June 4th, 2018

At the request of the U.S. State Department, Kolmac hosted a delegation from the People’s Republic of China. The purpose of the visit was to show how outpatient addiction treatment has worked in this country and can be applied in China, which like all countries has its own addiction problems. The AA Big Book, for example, has been translated into Chinese and is available in that country. Through an interpreter, the international visitors asked me questions about the details of our program, even though they were not clinicians. They were interested in knowing if the government had helped me with the program and laughed when I shook my head that it had not.

Over the years, Kolmac has welcomed international visitors from many countries, including Russia, Ukraine, Vietnam, and Bhutan. I take the time to meet with visitors such as these partly because I am proud to show off what we have accomplished. I also want to learn what is happening in other parts of the world.

For example, Russia has a large problem with HIV infections, in part because of intravenous use of heroin coming from Afghanistan. Methadone and buprenorphine, however, are not permitted to be used for treatment. When I asked the Russian visitors about their clinical outcomes in the absence of those useful medications, the answer was that their outcomes were positive. One of the Americans assisting with the visit told me quietly that in fact only about 5% of opioid addicts achieved recovery. A follow up visit included legislators from the Russian Duma, in recognition that laws would need to be passed for Russian heroin addicts to get access to these medications.

Bhutan is a small Buddhist country in the Himalayas, sandwiched between China and India, that for many years was closed to the rest of the world. I learned from my international visitors that opening the country to tourists had resulted in alcohol having become widely available. As a result, alcoholism had become a major cause of death among Bhutanese men.

What I have not found thus far is the existence of an outpatient model similar to the one developed at Kolmac. This is particularly striking to me because of the financial advantages of outpatient over an inpatient would be particularly important to countries with limited financial resources. I hope eventually to find a country in which this is being done and that they have discovered variations of the outpatient model which we could use to improve our own treatment program.

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