Introduction

Background

There are two sides to the drug policy in Western Europe. The production, trade and possession of hard drugs are prosecuted by law, but at the same time there are any number of facilities designed to reduce the harm caused by hard drug use. Examples include walk-in centres with special rooms where drugs can be used, public health information, needle exchange services and low threshold facilities for the distribution of maintenance doses of methadone and heroin.

The harm reduction approach is the opposite of the American War on Drugs, an ideology where it is not only the production, trade and possession of drugs that are forbidden, being under the influence of drugs is also punishable. Harm reduction is not focused on abstinence, and is consequently viewed by people involved in the War on Drugs as a threat to their reaching their ultimate goal, which is a drug-free society. In the worst case, harm reduction is discredited by comparing it to the political battle for legalization.

Drug users in Central and Eastern Europe and the New Independent States are confronted every day with the ideology of a drug-free nation. They are viewed as criminals and confronted with a criminal justice system approach. They do not receive adequate care and AIDS is spreading like wildfire.  Development aid organizations such as Medecins sans Frontieres and the Soros Foundations Network are making every effort to introduce harm reduction, but public and official opposition is still very strong, there is sometimes not much experience in working with drug users, and funding is limited.

In most of the cities, steps are taken by outreach workers to promote the interests of drug users. They are drug users who pass on the safe use message on behalf of a harm reduction project, for example by passing out prevention folders, setting up a mobile needle exchange facility and giving training courses The initiators of these programmes feel that harm reduction should be interpreted more broadly than is now the case. Drug-related harm is not necessarily only medical. The quality of life is also threatened by repressive police conduct, the restriction of civil rights, and the exclusion of certain groups from society. The harm reduction project shares this perspective, the perspective of user activists, in many cases, but is not in a position to actively contribute towards political and social changes. In CEE/FSU, harm reduction programs are often so focused on simply finding the resources to keep functioning that they cannot devote the energy needed to instigate political change. So it is only logical that drug users should try to do something to improve the situation themselves. Sometimes they can count on material and other support from the harm reduction project.

Several of the users’ organizations present themselves mainly as self-help organizations. They do not feel the harm reduction projects are providing the necessary emotional and psychological support and assistance in coping with drug use. They also have some criticism about the prevention material, which is often formulated by physicians and is not relevant to the world drug users live in. The self-help organizations organize meetings to give drug users an opportunity to get to know each other, and distribute their own brochures about safe drug use. Since it is the aim of the self-help organizations to improve drug users’ quality of life and it is the drug users themselves who take the initiative for this, they are referred to in this manual as users’ organizations.

It is important to note that all the organizations mentioned in this manual are active in the area of self-help. In addition, some of them make efforts to change the political and social situation.

In the Russian cities Moscow and Omsk for example, the groups focus on a complete range of activities to promote their own interests, including outreach work for prevention, self-help projects, launching a social and political debate, and rehabilitation activities. The organizations in Vilnius,  Lithuania and Sofia, Bulgaria are following their example, but are still mainly focused on outreach work and self-help activities. To a much larger extent, the same holds true for the cities Kislovodsk in Russia, Odessa in the Ukraine, and Koper and Ljubljana in Slovenia. 

Manual

The aim of this manual is to support drug users in their efforts to improve their quality of life, i.e. to reduce the harm caused by drugs and create political and social change. The manual is intended for users who are planning to get organized as well as for users who have already set up their organization.

            This manual provides insight into how drug users manage to get along in society and how they make a collective effort to bring about structural change. This makes the manual interesting for everyone interested in the position and interests of hard drug users in general and hard drug users in Central and Eastern Europe and the New Independent States in particular.

            This manual is recommended reading for all the people who work in harm reduction projects and work towards the empowerment of their clients. The reader’s perspective however is the perspective of the drug user.  

Activities

The information in this manual comes from interviews with the staff at the Dutch National Interest Group of Drug Users and the reports drawn up by them, the seminar in February 2003 in Odessa in the Ukraine, and the written questionnaire survey conducted among the users’ organizations known to the Dutch National Interest Group of Drug Users.

References are made in the manual to the following organizations:

·         Kolodets                          Moscow, Russia

·         IDUMS, the Initiative of Drug Users Mutual Support

Vilnius, Lithuania

·         Hope 01                           Sofia,  Bulgaria

·         Um                                    Koper, Slovenia

·         Open Space                    Odessa, the Ukraine

·         UHO                                 Zagreb, Croatia

·         Mogol                               Omsk, Russia

·         Self-help group Anti AIDS Centre

Poltava, the Ukraine

·         Self-help groups “We” and “Way Out” of CF Charity

Nikolaev, the Ukraine

·         Self-help group Anti AIDS Centre

Voronezh, Russia

·         Self-help group AIDS Centre

Kislovodsk, Russia

·         AIDS Fondacija Robert Ljubljana, Slovenia

The numerous practical examples illustrate the theory, which is derived from the following publications:

·         Trautmann, F. & C. Barendregt. The European Peer Support Manual. Peer Support as a Method for AIDS Prevention in Intravenous Drug User Communities. Trimbos Institute. Utrecht, October 1994.

·         Southwell, M. A Guide to Involving & Empowering Drug Users. National Treatment Agency. London, undated.

·         Civil Society Development Foundation Hungary.

NGO Management Training Course, undated.

Reading the manual

The manual consists of three parts:

1)     Mission, vision and aims

2)     Founding an organization

3)     Continuity

As is clear from the titles of the three parts, the manual can be used as a step-by-step course in setting up a special interest organization. However, this does not make the manual any less useful for special interest organizations that are already well on their way. Whenever there is a need for information on specific topics such as fund-raising or the media, you can consult the Contents.

The various sections are not numbered, but they do each start with a cloud or some other symbol.

Unless it is inconvenient for the lay-out, most of the practical examples are in a separate box. To let you know where each example comes from, the name of the city is mentioned. To make the manual easier to read, we do not mention the names of all the users’ organizations, but you can find them by looking at the list of organizations in the Introduction. The references are not included in the text either, they are simply referred to as i, ii or ii, and you can look them up at the back of the manual .

The term harm reduction project is used in this manual to refer to the organizations focused on addiction care, AIDS prevention and public health care. Rather than mentioning each centre by name, this collective term is used to make the manual easier to read.