Report of the orientation and programme formulation workshop on drug rehabilitation for the countries of the Middle East

Transcription

1 MIDDLE EAST Report of the orientation and programme formulation workshop on drug rehabilitation for the countries of the Middle East Amman, Jordan, November 1989 International Labour Office Geneva United Nations Fund for Drug Abuse Control

2 Copyright International Labour Organisation 1990 Publications of the International Labour Office enjoy copyright under Protocol 2 of the Universal Copyright Convention. Nevertheless, short excerpts from them may be reproduced without authorisation, on condition that the source is indicated. For rights of reproduction or translation, application should be made to the Publications Branch (Rights and Permissions), International Labour Office, CH-1211 Geneva 22, Switzerland. The International Labour Office welcomes such applications. ISBN First published 1990 The designations employed in ILO publications, which are in conformity with United Nations practice, and the presentation of material therein do not imply the expression of any opinion whatsoever on the part of the International Labour Office concerning the legal status of any country, area or territory or of its authorities, or concerning the delimitation of its frontiers. The responsibility for opinions expressed in signed articles, studies and other contributions rests solely with their authors, and publication does not constitute an endorsement by the International Labour Office of the opinions expressed in them. Reference to names of firms and commercial products and processes does not imply their endorsement by the International Labour Office, and any failure to mention a particular firm, commercial product or process is not a sign of disapproval. ILO publications can be obtained through major booksellers or ILO local offices in many countries, or direct from ILO Publications, International Labour Office, CH-1211 Geneva 22, Switzerland. A catalogue or list of new publications will be sent free of charge from the above address. Printed by the International Labour Office, Geneve, Switzerland

3 i PREFACE Drug abuse is a global threat which has no respect for national borders. Statistics on seizures and arrests in both developed and developing countries demonstrate the magnitude of the drug-trafficking problem and indicate the existence of world-wide networks for illicit dealing. Effective measures to address the drug problem as a whole must pursue the double objective of suppressing supply networks and reducing demand for dependence-producing drugs. Significant progress can only be made by implementing a strategy based on a consistent and balanced approach to attacking both sides of the problem simultaneously. Despite the extent of the problem, the facilities for treatment and rehabilitation of drug dependents are quite inadequate in almost every country in the world. There is an urgent need for greater efforts to address the demand side of the problem and to mobilise resources at national, regional and international level. Programmes have to be developed and implemented for prevention, treatment, rehabilitation and social reintegration of drug dependents. The International Labour Organisation (ILO) has an important contribution to make to this field. The International Conference on Drug Abuse and Illicit Trafficking, held in Vienna in June 1987, formulated a declaration and drew up a number of recommendations urging the ILO to assume a leading role in some significant areas of the drug control effort. Accordingly, the Organisation made approaches to governments and to employers' and workers' organisations to solicit assistance in broadening the scope of its traditional activities. In the field of drug abuse control one aspect of the ILO's programme concentrates on disseminating information on developments in rehabilitation and after-care programmes. Information dissemination is reinforced by technical co-operation activities, consultancy services and staff training. It was in this context that a regional workshop was organised in Amman, Jordan, in November 1989 with the purpose of conveying information and raising awareness of the various aspects of rehabilitation and the possibilities of providing rehabilitation services for former drug dependents. The proceedings of the meeting are described in the present report.

4 - iii - CONTENTS Page PREFACE i I. INTRODUCTION Background and objecti ves Outline of official arrangements Programme of the workshop Country papers Lectures Conclusion of the workshop " Acknowledgements 4 II. THE DRUG PROBLEM IN THE MIDDLE EAST General synopsis of country position papers as presented by the participants The Arab Narcoti cs Bureau 7 III. LECTURE PAPERS The global drug scene and its implications The international response Etiology of drug abuse, current trends and risk factors ILO's role and programme Regional situation and trends with comparative analysis of country responses Supply reduction Demand reduction, prevention, treatment, rehabilitation and social rei ntegrati on A model national strategy to combat drug abuse: Policy, legislation, action Drug rehabilitation: Principles, approaches, techniques Social reintegration: Principles, approaches, techniques Programme development: Assessment, policy formulation, legislation, implementation, evaluation Resource mobilisation, staff training and community participation Project formulation 18

5 - iv - Page IV. CONCLUSIONS AND RECOMMENDATIONS Introduction At the national level At the regional level 21 ANNEXES I. International project staff 23 II. List of participants 24 III. Programme of the workshop 28 IV. Documents distributed to participants 30 0

