872343

research-article2019
APHXXX10.1177/1010539519872343Asia Pacific Journal of Public HealthSabarinah

Original Article
Asia Pacific Journal of Public Health
1­–11
Use of Drug Treatment and © 2019 APJPH
Article reuse guidelines:
Rehabilitation Services in sagepub.com/journals-permissions
DOI: 10.1177/1010539519872343
https://doi.org/10.1177/1010539519872343
Indonesia: Findings of the 2014 journals.sagepub.com/home/aph

National Narcotic Survey

Sabarinah, MD,MS,PhD1

Abstract
This study was conducted to identify factors associated with the utilization of treatment
and rehabilitation services by drug abusers. Around 14.7% of drug abusers self-reported as
having used treatment and rehabilitation services at any point in their lifetime (90.8% male
and 9.2% female). The dependent variable of having “ever used” the services was positively
associated with receiving support of family and friends, knowing of an existing treatment and
rehabilitation program, having ever been involved in an outreach program activity, experiencing
self-treatment, and having a positive perception of the efficacy of the program. Among the 10
cities examined, the findings showed unequal utilization of treatment and rehabilitation services,
implying the need to better monitor the use of the services and to develop a community-based
treatment that both enables drug abusers to confront barriers to the utilization of treatment
and rehabilitation services and also reintegrates drug abusers to the community.

Keywords
drug abuse, family support, Indonesia, treatment and rehabilitation, utilization

What we know:
•• The use of therapy and rehabilitation in drug abuse is believed to be caused more by indi-
vidual factors and service programs.

What article adds:

•• The study shows the community’s support was very big influence. Therefore in every
therapy and rehabilitation design, it has also to use a community-based method.

Introduction
The definitions of drug user and drug abuser are related to the use and abuse of a substance. Drug
use is drug consumption that does not negatively impact health, while drug abuse is drug con-
sumption that becomes abusive because the use of the drug becomes a priority of the individual

1Universitas Indonesia, Depok, West Java, Indonesia

Corresponding Author:
Sabarinah, Faculty of Public Health, Universitas Indonesia, Kampus UI Depok, West Java 16424, Indonesia.
Email: sabarinahprasetyo@gmail.com
2 Asia Pacific Journal of Public Health 00(0)

