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.

• Psychiatry and Addiction
  Filling a Gap in Dual Diagnosis Training
  Dr. Brion Sweeney
• Motivational Interviewing workshops for O.KA.NA, Greece
  Dancing or Wrestling?
  Jeff Allison, Rik Bes
• EATI Consultancy for Pompidou Group
  Wim Buisman
• MI Videotapes, Announcement
• New Approaches in Drug Care
  "Belonging to the European Family" by Carmen Mihalcea
  The big job still has to be done tomorrow! by Dominic Willaert
• EATI Training Calendar 2000

It was extremely refreshing to attend the EATI training in Psychiatry and Addiction. This type of programme fills a gap in Addiction Training. As one of the fastest moving fields in medicine it needs continual updating to stay abreast of new developments. Added to this is the gap created by the dearth of training in this area at an undergraduate level.

The number of drug clients with a double diagnosis increases in Europe. Professionals in the field of addiction need special skills to provide treatment for this complicated group. These clients often have problems to find their place in the current care and cure programs. As a consequence a high drop out can be observed, both in drug treatment services and in psychiatric treatment programs. Therefore it is an important challenge to identify new ways and policies to deal with this specific group of clients and develop more adequate interventions. The three-day training offers professionals the opportunity to learn about methods and strategies of treating this specific group of clients in their own setting.

For us in Ireland the topic of double diagnosis is particularly relevant. We in the Eastern Regional Health Authority area, which includes Ireland's capital Dublin, have been through what could be seen as the first two phases of tackling the drug problem. The first of these was a cautious launching of treatment programmes on a small-scale pilot basis. This phase came to an end in approximately 1990/1.

The second phase involved the rapid development of more extensive services with particular emphasis on prevention of the spread of HIV, HBV and HCV and the treatment of opiate dependency. This has involved needle exchange, residential detoxification, funding of therapeutic community initiatives and the provision of methadone maintenance. A recent capture/recapture study quantified the opiate abusing group within our region as 13,500 of which approximately 4,400 are in current treatment. The emphasis up to now has been on developing services where there has been none and in engaging general practitioners and community pharmacies in the treatment loop.

Enrichment
The third phase of the development has now begun. This might be termed the enrichment of existing services. Enrichment includes the further training of our existing staff in order to more successfully treat a difficult client group. This means further upskilling of counselling staff in research based protocolised brief therapy interventions. We are also looking at improving interventions in relapse prevention for those who have become abstinent. This means intensifying general practitioner training at both generalist and subspecialist level as well as incorporating clinical audit and evaluation of existing programmes.

Reflection
The recent EATI training course in dual diagnosis, which I attended, fits right into this framework and is timely for our services, as we now look more in-depth at our patient group and try to design our programmes to answer the needs of individuals in a more holistic way. In particular, we are aware of the need to do detailed psychiatric assessment on all patients attending our services and to address polysubstance abuse within this patient group. What I found interesting and informative about the training was the way in which it empowered the participants to reflect on their current practice stepping back to see how we are catering for dual diagnosed patients. The role-play and the fact that we had to present brief synopses on our own services helped greatly in this reflection.

Skilling
We are obviously doing quite well in this regard in Dublin, with a good compliment of psychiatrists within our service leading the way in the area of dual diagnosis. However it is equally clear that our existing staff, within the Eastern Region Health Authority in Dublin need further 'upskilling'. This upskilling of staff has two major paybacks for the service. One is the increased effectiveness of treatment for our patient group and the second is to prevent staff burnout. And increase job satisfaction. It seemed to me that the type of programme being provided by EATI should be available within various countries and should be bought in as a training package for staff. One way of providing such training is perhaps to send certain individuals to various modules of the EATI training, be that in dual diagnosis, the treatment of cocaine, etc. and thereby provide adjutants to our current training programmes. The second way is to have EATI and other such institutes provide the training on site in specific modules. Thus reaching more staff and likely being better value for money. Bringing these insights back home has been useful in terms of setting agendas and strategic plans for our Drug Training Department, helping us to plan inservice and induction training for our staff.

Dr. Brion Sweeney,
Consultant Psychiatrist in Substance Misuse Dublin, Ireland.

