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.

• Telematic methods in drug prevention
• Toolkit for training professionals
• EATI's plans for 2001-2003
• Medical education in alcohol and other substance abuse
• Harm Reduction - the paradigm shift
• ISO-9001 Quality Assurance
• New EATI staff member
• Announcement Training Seminar Psychiatry and Addiction (in French)
• Annonce Entraînement Psychiatrie et Addiction (en Français)
• EATI Training Programme 2001

Telematic Methods in Drug Prevention

Digital intervention prevention workers needed

Telematic methods no longer are a ‘castle in the air’. Youngsters are far ahead; they know how to use Internet, SMS, CD-ROMS or email where the generation that was raised in the sixties or seventies tries to keep up with them. The young generation already makes use of all kind of electronic communication methods. In the digital jungle of the World Wide Web they may be provided with doubtful information on drugs. The digital environment therefore asks for an intervention from prevention workers.

In the fall of 2000 a three-day training seminar was organised in Helsinki, Finland by EATI and A-Clinic Foundation titled ‘Telematic Methods in Drug Prevention’. Telematic Methods refer to all sorts of electronic and computer communication, technologies in delivering information and support at different levels as well as with multipurpose objectives. During the three days all aspects related with the construction, development, maintenance and evaluation of a prevention website were discussed. Also experienced speakers presented the various technological tools available to reach the different target groups.

First Mr. Teuvo Peltoniemi, head of the Information Department of the A-Clinic Foundation in Finland, talked about the challenges the information society we live in nowadays, raise to professional workers in the addiction field. In his presentation questions like why, how, when and who, were answered in practical terms: implementation of telematic methods. The differences between the real and the virtual world, between social and psychological distance regulation, anonymity, interactivity, utopia, chaos, methodology, symbolism and harm were only some of his topics. Mr. Tuuka Tammi from the Finnish Centre for Health Promotion presented a full picture on the planning and production of a website. We learned about the different stages and steps in the building process. After these inspiring lectures we visited STAKES where we had the opportunity to hear about their experience in creating and maintaining a website for institutions and professionals in Finnish welfare and health. STAKES is the National Research and Development Centre for Welfare and Health and also the focal point for EATI. Mrs. Saini Mustalampi, development manager, introduced the objectives and methodological process of STAKES online services. The main goal is to support and guide all network resources, ensuring equal, effective and quality access to research, development and databases.

Mrs. Kati Rantala, researcher in the Sociology Department of Helsinki University, presented study results on linkages between recreational drug users and internet. It became obvious that there is a gap between what recreational drug users seek in the cyberspace and the sometimes moralising and unattractive approach of most of the prevention drugs sites.

Mr. Roel Kerssemakers presented the Jellinek Drug Information Website from the Netherlands. He gave an impression of the questions and problems that are to be tackled during the design of an attractive and up-to-date website like the www.jellinek.nl. This site has special pages for young people, in particular for party visitors. The Jellineks philosophy is to present relevant information about recreational events in a positive way, combined with information about drugs. The site offers the possibility to send questions to the Prevention Department. Questions and answers are listed on one of the pages of the site.

The contents of the presentations as well as the experiences presented by the participants and the doubts about the implementation of telematic methods altogether were an enormous source of information. The diversity of the participants’ social and cultural background was a great contribution to the richness of the seminar.

As it was referred, we live in a world where the gap between virtuality and reality is becoming narrower. This makes me wonder if we are shortening time and space distances, but slowly becoming more far away from those we share our every days’ life with. This might be the key question to balance our individual and collective growing with the basics of emotional human experience: ‘Happiness land, where is it? How do we get there?’ These questions probably are often presented in a more or less undercover fashion, in some choices and decisions made by the drug users or to be more precise, in everyone’s life.