6 I. INTRODUCTION 1.1 Background and objectives The countries of the Middle East are facing a sharp increase in the abuse of drugs and alcohol. The most common drugs of abuse are khat, heroin and cannabis, but the abuse of psychotropic drugs is also rising in the region. In 1987 the Gulf Co-operation Council held its fifth conference of Ministers of Labour and Social Affairs. The topics discussed at the conference included social awareness of the dangers of drug abuse, control of drug trafficking and the design of effective measures to protect the Gulf States from the drug menace. In the Middle East efforts directed at supply reduction have generally received higher priority and more resources than those directed at reducing demand. However, more attention is now being given to demand reduction and in October 1987 a conference was held at Yarmouk University in Jordan to consider the demand side of the drug problem. Demand reduction implies a coherent programme of prevention, treatment, rehabilitation and social reintegration. However, prevention efforts remain sporadic and the necessary continuum of care for recovering addicts is far from realisation. Treatment is provided in isolation from supportive social services and after-care. Rehabilitation, which is the most significant phase in the recovery process, remains the most neglected area of drug control programmes. The design of rehabilitation programmes for ex-drug dependents is an area in which the International Labour Organisation (ILO) has developed competence. As a result the Organisation has received official requests for assistance in programme development from a number of Arab countries of the Middle East. In response to such requests this regional workshop was organised for orientation and programme formulation concerning drug rehabilitation and social reintegration in the countries of the Middle East. The major objectives of the workshop were to: - create among the heads of drug control agencies a greater awareness of the importance and role of drug rehabilitation programmes in national drug abuse control strategies and plans; - formulate guide-lines and recommendations to serve as orientation for the planning of specific drug rehabilitation schemes for action at the national level to reduce recidivism and facilitate social reintegration. 1.2 Outline of official arrangements An agreed project document was signed by the ILO and the United Nations Fund for Drug Abuse Control (UNFDAC) on 3 February 1989, the ILO being designated as the executing agency of UNFDAC. The ILO contribution of US$30,000 was matched by a similar contribution from UNFDAC. In March 1989 the Government of Jordan agreed to host the workshop. Brigadier- General Ghaleb Al-Zoubi, Director of the Anti-Narcotics and Counterfeit Department of the Ministry of the Interior, was designated as the government counterpart responsible for preparing the meeting, in collaboration with the Ministry of Health and Social Development. Captain Adnan M. Fraih of the Anti-Narcotics and Counterfeit Department was nominated as national co-ordinator for the task of preparing the workshop and an inter-ministerial committee was set up to make the necessary arrangements. Dr. Mustafa I. Soueif, Professor and Chairman of the Department of Psychology at the University of Cairo, was invited to act as principal lecturer. He was also requested to prepare guide-lines and questionnaires to assist participants in the preparation of their country papers. Two local lecturers were also nominated. Details of international project staff are given in Annex I.

7 - 2 - The workshop brought together 28 participants and observers representing ten countries of the Middle East and three organisations. The list of participants is given in Annex II. The workshop was held in Amman, Jordan, from 11 to 15 November 1989 and was conducted in Arabic. The title chosen was "Orientation and programme formulation workshop on drug rehabilitation for the countries of the Middle East". 1.3 Programme of the workshop The workshop was formally opened by His Excellency, Mr. Zuhair Malhas, Jordanian Minister of Health and Social Development, who spoke on behalf of His Royal Highness Crown Prince Hassan. The Minister emphasised that the dangers of drug abuse are not confined to one nation or region, but affect the lives of people everywhere. He pointed out that drugs worth US$500 billion are used annually in different countries and he insisted that urgent measures be taken to combat the serious consequences of drug abuse on the health of nations, their social and economic status and even their military and political life. He went on to say that rehabilitation and social reintegration are important components of any plan to address the drug problem. The provision of services requires specialised centres staffed by psychiatrists and social workers trained in the rehabilitation of drug dependents. The Minister concluded by expressing his belief that the workshop would make a significant contribution to the effort to combat the drug problem in the Middle East region. The workshop comprised five days of lectures, country position papers and group discussions. Two brainstorming sessions were held to stimulate the development of new approaches to problems of drug abuse. Five films provided by the United Nations Division of Narcotic Drugs and the ILO were shown during the meeting; demand reduction was the subject of four of the films, while the fifth dealt with reducing supply. In addition, Arabic and English publications on drug abuse and prevention were distributed to participants. Details of the workshop programme are given in Annex III and the publications which were distributed are listed in Annex IV. A statement was then made by Mr. Ghaleb Z. Barakat, Assistant Director-General responsible for ILO activities in the Arab States. He emphasised that international collaboration is essential in the fight against drug abuse and went on to say that the ILO has an important role to play in the field of demand reduction as it relates to the world of work. One area of action is the development of workplace initiatives to prevent and reduce drug abuse, thus contributing to the overall strategy of drug control. A second field of action is to help individuals who have become marginalised through their dependence and who are facing difficulties in their integration into the mainstream of social life. The Organisation is currently engaged in a number of activities in these fields in all regions of the world. The present workshop is the first step in familiarising the Arab countries of the Middle East with the work of the ILO in drug abuse control. The speaker expressed the hope that the discussions during the meeting would result in a clear definition of the role of rehabilitation in drug abuse control and would make participants aware of the ILO contribution to this field. He concluded by wishing the participants a successful week of discussion leading to the formulation of concrete proposals for follow-up action. The final speech of the opening ceremony was given by Brigadier-General Ghaleb Al-Zoubi, Director of the Narcotics Section at the Jordanian Public Security Department. He emphasised that neither Jordan nor any other country could be safe from drug dependence or trafficking unless concerted regional and international efforts are made to combat the danger. The speaker said that heavy penalties are imposed on drug traffickers and abusers in Jordan and he reviewed government measures to deal with the drug problem and to implement pan-arab and international resolutions concerning drugs. Following the speeches at the opening ceremony the chairman and vice-chairman were elected and the principal lecturer was nominated as rapporteur.