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Motivational Interviewing workshops for O.KA.NA., Greece
Dancing or wrestling?*

The arrival of the trainers on Thessaloniki airport was followed by a disturbing surprise; one suitcase had taken another route and appeared to be still on Amsterdam airport. That left us in Greece without a part of our training materials. And without clothes and other personal belongings for one of us. This was the first organisational hiccup that characterised this week. Luckily, just like the other hiccups that would follow, things landed on their feet, when the lost suitcase arrived a few hours before the start of the first workshop.

The principles and techniques of motivational interviewing have proven to be of practical importance for colleagues from different countries, settings and educational backgrounds. The EATI training seminar in Greece was tailor made for the Greek professionals. Motivational Interviewing is an interviewing style, which facilitates the expression, clarification and resolution of the ambivalence that may block a client from making a commitment to change. It provides a 'language' with which one can make sense of behaviour and its meaning. It makes one attentive to the delicate processes involved in discussing change. It increases one's curiosity about client's values and goals, and the complex dynamic processes between the therapist and the client. In this style of intervention, the therapeutic relationship is seen as a partnership where the client's autonomy, freedom of choice and sense of self-efficacy are actively supported rather than being directed by a therapist in an overtly 'expert' role. Executed with skill, it gives a sense of purpose and direction, and most importantly, a greater sense of optimism for both therapist and client because it assists clients in achieving their goals in making positive changes in their lives. The participants learned to develop clinical skillfulness in motivational counselling.

The first three-day session was held in Thessaloniki, 14 – 16 May 2000, in one of the lecturing rooms of the local Psychiatric hospital. 37 colleagues from the Greek organisation against drugs O.KA.NA. participated in two introductory workshops on Motivational Interviewing, run by Rik Bes and Jeff Allison, trainers on behalf of the European Addiction Training Institute ((EATI), Jellinek, Amsterdam.

Even though we started on Sunday morning, all participants were present at 09.30 for a first welcoming meeting with the trainers. After introductions, the workshop started as scheduled.

Soon we noticed that the materials (workshop handouts, programme, timetable, bibliography and an article) had not been distributed among the participants.

The second workshop was 18 – 20 May in Athens. This time the venue was a meeting room in an international hotel. Comfortable and efficient, and of course the famous Greek hospitality turned also this workshop into an unforgettable event. One evening the training group went out for dinner in a very nice restaurant, owned by the partner of one of the participants. Away from the well-known tourist areas, all of us enjoyed the atmosphere and the wonderful food.

The commitment and high level of professional expertise of the participants in both sessions made the workshops a success. The only thing that worried the trainers was the language barrier. Luckily most participants had a good command of English, the language in which the workshops were done. Discussions and lectures were therefore not a problem. Doing simulation exercises however, was a different story. The high level of language sensitivity of motivational interviewing made it logical for participants to do these exercises in Greek. The trainers did not master this language, so they could not monitor what was happening.

For an introductory workshop, this was not too bad. Further training and development of skills however, will require a trainer or trainers who can assist their colleagues in their own first language.

Prof. Anna Kokkevi, President of O.KA.NA. and initiator of these two workshops, said that she would very much like to facilitate two of the trainees to get further training in becoming MI trainers themselves. Besides that, all the material provided will be translated into Greek, literature will be obtained and studied and a small interest group of O.KA.NA. colleagues will be formed. All of this to ensure that the MI workshops were not just a one-off event, but as to ensure that they are a start in the process of integrating MI in the services provided by O.KA.NA. EATI staff and trainers look forward to assist our Greek colleagues in this process in the (near) future.

Looking back, the few organisational hiccups, which gave Jeff and Rik a ‘wrestling’ feeling at first, were in fact minor events, completely outweighed by the hospitality, commitment and professional expertise of our O.KA.NA. colleagues. The ‘dancing’ predominated and in fact we cannot wait to be invited to dance with all of you again!

