The EATI is a European training institute, supported by an international network of twelve major European institutions for addiction care and research. The EATI was founded in 1994 by the Jellinek, Amsterdam, The Netherlands.

• Harm Reduction Management
• New Approaches in Drug Care
• The Digital Jungle, Drug Prevention on the Internet
• Cocaine and other (new) stimulants
• "Never put the stick too high", training course on after care in Czech Republic
• "Make sure you know what to do", Policy and prevention XTC and Synthetic Drugs
• Adaptation of other visions and ideas. Cocaine trainer Rob van Meerten
• A European Perspective. Medical Education in Alcohol and Alcohol Problems
• A Farewell to Iris Geitel
• EATI Handbook on Local Drug Policy

Sixteen new friends from all over Europe

Harm Reduction Management

Harm Reduction projects tend to have a high profile within local communities. The organisation and supervision of harm reduction services require very specific management expertise. All European countries deal with the same issues when featuring harm reduction projects for drug users. The training needs assessment, performed by EATI in 1998 proved that there was a great interest in Europe to organise a training seminar on harm reduction management. The first training seminar was launched in Hilversum, The Netherlands, in September 1999.

All aspects of harm reduction management are included in the three-day seminar, which has been developed and carried out by Lesley Ann Brown and Bart Majoor. All European countries deal with funding policies, contacts with (local) government, the positioning and co-operation with more traditional drug cure and treatment agencies as well as non specific services. These characteristic topics require very specific management skills. The Harm Reduction Management training seminar therefore focuses on management professionals in the drug field. The promotion of this seminar resulted in a great number of registrations. Finally eighteen participants from twelve EU countries were selected, all working as manager, project co-ordinator, physician, psychologist or supervisor.

The trainees were introduced and guided into a number of specific harm reduction issues, such as client needs, safety for clients as well as staff members, HIV testing, case management, policy and protocols. After the introduction of this framework, managerial aspects like staff recruitment and development, team building, supervision and burn out prevention were thoroughly discussed. The last day of the seminar participants discussed relapse prevention, sexual health and a number of specific cases.

As most of the EATI training seminars, the Harm Reduction Management training course offers a variety of methodologies. The presentations given by the trainers are rather brief which offers participants the possibility to contribute actively to the discussions. Role-playing and small group exercises, case and homework discussions are some of the methods being used. As an example of good practice the participants were sent out on the street to deal with group problem solving.

One of the participants was Briege Quinn from the North and West Belfast Community Addiction Team. She described her first experience with EATI as an important way to share experiences and knowledge on a European Level.

"I travelled from Belfast, Northern Ireland to attend my first EATI training course. My Experience over the three days exceeded my expectations. Not only did I receive high quality course delivered by Bart Majoor and Lesley-Anne Brown and supported by Iris Geitel, but I made sixteen new friends from all over Europe. The importance of meeting fellow drug workers and sharing experience and knowledge cannot be under estimated, and for me was one of the most enjoyable elements of the course.

Bart Majoor gave an inspiring account of how he runs a drug service in New York. He deals daily with people who frequently are just managing to survive. He endeavours to keep the needs of this population at the centre of his work. While he spoke of the barriers to drug care, Bart encouraged us all to examine what might prevent us from providing a high quality service to drugs users and look at ways of dealing with such "pollutants".

We were also inspired by the work of Lesley- Anne Brown who assisted us in developing pragmatic proposals to commissioners regarding drug service provision. Her practical demonstrations were also a great source of learning and provided a few laughs as well!

Away from the classroom we spent time eating, drinking and enjoying each other’s company. The Christmas cards I received from Belgium, Spain and Germany demonstrated a test of the friendships formed. I eagerly await my next opportunity to participate in another EATI course and renew the friendships and networks embarked upon in 1999."

The evaluation of the training seminar proved that a prolongation is required. EATI organises two more harm reduction management training seminars in 2000. The first location will be Amsterdam, during the summer, the second location will be Porto, Portugal in the early fall. Announcements for these two seminars will be sent on short notice.

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New Approaches in Drug Care
Some have a liberal approach, some are punitive

Last year I was very pleased to be selected to attend the EATI New Approaches in Drug Care 6 day course in Lisbon and the 3 day follow-up in St. Margherita. On reflection now, these courses continue to profoundly influence my thoughts and the way I function as a drug care provider. Just to discover more about evolving drug policy in different countries has been so revealing and dramatically encourages the challenging of many assumptions.

