Drug Abuse Prevalence in Latvia, 2003

Table of contents

Drug use habits

107

Social and other problems of drug users

108

Attitude toward available sources of assistance

109

Required assistance and pertinent institutions

111

Chapter VI. The knowledge and attitude of students toward drug use and prevention 115 Methodology Target population

Results

115 115

116

Estimation of prevalence and risk of drug use

116

Assesment of students’ acquired knowledge

117

Comparison

122

Opinions and suggestions for the reduction of alcohol and drug abuse in Latvia

123

Conclusions

Survey of NGOs involved in the restriction of drug use and the treatment and rehabilitation of drug addicts

125

129

Introduction

129

Information about NGOs

130

The work of the NGOs

131

Organizations working in drug prevention

131

Organizations working in the field of health promotion, healthy lifestyle and youth leisure time

134

Organizations working with risk groups

135

Organizations working with the rehabilitation of former prisoners

136

Organizations working with rehabilitation of drug addicts and alcoholics

136

Evaluating the work of NGOs Problems encountered by organizations

Recommendations for improving the work of NGOs

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reduction

137 138

139

143

Methodology

143

Overview on expert interviews with drug prevention specialists

143

Overview of educators' opinions about drug use

149

Overview of interviews with experts – addiction therapists

151

Overview of interviews with legal experts on the main issues in drug-related law enforcement

157

Overview of interviews with politicians on drug policy

163

Results of express survey with politicians on drugs

167

Conclusions

168

5

Drug abuse prevalence in Latvia

lifestyle (perceiving one's health as "bad" or "not very good"; having had serious psychological problems or depression; being unhappy with one's life in general or with one's family life, career, and relationships with other people; not going out at night).

Only a subset of the independent variables listed above turned out to be significant predictors of drug use status and were included in the final model. Neither marital status and ethnicity, nor bad health or a history of psychological problems were found to be significant predictors for either lifetime or recent use of drugs. Education was found to be a significant predictor only of recent, but not of lifetime use. Personal income, history of depression, and unhappiness with life were found to be significant predictors only of lifetime use. The variables that were found to be significant predictors of both lifetime and recent use were age, sex, level of urbanization, drug use among one's friends, and the indicator variable for staying home on most nights.

Even controlling for all the other variables, sex and age remain among the most important predictors for drug usemales are more likely to have used drugs than females are, and older people are less likely to have had experiences with drugs than younger people are. The regression coefficients (beta) for age are negative and highly significant, and those for male sex are positive and highly significant. The odds ratios for male sex show that, controlling for all the other variables, males are still almost three times more likely than females to have tried an illegal drug and more than twice as likely as females to have used an illegal drug recently.

The level of urbanization is another important factor both in lifetime and recent drug use — higher levels of urbanization correspond to higher levels of drug use prevalence. Overall, urbanization is a highly significant predictor for both LTP (.016) and LYP (.014) of drugs. However, of the individual indicator variables for the different levels of urbanization, only the one for rural areas and villages is significant. This confirms our previous (and intuitive) observation that the most marked difference in drug use by the level of urbanization is the difference between rural areas and the capital city. The regression coefficients for all levels have the expected sign (negative for all three lower levels, with Riga as the reference category), which, together with the overall significance of the urbanization variable, leads us to believe that the non-significance of the coefficients for the individual indicator variables might be just a statistical artifact.

Personal income is a significant predictor for lifetime, but not for recent use of drugs. Higher income is associated with a higher probability to have tried drugs, which is plausible, since drugs are clearly not a cheap means of entertainment. It must be noted, however, that many respondents have refused to report their incomes, and there is some doubt as to the truthfulness of the answers received. The results regarding the effect of income on drug prevalence should therefore be viewed with caution.

One's level of education is not a significant predictor of lifetime prevalence of the use of illegal drugs. It is, however, a highly significant (p<.001) predictor for recent drug 24

use. Higher levels of education are associated with lower probability to have used illegal drugs during the last twelve months. Of the individual indicator variables (with higher or incomplete higher education as the reference category), only the ones for incomplete primary and primary education are significant (p=.041 and p<.001, respectively). However, the fact that all of the indicator variables have the expected sign suggests that the nonsignificance of the other two levels might be just a statistical artifact resulting from the low variation in the dependent variable.

The indicator variables for one's unhappiness with life are a set of predictors that are clearly significant for the LTP of illegal drugs and are bordering significance for the LYP. Those who are unhappy with their lives are more likely to have tried an illegal drug than those who are content with their lives, and they also seem to be more likely to be recent drug users. Both unhappiness with one's career and unhappiness with one's life in general are significant (p=.009 and p=.018, respectively) predictors of the LTP of drugs. The regression coefficients are positive; the odds ratios indicate that unhappiness with one's career and unhappiness with one's life in general each make one about 1.6 times more likely to have tried illegal drugs. For LYP, only unhappiness with life in general could be included in the final model, and even then the predictor was not significant, even though bordering significance (p=.067).

The observed positive relationship with unhappiness and drug use prevalence points toward willingness to forget one's problems and worries as an important motivator for the incidence of drug use.

Having ever been in serious depression is another significant predictor for having tried illegal drugs: those who report having been in depression at some point in their lives are approximately 1.9 times more likely (controlling for the other variables) to have ever used illegal drugs than those who report having never been seriously depressed. Lifetime history of depression is not significantly associated with recent use of drugs, which is not very surprising, since it is unlikely that an occasion of depression a long time in the past could directly affect one's use of drugs during the last twelve months (even though a general tendency toward depression, for which the lifetime history variable is an imperfect proxy, could be associated with recent drug use). The association between lifetime history of depression and lifetime prevalence of illegal drug use again suggests that some people might start taking drugs to escape from reality and to forget their problems.

The regression results give very strong support to our previous observation of the importance of the social environment in one's drug use patterns. Drug use by one's friends is a highly significant (p<.001) predictor for both lifetime and recent use of illegal drugs (with higher prevalence of drugs among one's friends corresponding to higher likelihood of having used drugs oneself). Judging by the odds ratios for the indicator variables for each of the levels of drug use by friends, those who have no friends taking drugs are 77 (!) times less likely to have tried and 333 (!) times less likely to have recently used an

Drug abuse prevalence in Latvia

For these reasons, in addition to the aggregate and ageby-age analyses of the direct age-of-onset questions, we also calculated the age of onset from the prevalence questions. This method has the serious disadvantage that it requires the unrealistic assumption that the age of onset for alcohol remains constant over time, i.e., that students start drinking at the same age now as their peers did several years ago (and hence, unlike the age-of-onset questions, this estimate cannot be used to gauge changes in the age of onset over time). However, the method also has the advantage that it is not subject to recall bias. The estimate is calculated as follows. Among the students now at age X, the proportion that tried drug Y for the first time at this age can be estimated as the difference between the proportion of abstainers among those now aged X-1 and the proportion of abstainers among those now aged X (e.g., if 30% of 11–12-year-old students and 20% of 13–14-year-old students were abstainers, then 30%-20%=10% of those now aged 13–14 tried the drug for the first time at their current age).

Note that this calculation assumes that the age of onset remains constant over time — that the proportion of abstainers among the now-X-year-olds when they were aged X-1 is the same as the current proportion of abstainers among the now-(X-1)-year-olds. Finally, applying the constant age of onset assumption again, we can assume that the share of now-13–14-year-olds that tried drug Y for the first time at 13–14 is representative of the share of all students that tried drug Y for the first time at 13–14, and hence use the former figure as our estimate of the latter.

Results Tobacco Questions on tobacco smoking were included at the beginning of the questionnaire not only in their own right, but also to ease students into the survey and to set the groundwork for the more sensitive questions on illicit drug use. Since smoking is generally a socially accepted practice (even if frowned upon when engaged in by minors), students are usually quite frank in their answers to questions about it.

An overwhelming majority of students try smoking a cigarette sometime during their school careers. Already at the ages of 13–14, more than one half of all students (60%) have smoked at least once, and by the age of 20, the proportion of ever-smokers reaches 84%. Boys are considerably more likely to have smoked than girls in every age group. Overall, 77% of all boys have smoked at least once, as opposed to 63% of all girls. The gender gap is considerable in all age groups (e.g., 48%–19% among the 11–12-year-olds, and 11%–22% among the 19–20year-olds).

The proportion of students that have ever smoked regularly can roughly be gauged by the proportion of students who report having smoked more than 40 cigarettes in their lifetime. Unsurprisingly, this figure is low among younger students (3% at age 11–12; 8% at 13–14), but it 40

increases steadily with age, reaching 44% among the 17–18-year-olds and 52% among the 19–20–year-olds.

Regular smoking, just like any experience with smoking, is more prevalent among boys than among girls in every age group. Overall, 31% of boys and only 21% of girls report having smoked 40 or more cigarettes in their lifetimes (see Figure 3.1.).

To find out about their current smoking behavior, the students were asked how often they had smoked over the last month. Students' answers to this question show a similar picture to that revealed by their answers on lifetime smoking experiences. An overwhelming majority of 11–12-year-olds (95%) have never smoked during the last 30 days, but the proportion of non-smokers falls to 50% by the age of 17–18. The share of daily smokers in the 11–12-year-old group is only 1%, but it reaches 23% in the 17–18-year-old group and 31% in the 19–20-yearold group. Like smoking in general, daily smoking is more common among boys than among girls (27% and 18%, respectively), and the gender gap can be observed in all age groups (see Figure 3.2.).

Both methods of estimating the age of onset for tobacco (prevalence tables and the age-of-onset question) show that students typically smoke their first cigarette either before their 13th birthday or between the ages of 13 and 14. The estimates from prevalence tables suggest that 32% of all students try smoking when they are 12 or younger, 28% do so between the ages of 13 and 14, 17% at 15–16, and only 23% have not smoked by the time they are 17. The age-of-onset question suggests a somewhat earlier age of onset (41% at 12 or younger, 16% at 13to 14). The high percentage of never-smokers and the low proportions of those who started at 15 or later that are suggested by the aggregate answers to the age-of-onset question are misleading, since they result from the fact that many respondents had not yet reached the age of 15.

Analyzing the age of onset question by age group, we see that younger students tend to report an earlier age of onset for tobacco than older students do. Thus, 42% of the 11–14 y.o. students, but only 34% of the 17+ y.o. students report having smoked by the age of 12. Similarly, 71% of the 15–16-year-olds, but only 58% of the 17+ year-olds report having smoked by the age of 14. Part of this difference could be explained by imperfect recollections by the older students and desirability bias among the younger students (falsely reporting having smoked at an earlier age in order to appear more "grown up"), but it is unlikely that a difference this large is entirely due to these factors. It therefore appears that there has been a real shift toward experimenting with tobacco at a younger age. Students now seem to be more likely to try smoking a cigarette at an earlier age than their older peers were a few years ago (see Table 3.2.).

The first experience with smoking does not typically seem to lead to the onset of daily smoking. Thus, even though well over one-third of all students report having smoked their first cigarette by the age of 12, only 6% report having started smoking regularly by that age. Whereas over one-half report having smoked by the time they were 14,

Drug abuse prevalence in Latvia

smoked over the last 30 days, the K-W test failed to capture differences in the frequency of smoking. When the test was applied separately to the dummy variable indicating smoking over five cigarettes a day, highly significant differences were shown (p<.001). Thus, the urbanization effect on smoking habits can be described as follows. There are no differences in the proportion of abstainers by level of urbanization, but there is a considerable and statistically significant positive effect of urbanization on the likelihood of smoking more than five cigarettes a day (16% in Riga, 13% in other major cities, and 12% in other settlements). This effect could be due to differences in income and in the availability of cigarettes (see Figure 3.3.).

While data on lifetime experience with drinking is illustrative of the overall social acceptance of alcohol, it tells little about the actual drinking habits of students. Having consumed alcohol on more than 40 occasions is a better indicator of having developed a more or less regular drinking habit. While much lower than the overall experience figures, the likelihood of having drunk alcohol more than 40 times is still rather high and increases sharply with age. It is about one-fourth (23%) among the whole 11–20-year-old school population and ranges from 2% among the 11–12-year-olds to 53% among the 19–20year-olds. Thus, about one-half of all students have consumed alcoholic beverages on 40 or more occasions by the time they graduate from secondary school. Boys are more likely to have had 40+ drinking occasions than girls are (the respective overall frequencies are 27% among boys and 20% among girls). The gender gap exists in all age groups except the 13–14-year-olds (in this group, the ratio is 7% among boys to 8% among girls) (see Figure 3.5.).

30 25 20 15 10

Alcohol While technically a drug, alcohol has gained such social acceptance and place in European societies that its use has become the norm, and total abstinence from it an exception, rather than the other way around. This is also reflected in students' experiences with drinking. Among the entire 11–20-year-old school population, only 9% have never tried any alcoholic beverage. Already in the 11–12-year-old group, lifetime abstainers constitute only 31%, a proportion that decreases with age to 3% among the 17–18-year-olds and 1% among the 19–20-year-olds.

There are virtually no gender differences for lifetime experience with alcohol, except among the youngest students (11–12-year-olds), where boys are less likely to have abstained (25%) than girls are (35%) (see Figure 3.4.).

30 25 20 15 10 5 0

42

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Apart from the 11–12-year-old group, an overwhelming majority of students have drunk alcohol also during the last year. Among the entire 11–20-year-old population, 78% report having consumed alcohol over the last 12 months. The proportion of abstainers decreases sharply with age, from just under two-thirds (62%) among the 11–12-year-olds to less than one-tenth (8%) among the 17–18-year-olds and less than one-twentieth (4%) among the 19–20-year-olds. There are no clear differences in the shares of abstainers among girls and among boys — in some age groups (13–18) boys are more likely not to have drunk any alcohol recently, while in other groups (11–12, 19–20) girls are more likely not to have done so.

Overall, the abstention rate is 23% among boys and 22% among girls.

The most accurate gauge of current drinking behavior is the frequency of drinking over the last month. Among the entire 11–20-year-old population, just over one-half (52%) have consumed alcohol during the last 30 days. The likelihood of having drunk alcohol during the last month increases with age from 17% among the 11–12-year-olds to 74% among the 17–18-year-olds and 83% among the 19–20-year-olds. This likelihood does not vary significantly by gender. A more regular drinking habit is signaled by the use of alcohol on six or more occasions dur-

School survey

ing the last 30 days (i.e., more than 1.4 times a week).

Such behavior is reported by 11% of all respondents. The increase with age is from 1% among the 11–12-year-olds to 18% among the 17–18-year-olds and 22% among the 19–20-year-olds. Drinking that frequently is considerably more common among boys than it is among girls (13%–9% in the entire population). The gender gap is most pronounced in the older age groups: 25%–13% among the 17–18-year-olds and 29%–11% among the 19–20-year-olds (see Figure 3.6.).

The fact that a majority (56%) of students between the ages of 15 and 16 drink alcoholic beverages at least once a month and almost a quarter of students in that age group (24%) drink three or more times a month suggests that the 18–year legal drinking age in Latvia is not adequately enforced, since it is unlikely that most students can obtain alcohol this frequently in their parents' home.

This conclusion is further supported by the fact that more than one-third (35%) of the 15–16-year-old respondents report having bought an alcoholic beverage themselves during the last 30 days. It therefore appears that stricter punitive measures for retailers who sell alcohol to minors and/or closer control of the sale of alcohol are necessary components in any program aimed at limiting underage drinking.

While experiences with alcohol per se might be seen as rather innocuous, getting drunk on alcohol is a much more obviously hazardous behavior, and is hence of particular interest to the researcher in the evaluation of the extent to which alcohol presents a societal problem. The students were thus asked not only about their use of alcohol in general, but also about the occasions on which they had been drunk on alcohol.

The respondents' answers show that most students do get drunk at least once during their school careers. The frequency of having been intoxicated with alcohol increases from 14% among the 11–12-year-olds to 80% among the 17–18-year-olds and 88% among the 19–20year-olds. The fact that most students (69%) have been drunk at least once before their 17th birthday provides further evidence for the inadequate enforcement of the legal drinking age.

15 through 20, boys are more likely than girls both to have been drunk at all during the last 30 days and to have been drunk more than 3 times over that period. There is no gender gap for this behavior in the 11–14-year-old group (see Figure 3.8.).

The students were also asked about drinking the three most common types of alcoholic beverage, namely, beer, wine, and hard liquor (spirits). Their answers reveal that beer is the most popular alcoholic beverage among the school population in Latvia (last month prevalence 52%), followed by wine (LMP 38%) and hard liquor (LMP 28%).

This hierarchy is true for all age groups, except for the 17–18-year-olds, who drink wine and spirits with nearly equal frequencies (47% and 46%, respectively), and the 19–20-year-olds who drink spirits more frequently than wine (53% and 47%, respectively). Beer remains the most popular drink by a wide margin in all age groups.

There is a definite gender pattern to the relative frequencies of use of the three types of drink: while beer and hard liquor are consumed by boys more often than by girls, wine is more popular among girls than among boys.

50

40

30

20

10

0

In all age groups, males are more likely to have been drunk than females are. Among the entire population, the probabilities of having been drunk are 61% among boys and 54% among girls (see Figure 3.7.).

The most accurate indicator of problematic drinking behavior is the frequency of drunkenness during the last month. The data suggest that while getting drunk at least on a monthly basis is an uncommon practice among 11–14-year-olds (1% in the 11–12 y.o. group; 6% in the 13–14 y.o. group), it becomes quite common after the age of 15 (reaching 27% among the 15–16-year-olds and 39% among the 17–20-year-olds). Getting drunk at least once every 10 days (3 or more times a month) is less common, but still not unusual. Such behavior is reported by 7% of all respondents: from less than 1% among the 11–12-year-olds to 14% among the 18-year-olds and 16% among the 19–20-year-olds. In all age groups from 43

Drug abuse prevalence in Latvia

35 30 25 20 15 10

abuse and the increase of prevalence for other drugs.

For definition II drugs (truly illegal drugs), the current prevalence rate rises steadily with age from virtually zero at age 11–12 to 7% at age 17–18, and then falls slightly to 6% at age 19–20. According to both definitions, males are more likely than females to have used an illegal drug during the last 30 days in all age groups but 13–14, where the opposite is true. In the entire population the LMP rates are 7% (males) : 4% (females) for def.I drugs and 5% (males) : 2% (females) for def.II drugs (see Figure 3.12.).

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respectively. The prevalence figures are much lower and the disparity between estimates according to the two definitions is much higher in the two youngest groups. Thus, 7% of the 11–12-year-olds have used a definition I drug during the last year and virtually no one in this age group has used a def. II drug. For the 13–14-year-olds, the figures are 8% and 3%, respectively. Unsurprisingly, the likelihood of having taken an illegal drug recently increases sharply with age, and males (except in the 13–14year-old group) are more likely to report recent (last year) use of an illegal drug than females are. Among the 13–14-year-olds, girls are slightly more likely to have taken an illegal drug recently (3% vs. 2%, def. II) than boys are. This deviation from the overall gender pattern could be due to the earlier onset of puberty in girls, which is likely to account for more "grown up" behaviors, including behaviors associated with drug use (see Figure 3.11).

0

Of all prevalence indicators, current (last month) use of drugs is the most likely to signal the development of a regular (and hence highly problematic) drug habit. The LMP data show that current drug use is a behavior that is not very widespread, but also not negligible. Among the entire 11–20-year-old population, 5% report having used a def. I illegal drug during the last 30 days, and 4% report having used a def. II drug. For def. I drugs, the current prevalence figure remains virtually constant between the ages of 11 and 16 (5%, 4%, and 5% among the 11–12, 13–14, and 15–16 y.o. students, respectively), then increases considerably to 8% among the 17–18-yearolds, and stays at that level for the 19–20-year-olds. As the more detailed drug prevalence questions will reveal, the virtual constancy of the prevalence rates between the ages of 11 and 16 is the product of two simultaneous and opposite trends — the decrease of prevalence for solvent 46

PREVALENCE:

CANNABIS

Cannabis is by far the most widely used of all illicit drugs.

The data show that by the time of graduation from secondary school about one-fourth of all students (24% of the 17–18-year-olds and 28% of the 19–20-year-olds) have used marijuana or hashish at least once. These data expose an awkward contradiction between the legal and social statuses of the drug. On the one hand, the possession of cannabis is legally regarded as a serious crime.

On the other hand, the use of the substance is very widespread and is socially accepted even by parts of mainstream society. It would be hard to name any other behavior that, despite having the legal status of a serious crime, has still been engaged in by one in four secondary school graduates. Unless one seriously believes that it would be practical and beneficial for society to imprison a quarter of the school-leaving population, it seems obvious that it is necessary to consider replacing the current strictly punitive practice with a more flexible and complex preventive and regulatory policy in order to limit and control the use of cannabis among the school population. It is essential to pay more attention to educating students about the risks inherent in drug use and to promote healthy free-time activities, instead of focusing exclusively on prohibition and punishment.

Recent (last year) prevalence and current (last month) prevalence of cannabis use are considerably lower than lifetime prevalence, reaching 15% and 6%, respectively, among the secondary school-leaving (17–20-year-old) population. While last year prevalence reflects a combination of continuation and incidence of the use of the drug, last month prevalence most likely indicates the development of a more or less regular drug habit, and thus the size of the subpopulation reporting LMP of cannabis represents a high risk group for health and social hazards arising from drug use. The proportion of

School survey

with a list of possible sources and were asked to evaluate whether they had used each of these sources and whether they trusted the information obtained from the source.

Parents are named as a trustworthy source of information, the most frequently (by 53% of the respondents).

Another 24% trust the information gained from parents partially. Only 5% do not trust information from parents at all, and 18% have not acquired information on drugs from their parents.

A lower proportion, 17%, state that they have not acquired information from radio and TV; 16% have not gained information from friends and people at school.

Hence one could say that these sources (mostly representing the immediate environment of the individuals, except in the case of the electronic media) are the most widespread, though not recognized as the most trustworthy ones. On the scale of trust, parents are followed by doctors and narcologists (41% trust them completely and 21% partially; 33% have not acquired information).

Teachers, trusted fully by 35% and partially by 40% of respondents, come third on the list. Nearly the same proportion of respondents trust completely the information gained from anti-drug ads on TV and from TV and radio in general (33% trust each of these sources completely; the proportions of those trusting partially are 28% and 39%, respectively). 32% of respondents trust completely and 40% partially the information they gain from friends.

These sources are followed by some that have gained considerably lower evaluation in terms of trust and are not used by more than a half of the respondents.

The top four sources of information in terms of frequency of use (friends, school staff, TV and parents) are part of students’everyday environment and are therefore easy to access. The fact that this information exists in the students’ environment and does not have to be sought out actively could in part explain the variable levels of trust students express in these sources. Parents are a notible exception — even though they are a source of information that needs not be sought out actively, students’ trust in them is remarkably high — higher in fact, than in any other source of information.

Other sources are not so general in their capacity to reach people in general and teenagers in particular.

Information gained from narcologists and other specialists ranks high by trust, but a considerably smaller proportion of people have gained any information from this source, if compared to the proportions who have obtained information from parents or friends.

It might be helpful to distinguish between (1) general sources that distribute information without prompting, and (2) more specialized sources that are actively sought by those interested. Precisely because they have sought the sources themselves, students are more likely to trust sources of the second type. However, the more particular and problem-oriented the source gets, the smaller the proportion of people who use that source of information.

An exception might be priests, athletics coaches, and celebrities, as they imply some other kind of specificity

(one has to belong to a congregation or do sports regularly, etc).

Neither the Internet in general, nor the particular websites listed (www.narcomania.lv and www.narko.lv) are used very frequently by students as sources for information on drugs (41% of respondents have not gained info from the Internet). This fact might depend on the specificity of use of the Internet among the school population. The proportion of students who have used any of the Latvian drugrelated websites is even lower than the frequency of those who have gained information on drugs on the Internet in general. On the other hand, the proportion of respondents trusting these sources completely does not differ much (18% for the Internet in general, and 16% and 15% for www.narcomania.lv and www.narko.lv, respectively).

It is worth noting that the police and policemen are mentioned as sources of information on drugs by 30% of respondents, and only 12% trust the source completely.

This might represent an overall tendency of distrust toward police among young people. It might also reflect frustration about the inability of police to fight the criminality connected with drug abuse.

The lowest proportion of respondents have mentioned calling a specialized hotline number as a source of information on drugs (12%), and only 7% trust such information completely. The most likely reason for this is that the existence of such services is not very well known by students.

22% of respondents have used sources of information that are not listed above. 9% of all respondents state that they have not only gained such information, but also that they trust their source completely. Most of the sources are not mentioned by more than one respondent, and some respondents have not specified a particular source.

The most often named sources are books (mentioned by 23% of those who report a source other than those on the original list), own observations (13%), newspapers, and drug addicts (10%).

Analysis of variation by socio-demographic categories reveals a general tendency for respondents in the countryside to use most sources more frequently than respondents in cities do. A similar tendency can be seen in the comparison between the grade groups; respondents in grades 8–9 seem to use most sources of information more often than students in grades 10–12, and they also seem to trust the sources more. Students in grades 10–12 in secondary schools are more suspicious than others of the trustworthiness of most sources.

Parents as a source of information are used and trusted the most by respondents in grades 8–9. Students in this group seems to have a slight tendency to use and trust information from more specific sources. It could be possible that they are told and taught a lot about the problem and the institutions connected with it, but it seems that they do not talk that much with their friends about drug abuse. Students in grades 8–9 use and trust friends as a source of information to a lesser extent than secondary school (grades 10–12) students do.

59

Drug abuse prevalence in Latvia

hold their opinions, whatever they may be, more strongly than females do.

It must be noted that respondents frequently hold mutually incompatible views, which indicates that they often do not have a very clear overall vision of how to deal with the drug problem. Support for strict punitive solutions is often mixed with more liberal ideas. For example, there is a statistically significant (p<0.01) positive correlation (r=.071) between the levels of agreement to the nearly opposite statements that "drug use should be considered a criminal offence" and "'light' drugs should be legalized while at the same time implementing control of the quality of drugs and of their use in public places". Similarly, 79% of those who think that the existing punishments for drug dealers are harsh enough still think that drug dealers should be given life imprisonment. These examples suggest that many respondents might have answered the questions without giving them much serious thought, and in some cases might not even have completely understood what the various policies (particularly legalization a la the Dutch model) entail.

Comparison with past surveys No survey on drug prevalence among the entire school population has ever been done in Latvia. The only data available for comparison come from the Latvian portion of the 1999 ESPAD survey, but this survey covers only one birth cohort (those born in 1983 in the case of ESPAD '99). The equivalent of this cohort in the present survey is the 1987â&#x20AC;&#x201C;born cohort (i.e., the ESPAD'03 sub-sample).

Consequently, only data from this cohort will be used for comparison with ESPAD'99 in this section. It should be noted, however, that the population covered by the subsample consisting of the 1987-born cohort in the present survey is not entirely comparable with the population covered by the ESPAD'99 sample, because the latter covers only grade levels nine and ten, with most respondents attending grade ten, while a substantial portion of our sample consists of eighth-graders and most respondents attend grade nine. This difference is not necessarily a sign of compromised representation in the 1999 study, since there might actually have been a change in the population distribution of 16-year-olds by grade levels due to the fact that most of the 1983 cohort started school at age six, while most of the 1987 cohort started formal education at age seven. The difference in the grade-bygrade distribution of the two samples is likely to make our estimates of drug use lower than those from 1999, even if no real changes have occurred since then. This is because many students have their first experiences with drugs precisely while in grades eight through ten, so that drug use prevalence in grade eight is much lower than in grade ten, and consequently a higher proportion of eighth-graders and a lower proportion of tenth-graders in the sample lead to lower prevalence estimates for the entire sample.

The prevalence rates for tobacco seem to have changed little since 1999. The lifetime prevalence figures have slightly increased (from 77% to 78% for use-ever and from 30% to 32% for 40+ uses); the last month preva62

lence rate for use-ever has remained unchanged at 40%, and the last month prevalence rate for daily use has decreased from 33% to 28%. We do not have sufficient information to determine whether any of the changes are statistically significant. If the changes are real, the increase in the LTP of tobacco might be due to the previously mentioned tendency of today's students to start experimenting with tobacco earlier than their peers had done in the past. The decrease in the observed prevalence of daily smoking should be regarded with cautious optimism: while it could reflect a real decrease in the prevalence of such behavior, it could also be in part an artifact of the previously mentioned differences between our sample and that of ESPAD'99.

While the proportion of students who have ever tried an alcoholic beverage has remained unchanged at 96%, all other alcohol prevalence figures have increased since 1999 (we must note, however, that we do not know if the changes are statistically significant). To quote a few examples, the likelihood of having consumed alcohol on 40+ occasions in one's lifetime has increased from 20% to 26%; the probability of having been drunk more than six times during the last 30 days has increased from 8% to 12%, and the frequency of having been drunk more than three times during the last 30 days has risen from 7% to 9%. This finding of higher prevalence for alcohol in our survey vis-a-vis ESPAD '99 is consistent with our earlier observation that students tend to start drinking at an ever-earlier age and suggests that the use of alcohol among the school population is a problem of growing importance (see Figure 3.24.).

Unlike the prevalence rates for licit substances, the prevalence rates for illicit drugs observed in the present survey are substantially lower than those observed in ESPAD'99. However, we should not rush to the conclusion that there has been a significant improvement in the drug situation among teenagers since 1999. While it is possible that the observed changes might indeed reflect actual lessening in the prevalence of drug use among the school population, it is likely that a considerable portion

School survey

of the differences are caused by the previously mentioned differences between our sample and that or ESPAD'99, by some overestimation in ESPAD'99, particularly for amphetamines and ecstasy, and by some under-estimation in the present survey.

Since 1999, the lifetime prevalence for "any illegal drug" among 16-year-olds has decreased from 22% to 18%, the LTP for cannabis from 17% to 16%, and the LMP for cannabis from 5% to 4%. For "any illegal drug other than cannabis", the prevalence rate has gone down from 11% to 7%. The two drugs with the most radically changed prevalence rates are ecstasy (from 6% to 3%) and amphetamines (from 4% to 2%). However, the fact that in 1999 the observed ecstasy and amphetamine prevalence rates were much higher than the European averages, which were 2% for ecstasy and 3% for amphetamines, makes it quite likely that the 1999 sample overestimated the prevalence of these two drugs (and consequently also the prevalence of illegal drugs in general).

Such overestimation is possible even if good research practices have been strictly adhered to, because the stochastic nature of measurements obtained from random samples means that there always remains a positive, even if low, probability of obtaining sample statistics that are very different from the corresponding population values.

The prevalence rates for hallucinogens and for tranquilizers and sedatives without prescription have remained unchanged at 3% each. Inhalants are the only type of substance (excluding tobacco and alcohol) whose lifetime prevalence rate has increased since 1999 (from 7% to 8%). This is consistent with our previous observation that solvent abuse is becoming an increasingly serious problem for the younger school population (see Figure 3.25.).

63

Drug abuse prevalence in Latvia

and the education of prisoners were ensured by employment in industrial production, general education and professional-technical training. About 85% of convicts were employed in production, and the gross production reached a value of 300 million rubles; these were very impressive data.

Every convict under the age of 40 had to study in the general education program, and professional-technical schools offered more than 25 specialties. Employment safeguarded order while the trade mastered while in prison helped in the adaptation process after imprisonment.

However, the prison system had its shortcomings. The majority of offenders, according to the Latvian Criminal Codex, received sentences of imprisonment, which contributed to great numbers of prisoners concentrated at correctional institutions. For example, in the late 1980s correctional institutions in Latvia held about 16 thousand convicts from all over the Soviet Union. The large numbers of convicts turned these institutions into barely manageable conglomerates. In addition, the corrections part of imprisonment was not fully realized because the proportion of repeaters offenders was quite high, and almost every third released prisoner returned to prison.

Based on world practice, the 1995 Amendments to the Latvian Sentence Execution Code introduced a progressive punishment system. This system is derived from the English Progressive Punishment System, based on differentiation within each type and regimen of prison, and displacement of convicts from one type of prison to another, taking into account the completed portion of the sentence, behavior, previous criminal record, and attitude towards other inmates and prison staff.

At present there are 14 prisons and one correctional institution for juveniles. There are five types of facilities: • 3 investigation prisons — Riga Central Prison, Liepaja Prison and Brasa Prison; • 6 closed-type prisons — Daugavpils, Valmiera, Griva, Jelgava, Parlielupe and Matisa prisons; • 3 semi-closed-type prisons — Ilguciems Women's, Skirotava and Jekabpils prisons; • 2 open-type prisons — Olaine and Vecumnieki Prisons; • One correctional institution for juveniles. — Cesis Corrections Institution for Juveniles.

Daugavpils, Valmiera, Ilguciems Women's, Matisa and Cesis also have investigative departments. Closed and semi-closed prisons have three degrees of regimen — low, medium and high, with the lowest regimen prescribing stronger restrictions than the others. Convicts at closed- and semi-closed prisons are accommodated in single cells or in units together with 10 other convicts.

Convicts located at lower regimen levels are accommodated in units holding over 20 convicts and have the right to move around the territory more freely, send letters more often, and receive parcels; and they often enjoy more time for visiting.

According to Paragraph 35 of the Penal Code and Paragraph 2 of the Latvian Sentence Execution Code the 72

objective of punishment is "to punish the offender for the performed offensive action, and to achieve that the convicted and other persons obey the law and refrain from offences".

The objectives of imprisonment are: •

to execute the court's decisions;

•

to ensure the correction and re-socialization of convicts;

•

to prevent repeat offences by the convict;

•

to prevent others from committing offences.

The effectiveness of prison work is defined by connection with other law enforcement institutions, for example, the court and prosecutor's office, and also contacts with society. When isolating individuals from society, it is important to remember that the term of punishment is not infinite, and that after having served his sentence, the person should be re-integrated into the normal social environment. For that purpose the Latvian Sentence Execution Code defines the activities of the Probation Agency. Its objective is to reduce the baneful influence of detention and to help persons who are freed from prison to integrate back into life and society. However, a probation service exists on paper only, and a Law on Probation Service has not yet been ratified, although in March 2003 it was introduced in the Cabinet of Ministers. It must be noted that at present, relative to the Probation Service, the Latvian Sentence Execution Code provides material assistance to persons released from prison, covering travel costs to their place of residence or work, paying a one-time relief subsidy according to the rules of the Cabinet of Ministers, and an issue of appropriate clothing and shoes. Promoting re-socialization of ex-prisoners, the law determines the rights of those persons who received salaries for employment during imprisonment. It says that they have the right to register at the National Employment Office to receive their unemployment status.

The Latvian Sentence Execution Code obligates municipalities to provide living space to those ex-prisoners who so require.

We must mention the improvement of the prison system as part of the Nord-Balt prison project — a regional project of the European Council, within which Latvian prisons have successfully collaborated with Scandinavian countries since 1995. The objective of this collaboration is: •

to promote reform of the prison system;

•

to improve and develop the prison system in accordance with international standards and particularly with European Prison requirements;

•

to support the Department of Imprisonment and its administration, administration of Fellowship prisons and headquarters of Methodological Education Center 'Dzintari'.

The Nord-Balt Prison Project is the most successful prison collaboration project to date within Eastern Europe. Latvian prisons have direct collaboration with five Norwegian, three Swedish, two Finnish prisons and one German prison, and the Methodological Education Center 'Dzintari' and the Norrkoping's prison Personnel Training Center.

Prison survey

Another essential improvement of the prison system is transition to a system of professional security staffing. To date, in 7 of 14 prisons the outer security staff was provided by compulsory military troops of the National Guard, under the jurisdiction of the Ministry of Interior. National Guard troops also would convoy convicts between prison and court. It became clear that a professional security staff was needed; taking into account that members of compulsory military troops are young men aged 18–20.

In the majority of cases they are not psychologically or professionally prepared to enforce the specific functions of a prison guard.

Legislation pertaining to drug use, possession and trafficking In 1999 when the Penal Code was amended, it included several paragraphs related to narcotic and psychotropic substances. Paragraph 253 is the most significant; it defines criminal liability for illegal production, purchase, possession, and trafficking. It says that punishment for the above mentioned activities is a time period up to seven years with or without confiscation of property. In the case when the illegal activities have been performed in order to realize a profit, the Penal Code has foreseen imprisonment up to 10 years, with or without confiscation of property and with police control up to 3 years. Repeat offenses, group activity and cases of theft of narcotic or psychotropic substances are described separately.

Cases involving the illegal production, purchase, possession or sale of narcotic or psychotropic substances are much more unwieldly. This part of the paragraph had been amended already in April 2002. The illegal sale of narcotic or psychotropic substances to juveniles in schools or their territory, restaurants, cafes, bars, and public entertainment places spurred the amendment.

