(in The Slovak Republic)

Author: Lubomir Okruhlica,

Institution: Institute on Drug Dependencies, Bratislava

Paper for: “The Seminar on professional Reinsertion of Drug Users in the Europe”

EUREHA Project, Group Pompidou

Place: Bratislava

Date: 24.-25. January 2000.

The epidemic of heroin use started and achieved its peak practically in the conditions of full employment in our country, in the years 1994-95. That was particularly true about Bratislava, where it had its beginning. The Ministry of Health had a swift response to the situation. It has created the specialized treatment facilities with appropriate programs for prevention and treatment such as: needle exchange program, methadone maintenance program, program of detoxification for opiate dependent clients, programs for prevention and testing of blood-borne infectious diseases etc.

We had some good achievements in the last five years. The HIV and hepatitis B among the IVDU is kept under the endemic level (1% and 6% respectively). There was even observed steady decrease in hepatitis C incidence among the new IVUs admitted to treatment during the last two consecutive years. There is an immediate access to health care for all people in that need. The multi-modal treatment center for drug dependencies was built in Bratislava.

There are two main approaches in the treatment of the opiate dependency, which are applied here: maintenance treatment and drug-free treatment.

Out- and inpatient drug free programs are two main alternatives. Duration of three months is a standard at inpatient drug-free treatment in the health care services in Slovakia. The continuation is in out-patient follow-ups.

There are two principal preconditions to preserve the patient’s successful abstinence after the treatment:

• supportive, drug-free living environment (family, household),

• regular full-time employment (working place).

Part of our comprehensive effort is targeted at these issues especially in the second phase of the inpatient drug free treatment. Not fulfillment of these preconditions is sooner or later leading to relapse of opiate use. The professional reinsertion and proper living conditions are the main protective factors, which help to stabilize the former user in the abstinence.

Those who are in bed need of the improvement of their conditions are recommended to continue with resocialization process in the specialized residential institutions : therapeutic communities and half-way house.

(We have observed about 50% of abstinent individuals in our long-term cohort, follow-up evaluation study after one year in 1998.)

Recently due to the economic situation the prospects of the employment and housing situation have worsened in the country.

The overall unemployment rate has risen from 7% to 18% in the last five years.

The especially vulnerable group are ex-users . They have typically low level of education and frequently records in criminal register.

The observed consequences:

• Now, it is more difficult for them to find a job after successful treatment even in Bratislava, where is the best situation on the labor market.

• We have currently recorded more relapses of our former patients, who had been abstinent for several years, soon after they have lost their jobs.

Prospects and solutions:

• More patients, who wish to stay drug free, should continue into residential programs specialized in resocialization (TC, half-way house) after their treatment in the health facilities.

• More patients would incline to accept maintenance treatment, which can provide sufficient protection from relapse for many patients even under the unfavorable conditions of prolonged unemployment and in stressful living conditions.

This is how economy can influence our policy and decision-making processes, as well as our clients. We have to pay an attention to two important factors in the planning of our steps in the future:

• effectiveness of the programs,

• based on the clients’ willingness ( free, voluntary decisions).

There is a perspective that the fluctuations in macro-economy will change significantly our choice of the types of our services provided for people with drug dependency. (This will be due to the shifts of their effectiveness).