occasions or to certain times of
the day.
I think I ought to drink less.
Without alcohol I would have fewer problems.
When I am upset I drink alcohol to calm down.
I think alcohol is destroying my life.
Sometimes I want to stop drinking and sometimes I don't.

True False

Other people can't understand why I drink.

I have sometimes tried to get along without any alcohol at all.

I would get along better with my spouse if I didn't drink.

I'd be content if I didn't drink.

People have often told me that they could smell alcohol

in my breath.

To be assessed by the Physician Yes No

a) Diseases of the liver (at least one symptom

 34

found on physical examination in addition

to one positive laboratory test)

b) Polyneuropathy (only if no other cause is known,

e.g., diabetes mellitus)

c) Delirium tremens
(on the present examination or previously)

d) Alcohol consumption of more than 150 ml

(women 120 ml) of pure alcohol a day
at least continued over several months

e) Alcohol consumption of more than 300 ml

(women (240 ml) of pure alcohol at least
once a month (alcohol benders)

f) Foetor alcoholicus
(at the time of medical examination)

g) Spouse, family members or good friends have

sought help because of alcohol related problems
of the patient (e.g., from a physician, social worker
or other appropriate source)
 35

Suggested tests for screening

Short michigan alcoholism screening test (smast)

The short Michigan Alcoholism Screening Test is a 12 item questionnaire that requires only a few
minutes to complete. It was developed from the Michigan Alcoholism Screening Test. Evaluation data
indicate that it is an effective diagnostic instrument, and does not have a tendency for false
positives.

Administration: Self-administered. All questions are to be answered with "Yes" or "No" answers
only.

Scoring: Each "Yes" answer equals one (1) point. A score of 1 or 2 indicates there is no alcohol
problem. A score of 3 indicates a borderline alcohol problem. A score of 4 or more indicates an
alcohol problem.

SMAST

S.No Question Answer Yes

or No
1. Do you feel that you are a normal drinker? (By "normal" we mean that you drink
less than or as much as most other people)
2. Does your wife, husband, a parent, or other near relative ever worry or complain
about your drinking?
3 Do you ever feel guilty about your drinking?
4. Do friends or relatives think you are a normal drinker?
5. Are you able to stop drinking when you want to?
6. Have you ever attended a meeting of Alcoholics Anonymous?
7. Has drinking ever created problems between you and your wife, husband, a parent,
or other near relative?
8. Have you ever gotten into trouble at work or school because of drinking?
9. Have you ever neglected your obligations, your family, or your work for two or more
days in a row because you were drinking?
10. Have you ever gone to anyone for help about your drinking?
11. Have you ever been in a hospital because of drinking?
12. Have you ever been arrested for driving under the influence of alcoholic beverages?
13. Have you ever been arrested, even for a few hours, because of other drunken
behaviour?

Source: Selzer, M.L., Vinokur, A., and Van Rooijen, L. A self-administered Short Michigan
Alcoholism Screening Test (SMAST) Journal of Studies on Alcohol 36(1):117-126, 1975.
 36

Suggested tests for screening

Drug use questionnaire (DAST)

Instructions

1. The following questions concern information about your possible involvement with
intoxicants not including alcoholic beverages during the past 12 months. Carefully read
each statement and decide if your answer is `Yes' or `No'. Then, circle the appropriate
response beside the question.

2. In the statements `drug abuse' refers to (1) the use of prescribed or over the counter drugs
in excess of the directions and (2) any non-medical use of drugs. The various classes f
drugs may include: cannabis (e.g. charas, bhang), solvents, tranquilizers (e.g. vallium),
barbiturates, cocaine, stimulants, (e.g. speed), hallucinogens (e.g. LSD) or narcotics (e.g.
heroin, opium).

3. Please answer every question. If you have difficulty with a statement, then choose the
response that is mostly right. If you have difficulty with a question or have any problems,
please ask the questionnaire administrator.

Definitions

Drug:

Drugs are substances, administered to alter the function of living system, may occur naturally or may
be synthesized.

Intoxicant:

Substance that produce altered state of being drunk, high or excitement. This state usually
interpreted as being due to alcohol but may be caused by numerous other drugs.

