HO TRd TAM LY VA KY NANG CHO NGtfCJl CAI NGHIEN CAC CHAT DANG THUOC PHIEN BANG METHADONE TREN DIA BAN THANH PHO H A I PHONG Vu Thi Hanh Khoa Tdm ly - Gido due hgc Email: hanhvt@dhhp edu.vn Ngdy nhgn bdi: 04/12/2017 Ngdy PB ddnh gid: 28/2/2018 Ngdy duyet ddng: 03/3/2018 TOM TAT Chuong trmh hd frg dieu tri phuc bdi cho benh nhdn cai nghien cac chdt dang thudc phidn bdng Methadone tren dia bdn Thanh phd da trien khai thye hien duge 02 ndra Trong hd tara ly va ky ndng cho benh nhan da va dang dugc diyc hidn diu dan vd budc ddu thu dugc kit qua khd quan Benh nhan da ddn dn dinh tdm ly, Idy Iai niem tin vdi chinh ban than, gia dinh, cdng ddng va xa hgi Tuy nhien, benh nhan vdn gap mdt sd khd khdn chua ty gidi quyet dugc, hg van can nhan dugc su hd trg vd tdra Iy vd ky ndng frong mdt qua trinh lau dai, lien tuc, kien tri va ben bi de ty tin hon nfta kbi tham gia vao cac boat dgng ttong cgng ddng, xa bdi Ddc bidt, chinh quyin dia phuong can ed sy chi dao ey thi ban ddi vdi boat ddng hd frg dilu tn phyc hdi; Cdc Sd, Ban, Ngdnh, CO quan chuydn mdn cd lien quan can tidp tuc phdi hgp chat che nhdm hd trg cho benh nhan gdp phdn dam bao trat ty xa hgi va an sinh xa hgi trdn dia ban phd Tu khda: hd trg, didu tri phyc hdi chue nang, thude Methadone, benh nhan Methadone PSYCHOLOGICAL AND SKILL SUPPORTS FOR DRUG ADDICTS TREATED WITH METHADONE MEDICINE AT HAI PHONG CITY ABSTRACT The program supporting dmg addicted patients freated with methadone withdrawal drug m the city has been implemented for years The psychological and skill supports for them have been and are being carried out regularly and mitially they have obtamed positive effects Patients have gradually stabiUzed psychology, regam trust with themselves, family, community and society However, they still face sorae diiticulties that are not solved themselves They still need the psychological and technical support in a long, persistent process m order to participate into tiie activities of the community and society more confidendy Particularly, flie local authorities should have more specific guidance on rehabilitation freatment Different units such as the relevant departments, sections and agencies should continue to work closely together to support those patients, which helps to ensure the social order and social security in the city Keyword: methadone support, rehabilitation freatment Methadone medicine Patients with T^P CHi KHOA HQC, So 27, thang 3/2018 I 45 DAT VAN DE Theo Chi tiii sd 32/CT-TTg 31/10/2014 ciia Thu tudng Chinh Phu vd day manh didu tri nghidn cac chdt dang thudc phidn bang thudc thay thi ddng vai trd quan frgng frong phdng, chong HIV/AIDS, lara giara nhu cdu su dung ma tiiy vd hdnh vi pham phap luat lien quan den ma tuy, gdp phdn dam bao an ninh, frat tu xa hdi, phdt triin kinh te - xd hdi cua cdc dia phucmg va ca nude Hidn nay, khdng it ngudi nghien cac