Taking into account that in recent years the number of juvenile drug users has increased, the punishment prescribed in the Penal Code seemed to be too disproportionate and unfeasible, because it was not possible to punish and imprison every youth in posession of drugs.

On the basis of reality in the field, amendments to the Penal Code were initiated in 2002. The most significant addition was paragraph 2532 defining criminal liability for the purchase, possession, transportation or sale of illegal narcotic and psychotropic substances in small quantities and usage of narcotic and psychotropic substances without a doctor's prescription. The introduction of this paragraph has thereby changed the policy of fighting drug distribution now making drug use criminally punishable. If previously criminal penalty was not imposed for the purchase, possession, transportation or sale of illegal narcotic and psychotropic substances in small quantities, and there was no responsibility for usage of narcotic and psychotropic substances without prescription, now the Code proscribes imprisonment up to two years, forced labour, or fines — up to 50 minimum monthly wages. Drug use without prescription is criminally punishable if the person is caught repeatedly during one year.

Introduction of the term "drugs in low quantities" is anoth-

er significant innovation. Prior to this distinction, a more severe penalty was imposed for the sale of high quantities. Introduction of the new term defined a three-step differentiation of drug quantities — low quantity, quantity and high quantity with respect to differentiation of penalties.

Implementation of paragraph 2532 pertains to prisoners because earlier drug use at prisons could be punished only according to Paragraph 70 of the Latvian Sentence Execution Code that defined the penalty for violation of regimen rules. According to Paragraph 70 one violation of prison rules was defined as the use, purchase, possession, transportation or sale of alcohol and illegal narcotic and psychotropic substances. Now repeated detection of drug use within a year is criminally punishable and additional years can be added to the penalty. Search and inspection procedures revealing the use of alcohol, narcotic and psychotropic substances need to be established. Expertise should be provided according to Penal Code. Process is expensive and one week takes results.

A current project of the Cabinet of Ministers is the "Procedure for inspection of arrested and convicted persons to recognize whether they have used narcotic and psychotropic substances". Regulations provide for the use of a test apparatus for quick detection of drugs in a biological environment. Thus it will be possible to perform such tests in prison conditions.

Report on interviews with prison administration According to the research concept, one of the methods used in this study was expert interviews with a representative of the prison administration. The objectives of this part of the research are: •

to learn the administration's opinion about the prison system in Latvia;

•

to inquire about the prison administration's assessment of its inmates, their contingencies, privileges and constraints;

•

to inquire about the problems of drug addiction among prisoners in different institutions, including numbers/ proportions of drug addicts, their mode of receiving the drugs; activities devoted to restricting and localizing drug use;

•

to inquire about the substances and methods prisoners use for intoxication (not classified as drugs);

•

to inquire about the use of various intoxicating medications in prison;

•

to inquire about the prevalence of different dangerous illnesses (AIDS, HIV, and hepatitis), the means of contracting these illnesses, and methods employed to decrease prevalence of these illnesses in the prison environment.

Target group 14 representatives of prison administrations from 11 prisons were interviewed for this study. The following prisons are covered: Skirotava, Matisa, Olaine, Griva, Parlielupe, Daugavpils, Valmiera, Jekabpils, Jelgava, Ilguciems and Cesis.

73

Drug abuse prevalence in Latvia

Methodology

•

The expert interviews were organized as in-depth, structured interviews.

The interviews were conducted by permanent interviewers of the Philosophy and Sociology Institute of the University of Latvia. All of them were familiarized with the prison system in Latvia prior to the interviews. They were also informed about problems specific to this assignment.

The interviews were conducted in July and August of 2003. Most of the experts were quite responsive, giving in-depth answers to the questions. In order to ensure more true and precise information, notes were taken but the interviews were not recorded. For the same reason the experts interviewed remain anonymous here.

Results BACKGROUND

THE

PRISON SYSTEM IN

LATVIA

Comparing the present prison system with that of the Soviet era, there have been notable improvements pertaining to the protection of prisoners' interests. According to experts, the most significant among these are: • change in attitudes toward prisoners. Today prisoners are viewed as a part of society to be reckoned with, attitudes toward them have thus become more democratic; • the introduction of a progressive system of sentence execution, providing privileges for those who have served the bulk of their sentences and exhibited exemplary behavior; • improvement in the quality of food and medical care; • improvement of living conditions — the prison environment has become more orderly, most prisoners live in dormitory type rooms; • prison staff must meet more stringent requirements; • prisoners are ensured items of personal hygiene; if previously prisoners were responsible for these items, then now they are assured such things as their own toothbrush and toothpaste; • information about prison activities is more accessible to society as a whole; today both journalists and representatives of community organizations offering training and other types of programs are welcome in prisons; • the prison contingent; there are virtually no prisoners from other former Soviet republics, who used to stand out with their provocative behavior, rough and crude language and a tendency to organize fights; 74

The main areas of decline and the most significant problems in the prison system are: •

the prisoners' level of education — some prisoners do not even have an elementary education, nor any professional skills; this low level of education is reflected in the prisoners' behavior and attitude toward life and society;

•

the opportunity to receive an education and master a vocation in prison; earlier, prisons offered both general education and vocational programs; today, not all prisons can ensure provision of such programs;

•

shortage of employment opportunities; unemployment in prisons is a serious problem, with only 15% of all inmates working; earlier times, practically all were employed;

•

the length of extended visits; at present, extended visits are limited to 48 hours, while previously extended visits could last up to 72 hours; according to experts, this type of social isolation does not promote moral growth.

INFORMATION ON EXPERTS

Of the respondents, two administrative representatives have worked in their respective institution longer than 30 years, three respondents — longer than 20 years and three respondents — five years or longer. Two have worked in their prison less than two years; however, both have extensive experience in other prisons in Latvia.

Four of the respondents declined to provide any of the above information.

the opportunity to receive aid from collaborative partners abroad; most of the prisons collaborate with like institutions in Sweden, Norway, Germany and other countries.

CHARACTERIZATION

OF THE PRISON POPULATION

There are more younger prisoners today than ten and more years ago. If earlier there were practically no prisoners under age 25, then today the majority of inmates are 18–25 years old. These people, for the most part, have been convicted of drug related crimes.

Previously, the majority of crimes were committed under the influence of alcohol, but today most crimes are committed either under the influence of drugs or in connection with drugs — for example, robberies committed to get money to purchase drugs.

The level of education among prisoners has decreased significantly. Many lack even an elementary education, not to mention vocational or professional training.

For the most part, it is the lower echelons of society that are in prison and often the crime is not commensurate with the punishment. One of the experts cited the example of a four-year prison sentence for the theft of four chickens, which is the common sentence for inflicting grievous premeditated bodily harm.

In general, crimes have become more serious. Whereas earlier there were many convictions for hooliganism and robbery, today, the proportion of murders and crimes of premeditated bodily harm has increased. Youth crimes have become especially vicious and violent.

Possible prison privileges significantly affect the behavior of inmates. These include more frequent visits with relatives, use of the telephone, the opportunity to write letters.

The more inmates are isolated from social contacts with people on the outside, the more likely they are to turn to destructive activities such as drug use. Fights usually break out in prison for no good reason, out of boredom, but on occasion informers get beaten up.

Prison survey

Prisoners have no leisure time activities — not all prisons have television. Cooperation between inmates and the prison administration is necessary to organize various events. In one prison, the prison staff celebrates all official holidays with the inmates. Such activities add variety to the daily routine and have a positive effect on behavior and moral rehabilitation.

There have always existed various attacks and threats on the prison administration from among inmates, but they are not a significant problem. Serious attacks on prison officials took place in the early 1990s as a result of a dysfunctional prison system, but recently there have been no serious conflicts.

EMPLOYMENT The employment rate in prisons is very low because there is low demand for this kind of. Only 8–20% of all prisoners are employed, with the exception of two institutions where the employment rates are 54% and 70%, respectively.

For the most part inmates are employed in the service sector at their prison — they do work in the kitchen, keep the territory clean and perform other similar duties. They receive the minimum monthly wage of 70 Lats. In several prisons the inmates fill orders for specific companies, for which they receive higher levels of compensation.

Some prisoners are employed in woodworking, making fishing nets, model-ship building, furniture production, metalworking (making fishing lures), printing, and sewing, gluing plastic bags. In certain prisons inmates are involved in community service work with no remuneration.

•

level of prison regimen; usually jobs are offered to those inmates in a higher level of regimen;

•

the desire to work; though not all prisons pay attention to this factor, prison administration tends to select inmates who have expressed the desire to work.

When asked if the wage structure provides enough motivation, all responded that “it's better than nothing.”

DRUG

USE

Drug use is a very serious problem. According to experts, drug use is prevalent in seven out of eleven prisons.

Drug use is more prevalent in closed-type and investigative prisons. Inmates at investigative prisons perceive themselves as free individuals who are allowed anything.

This attitude accounts for widespread drug use in these types of institutions.

Drug use has been prevalent in prisons since 1997. Prior to that prisoners tended to use alcohol to intoxicate themselves. Since it is easier to hide drugs, and thus easier to bring them into prison, cases of drunkenness have decreased in recent years.

Drugs are delivered into prisons in a variety of: •

thrown over prison walls. This is common in prisons with a large territory where it is difficult to guard the outer peripheries. The delivery takes place at a prearranged time and place when there is no guard present. Often drugs are hidden inside plastic bottles or tennis balls. Drugs are often thrown over by dealers;

•

at meetings and extended visits with relatives; in one prison, drugs are found among items brought in by relatives at least three or four times a year; through bribery of prison officials; incidents involving prison officials delivering drugs have occurred at almost all prisons; these officials have been fired; with prisoners in the isolation chamber; in those prisons where arrested criminals are kept pending sentencing in close quarters with the convicted, drugs often get into prison with the help of the arrested. They are taken outside prison territory during their investigation and trial and upon returning often try to bring in drugs hidden in their clothes or on their body, their stomach, for example;

The main reasons for the low rate of employment are: •

legislation does not promote use of the prison work force. According to experts, businesses employing prisoners should receive tax reductions as an incentive;

•

•

the professional level of prisoners; businesses refuse to cooperate with prisons with their poorly qualified labor force; for this reason experts feel it is vital to offer inmates a wide selection of vocational training programs;

•

•

lack of necessary technology and work equipment; the equipment remaining from the Soviet period is outdated, if not useless. Thus, when a business places an order, it often must provide the necessary production equipment as well.

•

the severity of the crime; usually jobs are offered only to those inmates having committed less serious offences;

•

character traits; it is important for the prisoner to get along well with others;

through the Central Prison hospital; drugs are easily available at the Central Prison hospital, thus inmates often deliberately invoke health problems in order to be sent there.

The most prevalent drugs used in prisons are cannabis, amphetamines, and heroin; ecstasy, cocaine, opiates and barbiturates were mentioned least often.

•

health status; the health of the inmate is especially important for work in the kitchen as well as for physical labor;

Heroine is used mainly by those prisoners addicted or already done so prior to imprisonment. Cocaine is used mainly by wealthier prisoners.

•

area of specialty and existing work skills;

•

behavior while in prison; jobs are offered only to those inmates exhibiting exemplary behavior and not having been involved in fights;

Assessments of the number of drug users vary: one expert claimed that unofficially almost everyone at his prison uses drugs. Other experts claimed that the number of users in prison is between 10 and 30 percent.

The main criteria by which prisoners are employed:

•

75

Drug abuse prevalence in Latvia

Experts mentioned two main reasons for drug use: •

•

the prisoner had already been a user and became addicted; despite the fact of withdrawal while under investigation, the desire for drugs remains strong; the prisoners are not employed; they have too much free time, which causes them to turn to various destructive activities, including drug use.

It is difficult to fight drug use in prisons not only because drugs are easily hidden and brought into prisons, but also because inmates are seldom punished for it.

In order to punish someone for using drugs, an investigation must be conducted to confirm the use. Such an investigation costs between 20 and 36 lats depending on the drug in question. In the case of positive investigation results, the prisoner has to cover the cost of the analysis, but prisoners seldom have any money in their bank account and the prison winds up paying for the analysis.

The prison also covers the cost of the investigation in cases where the results are negative and the prisoner is found to have not used drugs. Since the costs involved are significant, prisoners often remain unpunished because neither they nor the prison have the necessary funding.

The high cost of drug investigations are the reason for the low number of drug use cases initiated in the last six months. The highest number of cases mentioned was 20 at one prison, three prisons nine, five and two criminal drug use investigations, respectively. On the other hand, one prison investigated 96 cases of drug and medication abuse and confiscated 190 grams of drugs. Compliant with legislation, drug use investigations are initiated only if the prisoner has been caught using drugs repeatedly during the same year.

Drug users are usually young people under the age of 25 with a low level of education, some having completed only the sixth or seventh grade. They are psychologically imbalanced, they are easily agitated, and they have impaired communication and language perception skills.

These young people usually come from socially dysfunctional families, often have grown up without one or both parents. Most often they have been convicted of a drug related crime, either use or distribution of drugs or robberies committed to get money for it. Drug users are often hostile and ungrateful for the help available; they don’t want to study or work, and many intend to continue a life of crime after release from prison.

There are no drug treatment programs at prisons; only two prisons claim to have any sort of drug treatment, although several experts expressed the desire to institute methadone and other treatment programs in prison.

According to the experts, most prisons have specially trained doctors or staff members who have attended seminars and courses on working with drug users.

There have been cases of the use of strong medications such as ephedrine, bromazepam and phenobarbital. All the experts denied that the medications could have been brought into prison through the prison clinic. Medications entering and leaving the clinic are closely monitored and 76

used under the strict staff supervision. The only exception is cases of epilepsy, when the medicine is kept by the prison guard on duty.

Other intoxicating substances are also used in prisons but they cannot be classified as drugs and the experts refused to elaborate on this point.

INCIDENCE

OF

AIDS, HIV AND

HEPATITIS

There are HIV, AIDS or hepatitis B/C patients in all prisons, but five of the experts refused to specify the number.

Of six prisons that reported patient numbers, four prisons have one to four AIDS patients and five prisons have 6–15% HIV and hepatitis B/C patients among the inmate population.

All of the prisoners contracted it prior to imprisonment.

Based on available information 90% of the HIV-infected are drug users who had used intravenous drugs and shared syringes.

In two prisons the inmate HIV or AIDS patients live separately. Some experts believe that shared living quarters with AIDS and HIV patients pose a threat both to prisoners and guards, but most prisoners are tolerant toward HIV patients. Most often the patients themselves choose to inform the other inmates of their condition.

The majority of experts were unable to specify the frequency of prisoner testing in order to control the spread of HIV, AIDS and hepatitis, but they confirmed that testing is done regularly. Others stated that blood tests are done as soon as the inmate enters prison and then every six months thereafter. One prison has regular AIDS and HIV testing, but there is no testing for hepatitis due to prohibitive costs.

In the interest of restricting the spread of dangerous disease, AIDS and HIV patients are placed in a specialized prison facility. Some prisons have organized lectures for their inmates in collaboration with the AIDS Prevention Center and the organization Youth Against AIDS.

CONCLUSIONS In analyzing the responses of the prison officials, one can conclude that there are three significant reasons for drug use: •

first of all, prisoners who have used drugs prior to imprisonment are not treated in prison; they are isolated from drugs as much as possible, but their addiction and craving remains. Thus, these prisoners find and create opportunities to do so;

•

secondly, the experts agreed that prisoners do not have enough to do. In most prisons only a small portion of the inmate population is employed either in community service or in a salaried job, for which they receive only the minimum. Due to unemployment prisoners turn to often destructive activities such as drug use;

•

thirdly, deprivation. As confirmed by the experts, drug use is most widespread in closed-type prisons. The experts also feel that prison privileges such as supplemental visits, phone calls with relatives and longer walks significantly affect behavior, including drug use. The harsher the restrictions

Drug abuse prevalence in Latvia

neglecting attitude towards those who want to be cured."

The above opinion was expressed by other prisoners, noting that drug users shouldn't be imprisoned in strong regimen prisons because even those who are not dependent on drug use cannot survive this regimen.

They all think that drug users should be treated. Some of the questioned prisoners remarked that drug users should receive compulsory treatment, but they shouldn't be imprisoned. One of the comments was quite pointed: "drug habits and alcoholism are diseases and society is responsible for their origin. Therefore I can say â&#x20AC;&#x201D; sick people shouldn't be punished because their level of guilt is low. Dealers of the disease should be punished, in this case the drug providers."

When speaking about treatment, convicts also mentioned that it is not possible to be cured of drug use in jsut a few months, rather several years are needed. Therefore in specialized centers where drug users are torn away from their usual drug environment, they should receive not only the opportunity to live and be cured, but they should also have the opportunity to learn. Some added that drug users should have access to a psychiatrist because this is the way the drug habit can be cured. Many agreed with the opinion that drug use among young people speaks volumes about relationships in the family and that they are having problems.

"I am sure that my children won't use drugs, I will try to make the lives of my children interesting and they won't make the mistakes I did. Everything depends on how you raise them."

Drug trafficking Convicts believe drug dealers should receive more severe punishments than the Penal Code now prescribes. They think drug dealers corrupt public prosecutors and judges in order to get more lenient sentences.

There was also an opinion that drug traffickings are being lobbied in the structures of state administration and among politicians.

"The root of all disasters shouldn't be sought in prisons but among upper officials. Opium is not produced in Latvia, neither is cocaine, "vitamins" and so on; it is being imported from somewhere and simple humans don't do it.

One can get years for an empty syringe, but another is being released in the halls of the courthouse for a hundred and more grams of cocaine."

Prisoners think the fight against the drug trade is hopeless and that the real drug dealers won't be punished anyway. The drug transit through the country is profitable to someone and it is very convenient not to treat drug users, so that the drug business does not stop. Prisoners said that drug users are not encouraged to enter treatment in this country and in some cases are even afraid they might be punished when reaching for help.

Legalization of drugs Some prisoners, citing the experience in other countries, expressed the opinion that some drugs should be legalized. In their opinion it could help to control distribution of 90

drug habits. As told by the prisoners, "I suggest that government and lawmakers legalize soft drugs and prostitution. By legalizing soft drugs and prostitution (as in the Netherlands), sick people and people from a risk group will be under control. Control of dose and good income but most importantly â&#x20AC;&#x201D; full control!!! It is just a small opportunity which appears. Just listen to it!"

In this matter there was also an opinion that by legalizing soft drugs, such as cannabis, young people would use less of the so-called problem drugs, like heroin.

Others were more categorical and stated that the country should legalize all kinds of drugs. This group believes drugs should be distributed by medical institutions.

There was also the opinion that the number of heroin users in the country grew sharply when supplies of ephedrine ran out. Some convicts believe it would be better to allow heroin users to use ephedrine rather than treat them in a methadone program. They think methadone is even more dangerous than heroin and causes irreversible addiction.

DISTRIBUTION

OF DRUGS IN PRISON

In their comments convicts described the existing situation in prisons regarding the distribution of drugs, gave written descriptions of the drug user contingent and noted methods of drug supply and possible ways of fighting against drug abuse in prisons.

Drug users Most were in a quandary about drug users and their motivation. Prisoners' attitudes seemed disapproving, but at the same time they understood the need for treatment.

One prisoner wrote that drug users in prison are hated and that only those who have money use drugs.

Whereas others wrote that people who use drugs are psychologically unstable and therefore they shouldn't be kept in closed premises. This was understandable because drug users endanger the health of others in the cell.

"Drug use in prison can be fought only by putting them in half-open regimen prisons, where they would have some life stimuli and some freedom. In hard-regimen prisons, especially in cells where for twenty-four hours you are among four walls, many start shooting up and popping pills out of laziness, dampness, debility and anger."

One of the convicts gave a pointed description of drug users: only those who are psychologically dependent, depressed out of laziness, use drugs: "One can become a drug user in prison by being weak. This means, those who are looking for entertainment and don't know how to employ themselves".

One drug user noted that he is not using drugs in prison, but will continue using cocaine when he gets out of prison because cocaine is his life.

Types of drug supply Convicts also wrote comments about ways of getting drug supply into prisons, saying that one method is prison staff

Prison survey

and the other — on visiting days. We received many accusations of staff corruption, malicious mismanagement of authority by supplying drugs in prison. One of the convicts wrote that only 20% of drugs are provided by prisoners themselves and the other 80% are supplied by prison staff.

"Drug users?! What about drug users! People are being sentenced to prison for six-and-a-half years for stealing eight red beets. He has lived in the countryside all his life where there are no drug users. And the next six-and-ahalf years he has to spend in one cell with drug users and has to meet the principal of the unit who offers drugs at a price 5–10 times higher."

Whereas other convicts noted that drugs are supplied to prisons also during visitations, but it also happens in cases where the prison administration knows about it.

"Why is there an inflow of drugs into prisons? Because the principal gets paid for it from the outside and he freely allows it to pass in durign visitation hours. He just closes his eyes to it. All cops who allow drugs to be brought in should be arrested. There is no place for drugs here."

Several comments praised the Jelgava prison administration for having taken maximal control of drug flow to the prison. Prisoners noted a very strict regimen and sometimes even a dishonest attitude towards prisoners as reasons for its success.

"Jelgava prison — it is a hard period for drug users because there are no drugs and I haven't heard from other prisoners as well. Everyone is frightened of this prison as from fire."

Inmates of Jelgava also said that there have been separate cases when once or twice a year small groups of convicts had pills or cannabis, but in Riga Central Prison they have everything all the time.

Convicts from other prisons reported that Riga Central Prison is like a market where you can buy anything.

"Riga Central Prison is like a market: drugs, mobile phones and all sorts of things. The leniency is unbelievable. Many know that, but don't tell anyone, because this is very convenient for someone."

Discouraging drug abuse in prisons Questioned convicts had different opinions about how to discourage drug abuse in prison. A large portion of convicts think there should be drug-free zones because drug users degrade other convicts and push drugs.

"It should be normal to organize drug-free units. But first of all, there is no one who would do that and secondly, if somebofy would organize it, there would be no reason because "blatnije" will shut their mouths and no one will listen to them. It is more realistic that "blatnije" could organize that or support it, but there is little probability of that because all the drugs come from them."

One of the convicts explained that in units day and night one of the prisoners is on guard while others shoot drugs.

More categorical prisoners think drug users should be placed in different units and they should have more

severe control and more regular raids.

"Drug users in prisons should be put in separate cells so they don't trick other convicts into it. And they should be pushed to receive treatment. There should likewise be special guards so that prison administration couldn't sell them drugs."

Other opinions about feasible activities to reduce drug abuse conflict with the previous one. Some convicts think drug users should be placed one at a time in cells among those who don't use drugs and thus they would be integrated into a normal environment and would give up drug use.

"I heard about drugs for the first time when I got into prison at age 16. Drug users' creeds about "benefits" found welcome ears: I got out of the prison with confidence that alcohol is bad, but drugs are good. If I wasn't now imprisoned for drug use and distribution, most likely I would already be dead from a drug overdose. Only prison helped me. I was lucky and I got in a cell with people who didn't use drugs and had a negative attitude towards them. Without drugs and conversations about them I arrived at the conclusion that it is possible to live without them and it's not even so bad. It is enabled by being busy all the time and a common atmosphere in the cell. I can say thanks to prison for still being alive and healthy and for not using drugs for more than a year!"

The above opinion can be supplemented by the conclusion that drug users should be allowed to be in contact more often with social workers and representatives of different religious confessions.

Some prisoners think it is necessary to perform activities in order to eliminate staff leniency in supplying drugs.

They think it is necessary to inspect prison personnel before they arrive in the prisoners' zone.

Some stated that the number of drug users could be lowered under strong prison administration control, if alcohol was distributed from time to time. Others pointed to religion as a way to remove thoughts of drug use.

"I quit (drugs) thanks to reading the Bible. Since then I don't use drugs, alcohol or nicotine at all."

Likewise, some convicts state there are no such thoughts of using drugs if there are interesting things to do in one’s spare time. They think prisoners should have more sports activities.

"The best way to kick a drug addiction is sports and physical activities. Organizing tournaments between prisons, team sports wouldn't provide the opportunity to use drugs. Permission to receive food parcels could be a good encouragement bonus for those who don't use drugs. It also positively affects physical health and moral stability with a feeling that you are not forgotten."

CRIMINAL PUNISHMENT AND

SYSTEM OF JUSTICE

In comments some prisoners stated their opinion about Latvia's system of justice and criminal punishment corresponding to the criminal offence. Many comments cited 91

Drug abuse prevalence in Latvia

specific examples the inadequacy of criminal punishments for the criminal offences in question.

Latvia's system of justice As prisoners see it, in some cases justice is not served because judges submit to their mood and don't consider the objective circumstances of the case. Some prisoners write in their comments that they were sentenced for offences which they didn't commit. In their opinion judges too often consider their first impression about the suspect and only afterwards judge the offense de facto. Convicts write that in cases where a person has already been judged once, judges will be more likely to decide that a detainee is guilty despite a person's guilt not being proven.

"Latvia's court system should be revised because now they judge as they want. In no other country in the world do they judge a person first and only then — de facto the offence. If you have been punished once, Temida of Latvia in 90% of cases out of 100% would judge for any criminal offence, even if you haven't commited it. And the judge’s last words would be: "Previously punished, could have done this taking into account suspect's personality and temper…" If you don't have enough money to have a good lawyer then you can't be saved from prison — you will be spattered and no one will try to find out anything — you will be sentenced to sit."

Likewise some noted that not all are equal and that laws are not applied equally to all. Usually those who don't have money for a good lawyer are sentenced.

"I got three years for driving drunk, but at the same time our law-makers, judges and others who run down people to death — they don't even get their driver's license revoked."

Several convicts suggested that cases should be judged without favoritism, that there should be an independent assessors' court.

Adequacy of criminal punishment in relation to criminal offences Many convicts stated that the adequacy of criminal punishment in relation to the criminal offence in the Penal Code is not observed — for some offences, such as theft one can get an unfoundedly harsh punishment while drug dealers and murderers — unfoundedly light terms.

"60% of all prisoners serve more severe sentences than they deserve for what they have commited: one thief gets 3 years, but another in a similar case — 8 years.

Pedophiles get 3 years in prison for child abuse and destroying a life (because they become psychologically traumatized), but a person who steals a bag of potatoes gets 4 years. The fate of our children is not even worth a bag of potatoes!"

Prisoners think that the adequacy of criminal punishment should be revised and there should be more criminal punishments without imprisonment. Other types of punishment could be economically more beneficial because 92

there would be no need for funds to maintain prisoners.

The second benefit of punishment without imprisonment could be that prisoners and their families would suffer less, there "would be fewer broken lives", but they would receive a fair sentence.

"A severe prison sentence can't correct a person, imprisonment shouldn't be the predominant punishment. It is necessary to involve psychologists in the process. It is necessary to pay more attention to activities of adaptation. After release from prison people should get material support. The law of amnesty should be activated because it actually doesn't work. People should have more opportunities to get out of prison early because after conviction a person is sent into an environment where only bad things are dominant, where hate is dominant."

THE

PRISON SYSTEM

When responding about the prison system, prisoners expressed their indignation about inequity in prisons. The prisoners accused prison administrations of leniency, cruelty towards prisoners and fostering disagreements among them. At the same time we received comments expressing appreciation for the prison system and offering suggestions for improvement. Many comments addressed the issue of early release and probation.

In their comments on the prison system, convicts referred to Latvia's need to join European Union. They think the system should be improved before accession.

"As far as the prison system is concerned, it should be broken "at the root". This is hard to do while clerks and officials from Soviet times are in leading positions.

"Scratch my back and I'll scratch yours", like a mafia.

With this kinds of prison and attitudes towards people from the politicians, clerks and most of all — from the administration, we have nobusiness being in the EU! If nothing is changed, we will have scandal and shame throughout Europe."

Prisoners also stated that the Probation Service doesn't work, although Latvian Sentence Execution Code prescribes it. Released prisoners don't get anything more than just ticket fare to their place of residence. Besides, many of the prisoners lose their homes while in prison.

"The law means that ex-prisoners, upon release, should receive an apartment and financial support in the amount of minimum wage, but the law is on paper only. The truth is that upon coming back to his place of residence, the municipality answers that "we don't have that money to give you". Upon going to the local government, we receive the answer: "Go and steal! We will take you back to prison." Therefore most ex-prisoners have to return to prison — nothing to eat, nothing to do. Therefore laws should be readjusted taking into account real capabilities for consideration of this law."

Prison administration We received many comments about staff attitudes toward prisoners. Many pointed out that often the attitude from prison personnel is cruel and supervisors take out their anger and frustrations on prisoners. "In place of healing

Prison survey

•

The experts believe that only low-ranking prison employees and guards are involved in the provision of drugs to inmates. The information provided by the inmates themselves shows that in some cases higher-ranking prison officials, such as unit supervisors, are also involved in the smuggling of drugs into prison.

•

Almost all experts denied that drugs could be used intravenously in prison. The survey data show that 14% of all inmates have taken drugs by injection while in prison.

•

Experts didn't believe that one could contract HIV while in prison. According to the survey data, 10% of all prisoners are HIV positive. Given the fact that 86% of the intravenous users of drugs in prison have used previously used syringes and needles repeatedly, it is unlikely that none of them has contracted HIV while in prison.

Assessing the prison system and drug use prevalence therein we can prioritize the following directions for further work.

Activities to prevent drug abuse in prisons To develop drug-free zones and units As survey data show, a majority of respondents (62%) consider it possible to establish drug free-zones/ units. A majority of convicts who do not use drugs want to live separately from the drug users because they push others to use drugs, are obnoxious, and at the stage of affect they are importunate. European practice shows that it is possible to develop drug-free zones as in 10 European Union countries and Norway. Establishing drug-free zones guarantees not only the protection of non-users, but also promotes treatment of drug addicts. For example, there are 20 drug-free zones in the Netherlands housing 446 prisoners, in Sweden 356 prisoners reside in drug-free zones.

To introduce voluntary treatment programs in prison for the addicted The data show that the majority of convicts (87%) would support a voluntary drug treatment program, particularly among those who have tried drugs at least once in their life. Their comments note that prison is appropriate place to treat drug addicts. However, they feel it whould not be organized like the prison medical departments. Expert interviews do not stress the need for such programs, except when directly asked about treatment. Experts have stressed a different list of priorities. Treatment programs could be introduced within the Probation service or within drug treatment centers in collaboration with certain prisons.

Convicts have noted the need for a psychologist staff unit.

Some prisons have such unit, but the others don't.

To organize lectures on drug abuse in collaboration with different state institutions and NGOs Already some prisons places collaborate with the AIDS Prevention Center and Youth Against AIDS, of organizing seminars on AIDS for convicts. Convicts suggest this experience should be continued.

From visiting the prisons we can say that the majority of convicts are co-operative and appreciate the time devoted to them, and they willingly read information they receive. Therefore it seems that such simple activities as sending booklets with information about drug problems, drug treatment centers and the services they offer, and dissemination of this information to convicts near the end of their sentence, might be helpful, as some people would remember the information and turn for assistance to those centers.

To reconsider the activities of several investigative prisons and investigative departments Both interviews with prison administration and convicts showed that investigative prisons face serious drug problems. In those prisons arrested persons wait for judgment and their status differs from that of convict. Arrested persons consider themselves "free persons", therefore they can behave more freely. During interviews we received information that drugs could circulate through investigation departments to the entire prison.

Control of prison staff Both prison staff and inmates have stressed that a great deal of drugs arrive through employees, therefore it is necessary to tighten aimed controls at decreasing the supply of drugs and other illegal substances.

The Cabinet of Ministers should pass and adopt regulations about governing inspection to establish the fact of use of alcohol, drugs or toxic substances Expertise performed according to Latvian Penal procedure Code to prove the fact of drug use is expensive and takes one week. An alternative was elaborated to facilitate performance of analyses. The draft is already under consideration by the Cabinet of Ministers.

Indirect activities to reduce drug use prevalence Employment and education Both convicts and prison staff suggest that the prevalence of drug use would be less widespread, if as many inmates as possible were provided jobs or opportunities for education. As shown by the interviews, 8–20% prisoners are currently working in prison; in two prisons 54% and 70% respectively are said to be employed. This problem should be tackled not only on the level of prison administration, but also in legislation, passing regulations that reduce taxes for enterprises employing inmates. In addition, in cooperation with the Ministry of Education and local governments, opportunities for continued education should be provided for all inmates desiring to do so, as there is a high proportion without elementary or secondary education. It could be possible to raise funds from international foundations for this purpose. It must be noted, that it is mostly those with less education that use drugs, so their education could help both heal and resocialize them.

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Drug abuse prevalence in Latvia

Improvement of the conditions of daily life

Development of a probation service

Improvement of conditions of daily life would positively influence the psychological atmosphere in prison and would diminish the desire to become intoxicated.

Establishment of a Probation service is provided for in the Latvian Sentence Execution Code (an amendment in the Code providing for establishing the service was already passed in 1998). Still, this institution is not functioning in reality. Also the State Probation Service Law has not been passed even though the draft has been submitted to the Cabinet of Ministers. The probation service is the institution that should deal with the resocialisation of inmates. With the help of this institution it could be possible to create a more favorable environment to positively influence a decrease in drug prevalence. In addition, one of the tasks of the Probation Service would be to popularize the implementation of alternative forms of punishment. That would certainly reduce the number of inmates in prison and be of greater benefit to society.

Permission to have food parcels delivered As can be concluded from interviews with the prison staff, drug abuse in prisons has not decreased. It has only made the work of the staff easier. Taking into consideration the facts mentioned above and the complaints of the inmates about catering in prison (essential vitamins are not provided, so many of the inmates get sick illnesses like stomach and duodenal ulcers), there is no reason why the prohibition to receive food parcels should remain in force. Inmates suggested that permisson to receive food parcels should be denied only for those who have had drugs found in their parcels.

100

Prison survey

Appendix III. EMCDDA standard tables on drug prevalence

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Drug abuse prevalence in Latvia

102

Survey of drug users

5

Chapter V. Introduction One of the objectives of this research projects was to carry out the first estimation of the number of problem drug users in Riga. For the estimation the methodology recommended by EMCDDA was first used in Latvia. The statistical estimation was accompanied by the interviews with drug users. During the interviews we tried to clear up the social standing of the drug users, their daily habits and patterns of drug use, as well as their attitude toward different drug treatment services available in Latvia and the quality of these services. It was also important to study the problems and needs of this group.

Previous chapters of this report looked at opinions and attitudes of Latvian society in general, of the individual risk groups specifically (students, young people in general, prisoners), and of the professionals working in the drug field regarding to the drug phenomena and the state responses to this problem (preventive activities and programs designed to prevent or reduce the drug related crime and drug abuse etc.). The survey of drug users provides information about problems these people have actually encountered. The valuation of various preventive activities provides valuable information about the type of activity users find most effective and useful. It is very important to understand the manner in which the user wants to receive help as well as the desired nature of the assistance.

The survey of drug users, then, allows us to: â&#x20AC;˘

outline the problems and needs of drug users;

â&#x20AC;˘

record their valuation of existing drug use prevention measures and activities, which is worth considering when planning activities to resolve the drug problem. We can also infer from the data how informed drug users are about various assistance opportunities;

â&#x20AC;˘

estimate approximate numbers of problem drug users.

Possible information sources of various estimation methods of problem drug users in Latvia In recent years the new patterns of drug use has changed the situation in drug abuse in Latvia. According to the data from drug treatment agencies in 2002 there has been decrease in first-time-registered opiate users although in the meantime there has been increase in the first-time-registered amphetamines and poly-drug users.

There are some regions in Latvia where no drug users were registered in 2002 but this data could be misleading because of lack of specialists and/ or services for drug users in some parts of the country as well as gaps in the exchange of information between treatment agencies.

Regarding to national or local problematic drug use estimations, such estimates never have been carried out at the national level with EMCDDA-approved estimation techniques. However, there are a variety of possible data sources of relatively good quality, but there was no tradition/experience in the country for such studies before, and this study was the first attempt to use treatment multiplier method to estimate the number of problem drug users in Latvia as well as possible data sources for capture recapture estimations and other methods to estimate problem drug users in Latvia, in this case in Riga. These studies require to develop the substantial background work with Universities and research institutions in future.

Definition For this part of the survey the opiate users are defined as problem drug users.

On future surveys it would be necessary to expand the definition to the "intravenous drug use (IDU) or long duration/regular use of opiates, cocaine or amphetamines" .

This definition would allow to get more realistic insight and numbers on problem drug users.