8 Country papers Prior to the workshop, questionnaires and guide-lines were issued to participating governments to assist them in preparing their country papers. The material which was presented provided valuable data on the situation in the countries concerned and included information which is not available elsewhere. Chapter II of this report contains a general synopsis of the country papers together with a summary of the position paper given by the representative of the Arab Narcotics Bureau of the Council of Arab Ministers of the Interior. 1.5 Lectures The lectures given during the meeting covered the following subjects, which are listed in the order of the workshop agenda: 1. The global drug scene and its implications 2. The international response 3. Etiology of drug abuse, current trends and risk factors 4. ILO's role and programme 5. Regional situation and trends with comparative analysis of country responses. 6. Supply reduction 7. Demand reduction, prevention, treatment, rehabilitation and social reintegration 8. A model national strategy to combat drug abuse: policy, legislation, action 9. Drug rehabilitation: principles, approaches, techniques 10. Social reintegration: principles, approaches, techniques 11. Programme development: assessment, policy formulation, legislation, implementation, evaluation 12. Resource mobilisation, staff training and community participation 13. Project formulation Summaries of the lecture papers are given in Chapter III of this report. 1.6 Conclusion of the workshop The final session was devoted to drawing conclusions and drafting recommendations. The process was facilitated by the work of a special committee of four participants selected at the initial session of the workshop. The committee was responsible for identifying potential recommendations as they emerged during the discussion sessions; the four members held daily meetings to consider the material and structure it into draft resolutions. During the final plenary session the draft resolutions were debated and 15 recommendations were adopted. These are given in full in Chapter IV. The workshop was officially closed by a brief address given by the ILO representative. During the closing ceremony the participants were given certificates on behalf of the ILO and the Jordanian Ministry of Health and Social Development.

9 Acknowledgements In presenting this report, the Director-General of the ILO wishes to express his appreciation of the generous assistance and co-operation given to the workshop by all officials, authorities and organisations concerned with the work of the project. Special thanks are extended to the staff of the Anti-Narcotics and Counterfeit Department and to the staff of the Jordanian Ministry of Health and Social Development for the work they did in preparing the meeting and for the efforts of their preparatory committee. Deserving special mention is the principal lecturer, who played a central role in workshop activities. His contribution was much appreciated by all participants in the meeting.

10 - 5 - II. THE DRUG PROBLEM IN THE MIDDLE EAST Drug abuse control efforts in the Middle East are faced with every aspect of the menace. They must address all the problems associated with the cultivation of drug-producing plants and the processing and trafficking of substances of abuse, as well as the prevention and treatment of addiction. Some countries already face serious health and social effects as a result of the abuse of drugs and alcohol while others are struggling to prevent the threat from taking hold. 2.1 General synopsis of country position papers as presented by the participants In the People's Democratic Republic of Yemen it is estimated that about 40 per cent of city dwellers and 60 per cent of the rural population in the age group are using khat on a regular basis. All social classes are affected and users spend up to 20 per cent of their income on khat, often depriving their families of basic necessities. The disintegration of family life is one of the most serious social effects of drug use. Attempts to reduce the cultivation of khat have had only limited success so far, as khat is more profitable than alternative crops such as coffee. A Law passed in 1976 restricted the buying and selling of khat, but the problem of abuse continues unabated. Until recently Jordan has been relatively free of drugs, but there are indications that substance abuse is beginning to be a problem. Indicators include the increasing quantities of drugs seized by law enforcement agencies, growing demand for psychoactive pharmaceuticals, rising alcohol consumption and the abuse of solvents among school-boys. This is still on a small scale but is becoming more common. Jordan has facilities for treating 25 drug dependents as in-patients at a special section of the National Centre for Mental Health. There is a recognised need to create a special centre for the care of drug dependents, staffed by a team of physicians, psychiatrists, nurses, social workers and rehabilitation specialists. In 1989 a National Committee was established to co-operate with the Ministry of the Interior in the effort to combat the drug menace and to expand the facilities available for treating drug dependents. As in Jordan the problem of drug abuse in Syria is not really widespread. Only in Aleppo among men aged is the consumption of cannabis, heroin and hashish reaching a worrying level. The real problem in Syria is that, because of its geographical situation, it is a country of transit for drug traffickers from the producing countries to the demand areas. In 1987 a National Committee was established by the provisions of Law No. 271 on the control of narcotic drugs. The Committee, which is part of the Ministry of the Interior, includes representatives from the Ministry of Health and Social Affairs as well as other government departments. It is responsible for addressing the drug problem through an integrated strategy aimed at reducing both supply and demand. A critical problem in Lebanon is that drugs are illegally produced there. Owing to the continuing hostilities it is difficult to control cultivation and production. For the same reason drug abuse is rising and adding to the distress of the population; this is a common phenomenon in areas of armed conflict. The most usual drugs of abuse are opium, morphine, heroin, cocaine, the amphetamines and cannabis. Drug abusers are mostly young men in the age range. Lebanon has a Narcotics Bureau which is responsible for controlling production and trade in drugs and which attempts to suppress illegal activities in the face of almost insurmountable difficulties. Media campaigns are organised to raise public awareness of the dangers of abuse and dependence, but despite such efforts the consumption of drugs continues to rise. In Lebanon the drug problem cannot really be isolated from all the other social effects of war. In the United Arab Emirates the problem of drug abuse is also on the increase, but for less obvious reasons. Over the last decade drug dependence has risen considerably and since 1980 the use of hard drugs has prevailed. In 1985 heroin dependence reached an unprecedented level, particularly among young men. In the United Arab Emirates it is recognised that drug control is the joint responsibility of every sector of the community, including public health authorities and voluntary organisations. Dependence is, at the same time, an offence against

