Addiction is the leading risk factor for health and social problems. Psychoactive substances have important mechanisms of action in the brain, which is the central nervous system (CNS). When substances are introduced into the body system, they can cause changes in the limbic and reward systems of the brain, which can eventually lead to addiction. This can occur in both legal substances such as alcohol and tobacco as well as illegal substances such as methamphetamine, cocaine, opioids, and cannabis. Therefore, surveillance and research to obtain academic information on substance use are essential.

The Centre for Addiction Studies (CADS) was established in August 2019 after long attempts to build a focal point for academic research activities for addiction researchers throughout Thailand. It is supported by the Thailand Health Promotion Foundation (ThaiHealth), where academic and research personnel involved in drug addiction-related work in the country are gathered. The CADS headquarters is located at the Department of Psychiatry, Faculty of Medicine, Chulalongkorn University (MDCU), Bangkok, Thailand. CADS works closely with the 1413 Alcohol and Addiction Helpline, located at MDCU in Bangkok, and the Centre for Alcohol Studies (CAS), located at Prince of Songkhla University in the south of Thailand.

The objective of CADS is to create knowledge about prevention and care for people with addiction problems. The knowledge produced will contribute to an efficient cycle of development to manage addiction problems in Thai society, especially among children and adolescents, by increasing the understanding of people in all social sectors about the factors that affect addiction and measures to manage them. It also aims to raise awareness and participation of individuals in all social sectors in the management of addiction problems and to organize and continue academic knowledge and development work to be efficient and sustainable.

Background of academic networks on addiction research in Thailand

The development of policies or participatory measures based on data/academic evidence is an important factor in formulating policies in the right direction and achieving sustainable results. It is considered a highly efficient mechanism and has been used to continuously drive health improvement to overcome health problems and related factors through collaboration between the government, civil society, and the academic sector. During the period from 2014 to 2017, the Thailand Substance Abuse Academic Network (TSAAN), a short-lived network, had supported a comprehensive and clear framework for drug-related studies. However, between late 2017 and mid-2019, there was a lack of support for academic addiction plans that have a comprehensive framework for research and development.  Previously, addiction research had little impact on changing policies to solve the problems. Furthermore, there are no agencies or organizations that oversee and are responsible for the development of holistic addiction research/academic programs, causing the research work to be duplicated or lacking in some areas. In terms of  treatment , there is a shortage of health personnel to handle the problem. As a result, many people receive treatment from non-experts. And the community itself could not take action due to the lack of experience of those working in the field and the lack of involvement of people in determining their own local policies.

Thailand's drug-related academic activities have been developing for several decades. Thailand has a wide range of drug-related personnel working in various sectors, including government, universities, and private organizations. Each has its unique work structure, expertise, and a wide range of connections with policymakers. Currently, there are several specialized organizations working on academic research related to substance abuse, including legal and illegal substances, such as the Centre for Alcohol Studies (CAS), Tobacco Control Knowledge Management Centre, Northern Narcotics Academic Centre of Chiang Mai University, WHO-collaborating Drug Research Unit of Chulalongkorn University's College of Public Health Sciences. Some closed plans have been working consistently for some time, such as the Integrated Management for Alcohol Intervention Program (i-MAP), the Knowledge Management Centre for Drugs, and the TSAAN. In addition to this, there is a working group that includes specialized committees or permanent organizations that have been assigned to address the problem of drug addiction in the country.  The academic aspect of drug addiction is also part of their work, both in the form of conducting internal research or funding for external research. These agencies or organizations include units, projects, or networks that work under the Office of the Narcotics Control Board (ONCB) and the Ministry of Public Health. In addition, there are also professors and researchers in the field of drug addiction, spread across social and medical institutions throughout Thailand.