Intoxicating medicine:

Any medicine used for the treatment or prevention of disease that produces intoxication.
 37

These questions refer to the past 12 months

1. Have you used intoxicants? Yes No

2. Have your abused intoxicating medicines? Yes No

3. Do your abuse more than one drug / intoxicant at a time? Yes No

4. Can you get through the week without using drugs / intoxicants? Yes No

5. Are you always able to stop using drugs / intoxicants when you want to? Yes No

6. Have you had `temporary loss of memory' or `memories of past drug / Yes No
intoxicant experience as a result of current drug / intoxicant use?

7. Do you ever feel bad or guilty about your drug / intoxicant use? Yes no

8. Does your spouse (or parents) even complain about your involvement with Yes No
intoxicants?

9. Has drug / intoxicant use created problems between you and your spouse Yes No
or your parents?

10. Have your lost friends because of your use of drugs / intoxicants? Yes No

11. Have you neglected your family because of your use of drugs / intoxicants? Yes No

12. Have you been in trouble at work because of intoxicants use? Yes No

13. Have you lost a job because of drug / intoxicants use? Yes No

14. Have you gotten into fights when under the influence of intoxicants? Yes No

15. Have you engaged in illegal activities in order to obtain intoxicants? Yes No

16. Have you been arrested for possession of illegal drugs? Yes No

17. Have you ever experienced withdrawal symptoms (felt sick) when you Yes No
stopped taking drugs / intoxicants?

18. Have you had medical problems as a result of your intoxicant use (e.g. Yes No
memory loss, hepatitis, convulsions, etc.) ?

19. Have you gone to any one for help for a drug problem? Yes No

20. Have you been involved in a treatment programme specifically related to Yes No
intoxicants use?

DAST SUMMARY

No problem reported 0
Low level 1–5
Moderate level 6-10
Substance level 11-15
 38

Severe level 16-20

Low Level (1-9)

Often - 2 points Medium Level (10-19)
Nearly always - 3 points High Level (20-45)

----------------------------------------------------------------------------------------------------

ANNEXURE 7
Case History Form to be used prior to detoxification / after treatment
Medical history and drug taking history are available in Intake / Medical form.
I. Family History
1. Details regarding parents and siblings

2. Father's Name: Age: Occupation: Income:

Mother's Name: Age: Occupation: Income:

Reason for death

3. In case of death of parents Father
Mother
4. How old were you at that time? Father's Death
Mother's Death

5. About siblings
Relationship Age Education Occupation

II. Childhood and adolescent history

6. How would you describe your childhood / teenage years?
7. Did you experience the following before the age of 15 years?

Situations Present Absent

- Poverty / severe debts

- Early parental loss
- Extra marital affairs of parents
- Broken home / single parenting
- Violence
- Sexually abused by others
- None
- Any other

8. Childhood / adolescence (before the age of 15 years)

Behaviour Problems Childhood & Adolescence

identified Present Absent

Running away from home

Frequent physical fights and violence
 39

Destruction of others property

Stealing
Scholastic backwardness
Experimenting with drugs / alcohol
Gambling
Any other

III. Educational history

9. Years of education:
10. Achievements in the past Present Absent
Good academic records
High achiever in extra curricular activities

IV. Marital History

11. Details regarding spouse:

Name
Age
Religion / Community
Education
Occupation
Income per month

Other details about spouse (history of addiction in her family, her addiction history if any,
any other significant event in her life and attitude towards addiction)

12. Number of years of marriage

13. Is this marriage arranged or by choice? Arranged Choice

If by choice, accepted by family

(present status) Yes No

14. Details regarding previous or subsequent

marriages, if any Yes No

15. Have you been separated from your spouse

due to your addiction? Yes No
If yes, period of longest separation

16. Is patient suspicious of wife? Under the While

Influence of Abstinence
Alcohol/drugs

17. Any instance of family violence? Yes No

If yes, give details

Physical violence directed

towards family members

Verbally abusive

Violent incidents with

neighbours and outsiders

Breaking articles at home

 40

18. Details regarding children

No. of children Male Female

19. Health status of family

Has there been anyone in your family who has suffered from any of these problems?