The courses were facilitated by two very experienced drug care practitioners and trainers; Bart Majoor and Gian Paolo Guelfi with the expectation that we were required to work hard and to tight schedules. Both events were very accurately organised by Iris Geitel from EATI.

The participants came from a variety of drug treatment backgrounds and were generally in senior positions, experienced clinicians, or both. Overall the exchange of information and ideas both formally and informally was phenomenal. With a general agreement that we all lived busy lives it was great to have some valuable time-out to reflect and share our thoughts. We all discovered that we had much in common having to contend with similar problems and frustrations as well as enjoying similar successes.

The facilitators covered a wide range of issues in relation to drug treatment provision using a variety of conceptual frameworks. They also created a working environment where all participants were empowered to provide very useful and meaningful contributions.

The overall programme was designed in such a way that participants were able to identify possible areas of change within their practice and then feedback at the follow-up course, their success or otherwise in implementing the proposed changes. Generally we were all able to report significant changes had been possible, but acknowledged that things like bureaucracy or lack of resources sometimes stood in the way. The participants came from a total of 12 European and Scandinavian countries and we all gave quite detailed reports about the models of drug treatment services in our respective countries. It was very interesting to hear the different approaches to drug care, driven by different drug policies, adopted by different countries. Whilst some countries adopt very liberal approaches to drug use, others are very punitive. Much discussion focused on speculating which direction different countries may be going in the future and there seemed to be a consensus view that mainland Europe was generally harmonising towards a much more liberal approach.

Specific topics covered in the programme as a whole included the description of a comprehensive model of drug treatment embracing a care cure continuum, pharmacological responses including variations between countries, a reaffirmation of the importance of harm reduction and meeting people's basic needs, managing dual diagnosis, women-specific issues including pregnancy, child protection issues, motivation and change, relapse prevention, the ethics and effectiveness of coercive treatment, strategic planning of projects, measuring treatment outcomes, staff supervision and safer injection issues.

Site visits included going to Casal Ventosa, a shanty town in Lisbon to examine the various Non-Government Organisation's responses to very high levels of drug use in an extremely deprived area and a visit to Genoa prison to examine a well funded and quite sophisticated drug treatment programme. We were also the honoured guests invited to attend the reopening of a night-hostel for drug users in Genoa.

One important function of EATI is to share good practice between individuals on an international basis by forming networks between participants. I continue to maintain contact with numerous colleagues that I met on these courses and have even been able to set-up a useful information exchange visit and the beginnings of a partnership arrangement between health, community safety and criminal justice colleagues in southern Holland and my own area.

Chris Brazil, Manager Substance Misuse Services, Worcestershire Community
Healthcare NHS Trust

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The Digital Jungle
Drug Prevention on the Internet

One simple search on the Internet, to acquire information about drugs, presents ten thousands of links to homepages, related to drugs. All these homepages of course have a special page with links to other sites. The Internet has become a digital jungle. Any internet user has access to all this information but most users do not know which facts and figures are the most reliable. Various European countries already have united their digital skills and knowledge in a network, named Prevnet. On the Prevnet Homepage reliable links can be found to European homepages on alcohol, drugs, gambling and addiction.

EATI launches the new training seminar Telematic Methods in Drug Prevention. This seminar is being prepared in co-operation with Prevnet and STAKES. As the role of telematic methods in today's information society has become a very important one, the drug prevention field must keep abreast of these developments. The EATI slogan 'crossing borders' exactly fits the variety of possibilities to co-operate on a digital level.

Telematic Methods involve more than the Internet, of course. Telephone, fax and CD-ROM are being used in the day-to-day practice. The training seminar will focus on the latest techniques to integrate these techniques in drug prevention. An example for using fax machines more effective is to send fact sheets or drug information on demand. The most important topic in the training seminar, however, will be to provide for alcohol and drug consultation on the Internet. This way of consultation is less time consuming than a telephone helpline. Moreover people can ask questions at any time of the day or night and collect the answer whenever it suits them.

The Telematic Methods in Drug Prevention training seminar will focus on all these modern techniques to integrate them in drug prevention. The aim is to give an overview and demonstration of new communication technologies. These will make drug prevention more effective and accessible than ever.

The training seminar will be organised in September 2000. More information will be provided soon.

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Overwhelming daily work
Cocaine and other (new) stimulants

It is clear that cocaine is available in almost Western European countries. Consequently problematic use of cocaine has increased. The daily work in this field of addiction care was one of the main topics during the EATI training seminar on Cocaine and other (new) stimulants. Helena Dias was one of the participants in Porto, Portugal, where this training took place from 6-8 December 1999. Once again, it was demonstrated that EATI training seminars offers participants a way of crossing borders.

