Drug Abuse

3. Prevention

In this chapter are reviewed the activities directed to drug use prevention which were done in the country in 2006. The focus will be mainly on:

•    The general prevention at school,
•    Prevention at municipality level,
•    Prevention in the family.

The most popular projects on prevention, which are being implemented in the country, will be shortly described. In the chapter is also presented the selective and indicative work on prevention, done in specific towns in the country.

The frame of the approaches reviewed for the prevention of drug use contains three categories: universal, selective and indicative prevention. Each specific category represents specific target population in respect to the risk of starting drug use, and from this point of view, the level of intensity of the interventional practices. The universal prevention is addressed to three whole groups from the population- national, municipal and school group. The purpose of the universal prevention is to prevent the initiation of drug use. The selective prevention focuses the attention on a more specific part of the population, which is at risk of initiating drug use. An example of selective prevention is the psycho-social assistance rendered to chronically ill people. The indicative prevention is targeted at a group of individuals greatly at risk of becoming drug — addicted, but who still do not meet the criteria of DSM-IV for addiction. Such types of programs demand initial screening to determine the level of risk.

Universal prevention

School

The state educational requirements for educational content are based on the integrated approach to health education. The basic knowledge, skills and aptitudes to be developed in the students are described. The approaches, based solely on the health education, are also limited only to theft impact on the cognitive processes and often lack the particular components of the behavioral training and of the training in social relations. The most important cognitive element, on which prevention can have an effect, is the wrong concept of drug use as something normal and socially acceptable among the population of the same social status. The programs implemented at school environment are already directed to acquiring a large range of skills. Most of them are aimed at introducing into practice life skills training and peer education 25.

In November 2006 the Ministry of Education and Science started a national awareness campaign for the prevention of drug use by minors. For a month the national TV and radio programs in Bulgaria broadcast a clip informing about the social problem and appealing to the public to unite their efforts in preventing the Bulgarian children from the risk of becoming drug addicted. "If you begin, life ends" is the message of the campaign. Apart from the electronic media, the schools also disseminated the message to the adolescent. At schools the Ministry of Education and Science disseminates brochures presenting the problem in terms familiar to the teen-agers.

The project "Social program to prevent drug use at school" has been worked out and implemented by the Trimbos Institute- the Kingdom of Netherlands- whose activity is within the sphere of psychic health and addictions. The project is funded by the MATRAKAR program of the Ministry of Foreign Affairs of the Kingdom of Netherlands.

The project is aimed at working out a clear, effective and consistent social program for the prevention of drug use among students at secondary school and is based on the experience and the standards which have been worked out within the frames of the project "European Schools Promoting Health", funded by the European Committee, and implemented on the territory of the European Union. The main purpose of the project, which was implemented in the period from March 2004 to December 2006, is the introduction of health education curriculum, applicable at the secondary schools in the country, and using the most successful European practices. In the long run the project is aimed at amending the hazardous behaviour of the young people and alerting the public's consciousness on the necessity of turning the school and the territory around it into environment promoting the principles of healthy lifestyle.

The main activity of executing the social program for drug use prevention and promotion of healthy lifestyle among the young people at school level is the implementation of health education curriculum. It is based on the personality-centered approach — the focus on the educational process is directed to the student's personality.

The main point is the social skills training of the students participating in the studies conducted. The social skills training is directed to augmenting the psycho-social skills in a way appropriate to the cultural context and to the level of development of the trainees, contributing to the personal and social development and health and social problem prevention. The interactive method of training is aimed at the active participation of the students in the educational process, and not at the passive acquisition of ready ideas and rules. The individual and group work, discussions, solving cases, role games and debates are the basic methods used within the frames of the health education curriculum. The students from VIII to XII grade are the target group of the program presented.