Problems Parents & Siblings Wife / Children

Yes Relation No Don't Yes Relation No Don't
-ship know -ship know

Major depression
Suicide / attempted suicide
Psychiatric illnesses
Alcohol dependence
Drug dependence
Any other

20. Adjustment patterns

Relationship with family Parents Siblings Spouse Children

members

No family (Dead)

Disowned by family / mutual

rejection

Mixed or indifferent feelings

Usually friendly minor conflicts

Supportive

Not applicable

21. Family Damage as seen by the counsellor Mild Moderate Severe

 41

V. Sexual history

22. Record extra marital experiences Present Absent N/A

(If unmarried, pre marital)
If present,

- Age of partner:

- Is it a sustained relationship ?

- For how many years have you known each other ?

- What is the living arrangement ?

- Any children Yes No Details

23. Have you involved in any high risk sexual activities? Yes No

Sex with commercial sex workers

If yes, did you use condoms Always Sometimes Never

24. Sex with causal acquaintance Yes No

If yes, did you use condoms Always Sometimes Never

25. Have you been tested for HIV?

If yes,
Positive/ Negative
Not willing to reveal
Not collected reports
Not applicable = NA

26. At present do you have any sexual problems? Yes No

Reduced libido
Impotency
Excessive sexual urge
Complete abstinence
Any other

VI. Occupational History

27. At what age did you start working?

28. How long have you been working?

29. Have you received any special award, recognition, merit certificates or promotions in the
past?

30. Did you change your job frequently due to addiction? Yes No

31. Did you have any periods of unemployment? Yes No

If yes, for how long and for what reasons?

32. Occupational damage

 42

Absenteeism Yes /No Loss of pay Yes/No

Warning / Memos Accidents on the job
Suspension order Attend Work under the influence
Dismissal order of alcohol / drugs
Transfer order

33. Specify nature of current work:

34. Occupational damage as perceived Mild Moderate Severe

by the counsellor

VII. Financial History

35. Details of debts to be cleared: Amount

Money borrowed from family and friends

Loans from Banks
Loans from place of work
Money borrowed from money lenders
Money for redeeming articles from pawn shops
Outstanding debts at various shops
None

36. Financial damage as perceived by counsellor Mild Moderate Severe

VIII. Legal history

37. Have you been arrested for sale of drug? Yes No
If yes, No. of times
Have you been arrested for possession of drugs? Yes No
If yes, no. of times

38. Have you got into trouble with law for the following Yes No
If yes No. of times
Arrested for drunken / drug influenced behaviour

Fined for drunken driving

Had an accident (even minor) while driving under the

influence of alcohol / drugs

Assault

Any other

IX. Leisure time activities

---------------------------------------------------------------------------------------------------
39. Activities Before addiction In the last one year
---------------------------------------------------------------------------------------------------
Playing Games, physical exercises
Going to movies, dramas
Watching TV / video, listening to music
Reading
Visiting relatives / friends
Other Hobbies / talents
 43

---------------------------------------------------------------------------------------------------

X. Religious beliefs

40. Are you a

believer
non believer
indifferent

41. Do you
Always Sometimes Never

Pray at home
Visit temple regularly
Go on pilgrimages
Celebrate festivals

XI. Treatment received in other centres referred by the counselling centres

Details :

XII. Case Summary

XIII. Hospital Visits

Date and details of visits

XIV. Counselling Notes:

Session No. with date:

Issues dealt with:

---------------------------------------------------------------------------------------------------
ANNEXURE 8
Therapy Manual
Guidelines to prepare therapy manual
• Schedule / timetable for patients
• Rules that need to be adhered to by the patients at the counselling centre
• List of re-educative topics
• Content of re-educative topics
• Issues to be dealt with in counselling sessions for patients
• Group therapy rules, topics for group therapy and role of therapists
• List of re-educative topics for family members
• Content of re-educative topics
• Issues to be dealt with in counselling sessions for family members
---------------------------------------------------------------------------------------------------
ANNEXURE 9
Network Directory
Name of the organisation:
Address:
Phone No.
Contact person:
 44

Government / Non-government
Admission procedures:
Time and day of admission:
Duration of treatment:
Kind of treatment provided:
Discharge policy:

ANNEXURE 10
Group Therapy Record Form - Weekly

Patient’s Attendance Level and Non-verbal Participation / Comments and

Name focus of behaviour response to signature of
sharing other's sharing counsellor

----------------------------------------------------------------------------------------------------

ANNEXURE 11
Follow-up card

Name of the patient: Reg.No.