to the point that it creates a public health problem.1,2 The decision to take psychoactive sub-
stances is usually voluntary in the beginning, but repeated consumption typically leads to brain
changes that create (1) physical dependence or a state of adaptation of the person to the presence
of the drug, manifested by the appearance of intense physical discomforts such as tremors, chills,
insomnia, and other symptoms when stopped; or (b) psychological dependence or a situation in
which a person feels an emotional need and urge to consume a drug on a regular basis in order to
feel good, even though he or she does not need the substance physiologically.
Worldwide, the prevalence of people who used drugs in 2014 was about 5.2% of adults
aged 15 to 64 years.3 In Indonesia, it was estimated that around 2.4% of people aged 10 to 60
years used drugs in 2005, a figure that was unchanged in 2010. The prevalence of past-year
active user did not decrease much either, from 0.8% in 2005 to 0.6% in 2010.4 In 2017, a
study estimated that, in Indonesia, 1.8 million people were experimental users, 1 million were
regular users, and 500 000 people were addicted or dependent. Number of males (88%) was
higher than number of females, and the study found that 65% of male drug users and 51% of
female drug users comprised poly-drug users—meaning those who used more than one sub-
stance at the same time. The most popular substances used were amphetamine-type stimulants
(47%), and marijuana (46%), while opiate substances, such as heroin or methadone, were
used by around 8% of drug users.5
Indonesia over a long period learned of the need for a treatment and rehabilitation (TR) ser-
vice. Pamardi Siwi, a temporary detention center for children and adolescents with delinquency
problems—including drug addiction—was established in 1971. As drug problems continued, and
even increased, the government and the house of representatives ratified Law No. 5/1997 on
psychotropics, followed by Law No. 22/1997 on narcotics. Based on these 2 laws and Presidential
Decree No. 116/1999, the National Narcotics Coordinating Board (BKNN) was formed, chaired
by the chief of police. In an effort to have a more independent budget plan, in 2002, Presidential
Decree No. 17/2002 replaced the BKNN with the current National Narcotics Board (Badan
Narkotika Nasional [BNN]), in having the distinct authority to coordinate 25 relevant agencies,
including the Ministries of Health (MoH) and Social Affairs (MoSA), in the formulation and
implementation of the national policy on the prevention of drug use. Following this law on the
organization of the BNN, Presidential Regulation No. 83/2007 established the provincial (Badan
Narkotika Provinsi) and district (Badan Narkotika Kota/Kabupaten) narcotics boards as extended
arms at the provincial and city/district levels, which were directly responsible to the governors
and mayors/regents not having a vertical, structural relationship with the national BNN. Law No.
22/1997 was amended to become Law No. 35/2009 on narcotics, which gave the BNN the author-
ity to investigate all narcotics crimes and narcotics precursors (chemical substances used or
incorporated in the manufacturing process).6
In addition to existing private services, the BNN, together with MoH and MoSA, has devel-
oped various TR services since the year 2000.6 The service can be an inpatient/residential
approach implemented abstinence method, therapeutic community combined with medical treat-
ment, and aftercare services. Another approach was ambulatory service that applied outreach
activity with counseling as well as education on safe injection and methadone treatment in out-
patient services provided by some clinics or hospitals. The government also supported commu-
nity-based TR usually run by nongovernmental organizations. The goal of TR services is to
improve personal health and social function (recovery), to reduce threats to public health and
safety, and to completely free individuals from destructive processes and repeated drug use situ-
ations.6 However, a survey in 2014 revealed that only around 5% of drug abusers had ever used
these TR services.5,7
The Indonesia Law on Narcotics (No. 35 in 2009) includes the death penalty for drug offenses,
but not for victims of drug abuse or for those who only use drugs. Drug users or addicts, as vic-
tims, can be sent directly to TR services instead of prison, a process known as mandatory
Sabarinah 3

rehabilitation.8 To distinguish a victim of drug use from a drug producer, dealer, or trafficker, a
set of criteria can be used, which starts with a regulation issued by the Indonesia Supreme Court
in 2010 and that was updated by a joint decree of 7 bodies/ministries in 2014. These criteria now
encompass those caught with drugs on their hands, those with drugs that can be consumed in only
a day, those found positive for narcotics in urine laboratory checks, those with a medical explana-
tion issued by a psychiatrist regarding their drug use status, and those for whom there is no proof
of being involved in producing, dealing, or trafficking in drugs.9 However, some weaknesses
have been identified in the field in the implementation of this regulation that might raise barriers
for drug users seeking TR services.10
A further issue is the source of support for TR services. Facilities provided by the government
(BNN, MoH, or MoSA) can be accessed free of charge, as long as an individual has been pro-
cessed and endorsed by the BNN or police. If an individual seeking TR services is driven by
self-motivation to a nongovernment facility, the Indonesian National Health Insurance system—
managed by the Social Insurance Administration Organization, BPJS Kesehatan (Badan
Penyelenggara Jaminan Sosial)—unfortunately cannot provide reimbursement for the utiliza-
tion of TR services. Other factors could also impair access to TR services, such as the presence
of societal stigma against drug user.11,12 This study therefore aimed to identify factors that cor-
related with the low use of TR services in 10 cities in 2014.