chat dang thudc phien da cai nghien bdng Methadone Nhirng benh nhdn den udng thudc tai cac ca sd dieu tri Methadone thudng da ed radt thdi gian dai sii dung cac chat gay nghien nen hg thudng bi suy nhugc ve the chat, nao bg tdn thuong nang, tam ly tieu cyc, ty danh mat di nhieu gia tn sdng vd ky ndng sdng Viec fri udng lieu Methadone deu ddn giiip benh nhan nhanh chdng cat va cd mdt sd bieu hien phuc hdi ve mat the chat, sue khde Tuy nhien, de giiip benh nhan hda nhdp gia dinh, edng ddng, xa hdi hg edn cd su hd trg td cac ehuyen gia nhdm khdi phyc ve mat tam ly, hinh Iai cac gia fri sdng va ky nang sdng da bi mat Viec hd frg tdm ly va ky ndng cho benh nhan cai nghidn bang Methadone bude ddu cho thay nhung bieu hidn phuc hdi: benh nhan khdng ty ky thi vd giam ky thi cua gia dinh, cgng ddng xa hdi; hda nhdp dugc vdi mgt sd boat dgng cdng ddng; gay dung lai nidm tin vdi gia dinh va xa hdi CAC KHAI NIEM 2.1 Methadone Theo Nghi dinh sd 82/2013/ND - CP 19/7/2013, Methadone cd frong danh muc cac chat ma dugc dung ban chd frong vide phan tich, kidm nghiem, nghien ctm khoa hgc, dieu fra tgi pham hoac frong 46 TRirdNG DAI HQC HAI PHONG linh vyc y tl theo quy dinh cua ca quan cd thdm quyin Theo Vdn ban quy pham cua Bg Y tl Methadone dugc ggi chat dang thudc phien tdng hgp, ed tac dung duge ly tuong tir nhu cdc chat dang thudc phien khde (ddng van) nhung khdng gay nhiera dgc he than kinh tnmg uong vd khdng gay khoai cam lidu dieu tri, cd thdi gian ban buy ddi (trung binh la 24 gid) ndn ehi su dung lan frong la du de khdng xudt hidn hgi chung cai Methadone cd dung nap dn dinh ndn it phai tdng lidu dieu frj Idu dai [5.5] Hidn nay, thudc Methadone dugc Bg Y te quan ly chat che va phdn phdi cho cac co sd dilu tri benh nhan eai nghien cac chat dang thudc phidn dugc thuc hidn theo mgt quy trinh nghiem ngat Qua nghien cuu, cdc nhd khoa hge da chi dieu fri nghien cac chat dang thudc phidn bdng Methadone cd the giup ngudi nghidn: giam cam giac them ma tiiy, gidm tan sudt su dyng cac dang thudc phi^n, giam cac hanh vi nguy co lay nhiem HIV, viem gan B, C, cai thidn tinh trang sftc khde, dinh duong, dimg cac hanh vi pham phap de kiem tien mua heroin, giiip dn dinh eudc sdng, cd CO hgi tai hda nhdp vdi gia dinh va cgng ddng 2.2 Ngu&i cai nghien cdc ch&t dgng thuoc phien bang Methadone Trudc day, nhimg ngudi cai nghien cac chat dang thudc phien thudng bi gia dinh, cgng ddng xa hdi ky thi, xa lanh Tbdi gian gdn day, vdi sy ddi cua nhiing Van ban phap quy cd lien quan den nhirng ngudi cai nghien cac chat dang thude phidn vd qua cac kdnh tmyen thdng, xa hgi da cd nhimg thay ddi frong nhin nhan ddi vdi ngudi cai nghien, Theo Nghi dinh sd 90/2016/ND - CP vl Quy dinh dieu frj nghidn eac chat dang thuoc phien bdng thudc thay the thi nghien eac chat dgng thudc phien la mdt benh man tinh cdn dugc didu tri ldu dai Cung frong Nghi dinh quy dinh cu