Data sources for estimation methods Due of the various problems, mainly because of too strict regulations on personal data protection to use these data for scientific research it is hardly to access the necessary information sources. However the information on possible data sources for estimation methods was collected 105

Drug abuse prevalence in Latvia

and analyzed as well as discussions on ways of access to sensitive data from databases are in progress.

DRUG

TREATMENT DATA

In Latvia, the Narcology Centre manages the State Register of Persons with Drug Dependence and Substance Abuse across the country. The data are collected individually and it contains all necessary personal data including name, surname, date of birth, sex, personal code, place of residence, primary and secondary diagnosis (coded in accordance with ICD 10) as well as other data, which is essential for further analysis using EMCDDA recommended estimation methods like capture recapture method. Upon this data it is possible to construct indicators related to the total number of patients, e.g. the number of patients admitted and treated in a given year.

DATA ON HIV/AIDS Another source for employing capture recapture method is HIV/AIDS database. The database contains patients' Soundex code for name and surname, year of birth, sex, personal code, place of residence, whether patient is using drugs intravenously as well as other socio-demographical data.

The Soundex code which contains data on patients' name and surname might be the only problem in identifying overlaps between databases.

DATA ON

purposes.

Estimations of opiate users based on treatment multiplier method Methodology This study was conducted as a pilot survey in Riga for a more comprehensive snowball study of drug users. Its aim was to identify high risk groups and to examine drug users' risk behavior. The data from the survey were used to estimate multiplier of registered problem drug users in Riga.

The first part of the study was designed to estimate the proportion of drug users who had been registered with treatment agencies. Since the study does not cover entire country rather just Riga city and its surroundings the data collected are not representative for a whole country.

A questionnaire including questions about risk behavior as well as attitudes towards various treatment programs and problem encountered by drug users was conducted by trained interviewers.

Second part of this study was to gather information on treatment data form the Narcology Center. This information serves as a benchmark for the prevalence estimation of heroin and other opiate users in Riga (see Table 5.1).

OTHER INFECTIOUS DISEASES

In Latvia, databases on tuberculosis patients' as well as on hepatitis B/C could be used in prevalence estimates for intravenous drug users. Both databases contain personal data as well as whether a person is using drugs intravenously thus it is possible to identify overlaps between databases.

DATA ON

DRUG RELATED DEATHS

Another source for using prevalence estimations using multiplier method is data on drug related deaths.

According to the available data there are two databases collecting this data and unfortunately are disparate.

The other problem from being disparate is reliability of this data because it is accessible by insurance companies and might be that sometimes drug related deaths are not recorded because of sensitive issues concerning one's death.

POLICE

DATA ON DRUG USERS

In Latvia, drug use possession of drugs as well as more severe offences like possession, selling, trafficking or production of drugs is criminally punishable.

According to our information there are no official statistics on police arrests of drug users. Drug Enforcement Bureau holds limited access operative database on arrests of drug users.

Unfortunately at the time of writing we were not able to gather additional information on whether it is possible to obtain any data containing personal data from police databases of drug users that might be used for research 106

Results A total of 64 drug users completed the questionnaire.

Majority (56) of respondents have used heroin and/ or other opiates during their lifetime. Thirty per cent (17) were registered in the State Register of Persons with Drug Dependence and Substance Abuse. This number was used as one of the multipliers for the prevalence estimations. The other multiplier (and maybe more accurate since it is more probable that regular problem drug users will appear in the register than one who tries the drug once or twice and does not become a regular user) was calculated from the last year prevalence (LYP) of opiate users resulting 34% (16 out of 46 respodents reporting LYP of opiates are registered in the State Register of Persons with Drug Dependence and Substance Abuse).

The benchmark for these estimates was used from the data from the State Register; the number of opiate users

Survey of drug users

in Riga (1436) was used in this case since our study does not cover entire country.

The following formula was used for approximate opiate users in Riga:

origin. The majority permanently reside in Riga (58 of 64 drug users), 6 respondents named another town in the Riga district as their permanent place of residence; none of the respondents live in the countryside (see Table 5.2.).

resulting approximate estimate of opiate users in Riga to be from 4108 (using the multiplier of LYP opiate users) to 4786 (using the multiplier of LMP opiate users).

However we must note that this is very rough estimation and its confidence intervals are very wide since we were not able to assess representativeness of our sample.

Despite this fact this is the first reasonable scientific estimates rather than stochastic estimates often offered by experts.

Conclusions Although with confidence intervals being very wide the estimate of opiate users in Riga is first approach to estimate opiate and other problematic drug use prevalence in Latvia. This is a good starting point for planning better quality and specialized treatment services for opiate users.

Other estimates using capture recapture method as well as death multiplier and other statistical methods used in other countries can be employed in the future with willingness and collaboration of holders of various databases and more research in this field. Another point to advance would be a conduction of a study by employing a multistage snowball sample among opiate users and reaching to "hidden users" and thus it might be possible to generalize the estimates to the whole country.

Results of survey of drug-using population

25 indicated a paid job as their main occupation. 13 of 64 surveyed users attend school, vocational school (5) or university (3). 26 respondents neither work nor study.

However almost half work 3 hours per day on a regular basis. About a third have not sought employment since becoming users (20); similar numbers (22) have and have not encountered problems finding work since becoming users. So generally we see that of the 64 drug users surveyed slightly more than a third (26) neither work nor study, about just as many (25) keep a paid job, about a fifth (13) attend school. Work and studies are significant for forming social contacts. Shortage of job opportunities for drug users triggers a significant reduction of social relationships, thus influencing other lifestyle areas, problems, needs and attitudes toward various sources and types of assistance.

Drug use habits "The length of use" of the surveyed drug users is from 6 months to 28 years (mean=55.05 months, median=48 months); half of those surveyed have been using drugs less than 2-6 years (24-72 months). Slightly less than a third use drugs every day (19), about a fifth indicate they use drugs less than once a week (12) (see Figure 5.1.).

Description of respondents In order to better understand the origin of the opinions and attitudes of drug users, we first provide a characterization of this respondent group. (These traits cannot be viewed as a universal description of drug users, but rather as specific to this particular group. Thus they are to be considered only in connection with the opinions, lifestyle and habits of this specific group.)

The drug users surveyed (n=64) are aged 15 to 41, mostly 20 to 30 years old (the average age of the respondents is 22; that is also the median age; one half of the respondents are aged 19 to 26). This is not surprising since drug use is most widespread among young people. 23 women and 41 men were surveyed. 33 of the respondents claim to be Russian, 26 are Latvian, 5 claim a different ethnic 107

Drug abuse prevalence in Latvia

On average half of the respondents' frequency of use falls between daily use and at least once a week.

For the most part, respondents were surveyed at syringe exchange locations, thus it was logical to ask about the frequency and habits of intravenous drug use. The majority of respondents use or have used drugs intravenously (50, on average once to three times per week as shown by the quartile distribution). Of those about half have shared a syringe during the past 12 months (26), a considerable part of those surveyed. Of the 14 respondents indicating no intravenous drug use, half have not done so in the last year, one respondent has, but six respondents repeatedly emphasize that they do not use intravenous drugs. It is possible that intravenous drug use has been the prevalent drug habit among several respondents, though perhaps not recently. Memory lapse could be one explanation for an inaccurate response regarding intravenous drug use. Similarly, some of those surveyed have been users, who at the time of the survey worked at syringe exchange locations.

The drugs used most often by the respondents during the last 30 days are cannabis and amphetamines, used by slightly more than half (the personal last month prevelance (LMP) indicator was selected for the profile, since it also provides respective last year and lifetime information).

More than one-third (24) used heroin within the last 30 days. Since this substance is largely used intravenously, its indication by drug users is no surprise, since the interviews for the most part took place at syringe exchange locations. The use of other narcotic substances during the last 30 days is somewhat lower: 18 used alcohol in combination with pills, slightly more than 10% (8) used LSD and other hallucinogens, as well as opiates (8 respondents) and ecstasy (7).

During their lifetime, fairly many admitted to having used cocaine (26), amphetamines (20), various hallucinogens (17) and inhalants (18). These consistencies seem to indicate changes in drug use habits over time. It could be that cocaine and ecstasy are substances a considerable number of respondents have tried but ceased using. A similar use model could exist with hallucinogens and inhalants among the 64 surveyed users. (18 used them

108

sometime during their life, of those 11 mention FOV and 19 respondents, within the last 12 months â&#x20AC;&#x201D; 2, within the last thirty days, 8 and 1, respectively). The distribution of ecstasy users also could indicate experience over the lifetime of the user and not a regular habit. About one-third of the respondents (20) have tried ecstasy during their lifetime, slightly fewer have done so in the past year (16) and only 8 have done so in the past month.

One gets the impression that cannabis, amphetamine and heroin users have tried these substances and continue to use them (for example, 11 respondents have tried cannabis during their lifetime but have not continued to use it, but the last month prevalence of cannabis is about three times higher â&#x20AC;&#x201D; 36) (see Figure 5.2.).

Social and other problems of drug users Regular drug use poses serious health risks to the individual and inhibits equitable functioning within society.

However, of the 64 surveyed drug users almost onefourth (15) indicated that they have not had any problem with drug use. This attitude could be explained in terms of perceiving problems as direct and negative results of an action; thus, drug users may not perceive problem situations developing over time as related to their drug use.

In general, surveyed drug users most often mention problems in their relationships with friends and family members. Slightly more than one-third of the respondents (28) at the time of the survey had a long-term relationship with another person. Slightly more than two-thirds (49) do maintain regular contact with their families. The respondents do mention, however, the loss of friends and family. As already mentioned, the average age of the surveyed drug users is 22, and one-fourth are 15-19-yearsold. This could be one explanation for the fact that family ties have not been completely severed. Problems with family do exist, and users perceive them as important enough to mention (12 respondents mentioned loss of family members, 15 said they have no family or they do not maintain regular contact with their family).

Social problems in general are mentioned fairly often (loss of one's home or job, relationships with neighbors and police, social alienation); this is the second most often mentioned problem group (24). More than half (38)

Survey of drug users

have had conflict situations with the police resulting from their drug use. Drug-related criminal activity is mentioned as a problem by 7 respondents. These negative experiences can be widespread, starting with robbery and other crimes committed with the intent to get money for drugs and ending with drug-related conflicts with the police, since drug use falls under police jurisdiction.

Other social problems often mentioned include loss of friends, family or work, which has reduced the social circle, making it difficult to find someone with whom to discuss problems and other matters. However interviewers observed that though many showed a genuine desire to converse, they often had a hard time answering more complicated questions. Similarly, many had a difficulty concentrating their attention. The surveyed users themselves have mentioned similar psychological problems, while various other emotional/ psychological disorders (bouts of aggression, memory lapses, lapses in perception and thinking, nervousness, hallucination, suicidal thoughts) were mentioned less frequently (see Figure 5.3.).

of (1) the desire to do so or (2), the opinion that drug use is an undesirable social phenomenon. About half have at some time in their lives tried to free themselves of their drug addiction. Slightly less than one-fourth and onetenth of the respondents, respectively have tried a detoxification program (15) or a motivational program (10), while half have tried to kick their habit on their own (see Figure 5.4.).

Anywhere from 1 to 10 times over their lifetime respondents have tried to quit drugs on their own; they have tried detoxification programs 1-3 times, motivational programs 2-4 times. We see on average that respondents have sought help from treatment and rehabilitation programs about 1-4 times, while they have tried to kick the habit on their own slightly more often. This could be explained by:

However the level of information and knowledge about various health problems resulting from drug use is high, as can be seen in the responses regarding perceptions about the kinds of diseases one can contract intravenously. The majority of respondents named such infectious diseases as HIV (50) and hepatitis (36). One-fourth believe they can contract sexually transmitted diseases this way, one respondent mentioned cancer and tuberculosis. This question was presented in a free format, so it is possible that some chose to mention problems concerning them personally. It is likely that health problems have become a permanent backdrop to their daily existence, thus the tendency to mention the most painful problems such as the loss of a dear person, or social status. The health problems mentioned are directly related to drug use (withdrawal, HIV, injuries received while under the influence).

The majority admit they would like to stop using drugs (40), though only 6 respondents are currently taking part in a treatment/rehabilitation program. This shows that the surveyed drug users are aware of the existing problems and at least theoretically wish to resolve them. At the time of the survey only 6 were undergoing treatment. It is possible that the desire to quit is to some degree a reflection

â&#x20AC;˘

a general distrust of treatment and rehabilitation institutions as well as government institutions, or,

â&#x20AC;˘

limited information about treatment and rehabilitation opportunities.

The next sections of the survey will address the factors of trust and level of information as related to treatment and rehabilitation opportunities, and the opportunities to receive assistance considered significant by respondents.

Attitude toward available sources of assistance Various institutions such as the police, specialized treatment facilities and various NGOs are involved in drug prevention efforts. The users' family and friends may also be involved in the attempt to resolve the problem. There is a broad spectrum of problems related to drug use; the institutions registering drug users are not only involved with prevention. In order to determine the efficacy of the assistance offered by various institutions, respondents were asked to evaluate their ability to provide assistance and trust in the event of a problem (see Table 5.3.).

The highest number of respondents indicated that in the case of drug-related problems they would trust their friends (44 of 64). This is the only informal source of assistance mentioned and its high level of trust (receiving a rating of 1.90) might indicate the desire to trust those with whom one has a close relationship. 23 respondents would definitely trust their friends (the highest number in this category), but about one-fifth (17) would definitely not trust their friends. This could possibly be explained by the lack of social ties among many drug users.

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Drug abuse prevalence in Latvia

The level of trust in social assistance and rehabilitation institutions or programs, and drug treatment institutions is quite high (about half). As we see, the level of trust in treatment institutions is quite high and suggest that (1) the respondents feel that problems resulting from drug use can be resolved by treatment and reintegration; and (2) it is possible that some of the problems are actually of this nature (for example, 40 would like to stop using drugs, 24 rate social problems as important). 35 respondents would trust drug users who have managed to free themselves of their addiction. 25 respondents would trust their parents, while 36 would absolutely not trust their parents.

There is a relatively low level of trust in such sources of assistance as volunteers on the streets (44 would absolutely not trust) and the church (43 would absolutely not trust). This is likely linked to a lack of concrete information about the help available from these organizations, resulting in a certain level of distrust. Respondents would least of all trust the police (only 3 said they would trust the police, while 58 would not), which is easily explained by the specifics of existing legislation; in reality, the penalty for possession of drugs applies directly to the drug user.

The blatant distrust of the police (average trust level of 2.93, with a standard deviation of only 0.31) shows that the methods used by the police are inadequate for providing the type of assistance needed and desired by drug users (treatment, rehabilitation, reintegration).

The attitude toward various institutions and assistance opportunities is closely linked to the level of information.

The majority indicate that they know where to obtain medical or psychological help. More than half (37) would turn to a treatment facility (16 mentioned drug treatment centers, 7 mentioned emergency first-aid, 6 mentioned Linezers Hospital; other institutions were also mentioned by one respondent each); which confirms the previously noted tendency to trust treatment and rehabilitation facilities. 18 respondents mentioned NGO centers and consulting facilities as possible sources of help (12 mentioned the organization "Dialogs", 6 mentioned the Drug Hot Line). Only 6 respondents would seek medical or psychological help from their relatives.

When selecting a treatment facility based on financial structure (national or private), half said they don't know which they would choose (32); 18 would choose a private 110

facility while 14 would choose a state facility. In justifying their choice, they mention such factors as differences in attitude (12 feel it is better at a private facility, mentioning such factors as a more personal attitude, better guarantees of anonymity, distrust of national institutions), quality of service provided (7 feel it is higher at a private institution, based on personal experience with known doctors and programs), and finances (9 indicate that they can't afford to seek treatment in state institutions). 2 felt that the attitude is more appropriate and the quality of service higher at state-run facilities while 2 see no difference between the two types. Thus the surveyed drug users seem to regard attitude and quality of service s very important; this is what they would look for when selecting a treatment facility, giving preference to a known program/ doctor.

The best known and recognized treatment and rehabilitation facilities were the Drug Treatment Center and the AIDS Prevention Center (recognized by 59 and 58 respondents, respectively). Although the level of recognition for both facilities is similar, there are differences in their ratings of the usefulness of the services provided.

More than half who recognized the AIDS Prevention Center feel it provides worthwhile assistance (33); that is the second highest rating. 22 respondents expressed a similar opinion about the Drug Treatment Center. About one-third who recognized both facilities had no opinion regarding the services available (19 for the AIDS Prevention Center, 23 for the Drug Treatment Center).

The high-profile of both of these facilities is connected with the fact that, unlike many individual programs, they are involved in a wide range of activities related to drug use. The service provided by the AIDS Prevention Center is rated highly more often, possibly because its service is so specific. In sum, both of these organizations are involved in various programs not connected with concrete treatment/ rehabilitation measures, and for this reason they are better known than many individual programs.

Nevertheless, though the overall rating is positive, variations do exist (see Table 5.4.).

Slightly fewer users recognized the names of individual programs and rehabilitation centers: the Methadone Program (45), the program "Dialogs" (44), Rindzele Rehabilitation Center (42). Proportionally among respon-

Survey of drug users

dents recognizing the "Dialogs" program, it received the highest positive rating among 31 respondents (70%).

About half rated the Rindzele Rehabilitation Center favorably, making it the third highest-rated facility. On the other hand, the Methadone Program's rating is the lowest.

Perhaps respondents dislike the fact that the addiction isn't cured, that one drug is simply replaced by another.

However we know that only 6 respondents had ever taken part in a methadone program, thus personal experience could not be the reason for this evaluation.

About half recognize treatment and rehabilitation opportunities such as the Minnesota Program, the Daytop Riga Drug Rehabilitation Center, Bikur-Holim Hospital, and the therapeutic community for teens, Saulriti. The least known are private institutions such as Detox (19), Akrona (6), and Vilongs (3).

The positive evaluation proportional to recognizability (except for the latter two) for these programs is about one-half to one-third (47â&#x20AC;&#x201C;37%). The only exception is the Minnesota Progam, which is rated highly by slightly less than one-third of those recognizing the program.

Comparing recognizability (in absolute numbers) and evaluation, we see that only the AIDS Prevention Center is both highly recognized and highly rated, much like the program Dialogs. Proportionally, the Rindzele Rehabilitation Center, Detox and Daytop Riga Drug Rehabilitation Center, Bikur-Holim, the therapeutic community Saulriti and the Drug Treatment Center are rated similarly. The Minnesota Program and the Methadone Therapy Program received slightly lower ratings. Recognizability and positive evaluation ratings coincide for the AIDS Prevention Center, the Rindzele Rehabilitation Center, the teen community Saulriti, and the Daytop Riga Drug Rehabilitation Center. The respondents indicated the above based on personal experience gained through participation in the programs.

Among those familiar with therapeutic communities and their activities, they are rated somewhat favorably (31 rated these communities highly, only two gave negative ratings). About half were unable to give a rating due to lack of information (10) or inability to decide (20). Though the medial response category in this case is "more positive than negative", about one-third of the respondents had no opinion. This attitude possibly results from a lack of information, because there are no specific programs mentioned or because the surveyed users lack personal experience pertaining to the treatment and rehabilitation opportunities offered at these communities.

The majority feel that drug treatment should be anonymous (49) and only 3 feel that drug treatment does not need to guarantee anonymity. This clearly reflects society's attitude toward drug use as a socially undesirable phenomenon, as users are stigmatized by the prevailing attitude. Drug use is a habit difficult to escape, but the social consequences are much more lasting. Thus the desire for anonymity on behalf of the surveyed drug users is understandable.

Required assistance and pertinent institutions Respondents were asked to express their opinion about the drug user's place in society. They were offered two prevalent social views - one of the drug user as a victim of illness and the other of the drug user as a criminal. The majority of respondents, though not nearly as many as might be expected, perceive the drug user as being sick (29), 2 view the user as a criminal and 7 respondents see both elements. One-fifth of the respondents (12) were unable to decide and about just as many objected to both descriptions (13). One suspects that the surveyed drug users find it difficult to place themselves in these categories. Quite possibly this results from too vague an understanding of the terms 'ill' and 'criminal' as well as prevailing attitudes. On the whole, however, the drug users' opinion of their own group is more or less dominated by the notion of 'illness'. Thus, it would be appropriate to keep in mind the group's self-perception in resolving drug-related problems and planning assistance programs.

In the previous section we described the main problems encountered by drug users as well as their level of trust in various institutions working on these problems, especially treatment and rehabilitation facilities. The medical and social consequences of drug use concern all of society.

For this reason the resolution of these problems cannot be left solely up to the nongovernmental organizations; it is important to involve national institutions with their ability to reach and realistically help these people and fully understand the types of assistance they need.

The majority named two main types of assistance necessary for social reintegration: changes in social environment and material assistance (14 respondents mentioned each option). Moral support, overcoming social alienation and enlarging one's social circle are areas in which the respondents would like to receive assistance. Two suggest a potential assistance measure which would help improve their social environment and contacts - a broadbased consulting center where experts would provide advice regarding a wide range of issues. Just as many respondents would like to receive financial support, to provide an incentive to start a drug-free life. 4 respondents indicated they would need help finding employment and 7 would like to receive serious health assistance. All specialized centers and programs should be equipped to provide the above types of assistance, which includes a wide range of reintegration elements.

However a sizable number of respondents (13) feel they don't require any kind of assistance. 2 want easy access to higher-grade drugs, and one would like more effective police efforts in fighting drug dealers.

There are several institutions in Latvia providing assistance for drug users and dealing with various drug-related problems. These institutions have access to the numbers and other characteristics of the target group seeking assistance. Of the drug users surveyed, no more than half are registered at one of these institutions. Most of them are registered with the police (31 of 64), implying a 111

Drug abuse prevalence in Latvia

connection between drug use and crime in general, but especially with drug-related crime. About one-third of the respondents (22) are registered with the Social Services, 18 are registered at the Narcology Center and fewer still at the Prevention Center. 2 respondents are registered at a psychiatric center and another institution, respectively (see Table 5.5.).

It can be observed that the institutions that drug users have the most frequent contact with are state institutions such as the police and social services rather than specialized treatment centers. It is possible that the unfavorable social consequences of drug use such as poverty and crime are registered, and efforts are made to correct these consequences rather than to stop the drug use itself.

It is significant that about one-third of the respondents indicate having had no contact with any of the above institutions. One respondent is registered at all of the institutions, another six are registered at all except the Psychiatric Center. 11 respondents are registered only with the Police, 6 are registered only with the Social Services.

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The knowledge and attitude of students towards drug use and prevention

6

Chapter VI. Methodology Students in tertiary education, whose fields of studies make them likely candidates for becoming professionals, officials or officers involved in drug abuse prevention, treatment of drug addicts, or drug related law enforcement, in particular prospective lawyers, police officers, health care professionals and educators were surveyed.

The purpose of the sub-study is to assess: • the opinion and knowledge of students on the prevalence and the restriction of drug use; • the knowledge on drug abuse prevention and ways to acquire it; • drug-related personal experience.

A questionnaire both for all students as well as for specific specialties was developed. Students were surveyed in their higher education institutions.

A cluster sampling method was used. A list of institutions offering study programs in the particular field was compiled, and in cooperation with the administration of the educational institution, a list of final-year student groups was derived. These groups were included in the study and the time of surveying was set. All the students included in the sample were surveyed. Every sampled group presents a different strata.

Target population 546 students participated in the survey from six higher education establishments in Latvia, — 3rd year, 4th year, and, in several cases, some 5th year students. Women composed the major part of students of medicine and pedagogy, 77% and 95% of the respondents, respectively, as well as of the students of law — 56%, while among the students of Police Academy, only 22% are women.

The students’ experience can be acquired not only in the process of studying, but also by working, therefore students were asked to clarify if they are working apart from their studies. Students working apart from their studies were found more among the prospective medical professionals (51%) and educators (54%), but less among students of law (29%) and students of the Police Academy (10%). Students of medicine are working in positions that are related to their specialty (see Table 6.1.).

PROSPECTIVE

EDUCATORS

In the sample 3rd and 4th year students from higher education institutions from the University of Latvia (LU), the Academy of Pedagogy in Liepaja (LPA) and Riga Pedagogy and Education Management University College (RPIVA) were included. The sample was calculated in proportion to the number of students of pedagogy in the particular education establishment. In total, 150 respondents were included in the sample, although 144 questionnaires were filled out: LU — 42, RPIVA — 66, LPA – 66.

PROSPECTIVE LAWYERS The accredited higher education institutions, that offer study programs in Law, were selected: University of Latvia, Police Academy of Latvia and Higher Education Establishment "Turiba". The sample was drawn as follows: LU — 57, Academy of Police — 56, "Turiba" - 29.

PROSPECTIVE

POLICE OFFICERS

The Police Academy of Latvia is the only institution that prepares police officers in the first level professional higher education study program. All the present students of the particular study program were surveyed, altogether 105 respondents: 3rd year students — 61, 4th year students — 44.

PROSPECTIVE

MEDICAL PROFESSIONALS

In the survey, students of medicine from the Riga Stradina University (RSU) and University of Latvia were surveyed; a sample of 135 respondents: LU — 55, RSU — 80.

As the aim of the study was not to compare the opinions of students from different programs of study, the results 115

Drug abuse prevalence in Latvia

are not comparable between the institutions of higher education covered in the study. The number of respondents is sufficient to compare the opinions of students from the selected programs of studies, and they cannot be related to the particular establishments of higher education as well as programs of studies.

Results Aproximately 60% of students do not smoke, and most of the 'non-smokers' are among students of pedagogy (67%), but less among prospective police officers (59%).

Slightly more students had not used any kind of drugs (60–70%). Alcohol is not being used by 30% of respondents (27% of students of law and pedagogy, 35% of students of medicine).

The number of those who have used marijuana exceeds 10% of the surveyed students — most among prospective lawyers (17%), least among prospective educators (11%). Half (51%) of the prospective police officers know someone, who uses marihuana, while among the prospective educators the number is considerably lower (27%) (see Table 6.2.).

Estimation of prevalence and risk of drug use Most of the students have estimated the use of alcohol as a serious issue in Latvia (75%–90%), but drug use has been estimated as a problem of average importance (49%–67%). A comparatively large number of prospective police officers regard drug use as a problem of wide prevalence (45%) and medium prevalence (49%) (see Figure 6.1. and 6.2.).

Prospective police officers have agreed more with the

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statement that a restrictive policy of drug and alcohol use is being implemented in Latvia, than students from other specialties. But half of the students of the Police Academy have agreed with the statement that a restrictive policy of alcohol use is being implemented in Latvia, while only one third of students of other specialties have agreed with this statement. Regarding the restrictive policy of drug use, one third of prospective police officers have agreed that it is being implemented in Latvia, while only 10–20% students of other fields have agreed (see Table 6.3).

Two questions regarding the main reasons for trying drugs and the main consequences of drug use were posed. Students had to choose from three answers.

Opinions regarding the main reasons for trying drugs differ among prospective lawyers, police officers, health care professionals and teachers. Prospective lawyers and police officers noted recreation, peer pressure and search for feelings enhanced by drug use, whereas prospective medical professionals and educators put peer pressure of friends first, and paying more attention to the influence of problems at school, work and home (see Table 6.4.).

The main consequences of drug use can result in: addiction, infection with HIV/AIDS and other diseases and breach of law. Prospective police officers and medical professionals had selected both addiction and contraction of HIV/AIDS as the main consequences, while prospective lawyers and teachers, in most cases, have regarded addiction as the main consequence. A larger portion of prospective lawyers (31%) and medical professionals (27%) had pointed out mental disorders as a serious consequence of drug use, while the prospective teachers had pointed out worsening of health (27%). The prospective police officers, more than the students of other specialties, had emphasized prostitution as a consequence of drug use (see Table 6.5.).

The knowledge and attitude of students towards drug use and prevention

Most of the students regard themselves as being informed about the consequences of drug use, but they would like to know more. Most, of those willing to know more, were found among prospective teachers (68%), while 17% of prospective lawyers and 13% of prospective police officers regard themselves as being rather poorly informed. Among the prospective medical professionals and teachers, 8% regard themselves as being poorly and rather poorly informed (see Figure 6.3.).

In order to determine the awareness of students on the risks of drug use, students were asked to evaluate the addictive substances as very dangerous, rather danger-

ous, not very dangerous, and not dangerous at all. The possible answer of "don't know" was also offered. A similar number of students in all the groups regarded the use of heroin (88%–94%) and cocaine (60%–73%) as very dangerous. A larger part of the prospective police officers regarded the use of crack as dangerous (59%), while prospective medical professionals think the same for morphine (59%). Prospective teachers, more than other students, regard the use of marijuana as very dangerous (42%) (see Table 6.6.).

The majority of students, except prospective police officers, are not informed about the danger of using crack (23%–37%). More answers of "don't know" had been chosen by prospective lawyers and teachers than police officers and medical professionals.

The majority of respondents regard the use of cigarettes as slightly risky — 43% of prospective lawyers, 51% of prospective police officers, 46% of medical professionals and 29% of teachers. The use of marijuana is regarded as slightly risky by 34% of students of law, 27% of students of the Police Academy, 19% of students of medicine and 15% of students of pedagogy (see Figure 6.4.).

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Assesment of studentsâ&#x20AC;&#x2122; acquired knowledge PROSPECTIVE LAWYERS The majority of surveyed law students (83%) had stated that in their study programs, they have covered legal aspects of drug use. Information about addictive substances and their impact on the human body have been covered or are planned to be covered in the study programs for half of the students (52%). Most of the students had admitted that the basic principles of drug prevention (66%) as well as foreign experience in prevention of drug use (69%) is not being covered in their study programs (see Figure 6.5.).

stances and their impact on the human body (83%), the basic principles of a drug problem (71%). Student consensus is divided when it comes to covering such topics as the treatment of drug addiction and rehabilitation; 55% of students regard it as necessary, and the rest (45%) as not necessary (see Figure 6.7.).

As the aim of the study is to uncover the opinions of law students on drug prevention in regards to legislation â&#x20AC;&#x201C; the respondents were asked to express their opinion on this issue. Most of the surveyed law students (53%) regard the existing penalties as appropriate, while the penalties for producing and distributing drugs as too lenient (respectively 68% and 64%) (see Figure 6.8.).

Students of law, for the most part have covered the legislation in Latvia and, in some of their study programs, have acquired knowledge of drug-related problems in contemporary society. Based on the knowledge acquired, they had proposed changes in the legislation to tackle the drug problem. A large part of students (25%) think that a drugrelated crime can be restricted by more severe punishment, where as a minor part (1%) of students think that the problem derives from unfavorable socio-economic conditions (see Figure 6.9.).

About half of the surveyed students (49%) had admitted that topics related to the drug problem and its prevention have been covered in lectures of specific courses. About one third (30%) of the students have covered these topics outside their study program. About one fifth (19%) had admitted that they have not covered these topics (see Figure 6.6.).

Students were asked to evaluate the work of police, the prosecutor's office and political parties in the fight against drugs. The work of police was evaluated as positive by one third of the respondents, but two thirds of the students gave a negative evaluation. The work of the prosecutor's office was evaluated by half of the respondents as positive and by the other half as negative. Most of the students (three fourths) regard the work of political parties in restricting of drug use as negative (see Table 6.7.).

In order to test the knowledge of students, specific questions requiring knowledge of the Criminal Law were included in the questionnaire. The questions show that the law students do not know the answers "by heart", without checking them against in the Criminal Law. Regarding the question â&#x20AC;&#x201D; "If a person of his/her own free will hands over the narcotics or psychotropic substances, is he/she exempt from criminal liability for obtaining, possession and proliferation of drugs?", 44% agreed, 33% disagreed, but 23% of students didn't have an opinion.

Regarding the question "What is the smallest amount of marijuana (dried) possession of which the person comes under criminal liability?", only 25 per cent of students chose the right answer.

Education, gained in the study program, regarding the prevention of drug use, is evaluated as broad and sufficient only by 16% of respondents. A large part of the respondents (50%) regard their knowledge as minimal or insufficient and 34% regard their knowledge as partial.

The majority of students regard that the following topics should be covered in the study programs of law: the legal aspects of drug use (95%), information on addictive sub118

The majority of students (66%) regarded themselves as not informed about the attitude and stance of the EU towards drug trafficking; 29% regarded themselves as partially informed and only 5% of students regard themselves as being well informed. Students were asked to identify those European countries, that has had experience in the fight against the prevalence drug use. Most of the students chose the answer "Don't know" (39%) or didn't give any answer (25%), The Netherlands was mentioned by 22% of respondents, Germany by 8%. Among others, such countries as the Great Britain, Finland and Sweden were also mentioned.

The knowledge and attitude of students towards drug use and prevention

PROSPECTIVE

POLICE OFFICERS

Most of the surveyed students reported to have covered, in their study programs, all of the topics covered in the questionnaire. Almost all of the students (96%) had pointed out that topics related to drugs, their impact on the

human body and the legal aspects of drug use have been or will be covered in their programs of study.

Comparatively, less was covered on the issue of other countries' experience in the reduction of drug problems, 28% of students had stated that this issue has not been and will not be covered (see Figure 6.10.).

Most of the students have admitted that topics related to the drug problem and prevention had been covered in one or several lectures in specific courses (see Figure 6.11.).

Most of the students (95%) think that the prospective police officers should have to acquire knowledge on addictive substances and their impact on the human

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Drug abuse prevalence in Latvia

body, legal aspects of drug use (91%), treatment and rehabilitation of drug users (64%) (see Figure 6.12.).

Most of the surveyed students (61%) regard knowledge on drug prevention gained in the program of study as partial, 24% regard it as broad and 15% regard the knowledge as minimal.

Prospective police officers were asked the same questions as the prospective lawyers regarding the sanctions in force. The prospective police officers are more united in their opinion, that the existing penalties are too lenient; 32% regard that the existing penalties for drug users are appropriate, while 59% think that the penalties are not severe enough (see Figure 6.13.).

When asked to point out the necessary changes in legislation, most of the answers were concerned with the necessity to introduce more severe punishments.

Students were asked to evaluate the work of police, the prosecutor's office and political parties in the restriction of prevalence drug use . The work of the police has been regarded as positive by 70% of the students of the Police Academy, 59% have regarded the work of the prosecutor's office as positive (41% as negative) and 68% of students regard the work of political parties in popularizing the fight against persons commiting drug-related crimes as negative (see Table 6.8.).

In order to test the knowledge of students, specific questions requiring knowledge of the Criminal Law were included in the questionnaire. The questions show that almost half of the students of law did not know the answers without checking them against in the Criminal Law. Regarding the question â&#x20AC;&#x201D; "If a person of his/her own accord hands over the narcotics or psychotropic substances, is he/she exempt from criminal liability for obtaining, possession and distribution of narcotics?" 51% agreed, 31% disagreed, but 17% of students didn't have an opinion.

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Regarding the question "What is the smallest amount of marijuana (dried) for the possession of which the person comes under criminal liability?", only one-third of students chose the right answer.

The largest portion of students (54%) regarded themselves as not informed on the attitude and stance of the EU towards drug trafficking; 43% regard themselves as partially informed and only 3% of students regard themselves as well informed.

Students were asked to identify those European countries, that has had experience in the fight against the prevalence drug use. Most of the students chose the answer "Don't know" (16%) or didn't give any answer (44 %), Germany was mentioned by 15% of respondents, the Netherlands by 15%. Among others, such countries as the Great Britain, Finland, Sweden and Belgium were also mentioned.

PROSPECTIVE

MEDICAL PROFESSIONALS

Most of the students stated that topics related to addictive substances and their impact on the human body (84%), treatment of drug addiction and rehabilitation of drug addicts (67%), basic principles of prevention of drug use (58%) have been or will be covered in their programs of study. 63% of students have admitted that legal aspects of drug use are not being covered in their programs of study (see Figure 6.14.).

Almost half of the students of medicine (49%) evaluated gained knowledge on the prevention of drug use and treatment and rehabilitation of drug addicts as partial, nevertheless, attention should also be paid to the students that regard the knowledge as minimal and insufficient (respectively 39% and 42%). Students also regarded the knowledge on treatment of drug addicts in Latvia (53%) and in other countries (58%) as insufficient (see Table 6.9.).

Most of the students (40%) had admitted that topics relat-

The knowledge and attitude of students towards drug use and prevention

ed to drug problems and rehabilitation of drug addicts have been covered outside their study programs. These issues had been covered in one or more lectures in specific courses (34%) or in guest lectures or seminars (19%) (see Figure 6.15.).

posals stated the necessity to pay more attention to this field of medical care, broadening the information on the necessity and opportunities of treatment, changes in legislation, as well as of the more concrete things, such as compulsory treatment, observing of anonymity etc.