Methods
The joint 2014 BNN and Universitas Indonesia survey covered those 17 cities with the highest
number of police-reported drug abusers. The current study included only 10 of these: Jakarta,
Bandung, Surabaya, Medan, Bandar-Lampung, Pontianak, Makassar, Manado, Mataram, and
Denpasar. The exclusion of the other cities was because of very low frequencies of TR service
utilization. Ethical clearance was issued in 2014 by the Ethical Committee for Public Health
Research of the Faculty of Public Health (IRB #00006120) at Universitas Indonesia, after review-
ing all study procedures. The procedures included giving a written informed consent form to each
respondent to obtain her or his signature. The population defined by the survey was drug abusers,
and the sample of respondents was selected using respondent-driven sampling (RDS).13,14
In each city, 140 drug abusers were recruited, with a total sample of 1411 drug abusers recruited
in the 10 cities. The RDS method is useful for recruiting hard-to-reach hidden populations, includ-
ing drug abusers. It would be impossible to construct a standard statistical sampling method, which
would require a sampling frame of drug abusers from which the study sample could be drawn. The
population of drug abusers is small, relative to the general population, it is geographically dis-
persed, and its networks are difficult for outsiders to penetrate. In the initial phase of the study, a
convenience snowball sampling method was used to locate drug abusers in a city. Each city was
divided into 5 areas (east, west, north, south, and central); in each area, a total of 3 “seeds” (wave 1
subjects) was identified, composed of a student, a worker, and an unemployed drug abuser. These
wave 1 respondents in turn nominated their peers (students, workers, and unemployed drug abus-
ers) as the sample’s wave 2 subjects. One “seed” recruited, in general, 2 other drug abusers (peer
recruitment), and the sample was subsequently expanded, wave by wave, until a total of 140 respon-
dents were enlisted per city. A total of 1411 drug abusers (respondents) were recruited in the 10
cities. According to Heckathorn,13,14 any bias in the snowball sample of first-round subjects (seeds)
would be progressively reduced as the sample expanded, wave by wave, reaching an equilibrium
that was independent of the convenience sample of “seeds” from which it began. Thus, the RDS
method becomes reliable once the number of waves is sufficiently large to enable elimination of
bias from the non-random selection of seeds in the initial wave.
The study instrument was previously used in a 2004 national survey on drug abusers, includ-
ing questions about using drugs and contacting TR services. A pilot of the questionnaire was
4 Asia Pacific Journal of Public Health 00(0)

conducted prior to the survey.7 The 2014 reliability test of the TR variables showed a Cronbach’s
α coefficient of 0.779 and a Guttman split-half coefficient of 0.981. The sample size was suffi-
cient to confirm that the margin of error was small enough to be informative and to have a high
(95%) confidence level for testing hypotheses of a 10% difference between 2 proportions with
80% power for the test.15
The dependent variable was “self-reported ever used” TR programs, defined as a person
who has used illicit drugs (alcohol, marijuana, opiates and their derivatives, cocaine, amphet-
amine-type stimulants, hallucinogens, and other addictive substances) or who had abused
illicit medications (including over-the-counter drugs) in the past year. The Andersen concep-
tual framework16 was employed to link the utilization of TR by drug abusers, as the dependent
variable, with 3 associated independent variables:

1. Drug abusers’ background variables, consisting of sociodemographic variables, such as

gender (male or female), age (categorized as <20 years, 20-29 years, 30-39 years, and 40
years or older), educational level (grouped as junior high school or lower, and senior high
school or higher), employment status (comprising unemployed, student, employed, and
blue-collar labor), marital status (categorized as unmarried, married, and other), and
house ownership (as a proxy of economic states, consisting of self-owned, family-owned,
and other). The characteristics related to drug use such as type of drug abuser (grouped as
experimental user [those who had used drugs on 5 or fewer occasions, with no injections,
in the previous year], regular user [those who had used drugs on 5 to 49 occasions, with
no injections, in the past year], and addict or dependent [drug abusers who used drugs
continuously—more than 49 times in the previous year—or who had used injections,
regardless of the frequency of use, in the past year]). Other variables related to drug use
were length of time of drug abuse (categorized as <5 years, 5-9 years, 10-14 years, and
15 years or more), drug abuser who had ever committed crimes other than drug use, and
drug abuser having any experience of self-treatment. Some variables originally were
measured in continues scales, such as age (in years) and length of time of drug abuse (in
years); hence, in this study, they were converted into category due to reduction in the
irregular forms of data distribution.
2. Program-related factors, consisting of ever having heard of an existing TR program,
knowing how to access TR services, and perception of efficacy of TR services (effective
or ineffective).
3. Community efforts, comprising of current shared living arrangements, perception of
whether the surrounding community is protective or risky, family members who have
ever abused drugs, and positive support from family or friends, such as being accepted.