11 - 6 - the law, a medical problem and a social scourge; it cannot therefore be the responsibility of any single agency to plan and implement control measures. A whole range of government authorities and other agencies are being mobilised in the national strategy for prevention and treatment of drug dependence. In Egypt the drug control effort depends mainly upon government action. As early as 1966 the General Administration for Social Defence was set up within the Ministry of Social Welfare. This office is responsible for the development and implementation of projects for the prevention of drug abuse and for the rehabilitation and social reintegration of ex-drug dependents. In 1976 the General Administration for Social Defence began a policy of encouraging and financially supporting the establishment of "social defence clubs", of which there are now 39 scattered over the country. These clubs provide rehabilitation and after-care services for former drug dependents. In 1986 the Government also established a National Council which is responsible for addressing problems of drug dependence and the control of narcotics. In the field of demand reduction a number of non-governmental organisations are also active in Egypt. A National Committee for the fight against drug abuse was also established in Saudi Arabia in As in Egypt the National Committee is mainly active in the field of prevention. Saudi Arabia has a number of medical institutions for the treatment and care of drug dependents where addicts can apply directly for treatment on a voluntary basis. Detoxification may also be made compulsory for addicts who are sentenced by court authorities to an institution for treatment and after-care. After-care is continued for a long period following discharge from the institution. The main drugs of abuse in Saudi Arabia, apart from alcohol, are cannabis and pharmaceutical stimulants and depressants. Recently an illicit market has appeared in heroin and cocaine, but the quantities involved are still very small. The need for vigilance is urgent and obvious. In Oman too the main drugs of abuse are cannabis and mood-modifying pharmaceuticals; opium and heroin are used by some dependents. Figures for drug seizures and arrests over the last few years indicate that the drug problem affects all age groups from early adolescence to old age and that many dependents use a variety of drugs. The problem of heroin addiction reached a peak in the early 1980s in Bahrain, with several reported deaths. In response the drug and alcohol unit of the Ministry of Health Psychiatric Hospital developed a programme of treatment and rehabilitation with supportive follow-up services. The hospital provides for in-patients, out-patients and day-patients. It is the only officially approved centre for the treatment of drug dependents in Bahrain and accepts referrals from all sources, including self-referrals. The approach used is based on a "treatment contract" between the hospital and the patient. Drug abuse in Qatar rose considerably between , but seems to have decreased again during Approximately 60 per cent of the population of Qatar are expatriate workers and drug and alcohol legislation provides for immediate deportation in the case of abuse with a prison sentence and deportation for trafficking. Provision for treatment and rehabilitation is made only for Qatari nationals. In 1989 the Department of Psychiatry at the government-run Hamad Medical Corporation began an out-patient treatment programme for Qatari drug dependents; in-patient detoxification is provided as necessary. A National Mental Health Programme is to be implemented in the near future with the collaboration of the World Health Organisation. The programme is designed to integrate mental health care into the primary and community health sector with emphasis on prevention and education. A national workshop to establish the framework of the programme will be held during An important aspect of the programme is direct and continous interaction in the mental health field with other States of the Gulf Co-operation Council as well as with other Arab countries. It can be seen that the countries of the Middle East cannot depend on national programmes alone to combat the drug problem. Regional and international planning is required to develop integrated programmes for reducing both supply and demand in an effective way. The Arab Narcotics Bureau works to promote drug control in the Arab countries, with programmes designed in such a way as to produce a co-ordinated strategy to combat drug abuse in the region.

12 The Arab Narcotics Bureau The Arab Narcotics Bureau aims at developing co-operation between its member countries in their efforts to combat the drug problem. In 1986 the Council of Arab Ministers of the Interior adopted a unified model Law to be used as a guide by States wishing to amend their legislation or enact new laws on drug-related crime. The Council also adopted and approved an Arab strategy for combating illicit trafficking in narcotics and psychotropic substances. The main objectives of the strategy are as follows: - At national level: the establishment of national councils and special administrations for combating the illicit trade in dependence-producing drugs. - At regional level: the setting up of working groups for the exchange of information, ideas and experience; the organisation of meetings between the relevant national authorities to co-ordinate the activities undertaken to control drug trafficking. - At international level: the adoption of international conventions on the control of trafficking and the use of psychoactive substances; participation in international conferences and meetings on drug control. At national level the Arab strategy emphasises prevention efforts through public awareness campaigns and educational programmes with a bias towards the religious teachings of Islam. The mass media play an important role in disseminating information and influencing public opinion. The media can promote an anti-drug attitude among the population by presenting materials designed for this purpose and by avoiding films and other entertainment that may encourage the use of drugs. The Arab strategy involves the national social services, which can help young people and workers to solve the social or personal problems that may cause them to start taking drugs. It also includes health authorities, which can take steps to tighten surveillance of medical prescriptions for drugs and psychotropic substances and also take action against the misuse of prescriptions. The Arab strategy pays special attention to treatment, rehabilitation and after-care, and encourages the creation of special associations to promote the treatment and rehabilitation of drug dependents. Drug abuse and addiction are seen as part of the general health situation of a country and they should therefore be included in national health programmes. It is considered preferable to create special units for the treatment of drug dependents, rather than to admit them as patients in general or psychiatric hospitals. The special units should be staffed by teams of doctors, psychiatrists and social workers trained to provide the necessary care. Rehabilitation centres are also needed in order to assist ex-drug dependents to resume normal life and to avoid the circumstances which caused them to first begin using drugs. Some countries in the region have now established modern rehabilitation centres for ex-drug dependents and five countries have special treatment facilities. Nine member States run a special anti-narcotics administration, while the other countries have a branch or division of the Ministry of the Interior assigned to drug control. Eleven countries also have a National Council, whose work is mainly in the field of prevention and public awareness. At regional level the General Secretariat of the Council of Arab Ministers of the Interior holds a biennial meeting for the heads of national law enforcement agencies, in addition to annual meetings for lower-level personnel. Drug control at the regional level is mainly directed at the supply side of the problem. The Arab Narcotics Bureau monitors seizures and arrests in the member States and keeps a list of the most dangerous known drug traffickers. The Bureau issues a quarterly bulletin and also publishes regular statistical reports. The statistics indicate that cannabis is the most common drug in the Arab countries, followed by opium and heroin; the use of heroin appears to be on the increase. Only small quantities of cocaine have been seized. Amongst the psychotropic substances (in tablet form) the largest seizures have been of phenethyline, widely known as Captagon. Next in importance is Seconal, then amphetamine and Mandrex. The number of seizures reached a peak in 1982 and has decreased noticeably since that date.