Address:
Referral to:
Date /month Issues dealt in Recovery status – abstinence Other forms of
counselling as well as progress made communication – letter,
telephone calls etc.

Home visits
Date and month Date of last visit Reasons for Issues dealt Response to the home
to the centre making home during the visits visits
visits
 45

Status of whole person recovery – Half yearly assessment

Areas of improvement Half yearly Half yearly Half yearly Half yearly

Alcohol / drug free life

Physical well being

Healthy relationship with family members

Crime free

Occupational and financial improvements

Regularity in follow-up

---------------------------------------------------------------------------------------------------

ANNEXURE 12
Letter of endorsement for free treatment

Name of patient : Reg. No.

I, Mr / Ms…………………………………………….of age ……………residing at

(address)…………………………………………………………………………………………. have received free

counselling services from (date) …… …….. to………… ……… for alcohol / drug addiction.

Signature of the patient

Date :
Signature of support person
 46

ANNEXURE 13

Half yearly Report format for drug awareness and counselling as prescribed by the
Ministry of Social Justice & Empowerment

----------------------------------------------------------------------------------------------------

ANNEXURE 14
Admission Register

Name of patient:
Address :
Telephone :
Name of family member / support person :
Address :
Telephone :
Date of admission:
Date of discharge :

If drop out, reasons for drop out : Lack of motivation

Lack of family support
Poverty
Legal problem
Unable to cope with treatment
Inadequate facilities
Discharged on disciplinary grounds
Any other reasons

If extended, reasons for extension:

Period of extension:

Name of the Counsellor :

 47

ANNEXURE 15

Stock Register (pertaining to detoxification and emergency

medical conditions)

Date Items Available Nurse’s signature

stock in No.

----------------------------------------------------------------------------------------------------

ANNEXURE 16

Endorsement register for providing free medicine to patients

Month & Year Name of the patient and Medicines Cost of Signature of patient
Registration No. provided medicine
 48

ANNEXURE 17
Medical Form
Regn. No.
Name : Age : Date of Registration :

Drinking / Drug History

Details of alcohol /drug abused

Drugs Age of Years Years of Specific Route of Frequency of Quantity Past

first use of use excessive type of admini- use in the used in use
use drugs stration last 30 days the last 30 if
days any

Depressants
Alcohol,
Tranquilizers,
Sedatives /
Hypnotics

Narcotic
Analgesics
Opium,
Heroin / brown
sugar,
Morphine,
Codeine,
Pentazocine ,
Buprenorphine

Cannabis
Ganja, Hash,
Charas, Bhang

Stimulants
Amphetamine
Cocaine
 49

Drugs Age of Years Years of Specific Route of Frequency of Quantity Past

first use of use excessive type of admini- use in the used in the use
use drugs stration last 30 days last 30 days if
any

Hallucinogens
LSD, PCP

Inhalants
Petrol,
Glue

Substance not
classified
Cough syrup, Anti
histamine / Anti
depressant / Anti
psychotic / Anti
cholinegic

Last drink / drugs taken ….. days ago

Diagnosis:
Prior treatment for addiction: Year Place of Days/months
Treatment of sobriety
Previous history
Withdrawal symptoms experienced when the patient stopped
Alcohol Drugs
‰ Tremors Tremors
‰ Insomnia Insomnia
‰ Fits Diarrhoea
‰ Nausea Severe pain
‰ Aches / Pains Restlessness

Other psychiatric complications

‰ Depression
‰ Suicidal ideation / attempts
‰ Confusion
‰ Aggressive outbursts
‰ Hallucinations
‰ Paranoid ideas
 50