All independent variables were categorical, in which the first group was assigned as the refer-
ence (Table 1). A χ2 test was employed for bivariate analysis (see Table 1), and binary logistic
regression was conducted to demonstrate any association between the dependent variables and
the independent variables, using RDS Analyst (2014) software. By implementing the backward
elimination approach (step by step the variable was excluded if significance of regression coef-
ficient was greater than 10%), the final figures for the odds ratio were presented as adjusted odds
ratio (AOR) to the other variables in the last model.

Results
Of the 1411 respondents, 14.7% had accessed TR services ever. The data show wide variation by
city, from 5.4% in Mataram to 35% in Jakarta. Table 1 presents characteristics of the respondents;
the majority was males (91%), most had a high level of education, and the average age was 28 years
Sabarinah 5

Table 1.  Demographic and Sociobehavioral Characteristics of Drug Abusers and Percentages of Use of
Treatment and Rehabilitation (TR) Servicesa.

Frequency, n (%) % TR P
Background variables
Gender
 Male 1281 (90.8) 14.91 .52
 Female 130 (9.2) 12.31  
Age (years)
  <20 189 (13.4) 5.3 <.01
 20-29 615 (43.6) 8.3  
 30-39 518 (36.7) 23.7  
  ≥40 89 (6.3) 25.8  
Educational level
  Junior high school or lower 384 (27.2) 9.64 <.01
  Senior high school or higher 1026 (72.7) 16.57  
Employment status
 Unemployed 263 (18.6) 16.3 <.01
 Student 279 (19.8) 3.9  
 Employed 509 (36.1) 20.6  
  Blue-collar labor 353 (25.0) 13.6  
Marital status
 Unmarried 840 (59.5) 9.8 <.01
 Married 442 (31.3) 20.1  
 Others 128 (9.1) 28.1  
House ownership
 Self-own 170 (12.0) 21.2 .03
 Family-own 884 (62.7) 13.7  
 Others 356 (25.2) 14  
Type of drug abuser
  Experimental user 19 (1.3) 15.8 <.01
  Regular user 156 (11.1) 5.8  
 Addict/dependent 1202 (85.2) 14.6  
Time/length of drug abuse (years)
  <5 302 (21.4) 4 <.01
 5-9 329 (23.3) 5.2  
 10-14 259 (18.4) 11.6  
  ≥15 516 (36.6) 28.5  
Ever did crime
 Yes 1086 (77.0) 17.3 <.01
 No 325 (23.0) 5.8  
Self-treatment experience
 Yes 490 (34.7) 31.6 <.01
 None 921 (65.3) 5.6  
Program-related variables
Ever heard of existing TR program
 Yes 1258 (89.2) 16.2 <.01
 No 153 (10.8) 2.0  
Know how to access TR services
 Know 813 (57.6) 80.2 <.01
  Do not know 598 (42.4) 6.9  
(continued)
6 Asia Pacific Journal of Public Health 00(0)

