Preventing Drug Use & Treating Disorders in At-Risk Youth

1. GLOK42: Prevention of illicit drug use and treatment of drug use disorders for children/adolescents at risk “Evidence-Based and Ethical Prevention of Drug Use and Treatment and Care of Drug Dependence” Training of UNODC Field Staff23-25 November 2010 Vienna International Centre Elizabeth Sáenz Miranda Project Coordinator Drug Prevention and Health Branch

2. Main purpose: • To promote a worldwide coordinated response of public institutions and NGOs to children and adolescents at risk and/or those affected by drug use dependence and its health and social consequences, with the aim of preventing drug use, treating drug dependence and facilitating their integration into society. Strategy: • A large scale mobilization, including the involvement of civil society, academics, media and high ranking personalities to call for immediate action to improve the living condition of children worldwide, reduce the risks of developing drug use disorders and provide appropriate treatment strategies tailored to respond to the specific needs of this age group.

3. Background • Substance use disorders appear to be more problematic when the age of onset is low, given the increased damage that is produced in the underdeveloped brain. The larger the number of adolescents and young adults exposed to experimenting with alcohol, tobacco, illicit drugs and controlled psychoactive medications, the larger the rate of vulnerable population at risk of developing addiction. • In most cases, the decision to experiment with psychoactive substances in adolescents and young adults is related to a combination of genetic and environmental factors contributing to psychobiological vulnerability and reduced resilience. Adverse childhood experiences such as neglect and abuse, together with temperament and personality traits at risk, lack of bonding to family and poor parenting, low levels of engagement in school activities, social deprivation and exclusion, extreme poverty, instability and exposure to violence, early onset mental health disorders may be frequently evidenced in the history of addicted individuals. • Evidence-based prevention methods are effective in reducing or delaying the exposure to psychoactive substances and decreasing the rate of those becoming dependent. Accordingly, a wide range of ethical and science-based treatment methods and rehabilitation programs have been proven effective in stopping or reducing the behavioural consequences of addiction, providing the opportunity of a normal life for a large rate of the patients and standard expectation of life. • A huge human and economic capital can be saved and enormous resources redirected to socioeconomic development and progress. Cost-effective prevention and treatment tools exist and should be used to alleviate the consequences of substance abuse.

4. Children in conflict and post-conflict areas are often heavily affected by severe problems. In general, it seems that the prevalence of mental diseases in post-war countries is increasing, particularly posttraumatic stress disorder. Children’s mental health is affected by severe traumatic experiences such as the killing of family members; posttraumatic stress disorder develops through permanent exposure to violent events. • In Afghanistan, political and military conflicts have led to massive disruptions of livelihoods, education and networks of social support. In 2007 in Afghanistan, 39% of children reported at least one type of war-related traumatic event during their lifetime. General health condition and development are also impaired in Afghanistan because of war-related events and a violent environment. • Children not directly exposed to war are living in an environment where their caregivers might have been directly exposed to war and combat and are, facing psychological traumatic consequences and may lose the capacity to give adequate support and care to their children. • Moreover these children suffer from indirect consequences of the war and community-level stressors such as child labour and poverty: in Kabul, 36000 children were reported as carpet weavers (Cooperation Center for Afghanistan, 2002) and traumas that were not related to war were among those most distressing to children in Afghanistan (Panter-Brick et al., 2009). • Despite the violent environment and the war-related events experienced by Afghans, Kanji et al (2007), identified three main protective factors that help them coping with life: religious believes, family support and community support. Religious believes provide Afghans not only with hope for the future, but also serves as a driving force to the other protective factors such as family and community support. Culture of hospitality and family values ensure bodily cleanliness, respect for elders and a good language. Sometimes also ideology and political processes help Afghan families rationalise the experiences of war and everyday coping is supported by a religious orientation. Negativism and hatred can sometimes be considered as tools for coping.

5. According to an Afghan drug use survey made by UNODC, the prevalence of opiate use is between 2.3 to 2.9 % in the adult population (between 285,000 and 360,000 persons). • Opium is the most common used opiate with an estimate prevalence of 1.7 and 2.1 per cent of the adult population or between 208,000 to 250,000 regular opium users. • Moreover, Opium abuse is not only a matter of adult Afghans but also involves children who are exposed to indoor environments where opium is consumed. • Traditional use of Opium is common in Afghanistan. Opium is commonly used by parents to calm their children down during the work hours and as replacement to food they cannot afford because of the extreme poverty.

6. Target group • Children/adolescents living in marginalized communities, streets and/or institutions such as orphanages, with increased vulnerability to drug use or is already suffering from problematic drug use and/or dependence.

7. Target groups in detail The specific target groups of the Afghanistan segment of the project in this initial phase are: 1. children (and their mothers) and adolescents staying at Colombo Plan and Nejat drug treatment centres 2. children/adolescents living in public orphanages (Ministry of Social Affairs) 3. families and parents using drugs in sub-urban areas and entering the Community-Based Treatment centres 4. children/adolescents in the street, street workers, and the children/adolescents living in poor sub-urban districts, particularly the children of drug users 5. children and adolescents in prison/closed settings The capacity building component will target clinical/educational service providers from various disciplines working at various levels and settings such as: a) personnel working in existing residential treatment, b) personnel working in outreach work and community based treatment for children and families; c) juvenile rehabilitation/open centre personnel; d) non-professional personnel: Preparing adolescent leaders, sensitized parents, ex-uses, teachers, police, community leaders, and religious leaders to contribute to screening, treatment rehabilitation and reintegration

8. Objective • To lead a coordinated worldwide response of public institutions and NGOs to children/adolescents at risk, with the aim of preventing drug use, treating drug dependence and facilitate the integration into society.

9. Outcome 1 (global level) • International community (governments, policy makers, parliamentarians and other key stakeholders) are mobilized and a large-scale urgent process is started to develop effective prevention, treatment and health/social protection systems targeting children and adolescent at risk.

10. Outcome 2 (national level) • Increased access to drug prevention, drug dependence treatment and social support measures for children/adolescents at risk of developing drug use related disorders and/or those affected by drug use dependence and its health and social consequences, in participating countries.

11. Outputs • A global advocacy strategy • A basic package of integrated cost-effective prevention, treatment and social protection services for children/adolescents, that are science- and human rights- based is provided, improved and/or expanded in Afghanistan. • Implementation of the adapted package of sustainable structured interventions for preventing drug use, treating drug dependence and ensuring health/social protection/reintegration of children and adolescents at risk or suffering from drug use dependence in 5 low-income countries in all regions.

12. Interventions in brief • Screening and Assessment protocol (treatment planning, brief interventions) • Psychosocial treatment protocols • Pharmacological treatment protocols • Capacity building for professional at various levels • Improvement of drug treatment and support services

13. Interventions in brief cont… • Development and Expansion of community-based treatment services in priority areas of Afghanistan.. • Development and Expansion of outreach services for children living in families affected by drug use and dependence and affected by traumatic events • Activation of “open centers” for children/young people with substance abuse/mental health problems in contact with the criminal justice system in different regions of Afghanistan.

14. Partners • Regional international organizations • National authorities • UN agencies, in particular WHO • The John Hopkins University • The Vienna University • The National Institute of Drug Addiction (NIDA) To ensure technical soundness, avoid duplication of efforts and ensure that technical assistance is delivered in a well-targeted, effective and structured manner. Furthermore other international organizations such as The Colombo Plan, governmental counterparts, non-governmental organizations and academic institutions will be invited to join this initiative.

15. monitoring and evaluation

16. Thank you