Situation of substance use in Thailand

According to CADS annual surveys conducted in the Thai population aged 18 to 65 years since 2019, the estimated prevalence of cannabis in the past year had increased from 2.3% in 2019 to 2.5%-4.3% in 2020-2021 and 25% (ten-times increase) in 2022, respectively, while those of the past year methamphetamine (0.1%-0.5%), alcohol (36.8%-51.0%), and tobacco use (22.1%-28.5%) had not changed or decreased during the coronavirus disease (COVID-19) pandemic in 2019-2022. The younger population aged 18-19 had an increase in cannabis smoking in the past year from 0.9% in 2019 to 2.0%-2.2% in 2020-2021, then increased sharply to 9.9% in 2022 after delisting cannabis from the list of narcotic drugs. According to the national household survey conducted by the Office of the Narcotic Control Board (ONCB) every 3-5 years, although the proportion of new users of illegal substances decreased in the last decade, the proportion of 15 to 19 years of age using illegal substances increased from 18.6 percent to 21.4 percent in 2017. Half of them were in high school. The drugs that have increased in use among this age group are cannabis, kratom, and heroin. In addition, there is a continuous increase trend in the use of more than one type of illicit substances.

The 'supply' situation of domestic illegal substances is still at a level that causes problems. The public has easy access to illegal substances. The 'demand' situation has changed rapidly according to the rapid policy change on cannabis and drugs. In the years 2019 to 2022, efforts were made to legalize the medical and recreational use of cannabis and kratom. The new Drug Act was issued in 2021. Currently, if people who used illegal substances are arrested, they are likely to be sent to receive treatment if they do not commit other crimes.  Only if repeatedly arrested, they may be subjected to punishment. This is in line with current measures in Thailand and other countries that aim to provide treatment for people who use illegal substances rather than criminal punishment. As a result, the number of people who voluntarily enter the treatment system increased, with about half of all those who receive treatment doing so voluntarily.

Research studies are conducted at the community level to cover research work in various regions of the country, such as regional research plans based on the report of a household survey to estimate the number of drug users in Thailand in 2019. The southern region was found to have the third highest number of people who had used any type of drug in the last year and 30 days, following the Northeast and Central Region (389,336 people and 291,149 users, respectively). ‘Ya-ba’ (methamphetamine) was the most commonly seized drug followed by kratom, ice and dried marijuana. Additionally, interviews with community leaders in each region on the social impact of the COVID-19 pandemic revealed that the price of methamphetamine has decreased, the use of heroin has increased, and most of the users in different provinces are individuals who have undergone rehabilitation but cannot quit. During the emergency period, the overall picture of drug users in groups decreased, but they resorted to using drugs at their own private residences. In addition, it was found that drug networks had been adapted to the current situation by using online social media platforms for drug trafficking, making it more difficult for authorities to detect.

CADS mission: 'Creating academic stability in addiction research in Thailand.'

Creating academic knowledge that is evidence-based support to be used for the purpose of monitoring, preventing new drug users, reducing drug prevalence, and reducing the impact of substance abuse and addictive behaviors. The main target group of the project is researchers and academics working on drug addiction throughout the country, organizations and agencies working on drug addiction policy formulation and practices, and populations at risk of being affected by substance abuse. The project aims to respond to the needs of society and government by working closely with key policy agencies, the strategic and operational unit.

Specific aims

To develop academic work and study addiction problems in Thailand,  the Centre for Addiction Studies (CADS) works in collaboration with academics / researchers on addiction from various educational institutions throughout the country, as well as academics and personnel from government agencies related to the problem of addiction, including personnel from civil society and community members. The goal is to monitor, prevent, treat and solve addiction problems in children and youth in Thailand.  The specific objectives are as follows.

1. To study lessons and knowledge from both domestic and foreign sources and to monitor the situation / impacts caused by drug use and addictive behavior on children / youth / community and society in terms of health and social aspects.

2. To develop methods for prevention, harm reduction and treatment of substance use and addictive behavior in children and adolescents by working together to spread knowledge and policies to the policy-making and implementation units.

3. To support the creation of a network of researchers and academics and a system to support academic work on substance abuse and addictive behaviors in Thailand.

4. To communicate with society about situations and knowledge related to addictive substances and behaviors. To provide accurate and evidence-based knowledge to address problems and approaches in the care and prevention of addiction problems among children and youth in Thailand.

5. To conduct research and study in collaboration with international and foreign organizations in order to track and disseminate knowledge related to addiction and addictive behaviors.