13 - 8 - With regard to international co-operation in the fight against drugs, 16 member States of the Arab Narcotics Bureau have ratified the 1961 Single Convention on Narcotic Drugs and its amended Protocol of 1972, and 13 countries have signed the 1971 Convention on Psychotropic Substances. Five countries so far have ratified the 1988 United Nations Convention on Illicit Traffic in Narcotic Drugs and Psychotropic Substances. The Arab States Members of the Arab League fully support the international efforts to combat the drug problem, which affects both industrialised and developing countries all over the world. In 1987 the Council of Ministers approved a five-year programme of action for the Arab Narcotics Bureau. The programme, which runs from , includes work programmes for the member States, the General Secretariat of the Council and the Arab Security Studies and Training Centre.

14 - 9 - III. LECTURE PAPERS 3.1 The global drug scene and its implications Addiction to drugs and alcohol is one of the gravest social problems of our time. It is a problem which recognises no boundaries of nations or social class. Apart from the human suffering caused by the abuse of drugs there is an incalculable economic burden resulting from the loss of manpower, the need to provide services for prevention, treatment and rehabilitation and the costs of the effort to suppress illicit production and trafficking. The scale of the problem must not be underestimated. It has been calculated that illicit trafficking exceeds the world oil trade in value and is second only to arms dealing in the sums of money involved. Furthermore, there are indications that the supply of dependence-producing drugs has been growing in recent years and that drug abuse among young people is on the increase. The assessment of drug abuse is a complex matter and it is necessary to use a variety of approaches in order to cover the many dimensions of the problem and the various social groups affected. One way of estimating the level of drug abuse among workers is through the analysis of fatal accidents in industry. It is known that per cent of such accidents are associated with drug dependence. Another relevant index of drug abuse among workers is the rate of absenteeism, as it is estimated that drug dependents are absent from work twice as often as non-users. Over a number of years the international community has been working to develop a concerted approach to the drug problem. To be effective policies must be aimed at reducing the production and trafficking of drugs, as well as at demand reduction. Significant progress in this field has been made by the United Nations and its agencies. An international conference organised by the United Nations in 1987 led to the following main conclusions: - the world-wide drug problem cannot be addressed effectively by individual nations; - a simultaneous effort must be made to reduce supply, demand and trafficking and to improve prevention and treatment; - no single group of nations can be considered responsible for the world drug situation; - a vital element in drug control is the political will and commitment of governments to participate actively in programmes requiring international co-operation. The present workshop represents a contribution at regional level towards reducing illicit demand in the Arab countries of the Middle East. 3.2 The international response International co-operation in the field of drug abuse control began in 1909 with the first attempt to limit the transport of narcotic drugs. The early endeavours led to the signing in 1912 of the Hague Convention, the first drug control treaty. A number of treaties have been formulated since that time, including those which serve as the foundation of today's international drug control system. Examples are the 1961 Single Convention on Narcotic Drugs as amended by the 1972 Protocol, and the 1971 Convention on Psychotropic Substances. The United Nations adopted the International Drug Abuse Control Strategy in 1981 and in 1987 organised the International Conference on Drug Abuse and Illicit Trafficking (ICDAIT). The Commission on Narcotic Drugs, established in 1946, is the central policy-making body in the UN system for drug abuse control. The International Narcotics Control Board was established by the 1961 Single Convention to monitor the supply of drugs for medical purposes and to prevent diversion to illicit traffic. There are three units in the UN Secretariat responsible for drug control activities, all based in Vienna. The Division of Narcotic Drugs provides advice and assistance to governments and specialised agencies on the application of drug control treaties and on supply and demand reduction. The International Narcotic Control Board Secretariat serves the Board and carries

15 out its decisions and policies. The United Nations Fund for Drug Abuse Control (UNFDAC) is responsible for funding country programmes on drug abuse control and selected activities and projects of the Division of Narcotic Drugs and UN specialised agencies, WHO, ILO, FAO and UNESCO. UNFDAC is entirely financed by voluntary contributions from member States. A number of UN specialised agencies and programmes carry out drug abuse control activities in their respective fields of competence, often jointly or in co-operation with other agencies. Following is a brief description of some of the main agencies involved. The ILO carries out drug control activities directly related to employment and workers' welfare, through the rehabilitation of recovering addicts and through programmes against drug problems in the workplace. The World Health Organisation (WHO) focuses on treatment and also plays an important role in determining which substances should be brought under international control. The prevention of drug abuse through education and public awareness is central to the activities of the United Nations Educational, Scientific and Cultural Organisation (UNESCO). The International Maritime Organisation, the International Civil Aviation Organisation and the Universal Postal Union are all concerned with controlling the illicit transport of drugs. The Food and Agriculture Organisation (FAO) works to promote crop substitution within the context of integrated rural development. Other agencies involved in combating the many facets of drug abuse are the UN Industrial Development Organisation (UNIDO), the UN Development Programme (UNDP), which is a main executing agency for projects financed by UNFDAC, the UN Children's Fund (UNICEF), the World Food Programme, the UN Regional Institutes for Crime Prevention and Criminal Justice and the UN Regional Economic Commissions. The Under Secretary-General for Political and General Assembly Affairs is responsible for the overall co-ordination of all UN drug control activities. 3.3 Etiology of drug abuse, current trends and risk factors It is recognised nationally as well as internationally that drugs destroy individuals and societies and that the social and economic costs of drug abuse must not be underestimated. Every country today has to face the dangers and take steps to prevent the spread of drug abuse by reducing both supply and demand to the lowest possible level. The basis of a strategy to reduce the demand for drugs must be a clear understanding of the causes and consequences of drug abuse for the individual. Five main reasons for taking drugs have been distinguished in the literature. People take drugs as an escape from worries and tension; in a search for identity and the inner self; as a form of rebellion against society; in response to peer group pressure; as a form of entertainment on social occasions. Drug taking is associated with certain personality types. The addictive personality becomes dependent both physically and psychologically on the drug; the substance of abuse exerts a visible influence on the addict, particularly when the drug is discontinued. The dependent personality needs drugs to cope with the stresses of daily life; dependency is the first stage of addiction and withdrawal causes great distress. The habitual drug taker takes medical drugs or alcohol to achieve mental stability under stress, but does not actually depend on the drugs. Drug taking may lead to death or suicide. It inevitably causes problems of many kinds for the individual concerned, including family and marital problems, difficulties at work, isolation from society and behaviour problems possibly leading to criminality. Health problems also arise, notably general debility resulting from poor nutrition and low resistance to disease. The spread of AIDS is also, of course, linked to intravenous drug taking. Young people need guidance to prevent them from experimenting with drugs. This is particularly the case for those who are living away from the support of their family, having left home to study or to find work. Governments must work together with international agencies to combat drug abuse and to limit the spread of drug taking, particularly among young people.

