First alcohol treatment institutions in today's Czech Republic and Slovak Republic.

OBJECTIVE: Drawing on qualitative analysis of selected historical documents, the paper seeks to provide a definition of the general characteristics of the first institutional alcohol treatment facilities in today's Czech Republic and Slovakia, taking into account the historical context of the first half of the 20th century. An additional aim was to point out the importance of archival research and its contribution to understand the determinants of alcohol-related agenda and alcohol treatment. METHODS: The basic data platform was generated by analysis of historical documents pertaining to the subject matter under study and to institutional processes in different periods. The data was processed using the open coding method (as part of the grounded theory approach) and other specific methods based on the matching of data from scientific and professional literature and archives in different periods. Over 1,100 pages of text from relevant archival materials were analysed. This research is original, no such systematic analysis of historical documents on this subject matter has been conducted on such a scale with the intention of identifying the general correlates of the historical development of an alcohol-related agenda and alcohol treatment. RESULTS: The establishment of the first institutional facilities intended to provide treatment for alcohol dependency was based on the notion of addiction as a disease, which needs to be treated in dedicated facilities applying an individualised approach. The circumstances of the establishment of the facilities under analysis were similar. Their existence was made possible by distinguished personalities rather than a general belief and social pressure that the issue of alcohol addiction should be addressed. This also explains the fact that the occupancy of these facilities never reached their full capacity, that they were not self-reliant in economic terms, and that they did not readily resume their operation after 1945. CONCLUSIONS: The analysis of the establishment, operation, and dissolution of these facilities at the time reveals the discontinuity in the approach to alcohol abuse and its treatment in the context of the historical development and perception of alcohol-related problems in Czech and Slovak society in the first half of the 20th century. Significant social changes occurred after 1948. New legislative instruments were used to enforce treatment based on a principle that was different from the previous approaches. The results of our study also make it possible to reveal the intensity of apparent individual and institutional motives in the process of the development of alcohol treatment in historical terms and its projection into different post-war periods. The understanding of these correlates will help in designing additional trajectories of research into the effects of social and political changes on addiction treatment and thus identifying the intensity of the historical development and its influence on the perception of addiction treatment at present. These findings will also be of great importance for a historical comparative analysis, including overlaps with the development of recent theories, and will support the emergence of new areas of study for the social sciences.

The evolution of addiction treatment and harm reduction programs in Iran: a chaotic response or a synergistic diversity?

BACKGROUNDS AND AIMS: Iran has 2.1 and 1.8% of its 15-64-year-old population living with illicit substance and opioid use disorders, respectively. To address these problems, Iran has been developing a large and multi-modality addiction treatment system, spanning the time before and after the Islamic Revolution. METHODS: Iran's current drug treatment scene is a combination of services, ranging from medical/harm reduction services to punitive/criminal justice programs. Included in this array of services are drop-in centers providing low-threshold harm reduction services, such as distribution of sterile needles and syringes; opioid maintenance treatment clinics providing methadone, buprenorphine and opium tincture; and abstinence-based residential centers. We will review the evolution of this system in four phases. RESULTS: In 1980, Iran's revolutionary government shut down all voluntary treatment programs and replaced them with residential correctional programs. The first shift in the addiction treatment policies came 15 years later after facing the negative consequences. Addiction is viewed as a disease, and new voluntary treatment centers offering non-agonist medications and psychosocial services were established. With an increased number of people who inject drugs and HIV/AIDS epidemics, in the second shift an extensive move towards harm reduction strategies and opioid-maintenance programs has been implemented to reduce HIV-related high-risk behavior. The emergence of a methamphetamine use crisis creating an increased number of socially marginalized addicted people resulted in public and political demands for stricter policies and ended in the third shift starting in 2010, with extended compulsory court-based residential programs. Currently, there is a new shift towards reducing the severity of criminal penalties for drug use/sales and promoting proposals for opium legalization. CONCLUSION: Iran's evolutionary experience in developing a large addiction treatment program in a complex combination of medical/harm reduction and punitive/criminal justice addiction treatment can be examined in its political, clinical and pragmatic context.

