Newsletter

Bulletin of the European Addiction Training Institute

Volume 7, No. 1/2, May 2002

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.

Articles

• Porto course on cocaine, crack and new drugs
• The experience of a participant of the Porto training course
• A programme for sex workers addicted to cocaine/crack
• EATI Task force meeting on medical education
• The Transdrug project on training needs assessment
• New approaches to substance use treatment in Romania
• Techniques of relapse prevention in addictive behaviours
• On line registration, a double win situation

The information on cocaine EATI sent me in advance really helped me to prepare for the training and follow the course better. This also holds for the "homework" we were assigned before the meeting, since I had to search for information regarding cocaine and crack, which created for me an overall picture of the problem in our country. The training provided me with full information about cocaine as a drug, about ways of using it and treating addiction. It was also interesting to hear about other party drugs; new ones emerging on the scene, the way they work and how dangerous some of them can be. As we heard, harm reduction can play a big role in helping drug users, who are mostly young people for whom drugs are part of their culture.

The biological explanation of how various drugs work on different neurotransmitters and their release in the brain was not entirely new to me as a general practitioner, but I didn't know it as precisely as it was explained in the training course. It explained a lot, but did not answer all of the questions about how addictions begin and evolve. We obviously need more knowledge and skills to cope with the problem of addiction successfully, and the training provided us with lots of both. The harm reduction programme devised for cocaine- and crack-dependant users was quite new to me, especially regarding how much research has to be made and how many things known to make it successful and useful.

For me this EATI training was full of new information, a lot of which was also acquired from other participants in our spare time, when we would compare how one copes with addiction in other European countries. The trainers organised our work very well, with everyone in the group actively participating (it could have lasted a day longer, though, so that more group work could have been done). I hope that when the time comes (as it probably and unfortunately will, since drugs are gradually becoming a presence in our country), we will be prepared to deal with cocaine/crack addiction with the help of this seminar as well.     

And on a more personal matter; I think Porto is a beautiful city and (at least for me) it surely contributed to the atmosphere of the training.

The projects’ main aim was to design a harm reduction intervention at the First Contact and Treatment level. The group proposed the preparation of a documentary, showing interviews with prostitutes (male and female), in which they talk about the reasons why they began and continue to use cocaine/crack. The group also proposed publishing an advert that would demonstrate some of the negative consequences of cocaine use and give some basic information on a (free) therapy programme. In addition advertisements would be put in sex-magazines and newspapers and a trained team of health educators/advisers would give information about cocaine use and sex. They will dispense condoms and handouts containing information regarding the therapy programme, while also explaining that sexual disease screening is available. There will also be a Drop-in Centre which will have a relaxed atmosphere where prostitutes will be able to shower, sleep for a while, attend group or individual therapy sessions if so desired.

Clients requesting individual therapy will, for the first 3 months, receive motivational interview sessions in which the aim will be to progressively gather information regarding their life and drug use history.

For the Intervention stage, which has been called “State of the art in treatment”, two formats have been chosen, the first a community therapy, the other an out patient one. The first treatment (supposing we have “unlimited resources”) will be on an island, away from clients usual environment (to break the “cycle”). During this phase, which will last approximately twelve weeks, clients will have two daily group meetings of approximately 60 minutes each, and have access to relaxation sessions, acupuncture, a fitness centre, bicycles, a nutritionist, and a financial advisor. They will also work in a garden and on a farm. After this in-house treatment they will be moved to a halfway house to readapt themselves to their environment, find a place to live, get a job, start studying etc.

As regards the outpatient form of treatment, this will last for 6 months and clients will have daily group sessions with an integrative approach.

Both types of patient will attend an After Treatment Centre, where they will have group sessions three times a week and the possibility of individual counselling. They will be required to sign a contract in order to participate in this group for a year. After this stage follow-ups will be done, the first 6 months after completion of the After Care treatment and the second a year after the first.

This project is the result of much discussion and the input of many different points of view and experiences, which was noted all through the training course, this in turn made it an extremely enriching and worthwhile exercise.

All participants of the Task Force presented the “state of the art” on medical education on substance use in their country and medical faculty. They outlined the “philosophy” of the curriculum, the features (which year, which medical disciplines involved, content & methodology etc) and the problems that currently exist.

With regard to the “philosophy” of the curriculum, different models and concepts were discussed such as: the bio-psycho-social approach, the multiprofessional and the substance use specialist concept and the behavioral medicine approach. Also the role of general practitioners and of family doctors (who have different positions in the health care systems in EU member states) was discussed. Other topics under discussion consisted of the need to have European guidelines on medical education on substance use and the question “how to profile substance use training” in the medical curriculum.

