Björn Fries, the Swedish co-ordinator for "Mobilisation Against Drugs", spoke yesterday about the direction of the national segment of this initiative. In partnership with the other two large Swedish cities Gothenburg and Malmö, Stockholm has initiated a common "Tri-city Initiative" to develop pilot projects related to each of the three cornerstones of the national drug policy:

• Prevention
• Care and treatment
• Restriction of supply

1. Schools

Swedish society has traditionally imposed high standards for what our schools must achieve. We have had great hopes for the ability of the schools to compensate when parents do not provide adequate supervision. In recent years, less emphasis has been put on drug prevention efforts in the schools, even as we came to the realisation that the schools' traditional tools for influencing the behaviour of students in relation to drugs have not produced satisfactory results. Drug prevention efforts in the schools have consisted of the knowledge-oriented ANT (Alcohol, Narcotics, Tobacco) programme, which has had no proven significant effect on drug consumption. Nor have programmes designed to change attitudes and values shown any results worth mentioning.
Instead, we have increasingly begun to understand the strong correlation between risky behaviour among students and their relationships with their parents. In cases where students say they talk to their parents when they are troubled, the percentage of students who have tried drugs is lower. This makes it clear that establishing a partnership between parents and the schools is a prerequisite for reducing risky behaviour among students. This is accomplished through measures designed to make parents feel empowered in the schools and by improving the pedagogical skills of teachers. The city has taken on the responsibility for an annual media campaign directed at parents, for which this year's theme is "Peddling". The media campaign has also been published in the underground system, has been translated to nine languages, and has its own web site.
We have acquired solid knowledge concerning schoolchildren and risky behaviour in Stockholm through the Drug Habits Study. We have conducted regular studies of drug habits among Stockholm schoolchildren since 1972. Currently, studies are carried out every other year through surveys given to all 9th grade compulsory school students and 2nd year upper secondary students. In 2000, the Drug Habits Study was expanded to include questions about risk and protection factors, i.e., questions that concern relationships in the family, in the peer group, at school, etc.

2. Pubs and entertainment venues

The STAD project has been ongoing in Stockholm since 1995. The STAD project is three- pronged: one segment is directed at youth, one segment focuses on handling of drug-related issues in the healthcare system, and one segment is oriented towards the restaurant industry. The purpose of the restaurant segment is to achieve "Responsible Serving of Alcohol." In concrete terms, the method entails educating pub and restaurant owners and their employees about laws and regulations surrounding the serving of alcohol, as well as the medical effects of alcohol and drugs. The objectives are to eliminate the serving of alcohol to minors, reduce serving of alcohol to intoxicated persons, and enhancing the ability of service personnel to identify risky situations. The programme includes knowledge of specific drugs and how to detect the effects of drugs. The project is also aimed at encouraging restaurants to develop common rules concerning alcohol handling and common drug policies, to the greatest possible extent.

The STAD project even uses actors to test the ability of service personnel to observe severely intoxicated individuals and thus avoid excessive serving of alcohol. In addition to improving the knowledge of everyone in the restaurant business, the STAD project is also contributing to understanding of the industry among government agencies. The project is continually followed up and evaluated in close co-operation with Karolinska Institutet. Stockholm's alcohol policy requires all restaurants and pubs that are open after 1 a.m. to arrange STAD training and that all personnel who serve alcoholic beverages must have completed the STAD programme.

The part of the restaurant project oriented towards drugs focuses on drug use by employees as well as abuse of so-called "parry drugs". Studies show that pub and restaurant employees are over-represented in drug abuse statistics. It is vital that we work to improve the knowledge of restaurant personnel and influence their values in order to counteract the drug culture in the hospitality and entertainment industry.

3. New support and treatment programmes for young substance abusers

There is currently a severe lack of good outpatient care choices for youth who have begun a substance abuse or criminal career. Institutional care is very costly and does not always produce desirable results over the long term. Accordingly, Stockholm recently began a Multi Systemic Therapy initiative. MST is an American example of an outpatient treatment programme that works. The programme is based on having the young substance abuser remain in the family home and working with his or her entire situation - at home and at school, with friends and the neighbourhood. In other areas, the MST programme has proven to be cost-effective and more likely to result in lasting improvement compared to traditional institutional care.