The main objective of the health education curriculum is for the students to acquire knowledge, to form positive attitude and to acquire skills of healthy lifestyle, to avoid risky behaviour, and to acquire socially adaptive conduct. The health education curriculum includes 36 seminars worked out for the VIII, IX, X and XI grade. It is planned the same number of seminars to be conducted in the XII grade. These 36 seminars are structured in three modules which are the same for all the years - "Personality and Health", "Health and Sexuality", "Drugs-Risky Behaviour".

"Prevention and Anti-Aggression I-V Grade" program uses adapted methods and is addressed to the age group- 7-12 years (I-V grade incl.). It consists of 30 lesson plans for each grade, organized in 30-minute lessons, with detailed instructions for the person conducting the lesson and work sheets for the students. The starting point of the method is to teach the students how to identify and understand their feelings, how to share them and how to express their difficult experiences in a safe way, which does not result in aggression or hazardous behaviour.

The topic of the chemical substances is introduced in a delicate way, again closely related to feelings and behaviour, highlighting the fact that there are substances which change the mood and the specific stages of becoming addicted are illustrated by appropriate age group examples or cases. In this respect the topic is introduced of making decisions and the responsibility of the choice made in relation to cigarette smoking, drinking, drugs, and also the risk on the part of the people around them influencing these decisions- i.e. how to resist the pressure of the group and to run only adequate risk. After the topic of running the risk and the consequences of the hazardous behaviour has been introduced, next comes the topic of the family as something very special and important- the different types of families, difficult family situations, the favourite family occupations and the values cultivated by the family. The last section focuses on improving the self assessment and the self esteem of the students as a strong protective factor for a full-value and healthy lifestyle: perceiving the uniqueness and the strong points every child has- his/her gifts and unique endowments.

The Multi-Module Program, after which work the specialists from the Prevention and Information Center on the Problems of Addiction (PICPA) in the capital is targeted at the following groups: school specialists- pedagogic advisors, teachers, class teachers; nurses; school guards, parents, students from the primary and secondary school. The program is applied in its complete form or in the specific modules depending on the needs of the school and on the specific request. The modules included in the program are as follows: educational and information module for teachers, educational and information module for parents, educational and information module for students from the primary and secondary school, program to train the pedagogic advisors, training module for school health specialists, educational and information module for school guards.

The other program, for whose implementation the PICPA is working now in the capital, dispersing its expert activity in the country as well, is "Prevention of hazardous behaviour after the "Peer Education" approach". The team conducting the training is working with an outer consultant and a trainer who works at the UN Fund for the Bulgarian population. The topics included in the training are: self knowledge; making decisions; confident behaviour; HIV/AIDS; sexually transmitted diseases; unwanted pregnancy; psychoactive substances; training to develop skills for team work.

Community

In 2006 the Regional Councils on Drugs (RCD) with the help of the Prevention and Information Centers implemented activities in accordance with the strategies approved to combat drugs and the yearly plans confirmed as well as in accordance with the decisions made at the respective sittings of the RCD.

The main part of the work of the Prevention and Information Centers consists in organizing different forums of training to increase the awareness of the students, pedagogic advisors, school psychologists, teachers and other professionals 26. Similar types of training have been conducted in Blagoevgrad, Bourgas, Varna, Sofia, Plovdiv, etc. The common goal is to achieve a higher awareness level, broader public impact, initial change of the negative attitude to drug users, to identify and reject the widely spread myths in relation to drugs and drug addictions.

One of the basic emphases in the activities at national level is the  working out of programs  for sport and tourism for the children and youths as an alternative approach in relation to the  behaviour related to use and abuse of psychoactive substances. In 2006 those were:

•    The "Holidays and Sport" Program, conducted with the organized participation of 28 Regional Inspectorates on Education and 46 servicing sections, with 150,000 children included in it.
•    The "Sports Holidays" Program, after which the State Youth and Sports Agency (SYSA) has funded 306 projects from 208 municipalities with a total number of participants 361,000 people.
•    The "Sport for disabled children and for underprivileged children" Program in which 2,080 children from 17 municipalities are included. After the students' sports competitions, organized and conducted for students of special educational needs, in the final competitions 600 children were included in 7 types of sport.
•    Students' Games — joint initiative of the State Youth and Sports Agency, the regional inspectorates on education, the municipal administration and the sports clubs - students from V to XII grade were included. 115,720 students took part in the first stage - 11 % from the total number of students in the country. In the final competitions 516 school teams exercising 9 types of sport with a total number of participants 5,840 were included. In the sports competitions organized for students from the school sports clubs in the regional and final competitions a total of 10,000 children were included for 19 types of sport. A significant part of the activity at regional and local level for the last years is the organizing of competitions, exhibitions, campaigns and happenings. On the occasion of the World Day to Combat Drugs - 26th June-the State Agency for Child Protection (SACP) 27 organized free shows of the film "Addiction" at the Arena cinema for the students from Sofia. This initiative was also spread in the country.

Another frequently used form of activity at regional and local level is the issuing of different types of information and health-educational materials, including:

/    Manuals with policies and positive practices to prevent addictions, meant for institutions, organizations and professionals;
/    Studies;
/    Information bulletins on the activities to prevent addictions, realized by the specific municipalities or containing addresses of offices and services;
/    Translation in Bulgarian of specialized literature on drugs;
/    Fliers for students and parents;
/    Brochures for students and parents;
/    Posters;
/    Stickers.
/    Joint project to work out and disseminate information materials for children and parents in co-operation with the constructing company "Torin-Tonchev and partnership" was carried out during a charity concert "I want to say" in Sofia- State Agency for Child Protection /SACP/.
/    SACP organized the printing of the Message of the Children's Council against Addictions in the students' notebooks at the beginning of the school year 2006- 2007 implemented with the financial assistance of the "Esmeralda Print" company.

Conducting of information and media campaigns is also among the key activities arganized by the municipalities. Here are included:

/    Publishing materials in monthly printed editions, TV and radio, reports in the local media on the problems of addiction;
/    Maintaining website;
/    Conducting press conferences;
/    Carrying out research on the problems of drug use;
/    Setting up and running database on the problems of addictions at local level;
/    On the occasion of 26 June 2006 — The International Day to Combat Addiction in the town of Rousse a rally- concert under the motto "Let us be free, not addicted" was organized by the Rousse Department together with "Healthcare, Social Policy and Sports Activities" Department — the municipality of Rousse, "Education and Youth Activities" Department- the municipality of Rousse, the "Rousse Christmas" Socially Useful Association and by the Prevention and Information Center in the town of Rousse. Children from sports and cultural clubs presented a performance. To all the spectators were given sheets with songs printed on them: "Salvation" by the band B.T.R. and K. Vodenicharov's song "I haven't run away" and the spectators and the audience sang together.

Among the important activities at regional and local level is the establishment of network of specialists at the specific sites, including the maintenance of youth networks.

/    The experts from the SACP in the Plovdiv Department in 2006 conducted a meeting with the members of the NGO "Mothers against Drugs", meetings with the representatives of the Regional Probation Service (RPS) — Plovdiv, the center of Social Rehabilitation and Integration at the municipality of Plovdiv, as well as the Regional Inspectorate of the Ministry of Education and Science, on the topic of addiction prevention in the region of Plovdiv.
/    The experts from SACP in the town of Vratsa conducted in March 2006 a meeting with the Director of the Regional Dispensary of Psychic Health - Vratsa. The options for the future co-operation in the work to prevent addictions were identified. A meeting was also conducted with the secretary of the LCCADMUP and a representative of the Prevention and Information Center at the municipality of Vratsa. In June there was a work meeting to discuss the documentary "Addictions" of the "Bitie" foundation and the manual for work with children with behavioral problems and with minor delinquents. At the meeting were present representatives of the Prevention and Information Center of the problems of addictions in the municipality of Vratsa, and a representative of Regional Inspectorates on Environment and Public Health Preservation and Control /RIEPHPC/ — Vratsa, the regional administration, Child Protection Department /CPD/, Regional Directorate for Social Assistance /RDSA/, the regional probation office, LCCADMUP at the municipality of Vratsa, the Regional Dispensary of Psychic Health with clinic - Vratsa, and the chairpersons of the licensed associations from the SACP "Drugs — and — crime — free life" and St. Mina. On the initiative of the experts from SACP, the department of Vratsa, the film "Addictions" was shown at two comprehensive schools in the town of Vratsa. The film was also shown at the Prevention and Information Center on Addictions at the municipality of Vratsa. Representatives of two other schools and of the Municipal Children's Complex for work with children in the town of Kozlodui expressed their desire to be given the disk with the film.