Table 1. (continued)
Frequency, n (%) % TR P
Perceived efficacy of TR services
 Effective 242 (17.2) 35.1 <.01
 Ineffective 1169 (82.8) 10.4  
Experience of outreach program
 Ever 477 (33.8) 32.5 <.01
 Never 934 (66.2) 5.6  
Community and family support
Living with
 Parents 683 (48.4) 12.4 .01
 Spouse 383 (27.1) 19.8  
 Alone 138 (9.8) 15.2  
 Other 207 (14.7) 12.1  
Perceived surrounding community
 Protective 194 (13.7) 14.4 .92
 Risky 1217 (86.3) 14.7  
Family members are aware of drug abuse
 Yes 833 (59.0) 21.6 <.01
 No 578 (41.0) 4.7  
Family members have ever abused drugs
 Yes 383 (27.1) 17 .15
 No 578 (41.0) 13.8  
Positive support from family or friend
 Yes 269 (19.1) 40.1 <.01
 No 1142 (80.9) 8.7  
City
 Mataram 147 (10.4) 5.4 <.01
 Pontianak 141 (10.0) 5.7  
 Medan 140 (9.9) 8.6  
 Manado 139 (9.9) 8.6  
 Makassar 140 (9.9) 10.7  
  Bandar Lampung 146 (10.3) 13.0  
 Surabaya 140 (9.9) 13.6  
 Bandung 141 (10.0) 15.6  
 Denpasar 137 (9.7) 31.4  
 Jakarta 140 (9.9) 35.0  
  10 cities 1411 14.7  
aP value is the significance of χ2 test; TR is a self-reported ever use of TR services.

(standard deviation of 7.5 years). Over half were employed, and 60% had not yet married. They
generally lived in a family member’s house—nearly half with their parents. According to their drug
use histories, half had used drugs for 10 years or more, 85% were drug-dependent, and 77% con-
fessed to having participated in criminal activities. One-third confirmed experience of self-treat-
ment to deal with their drug use problems. Regarding programs related to TR services, most
respondents had heard about existing programs, conducted either by the government or by private
clinics run by non-governmental organizations, and knew where to access the services, and one-
third had experienced being in an outreach program. Interestingly, about 17% thought of these
existing TR services as ineffective. Regarding community support, around 86% of respondents
perceived their surrounding community as being high risk for drug abusers, 27% had a family
Sabarinah 7

Table 2.  Factors Associated With Ever Use of TR Services in Indonesia (N = 1411)a.

95% CI of AOR

  AOR Lower Upper P

Education level
  Junior high school or lower 1.00  
  Senior high school or higher 1.43 0.93 2.20 .10
Time/length of drug abuse (years)
  <5 1.00  
 5-9 0.61 0.27 1.36 .23
 10-15 1.15 0.54 2.43 .72
  ≥15 1.82 0.92 3.60 .09
Self-treatment experience
 Never 1.00  
 Ever 2.82 1.87 4.27 <.01
Ever heard of existing TR program
 No 1.00  
 Yes 3.21 1.05 9.79 .05
Perceived efficacy of TR services
 Ineffective 1.00  
 Effective 1.52 1.01 2.31 .04
Outreach program experience
 Never 1.00  
 Ever 2.91 1.90 4.46 <.01
Positive support from family or friend
 No 1.00  
 Yes 4.43 3.04 6.45 <.01
Constant 0.006 <.01

Abbreviations: TR, treatment and rehabilitation; AOR, adjusted odds ratio; CI, confidence interval.
aTR is a self-reported ever use of TR services.

