In my 21 years of working experience in the Centre for Prevention and Treatment of Drug Abuse and Abuse of Other Psychoactive Substances I have never encountered so many young people experimenting with drugs or using marihuana as I encountered in the first 6 months, and afterwards, at the Counselling Centre for prevention of drug use and use of other psychoactive substances among high school students in Skopje. I wondered why treatment centres for drug abuse and addiction had so few young clients, and I presumed it was two reasons; one reason was that young people have few problems related to psychoactive substances, and the other that these programs weren’t appealing to them. However, when I began working at the Counselling Centre I realized that young people had problems they wanted to share and solve with the help of a professional but had nowhere to turn to before the Centre was opened. Young people avoid visiting the existing prevention and treatment programs from one simple reason – they are not tailored to their needs, hence they are unappealing to them. Anonymity and confidentiality were crucial for my clients at the Counselling Centre. At first I had clients who refused to reveal how old they were, where they studied or what year at school they were due to the fear that some information might be shared with the school. Adults were no different, or if you wish, the other way round, children were no different than their parents. Some parents were very cautious in their conversations with me, afraid they might share some information that might help identify them. There were cases when I couldn’t see the colour of their hair because they wore hats, but after 2 or 3 meetings they felt safe and secure at the Centre and felt free to reveal their identity, although nobody asked them to. It was not difficult to understand that many young people and their parents were stigmatized due to drug use, and in order to avoid it and not reveal their identity they were ready to deprive themselves of any kind of treatment.
The Counselling Centre for prevention of drug use and use of other psychoactive substances among high school students in Skopje started work in September 2012. It is only part of the efforts to prevent drug use and use of other psychoactive substances among high school students in Skopje, supported by the City of Skopje and implemented by HERA – Health Education and Research Association. The activities are included in the Local Drugs Strategy of the City of Skopje. At first, the Centre was opened twice a week for two hours. A year later, due to the increased demand for the services, it started working three days a week for three hours, however later due to financial restrictions it was decreased to twice a week for three hours daily. During 2015 there was an unexpected 2-month interruption due to insufficient funding, which later reflected the frequency of visits, i.e. we “lost” some of the clients who had been visiting the program continuously. Lack of funding is a serious threat and sudden interruptions in the work must be prevented in future. At present, the Centre works twice a week (Monday and Wednesday), three hours a day – Monday from 2.30 p.m. to 5.30 p.m, and Wednesday from 4 p.m. to 7 p.m. In 2015, in just 10 months, 207 clients visited the Centre during 242 visits, out of which 141 clients were new (young people, parents, partners and professionals). Some of the clients require several visits and continuous work and monitoring, some information and psycho-education and visit the Counselling Centre only once, while other clients, the smallest percentage, are referred to another institution. The clients mostly use marihuana, alcohol and sedatives, rarely narcotic substances and opioids and some clients do not use any substances.
The Counselling Centre offers several types of services – counselling, support and treatment for young people as the main target group, but also for partners, parents and professionals from within the educational system. The access is comprehensive and we offer support not only for the people with problems but also for the neighbouring community as well.
Of particularly importance were the visits from high school students accompanied to the Counselling Centre by professionals and teachers, although there was a case when a professional asked for advice on how to remove a student from the school due to the pressure of the students’ parents. Particularly impressive were the rational and emphatic teachers who visited the Counselling together with their student/s, with or without the parents.
The Counselling Centre functions within the Counselling Youth Centre “I Want to Know” which offers confidential and free services for sexual and reproductive health. This Centre has been active since 2005 and throughout the years, the friendly, non-judgmental, non-moralizing, emphatic, understanding and rational approach to the problem proved as very effective and functional for youth health care. It was the reason for launching the Counselling Centre for Prevention of Drug Use and Use of Other Psychoactive Substances within the Counselling Youth Centre “I Want to Know”. Furthermore, the clients find it useful to receive several services in one place, such as: counselling for preventing use of psychoactive substances by a psychiatrist and confidential services for sexual and reproductive health by a gynaecologist and a dermatovenerologist.