[Fragments of the history of healthcare for users of alcohol and other drugs in Brazil: from Justice to Public Health]. / Fragmentos da história da atenção à saúde para usuários de álcool e outras drogas no Brasil: da Justiça à Saúde Pública.

The purpose of this article is to identify, factors that could be associated to the establishment of the country's health policy for users of alcohol and other drugs in 2003. It makes particular use of semi-structured interviews, as well as a study of the literature and documents. The article shows that the Brazilian State's approach to alcohol and drugs emerged in the early 20th century with the creation of a legal and institutional apparatus designed to control the sale and use of drugs, justified by the need to assure public security and public health. This apparatus permitted the development of healthcare practices for drug users based on the penalties it proposed. The article concludes that even though the rationales behind legal and public health measures do not always coincide, some of the practices that emerged in the legal sphere did help provide the conditions needed for the creation of a health policy for alcohol and drug users in Brazil in 2003.

The narcotic clinic in New Orleans, 1919-21.

AIMS: This paper traces the history of the narcotic clinic in New Orleans, Louisiana, comparing its merits to a similar clinic in Shreveport. How do the clinics compare, and why did the Shreveport clinic operate for longer than its New Orleans counterpart? METHODS: Qualitative analysis of contemporary medical journals and newspapers, as well as archival materials from the Narcotic Division. In addition, the records of Louisiana Governor John M. Parker, the papers of Dr Willis P. Butler in Shreveport, as well as the records of the Orleans Parish Medical Society have been utilized. FINDINGS: The narcotic clinic in Shreveport benefited from strong local support, while the New Orleans clinic faced a more vocal opposition. In addition, the Shreveport clinic offered a broad array of services and was a pillar of the community; the New Orleans clinic was newly established and offered fewer services. It was especially the influx of out-of-state addicts that angered many New Orleanians, many of whom witnessed the addicts lined up in the French Quarter. CONCLUSION: The effectiveness of the narcotic clinics in Louisiana (1919-23) was influenced by local opinion. The New Orleans clinic faced a tougher political climate than its counterpart in Shreveport, and therefore proved less resilient in the face of federal opposition.

Coolmine Therapeutic Community, Dublin: a 40-year history of Ireland's first voluntary drug treatment service.

AIM: To document the evolution over 40 years (from 1973 to 2013) of Coolmine Therapeutic Community (Ireland's first voluntary drug treatment service) against a background of broader drug policy developments in the Republic of Ireland and elsewhere during this period. METHODS: Data were gathered by means of archival research within Coolmine, complemented by semi-structured interviews with former clients, current and former Coolmine management and staff, and representatives of outsider stakeholder interests. RESULTS: Coolmines's history has three phases: (1) an early and uncontentious phase, in which external authorities provided financial support for Coolmine without questioning its work practices or outcomes; (2) a middle, controversial phase, in which Coolmine struggled for survival in an external policy environment now dominated by harm reduction strategies; and (3) a final phase in which, through the use of conventional corporate governance, Coolmine management sought to repair its damaged reputation by introducing evidence-based clinical practices. CONCLUSIONS: Coolmine Therapeutic Community was established when drug treatment services in Ireland were in their infancy, and its changing fortunes over subsequent decades reflected changing perceptions of what constitutes appropriate addiction treatment-and in particular the role to be played by former addicts within addiction treatment systems-as well as changing perceptions of funding relationships between statutory authorities and voluntary providers of health and social services.

A brief history and some current dimensions of adolescent treatment in the United States.

Resources for the treatment of adolescent substance use disorders have increased over the past century in tandem with the increased visibility and cultural alarm regarding adolescent substance-related problems. The United States now has a multi-branched and growing system of adolescent treatment services that spans public and private sectors and offers services in both specialty and non-specialty service settings. Most adolescents are entering treatment due to alcohol and/or cannabis-related problems (and, to a lesser degree, other illicit drugs), but present with a wide array of co-occurring problems and obstacles to recovery. Multiple levels of specialized care are available but most adolescents being treated via outpatient counseling. The number and methodological rigor of adolescent treatment outcome studies have increased dramatically in recent years. The findings of these studies suggest the need for earlier systems of problem identification and intervention, a model of sustained recovery support for adolescents presenting with high problem severity and complexity, and sustained interventions with the adolescent's post-treatment family and social environment. In the opening decade of the twenty-first century, the treatment of adolescent substance use disorders is itself maturing into a professionalized and science-guided service arena.

