Czech Republic

Following the Velvet revolution of 1989, the healthcare system in the Czech Republic has been undergoing dramatic changes. Healthcare is free to all citizens, and every citizen, with the exception of certain designated vulnerable groups, must make compulsory contributions to an approved Czech health insurance company, thereby keeping costs low.

The most frequently used illicit substances in the Czech Republic are cannabis, ecstasy, amphetamine, and LSD. There has also been a recent increase in the estimated number of methamphetamine users and a decrease in the estimated number of opiate users. The national drug strategy has been centered on reducing illegal drug use and access, particularly among those aged 15–24.

South Africa

South Africa has parallel private and public health systems. Although the public health system serves the majority of the population, it is chronically understaffed and underfunded, meaning that the services it offers are often inadequate. Meanwhile infectious diseases, HIV/AIDS in particular, are overwhelmingly prominent in the nation.

Drug use has increased six-fold within the past decade in South Africa. A common drug is Nyaope, which is a highly addictive and locally produced mixture of marijuana, heroin, rat poison, and cleaning products. It is even sometimes laced with anti-retroviral medication. Other common drugs include cannabis, heroin, and cocaine. In addition to facing worsening security conditions as a side effect of excessive drug use among a considerable percentage of its population, South Africa is a trans-shipment hub for the import and export of a variety of drugs.

Cognitive Behavioral Therapy Training Project in the Republic of South Africa CBTTPRSA)

Solomon Rataemane, M.D., Medical University of South Africa, & Richard Rawson, Ph.D., Co-Investigators
& Jason McCuller, M.A., Project Directors

The goal of this project was to assess the efficacy of three training approaches on Republic of South Africa (RSA) clinicians' ability to adhere to the core elements of a research-based model for individual cognitive behavioral therapy (CBT) that is adapted for use in RSA. These methods included: (1) An in-vivo (IV) CBT program in which clinicians receive training and supervision from an expert trainer; (2) A distance learning (DL) training and supervision approach via a teleconferenced and interactive broadcast with the same expert trainer; and  (3) A self-instructional manual-only approach (MO). Results indicate that the IV and DL approaches resulted in superior CBT knowledge acquisition and significantly greater acquisition of CBT skills compared to the C condition, but there was no difference between the IV and DL conditions.  During the implementation phase, the IV condition produced a significantly greater frequency of CBT skill application than the DL condition, and the DL condition promoted more CBT application than the C condition.  The IV condition resulted in a superior level of CBT quality than the DL and C conditions.  Cost data indicate that the IV approach cost twice the DL approach and the DL approach cost 5 times the C condition.

(Additional information is available at: www.uclaisap.org/InternationalProjects/html/cbttp/index.html.)

CBTTPRSA was funded by the National Institute on Drug Abuse, Grant DA019063 to Friends Research Institute, Inc. (September 2005 through June 2010).