tbi ngudi nghien chdt dang thude phien duge quyen lya chgn tham gia dieu tri nghien chdt dang thudc phidn tai eo sd didu tri bode ty cai nghien tai gia dinh, edng ddng vd vide dilu tri nghidn chdt dang thudc phidn chi dugc thyc hidn ngudi nghien ty nguydn tham gia dieu tri Nhu vay, ngudi cai nghien cac chdt dang thudc phien bdng Methadone (benh nhdn cai nghien eac chat dang thudc phien bang Methadone) Id nhftng ngudi Id thudc vdo cdc chdt dang thudc phien (cd ngudn gdc ty nhidn, tdng hgp vd ban tdng hgp cd tac dung gidng thudc phidn) dugc dieu fri su dyng thudc Methadone thay tbi, dam bao an toan va sd dung Idu ddi giiip ngudi benh gidra hoac ngung su dung chat dang thudc phien 2.3, Ho trgr t&m /jJ vd ky nang cho ngu&i cai nghiin cdc chdt dgng thuocphi^n bang Methadone Nhimg ngudi radi tham gia cai nghien bdng Methadone thudng cd tinh trang sdc khde suy sup, nao bg bi tdn thuong ndng Hdu bet nhirng ngudi cai nghien deu cd tam ly khdng dn dinh, hoang raang, dao ddng Ben eanh do, thdi gian sd dung chat gay nghien, de thda mdn can them mudn hg dd tira raoi cdch de cd tidn mua thudc nen danh mdt nhiiu gid tri sdng, nhdn each meo md Sau mgt thdi gian cai nghien, nlu tudn thu quy trinh dilu tri nghiem ngat (dd lidu, dilu chinh liiu, lilu fri) ngudi cai nghien dugc phyc hdi vd thi chdt, giam lidu Methadone Tuy nhien, nhiing tbdi quen xdu, hanh vi lech chudn chua mdt ban Idra eho hg chua du ty tin dl hda nhdp gia dinh, cdng ddng xa hdi Hd frg tdra ly va ky ndng cho ngudi eai nghien eac chdt dang thudc phien bdng Methadone la sy ttg giup ky thudt tu eac chuyen gia tam ly giup ngudi cai nghidn ty hinh thdnh Iai nhiing ky nang sdng, gia tri sdng da mat, dan dn dinh tdm ly, bd ty ky thi ban thdn, tham gia vdo eae boat ddng tai gia dinh, cdng ddng, xa hgi, ty tin hda nhap ben vftng khdng tdi su dyng chdt gdy nghidn Hd ttg tam ly vd ky ndng cho ngudi cai nghidn cdn dugc thuc hien lien tuc, deu dan, ben bi, lau dai Bdi ddy la qua trinh frg giup ngudi cai nghien phat huy ngudn lye cua chinh ban thdn (y thftc mudn thay ddi ban thdn, khdng mudn Id thudc vdo chdt gay nghidn, da sd ngudi mac nghien tudi ddi edn fre ) ty frang bi nhiing hiiu bidt vd cdc chuan myc xd hgi va gia fri sdng ca ban cua ngudi Tir do, ngudi cai nghidn tin tudng vao chmh ban thdn cd thi thuc hien dugc nhiing hdnh vi, vide lam phu hgp vdi nhimg chudn muc xa hgi thi hidn gia frj sdng tdt dep Nhd sy ldng nghe, cam thdng, chia se, thdu cam cua cac chuyen gia tam ly, nhiing ngudi cai nghien dugc hoc Id suy nghT, tdm tu giup hg cam thay ty tin, thoai mdi ddn bd di thai ty ky thi ban thdn Qua cac boat dgng chuydn gia tam ly thiit kd vd td chftc, ngudi cai nghien duge trai nghigm cae cam xuc tich cyc, dilu giup hg cd ddng lyc mudn the hien hdnh vi, thai dung ddn vdi nhiing ngudi xung quanh Vide hd frg tdm ly va ky ndng cho ngudi cai nghien edn thyc hien nhiing boat dgng