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National Addictions Management Service

The History of Addictions Treatment in Singapore & NAMS
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Addiction was not fully understood as a mental health condition for many years but the Institute of Mental Health (IMH) has been offering addiction treatment from as early as 1987. Since then, its addictions management programme has undergone significant transition over the years.


Bringing Home a Message of Hope and Recovery & Launch of CAP

NAMS produced another book "Hope in Adversity" in March 2018. Using the first-person narrative approach to recount personal stories, the book chronicled how patients and caregivers were able to bounce back and put their lives in order after overcoming years of adversity caused by addiction.

In April 2018, the Community Addiction Programme (CAP) was launched as a new service targeted at patients with alcohol use disorder who had frequent emergency room visits in a year. Applying the Assertive Community Treatment (ACT) approach, these patients were actively supervised with regular home visits, so as to reduce their hospitalisation likelihood and effectively manage them in the community.


Evolution of BRIDGE & GAME

Over time, new gambling-related service groups were added to complement GAME. These included sessions of GAME-Family targeted at caregivers, and Gamblers Anonymous for GAME graduates, which were all conducted on Thursday evenings.

In 2016, service groups targeting patients recovering from substance use and their caregivers were revamped and enhanced. The remodelled groups rode on the foundation and early success of BRIDGE during the CAMP years and were duly referred to as BRIDGE (for patients) and BRIDGE- Family (for caregivers). BRIDGE differentiated itself from prior groups by leveraging on smart phone technology. Through a chat group administered by BRIDGE, group members were able to post meeting reminders and group activities updates.


Set Up of Volunteer Management System

During the early CAMP years, recovering patients were hired as staff to tap on their personal experiences and recovery journeys to connect with existing patients. The tradition of getting patients-in-recovery involved in treatment services was continued even as NAMS grew and evolved. Stable patients who had been in recovery for at least two years were recruited as Peer Support Volunteers (PSV) to share their knowledge and experiences during Gambling Addiction Management Through Education (GAME) sessions. The practice was further internalised in 2015 through the set-up of a volunteer management system, which was developed to recruit, manage, train and provide regular supervision to PSVs.


Self-Help Workbook for Problem Gamblers & Creation of National Addictions Awareness Day (NAAD)

The NAMS website was revamped to include video presentations and an online gambling workbook in 2013. The public could go online and complete a gambling workbook, which allowed the user to administer a self-screening test for problem gambling, and work through various chapters that provided advice on lowering gambling risk and managing debts. The online gambling workbook was an avenue to reach out to problem gamblers who were not ready to seek treatment, but might hopefully reflect on their own gambling behaviours, thereby reducing risk of further harm to themselves and family members.

Concurrently in the same year, the creation of NAAD was inaugurated at the South West Community Development Council (CDC). NAAD was conceived to take place in the form of a roadshow that focused on addiction education. It would be conducted at a different CDC once every one to two years, so as to increase public awareness of addiction. Eventually, all five CDCs would get a chance to hold the roadshow. Various community partners were invited to attend and set up booths at the event to publicise their achievements. To date, NAAD had been held at four CDCs, of which the last one was at North East CDC in 2018.


Clinic for Adolescents

Various adolescent services and projects aimed at young patients between 13 and 18 years of age were rebranded under the ReLive label in 2011. This was done to align all educational and publicity materials to project an image that is appealing to young people.


Community Outreach & Training

Two casinos in the two IRs on the island began operation in 2010. Prior to their opening, the government introduced deterrent mechanisms to safeguard the public from potential gambling addiction, including casino exclusion orders and capability building in the community to assist individuals and families who may be harmed by gambling.

In line with the government’s policy direction, the NCPG was set up under MSF to provide direction on gambling prevention, societal harms and safeguards. NAMS collaborated with NCPG to provide training for community-based agencies, in order to equip them to assist individuals and families effectively.

Towards this end, NAMS worked closely with NCPG to educate the public on the potential harms of gambling. With greater public education and awareness, more people were motivated to seek help earlier. The number of calls made to the helpline increased as the nation geared up for the opening of the casinos. Given the increase in helpline calls, six para-counsellors were added to operate the helpline full time from 2013 onwards.

A One-Stop Clinic

Various adolescent services and projects aimed at young patients between 13 and 18 years of age were rebranded under the ReLive label in 2011. This was done to align all educational and publicity materials to project an image that is appealing to young people.

Clinic for Adolescents

Various adolescent services and projects aimed at young patients between 13 and 18 years of age were rebranded under the ReLive label in 2011. This was done to align all educational and publicity materials to project an image that is appealing to young people.

A One-Stop Clinic

NAMS marked a major milestone in its history with the official opening of Specialist Outpatient Clinic C on 14 July 2010. The new clinic boasts a comfortable and more private setting aimed at providing an environment to encourage patients to come forward and seek help. It would function as a one-stop clinic with its own patient registration and pharmacy counters, consultation rooms, nursing treatment rooms, and therapy rooms for allied health professionals, including counsellors, psychologists, and social workers. NAMS Clinic was officially inaugurated by Professor Satku K, Director of Medical Services, MOH.

