Side Event: Drug Treatment in Southern Europe: Providing Solutions in Times of Crisis

Gilberto Gerra, UNODC |Thank you for the invitation to moderate this panel. When I was asked what I had for the day, I said that I was going to start the day with the friends of Kethea, Dianova and Proyecto Hombre. I feel at home with you in such this environment of treatment, prevention, humanitarian approach, etc.

Yesterday on the event “On the road to recovery”, somebody asked what we meant by stigmatisation. Imagine the level. We are starting from here.

Anamnesis, which is the time we spend on studying the history of the person, in some cases is not carried out. Specialists do not spend time on this issue. Our patients are mostly denied the time of telling their history, and therefore it becomes very difficult to understand why they do such things.

Southern Europe and the crisis. Let me say one thing; I have very clear in my mind what migration, financial crisis, being on the edge of dramatic bankrupt situation implies. I have seen with my eyes how the funding has been cut, how epidemics have expanded because there is a lack of services. This is putting us in a very difficult situation. People affected are the poorest of the poor. That is why I started speaking about stigmatization. We have the duty to defend this population, give them a voice. The first stigmatization happens in school, by saying: you are a problematic boy, an underachiever, an underperforming, you have conduct disorders, etc. Then immediately, you have a tattoo, put by the teacher, parents… stigmatization is becoming a mantra that will follow them for many years.

I will like to give the floor to Elena Goti, from Dianova International.

 

Elena Goti | Dianova International

We are going through a major crisis. In 2016, the risk of poverty and social exclusion in the European Union affects 1 person in 4, that is 122 million people.

Moreover, the proportion of people at risk of poverty or social exclusion in 2016 is 23.8% higher than it was in 2008: Greece went from 28% to 36%; Spain, from 24.5% to 29.2%; Italy, from 25.3% to 28.1%; Portugal, from 26.0% to 27.0%; Slovenia, from 18.5% to 20.4%

In 2015, 11.1% of the E.U. population aged between 0 and 59 was living in households where the adults work at less than 20% of their total labour potential, called “low work intensity”. In both its duration and its amplitude, the crisis that has been rampant in Europe since 2008 is the most severe since the 1930s.

In such a dilapidated macroeconomic context, systems of social protection have played their traditional role, at least in the beginning, by cushioning the social consequences of the crisis. Unfortunately, most European countries, following the dogma of reducing deficits, have rapidly imposed austerity policies, with the same consequences everywhere: budgetary cuts in numerous sectors, including those of health and social protection when it seems quite evident to us that systems of social protection ought to be strengthened in times of crisis.

Unfortunately, we are witnessing the contrary: a diminution of social expenditure everywhere in Europe, although experts stress that an improvement in the sector would allow not only reducing the negative impacts of the economic crisis, but might also be a significant advantage in reviving the economy.

These cuts have generally represented less than 1% of the budget of these sectors; however, they have been significantly higher in many Southern Europe countries, especially in Greece – the risk of poverty has raised to 36% – and in Spain, where the austerity policy has been translated into massive job eliminations leaving behind demotivated personnel, and patients who have become the victims of interminable delays in treatment.

This state of affairs leads us to several considerations essential for the future of our organisations and for the future of the third sector as a whole, meaning the family to which we all belong.

We are worried by the realisation that political authorities seem increasingly tempted to make the third sector a component of a low cost protection system. We fear the even worse possibility of systems based on private or “church” philanthropy being re-established, with the long term objective of replacing (in whole or in part) the political commitment to maintain a public health and social protection system based on citizenship rights.

These days, our associations are all confronting the reality of the crisis, of budget cuts. And we sometimes have to make cuts ourselves either in some of the investments required to ensure the quality of our services, or else in hiring, in salaries, which entail the casualization of our employees.

We are also witnessing increased competition between NGO actors of the third sector and those in private industry, notably by means of calls for tenders – all of which is remote from our values, our traditions and from what we naturally try to privilege, which is cooperation, consensus and networking.

What is currently happening runs counter to the conclusions of many experts, for whom each euro invested in public health and social protection generates almost three euros in terms of growth and contributes in a significant way to reviving the economy.

In short, social solidarity would permit not only attenuating the suffering among the most vulnerable, but might also contribute to economic development.

The Vision of Addiction, let me stress two elements:

1) At present, in the collective imagination, the fear of unemployment, casualisation, Islamism, and even immigration, has replaced the former fear of “drugs”. Of course everybody knows that drugs are still present, but the image of the addict is no longer as visible and hence drugs do not frighten, do not worry as much as previously.