member using drugs, and 60% acknowledged their families being aware of their drug use. One-fifth
of respondents mentioned experience of obtaining support from family or friends to undergo TR.
Table 1 also reveals the result of bivariate analysis. Of background variables, except gender,
all others were significantly associated with TR use. Low TR use percentage occurred in the
group having young age, low education level, student, unmarried, and living in a house not self-
owned. High TR use percentage was observed in the group of long-time drugs use, had self-
treatment experience, and was involved in crime activities. Regular drug users tended not to seek
TR. TR use also has association with factors related to TR program, such that higher percentage
of TR use was found in the subject who had heard of an existing TR program, who knew how to
access TR services, had positive perception on effectiveness of the TR program, and had involve-
ment in an outreach program. Data also depicted the association of factors of community and
family support with TR use, such as living with spouse, family members being aware of drug
abuse, and positive support from family or friends to seek TR. In fact, respondents’ perception of
their surrounding area was not related with seeking TR services. The disparity of TR use percent-
age across studied cities was also disclosed.
The final binary logistic regression model (Table 2) reveals that, of the 3 studied factors, the
highest association was with support of family or friends (AOR 95% confidence interval [CI] =
3.04-6.45), followed by having ever heard of, or knowing of, an existing TR program (AOR 95%
CI = 1.05-9.79), having experience in an outreach program (AOR 95% CI = 1.90-4.46), and
8 Asia Pacific Journal of Public Health 00(0)

having practiced self-treatment (AOR 95% CI = 1.87-4.27). Better perception of respondent on

TR efficacy could mean the likelihood of using TR up to 2 times (AOR 95% CI = 1.01-2.31).

Discussion
The external validity of this study’s result must be carefully considered, since the analyzed study
sites include only 10 of the 17 large cities originally surveyed, or about one-third of the 34
Indonesian provincial capitals. The purpose of excluding the 7 cities (with very few points of
access) was to increase the goodness-of-fit for statistical analysis. The other limitations regarding
the sampling procedure were as follows: (1) the study used an RDS method that was not able to
establish trends and causality between “self-reported ever use of treatment and rehabilitation”
and the predictors; (2) males were overrepresented in the sample because of disproportionate
12-month prevalence estimates for drug use disorders (90.8% males vs 9.2% females); and (3)
there was a small sample size of female drug abusers, which contributed to broader confidence
intervals with low precision.
The other study limitation was the self-reporting used in the data collection, which might
influence the criterion validity. However, some studies have disclosed that self-report has accept-
able accuracy, both for amphetamine-type stimulant17 and depressant use.18
The results show that half of the respondents had used drugs for 10 years or longer (55%), and
the majority (85%) of the respondents was drug addicts. This indicates the urgent need for TR. In
addition to the inequality of access to TR between the cities (the range was from 5.4% to 35%), the
overall figure of 14.7% of drug users who had ever used TR services calls for serious attention. This
is because, since 2001, the United Nations Office on Drugs and Crime has set a target for ASEAN
(Association of Southeast Asian Nations) countries to increase the provision of TR by 10% annu-
ally.19 Identifying the determinants of access to TR, therefore, becomes very important.
The final statistical model in this study reveals that sociodemographic characteristics (gender,
age, educational level, employment status, marital status, and house ownership) of drug abusers
had no significant association with utilization of TR services. This pattern of association with
sociodemographic variables is similar to that of the findings of Kelly et al,20 which showed no
direct correlation between either age or employment status and the utilization of TR services
among Chinese drug abusers.
The current analysis discovers that family, friends, and community support for drug abus-
ers is very important in increasing the chance of utilizing TR services, by up to 4 times.
Family and community support are the basis for a more recent concept, which emphasizes
the importance of community-based drug treatment models for drug abusers.21,22 Given the
fact that community factors correlate with the use of TR services, the challenge is in making
good use of local community culture. Such was recommended by Pullen and Oser23 in
Indonesia, with so many local customs and norms that there is a need to explore how to
employ local customs to build rapport between drug users and counselors. The communica-
tion style and nonverbal as well as verbal messages, as part of the culture, have to be incor-
porated into the counselor’s action.24 Some studies showed that there were differences in
expression and wording across the ethnics in Indonesia,25,26 and it had an impact on the
counseling process. Therefore, it is important to increase awareness of community members,
as well as to improve the competence of health personnel and counselors, to be culturally
responsive. Other components of culture are the beliefs, values, and norms those might bring
to cultural barriers, or stigma.11,12 Indonesians mostly have strong religious norms, and the
prevailing ones perceived drug use as an unacceptable behavior. This kind of stigma could
reduce the readiness of community members to accept and care for drug abusers.10 Therefore,
public education on drug abuse treatment is needed. Another important matter is the death
penalty in Indonesia, whereas perpetrators of several cases of drug offenses were sentenced
Sabarinah 9