Jeff Allison
Rik Bes

*The ‘Dancing or Wrestling’ metaphor can be used in MI workshops, to describe the different atmospheres one could encounter in counselling sessions. Sometimes it feels like the counsellor is wrestling with the client; communication doesn’t run smoothly, there is a lot of resistance and the counsellor and client seem not to be able to tune in to each other’s wavelength. The skilful application of motivational interviewing often results in a counselling session that feels like the counsellor and the client are dancing with each other; both partners are in harmony with each other and together they perform a difficult task.
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EATI Consultancy for Pompidou Group

Earlier this year EATI has been contracted by the Pompidou Group (Council of Europe) to implement consultancy missions in the framework of its Drug Demand Reduction Staff Training Project ( DRSTP Phase II). This DRSTP II is aimed at supporting the development of multidisciplinary staff training for practising professionals and administrators from twelve Central and Eastern European Countries. In all these countries National Project Teams (NPT) have been created to elaborate priorities in multidisciplinary training and educational materials. Consultants from European Union and other European countries, selected by the Pompidou Group will assist these NPT's.

EATI was requested to provide consultation for the projects under development in the Czech Republic and in Romania. In these countries priority is given to the development of national curricula on multidisciplinary drug treatment and rehabilitation. In the Czech Republic a multidisciplinary postgraduate training has been developed during last year. In this country there is a strong need to create training material to be used in postgraduate curricula and other training contexts.

During the first consultancy in February 2000, on behalf of EATI Wim Buisman met with the Czech NPT to discuss the preparation of training materials. It appeared that the Czechian colleagues preferred to realise three publications: a glossary/lexicon (outlining basic terms, definitions with respect to substance abuse treatment, prevention, demand and harm reduction), a textbook (containing high expertise articles on treatment modalities, guidelines for intervention, early prevention methods etc) and a teaching guide to support trainers/teachers in conducting curricula and seminars.

In March a consultancy mission was undertaken by EATI to meet with the Romanian NPT to discuss their priority in training material development. In Romania an urgent need exists to design a multidisciplinary treatment guide with guidelines for drug treatment staff employed in drug services. As a result the main features of such a guide was discussed and an editorial group was established to prepare an outline of the philosophy, sections and chapters of the treatment guide. The creation of the treatment guide (lines) will be closely related to the further development of (new) drug services in Romania. In this respect, the emphasis is put on the establishment of so-called "post cura" drug services (or follow up, psychosocial treatment after detox- or crisis intervention).

The consultancy missions appeared to be very satisfactory, both for the Czech and Romanian NPT’s as well as for EATI. Next missions to Prague and Bucharest (very well facilitated by the secretariat of the Pompidou Group/DRSTP co-ordination) are planned during the summer of 2000.

Wim Buisman

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MI Videotapes

EATI is no longer in charge of the distribution. If you would like to order the tapes, please contact:

Mr. Tom Barth
The Bergen Clinics Foundation
Outpatient Clinic
P.O. Box 297
N-5804 Bergen
Norway

T: +47 559 086 00
F: +47 559 086 10
Email: tfwb@online.no

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New Approaches in Drug Care

The training New Approaches in Drug Care enables participants to integrate innovative approaches in drug care in the management and provision of services. Continuity of care and cohesion between provided services are main topics. Participants learn to establish health promotion and treatment enhancement. An overview of the services provided out of an approach of Comprehensive Drug Care is presented and discussed. Participants are able to manage and integrate these approaches into their work. Two participants, from Romania and Belgium, report about their experiences.

"Belonging to the European Family…"

In February 2000, I had the opportunity to attend a six days intensive training of EATI entitled "New Approaches in Drug Care ", in Vienna. It was a great experience for me, although it was my second EATI training. My first training was last year in Prague, organised by Geneva Initiative on Psychiatry with the support of EATI, for East-European Countries. This first training changed the course of my professional life. I began to work in an addiction psychiatric ward and became involved in the drug care field.

The Vienna training course was even more special. Two very experienced drug care practitioners and trainers were facilitating: Gian Paolo Guelfi and Wim Buisman. The facilitators covered a wide range of issues concerning drug care and a variety of concepts. A frame was created, in which all participants provided a lot of meaningful and useful contributions. There were 15 participants from different Western Europeans countries and myself from Romania, a Latin East European country. This mixture of professionals, with such a variety of backgrounds, was very inspiring. Sharing experiences - successes as well as mistakes - they "don’t only take but also bring" a lot to each other.

