Why are drugs attractive? How does an addict behave? What can I do to help my child avoid drugs? What can I as a teacher do? What can a community do to educate its population about the harm of drug abuse? What is best - hospitalization or therapy? Or both?
Delving into these and similar questions in search of answers to fit their specific populations and witnessing some of Israel's answers, 35 men and women from 28 countries recently participated in an International Seminar on the Prevention of Drug Abuse, held under the auspices of the Foreign Ministry's Center for International Cooperation, MASHAV, between October 28 and November 30, 1998, at the Aharon Ofri International Training Center at Kibbutz Ramat Rahel, on the outskirts of Jerusalem.
They came to Israel from China, Brazil and Azerbaijan, Turkey, Vietnam and Colombia, from Buthan, Cyprus and Yugoslavia, from Cameroon, Kenya and Romania, from Jamaica, Mauritius and the Philippines, and from many more places where people are concerned with the growing problems brought on by drug abuse. They came to learn how Israel, both on the governmental and the public level, is tackling drug addiction. And they went back to their countries full of enthusiasm and revitalized energy, strengthened in the knowledge of the importance of their mission.
In the pleasant, sprawling grounds of Ramat Rahel, the 35 psychologists, psychiatrists, doctors, nurses, police officers, educators and social workers came to gain knowledge and learn new techniques to combat one of the scourges of modern life. This interdisciplinary course - the second of its kind - dealt with concrete programs in the fields of prevention, treatment and law enforcement of drug abuse. Cooperating with the Ofri Training Center in the organization of the 5-week course were the Israeli Ministries of Health, and of Labor and Welfare, the Anti-Drug Authority in Israel and the Police Department.
"Drug abuse is a problem which weighs heavily on each of the countries from which our participants come, no matter what other specific problems these countries may have. What we are saying to them is, 'Let's work on the problem together,'" said Yehudit Rosenthal, director of the course at the training center.
The Ilanot therapeutic community in a rural area near the center of the country, a Methadone Center in Jerusalem, a hospitalization and rehabilitation center in Beersheva, the Rishon le-Zion community project and a comprehensive municipal anti-drug project in Haifa were among the places of professional interest the group visited, in addition to touring Jerusalem, Tel Aviv and the Dead Sea area and seeing the holy places around the Sea of Galilee. The participants listened to lectures on the theory and practice of drug and alcohol prevention, on the Israeli model of organizing the community to fight drug abuse, on new perspectives and directions of the educational system in this fight, on methadone treatment of addicts and on police enforcement of the law against drug abuse.
In addition to learning about the Israel experience, the participants interacted closely with one another, gaining knowledge about the respective problems and programs in the various countries. "None of us is so rich that we can afford not to fight drug abuse," is how one of them put it.
Gabriel Hernandez Kunzel, a psychiatrist at the Hospital Militar Central and also at the Instituto Colombiano del Sistema Nervioso Clinica Monserrat, in Santafe de Bogota, whose country, Colombia, has an enormous drug problem, both in production and consumption, spoke about man's search for meaning. "People look for happiness through science and technology, falling into the use and misuse of drugs, sex and violence to fill the void in their existence, to find relief from sorrow and boredom in their lives." While there are drugs which are illegal, there are others which are legal and easily obtainable, such as inhalants, alcohol and tobacco - all of which are also harmful to the individual, the family and society.
One Israeli lecturer, Hana Gibor, who works for the Youth Department of the Ministry of Education, spoke of how children can be "ambassadors of drug prevention" in their school. She also spoke of the program, "Enough - Life without Drugs," which, via games, in a group environment, develops and expands individual interests. When a youngster is motivated and given the opportunity to, for example, become a sports trainer or learn the tricks of a magician, he can be shown the way to success, and thus be diverted from taking drugs. What is problematic, she added, is to know how to divide government funds: how much to spend on prevention and how much on treatment. Importantly, according to a recent study in the United States, every $1 spent on prevention saves $17 in terms of crime and human suffering - both in developed and developing countries.
