1. CRDF Workshp, Brandeis University, August 2004 Building on a Strength: The Role of Family in Substance Abuse Treatment and HIV Prevention in Kosovo Presented by Anne E. Brisson, Ph.D. Visiting Assistant Professor, Department of Psychiatry and International Center for Response to Catastrophe, University of Illinois, Chicago, USA

2. CRDF Workshp, Brandeis University, August 2004 Kosovo and the United Nations Mission in Kosovo (UNMIK) 10,500 sq. km (1/2 the size of Massachusetts) 1.8 million inhabitants –90% K. Albanian –8% K. Serbian –60% under 30 years old Formerly part of Yugoslavia, lost autonomous status in 1990 1998-1999 war with ex-Yug. Since June 1999, a United Nations protectorate Ethnic tensions continue Poor economy Final status not known

3. CRDF Workshp, Brandeis University, August 2004 Substance Abuse in Post-war Kosovo Increase –Number of users –Availability of drugs (borders more porous, lack of rule of law) Decrease –Prices –Age of first use Pre-war treatment options no longer available for Albanian population Social risk factors ( young population, poverty, unemployment, lack of educational opportunities, mobile population) Inadequate mental heath services (PTSD) Very limited prevention and treatment (focus on supply)

4. CRDF Workshp, Brandeis University, August 2004 Risk Factors for Substance Abuse (heroin) and HIV/AIDS Cheap and readily available heroin –Main trafficking route from Afghanistan –60% reduction in price per gram since 1999 Injecting drug users reporting risky practices (HIV) –Sharing needles and equipment –Unprotected sex No harm reduction information available HIV-IDU link in neighboring countries Limited detoxification and treatment –Self-medicate –Black-market –Very few trained (and informal) providers

5. CRDF Workshp, Brandeis University, August 2004 Existing Substance Abuse Treatment One private drug treatment clinic Two psychiatrists with specialized training (methadone) Informal system (including black-market) Acupuncture detoxification program funded (to be implemented in November) Family-supported treatment Many gaps in the system

6. CRDF Workshp, Brandeis University, August 2004 The Role of Family in Substance Abuse Treatment The family unit has functioned as civil society – in recent and past history Users live at home Families go to extreme measures to pay for out-of-Kosovo treatment Families seek informal treatment and face difficult choices

7. CRDF Workshp, Brandeis University, August 2004 Fundamental Problem Limited resources (and lack of funding and attention) for substance abuse prevention and treatment Society becoming modern and new institutions are being developed Institution building is being driven by internationals, often with civil society that does not rely on the family unit How to develop programs and encourage institutions to build upon the positive protective factors the family unit can provide?

8. CRDF Workshp, Brandeis University, August 2004 Evidence of Family Support How do we know the family is strong and can provide support and protective factors to reduce risk? –Case studies of families of substance abusers –Kosovo Attitudes about Drugs and HIV/AIDS (KADAH) project results –The community-mental health programs and the multi-family interventions with severely mentally ill patients

9. CRDF Workshp, Brandeis University, August 2004 Rationale It works –Psycho-social education for severely mentally ill patients (MOH and UIC) Public wants it –KADAH Project results (MOH and UIC) Is happening anyway –RAR Report and other examples Is cost-effective Builds upon cultural traditions (but adapted to modern problems)

10. CRDF Workshp, Brandeis University, August 2004 Policy Recommendations Provide specialized public treatment Support (educational) programs for families (for drug users and HIV/AIDS) Encourage/assist family members be advocates for health and social services (overcome stigmatization) Implement non-governmental, community based prevention and treatment programs (currently top-down, medical focus)