Protocole National de Prise en Charge de la Consommation et des Troubles Liés à la Consommation d’Alcool et de Drogues

Objectives

The national protocol establishes a standardised, decentralised framework for preventing and managing alcohol- and drug-related disorders across Côte d’Ivoire’s health-system pyramid, while supporting rehabilitation and social reintegration through health, social, socio-educational, family and community networks.[1][2][3]It seeks to reduce demand for psychotropic substances through linked primary, secondary and tertiary prevention, alongside preventive and curative care for people affected by harmful use or dependence.[4][5][6]

• Identify alcohol and drug use, harmful consumption, dependence, intoxication, withdrawal, co-addictions and associated physical, psychological, social and legal harms at an early stage.[7][8][9][10]
• Provide non-stigmatising care that assesses substance-use patterns, severity, risks and comorbid conditions, and that offers first aid, clinical management, psychosocial support and referral where needed.[11][12][13][14]
• Promote abstinence and relapse prevention for dependence, while allowing consumption reduction and risk-avoidance measures where immediate cessation is not accepted or where harmful use occurs without dependence.[15][16][17][18]
• Strengthen psychological wellbeing, family relationships, autonomy, quality of life and reintegration into family, education, employment, community and, where relevant, spiritual life.[15][19][20][2]
• Address alcohol care through prevention, screening, brief intervention, withdrawal management, treatment of psychiatric and physical comorbidities, family support, peer groups and pharmacological treatment.[21][22][5]
• Address drug care through health education, management of vulnerability factors, medical and psychological treatment, harm reduction, withdrawal support, family and community participation, psychosocial rehabilitation and reintegration.[6][19][23]

Implementation

Implementation is coordinated by the National Programme for the Fight against Tobacco and Other Addictions, which organises prevention and control activities, draws on national and international expertise, and oversees the application of relevant national regulations.[1][4]Care is organised at peripheral, intermediate and tertiary levels, with patients referred upwards when required and supported through referral and counter-referral arrangements.[24][1][25][14]

• Deliver services through health facilities, including school and university health services, social centres and socio-educational complexes, alongside specialised psychiatric hospitals, outpatient services and day hospitals.[26][21]
• Use empathetic, respectful and non-judgemental reception, consultation and communication, including reassurance and information for patients and families.[12][27][28][10]
• Screen systematically for alcohol use through questions on beverage type, frequency, quantity, regularity, solitary drinking, prior attempts to stop, loss of control, cravings and withdrawal symptoms.[29][30]
• Use clinical interviews, physical examination, standardised questionnaires and laboratory testing to assess alcohol or drug use, dependence, intoxication, withdrawal and related complications.[30][31][27][32]
• Apply alcohol screening tools including CAGE/DETA, the Alcohol Use Disorders Identification Test, the Michigan Alcoholism Screening Test and the Alcohol, Smoking and Substance Involvement Screening Test where appropriate.[30][31]
• Provide alcohol withdrawal care according to clinical risk, using outpatient management for lower-risk patients and inpatient or specialist care where there are severe complications, comorbidities, aggression risk, other dependencies or unsuccessful outpatient treatment.[15][33][16]
• Combine medical, psychological and social interventions, including motivational interviewing, supportive therapy, cognitive behavioural approaches, psychotherapy, psychoeducation, family support, peer-support groups, social support and rehabilitation activities.[31][22][16][34]
• Manage drug dependence through assessment of readiness to change, brief interventions for cannabis and stimulant use, specialist withdrawal care for opioid dependence, family and mutual-support involvement, and psychiatric or psychological consultation.[35][36][37]
• Undertake drug withdrawal in specialised medical facilities where needed, combining physical detoxification, pharmacotherapy and psychological support tailored to the substances and pattern of use.[19]
• Engage psychologists, social workers, health workers, education professionals, religious workers, families, community groups, peer groups and specialist services in psychosocial care and reintegration.[23][2][3]
• Coordinate referrals by contacting receiving facilities, preparing referral reports and liaison forms, confirming patient arrival and ensuring counter-referral.[25][38][39]
• Monitor drug-care results through registers and reports covering patients received, followed, referred, counter-referred, reintegrated or lost to care; substances used; risks; comorbidity; relapse; and reintegration activities.[18][20]
• Assess service functioning through the availability of equipped operational structures and communities, completed activities, and the number, quality and distribution of personnel.[20]
• Produce monthly, quarterly and annual reports, with information collected through identification and follow-up records, registers, activity reports and forms, and intended for computerised entry.[20]
• Recognise that the protocol does not specify budgets, financing sources, costed resource requirements, funding gaps or economic assumptions.[17][18][20]

