Psychotherapy co-provision by peers and healthcare workers for substance use disorders in Indonesia

Abstract

For many decades, the infringement of the autonomy of people who use drugs has permeated many levels in Indonesia. Drug use has been disparaged as a moral issue, marginalised by the public, and criminalised by authoritative governing bodies. For people who develop substance use disorders (SUD), healthcare services also commonly enact compulsory treatment that disregards clients' autonomy seeking help. However, in recent decades, there has been a growing movement of people who use drugs to regain autonomy in attaining health rights. In this chapter, we first describe the lack of autonomy experienced by people with SUD, particularly in regard to their health rights. We then outline roles of peer counsellors through direct observations of psychotherapy co-provision by both peer counsellors and healthcare workers (HCWs) in a novel SUD psychotherapy module we designed ourselves, termed Indonesia Drug Addiction Relapse Prevention Program (Indo-DARPP). We observed various peer counsellors' roles, including diversification of the knowledge taught in the sessions. We also report the preliminary results of the pilot study of Indo-DARPP, which showed that participants who received Indo-DARPP for three months reported good acceptability and usability. Finally, the design of a randomised controlled trial for Indo-DARPP evaluation is presented. Ultimately, we hope to present insights reinforcing peer involvement into formal SUD care, with the aim of helping people with SUD to regain their autonomy in healthcare.