The data show that probably the most widely spread prevention method in the country remains presenting information on drugs and addictions, especially in the form of brochures, fliers, posters, etc. despite some doubts expressed in the specialized literature [Botvin 1999, 2000] about its usefulness in preventing drug use. The contents of the information materials varies to a great extent - from purely informative and not containing direct messages to formidable and dramatic fliers, illustrating drug use in the darkest plan.

The main target groups are the public, as well as the students and their parents. The reason why this approach is the most widely used is that it is accessible and cheap to apply. It does not necessitate the availability of a trained and prepared team, from which relatively continuous and consistent work is expected. Principally the information should be part of a wholesome and completed approach to prevention, but as a single activity fulfilled it seems inadequate. The good will of the teams applying such methods should not be ignored, but in many cases achieving good results demands compliance with the European and world models of efficacy of the prevention activities. Conducting competitions of drawings, exhibitions, concerts and happenings focuses the public's attention on the problem for a short time only, but all these activities can hardly be considered a serious and consistent approach of prevention.

Nevertheless, in many of the municipalities there begin to develop, still yet as pilot ones, prevention programs containing elements of social studies, building up attitudes, acquiring specific skills for social communication; programs containing recommendations for work with parents and teachers. The topics encompassed in such type of programs include making decisions, coping with particular situations, setting goals and pursuing them, communication and expressing commiseration. Most of them, even in the context of a lesson, use interactive components.

The prevention programs, which are applied in the specific municipalities, are:

„Prevention and anti-aggression I-V grade" - "Index" Foundation under the methodological guidance of the NFPDDA — Sofia, Kyustendil, Kurdzali, Pazardzik, Pernik, Silistra, Sliven. Smolyan, Vratsa, Jambol, Pleven, Bourgas, Blagoevgrad 28 ;

The"Youth in Europe- Program for Prevention of Drug Use" project at the European cities against drugs /ECAD/ — Bourgas, Perushtitsa, Plovdiv, Silistra, Sofia, Varna, Vratsa;

The public program to prevent drug use at school and to promote healthy lifestyle among the young people — 8-12 grade, in Sofia, Blagoevgrad, Varna, Vratsa, Kyustendil, Silistra 28;

Program to organize and train youth leader teams "Give me a hand - peer training" prevention of alcohol use, cigarette smoking, and drug use - Sofia, Bourgas, Plovdiv, Silistra 30;

Project of Care International — the town of Pernik;

Other prevention projects, implemented only in some towns of the country are: Teenagers involved in the prevention of hazardous behaviour" — international prevention project- Bulgaria, France, Italy- the town of Montana; Be aware of the drug addiction — USIS/USA, the town of Plovdiv; - Don't give up MATRA/I<AP program-the town of Plovdiv; Work of the police at school-"Children's Police Academy" — the town of Silistra.

In the town of Bourgas the IV Balkan Conference was held - "Establishing and Development of a Balkan Network to Prevent Drug Use" jointly with the ECAD Project (European Cities against Drugs) 31. Sofia joined the project "Youth in Europe - Program for Prevention of Drug Use". This is a developing program for the prevention of drug use; international project lasting 5 years, aimed at setting Europe free from drugs. The project is being implemented in more than 10 European cities. The aim is to compare strategies of prevention, which are being applied in different European capitals, and to seek the best practices for the prevention of drug use. The honorary patron of the program is the President of Iceland Olafur Ragnar Grimsson. "Actavis Group" is the main sponsor of the project and it will donate for its implementation in Bulgaria EUR 40,000. Several municipalities have expressed their desire to participate in the project.

