Addiction training for health professionals as an antidote to the addiction health burden in Indonesia.

Abstract

While Indonesian policy-makers consider various options to target the ‘national substance-use epidemic’, ranging from crocodiles to guard drug offenders in Indonesian drug-prisons to scaling-up of rehabilitation services, an academic partnership between the major universities in Indonesia and academic partners in the Netherlands launched a national postgraduate addiction medicine curriculum. Recently, Irwanto and colleagues stated that the current governmental response to the ‘national drug emergency’ is dominated by a criminalizing viewpoint on substance use disorders (SUDs) and includes mainly ineffective punitive interventions 1. They plead for more evidenced-based approaches to SUDs in Indonesia 1. Approximately half the drug-convicted prisoners in Indonesia suffer from SUDs. A large body of evidence indicates that such punitive interventions and compulsory detention are ineffective 2. Several effective alternatives are available, ranging from harm-reduction strategies (including needle-exchange programmes and methadone maintenance treatment) to abstinence-directed strategies through psychosocial and pharmacological interventions 2. These approaches need urgent implementation at a large scale to target the ‘national drug epidemic’ effectively in Indonesia. Educating health professionals on addiction topics is key to implement these strategies 3. Studies show that training in addiction topics is highly effective in improving knowledge, skills and attitudes towards SUD patients 3. However, teaching hours dedicated to addiction topics are extremely limited. For instance, Indonesian medical schools typically provide addiction training as a 2-hour lecture only 4. Without proper training in addiction, undergraduate medical students lack the basic knowledge and skills to detect and treat SUDs and its complications 5. World-wide SUD patients suffer greatly from stigma and negative attitudes among the general public, policymakers and health-care professionals 6. During medical school, students develop more negative attitudes towards SUD patients 5. Recently, several addiction medicine training programmes were developed in Indonesia: an undergraduate addiction medicine block (Atma Jaya Catholic University), the postgraduate Indonesian Short-Course in Addiction-Medicine (ISCAN) (University of Padjajaran) and specialized addiction psychiatry training (University of Indonesia) 3. Systematic evaluation of these ongoing training programmes indicates that addiction medicine training can target the urgent training needs of medical doctors, mainly a need for skills in assessment and basic treatment approaches of SUDs 3, 4. Such training also improves attitudes towards SUD patients. We call upon the international academic community to collaborate on establishing evidence-based addiction training for all health professionals. A well-educated, skilled academic community will be able to improve standards of care for SUD patients, inform policymakers on effective, evidence-based responses to the ‘drug epidemic’ and contribute to reducing stigma against people with SUDs. None. A.P.A. received a grant from the Indonesian Directorate General of Resources for Research, Technology and Higher Education Ministry of Research, Technology, and Higher Education, no: 94.19/E4.4/2014. The funder had no role in writing and publication of the manuscript.