"The phenomenon of drug abuse is neither new nor simple," says Dana Slobadanka Kitic. "It has existed for ages and has many facets - it is a worldwide phenomenon. I live in the Serbian city of Nis, which is at the crossroads of the main drug-routes. The consequence of our recent economic and political crises, the social disturbances and the consequent loss of values have both lowered and raised the age of drug addiction: it now affects 9- to 35-year-olds. Almost all experts would agree that the situation is alarming. It is obvious that the problem of drug abuse isn't overseas or over the border....it is in our own backyard."
Thus a decision to do something on the local level, in Nis, produced a 10-citizen Committee for Civic Initiative "to ring all the bells in the town to awaken the sleeping citizens and help the weakened institutions to cope with the problem," says Kitic, who was the only non-professional among course participants dealing with drugs - she is professor of linguistics at the local university. Drugs in our Yard, A Smoke of Joy....a Horror Toy, Taking dope = hopeless hope are some of the slogans (translations from Serbian), used by the committee - the results of competitions among youngsters in the town. In addition to the competitions for slogans, posters and badges, the committee sponsors street concerts by youth groups, peer teaching in high schools and universities, as well as live programs and audio and video clips on radio and television, together with articles in the printed media, such as My Story and the ABC About Drugs. "We also organized two happenings: Let Us Play Music Against Drug Abuse and Let Us Paint Against Drug Abuse," she adds.
"Drug crimes in the People's Republic of China, which had been almost completely eliminated for 40 years, started reoccurring in the 1980s," says Li Huifen, senior pharmacist at the Beijing Municipal Institute for Drug Control of the Bureau of Public Health, "and there is a sharp increase in the number of drug crimes in large cities in recent years." A special anti-drug force has been formed, prevention and education programs are carried out via the media, and school programs aim at students in areas where drug abuse is a particularly prominent problem. Some 800 detoxification centers are in use throughout the country: when a drug user is discovered, he is sent to such a center for 3-6 months.
"But," adds Li Huifen, "95% of the drug users experience a relapse." She therefore proposes to set up a pilot project "based on the knowledge gained and absorbed from the MASHAV seminar." The pilot project she proposes, to be located in a big city, is a methadone treatment center. In China, she adds, methadone treatment goes against tradition. While it is legally manufactured, it is under strict control. "But since the drug abuse problem is increasing and the relapse rate after detoxification is so high, we have to find a better method to keep people off drugs, and MM treatment is one of the most effective and cheapest methods."
Treatment requires daily on-site oral intake of methadone, as well as participation in an on-site counselling program. Applicants for the treatment center, opiate addicts for aleast two years, would be carefully screened and interviews with them and their families conducted. The training of the working staff - doctors, pharmacists, social workers and others - could be done by inviting experts from abroad (such as Israel), she suggests to lecture in China, and by sending some of the key staff abroad to study.
Social worker Eunice Muthoni Ndonga of Kenya says that in her country the drug problem cuts across the economic, religious, cultural and political divide. Ndonga says that the number one problem in Kenya is home-brewed alcohol to which chemicals and gasoline are added. That is illegal, and is the cause of many car accidents. But a stimulant called khat which can be chewed with chewing gum and has the same effect as cocaine is legal and in common use.
Back in her city of Nairobi, she expects to set up a project she calls "We are the Tools," which would concentrate on a prevention program for mothers aged 30-50 and teachers in primary and secondary schools. Her rationale is that mothers and teachers produce a multiplying effect and can directly or indirectly train other mothers and adolescents. The year-long program would aim at: the strengthening of the family unit, teaching effective communication skills to mothers and teachers, establishing a community-based resource/information center and using the local print and electronic media for the transfer of information. Accompanying the activities would be a continuous monitoring process and evaluation during and at the end of the project. "I have gained some tools for delivering information from the lectures we heard, and primarily from the professional visits to Ilanot and Rishon le-Zion, as well as from the experience of my colleagues at this seminar. 'Harambe' in my country means pulling together. I want to emphasize that everybody must join hands for a concerted effort to fight the drug scourge which is threatening the whole of mankind," Ms. Ndonga concludes.