In spite of the modest evaluation of personal knowledge, almost all of the students admit that the study program should cover the treatment and rehabilitation of drug addicts (99%), basic principles of drug prevention (97%) and information about addictive substances and their impact on the human body (97%). Less conformity of opinion was found on the topic of legal aspects of drug use — 88% think it should be covered, 12% do not think it is necessary (see Figure 6.16.).

The prestige of the narcologists is regarded as average by 50% of the respondents, 14% regarded it as high, 3% as very high, 9% as low, but 24% admitted that it is hard to evaluate.

Medical students were asked questions to test their knowledge, as it helps to specify the self evaluation of personal knowledge obtained by students.

PROSPECTIVE EDUCATORS

Several questions were asked to test the awareness of students of the treatment of drug addicts in Latvia, and most students responded "Don't know".

In response to the question about how the treatment of drug addicts has changed in Latvia, 44% of respondents chose the answer "Don't know", 30% noted that the situation has not changed, 17% regarded the situation has improved and 9% that it has worsened. Asked to evaluate the existing system of treatment of drug addicts, 34% of students regarded it as average, 30% as bad, 2% as good, but 34% didn't know.

Students were asked to come up with suggestions to improve the treatment of drug addicts. Most of the pro-

Asked to substantiate their opinion, 11% regard narcologists as important as any other medical professionals, 4% stressed the low wages, 2% admitted that there are no evident results of the work by narcologists and 2% pointed to the low status of the patients’ prestige.

In the framework of study programs, addictive substances and their impact on the human body most often was mentioned as topics covered (69%). Other aspects – legal aspects of drug use, drug-use prevention and related school policy, as well as treatment of drug addiction and rehabilitation of drug addicts – had been noted as not dealt with by 81%, 73%, 69% and 67% of respondents respectively (see Figure 6.17.).

Most students (37%) had noted that their studies have covered themes relating to drug abuse and its prevention in one or several lectures within the framework of one course. A large part — 27% of respondents had admitted gaining information outside the study program. Other responses (information gained through self-education, from mass media, in practice) have been chosen by 11% of respondents. 6% had covered this theme in a separate course. Only 4% had acquired knowledge relating to drug abuse in several courses. 5% of the students had not covered these subjects in the framework of their study programs (see Figure 6.18.).

Most of the surveyed students admitted that knowledge acquired through their study program about drug abuse and prevention in school was insufficient. Such answers were given in 57% of the cases, 33% responded that their knowledge was partial, but only 9% - that it was sufficient and extensive. No answer was given in 1% of the cases.

Almost all surveyed students, 99% positive responses,

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replied that information about addictive substances and their impact on the human body should be included in the curriculum of pedagogic studies. Just as many students (99%) admitted that it would be necessary to include the basic principles of prevention of drug use in the study program. A little less — 94% have agreed that the study program should include legal aspects of drug use.

Treatment of addiction and rehabilitation of drug addicts is considered as relevant to be included in the study program by 84% of respondents (see Figure 6.19.).

To ascertain student interest about the questions of drug prevention, the questionnaire gave the titles of 8 books; the students had to say which of the given books they had used to gain more knowledge. Most of the surveyed students had not read or heard about any of the books on the prevention of drug addiction given in the questionnaire.

21% named "A Handbook for Teachers”. Pupils and Drugs" as the book most used, 20% of respondents named methodical materials for schools published by Riga City Drug Prevention Centre. Most — 39% of surveyed students admitted knowing V.Rudzitis "Bendes meitina", but hadn't used it.

On the question of other books read on the subject of drug abuse, most respondents (37%) answered that they had gained information from mass media, 33% named other books and 22% — brochures.

When asked to mention institutions with which the schools should cooperate in order to be more successful in accomplishing prevention of drug use, most students — 48% named centers of drug use prevention, followed by medical institutions (25%) and police (23%).

Suggestions offering for more successful work in preven-

tion of drugs use in schools, most often the respondents had mentioned the dangers and consequences of drug use — 65%. Considerably fewer students mentioned support for children from their parents or social workers as a factor in preventing drug use (10%), cooperation with drug abuse prevention centers (6%), amending legislation (4%) and development of informal education. In addition, students mentioned demonstration of video materials, meeting with ex-drug addicts, diverse project exhibits and organization of discussions.

Comparison According to student opinions, subjects related to drug use have been most extensively covered in the Police Accademy’s professional higher education program. The law program covers legal aspects of drug use. Medicine, education and pedagogy study programs concentrate

mostly on addictive substances and their impact on the human body (see Table 6.10.).

More than half of the surveyed law students had admitted not having learned about the basic principles of drug prevention, as well as foreign experiences in this field. Most of the prospective health care professionals and pedagogues admit not having covered legal aspects of drug use. Attention must be drawn to the fact that most of the prospective educators do not learn the basic principles in prevention of drug use (73%) and school policy (see Table 6.11.).

Comparatively, the prospective police officers estimate their knowledge higher than students of other specialties in prevention of drug use. 85% of prospective police officers estimate their knowledge as sufficient, the same estimation is given by 60% of prospective lawyers and 42% of emerging educators. About one half of law students (49%) and education and pedagogy students (57%) estimate their knowledge as minimal in prevention of drug use (see Figure 6.20).

At the same time, almost all prospective police officers (91%), health care professionals (97%) and educators (99%) consider that in the framework of their study program, they should acquire knowledge about the basic 122

The knowledge and attitude of students towards drug use and prevention

principles of drug prevention. Practically all emerging lawyers think they should acquire legal aspects of drug use (95%), while 83% consider it relevant to know about addictive substances and their impact on the human body. Less agreement among prospective lawyers and police officers was noted regarding the treatment of drug

tion of drug use. Future doctors similarly estimate the role of police officers and medical professionals, but put journalists in the third position. Prospective educators consider medical professionals as the most important profession in preventing drug use, followed by social workers and police officers (see Table 6.13.).

Almost 1/4 of all respondents answered that priests have no role in prevention of drug use and restriction of drug prevalence. Estimates on the role of lawyers vary — 31% and 35% of students of medicine and pedagogy, respectively, have admitted that lawyers have no role in this aspect, while only 12% of future lawyers and 14% of

future police officers have admitted the same (see Table 6.14.).

Opinions and suggestions for the reduction of alcohol and drug abuse in Latvia In order to find out student opinions toward different activities for the reduction of drug use, students were presented with 15 statements. They could express their attitudes by choosing the answers: fully agree, rather agree, rather disagree, and fully disagree. The student responses can be divided in 3 groups: statements with which most of the students fully agree or rather agree; statements which most of the students fully disagree or rather disagree; and statements with which most of the students agree, but some disagree. addiction and rehabilitation of drug addicts (see Table 6.12.).

The views of students in different specialties vary regarding the role of certain professions in the prevention of drug use and the restriction of drug prevalence.

Prospective lawyers see police officers, social workers and medical professionals as the three most important professions. Prospective police officers note themselves, medical workers and educators as important in preven-

Activities favored by most students: • to increase the number of treatment and rehabilitation institutions, where people with addictions could get free help (86–96%); • while testing a driver's blood alcohol concentration, a test on drugs must also be performed (80–88%); • drug users should have easy access to cheap, clean syringes and syringe exchange possibilities (78–84%); 123

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•

introduction of compulsory treatment for drug addicts (76–81%); • use of drugs is a criminal act (72–81%); • setting more severe penalties for drug traffickers is a solution in the fight against drug problems (66–90%); • schools and workplaces should have inspections introduced to reveal drug use (57–80%).

Most of the respondents agreed with the statement that more severe penalties would be a solution in the fight against drugs, the prospective lawyers agreed with this statement in slightly fewer cases than students of other specialties. Prospective police officers, in turn, are more certain about the need for inspections in schools and workplaces to reveal drug use (see Table 6.15.).

Statements disagreed on by more than half of the different specialty students: • legalization of soft drugs would reduce crimes related to drug use (70–81%); • there are enough medical institutions in Latvia where people with addictions can turn (66–73%); • legalization of soft drugs should be allowed, at the same time ensuring control on drug quality and use of drugs in public places (66–73%); • compulsory treatment of drug addicts is a violation of human rights (64–67%); • Current penalties for drug related crimes in Latvia

124

are compatible with other penalties set in Latvia (44–53%) (see Table 6.16.).

On the question of compatibility of penalties, law students' opinions are inconsistent: 44% rather or fully disagree with the statement, but 42% fully or rather agree.

Regarding certain questions, the opinions of students of different specialties vary. Ensuring free methadone delivery to drug addicts throughout Latvia is agreed upon by most prospective medical professionals (52%), but disagreed by most future police officers (58%).

Most prospective lawyers disagree that more severe penalties would restrict drug use (53%), while most students of other specialties agree (64–71%).

In turn, replacing imprisonment with treatment as a penal-

ty for drug users is not agreed upon by most prospective medical professionals (51%) but agreed by most students of other specialties (57–70%) (see Table 6.17.).

Students were asked to choose the most effective activities in restricting the prevalence of drug use out of 13 activities mentioned in the questionnaire. The answers marked the professional approach of the different specialties. Priorities of prospective lawyers and police officers are about the same in admitting that the most important are: activation of police and customs service, toughening of penalties against drug traffickers, more active police work in public places. Prospective medical professionals and pedagogues regard toughening of penalties against drug traffickers and activation of police and customs service as most effective. Medical professionals also noted increasing of the number of treatment and rehabilitation institutions as important. Educators consider diversifying leisure time activities for youth, introduction of special educational/informative programs in schools, and broader information campaigns on consequences of drug use as being effective (see Table 6.18.).

Legalization of soft drugs in Latvia is not supported by most of the surveyed students. Students are likely to disagree with people having a legal right to use heroin (89–95%) or hashish and marijuana (76–88%) (see Table 6.19.).

Most students regard drug addicts as sick people or criminals. Prospective educators view them as sick people (58%), future lawyers also see drug addicts as sick people (43%), but a few less people view drug addicts both as criminals and sick people (39%). A similar attitude towards drug addicts is revealed by prospective police officers and medical professionals, most of whom see them both as criminals and as sick people (44–48%) and only a smaller part regards them only as sick people (37–39%) (see Figure 6.21.).

Surveyed students were asked to name those sources of information that would provide young people with adequate information about drugs and alcohol. A certain

The knowledge and attitude of students towards drug use and prevention

trend in defending professional interests is revealed in the distribution of responses: prospective police officers, who tend to be more sceptical about public information, acknowledge that information can be obtained from the police; prospective educators acknowledge the information can be gained from teachers and trainers (see Table 6.20).

The questionnaire left a space for the student's own ideas on the restriction of drug and alcohol prevalence at the national level. The national activity restricting the prevalence of alcohol use, mentioned most frequently, was the necessity to control the sale of alcohol (raise the alcohol purchasing age and times and enforcement of the controls) — 32%. The second most often mentioned activity was combating smuggling of alcohol and illegal sales locations — 17%. Another effective tool in combating

alcohol prevalence is raising the general living standards and reducing unemployment — 13%.

Some have pointed out the necessity of raising the prices of alcohol (10%), informing society about the hazards of alcohol (9%), and activating police raids in public places (5%). Some have mentioned the development of informal educational programs, and the need to provide leisure time activities.

18% of those surveyed had mentioned strengthening of penalties for drug traffickers as an effective measure in restricting drug prevalence on a national level. Just as often mentioned, aligning legislation and the work of customs (18%), informing society about the harmfulness and consequences of drug use (15%), strengthening of penal-

ties for drug users (11%), increasing the number of treatment and rehabilitation centers (7%) and developing informal educational programs (4%).

Conclusions This research concludes the overall level of students' knowledge about the causes of drug addiction, consequences, specific drugs, and information sources as well as their knowledge of types of drug abuse prevention. It was ascertained how students asses the knowledge gained in their higher education establishments as well as about the prevention of drug use in school policy.

Estimating the prevalence of alcohol and drug use, most students have admitted that alcohol use is a very common problem in Latvia (75–90%), but drug use is of average importance in Latvia (49–67%). A considerably large part of prospective police officers think that drug use is a widespread problem in Latvia (45%) and that it is of medium importance (49%).

A slight difference is seen in the responses of future 125

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lawyers and police officers regarding reasons to try drugs compared to medical professionals and educators.

Prospective lawyers and police officers considered recreation, peer pressure and search for new sensations given by drugs as the main reasons for trying them. Medical professionals and educators put peer pressure first, and emphasize problems at school, work and home.

Most important, consequences of drug use are considered: addiction, contraction of HIV/AIDS and other infectious diseases, and breaking the law. Future police officers and medical professionals have attached importance to the problem of addiction and contraction of infectious diseases, while prospective lawyers and educators, in most cases, regarded addiction as more essential.

Assessing their awareness of the consequences of drug use, most students claimed to be informed and would like to know more. Most of those willing to know more were among prospective pedagogues (68%). 17% of prospective lawyers, 13% of future police officers; 8% of future medical professionals and educators consider themselves as poorly or rather poorly informed.

A similar number of students consider the use of heroin (88–94%) and cocaine (60–73%) as very dangerous.

Most of the prospective students consider crack as dangerous, but 59% of future medical professionals consider the use of morphine dangerous. Prospective educators, more than other groups of students, regard the use of marijuana as highly dangerous (42%).

Evaluating student responses, it is evident that themes related to drug use have been covered more extensively in the Police Higher Professional Education Program.

The law study program covers the legal aspects of drug use. Medicine and pedagogy study programs emphasize addictive substances and their impact on the human body.

More than half of the surveyed law students had admitted that they have not acquired the basic principles of prevention of drug use as well as any foreign experience in drug prevention. Most prospective medical professionals and pedagogues admit not having studied the legal aspects of drug use. Attention must be drawn to the fact that most future educators do not study the basic principles of prevention of drug use (73%) and in prevention of drug use in school policy.

Almost all prospective police officers (91%), medical professionals (97%) and educators (99%) consider it necessary to acquire the basic principles of prevalence of drug use in their respective study program. Almost all prospective lawyers think that they should learn the legal aspects of drug use (95%) and 83% regard it as necessary to obtain information about addictive substances and their impact on the human body. There is less conformity among the prospective lawyers and police officers on the question of learning about the treatment and rehabilitation of drug addiction as part of their studies.

Students’ views of different specialties vary regarding the specialties that are considered to have an important role in the prevention of drug use and restriction of drug prevalence. Prospective lawyers name police officers, social workers and medical professionals as the top three 126

important professions. Police officers, in turn, name themselves, medical professionals and educators as important. Future medical professionals rate the role of police officers and medical professionals of same importance, but put journalists in third place. Prospective educators consider medical professionals, social workers and police officers as the most important professions in the prevention of drug use and restriction of drug prevalence.

Summing up student assessment of their own knowledge based on answers to the questionnaire, we see that students know comparatively little about the prevention of drug use. Not only as future specialists, but also as future parents, students should have more clarity and extended knowledge of the prevention of drug use. It is important especially when preparing future educators.

The conducted survey may be considered as a pilot project due to the small number of respondents, but it denotes the main problems in preparing future professionals in restricting the prevalence of drug use in society. Student answers indicate that higher education institutions do not sufficiently prepare these professionals.

Heads of departments need to analyze study programs and consider including courses on prevention of drug use in order to attract the attention of the teaching staff to these questions. Similarly, more precise information about what is being taught and where it should be in the program would be better discussed with department heads.

To improve student knowledge and to encourage their interest on the questions of prevention of the use of addictive substances, it is necessary to: • develop a course on prevention of drug use in cooperation with specialists and university teaching staffs. Agreement between the direction of a university and heads of the departments, a course should be included in law, social study and pedagogy study programs as an optional course; • special attention should be paid to prevention of drug use in professional pedagogy study programs. Leaving these questions only to the competence of teachers of health and social issues, the efficiency of preventive measures in schools is less. All prospective educators do not need to be prepared at such a level, but be able to teach about prevention of drug-use, their knowledge and experience must extend to being able to develop school policy, make decisions on specific situations and cooperate with specialists when needed.

As the questions regarding the prevention of drug use are relevant to students of different specialties, higher education institutions should encourage student cooperation and participation in projects outside their study programs.

This can be done by organizing summer universities and competitions on scientific papers for students on the questions in prevention of drug use. It would be worthwhile to involve NGOs in these activities. Some organizations already offer internships for students of different specialties and a lot of students are active in NGOs outside their studies. Such cooperation would popularize the work of NGOs to less active students to encourage their involvement within.

Survey of NGOs involved in the restriction of drug use and the treatment/ rehabilitation of drug addicts

7

Survey of Introduction The goal of this part of the study is to compile information about all organizations and private initiatives involved in drug prevention, treatment and rehabilitation of drug addicts in order to assess the present situation and to prepare Latvia to join the EDDRA (European Network of the Exchange On Drug Demand Reduction Action). We will also evaluate the potential of NGOs and individuals to become more actively involved in this field.

COURSE

OF

ACTION

Using the NGO catalogue, 53 organizations, directly or indirectly involved in drug prevention, treatment and rehabilitation, were sorted out of more than 900 registered organizations, with the help of a telephone survey. The selected organizations were mailed a questionnaire asking for precise information regarding the work of the organization, projects completed in the last three years and any type of collaboration with other organizations in Latvia and abroad. Partially structured interviews were conducted with directors and members of the active organizations.

In order to arrive at a more precise listing of existent and active organizations, interviews were conducted with representatives of various foundations, international organizations and national institutions about their collaboration with NGOs. Twenty five organizations responded to this research and provided information about their work. Although organizations with the basic information about their activities is compiled in the register, the number of organizations, the direction of their work and their collaborative partners is inconsistent. This results from the working conditions, which are often quite difficult, force organizations to struggle for their survival. There are several strategies which help organizations to survive and to ensure their longevity: • choosing a multi-directional approach to activities and projects. The ability of organizations to obtain funding depends on the project topics offered by the various foundations, national institutions and municipal projects. The survival of organizations, for the most part, depends on their ability to respond to current social needs and their capability to offer solutions to significant and pending problems;

•

•

establishing cooperation among similar organizations, helps develop a collaborative network.

Cooperation among organizations in Latvia ensures an inter-regional connection. Working in a collaborative network allows smaller organizations to be actively involved in the implementation of major projects; smaller organizations find it difficult to maintain their infrastructure; unless the organization has stable funding, the organization tends to reduce its infrastructure expenses. The organization exists in fact, but it does nothing. This is one explanation why many organizations were not able to be reached at the phone number provided and did not return the questionnaire about their activities.

NGO activities in the area of drug demand reduction are mainly concerned with primary prevention. Most of them are concerned with promoting health and healthy lifestyles, informing about harmful habits and addictions, and promoting abstinence and more effective prevention measures. Organizations working in Latvia can be theoretically divided into three groups: 1. a collaborative network of organizations concerned with addiction; members who are familiar with the harmful effects of drug abuse. These organizations have active youth sectors that promote healthy lifestyles and meaningful leisure time activities. One of their work areas is prevention of drug use. These organizations are united in the Association of Temperance Organizations "IOGT– Latvia" as well as the Children's and Youth Temperance Federation of Latvia; 2. the NGOs coalition for drug prevention is a network of organizations which includes groups directly involved in primary drug prevention — education and information. The main activities of these organizations include the training and involvement of specialists, preparing informative and educational materials and organizing events and campaigns. The core of these organizations is the Education Centre for Family and School; 3. organizations that have Latvian branches of international organizations and movements; some of these organizations have offices outside of Riga.

Examples of this type of organization include the Project of Health Promoting Schools and the Latvian Youth Red Cross.

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Considerably fewer organizations are concerned with secondary and tertiary drug use prevention. According to their field of action they can be divided into two groups: 1. organizations working with the treatment and rehabilitation of drug addicts. Together with national institutions, there is also one NGO working in this field. This organization â&#x20AC;&#x201D; "Apzinas ekologija" (Ecology of Consciousness) consists of ex-users and several religious organizations. Its field of action goes beyond the establishment of a drug treatment centre (community); 2. organizations that work with risk groups such as former prisoners and people infected with HIV. Drug addiction prevention is not the main activity of this group. For example, the Tukums sector of the Riga Samarian Society established a day centre "Avots", providing social and psychological assistance to Tukums residents and their families struggling with drug and alcohol addictions.

The advantage of NGOs in the area of drug use prevention is their flexibility in determining the needs of various target groups and to offer possible solutions. NGOs are able to react quickly to urgent social problems. In many cases, NGO members are able to gain the trust of their clients more easily.

In order for NGO work to develop, it is necessary to develop a more flexible system of national and municipal cofunding. NGO participation in various prevention projects must be actively promoted.

Information about NGOs The NGO Centre catalogue was used to sort the 976 registered organizations, who use the following key words in descriptions of their goals or characterizations of their target group: intoxicating substances, abstinence, addiction, addictive substances, drug addicts, alcoholics, alcoholism, drug addiction, healthy lifestyle, young people's leisure time, risk groups, former prisoners, street children, children from dysfunctional families.

The NGO data base was the main tool used in selecting the organizations. The organizations were grouped based on key words appearing in the descriptions of their goals, characterizations of their target audience or project descriptions (see Table 7.1.).

An automatic search was conducted in the Lursoft data base using key words with the root 'narco'. As a result, 13 organizations were found using one of the following in their goal descriptions: drugs, addicts (drug addicts), addiction (see Table 7.2.). Another group of organizations was separated on the basis of the following key words appearing in their goal descriptions: intoxicating substances, abstinence, addiction (with no specific substance mentioned); there were 10 such organizations (see Table 7.3.). The two groups of organizations we tried to get the most information, based on their field of activity, these groups could be involved in drug use prevention the most.

Two more groups of organizations were separated: organizations promoting healthy lifestyles and risk group organizations. 14 groups fit in the first category and 17 groups formed the latter category; those working with risk 130

Survey of NGOs involved in the restriction of drug use and the treatment/rehabilitation of drug addicts

groups, such as: former prisoners, HIV/AIDS infected, street children or risk groups in general.

The latter two groups were sent questionnaires by email and regular mail. They were asked to fill out the questionnaires regarding the last 5 years and if they had dealt with drug use prevention, treatment or rehabilitation of drug addicts. If the organization did not respond, an assumption was made that they had not worked in this area.

Organizations listed as possible sources of information were questioned by telephone or email regarding their possible contact with organizations working in the area of drug prevention, treatment or rehabilitation of drug addicts.

According to the organization registration data, there were three nongovernmental organizations with the words drug addiction (narcomania) or drug treatment in their title: community fund 'Narcological Assistance' (Jurmala), the Open Society Fund Against Drugs and Drinking (director Artis Silaroze) and the International Alliance of the Drug Abuse and Drug Trafficking Combating Organization. Unfortunately, none of the organizations responded to our calls for information about their work. Drug use prevention was mentioned in the goal description of one organization — the Family and School Education Centre.

The work of the NGOs Organizations working in drug prevention The Family and School Education Centre The organization has been in operation since September 1997 working in the area of drug prevention. The goal to promote effective drug prevention work in Latvia. This goal resulted from the awareness of the increasing prevalence of addictive substance use among young people as well as the lack of effective prevention measures. The organization consists of professional psychologists, university lecturers and high school teachers.

International cooperation efforts on behalf of the organization include joint projects and shared experiences with experts from Austria, the Netherlands, Germany and Great Britain. In 1998, the Education Centre became an associate member organization of the EURONET (European Network for Practical Approaches in Addiction Prevention).

Extensive collaboration with experts in the area and openness to new approaches has made the Education Centre one of the first organizations in Latvia to introduce new, contemporary approaches and methods in drug prevention: peer education (for parents and young people); life skills approaches; and elaboration of school policy in the area of drug prevention.

The organization provides courses for various target groups and produces specialized materials about drug prevention for practical use. The main target audiences of their efforts are young people, parents and teachers.

Each year, the Education Centre involves about 1000 young people and 650 adults from all parts of Latvia in their various projects.

Since 2000, the Education Centre has purposefully worked at promoting expert idea exchanges about effective prevention measures and changes in existing programs. The Centre has completed several significant projects. At the end of 2000, the Centre started a project which included a coalition of 7 NGOs to promote successful drug prevention. The NGO coalition's project "About Effective Drug Prevention" covers a broad range of drug use prevention issues: primary, secondary and tertiary drug prevention, HIV/AIDS prevention, promotion of reproductive health, prevention of crimes committed by minors. The organizations in the coalition are 'Apzinas ekologija' (Ecology of Consciousness), the Daugavpils Pedagogical University Health Centre, the Family and School Education Centre, the Latvian Family Planning and Sexual Health Association 'Papardes zieds', the Athletic Society 'Duksis', the Valka Regional Youth Health Movement, and the Ventspils Children's and Youth Support Centre 'Nac lidzi'.

In October 2001, the NGO coalition 'For Effective Drug Prevention' organized a seminar and Forum for Drug Prevention Specialists and set as its goal the promotion of the professional competence of specialists in this area, to promote the exchange of ideas and experience on the road to a unified understanding of effective drug prevention. The most well-respected experts in the fields from international, national, municipal and non-governmental organizations participated in the forum.

Within the framework of the project 'School policy for drug prevention’, the Education Centre is working with 8 schools in Latvia to develop specific drug prevention policies. This policy anticipates drug prevention education as part of the school curriculum, providing guidelines on how to react to incidents involving drugs. During the project, the schools are using the handbook prepared by the Education Centre about the formation of school policy.

The goal of the EU Phare Access 2000 Project 'Collaboration between NGOs and Schools working with children from risk groups' is to strengthen NGO capacity and cooperation with schools, to promote drug use prevention, and to integrate children from risk groups into the school environment. The Education Centre is working with 20 NGOs and 9 schools in Latvia from Riga, Daugavpils and Liepaja on the realization of the project.

The result of this project will be a teachers' handbook about working with children from risk groups, recommendations to government institutions and an experience exchange seminar.

In 2001, a research study about the work of NGOs, national and municipal governments in the area of drug and HIV/AIDS prevention was conducted. As part of the research, interviews were conducted with 16 NGOs that work in this area. Information about the following groups was compiled as part of the study — Youth Against AIDS, Club 10x10, the Education Centre, Athletic Society 'Duksis', Latvian Youth Christian Society, 'Apzinas ekologija', Latvian Family Planning and Sexual Health Association 'Papardes zieds', Valka Regional Youth Health Movement, Latvian Association 'For Safe Sex', the Daugavpils Pedagogical University Health Centre, the 131

Drug abuse prevalence in Latvia

Ventspils Children's and Youth Support Centre 'Nac lidz!', the Latgale Teachers Abstinence Association, Latvian Sexual Problem Centre 'Genders', and Latvian Youth Health Centre Board.

In 2002, the NGO survey was carried out. 11 organizations took part in the survey; six of them had also taken part in the previous year's survey, five participated for the first time.

'Apzinas ekologija' (Ecology of Consciousness) ‘Ecology of Consciousness’ is a non-governmental organization which initially was formed by former drug users — people with unique personal experiences — as well as specialists, who worked with problems caused by addiction. Their goal was to reduce the prevalence of addiction in Latvia by sharing experiences and passing on their knowledge.

‘Ecology of Consciousness’ was established in 1998 in order to provide support for young people, who start life without drugs, according to the behavioural and ethical norms of the society.

At present, ‘Ecology of Consciousness’ has 115 active members. The home office of the organization is in Riga with branches in Jelgava, Ventspils, Tukums and in the Cesis region.

Any person living a healthy, purposeful and sound lifestyle, appreciating and maintaining the good reputation of the organization can become a member.

During the time of its existence, the organization has completed various projects and organized seminars on the following topics: • research of drug and HIV/AIDS prevalence in Latvia; • sociological studies of users and co-dependants; • calling attention to and informing society about the problems associated with drugs and HIV/AIDS (publications in the press, internet, radio and TV interviews); • drug and HIV prevention (seminars at schools and joint seminars with local municipal governments); • rehabilitation of drug addicts (treatment, Latvian language courses — about 70 % of young people do not speak Latvian —, computer classes, professional skills based on job market demands); • re-integration of rehabilitated users into society; • counselling and psychological support to former drug users and their families; • founding of support groups for co-dependants in Riga and Jelgava.

The organization has cooperated with the following institutions on various projects — the Baltic Bureau of the UNDCP (United Nations Drug Control Program), the Soros Foundation, the European Union development program 'Youth', RFHL (Swedish Drug Rehabilitation and Reintegration Support Association), WHO (World Health Organization), the community organization 'Nac lidz!'

(Come Along!), the AIDS Centre, the Ventspils municipal government, the Jelgava municipal government, University of Latvia Philosophy and Sociology Institute, the Family and School Education Centre, the nonprofit/governement organization 'Rindzele Drug Rehabilitation Centre', NAB (Drug Enforcement Bureau), and the Jekabpils Orthodox Convent. Since 2001, Ecology of 132

Consciousness is a member of the NGO coalition 'For effective drug prevention'.

Current projects: • 'A United Latvian Society in the Fight Against the Prevalence of Drug Addiction' – an educational program financed by BAPP (the Baltic American Partnership Program) in conjunction with specialists from the public relations firm 'Consensus PR'.

Its goal is to raise the qualification of organization members, to guarantee the quality of services provided by the organization and to increase the scope of the organization's work.

• 'Dialogue and Information' – financed by the European Commission, this is a joint project between the European Union and Poland, Rumania, Slovakia, Bulgaria, the Czech Republic, Hungary, Estonia, Lithuania and Latvia. The project is devoted to experience exchange, joint drug studies, development of a strategy to decrease the demand for narcotics and the introduction of new methodology.

Day Centre for Street Children 'Baltais Zvirbulis' (White Sparrow) The name of the organization is the Association of Abstinence Organizations "IOGT–Latvia" Day Centre for Street Children 'White Sparrow'. The centre was established in 1998 as part of the "IOGT–Latvia" street children project. The club works with street children from ages 13 to 17. It organizes various events for children from poor families of the Latgale suburb area of Riga; it also organizes local and international summer camps. The club is funded by the municipal government and various support foundations.

Latvian Youth Social Health Organization Established in 2002, the main focus of activity of the organization is health promotion. The goals of the organization are promotion and popularisation of a healthy lifestyles and informing the public about the harmful effects of bad habits such as drug use.

Completed projects: • 'Society Against Drugs' — a bus load of popular people in society, following a given route, handed out booklets and information about drugs; an interuniversity poster contest took place as part of the project.

• 'From Drugs to AIDS' — a conference at the LSPA dealing with various aspects of drug addiction.

The organization collaborates with the Riga City Drug Prevention Centre.

Saldus Regional Youth Centre 'Laipa' The centre was established in 2002, to deal with the protection of children's and young people's rights providing psycho-social assistance. The main goals of the Centre are providing meaningful ways to spend leisure time, second level drug prevention and the rehabilitation and reintegration of the socially excluded.

Completed projects: • Peer Education on Prevention of Addiction — 16 young people were trained with the goal to pass on the information about drugs to their peers; • a study of the use of alcohol and psychotropic substances among 15-18-year-olds in Saldus — the

Survey of NGOs involved in the restriction of drug use and the treatment/rehabilitation of drug addicts

study was conducted at four Saldus’ schools and focused at the experimental use of drugs, alcohol and cigarettes.

In Latvia, the Centre collaborates with 'Youth against AIDS' and 'Levestes spicie'. It receives financing from various support foundations.

Association of Abstinence Organizations "IOGT–Latvia" and the Youth Abstinence Federation The basic contingent of Abstinence Organizations was formed in 1979, "IOGT–Latvia" was registered as a social organization in 1995.

Organizations comprising the association — the Temperance Society 'Ziemelblazma', the Latvian Children's and Youth Abstinence Federation (JAF), which includes the youth organization Juvente and the Education Centre 'LATI', the International Abstinence Club 'Avante', as well as associate organizations — 'Noa' and 'Velogrupa'.

Members of the associate organizations are not all abstainers; these organizations do not hold positions on the board of the Association. Members of the Association are all abstainers. The above mentioned are abstinence organizations, which means that abstinence is a lifestyle.

Other organizations emphasize a healthy lifestyle, but do no stress abstinence.

The association works closely with the Latgale Abstinence Association and the University of Latvia Davis Fund.

International cooperation: IOGT is an international organization, the Latvian organization is a local branch. The organization is also involved in NORDAN (the Nordic Alcohol and Drugs Policy Network) and IVES (the International Association for Education of a Life Without Drugs).

Financial and other types of assistance have been received from the Education, Youth and Athletic Department of the Riga City Council, the National Youth Council of Latvia, the Queen Juliana Foundation, Youth Initiative Centre, the Children's and Youth Centre 'Daugmale', the NGO Centre.

The main project that "IOGT–Latvia" is currently involved with is the Formation of a Secondary Prevention Network for Intravenous Drug Users in Jurmala. A bus, where five organization workers provide a syringe exchange service; financed by the UNDP, the AIDS Prevention Centre and the Jurmala municipality.

Other project proposals have been submitted to the Health Promotion Centre and the Society Integration Fund.

The Latvian Children's and Youth Abstinence Federation (JAF) was registered in 1993. Its goal is to provide leisure time activities for children and young people without the use of drugs.

Support organizations and cooperation partners are IOGT, EGTYF (European Good Templar Youth Federation), Education, Youth and Athletics Department of the Riga municipal government, the NGO Centre, National Youth Council of Latvia, Jekabpils Municipality, Welfare Board of the Jurmala Municipality, and AIDS Prevention Centre in Jurmala.

Current projects: • school programs, which include lectures, discussions in schools about drugs, video demonstrations. During this program, good collaboration has taken place with the State Police. During 'Police Days' at the schools, organization representatives participated with lectures, poster sessions and video demonstrations; • summer camp program such as 'Alternativa', 'Ricu-racu', 'Grietinas'; • leader training program 'Action against Drugs' has been working very effectively.

'Club 12' Goals: Education of society, treatment, and promotion of a healthy lifestyle.

Established in 1994 by addicts and alcoholics who wished to remain anonymous. Initially part of 'Ziemelblazma'.

The main goal is rehabilitation and the education of society. The main tasks are to work with schools and to inform society about the problem of addiction. The former alcoholics organized informative lectures and seminars about their personal experience and the consequences of addiction.

All of their projects have been completed with almost no outside financing: • marathon 'Juglas aplis' has taken place since 1985, 30–50 participants; • treatment Program '12 steps' for addicts and codependants. It is based on the Anonymous Alcoholics' 12-step therapy program. Work takes place in groups, it involves more than 100 people who remain anonymous. The only outside support has been from private donations and the Vidzeme suburb municipality; • series of articles in ‘Neatkariga Rita Avize’. The articles have been compiled and published in the book 'Dzidravots', 5000 copies were printed; • lectures and seminars in schools.

• publishing of the 'Alcoholics' Calendar'.

International Abstinence Club 'Avante' Goals: To unite people who want to live a drug free life and to avoid addictive activities such as gambling; to openly abstain; to propagate their views and opinions in every possible way — lectures, discussions, personal experiences.

Activities include cooperation with schools (2002–2003); two school clubs have been established at Natalija Draudzina Secondary School and the Riga Music Boarding School. Members of the clubs take an oath not to use drugs; cooperation with the Latvian Army. Soldiers take an oath that they will not use intoxicating substances while on duty, for this, they get invitations to events organized by 'Avante' (hikes, carnivals, dances, lectures, seminars); organized hikes take place every Sunday all over Latvia; cooperation with the teen drug centre 'Saulriti'; they organize joint events such as swimming and soccer matches.

Collaborative partners: The Riga City Drug Prevention Centre, the Narcology Centre, the National Armed Forces (a one-day seminar is organized for all new recruits), the Riga Music Boarding School.

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Financing: • 'Establishing abstinence clubs at Riga schools' — the Riga City Drug Prevention Centre; • The Queen Juliana Foundation — a minibus has been purchased, club rooms have been renovated.

Temperance Society “Ziemelblazma” The goal of the organization is to rehabilitate the nation from the traditions of alcohol use and other drugs, to promote traditions of spirituality, culture, athletics and national pride, especially among the young, to develop historic Latvian traditions of temperance.

The organization publishes a newspaper “Ziemelblazma” (monthly, 1000 copies). Cooperation with schools is ongoing: lectures, discussions, video demonstrations about addiction at parents' meetings, student and teacher extracurricular activities; the dissemination of informative materials from specialized drug centres.

The University of Latvia Abstinence and Health Foundation The University of Latvia Abstinence and Health Foundation (LUAVIV) was established in November 1999.

