3. Procesos para el transporte aéreo de Human Remains
3.2. Documentación
One example of improving the socioeconomic status of the poor, especially women and disadvantaged groups, although not directly focused on substance use issues, is the Odisha Rural Livelihoods Project in India.a It does so through self-help groups and by building and mobilizing community institutions,
creating community investment funds and providing specific livelihood funds.
These self-help groups have reached over 929,000 households in rural India and are recognized as an effective tool to improve the socioeconomic status of the rural poor. Similar self-help finance groups have been successfully implemented in rural Uganda.b
aThe World Bank. “In Rural India, It Takes a Village — and Women’s Self-help Groups — to Improve Livelihoods”, available: http://www.
worldbank.org/en/news/video/2015/09/04/in-rural-india-it-takes-a-village-and-womens-self-help-groups-to-improve-livelihoods. Downloaded: October 12, 2016.
bFlynn, R. “A Case Study of Rural Finance Self-Help Groups in Uganda and Their Impact on Poverty Alleviation and Development” (2013).
Independent Study Project (ISP) Collection. Paper 1688. http://digitalcollections.sit.edu/isp_collection/1688.
As a supplement to more formal recovery pro- grammes, it is important for policymakers and rural advocates to focus on addressing the socioeconomic disparities impacting rural settings by investing in:
• Education, job counselling and training, and
housing programmes in rural areas
• Mentorship programmes to help those in recovery
to develop the cooperation, skills and confidence to maintain sober lifestyles
The development of these types of programmes in rural areas can help to create a pathway out of poverty
for those in recovery. Moreover, they also serve as prevention strategies to intervene in the drivers of substance use in rural settings.
As can been seen from the evidence and the case study highlighted above, programmes targeting edu- cation, job skills and other life skills can help reduce socioeconomic disparities, known drivers of sub- stance use in rural areas and beyond. At the same time, participation in local peer support programmes can provide individuals in recovery with an opportu- nity to engage in meaningful, self-fulfilling activities that can help maintain their sobriety, ideally without having to leave their community.
Conclusion
As discussed at the beginning of this chapter, recovery services should:
• Form an integral part of substance use systems of care.
• Begin when an individual makes the decision to seek treatment and can facilitate successful engagement in treatment by providing support and encouragement during the difficult process of giving up drugs and other substances.
• Support an individual with SUDs to re-engage in treatment if and when relapses occur.
• Provide a “pathway” to sobriety, particularly when that pathway is outlined by others who have suffered with their own SUDs.
It is also important to address both the internal and external community-based characteristics (i.e., recovery capital) that complement formal services to support recovery. This should be done through a broad-based community engagement strategy that engages faith-based organizations, service agencies, business, schools and other key community stakeholders to address local social disparities that can inhibit recovery and encourage substance use.
Recovery is an essential component of rural systems of care, along with compre- hensive treatment and prevention strategies. The evidence base clearly demon- strates that recovery is possible over time, even though many with substance use disorders will relapse multiple times before succeeding in recovery. This argues for a long-term approach that defines clear plans of action, integrates recovery into treatment, and recognizes and accommodates rural people with substance use issues. Although the development of rural recovery programmes can be difficult due to certain barriers and the resource constraints of many rural settings, the pro- grammes highlighted are successful examples of rural recovery initiatives. At the same time, technology, including mobile phones, tablets and laptops, can be used to support recovery.
Finally, formal recovery programmes can be supported by efforts to specifically address the socioeconomic disparities suffered by rural settings through broad-based community engagement strategies involving a wide range of community stakeholders and organizations. Such efforts should build on community assets and resources to construct internal and external recovery capital, peer support services and a path forward that supports and maintains recovery for rural people with SUDs.
This document describes possible ways for policy- makers, managers, practitioners and the community at large to address rural substance use and to support prevention and treatment in rural settings. The evidence clearly points to significant disparities in socioeconomic challenges, health-care access and health-care funding in rural areas worldwide. More- over, it confirms concerns regarding the level of substance use in rural areas, the substantial negative impact on the lives of individuals, families and communities suffering from substance use disorders, and the negative health and social consequences that threaten the viability and future of rural communities.
In order to identify and implement substance use pre- vention, treatment and rehabilitation programmes in rural settings, it is critical to conduct a system assess- ment. This analysis will then permit policymakers to plan the concrete delivery of evidence-based preven- tion, treatment and rehabilitation programmes and services in rural settings. The key principles of the UNODC-WHO International Standards for the Treatment of Drug Use Disorders as well as the framework of the UNODC International Standards on Drug Use Prevention may provide helpful tools in this endeavour.