CCCSAPR: a new approach to drug policy research in the twenty-first century. California Collaborative Center for Substance Abuse Policy Research.

The California Collaborative Center for Substance Abuse Policy Research (CCCSAPR) was established in 1997 to provide a nucleus for policy research in addiction and allied fields throughout the nine University of California campuses and allied research endeavors. The primary goal of CCCSAPR is that of providing data on statewide and national substance abuse issues toward the development and maintaining of a coherent substance abuse policy in the state of California. The authors present the history and scope of the Center as a new approach to drug policy research for a new century.

History of the methamphetamine problem.

Methamphetamine, called meth, crystal, or speed, is a central nervous system stimulant that can be injected, smoked, snorted, or ingested orally; prolonged use at high levels results in dependence. Methamphetamine (MA) is a derivative of amphetamine, which was widely prescribed in the 1950s and 1960s as a medication for depression and obesity, reaching a peak of 31 million prescriptions in the United States in 1967. Until the late 1980s, illicit use and manufacture of MA was endemic to California, but the MA user population has recently broadened in nature and in regional distribution, with increased use occurring in midwestern states. An estimated 4.7 million Americans (2.1% of the U.S. population) have tried MA at some time in their lives. Short- and long-term health effects of MA use include stroke, cardiac arrhythmia, stomach cramps, shaking, anxiety, insomnia, paranoia, hallucinations, and structural changes to the brain. Children of MA abusers are at risk of neglect and abuse, and the use of MA by pregnant women can cause growth retardation, premature birth, and developmental disorders in neonates and enduring cognitive deficits in children. MA-related deaths and admissions to hospital emergency rooms are increasing. Although inpatient hospitalization may be indicated to treat severe cases of long-term MA dependence, optimum treatment for MA abusers relies on an intensive outpatient setting with three to five visits per week of comprehensive counseling for at least the first three months. The burgeoning problems of increased MA use must be addressed by adequate treatment programs suitable for a variety of user types.

The origins of commitment for substance abuse in the United States.

Policymakers in the United States have long been perplexed by how to deal with substance abuse. As attitudes shifted in the 19th century toward viewing substance abuse as a medical problem akin to insanity rather than as a moral failing, greater emphasis was given to the potential for treatment. Thus, by the middle of the 19th century, states began developing substance abuse commitment codes and institutions to which substance abusers could be committed. Public ambivalence over whether substance abusers should be seen as having an illness or a weakness of will, however, was reflected in the lack of sustained support for these efforts, in contrast to support accorded systems for commitment of the mentally ill. Contemporary policymakers are faced with the same ambivalence, as they struggle with the extent to which substance abusers ought to be subjected to involuntary treatment. The legacy of the early years of substance abuse commitment lives on.

A recovery story that heals.

It is one thing to talk about intergenerational trauma and substance abuse in general terms, and quite another to get an experiential sense of what it is like for someone dealing with it firsthand. In a profoundly courageous presentation, Mabel Kudralook Smith, who is originally from Barrow, presents her personal story. She takes to heart the notion that to heal, you have to talk about those matters that are causing you pain. Such accounts are healing because they allow the storyteller to pull together a coherent narrative that helps make sense of what she or he has experienced. The narratives often provide a sense of release as the teller is no longer expending energy on keeping personal or family secrets and being ashamed. Such stories are also healing for the audience, because they allow others, through the sharing of experience, to better understand what the speaker has endured and learned. If the listeners have faced similar issues, the narratives can inspire them to embark on or persist in their own similar journies.

Community responses to violence in Holman, Northwest Territory.

