Creating global standards in rehabilitation: Why it’s time for a unified framework of care

The United Nations Office on Drugs and Crime (UNODC) in 202O reported that over 284 million people worldwide engaged with drug use, with approximately 38.6 million struggling with substance use disorders (SUD’s). However, fundamentally access to treatment services remain inadequate with only 1 in 11 individuals having access to services (UNODC 2024). It is also clear that some commonly used treatment interventions for managing SUD’s lack scientific evidence and maybe ineffective or even harmful. 

We also know that untreated SUD’s is costly, in terms of harm to individuals, families, communities and the economic burden – however SUD’s can be treated successfully if the treatment is of a good quality and is tailored to individual needs. 

The idea of creating global standards for substance use disorder rehabilitation has been in process for some time.  The ICQ (International Consortium on Quality in Substance Use Disorders Treatment) is an initiative that was set up through the Colombo Plan, but sadly has been halted during Donald Trump’s recent purge on social initiatives.  The committee on treatment providers was made up of a number of leaders globally in the field who are able to display recognised treatment standards either through statutory standards or accreditation standards such as those of the Joint Commission International (JCI) and the Commission on Accreditation of Rehabilitation Facilities (CARF) – these were from countries such as the US, the UK, Australia, Qatar, Chile and India. 

Quality in treatment services is everything – the World Health Organisation (WHO) lays it out as “the extent to which healthcare services provided to individuals and patient populations improved desired outcomes”. In essence, treatment must be safe, effective, timely, efficient, equitable and people-centred – something that unified frameworks are able to address – it is quite evident that even in India, there is significant disparity between the services that are offered, as well as the implementation and enforcement of even minimum statutory requirements. Sadly, it is not uncommon for people accessing services in Indian rehab centres to be abused physically or psychologically, as in the case of SR Varunkath who was beaten to death and buried to cover up the criminal act at the rehab centre in Tamil Nadhu. 

Implementing certain standards does not need to come at a costly price – things such as respect of human rights, person centred care have minimal costings, and simple clear guidelines in countries where services are less developed are helpful – however, there has to be a desire for people to want to raise the bar, be accountable and be willing to change.  Organisations such as Samarpan in India have voluntarily put themselves forward to be accredited by CARF, and to work to the 1,500 individual standards that are required – these enable services to review all aspects of their care, and have feedback from patients, families, professionals, as well as tracking outcomes in treatment and out of treatment. It is imperative that in an ever evolving society, that the desire to do things a little differently, and not hide behind  old beliefs  of “we have always done it like this” or that “this is not the same in our culture” are challenged, because standards in care are not about East or West, they are about compassion, empathy, collaboration , safety and ethics – the cultural adaptations will be adjusted accordingly, but the standards need not. 

It will take a mindset shift for organisations to invest in training,  be open to constructive feedback and design programs that are person centred if we are to see an improvement in the reputation of the rehab field here in India; where sadly many programs are set up by people with no training, minimal experience or have just found themselves in their own personal recovery, and are offering nothing more than a peer support 12 Step methodology of treatment. 

I sincerely hope that the International Consortium on Quality in Substance Use Disorders Treatment (ICQ) is able to once again commence its valuable work, but if not, then organisations such as Samarpan in India can raise the bar for others to follow.