Calcutta Samaritans

Addiction Recovery & Rehabilitation

Standard Operating Procedure Manual

Jyotin Bhat| Sushant Mohan| Ashok George| Yashovardhan Prabhakar| Aayush Sinha
Acknowledgements
This manual is based on the experiences and hard work of those running the Calcutta Samaritans,
Arunoday Midway home and the detoxification centre. This includes Mr. Debashis Mr. Prashanto, Mr.
Abhishek , Ms. Jayashree and Mr. Ramadri ,. If the risks involved in supporting drug addiction recovery
were not taken, services to support drug users with recovery knowledge and methods would not have
been explored and offered to people. This project was ahead of its time when it started and now moves
forward with involvement from government. The authors also acknowledge the efforts of peer motivator
and volunteers like Chou and Lal at the Arundoday Mid-way home.
About us

EMMANUEL MINISTRIES
Emmanuel Ministries Calcutta is a Charitable Trust, registered in 1985, serving the poor, marginalized
and vulnerable communities within, and outside, the city of Kolkata, India. “Let each one have his dignity
and a chance to be on the road… to freedom.”
OUR VISION
A movement of affirmed and empowered communities and individuals who in turn hold out hope and
dignity to others.
OUR MISSION
Our activities through the various departments include listening, befriending, counseling, awareness and
education, health care, prevention, intervention, treatment, rehabilitation, training, capacity building,
advocacy and campaigning on behalf of the homeless, hand rickshaw pullers and ragpickers, self-help
groups and job skills development. Our aim is to improve the quality of life of the individual and re-
integrate him into society as a contributing, self-respecting citizen.
How to Use the Standard Operations (SOP) Manual

This document’s primary purpose is to serve as a Standard Operating Procedure (SOP) manual. This SOP
can be used to orient new staff to the overall operations of the Center, while also serving as a useful
resource for staff to review specific procedures in detail. It is recommended that this manual be reviewed
by all staff and updated on an annual basis at a minimum or ‘as needed’, if changes are needed prior to the
annual update. In addition to supporting those at the Calcutta Samaritans, this manual makes it possible to
share the Center’s methodology with other individuals and organizations interested in developing
community-based drug recovery support centers. It should be noted that the two program phases
(Detoxification, Rehabilitation) are sequential phases through which all new clients will pass, however
once the client becomes involved in the Center’s Case Management component, they are then assigned to
one of two sections of the program:
Active Drug Users Program, Home-Based Detoxification, or Relapse Prevention. As their participation in
the program continues, so do the Case Management services; Case Management is ongoing for any
Center client. While the manual is constructed so the reader is able to read from beginning to end in
sequential order, it is also designed to be useful for referencing or reviewing a particular procedure or
tool.
The major sections of the manual are as follows:
• Overview: A brief description of the Calcutta Samaritans
• Recruitment: Identifying and reaching potential center clients.
• Orientation: Providing information regarding the Center’s program, services, benefits of participation,
and expectations of clients.
• Case Management: Conducting detailed client assessments, assigning prime counselors, matching
clients to appropriate program components and services, developing action plans, and monitoring the
ongoing progress of each client
• Individual Counseling: Providing each client with individual counseling to guide them through the
recovery process, ensure program compliance and assist clients in Introduction Drug Recovery &
Reintegration Standard Operating Procedure Manual 15 addressing personal issues. Individual counseling
includes links to ancillary services (health care, social skills, job support, family counseling), and each
type of service is described in individual sections of the manual.
• Active Drug Users Program: Engaging and supporting those individuals who are actively using drugs to
reduce the harm associated with current use, as well as encourage future participation in drug
detoxification and recovery group components.
• Relapse Prevention: Providing a series of education and counseling sessions designed to support clients
through the immediate post-detoxification phase during which the possibility of relapse is greatest.
• Post-Graduation/Support Group: Providing ongoing counseling sessions and support group sessions
after graduation from the relapse prevention program at the Center to sustain a long-term recovery
process.
• Social Skills and Job Support: Providing skills development for social interactions as well as
employability, offering short-term employment at the Center as a part of labor therapy, and assisting in
the development and implementation of individual plans to seek and obtain employment in an appropriate
community setting.
 DETOXIFICATION CENTRE
Administrative Hierarchy