When we talk about narrative, we often focus on the story and the teller, but rarely on the listener. Yet often the first step in healing is finding someone who will listen to you and truly hear your story. Alice Kimiksana and others in the Canadian Arctic village of Holman, who are concerned about the community's high suicide rate, understand this basic healing principal very well. They have worked together to create a Help Line­a confidential listening and crisis intervention program­for their community. Kimiksana talks about how in Holman, as in other northern communities, trauma led parents to teach their children not to talk about their pain, their fear, or their abusive experiences, including those that occurred in the residential schools. As a result, even years later, the pain, fear, and hurt can become unbearable, leading sometimes to alcohol and drug abuse, and sometimes to violence toward oneself or others. Educational groups, Healing Circles, and youth groups are starting to help. However, unless there are helpers who will listen when people begin to tell their stories, this first step in healing cannot take place and the cycle of intergenerational trauma will not be broken.

Addiction research centres and the nurturing of creativity: National Drug Dependence Treatment Centre, India--a profile.

The National Drug Dependence Treatment Centre (NDDTC) is a part of the All India Institute of Medical Sciences, a premier autonomous medical university in India. This article provides an account of its origin and its contribution to the field of substance use disorder at the national and international levels. Since its establishment, the NDDTC has played a major role in the development of various replicable models of care, the training of post-graduate students of psychiatry, research, policy development and planning. An assessment of the magnitude of drug abuse in India began in the early 1990s and this was followed by a National Survey on Extent, Patterns and Trends of Drug Abuse in 2004. Several models of clinical care have been developed for population subgroups in diverse settings. The centre played an important role in producing data and resource material which helped to scale up opioid substitution treatment in India. A nationwide database on the profile of patients seeking treatment (Drug Abuse Monitoring System) at government drug treatment centres has also been created. The centre has provided valuable inputs for the Government of India's programme planning. Besides clinical studies, research has also focused on pre-clinical studies. Capacity-building is an important priority, with training curricula and resource material being developed for doctors and paramedical staff. Many of these training programmes are conducted in collaboration with other institutions in the country. The NDDTC has received funding from several national and international organizations for research and scientific meetings, and, most recently (2012), it has been designated as a World Health Organization Collaborating Centre on Substance Abuse.

Contrasting medical models of alcohol problems in Victoria around 1900.

AIMS: This paper examines four specialist medical inebriety institutions in Victoria, Australia between 1870 and 1930, which positioned themselves in distinct ways. It analyses how the treatment in each institution was located within wider medical approaches and contemporary medical ideas and practice. METHODS: Medical journals and texts, newspaper articles, government reports and institutional archives are used in the analysis. FINDINGS AND CONCLUSIONS: Alcohol treatment institutions in the late 19th and early 20th centuries were of several types, differentiated according to treatment approaches and their underlying premises as to the nature of the disease being treated, the particular patient groups for which they catered and their funding models and capacity to take patients committed for treatment under legislation. The institutional types identified in other Anglophone countries in this period can be extended to Australia, with some local variations in the timing of the appearance of the models, the longevity of institutions and gender of patients. In Australia there was no tradition of mutual patient support, as seen at the time in the United States. Each institution represented itself differently, in particular in terms of its particular medical model, although the treatments in practice differed less than in theory. The models employed allowed each institution to position itself in relation to trends in medical theory and practice, in particular to different conceptualizations of the type of disease being treated. Evaluating treatment models for alcohol problems in terms of medical theory and practice of the time can explain contrasting approaches.

Seeing America--diary of a drug-focused study tour made in 1967.

In 1965 the British government was forced to admit that the country had an escalating heroin problem, with the supply coming mainly from prescribing by private practitioners. Within the official responses to what was seen at that time as a very worrying public health situation was the decision to fund the setting-up of the Addiction Research Unit (ARU) at the Institute of Psychiatry, London. The US National Institute of Mental Health (NIMH) generously sponsored a study tour for the nominated director of the ARU shortly before the opening of the British research centre. Extensive contemporaneous diary notes of a visit included contact with administrators, researchers, clinicians, parish priests, narcotic agents and addicts themselves. From a mass of often conflicting advice, some insights could be derived. In particular, these included the need for an awareness of any country's way of dealing with drug problems as a dynamic, multi-factorial total system--a holistic 'national response'. A further conclusion was to see policy itself as a complex subject for analysis: drug policy should be as much an issue for research as drug taking. Besides these broad conclusions, the experience provided many specific leads to development of a British addiction research programme, and fostered professional friendships of immeasurable worth.