"There is a growing awareness and appreciation in recent years of the struggle with the phenomenon of drug abuse, which is spreading like an infectious disease," says Nazan Unsal of Turkey, who works in AMATEM, acronym for the 120-bed Alcohol and Drug Addiction Research and Treatment Center in Istanbul. "We have similar centers in other cities, but what is that for a population of 70 million? Tobacco and alcohol are our traditional ills," she adds. "Then come marijuana, heroin and inhalants, which are the cheapest and most available: paint solvents, nail polish, glue, etc." Patients in the center submit voluntarily to a 10-day detoxification process and subsequent 28-day in-patient treatment. After their discharge from the hospital, there is no organized follow-up program, states Unsal, and there exists no therapeutic community which can offer the addicts help. "Since 28 days are not enough for the patient to change his or her addictive habits, I feel that a rehabilitation program must be longer and ought not to separate the patient from his or her family and social environment." Unsal, therefore, proposes a new model of out-patient treatment, a program which would include a halfway house, rehabilitation activities and psychological treatment for addicts of all ages. Its specific objectives would be aimed at: 1. preventing a relapse in patients, 2. enriching the relations between the patient and society 3. improving relations between patient and his/her family, 4. teaching him/her to take responsibility for his/her life without the use of psychoactive drugs, 5. improving the patient's self-esteem, 6. improving his/her life skills, 7. having him/her learn to enjoy new hobbies, such as gardening, cooking, etc. Music, art and sport teachers, as well as a gardener, carpenter and chef would be on the teaching staff. These could be ex-addicts, who by their presence might motivate the patient to rid himself of the drug habit. Another part of the plan is to have "clean addicts" tell their life story and experiences to students in schools.
Dr. Argyris Argyriou, a psychiatrist working in a hospital in Limassol, Cyprus, considers his experience in Israel "rich, unique, valuable and very useful." According to Dr. Argyriou, the reason for Cyprus being the country in the region with the smallest drug abuse problem is the protective factor of the strong family structure. He says that while only 2-3% of the youth population and only 1% of adults (of these, 80% men and 20% women) have tried drugs, the problem of drug abuse is growing. The most frequent substances of abuse are tobacco and alcohol and among the illegal ones, cannabis and, in a few cases, heroin. Treatment centers exist in Nicosia, Limassol and Larnaca. The Cypriot psychiatrist hopes to "transplant this most useful cooperation and coordination between the various services and professions, government and public organizations I witnessed in Israel."
His plan aims at instigating competitive motivation between the various political parties: he wants to sensitize politicians to prevention strategies, involving in particular the parties' women and youth sectors. These would then be involved in anti-drug activities in the community. Training workshops - of a 60-hour duration in the course of 4 months - would produce paraprofessionals who could then teach youngsters such life skills as decision making, problem solving, assertiveness, resistance to social pressure and stress management.
Thomas Lekama, MD, from Cameroon, says that the most common problems in his country are delinquency, all forms of abuse, accidents, crimes and diseases such as hepatitis and AIDS many of them a consequence of drug abuse. Some citizens acknowledge the problem of drug abuse and its effect, he claims, but lack motivation to take action. The project he suggests for fighting drug abuse is a one-year interdisciplinary program targeted at youth between the ages 10-30 in formal and informal education sectors in the capital of Yaounde. The program objectives would be: 1. informing youth of the dangers of drug abuse, 2. mobilizing a joint community action against drugs, 3. strengthening young people's self-esteem, and 4. identifying the services involved in early diagnosis and treatment of the addicts.
The activities would be on four levels: 1. educational - lectures in schools and workshops for parents, 2. medical - treatment and rehabilitation, 3. psychological counselling, and 4. law enforcement - drug addicts identified but refusing treatment would be punished. "We hope that if this program succeeds, many young people would start to open their eyes and unfold their arms. The whole nation would benefit."
The Brazilian state of Rio Grande do Sul has a population of 10 million living in 667 municipalities. Dr. Carmen Co Freitas, a psychiatrist, is director of Centro Wallace Mandell, a mental health facility in the municipality of Porto Alegre. "If it is true that marginal socioeconomic conditions provide fertile ground for increased drug abuse problems, Brazil, as well as other South and Central American countries, during the last decades, have become the ideal environment for the growth in production, trafficking and consumption of legal and illegal drugs." In the last 10 years, the consumption of tobacco among students from 5th grade to the end of high school in her city jumped from 20.8% to 44.1%, of marijuana from 4.5% to 14.4%, and of cocaine from 0.3% to 4.5%.