kit ndi benh nhdn vdi mdt sd td chftc, ca nhan frong cdng ddng, xd hdi nhdm phat huy nhftng kiln thftc va ky nang da khdi phuc hoac hinh ky ndng mdi d hg Qua dd, benh nhan thyc hanh cdc boat dgng giao tidp, tmyen thdng, vdn hda, van nghd, thd due, thd thao hg ddn bgc Id tdm ly tich eye, pha vd thdi quen tmdc day, ddu franh ban thdn dl vugt qua nhftng khd TAP CHI KHOA HQC, S6 27, thang 3/2018 4? khan, khdng hi anh hudng bdi nhirng tdc ddng xau Kdt qud eua qua frinh hd trg ve tam ly va ky nang eho benh nhdn cai nghidn bdng Methadone khdng nhin thdy ma nd dugc thi hien qua su chuyen biln tu nhdn thuc dung ddn vl cac chuan myc, gia tri xa hdi din vide ddn khdi phuc lai nhftng xuc cam, tinh cam tich eye d bdnh nhan Tft viec hdi long vl nhiing gia tri sdng vd ky nang sdng dugc frang bj gdp phdn tao cho benh nhdn cd ddng luc mudn thay ddi ban thdn, cd nhu cau tbi hien nhftng hanh ddng tdt dep vdi gia dinh, cgng ddng, xd hdi Bidu hien phuc hdi eua bdnh nhdn da tham gia ho trg dieu tri dugc bang cdc boat ddng cu thd d benh nhdn nhu cd viec lam dn dinh vdi mdc thu nhdp tmng binh khd (so vdi muc luong tdi thidu cua lao ddng phd thdng xd hdi), tu tin giao tiep, manh dan chia se ve ban than cimg vdi kiln thuc, ky ndng va cam xiie dugc phuc hdi, khdng ne franh nhiing vdn de lien quan den chat gay nghien Dd cung chinh la ket qua tich cyc cua qua trinh hd frg tam ly va ky ndng cho benh nhdn eai nghidn cdc chdt dgng thudc phien bang Methadone Hoat dong ho t r o tam ly va ky nang cho benh nhan cai nghien cac chdt dang thuoc phien bang Methdone tai thdnh ph^ Hai Phdng Chuang frinh didu tri nghidn cac chdt dang thudc phien bdng thudc methadone dugc chinh thuc tridn khai thi didm tai Viet Nam ttr tbdng 4/2008 tai phd Hai Phdng va Thanh phd Hd Chi Minh Vdi nhung cdng ban dau tai thdnh phd, tir nam 2011 ddn nay, chuong frinh lien tuc dugc nhan rdng nhieu dia phuang tren ea 48 TRirONG D^I HQC HAI PHONG nudc Dudi sy chi dao cua Chinh phu, Hai phdng va nhiiu dia phuong frong cd nudc da md rgng thera cae co sd dilu tri Methadone, cimg vdi ddra bao lilu udng Methadone, ngudi cai nghien cdn dugc hd trg ve tam Iy vd ky nang Tft ndra 2015, chuang trinh hd frg didu tri phyc hdi da duge tidn hanh thi didm tai co sd dilu tri Methadone Thiiy Nguyen va ca sd didu frj Methadone Kien An Vdi hieu qua budc dau, Uy Ban nhan dan phd da giao cho Lien Hiep Hoi Khoa hgc Ky thudt phd Hai Phdng quan ly Chuong trinh bd ttg dieu tri phue hdi ddi vdi bdnh nhdn eai nghien tai mgt sd co sd dilu tri Methdone Vdi sy quydt tdm cua TS Hoang Vdn Kd (Nguyen Phd Chit tich Uy ban nhdn dan phd Hdi Phdng) va Ban didu phdi Chuong trinh hd ttg dieu tri phuc hdi eho ngudi cai nghien cac chdt dang thudc phien bang Methadone, ndra 2016 Hai Phdng da cd thdm co sd dieu tri cai nghidn bang Methadone tai Hdi Phong cd chuang trinh ho ttg didu tri phuc hdi cho ngudi cai nghien Tii