Changes in the drug scene are a challenge for professionals working in the field of addiction. The increasing number of polydrug-users and the changing pattern of using ecstacy and other stimulants have been recognised for a longer period already. More problematic patterns of multiple use of licit and illicit substances are a phenomenon that requires an adequate approach. To tackle these problems professionals need special skills and expertise. Therefore the TransDrug project will develop a Tool Kit which provides trainers with all necessary methods to analyse the requirements for training professionals.

The TransDrug project aims at training needs analysis in health and social services. The project is funded by Leonardo da Vinci and will be co-ordinated by A-Clinic Foundation in Finland. EATI will be participating together with partner organisations from Italy (Padova, Rovigo, and Adria) as well as the Centre for Treatment of Drug Dependence Bratislava, Slovak Republic. The duration of the project will be 30 months.

Improving the quality, relevance and effectiveness of training offered to professionals involved in the management of substance abuse problems is the main topic of the project. To achieve this the partnership will develop a set of training needs assessment methods that will be disseminated in the form of a Tool Kit. With this Tool Kit trainers and service planners will be provided with all relevant information which is essential for training professionals.

The project is a response to challenges that arise from the changes in the drug scene aiming at strengthening the competence of a broad range of professionals which, in turn, requires an understanding and an appropriate assessment of existing and emerging needs for training.

The Transdrug project is characterised by a cross-sector approach focused on local/regional level, practicality and a close link between needs assessment and training planning.

The first transnational work meeting of Transdrug was held in Helsinki from 22 - 24 February with participation of the Italian and Slovakian partners, EATI/Jellinek, A-Clinic Foundation and nine national Finnish professional networks.

For further information, please contact Mr. Dick Osseman, EATI Staff Office

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EATI’s plans for 2001 - 2003

Founded in 1994, EATI is about to start a fourth period of training professionals and crossing borders. Europe in 2001 looks quite different from the Europe we knew in 1994. EATI already started to cross borders from several ‘new’ countries. The knowledge and expertise in countries all over Europe is being shared and exchanged.

Reviewing it can be concluded that EATI has achieved to be a leading and well-accepted network in the European field of substance abuse treatment, prevention and research. In the period of 1998-1999, 85% of all participants came from fourteen member states. A special training for professionals in the fifteenth country, Luxembourg, will be given in 2001. The other 15% came from the pre-accession countries Poland, Czech Republic, Slovenia, Estonia and the Slovak Republic. The trainers network now consists of 25 specialised professionals. With the exception of Sweden and Luxembourg, training courses have been organised in all the EU member states. Up to January 2001, EATI has implemented 32 training courses, seminars or summer schools with a total of 127 training days and an average duration of four days. In total about 600 trainees participated in these intensive training courses. These trainees rated the training programmes with an average of 8.4.

For the fourth period, EATI will continue to develop, organise and implement a package of new training courses. Furthermore the development of curricula, methodologies, evaluation and further strengthening the network of trainers and trainees, will be emphasised. Special projects will be developed in co-operation with pre-accession countries.

Though some useful initiatives have taken place, for example in the U.K., Sweden and The Netherlands, there is no standardised system of training and education on substance or alcohol problems in Europe. The standards vary from country to country. Still, there are some important common features. Medical education has suffered everywhere from the limitations of the traditional medical curriculum. Health issues with a major psychological component that require integrative, multidisciplinary learning, are not the first priorities in the medical curriculum. It seems that medical education on alcohol is inadequate quantitatively as well as qualitatively. In many countries the time devoted to study alcohol and other substance abuse problems seems to be limited to a few hours. Only recently some countries have undertaken steps to integrate education about substance abuse problems into the core curriculum.