Framework of operational plans

Definition of addictive substances: This includes all types of psychotropic substances that have an effect on the nervous system, such as cannabis, methamphetamine, opioids (morphine, heroin, etc.), kratom, inhalants, cocaine, ketamine, GHB, and other drugs used for recreational or illicit purposes, such as sleeping pills, sedatives, antipyretics, pain relievers, cough suppressants, and diet pills. This also includes new psychoactive substances (NPS) that require ongoing studies and monitoring. Although alcohol and tobacco are not the focus of this study, these two types of addictive substances may be the subject of research supported by CADS if they are relevant to the study of other addictive substances or addictive behaviors.

Definition of addictive behavior: Here, it refers to the behaviors of becoming addicted to tools, devices, and other activities beyond the definition of substance addiction mentioned above. For example, gambling addiction, online and offline gaming, internet addiction, and so on.

To create academic stability,  the work is done closely with important policy, strategic and operational units and is coordinated with researchers and experts on drug addiction from various educational institutions across the country, as well as civil society and community personnel. The objective is to monitor, prevent, treat, and solve drug addiction problems in children and youth in Thailand, with a specific goal of studying lessons and knowledge both domestically and internationally. This will lead to the development of prevention and intervention strategies by cooperating and sharing knowledge with policy and operational units. Additionally, it will support the formation of networks of researchers and academics, both local and international. There is also communication with society about relevant situations and knowledge. Therefore, the conceptual framework and the strategies to lead the operation are as follows.

The conceptual framework of CADS

In the year 2021, it will be a continuity from the previous year's focus by emphasizing on "responsiveness to the needs of users" by using both "academic development" format in various universities and the "academic networks" format by collaborating and supporting academic work or working with networks of academics, researchers, and practitioners in the public and private sectors, society, and local communities that are already working on addiction. This is to achieve the common goal of creating academic evidence that leads to driving social development and policy advocacy to reduce problems, prevent, treat, and restore the health of children and youth who use drugs. or engage in addictive behaviors in Thailand.

Scope of work

The CADS position focuses on being a source of academic knowledge and producing academic work to support efforts to combat addiction with various related organizations.  It also guides society by using empirical sources of knowledge as a basis, covering support for academic and research work for job development, promoting policies and driving the society on issues related to addressing drug addiction in children and youth in the public healthcare system, education system, and communities including government agencies, private, civil society, and the public. This includes academic work related to addictive behaviors such as gambling, gaming, and social media addiction, as well as the economic impact of addiction on individuals, families, and society compared to the economic benefits derived from using the substance for specific purposes. In the coming year and for the immediate future, the scope of the work will focus on recovery and service accessibility/prevention in the community to have a positive impact on the prevention of addiction in the community. A survey database will be established at least once a year to assist in the timely follow-up of policy directions to support the 3-year intervals of the ONCB national household survey. The continuous network of addiction researchers (researcher networking) as well as communicating academic work with the public (public communication).

Operational strategy

CADS will be carried out based on three strategies that are in line with the objectives, conceptual framework, and scope of CADS.

Strategy 1: Knowledge generation

This strategy focuses on managing knowledge , conducting research studies for empirical data and new knowledge on issues related to problem surveillance, prevention, treatment, and health rehabilitation of children and youth who use drugs or have addictive behaviors in Thailand through activities as follows:

·        Establish goals and targeted actions. Organize academic seminars with researchers. Stakeholders (e.g., executive policymaker, experts in relevant organizations, representatives from civil society, public health or education sectors) will determine the main research issues and conceptual frameworks for research and development. Knowledge management (research mapping) in the surveillance, prevention, treatment, and health rehabilitation of children and youth who use substances or have addictive behaviors in the public health system, the education system, and the community. This is to ensure that research results are directly beneficial and accepted by users and beneficiaries of the work as a current needs.

·        Organized seminars to analyze knowledge on addiction in order to be able to formulate research plans for researchers/academics by emphasizing important goals. The scope of work will focus on recovery and accessibility to community services to have a positive impact on preventing addiction issues in the community. This includes the work on prevention and development of early intervention programs for youth (recovery and access to services / prevention). It is important to regularly gather a survey-based database for policy making (national survey), create a continuous academic network on addiction research (researcher networking) and communicate research findings to the public (public communication).