It is often called the Davis Foundation because in January 1940, Janis Davis, a member of the popular national temperance movement, donated his house to the university as a dormitory for students belonging to temperance societies.

The goal of the Foundation is to promote a wholesome and healthy lifestyle, free of alcohol and drugs, especially among the young. The main tasks of the members are to acquire the necessary skills and knowledge; to take these skills and knowledge, along with personal experiences, into society and to conduct research studies.

Student members of the Foundation (and others) have completed the course 'The Basics of Abstinence', 'Antialcohol Thinking and Movements in Latvia — a Culturalhistoric View'. The foundation has published the book 'National Sobriety'.

Foundation 'Society and Addiction, Education and Rehabilitation' The Foundation has existed for less than a year. Its goal is to support the education of young people in matters of addiction, to help society change its existing views about the effects of alcohol and alcoholism, and to support a methodical rehabilitation and reintegration process. The two main directions of foundation activities, as reflected in its name, are rehabilitation and education. The project Primary Prevention for Preschool Age Children has been completed. The underlying idea of the project is that it is vital to discuss the problem of alcohol with children from families with a history of alcoholism before the age of 10.

It is important that these at-risk children receive information that is unavailable at an early age.

In their rehabilitation efforts, the foundation plans to work with the Social Assistance Centre, taking advantage of the Scandinavian experience in rehabilitation and reintegration of addicts.

The Latgale Teachers Abstinence Association The NGO was founded in 1994. Its aim is to promote the establishment of a healthy, abstinate society in Latgale through education. Members are teachers, parents and students involved in education. Members request total abstinence from alcohol, nicotine and other drugs.

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Activities: abstinence education, health promotion, promotion of education, production and creation of educational materials, promotion of alternative leisure time activities, community work with teachers, parents, physicians, police, promotion of student abstinence clubs, providing information and advertising.

Projects completed in recent years: • 'Youth–2000' (SAWA-MATRA financing): peerleader training for work in five Eastern Latvian regions and drug use prevention among the youth of these regions. A study was conducted about the effectiveness of the peer-leader training; • the Balvi Youth Club (PHARE-LVAVP financing): popularisation of a healthy, drug-free lifestyle among the youth of three Balvi city schools; • 'A Sober Choice': a society activation project in drug prevention — activities for young people led by their peers, seminars for parents and teachers at Balvi Secondary School.

Cooperation partners in Latvia: JAF, IOGT–Latvia, and 'Avante' and IOGT-International, IVES, EURAD, NORDAN abroad.

Organizations working in the field of health promotion, healthy lifestyle and youth leisure time The Project of Health Promoting Schools Latvia became involved in the World Health Organization Health Promoting Schools network in 1993. At present, 120 schools throughout Latvia are part of the network.

Four regional methodological centres have been established: Daugavpils Pedagogic University as the Latgale regional centre; Kalnciems Elementary School as the Zemgale regional centre; Krimulda Secondary School as the Vidzeme regional centre; Broceni Secondary School as the Kurzeme regional centre.

The aim of the project is to develop the school as a favourable environment for health promotion; students learn to take responsibility for their own health. One of the components of health promotion is drug prevention.

During the summer, teachers take courses and attend classes to learn about new teaching methods. They share experiences about developing an appropriate school atmosphere and formulating school policy.

The project is supported by the World Health Organization; it takes place under the auspices of the Ministry of Education and Science.

Teachers of member schools are involved in various projects, for example, the UNDP project 'Reduction the Prevalence of HIV/AIDS'. Part of this project is teacher education. Youth leaders receive training as part of the Youth Against AIDS project. The organizational experience gained from these projects is significant; during the last 10 years an effective consulting network has been formed. It is open to involving new schools and taking on new projects.

Education Centre 'L.A.T.I.' Established in 1997 — its goal is the popularisation of a healthy lifestyle and meaningful leisure time activities, the promotion of abstinence and drug use prevention.

Drug use prevention projects: • Street Children's Project 'White Sparrow' - organization of hikes, summer camps etc; • project 'Vesels vesela' — annual participation in

Survey of NGOs involved in the restriction of drug use and the treatment/rehabilitation of drug addicts

•

international camps, seminars about drugs and organization of discussion groups; study circles — a series of seminars about addiction, learning the Swedish study circle method.

Ludza Regional Youth Club 'Lietussargs' The club was established in 1998, its work deals with education, information and entertainment. Specific projects have dealt with drug use prevention at the primary level. During the last year, the club has been part of the 'Peers for Peers' project. The aim of the project is to educate young people about HIV/AIDS/STS and the harmful effect of drugs, so that upon returning to their schools and social groups, they can pass on the knowledge and skills to their peers.

Current activities: • a seven-day training program for young people where they learn about the problems associated with HIV/AIDS/STS and drugs. Skills taught include communication, problem resolution, creative and critical thinking, decision making; • Ludza region questionnaires to determine level of awareness and knowledge about HIV/AIDS/STS and drugs and prevailing attitudes; • publishing information at the local and regional level in order to make information available to young people and society at large about healthy sexual relations, reproductive health, drug abuse and the progress of the project; • a team of 10 young people, who are able and motivated, has been formed to train their peers; • educational sessions for peers about HIV/AIDS and STS, drug use and attitudes.

Cooperation takes place with 'Youth against AIDS'.

The organization has carried out a questionnaire about the availability of addictive substances, their use and the level of awareness among young people about the effects of drug use. The results have been published in the local youth newspaper.

Athletic Society 'Duksis' The Athletic Society 'Duksis' was established in 1993 as an alternative choice for leisure time activity for the children and young people in the city of Ogre, promoting and popularising healthy and active lifestyles. The main intent of the organization is the development of the individual's abilities and talent in a non-competitive environment, where each individual has his own weaknesses and strengths. The basis of the organization's activities is 'learning by doing' and 'teaching by experience'.

'Duksis' has been active in organizing summer and winter camps, hikes, single-day leisure time projects, organizing youth discussion groups. From 1996 to 2002, 'Duksis' completed the Ogre Dysfunctional Teen Project, which included work with the police and teens on the social welfare rolls.

In July 2002, 'Duksis' organized an international training seminar 'Teaching by Experience in Working with Teens in Risk Groups’, which involved social workers from Belgium, Lithuania, Luxemburg and Latvia. During the seminar, discussions of comparative methods and principles in work with risk group teens were used as in other European countries.

Organizations working with risk groups Community organization 'Soli' (Steps) The organization 'Soli' was established in February 2003.

It is taking part in the AIDS Prevention Centre project 'Reducing harmful effects for drug addicts and their families', which is financed by the Soros Foundation–Latvia, co-financed by the AIDS Prevention Centre.

The organization was established with the intent of attaining the goals that the AIDS Prevention Centre was unable to include in its work, for example, provide support for drug addicts.

The work is largely HIV prevention supplemented by social work, work with former users and their families and family assistance. In this way, young children are protected from being swept up by the world of drug use.

The main objective of the project is two-fold — providing HIV preventive care, both on an in-patient basis as well as on the street. At the HIV Prevention Station, consultations are offered and HIV testing is done. Each month about 270 people take advantage of the consultations.

Mainly former users work on the streets; they each have their designated neighbourhood and clients, they get calls, they exchange syringes. They are the first to establish contact with people using drugs.

Collaborative partners: • Youth against AIDS — they organize meetings to inform young people about the work of the organization; provide opportunities for information exchange, ensure the availability of informative materials; working on the joint project 'Help for the HIV positive'. All year long the group does counselling work, both on-site and through the prison system (all prisons in Latvia are included); • Youth Red Cross — they sponsored a syringe exchange station; have taken part in various campaigns including 'AIDS Day' and 'A Day in Commemoration of Those Having Died of AIDS'; organized experience exchange seminars; • the organization 'Dia+LOGS'.

'DIA+LOGS' The organization receives funding for its work from Norwegian foundations and Norwegian national institutions. The organization was founded in 2002. Much time has been spent renovating their quarters.

Target group: the HIV infected. The goals of the organization coincide with the goals of the AIDS Prevention Centre.

Prison project — providing psychological and informative support for HIV positive individuals in prison. The project has ended, but it hopes to receive additional funding for further work.

The international project ‘Integration’ deals with the integration of NGOs in the European Union with the integration of the NGOs of EU accesing countries; working jointly with Finnish NGOs. Work on the project is resulting in increased awareness, more information and experience.

Youth against AIDS The organization was established in 1998. Its main goal is to inform about HIV/AIDS and related issues. The organization collaborates with the Riga City Drug Prevention Centre and the AIDS Prevention Centre.

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On-going project: 'Youth-friendly health services'.

The Junior Red Cross The Latvian Junior Red Cross is a volunteer youth NGO, that operates under its own charter and is the affiliate of the Latvian Red Cross. It is one of the largest youth organizations in Latvia with a membership of more than 250 young people in 17 Latvian cities.

Five programs form the basis of the work of the organization: • HIV/AIDS and drug use prevention; • first aid/ blood donor campaign; • fight against social ills (starvation, poverty, violence); • the integration of minorities; • popularisation of the ideology of the Red Cross.

All of the work provides information about harmful substances, and programs to reduce the harmful effects of drugs. The main idea is to have the young people meet with their peers and inform them about the harmful effects of drugs, various kinds of protective measures, etc.

Project: 'Establishing a Syringe Exchange Station' (2001–2002) with the AIDS Prevention Centre and the Riga City Drug Prevention Centre. The JRC purchased the syringes, the Riga City Drug Prevention Centre provided the location and the AIDS Prevention Centre provided all the necessary information.

The JRC regional organizations are active as well, for example, the informative event 'BE Free!' in Limbazi.

Information about the harmful effects of addictive substances was available, a poster contest was organized, and lecturers from the organization 'Education Centre for Family and School' gave presentations.

In Mazsalaca, seminars about drug abuse prevention have been organized.

In Rezekne, a camp for young people was organized.

'We are Against AIDS!', whose purpose was to educate young people about the dangers of drugs, in order to restrict the spread of HIV and drugs in Latvia.

Success in attracting funding is dependant on the initiative and willingness of the members’ volunteer work.

Municipal governments are very supportive, for example, covering the administrative costs incurred during the realization of projects.

The JRC collaborates with the AIDS Prevention Centre, the Liepaja Anti-drug Centre, the Riga City Drug Prevention Centre.

The NGO Support Centre of Southern Latgale The organization provides technical, informative, consultative and educational support to the NGOs of Southern Latgale. The activities of the organization are not directly linked with drug use prevention issues. It has, however, participated in projects dealing with this topic. For example, the project 'Establishing a youth collaborative network for the development of a regional health policy' included a health awareness campaign, in areas of Latvia and Lithuania, paying special attention to alcoholism, HIV/AIDS, and the spread of drug addiction in the region.

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Organizations working with the rehabilitation of former prisoners The International Foundation 'Glabsana' (Salvation) and The Social Rehabilitation Centre Established in 1996, the organizations work on social rehabilitation. Their objective is the rehabilitation and reintegration of the socially excluded, as well as, decreasing the incidence of crime.

Current projects: 'Implementation of complex social rehabilitation programs for former prisoners in Latvia' and 'Employment of former prisoners in a self-made rehabilitation centre'.

Cooperation partners: Riga City Council, the European Commission Delegation, the Soros Foundation-Latvia.

The Latvian Prison Chaplain Association Established in 2000, their work consists of providing spiritual care and social rehabilitation.

Current projects: 'The experimental rehabilitation program at the Parlielupe prison and the educational program 'Mirjama'.

Latvian Public Prison Reforms Support Foundation 'Uzticiba' (Trust) Several projects have remained unfinished due to lack of funds. At present, the organization is, for all practical purposes, non-existent, due to lack of financing.

Organizations working with rehabilitation of drug addicts and alcoholics The 'Ecology of Consciousness' Training and Research Centre 'Lapaini' Since May 16 of this year, five young people with addiction problems have been living at the farmstead 'KalnaLapaini' at the Vaive parish in the Cesis district. They have not been able to find their place in society and need to acquire social and professional skills. The young people live and work under the supervision of three specialists.

Their life and work is organized according to the communal principle, which works in communes in Italy and Sweden. The wishes and professional abilities of the young people are determined; they choose their training specialty (carpenter-craftsman, carpenter-restorer, farmer, forestry specialist) as well as the direction of centre's development.

The new Centre has attracted the attention of several social service providers; a contract has already been signed with the Vidzeme Regional Social Service Centre.

Support has been received from the Vaive parish municipality, the Ramuli Elementary School, the Ministry of Finance; moral support has been expressed by the Welfare Ministry and the Minister for Special Assignments for Children and Family Affairs. The organization is hoping to receive assistance from the Ministry of Transportation and Communications, because at present, the centre can be reached only by foot or by tractor.

Corporate sponsors include 'Lido' meats, the commercial division of 'Reaton' foods, and 'Apsara' teas. Private donations are welcome.

Survey of NGOs involved in the restriction of drug use and the treatment/rehabilitation of drug addicts

A protocol of intent has been signed with a Swedish company to produce fishing equipment starting in August 2003, so the young people can continue to work and grow professionally during the winter months as well.

The 'Kalna svetiba' Community Thanks to the efforts of the priest Medins and the support of the local government, a rehabilitation community for young people with addiction problems started in Brukna manor, 17 km from Bauska. The 'Kalna svetiba' Community registered as a non-government organization on October 23, 2001. The main goal of the Community is to rehabilitate and reintegrate young people, having suffered from violence, abuse and addiction (drugs, alcohol, etc.), by providing psychological and social support. The Community is not a health facility, nor a Christian confessional group — it is a school of life, a place and an opportunity for the addict to live outside the environment responsible for his addiction, to live in and with nature, to search for the meaning of his life, and his very being.

This is the first and only rehabilitation community of this type in Latvia, but worldwide there are many similar institutions in France, Austria, Italy, Brazil and the United States among others. The 'Cenacolo' Community in Italy served as the model for the 'Kalna svetiba' Community.

The philosophy of rehabilitation is the view that drug addiction and addiction, as such, are diseases that cannot be cured with medication. First of all, the soul must be healed and such spiritual healing can be achieved only through prayer and the help of God. Secondly, a favourable and love-filled environment must be created, friendship and prayer lead to a renewed faith in God, oneself and others. And third, joint physical labour instils a sense of responsibility, teaches new skills and perfects existing ones.

The healing process is based on the principle of family; all the members of the community are like brothers and sisters.

Since November 23, 2001, 58 members, from ages 18 to 40, have registered with the Community, 6–10 members live in the Community. To date the length of stay has been a minimum of a couple of days to the maximum of 14 months. 1/4 of the membership has left the Community several times only to return. 1/4 of the membership finds work or attends a religious seminary after leaving the Community. There is no information about the other 1/2 of the Community members.

The Community has set the following goals: 1. to stabilize the health and psychological condition of the individual; Drugs, alcohol and cigarettes are serious health threats, as well as being psychologically traumatic. For this reason, the use of these substances is forbidden at the Community. Improved physical and spiritual well-being is the basis of the rehabilitation program. The members are given an opportunity to lead a healthy life: three meals a day, fresh air, physical labour, a healthy and uninterrupted night's rest. It is vital that an addict changes his state of awareness or consciousness.

2. to help relationships with family and relatives and to change attitudes toward society;

During the first six months at the Community, contacts with family (letters, visits) are not recommended. TV and secular music are not recommended; the importance of silence, peace and work are emphasized as important for the healing process. At the beginning of rehabilitation, it is crucial that the environment does not distract the individual from listening to his inner voice and understanding that the problem is within and not with those around him.

3. to help change attitudes toward work and to find meaningful ways to spend leisure time; Each member of the community is assigned chores, such as: preparing meals, washing dishes, cleaning house, taking care of the domestic animals, etc. Every day there is work to be done at the Brukna Manor farm, including renovation of the Manor house.

The main source of income for the Community is donations (money, groceries, apparel) and income from the organic farm run by the members themselves.

The Evangelic Christian Congregation 'Zilais krusts' (Blue Cross) This is a rehabilitation and social integration centre. The Centre was created for the homeless, alcoholics and former prisoners. There is a staff of five with 30–40 residents at the Centre at any given time. The length of stay is from one month to one year. Anyone wanting to turn their life around is accepted. There have been drug addicts among the residents, but they were asked to leave. Donations provide for three meals a day. Church services take place every Sunday. There are plans for expansion this autumn, providing for a larger staff and more residents.

Evaluating the work of NGOs NGOs in Latvia have various target audiences: parents, children and young people, teachers and administrative staff; drug users and people suffering from addiction, NGO representatives, medical professionals and the police.

NGO activity in the area of drug use prevention has several advantages over the work of national and municipal institutions: • the organizations have united people who are convinced of the necessity of their work, they do this of their own free will, not as part of their work duties. For this reason, the enthusiasm of the NGO members in drug use prevention work cannot be valued highly enough; it is a very significant resource to be respected; • organizations tend to be flexible, they can react quickly to current social problems. NGOs can determine the needs of a target group and offer appropriate solutions. They can react quickly to cooperative offers from state and municipal institutions. Organizations are involved in areas where it is possible to secure international, national and municipal financial support. If these opportunities do not exist, organizations are able to change the direction of their focus; • NGO workers find it easier to earn the trust of their clients, which is an invaluable part of any preventive measure.

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Problems encountered by organizations FINANCING Lack of financing creates instability and the lack of succession within the organizations. Successful operations and existence are dependant on financing secured for projects and contributions. There are several sources of financial support: • international organizations and foundations, • national and municipal funding for specific projects, and • contributions.

Dues or membership fees could possibly be a source of financing, but none of the organizations questioned mentioned this possibility.

The majority of organizations questioned had received funding from international organizations and foundations, which were used for both infrastructure improvements, as well as for the realization of specific projects. In order to secure such financing, it is in the interests of the organizations to become part of the international collaborative networks, in order to popularise the work of their specific organization and to be competitive on an international level. The Soros Foundation Latvia, UNDP Latvia, BAPF, and the Queen Juliana Foundation are among the foundations that have invested heavily in NGO activity in Latvia.

Financing from the state budget is available to organizations if they are involved in prevention work dealing with drugs, tobacco and alcohol use. Project proposals are accepted in five sub-program groupings: municipal programs dealing with drug prevention; programs of prevention designed for children and young people; programs of prevention instruction for medical personnel and social workers; programs of prevention for drivers; and programs designed to inform society about the harmful effects of drug abuse. In 2003, financing was awarded to 16 projects fulfilling the above program requirements; the total sum of financial support was 46,000 Lats. Six of the projects are being realized by NGOs. The Health Promotion Centre coordinates the projects. Ms. Pirktina, Director of the Centre, explains that there are twice as many proposal submissions as can be funded; only half of the project proposals are funded. This program is highly respected among organizations involved in prevention work. Even those organizations that did not receive funding this year hope to improve their chances by reworking their proposals for next year.

Non-government organizations can become involved in projects on the municipal level as well. Based on information received from the organizations responding to the questionnaire, positive experiences with the Riga City Council Education, Youth and Athletics Department, and the Welfare Department.

Contributions are especially significant for those organizations running rehabilitation programs or centres, since contributions help ensure the subsistence for the participants of these programs and centres. Certain organizations have been awarded the right to receive contributions by the Ministry of Finance, with contributors receiving an income tax reduction. This is how the national 138

budget funding translates into the NGO contribution system. In 2003, 432 organizations were awarded this right to receive contributions; nine of these organizations are involved in drug prevention or work with risk groups.

These organizations form 2% of all organizations, whose contributors receive tax reductions.

List of organizations involved in drug prevention or work with risk groups that have been awarded the right to receive these tax contributions in 2003 by the Ministry of Finance in conjunction with paragraph 20 of the law 'About Corporate Income Tax'. These are: Latvian Prison Reform Support Foundation 'Uzticiba', the Riga Samarian Society, The Social Rehabilitation Centre, the Madona Regional Abstinence Society, the Evangelical Christian Congregation 'Zilais krusts', the 'Kalna svetiba' Community, the Community Organization 'Ecology of Consciousness', the Public Foundation 'Society and Addiction, Education and Rehabilitation', and the Health Education Centre 'Krimulda'.

Most of the organizations, whose contributors are entitled to tax reductions, are sports organizations. The government's intention to restrict or repeal these reductions is not well-founded and would create serious obstacles for the organizations working in the area of drug prevention and rehabilitation. It is vital to consider tax reductions for all organizations involved with drug prevention and rehabilitation.

INSTABILITY The activity of organizations is directly linked to the ability to secure financing. Constant lack of financing makes it impossible for the organization to develop and maintain a stable infrastructure. Many organizations forego establishing an office because that requires funds that the organizations do not have.

Organizations indicate that ‘as soon as a project is completed, all other activities cease as well'. Project funding does not guarantee the continuation of work and does not allow for planning of future activities. For this reason, the work of organizations is characterized by active and passive periods. If a project proposal is not financed, the organization narrows its line of activity. It is especially difficult for new organizations to start up any kind of activity, because they lack the necessary experience to compete with older organizations in the struggle for funds. The new organization almost always loses. Some of the organizations questioned admitted that they had not been able to start any active work and had given up the realization of their plans due to the lack of financing. NGO expert Zinta Miezaine characterizes the Latvian NGO environment as dynamic — every month, up to 15 new organizations get registered. However, only 1–10 per cent of the 6000 registered NGOs are more or less active.

There are several strategies that help organizations survive and ensure their longevity: •

choosing several directions in which to work and complete projects. The ability of organizations to secure funding is related to the thematic priorities of various foundations, state and municipal institutions. The survival of the organizations depends

Survey of NGOs involved in the restriction of drug use and the treatment/rehabilitation of drug addicts

•

•

largely on their ability to react to current social needs and offer solutions to these problems. The activity of abstinence organizations is often associated with the formation of youth chapters and the popularisation of abstinence as a lifestyle among young people. Second level drug use prevention with the aim of reducing the spread of HIV/AIDS is currently a viable area; establishing collaborative networks or coalitions among organizations with similar goals.

Cooperation among organizations in Latvia guarantees a regional connection. Working in a coalition or a network of organizations allows smaller organizations to become involved in larger projects. The ability to participate in organizational networks is more restricted outside of Riga because of additional transportation expenses and electronic communications; small organizations have a difficult time maintaining the infrastructure of their organization due to the lack of consistent funding, thus infrastructure expenditures are reduced. The organization exists in fact, but carries out no activities. This could be the reason why many organizations could not be reached at the telephone numbers supplied and did not respond to the questionnaires.

PASSIVITY AND

LACK OF DESIRE TO GET INVOLVED IN

• Tax breaks.

As maintained by the organization 'Ecology of Consciousness', all efforts to cooperate with businesses have been unsuccessful due to the lack of interest on behalf of the business community. It is unprofitable for businesses to get involved. At present, both small and medium-sized businesses are working without a significant profit, because all available resources go into development of the business; to avoid declaring large incomes and paying excessive taxes. To avoid suspicion by the State Revenue Service, these businesses declare some income at the end of the year, but these amounts are insignificant. Because of the existing law, that donations cannot exceed 20% of the total tax amount, the donation is so small, that the business winds up paying more in administrative costs to process the donation than it gains in any sort of tax break. Thus, small and medium-sized businesses are, for all practical purposes, locked out of the development of a civil society. Some large businesses that faithfully pay income tax do remain. But not all employees of these businesses support the idea of community philanthropy. For this reason, the importance of business contributions to social activities, culture and arts must be stressed as a priority in any legislative changes with the aim to promote the development of a civil society in Latvia.

Recommendations for improving the work of NGOs

To achieve this goal, the following would be necessary to introduce favourable conditions, whereby, businesses would contribute: • in the law 'About Income Tax', repeal the restriction in Section 1, Paragraph 20, Item 1 that states: "...for residents and permanent agencies the tax is reduced by 85 percent of the amount donated to budget institutions as well as to LR registered community culture, education, science, athletic, charity, health and environmental protection organizations and foundations, and religious organizations that are allowed to receive contributions, with the donors receiving the aforementioned tax break". It is in the interest of businesses to receive a 100% tax reduction. Of course, if a business contributes 10 LVL, this 15% is insignificant to the 85%. But, if a business donates 10,000 LVL, the 15% becomes very significant; • in the same paragraph, repeal the restrictions in Item 3, which states "that the total tax reduction may not exceed 20% of the total amount of the tax". This restriction, given the existing income tax structure, makes donation even less advantageous. Given the existing deficit budget, these recommendations seem rash, but if these changes are not implemented, community organizations, due to a lack of funds, will not be able to attract professional workers to offer quality services and will try to eke out an existence from one international project to the next.

RESOLVING

PURPOSEFUL DELEGATION

THE ACTIVITIES OF THE ORGANIZATION

The number of people involved in drug prevention activities is not large. Often the same people work in more than one organization. The people involved in coalitions or collaborative efforts get to know each other quite well.

There is little, if any, cooperation between the abstinence organization network and the coalition of drug prevention organizations. This could be explained by the differences between the respective areas.

A small portion of organizations have salaried employees or the ability to ensure their workers a stable income during project realization. For this reason, most organization members work elsewhere. One of the factors deterring the work of organizations is precisely the work load of the members outside the organization.

Some of the organizations claim that it is difficult to get young people involved in their work due to their lack of motivation and the seemingly uninteresting nature of what the organization has to offer. Work in the field of drug prevention is very specific and it demands conviction and a desire to solve the drug problem. It does not give quick results and popularity.

•

QUESTIONS OF FINANCING

National co-financing of projects from international foundations. Organizations are capable of producing good projects, but it is precisely the lack of cofinancing that inhibits receipt of funding from EU and other foundations. Tax breaks for foreign funding.

OF FUNCTIONS

In characterizing social organizations, an NGO expert pointed out that these organizations unite members who are concerned with issues that are important for all or part of society — the environment, health, and socially unprotected groups. The financial base of such organizations 139

Drug abuse prevalence in Latvia

usually results from funding from various private or government foundations, which is acquired for specific projects. The advantage of these organizations is their extensive knowledge about specific questions in their area expertise and their ability to attract volunteers. These organizations can be a valuable asset in the formulation and realization of a national policy. Project of The National Drug Control and Prevention Programme Plan for 2004–2008 also emphasizes that NGOs and the efforts of society at large can be of invaluable help in the area of drug prevention.

How to achieve an effective cooperation of the above mentioned?

• A clear list of NGO functions and tasks to be delegated must be compiled. This would make it easier for organizations and state and municipal institutions to reach an understanding. The organizations point out, that at present, there is often an unnecessary competition among the organizations themselves, as an attempt to 'stake out their territory'. It would be more effective for organizations to pool their resources and take responsibility for a specific task. Some organizations ease this competition themselves by forming coalitions and collaborative networks.

• In conceptual documents, it is imperative that NGOs be viewed as collaborative partners in function and task execution, both at the national and municipal level, rather than viewing NGO work as a separate area of activity with special functions and tasks. This means that NGO activity must be viewed as parallel to the function of national and municipal institutions in order to accept NGOs as collaborative partners in the execution of these functions. For example, In the National Drug Control and Prevention Programme for 2004–2008, the prevention section should contain a table which would delineate, parallel to national institution functions, what tasks are expected on behalf of the NGOs for the execution of these functions. This would make collaboration more specific and easier to plan. In describing the functions of national institutions, general phrases such as 'promote collaboration with non-governmental organizations' should be avoided. Also planning prevention work at the municipal level, specific and concrete functions should be prescribed to community organizations with provisions for appropriate financing.

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OTHER

RECOMMENDATIONS

In the realm of legislati on, the following recommendations are offered to improve the work of NGOs: legal status of volunteer work; speedier ratification of the law about youth; national support of continuing education for organization membership to raise the level of qualification and education; national support for experience exchanges; and the development of organization associations and collaborative networks.

RECOMMENDATIONS FOR THE 'NATIONAL DRUG CONTROL AND PREVENTION PROGRAMME' •

•

• •

Create more stringent regulations regarding the use of addictive substances. Significantly restrict the opportunity for young people to smoke in public places as well as to purchase and drink beer.

The beer trade in Latvia is subject to special restrictions because beer is not viewed the same as other alcoholic beverages. Drug addiction is simply an indicator of the consequence of children and teens smoking and drinking, which shows to what degree young people have started on the road to intoxication.

A law must be ratified making school principles liable if drugs are used or sold on school grounds.

Officials who work in the area of educating others must set an example by not using drugs — teachers, judges, etc. One who makes demands on others has no right to do so if one oneself is not sober. Personal experiences are very effective and require no national funding.

Change National protocol by not allowing alcohol at government receptions.

Collaborate with religious organizations to take advantage of church resources. All religious units (churches) must be involved in the formulation and realization of the project, because in our work with prisoner addicts, we have concluded the following: in order to change a person's behaviour, the person's thinking must be changed; in order to change a person's thinking, the world view must be changed; but in order to change the world view, a person's faith must be changed. A person's world view, thinking and behaviour is based in faith. Experience shows that when an individual's questions regarding faith are resolved, his world view, thinking and behaviour fall into place.

Without the help of churches and congregations, we are at a dead end and it would be a waste not to take advantage of church resources.

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reduction

8

Evaluation of the

Methodology

METHODS

The drug problem is one of the most complex problems, as it involves many disciplines (jurisprudence, criminology, sociology, psychology, health, and also culture and ethics) and covers a wide range of issues. Therefore the successful fight against drugs should have a multidisciplinary approach.

The methods employed in this study are expert interviews and focus group discussions, as well as a survey of decision makers on attitudes, knowledge on drug issues, existing policies and approaches, etc.

This chapter describes the mainly qualitative research methods employed to study attitudes and information on the drug problem among the professionals and officials involved in dealing with its various aspects. The selection of expert groups and experts was coordinated representatives of the State Centre for Drug Abuse Prevention and Treatment (Narcology Center).

Through facilitating access to current information on the ways data and information are communicated to policy and decision makers, legislators and local authorities, the significant task is oriented to the needs of health service providers, planners, administrators, the police and prevention specialists.

On the local level and, consequently, related to the national level, it is important to determine who needs the information, to whom it should be directed and disseminated, and why. This information contributes to the growth of an effective capability of establishing communications with a network of agencies and organizations through common interests.

TARGET

GROUPS FOR THE QUALITATIVE RESEARCH

The target groups are the following: • professionals involved in drug abuse prevention and treatment of problem drug users: addiction therapists, health care professionals, educators, school board members; • professionals and officers involved in drug-related enforcement: police officers, prison administration officials, judges and prosecutors, customs officers; • policy makers: parliament members, local government, public administration officials involved in the solution of the drug problem.

The list of the particular experts within each expert group was composed together with specialists from the State Centre for Drug Abuse Prevention and Treatment.

EMPLOYED

The expert interviews were conducted as in-depth or semi-structured interviews with experts in the area under investigation. The focus group discussions were organized with health care professionals and educators.

The authors thank Ieva Karklina and Inese Stars for their input in the development of this chapter.

THE •

• •

MAIN TASKS

To study attitudes and information on the drug problem among professionals and officials involved in dealing with the drug problem; to specify and define problems in drug prevention; to define more accurately the main problematic legal issues related to the drug problem.

Qualified interviewers were selected. The interviewers received additional training on various aspects of drug related problems.

Expert interviews were carried out during February–May, 2003. In general, the experts' attitude towards the interviews was positive. The average length of the interviews was two to three hours. When experts agreed, the interviews were tape recorded and then transcribed.

Overview on expert interviews with drug prevention specialists INTRODUCTION Expert interviews were conducted with 13 drug use prevention experts. The list included specialists from the Health Promotion Center, the NGO Educational center for school and families, the Narcology Center, the State Youth Initiative Center, the Riga City Drug Abuse Prevention Center, and others. All were asked questions according to the interview scheme discussed at the Narcology Center.

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Drug abuse prevalence in Latvia

AN OVERVIEW 1990S

OF MAJOR PREVENTION ACTIVITIES IN THE

According to prevention experts there are two periods in the development of drug use prevention activities: 1. A large number of preventive programs of various types emerged during the mid–’90s. Many of these were short-term programs, simply oriented toward transfer of information. The majority of the prevention programs were focused on the population of schoolchildren.

2. Later a rapid institutional differentiation of program-providing institutions started. This differentiation is part of the process of the democratization of civic society. The result could be seen in the large number of NGOs, especially in the “social sector”. The problem for these new organizations is that the legal framework for their existence often changed and the system or mechanism of their financial security was unstable. These circumstances make it difficult for many NGOs to maintain long-term programs, stabilize their teams, ensure further professional education, etc.

In general, drug prevention experts emphasize education and dissemination of information on harm related to drug use as the main aspects of prevention activities.

Some experts differentiate three specific target areas where improvement of preventive measures has the highest priority: • primary prevention programs for schoolchildren; • selective prevention programs focused on the recreational and experimental use of drugs; • programs focused on harm reduction and prevention of relapse.

However, the majority of existing prevention programs are tailored for primary (or universal) prevention, which is mainly understood as part of health education at school.

All the prevention experts have developed ideas for primary prevention in schools. Sometimes, referring to existing programs of, for example, the Healthy Schools Project, life-skills training programs are proposed for school pupils. They emphasize that in education it is necessary to systematically support a healthy lifestyle; to continue or to initiate new targeted preventive programs at schools (and at leisure time facilities) and to provide children and youth with opportunities to spend meaningful leisure time in addition to traditional ways of preventing drug use, such as lectures, brochures or leaflets; to use contemporary media and technology that appeal to children and youth.

Experts have different attitudes towards peer programs.

Some experts emphasize the need for peer programs “to increase the pro-social orientation of young people, to make more use of the positive influence of peer programs”; other experts do not think that peer programs are effective.

A further element mentioned by some experts is awareness–raising campaigns in the general population. Only one expert made a link with activities creating supportive environments for all members of society, including drug 144

users. Some experts expressed their concern about the negative attitude of the general population towards drug users. The expert stresses: “One has to be aware that media campaigns to raise awareness about the problem — when not designed with special care — can actually aggravate it instead”.

FINANCIAL MODEL OF

PREVENTIVE WORK

All of the experts confirm that the state budget provides financing for prevention work. The total funding for prevention work comprises 0.5% of the health budget. The State Health Promotion Center has the right to organize tenders on the state budget. State funding is divided into two parts — for projects on the national level and projects that are realized on the basis of free tender (including the organization of tenders). Experts hypothesized that during the next four to five years there would be only free tenders and no earmarked national project funding.

According to reforms initiated by the Ministry of Health, the Health Promotion Center is to be the central institution in the field of drug prevention in the future. At present the Health Promotion Center has nine regional coordinating points and funding reaches each region through them.

(Formerly the Narcology Center was the main institution for prevention work and made the main decisions regarding the distribution of funding. One expert mentioned that during that time, the State Narcology Center directed the bulk of state funding to drug prevention projects in Riga.

At present the Health Promotion Center is responsible for the redistribution of state financing for drug prevention.

According to experts, future funding for prevention will be strictly separated from funding for treatment, blood tests, renovation of buildings, etc. The new system will provide higher return and control over the progress of projects.

Another expert had a different approach: “First, it is necessary to define the target groups, their needs. This should be based on research”. This means that inquiries should be made before redistribution of the budget.

According to some experts, the principle of tender in the field of prevention does not work efficiently because tenders are not organized regularly/ systematically through out the whole year. Therefore there are breaks within the regular prevention work.

The experts stressed that the principle of tender organization needs to be changed. They did not agree that one institution should take responsibility for coordinating all preventive work in Latvia. The experts proposed that the Drug Control and Drug Abuse Prevention Co-ordination Commission should be the primary decision–making institution and/or coordination center. This institution should take responsibility for organizing tenders and distributing funding for various projects. The experts felt strongly that distribution of funding and control needs to be administered by a Commission consisting of specialists from different ministries.

Also majority of experts emphasized that redistribution of state funding and supervision of each project should be performed by an intermediate ministry commission.

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

Members of this commission should be experts both on training programs and legislation in order “to avoid parallel hustle”.

Some experts do not agree with the principle of tender as the main source of funding because then preventive work will have to be organized only at those municipalities with the human resources in project writing: “preventive work needs to be organized everywhere, not only in those places where there are individuals who know how to write a good project. Good writing skills do not guarantee good preventive work”. The main concern is related to shor–term projects and lack of long-term programs: “The tender system in drug prevention provides opportunities to conduct individual projects, but does not provide longterm, continued activities”.

Those experts who stressed school education as the main drug prevention activity do not see financial problems in implementation of educational programs at school. They noted that health, biology and other classes at school are a very important aspect of drug prevention. Prevention teaching at school receives state funding and therefore does not need other funding.

