Filenews 29 January 2023 - by Marios Demetriou
"Addiction and dangerous substance use are the biggest health problems we face today in Cyprus", reveals a recent study by the Center for Information and Treatment of Addicted Persons (KENTHEA), while as the president of KENTHEA, Metropolitan of Tamassos and Orinis Isaiah, emphasizes in an interview with "F", "the second biggest problem of Cyprus after the Turkish occupation is drug addictions and behavioural dependencies, with all the delinquency and social problems associated with it."
He added that "the Secretariat of KENTHEA, with the agreement of the Board of Directors, has requested in a written letter a meeting with the main candidates for the Presidency of the Republic in the elections of next Sunday, February 5, so that each one in case of his election has high on his agenda the issue of drug addiction, which is one of the biggest destructive factors of the progress of our country".
According to the study concerning the "decisive treatment of the problem of addictions to substances and behaviours in Cyprus" and signed by the scientific director of KENTHEA neurologist psychiatrist Dr. Kyriakos Veresies (M.D.Ph.D): "In recent years, a large amount of scientific research has accumulated that clearly proves that addiction that includes smoking, alcohol, controlled prescription drugs and illicit substances - cannabis, cocaine, heroin, ecstasy, crystalline amphetamine, LSD and others - end up becoming a complex brain disease, a disease that, like other diseases, can and should be diagnosed and treated within the public health system, using available evidence-based practices.
The dangerous use of addictive substances is a public health problem, and there are tools available for a wide range of professionals in the field of health, social services, education, criminal justice and other fields to control it and intervene to reduce its consequences as well, including the chances of developing addiction." And yet, as the study found, "screening and early intervention for hazardous substance use is rare in Cyprus and the vast majority of people in need of drug treatment receive nothing approaching evidence-based care, since based on empirical evidence, less than 5% of people who meet diagnostic criteria for addiction to illegal substances and alcohol, receive comprehensive treatment, care and monitoring by the GHS (General Health Plan)." And this is the case, as stated, "despite the prevalence (frequency of occurrence) of these situations, the enormity of the consequences arising from them and the availability of effective solutions".
1 in 10 treatment addicts
Key findings of the study are that "150,000 Cypriots aged 12 and over meet the clinical criteria for addiction that includes nicotine, alcohol or psychotropic drugs and illegal substances and this number is higher than the number of people with heart disease, diabetes or cancer. Another 150 thousand people fall into the category of dangerous substance users, defined as those who are not addicted, but who use tobacco, alcohol and other substances in ways that threaten their personal health, but also public health and safety. Only about 1 in 10 people with an addiction involving alcohol or illegal substances, other than nicotine, receive any form of treatment. Of those who receive treatment, few receive anything that approaches evidence-based care. Most healthcare professionals who should provide addiction treatment, are not sufficiently trained to diagnose or treat the disease, do not have the necessary knowledge, skills or credentials to provide the full range of effective treatments." It adds that "addiction and dangerous use lead to and contribute to a wide range of costly social consequences, including crime, accidents, suicide, family violence, child neglect and abuse, family dysfunction, unplanned pregnancies, loss of productivity, and more. In addition, addiction and dangerous use cause or contribute to more than 70 other conditions requiring medical attention, including cancer, respiratory diseases, cardiovascular disease, HIV/AIDS, complications of pregnancy, cirrhosis, ulcers and trauma."
As the president of KENTHEA, Metropolitan Isaiah, pointed out to "F", "the fact that drug addiction and addictive behaviours are a matter of public health, is a bell that rang in Cyprus for many years, but unfortunately it is not heard and taken into account by those who should. There are good intentions and officials who agree, but what is lacking is the political will to include this problem in the GHS and make it a public health issue. Drugs have penetrated into our lives and daily lives, into thinking, entertaining, problem-solving, to the extent that society as a whole is affected and a huge social and institutional alliance is needed to tackle it effectively – a large number of road accidents and even serious ones linked to substance use, as well as many crimes, including human trafficking and violent racism. Recently there was a fight between young people at a memorial service, apparently related to substance abuse. There must also be restrictions on easy access to legal addictive substances. There is no aspect of the social fabric that is not affected by dependencies. If addictions are not a public health issue, then what is a public health issue? State institutions must operate inclusively and give "weapons" and "bullets" to non-governmental organizations that can help, of course through control, monitoring and supervision."
The president of KENTHEA made special reference to the Protocol concerning adolescents for treatment instead of imprisonment in relation to possession and use of small quantities of cannabis and told us that "this should include in addition to minors and adults for all illegal substances". He added that "many people have family and financial failures, mental problems due to these failures and fall into the trap of substance use that can lead them to commit various criminal offenses. They too are entitled to a second chance, they are not born criminals - no one is a born criminal or a drug user or a bad person. And the state and every government must behave like a mother towards its children - you do not close the door on them, you do not expel them, you do not lock them in a dark cell. In the behaviour of the state we see only a legalistic approach and not parental responsibility, as exists in developed countries, especially in the Scandinavian ones, which think "outside the box" and achieve a lot. I read somewhere and I liked that "if a whole village is needed to support and save a child from something bad, he needs a whole village to "abuse" him, since due to indifference, he let him be abused".
