Drug use among children in Macedonia is becoming an increasingly visible problem requiring serious approach and immediate reaction by professionals working in this field as well as the decision-makers in order to introduce changes in the health and social care system. The crucial step now is for the Ministry of Health and the Ministry of Labour and Social Politics to work jointly towards opening programs for treatment and care of children who use drugs. Such programs at the moment do not exist in Macedonia.
HOPS has been calling attention to the problem for several years now by organizing press conferences, a national conference with international participation, a study visit to Vienna for representatives of Macedonian institutions to gain more information on how this city has solved the issue of treatment and socialization of children who use drugs, by realizing a large number of meetings etc. Bearing in mind that the Ministry of Health has no treatment protocol and the lack of relevant literature, in 2014 HOPS issued a special “Guide for treatment and care of children who use drugs” with the intention to assist the Ministry in writing the protocol, as well as in the implementation of the new programs. Since then the Ministry managed to write a draft-version, however has failed to adopt the protocol.
Bellow you can find small segments from the Guide, the most significant in working with children who use drugs.
The Guide is intended, above all, for professionals included in the treatment and care of children who use drugs but also aims to give directions in policy creation regarding treatment and care of this group, hence can be used by decision-makers as well.
The Guide’s directions refer to all types of programs for treatment and care of children who use drugs, including re-socialization and rehabilitation programs. Ideally, these programs should be complementary and received at one place. It is also necessary to establish a functional cooperation and referral system.
Legal and ethical aspects:
- Parents and family inclusion is key to successful treatment of children. However, in certain cases the inclusion of the family/guardian and providing their consent will not be possible. According to NTA experts – the National Agency for Substance Misuse in England in cases when children do not wish their parents/guardians to know they are seeking assistance and help due to drug use, and it is in their best interest not to inform them, we should consider their wish and offer treatment in complete anonymity and confidentiality. This issue should be thoroughly regulated with national treatment protocols. In cases when a child from a dysfunctional family is to be admitted to treatment, the team should report the case to the Social Work Centre and ask for assessment whether the parents should lose guardianship and another guardian be appointed instead,
- For the few children in need of hospital treatment safe residential conditions should be provided. Hospitalization is 24-hour intensive medical, psychiatric and psychosocial care administered in residential conditions. Such treatment usually lasts 6 to 14 days, i.e. as short as possible.
- Substitution treatment for individuals under 18 should be introduced only by a psychiatry specialist.
Types of treatments
Treatment and care programs can be different. According to the treatment ambient and the type of treatment they can be:
- Dispensary treatment programs;
- Hospital/residential treatment programs.
These type of programs further divide into:
- Detoxification, which normally finishes in 6 to 14 days with 24-hour intensive medical and psychological care;
- Psychosocial rehabilitation and social reintegration, such as therapeutic community, above all intended for children with numerous problems where treatment lasts from 3 to 18 months;
- Use of medication in treatment (substitution therapy, anti-depressants, psycho stabilizers, psychomotor stimulants);
- Continuous care programs. Such programs are crucial and success in treatment largely depends on their availability. Namely, once a treatment is finished there is a high risk of recidivism, hence prolonged, continuous care is required after every treatment. Such programs can be self-help groups, personal development groups, recidivism prevention groups, AA and NA groups (alcohol and narcotics anonymous groups), professional and personal development groups, housing programs etc.
During the first contact with the child a comprehensive assessment is made in order to determine: the level of addiction, the risk factors, possible comorbid psychiatric disorders and other problems. Children should receive treatment and interventions immediately after assessment.
Upon admission, whether it is medical, psychosocial or combined treatment, the entire team jointly works on a treatment plan. The child-patient also participates in this process, as well as its parents, i.e. guardian if possible.
The plan clearly defines the child’s mentor from among the team members who will provide coordination throughout the programs and organizations/institutions and whose competences are known to the child and all those included in the treatment.
Functional system for cooperation and referral
In order to gain the necessary support for all treatment benefits, children and parents/guardians pursuant their needs should be referred to adequate institutions’ programs, as well as to local civil society organizations, peer groups, self-help groups, including culturally specific groups and organizations. Hence, there is a need for establishing a proper network of organizations and institutions working with children.
Transfer from children’s programs to adults’ program
Children’s programs have to be separated from adults’ programs and children cannot have contact with adult users.
For children approaching the program’s age limit (for instance, at the age of 18 they have to switch to an adult program) a joint plan for transfer to an adult program in a period of 6 months is necessary. However, the plan should provide for a possibility that the transfer might not take place within these 6 months. After assessment, the team can decide to keep the person for a longer period in the children’s program, despite his maturity, if it is in the person’s best interest.
The “Guide for treatment and care of children who use drugs” is available on HOPS’s website, category “Publications”, but only in Macedonian.
The author is currently pursuing his Master’s degree in social politics. He has been working on addiction related issues for fourteen years and has developed most of the harm reduction programs in Macedonia. Currently he is working as a manager of CEDR – the Centre for Education, Documentation and Research within HOPS. He is the author of numerous papers, publications and research. He is also an activist for human rights of marginalized communities and a member of several national and international committees, bodies and forums, such as the European Commission’s Forum on Drugs in Brussels.