thang ndm 2017, Hdi Phdng cd tdng sd cu sd didu tti eai nghien bang Methadone thuc hien ehuong trinh hd ttg tam ly va ky nang cho ngudi cai nghien (Thanh Xuan, Hai An, Kien An, An Lao, Tien Lang, Ld Chan, An Hung, Thuy Nguyen) Qua qud trinh phoi kit hgp vdi Lien Hiep eae Hgi Khoa bgc va Ky thudt Hai Phdng, ndm bdt ddc diem va nhu cdu cita ngudi cai nghidn tai cac co sd dieu tri Methadone, khoa Tdm ly - Giao due hgc trudng Dai hgc Hai Phdng da xdy dung nhiing chuydn dd vdi rauc tidu hudng den hinh thanh, cung cd eho bdnh nhdn nhung ky ndng sdng va gid fri sdng ca ban, tren ca sd dd tilp tuc trang bi cho bdnh nhdn nhiing kJ ndng sdng ve y thuc frach nhidm vdi chinh ban than, vdi cac vidn frong gia dinh, cgng ddng noi benh nhan sinh sdng Dgc bidt, frang bi cho benh nhan mdt sd ky ndng gdp phan giai quydt nhftng vdn dl xa hgi Hoat ddng cung cd, phat trien ky nang sdng va gid tri sdng cho bdnh nhan Methadone hudng vao eac chuydn de: Lam the ndo dd vui sdng; Hgc each quan tdm; Ban ldra gi d noi rainh dang sinh sdng; Quan ly cam xuc ban thdn; Ban va ma tiiy, HIV/AIDS; Ban vdi mdi tmdng; Ban vdi ban ddng ddng; Ban vdi vdn de an todn giao thdng Vdi nhiJng chuyen de da trien khai, frong chuydn dd "Ban va Methadone" hudng ddn muc tieu: Nang cao cho bdnh nhan ky ndng tmyen thdng vd Methadone Tren co sd do, giup benh nhan tuyen truyen vd eai nghien raa bdng Methadone; Cung ed cho benh nhan niem tin vao thdnh cdng cai nghidn ma bdng Methadone tu gay dnh hudng den nhiJng ngudi dang sft dung ma tiiy chua cai nghien hoac cai nghidn ehua thdnh cdng Sau thyc hien chuyen de "Ban va Methadone" cho bdnh nhdn tham gia hd trg didu tri phyc hdi tai 08 CO sd, ehung tdi tien hanh khao sat va thu dugc kit qua danh gid vl mftc hai ldng cua hg nhu sau: Bdng Mirc dQ hdi Idng cua ngirdi cai nghien tham gia ho trgr tdm ly va k^ ndng chuydn dl "B^n vd methadone" Mftc a§(%) STT Ten cff s& dieu tri R^t hai l&ng H^i long Khong hai ldng Thanh Xuan 85 15 An Hung 90 10 Kien An 90 10 An Lao 80 20 Thuy Nguyen 75 25 Hai An 95 Le Chan IGO 0 Tien Lang 80 20 (Ngudn • Tdc gid khdo sdt thdng 11 nam 2017) Qua k a qua khao sat a Bdng cho M y dugic hS tro kiln thiic va ky nang qua chuyen di "Ban vd Methadone" benh nhan tai cac CO so tham gia ho trg diSu tri phuc hdi da th6 hi6n miic hai long voi chuyen d i Cac benh nhan dugc khao sat dSu danh gia a m\ic rit hai long va hai long voi chuyen de Tai bon eg so: An Hung, KiSn An, Hai An, Le Chan CO 90% dSn 100% bSnh nhan danh gia rit hai long voi chuyen de Qua nghien ciiu truong hgp benh nhan N.T H tai eg so di^u tri Methadone Hai An cho thSy chi H la benh nhan tham gia dieu tri h6 trg phuc hoi dugc 02 nam, tir mpt nguoi danh m4t h8t gia tri ciia ban TAP CHI KHOA HQC, Si 27, thang 3/2018 49 tiidn, mdt niem tin vao chinh minh, den chi H da ty tin hon rdt nhiiu, ty tao viec lam va cd tiiu nhap dn dinh, cd tinh yeu va xdy