2) In a context of economic precariousness, unemployment and a lack of prospects for the future, the drug traffic does generate a veritable parallel economy that provides income to some particularly disadvantaged neighbourhoods. In this domain, creativity seems unlimited: each week, new drugs are conceived, fabricated, and put onto the market. New methods of smuggling are invented – not to mention the proliferation of drug sales on the Internet.

On Addiction Treatments, I would like to make an appeal for conserving the quality and plurality of treatment approaches.

Some novelties on the addiction treatment sector. In the domain of addictions, 40 years of experience have enabled us to define a dozen “best practices,” meaning approaches to care that aim to improve the well-being of persons who are dependent on alcohol and other drugs. There is a consensus, based on evidence, that each of these approaches to treatment 1) has a real impact, meaning that it produces measurable clinical results; and 2) has not demonstrated superiority over the others.

Having said this, does that amount to saying that it is sufficient to choose the least expensive? No. Even if “low threshold” treatment services are proliferating everywhere in Europe, a certain number of factors do influence the efficacy of treatment, such as whether the therapist adheres to the treatment model adopted, whether bonds of trust are created between the therapist and the user, and finally whether the client adheres to the model in question, that is to say in its capacity to respond to clients’ expectations, to arouse their hopes and to help them recover confidence.

These different approaches may be combined so as to provide therapists and drug counsellors with additional tools which may enable them to respond to people’s needs more effectively and tailored to each individual’s profile and expectations.

To conserve the quality and plurality of treatment models is the guarantee of a quality network capable of responding to the needs and expectations of all substance abusers, whatever their profiles.

To privilege “least expensive” approaches to the detriment of others makes no sense. To place the different approaches to treatment into competition or in opposition with each other makes no sense at all. Each approach and each strategy can be complementary to another one. And we assert without a shadow of a doubt that a “good treatment” results from a successful encounter between an individual and a treatment approach that occurs at a specific moment in that person’s life.

 

Gilberto Gerra | I would like to point out, the complementarity of services. It is necessary not to create one new intervention but many services and stages. I now give the floor to Phaedon Kaloterakis, from Kethea.

 

 

Phaedon Kaloterakis | Thank you Gilberto Gerra and UNODC for their timeless support, and the Greek government and colleagues of Proyecto Hombre and Dianova. I would like to do a brief presentation on the two new units we have in Greece that came out to deal with the crisis consequences.

Let me start with a true sad story of desperation. A colleague from Thessaloniki went to Athens and there she met a girl who was a prostitute. When she came back, she urgently requested a meeting with me. While crying she explained me the girls situation, how really old guys approached this girl, bargaining for money for their services. The worst thing was that, in front of here there was something wet; two days before she gave birth to a boy right there. Now she had to make money. It sounds very dramatic, specially so early in the morning. In any case, I wanted to show you that we have to deal with people that are desperate.

The first half of 2015, there were over 1 million people unemployed, 350.000 families with a member that was unemployed, and 48,5% of the 18-24 years old were unemployed. 36% population is under the poverty line. There are many homeless people, over 40.000 people now among which 20% are university graduates. It is dreadful.

Regarding the situation of mental health, there has been an, increase of 40% of clinically diagnosed depression in a period of just three years. This is the present reality concerning drug use.

The present reality has changed: there are new substances, cheaper drugs, etc. Another thing is with the medical side, people are sharing needles again, people are prostituting themselves, sometime do not even use protection (they get more money if they do so). There is ore poverty, homelessness and social exclusion.

Kethea uses the biopsychosocial model framework defined by UNODC in 2009. Kethea means “Therapty Center for Dependent Individuals”. We run 120 units with a wide variety of services.

I will now present the two outreach units on harm reduction that we have in Athens and Thessaloniki. These are financied by Stavros Niarchos Foundation by a 3-year grant. Our contract with them expires in October, we hope to renew it.

Off-Clubs. Services provided: immediate need food, clothing, shelter, cloth washing and drying, personal hygiene. Once these basic needs are covered, we start to work on the addiction. We also provide psychological support, condom distribution, medical care, dental care, legal counseling, networking with social services and treatment facilities, etc.

Street outreach and mobile units, we provide same services and also overdose prevention. We own two big cars, where we attend them on the streets.

Let me give you an example to illustrate our realities. I will give you an example on needles are these easy to measure:

 

existing unit             needles given away           2.239,42

(in the street)           needles received                 2.005,08

new unit                 needles given away           1.086,75

(in the street)           needles received                   953,42

(at the “off club”)       needles given away           3.643,92

needles received               3.342,83

The number of needles given out it is almost the same as the needle given back.

Let me finish by referring to the word therapy, which has its roots in Homer. A therapist was the servant of a warrior who used to take care of the warrior’s weapons and was helping him to wear his armour. We are not gods. What we do is to enable people to come for help, we armed them, but they have battle for themseleves. We just served this people, nothing more nothing less.

 

Gilberto Gerra | Thank you for showing us the figures and photos, which continue to exist.

We have to ask for our patients to have such high standard of treatment. The recognition of the dignity of the person starts by providing clean and appropriate goods. I have in my mind, cases where they need to first eat and then can deal with addiction. Or when they do not have electricity and could die because of the cold. These are the primary things we have to deal with first.

Thank you for the idea of the warrior and the servants. It is true, each of them have to fight their own battle.

 

Oriol Esculies, Asociación Proyecto Hombre | The high rate of unemployment in Spain in the last decade reduces even more the possibilities for drug-dependent people to find a job, therefore worsening their social reintegration. One thing that really matters is employment, or better said unemployment. Unemployment Rate: 21% when it come of unemployment rate among minors 25 years old it goes up until 45%. It is worth noting that 67% of the drug-dependent population that first come to Asociación Proyecto Hombre, are unemployed.

Work is one the most powerful long-term protective factors for recovering. It becomes a core pillar against drug use relapses and then an essential part of the treatment. Its benefits in terms of their own and family economic sustainability, setting up social networks or reaching self-fulfilment allow them to pursue a real autonomous way of living.

The profile of people that come to our services is male, aged 38, with main consumption of alcohol, cocaine, psychiatric disorders and mostly with severe economic problems. In light of this situation, NGOs in Spain such as the Association Proyecto Hombre have driven new initiatives of a high impact which will contribute to achieve employment for thousands of assisted people.

Proyecto Hombre has many facilities, TC , out patient, dual diagnose, in prison treatment… Today I want to focus on the employment reintegration service.

We take the great advantage of working with them while they are in treatment to empower them to find a work after that. Steps:

  1. Vocational guidance – design together a personal itinerary, informing them about the job vacancies, follow up, with well-prepared specialist.
  2. Pre-empolyment activities to acquire basic social skills and computer competences.
  3. Job-search workshop to train how to obtain employment: elaborating the cover letter and CV, practicing how to behave in a job interview, learning to use the job browsers
  4. Professional courses to prepare and direct link to reasonable jobs: short-term, specialized courses, focusing on those with less educational level, higher probability to find a job, include training in companies.
  5. Proyecto Hombre reintegration companies: to employ through our own vocational enterprises. It is a half solution, and it is focused to those with less income. (i.e.: we own a restaurant, a cloth shop, fish and cattle farm, etc. )
  6. Cooperative employment network – we need to belong to networks that involve key stakeholders to raise jobs for vulnerable people. For example, thanks to the Incorpora initiative of Caixa Bank, last year 23.000 contracts were signed.

It is worth noting that while 67% of the drug-dependent population that first come to Asociación Proyecto Hombre wee unemployed, after treatment 76% were employed. This is indeed a big success.

To conclude, let me say that drug treatment’s efficacy may fail if we don’t pay accurate attention on promoting real job opportunities. We shall stress national and local governments to adopt more employment measures for vulnerable populations and encouraging the private sector through tax benefits. Moreover, stigmatization will be diminished if we demonstrate to the society the advantages of a recovered person at work. Finally, dealing with unemployment is definitely related to drug demand reduction and these practices should be properly evaluated.

 

Gilberto Gerra | These were all, perfectly complementary presentations, giving us the evidence that this people have resources, and that they can put them to work. Therapist can help them. Initial reaction of users: do I have resources? These people are full of resources; the therapeutic program helps them finding it out. It is extremely important to help people after treatment to find a job.

 

Questions and Answers

Thanasis Apostolus, Diogenes: I wished we had a more global and integrated presentation of the situation, which would involve other institutions working in Greece.

Gilberto Gerra: that would be good, if you want, we can book M3, for 2 slots next year and invite all the stakeholders. It is not possible to deal with it in a frame as the one we have today.

Phaedon Kaloterakis: We use to cooperate, as we always say, you can do it, but not alone.

Medical doctor in Rumania: these were very inspirational presentations on how to effectively help people. I encourage you to carry on.

Elena Marini, Kethea: I lead a street group team in Athens. I do not understand the comment made by Thanasis, because on the streets we use to support other organisations. Indeed, we cooperate. I invite you to visit the exhibition Kethea has organized this year near the plenary room.

We have reached the maximum time. With this I close the session. Thank you!

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