16 ILP's role and programme The rapid escalation of drug and alcohol abuse is increasingly regarded as a major social problem in many countries. There is growing recognition of the devastating impact of drug and alcohol problems in the workplace and in society at large. Drug and alcohol problems in the workplace lead to sickness, absenteeism, accidents, lower productivity and job losses. The ILO is involved in this field and has an important role in the international fight against drug abuse. This is because it is commonly agreed that workplace initiatives are effective means of preventing and reducing drug problems, thus protecting workers' welfare and promoting enterprise performance. Furthermore, the ability to obtain and hold a job is considered essential in the rehabilitation and social reintegration of recovering addicts. The ILO mandate At its 73rd Session, in 1987, the International Labour Conference adopted a resolution on measures against drug and alcohol abuse in working and social life. The resolution called for ILO action in the following areas: vocational rehabilitation and social reintegration; drug and alcohol problems at the workplace; integration of young people into social and working life. It also called for increased inter-agency collaboration. In the same year the International Conference on Drug Abuse and Illicit Trafficking (ICDAIT) adopted a Declaration expressing the determination of member States to control the drug menace as a matter of urgency. ICDAIT also adopted a Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control, consisting of 35 targets, or practical courses of action, several of which are directly related to ILO areas of competence. These include drug rehabilitation, social reintegration of recovering addicts, and prevention and reduction of drug and alcohol problems in the workplace. In carrying out its mandate the ILO approach focuses both on the community and on the workplace. The ILO's role in the community Within the community, the ILO programme deals with rehabilitation and relapse prevention leading to the social reintegration of the recovering addict. The ILO provides advice and assistance to governments in establishing the rehabilitation component of national strategies to reduce demand. Most of these efforts have been supported by financial inputs from extrabudgetary resources, especially the United Nations Fund for Drug Abuse Control (UNFDAC). The ILO has carried out or is currently implementing drug rehabilitation projects in several countries including Burma, Pakistan, Peru, Thailand and Zimbabwe. Training for rehabilitation staff has also been provided through regional workshops and training courses in Asia, Africa and Latin America. Staff training in fact constitutes the central activity of the ILO drug rehabilitation programme. A three-year ILO/UNDP/ASEAN Training Course for Drug Rehabilitation Professionals has recently been successfully concluded. The ILO has also collaborated closely with the International Council on Alcohol and Addictions by contributing drug rehabilitation curricula, publications, resource persons and lecturers to their training courses in Africa. The ILO role in the workplace With its overall concern for the world of work, safety and welfare of workers as well as productivity and economic development, the ILO has a central role in preventing drug abuse in the workplace. The Organisation has taken a number of initiatives to promote the availability of information on existing programmes and means of developing workplace services around the world. As a first step, a multi-media resource kit, "Responses to drug and alcohol problems in the workplace" was produced and distributed. It was developed in collaboration with WHO and with the assistance of UNFDAC. The kit provides information on the problems of drugs and alcohol in the workplace, the range of available responses, the design and implementation of programmes and data on existing resources.