Young people and their parents or partners come to the Counselling Centre usually because of: peer pressure to use psychoactive substances, someone offering them drugs, friendship with a peer who uses drugs, a partner who uses drugs, fear they might turn to drugs, bellow-average success in school, a parent who has found a psychoactive substance, fear they might be “tricked into consuming drugs” without their consent, experimentation with psychoactive substances, harmful use, mental states caused by the use of psychoactive substances, maintaining abstinence. The Counselling Centre is also visited by young people from the Children’s Village, high school students in Skopje, civil society organizations who seek information, education on prevention and refusal techniques.
The most sought psychiatrist’s services are: counselling, psycho-education of parents, partners and young people, supportive therapy, motivational interviews, refusal techniques preventing recidivism etc. Psycho-education is particularly important not just for young people but also for parents or partners to understand and accept them easier, not judge but support them in finding the strength to fight the problem. Although, honestly, there are many stubborn parents/partners and in such cases the entire process is long and frustrating. Support for the clients in such cases is very useful. Supporting the confused and scared parents is also useful because the parents’ stress and fear might cause greater harm in the home than the substance consummation could. Psycho-education on psychoactive substances is realized through videogames for legal and illegal psychoactive substances designed to encompass all aspects (legislation, forced sexual services, somatic and psychological disorders), through various characters and their lives, guides on drugs (form, effects, risks, legal aspects), teaching them how to respond if they are offered drugs, surveying drug attitudes, information that possession of the drugs offered is illegal and that its contents are unknown.
We raise awareness in young people of the pressure their peers impose on them in order to lure them to drug use, teaching them how to avoid this pressure by practicing refusal and avoidance techniques. Very often young people, or even adults, don’t know how to say “no”. In the Counselling Centre they learn and practice how to say “no”, how to avoid the pressure. They are encouraged to apply the techniques in reality and a client’s success is awarded with affirmative messages which additionally motivate them to further personal growth and development. A client who learnt how to be assertive, how to refuse and say “no”, later brought a friend to the Counselling Centre.
Regarding use of several substances simultaneously, whether legal or illegal, young people are taught about the risk of mixing different substances and surveyed as to the reasons of taking several substances at once etc.
Regarding the legal aspects, they are offered information and counselling that drug possession and “dealing” is punishable, that punishments for “drug dealing” are high, and that even buying drugs for a friend is also defined as “dealing”, we help them learn how to respond when they are asked to do something illegal and how to negotiate with peers.
The remaining services clients receive in the Counselling Centre are: gynaecologist’s and dermatovenerologist’s examinations, testings, counselling on pregnancy and contraception, HIV testing and counselling, and counselling on sexually transmitted diseases.
The friendly approach drew young people from other cities as well, who were accepted and treated equally to the Skopje youth. This demand for our services demonstrates the dire necessity throughout Macedonia. Our willingness and availability to help them is not a solution because access and travelling expenses present a serious obstacle to these services for most young people and parents. The City of Skopje and the professionals have to contribute in training staff who could work in such counselling centres established in other cities, of course should the need arise. Still the biggest responsibility and the decision to open such counselling centres should be of the cities themselves, with the support of the Ministry of Health, the Ministry of Education and the Ministry of Labour and Social Politics. Apart from high school students, many of the clients are older adolescents. Sometimes adults ask for services as well, for instance the case with an adult woman asking for help from the Counselling Centre due to lack of specific programs for women, an exception of course. She scheduled the appointment in the name of the child of a colleague’s friend; perhaps my colleague was not aware who the client exactly was, but to my surprise an adult woman appeared at the scheduled time. After I listened to her, I had no choice but to continue working with her on her problem because I did not know where to refer her without making a bigger damage. During my work with her she gave me information on a younger member of her family who had problems and had been taking sedatives, who later also became a client. Still, I will never forget her happiness and contentment from the approach and treatment.
Docent d-r Liljana Ignjatova is the Head of the Centre for Prevention and Treatment of Drug Abuse and Abuse of Other Psychoactive Substances at the PHI Psychiatric Hospital “Skopje,” Macedonia, and a Docent in Psychiatry and Medical Psychology at the Medical Faculty at the St. Cyril and Methodius University in Skopje. Doc. D-r Igjnatova is a founding member of the Board of Directors of the SEE Adriatic Addiction Treatment Network, as well as a founding member of the World Federation for the Treatment of Opiate Dependence. She is a permanent correspondent from Macedonia for Pompidou Group, Council of Europe. In 2015 she was awarded with the SEE net Reflection Award.