Mr. Ramadri Sengupta- Incharge, Detoxification Centre

Mr. Subhashish Chatterjee
Mr. Biswajith Ganguly

The client’s responsibility rests with the Administration at the Detoxification centre. In the event of any
issue with the client, the family is informed immediately. In the event of any medical problem, the client
maybe shifted to a hospital upon consultation with the guardians and in house doctor.
In case of death of the patient, the local police is informed and due process is followed.
 DETOXIFICATION CENTRE
Therapeutic Care SOP

1. Client arrives at detox centre

2. Client fills out the form for admitting into the 4 month long process
3. Undergoes medical check up
4. Medical history is enquired
5. Medical test for any transmittable disease
6. Given a room for retiring
7. Daily dosage of medicines for taking out the toxins from body
8. Recreational activities like caroms, movie watching,
9. Counselling sessions with trained counsellors
10. Group discussions and support groups with people of similar
background
11. A visiting psychiatrist takes care of the mental imbalance that may be manifested in client due to
sudden absence of drugs
12. Yoga sessions every day to calm the mind and take it off into a world other than that of drug
abuse
13. Daily interactions with ward boys, who themselves have gone through the same process some
time back helps in imbibing hope into the clients that they too can recover
Client Arrival
Intake is the process of determining whether a particular rehab centre is a good fit for you. This is a stage
to ask the questions of the centre that are most important to you.
The client arrives at the detox centre due to many reasons:

1. If the individual is experiencing an emergency as a result of an overdose

2. If the person is experiencing some psychiatric issue, such as becoming psychotic as a result of
some reaction to some drug

3. If the individual is asked by his family and friends to get admitted and make yourself better.
The people can physically come to the EMC detox centre or staff may be sent to pick up the clients.
When a client has made a decision on the facility, they contact the centre and make arrangements for
getting their treatment underway

Documentation
The client then commits himself to the detoxification program. He completes the documentation process
himself or with the help of his family or friends. He agrees to the date of arrival, rules about what they
may or may not bring with themselves and any remaining questions they might have about the duration
stay, finances, and visitation
As per the government regulations they sign a form allowing the EMC to keep them in the detoxification
centre for a minimum of one month for the initial detoxification process. Following this period an
evaluation of the condition may be made and the client’s stay in detox may be further extended.

Medical Check Up
The first thing to do when a client is committed into the EMC is evaluation. There is an intake
assessment. A physician or nurse will evaluate the individual’s current state of intoxication and any
withdrawal symptoms that are occurring as well as gather other needed information regarding the
individual’s history, physical health, and mental health. It must first be determined if the person is under
the influence of any drugs. This can be done both with physical testing, such as looking at blood alcohol
content (BAC), other physical tests, and behavioural signs. An individual entering a detox program with a
high BAC that indicates severe alcohol intoxication would require a different approach than someone
entering without such a level of intoxication. The same is true for signs of any other drug intoxication
occurring in the person.
Based on the information given to the team by the client regarding the type of drug use, amounts,
frequency, etc., the team can determine the general effects of any withdrawal symptoms and their
severity. The team can also determine if the individual is experiencing any withdrawal symptoms. This
information can help prepare the detox protocol.
Medical History
To further facilitate the process, the client has to give his/her detailed history, any medical conditions
he/she may have or had earlier. They should also give correct information of the substance/s they are
abusing. This document is an essential component of the detox because the medications provided will be
dependent upon this information
A person who presents with a complicated medical history can alter the program of detox. For instance,
someone with a history of stroke or extremely high blood pressure will be treated differently than
someone without these issues. An individual with a condition that requires medical monitoring, such as
diabetes, will need to be considered for a different level of care that an individual who has no such issue.

Precaution for Communicable Diseases

Sometimes the issue of the patient having a transmittable disease is present. At such times, the personnel
at the detox centre take special care to ensure that the proper hygiene is followed with regards to the
patient and that he/she is kept in some level of isolation until he/she is cure of the disease.
Proper system of medication is followed and the needles and syringes are not used again to prevent HIV
AIDS.

Room for the Patient

The clients are then given a room on any of the two floors to live in at the detoxification centre. The room
is one of several in a corridor. To prevent any chance of patients escaping, each floor has a gate which is
locked and is only opened for the medical officer, psychiatrist and the counsellors. The windows are
sealed and are fitted with grilled bars to make the patient stay securely in the room and not think about
escaping and just concentrating on the rehabilitation.

