Challenges and Opportunities in Drug Demand Reduction (Continued)
Rafael Velasco Fernández
President, Center in Studies on Alcohol and Alcoholism, A.C.
Mexico
The first thing I want to say is that I feel very
fortunate and surely so do you of having been
here, listening to people who know what they’re
talking about. They are conveying their
experience and in some point, really update us
of things on which we all want to know. If you
will allow me, I would just like to stress on the
basis of my own criteria, which I hope you find
useful, something of what was said here by
each of those who spoke before me. Especially
as regards those things that have a certain
impact on our own country.
Mr. Wilson gave us a good and bad piece of
news initially. This has become customary
whenever we speak of drugs. Almost always
when we have piece of good news regarding
some reduction in use and so on, it comes hand
in hand with something which is not all that
good. Mr. Wilson was telling us, and this is
excellent, that adolescents in the United States
and juveniles are consuming less drugs now.
Less illegal drug use. This seems to me to be
excellent news and it has already happened in
other areas, stages of time. And then it goes up
again. But it seems that the reduction now is a
sustained one, which is good news. And we
have to begin to ask ourselves whether it is
because of programs that they have underway
or are providing very good results or whether
there are other factors involved. Probably
there’s a bit of everything that is responsible,
but we would have to research more in depth to
know what is helping to improve things.
The bad news is that more and more young
people are initiating the use of alcohol and
tobacco. So this leads to other questions. All of
the fruitful research that is done brings up new
questions. It provides answers to certain
questions, previous questions, but it opens up
other questions not yet answered. He also said
something that was of great interest to me
regarding the youth groups in the United States,
along the U.S.-Mexico border. He asked that we
have an exchange so that the groups on our
side, on the Mexican side, can get in touch with
them. Well, probably, the funding of our groups,
in spite of what we’ve heard here with our
Secretary of Health giving them the financial
support, is not very similar to the 30 million
dollars being devoted to such programs in the
U.S.
Nevertheless, I believe that establishing links
doesn’t necessarily mean that they have to lend
us some of those 30 million dollars. It means
that we must work together and do things that
will really help to improve the programs that we
have along the border. Mr. Wilson has worked a
great deal in the field of drug-related
delinquency. And it is an excellent thing for me
to have had the opportunity of hearing him
today. Dr. Clark told us about the end product of
treatment as he called it. What happens at the
end of these prevention programs and the
treatment of drug addictions and use. He
reminded us of something that we often forget,
that the treatment of episodes must be cost
effective. And if we don’t do it appropriately, it
will be more costly later on.
Although perhaps not specifically, but Dr. Clark
did speak in favor of assessments and
evaluations. And I’m very pleased because that’s
one of the problems that we have in our
Mexican programs. We have to work towards
assessment. Not a quantitative type of
assessment or evaluation, not the one that has
to do with how many took the courses, how
many supervisors we have to train. But rather
the qualitative assessment of what we have
done. Whether the goals of our programs have
been met, what we expected to do was actually
being done. So, a qualitative type of assessment
is fundamental. And it is being done on the U.S.
side and it’s producing good results and I’m glad
that he stressed this.
He also announced a study to be done on the
best treatment adapted to specific high-risk
groups. He ended by saying that, this is very
interesting because it will provide us with further
news in future that could be useful. What I’m
saying is that luckily we are now undergoing
moments during which programs are being
assessed after 20 or more years that they have
been underway. This discovery which seems to
be a very basic one—that we have to discover
what are the protecting factors and the risk
factors—could seem like a truism, something
very logical that everybody should be aware of.
But if we really don’t know what those risk
factors are and if we don’t identify what the
protective factors are, we cannot really put out
very many protective programs and effective
ones. And here they are undertaking an effort to
continue to assess programs.
He also said something very interesting. He said
detoxification is not treatment. At least not the
comprehensive treatment against addictions and
drug use. Nevertheless it is a very important
part of it. And it must be done.
Fine. I think I should go on to talk about Dr.
Condon. His expression that science is
international is an excellent one, and we all
know it, but we don’t always remember this.
Modern imaging and the images that we have of
drug use and abuse and addictions are
something which is relatively modern and is
increasing in importance to all of us. But it’s very
important that in meetings such as this, and
that’s why I’m saying that we’re fortunate in
having heard so many points of view, it’s very
important that we’re told about basic sciences
and the research that leads to other things, in
terms of prevention for example. And his
expression that drug use is preventable, and
addictions are treatable, is something that we all
have to learn. When we first give a conference
or lecture on subjects such as this, its very
important that everybody listening understand
this, especially in the field of health.
Mr. Condon spoke about risk reduction and
strengthening protective factors, and the idea of
introducing these into the very effective
programs. He also said a very basic truth that
we must all remember: that young people take
drugs in order to feel better and to feel good
about themselves. This is something we must
not neglect or forget when we talk to our young
people about the problems that they have to
face and the reasons why drugs are consumed.