As a result of this first Task Force meeting it was decided to conduct a feasibility study to assess the determinants that facilitate effective medical training and faculty development on the theme of substance use.

The preliminary results of this feasibility study will be presented during the second meeting of the MED-ED Task Force. This meeting will take place on the 28th and 29th of June in Antwerp, Belgium, hosted by the Medical Faculty of the University of Antwerp.

This project has been under way now for over a year. Partners from the participating countries (Finland, Italy, Slovakia and the Netherlands) have collectively met on three occasions and within each country contacts have been established or extended between relevant organisations. Several methods have been applied to establish the training needs mentioned, with different methods being preferred in the countries involved. As a result a body of knowledge is gradually emerging concerning the feasibility of the methods tested, for instance futures scenario's, SWOT analysis, brainstorming or brain writing ( a method we did not ourselves know of, more can be found at http://www.creativityatwork.com/brainwri.htm) the dual group method and many more.

The latest meeting took place in December 2001 in Haarlem, the Netherlands. Hosted by EATI, participants from the partner countries congregated to discuss the state of things. Thirty-five participants, 3 Dutchmen and on average 11 from each of the visiting countries spent an interesting three days. On the subject of the training needs assessment so far, some true words were spoken by a Slovak representative: many respondents - to whatever form of questioning one uses - indicate what they want, and not necessarily what they need. The elderly amongst us immediately started humming an old Rolling Stones tune (for the younger readers: "You can't always get what you want ..."). But the remark reflected a recurring problem: how can one be certain that what respondents mention is more than "just" a momentary need, is instead essential information that will be of value in the years to come? And linked to that question: what does the future hold in store for us, working in the addiction field?

A trend than is already apparent, and that receives lots of attention in the project, is the increasingly important role played by poly-drug use and the changing patterns of the consumption of ecstasy and other stimulants. But ideally such elements as the effects of changing drug policies within or without the participating countries, the increased professionalism of the workers, the greater role of networking seen in most professions and the greater attention on the interplay between social, psychological and biological aspects in treatment and prevention should all be taken into account.

The extent to which a training policy is already in place in the partner countries (or organisations) has a strong influence on the route taken by a country. The professionalization of specialised nurses, who are themselves requested to state their training needs, in Finland leads to structures of assessment that are different to the ones in Italy, where a strong accent is laid on the prognostication of developments in drug care by experts. Experts also play a major role in Slovakia. In the Netherlands EATI found inspiration in a report on future training needs that was published at approximately the time EATI started it's participation, as well as in trends emerging from the "development centres" that were founded by the collaborating drug assistance organisations, Jellinek being one of them.

A new element is the use of a "project room", a virtual space on the World Wide Web, that participants can use to e-mail to individuals or groups, but also to publish articles and to start or take part in discussions on specific issues. During the first months of 2002 the subject matter of discussion is a number of assessment methods: their pro's and con's, when and how to use them, their pedigree and offspring. Next in line is a discussion on terminology. The project room was a bit empty at the start, and when we tried a chat meeting people found themselves in different corners of the room (or rather: rooms of the project house). Then the whole site was hacked. After a week and a half of tidying up the old furniture had been reinstalled and discussions really took off, and they are flying now. Participants scan the internet for links to informative sites on the methods chosen, inform each other on important articles and books, discuss problems they ran into, solutions they found, and reflect on and react to what others wrote. All the input is saved on the server of the organising partner, A-clinic in Finland. In due course the contributions will form part of the raw material for a booklet (Toolkit) on the assessment methods. For an internet-view on the project surf to http://www.a-klinikka.fi/transdrug/information/ .

Leonardo da Vinci has a site also: http://europa.eu.int/comm/education/leonardo.html

The main reason to organize these training seminars has been the fact that by the end of 2001 the first Romanian Treatment Guide on Substance Use was launched. The goal of the seminars was to introduce this Guide and to present the main topics on substance use treatment and policy to a core group of 45 addiction professionals working in the Romanian alcohol- and drug services. The trainees who were selected for this purpose came from all regions/cities of Romania, having a professional background of psychiatrists, psychologists, nurse or social worker.

The seminars took a total of 5 days (3 in January, 2 in March) and were carried out by leading specialists in the field of addiction (including the main authors of the Guide). EATI also contributed to the seminars by delivering lectures on drug policy, evidence based treatment and modern drug service development.

During the first seminar (January 16 - 18 2002) the main topics of substance use were presented:

§         Overview of drug policies, mechanisms of addiction, alcohol & opiate dependence

§         Overview of different kind of interventions: detoxification, relapse prevention, motivational interviewing, substitution treatment, psychopharmacological interventions etc.