One drug prevention expert mentioned that financing prevention activities in Riga are quite different from the rest of the country and stressed that “Riga’s budget allots much more money for preventive work than the country as a whole”.

Financing for drug prevention as a special line within the state budget The majority of experts support drug use prevention financing as a special line within the state budget. Some experts stressed that the special budget line should be complex – concerning all aspects related to drugsprevention, treatment and rehabilitation. Some experts emphasized that the special budget line should have specific objective, and be oriented towards specific target groups and achievements, concretely defined parameters. “This is a prerequisite for further assessing effectiveness of each Lat and how successfully/ unsuccessfully the money has been spent”.

However, there were two other experts who did not agree with the “drug use prevention” budget line. They suggested that there should be a budget for prevention of any type of “addiction”. They noted that “drug use is relevant primarily in Riga. Outside the capital there are different types of addiction and different problems”. The same experts strongly emphasized that financing youth leisure time activities is a type of drug use prevention. They have proposed analysis of the effectiveness of funding for preventive work. “On the basis of such analyses policy makers and the population could understand the correlation between funding youth leisure time and drug use. The analyses could lead to conclusions about which youth groups are mainly involved in drug use and what their preferred leisure time activities are”. Experts working on the State Youth Policy (2004–2008) strongly emphasize that a drug use prevention subprogram should be a part of the youth program.

THE

NECESSITY OF ASSESSMENT AND EVALUATION OF

DRUG PREVENTION PROGRAMS

All the experts agreed that it is necessary to introduce assessment of prevention programs. According to the experts, there are several reasons why evaluation of programs is important: • evaluation provides an opportunity to improve the project, if necessary; • results of the evaluation could provide criteria for continued financing of the project in the next phase; this particularly concerns those projects that had foreign funding in the beginning, and need to be continued after the foreign funding is finished; in those cases evaluation is a basis for application for state funding; • evaluation provides an opportunity to estimate the effectiveness of resources.

All experts have stressed that prior to the actual evaluation, the criteria need to be elaborated and the main principles of evaluation should be defined.

All the prevention experts emphasized that at present there is no evidence about the results of any of the preventive programs. The main reason is lack of knowledge on the methods of evaluation; lack of resources for implementation of evaluation, and in some cases, the idea of evaluation has been rejected or is seen as not desirable.

In recent years many efforts have been made in Western Europe to improve our knowledge about what does and does not work in prevention, and Latvia also needs to develop a system of evaluation of prevention programs.

DEVELOPMENT

OF QUALITY CRITERIA

All experts say that quality criteria of prevention programs are not elaborated yet. One expert thinks that “some people have developed their own quality criteria and apply those criteria for their own practice.”

The majority of experts doubt whether the funding of prevention programs nowadays is based on quality criteria.

However, experts have different views in this regard. One expert noted that tender regulations do not describe criteria that could refer to effective prevention work. Another thinks contracts with specialists who develop prevention programs contain quality criteria or program evaluation.

One expert expressed a rather critical opinion about quality criteria: “the present situation is absolutely chaotic…

Quality criteria are imperative! At present there are few real specialists and in many cases non-specialists receive funding”. This expert proposes the necessity for a Commission that would develop the unique quality criteria.

THE

QUALITY OF PREVENTION PROGRAMS

Prevention programs are closely to quality criteria.

However, experts have very different opinions about the quality of existing drug prevention programs. they expressed various views on the quality of programs: some experts are concerned of the variations of the quality of programs ; some think the quality of programs is quite good. One expert from Riga took a broad view over 145

Drug abuse prevalence in Latvia

elaborate prevention programs in Latvia and was highly appreciative of some. However, the prevailing short-term perspective in prevention work negatively influences the quality of programs.

One expert explained differences in the quality of programs: “Drug prevention organizations have a different ideology, which is the basis for differences in the quality of programs. Some organizations put a strong emphasis on the harm reduction of drug use; others do not speak about the harm done by drugs”.

Experts suggest that collaboration among specialists in drug prevention work is essential for the improvement of quality of programs. However, organizations with very different approaches do not collaborate and this impairs the quality of programs.

Several experts were concerned about present isolation among drug prevention specialists and emphasized the need for cooperation: “We have not had the opportunity to meet NGO representatives, employees of municipalities and professionally discuss various drug prevention issues. At present we are in competition — we know that each of us has done something worthwhile. However, we really do not know what other professionals have achieved”.

The expert from the NGO sector emphasized non-adequacy between objectives and real life: “The main mistake is unrealistic objectives. Therefore, it is very difficult to assess the quality of programs”. Other obstacles influence the quality of prevention programs — fragmentary knowledge on the part of some people working in the field and lack of a coordinated training institution for trainers.

PRINCIPLES

OF DEVELOPMENT OF PREVENTION

PROGRAMS AND CERTIFICATION

All experts mentioned that prevention specialists should develop certification of their prevention programs.

The experts have different opinions about certification.

50% think that certification is very important because “it is a basis for a unified approach. If a program is certified we know what is going on”.

Other experts said that “certification is necessary if there are concrete criteria of quality, and methods to meet these criteria. That is the way to control quality”.

Two experts stressed the need for certification “in order to know what programs are realized”.

Some experts suggest that development and certification of programs could be realized by NGOs or municipality.

However, a Commission should assess the program and assign funding: “Program development must be done by experts. Certification could be realized by an inter-ministry commission. The work of this Commission must be based on certain criteria as it is in other countries”.

NEED

FOR A COORDINATING STRUCTURE

There is an urgent need for a coordinating structure which would take responsibility for the distribution of funding, elaboration and development of quality criteria and assessment: “They have to be knowledgeable in all 146

aspects — situation, finances, and criteria. They must be highly competent. At the same time they are not obliged to do everything themselves. They could hire someone to elaborate criteria, develop standards, etc.” Several experts stressed that the lack of such a structure is conducive to a situation where non-professionals are taking responsibility for prevention work. The expert who represents the coordination structure at present has a different opinion: “The Health Promotion Center coordinates the prevention work, methodologically supervises and coordinates, and methodologically helps to conduct prevention programs”.

CREATION

OF A PREVENTION PROGRAMS DATABASE

Experts were asked about the creation of a database — whether such a database is necessary, whether it could help monitor drug prevention policy and development of new prevention programs.

Experts mentioned several objectives for creation of a national database on completed projects: to see what programs there have been and how they have been conducted, and to provide information on the details of drug prevention policy and prevention programs: “It will be planning, strategy and tactics, because otherwise this information does not reach distant regions if there are no active leaders or school board directors. The state is responsible for drug prevention policy and has to coordinate and offer the best it can”.

All experts consider a database extremely necessary.

They suggest the development of a database as a good way to popularize and disseminate the best programs and practices: “It is important to have a list of already developed programs, so people do not need to waste time developing already existing good programs”. The experts complained that municipalities are not ready to invest in prevention because they do not know what they could really do. A database with research about effectiveness of prevention programs could be a good stimulus for municipalities to invest in prevention programs.

The Health Promotion Center has started a database on those projects that have received state funding through tenders. Experts suggest that it is important to expand the database with projects from municipalities, NGOs and various centers, and the database is particularly important to rural districts.

MUTUAL COORDINATION AMONG

EDUCATIONAL, SOCIAL

AND HEALTH CARE INSTITUTIONS

There is no unique opinion about the existing coordination between educational, social, and health care institutions in the sphere of drug prevention.

Some experts appreciate the existing coordination work, and some are quite concerned about the existing coordination between educational, social and health care institutions in the sphere of drug prevention.

The Health Promotion Center has a good collaboration with the Ministry of Education and Science on drug prevention education programs. The Health Promotion Center is a member of the inter-ministry committee on

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

health education. This committee works on prevention programs which are implemented in health classes at schools. It is involved in coordination of further training (so called post-diploma education), and in the elaboration of teaching materials for schools.

However, relations with the Ministry of Health need to be improved: The Ministry needs to put more emphasis on the prevention of drug abuse among children and teenagers. In addition, stronger emphasis needs to be put on funding for youth treatment and rehabilitation.

At the same time, other experts are concerned about the Coordination Body uniting municipalities, state institutions, the police, the Narcology Center, the AIDS Prevention Center, school boards, and customs: “Practice shows that coordination among those institutions is quite weak”.

MUTUAL COORDINATION BETWEEN STATE AND MUNICIPALITIES, STATE AND NGOS, AND NGOS AND MUNICIPALITIES According to NGO experts, traditionally the collaboration initiative between municipalities and NGOs comes from NGOs. Experts mentioned several good examples of collaboration in Jelgava, Liepaja, Riga, Daugavpils, and Valmiera. However, different experts named the same municipalities both as good and bad examples of collaboration. Besides, experts could not remember any case where a municipalitys had sought collaboration with NGOs. In general, collaboration between NGOs and municipalities is assessed as being better than between NGOs and the state or municipalities and the state. According to experts, “the state has some functions and responsibility, but has no money. Some municipalities (at least some) have money, but no mandate”.

Some experts suggest that regional health promotion coordinators could become a coordinating structure in Latvia.

SCHOOLS AND

DRUG PREVENTION

Experts have different opinions on school policy on drug prevention. Some experts highlight the work done at health – promoting schools and emphasize that health – promoting schools have implemented good drug prevention policies.

The majority of experts consider that so far in Latvia there have been some pilot projects on primary drug prevention at schools. However, the results of those pilot projects have yet to be evaluated.

According to the experts “The most serious problem is – what to do when drugs are found or sold at school. Some schools have explicit rules and a system of reaction.

However, the majority of schools pretend that drugs are not a problem relevant to their school. Probably, it comes from lack of knowledge or fear of possible sanctions that could emerge”.

agreed that prevention should be seen as an integral part of the school curriculum.

Some stressed that drug prevention issues are very specific and teachers need to have appropriate training. At present not all health teachers are able to discuss drug prevention issues: “School drug prevention policy is closely related to the teachers' ability to talk with teenagers about drug prevention”. According to new school curricula, health will become integrated into the social sciences curriculum. So far, it isn’t clear how many hours will be devoted to health and how many to drug prevention. This uncertainty is an additional embarrassment for teachers. In 2003, health is a compulsory subject in 5th and 8th grade and is optional for one year at secondary school.

New educational standard is currently under elaboration, which means that the position of health in basic education is changing — it will be integrated within other subjects and no longer be taught as a separate subject. Experts worry whether teachers of social sciences are professional enough to teach such different topics as drug prevention and healthy lifestyle. Health in the 5th grade and 8th grades will subsume drug prevention. However, time devoted to the topic will likely be much less than it is now.

To conclude, experts emphasized that the number of lessons currently devoted to health is insufficient, and probably will decrease as a result of the new reforms of school curricula. They are very concerned about the decreasing number of health lessons.

The success of school projects largely depends on whether teachers support the idea of a prevention program. In general, experts feel that school is a good place for a comprehensive, educational, prevention strategy.

As well as providing straightforward information, this approach includes developing children's psychosocial skills, as prevention should not just be aimed at drug use, but at all deviant behavior. As people of trust, teachers can also offer guidance in personal development.

Another issue is collaboration between the school and parents. At present, parents tend not to be involved in discussions that lead to a call for prevention, as they are seldom mentioned as a target group. A possible reason is that young people do not want to talk about their problems with adults, especially parents. Family structure is changing so that it becomes increasingly difficult for parents and children to understand each other. Parents' excessive work schedules are one reason for losing contact with adolescents. Hence the need for mediators who can pass messages and explain concerns. However, many teachers are unable to distance themselves from their pupils' problems and become mediators, and may thus react rather like parents than peers.

The experts discussed the need for prevention programs to be undertaken with different age groups, since different age groups require different kinds of programs. They 147

Drug abuse prevalence in Latvia

SUCCESSFUL AND AND PROGRAMS IN

UNSUCCESSFUL ACTIONS, PROJECTS

LATVIA

Experts were asked to describe the most successful and most unsuccessful examples of drug prevention.

Successful actions: • Publication of a book “School policy in the field of substance prevention”; •

Annual teacher training for improving understanding of the teaching materials in the above book;

•

The educational film “Anatomy of Dependency”.

The objective of this film was to discuss the mechanism of dependency, and how to dissolve crisis;

•

Program course “Preventing dependency” (1999 — 2002). The number of trainees was 1083.

Among them were teachers, social workers, policemen, municipal authorities, and children's rights specialists from all regions of Latvia;

•

Collaboration with the World Health Organization and the UNDP, which has resulted in a handbook and methodological materials for teachers on drug prevention;

•

Harm reduction strategies to eliminate HIV prevalence among drug users;

•

Training of new leaders;

•

Training of teachers for drug prevention work at schools. “We help them to work with those methodological materials that teachers already have at schools. Otherwise teachers do not use them and the materials are left sitting on shelves.”

•

Teacher training for work with risk group children.

Ineffective measures and unsuccessful activities: The experts mentioned the most unsuccessful actions: •

TV clips against drugs and alcohol on Latvian TV;

•

Events and activities using the slogan “without alcohol and drugs”; Some experts are quite critical towards training for youth leaders or “peer education”. One believes that “training for youth leaders is effective only for youth that have received training from adults. It is not possible that youths could train their peers, they could only pass on information, but are not able to develop the necessary life skills.”

•

In addition, the experts mentioned several ineffective drug prevention measures: • Dissemination of leaflets and booklets on the harm of drug use; • Visiting schools and explaining that “drug use is harmful”; • Many drug prevention campaigns are not effective because they don’t address a certain target group and the visual design is unsatisfactory; • Street stands, because they are expensive and wish to attract a wide target group; •

148

Films (for example, “Flypaper of death”) should be shown only to prepared audiences because emotionally they could send too strong a message.

Therefore it is necessary to discuss drug issues and problems beforehand.

ASSESSMENT

OF POLITICAL SUPPORT FOR DRUG POLICY

AND DRUG PREVENTION

All of the interviewed experts expressed similar opinions: there is no real political support for drug policy and drug prevention. There is also no constructive lobbying in the political arena on the part of practitioners. Drug prevention programs are not a priority: “There are only some initiatives from individuals, but no focused actions”, the opinion prevails that politicians are interested in drug prevention programs only in the pre-election period.

When asked whether drug prevention programs should be centralized and what structures could take responsibility for prevention, experts emphasized that there should be coordinated activities and actions: “Everything should be coordinated, maybe something could be centralized.

At the same time there are so many unique situations that local programs are essential. The basic principle of prevention is based on concrete localities and their needs.”

In general, drug prevention work should not be centralized “because the state will never have enough funding…

I do not believe that there should be programs that cover the whole country and they would not have sufficient funding”.

THE

MAIN NEEDS FOR DRUG PREVENTION IN

LATVIA

In the end experts were asked to assess the main needs in the field of drug prevention. Summarizing the experts' suggestions, we conclude that there is still much to do in developing a drug prevention policy in Latvia.

• The need for research on the real situation about drug use among youth because “we lack research on the behavior of young people aged 13–25 “.

• The need for a coordination committee on drug prevention to coordinate programs and their financing.

• Creation and development of the state database on drug prevention programs and activities.

• Collaboration among institutions — state, NGOs, municipalities.

• More resources for drug prevention in municipalities.

• Sufficient funding to ensure systematic, regular and continued training.

• Funding for more effective rehabilitation of young drug users. So far, “funding is insufficient, rehabilitation is not complete and many young people return to drug use soon after”; • Development of life skills, “the best prevention that shows results”; • Drug prevention campaigns addressing particular target groups; • Visual ads tested in target groups. However,there are currently two problems with visual ads – they are of low visual and artistic quality and not addressed to a target group.

CONCLUSIONS AND

RECOMMENDATIONS

1. Drug prevention has developed from being rather sporadic in the mid 1990s to more systematic today.

However, it needs to adopt a more long-term approach.

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

2. Drug prevention programs are focused on the general population of schoolchildren aged 11 to 14. According to the experts, the goals of the program should be: • relevant information about addictive substances and their effect upon the organism; • formation of attitudes favoring a healthy lifestyle; • influencing behavior toward not using drugs.

3. Drug prevention programs should be differentiated by age and target groups. Only a few experts suggested the need for specific prevention for risk group adolescents.

Adolescents at risk should receive selective prevention programs for the target population with elevated risk.

Specific attention should be devoted to: • children of alcoholics; • children having drug abusers among family; • children with behavioral disorders (incl. hyperactivity and attention deficit); • physically abused children; • children from a disadvantaged social condition.

4. More research is needed on an ongoing basis to allow for well-informed and targeted action. The current research is a good starting point to more detailed drug research in Latvia, which needs to be followed up and supported in the future. So far the research gives an overall picture, but each aspect of the drug problem needs to be studied in detail, and research needs to be done on a regular basis.

5. Publication of the results in special drug prevention, treatment and rehabilitation related journals can improve the credibility of the completed research and consequently ensure granting for further projects by international or national research foundations.

6. The need for adequate training for people working in drug–related fields, particularly persons working in prevention schoolteachers, health counselors, social workers, etc.

7. The prerequisite for success of drug prevention programs in schools is adequate teachers training. After training teachers should receive workbooks, published guidelines, etc. for work in the classroom.

8. Publication of manuals, teaching materials (including translations) for both trainers and target groups.

9. Another prerequisite for successful implementation of general/primary prevention programs is better coordination of different agencies involved.

10. Need for development of a database on successful drug prevention projects.

11. The need for adequate evaluation of prevention activities as a prerequisite for successful work and therefore an integral part of a comprehensive prevention strategy.

12. The role of so–called indirect prevention has several aspects, which need to be further developed: • to counteract aggressive marketing of drugs (formal restriction as well as competitive health message); • to promote leisure alternatives (strength of existing infrastructures in culture, recreation, sports etc.);

•

to pay more attention to the family as a crucial “preventive agent”;

13. To increase funding for prevention programs, and develop a long–term program for development of prevention programs.

Overview of educators' opinions about drug use This part of the study looks into educators' opinions on issues related to drug use and distribution in school on the basis of focus group discussions. Teachers, School Boards representatives, Education State Inspectorate, and from Educational committee from several municipalities participated in the focus group.

Participants were invited to raise the main issues related to drug use in the school environment and possible solutions to the problem. Educators stressed several aspects.

EXPERIMENTING

WITH DRUGS/ PSYCHOACTIVE

SUBSTANCES AND DRUG ABUSE

Educators argued that experimenting with drugs is a new phenomena that reached schools and youth centers the last 5–6 years. The majority of educators noted that until recently this was a problem exclusive to Riga, yet has now spread to other cities and smaller towns. The majority of teachers are not prepared for the new situation. So far, only health teachers have some knowledge on drug issues, but many other teachers have no clear understanding of the symptoms of drug/ psychoactive substance use, and where to turn if they have suspicions about it at school.

DRUG ABUSE

PREVENTION

Educators stressed drug abuse prevention at school as a the main concern, discusseing only primary prevention, and none even mentioned secondary and tertiary prevention. Asked about the need for secondary prevention, they agreed that it is an issue of addiction therapy, and does not concern them.

The dominant approach is one of dissemination of informating information, based on the assumption that knowledge about the negative consequences of drug use would prevent people from using drugs.

In the introductory part of the discussion teachers argued that the main prevention work takes place in Health lessons, which is taught in 5th and 8th grad at school, and also can be taken during the secondary education program (as an “elective” subject — 1 lesson per week).

However, drug prevention is only a small part of Health, and in many schools prevention work usually takes the form of information disseminated to students in clas. Of course, new teaching methods have recently been introduced at many schools.

All the prevention experts have developed ideas for primary prevention in school. According to educators and education management, the main aim of prevention work is education about drugs. In general, the majority under149

Drug abuse prevalence in Latvia

stand preventive work traditionally as promotion of a healthy lifestyle, development of educational programs at school, centrally launched and local campaigns to raise public concern. At the same time some referred to existing programs such as the Healthy Schools Project, and life-skills training programs for school pupils. They emphasized that it is necessary to systematically support a healthy lifestyle; continue or launch new targeted preventive programs at schools (and at leisure time facilities) and provide children and youth with opportunities to spend meaningful free time; in addition to traditional ways of preventing drug use such as lectures, brochures or leaflets. Some teachers stressed that lectures, brochures and leaflets are not effective prevention measures, if not folloved up with discussions between pupils and teachers well–trained on the topic. Some emphasized the importance of using contemporary media and technology that appeal to children and youth. At the same time, only youth from the largest cities have free access to information technologies that could be used for educational purposes. In small towns the use of information technologies after school is almost impossible, and Internet is not available because it is too expensive.

Teachers who work at Health Promotion schools emphasized that “Prevention and health promotion are two related and inter-connected strategies aimed at protecting and promoting a healthy life-style”.

Focus group discussion participants concluded the following about the characteristics (requirements) of an effective drug prevention program: • the content of the program and the applied methods should be age-appropriate; • the program should have a strong interactive orientation; • the activities should involve all children in the group or class; • social skills training needs to be included in the drug prevention program; • teaching program must provide positive models; • the program suggest problem–solving strategies; • the risks of using addictive substances (like tobacco and alcohol) are integrated into the program; • the program is long–term and continues after compulsory Health lessons in the 5th and 8th grades.

Educators from Vocational fields emphasize that drug prevention programs are more widespread for general education schools, and rarely implemented at vocational schools. They strongly emphasize that vocational school students (particularly those who train at short term education and training programs) need Health lessons at school, which should include a unit on drug prevention. A large proportion of these young people have low grades, problems at home, and many could be considered a part of risk group. Unfortunately, the curricula of vocational education programs do not include Health studies.

Teachers from Health Promotion schools have been particularly active in discussions on the kind of interventions that should be included in programs of health and drug prevention. The discussion singled out the following concerns: 150

• • • • •

counselling individual problems (needs) of a pupil; training of behavioural techniques; social skills training; training of techniques for coping with stress; strategies for coping with impulsiveness and aggressive behaviour; work with the parents and family ; collaboration with specialized centers and/or services.

• •

Prevention programs require particularly well-qualified, trained and motivated teachers and/ or social pedagogues and social workers.

Representatives from municipalities and Health Promotion schools emphasized the role of direct and indirect prevention work.

Teachers are concerned that many adolescents are out of adult control for a number of reasons. During the discussions they formulated the following: • parents are overworked • lack of and/or high cost of after school–activities; • lack of emotional education and training for adolescents at school; • willingness to experiment.

ROLE

OF PARENTS IN PREVENTION WORK

All participants stressed lack of collaboration with parents of adolescents. Parents tend not to be involved in discussions on drug use prevention, and participants of focus group discussions did not mention parents as a target group. However, several emphasized that collaboration with parents is essential.

WORK

WITH ADOLESCENTS FROM RISK GROUPS

Participants from regional youth centers discussed the need for special prevention measures for adolescents from risk groups. They emphasized that young “risk-takers”, are not likely to see themselves as having drug problems and are more likely to be concerned about concealing than drug use from others. However there is a particular need to involve them in combined preventive drug education and after–school activities; and, if necessary, to involve them in therapy and harm–reduction programs.

Adolescents from risk groups should have a substitute for lost emotional bonds, should be counselled often by a trusted adult about avoiding risks. They should be given a chance to quit, and not to start more risky behaviour.

When planning special services, their age and pattern characteristics should be kept in mind.

CONCLUSIONS 1. Focus group discussions with educators proved that prevention programs are generally understood as education and information dissemination, undertaken mainly at school. Education usually takes place as part of Health studies.

2. Current barriers to further development of prevention programs include: • few training opportunities for teachers, • insufficient number of useful publications and teaching materials,

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

• •

teaching on drug prevention takes place only as a small part of Health studies, lack of resources to build a minimal network of specialized facilities with qualified personnel, particularly at vocational schools;

3. No proposals really dealt concerned with risk groups, neither within the non-drug-using population nor among drug users.

4. Initiation of a set of community-based general health and family educational programs in cooperation with the public health system, on smoking, alcohol, i.e. the usual guide to drug use, as a general indirect measure for the prevention of drug use in Latvia.

Overview of interviews with experts – addiction therapists INTRODUCTION Drug addiction is a chronic illness requiring long-term, complicated treatment. Even the most qualified medical assistance cannot guarantee complete rehabilitation.

Unlike other illnesses, drug addicts try to avoid medical treatment and consultations.

When planning activities to eliminate drug abuse, a multidisciplinary approach should be employed, i.e., a multidisciplinary team (medical doctors, lawyers, government representatives, social workers, educators, psychologists, other professionals who are directly or indirectly involved in drug addiction treatment, rehabilitation and social rehabilitation, and drug use prevention, planning, elaboration and realization).

Doctors — addiction therapists admit that drug addiction is not isolated to a specific social group. It is a problem of society as a whole . To use or not to use drugs — is a question of education, culture, morality and upbringing.

Drug use is illegal.

Because drug use is expensive, it can result in antisocial behavior by the drug abuser. According to the disdainful attitude towards drug users form the sequence: drug user — criminal — hopeless. There is a myth that drug addiction is incurable. Results of treatment depend on its severity and the patient's motivation. Those patients starting professional treatment in time could soon return to society. Therefore, with regard to drug addiction, the priority should be the whole of society. Unfortunately, there is still a stigma associayed with drug addictionin in our society.

The experts were asked to evaluate various aspects of the drug problem.

All stressed the legal aspects of the drug problem, emphasizing the shortcomings, controversies and unresolved issues pertaining thereto. Some had participated in the development of drug legislation and activities related to the prevention of drug use since the early 1990s.

These activities were precipitated by the public scandal in 1993 when 3.5 tons of MDA were illegally produced in a state pharmaceutical factory and exported to Germany.

Following this incident the necessity for drug-related leg-

islation was understood, a working group was established, and work on legislation began.

Several experts stressed that during the 1990s Latvia’s Parliament (Saeima) ratified three UN Conventions on drugs; the Ministry of Welfare developed institutions for drug control and prevention (Committee for Drug Control, and Committee for Control of Legal Drugs); and basic legislation was drafted before 1996.

The experts mentioned the development of techno music and the cannabis trade, followed by heroin, as the main reasons for the surge in drug use during 1996–1997.

Several experts mentioned that “the global drug phenomenon” works in Latvia also, whereby drugs are illegally produced, imported and traded for maximum profit.

“Specialists” from many fields are involved in different stages and aspects of the “business”, including organization, farming, production, transportation, trading, and bribery. All the experts stressed the high profits that the persons involved can make.

Several mentioned that besides legislation, some other approaches are also important, such as prevention, medical assistance, and rehabilitation. They named problems affecting medical assistance and rehabilitation, including anonymity, the State Register of Persons with Drug Dependence and Drug Users, financing of state services and salaries for medical personnel, and services provided by non-certified private clinics.

Experts had several suggested ways to improve the work of drug-control institutions. In the field of prevention, the need for academic research and highly qualified specialists was mentioned as a prerequisite for further effective work in the field.

Several experts raised the importance of a specific attitude towards teenage drug use and prevention.

Some emphasized the importance of international cooperation in drug use prevention, treatment and rehabilitation, citing existing cooperation partners.

One expert elaborated an optimal model of rehabilitation for drug abusers to last at least three years.

The main objective of this chapter is to present the information about the main drug abuse problems from the viewpoint of the medical profession.

Medical doctors — addiction therapists are closely involved in the treatment and rehabilitation of drug addicts. Therefore they are best qualified to provide qualitative and detailed information about the research problem.

Interviews with 16 medical addiction therapists were conducted. All had thorough theoretical knowledge of drug treatment, and extensive practical experience as highly–qualified specialists. All have had foreign training (in Scandinavia, the Netherlands, Spain, etc.), so they have a broader perspective when analyzing the drug situation in Latvia and critically evaluating the existing system.

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Addiction therapists from the Minnesota and Motivation programs, hospital administrators, doctors from the juvenile department, receiving-room, and addiction therapists from regional hospitals participated in the study.

The method employed within research — was semi-structured interviews on the following topics: • analyses of drug–related legislation and financing; • anonymity and confidentiality; • analyses of patients' treatment, social rehabilitation and prevention, evaluation of different treatment programs, prevention and social reintegration; • assessment of scientific development of drug treatment.

ASSESSMENT

OF EXISTING LEGISLATION

Several legal acts are currently in rorce: the Law on Treatment, Law on Social Assistance, Criminal Law, Law on Children's Rights Protection, Cabinet Regulations on the Treatment of Drug and Alcohol Clients and Solvent Abusers and other laws.

In their view of the existing legislation related to treatment, rehabilitation and prevention of drug addiction, addiction therapists indicated several essential gaps and shortcomings that hinder the realization of prevention, timely treatment and social rehabilitation.

Addiction therapists specified the following shortcomings and uncertainties: • Regarding the compulsory treatment of drug addiction and interpretation of compulsory treatment, medical doctors interpret treatment as assistance, support, and never as punishment. If a drug addict receives compulsory treatment as punishment, this does not motivate the patient to undergo treatment.

• On the other hand, one often hears the argument that compulsory treatment is a violation of human rights. At the same time, compulsory treatment exists in Sweden which is very strict on observing human rights.

The problem is related to the criminal punishment of drug addicts. Experts suggest that the patient first be treated and only then receive punishment. Usually the criminal condictions of drug users – theft, robbery are the consequences of drug addiction. The criminal (at the same time – addict) serves his/ her sentence, returns to the same roots and again abuses drugs and returns to the same chain (drugs – criminal offence – punishment – drugs – criminal offence). Addiction therapists suggest imprisonment be replaced with treatment because prison as an institution does not offer treatment, but contributes to further degradation. The main problem in this respect is lack of a Law on Custody. For example, a judge can remand a person to treatment. However, he has no right to monitor or start punishment if the person is not undergoing treatment. There is no legislation on further monitoring.

Legislation geared towards adjustment of the prevention system is incomplete. Addiction therapists believe that first there is a need to regulate development and imple152

mentation of prevention programs at state level because currentt these programs and activities are no more than sporadic campaigns, — in contradiction to Riga Council that carries out its own drug prevention work according to annual drug strategies and working plans for four years period (2002-2005). Second, there is a need urgent to develop legislation regulating the activities of nightclubs points of sale alchocol. For example, there is a need to monitor and control the nightclubs most active in the field of illicit drug distribution. A nightclub cannot be shut down without direct evidence of a drug sale on premises. The law prohibiting sale of alcohol after 10.00 P.M. should also include beer, the most popular alcoholic beverage among teenagers.

The discrepancy between addiction treatment programs and legislative measures — is what addiction therapists feel in their dayly work. Therapists feel the law regulating addiciton treatment should be improved, which would adjust the treatment of addicts according each patient’s needs. Existing legislation doesn’t take into account the individual situations of drug addicts, or accomodate the use of flexible treatment methods. It is very necessary to develop and introduce certified treatment technologies, which are still under preparation.

Experts conclude that the state-financed treatment terms are too short. For example, the termfor alcoholics is only five days, in case of psychosis — ten days. Such shortterm treatment could be called a “dousing of the fire”.

During these few days a patient starts to become accustomed to a new regimen as he/she undergoes detoxification. Afterwards he/she returns to an unfavorable environment and usually continues to use addictive substances.

Recommendations for legislation 1. Lawyers and medical doctors — addiction therapists need to collaborate and coordinate their activities when develop legislation in the field of addiction and criminality.

Medical doctors are not going to write laws because they don’t have the appropriate legal knowledge. Ideally, a person drafting the law should have both medical and legal education. However, there is a lade of such specialists, hence the dire need for effective collaboration between doctors and lawyers. Therefore during the development of legislation a team should work i the following sequence: •

lawyers to draft the law;

•

a group of medical practitioners to discuss health–related issues;

•

social workers, educators and other professionals who work with addicts in their treatment and rehabilitation.

Often medical terms are misinterpreted by lawyers in the regulations related to drug treatment — even after counselling with addiction therapists.

In some cases it is necessary to have a public discussion (on a national level), which is not common in Latvia so far.

It is more important to have a rational and effective law, even if drafting it takes longer.

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

2. To improve the control mechanisms for implementing legislation.

Such mechanisms are necessary in cases when, for example, legislation requires a person to undergo treatment, and the court decides on some alternative punishment. At present there is no agency or authority that controls qualitative performance of sentencing. The control mechanism should be safeguarded by police, organizing a complex system, involving social workers and family members.

ASSESSMENT

OF THE FINANCIAL MODEL FOR THE FIELD

OF DRUG TREATMENT

When analyzing the present situation in the field of drug treatment, experts recognize two important tasks for improving the situation in the field of drug addiction – to improve legislation and adjust the funding system.

The main problem in the everyday life of drug treatment is the lack of funding. Insufficient funding prohibits qualitative medical treatment. It is necessary to follow the scheme “money follows the patient” rather than vice versa. This gives opportunity of choice both to the patient and doctor, thus introducing a key democratic principle to medical care.

Expert interviews show that practitioners are disappointed with present distribution of finances among regional medical insurance funds. Each regional medical insurance fund undertakes treatment of a limited number of addicts. However, in some cases there are more patients than funding can accomodate. In such cases there are few options: • To admit a patient into hospital, with the patient covering all treatment expenses. This is very rare.

• To admit a patient into hospital and provide treatment “at the expense of the hospital”, with no payment received from medical insurance funds there after.

• No admittance to hospital. In this case the patient, his family and the whole of society will suffer.

There are medical insurance funds that calculate the availability of free hospital beds, and on the other hand there are patients waiting for treatment. There are two types of assistance in health care: emergency and planned. Drug treatment is defined as planned assistance. This is the reason for the absurd situation with hospital beds paid for by medical insurance funds. There is a general mismatch in the number of available places and demand. Thus limitation on drug treatment patients may become critical or dangerous, because drug treatment and emergency assistance cannot wait.

The state has defined the number of days of paid treatment. If a patient does not recover, no adequate response occurs — the patient stays in hospital too long or not long enough (experts mention that early hospital leavers often return in a few days heavily intoxicated).

Experts believe there is a need for mor freedom for the therapist to decide on the number of days of treatment on an individual basis.

At the Narcology Center patients pay 0.45 LVL per day.

Experience proves that payment influences motivation to receive treatment. When expenses are covered by family, the patient has a more serious attitude towards treatment. Presumably, all patients should be required to at least partly fund their own treatment.

Assessing government interest in drug treatment , addiction therapists stress that during pre-election campaigns politicians offer an active policy for resolving dependency problemse. However, after the elections politicians have little interest in real political activities that could help solve the problem.

Addiction therapists also stress that political decisions related to the drug problem must be made in consultation with professionals.

ANONYMITY, CONFIDENTIALITY, AND DEVELOPMENT OF THE STATE REGISTER OF DRUG USERS AND PERSONS WITH DRUG DEPENDENCY Before analyzing the issue of anonymity and confidentiality it is important to define both terms.

It is not a question of absolute anonymity, because the doctor musto know the name and basic data about the patient, and the patient also must know the doctor's name. Patient and doctor may not be just 'anyone' to each other.

The other term 'confidentiality' means that data are inaccessible to third persons, so that the patient remains safe from possible intervention by various groups in society.

Treatment is confidential if the patient follows the treatment rules and doesn’t become aggressive or dangerous to others. Doctors make the following distinction: • first, when a person voluntarily goes in for treatment, follows the doctor's prescription, regularly visits the doctor, doesn’t exhibit behavioral problems – registration could be discontinued; • second, in those cases when an addict has committed a crime, registration is compulsory.

The Register of drug clients was developed at the Narcology Center providing objective information about out-patients and in-patients. The register begans as a database for epidemiological analysis, but in real life it was authorized as an information source for various institutions such as the police, courts, prosecutors, weapons committee, etc. Experts cited several problems with this Register: • related to the registration of drug clients, the doctor should register any person seeking medical assistance for the first time and diagnosed as alcoholic or drug addict; • it isn’t clear when to remove a person's name from the register. Formerly the person was in the register for three years; • the requirement to enter data into the register applies only to State drug treatment centers.

There are, however, several treatment centers that are not so classified, but nevertheless provide medical treatment to drug patients. Data on these patients do not appear in the drug client register and therefore the drug client Register is incomplete.

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Recommendations 1. Strong execution of functions of control should be assumed by medical insurance funds. Current legislation defines who should be registered and how this is done.

However, it does not define how and when to delete a person from the register. Therefore, there is much room for misinterpretation and misunderstanding. Adjustment of the register is a question that must be settled on the legislative level.

2. To adjust the system, it is necessary to elaborate the “Standards of drug treatment assistance”. The current system is not adjusted: in many cases only the first stage of treatment, namely, detoxification, is covered.

Assistance in cases of drug addiction is qualitative and effective only when all the steps of treatment are followed: motivation program, medical therapy, psychotherapy, etc.

3. There should be a unique understanding of the quality requirements. This means patients in private clinics also must go through all steps of treatment.

