Seized drugs, police raids and sting operations grab headlines, but prevention, treatment and rehabilitation are equally important in curbing the drug problem. "Supply and demand are equal evils, which must be attacked simultaneously and with similar vigour and conviction", says Pino Arlacchi, Executive Director of the UN International Drug Control Programme (UNDCP). "Success of demand reduction is crucial if we want to ensure permanent success in the fight against drugs."
The push for balanced drug policies which tackle both supply and demand is gaining momentum. In February 1998, U.S. President Bill Clinton set a goal to cut national drug demand in half by the year 2007. Around the world, there is a growing consensus that more should be done to understand and reduce rising demand for drugs.
In the developing world, producer countries are increasingly aware of rising drug-abuse within their national territories. Heroin abuse is increasing in Afghanistan and Myanmar, the world's biggest opium-producing countries. In Eastern Europe and the former Soviet Union, where drug abuse was almost non-existent during communism, it is now a growing problem. According to some surveys, the number of persons abusing drugs regularly in the Russian Federation is estimated at about 2 million. In Ukraine, the number of registered drug addicts rose from 8,000 in 1992 to 65,000 in 1996, according to the International Narcotics Control Board. And consumer countries in the industrialized world are worried about the added threat of new manufactured synthetic drugs like methamphetamine.
Demand reduction is one of six key issues to be tackled at the United Nations General Assembly special session on the world drug problem, to take place from 8 to 10 June in New York.
Reaching young people
Most prevention campaigns focus on youth, because the longer initiation into drug use can be delayed, the less likely it is to begin or, if it does begin, to become compulsive. Other target groups include women, minorities, street children, workers and prisoners - all of whom have special needs and concerns.
"When you start an education strategy, you cannot have results in one or two years", says Mr. Arlacchi. "You have to understand that the results come after years of continuous efforts. But these are permanent results."
Globally, school-based activities, especially in secondary schools, are the most widespread form of drug-abuse prevention.
The most effective programmes are those which are long-term, comprehensive and embedded into existing curricula. Of course, it is also necessary to target those who are not in school. Therefore, outreach efforts on the streets are often helpful.
Overall, there is a move away from simple "anti-drug" messages to "pro-health" campaigns and life-skills training. Recreational, sporting and cultural activities are offered as alternatives to drug-taking. Rather than just imparting knowledge, this new emphasis aims at building self-esteem and skills in problem-solving and communication. This departure reflects a growing awareness of the limitations of past campaigns which were not very effective, especially in the classroom.
Many educators have viewed schoolchildren as a captive audience to bombard with information. While accurate information is certainly needed, the new approach replaces lectures with student participation, opening up new possibilities. "This training helps kids develop skills so they can face stressful situations and peer pressure, which usually tend to be related to certain types of risky behaviour such as unprotected sex, teenage pregnancy, drug abuse and crime", says a UNDCP official. "The issue is not so much about providing information about drugs but providing them with coping skills to face situations which can lead to drug abuse."
These programmes, based on social-learning theory, teach children how to recognize pressures that influence them to smoke, drink and use drugs and how to resist these pressures. The impact of these programmes is much greater when prevention includes families, media and the community in a comprehensive effort to discourage drug use.
Another emerging field is gender-based prevention programmes, which focus on the difficulties many women and girls encounter in seeking advice, information and treatment. In the Congo, for example, a"mother and child foundation" has been set up to help young girls with drug problems, while in Zaire the media provide weekly awareness messages for women. A UNDCP initiative covering eight African countries incorporates a drug-abuse prevention element into an existing women's health research and intervention project.
While widely used, general public information campaigns have demonstrated little effectiveness in changing behaviour. Frequently, the campaigns have been poorly targeted. However, they can be used to raise awareness concerning not only the dangers of drug abuse but also the dangers of specific practices, such as injecting drugs. A successful television campaign in Brazil, which was mounted to counter rising rates of HIV infection due to intravenous drug use and unprotected sex, uses the Carnival season as a backdrop to promote condom usage. The campaign by the Brazilian Ministry of Health promotes the use of condoms as part of Carnival festivities.
