Pubdate: Sun, 03 Jul 2005
Source: Cyprus Mail, The (Cyprus)
Copyright: Cyprus Mail 2005
Contact:  http://www.cyprus-mail.com/
Details: http://www.mapinc.org/media/100
Author: Stefanos Evripidou
Bookmark: http://www.mapinc.org/pot.htm (Cannabis)
Bookmark: http://www.mapinc.org/mdma.htm (Ecstasy)
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

LIFE ON THE OUTSIDE

LAST week we looked at life in an inpatient centre dealing with the 
addiction of drugs when psychologists at Ayia Skepi Therapeutic 
Centre in Filani village opened a small window to the world of 
intensive, sequestered treatment, where addicts were prevented from 
contact with the outside world for months. The aim of this policy is 
to deconstruct the force behind their habit and build up enough 
self-esteem to help them face the world on a stronger footing.

Today, we get a look inside the outpatient centre I Tolmi in Nicosia, 
where drug addicts who continue to live, work and interact in society 
try to kick the habit by visiting a couple of times a week. Unlike 
the inpatient centre, when I Tolmi's participants leave the centre 
after each session, they return to the house, family, spouse or job 
where their habit first started.

TOLMI opened in Larnaca in 1992 to deal with alcohol addiction. Soon 
after, it became apparent that drug use was becoming more prevalent 
and in 2000 a Nicosia centre opened, followed by one in Limassol four 
years later. The board of directors (volunteers, former addicts and 
members of staff) are hoping enough funds and sponsors can be raised 
to open a much-needed outpatient therapeutic centre in Paphos soon.

The proportion of people now seeking help for drug, rather than 
alcohol, abuse at one of the Tolmi centres on the island has reached 
95 per cent.

The Sunday Mail visited the Nicosia centre. Up a small flight of 
stairs, the a flat has been transformed into an outpatient centre 
with rooms for individual therapy, group therapy and a small room for 
drama therapy. Funds seem tight.

Tolmi psychologist Georgios Poyadjis explained that people from all 
walks of life, educational and social backgrounds, from 16 years up 
come seeking help for drug addiction.

"We have a 24-hour hotline. We get police, doctors, and lawyers 
calling us wanting treatment for a client. This is a good motive, 
getting treatment before a trial. We insist that addicts are clean 
before therapy starts. To get a paper from us to use in trial we 
insist they do a six-month programme," he said. Those that complete a 
six-month programme can go on to do a further six months.

The treatment is called 'tertiary prevention', where trained 
individuals try to help addicts from using again. Therapy takes place 
four times a week, two hours a session. Anyone participating on the 
programme gets two sessions alone with a psychologist, one in group 
therapy, one doing drama therapy and, as Poyadjis tellingly says, 
"when we have money we do occupational therapy too".

There are 70 drug addicts currently in the programme, 40 are fully 
involved while 30 are half in half out, still thinking about it. 
"Most, 35, are here for heroin, around 15 for marijuana and other 
substances while the remainder are multi-users, who take a bit of 
everything apart from heroin," said Poyadjis.

The majority are socially active, may work sporadically or go to 
school. Around 85 per cent are male.

"From the kids that come here, we ask at least one parent to have one 
session of therapy per week with us, by themselves."

Going to the centre "means a change of life and thinking," Poyiadjis 
said. "There is no magic; it is the work of the person. We help them 
respect themselves and become productive citizens in society.

"The risk of relapse is quite high but if someone relapses, it gives 
us a chance to work on what we missed about that person before," he said.

He acknowledged that people from a healthy family environment had a 
better chance in an outpatient centre, compared to addicts who need 
distance from dysfunctional family environments to begin the process 
of losing the addiction.

"Incomplete socialisation is the biggest problem. There are many 
factors involved - manipulation, authority exercised in the family. 
Every person is different. No one therapy fits all. The aim is to 
mould and re-socialise the person."

Statistics show that from those who complete a one-year programme, 60 
to 70 per cent stay clean for three years.

"Those in society run more risks of relapse but if they face those 
risks, it makes them stronger. Research shows patients who complete 
outpatient programmes can stay clean four to five years longer than 
those in inpatient programmes. It's also cheaper. A person in therapy 
costs us UKP 500-UKP 700 a year, inpatient centres can cost up to UKP 
50,000 a year per person."

 From those who come to the centre, half end up leaving after one or 
two visits. "A big problem is denial. There is a shift in attitudes. 
Young people think marijuana is nothing. Over the last two to three 
months, there has been a lot of skunk around from Holland. The 
Tetrahydrocannabinol (THC) content in skunk can bring on paranoia, 
psychosis in a lot of cases. Normal grass has four to six per cent 
THC content, where as skunk has up to 20 per cent now.

"So first you have to deal with denial, try to minimise it because 
it's always there. You need to motivate people to stabilise the 
decision to stop drugs, make them realise they have a problem, then 
build on that," said Poyadjis.

"The philosophy behind this is the need to change the whole person. 
Give them social and psychological skills to work on their behaviour, 
find the underlying problems." For those who make it and stay the 
course, the biggest problem they have to face is finding a job afterwards.

"When people get clean, they are stigmatised. It's a small society 
and it's very hard to get a job. They face a lot of problems getting 
back into society. Most people who finish with us don't want to be 
identified with the programme, apart from our treasurer, an ex-addict 
who owns a restaurant and tells everyone."

Poyadjis highlighted the seriousness of stigmatisation for former 
addicts. "We had a professional businessman who was shooting heroin 
for eight years. When he got clean he didn't want anyone to know. 
After three years, he met his fiancee. We had eight sessions just 
discussing whether to tell his fiancee about his past or not. Eight. 
He did in the end."

Asked how therapists deal with questions on the effects of drugs that 
science knows little about, like ecstasy, he replied: "We don't tell 
them things like drugs are good or bad. Who am I to say that? We ask 
them questions about how it affects their lives, we let them know 
continuous use of marijuana creates problems, that there is no 
control over the production of ecstasy, that it is made in 
clandestine laboratories.

"It's not 'why do you try drugs?' It's why do you continue using 
them, that is the root of addiction," he said.

Tolmi has 12 members of staff working in the three centres: nine 
psychologists, one drama therapist, one sociologist volunteer and one 
social worker.

The budget for the three centres comes to UKP 60-70,000 a year, 
markedly less than what Tolmi would like.

"We asked the Health Ministry to give us equipment to run our own 
drugs screening tests for participants but we have heard nothing. So, 
we have to ask people to pay UKP 20 to 30 a week to make their own 
tests," said Poyadjis.

"We get UKP 15,000 from the Anti-Drugs Council a year, UKP 6,000 to 
UKP 7,000 from the government, and the rest is left to us to raise. 
Last year members of staff went months without payment. Our biggest 
problem is money. We have become a revolving door; all therapists 
pass through here first, and leave because we just don't get enough money."
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MAP posted-by: Beth