Andrey Rylkov Foundation
for Health and Social Justice

State-run rehabilitation program needs more work

Denis Avtonomov

Denis Avtonomov

By Denis Avtonomov

On June 28, 2013, a project run by the State Interdepartmental Program (“Comprehensive Rehabilitation and Re-socialization of Consumers of Narcotic Drugs and Psychotropic Substances”) was presented. The Russian Federal Drug Control Service, which is a law enforcement agency, drafted the document and is responsible for the execution of the program.

The purpose of the state-run program is to reduce the demand for drugs, develop rehabilitation resources and provide access to social and rehabilitative care for all those who want to stop using drugs.

The following essential stages were highlighted in the project: prevention, early diagnosis and intervention, treatment and protection, rehabilitation, social integration, provision of additional services (including employment assistance, access to education, etc.).

According to the Federal Drug Control Service there are currently around 500 non-medical rehabilitation and re-socialization centers that have been created by nongovernmental organizations in the Russian Federation. Up to 20,000 drug addicts undergo rehabilitation in these centers annually.

According to the government project, “an establishment of necessary mechanisms and modalities for increasing the number of rehabilitated drug users to 150,000 people each year is required.”

It is assumed that the state will select and create a unified database of private rehabilitation centers and, by means of using a non-cash payment method, pay for rehabilitation services for every citizen of Russia who wants to get rid of his or her drug addiction. The program is scheduled to run in 2013–2020, with total funding at 179 billion rubles (nearly U.S. $ 5.5 billion).

On paper, it looks great — rehabilitation, care, employment, social services, etc. However, “the devil is in the details.” To begin with, instead of the term “addict” (a person who has been diagnosed with substance abuse or drug addiction), the term “drug user” is predominantly used in the project and is not defined as a disease in the medical sense of the word. Only a minority of drug users have an addiction.

Nonetheless, according to the Federal Drug Control Service project, a person is supposed to be referred to rehabilitation even in the case of a single (!) use of a narcotic and psychotropic drug without a doctor’s prescription. That is, a person who is not ill is supposed to be treated prematurely.

In general, the methodology of the project is based on the erroneous assumption that “drug users” and “drug addicts” are identical. Another miscalculation of the project’s developers is the belief that anyone who uses drugs will become addicted if not treated urgently.

The principle of anonymity is not even considered in this project. The fear of being recorded is the main reason addicts avoid substance abuse treatment in public hospitals and rehabilitation centers under the Russian Health Ministry.

A “data bank” is supposed to be created for all the individuals who use drugs. Being on the list can have serious consequences and become the basis for significant deprivations of rights for a citizen of the Russian Federation (including limitations concerning employment, use of weapons, driving vehicles, caring for and adopting children, etc.).

In general, the State Interdepartmental Program rehabilitation project is unreasonably expensive, creates preconditions for the creation of a narrow circle of their own rehabilitation centers, contains methodological errors and is contrary to the principles of medical ethics and validity.

The project involves a more than seven-fold increase in rehabilitation resources (from the original 20,000 to 150,000), without providing any evidence-based assessment of the need for these resources to be used.

With all of these shortcomings in the program, the government must first conduct a thorough, evidence-based, representative estimate of the number of drug users in the Russian Federation (which has not yet been done), by type of psychoactive substance used, age, gender, employment status and frequency of drug use.

It is necessary to distinguish these individuals from those who meet the criteria of drug abuse and separate them from those who meet the criteria for drug dependence.

The lack of such baseline data does not allow for the assessment of the need for rehabilitation resources or implementation of a plan of expected performance. The development of the project should involve competent experts — primarily lawyers, psychologists and doctors, and not security forces — followed by an assessment carried out by the experts of leading specialized research institutes.

Denis Avtonomov is a medical psychologist and the head of a charitable Russian rehabilitation program (“No to Alcoholism and Drug Addiction”).


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