dyng gia dmh vdi ban ddng ddng Trong cae budi thara gia hd frg dilu tri phuc hdi chi H thudng xuyen chia sd suy nghi vd cam xuc tich cyc Khi dugc hdi diem vl chuyen dl "Ban vd Methadone" ehi H cho biit sd di chi rdt hdi long vd chuydn dl bdi qua budi sinh boat, chi va cac ban ddng ddng dugc chia se nhirng kien thftc vd Methadone dd dugc trang bi qua cdc dgt tap budn, ddng thdi cdn dugc bd sung tiiem kidn thftc mdi Dac bidt, ehi va cac vidn tham du chuyen dl hieu dugc rdng cdc bdnh nhan dang dieu tri cai nghien bang Methadone cdn cd nhung hanh dgng thidt thyc vd cu the nhu truyen thdng, xd hgi cdng ich hay nhan dao, tft thien de cdng ddng, xd hdi hieu ban ve Methadone va nhiing bdnh nhan dang dieu tri cai nghidn bdng Methadone, edng la each giup chi va cac ban ddng dang xda bd khoang each vdi cae vien frong xa hdi Trong sd bdnh nhdn cua eo sd didu tri Methadone Thuy Nguyen thara gia hd frg dieu tri phuc hdi cd 25% y kiln ddnh gia hdi ldng vdi chuyen de Day la ca sd cd sd y kien danh gia hai long eao nhdt frong 08 co sd tac gid khao sdt Dieu cho thay mue hdi rat hai long cua bdnh nhdn ddi vdi chuydn dd la thdp nhdt (chiim ti le 75%) Tim hiiu ki hem ve ket qua ddnh gid frdn cua nhdm benh nhdn tham gia hd trg didu tri phuc hdi tai co sd Methadone Thuy Nguyen tap tnmg vdo mgt sd yeu td: cd 01 thdnh vien tham gia sinh boat chuyen de ehua thye sy the hidn ki ndng lang nghe tdm li ca nhan chua dn dinh; mdt vien rdi khdi budi sinh boat chuyen de chua kit thdc cd cdng viec ca nhdn ddt xuat; vide thyc bidn nhitiig hoat dgng thyc hanh cua chuydn dl tai cgng ddng 50 TRircUNG DAI HQC HAI PHONG thyc sy la vdn dl khd khdn (thdi gian, co sd vat chdt, kinh phi ) ddi voi nhidu thdnh vien tham gia hd frg dilu tri phyc hdi; e ngai vi sg khdng nhdn dugc su hd frg, giup dd cita ehinh quyin dia phuang va ngudi dan Tim hieu them cdc co sd khae vd nguyen nhan danh gia mftc hai long vdi chuydn dd cung cho thdy da sd cae nguyen nhdn gidng nhu y kien ciia benh nhdn thara gia hd frg dieu tri phuc hdi tai eo sd didu tri Methadone Thiiy Nguyen Qua ddy eho thay mac du bdnh nhan da cd mdt sd bidu bien phue hdi nhung gap nhiJng khd khan hg ddc lap thuc bien nhirng boat dgng vi cgng ddng, dieu cung the hien hg vdn chua thyc su ty tin ma vdn can cd sy tiep tuc hd frg frg dd hda nhap cgng ddng sdu hon vd hidu qud ban Nhu vay, de bdnh nhan tham gia hd frg dilu tri duge phuc bdi ben vftng, ty tin thi hien ky nang sdng va gia tri sdng da dugc khdi phue can ket ndi eac ngudn lye xa hgi vdi benh nhdn gidra bdt nbftng khd khdn, frd ngai benh nhan thyc hdnh cac boat dgng phyc hdi tai cgng ddng Qua viec phdn tich rafte hai long cua ngudi cai nghidn vdi chuyen de "Ban va Methadone" dd phdn nao cho thdy tdm quan trgng va y nghTa eua boat dgng hd frg tam ly va ky nang cho benh nhan Tuy nhien, de thuc hanh cac boat dgng phuc hdi frdn dia ban thdnh phd Hai Phdng, nhirng