to death. This might contribute to the barriers of voluntarily seeking TR services that exist
among drug abusers.10
The poor impression of TR effectiveness (17%) might be related to the perception of poor
quality of care delivered in TR services. This distrust toward professional help might be
related to the opinions of respondents who had never used TR services. This was similar with
the finding of Sharma et al27 in their study that negative attitude toward pharmacotherapy
would decrease the rate of buprenorphine use. Additionally, the analysis indicates that self-
treatment experience increases the likelihood by 4 times of a drug abuser utilizing TR ser-
vices. This high motivation for self-treatment is associated with self-efficacy28 and it reflects
the readiness to take the next step to change. Furthermore, this self-efficacy could be ampli-
fied by TR services since the objective of TR is to enhance self-efficacy.29 However, these
data are different to that of the finding by Sharifi et al30 that there is no association between
self-treatment and the use of TR services.
Having contact with existing outreach program(s) has increased by up to 4 times the chance
of using TR services. Notably, the data show that familiarity with existing TR programs, includ-
ing residential and outreach services, also affects the utilization of TR services. Most likely, this
relates to the outreach programs that, in addition to counseling, also disseminate information on
the availability of TR services.10 Thus, outreach activity should continue to be part of any outpa-
tient TR program.
Overall, Table 2 shows that family and community support demonstrate the most significant
association (AOR of up to 5.5), followed by having been in an outreach program or self-treat-
ment experience (AOR of up to 4), perceived TR effectiveness (AOR of up to 2.85), and senior
high school or higher education (AOR of up to 2.56). Findings indicate that the government
should encourage existing TR services to focus primarily on outpatient or community-based
treatment services, with the goal of increasing drug abusers’ self-efficacy. Self-efficacy is the
belief that one can produce desired results by one’s own efforts, and it is recognized as a strong
factor or mediator in influencing outcomes.29
Community-based treatment has the potential to tap into community resources and mobilize
participation, and it is noticeably less costly than being in a residential service.31 Friel32 recom-
mended that a community-orientated initiative should return to the community, and it is for the
community to help in solving community problems. This new paradigm, called community jus-
tice, is a new trend that involves equipping existing TR services with community paralegal work-
ers who have the knowledge and skills to deal with the legal issues of drug abusers.30 Empowerment
of family, friends, and the community will help in creating ways to reintegrate drug abusers to the
local society, strengthening commitment to sobriety, and addressing stigma, while necessitating
paralegal advice as part of TR services.

Conclusions and Recommendation

The rate of drug users’ utilizing TR services was low, at around 15%. Inequality in TR service
utilization between the 10 cities suggests the need for better monitoring of service utilization and
treatment quality. The use of TR services was associated with family and community support,
previous participation in an outreach program or self-treatment experience, and perceived TR
effectiveness. Current findings suggest the need to adopt a long-term community-based TR
approach that is capable of enhancing self-efficacy and motivation for abstinence.

Acknowledgments
The author is grateful to the staff of the Indonesia National Narcotics Board and the Center for Health
Research, Universitas Indonesia. The author and her research team are indebted to all respondents in the 10
10 Asia Pacific Journal of Public Health 00(0)

cities that participated in this study. Great appreciation is addressed to Prof Dr Meiwita Budiharsana for
remarkable input in the article’s writing.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publi-
cation of this article.

Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or pub-
lication of this article: This research was supported by the Indonesia National Narcotics Board and
Universitas Indonesia. However, the funder did not play any role in the writing of the article and the
decision to submit it.

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