Raising Awareness about Gambling Disorder

NAMS published its first book "Dont' Gamble Your Life Away: Help for Pathological Gamblers" in 2010. The nine-chapter long book depicted gambling disorder in detail and provided case studies as illustrations, providing advice and a list of useful community resources for gamblers and caregivers. The book is the first local publication on pathological gambling and is written for both professionals and laypersons.


Continuing the Quest to Understand Addiction

NAMS has an important task to help deepen understanding of addiction in the local context. In 2009, a dedicated research unit was established to not only track important statistics for the service, but also to build competency in local knowledge of addiction in terms of local prevalence, impact, and treatment efficacy.

Over the years, the research team has published numerous papers, including a double-blind randomised controlled drug trial in 2012 on the effectiveness of Lofexidine in opioid detoxification. Other notable studies comprised the predictors of change in patients with alcohol and gambling disorders, offline and online gambling in Asian population, as well as cognitive impairment and decision-making capabilities of local alcohol and drug users.


Establishment of NAMS

NAMS was set up at IMH in August 2008 with the support of and funding by MOH to provide treatment for people with addictions. NAMS provides treatment and support for patients with addictions to drugs, alcohol, gambling, gaming and others.


Set Up of International Advisory Panel (IAP) & Launch of National Addiction Helplines

An IAP was jointly set up in 2007 by MOH and the former Ministry of Community Development, Youth and Sports (MCYS), currently the Ministry of Social and Family Development (MSF), to guide Singapore in the development of a national addictions treatment service with a focus on treating gambling disorders.

In July 2007, an addiction helpline was set up. The helpline had two phone lines with one for gambling support and the other offering assistance for other addictions. Qualified counsellors were rostered to answer calls on the helpline. They had received training on running a gambling helpline by GamCare, the largest problem gambling helpline service provider in the United Kingdom.

In December 2007, CAMP collaborated with the National Council on Problem Gambling (NCPG) to manage the National Problem Gambling Helpline Network. This was part of a national effort to streamline the National Problem Gambling Helpline management and enhance its services by providing phone-based counselling.


Review of Addiction Treatment Services & Launch of Gambling Addiction Management Through Education (GAME)

The 5-year HSDP funding for CAMP ceased in 2006, but it continued to function as an IMH programme. Notwithstanding, the groundwork laid down by CAMP paved the way for the advent of addiction treatment services with a national mandate to treat patients, train professionals, and provide advice to policymakers.

In preparation of the opening of two Integrated Resorts (IRs) on the island state in 2010, CAMP introduced various initiatives to provide support to gamblers, particularly if the number of help-seekers was to increase. An inaugural gambling-themed group programme, GAME was conducted in 2006 and continues its run till this day. Held in the evenings, the entire GAME programme is made up of eight psychoeducation group sessions, which are facilitated by a counsellor and assisted by a peer in recovery.


Establishment of WE Centre for Addictions Recovery and Education (WE CARE)

Building on its progress, CAMP continued to innovate by setting up WE CARE in 2005 at the Alexandra Day Centre (ADC). The primary role of WE CARE was to serve as a drop-in centre for patients, where they could safely interact with one another and centre staff. Eventually, WE CARE grew to become WE CARE Community Services Limited, which is currently located at Kembangan-Chai Chee Community Hub.


Evolution of Treatment Services & Launch of BRIDGE Programme

The Alcohol Treatment Centre (ATC) evolved into Community Addictions Management Programme (CAMP) in April 2001. CAMP, which was funded by the Health Services Development Programme (HSDP) under the Ministry of Health (MOH), was set up to treat all types of addictions, including substance and behavioural addictions such as gambling disorder. CAMP started out offering mainly inpatient and outpatient treatments.

In December 2001, a novel day treatment programme called BRIDGE was conceived to link both treatment services. BRIDGE was a 20-day outpatient programme conducted from 10 am to 4 pm. The programme was conducted in a closed group setting, offering psychoeducation, skills development guidance, and peer support.


Introduction of Inpatient Services

An increased demand for inpatient treatment gave rise to the set-up of a 38-bedded ward in 1993. With the introduction of a fledgling inpatient adult psychiatric treatment ward, the clinic was renamed the Alcohol Treatment Unit (ATU). Patients with alcohol issues were collectively managed at IMH Clinic B and the Alexandra Outpatient Clinic.


Beginnings of Addiction Treatment in IMH

Addiction treatment in IMH began modestly in May 1990 with an outpatient Alcohol Treatment Programme (ATP) conducted at the Alcohol Dependency Clinic. The clinic was formerly located at the then Alexandra and Mandalay Day centres.

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