KETHEA MOSAICSupporting drug addicted

emigrants: Visible and Invisible

particularities

DIMITRIS GIANNATOSHead of KETHEA MOSAIC Unit

(Cross-cultural Center of KETHEA)

In the Beginning…In the Beginning…

Low rate of approach in therapeutic structures for drug-addiction

emigrants faced difficulties to follow up the therapeutic process.

• Different view in the streets: increase of population of depended

immigrants /refugees with intense and different needs compared to the locals.

KETHEA MOSAICSince 2003…

1. Supporting drug addicted - Harm reduction services - Motivation for drug addiction treatment - Psychological support and relapse

prevention - Counselling for relatives and "important

others“ - Educational activities - Street work activities - Self help groups in prison

KETHEA MOSAICSince 2003…

2. Psychosocial support for emigrants/refugees related to :

- Social intergration problems - Family problems - Drop out from educational process

- Emotional crisis management

- - Adults and juvenile delinquency

Important points…Important points…

• The drug users consist a special group among the emigrants/refugees

• Case of “double exclusion” : drug addiction’s stigma and stigma of being “stranger”

• Apart from the social exclusion, two other facts that increase the percentage of drug addicts (emigrants & refugees), are:

a. The availability of substances and alcohol in the places where they live or spend their time

b. The connection between trafficking and (illegal) market of drugs

Important points…Important points…

• They are a vulnerable population and dependable on trafficking networks or other “groups” : exploitation from co-patriots, lawyers who promise “legalization”, affinity and exchange with delinquent people

• They are a high risk population. They need services of Prevention, Harm Reduction and Therapy.

Supporting the population…

• Essential point : the “integration” of cross-cultural care in the “cultural” system of health Organizations

• Very intensive and “deep” intervention • The information for Mosaic spread among them• New-comers addicted refugees – multilevel needs

– “invisible” population• Emigrant’s Communities are difficult to be

motivated (fear, “stigma”, other priorities, “profits”

expectation, etc)

Supporting the population…

• Many of the emigrants start using drugs after they left their country or they used to do occasional use of drugs without passed to addiction

• The treatment related to the total improvement of life.

• Covering financial needs is or the preparation for a new immigration is the first priority and affect to the therapy perspective and time investment in this process.

• The “paradox” of problem and trauma : addiction and sensitization of health system – services and DIGNITY

Clinical remarks…• Many times, the use of substances and alcohol is

a way of self healing and self empowerment , helping these people to be relieved from the emotional pain and the difficult conditions they experience (uprooting, fear, loss & nostalgia of beloved people, homesick, trauma, uncertain legal status, etc).

• Psychic trauma - three phases : a. difficult conditions before immigration b. traumatic roaming c. relocation in the reception country

Clinical remarks…• Mental dipole : Oblivion – Memory Use of substances = self-healing “Help me to forget - help me to remember

without pain” Various substances and alcohol

• Drug addiction seems to act as a latent effort of incorporation or as an expression of bereavement or as a resistance to the family system after the emigration.

Clinical remarks…• Political asylum seekers – intensive action for

freedom and justice – often weaker motive for therapy- they focus in the change of their political status as solution in the problem.

• Some emigrants want to change without realize the need of therapy - self control, move to other town, find job, medical help from the homeland, etc

• Some structural and cultural issues make the wounds invisible : drug addiction as a medical problem – seeking help from co-patriots leads often in provisional solutions,

Clinical remarks…

• Many drop-outs from motivation process : - Seeking for medical treatment - Deprival syndrome - Language - Cultural differences in the groups ( in

groups with people from many different nationalities)

Clinical remarks…

• Families : - guilt – wounds from their uprooting –

protect the drug user as a weak member of the system – avoid make changes helping the therapy

- Many times, “send” the drug addicted back to homeland

(symbolic correction of trauma)

AND WHAT HELPS ?

• The therapy from drug-addiction seems difficult – but is not unrealistic.

• Trauma has the emotional material for the therapy • «O τρώσας και ιάσεται» (Τηλέφεια τραύματα)• It’s necessary to exist a safe environment, that

pay attention in different needs and respects their cultural differences

• Essential condition of support : The transition ( access – approach – empowerment – motivation).• Efficient in therapy context the interaction with

local culture

Supporting strategies…Supporting strategies…

• Familiar space – Home Familiar space – Home • Multi-ethnic Therapeutic Staff Multi-ethnic Therapeutic Staff • Individual Therapeutic PlanningIndividual Therapeutic Planning• Cross-Cultural approach• Networking Counselling • Cross-cultural education • Volunteers – Interpreters – Cultural Mediators • Welfare networking • Cross-cultural evaluation of treatment reference