Creating an effective drug-abuse prevention message is not easy. But experts who have been working in the field find that paternalistic, exaggerated and shock-filled messages are bound to fail. "The simple message `Don't do drugs' is not particularly useful, because there is the risk that young people will perceive it to be coming from grown-ups whom they want to challenge", says Jukka Sailas of the World Health Organization's Programme on Substance Abuse.
Of particular concern to drug counsellors and other experts is the fact that young people are increasingly surrounded by messages which tolerate and even promote drug use. Drugs are often glamourized in popular songs, movies and even advertising, as witnessed recently in the "heroin chic" fashion look. With global media outlets, these messages are reaching young people around the world - a trend that worries the International Narcotics Control Board, which monitors the drug situation worldwide. In its 1997 report, the Board invites Governments to contact music and sports stars to explore ways of contributing to the development of a popular culture that is against drug abuse.
Conflicting messages - some glamourizing drug use and others condemning it - confuse young people. "It is important to tell it like it is and then accept that young people will make their own choices", says an official of UNDCP. "The best thing is to make sure the information is reliable and factually correct, and to provide youth with more healthy alternatives."
There is a push to link media campaigns to community-based prevention and treatment services to effectively reduce demand for drugs. With this in mind, a five-part public television series on addiction in the United States, which aired in 1998, was coupled with a nationwide outreach campaign to inform people and involve them to take steps to address addiction in their homes, schools, workplaces and communities.
Prevention in the workplace
Drug and alcohol abuse affects workers' health and productivity as well as companies' profits. Abuse is sometimes exacerbated by working conditions.
* Absenteeism is two to three times higher for drug and alcohol users than for other employees.
* On-the-job fatalities linked to drugs and alcohol account for 15 to 30 per cent of all accidents.
* Employees experiencing drug and alcohol problems may claim three times as many sickness benefits and file five times as many workers' compensation claims.
In 1997, UNDCP, the World Health Organization and the International Labour Organization completed a $2.6 million, five-year joint project to prevent and reduce substance abuse among workers and their families. Model programmes, which focused on early detection and intervention rather than crisis management, were developed for 58 companies in Egypt, Mexico, Namibia, Poland and Sri Lanka. Due to its success, the concept has been expanded to Central and Eastern Europe, Brazil and Jamaica. A training manual is being produced for business managers interested in adopting the model in their workplaces.
Treatment and rehabilitation
"Fundamentally and at its core, addiction is actually a brain disease", says Dr. Alan Leshner, Director of the US National Institute on Drug Abuse. This disease is too complex to be cured by a single magic bullet, he cautions.
High-tech imaging technology which shows how the brain is affected by drugs has improved the understanding of addiction. "Addiction is a chronic, relapsing disorder", says Dr. Leshner. "It is not like breaking a bone. It is more like diabetes and chronic hypertension, where there will be or is a high risk of occasional relapse."
In fact, one major problem associated with any service for drug addicts is that expectations by the service providers are often too high. Reviews of the success of treatment regimes indicate that, in Europe and North America, there is a substantial relapse rate for addicts within three months of completing a treatment programme. However, experts caution that relapse should not be considered a failure, but rather a step on the road of rehabilitation.
"Careful and systematic research on the effectiveness of treatment for various psychoactive substances has shown that treatment indeed works and is cost-effective, despite a general opinion to the contrary", says Jukka Sailas. "Both pharmacological and non-pharmacological treatments have been evaluated and proven effective. Morbidity and mortality from psychoactive substance abuse can be effectively reduced by adopting strategies that do not focus primarily on stopping abuse, but on reducing the harm that use is causing."
Even though therapeutic treatment communities still exist, the trend is towards shorter stays, greater professionalism, individualized therapy and more emphasis on helping people to prepare themselves for independent living after treatment. Substitution or maintenance programmes, such as methadone for heroin addicts, are available in a number of countries. So far there is no substitution drug therapy available to treat addicts of cocaine or amphetamines. Experience has shown that substitution programmes are hard to sustain in developing countries because of high costs.
