1. 1 COMPREHENSIVE APPROACH TO THE DRUG ABUSE PROBLEM IN RUSSIA RUSSIA-US BILATERAL PRESIDENTIAL COMISSION: DRUG TRAFFICKING WORKING GROUP Veronika I. Skvortsova, Ph.D, M.D., Professor, Corresponding Member of Russian Medical Science Academy, Deputy Minister, Ministry of Health Care and Social Development of Russian Federation FEBRUARY, 2010 MOSCOW, RUSSIA

2. 2 THE POLITICAL DECLARATION, THE GENERAL ASSEMBLY, THE 20 TH SPECIAL SESSION, OTHER DOCUMENTS DEMAND REDUCTION STRATEGY THE POLITICAL DECLARATION and PLAN OF ACTIONS ON INTERNATIONAL COOPERATION TOWARDS AN INTEGRATED AND BALANCED STRATEGY TO COUNTER THE WORLD DRUG PROBLEM, THE GENERAL ASSEMBLY, THE 64 TH SESSION SUPPLY REDUCTION STRATEGY WORLD DRUG PROBLEM SOLUTUION INTERNATIONAL DRUG CONTROL TREATIES INTEGRATED MULTIDISCIPLINARY MUTUAL REINFORCING APPROACH BALANCE

3. 3 CHRONIC MULTIFACTORIAL DISEASE, CAUSED BY PSYCHOLOGIAL, BIOLOGICAL, GENETIC AND SOCIAL FACTORS UNITY OF UNDERSTANDING DRUG ABUSE

4. 4 DYNAMICS OF DRUG ABUSE MORBIDITY DRUG USERS, TOTAL : 2007 YEAR –537 774 PEOPLE 2008 YEAR –549 577 PEOPLE PATIENTS, TOTAL : 2007 YEAR –356 188 PEOPLE 2008 YEAR –358 120 PEOPLE CHILDREN, TOTAL (0-14): 2007 YEAR –49 PEOPLE 2008 YEAR –46 PEOPLE ADOLESCENTS, TOTAL(15-17) 2007 YEAR – 1 628 PEOPLE 2008 YEAR –1 434 PEOPLE DRUG ABUSE PREVALENCE ( to 100 000 PEOPLE ) 2000 198,4 Drug dependence syndrome 20012002200320042005200620072008 176 10,8 3,7 7,6 11,7 4 7,9 233,2 213,5 13,4 4 8,6 239,6,3 211,7 14,5 3,9 9,2 240,2 211,4 14,9 3,7 10 241,3 212 15,4 3,6 10,3 245,4 215,2 15,8 3,8 10,6 209,4 250,5 219,6 16,6 3 11,2 252,2 220,7 17 2,9 11,6 heroinmarijuana amphetamines other drugs

5. 5 DYNAMICS OF DRUG ABUSE MORBIDITY IN RUSSIA Russian population aged up to 39 years old Rural inhabitants, up to 39 years old ∆= 19% ∆= 13% drug userspatients drug users

6. 6 STRUCTURE OF REGISTRATED PATIENTS (EXCEPT OPIATES AND COCAINE) INCREASE IN MULTIDRUG USERS ∆= 6% ∆= 5% HEROIN USERS 87,5%

7. 7 DRUG ABUSE PREVENTION RISK FACTORS MENTAL AND PHISICAL DISTURBANCES INFLUENCE OF MICRO- AND MACROSOCIAL ENVIRONMENT CONFLICTS IN THE FAMILY, RELATIONSHIP WITH FRIENDS- DRUG USERS, PERSUADED BY PEERS INDIVIDUAL MENTAL FEATURES LOW INTELLECT, SELF- DEPRECIATION DENIAL OF SOCIAL AND MORAL RULES, AND OTHERS PROTECTIVE FACTORS INFLUENCE OF MICRO- AND MACROSOCIAL ENVIRONMENT FRIENDLY FAMILY CLIMATE, OPEN RELATIONS AMONG FAMILY MEMBERS, ANTI-DRUG POLICY INDIVIDUAL MENTAL FEATURES HIGH INTELLECT, SELF-ACCEPTANCE, CONSCIOUS RESPECT OF VALUES AND NORMS QUALITIVE MEDICAL CARE ELIMINATIONSTRENGTHENING