§         Introduction of specific topics such as legislation, drug services, evidence based treatment

The second seminar (March 6-7 2002) consisted of a series of workshops (skills training) and case presentations.

The main themes that were presented and discussed include:

§         Presentation and case discussion based on the cognitive behavioral approach to addiction problems

§         Drinking career & treatment presentation by a former alcoholic male and his partner

§         Video demonstration and small group exercises introducing and applying techniques of Motivational Interviewing  

§         Presentation of intake & assessment procedures and networks of drug services

In the final evaluation session all trainees expressed there high appreciation of the training seminars. In particular, they were very satisfied with the publication and presentation of the Guide and the practical skills-oriented training and case discussions.

A number of participants explained that in Romania the dominant focus is on crisis intervention and detoxification. But at present no real follow-up training (so called “post cura”) programs are available and there is a great lack of psychosocial interventions.

Finally it can be concluded that the implementation of these 2 training seminars (very well organized by the NGO ALIAT and officially certified by the Romanian Institute for Postgraduate Training), have been successful. The training events have contributed significantly to a better understanding and awareness of the substance use problem in Romania and to getting a clearer picture of the opportunities and interventions to treat this problem.

Moreover the training seminars have contributed to the empowerment of the network of professionals, working in the field of addiction in Romania.

The speakers of the seminar spoke extensively about Motivational Interviewing and about Motivational Interviewing techniques and Skills. But the greater part of the seminar consisted of workshops and exercises. This helped a lot in training the skills discussed in a previous lecture. It also enabled the participants to get to know each other better and so a relaxed and comfortable atmosphere was created which, in turn, helped the dialogue and the conversation.

In this atmosphere my horizons regarding relapse prevention techniques broadened, that is, in addition to my knowledge and experience on the subject, I started incorporating new information or would reflect upon my own practice regarding the subject.

Since colleagues from many different countries, disciplines and backgrounds participated - all working in the addiction field - I got a chance to see where other countries and philosophies than my own stand. Through conversation during the lectures or the role playing exercises I  even did reconcile my opinions with opposing philosophies, because I understood that most of the colleagues shared the same or at least similar agonies about where things are going.

Returning from the seminar, I found that apart from having acquired some new information on the subject of relapse prevention, my previous knowledge and experience had somehow become more specific and structured. In fact, I found the seminar to influence some of my everyday activities at work (this will show more with time). From this a need emerged: I think it would be a very fruitful experience if the seminars had a follow-up circle after some time, to check and see how the training influenced the participants and maybe even, add new thoughts and problems in the relapse prevention practices.

The fact that pleased and even surprised me (and I thank my supervisor at my job and EATI for this), is how new perspectives and the exchange of information triggered new ideas and made me review and maybe reaffirm already existing practices even though the seminar lasted only for three days. I believe this to be a need for every professional, especially in our field, that has to be met regularly, if we are to be able to satisfy the needs of the people who come and ask our help in the best way possible.

Go to http://www.eati.org , our "site". Click on Training Programme in the box on the left. On the next page a bright red text says "You may also click HERE ….." Click the HERE. And presto, you can fill in the registration form. Further instruction is given on the page. You do not need an e-mail program or connection, your application is sent by our provider to EATI. You can print the text, and save it. The nice thing, of course, is that you can do this in the evening, the weekend, whenever. The system has been running for almost half a year now, and seems to work fine.

We consider this to be a double win situation: your registration is with EATI seconds after you sent it, and you do not have to worry if we did get it (technically, servers may break down, but until now they didn't and we are well satisfied with the system). For EATI the advantage will be that shortly after sending out an invitation to register we will get the first responses, so that we will more quickly get an indication if a course will be, well, sold. This has advantages for the prospective participants, but also for the hotel we book rooms at, the trainers, training facilities, restaurants et cetera.

A similar form enables you to send us questions, remarks. And in the future we will try to extend our e-facilities. For instance, we would like to send our newsletter in future as an e-mail attachment to those contacts who provided us with their e-mail address, saving stamps and time (and did you know we put our newsletter on our web-site: click on "news" in the box on the left of our opening screen and find both the present and earlier newsletters). We would like to send prospectuses for new courses by this method also. And maybe we will gauge training needs in future making use of some e-questionnaire.

Having explained how we will use the e-option more often in the future it will not come as a surprise that we ask all readers who would like to be regularly informed on EATI-activities to supply us with their e-mail address in case they feel we might not have it yet. The easiest way would be to use the e-mail option in the menu in the left hand corner of every EATI-page, and write us an e-mail (to "").