History of other medical problems in the past

‰ Haematemesis
‰ Jaundice
‰ Abscesses
‰ Bleeding piles
‰ Skin problems
‰ Any other

Chronic health problems

‰ Diabetes
‰ Liver disorders
‰ Epilepsy
‰ Respiratory problems – Pulmonary TB / Chronic Bronchitis / Bronchial asthma
‰ Cardiac problems – HBP / IHD / RHD
‰ Infections
‰ Others

History of previous head injuries, if any

Other information
Use of Tobacco Products – Smoking / Pan chewing / Others :
Knowledge of allergy to specific drugs :
Family history of alcoholism / drug abuse / psychiatric illness :
Physical condition at the time of admission
Physical examination on the day of admission
Pulse rate Blood pressure
Urine sugar Weight

* Tremors * Jaundice * Malnutrition

* Lymph nodes * Loss of body hair * Clubbing of nails
* Glossitis * Wasting of muscles * Spider naevi
* Flushed face / excessive sweating * Abscess * Anemia
* Palmar erythema * Gynaecomastia
* Pedal Edema * Injection marks

Record abnormalities, if any, on examination of the following :

Respiratory system Yes / No
Cardio vascular system Yes / No
Gastro intestinal system Yes / No
Nervous system Yes / No
 51

Medication provided during treatment

Date / Complaints Medication Reasons for continuing / Signed by physician

month change of medication

Any untoward incident occurred during treatment Yes No

If yes, describe the incident
Action taken:

Referral to other organisations

Date of referral:
Need for referral: Medical Psychiatric problems
Name of the institution where
referral was made
----------------------------------------------------------------------------------------------------

ANNEXURE 18
B.P. Chart

Name : Age :
Reg. No:

Date Time B.P. Pulse Medication

 52

ANNEXURE 19
DIABETIC CHART
Urine sugar chart
Name: Reg. No.
Age:
Colour of Urine AM PM AM AM AM PM AM PM AM AM
Date PM PM Date Date PM PM
Date Date Date Date
B.Red
Orange
Yellow
Green
Blue
Anti Diabetic
medication (dosage)
Insulin (dosage)
----------------------------------------------------------------------------------------------------

ANNEXURE 20
Temperature chart
Name ……………………………………… Age ………………..
Month ………………….. Year ………………
Diagnosis……………………………………………………..
Date
Hours 7 13 19 7 13 19 7 13 19 7 13 19

F
107.
106.
105.
104.
103.
102.
101.
100.
99.
98.
97.
Pulse :
B.P.
 53

ANNEXURE 21
Medical Assistance Directory (Hospitals and medical specialists)

Name (hospital / medical specialist) :

Address :
Telephone No:
Type of services :
Contact person :
Consultation time :
Cost of treatment (free / paying) :
----------------------------------------------------------------------------------------------------

ANNEXURE 22
Equipment Maintenance Register

Date & Month Items Condition of If defective Medical officer's

equipment action taken signature
ECG Machine
Oxygen cylinder
Suction apparatus
B.P apparatus
Weighing machine
Urine sugar testing material
----------------------------------------------------------------------------------------------------

ANNEXURE 23
Follow-up records (for each patient)
Name of patient :
Registration Number :
Date of admission :
Date of discharge :
Counsellor’s name :
Other known medical issues : (diabetic / IV user/ hypertensive)

Follow-up date Complaints by Name of medicine with Reasons for continuing / change of
patient dosage medicines
 54

ANNEXURE 24
Therapy Manual

Guidelines to prepare therapy manual

• Schedule / timetable for patients
• Rules that need to be adhered to by the patients
• Issues that warrant disciplinary action
• Disciplinary measures prescribed by the management
• List of re-educative topics
• Content of re-educative topics
• Issues to be dealt with in counselling sessions for patients
• Group therapy rules, topics for group therapy and role of therapists
• Strategies to deal with relapses – re-educative sessions and their content, issues to be handled
in counselling sessions.
• List of re-educative topics for family members
• Content of re-educative topics for family members
• Issues to be dealt with in counselling sessions for family members
----------------------------------------------------------------------------------------------------

