SMART Recovery helping people in the Punjab
I am Dr Kaustubh Sharma and I serve in Punjab State of India as Inspector General of Police, Faridkot Range. I am a post-graduate in Internal Medicine from Gajra Raja Medical College, Gwalior. I joined the Indian Police Service in year 2001.
I have been involved in anti-narcotics work throughout most of my career. I gained insights and experience in narcotics control, treatment and prevention aspects during my various policing stints in Patiala, Amritsar, Firozepur and State Special Operations Cell, while the state was witnessing a high opioid use epidemic.
Over the last two decades, the state started to see a shift in opioid use pattern from natural low potency opioids to heroin emanating from the Golden Crescent area. The matter of opioid dependency and deaths soon became a political issue and special operations were launched.
Punjab police launched one of the most extensive and long running narcotics control campaigns which was associated with expansion of treatment and drug prevention programs by the Health Department of Punjab.
In the year 2018, I was selected for a Hubert H Humphrey fellowship program at Virginia Commonwealth University, part of Fulbright programs sponsored by the US Department of State.
On my return from fellowship in the year 2019, I was assigned to work with the Special Task Force on drugs constituted by the state of Punjab which has been implementing ‘Comprehensive Action Against Drug Abuse Program’. The CADA is being implemented under supervision of the Special Principal Secretary to the Chief Minister of Punjab State. It has Health, School Education, Higher Education and law enforcement officers as its chief components. The group reviews the current program and the progress made in implementation of the core strategy and decides on the future thrust areas.
How did you first hear about the SMART Recovery program?
I was undertaking Fulbright fellowship at VCU, USA in year 2018 where I found regular SMART Recovery sessions being organised at the campus. I got the chance to attend a few sessions. I did not, at that time, think of it being the program to be implemented in Punjab and went to the few sessions with an aim to experience the difference in techniques.
What elements of the program really resonated with you and made you think it would be a good addition to your current treatment program?
It was on my return, that I was entrusted with the coordination work with the Health Department and to implement the community prevention and outreach program. The health department had done a particularly good job by enhancing the number of Outpatient Opioid Assisted Treatment Centres in the State to 198, all of which are Government run and providing free of cost opioid substitution treatment. This step led to enrolment of 550,000 persons into treatment fold in both Government and Private sector. The Government sector did not have a structured program for weaning off and preventing a relapse to substance use. I started to connect to some of the resources that I knew including Thomas Bannard, Program Coordinator of Virginia State University program called ‘Rams in Recovery’ and my guide Dr Mishka Terplan, MD who was professor in Department of Psychiatry. Both of them recommended the SMART Recovery program, suggesting that it would be suitable for the circumstances, as Punjab was already running opioid substitution therapy centres for large numbers of people suffering from substance use disorders.
How did you and your team find the SMART Recovery Facilitator training program?
The team members have all completed the SMART Recovery program and found that though counselling activities were being run in some centres over past year or more, the SMART Recovery program provided a structured program for induction of the counselling and peer support activities into the treatment regimen. The premise of introducing it has been to facilitate recovery and long-term abstinence by the participants by bringing change in their behaviours and thoughts and to maintain motivation throughout the recovery process.
How do you think the SMART program will translate culturally into the Punjabi cultural context?
The SMART program is being run in major centres of Firozepur, Fatehgarh Sahib, Tarn Taran Districts currently and the concepts are being translated by the psychiatrists and psychologists into Punjabi. Home assignments based on translated sheets from the Facilitator’s Manual are also being provided. A WhatsApp group to create better bonding between participants has also started by the Tarn Taran District team. Some of the group members have welcomed the idea while others who are not part of the group have evinced interest to try it out.
What are your long-term plans for SMART in your organization?
SMART Recovery is the first structured recovery support program introduced in Punjab and based on the cultural context there is a need to introduce some more cultural content into the program. Since the facilitators are themselves new to the concept, more experience is required before finding the success rate or finding the right mix of inputs to find the benefits to the participants. Once the program becomes acceptable and shows that it is indeed suited to the people in Punjab, Department of Health would be persuaded to implement the program in all districts and induct more counsellors who could be trained in SMART Recovery program.
Would you recommend the SMART Recovery program to other treatment providers and why?
The simplicity of the program and the support provided by SMART Recovery International in training of our psychiatrists and counsellors and the ease of reaching out to the experts involved, has facilitated a smooth induction of the programs in different Districts. I would certainly recommend it; the concepts are sound and simple for the person(s) in recovery.
What would you like people to know about the SMART program, and/or about recovery?
Certainly, the SMART Recovery program brings together four simple steps to aid the substance dependents in recovery and encourages people from diverse backgrounds to enter the program and be part of it.
What would you like people to know about your organization and how can they support your work?
Punjab has been facing an onslaught of international drug traffickers and it has been a challenge to reduce the availability of substances over last decade. Law enforcement has led to incarceration of thousands of young persons without giving them a chance for proper recovery. However, the introduction of free treatment with Buprenorphine-Naloxone combination through Government run centres and also allowing another 120 centres in private sector to start the dispensing of the opioid substitution therapy has led to enrolment of 550,000 substance dependent persons into the outpatient opioid substitution program in the state. The medicine acts as a great stabilizer and a program like SMART Recovery is being tried as a scientific program to support recovering individuals.
Anything else you would like to share?
The project in Punjab is being implemented in close conjunction with Department of Health, Government of Punjab and all the facilitators trained are working for the Government of Punjab. The Psychiatrists Dr Esha Dhawan, Nodal officer for Tarn Taran District, Dr Rachana Mittal, Psychiatrist at Firozepur District, Dr Preetjot Kaur, Psychiatrist at Fatehgarh Sahib District have been primarily overseeing the implementation of the program.
Currently the Tarn Taran unit under Dr Esha has been implementing the program after training of their psychologists, the Tarn Taran team has been implementing the various facets of the program at four centres and holding regular sessions despite challenges faced due to Covid-19 Pandemic. They have formed groups at four different locations and are introducing the concepts of the SMART Recovery program to group participants. The results should become evident in coming times. We also intend to bring in some peer support through identifying the right persons who are sufficiently capable of taking up a facilitator’s role.