·        Promote topics and research frameworks, and organize knowledge for researchers / academics / practitioners who are interested in them. Place emphasis on communication and virtual work or online formats to suit the situation of the COVID-19 pandemic outbreak.

·        Organize a meeting aimed at developing some important research project proposals, oversee the review of research proposals, provide research progress report, conduct seminars in both physical and online format to obtain opinions and suggestions from the research project stakeholders Including those who will use and benefit from the research findings.  This will help develop research questions that meet the needs of users / recipients, resulting in research outputs that are most useful and applicable to the relevant organizations.

·        Provide funding for research / knowledge management / evaluation / development of information systems for researchers / academics / practitioners who are interested and have high potential and success opportunities.

·        Support research and / or development with the participation of practitioners and communities to drive immediate social change or policies. Emphasize working in the context of a new way of life.

The planned research issues and knowledge management are important and serve as a framework for supporting research projects. The research will be carried out by the institutions initiation itself, together with the recruitment of high-quality and expert researchers in that field, including:

1. Development of an annual pattern for estimating substance use behavior and development of a survey format to assess the perceptions of the public and Thai society of substance use.

2. To assess the impact of changes in the policy of the Narcotics Act in the past, evaluate the impact of measures regarding medical and recreational cannabis, as well as review international research articles on relevant topics that may arise in the future.

3. Impact of new lifestyle changes on substance use behaviors in the era of the COVID-19 outbreak

4. To evaluate the results of drug users in rehabilitation and recovery to study changing situations and various factors related to the development and improvement of treatment, rehabilitation, and recovery systems until individuals return to the community. This would involve examining centers that were not operated by government agencies, such as those managed by religious schools or institutions, conducting further studies on behavior, causes, and factors that lead to cessation or relapse of drugs, as well as the reasons for unsuccessful rehabilitation. Other contributing factors such as families and communities that facilitate drug use or aid in the cessation of drugs should be explored.

5. Prevention and management of drug problems such as cannabis, methamphetamine, kratom, inhalants, opioids, ketamine, and ecstasy at the community level and addictive behaviors such as game addiction in children and youth, and gambling addiction.

Example of supported research

Research operation plans for each region, for example

·        Substance abuse behavior surveillance research project and health risk behaviors among people in the four southern provinces (Songkhla, Pattani, Yala, Narathiwat) and community-based rehabilitation treatment for drug users, released people, and post-release care using the district health system plan. The Muslim community in the lower southern region is a community with unique identity and characteristics that are different from other societies. It is a society that strictly adheres to religious beliefs. Customs are so closely related to religious beliefs that extend to dictates a style of life that Allah and Prophet Muhammad forbid Muslims from drinking alcohol which is considered a sin. As a result of this belief, the statistical prevalence of alcohol drinkers among Muslim societies or countries is significantly lower than in other social contexts. However, the prevalence of drug users in the Muslim community is not the same as that of alcohol drinkers. In 2017, the prevalence of drug users in Muslim male communities in the three southern border provinces was twice the national average, and it is one of the main problems for people in the area. This study aims to reduce the number of drug users in the village/community level and prevent at-risk youth, such as the "Parent School" training program in conjunction with the training of community leaders, teachers, and religious leaders. The training aims to provide understanding on the cognitive and physical development of adolescents, as well as developing skills in refusal, in-depth knowledge related to substance abuse, and providing psychological support for at-risk children and youth who use drugs. The training also covers the surveillance and monitoring of high-risk groups, establishing a community-based rehabilitation process, and creating a common monitoring system between parents, educational institutions, community leaders, and religious leaders. The system will monitor risk behaviors in the community and promote collaboration with religious activities within the community. To gather the maximum amount of information, a detailed form will be used to monitor the behavior of the adolescents. Furthermore, the knowledge and skills of community leaders, religious leaders, teachers, and parents will be measured in addressing substance abuse problems at the individual and community levels.

·        A health survey among heroin users in the lower southern region explores trends and prevalence of substance abuse by looking at data from the past 10 years. Data are provided by NGOs working on drug abuse in the area. The study will also investigate the relationship between heroin use, other substance use, and polydrug use.

