A gentle start: the global state and “the do’s and don’ts” of psychotherapeutic approach towards addiction
As a rule, statistics is a very boring job. However, with its irrefutability and urgency, this numeral approximation of reality attracts our attention the most, motivating us to deal with the specific problem more thoroughly. The number of 208 million individuals who use illegal drugs throughout the world, a number I was faced with during a conversation with d-r Hristijan Jankuloski from HOPS, cleared my focus: What does this mean translated into human lives? What are the consequences? Are we speaking of a growing trend – and for which type of drugs? What does this tell us about the efforts and the millions invested in prevention, information, demonizing and regulation of illegal substances? What weakness and failures are reflected by this situation? How, if at all possible, can we approach effectively these users whose normal functioning is prevented due to drug related problems?
An important notion I came to realize on the second day of the School, during the lectures of Prof. d-r Slavica Gaidadzis-Knezevic, was the objective account on drug use – for my value system it’s very logical that the truth is never monochromatic and no one thing in the world as we know it is bad or good in itself. Bearing in mind that the issue of addiction has been prevalent for decades throughout the world, I asked myself why aren’t we still able to discuss this subject openly. Don’t all the fruitless efforts in emphasizing the evil of drugs prompt us towards a new approach with people who use drugs? Do we even make an effort to understand or are we barely managing to isolate ourselves on a safe distance from the “normal”? Indeed, isn’t it true that we as professional supporters most often treat drug users as weaklings too lazy to carry the burden of live on their own. Furthermore, do we ever sometimes dare to reach to the root and background of the addiction problem, deeply entwined in the network of socio-economic conditions, social behaviours, dysfunctional family patterns and inadequate legislative regulations or are we simply aimlessly going in circles around the symptoms.
The creative analysis of doctor Gaidadzis-Knezevic enlightened a new moment in my perception – there are different types of drug users. There are different levels of self-control in drug use. There are different levels in the preparedness for a change. The final goal of therapy cannot be saving the clients at all costs, rather developing a higher potential for change. Such setting does not limit people with addiction problems to merely nourish our need to be their saviours. Any improvements in the quality of life of people who use drugs is a great start, contrary to the public beliefs, insisting on complete abstinence is not the only method of achieving this goal. They cannot become hostages of our arbitrary moral system.
We continue: a peek in the cortex and introduction with the programs for harm reduction and psycho-social support
My days are filled with such enhancing conversations that I hardly manage to go through the whole material and assimilate it, and while I am still hang up on psychotherapy the third day of the School has arrived. Doctor Darko Kostovski’s lectures clarified my questionable knowledge about the medical model of addiction, and it became clear that over-psychologising the phenomenon leads towards minimizing its neurophysiological basis, not to be underestimated on account of glorifying will power. Immediately, I acknowledge that I have never previously understood the entire role of substitution therapy in drug addiction treatment and I appreciated the chance to get some insight in the mechanism functions of, for instance, opioid addiction as a serious transformation of the cerebral biochemistry. As much as we might refute it, though imperfect, this medical method allows the stabile functioning of many users. In the methadone centres the professional team has regular access to the user population and insight into their lives, thus acquiring an opportunity to deal with the psychosocial part of addiction, necessary in order to achieve essential and sustainable effects.
I hold in high regard my visits to the Day Centre for drug users – Inter-municipal centre for social work – Ohrid and the offices of the harm reduction program within the NGO Option – Ohrid, where our small but versatile group was able to experience the conditions (or the lack thereof) in which expert teams engage in this issue. In the discussions with Vlatko Dekov from HOPS I was introduced for the first time with the term harm reduction in this context which mainly covers HIV/AIDS prevention, Hepatitis C and other diseases by providing access to sterile injecting equipment via painstakingly accomplished trust and space to approach users, successfully managed by several organizations in Macedonia. Quite unexpectedly, instead of lethargic resignation we were welcomed to these places with the enthusiasm and dedication essential for working with this marginalized group. However, it is uncomfortable to reveal the small number of health workers who have the will to work in this field, although the general wellbeing of people is the noble principle in the core of their professions. It might sound naive and rhetorical but aren’t discriminatory politics within health care a particularly shameful characteristic of a society striving towards humane development?
The end is near. Wait, what about punishments?
On the sixth day Natasha Boshkova, a lawyer, gave a presentation on the legal regulation of illegal drug use and possession in Macedonia. The unbalanced approach towards different types of criminal acts related to illegal drugs and the Draconian punishments lead to unnecessary destruction of human lives instead of a mature social change, while the problem sinks further down in the underground. The notion that drug use can be controlled, but not eliminated has still not found fertile ground in the judicial system of our country. I can’t say that I was surprised by the data that around 60% of the prisoners in the prison Idrizovo have committed the same crime more than once, while a third of them are drug users. We don’t require a special analysis to conclude that the system is explicitly rotting, although obviously it is still too comfortable. The lack of psychosocial support for drug users is obvious in certain environments, however the prison population might be the most specific vulnerable group, as was elaborated in details by Anica Dimovska, who presented the results of the one-year project HOPS did in collaboration with the prison Idrizovo. Isolated far from our eyes, we don’t know and we don’t wish to know about their struggle with addiction.
To be honest, I would be lying if I said working with drug addiction is my professional dream come true. It is a difficult and unpromising job requiring a tough stomach, sharp teeth and steel nerves, while on the other hand it has a weak “feedback” and even smaller social support.
However, the common ethics I consciously synthesized from the principles of applied psychology instructs me to direct my energy, knowledge and support where they are needed, within an organized system of efforts for the promotion of quality life. In this context, my profound interest in this topic was the motivational basis on which the short but intensive school built the foundations for future growth. With my novice motivation to challenge rotten norms and inefficient practices, together with my colleagues from the Summer School, I dared to enter a process of destroying myths, painfully forgoing introverted taboo attitude and a patient practice of the ability for authentic understanding. At the same time, this attitude was strengthened with the cooperation, the unselfish sharing of skills and experiences and friendship with the organizers and lecturers. I would also like to mention the presentation of Vanja Dimitrievski, M.A. on the methodology in social research on drugs and the lively discussions with Zoran Jordanov from the NGO Egal who gave a lecture on protection from HIV/AIDS, and urged us to entirely deconstruct the prejudices towards marginalized groups in society. A whole is when you have all the pieces – this is what I received from the School which I sincerely hope it will continue to exist and prosper and deepen its profoundness to create a functional multidimensional network of experts dedicated to diminishing the degradation and exclusion of citizens facing addiction issues – and I firmly believe that we are moving in the right direction.
Marija Grubor was born in 1992 in Veles. She graduated at the Psychology Institute within the St. Cyril and Methodius University in Skopje, and is currently enrolled at the postgraduate culture studies at the Institute for Social Studies and Humanities. She is an intern at the PHI University Psychiatry Clinic and is an activist in several progressive social movements. She writes and has published poetry, prose, articles and essays.