DRUG ABUSE

TREATMENT

Therapy in cases of drug addiction should follow the scheme: prevention – treatment – rehabilitation (social reintegration). The fight against drug abuse is a complex issue, say experts. Therefore the measures regarding control of drug abuse must be closely related to treatment methods, social reintegration after the treatment period, and an effective prevention program.

Experts had diverse attitudes towards the weakest stage of this complex — therapy of drug abuse patients. There are many problems in the treatment. Experts admit that the form of treatment — in-patient or out-patient — depends on many factors: • Severity of the condition, i.e., the depth of harm and lasting consequences. In more severe cases in-patient treatment ir required. In general, Latvia is characterized by severe diagnoses of addiction.

• Patient motivation — the level of motivation to undergo treatment, understanding the urgent need for it; • The patient's general educational level. Experts admit it is easier to work with educated and intelligent people; • The patient's social environment. If the patient is located directly in a unfavorable social environment, it is better to isolate him/her from it, at least for the time of treatment; • Form of addiction. There are patients whom it is possible to treat only in hospital, for example, heroin and opiate addicts.

TEENAGERS AND

DRUG ADDICTION TREATMENT

Drug dependency is encountered among children, adolescents and teenagers more and more often. It is particularly important to study and at the same time also to qualitative and timely treatment.

The youth treatment system was elaborated following various European models. Theoretically, almost all treatment opportunities are provided: counselling, outreach, 154

pharmaceutical and non-pharmaceutical treatment, rehabilitation and prevention. But implementing all the scheduled measures remains a problem.

Quality standards haven’t beent elaborated, there are no vacancies in rehabilitation institutions and there are long waiting lists of teenagers requiring treatment.

Teenagers, similar to adults, can receive in-patient or ambulatory treatment.

COMPULSORY TREATMENT The problem of compulsory treatment is widely discussed, and there are a variety of viewpoints. So far, compulsory treatment, according to legislation could apply in cases where the court imposes a conditional sentence or the person is released from punishment on the promise of starting a treatment program.

In many cases the main stimuli come from the patient's family or colleagues; this is called indirect forced treatment.

Motivation FOR compulsory treatment: • The doctors interviewed admit that society isn’t ready for democratic treatment methods. The democratic approach better fits societies with basic democratic traditions.

• It must be noted that addiction patients are noncritical towards themselves and others and could become a threat to the security and health of others. Therefore these patients receive compulsory treatment.

Motivation AGAINST compulsory treatment: • Compulsory treatment is non-effective because addiction cannot beo cured by forced action.

Patients do have understanding of compulsory treatment. A young person is not fully developed physically and psychologically until about age 21; therefore forced treatment probably is more effective for young addicts.

• Forced treatment is a violation of the patient's human rights.

Recommendations related to compulsory treatment 1. Thefunctional meaning and legal aspects of compulsory treatment are very complicated, therefore the solution to the problem must be based on an integrated approach, i.e., with lawyers, doctors and social workers collaborating. One-sided decisions usually create new problems. The state needs offer treatment, not penalties.

Unfortunately, four weeks of compulsorytreatment isn’t enough time to rehabilitate a patient. At best, during this period the addiction therapist can create a motivation for treatment, but cannot finish the job.

2. During compulsory treatment, physical activities should be involved as much as possible, particularly for young people.

3. Compulsory treatment is an additional concern in the case of teenagers. Some experts suggest that compulsory treatment is a must. It is necessary to have good collaboration with parents. Doctors cite Sweden as a state with a mechanism for compulsory treatment of teenage-

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

addicts. Teenagers learn new skills that can change their thinking, attitudes and opinions and thus bring positive change into their life.

NON-PHARMACEUTICAL METHODS

OF TREATMENT

Doctors – addiction therapists assess non–pharmaceutical treatment methods as effective. However, this may not be the only alternative treatment, because the problem of addiction has four aspects: social, psychological, familial, and physiological. All of these need to be taken into account when treating a patient. Psychotherapy is not enoughfor successful treatment of addiction and must be combined with pharmaceutical and social assistance.

At present there are two non-pharmaceutical methods of treatment: 1. The Minnesota program — a psychotherapeutic treatment program for addicts. During treatment the patient gains a sense of personal values, obtains the necessary information about the dependency, and learns skills to manage the problem.

2. The Motivation program objective is to help the patient understand the dependency problem and stimulate motivating to begin long-term treatment.

Arguments for non-pharmaceutical methods for treatment: • They can provide an individual approach to each patient, as well as more moral support.

• The patient's work with him/ herself is impereative so that the self view changes.

• Different tasks are completed regularly.

• The patient is isolated from an unfavorable environment and slowly undergoes rehabilitation.

• The patient has an opportunity to organize his or her own free time.

• Patients can attend various anonymous support groups.

Arguments against non-pharmaceutical methods of treatment: • Higher expenses • Longer rehabilitation periods • Sick leave necessary for some terms The method of treatment depends on the intellectual level of the patient. Intellectuals more often choose non-pharmaceutical methods of treatment instead of pharmaceutical ones.

Addiction therapists emphasize that successful treatment of drug addicts is closely related to their social and voca-

Model of optimum care of drug addicts

Basic services Street work Night shelters Consultations for parents

Consultations on drug issues (district narcology in-patient and out-patient services) Methadone program

Pill test

Detoxification Up to 10 days

Motivation programs (up to12 days)

Short therapy (Minnesota) program (up to 28 days)

Thrapeutical communes (up to 1 year)

Day therapy Post-treatment care (not less than 3 years)

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Drug abuse prevalence in Latvia

tional rehabilitation. They stressed that employment is seen as • an indicator of successful treatment. In evaluation research, employment is viewed as a desired outcome of treatment. Therefore, employment is a criterion closely related to successful treatment outcomes.

• a predictor for staying in treatment. Evaluation research shows that employment is a predictor for retention in treatment. When the drug-dependent person holds a job, the chances are — he will stay in treatment.

• a reasonable means for reintegration into society.

Employment is key to many drug treatment programs and plays an important role to preparing drug-dependent persons for regular work and daily life.

Experts mention the positive aspects of the vocational rehabilitation of drug users. These are factors that support a positive outcome of treatment.

• Employment before treatment is a positive predictor in view of vocational rehabilitation. A favorable work record as well as a good educational background indicates a better outcome prognosis.

• Duration of treatment — social reintegration and, in particular, vocational rehabilitation, must be seen as a process requiring time. Continuous support over time increases the chance for successful vocational rehabilitation.

• Motivation/positive work experience – motivation for work and positive attitudes also increase the chance for successful vocational rehabilitation.

• A stable social situation definitely supports the vocational rehabilitation efforts of drug-dependent persons. A structured day, no contact with drug users, no criminal activities are vital support mechanisms in vocational rehabilitation.

ASSESSMENT

OF

METHADONE

PROGRAM

Positive aspects of the Methadone program • Methadone allows continuity and a step-by-step return to society; • It takes regular control over the patient; • The patient can get a doctor's advice and consultations on a regular basis.

Negative aspects of the Methadone program • It is a expensive treatment method; • It imust be combined with alternative treatments and various social activities; • Methadone sometimes appears on the “black market”; • A gathering of drug users occurs; • The socio-psychological portrait of the patient and his or her intellectual development are very important (understanding the treatment method, one's own responsibility, etc.) This program requires the patient's own initiative and intellect, to avoid using other drugs and methadone in the appropriate doses.

At present the Methadone program is available only in Riga. In general, about 70-80 patients use this program.

Several experts admit that the Methadone program should be expanded to include other major cities. Other experts are against the Methadone program and suggest putting funding into other progressive methods of treatment, prevention and social rehabilitation.

THE

ROLE OF SYRINGE EXCHANGE POINTS

The creation and development of syringe exchange points are seen in a positive light, because • They improve the health safety of society, including drug users themselves; • Drug addicts become accessible to social workers; it is possible to contact them, and drug addicts have the opportunity to talk and ask questions; • They decrease the risk of HIV and hepatitis.

Methadone is a synthetic opioid employed in therapy of opiate addicts. The aim is to decrease the use of heroin among drug users to stabilize and help them avoid a relapse.

Recommendations for syringe exchange points:

Overview

2. The qualifications and experience of staff at syringe exchange points is of crucial importance. Several experts mentioned that ex-users should be involved in this work.

However, there is a risk that ex-users could use their power and demonstrate their superiority over the addicts.

That could cause a unfavourable psychological climate.

The aim is to help those patients who have had several unsuccessful cases of treatment, long-term addiction and a severe diagnosis. Some experts have criticized this program as it pertains to young patients or patients with mild diagnosis. Methadone is an addictive drug, therefore this form of treatment must be taken seriously and used only as a last resort.

Isolating the patient during the program does not provide good results, because the methadone alone doesn’t solve the problem. This program wait work without the patient's social integration. The patient is typically unemployed, therefore it is important to involve him/her in social activities, give him/her an opportunity to work (paint windows, wash floors, etc.), involve the patient in training. So far there is no such system of opportunities in Latvia; therefore the program must be complemented with a real rehabilitation and motivation program.

156

1. It is necessary to coordinate locations of syringe exchange points, i.e., they should be located in districts with a high concentration addicts;

3. Syringe exchange points mus certainly be combined with other types of social assistance: they should have access to consultations with doctor and social worker , psychological support, etc — there should be a complex of activities to provide social integration, not only syringe exchange.

CONCLUSIONS Drug addiction is a chronic illness requiring long-term, complex treatment. Unlike other victims of disease, drug addicts tend to avoid medical treatment and counseling.

Experts — addiction therapists admit that fighting drug

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

use and its consequences must be a part of complex system, combining treatment of drug addiction, rehabilitation and social integration, and prevention. This system must be coordinated on a state policy level, establishing legislation to regulate the procedure and sequence of treatment, rehabilitation and social reintegration, and drug use prevention activities. According to experts, there are still many to combating drug use in Latvia. These gaps could be eliminated if: • legislation pertaining to drug use and abuse were improved; • an adequate financing model for the drug addiction treatment field were developed; • new methods in drug use treatment, rehabilitation and social integration, and drug use prevention were adopted; • the theoretical knowledge and training of addiction therapists rwere improved, and the fundamentals of drug treatment taught to medical students; • regular long term scientific research in the drug treatment field were conducted.

A multidisciplinary approach should be employed in planning activities to eliminate drug abuse, and a multidisciplinary team should be involved (including doctors, lawyers, government representatives, social workers, educators, psychologists, and other professionals directly or indirectly involved in drug addiction treatment, rehabilitation and social reintegration, as well as in the planning, elaboration and realization of drug use prevention programs and/ or policies) (see Model of optimum care of drug addicts above).

Drug addiction therapists point out a particular problem area: for the individual it is often difficult to resist social pressure when drug use begins; on the other hand young people feel lost and hopeless when confronting. They don’t know where to turn for help or how to help their friends. These are areas where prevention and education programs could be better developed and coordinated.

Health care specialists stress secondary prevention, with individuals who only experiment with drugs and have no serious problems with drugs, but are at a high risk of being infected. At the moment, we do not have enough knowledge to recommend the introduction of secondary prevention interventions into every primary and secondary school with counseling services. Probably more interventions directed towards primary prevention should confront youths already experimenting with drugs.

RECOMMENDATIONS Medical care should be conducted in accordance with the national Drug Addiction Treatment Program to be adopted by the government.

It is necessary to develop and expand facilities to provide screening, early diagnosis, treatment, risk reduction and links to long-term re-socialization. This requires – close coordination of the activity of health, social, and self-help facilities.

Experts called for special attention to be paid to the establishment and development of facilities to provide health

and psychosocial care for drug-addicted pregnant women, their newborns and possible foster family care.

To re-socialization of drug-addicts requires support from public and private entities. Staff should have specialized training, including psychotherapy, a work system and treatment regimes in community, family and work therapy, professional adaptation and reintegration into the natural social environment. Cooperation with the healthcare sector in the prevention of HIV and hepatitis is needed, to support treatment and social care.

Addiction therapists emphasize that the drug problem also occurs in prison, therefore there is a need to improve conditions for protective and voluntary treatment over the course of imprisonment and to establish departments with elements of a drug-free therapeutic community regimen.

Overview of interviews with legal experts on the main issues in drugrelated law enforcement INTRODUCTION In this chapter we review drug–related problems from the perspective of lawyers, judges, prosecutors, police and customs officers. Within the framework of our research eleven expert interviews with specialists in each area of law enforcement were conducted. The interviews were based on the semi–structured previously devised interview plan. The sequence of the questions varied for each specific interview.

During the interview, experts were asked to evaluate and discuss the formulation and conduct of drug policy in Latvia.

The aim of this chapter is to provide a description of drug policy: strategy, coordination and laws. Some experts were also willing to discuss the problems of implementation of strategy and legislation.

In 1993 Latvia ratified the UN conventions on drugs (1971), psychoactive substances (1971) and Convention against illegal trafficking of drugs and psychoactive substances. The main legislation related to drugs is incompliance with these UN Conventions. At present there are several laws regulating illegal circulation of drugs: Law on the Circulation of drugs and psychotropic substances; Law on Pharmacy, Law against precursors. So far, legislation related to illegal trade of drugs, drug use and drug related crimes is included among several paragraphs of the following laws: Penal Code, Code of Administrative offenses, and amendments to these laws (for example, amendments on reinforced responsibility for drug smuggling, trafficking, and drug use without a doctor's prescription). The National drug strategy “Drug Control and Drug Abuse Prevention Program, 2004–2008, drafted in 2003.

The strategy is based on the revised previous strategy and on the new drug situation. According to experts, the new strategy has appeared due to the non-implementation of the previous one.

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EVALUATION

OF THE WORK OF INDIVIDUALS AND INSTITU-

TIONS INVOLVED IN THE FORMULATION AND IMPLEMENTATION OF DRUG POLICY

Latvia has been active in developing a balanced, comprehensive and multidisciplinary approach to drug policy.

Experts admit that Latvian National Drug strategy is target–oriented, implementation and coordination.

Experts indicate three areas that should be covered by the National drug strategy: a realistic approach to illegal drug use and trafficking; effective implementation and delivery of coordinated actions in the field; and reducing problems caused by drugs. One of the main preconditions of a successful the National Drug strategy is efficient coordination and guaranteed financing of National Action Plan. It also needs an effective coordination mechanism at two levels — Commission of Political coordination and a Technical Secretariat. Legal experts emphasize the importance of both structures. The Political coordination should be based on representatives from all Ministries involved in drug issues (Interior, Health, Education and Science, Culture, Welfare, Economics, Finance, etc.).

Legal experts defined the main functions of this Commission — to supervise and evaluate the conduct of the Program, to facilitate coordination among ministries and other state institutions, to authorize ground rules to be implemented by the Technical Secretariat, and to support the fight against drugs.

Experts strongly support the urgent need for the development of Technical Secretariat of the Political Commission.

They explain that one of the main aims of this secretariat is to establish a close link between policy makers, branch experts and practitioners. Another aim is related to coordination and management of the implementation of the Drug Programme. Therefore it must be able to plan the implementation of state policy (for example, to elaborate proposals for discussion at the Commission of Political coordination), to define needs and priorities for the anti–drug policy and its implementation. Legal experts mentioned the need for the technical secretariat — information on drugs to gather disseminate, facilitate the work of state administrative bodies and dialogue with NGOs, and also to coordinate and monitor research on drugs.

Drug Control Commission Regarding the work of the Drug Control Commission and its role in the formulation of a national anti–drug policy, most of the experts were quite skeptical. They see the work as formal and episodic, populist in nature with no evidence of significant progress. One of the legal experts was more positive and admitted that, “without some cooperation and joint effort, there would be no new legislation and no drugs criteria classification.”

Personal involvement in the national drug policy The experts were asked to rate their own level of involvement in the formulation of a national policy on drugs.

Only a few experts have indicated that they are seriously involved in the formulation of a national policy on drugs.

Experts from the Latvian Police Academy are involved in 158

numerous programs and they have participated in the development of various anti-drug projects, other experts are involved in the formulation and realization of municipal strategies and action plans.

The other legal experts admitted they had contact with drug-related problems of in their work, but do not participate in the elaboration of national policy on drugs and national strategy on drugs.

Understanding the drug problem in Latvia Several experts indicated that there is no unified understanding of the drug problem among Latvian law enforcement institutions and courts; this is evident in the actions of the police, court decisions and investigations into illegal drug trafficking and with the spread of drugs in Latvia.

The coordination of work among these institutions and the development of a unified level of understanding must originate at the highest level of government, and be supported through appropriate legislation.

Several legal experts were favorable in their views regarding efforts of the present government in fighting drug abuse: “The fact that amendments are drafted is evidence in itself of political action. Of course, campaign promises were made, but now constructive activity is also evident.”

However, some legal experts have agreed with the above contention, emphasizing that it “was particularly evident in the last Saeima elections”.

Cooperative efforts between politicians and professionals in the formulation of the national drug policy All the experts feel that it is vital to create and develop the cooperation when formulating the policy on drugs. They emphasize that cooperation with addiction therapists, school representatives, social workers, ministries and institutions involved is very important. Cooperative efforts should take place from the upper levels of government down to the lowest social stratum.

Few of the experts have positively evaluated the cooperation efforts between politicians and professionals, mentioning recent legislative amendments. The majority of the experts interviewed viewed cooperative efforts between politicians and professionals negatively, indicating that cooperation takes place on a theoretical, not a practical level; legislation is in place, but it is not enforced.

However, they stress the necessity of such collaboration.

Level of information regarding the EU drugs strategy for 2000–2004 The experts were asked to evaluate their own level of knowledge about the EU drugs strategy for 2000–2004 and the main goals and principles of its action plan. They were also asked whether they felt that the drugs policy in Latvia is being formulated according to EU guidelines.

Based on interview information, we see that the majority of the experts rate themselves as well informed and knowledgeable in this area, while some experts are poorly informed, for which they blame themselves. It should be noted that the first group of experts attributes its high

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

level of knowledge and information to being involved in EU drug related projects and activities as part of their work and paying special attention to the subject. They highly evaluate the role of EMCDDA in the development of knowledge on EU Drug Strategy for 2000–2004, and also the development of Latvian Drug Programme 2004–2008.

Several experts have indicated that Latvia must carefully consider the direction of its drugs policy, firstly creating unified coordinating institution on a political level, and a working technical secretariat.

Legal experts highly evaluate the PHARE Twinning project and its guidance by Spanish experts. This project has contributed to the promotion of good practice, and this project has been a key factor in the development and elaboration of National Drug Programme in accordance with the main aims of EU Drug Strategy for 2000–2004.

All the experts reported that the Twinning program with Spain has played a major role in promoting the adoption of a new structured policy plan and focusing to modify the drug coordination mechanism through establishing Drug Commission and executive Technical Secretariat.

Experts highly appreciate the valuable, interesting and high standards of workshops and seminars organized by Spanish experts. They have emphasized the important role of the workshops for development of the National Drug Programme in line with the EU Drug Strategy 2000–2004, and the EMCDA priorities.

Evaluation of the pronouncement by the Minister of the Interior that there will be a completely new and different approach taken in the fight against drugs The legal experts had differing opinions about the Minister of the Interior's pronouncement. A certain number view this kind of pronouncement as very positive, pointing to the fact that the fight against drugs is a state priority. Some experts emphasized that effective drug policy needs a National drug policy, National drug strategy and a clear National Drug action plan with distinctions among these three levels. In reality there is inconsistency between the three levels of drug policy. It is not easy to drow the line between policy and strategy, strategy and action plan. The two concepts are combined in one document. Another serious concern is implementation.

Some legal experts emphasize that a very important aspect of the new approach ise “its binding character for all the ministries involved in the implementation of the new strategy”. Therefore the pronouncement on the new drug strategy will become reality only if there is strong collaboration between all ministries involved. Experts indicate that so far, the Ministries of Interior, Education and Science have been active in developing the National Strategy and its implementation plan. Again, they stress the need to develop a Political Coordination Commission and create a Technical secretariat to coordinate work between these institutions.

Otherwise the new “approach” will be the only “approach” without any effectiveness. The precondition of successful drug policy should be coordinated collaboration among ministries.

Other experts, however, viewed the pronouncement

about “the new approach” in a critical light. The experts negatively disposed regarding this question reported that the Ministry of the Interior needs to elaborate and implement a clear concept, program and unified approach in these matters, coordination mechanism. They indicate that development of “the good approach” also needs a clear mechanism of implementation and appropriate budget resources.

Evaluation of the reorganization of the Drug Enforcement Bureau Although most experts viewed the reorganization as positive, some expressed a negative opinion: “During the reorganization the Drug Enforcement Bureau was basically ruined.” First of all, it was noted that the result of any reorganization should have been one, not two institutions that compete with each other, duplicated functions and information, because previously both the Drug Enforcement Bureau and the Anti-Drug Board dealt with these issues. A second negative factor in the reorganization is the reduction in Drug Enforcement Agency staff and salaries. It will take time for the new employees to attain the necessary skill levels.

Experts supporting the reorganization feel it will lead to positive results. However it takes time before the results of reform become visible.

Opinion on the formation of the European Police (Europol) office and its further activities in Latvia Almost all the experts view the opening of a Europol office in Latvia favorably. The nneed for such an office is substantiated by the fact that the Latvian Interpol office, although operating within its statutory guidelines, is not effective enough. For this reason another international institution with its branch in Latvia is helpful, having a broader sphere of authority.

The experts hope this will not be just another bureaucratic institution, but will foster real international cooperation: “this is one of the great opportunities to fight drug abuse and drug related crime on an international level”.

The Customs Service During the interview experts were asked to evaluate the work of Latvian customs in the fight against of drugs.

Legal experts indicate customs work as crucial to combating the drug trade. However this is very complicated work and needs collaboration both on national and international levels. The importance of collaboration between customs and the police was strongly emphasized.

Several experts felt the individual character of customs officers plays a significant role in the work – their level of honesty, loyalty to their job and country.

The major deficiencies in the efforts to effectively reduce drug use in Latvia The following was presented as the main deficiencies and obstacles to effectively reduce drug use in Latvia: • in various countries, there is no unified understanding of what a drug related crime is, what is the amount of drugs results in criminal liability; 159

Drug abuse prevalence in Latvia

• • •

liberal legislation in certain countries, the trend to legalize light drugs; deficiencies in the work of the police and customs in Latvia; the changing direction of global policies on drugs; various high level officials have openly and publicly announced that they use so-called light drugs.

The experts made the following suggestions for the improvement of the existing situation both in Europe and in Latvia: • on the European level, create a consolidated front and coordinated multi-national movement in the fight against drug abuse; • establish a unified and responsible drug-related enforcement institution in Latvia; • closely monitor the quality of work of the institutions involved (the police, customs etc.)

• increase the effectiveness of the formal and informal education in Latvia; • develop employment opportunities for young people, because the experts believe that unemployment is one reason that they start to 'fool around with drugs'.

Some proposals are related to the direct development in drug enforcement. However, also indirect prevention of drug use is very important, like the importance of education, organized leisure time activities and active employment measures for young people.

EVALUATION

OF EXISTING LEGISLATION AND SPECIFIC

PUNISHMENTS FOR DRUG RELATED CRIMES

Amendments to the Criminal Law During the interview experts were asked their opinion about changes in the Penal Code raising liability in the commitment of drug-related crimes.

Some view the changes aimed at increasing liability in a positive light because “drug abuse as a social phenomenon is constantly changing, both qualitatively as well as quantitatively. It is becoming a specific form of organized crime and that means that respective legislative changes must be made.” At the same time, however, it was noted that strict monitoring is imperative to assure that the provisions of legislation be implemented. According to some experts there have been so many changes and amendments made to the Penal Code, that now it is necessary to allow the situation to stabilize.

Opinion on life imprisonment as a punishment for drugrelated crimes Based on the interview responses, almost none of the experts support life imprisonment as an appropriate punishment for crimes related to drug dealing and distribution. They noted that measures such as life imprisonment and capital punishment exist in Islamic nations, where religious traditions have merged with powers of the state.

There is no place for such trends in democratic societies.

Another argument against life imprisonment is the question of why tax payers should continue to pay for a criminal’s life sentence.

160

Several pointed out that in despite the fact that legislation regarding criminal punishment is strict, it doesn’t work in reality because it is not enforced in certain situations.

Thus, neither life imprisonment nor capital punishment will solve anything if it exists only 'on the books' without being enforced.

Evaluation of existing drugs classification by volume Latvia refers to the “use per se” as a criminal offence.

The Amendments of November 21, 2002 to the Penal Code introduced as an offence consumption of narcotic and psychotropic substances without prescription, if committed repeatedly within a period of one year. The applicable sentence is deprivation of liberty for a term not exceeding two years, compulsory work and a fine. Latvia also prohibits consumption of controlled substances without a prescription. This is usually punishable by administrative sanction.

“Possession of small amounts of drugs for personal use” is also treated as a criminal offence. Latvian legislation and prosecution guidelines set specific limits to indicate the maximum amount of a “small quantity”. Legal experts indicate that many EU countries leave this to judicial or prosecutorial discretion.

Experts were asked for their thoughts on the existing drugs classification by volume as well as their opinion on the substantiation and efficacy of such a classification.

Their opinions varied greatly on this question. Several felt that since the classification was devised by experts, the volume at which criminal responsibility sets in should be accepted as appropriate. It was noted that despite the fact that this classification wasn’t bad, it was not a perfect system. The experts hope that upon joining the EU, legislation in this area will be improved.

Several however were quite negative in their comments about the classification by volume.

Applicability of alternative punishments The experts were asked whether application of alternative punishment should be related to and based on the severity of the sentence. For example, if the sentence is more than two to three years, then application of alternative punishment is not appropriate.

In general, most of the experts view the application of alternative punishment for drug-related crimes as optimal, because “prison is undoubtedly the harshest of punishments, but it has not been proven to be the most effective”. Experts agree that there should be an alternative punishment because the fact that there is an alternative affects the person psychologically.

Several attorneys expressed the view that considering alternative punishment, one should take into consideration the severity of the crime, i.e. what quantity of drugs were distributed, the consequences of these actions, etc.

One should also, in their opinion, consider the person committing the crime, e.g., if he/ she was underage, or a drug addict.

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

users.

Opinion about compulsory treatment for drug dependency, alcoholism, gambling addiction etc.

Attitude toward publicly available information about the legalisation of drugs in Latvia

All of the experts were favourably disposed and confirmed the need for compulsory treatment. It was suggested, however, that the treatment be called 'mandatory' rather than 'compulsory', thus pointing to self-initiative and motivation on the part of the individual to seek help.

During the interview the experts were asked for their evaluation of publicly available information about the legalization of drugs in Latvia.

They noted this type of compulsory treatment might be especially effective among minors and prisoners.

However, if the specific drug user tries to avoid treatment, he could face criminal liability.

ASPECTS

OF THE DRUG POLICY

Trafficking There are distinct criminal offences beyond possession of small amounts that specifically refer to the intent, and the sentencing range is higher when the possession is with intent to sell for profit. Trafficking offences (possession or supply for sale) include production and cultivation.

However cultivation is assigned a lower sentence than for production or trafficking. Experts emphasize that Latvian legislation differs from some other East and Central European countries which apply higher sentences to a group formed for purposes of production or cultivation rather than trafficking.

Attitude toward dividing drugs into categories 'soft' and 'hard' Law enforcement experts have given a great variety of opinions regarding the question of division of drugs into categories 'soft' and 'hard'. Some of the experts pointed out that this categorization most likely has nothing to do with enforcement activity. Therefore, from the point of view of enforcement/ legal institutions, this kind of categorization is meaningless.

Other experts maintain that the present categorization should remain in place: “First of all, in order to incriminate criminal liability. The liability and guilt of a person distributing soft drugs and hard drugs cannot be comparable”, though the same experts claimed they do not support legalization of the soft drugs.

Attitude toward decriminalization of certain narcotic substances The majority of legal experts opposed the decriminalization of certain narcotic substances because “the drugs trade is a criminal activity; it is a crime, and thus, any legalization of any class of drugs is impermissible”; moreover, in the Netherlands, for example, where the use of cannabis is legal, other substances are also made available for sale.

Some were not as negatively disposed toward the question of decriminalization, admitting it is a substantiated approach. The harm done by any given substance is a question for medical experts, since a judge has difficulty knowing how any certain drug can affect an individual.

The proponents of this stance, however, admit that Latvia is not ready for legalization of the soft drugs, as it could result in an uncontrollable increase in the number of drug

Several experts rated the available information as superficial; analytical information presenting varying viewpoints is very seldom available. Sometimes hidden advertising for light drugs is evident in ads for drinks, such as: Red Bull, XTC, etc. It was noted that enforcement institutions should actively fight the spread of these products and ban advertising of products that promote drug abuse.

Most of the experts agreed that to lessen the impact of information regarding drugs legalization and the nonharmful nature of drugs, more preventive and educational information should be made available in the mass media.

In response why information about the legalization of drugs is being popularized, the experts cited the lack of a unified national policy on drugs and strategy, as one reason. Also, there is no institution that would administrate and direct the movement toward a national policy and manage preventive efforts.

Attitude toward the popularization of safe drug use The experts were very critical regarding this question.

Drugs in whatever form and their popularization does not decrease their harmful nature: “it is the same evil, just in a different packaging”. Experts, with a less negative mindset in this matter, feel that popularization of safe drug use would be necessary among people with problems of drug use.

Involvement of society in the fight against drug abuse The legal experts were asked to describe how society as a whole could become involved in the fight against drug abuse.

The experts noted that society, in this case, should not be defined as a unified whole, but rather as a group of various institutions with qualified specialists in related areas.

In order for society to become involved in the fight against drug abuse, it must first become educated; it is vital to educate families.

A significant aspect in the fight against drug abuse would be personal responsibility and involvement — for example, a person sees a child using drugs, his responsibility would be to immediately inform the respective institutions.

This might facilitate the closure of new dealer networks.

Reduction of drug related crimes The experts were asked to give examples and suggestions for the effective reduction of drug related crimes.

It must be noted, that only one example of an effective reduction of drug-related crime rate was givenfrom India and other Muslim countries, where punishment is very harsh. “The only kind of extreme measures and exception rights that are given enforcement institutions in the 161

Drug abuse prevalence in Latvia

fight against drug abuse are capable of stopping the drug abuse. Any alternative measure in tempting to reduce the spread of drugs is weaker than the one measure promoting the spread of drugs, that is, drug use. This market is much more powerful than any social self-protection alternatives”.

The experts suggested the following to reduce the incidence of drug related crimes: • creation of a complex structural entity which would include representatives from all social and political structures working with drugs: qualified representatives from the border patrol, custom, the financial, economic and criminal police, the prosecutor's office and the specialized courts; • demand defines supply in the drug business; for this reason, serious preventive measures must be instituted at the primary, secondary and tertiary levels; • the national budget must provide resources for the resolution of this problem; • society must be educated.

In general, many experts have emphasized the importance of education for lowering the rate of crime, including crimes related to drug use: “'Statistics show that the higher the level of education, the lower the crime rate.

Everyone must study somewhere”.

Problem of drug use in prisons Almost all of the legal experts recognize the spread of drugs and drug addiction in prisons as a topical and very serious problem because “many people who have never used drugs, start to use in prisons. That is related to unemployment; drugs is what they can get carried away with.”

A considerable majority of the experts indicated that the prison administrative staff and personnel are to blame for the problem. Dishonest attorneys were mentioned as one means of getting drugs into prisons when they visit their clients.

In order to find a solution for the problem, it was suggested that the Ministry of Justice carefully consider the existing prison administration system because “the prison administration is the last remaining bastion of the Soviet regime”, for this reason carefully considered prison reforms are extremely topical. It was suggested that dishonest prison employees be held morally and criminally liable.

Another suggestion to resolve the problem was the search of prison visitors as well as of prison staff.

Development of illegal drug trade after Latvia joins the EU In response to the question of how the illegal drug trade will develop after Latvia joins the EU, opinions varied.

Some of the legal experts felt that initially nothing would change and the illegal drug trade would not increase, because all of the European nations are fighting drug abuse as much as possible.

Several of the experts were less optimistic and remarked 162

that the illegal drug trade would increase after Latvia joins the EU. One of the experts was extremely skeptical about predicting future trends and said that increases in illegal drug activity could not be directly linked with Latvia entering the EU; drug use will increase whether Latvia is a member of the EU or not.

RECOMMENDATIONS Analyses of experts’ opinions and attitudes related to various aspects of drug policy giving an opportunity to elaborate conclusions and make recommendations to improve the situation of a drug policy in Latvia: • legal experts highly evaluate the PHARE Twinning project and its guidance by the Spanish experts.

This project has contributed to the promotion of good practice, and has been a key factor in the development and elaboration of the National Drug Control and Drug Abuse Prevention Programme 2004–2008 in accordance with the main aims of EU Drugs strategy for 2000–2004; • development of the Commission of Political Coordination in the Drug Field, and creation of a Technical Secretariat that will coordinate the implementation of the National Drug Strategy; • efficient coordination and guaranteed financing of the National Action Plan; • it is necessary to facilitate the collaboration between politicians and professionals in the development of a drug policy. According to the expert interviews, the majority of experts evaluate negatively the existing collaboration; emphasizing that the collaboration is more theoretical than practical.

They stress that legislation has been developed, but is not implemented; • in the development of drug policy, it is important to involve young, qualified and committed professionals, and to plan financing for this work; • the majority of experts have followed the improvements in drug policy and estimate themselves as being well informed in the drug policy field.

However, they suggest, it is necessary to organize seminars and workshops for lawyers and other legal experts on the topical issues in drug policy.

The workshops could be organized for advocates, judges (at Collegia of Attorneys, Training Center for Judges).

There are several aspects for an effective drug demand reduction and decrease in drug-related crimes • consolidate and coordinate actions against drugs on the European level; • to establish the supervision authority in the field of drug enforcement in Latvia; • increase effectiveness of analytical and educational activities; • employment measures for young people and education of society on drugs; • drug demand sets levels of drug supply, therefore it is important to realize effective drug prevention programs on a primary, secondary and tertiary prevention level; • plan appropriate funding from the State budget for implementation of drug policy; • develop collaboration between the police and cus-

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

toms.

Overview of interviews with politicians on drug policy INTRODUCTION In this chapter, we analyze politicians’ attitudes towards the formulation and implementation of a drug policy in Latvia.

As part of the study, ten interviews were conducted with deputies of the 8th Saeima. The politicians interviewed represent the political parties in the 8th Saeima. The interviews were performed based on partly structured basic interview principles.

Within the framework of the interviews, the politicians were asked to give their opinion about questions dealing with the formulation and implementation of a drug policy as well as to comment on drug policies in Europe. During the course of the interviews, the politicians' level of knowledge about institutions that formulate drugs policy in Latvia and Europe, as well as Latvia's cooperative efforts in the realm of drugs policy, was revealed.

INVOLVEMENT

OF GOVERNMENT IN THE IMPLEMENTATION

OF THE NATIONAL DRUG POLICY

In evaluating the level of governmental interest in implementing a standard national drug policy, it was shown that the level can be determined by two indicators: • whether the government recognizes the specific problem as one of its priorities; • whether funding has been allotted for the resolution of the specific problem.

Some of the politicians indicated that although much has been done in the area of a drug policy formulation, some new approaches have been attempted; government efforts have been less than effective: “to date, the Ministry of Justice and the Ministry of Interior have not received adequate funding for this purpose, a decision, which we may dearly have to pay for in the years to come”.

One of the interviewed politicians related that a work group has been formed in the Saeima, which has made drug policy questions as its priority: “we all agree that the reason is the lack of a politically unified umbrella policy, a lack of genuine governmental interest”. The work group has met several times, meetings with Twining partners from Spain and Latvia and representatives from the European Drug Monitoring Agency (EMCDDA) have met with active members in Latvia.

It was indicated that within the framework a decision was made to create a Saeima subcommittee, under the auspices of the Social and Health Commission, which would work on researching problems of reproductive health and drug addiction. Such a subcommittee could act as an expression of political will and a step toward an organized approach in the fight against drug abuse. Professional experts would be invited to participate in group meetings; they would discuss and analyze specific situations, and then report to the government that there is such a problem. These are resolutions possible.

In positive recognition of the present government’s efforts in the field of drug policy formulation, the following were presented as positive indicators and the fight against drugs has gained strength: • disclosure of drugs at the border; the first large shipments of heroin, not been possible in previous years, have been detained at the border; • policemen dealing in drugs have been arrested; • several high ranking officials have been replaced.

