Building an Evidence Base for Drug Abuse Treatment in Afghanistan: Lessons Learned and Implications for Future Research

Introduction Although, drug addiction is well documented in Afghanistan, organised drug abuse treatment (DAT) has been limited there until recently, and no evaluation studies of DAT outcomes in Afghanistan have been conducted. In response to this need, a feasibility study was conducted between October 2009 and January 2012 to evaluate the drug abuse treatment (DAT) model being implemented in Afghanistan, by the Colombo Plan for Cooperative Economic and Social Development in Asia and the Pacific (CPDAP).1 Two research questions are addressed by the evaluation study: Q1. What is the pre-post change in treatment outcomes (drug use and criminal behaviour) for patients in the participating Afghan DAT Centers? Q2. What factors explain changes in these outcomes? Methods A prospective cohort design was used to examine change in treatment outcomes in seven Afghan DAT centers that operate using the CPDAP treatment model. Four centers served males and three served females. A total of 504 in-person baseline interviews were conducted within 0 to 5 days of patients completing their detoxification process in the DAT centers. Baseline interviews were completed with 326 males and 178 females. On average, upon entry, male patients were 30.7 years old and female patients were 38.8 years old. Because the CPDAP treatment lasted up to 10 days of detox, 30-45 days of inpatient treatment, and 12 months of outpatient treatment, in-person post-test interviews were conducted 12 months after patients completed inpatient treatment. A total of 353 in person post-test interviews were conducted 13.5 months after DAT entry, yielding a 70% study retention rate. Results The study found that participation in DAT resulted in statistically significant decreases, in past 30-day use of any illegal drug, opiates, and alcohol. The results also showed statistically significant reductions, in the frequency of self-reported crime-related behaviour among patients from baseline to post-test. Finally, the study also found that completion of the first year of outpatient treatment, and completion of prior drug treatment predicted larger treatment effects. Discussion The findings of the present study suggest that DAT is effective in Afghanistan. As we have found that completion of the first year of outpatient treatment predicted positive treatment outcomes, DAT centers need to continue their emphasis on ensuring that patients complete both inpatient and outpatient treatment. Our findings also suggest that drug testing - utilising newer technologies such as oral fluid assays - should be used at both