The narcotics dilemma: hospitalization or jail time?

20.11.2012 — Analysis

The creators of the new state rehab center for substance abuse, Ural Without Narcotics, have a long, difficult path ahead. Officials from the Sverdlovsk region intend to restore hundreds of local residents to meaningful lives, returning them from the alternate universe of drug addiction. At a meeting with Evgeny Kuyvashev, the governor of the Sverdlovsk region, Russian President Vladimir Putin approved the establishment of a state-sponsored center. However, no quick victories can be expected in the struggle with a scourge that Europe and the USA have been battling for years. The Russian system for rehabilitating drug addicts is still weak, and the law does not allow them to be treated involuntarily. Anton Poddubny, the head doctor at Ural Without Narcotics, spoke to RusBusinessNews about whether the strong arm of the state should be used to help addicts.

- Anton Vladimirovich, how will the center's work be organized?

- The center's front office opened in Ekaterinburg a little over a month ago. Our professional staff - a social worker, a psychologist, and an addiction psychiatrist - counsel drug addicts on an individual basis, and there are group sessions available for their families.

The center's main site will open on Shirokaya Rechka in July 2013. It is designed for 60 patients - 15 women and 45 men. That's where the third phase of the addiction treatment will be held (the first consists of outpatient care by an addiction psychiatrist who is registered for that district, and the second is inpatient addiction treatment). It is over the course of these phases that the patient will be brought out of his or her narcotic intoxication and will be motivated for rehabilitation. This is very important because individuals who have become a prisoner to drugs don't believe they can be cured. Far from all addicts make it into treatment on their first try, only about 10-15% take the leap. The rest don't even consider the possibility until they've had a few unpleasant experiences on a drip at the hospital. Addicts come to the center purely on a volunteer basis. We don't intend to drag anyone here by force.

The rehabilitation treatment will be offered at no cost to patients and will last from 4 to 9 months, but no longer than a year. The first two months, of course, are the most difficult. That's when we plan to focus on the spiritual component.

Once things ease up a bit for the addict, then psychotherapists, substance-abuse specialists, social workers, and occupational therapists get into the game. Our patients will earn their keep doing farm and garden work. There are plans to launch a small business, but no decisions have yet been made as to what kind. One interesting idea, which we have discussed with Mikhail Kagan, the head of the regional office of the Federal Drug Control Service, is breeding service dogs. If that office built a breeding nursery, that would be a starting point for us in this project.

Sports will play a major part in their rehabilitation. The building that is currently being renovated has a gymnasium for volleyball and basketball, and we'll install exercise machines and punching bags. There'll be a stadium with a track, and we'll bring in some reputable trainers.

- Do you believe in the success of the project? Do you, as a doctor, feel confident that recovered addicts who leave this center will not go back to their dealers?

- It's easy to make sure that people don't use drugs, you just have to isolate them. Then everything comes to a halt, because they don't have anywhere to get their powders or weed. That's essentially what we do at the center - patients are literally isolated from society. But the main goal is not just to keep them from using drugs while they're here, it's to ensure that after their treatment they don't go back to associating with the same people.

As Mark Twain said, "Quitting smoking is easy, I've done it 100 times." That's why we're starting a post-rehab, outpatient program, which will operate at the front office. The "graduates" of the center will be divided into groups of about 15. They'll get together periodically and spend time with our professional staff, receiving psychological support. Each group will have an individualized program.

The experience of other rehab centers shows that people who have a positive view of their recovery will stay in touch with each other. They have an emotional bond. But no one claims that life after rehab will be easy - you have to believe in yourself and possess an unusually strong will. Because it's not just your environment you have to face, where people are begging for drugs, but all of society. People see drug addicts, even those that have reformed, as hopeless cases. But this is a terrible mistake. I know dozens of people who no longer use drugs. They're no different from you or me, except that they understand the price of the freedom that drugs stole from them.

- And will you help them find work?

- Of course. Former drug addicts go back to their old lives if they don't have jobs. Someone who wants to make things right will find a way, those who don't will find an excuse. I hope that our former patients will find a way. No one is promising that they'll immediately become directors, but no one is promising that that won't happen in ten years. It all depends on the person, but you have to give him a chance. Whether or not he takes advantage of it is a different matter.

- Europe has struggled with drug addiction for a long time. What are some of their progressive practices that could be adopted in Russia?

- As Oleg Zabrodin, the chief substance-abuse specialist for the Sverdlovsk region, has mentioned, Europe and Russia see different types of drug addiction. They have a different mentality and use different types of drugs. In terms of heroin, for example, their choice is very clear - they can either go to prison or into treatment. Take France, Sweden, and other very democratic countries - there it's illegal to use narcotics. If you're found on drugs, you go to court and either have to voluntarily undergo treatment or go to prison. So, 100% of those who are faced with that kind of choice prefer treatment. Here we don't currently offer that option, but I hope that the question of coercive treatment will soon be resolved.

- What's the official number of drug addicts in the Sverdlovsk region?

- In 2011, almost 11 thousand addicts were registered, and a little over 12 thousand in 2009. The structure of substance abuse is changing in Russia and the CIS. Within another three or four years none of the classic heroin or Desomorphine addicts will be left. They're dying off, and the younger generation is now abusing different, ostensibly legal drugs. You have to really work to find heroin in Ekaterinburg, because our drug enforcement agencies and police are very active. It's also hard to get plant-based narcotics such as opiates or cannabinoids. The work of the Russian Federal Drug Control Service is very evident here - they cover the drug highway from Central Asia. 20-year-old boys are just not going to make heavy weather of buying the drugs when they can just buy smoking mixes or bath salts over the Internet. And we also look for those types of websites and report them to the appropriate agencies. Virtually all drugs now are synthesized. They're frightening because they cause a powerful psychotic reaction - people literally lose their minds. It's not just a sense of euphoria, a person suffers an organic disorder of the brain. And these types of psychoses do not respond to ordinary, medication-based therapy.

- We see two diametrically opposing opinions in Russia: the first held by adherents of a rigid drug policy, and in the second camp are those who favor legalizing "soft" drugs. What's your position?

- I strongly oppose legalizing "soft" drugs. What's the difference - "soft" or hard? All drug addicts begin with so-called "soft" drugs, which include cannabinoids, and then they are sucked in further.

The Russian nation is dying off, but you can't just give up. I realize that perhaps we are several years too late opening the Ural Without Narcotics rehab center. But so what? If we're late, we're late, but you still have to do something. There's an insane amount of work to be done. We can't get by with just one center here. Evgeny Kuyvashev, the governor of the Sverdlovk region, has directed the regional Ministry of Health to open centers like this in every administrative district by 2017.

If you look at the deeper issues, ideally we need to bring young people in off the streets. They need to be doing something worthwhile, not drifting around in search of adventure. We need to establish more sports leagues and recreational centers, and those need to be free of charge. A love of health and a healthy lifestyle need to be instilled almost from kindergarten. It's important to teach young people how to live healthy, rich lives filled with meaning - and right now that is our most difficult and important task.

Interviewed by Anna KHORKOVA