Sixteen participants, including myself, from different European countries - Portugal, Germany, Ireland, Finland, Scotland, Austria, England, Denmark, Belgium - joined this course that took place in Porto, Portugal. The very first day, thanks to the participants' heterogeneous backgrounds, started by gently 'breaking the ice' . Most of the participants work in the practical field of addiction. The first achievement was to reach a consensual platform of understanding. Attention was given to the different political, financial and practical ways of approaching the 'overwhelming daily work with so few resources, (except perhaps in Denmark).

Treatment of cocaine addicts is rather complicated, especially since there is no substitute medication available. It is important to know which stages of withdrawal are possible. People feel unsettled and depressed, they have no appetite and a strong craving for cocaine. After one week people start to feel better and craving decreases. The withdrawal symptoms are related to the fact that the production of dopamine and serotonine is distorted. It takes about seven months to normalise the neurotransmitters People do not only suffer from drug use but also from the circumstances related to their drug use. The trainers, Rob van Meerten from the Netherlands and Françoise Lequarré provided the participants with thorough theoretical knowledge on all aspects of cocaine use.

The second and third day, with the help and smooth leadership of the trainers Françoise Lequarré and Rob van Meerten, were spent on the discussion of specific aspects of daily practice. Theoretical knowledge and every day practices were constantly matched. The issues were for instance the large amount of cocaine on the European market, as seizures all over Europe show; the growing number of addicts and especially the increase of i.v. users of cocaine and crack. Special attention was given to the difficulties to provide for appropriate treatment. Compared to the substitute treatment of opiate addiction, it is not possible to provide for pharmacological or other treatment.

The participants had to discuss, in small groups of different nationalities, a specific issue as a 'task'. Divided in two larger groups they could also visit one of the two public centres of drug services nearby (Gaia and Cedofeita). There, they were able to collect information concerning the specific way of working; meeting the Portuguese team they could discuss the general approaches in a Southern European way and, of course, take a look around!

The overall relaxed atmosphere, the warmth and mutual respect compensated those long hours of work (besides thinking, listening and talking in English....!) Well, there is always a sense of sorrow when we say goodbye (believe me, I attended other EATI courses so I know).

Helena Dias
S.P.T.T. CAT-GAJA

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Training Course on After Care in Czech Republic
"Never put the stick too high"

 During the past few years many after care services have been set up in the Czech Republic. There appears to be an urgent need for these services in order to reintegrate clients in to society. Being confronted with a normal daily life, clients experience that reintegration and relapse prevention seem to be very difficult .

Anticipating on the necessity of sufficient after care programmes the leading drug service in the Czech Republic, SANANIM, initiated an intensive 4-days seminar on after care policies and practice. Funded by the Chech Ministry of Health, Sananim invited EATI to prepare and implement this training course.

The aim of the seminar was to introduce principles of after care (programs) and relapse prevention and to discuss the possibilities for further strengthening after care services in the Czech Republic.

About 20 drugworkers from the main regions of CR (Prague, Bohemia, Moravia) participated in the seminar, which was held in Prague, 22-25 November 1999. They have a background as social worker, psychologist, physician or manager and are working in staff positions in aftercare and/or therapeutic communities.

On behalf of EATI Mr. Peter Scholten, director of Jellinek Aftercare Department, acted as the co-ordinating trainer. As a tradition in EATI seminars, the training started with an assessment of the experiences and expectations of the participants. It appeared that most people, besides their interest in learning more about the scope and opportunities in after care, were preoccupied with their specific role as care providers working with drug clients. Moreover, many questions were raised about the goal of after care and treatment of clients as such.

The main drug services in the Czech Republic consist of after care centres, contact (K-) centres and therapeutic communities. Leading organisations are Sananim and Podane Ruce (Moravia).

After care services aim to guide (ex) drug users back to society. Clients are being provided with sheltered homes, counselling and assistance to reintegrate, finding new housing facilities, jobs etc.

During the seminar all kinds of after care services operating in Jellinek Amsterdam were presented and discussed. Some of the main services include worktraining (repair, recycle, art production and selling), budget training, computer training, and housing.

In these projects not only drug free clients participate, but also clients with methadone prescription. This presentation caused many discussions: how to work with different clients in one program, what is the role of a care provider, what of a professional who guides clients for example in a job training. However, a continuous discussion was focussed on the general aim of treatment and after care.

