NAD. Greek crisis: Impact on drug treatment services, research and population. Commentary

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1 NAD Commentary Greek crisis: Impact on drug treatment services, research and population ANNA TSIBOUKLI Whether the effects of the Greek socio-economic crisis can be portrayed as a humanitarian crisis is a much discussed matter in Greece. The numbers can however partly speak for themselves in a country affected by rapidly imposed austerity measures. Reforms should obviously have taken place in Greece at many levels years ago, but the speed and the vigour with which they have been imposed since 2010 have shocked many sectors of life with demands on staff cuts in both the public and the private sector, salary reductions and privatisation of the public health system. According to Eurostat figures (2015), unemployment rates rose from 9.5% in 2009 to 27.3%, and the annual GDP dropped by 26% (World Bank, 2015). Data shows that the percentage of the population living on or below the poverty line has increased from 9% to 25% since The United Nations Children s Fund Unicef (2014) has recently reported that one in three children in Greece live under the poverty line. In 2013, as many as 3,795,100 people were living on less than 60% of the national median income (IOBE, 2015). The number of homeless people has increased rapidly from 7720 to 20,000 (FEANTSA, 2008). Half of this population resides in Athens (Stamatis, 2012). Migration has doubled, and one in five Greeks now live in a family where no one is working. In the context of this general social crisis, perceptions of alcohol and drug problems have shifted. From being a high priority area, alcohol and drug problems have dropped to the bottom of the list of concerns and are not likely to emerge as a priority for either politicians or the public very soon. Some researchers have also cited police reports which suggest that alcohol consumption and drink-driving decreased during the first two years of the crisis (EKTEPN, 2010). Others claim that there is an urgent need to further research the changing patterns of alcohol misuse during Greece s socio-economic crisis (Pomini, Mellos, Paparrigopoulos, & Liappas, 2014). The alcohol industry reported a drop in alcohol sales by 46% during the first four years of recession and has also noted an increased illegal trade of alcohol. At 8.2 million bottles in 2012 alone, illegal sales have led to significant tax losses (IOBE). In any case, the existing services for alcohol misuse continue to remain limited, offering services to 2000 alcohol misusers in 2012 (EKTΠEN, 2014). Along with alcohol use, pathological gambling has also increased, and within the last two years the only helpline available in Greece received more than 2500 calls for help (Parios, 2015). In the area of other drugs, the percentage of mainly heroin abusers is rather stable according to the country report by the European Centre for Monitoring Drugs and Drug Addiction (EMCDDA) /nsad

2 The new government has already announced its priorities in the handling of the humanitarian crisis. These start with providing households with electricity, heating and food, and moving to improve the situation for underfed children and to other sectors of social security, such as unemployment benefits and care of poor pensioners and low-paid workers. Even within the Ministry of Health, where alcohol and drug problems are an area of concern, the recent announcements to cut down the budgets of public hospitals by a further 51% do not leave much room for hope that substance use-related problems will receive political attention. What does seem to be a matter of concern to the media and the public is the consumption of new types of drugs. Shisha, or cocaine of the poor, appeared in the streets of Athens in Also called the crisis drug, shisha is produced in small home labs and is mainly used by young drug users, as it is extremely cheap but also highly contaminated. The Guardian (Smith, 2013) and other international media (including VICE (Miller, 2013), CNN, BBC, Radio3, etc.) have reported on the issue extensively, linking the crisis with shisha and its lethal effects. Further, the UN Annual Report claims that Greece is developing into a cannabis hub and is still one of the main trafficking routes for heroin (International Narcotics Control Board, 2014). Despite calls for more effective and accessible treatment, the treatment has not received much attention. Even before the crisis, alcohol and drug policies served political purposes rather than the actual needs of the drug-using population, and left little room for independence in scientific research, treatment, training and prevention. The development of alcohol services was left to voluntary organisations. As a result, there are now only two small alcohol treatment programmes in Greece, one run by KETHEA in Athens (a therapy centre for dependent individuals) and the other by the Psychiatric Hospital of Thessaloniki. Many alcoholics gather around Alcoholic Anonymous, while others are left with no treatment at all. There seems to be no real political interest in developing alcohol-related programmes. Even though a National Action Plan against Drugs is launched at roughly two-year intervals, the political will to resource and effectively implement is weak. A number of staff in drug treatment, prevention and parole services was made redundant at the beginning of the crisis, while some left the organisations for other reasons. There are no more than 1200 people working in the drug field today. According to the KETHEA annual plan (2014), about one fifth its workforce left the drugs field. One thus can easily assume that accessibility and quality of treatment has actually declined. The services try to respond to the increasing needs of the drug- and alcohol-using population with limited resources and end up having long waiting lists in alcohol and gambling services in particular. Several organisations have sought to balance their finances by turning to philanthropy and alternative sources of funding from private donations and the Solidarity Now organisation. This has assisted in the development of street work programmes funded for two years by Stavros Niarchos Foundation in Greece and dual diagnosis centres financed by EU programmes, but their operation is now at 334