Supply, demand and a... erratic reality
The main factors that, as the KENTHEA study points out, lead to the gaps and weaknesses of the system to effectively deal with the disease of addiction, include the policy of reducing supply, instead of reducing demand, and the insufficient allocation of financial resources". It further adds the following:
"If we look at the general budget of the state, it seems that the main goal of the Cypriot state is to subsidize policies to reduce supply and not to reduce demand, which everyone accepts as the solution to the problem. This is indeed a very erratic reality, because whichever of the responsible state bodies asks, they will answer how they are working on prevention and ... reducing demand. But what happens in practice? Quite the opposite and no one needs to be an expert to understand it. The statistics show the wrong way to go, because very low percentages are allocated to prevention and treatment and there is a difference of EUR 1 in prevention, compared with EUR 57 in repression. (EKEPN 2020 data). Financial investments to address addiction and dangerous substance use in Cyprus are disproportionately aimed at addressing their costly health and social consequences, rather than effectively implementing the available prevention, intervention and treatment approaches. This allocation is made by the Cyprus Addictions Authority and covers non-governmental structures and programs and here there are no deviations from the criteria. The only issue that concerns us is the abandonment since 2007 of the implementation of universal primary prevention and the non-financial allocation of social intervention programmes to schools, groups of children, young people, adolescents and parents. Within the plans for investment in the health sector for the coming years there is not a single word about strengthening the field of prevention or even treatment of addictions." Another key gap in the Cypriot health system is, according to KENTHEA, "the inadequate integration of addiction care into mainstream medical practice".
As the study points out, "every year more than two-thirds of people with addiction are estimated to come into contact with a primary care physician or an emergency care physician. Most doctors and other health professionals only treat the symptoms of the disease that appear in front of them, but they do not recognize or diagnose the disease of addiction, because they do not have the necessary knowledge about how to intervene or do not know what to do with patients who present recognizable and treatable signs and symptoms of addiction." According to KENTHEA there is also "insufficient education and training of addiction treatment providers and insufficient planning for the creation of reception and treatment structures".
The vicious circle at Athalassa Hospital
KENTHEA makes special reference to the mandatory treatment of addicted people within the framework of the Athalassa Hospital. He states in the study that: "This is a new position in the treatment of drug addiction, because with the abuse of stimulants and the induction of psychosis, the addicted person lives in another reality, which does not allow him in any way to acquire a disease and voluntarily request his inclusion in a therapeutic process. The only place where such intervention takes place on the basis of a court order is the Athalassa Hospital. There, however, only treatment of the acute phase of the psychotic episode is offered and due to the lack of structures and therapeutic programs, no assistance is provided for rehabilitation and social rehabilitation of addicted people. Their brief dismissal follows and the vicious circle continues. We believe that during their hospitalization, they should also be given the opportunity to participate in a specialized rehabilitation program and psychological support within the psychiatric hospital. KENTHEA has prepared proposals to the Mental Health Services and AAEK (Cyprus Addictions Authority) on this issue and restores it very regularly. KENTHEA is ready within the framework of the hospital by securing space and resources in the fastest way to operate such a program. The experience of the cooperation between KENTHEA/AAEK and the National Guard is the best example of cooperation between the governmental and non-governmental sectors and the effective implementation of such programs. The families of addicts need help in managing their loved ones, when now due to use they become dangerous to themselves or to others."
Turning to prevention
"The revision of the policy of strengthening the reduction of supply and the decisive turn to enhance the reduction of demand" is one of the main recommendations of KENTHEA for an effective response to the problem. Its proposals include the need to "strengthen all good practices for the comprehensive implementation of primary and secondary prevention programmes at all levels – social, community, family and individual – and for the integration of testing, intervention, diagnosis and treatment for hazardous substance use into daily medical practice".
It also recommends "adapting the programs of compulsory treatment of psychotic conditions resulting from the abuse of psycho-stimulants, with treatment in the same place and the addiction part, that is, rehabilitation". KENTHEA also calls for the "creation of training programs for all health officers to address dangerous substance use and addiction, the creation of a Protocol of standards for accreditation, recognition and certification of Addiction Advisors for health professionals dealing with hazardous substance use and addiction and collective intervention in the GHS, but also in private insurance companies to provide coverage for integrated care for addiction."
Finally, KENTHEA emphasizes in its study that "the Protocol concerning adolescents who are arrested in small quantities for their personal use and are not brought to justice from the first time should be expanded, since they are given the opportunity to attend a number of meetings in specific treatment centres. But if the same offense is repeated, they are tried for the first. KENTHEA's position is that in order to safely go to treatment and not to prison, this must be extended to all ages and for all illegal substances."
