1. KETHEA MOSAIC Supporting drug addicted emigrants: Visible and Invisible particularities DIMITRIS GIANNATOS Head of KETHEA MOSAIC Unit (Cross-cultural Center of KETHEA)

2. In the Beginning…   Low rate of approach in therapeutic structures for drug-addiction   emigrants faced difficulties to follow up the therapeutic process. Different view in the streets: increase of population of depended immigrants /refugees with intense and different needs compared to the locals.

3. KETHEA MOSAIC Since 2003… 1. 1.Supporting drug addicted - Harm reduction services - Motivation for drug addiction treatment - Psychological support and relapse prevention - Counselling for relatives and "important others“ - Educational activities - Street work activities - Self help groups in prison

4. KETHEA MOSAIC Since 2003… 2. Psychosocial support for emigrants/refugees related to : - Social intergration problems - Family problems - Drop out from educational process - Emotional crisis management - - Adults and juvenile delinquency

5. Important points… The drug users consist a special group among the emigrants/refugees Case of “double exclusion” : drug addiction’s stigma and stigma of being “stranger” Apart from the social exclusion, two other facts that increase the percentage of drug addicts (emigrants & refugees), are: a. The availability of substances and alcohol in the places where they live or spend their time b. The connection between trafficking and (illegal) market of drugs

6. Important points… They are a vulnerable population and dependable on trafficking networks or other “groups” : exploitation from co-patriots, lawyers who promise “legalization”, affinity and exchange with delinquent people They are a high risk population. They need services of Prevention, Harm Reduction and Therapy.

7. Supporting the population… Essential point : the “integration” of cross-cultural care in the “cultural” system of health Organizations Very intensive and “deep” intervention The information for Mosaic spread among them New-comers addicted refugees – multilevel needs – “invisible” population Emigrant’s Communities are difficult to be motivated (fear, “stigma”, other priorities, “profits” expectation, etc)

8. Supporting the population… Many of the emigrants start using drugs after they left their country or they used to do occasional use of drugs without passed to addiction The treatment related to the total improvement of life. Covering financial needs is or the preparation for a new immigration is the first priority and affect to the therapy perspective and time investment in this process. The “paradox” of problem and trauma : addiction and sensitization of health system – services and DIGNITY

9. Clinical remarks… Many times, the use of substances and alcohol is a way of self healing and self empowerment, helping these people to be relieved from the emotional pain and the difficult conditions they experience (uprooting, fear, loss & nostalgia of beloved people, homesick, trauma, uncertain legal status, etc). Psychic trauma - three phases : a. difficult conditions before immigration b. traumatic roaming c. relocation in the reception country

10. Clinical remarks… Mental dipole : Oblivion – Memory Use of substances = self-healing “Help me to forget - help me to remember without pain” Various substances and alcohol Drug addiction seems to act as a latent effort of incorporation or as an expression of bereavement or as a resistance to the family system after the emigration.

11. Clinical remarks… Political asylum seekers – intensive action for freedom and justice – often weaker motive for therapy- they focus in the change of their political status as solution in the problem. Some emigrants want to change without realize the need of therapy - self control, move to other town, find job, medical help from the homeland, etc Some structural and cultural issues make the wounds invisible : drug addiction as a medical problem – seeking help from co-patriots leads often in provisional solutions,

12. Clinical remarks… Many drop-outs from motivation process : - Seeking for medical treatment - Deprival syndrome - Language - Cultural differences in the groups ( in groups with people from many different nationalities)

13. Clinical remarks… Families : - guilt – wounds from their uprooting – protect the drug user as a weak member of the system – avoid make changes helping the therapy - Many times, “send” the drug addicted back to homeland (symbolic correction of trauma)

14. AND WHAT HELPS ? The therapy from drug-addiction seems difficult – but is not unrealistic. Trauma has the emotional material for the therapy «O τρώσας και ιάσεται» (Τηλέφεια τραύματα) It’s necessary to exist a safe environment, that pay attention in different needs and respects their cultural differences Essential condition of support : The transition ( access – approach – empowerment – motivation). Efficient in therapy context the interaction with local culture

15. Supporting strategies… Familiar space – HomeFamiliar space – Home Multi-ethnic Therapeutic StaffMulti-ethnic Therapeutic Staff Individual Therapeutic PlanningIndividual Therapeutic Planning Cross-Cultural approach Networking Counselling Cross-cultural education Volunteers – Interpreters – Cultural Mediators Welfare networking Cross-cultural evaluation of treatment reference