·        The research project on kratom and cannabis includes the study of long-term changes in neurobiology and cognitive function in kratom users. The study also examines the potential of using kratom to alleviate withdrawal symptoms among heroin users in rehabilitation facilities and the community. Furthermore, the project also explores the effect of using kratom to reduce alcohol addiction in the community. Another aspect is to study long-term changes in neurobiology and cognition among cannabis users.

·        Substance abuse research programs in the north and other regions will focus on the study of recovery or the ability to live in society after addiction. Addiction is a health problem, not a moral failure of the patient/problematic substance abuse. The principle of recovery is a process of change in which individuals improve their health and well-being, live a self-directed life, and try to realize their best potential to become a new, better person who is not dependent on substance abuse. The Department of Mental Health has begun to outline the recovery model in the strategic plan to develop a rehabilitation system for people with mental health and psychiatric problems for the 5-year government action plan (2018-2022). During the first term of the 3-year period (2020-2022), a recovery master plan is developed to expand the results to all mental health service units throughout the country. However, manuals or important academic documents reflecting the principles of long-term recovery as a key standard for the country have not yet been found. The resolution of the 10th National Health Assembly on "Community as the center of prevention and solution to drug problems" uses the mechanism of the "Quality of Life Improvement Committee", which is considered an important mechanism according to the district health system policy of the Ministry of Public Health and Interior. The Narcotics Control Board Office (ONCB) and the Ministry of Public Health have implemented a policy that is consistent with each other using community-based treatment and care (CBTx) as a foundation for continued care until recovery. The goal of continuous care until recovery, as in the Guidelines for Rehabilitation Treatment and Recovery for Drug Users, Step 4, includes continuous monitoring (retention) and support to help drug users live a normal and healthy life in society (recovery). In addition, case studies have been collected in different areas of the country to be used to plan the operations of the agency at the local level. However, only 6% of the more than 800 district-level quality of life development committees across the country have prioritized drug abuse issues. Therefore,  a study on the conditions, obstacles and results of the resolutions of the Health Assembly is needed to develop a recovery model that is suitable for different contexts of the country. This includes voluntary rehabilitation, community-based rehabilitation, compulsory treatment system, punishment-based rehabilitation system, and private rehabilitation system to develop academic work and care system for long-term recovery from drug addiction and social reintegration of people.

Strategy 2: Policy and social communication

This strategy consists of delivering academic information to key target groups on a regular and continuous basis, including policy makers, government officials, civil society workers, media, academics, and the general public. In normal situations, this will be achieved through general mechanisms such as creating academic databases, article publication, disseminating information, news, web-based knowledge, and Facebook. Specific mechanisms to drive policy processes or in urgent situations, such as providing targeted information to specific groups and holding important press conferences by those who possess relevant information.

Activities based on this strategy include:

·        Regular and ongoing public communication through social networks focusing on raising awareness of substance abuse issues and providing accurate knowledge and understanding, especially for children and youth. It involves working with experts and professionals in public communications to create a continuous and systematic flow of information on relevant topics, based on the knowledge and research discovered in the initial strategy. This includes presenting research/academic results, either produced by the CADS or collected from the latest research sources from other countries, as well as conducting a media advocacy via live Facebook streams, to disseminate information on YouTube and sustain continuous flow of awareness.  

·        Communication through professional academic organizations through joint meetings with various medical universities related to the potential impact of substance abuse and the potential benefits in medical use. Additionally, we collaborate with other professional groups such as participating in the Thai Society of Addiction Psychiatry (TSAP) of the Association of Psychiatrists of Thailand, as well as various medical associations such as the Medical Council, to help review the content of each area of knowledge discovered and tailored to the context of each organization. This includes sharing and disseminating works related to their field.

·        Develop and improve the design and content of the CADS website and Facebook page to be user-friendly, modern, and beneficial to the public. This includes making it useful for various groups such as researchers and academics, government and civil society personnel, students, and the general public.