It is obvious that there is a need to embrace co-ordinated, multidisciplinary approaches addressing lifelong learning. Opportunities to advance the agenda currently are available in many European countries. New developments, especially in the field of health reform and in reforms of medical education, have become available. With respect to health reform, many countries are strengthening the primary care orientation, commonly associated with an increased emphasis on health promotion. Also activities related to prevention and early detection of substance abuse problems have become priorities. These activities often involve multidisciplinary team working. In many countries undergraduate medical and health curricula are becoming more community oriented and involve greater primary care input. In postgraduate and continuing medical education the importance of lifelong learning is recognised as well as education based on practice and multidisciplinary learning. It is rather clear that a broader curriculum on substance misuse is necessary, moreover because alcohol problems often are associated with prescribed drugs or illegal drugs, especially for younger patients.

WHO
The WHO Working Group reported recommendations on education and training in alcohol related problems in 1992. Medical colleges or faculties should adopt these. In principal the recommendations also refer to other substance abuse problems, such as illegal drugs.

1. Primary health care doctors should be trained and educated in knowledge, skills and attitudes needed to deal with alcohol use and alcohol related problems.
2. Teaching on alcohol and alcohol related problems should be included in medical education for general practice at all levels: undergraduate, postgraduate and continuing medical education.
3. At the undergraduate level, such teaching should be co-ordinated by academic departments of general practice and/or public health, where they exist.
4. Education and training programmes should impart an understanding of the behavioural and social determinants of alcohol use and alcohol related problems. Also knowledge of the medical, psychological and social consequences of alcohol (ab)use, their diagnosis and management should be part of training programmes. An understanding of the roles of the individual, the family and the community should be included. Knowledge of the principles and methods of health promotion, disease prevention and screening are topics to be covered.
5. A multidisciplinary approach should be advocated at all levels of education.
6. Doctors should gain understanding of the need for inter-sectoral collaboration in the prevention and management of alcohol related problems.
7. Education and training programmes should be based on current research findings.

A determined and co-ordinated effort is needed to ensure that doctors will be better equipped in future to deal with a major health problem. This requires preparation and implementation of an action plan from national health departments. The action plan should aim at undergraduate, postgraduate and continuing medical education in alcohol and other substance abuse problems. European support and leadership are necessary for these achievements.

EATI is currently preparing such an action plan to improve (under)graduate medical education at medical schools in Europe.

Wim Buisman

The participants from Ireland, England, Sweden, Denmark and Holland were very impressed by Lesley Anne Browne from England and Bart Majoor from the USA who proved to be very competent trainers on the subject. Although the participants came from countries close to each other, there seem to be considerable differences between the drug policies and the styles of intervention. The variety of views and perspectives caused a very intensive as well as pleasant training seminar.

During the seminar attention was given to the paradigm shift in the concept of harm reduction. The acceptance of drug as well as alcohol use and of addiction leads to a change in approach. This also influences the goals set by drug assistance organisations and health authorities. It has become obvious that also the police have become a partner in the field of harm reduction. They provide assistance, indicate problematic users and they help us to get in touch with the drug users. The time drug assistants waited in their office for the (motivated) clients to show up has gone by. They reach out, they hit the streets and they try to help their clients to live their lives in a more healthy and satisfying way. Drug assistants nowadays listen to the drug users instead of patronising them.

For some workers in the field this shift brings along a rather profound change in their professional attitude. What was formerly abhorred, now is being accepted. No longer the goal is to achieve a total and lasting abstinence. Instead of this, mediation is the way of approaching the target group. Some workers may find this beyond their reach. The ones who can come need constant training to help them re-invent their style, tuning in with changing behaviour amongst their clients. They need to know how to cope with different cultures, be aware of the elements of sex and age and they have to learn to find a balance between their heart and their head. Focussing on the client must not lead to a loss of identity for the worker. Supervision therefore is essential to prevent them from burn out.