17 Future directions In January 1989 the Director-General requested headquarters, departments and field offices to mobilise the ILO potential to combat the drug problem, focusing particularly on reducing demand for illicit drugs. The aim is to assist member States to improve basic services, strategies and programmes for recovering addicts. This will be supported by further expanding staff training programmes, promoting regional collaboration and disseminating information on the latest trends and developments. Intensification of the ILO's traditional programme of vocational rehabilitation and social reintegration will make an important contribution to the UN system-wide fight against drug abuse. 3.5 Regional situation and trends with comparative analysis of country responses Prior to the workshop a questionnaire was sent to the participating countries. The information it generated was valuable for the assessment of the drug situation in the seven countries which responded: Bahrain, Egypt, Lebanon, Oman, People's Democratic Republic of Yemen, Qatar and Saudi Arabia. The questions were grouped into four categories, headed "general information", "policy formulation", "policy implementation" and "planning/ administration". Drug abuse assessment refers to the collection and analysis of data on the incidence, prevalence and other characteristics of illicit drug use in a population. Planned and systematic approaches to assessment are necessary because illicit drug use is a complex and continuously changing phenomenon: assessment must therefore cover a broad range of characteristics if effective forms of intervention are to be designed and applied. The characteristics included in the questionnaire created for this study were: the age groups engaged in illicit drug use; the occupation or social status of the users; the drugs, or combinations of drugs, in illicit use. The questionnaire was administered to officials who had been in contact with drug dependents for several years. The respondents were thus able to provide an informed opinion on the situation in their countries. Clearly, no single method or investigative instrument can be reliably used to gather information from all the informed individuals in a community. Different individuals will be informed, or have opinions, about different facets of the phenomenon. Informed opinion may relate particularly to the health field, to education, social services, juvenile delinquency or the criminal justice system. Users of information arising from these different fields must take account of its limitations. Nevertheless, with proper interpretation the opinions of informed individuals can be useful for two principal reasons: they can indicate areas for more systematic and structured research; they can suggest areas for priority action, particularly where resources are scarce or where an immediate response is critical. Five out of the seven respondents stated that their countries suffered from drug-related problems among adolescents, young adults, industrial workers and artisans. The problem among adolescents and young adults was considered to be "serious" or "fairly serious". With regard to the drugs in use, six respondents named alcohol and five mentioned tranquillisers and cannabis. However, poly-drug taking is becoming prevalent in the countries of the study. A high proportion of users suffer from social and health problems associated with drug abuse. With regard to policy development and administration, four respondents stated that epidemiological studies exist in their countries, together with preventive and rehabilitation programmes. It is interesting to note that all the respondents stated that there was enough support in their respective countries for the development of programmes of prevention, treatment, rehabilitation and after-care. 3.6 Supply reduction Drug control activities cover a wide range of fields including legislation, the provision of health and social services and education. The search for effective measures is the main objective of international conferences and seminars but, in spite of the international

18 conventions and protocols that exist today, the drug menace continues to spread and to affect more and more people. This is partly because of the increased mobility of the population generally and the fact that many people are living away from home, without the support of family and friends. Some governments need to take measures to combat the illegal production of drugs while others face the problem of rising consumption. Jordan is in a special situation because it is a country of transit. The drug supply problem arises mainly because Jordan is located between countries of production and countries of consumption. Consumption of drugs is not a serious threat in Jordan: the number of known users of heroin and cocaine is only about 13 per 10,000 and the total number of addicts registered at official clinics is 458, only half of whom are native Jordanians. The control of smuggling is therefore the focus of Jordan's efforts to control drug supply. Opium and its derivatives, cannabis, mood-modifying pharmaceutical drugs and khat are the chief drugs that are smuggled into the country, mainly for transit but partly for consumption. The Anti-Narcotics and Counterfeit Department was set up in 1973 and has been responsible for implementing the Jordanian anti-drug legislation since that date. On 1 April 1988 the Law on Drugs and Psychotropic Substances (Law No. 11) came into force as part of the unified Arab Law on drugs proposed by the Council of Arab Ministers of the Interior. The new Law has two main provisions; it increases the punishment for trafficking and it encourages addicts to accept treatment by exempting them from arrest if they voluntarily report to a clinic. As a result of this Law the number of arrests and seizures has risen appreciably during In addition to its efforts directed at supply reduction the Government has also undertaken a number of public awareness activities aimed at demand reduction. Lectures and meetings are organised in schools and workplaces and publicity campaigns are held in the mass media. As a result of such activities the administration enjoys the co-operation of the public in its efforts to suppress drug trafficking and to reduce both supply and demand. At the international level Jordan fully supports the efforts made to co-ordinate national strategies and to promote full co-operation between all the agencies concerned in the worldwide struggle against drug abuse. 3.7 Demand reduction, prevention, treatment, rehabilitation and social reintegration Demand for psychoactive substances is a complex matter. The two main aspects of the phenomenon which need to be considered are the nature of demand and the function of demand. The "nature of demand" refers to the prevalent patterns of drug consumption in a society, including the frequency, intensity and duration of use. The term "function of demand" refers to the reasons for drug abuse and the kinds of need that are satisfied by drug taking. The relationship between nature and function of demand is not simple. Consumption patterns are determined by the extent to which the function of demand is satisfied; conversely, changes in consumption patterns reflect alterations in the function of demand, i.e. newly emerging motives and purposes. It is clear that programmes for demand reduction must be based on reliable information about who takes which drugs, why and how they take them. An integrated plan for demand reduction has to provide for prevention, treatment, vocational rehabilitation and social reintegration. Prevention: It is often the case that agencies limit their efforts to primary prevention measures in an attempt to eradicate substance abuse by suppressing the supply of illicit drugs, although such an objective is probably unobtainable. Prevention efforts should adopt aims that are realistic and clearly defined. The stated objectives should be precise about the target group(s), the type of drug(s) and the level of accomplishment aimed at. Treatment: The concept of treatment is sometimes equated with detoxification, although detoxification is only a part of the recovery process. Treatment is an interdisciplinary approach involving physiological, psychological, socio-psychological and social dimensions. Effective treatment takes account of the medical and psychological problems of the addict, as well as problems arising from the environment.