8. 8 M AIN TYPES OF PREVENTION PRIMARY (UNIVERSAL) MOSTLY SOCIAL AND POPULATION-BASED, ORIENTED TO CHILDREN, ADOLESCENTS AND YOUNG PEOPLE PRIMARY (UNIVERSAL) MOSTLY SOCIAL AND POPULATION-BASED, ORIENTED TO CHILDREN, ADOLESCENTS AND YOUNG PEOPLE SECONDARY (SELECTIVE) ORIENTED TO PEOPLE USED ILLICIT DRUGS OCCASIONALLY SECONDARY (SELECTIVE) ORIENTED TO PEOPLE USED ILLICIT DRUGS OCCASIONALLY TERTIARY (INDICATIVE) MEDICAL, INDIVIDUAL TERTIARY (INDICATIVE) MEDICAL, INDIVIDUAL

9. 9 COMPREHENSIVE PRIMARY PREVENTION APPROACH IN RUSSIA DEVELOPMENT OF HEALTHY LIFE-STYLE (MASS-MEDIA CAMPAIGN, INTERNET SITES, HOT LINES) ESTABLISHMENT OF OBLIGATORY TRAINING LESSONS AND HEALTHY LIFE-STYLE DEVELOPMENT PROGRAMS IN SCHOOLS AND COLLEGES INCLUDING ANTI-DRUG POLICY COURSES ANTI-DRUG CAMPAIGN TARGETED TO DEVELOPMENT OF PSYCHOLOGICAL STABILITY OF YOUNG PEOPLE POPULARIZATION OF PHYSICAL ACTIVITY AND SPORT

10. 10 ABILITY TO USE DRUG LABORATORY TESTS TO IDENTIFY ILLICIT DRUG USERS AMONG PUPILS, STUDENTS AND YOUNG PEOPLE USE OF SENSITIVE LAB TESTS DURING HEALTH SCREENING PSYCHOLOGICAL THERAPY (IN GROUPS AND INDIVIDUALLY) INFORMED CONCERN OF PARENTS OR LEGAL REPRESENTATIVES OF CHILDREN UP TO 15 COMPREHENSIVE SECONDARY PREVENTION APPROACH IN RUSSIA

11. 11 TERTIARY PREVENTION OF DRUG ABUSE – COMPREHENSIVE TREATMENT AND RECOVERY APPROACH DEVELOPMENT OF DRUG ABUSE TREATMENT FEDERAL REGULATION DEVELOPMENT OF RECOVERY PROGRAMS FOR PATIENTS AND DRUG USERS DRUG ABUSE TREATMENT STANDARD ELABORATION DEVELOPMENT OF THERAPEUTIC LABOR PLACES FOR RECOVERING PATIENTS (LABOUR THERAPY) COMPREHENSIVE TERTIARY PREVENTION APPROACH IN RUSSIA

12. 12 DRUG – FREE TREATMENT AND TREATMENT OF CONCOMINANT PSYCHIATRIC AND PHYSICAL DISORDERS EARLY DETECTION DURING HEALTH SCREENING PSYCHOLOGICAL THERAPY (IN GROUPS AND INDIVIDUALLY) COMPREHENSIVE TREATMENT AND RECOVERY PROCESS INTERVENTION IN DRUG USER’S MICROENVIRONMENT (PATIENTS AND FAMILY COUNSELING, MOTIVATION TO TREATMENT, AND ACCESS TO RECOVERY) DETOXICATION (PATHOGENETIC THERAPY OF DRUG WITHDRAWAL SYNDROME AND OTHER DISORDERS AND DISTURBANCES) RECOVERY, REASONABLE MEDICAL SUPERVISION AND PEER SUPPORT CONSISTENCY CONTINUITY REASONABLE MEDICAL SUPERVISION

13. 13 DEVELOPMENT OF INTEGRATED STATE ANTI-DRUG POLICY: improving access to prevention, treatment and recovery ANTI-DRUG POLICY LEISURE TIME ORGANIZATION OF YOUNG PEOPLE LEISURE TIME ORGANIZATION OF YOUNG PEOPLE ACCESS TO PSYCHOLOGICAL THERAPY ACCESS TO LAB TESTING AND TREATMENT ACCESS TO LAB TESTING AND TREATMENT ACCESS TO RECOVERY (MEDICAL AND SOCIAL ASPECTS) ACCESS TO RECOVERY (MEDICAL AND SOCIAL ASPECTS) LABOR ACTIVITY WITH PERMANENT PSYCHOLOGICAL TRAINING LABOR ACTIVITY WITH PERMANENT PSYCHOLOGICAL TRAINING TRAINING OF ANTI-DRUG PSYCHOLOGICAL STABILITY OF YOUNG PEOPLE

14. 14 INTEGRATED STATE ANTI-DRUG POLICY: improving access to prevention, treatment and recovery THE ESSENTIAL BASIS RUSSIAN STATE ANTI-DRUG STRATEGY

15. 15 MUTUAL ENRICHING AND CONSTRUCTIVE COLLABORATION UNITY OF UNDERSTANDING AND ACTIONS