Prevention is an important and integral component of efforts to reduce substance use and its related consequences. Using evidence-based prevention approaches is likely to have benefits that extend beyond reductions in substance use, and also contri- bute to lowering the incidence of other related risky behaviours and conditions, such as mental health issues, domestic violence or social marginalization, yielding important public health savings. For rural settings, models focusing on engaging community stakeholders and building on resources existing within communities, as well as mobile possibilities, are viable options for developing and sustaining pre- vention responses appropriate to local circumstances.
The provision of substance treatment services, parti- cularly in rural areas, remains a challenge due to limited resources, few providers, long travel distances, stigma and a variety of contextual cultural factors that limit the willingness of rural people to seek treatment. Given these challenges, the use of a regional approach to the delivery of services is crucial. It is also neces- sary to ensure the development of a coordinated continuum of services in rural settings to ensure that people living in these areas have the same level of access as their urban counterparts. It is also of great importance to acknowledge and address the needs of uniquely vulnerable populations, including women, children, adolescents, people in the criminal justice system and the elderly. Finally, creativity is necessary to marshal and deploy new technologies, alternative treatment models and lay providers in order to supplement existing treatment services and expand access to care.
Last but not least, recovery is an essential component of rural systems of care, along with comprehensive treatment and prevention strategies. The evidence base clearly demonstrates that recovery is possible over time, even though many with substance use disorders will relapse multiple times before succeed- ing in recovery. This argues for a long-term approach that defines clear plans of action, integrates recovery into treatment, and recognizes and accommodates rural people with substance use issues, in addition to making use of the latest technologies.
In conclusion, effective evidence-based substance use prevention, treatment and recovery strategies can be readily adapted to the cultural needs of rural settings, thereby reducing the impact on and nega- tive consequences for rural residents. Not only is it possible to address substance use problems in a cost- effective manner and reduce the disparate burden it inflicts on rural communities, it is also clearly the right thing to do.
Annex A
Toolkit
In supporting substance use prevention and treatment in rural settings, the following list of sources might provide useful first steps for expanding the guidance provided in this document.
Prevention
• Canadian standards for Community-based Youth Substance Abuse Prevention (http://www.ccsa.ca/
Resource%20Library/2010_CCSA_Community-based_Standards_en.pdf)
• Compilation of Evidence-based Family Skills Training Programmes (https://www.unodc.org/documents/
prevention/family-compilation.pdf)
• International Standards on Drug Prevention (https://www.unodc.org/unodc/en/prevention/prevention-
standards.html)
• ISSUP (https://www.issup.net/training/universal-treatment-curriculum) • Registries of evidence based programs (http://preventionhub.org/en/practice/
examples-effective-practice)
• The European Drug Prevention Quality Standards (http://preventionhub.org/en/practice/
examples-effective-practice)
• Universal Prevention Curriculum (UPC) (https://www.issup.net/training/
universal-prevention-curriculum)
• UNODC Guidelines on drug prevention and treatment for girls and women (https://www.unodc.org/
documents/drug-prevention-and-treatment/unodc_2016_drug_prevention_and_treatment_for_girls_ and_women_E.pdf)
Treatment
• Guidance for community-based treatment and care services for people affected by drug use and dependence
in South-East Asia (https://www.unodc.org/documents/southeastasiaandpacific/cbtx/ cbtx_guidance_EN.pdf)
• International Standards For The Treatment Of Drug Use Disorders, Draft For Field Testing (https://www.
unodc.org/documents/commissions/CND/CND_Sessions/CND_59/ECN72016_CRP4_V1601463.pdf)
• ISSUP (https://www.issup.net/training/universal-treatment-curriculum) • Policymakers Training on the Treatment of Drug Use Disorders (no0training/
universal-treatment-curriculum)
• UNODC Drug Dependence Treatment: Community based treatment, Treatnet (https://www.unodc.org/
• UNODC Guidelines on drug prevention and treatment for girls and women (https://www.unodc.org/
documents/drug-prevention-and-treatment/unodc_2016_drug_prevention_and_treatment_for_girls_ and_women_E.pdf)
• UNODC Treatnet (http://www.unodc.org/treatment/)
• WHO Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence