Organized by EURAD, Pertubuhan Bulan Sabit Hijau (Malaysia), the Brazilian Association for the Study of Alcohol and Other Drugs, the Jordan Anti Drugs Society, the Turkish Green Crescent Society, the Recovered Users Network and the UNODC Prevention, Treatment and Rehabilitation Section
Sultan Isik, Turkish Green Crescent, CEO:
I’m going to talk about evidence-based studies that we are doing in the Green Crescent Society – 100 years of experience, what have we been doing? TGC works against all kinds of addictions and while we are doing this we are trying to work with scientific methods. TGC works in preventive and rehabilitative health and advocacy activities. We believe we should build up scientific data and use evidence for our advocacy purposes. Recent work: environmental factors affecting internet addiction, understanding addicted women etc. Last year we worked in addiction prevention, rehabilitation phases and we revealed the importance of family participation in struggling against addictions. We’d like to present results of two sectional field research works among vulnerable social groups nationwide: women in alcohol substance and migrants with alcohol substance. Why did we choose this: women in alcohol substance addiction treatment and necessity to assess major social factors for treatment of women who have alcohol disorders. The necessity to assess major social factors affecting immigrants in Turkey regarding fields of addiction. For working with women it is important to determine and evaluate environmental, family and psychological factors, and also for migrants too. To be able to reach out to both women and migrants with alcohol abuse. Scope and gravity of studies: working with women, covering all in-patient treatment centres in Turkey. For the migrants part we work across major society groups and worked with state and society officials. For the women we worked with 65 women with substance disorders. For migrants 11 official regions with syrian migrants nationwide. When it comes to women in alcohol substance addiction treatment – the family and close environnement, traumatic experiences and comorbid mental disorders are all significant factors. Factors that delayed treatment: insufficient capacity in treatment services, social stigma – it is always harder for a women to get help and ask for help – financial difficulties, negative experiences relating to previous treatments and lack of information. What made some of them to be more motivated to get treatment or help? Physical withdrawal symptoms, deterioration in family relations. When it comes to migrants: the results: alcohol and drug prevalence are not that high in the initial phases of migration, however, they are higher day by day. Antidepressants significantly higher among women migrants. Alcohol use has high prevalence, followed by cannabis and opioids and clonazepam. Single male population within migrant population is the highest at risk – a surprising and unexpected result. Majority of migrants do not have plans to return to Syria in the near future. We must therefore consider the addiction issues of Turkey – but these are not the problems of Turkey alone but of the world. A significant number of children don’t go to school due to socioeconomic conditions and this makes them vulnerable. Early prevention is therefore a must – for migrants too. High risk sectors for addictive behaviors are construction workers, shoe makers. — These sectors should be a priority.
Dr Gilberto Gerra:
The idea that one type of treatment and method is applicable to everyone is something that belongs to the past. In reality treatment should be personalised responding to the specific group population or individual. We must acknowledge that sometimes treatment does not exist and so we must make treatment differentiated by age gender and individual. You find most of those affected in the street, however, many women affected are at home and therefore are a hidden population – this is a hidden addiction. To reach the population of women we must do home visiting, home intervention and within a social service setting by reaching children, as well as through sexual reproductive services. The stigma is already very bad for male patients and is even more so for women. The general society message is : you should be a good mother, you are a drug addict – a very stigmatising language. Not only categorised mental disorders such depressions, anxiety or bipolar but also physical and emotional and sexual trauma is prevalent amongst the population and suicide rates are high. It is a must to have psychiatric presence when treating the female population. The stigmatising mentality of the family and especially the partner are a barrier to the treatment process, and the access to treatment. We have anecdotal evidence of this. Women are trafficking, exploited and more exposed to sex work. Tomorrow in the plenary it will be discussed sexual exploitation and being given drugs before exploitation. When you go to work with these women it isn’t just an issue of detoxification you have to make them free from the racket and if you don’t offer serious alternatives of living then they are unable to leave their reality and will continue to use drugs to cope with this hell. If treatment is not tailored for women who have children then this will be another barrier and is another important aspect to take into account – making treatment available whilst taking into consideration that women will have child care duties. The adolescent population is typified by a lower ability to have personal control, they are in an immature state of development of their brain. This must be considered when administering treatment to the adolescent population. If you are exposed to cannabis as an adolescent you are developing a 17% chance of a cannabis disorder, almost double that of an adult. Firstly must make treatment not look boring or moralistic. We should systemise the variation of the route for adolescent population – warm, flexible and strong emotional alternatives. These are part of the theory of an enriched environment. There is evidence that enriched environment for humans offers an alternative and stronger emotional content and so lowers the chance of relapsing. Finally the necessity to involve the parents and caregivers is essential for working with adolescents. The family has an important role in managing the adolescent – the problem of the patient is not individually affected but is affecting the family at large. Is it legitimate to use drugs to treat the dependency of adolescents – i don’t have a response. We need a case by case evaluation depending on psychological conditions of each individual patient.
Alexandre Kieslich da Silva, Addiction Psychiatrist, Brazil:
Over the past 3 decades the human development in Brazil has increased by 20% but Brazil still struggles with great structural issues as well as social and regional inequality. Alcohol in Brazil has led to serious problems. 25 % of adults have an alcohol-related disorder, 25% engaged in binge drinking – alcohol addiction is a challenging issue in b+Brazil. There is one alcohol retail establishment for every 140 adults in Brazil. In some slums of Sao Paulo the concentrail of alcohol retailers can reach greater levels. Misuse among women of alcohol is increasing. We have many problems as they have unprotected sex, early pregnancy and abortion. There is a lack of treatment units for women and adolescents, most of those that have not been closed are for men. We have some good data: A study in Diadema, São Paulo, showed that 65% of violent incidents occurred near bars. In 2002 the mayor’s office drafted a law mandating bars close at 11pm and homicide rates reduced by 61% and have remained at this level 2002-2005. Instsnaced of violence against women reduced by 25%. We have a big problem in Brazil with Crack Cocaine, with higher toxicity and greater potency than powder cocaine. There are many ‘Cracklands’ in Sao Paulo – we have more than 5000 people living here, youth, unemployed, broken families, STDs – it is a difficult situation. We have a refugee problem, many coming from Venezuela, Haiti and Syria and they are living in the rainforest. The recognition of refugees is increasing in Brazil. Many people come from Syria. We have a law to protect these people: they don’t need to pay for health or education. We have a national committee for refugees- they can have indefinite residence whilst applying for citizenship and can extend application to family members outside of Brazil. However, we have a problem with poverty, with 50 million people in Brazil in poverty and therefore it is also difficult for refugees. We do have some opportunities for refugees, including language courses. Regarding prevention we have programmes, however, they were based on improper data, and they are not adapted to brazilian culture. We have some problems with public policies on drugs. When we change our govt we start again, and policies change. We have prevention in other policies related to violence, including programs and law from 2006 trying to differentiate dealers from users, however this law has not been entirely effective as the justice system does not differentiate when it comes to black, poor people who are always considered dealers. Brazil has 25 centres for treatment but they are not very well spread around the country and we have some programmes with harm reduction strategies but have no data to show whether they are effective.
Dr Mousa Daoud, Jordan Anti-Drugs Society and Jordan Green Crescent:
Today I will talk about the evidence-based studies and how they can be used in more effective public health policies. The key components of the evidence based public health include making decisions based on the best available scientific evidence. We must understand the issue and context in which they operated. Research can provide evidence of comparative effectiveness of alternative interventions for a given public health issue. These arguments apply whether we are considering national policies or focusing on policies already having been developed. Eastern Mediterrarnean Region: there are three parallel streams which have shaped policies. Firstly, there is growing interest in research evidence in health policies, also increasing population has resulted in increasing health care costs, the second stream is related to availability and validity of research evidence, in the last decade it has affected health policy-making; the third stream relates to institutional capacity of the ministry of health and other related public institutions. In summary, there is a strong political will in the eastern mediterranen region to engage the use of research evidence in decision-making. They committed themselves to take necessary action towards conducting public health research that is directed towards the requirement of health services and that address people’s health needs. In Jordan the situation is different, it has been at the forefront of different health initiatives and projects for 27 years. But what we need in Jordan is support including appropriate evidence-based national health policies strategies and plans and strengthen national human resources development, planning production and enhance knowledge transfer. We have some programmes at TJADS: early prevention programme; raising awareness amongst all segments of society, including clubs, societies, mosques and churches. We reach this by doing lots of activities schools, universities and clubs, including sports activities as well as drawing and painting competitions, street activities and community activities. And adventure activities and the use of the media.
Dr Agman Fairuz Mohamed Green Crescent Malaysia:
We heard presentations regarding poverty, family problems and more or less our countries have rehabilitation centres, policies, after care services. But i want to share the need of empowering the community, and the role of NGO. At UNODC we have community intervention and we choose marginalised communities with high prevalence of substance abuse and empower their socioeconomic status, especially the blurenabler members of the group : women and children by providing education and increase their socioeconomic status, especially from famine. We empower women to work and send their children to school to break the poverty cycles.
Stig Erik Sorheim:
The experience from public health teaches us that health problems come from a combination of vulnerabilities and risk factors. Vulnerabilities are breeding grounds of drug and alcohol problems as they can provide welcome relief from the the reality of problems however have increased problems in the long term. Public health intervention should be about reducing vulnerabilities, providing opportunities and meaningful activities. Limiting access to alcohol is a classic public health intervention to deal with the environment that we live in. We must address both individual factors and environmental factors and to always be guided by evidence.
Thanks for effective works in Turkey, particularly happy to see close cooperation between all NGOs. As the Turkish mission in Vienna we stand ready to support you