ANNEXURE 25
Attendance Register
For patients
Name of patient Date / Present / absent
1 2 3 4 5 6 7 8 9 10

For family / support person

Name of family member / Date / Present / absent
support person
1 2 3 4 5 6 7 8 9 10
 55

ANNEXURE 26

Identity Card
Name of the Organisation and Address

Name of the Patient :

Address :
Year of Admission :
Registration No:
------------------------------------------------------------------------------------------------
ANNEXURE 27
Letter of endorsement for free treatment
Name of patient :
Name and address of addiction treatment centre :

I, Mr / Ms…………………………………………….of age ……………residing

at(address)………………………………………………………………………………………. have received free

treatment from (date) …… …….. to………… ……… for alcohol / drug addiction.

I received free treatment which included medical care and counselling services at the treatment
centre.

Signature of the patient

Date :
Signature of support person
 56

ANNEXURE 28
A Manual on the functioning of the organisation
• Vision of the organisation
• Milestones in the growth of the organisation
• Organisation chart – functions of the organisation
• Functions of the organisations
• Registrar of Societies – formalities to be adhered to
• Grant application and other relevant material
• Contract for renting the premises
• Staff details
• Staff welfare measures – leave rules, list of holidays
• Information about issues like electricity, water, telephone etc.
----------------------------------------------------------------------------------------------------
ANNEXURE 29
Half yearly Progress Report on the functioning of De-addiction-cum-Rehabilitation
Centre as prescribed by Ministry of Social Justice & Empowerment
----------------------------------------------------------------------------------------------------
ANNEXURE 30
Congratulatory letter
Dear

Congratulations! You have successfully completed one year without alcohol and drugs. In addition,
you have also made many positive changes in your life after treatment. All of us here are
delighted and send our best wishes for many more years of sobriety.

Your efforts through follow-up have made it possible for you to stay sober. Your family members
have also extended their support for your recovery. We hope you will continue these efforts to
safeguard your sobriety in the future too.

We would like you to come to the centre and share with the patients who are currently
undergoing treatment. Your experience will provide hope for them and increase their motivation
to recover. This will be a gratifying experience for you. Do let us know in advance your
convenient date so that we can make arrangements.

You will be given a medal on that occasion.

Wishing you many more years of sobriety.
With best wishes

Yours sincerely,

COUNSELLOR
 57

ANNEXURE 31
Net working Directory - Specialised services
• Vocational Training Centre
• Job placement services
• Half way homes / After Care Centre
• HIV Rehabilitation Centre
• Day Care Centres
Name of the Organisation:
Address:

Phone No.
Contact person:
Services provided:
Admission procedure:
Charges levied:
Any other remarks:
----------------------------------------------------------------------------------------------------
ANNEXURE 32

Vocational rehabilitation unit- assessment form of trainees

Name & Address: Reg. No. Name of counsellor:

Age:

Education:

Marital status:

Kind of drugs abused Years of abuse Year of treatment Period of sobriety

Follow-up

Regularity of follow-up

Regularity for NA / AA

Work experience

Details of any skill training undergone:

Details of past employment if any:

Address and contact No. of employer:

Counsellor's remarks, if any

Reasons for initiation to vocational training:

 58

----------------------------------------------------------------------------------------------------

ANNEXURE 33

Vocational training centre

Assessment of work performance

Name of the trainee: Reg. No.

Training Course:

Assessment Jan-March April-June July-Sep. Oct-Dec

Regularity

Punctuality

Ability to understand

Ability to take up responsibilities

Ability to work as a team member

Amount of money earned

Any other
 59

ANNEXURE 34

Profile of host organisation

Name of the organisation:

Address:

Telephone No.

Contact person:

Year of establishment:

Services provided:

Community's perception regarding the

services provided by the organisation :
(interview five persons who have
made use of their services)
 60

ANNEXURE 35

Register for providing treatment to patients referred by industries

Name of the patient:

Name of the industry:

Department where the patient works:

Department / individual who referred the patient:

Problems due to addiction in the area of work :

Date of admission:

Date of discharge:

Type of intervention / treatment provided:

Remarks by the counsellor:

Date & signature of counsellor:

61