At the same time, the following statistical data back up the positive indicators: • infection of HIV decreased at the end of last year and the beginning of this year; • deaths resulting from drug overdoses have decreased by half; • the number of patients admitted to acute detoxification units has decreased; • the number of drug users in intensive care and poison units has decreased; • there is also information available, that whows the decreased use of specific drugs, such as heroin; however, at the same time, use of amphetamines and marijuana has increased.

Regarding the role of coordination, regular evaluation, compilation of information, analysis and monitoring in the formulation and realization of a drug policy, all the politicians interviewed expressed the opinion that all of the above are equally important and should be implemented both at the national and local levels. “The problem of drug addiction is very severe. Each year this problem takes a deeper and deeper root and will become more difficult to eradicate”. “The drug problem is a complex problem and complex problems call for complex solutions.”

One of the politicians explained this result by citing the following factor: “Politics reacts to social demands…politicians have no choice but to reflect social opinion. The politicians who disregard social opinion find their political careers threatened, since they have disappointed their electorate”. It is not enough that decision makers recommend more severe punishments. The initiative must come not only from politicians, decisions regarding change must come from society community organizations. People at all levels must be involved in problem resolution, as has been observed in other countries; volunteer organizations have managed to attract pensioners, the lonely and the elderly, thus reaping a double benefit — specific problem resolution takes place and the people involved in the process feel socially significant.

EVALUATION OF INTER-MINISTRY COMMISSION EFFORTS AND THE WORK OF THE DRUG CONTROL COMMISSION

The politicians interviewed expressed a somewhat more positive opinion regarding the efforts of the present government and the 8th Saeima in the area of drug policy formulation.

In evaluating the work of inter-ministry commissions, most of the politicians interviewed noted that their work adequately reflected their competence and expertise.

These commissions are necessary and are capable of 163

Drug abuse prevalence in Latvia

effective work, if they involve knowledgeable experts and qualified, interested ministry officials in the conceptual and the Cabinet of Ministers, for the regulation of a formulation. Otherwise the political efforts of such commissions are ineffective and pointless.

Regarding the evaluation of the Drugs Control Commission’s work, several of the politicians admitted that they were only partially informed about the work of this commission, therefore did not feel qualified to give an objective evaluation. Other politicians were skeptical about the work of the Drugs Control Commission and evaluated its efforts negatively.

DIFFERENTIATED APPROACH

IN PUNISHING DRUG USERS

AND DRUG DEALERS

During the interview, politicians were asked to express their views on whether there should be different degrees of punishment for drug users and drug dealers. All of the politicians agreed that there should be serious differentiation in punishment of drug users and drugs dealers.

As one of the politicians noted, there should be differentiated punishment based on whether the guilty party is a drug user or dealer. Further differentiation in punishments should take into account whether the user is a beginner or a long term user, and whether, in the attempt to acquire drugs, others are involved.

The same politician emphasized that the government and society should understand that young people who simply wanted to try drugs, and punishment for first offenders should be carefully considered, stressing the need for alternative forms of punishment and treatment.

“It has always been that way with young people, everything that friends talk about and do seems interesting and they want to try it. If we attempt to fight the psychology of youth; we would achieve the opposite effect, young people already feel distrust toward government and will follow the path of drug-use anyway.”

The opinion was, however, expressed that more severe punishments cannot be a solution, if existing laws are not enforced. The need for an effective mechanism of enforcement control was mentioned.

One of the politicians, who had previously worked in the legal field, said that he feels that the Criminal Law in Latvia is too harsh. On the one hand, severe punishments are meted out to small time criminals, while bigtime dealers and the like receive relatively mild sentences.

ALTERNATIVE

PUNISHMENT FOR DRUG USERS

All politicians interviewed commented favorably on attempts to find alternative forms of punishment for people who are drug users or addicts. It is interesting to note that several of the politicians, in discussing alternative punishment possibilities, mentioned so called forced medical treatment, especially in the case of teens and young people and this would not be in conflict with their human rights: “it seems, that it is possible to find a reasonable limitation in consideration of human rights, reasonable social interests, and interests of the individual”.

It was noted that this has already been applied abroad; Germany was mentioned as a positive example. A successful program has been established, creating treatment and rehabilitation groups, available to drug users after detoxification and abstinence. If it is ruled in court, that the crime in question was a result of addiction, the decision to send the user to a treatment facility can be made with the agreement of the user.

One of the politicians remarked that Latvia's Law on Treatment has a provision for 'treatment in the place of punishment', but unfortunately this law, which pertains to crimes committed by drug users or addicts, does not work in reality.

Punishment should be relatively more severe in regard to small time dealers, who deal every once in a while, to help eke out their existence. In applying punishment, the length of time and volume of drugs dealt should be taken into account.

Another politician feels that this type of 'treatment in the place of punishment' cannot solve the problem of drug use. It was noted that any type of alternative punishment must be differentiated with the goal of helping the first time users. In cases of 'being caught' the first time, the person already feels shame and guilt and, quite possibly, shock as a result of losing his anonymity. These people should receive treatment rather than imprisonment.

“When a person consciously starts dealing drugs, he should be aware that he has entered the next level — a level where he can, in fact, ruin his life by sitting in prison.

And, if having experienced this himself, he decides to involve someone else, this is moral degradation.”

As far as long term users are concerned, the politicians all felt that alternative forms of punishment are useless. The desired result — returning the person to society — would not be achieved in this case; it would simply be a waste of money.

The politicians all agreed that big time dealers, who are often linked to contraband, should be punished very severely and harshly with concrete minimum prison terms. During the interviews, it was pointed out that drug users cannot free themselves of the addiction, and dealers who take advantage of this situation to turn a profit must be aware of what is at risk. This particular politician noted that society also must be aware of “how deplorable and pathetic such a profit is, and that as a result, countless people have become drug dependent, have wound up in prison, have been infected and have died...”

It must be noted that one politician felt that an institution for specialized treatment would be significant. It is important to make available appropriate medications, professionals, addiction therapists, psychologists and psychiatrists.

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PROGRAMS

DESIGNED TO DECREASE HARMFUL EFFECTS OF DRUG USE

The politicians were asked about their views on syringe exchanges, methadone and other similar programs, and their role in decreasing the harmful effects of drug use.

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

The politicians were of an unanimous opinion that such programs have a definite place in the prevention of and the fight against drug use. Financial support must be found for these programs. Even though some of the politicians claimed to be poorly informed about the specifics of these programs, it was noted that “if it is possible to help a person return to a normal life or at least to protect those around the victim, I view that as positive”.

For example, while discussing the necessity of syringe exchange programs, one of the politicians emphasized the main goal of the program — to protect intravenous drug users from the spread of HIV and AIDS. In a different interview one of the politicians talked about an experiment that had been conducted abroad. During the experiment several thousands of syringes were exchanged at special exchange stations. In spite of the huge number of exchanges, the program did not increase the spread of various diseases and the incidence of various diseases among drug users decreased.

In evaluating the necessity for and the realization of such a program in Latvia, the demands of society must be taken into consideration. Due to the present complicated financial situation in Latvia, many people have a critical attitude toward things like syringe exchanges, methadone treatment programs, cost-free treatment in rehabilitation programs and other similar programs.

NECESSITY OF CENTER

THE

NATIONAL DRUG INFORMATION

The politicians were not in agreement as to the necessity of a national information center, whose function would be to provide the politicians and decision makers the latest and most current information about all aspects of drug problem.

On the one hand, such a center is viewed as a necessity.

It would work with other institutions and centers involved in the field of drug control, drug policy formulation and implementation. The politicians pointed out that often they “only hear complaints”, but there is a shortage of accurate and objective information.

On the other hand, politicians who do not perceive the establishment of such a national center as necessary, argue against the need to financially support such a center “This is not the direction in which the drug control area should invest resources”. It was noted by some, that there is no shortage of information available at present, but the politicians and decision makers who claim that there is a lack of information, quite simply are not interested enough in the problem.

“Politicians must be informed. In addition, by making use of current IT technologies, the Internet and listening to experts on the subject, it is possible to receive a great amount of extensive and detailed information. Of course, if one has the interest and motivation to do so…”

One of the politicians, expressing agreement with the above group, emphasized that during the rule of the 8th Saeima, there are several commissions and subcommissions that provide information about drug policy making:

• • •

the Social Issue and Labor Commission, the Education and Culture Commission, the Health Sub-commission.

OPTIMAL NATIONAL APPROACH

FOR DRUG TREATMENT IN

PRISONS

During the interview, politicians were asked to evaluate the necessity of a national strategy for treatment for drug addict in prisons and to suggest what such a strategy should consist of.

Most of the time, the politicians refrained from making specific characterizations of a strategy for treatment in prisons; it was clear that they rated this as something positive. The politicians were of the opinion that, given the nature of a prison environment with its high concentration of criminals, the resulting antisocial activities, including drug addiction, occur more frequently than on average in society as a whole.

At the same time, doubt was expressed as to the positive social attitude regarding additional funding for the rehabilitation of convicted drug addicts. “People in Latvia are not as poor as they are envious; they are used to criticizing and condemning those people who have been down on their luck.”

“Latvian society is characterized as a victim… people are used to criticizing everything. By contrast, people in the USA are very forgiving; the principle of “give another chance” is in place. Society would agree to give the person, who has become addicted to drugs or who has landed in prison, a second chance to prove himself. It is interesting that precisely this way, many people have become popular…”

In addition, society must be aware, that these people now in prison will once leave the prison. “What is a prisoner?

A product of society, who for a while, was isolated from society. We must think about what will happen when he returns.”

OPTIMAL DRUG

PREVENTION APPROACH

Compiling information regarding politicians' opinions regarding a national drug prevention program, it is clear that the ideal program must combine both centralized and decentralized elements.

It was noted, that a definite and unified control 'from the top' is necessary to oversee the field at the institutional level and to establish a national program. The controlling body could be the Ministry of Welfare or Health. This institution would guarantee that all drug prevention and rehabilitation activities follow unified and proven criteria.

One of the politicians felt that the drug policy and prevention program must be flexible and region-specific, thus providing the opportunity for closer individual contact.

Funding for each division and its activities would also be a centralized function. At the same time it would be necessary to establish a network of regional cooperative institutions, to develop cooperation with NGOs and local governments.

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Drug abuse prevalence in Latvia

ATTITUDE

TOWARD THE TENDENCY TO LEGALIZE SOFT

DRUGS IN

EUROPE

The interviewees were asked to express their opinion about the tendency to legalize soft drugs in Europe.

As a whole, the politicians were critical of the legalization of light drugs in specific European countries, perceiving this act as a sign of “weakness, resulting from the inability to legally fight the use of soft drugs and convicting only criminals using “hard” drugs” and “what people won't do in the name of humanism and human rights!” It was also noted that this is one trend, along with the spread of homosexuality and pedophilia, that Latvia should avoid altogether as it joins the European Union.

One of the politicians noted that legalization of soft drugs is a trend, periodic in nature, in certain European countries. The list of drugs to be legalized tends to grow and decrease periodically. For example, in United Kingdom – legalization of “soft” drugs happens periodically – for a while, they are legal, then again they are illegal, at present they are legal: “At present, they have raised the white flag, because a lot of immigrants have entered England from Africa and Southern Asia with Islam and Moslem traditions. Along with this, England has seen an increase in the use of marijuana, ecstasy and amphetamines. The government cannot stand up to the pressure and is considering legalizing the above mentioned drugs.”

Meanwhile, the Netherlands is reconsidering its ultraliberal approach to the legalization of “soft” drugs and discussions are ongoing about the possibility of repealing legalization legislation.

Since the drug trade, much like the tobacco and alcohol trade, involves huge amounts of money, which can exert extensive social and political influence; the only counter power to this flow of dirty money could be NGOs, various movements, mass media and people themselves.

Sweden was mentioned as a positive example.

Prescriptions are required for drugs, soft drugs were legalized for a short while, but that was followed by a serious increase in drug use. It was specifically non-governmental organizations and parents who succeeded in pressuring the government with the result that Sweden now has the strictest drug policy in all of Europe.

Politicians not as skeptical about the situation had pointed out that legalization of “soft” drugs should not be viewed as the country's inability to cope with the spread of drug use, but rather as a national policy: “It basically is as follows — smoking marijuana is not all that serious, it is better to control it than not to control it!”

It should be noted that the trend to legalize so called soft drugs was directly linked with democracy and radically liberal governmental traditions. It was assumed, that in Latvia, as a new country lacking a strong democratic tradition, society would not accept such notions, thus allowing the illegal drugs market to flourish and fill its coffers legally. The following assumption was expressed in one of the interviews: “It is simply a question of evolution. It is society's opinion that it is not needed. For example, if a certain fraction attempted to legalize soft drugs in Latvia 166

and make them available at the local pharmacy just like other medicines, they would not succeed, because, at the given moment, the opinion of society is against such legalization. But, as I said, it is just a matter of evolution…”

DRUG

POLICY AND ITS REALIZATION

We must admit that politicians, not directly involved with the formulation and realization of a drug policy, are the ones, who most often admitted to being relatively illinformed about activities in this area.

For example, when asked whether they knew about the work of the EU independent agency EMCDDA (European Monitoring Center for Drugs and Drug Abuse), several of the politicians noted that they know the agency. Some politician has indicated that “Drug abuse is a global problem and without cooperative efforts, it would be very difficult to accomplish anything”. It must be added that those politicians who were informed about the activities of the EU agency EMCDDA evaluated the agency positively, pointing out that the countries involved have achieved regular dissemination of information regarding drug abuse and the formulation of a policy to lessen the demand for drugs.

A similar response was given by the politicians when asked whether they knew about the partnership (Twinning) contract signed between Latvia and Spain as part of the PHARE 2000 National program project dealing with the formulation of drug programs in Latvia for 2000–2004. Several of the politicians said they had heard of the partnership project, but were unable to discuss it in any detail.

However, some politicians were not familiar with the EMCDDA work in detail. It was agreed that international cooperation is commendable but that these organizations function in reality rather than exist only 'on paper'. During the interview politicians were asked if they felt adequately informed about EU drugs policy. Several understand Europe’s concern for the destructive nature of drugs and its unified guidelines for the organization of prevention.

However, they admitted they lack information about the Drug Strategy and its implementation plan for 2000–2004 as well as guidelines for the period thereafter, 2004– 2008.

Several indicated they had adequate information on EU drugs policy, due to thei interest on the subject; and that they had participated in pertinent conferences and seminars.

One who claimed to be informed about the Twinning contract between Spain and Latvia as part of the PHARE 2000 National program project 2000–2004, remarked that the Spanish experts could have been performed more professionally, that the program may not be accepted as it stands and will need to be reworked. He was skeptical about the involvement of foreign experts and felt that the money to formulate the program should go to the Latvian experts, who are most aware of the specific situation in their country and would be honest and professional enough to create a viable national drugs program.

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

When asked about the fate of the Latvian Drugs Control and Drug Prevention Strategy for 1999–2003, they indicated that the commission to formulate such a strategy in reality existed only on paper and has never been implemented due to lack of funding for health care, education, social assistance, the legal system, and the war on drugs.

Thus, the Latvian Drugs Control and Drug Prevention Strategy for 1999–2003 was never implemented. In truth, most of the politicians interviewed admitted to knowing nothing about.

REORGANIZATION OF THE DRUG ENFORCEMENT BUREAU Politicians were asked to give their opinion about the reorganization of the Drug Enforcement Bureau and comment on the usefulness and justification of moving the Bureau’s subordination from the Central Criminal Police Board to the Organized Crime Fighting Board.

Opinions vary on the reorganization of the Drug Enforcement Bureau. On the one hand, moving the agency from under the Central Criminal Police Board to another board’s authority can be viewed in a negative light. The political status of the Drug Enforcement Bureau is thus diminished, leaving the impression that fighting drugs is not a priority.

At the same time, the politicians point to the Ministry of the Interior’s: the functions of the Drug Enforcement Bureau are maintained, but since drug abuse is related to organized crime, it is to be included within the structure of the Organized Crime Fighting Board. From this point of view the reorganization could be viewed as a positive move.

On the whole, it was agreed that it is too soon to judge the reorganization, because only the results will either justify or reveal the shortcomings of the reorganization.

THE

NEED FOR

“UMBRELLA”

LEGISLATION ON THE DRUG

PROBLEM

Politicians had some unique opinions on the question of “umbrella” legislation in the area of drugs. This has always been a topic of discussion among politicians, and expert opinions thereon have always been sought.

Though “umbrella” legislation could be useful, politicians agree it would not be productive to invest funding and human resources in drafting such legislation right now.

Theither is there any hard evidence of the value of such legislation from abroad either.

Many admitted that their goal and the goal of their party was not to secure a long political career to 'satisfy the whims of the masses', but rather to devote themselves to long-term social development, including the fight against drug abuse.

Several emphasized that Latvian politicians had developed a Drug policy as far back as the early 1990s. They emphasized this was complicated work that went on for many years. They stress there is currently a need to develop umbrella legislation regarding drugs. However, the first step now is to adopt the Drug Control and Drug Abuse Prevention Program, 2000–2004. Some were

very knowledgeable about the main objectives of this program and its main directions of activity. After the adoption of this Program the next step would be to create a Political Coordination Commission. According to some the representatives from Parliament should be included in this Commission (not just from Government). However, to raise the effectiveness of the Program, everyday work must be completed, planned and implemented by Technical Secretariat created at the State Chancellery.

Some would expect the Secretariat to take over the planning and implementation of the Program, coordinating the various institutions involved. Some stress that the Secretariat should be responsible for collecting information on drugs, coordinating the research and serving as the main monitoring institution on drug-related issues. As regards international cooperation and collaboration with EMCDDA, this would also be task of the Secretariat.

Results of express survey with politicians on drugs METHODOLOGY This part of the study measured attitudes among members of Parliament towards drug policy and their knowledge of drug-related regulations.

Saeima deputies were invited to answer the questionnaire asking about their knowledge, interest and assesment of existing national drug policy.

Deputies were also given the option to answer questions to an interviewer. About 30% of deputies agreed to the interview, while filled-in the questionnaire themselves.

The total number of respondents n=59 (the total number of Parliamentary deputies N=100).

Both men and women agreed to participate, the youngest respondent being 28, the oldest 67 years old; their experience in politics ranged from 1 to 16 years.

We note three types of attitude towards the questionnaire: 1) positive, deputies agreed to participate and have their views on drug policy and related questions after a short introduction about the PHARE project; 2) reserved or even negative at first, but upon further introduction deputies agreed to respond to the questions. Many of these interviews turned to be among the most interesting and valuable.

3) a negative attitude towards the survey, — categorical refusal to speak about drug issues without any further explanation or due to lack of time.

RESULTS Deputies were first asked whether they have expressed interest about issues related to drug abuse, combating drug abuse and drug prevention. All answered this question, and the data show that 45% regularly take interest, 45% sometimes, and 10% have not expressed interest.

Deputies were asked to evaluate governmental activities in conduct of drug policy in Latvia. Only 5% rate positively the work of government on drug issues. 68% view neg167

Drug abuse prevalence in Latvia

atively the work of government, and 27% think the government has done much, however, more attention towards the problem is needed.

Only 10% have ever heard about the National Strategy of Drug Control and Drug Prevention, 1998–2003. 90% had not heard and don’t know whether or not this Strategy was adopted. Those 10% who had heard of the Strategy, rate it as “very weak”, “to theoretical, not for practical activities”. All who knew of the Strategy expressed rather critical attitudes.

Some deputies took the Strategy, 1998–2003 for a coming National Program on Drug Control and Drug Abuse Prevention 2004–2008.

•

•

access to information about EU drug policy. 64% have sufficient access to information about this issue, 27% claim to have no access to these documents. 70% say they need such information, while 11% do not;

•

deputies were asked whether a National Drug Information Center should be established. The center would provide politicians and decision-makers with the sound and evidence based information on all aspects to drug problem. 54% would support the development of such an information center, 9% would not support such a center.

Others (37%) were unable to define their opinion;

•

deputies were asked about the new Umbrella legislation on drugs, taking into account the current situation and EU requirements. 50% agree that a new Umbrella law is needed, 25% think that there is no need for such a law, and 25% have no opinion.

Politicians were asked to list the main positive and negative aspects of existing attempts to combat drug supply and demand.

The most important group of responses relates to the financial aspect of combating the drug problem in general — “insufficient funding can not guarantee real results”.

Some specified spheres which need more funding: prevention, treatment and social rehabilitation of drug addicts, police, customs, law enforcement.

Another group of responses relates to existing legislation — comments include “non-elaborated legislation”; “the drug combat program is not yet adopted”; “punishment for drug dealing is too mild, sometimes even nonexistent” and “abolition of Drug Anforcement Bureau was not the right thing to do”. Some said that “judges have overly liberal attitudes”.

Another large group of responses (almost 50%) stressed the importance of primary prevention and education.

Many emphasized that “it is necessary to change the value system” and “to popularize a healthy life-style”.

A few emphasized the importance of international collaboration in learning about positive experiences in combating drugs abroad.

Some stressed the important role of the mass media in drug prevention.

Only 2 mentioned positive developments and changes in recent years: •

“the Narcology Center has introduced positive changes in coordinating drug-related problems and has become not only a treatment but also a coordination center”;

•

“In recent years several dishonorable policemen have been arrested for participation in drug dealing, several large quantities of drugs have been seized”

Parliamentary deputies were also asked about specific aspects of legislation related to drugs: •

86% believe punishment must be differentiated for drug addicts and drug dealers;

•

75% strongly support alternative punishment (treatment) for persons who have committed crimes and are drug users or addicts. 20% object to alternative punishment;

• 168

86% of deputies support the existence of harm

reduction programs, such as syringe exchange and Methadone programs; drug use is illegal in Latvia. Several countries (like the Netherlands) have changed their legislation concerning ‘soft’ drugs. Deputies were asked about their attitude towards legalization of soft drugs. 93% of deputies were against legalization;

Conclusions In this chapter we traced the opinions of three categories of experts: professionals involved in drug abuse prevention and treatment of problem drug users (addiction therapists, health care professionals and educators); professionals involved in law enforcement (police, prison administrators, judges and prosecutors, customs officers, lawyers) and policymakers (members of Saeima, local government, public administration officials).

Each of the expert groups stressed several aspects of the drug problem and policy.

All the expert groups directly or indirectly emphasized the importance of drug prevention, the necessity of effective treatment and social rehabilitation and integration of drug addicts, prisoners, and the role of legislation and drug policy in reducing both the demand and supply of drugs, and the need for cooperative action by all sides involved.

All experts (prevention, treatment, law enforcement and politicians) mentioned the role of preventive work as the most important. Regarding prevention the majority emphasize the role of indirect prevention among children and youth — stressing the need to organize leisure time (to promote leisure-time alternatives — develop existing infrastructures in culture, recreation, sports, etc.); and the importance of education for young people. Another aspect stressed by the majority is prevention programs at school. However, only prevention experts analyzed the most important problems of prevention work.

Drug prevention programs should be differentiated by age and target group. Currently the majority of drug prevention programs are focused on the general population of schoolchildren (aged 11 to 14). According to prevention

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

experts, the goals of the program are: to provide relevant information about addictive substances and their harmful effects on health; to form attitudes favouring a healthy lifestyle, and influence behaviour toward not using drugs.

Besides the universal prevention programs targeting schoolchildren, some experts have suggested the need for selective prevention for risk group adolescents, and addiction therapists have added a third target group for prevention programs — young people who have begun using drugs and need specifically indicative prevention programs designed to meet their individual needs.

Several groups of experts mentioned that drug prevention at schools is closely linked to general health and family educational programs held in cooperation with the public health system, on smoking and drinking, i.e. the usual predecessors to drug use, as a general indirect measure for the prevention of drug use in Latvia, where the prevalence of smoking and alcoholism is especially high.

The formulation of the most important problems in the drug prevention field shows that prevention activities have reached a certain level of maturity. The most important problems facing prevention programs were formulated as follows: 1. The need to introduce assessment and evaluation of drug prevention activities. Evaluation is seen as a prerequisite for successful work and therefore should be an integral part of a comprehensive prevention approach. The next step — quality criteria for prevention programs should be elaborated, and prevention specialists should develop certification for prevention programs. Besides, there is an urgent need for a coordinating structure which must take responsibility for the distribution of funding, elaboration and development of quality criteria assessment and evaluation of prevention programs.

2. The creation of a national database of successful drug prevention projects is needed, to help monitor drug prevention policy and development of new prevention programs. The Health Promotion Centre has begun a database on those projects receiving state funding through tenders. Experts suggest it is important to expand the database with projects from municipalities, NGOs and various other centres.

All of the experts expressed similar views: there is no real political support for drug policy and prevention. There is also no constructive lobbying in the political arena on the part of practitioners. Drug prevention programs are not a priority: “there are only some individual initiatives, but no focused action”, illustrating the opinion that politicians are interested in drug prevention programs only in the preelection period.

3. The need for research on the real situation regarding drug use among youth is important because “we lack research on the behaviour of young people within the age range of 13–25 years”. Current research is a good starting point towards more detailed drug research in Latvia, which must be followed up and supported in the future.

So far the research gives more of an overall picture, but each aspect of drug problem needs to be studied in detail, and research must be conducted on a regular basis.

Publication of the results in special drug prevention, treatment and rehabilitation-related journals could improve the credibility of the executed research projects and consequently ensure grants for further projects by international or national research funds.

4. Another important prerequisite for successful implementation of prevention programs is better coordination among the different agencies involved in prevention. A coordination committee on drug prevention is a possible way of coordinating activities and their financing. This coordination committee should coordinate collaboration among institutions — state, NGOs, municipalities.

5. The prerequisite for success of drug prevention programs in schools is adequate training for teachers, school social pedagogues and social workers. After training teachers should receive workbooks, manuals, teaching materials, guidelines, etc. for their work in the classroom.

6. Sufficient funding is essential for ensuring systematic, regular and continued training of prevention specialists.

7. the role of parents in prevention work is stressed by almost all experts. So far, there has been a lack of collaboration with parents of adolescents: parents tend not to be involved in discussions on drug use prevention, and participants of focus group discussions did not mention parents as a target group. However, several educators emphasize that collaboration with parents is essential for early drug use treatment.

8. Work with adolescents from risk groups is an issue noted by participants from regional youth centres. They emphasize that young “risk-takers” — recreational and experimental drug users, who are not likely to see themselves as having drug abuse problems but rather to be particularly concerned about concealing their drug use from others. However, there is a particular need to involve them in combined preventive drug education and after school activities; and, if necessary, to involve them in therapy and harm reduction programs. Adolescents from risk groups should have a substitute for lost emotional bonds, and should be counselled often by a trusted adult about avoiding “risks”. They should be given a chance to quit, and not start more risky behaviour. When planning special services, their special age and pattern characteristics should be kept in mind.

Addiction therapists must deal with the consequences of non-successful, ineffective prevention or lack of prevention. In their daily practice they face drug addicts and the bulk of problems related to drugs, both the clinical and social consequences of drug addiction. Drug addiction is a very severe and chronic disease requiring treatment.

This is possible in the case of timely diagnosis, the right treatment methods and appropriate social rehabilitation and integration measures.

Addiction therapists propose several improvements in the field of drug treatment, rehabilitation, prevention and legislation.

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Drug abuse prevalence in Latvia

According to medical doctors, the major problems in the field of drug treatment are related to legislation concerning compulsory treatment of drug clients, criminal punishment of patients and disruption of step-by-step long-term treatment in case of punishment, as well as issues related to patients' anonymity and confidentiality. Addiction therapists stress that lawyers and addiction therapists must collaborate and coordinate their activities when developing legislation in the field of addiction and criminality. The problem of compulsory treatment is widely discussed, and there is still a great variety of viewpoints. So far according to legislation, compulsory treatment could be realized in cases when the court imposes a conditional sentence or the person is released from punishment on the promise to start drug treatment. Addiction patients are non-critical towards themselves and others and they could become a threat to the security and health of others. Therefore these patients must receive compulsory treatment. On the other hand, compulsory treatment is ineffective because it cannot be cured by force. Patients do have the motivation for and understanding of compulsory drug treatment. A young person is not fully developed physically and psychologically until about age 1821; therefore compulsory treatment probably is more effective for them. The question of the functional meaning and legal aspects of compulsory treatment is complicated, therefore the solution must be based on an integrated approach, i.e., with lawyers, medical doctors and social workers working in collaboration. One-sided decisions are usually imperfect and only create new problems. The state must offer treatment rather than penalties. Unfortunately, four weeks of compulsory treatment is too short a time to treat most drug patients. During this period the addiction therapist can at best create a motivation for treatment, but cannot finish the course itself.

Addiction therapists have emphasized that successful treatment of drug addicts is closely related to their social and vocational rehabilitation. They stressed that employment is seen as a prerequisite for successful treatment.

Various groups of experts believe the Methadone program, which allows continuity and a step-by-step return to society, can take regular control over the patient.

However, this method has some negative aspects: it is a very expensive treatment method requiring extensive financial resources, it must be combined with alternative treatments and different social activities, and it is possible that methadone also appears on the “black market”.

Currently the Methadone program is available only in Riga. About 70–80 patients use this program. Several experts admit that the Methadone program should be expanded to include other larger cities. There is no unique attitude towards the methadone program and some experts oppose it and rather suggest putting funding into other progressive methods of treatment, prevention and social rehabilitation.

Experts – addiction therapists admit that fighting drug use and its consequences must be a complex system, combining treatment of the drug addiction, rehabilitation and 170

social rehabilitation, with drug use prevention. This system must be coordinated on a state policy level, exploiting legislation and regulating procedure and sequence of treatment, rehabilitation and social reintegration, and drug use prevention activities. According to experts, there are still many gaps in combating drug use in Latvia.

These gaps could be eliminated if legislation pertaining to drug use and abuse is improved, an adequate financing model is developed for the drug addiction treatment field, new methods are adopted in drug use treatment, rehabilitation and social integration, and drug use prevention and training of addiction therapists is improved. Medical care should be conducted in accordance with the National Drug Addiction Treatment Program that should be adopted by government.

It is essential to cooperate with the healthcare sector in the prevention of HIV and hepatitis, to support treatment and social care for the HIV+ and those living with AIDS. Addiction therapists emphasize that the drug problem can also be found in prison, therefore there is a need to improve conditions for protective and voluntary treatment over the course of imprisonment and to establish departments with elements of a drug-free therapeutic community regime in prison.

Like all other expert groups, addiction therapists indicate that need for regular and sufficient funding as a prerequisite for providing treatment. Shortage of funding puts limitations on the choice of treatment methods and tactics.

Drug treatment practitioners are disappointed with the present distribution of finances among regional medical insurance funds. Each regional medical insurance fund undertakes treatment of a certain number of addicts.

The need for regular long term scientific research in the drug treatment field is also urgent.

Law enforcement experts feel it is vital to create and develop cooperation in formulating a drugs policy. They emphasize that cooperation with addiction therapists, schools and social workers, the relevant ministries and institutions should be improved and institutionalised by establishing a permanent coordination body). Cooperative efforts should be tried from the upper levels of government down to the lowest social strata.

Only a few experts rated positively the cooperation efforts between politicians and professionals, mentioning recent legislative amendments. The majority indicate that cooperation needs to be strengthened because so far it takes place on a strictly theoretical, not a practical level: legislation is in place, but it is not enforced.

The new Latvian Drug Control and Drug Abuse Prevention Programme for 2004–2008 (national drug strategy) is based on a revised previous strategy and on the new drug situation in Latvia, and it is elaborated in line with EU Drug Strategy 2000–2004 and Drug Action Plan 2000-2004. Partly the new strategy has appeared because due to the non-implementation of the previous drug strategy.

Many experts stress the importance of the National Drug Programme and its binding character for all the Ministries

Evaluation of the information and attitudes of the individuals involved in drug demand and supply reducation

involved in its implementation. Legal experts have reported that Spanish experts within the Phare 2000 National programme's twinning project have contributed to the promotion of best practices, and have been the key factor in the development and elaboration of National Drug Programme. The Twinning programme with Spain has played a major role in promoting the adoption of a new structured policy plan and of a central coordination agency. They rate highly the role of EMCDDA in the development of knowledge on EU drugs strategy for 2000–2004, and also the development of the Latvian Drug Programme.

Comparing the different goals of the national drug strategy three large areas can be identified — improving effective implementation and delivery of coordinated actions in the field, providing a realistic approach to illegal drug use and trafficking and reducing problems caused by drugs.

National Drug Strategy includes all the aspects that experts have emphasized — coordination and institutional framework, drug demand reduction (incl. prevention, treatment and social reintegration), drug supply reduction; monitoring (information, research, evaluation), training of specialists, and international cooperation.

Experts have followed the improvements in drug policy and rate themselves as being well informed in the field.

However, they suggest that seminars and workshops for lawyers and other legal experts on the topical issues in drug policy are needed. Specific workshops could be organized, for example, for advocates and judges (e.g. at the Lawyers' League or Judicial Training Centre).

There are several aspects to effectively reducing the demand for drugs and its consequent criminality: the consolidated struggle and coordinated actions against drugs on the European level; creation of a central technical body for co-ordination of activities and approaches and establishing its legal basis, increasing effectiveness of analytical and educational activities; developing collaboration between police and customs.

To plan appropriate funding from the State budget for implementation of drug policy.

Lack of adequate financing for the national drug strategy was the alleged reason for non-implementation of previous policy plans and/ or coordination structures in Latvia.

Another aspect is the need to establish a coordination unit with some executive capacity in terms of management and coordination of the national drug policy and implementation of the national drug programme.

Politicians do not represent a unique opinion on drug issues. There are some issues where the opinions are similar, and some — quite contradictory.

First, majority of the politicians noted that an inter-ministerial commission is needed and capable of effective work only if it involves knowledgeable experts and qualified, interested ministry officials, otherwise the political efforts of such commissions are ineffective and pointless.

Regarding the evaluation of the work of the existing Drugs Control and Drug Abuse Prevention Coordination

Commission, several politicians admitted they were only partially informed about its work; others were sceptical about it, rating its efforts negatively. The politicians were not in agreement as to the need for a national drug information centre, whose function would be to make reliable information on drug situation in Latvia and Europe available to politicians and decision makers. On the one hand, such a centre is viewed as essential. It would work with other institutions and centres involved in the field of drug control, drug policy formulation and implementation. The politicians pointed out that often they 'hear only moans, groans and complaints', but there is a shortage of accurate and objective information. On the other hand, politicians who don't feel the establishment of such a national centre is necessary, argue against it.

“This is not the direction in which the drug control area should invest resources”, they noted. Some feel there is no current shortage of available information, but the politicians and decision makers who claim there is, are simply not interested enough in the problem.

During the interview politicians were asked to evaluate the need for a national approach for drug treatment in prisons and to suggest what such assistance could look like.

Although most politicians refrained from making specific characterizations of a drug treatment program in prison, it was clear that they rated this as positive. The politicians believe that, given the nature of a prison environment with its high concentration of criminals, the resulting antisocial activities, including drug addiction, occur more frequently than on average in society as a whole.

Also, those politicians well informed about the activities of the EU agency EMCDDA rated the agency positively, pointing out that the countries involved have successfully disseminated information regarding drug abuse and the formulation of policy to lessen the demand for drugs.

Several deputies emphasized that Latvian politicians have been developing a national drug policy already since early 1990s. This had been very complicated work for politicians for many years. At present they stress that there is a need to develop umbrella legislation in relation to drugs. However, according to them, the first step now is to adopt the Drug Control and Drug Abuse Prevention Program, 2004–2008. Some politicians were very knowledgeable about the main objectives of this program and its main directions of activity. Before the adoption of this Program, it is essential to create a political Drug Coordination Commission/ Council. According to some deputies, also representatives from Parliament should be included in this Commission (not only from Government).

However, to raise the effectiveness of the Program, the daily work should be performed, planned and implemented by an effective executive body like the Technical Secretariat of the political Coordination Commission/ Council, which ideally would be under supervision of the Prime Minster.

Some expect that the Secretariat will handle such duties as: the planning and implementation of the Program, coordination of various institutions related to anti-drug 171

Drug abuse prevalence in Latvia

efforts. Some politicians stress that the Secretariat should be responsible for collecting information on drugs, to coordinate research and to become the main monitoring institution on drug related issues. International cooperation and collaboration with the EMCDDA would also be the Secretariat's task.

In evaluating the situation in Latvia and the need for an effective drug policy, we conclude that drug policy should include the coordinated work of all parties involved: coor-

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dination and institutional framework, drug demand reduction (including prevention, treatment and social reintegration), drug supply reduction, monitoring (including information and research), training and international cooperation implemented and coordinated on the state level.