The project of Care International is directed at increasing the capacity of the non-government organizations, in order to increase their capability to effectively and continuously implement programs for general prevention and early community-based intervention. The experts apply the methods of a quick estimation of the needs and plan implementing the projects of community-based universal prevention and early intervention. It has been highlighted that there is an option for the NGOs to work through networks, to improve their organizational and technical skills, to acquire an enhanced ability of exerting an impact on the policy of reducing drug demand at local, national and regional level.

"Together against the drug" exhibition of the museum of the Ministry of Internal Affairs was inaugurated in 1998 and since then it has worked successfully for ten years now. Besides the information on the effect and consequences of drug use, the combat against the spread of drugs and their precursors in the country are shown, including the international operations. The exhibition has been prepared in collaboration with many institutions and organizations which are of great help to the team of the Ministry of Internal Affairs for the overall representation of the topic - the specialized offices of the Ministry of Internal Affairs, the Ministry of Education and Science, the Metropolitan Inspectorate on Education, The Central Committee for combating anti-social acts of minors and under-aged children, the NFPDDA, the Military Medical Academy, the "N. I. Pirogov" National Institute of Emergency Medicine, "Future for Bulgaria" and "Initiative for Health", "Antidot" Foundations and a lot more.

Up till now the exhibition has been visited by more than 100,000 people (only for 2006 — around 15, 000), mainly students from Sofia and other towns. Up till now there have been worked and exhibited in different settlements of Bulgaria more than 15 copies of the exhibition "Together against the drug" — in Pleven, Pazardzik, Plovdiv, Blagoevgrad, Rousse, Kneza, Jambol, Varna, Kurdzali, Chepelare, Sevlievo (2006). One of the copies is mobile and it has been moved for three years all round the country. The Museum of the Ministry of Internal Affairs is also used as a base to train specialists- students in Pedagogics, students at the Ministry of Internal Affairs School, volunteers, and people working at organizations dealing with the problem (Bulgarian Youth Red Cross, The Metropolitan Center of Drug Addictions, the "Initiative for Health" Foundation, etc.) It is already the sixth year that the "Antidot" Foundation uses the premises of the museum and the specialists to hold monthly seminars for prevention of drug addiction among the students.

Family

The realization of drug use and abuse prevention directed at the family may be discovered in some activities at regional and local level, implemented by the Regional Councils on drugs and the Information and Prevention Centers Established to them. Their main objective is consulting. In this sense there are consulting programs or offices run in Sofia, Rousse, Plovdiv, Gabrovo, Blogoevgra, V. Turnovo, Pleven, Pazardzik, Sliven, Smolyan.
In relation to the parents' needs to learn more about the drug and addiction problem the information brochure 32 has been re-published. It was written in co-operation with "Initiative for Health" foundation, the metropolitan municipal center on addictions and "Free and Democratic Bulgaria" Foundation 33 (see Fig. 3-3). It is aimed at increasing the parents' and teachers' awareness of the problem and at giving them initial knowledge on how to identify drug use and at making a hint how to react in such cases. The information available is the minimal necessary step to limit drug use and to reduce the number of the addicted persons. The program of the three institutions acts through educational meetings at schools between parents and teachers and through publishing and disseminating of the information brochure.

Anyhow it has to be summarized that the work with families is still not well enough developed in the frame of the general, universal prevention, the main factor in the majority of cases remaining the conducting of additional lessons with the parents after programs, Implemented at their children's schools. Running programs for work with the parents and friends of the addicted persons at national and local level is still not adequate.

Selective prevention

The selective prevention is directed to risk groups in respect to drug use. In the following table are marked the towns and the types of activities undertaken in relation to this type of drug use prevention (see Table 3-1).

In the country there are being carried out a number of activities, mainly in the big towns, whose target groups are children and young people with behavioural problems and greatly at risk for drug use,initiation and addiction.