bdnh nhan cai nghidn cdc chdt dang thudc phidn bdng Methadone cdn nd lyc nhidu hon nua de vuon len frong eudc sdng Ddc bidt, sy chi dao ciia chinh quyen phd va vide phdi hgp cua cae Sd, Ban, Ngdnh lien quan ddi vdi boat dgng hd trg didu tri phuc hdi tai cac CO sd dieu tri Methadone la vd eung can thidt; Dilu ndy la radt frong nhiing ca sd vftng chdc bd frg cho cdc benh nhan khdng tdi nghidn vd phyc hdi bin vftng KET L U ^ 4.1 Chuang trinh hd frg tdm ly va ky nang cho ngudi cai nghien bang methadon fren dia ban thdnh phd Hdi Phdng tmh din nam 2017 da thu dugc nhiing ket qua tich cue Dieu eho thdy ben canh sy phuc hdi vl the chat, benh nhan dd ddn dn dinh vd tdm ly, budc ddu dn dinh cugc sdng, tao dung niem tin vdi gia dinh, cgng ddng va xa hgi, 4.2 Vdi muc dich giup benh nhdn phuc hdi bdn viing, frong vai frd la don vi chuyen mdn tham gia bd frg phuc hdi, khoa Tam ly Giao due bgc trudng Dai hgc Hai Phdng dd trien khai cac chuyen de ho frg tam ly vd ky nang cho bdnh nhan Day la bidn phap quan frgng, can dugc thye hien ddu dan, kidn tri ben bi giup benh nhan timg budc thye banh nhftng kien thftc, ky ndng dd tich luy duge vdo frong cac mdi quan he vdi bdn thdn, ngudi thdn, ban be vd duong dau vdi nhiing thft thdch ludn ndy sinh frong cu0e sdng 4.3 Bdnh nhdn thara gia hd trg dieu tri phyc hdi mac du dd ed nhiing chuyen biln tich cyc vd tam ly, tim lai dugc nidm tin vao ban than, gia dinh, xa hdi nhung van cdn nguy co tai nghien bdi van edn nhiiu khd khan trudc mdt Mgt nhiing khd khdn ddi vdi nhftng ngudi tham gia hd trg dilu tri phye bdi va cd benh nhdn la hg ehua thuc sy ty tin thyc hanh cac boat ddng phuc hdi frong cdng ddng, xa hdi cdn cd sy quan tam ban nua eiia chinh quydn, co quan chuyen radn, cdng ddng, xa hgi nhdm hd trg bdnh nhan phuc hdi ben vung, gdp phan dam bdo trdt ty xa bdi va an sinh xa hgi MQT SO DE XUAT Qua vide budc dau danh gia ket qua eua Chuang trinh hd trg didu tri phuc hdi cho benh nhan cai nghien cdc chat dang thudc phign bdng Methadone eho thdy da thu dugc mdt sd kdt qua dang khich Id Trong pham vi cua bai viet, tae gia the hi$n dugc mgt nhftng ngi dung cua Chuong trinh Trong qud trinh trien khai thuc hidn, phan tich, ddnh gid vd boat dgng hd trg tam ly vd k^ ndng cho bdnh cai nghien cae chat dang thude phidn bdng Methadone tac gia ed mgt sd y kien de xudt, cu the: 5.1 Vd phia chinh quyen phd, tiep tuc ehi dao cy thd hon ddi vdi cac boat ddng bd trg didu fri phuc hdi nhu viec cac vdn ban hdnh chinh chi dao, hudng dan eac CO sd eai nghidn cac chat dang thudc phidn bdng Methadone trdn dja ban phd phdi ket hgp vdi cac co quan ehuyen mdn, xdy dyng vd triin khai kd hoach hd trg dieu tri phuc hdi cho benh nhan dang dilu fri tai CO sd 5.2 Lien Hiep eae Hdi Khoa hgc va Ky thudt phd Hai Phdng tidp tuc phat huy vai tid la co quan chuyen mdn, phdi ket hgp vdi cdc co quan, td chue frong va ngoai