19 Rehabilitation: This is the process of helping ex-drug dependents to cope with daily life and share the opportunities which are open to their peers. Re-entry into the normal social fabric, readjustment and independent functioning of recovered alcoholics and former drug dependents is the final goal of rehabilitation. There is considerable overlap between treatment and rehabilitation but the two should not be confused as they refer to different processes. Treatment is directed at the dependence syndrome, whereas rehabilitation is directed at the whole person. Experience shows that when treatment is not followed by rehabilitation then recidivism (or relapse) is likely to occur. Rehabilitation is, therefore, the means of consolidating treatment and it is a waste of resources to provide treatment facilities without rehabilitation. Social reintegration: This term refers to the process of achieving social fitness, i.e. adaptation to the demands of family life, the world of work and the community at large. Ex-addicts need help to achieve this high level of adjustment. In many cases recidivism begins with failure to interact successfully with other people in one or more of these crucial areas but supportive social services can help maintain the social fitness of ex-addicts. In order to provide effective support services it is necessary to offer special training for social workers, psychologists and medical staff working with ex-drug dependents. Social reintegration is vital for stabilising former addicts in their readjustment to a socially acceptable way of life. It should be emphasised that no single type of service can be prescribed; the most suitable type depends on the nature of the community and there remain many possibilities for new developments in this field. 3.8 A model national strategy to combat drug abuse: Policy, legislation, action When planning a national strategy it is essential to take account of socio-cultural factors and to avoid adopting wholesale approaches which have been developed elsewhere without modifying them to suit the local context. Nevertheless, there is a common core of international experience which can serve as a useful base for national planning. The three major components of a national plan are policy, legislation and action. Policy refers to the stated objectives of the plan, which must be clearly defined and realistic. Objectives are clearly defined when they specify the following: the particular drug(s), e.g. heroin or solvents; the method(s) of drug taking, e.g. injection or sniffing; the social group(s), e.g. young adolescent boys or young women who might become pregnant; the target to be reached, e.g. a demand reduction of 10 per cent or 30 per cent. Objectives are realistic when they are adequate to address the problem and are also attainable. Three main factors determine whether objectives can be effectively defined; the first is the availability of relevant information. Data have to be obtained from treatment centres and clinics, from law enforcement agencies and from research surveys. The second condition for the formulation of realistic objectives is the availability of adequate financial resources. It is often the case that drug abuse control has low priority in a government's resource allocation, which means that only modest expenditure can be envisaged. It may be possible to arrange for financial assistance from an international agency. The third factor to be taken into account when setting objectives is the availability of trained manpower. The shortage of professionals qualified in the field of rehabilitating recovering addicts is such that training may be the first requisite of a national strategy. In this area technical assistance can often be provided by an international body such as the UN or ILO. Bilateral or regional co-operation can also be valuable in designing training programmes. It should be emphasised that developing a policy is a continuous process; rigid plan can remain effective for long. no static or Legislation is a powerful means of institutionalising the responsibilities and sanctions provided for in a national policy. Legislation is a part of a national strategy; it is not possible to solve the whole drug problem by law and law enforcement. Continuous policy development, in response to the continuously changing drug situation, requires constant revision of legal provisions, possibly towards a more humanitarian approach. For example, it may be necessary to reconsider the legal status of a drug addict who needs medical and social help, as there is a growing feeling that the addict is a sick person rather than a criminal.

20 It is generally true to say that in the light of modern knowledge of drug abuse there is a need to re-examine existing legislation in order to facilitate a new approach to the problems of drug dependence. Action has to be taken at three levels - national, regional and international. should be complementary and mutually reinforcing. The three At national level the first priority is to establish an information-gathering system to provide reliable data on the drug situation in the country. The second step is to develop a core of specially trained professionals in the medical and social fields. At regional level bodies such as the Arab Narcotics Bureau can facilitate the exchange of information and experience in programme development. Geographical proximity probably means that there is a cultural similarity which enhances the potential for beneficial exchange of experience. At international level agencies such as ILO, WHO and the UN Division of Narcotic Drugs make provision for a variety of technical assistance programmes which are offered to individual countries. Such assistance can be a starting point from which to launch a nationally based effort. Training abroad for key professionals who will pass on their training to other workers can help build up the necessary core of qualified staff to start a national programme. 3.9 Drug rehabilitation: Principles, approaches, techniques An ILO definition of rehabilition is: "The combined and co-ordinated use of educational, social and vocational measures for training or retraining the individual to the highest level of functional ability." Rehabilitation covers a range of services directed at resituating the former drug dependent in the community, especially in the work setting. It should be noted that rehabilitation, by its very nature, has to be initiated, regulated and maintained within the community. It is self-contradictory and self-defeating to plan to rehabilitate ex-addicts in a treatment institution before reintroducing them into society. There is considerable scope for flexibility and innovation in devising vocational rehabilitation programmes, but programme designers should always provide for the following main components. Vocational counselling: providing information and advice to the ex-addict on general work requirements is a necessary first step. Emphasis should be placed on such matters as time-keeping and work discipline. The counsellor discusses with the recovering addict the need to select a suitable job, taking into account the characteristics of the individual concerned and the local labour market. Vocational assessment: a reliable and valid assessment of vocational aptitude is a prerequisite for successful vocational guidance. Aptitude testing has been developed to a high level of sophistication in the Western world, but it must be emphasised that instruments developed in the West are not necessarily valid for other cultures. However, specialists can adapt existing tests within a reasonably short time and can build up a battery of instruments of proven reliability and validity for their national culture. Vocational guidance: information gained through vocational assessment is used to direct the ex-addict towards the most suitable jobs. The counsellor must be familiar with the performance requirements of the jobs available, which means working in close collaboration with local employers. Vocational training: the selection of a suitable job does not mean that vocational resettlement will automatically be accomplished smoothly and directly. Some training or retraining is necessary and the best approach is usually on-the-job training. Being in the actual work situation helps the ex-addict adjust to working life at the same time as he is acquiring the skills necessary for a particular job. A period of on-the-job training should be considered as a favourable reintroduction to productive work. Follow-up: procedures to check on continuation in employment, compliance and progression need to be built into a rehabilitation programme. Continuation refers to attendance at work; an increase in absenteeism is an indication of impending relapse. Compliance refers to