Monitoring & Evaluation

The protocol combines clinical assessment and follow-up with a programme-level information system for drug-use care and reintegration. It specifies results, service-functioning and impact indicators, data-collection tools and monthly, quarterly and annual reporting, but does not set quantified targets, name an evaluation authority or describe a comprehensive surveillance system.[17][18][20]

• Assess alcohol use through systematic questioning on beverage type, frequency, quantity, regularity, drinking patterns, past attempts to stop, loss of control, withdrawal, cravings and related clinical or social signs.[29][30]
• Use clinical interviews, physical examination, standardised questionnaires and laboratory tests to evaluate alcohol dependence and its consequences; listed tools include CAGE/DETA, the Alcohol Use Disorders Identification Test, the Michigan Alcoholism Screening Test and the Alcohol, Smoking and Substance Involvement Screening Test.[30][31]
• Interpret gamma-glutamyl transferase, mean corpuscular volume and carbohydrate-deficient transferrin as indicators of chronic excessive alcohol consumption rather than direct markers of alcohol dependence.[31]
• Monitor alcohol withdrawal through repeated clinical assessment, including tremors, sweating, vomiting, cardiovascular changes, agitation, headaches, nausea and anxiety, and use the Cushman score and the Clinical Institute Withdrawal Assessment protocol where indicated.[40][41]
• Review alcohol-care progress through reduced consumption, patient review and home visits, while investigating complications through liver transaminases, imaging or digestive endoscopy when clinically indicated.[25][38]
• Support accountability for alcohol referrals by contacting the receiving facility, preparing referral and liaison documentation, confirming patient arrival and seeking counter-referral feedback.[25][38]
• Recognise that epidemiological evidence on illicit drug use is incomplete, partly because illegality constrains data collection; the protocol cites 2005 Bingerville figures of 4% of psychiatric hospital admissions and 8% of pupils identified as drug users, while characterising national data as incomplete.[7]
• Use drug-use assessment to examine patterns and level of consumption, harmful effects, dependence, intoxication, withdrawal, mental state, injection signs, co-addictions and physical complications.[13][10][36]
• Undertake paraclinical investigations for drug-related care where appropriate, including urine toxicology, serology for HIV and hepatitis B and C, sputum examination for tuberculosis, and other medical imaging.[36][37]
• Evaluate therapeutic progress and motivation, adapt methods and resources to personal and external factors, and use clinical review and home visits to look for reduced drug consumption.[42][14]
• Monitor programme results through the number and profile of people received, followed, referred, counter-referred, reintegrated or lost to care; substances used; risks and comorbidities; follow-up duration; relapse; and participation in community reintegration.[18][20]
• Assess service functioning through the number and type of equipped, operational facilities and communities, activities completed, and the number, quality and distribution of personnel involved in care and reintegration.[20]
• Assess impact through surveys of knowledge, attitudes and practices, changes in consumption during a defined care period, drug-related prosecution rates and trends in drug-related consultations.[20]
• Collect programme information through identification and follow-up records, registers, activity reports and activity forms, with computerised data entry envisaged.[20]
• Produce programme reports on monthly, quarterly and annual cycles.[20]
• Note that the available extracts do not define indicator denominators or targets, reporting recipients, audit processes, independent evaluation arrangements, formal surveillance procedures or named accountability bodies.[24][20]

Costing & Financing

No budget, costing framework, monetary allocation, financing source, funding gap, resource-mobilisation plan or economic assumption is specified for the national protocol, its alcohol and drug-care pathways, monitoring system or reintegration activities.[17][18][20]

• Identify clinical resource requirements without assigning costs, including medicines, laboratory investigations, specialist consultations, hospitalisation, psychosocial support and specialised withdrawal services.[36][37]
• Recognise that emergency departments may be relatively accessible and appear less costly to people affected by the socioeconomic consequences of alcohol dependence, although no price or comparative cost is provided.[8]
• Identify potential non-state material and financial support from community, professional, religious, association and mutual-support groups, without specifying commitments, amounts or funding arrangements.[2]
• List material inputs for reintegration activities, including games, photographic and audiovisual equipment, books, magazines and projection equipment, but provide no valuation or procurement budget.[3]