I was impressed by the variety of policies and services in drug care from the most liberal and complete Danish system to the almost Swedish prohibition system. Also I was surprised to notice that even very efficient systems could be perfectible in idea of client centeredness.

Much discussion focussed on which direction the drug care policy could lead. Does the new orientation overestimate the needs in harm reduction services? What is the place of cure/change and abstinence? The answer was that all these care, stabilisation and harm reduction services create the premise for cure, change and abstinence. This idea was materialised in the concept of "comprehensive care" and was illustrated by the "Funnel Model".

Site visits in Vienna to outreach services, lowthreshold centres and day care fulfilled the picture of the variety of services that are well adapted to clients needs.

As far as the participants are concerned, this unique mix of commitment and wellbeing, working hard, using head and heart, created an unforgettable atmosphere. They gave me warmth and motivation and this wonderful feeling of belonging to the European family. Thus it was so hard to say goodbye. But most of us will keep in touch and we hope to meet again at "the follow-up".

Carmen Mihalcea

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The big job still has to be done tomorrow!

The training week in Vienna started with unforeseen circumstances. First there was the tensed political situation which of course influenced the social conversation. Moreover the absence of Bart Majoor, a very experienced trainer, was initially seen as a disappointment. Although his absence was much regretted, it also caused the development of very special and characteristic dynamics during the training seminar.

With support and supervision of Gianni Paolo Guelfi, a very interactive and versatile way of working was set up. Participants from various countries made very interesting contributions on the themes of the seminar based on their professional knowledge and broad experience. In this way theoretical views were very concretely compared with the practical situation of the various participants.

Eventually it became very clear that basic professional knowledge often deals with difficulties during the quest for a practical development. The fact is that national as well as local drug policy causes restrictions in the adaptation of Harm Reduction strategies. In a Europe, which generalises on an economical level and at the same time aims at a united currency, the fragmentation concerning lots of other policy decisions is striking.

Edge
Most participating countries place themselves on the edge of on the one hand repression, and on the other hand of (in) formal tolerance. From another point of view one could draw a line between a moral-ethical position and the development of a rational attitude. It stroke me that within those countries which have the greatest needs in the field of drug care, the most pragmatic attitude has been developed. It is obvious that providing care with a very low threshold if frequently developed for those who really need it, despite of limited health care in the past and a former repressive government drug policy. I especially refer to the situation in Spain, UK and Romania.

The country reports, presented during the training seminar, showed a general approach as well as very specific accents. Next to providing methadone as a substitute drug, which has become rather common everywhere in Europe, I concluded that often a very strong therapeutic offer is being done to young drug users.

Weakest chain
As for 'counselling' and 'motivational interviewing' I think lots of methods have to be developed. Within drug care I find this the weakest chain. An explanation might be that there is not enough staff and education of staff is inadequate. Another thing is that primary needs have to be fulfilled first, before a specific therapeutic offer can be made.

Funnel Model
The two most important things I took back with me to Belgium deal with policy and methodologies. The 'Funnel Model', which outlines a comprehensive network of services in care, treatment and rehabilitation services, convinced me again of the importance to aim at a regional policy in addition to a national policy. This asks for a long-term vision and very often lots of patience and diplomacy. Most countries namely deal, even in the field of drug treatment, with certain monopoly strategies and lobbying in public or backstage.

Enthusiasm
On a communication level I am very grateful for the exchange of practical experiences among all participants. Enthusiasm linked to theoretical knowledge very often provided strong working hypothesis.

The exchange on a European level in an intensive way as was done during this training seminar gave me lots of energy. I was very much impressed after this training week.

Inequality
The most striking, however, is the inequality between lots of people and countries, which still exists in the present. The European continent and the world of the 21st century should be able to provide equal support for all people who suffer. Again, for me it was obvious that health and social care only are being developed in the path of economic and ideological movements. The big job still has to be done tomorrow!

Dominic Willaert

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EATI training courses 2000

Date	Topic	Venue	Price
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
10-12 December 2000	Psychiatry and Addiction	Porto, Portugal	496 Euro

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