The best treatment is that which will encourage drug addicts to come forward and seek help. Ideally, drug treatment should include counselling, guidance, motivation, medical treatment, rehabilitation and social integration. Treatment programmes should be individualized and geared to the patient's situation and personal problems. When appropriate, family members should be involved. "Transit" institutions, in which former drug addicts can be trained to lead an appropriate lifestyle, should be established. Youth movements, sports clubs and religious organizations can help people stay in drug-free environments.
There is a concentration of drug abusers in prisons. However, incarceration does not solve the problem. Any serious effort to reduce drug demand, as well as the spread of HIV/AIDS, requires effective treatment and rehabilitation services in these institutions. Advocates for drug treatment in prison also believe that the provision of such services will serve to break a vicious cycle of drugs, crime and imprisonment.
In the majority of developing countries, specialized drug-treatment provision is concentrated in the largest cities, while even the most basic medical services may be severely limited by lack of resources. Native wisdom and indigenous healing practices are often the sole source of treatment for drug abuse. Traditional healing methods are particularly widespread in Asia and Africa. Ritual and symbolic procedures involve incantations, invocations and various forms of spiritual and physical purification; death-rebirth scenarios may be played out. Herbal mixtures to induce vomiting and laxatives are used to drain or purge the body of the addictive substances, followed by intake of, or bathing in, consecrated fluids and massage and physiotherapy. Religious rites of confession, pledge and sacrifice are performed to signify the liberation of an individual from the scourge of addiction.
Yoga and other traditional practices such as homeopathic medicine, acupuncture and transcendental meditation have been adopted by western practitioners. Sometimes Eastern and Western practices are combined, as in Hong Kong, where methadone maintenance is provided on a short-term basis, and traditional treatment is provided in Buddhist temples. Monks dispense herbal medicines, provide spiritual guidance and encourage meditation and religious vows of abstinence.
Although there has been little scientific research on the subject, it is generally believed that traditional and spiritual practices to treat addiction are just as effective as mainstream Western medical methods. Most experts acknowledge that different treatments work for different people.
Overall, the success or failure of drug treatment programmes depends on many factors, both internal and external to the drug addict. For some, total abstinence is the most suitable course. For others, a slow reduction in dosage accompanied by supportive psychotherapy is preferable. Some need the axe of punishment hanging over them; for others the prospect of a more stable family life is sufficient motivation.
The longer an addict receives support, the better the chances are for recovery. A survey conducted in Hong Kong over a three-year period showed that addicts attending self-help groups remained drug-free significantly longer following treatment and recovered from their first relapse episodes more quickly than addicts who had no support.
The UN's role
As the 1990s UN Decade Against Drug Abuse approaches its end, the UN General Assembly will hold a special session on the world drug problem from 8 to 10 June in New York. A political declaration to be adopted commits Governments to set up new or enhanced demand-reduction programmes by 2003 and to"achieve significant and measurable results" by the year 2008. A declaration outlines principles to guide Governments in setting up effective prevention, treatment and rehabilitation programmes and calls for the provision of adequate resources for such programmes.
"This is the first time the countries of the world are placing as much emphasis on demand as on supply", says Mr. Arlacchi.
In collaboration with WHO, the ILO, the UN Children's Fund, the UN Development Programme and the UN Population Fund, the Vienna-based UNDCP collects information about the effectiveness of different prevention, treatment and rehabilitation approaches and analyzes which work best in particular contexts. It identifies alternative approaches that are effective in different social and cultural conditions. Through 22 field offices around the world, UNDCP provides technical assistance and shares information with experts from government and non-governmental organizations.
In order to develop effective demand-reduction activities, the Programme carries out rapid assessments to determine the nature and scope of the drug-abuse problem in a particular country or region. A draft rapid assessment manual has been developed. UNDCP also coordinates the International Drug Abuse Assessment System, which is a global clearing house for drug-abuse information.
Published by the United Nations Department of Public Information - DPI/1986 - May 1998
UN Department of Public Information
Bill Hass, tel. (212) 963-0353,
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UN web site: http://www.un.org
Sandro Tucci, Spokesman
UN International Drug Control Programme
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