·        Create and disseminate high-quality information in a form that is suitable for the intended recipients. This includes fact sheets, policy briefs, short news, translated articles, and situational reports that address significant drug-related issues such as the proliferation of new psychoactive substances and major drug problems in the country, and using research / academic results. The target groups are policy makers, civil society, youth, and the media, with an emphasis on the use of electronic media.

·        Production of books or knowledge documents, including drug situation reports, 'Facts & figures' on drug addiction in Thailand, a report on outstanding research projects, translated books / academic articles on policies, guidelines, manuals, treatment, prevention and management of substance abuse and addictive behaviors from international health organizations or academic institutions,  with the aim of disseminating knowledge to academics, practitioners in Thailand and the general public.

·        Hosting academic forums to facilitate exchange of knowledge and 2-3 press conferences, where topics may be jointly determined by the academic team of the policy-making groups and media professionals, in order to ensure continuity in the transmission of information arising from the synthesis of academic works produced by CADS.

·        Appropriate drug policies can be made by providing academic information to policy makers. CADS personnel served on various drug-related agency committees that can collaborate with policy makers, such as the Royal College of Family Medicine, the Royal College of Psychiatrists of Thailand, the Thai Society of Addiction Psychiatry and the academic sectors of the Ministry of Public Health. CADS will proactively provide various academic information to policy-making agencies to keep up with situations. This will be done in both formal and informal ways to ensure that these agencies have timely access to up-to-date academic information on addiction.

·        Driving social change can be achieved by emphasizing that the general public is aware of information that is academically referenced, in order to make them one of the driving forces behind driving social change. A national survey will be conducted on attitudes towards substance-related issues to reflect the desire of the social sector to address the country’s drug addiction problems to policy makers. Additionally, part of the research conducted by CADS will involve community research to standardized research findings for use in the community that is struggling with addiction problems.

Strategy 3 Network building and potential development (Strengthening network and comprehensive capacity building)

Focus on building networks and developing the potential of relevant personnel at each level to have knowledge and skills in research work, policy advocacy, including writing articles for publication or presentations in national or international forums. This includes the writing of policy and social communication articles and the development of work related to prevention, care and treatment issues related to substance abuse and addictive behavior in children and youth. Additionally, expanding networks of academics / researchers in substance abuse both domestically and internationally through activities as follows:

·        Established a network such as a Thai society for addiction research to bring together researchers in the field of addiction who have knowledge and expertise. They organize training sessions, academic conferences, practical workshops, and network coordination activities related to the experiences of international experts. They also provide training in monitoring and prevention of drug problems in educational institutions, as well as care and treatment of children and young people who use drugs or have addictive behaviors. In addition, they integrate academic addiction research into various educational institutions, some of which are already doing it. They focused on participating in the existing annual national academic conference on addiction, such as those organized by the Princess Mother National Institute on Drug Abuse Treatment (PMNIDAT) and the ONCB.  They also focus on creating academic works on addiction and developing strategies for the sustainable prevention and resolution of drug addiction problems in Thailand. They encourage the participation of academics from various educational institutions specializing in addiction located in various universities and promote social communication through the media to integrate different strategies. By collaborating with academic institutions, they will co-host training sessions, academic conferences, and practical workshops. Faculty members will also provide operational support, including conducting joint research funded by analyzing the drug system, health service system, and health supervision system and assessing the impact on the economy and health of the policy change.

·        Support and promote the establishment of an academic system for substance abuse in universities or educational units that have not yet established such systems, by supporting research and academics that serve as a consultation for the development of systematic operations. Currently, there are many organizations that are interested in substance research studies, especially those related to cannabis. Therefore, it may be possible to attract these organizations to conduct research studies on possible harmful effects in addition to the benefits of cannabis use.

·        Organize meetings and facilitate knowledge sharing among groups of academics, practitioners, and policymakers related to addiction from various disciplines and representatives of the public and civil society. These gatherings should provide a platform for exchange of research experiences, policy advocacy, and work to drive the society.

·        Support academics to participate in academic meetings, study visits, or quality training courses in the country or abroad, or through webinars.

Establish a support system to produce high-quality research results by providing a peer review system for research proposals, progress reports, and research output reports, as well as providing qualified and experienced professionals for work supervision, guidance, and project supervision.