In the seminar attention was given to funding harm reduction activities. A frequently discussed issue was the relation between assistance and the actual client. As a matter of fact the question raised who or what can be seen as the client. If society is the client, what does it want to buy? Is the drug user the client: how can we help him or her in the best way. It appeared to be rather obvious that a trap lies in wait. Of course drug assistants can offer all services the society requests, all for the sake of damaging the drug users’ freedom. A nice example was presented by one of the Dutch participants. The city council wanted her organisation to open the doors of an already existing ‘drug users room’ for alcoholics, who were almost certain to disrupt the pleasant atmosphere in existence. The purpose of the city council was not primarily to offer assistance to the alcoholics as such, but rather to put an end to disruptions in the street, caused by them. What to do? Give in to the pressure from who in the end are your employers, or make it clear to them that in solving one problem, they are destroying the solution to another? The discussion on this subject gave us insight in the relation between harm reduction and society.

Although the training seminar was an intense one, there was lots of fun. I will never forget the glorious appearance of one of the attendants who had put himself in a cardboard box, dressed up with all sorts of waste from the street. With a joint in one hand and a needle in the other, he illustrated harm prevention on a street level. The woman, who sat in a chair in the background, dressed in a white cocoon, representing a condom in use, never said a word, looked rather normal in the circumstances. We laughed a lot that day and we found it hard to part at the end of an insightful seminar. It may be concluded that follow-up training in harm reduction is a constant need.

Quality is an element that is considered continually within EATI. Continuous improvement of the quality means to function on the cutting edge. EATI has proved its merits by obtaining the ISO-9001 quality assurance within the EFQM framework. The reason EATI opted for the ISO-tool is that this system fulfils a number of practical criteria. It is a comparatively simple system which keeps alive during and by its being used, the costs of which do not exceed the proceeds.

EATI’s quality system is not a static book, but a living route. By analogy with education permanente, which has gradually become a generally accepted principle for individuals, it is true for quality management that there is a continuous process of development. By consciously applying quality as a system for improvement, EATI is raised to a particular level. The quality policy within EATI has been developed in coherence with Jellinek.

Recently EATI has published a report called "Quality Assurance within EATI: ISO 9001 within EFQM Framework". A copy can be ordered, free of charge, at the EATI Staff office in Amsterdam.

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Since the 1st of March, a new colleague, Dick Osseman, is employed at the EATI staff office.

Dick Osseman has a masters degree in Psychology, which he received at Amsterdam University in 1982. Due to his sympathy with the cause of drug addicts, he started working in 1983 at Princenhof. Through several mergers this organisation became part of Jellinek, the major drug service organisation in Amsterdam. There Dick Osseman organised housing facilities for (mainly active) drug users, and was co-author of a protocol for workers in the out reach for the hard core drug users. As such he has always worked in the harm reduction field of drug service provision.

At EATI Dick will be mainly working as a project researcher on the Transdrug project (see this Newsletter).

From 14 - 16 June 2001, the Luxembourg-based Centre de Consultation et Siege Social / Jugend- an Drogenhëllef in cooperation with EATI, organizes a 3-days training seminar on Psychiatry & Addiction for French speaking professionals in regions close to Luxembourg.

In principle this special training is based on the format of the European EATI training courses held in 1999 and 2000 (Porto).

As trainers for this seminar will act Dr. Geert Dom (Psychiatrist, Antwerp, Belgium) and Dr. François Charon (Psychiatrist, Charleroi, Belgium).

The whole training course will be hold in the French language; also the hand-outs will be provided in French.

De 14 à 16 juin le ‘Centre de Consultation et Siege Social / Jugend- an Drogenhëllef’, à Luxembourg et EATI organisent une cours entraînement de trois jours sur le thème ‘Psychiatrie et Addiction’. Cette entraînement est organisé spécialement en français pour les experts de drogues dans la région de Luxembourg. En principe cette entraînement spécial est basé sur le format standard des courses entraînement organisé à 1999 et 2000 au Portugal. Les entraîneurs à Luxembourg seront Dr. Geert Dom, psychiatre en Anvers, la Belgique, et Dr. François Charon, psychiatre à Charleroi, la Belgique. La langue véhiculaire est le français de même que les aides distribuèes.