nudc xdy dyng Chuong trinh hd frg dieu tri phyc hdi cho bdnh nhan nhdra thu dugc kdt qua cao nhdt 5.3 Dudi sy cbl dao cua Uy ban Nhdn ddn Thdnh Phd, cdc ca sd cai nghien cdc chdt dang thudc phidn bang Methadone tren dia ban thdnh phd Hai Phdng cdn xdc dinh viec hd trg tam ly va ky nang cho benh nhan eai nghidn la mdt frong nhiing hoat ddng hd frg quan frgng giiip benh nhan khdng tai nghidn va phdi hgp chdt che vdi co quan chuyen TAP CHI KHOA HQC, So 27, thang 3/2018 51 mdn frong boat ddng hd frg phyc hdi cho bdnh nhan phyc hdi tai cdng ddng giup bdnh nhan tai hda nhap ben vung 5.4 Vdi tu each la bg phan hd ttg ky tiiuat, khoa Tdm ly - Giao due hgc Trudng Dai hgc Hai Phdng cdn tilp tuc phdi kit hgp vdi Lien Hiep cac Hgi Khoa hgc - Ky thuat Thdnh phd nghien cuu, tim hieu nhiing khd khan eua benh nhan dang tham gia bd ttg didu tri phuc hdi, td chue nhirng ehuyen dd thiit thyc, hidu qua hd frg bdnh nhan tdt hon nfta ve tdm ly va ky ndng, dac biet la eac boat dgng thyc hanh 5.5 Ddi vdi benh nhdn dang tham gia h6 frg dieu tr| phue bdi can nd luc hon niia de khde phuc nhiing khd khan va ty tm thuc hanh nhung boat ddng phyc hdi tai cdng ddng Vdi sy dn dinh vl tdra ly, nhiing ky naig budc dau da duge binh thanh, benh nhdn cdn thudng xuydn tien hdnh cac hoat dgng cd y nghia frong cgng ddng, xa hdi dd qua trinh phuc hdi dat ket qua nhu mong mudn TAI LIEU THAM KHAO Ld Chi An (2006), Cdng ldc xa hgi cd nhdn, Trudng Dai hgc Md Thanh phd Hd Chi Minh, Tp Hd Chi Minh Bill Thi Xuan Mai, Nguyen Thi Thai Lan, Lim Shaw Hui (2008), Gido trinh tham vdn, Trudng Dai hgc Lao ddng - Xd hdi, Nxb Lao dgng - Xa hdi, Ha Ndi Bui Thj Xudn Mai, Nguydn Td Nhu (2015), Gido trinh tham vdn dieu trj nghien ma Nxb Lao ddng - Xa hgi Ha Ngi Mdt sd Van ban Quy pham phap ludt cd lien quan Chi thi sd 32/CT-TTg 31/10/2014 Thii tudng Chinh Phu ydu cdu cdc tinh, thdnh phd, cac bg, nganh day manh viec didu tri eai nghidn bdng thudc Methadone Nghi dinh sd 82/2013/ND-CP 19/7/2013 Nghi dinh sd 90/2016/ND -CP Quy dinh vl dilu fri cai nghidn cdc chdt dang thudc phien bdngMethadone Thdng frr sd 14/2015/TT- BYT quan ly tiiudc Methadone Quyit dinh sd 493/QD-BYT eua Bd frudng Bd y t l 18/12/2016 vd Hudng din dilu tri Methadone frong cdc co sd cai nghidn raa 52 I TRr6NG DAI HQC HAI PHONG ... cai nghien cac chdt dang thudc phien bang Methadone, ndra 2016 Hai Phdng da cd thdm co sd dieu tri cai nghidn bang Methadone tai Hdi Phong cd chuang trinh ho ttg didu tri phuc hdi cho ngudi cai. .. thdnh cdng cai nghidn ma bdng Methadone tu gay dnh hudng den nhiJng ngudi dang sft dung ma tiiy chua cai nghien hoac cai nghidn ehua thdnh cdng Sau thyc hien chuyen de "Ban va Methadone" cho bdnh... dd "Ban va Methadone" hudng ddn muc tieu: Nang cao cho bdnh nhan ky ndng tmyen thdng vd Methadone Tren co sd do, giup benh nhan tuyen truyen vd eai nghien raa bdng Methadone; Cung ed cho benh nhan