Republic of Macedonia, Prison Reforms Drug Treatment in Macedonian prisons

Prison Reforms in the field of Health Care Health Care Strategy for prisoners Guidelines/ Protocols Training of prison staff Psychosocial treatment for drug dependent prisoners in the biggest Penitentiary Institution Idrizovo

Health Care Strategy for Prisoners with Action Plan Sustainable system of health care for prisoners 12 Guidelines for different health care issues are implemented in all prisons - in February Protocols for health care of prisoners with infective diseases and harm reduction measures – will be implemented in December Specific treatment of vulnerable groups Continuing training for prison staff

2011 Drug Treatment in Prisons Risk assessment Instrument – as part of a general admission procedure Training for prison staff - Motivational interview skills – basic and advance training Methadone Maintenance Centers in other prisons, not only in Penitentiary Institution Idrizovo Prison staff education for Drugs, Drug Addicts Program, Infective&Sexual transmitted diseases

2012 Why – Health Care Strategy prisoners? Number of drug users in our prisons increases, so the treatment demands and the needs for health care services increases % drug users34 % drug users 1 Methadone Maintenance Center in Idrizovo 3 Methadone Maintenance Centers – In Idrizovo, Prison Skopje and Prison Bitola No Buprenorphine Treatment for prisoners ( expensive treatment ) Buprenorphine Treatment available under the country project in the Clinic for Toxicology - Skopje

Psychosocial support is the core of the addiction treatment Psychosocial support Methadone Treatment Drug users

2012 Macedonian Prison Substance Treatment Programme Assessment Manual for the Programme Macedonian Programme – was established in October 2012 Macedonian Relapse Prevention Plan

Macedonian Prison Substance Treatment Program - Is reality as prisoner sees, feels and behaves ? Through 36 group and 12 individual sessions, delivered 3 times a week, the Program team works with prisoners through: ABC model Cognitive distorsions Changing thinking patterns etc.

Cognitive Behaviour Approach Exercise: Which Cognitive distortions do I mostly use in communication with other people/ in professional work with prisoners?

Cognitive distortions All for nothing thinking Overgeneralization Magical thinking Mental filter Disqualifying the positive Jumping to conclusions Magnification/ Minimization Catastrophising Emotional reasoning Should statements Labelling/ Mislabelling Personalization Fallacy of fairness Blaming Fallacy of change Always being right

Thank you! Elisaveta Sekulovska, Licenced psychologist Accredited counsellor – EAC (Europian Association for Counselling ) Advisor – inspector for prisoners treatment Ministry of Justice - Directorate for Execution of Sanctions, Republic of Macedonia