He also clearly told to us about activating the
pleasure circuit as it has been called lately. He
talked about the dopamine effects or dopamine-like
effects. What happens with certain neuro-transmitters
and so on. And I would like to tell
our colleagues who are not physicians or
biologists or bio-chemists, but who view this
problem from the field of social psychology,
anthropology, and who collaborate with other
specialists in the field of drug use and
prevention, to also read this. They also realize
that in principle, addiction is a relationship
between a substance and a living biological
being. It’s fundamental that we know about this,
at least as has to do with the general guidelines
of it, the basics of this relationship.
That’s why his statement that addiction is a
disease of the brain, seems to me an excellent
way of viewing things because in fact the brain
does become ill when it has become used to
consuming these substances. The expression of
this problem goes beyond the purely biological
realm. It has to be something more than just a
brain pathology, although basically that is what
it is. Therefore, treatment must be
comprehensive, and that’s why I think that if we
are talking about a multi-factorial problem, then
the treatment must be comprehensive. And
include all of the factors that have an impact on
the problem when treating.
Haydée Rosovsky stressed the idea of leading
more healthy lifestyles. She led us from the
basic sciences to the psycho-social sciences. We
also must take note of. There are other factors
that we have to research for our young
population, not only those that will lead them to
deviations in behavior. She mentions self-esteem
and other things. She said that in school
and in the community and in the work place and
recreation centers, we must work towards the
self-esteem. And this goes hand in hand with
the idea that is in the minds of many teachers
who view the use of drugs and the appearance
of this use of drugs in the streets. They view
this, not only as an educational challenge but as
a universal failure of education. Many of these
outstanding teachers have said that we have
forgotten and neglected to shape personalities
and have devoted more time to providing
information. It’s a necessary supplement of the
basic sciences of course, this view. And we are
reminded to consider cultural diversity. That
which is implemented in one place is not always
as successful elsewhere. It is true that there are
certain aspects of basic sciences that are valid
without any borders or obstacles anywhere, but
she marked differences between our young
people, their habits and those of other latitudes.
And she almost closed by saying something
which was of great interest to me, which is to
point out that every preventive effort should be
based upon research first and foremost.
Research, not only basic research, but also
social and other types of research that will
provide support is truly useful for our programs.
Dr. Augustine Velez reminds us that we mustn’t
only ask ourselves about our children and
adolescents vis-a-vis drugs, but we should also
wonder about all individuals at all ages,
especially in the workplace. This is extremely
important and he reminded us not all young
people are students. In countries such as ours,
much less so. And, on the other hand, adult
teachers at school, at the workplace, are
sometimes consumers both of legal and illegal,
or licit or illicit, drugs. It’s hazardous for
teachers to take a mistaken approach to that
problem at the schools. And that’s one of the
issues that we have in our country which is that
of truly and really training our teachers
appropriately. This must be said. They are not
being truly well-trained to face up to this
problem. Truly in developing countries we
demand a great deal from teachers. If there’s an
ecological problem, we tell them to talk about
the ecology. If there’s a problem in sexual
education, we introduce sexual education in the
curriculum. If there’s a drug problem, we also
ask them to approach that. And in general
terms, they are not appropriately trained to do
it. I’m pleased that this was brought up here.
We were told about the money that is lost.
Absenteeism. The drop in productivity. And I
would yet add something else that was
somewhat expressed, but cannot be measured.
The moral suffering of the worker, of his or her
family and his co-workers. There’s also a
political issue here at stake, because we have to
try and involve entrepreneurs and businessmen
more, as well as the unions. Dr. Velez talked
about the two strategies: the one that attacks
the already existing problems and the other
policy to prevent problems.
Dr. Bernstein told us that in the United States
many young people work part-time and also full-time.
And that it’s quite fair that we should try
and make sure that their workplace be free of
drugs. We have to sit down and think in Mexico
about the great differences that still separate us
from what is being done in the United States. I
think we still have a long road to cover in terms
of knowledge, of training, and of revision of laws
and regulations. This is what I was taught by
what Mary Bernstein said here about the efforts
undertaken in the United States on this issue.
Drug users, she told us, get ill more often. And
this is a cost that we normally don’t take into
account. They get ill, not only of the things
directly related to their drug use, but they
simply are generally weaker and can therefore
contract illnesses more frequently. And since
they generally are less responsible, they have
more accidents, both in the workplace and
outside the workplace.
She also told us about the law. I hadn’t an
opportunity to jot it all down, but I do
remember that she stressed the aspect of
training, education, policies of zero tolerance.
She said, this is something we really have to
ponder. And timely care. She also mentioned
testing here which is something we have to
work a great deal on in Mexico. I’m not saying
it’s not done. It is done. But the test and the
comparisons of laboratories is a matter that we
have to really study in-depth.
Dr. Melody Heaps stressed the need of linking
the justice system to the health care system or
treatment system. Here again we in Mexico have
a great deal to be done. And what she said was
useful to me: more than anything we should
reflect upon the fact that our preventive
programs should be linked with many other
things and activities. In Mexico we are still not
establishing those links. So, this meeting, I
think, leaves behind good experiences and
learning. Each of those that has spoken, has
spoken on the basis of their own excellent
personal expertise. What they have said must
be translated to each of our countries so that
those of us who work in the areas of prevention
and treatment can really become enriched with
this knowledge here presented. And I repeat, it
was a pleasure to be here today.