The "Social Assistance" Departments at the Ministry of Labour and Social Policy and the "Child Protection" sections established are bodies pursuing policy to protect children within the frames of the municipality34. In their direct activity the "Child Protection" sections work with children at risk by providing co-operation, information and consultations, by assisting the children and referring them to the social services in the community, etc. This includes providing pedagogic, psychological and legal assistance to the children as well as to the parents or the persons exercising parental authority and financial support under the terms and conditions of the Regulations for Enforcing the Child Protection Act.

The work done by the "Child Protection" sections on the problem of drug use is related to activities of prevention. The social workers initiate or actively participate in holding lectures and discussions meant to prevent addictions among children. The aim of these undertakings is to promote the students' awareness of the noxious effect of drug use, of alcohol and of cigarette smoking and to enhance their knowledge of healthy lifestyle and of sexual education, to inform them about their rights and obligations.

The „Child Protection" sections work in co-operation with other institutions at local level, like Children's Pedagogic Rooms, Regional Healthcare Centers, Regional Education Inspectorates, etc. The "Child Protection" centers are also a welcome partner for the realization of a number of other projects of NGOs, focused on the problem of drug use.

Indicated Prevention

The target group of prevention on indications includes the persons who have already used narcotic drugs but who do not meet the criteria for addiction and problem drug use.
The Central and Local Committees for combating antisocial deeds of minors and under-aged persons (CCCADMUP and LCCADMUP) go on with their work of disseminating information, doing consulting and research activity, working out projects and programs, working with groups at risk, increasing the awareness of the specialists who work with children having committed anti-social deeds, qualifying the specialists from the system of Combating anti-social deeds of minors and under-aged /CASDMUA/, training in skills for detecting risk factors, hazardous behaviour, risk groups and how to work with them, working with parents to make them aware of this problem as well as teaching them how to detect and cope with drug related problems, writing and disseminating informational printed and audio and video materials on this problem 35.

On the request of the Central Committee for CASDMUA, the local committees adopted programs to prevent addictions aimed at implementing prevention activities, including assistance for parents. All the more successfully the LCCADMUP on its own or together with other bodies and NGOs work out projects related above all to the initial prevention, to training of parents and children and to training of peers by peers. The aim of the committees via these programs, projects and concrete activities is to spread knowledge to the adolescents of the essence of the problem, of the hazards of drug use, to develop abilities to resist the pressure, to work out and to introduce good practices of prevention.

The main objectives are to enhance the children's knowledge of healthy lifestyle, to work with parents, to improve and expand the co-operation among the institutions at municipal level. In relation to the working out of different activities media campaigns on the problems of drugs are organized and carried out and also biking campaigns, competitions, etc. Some important points from the work are discussing real cases, game strategies and training, achieving confidential communication through associative links, cultivating habits — assistance, readiness for change, a system of activities for the students' leisure time.
The committees also direct their work at making research to clarify the reasons for and the motives for drug use so that they can help to estimate the extent of prevalence and the types of drug use among the students and the attitudes of the different groups to drug use. As a part of their activity the LCCADMUP also publish information materials for parents and children on the problems of drugs.

25 Source: The Ministry of Education and Science

26 Accounts of the Municipal Councils on drugs and the Prevention and Information Centers to them for the year 2006

27 More information on the activities of the Agency: http.//www sacp government. b.g

28 For further information: http.//www index. bg  orgy_

29 For further information: httplfwww.drug,free-school,olal

30 For more information on the work of the Municipal Center for Drug related Prevention and Information in Sofia:

31 For further information refer to: http://www ecad hit.bq/nachalo.php

32 "Guidebook for parents and teachers. What must we know about drugs" "Free and democratic Bulgaria" Foundation, revised and enlarged edition, Sofia, 2003

33 For further information:

34 Source: The Ministry of Labour and Social Policy

35 Source:The Central Committee for combating anti-social deeds of minors and of under-aged persons

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