3 stake as the funds are running low and the two-year funding period is expiring. Researchers in Greece had anticipated the effects of the economic crisis on drug policy and strategy as well as the backdrop of legislative reform (Poulopoulos, 2012). Aware of the severe situation, the Pompidou Group experts gathered in Athens in 2013 and agreed on a number of priorities that should receive special attention. They signed the Athens Declaration (Pompidou Group, 2013), calling for attention to be paid to the discriminatory attitudes towards drug users and to the reduced resources. Their recommendations fell on deaf ears. Instead a witch-hunt started against drug-using women in prostitution, illegal immigrants and drug users (Mavroudi, 2013). This was a political choice for a drug control and criminal policy that does not respect human rights. This operation took place just before the 2012 national elections when a group of HIV-positive women detained by the Greek police were forcibly tested for HIV/AIDS, charged with felony, imprisoned and publicly exposed. Their mug shots and personal data were published in the media. This was one of the many violations of human rights. It marked a turning point in government politics, a shift from a supportive social welfare state to promoting social restriction and a state of social control (Poulopoulos, 2014). Other equally hard operations followed, named in accordance with ancient Greek mythology. Xenios Zeus (representing hospitality in ancient Greece) and Thetis (mother of Achilles and creator of the universe) were cover names for operations detaining illegal immigrants in purposely built detention camps. After the new government took office in January 2015, the new Minister of Citizen Protection visited these camps. He was shocked by the living conditions there and promised immediate reforms (Skai, 2015). Even before the crisis, the Greek government never really allocated funds for research in the addiction field. Organisations and young researchers had to find their own resources from other programmes. Research funding was indirectly available through EU-funded projects, but this limited the scope and quality of the projects. Greek organisations had to act as partners rather than as leaders of these projects. Government funding was available only for running the EMCDDA REITOX focal point in Athens that is still in operation. Overall, data sets in Greek substance-related questions are not of very good quality. Researchers and organisations are thus forced to carry out usually small-scale qualitative studies that cannot compete with international research standards. This is especially the case for researchers in social services and drugfree treatment organisations, where funding from sources such as pharmaceutical companies or tobacco and alcohol industries are not accepted for ethical reasons. With no such strings attached, however, there are possibilities to produce real-life data based on genuine research interests, but there are also serious limits for developing innovative ideas and knowledge. The challenges for researchers in Greece are many and will remain so in the coming years. Greek universities have never been interested in developing research and training in the addiction field. The only exception was a postgraduate programme 335

4 that had to close down after only a few years. In practice this left KETHEA as the sole key player for training, research and publications. These included the research journal Exartiseis and the development of a number of short training programmes in collaboration with other institutions mainly from Greece, the United States and the United Kingdom. The trouble is that this policy provides limited opportunities for further development, given the budget cuts, staff shortages and changes in the administration of the organisations. The various organisations, key players, the new government, and drug and alcohol users and their families face many challenges. Limited financial and human resources do not bode well for the further development of research, training and publications. Other sectors seem to be regarded as more important in the field. Policy and legislative reforms, care of human rights, implementation of a new drugs law, prison reforms, the closure of detention camps, the development of services for illegal immigrants and the fight for gender rights are some of the urgent entries on the list of priorities. This is why so many Greeks believe that this is in fact a humanitarian crisis. Anna Tsiboukli, PhD Chartered Psychologist, FBPSs Co-editor, Exartiseis anna@kethea.gr 336

5 References EKTEPN (2010). Annual report on the state of the drugs and alcohol problem. Athens: Greek Documentation and Monitoring Centre for Drugs. EKTEPN (2014). Annual Report: The state of the drugs and alcohol problem in Greece. Athens: EKTEPN Retrieved from pdf Eurostat (2015). Unemployment rate by sex and age groups monthly average, %. Retrieved from eurostat/en/web/products-datasets/-/ UNE_RT_M FEANTSA (2008). Greece National report on homelessness. International Narcotics Control Board (2014). Report Retrieved from AnnualReports/AR2014/English/ AR_2014_E.pdf IOBE [Foundation for Economic & Industrial Research] (2015). The Greek economy, Quarterly Bulletin, No. 78. Retrieved from KETHEA (2014). Annual report. Retrieved from Mavroudi, Z. (2013). Ruins: Chronicle of an HIV witch-hunt. Retrieved from ruins-documentary.com/en Miller, A. (2013). Austerity s drug of choice. VICE, May 16. Retrieved from vice.com/gr/read/austeritys-drug-of-choice v20n5 Parios, A. (2015). Telephone line For psychological support and tele-counseling on gambling: Three years in Operation. Telephoner s Profile and Request. Exartiseis, Vol. 23 (under publication). Pomini, V., Mellos, L., Paparrigopoulos, T., & Liappas, J. (2014). Alcohol misuse in Greece: A 15-year experience from a specialized outpatient service. Psychiatriki, 25(3), Pompidou Group (2013). Declaration on protecting public health by ensuring essential services in drug policy under austerity budgets (Athens Declaration). Retrieved from Pompidou/Source/Documents/Athens- Declaration.pdf Poulopoulos, C. (2012). Economic crisis in Greece: Risks and challenges for drug policy and strategy, Drugs and Alcohol Today, 12(3), org/ / Poulopoulos, C. (2014). Fear, crisis and the breakdown of social cohesion. Athens: Topos. Panousis, Yiannis (2015). Panousis on Amygdaleza: Even the worst racist could bend. Skai, February 15. Retrieved from greece/article/275431/panousis-giaamugdaleza-tha-lugize-ki-o-heiroterosratsistis/ Smith, H. (2013). Greek addicts turn to deadly shisha drug as economic crisis deepens. The Guardian, May 16. Retrieved from may/16/greek-addicts-sisha-drug-crisis Stamatis, G. A. (2012). Homeless in Greece in the current financial crisis. What perspectives? Retrieved from med.uoa.gr/elibrary/13.pdf Unicef Greel National Committee (2014). Unicef Report: Children of. Retrieved from World Bank (2015). Public data. GDP per capita in US$. Retrieved from explore?ds=d5bncppjof8f9_&met_y=ny_ gdp_pcap_cd&idim=country:grc:ita:gbr &hl=el&dl=el 337