Recreational activities
At the detoxification centre the clients are not just exposed to the path to a new life through medication
and counselling. The clients also are encouraged to pursue interests that take their mind off to different
world. Games like carom and chess ensure that clients can have learn group dynamics and have a solid
fun activity everyday helping in calming the mind.
Games and puzzles can be used to stretch the mind and introduce different ideas, but very importantly
they can also be used to entertain people. We think that relaxation and diversion should not be
underestimated. Relapse fears can be reduced greatly if the clients find themselves surrounded with other
simple and addictive games. The great part about this is clients are playing with themselves, reinforcing
the fact that they have to work together, helping each other to come out of this life.
Apart from the games, the clients also engage in occasional movie watching in the main hall. This
exposes them to the other aspects in life. Aspects to which they had bid goodbye and turned to drugs for
respite. Occasional exposure to on-screen romances and a stable family life ignite a new passion in the
clients to come back to the life they were leading before they fell into the trap of addiction. Thus a holistic
approach is followed even at the detox centre for natural process of gradual repulsion towards substance
abuse.

Counselling sessions
At Calcutta Samaritans we believe that there is no disease that can’t be treated with the right intervention.
And by this we intend to take the clients on a path of scientific counselling as well as spiritual
intervention. The detoxification centre has 3 well trained counsellors who work day and night to ensure
that the clients have a stable mental health during the abstinence period. Most clients have complained
that the physical withdrawal symptoms disappear after 10-15 days of medication, but it is the mental pain
and depression that make the time very difficult to bear. Counsellors ensure that no issues of the client
goes unheard.
Spiritual counselling is also a big part of the “treatment”. It is through the belief in God and the power
that we get in God’s trust that we encourage our clients to come out strong. Quoting from Bible, “ I can
do all things through Christ who strengthens me” Such a system ensures that the clients feel that there is
still hope. It is this hope that takes him forward.

Group discussions and group therapy

At Calcutta Samaritans we believe that the power of healing can be accelerated by the power of group
therapy. Clients often feel at ease when they are discussing the issues amongst each other. Hence, clients
often engage in group discussions and this yields very positive results. As already discussed the clients
often feel mentally unstable and house a lot of fear inside. GDs are a channel to vent out the frustration
among other similar people. GDs make the clients realise that they aren’t in this fight against the
addiction. Some group therapies may also involve small minute long relaxation techniques, creating a
good environment for the clients.

A visiting psychiatrist monitors the clients’ emotional stability

It is important to treat the patient with the background of his environment in view, as well as in the light
of the personal, interpersonal, and social meaning of his illness. The rehabilitation team, therefore, is ever
alert to any force which might impair motivation for recovery. The real problem of rehabilitation consists
in helping the patient realize and accept that the emotional rewards of health are greater than any
secondary gains derived from dependency ever can be. And this is where a role of a Psychiatrist comes
into play. Clients can talk to the Psychiatrist whenever they feel they have any tendency to go back into
their old world or stop all the treatment process. Psychiatrists ensure the following at Calcutta Samaritans:
1. Safe medical detoxification
2. Differential diagnosis to rule out other mental or physical disorders
3. Drugs prescribed as needed or helpful
4. Psychiatric evaluation and treatment of family members
5. Written, required documentation of the patient's progress (mental status and social/occupational
functioning)

Yoga sessions to calm the mind

Many addictions begin as a coping mechanism or a way of filling a spiritual void. As a result, people in
treatment for addiction must learn to deal with their emotions and environment in healthier ways.
Practicing yoga is an excellent complement to conventional chemical dependency treatment. The 12-step
program and the eight-fold path of yoga both emphasize truth, meditation, surrendering to a higher power,
and developing self-awareness, while healing body, mind, and spirit. It is in line with the spiritual
awakening that is emphasised here at Calcutta Samaritans.
Heals the Mind
Yoga has an ability to inhibit the dopamine surge that addicts get from using – and sometimes the
cravings they feel just even thinking about taking drugs. The breathing patterns in forms of yoga, such as
Kundalini, release the body’s natural pleasure-producing endorphins. This means a healthy yoga practice
can replace suppress addictive behaviours while restoring the brain’s dopamine functions to healthier
levels.
Reduces Stress
Stressful situations can trigger addictive behaviour and cravings. Just getting used to living a sober life
can be very stressful. Because yoga emphasizes willpower and stress-reduction, those in recovery can
learn to combat that stress, better combat temptation, and regain control over their bodies.
Spiritual Community
Yoga provides a spiritual environment, no matter your religious beliefs. Learning to slow down,
mindfulness and acceptance are central to yoga and a healthy spirit. Regularly setting aside time for
growth will help you focus on recovery and a healthy lifestyle.
Daily interactions with ward boys, who themselves have gone through the same
process
Here at Calcutta Samaritans we follow a novel policy of letting some of our clients, upon their request, to
volunteer at the institutions once their total treatment is completed. This helps in reinforcing the idea that
you can successfully come out of the system. Most clients face an existential crisis. They may not
acknowledge that they are afflicted with a psychosocial disease, which is also curable. Ward boys help the
clients with any issue in daily life in the detox centre. They along with the nurses form the backbone of
the centre’s operations. Because these wards have successfully come out of the process, they can guide
the clients much like a senior guides his junior in college. 24 hours a day the wards boys are on duty
catering to each and every need of the client. A sort of companion relationship forms between them,
fostering a healthy rehabilitation.
 Arunoday Midway Home
STANDARD OPERATING PROCEDURE

