Treatment and Migrant Drug Consumers

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Treatment and Migrant Drug Consumers

• migrant drug users in drug help services and the
  impact on practice
• Andrea Viktoria Kerschl
• SPI Forschung / Mistel gGmbH
• Berlin / Magdeburg

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Database and contents of the presentation

• Interim results of the Quasi Compulsory Treatment
  Europe study, 2002 2005 (qualitative research)
• Expertise on Migration and Addiction of the
  Ministry of Health and Social Security, Germany,
  2002
• Data on migrant drug users in Germany
• Migration specific risks for developing addiction
• Migrants and drug related criminality
• Migrants in drug help services - barriers of
  access from migrants and professionals
• Conclusions and recommendations SPI Forschung
  gGmbH

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Data on migrants in Germany

• About 7.6 Mio. migrants living in Germany
• Groups
• Working migrants from Eastern and Central Europe
• Working migrants from outside Europe (islamic
  culture group)
• Working migrants from former socialistic
  countries (working on contract)
• Migrants, who took refugee from countries with
  economic, political crisis
• migrants youngsters from crisis countries
  (Libanon, Kurdistan, Iran, )
• Resettlers from Russia or Rumania
• Migrants, who came for University studies

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Data on migrants and drug use in Germany

• The extention of licit and illicit drug users in
  the migrant community is estimated about 300.000
  to 400.000 citizens. 125.000 of those are russian
  resettlers.
• In some cities the estimations on migrant illicit
  drug users are about 16,8 (Nürnberg) to 37
  (Frankfurt).
• The average age of foreign drug users is
  significant lower than of German drug users. They
  are also of younger age, when they enter
  treatment services.
• The quota of hepatitis infections in the group of
  resettlers in prison is up to 50.
• 14 of the migrants drug users are infected with
  HIV, compared to 9 of the German users. The
  high morbidity is a consequence of a lack of
  knowledge about disease, drugs and risks
  consumption
• The quota of migrant alledged criminal, (18/25
  years) on drug related crimes (27) is higher,
  than their quota in general population (16).
• The quota of migrants in drug counselling
  services services in Berlin 19 and in the
  general public 13 (1998).
• SPI Forschung gGmbH

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Quasi Compulsory Treatment Europe

• 5h frame Research Programme 2002 2005
• 6 Countries (UK, Switzerland, Austria, Germany,
  Netherlands and Italy) to analyse the relation of
  treatment processes and outcome of for treatment
  convicted clients and voluntary clients in a
  longitudinal research design for about 2 years
• Intake phase 150 clients per country in the
  first 4 weeks of treatment 3 Follow up phases
  every 6 month.
• Qualitative and quantitative methods (expert
  interviews gt judicial and treatment staff, flank
  professionals and clients)
• SPI Forschung gGmbH

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German Intake sample

• Intake 153 clients (29 women 71 men) from
  in-patient and out-patient treatment services
  (91 in patient and 9 out patient services)
• 59 clients convicted to treatment 41 voluntary
  clients 63 of the men and 38 of the women were
  convicted to treatment
• to compare the relation between coerced and
  voluntary clients in the services has been in the
  average at the time of intake about 40 to 60
• SPI Forschung gGmbH

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German Intake sample - migrants

• 79 of the probands were of German and 21 had a
  foreign nationality (mainly Turkish and Eastern
  European nationalities) The convicted clients
  are younger of age, than the German clients
• 62 of the migrants had a judicial sanction for
  treatment, 90 of them were male. (58 of the
  German drug users convicted for compulsory
  treatment 72 of them were male)
• The migrants reported of worse conditions in
  prison compared to German offenders gt high level
  of discrimination in prison
• Migrant clients in prison are rarely informed
  about drug use, delinquent behaviour and
  possibilities of QCT
• SPI Forschung gGmbH

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Migrant specific risks for addiction

• Drug consumption as a way to cope with
  discrimination.
• Lack of integration, education, vocational
  orientation
• Lack of perspectives for professional development
• Drug use as a way to identify
• Loss of protective factors by breaking up the
  traditional familiar stuctures, which support
  positive integration.
• SPI Forschung gGmbH

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Migrant specific risks for addiction

• Attitude that addiction is evil, strong inner and
  societal refusal gt Addiction is a taboo
• To keep up normality as long as possible. Draw
  upon services very late in the addiction history.
  Family supports conciliation. Individual and
  social Resources are bailed
• Discrepancies for women / girls between
  traditional development and Western culture
  conduct risk coping strategies
• Young resettlers do not have a consciousness for
  problematic consumption patterns
• Accumulation of subgroups, cliques, which
  orientate on drug use hinder an integration and
  abstinent development
• SPI Forschung gGmbH

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Barriers of access

• System endogenous barriers intrinsic to the
  system
• Lack of professionalisation on the side of the
  services
• Assumption of prejudices and partiality
• Defense of client because of racism of the major
  society
• Defense of clients, where communication is
  roundabout
• Ethnocentrisms dominating the settings and
  provokes tends to
• misunderstanding by ethnocentric interpretations
• Residence restrictions hinder eligibility or a
  fluent access to rehabilitation
• Complicated prolonged process of judicial
  treatment applications, in case of non permanent
  resident
• Restricted cost compensations hinder free choice
  and access

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Barriers of access

• Culturally/ethnically barriers on a individual /
  social level
• Lack of information about treatment and language
  hindrances
• Recognition not having an addiction problem
• Addiction as a taboo and a concealed problem in
  the families
• Different concept of disease and treatment
• Resentments against psycho social verbal and self
  reflexive methods
• Bearish, wait-and-see-attitude, formal, critical
  mindset.
• Mistrust in intercultural communication
  possibilities
• Discrimination Fearing stigmatization gt fear to
  failure
• Mistrust and fear of judicial consequences

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Barriers of access

• Family constellations have a strong impact on
  treatment
• Extreme bad social chances cut down motivation
  for treatment
• Lack of conceding unjustness. Take treatment like
  imprisonment and accumulate subgroups, cliques
  which hinder access
• Attitude to criminal behaviour and drug use
  formed by earlier experiences
• SPI Forschung gGmbH

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Conclusions

• Communication in the language of origin to value
  up the multi lingual aspect of integration
• Multi cultural teams
• Information about and wider preperation for
  treatment in prison and couselling services
• The need to include the families in the treatment
  process as a relevant factor for abstinent social
  imbeded life
• Awareness of the specific problematic with its
  social, religious and legal implications
  especially on the attitude on health
• Continuity of the treatment staff to enable to
  keep up relations
• Focus on every- day-coping strategies,
  practicability of changes
• SPI Forschung gGmbH

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Conclusions

• Information groups in two languages on health and
  sickness to develop a knowledge and changes of
  the attitude towards disease to enable the
  development of motivation as a basis for social
  stabilisation
• Information groups on infection ways and disease
  gt health behaviour supporting group
• Information groups on knowledge on of addiction
  to develop a wider range on knowledge and
  understanding
• Secundary prevention measures
• SPI Forschung gGmbH

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Thank you for your attention.SPI Forschung gGmbH