Most participants felt that only a drug free goal should be achieved, in spite of the fact that this goal results in many relapses. During the seminar it was emphasised that care providers should not think instead of their clients but above all think together with them about individual goals of treatment.

To draw a parallel with athletics the goal of after care can be paraphrased as: "Never put the stick too high, because you organise your own relapses". This approach was even more demonstrated and explained in the motivational interviewing training, which was given the second day of the seminar. It turned out that most participants hardly ask any open questions to their clients, seldom express empathy and in fact are lacking basic skills of counselling.

On the last day an intensive evaluation of the seminar took place. After filling out a questionnaire, all expectations and results were discussed. It appeared that most participants had become more aware of their role and tasks as care providers. Due to the fact that they had learned more techniques and skills in interviewing, a change in more realistic (or even optimistic) attitude towards drug treatment could be observed. In the same time participants indicated to have acquired many eye-openers and "food for reflection". During the seminar, all participants received a book entitled "Social integration" which contains thirty articles and interviews on after care results achieved in the Netherlands.

In May 2000 a follow-up seminar has been planned. This seminar will focus on strengthening skills and intervention techniques in relapse prevention and in after care.

Wim Buisman

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"Make sure you know what you do!"
Policy and Prevention XTC and Synthetic Drugs

After a very nice fall, Amsterdam received me with rain. As I was glad to have left my daily routine for a few days, I looked forward to meet some European colleagues and to discuss and reflect our XTC prevention policy. Although two-and-a-half day is not much to create a good group atmosphere, thanks to all participants EATI is able to do so.

The content of the seminar on XTC and Synthetic Drugs, Options for Policy and Prevention, was to determine elements for a policy on XTC and other synthetic drugs. Topics were to discuss a public health approach versus a public order approach, the setting and target groups and the role of the media.

The first day, a Sunday, we started with introducing ourselves and clarifying our expectations. The discussion on a public health or public order approach was actually about drug demand reduction versus drug supply reduction policies. It was concluded that a very clear division of responsibilities between police and social workers is absolutely necessary. The trainer, Ernst Buning, presented very clear Dutch messages for youngsters: "Be Responsible", "Make sure you know what you do!", "We don't want you to drive with XTC!".

Ernst Buning explained his theory about youngsters being a digital generation. This means that young people live in many different settings whereas for the analogue generation sticks to "old fashioned' habits. Nowadays children grow up with broadcasating from all over the world, internet, virtual gaming, mobiles and a variety of leisure facilities. The more complex our society gets, the more choices we have. We have to make more decisions on our own, we need to segregate and jump from one reality to another. People have different roles in different situations and this results in a behaviour adjusted to the setting. This is what the 'new' generation does: they go to school or work during weekdays but in the weekends they want to have fun. XTC fits very well with party'ing the whole weekend. According to Ernst Buning the prevention message only works when it is adjusted to the digital world of youngsters. Analogue concepts are old-fashioned.

The next day we visited Jellinek Prevention. Roel Kerssemakers presented the monitoring system Antenna. This method of research is very interesting. Every two years pupils from secondary schools in the age of fifteen and seventeen years fill out questionnaires on their alcohol, tobacco and drug use. Separately every year a special risk group is subject of research. In this way once in three years coffee shop visitors, clients of youth facilities and 'outgoing people' are being surveyed. A panel study with 25 key persons like barmen in disco's, doorkeepers, discjockeys, drug uses and even dealers, provides for information about the scene. Antenna also describes questions which are being asked to the telephone counselling facility. The different methods of gathering data give a good and rather complete picture of the actual situation in Amsterdam. The Antenna method seems to be very suitable to implement as a survey study in other European cities.

On our last day we did, in my opinion, our best work. In little working groups we tried to solve a concrete problem which each group could choose for themselves. Beginning with the definition of the problem and defining the objectives, each group had to find instruments or methods, make a budget plan and decide on documentation and evaluation methods. All these items were necessary to find a solution for the problem.

The conclusions were rather clear. In every country or city we need a local approach for the problem because local conditions are very important. A good data base is absolutely necessary as well as cooperation with all agents involved. A clear definition of the roles and responsibilities is needed and agreemeent on objectives is essential. We need a good planning, effective instruments and an excellent documentation, to convince politicians to give us the money for our next projects. It sounds so easy in theory but we all know that in practice it is much more complicated. I am sure, however, that this was not my last EATI training seminar. It surely gives new impulses and exchanging experiences helps to cross borders and to create a European network for the future.