 After one month at detox, a client is sent to rehabilitation center if the medical staff at detox
center deems it fit for the client ( doc: intake form)
 Once he is physically free of drugs, he is sent to the rehabilitation center for the mental cleaning
process
At the rehabilitation center, the client is requested to undergo a disciplined routine that will take
care of all the needs that he has.
 Here the client starts his journey to sobriety and
 The main course of action taken there is to follow the 12 principles which revolve around
spirituality
 All the needs of the clients are taken care irrespective of the health conditions the client has
 The client is expected to follow the 12 principles whole heartedly
 The client is also expected to follow the daily routine which includes different type of tasks such
as sports, prayers, maintaining the center and developing their personality
 Once a client is accustomed to the ways of the rehabilitation center, he/she has to work on their
sobriety
 Here the client is kept for a minimum of four months of observation where he takes part in the
daily routine as specified by the center
 The clients are assigned the job of maintaining the day to day activities of the center on a
rotational basis
 Further, the counsellor deliberates with the client if he/she should extend the stay or not
 Group walks and physical training sessions early in the morning help clients get acquainted with
each other apart from maintaining physical fitness
 Clients are also actively involved in cleaning and maintain their own rooms as well as the
center(This helps them maintain a clean and healthy center without employing anyone from
outside)
 A regular GD session encourages clients discuss various issues among themselves and develops a
bonhomie between them
 Clients also keep in touch with the daily happenings that take place around the world through a
newspaper reading session
 Center provides the clients with good sporting infrastructure where they can play outdoor games
like volleyball, football, cricket and indoor sports like carom and ludo
 Client can also relax himself/herself by watching television
 Clients maintain a diary in which they reflect their daily thoughts and development
 A prayer session is held each day so that client can attach himself to service of god and help
himself on the path of sobriety
 Apart from this clients are given time to time meals, tea and snacks which is prepared by a cook.
Clients are given healthy food that helps them get back the nutrition back in their bodies
 DAILY ROUTINE

5:30 – 6:15 am 6:15 – 6:45 am 6:45 – 7:30 am 7:30 – 8:15 am

Wake up + PT/Morning T.D.A Wash up + Personal
Wash up + Tea Walk Devotion

10:30 – 11:15 am 9:45 – 10:30 am 9:00 –9:45 am 8:15 – 9:00 am

Assignment Reading session Devotion Breakfast
session

11:15 – 11:30 am 11:30 am-12:30 12:30-3:00 pm 3:00-4:00 pm

Tea Break Input session Lunch + Rest Group
Discussion

6:30-7:15 pm 6:00-6:30 pm 4:30-6:00 pm 4:00-4:30 pm

S.H.G meeting Tea Break Leisure/TV Tea Break

7:15-8:00 pm 8:00-8:45 pm 8:45-9:15 pm 9:15-9:50 pm

Off Time Dinner and Reflection Post mortem
counting

10:45 pm 9:50-10:00 pm
Lights Out Devotion
  On Sundays, there is no PT Morning walk and is replaced by T.D.A , GD is replaced by Lunch +
Rest and reading session is replaced by leisure time
 On Wednesday and Sunday, Post Mortem and Devotion are replaced by a movie screening
 Also special food is prepared at midway home on special occasions like festivals and birthdays of
clients
 Festivals are celebrated with great enthusiasm and clients participate in organizing special
programs on these festivals

On any usual day the activities are overseen by the counsellor and in absence of any counsellor the
direction is given to the senior most volunteer over. In any unusual case too, the counsellor is called up
and further actions are taken.
In case of the demise of any client, the body is handed over to the family members/Guardian and in
absence of any, the last rites are performed by the Emanuel Ministry as per the bond signed by the client
with the Emanuel Ministry.