1. Ministry of Public Health and Social Development of the Russian Federation The Moscow Research and Practical Centre for Narcology of the Moscow Department of Health for Narcology of the Moscow Department of Health Psychoactive substances demand reduction: Strategy and methods. The Moscow experience Malta, 23 September 2010 E.А. Bryun

2. Number of patients registered in narcological facilities in Moscow

3. Statistics of poisonings with psychoactive substances in Moscow in 2005-2009

4. Mortality due to drug overdose (data of the Bureau of Medical Forensic Expertise)

5. Structure of admissions to narcological hospitals: Diagnosed disorders 2009 г. 2002 г.

6. Risk factors (primary prevention) 1. Genetic factors. 2. Inborn risk factors: problems during pregnancy and labor. 3. ‘Mother – Child’ complex. 4. Attention deficit/ hyperactivity disorders, intracranial hypertension in children aged 2 to 6 years. 5. Risk factors associated with psychological atmosphere in the family: child neglect – too much or too little care.

7. Risk factors (primary prevention, continued) 6. Information environment as a risk factor. 7. The puberty turmoil (early and fast sexual maturation). 8. Psychological problems in adolescence. 9. Socialization problems in a peer group. 10. Joining in the drug subculture.

8. Secondary Prevention (dealing with focus groups) 1. Detection of risk groups in educational facilities and at workplaces in accordance with WHO and ILO recommendations (sociotherapeutic interventions). 2. Educational programs for different age groups. 3. Active involvement of the mass media.

9. Tertiary Prevention (treatment and rehabilitation program) 1.Intervention – patient’s involvement into treatment and rehabilitation programs. 2.Detoxification. 3.Treatment of psychopathological disorders. 4.Psychotherapy and correction of personality disorders. 5.Rehabilitation. 6.Development of a treatment subculture as an opposite to a drug subculture.

10. Authorities and agencies involved in prevention of alcohol- and drug-related disorders in Moscow: Mayor of Moscow Moscow Government Mayor of Moscow Moscow Government Anti-narcotic Commission of the city of Moscow Department in the Moscow government responsible for cooperation with security bodies Moscow Office of the Federal Drug Control Service Moscow Department of the Interior Moscow Office of the Federal Security Service Department of Health Department of Education Department of Social Support City Centre ‘Street Children’ Department of Youth Policy

11. Department of Health of the City of Moscow, Narcological Care Moscow Research and Practical Centre for Narcology Local departments of public health in administrative districts of Moscow Clinical Narcological Hospital No. 17 НД №1 ЮАО НД №2 ЦАО НД №3 СЗАО НД №7 СЗАО НД №8 ВАО НД №9 ЦАО НД №13 СВАО НД №12 ЮЗАО НД №11 САО НД №10 г. Zelenograd НД №4 СВАО НД №6 ЮВАО НД №5 ЗАО НД №14 ЦАО

12. Alcohol- and drug abuse prevention programs for families, business and educational facilities Individual prevention programs for concrete organizations and for general population Program for addiction prevention in organized groups Educational programs and information concerning prevention of addictive behaviors

13. Anti-drug information campaigns Anonymous and confidential treatment and rehabilitation programs Treatment and rehabilitation programs in out-patient care system Isolation in corrective facilities of the prison system FSIN Level I Educational programs Level III Level II Level V Level IV Narcological care ‘Narcological’ population Social pressure Police control Scheme of social pressure on the ‘narcological’ population

14. The standard of narcological care includes eight stages that cover prevention, treatment and rehabilitation of addiction disorders: Primary prevention Secondary prevention Intervention Detoxification Treatment of pathological craving Psychotherapy and correction of personality disorders Rehabilitation and relapse prevention measures Development of the treatment subculture as an opposite to alcohol- and drug subcultures

15. Relation of a one-year-long remission to the number of treatment stages 1-5 % 15-20 15-20 % 25-30 25-30 % 40-50 % Treatment of psychopathological disorders Treatment of withdrawal syndrome Psychotherapy programs Rehabilitation programs IV III II I

16. Number of patients treated during recent five years: 16927 persons 100%7,9% 1343 persons

17. Medicosocial rehabilitations (absolute figures)

18. Duration of remission as it is on 1 June 2010 (on basis of inquiry among 812 persons) Remission

19. Comparison of the periods of remission after rehabilitation and medical programs

20. Attending self-help groups (NA, GA, АА) Patients with a remission 1 to 3 years 1 to 3 years attend self-help groups (82%) 3 – 5 times a week Patients with a remission longer than 3 years longer than 3 years attend self-help groups At least 2 times a week

21. Patients’ employment Patients with a remission 4 to 5 years: 100% have a job, with recent employment history of 3 years at least 7 persons 7 persons work as counsellors in rehabilitation centers of Russia 3 persons 3 persons work in rehabilitation wards of the Moscow RPC for Narcology 10 persons have resumed study in educational facilities Patients with a remission 2 to 3 years: 98% have a job 7 persons 7 persons work as counsellors 13% have resumed study in educational facilities Patients with a remission 1 to 1,5 years: 67% have a job 2% have resumed study in educational facilities

22. Rehabilitation ward

23. Activities in the open air

24. Meeting of activists of the rehabilitation program

25. Thank you!