Christine Kohler-Azara
Senatsverwaltung fuer Schule, Jugend und Sport

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Cocaine trainer Rob van Meerten
Adaptation of other visions and ideas

Organising training seminars in Europe is only possible with a broad network of trainers. Without their expertise and support, EATI could not exist. Many trainees already experienced the dedication with which trainers disseminate their knowledge and professional skills. Rob van Meerten is an expert in treatment of cocaine users. As a consultant he has given many training seminars on this subject. Since 1998 he is the trainer for the EATI Cocaine training seminars.

One of the aims of EATI is to achieve a European co-operation within all drug-related projects and institutes. In Rob van Meerten's opinion the training seminars offer a unique possibility for professionals to exchange their opinion and methodologies. "I observe that workers from different nationalities get closer together. This makes it more easier to make use of each others possibilities." Working with very often heterogeneous groups could of course be complicated. For most people the training seminars are given in a foreign language and very often the participants have different skills and backgrounds. "At the contrary", Rob van Meerten says. "It is striking that there is no question of hierarchy among the participants. The mixture of different professionals is very inspiring. I believe that trainees have the same opinion. They learn from each other's success as well as mistakes. Most people, trainees as well as trainers, are very much predominated by their cultural background which makes it difficult to adopt different opinions. Still, I think it is remarkable to see that people adapt each others vision and ideas."

Although the network as well as the geographical area of EATI is quite large, there is a very small Staff Office, which operates behind the screens. Without email, fax and Internet a European organisation like this could hardly exist. Rob van Meerten says that support and organisation, offered by the staff office, has improved significantly. "It is very pleasant to give a training seminar when all organisational aspects have been taken care of. EATI trainers are responsible for the contents of the training and do not have to bother with any domestic aspect at all."

Rob van Meerten is quite fascinated by the fact that people working in the drug field, who have daily contact with drug users, can transmit their experience to professionals superior in the hierarchy. Should it perhaps be the other way around?

Ineke Hurkmans 

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Medical Education in Alcohol and Alcohol Problems
A European Perspective

Eurocare (European Council for Alcohol Research Rehabilitation and Education), published a European report on medical education in alcohol and alcohol problems. This report is the result of a conference with experts from all over Europe. It reflects what needs to be done to ensure appropriate management of patients with alcohol-related problems.

Doctors are potentially not just providers of treatment for those with alcohol-related problems, they are also 'gatekeepers' into treatment services and usually the leaders of the multidisciplinary teams involved. Additionally, doctors are well placed to act as advocates for alcohol problems prevention and treatment both within health services and more widely. The first part of the report contains valuable information for doctors to identify and respond to drinking problems. The second part consists of country profiles on the state-of-affairs of treatment of alcohol-related problems in eleven European Union countries.

Eurocare 1999
ISBN 1-871195-03-9
Email: eurocare@bbs.eurocare.org

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A Farewell to Iris Geitel

Unfortunately Iris Geitel, EATI's training manager, has decided to leave the office. She has accepted another challenging job as an officer manager in Hilversum by the 1st of March.
We deeply regret her departure, as she was a great pillar of EATI' s training activities for 6 years.

Most participants of EATI's training courses have experienced Iris as a main "linking pin" in the organisation, communication and presence in the training courses. Iris has contributed a lot in the development of what EATI has become up to now in 2000. I think that also on behalf of participants and trainers of EATI I can express our gratefulness to Iris for all the work she has done with such a big and good performance.

Iris, thank you very much and all the best in your new job!!!

Wim Buisman
Head of EATI

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EATI Handbook on Local Drug Policy

Soon to be published on this homepage!

The EATI Handbook on Local Drug Policy, which is a result of EATI training seminars on drug prevention, can be ordered by email to: eati"". A review on this handbook has been published in EATI Newsletter 1999, number one.

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EATI training courses 2000

Date	Topic	Venue	Price
30 March - 1 April 2000	Psychiatry and Addiction	St. Margherita, Italy	500 Euro
18-20 June 2000	Cocaine and other (new) stimulants	Antwerp Belgium	295 Euro
25-29 June 2000	Harm Reduction Management	Amsterdam, The Netherlands	425 Euro
3-6 September 2000	Harm Reduction Management	Porto, Portugal	425 Euro
24-26 September 2000	Drug Prevention on the Internet	Helsinki, Finland	325 Euro
22-25 October 2000	Methods and strategies of Addiction Research	Munich, Germany	295 Euro

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