In April 2016, a very important meeting will take place in New York dealing with the issue of decriminalization of substance use. The divergence of policies among the different countries is enormous; note that in some of them drug use still carries the capital punishment. What remains to be seen is whether this meeting will actually bring about significant results, for a large number of people hope that the first steps towards substantial reforms will be made. In the next issue of our journal we expect to be able to share with you the outcomes of this meeting as a way of initiating a meaningful dialogue on the issue of combating substance abuse.
In anticipation of these developments this issue is dedicated mainly on therapeutic developments and dealing with addiction issues. It focuses on areas concerning not only therapy but training groups as well, it presents a survey about the perceptions of the drug users on health and disease and explores how these (perceptions) change in the course of treatment. It is worth mentioning that all articles are based on data derived from addicts in Greece and they aim at promoting the debate about the quality of treatment and education in the drug addiction field.
Poulopoulos and Kokkini’s article explores important concepts of resistance, compliance and change in therapeutic groups for addicts, analysing the views and perceptions of the clients themselves but also of their parents and staff members.
Their study was conducted in the Therapy Center for Dependent Individuals (KETHEA) implementing focus group interviews, and content analysis. The researchers conducted four (4) focus group interviews where twenty-eight (28) people participated. Their analysis showed that the concepts of compliance and resistance are directly related in order to achieve personal change and they also form part of the pre-stages of change. When the change is finally achieved, there are obvious differences in the attitudes, behaviours and ways of problem solving for the people who participated in the treatment groups.
This study highlights important therapeutic pathways regarding the treatment process, such as resistance to change which is critical and can lead an individual to dropout or stagnation in treatment. Alternatively it may work in a positive and helpful way for the treatment process, thus becoming a necessary step towards change. The study also demonstrates the need for further research focusing on the people who have left treatment, in order to investigate their perspective and look deeper in the issues of compliance, resistance and change.
In the second study presented, Tzioubas aims to investigate the perceptions of the users who approach the KETHEA-ITHAKI program regarding physical health and health care issues. It also aims to investigate the possible interaction of these perceptions for health as they progress within the framework of drug addiction treatment.
Reviewing the relevant literature, about the perceptions of users with regard to health issues, highlighted the lack of any relevant research on a national level. Looking at the English written literature in particular, we came across a few relevant research studies; however those studies mainly focused on the perceptions of this population in relation to specific diseases.
The study applied qualitative research methods but was based on the theoretical background of the “health belief model” (HBM), which attempts to correlate the health behaviours with the beliefs of the subjects. A total of 32 people took part in the study; they were either members of the KETHEA ITHAKI Induction Center -with little or no substance use, or members of the Therapeutic Community or members of the Social Reintegration phase.
The results showed that taking a distance from active use is deemed a key factor in order to understand the risks of health negligence. They may adopt an indifferent behaviour or use drugs in order to deal with physical (or mental) pain and discomfort, but in the course of treatment the fear of the consequences becomes more visible. What seems to happen is that the context -within which the socialization takes place-, affects the individual’s perception of health, as well as their health behaviours.
The study also showed that the neglect of the self and the self-destructive behaviours are not the result of lack of knowledge of the risks involved. It is a deeper personal attitude towards life, in relation to the self and others. It is not a narrow, internal psychological process; rather a process that interacts with the social context of the smaller (drug scene) or wider community.
Interestingly, the barriers and constraints that prevent the adoption of positive health attitudes are both objective –i.e. the limited opportunities provided by the public health system for socially excluded populations- and subjective, like the fear of illness (or treatment), the need for work or the desire for activities limited by the health condition.
Finally, the Therapeutic Community is an active ingredient that affects positively the attitudes’ change, by altering the image of the self as reflected in the eyes of others. It also helps to understand the relationship between physical and mental health by adopting positive life attitudes and mobilizing people in order to actively influence their well-being and their own life. Tzioubas’ study, despite all the limitations described by the author, can contribute with its findings in more focused studies, of larger population samples that could support the need for policies for the promotion of health and health care, in a population that, according to the author, “desperately needs it”.
Finally, Chaidemenaki and Armaos’ study aims to explore the ways in which education enhances personal development and therapeutic development of incarcerated or recently released people in recovery. It also highlights the educational interventions within a therapeutic framework as a means of addressing the social and professional exclusion of this group of people. The results of the survey emphasize the relationship between education and the enhancement of self-esteem and self-efficacy of this population and can be used to design more appropriate educational programs for people in rehabilitation -prisoners and ex-prisoners.
The theoretical approach highlights the importance of providing education that liberates, as described by Freire, and the importance of transformative learning, as viewed by Brookfield. In an effort to emphasize the interaction of education with the social and political context as well as the importance of critical thinking, awareness and action taking, the aforementioned educational approaches support the therapeutic goals and highlight the systemic relationship and interaction with treatment as the key factors for eliminating social and professional exclusion.
The target population of this research study were adult men and women, prisoners and ex-prisoners, with problems of substance use, in the regions of Attica, Viotia and Thessaloniki. Quantitative (questionnaire) and qualitative (group focused interview) instruments were used for a comprehensive and holistic understanding of human behaviour and experience. One hundred questionnaires were collected, while a total of 22 people participated in the focus group interviews.
This study showed that the participation of people with addiction problems in educational activities has a positive effect on personal development, educational and academic achievement, and social action and in their re-entry in the labour market. Especially for the group of incarcerated and ex-prisoners with addiction problems, education can reinforce their decision to change and take control of their own life, as well as support them for an open, continuous and dynamic interaction with society. Moreover, the study revealed that the factor of incarceration calls for a remodelling of the educational program within the correctional setting. At the same time it shed light on the importance of gender differences, as it showed that among the incarcerated population, women present a higher percentage of disadvantages, a lack of self-esteem and self-efficacy.
The aforementioned studies included in this issue underline a series of key aspects for the improvement of the health of addicted individuals. They primarily emphasize the need of the therapeutic system to better understand resistance to change and use it for the benefit of the recovery process. They also pinpoint the importance of liberating and radical education for the reinforcement of dependent individuals within or outside the correctional system, in order to achieve recovery, change and social rehabilitation.
It is worth noting that all the studies were carried out without any funding, but they were carried out driven purely by scientific, therapeutic and educational eager to promote the potential for addiction treatment and the promotion of the right of people for a better life. Their value is, therefore, priceless and we hope that they will contribute to the improvement of treatment interventions and the motivation of other scientists to continue seeking new routes to deal with drug addiction based solely on their professional ethics.