The beginning of a substance abuse career in youth is closely associated with an early criminal career. Several intervention programmes are in progress for young offenders and young victims of crime. Seven social workers have been placed centrally at Stockholm Police Headquarters. The social workers are involved in mediation between perpetrators and victims and provide direct support to crime victims. Stockholm is also working with community service programmes for young offenders as one way of finding an alternative to incarceration or placement outside the home that still entails a palpable reaction from society.
In addition to developing support and treatment programmes, Stockholm is working actively to reduce underage access to alcohol and tobacco. Swedish laws concerning retail sale and serving of Class Two beer and tobacco were made more stringent some years ago. Based on the new, stronger legislation, Stockholm has increased supervision of local retailers that sell Class Two beer and tobacco.

4. Care and support programmes for addicts

Addiction care in Sweden underwent significant changes in the 1990s. Care and support programmes for adult addicts were hit hard by budget cutbacks. We are now working to identify new structures for those programmes. Addiction care also changed orientation in the 1990s from institutional to outpatient care. Despite all good intentions, we must admit that there are problems in the addiction care system today, particularly with co-ordination among different agencies. Addicts come into contact with many different agencies with different specialist expertise. These agencies may have varied objectives based on their areas of responsibility, organisation, governance and regulations. Agencies may also have different catchment areas. As a result, the list of agencies and officials that an addict is supposed to deal with can become very long indeed. In practice, the result is that it is up to the individual addict to adapt to the needs of various agencies, rather than the opposite, which naturally does not improve his or her chances for recovery from addiction.

There is a high level of awareness of these problems in Stockholm today. One research report after the next has shown that we need to "start where the client is", that is, base our programmes and interventions on the client's individual needs, current living situation and expectations. The ability to offer the client a secure context and a trusting relationship is a prerequisite for achieving that end. One concrete measure aimed at improving the situation is the "Client in Focus" project in one city district of Stockholm. The objective is to build a co-operative network among different agencies. The "Client in Focus" is meant to change the focus and let interventions be governed by the individual's needs. Consequently, the agencies must adapt the support they offer to the individual.

The "Client in Focus" project is closely related to the Addiction Severity Index, which has been used for many years in the United States and is already being used in some areas of Stockholm. The ASI model is aimed at giving the client an opportunity to describe his or her own situation and determine what help is most important and needed. This makes it easier for the agency to understand the individual's needs.

Another specific issue associated with adult addicts is use of the drug "Kat" in some areas of Stockholm. In Stockholm, Kat is abused almost exclusively by Somalians and experiences gained in Stockholm show that Kat often leads to abuse of other substances. We have been working with information programmes and method development to prevent Kat abuse since 1999. Within the Kat project, a number of Somalians have been trained as "outreach educators". In that role, they work within their ethnic networks in order to spread information and knowledge.
The laws that regulate addiction care stipulate that all measures taken must be viewed in a wider context, meaning that a "chain of care" must be created. Naturally, it is difficult to establish such chains of care in practice. A critical strategic issue is that of housing for addicts who are not in institutional care. The housing market in Stockholm is extremely strained. As a result, people are at high risk of being evicted from their homes for disturbing behaviour or failure to pay rent. At the same time, there is very little opportunity to regain own housing. Lacking viable opportunities for a "housing career" it is very difficult to establish a functioning housing chain.

We in Stockholm are in the initial phases of establishing a collaborative effort with a group of volunteer organisations, including the Basta labour co-operative for substance abusers based on the San Patrignano model and the Swedish branch of Dianova. We will be hearing more about those organisations after the coffee break. The collaborative effort is aimed at providing at-risk individuals the opportunity to re-enter society. The road back is meant to go through integration of these people. Many other programmes and interventions for these groups offer no real opportunities to re-establish a more normal life; instead, the result is that people become permanently marginalised. We are determined to avoid that. By means of this collaborative effort, which is so new that it has not yet been named, we should be able to offer job and housing training, as well as favourable conditions for active recreation. The participating organisations, mainly composed of formerly at-risk individuals and/or exaddicts, that are involved in this effort supplement society's capacity to offer support to the most at-risk segments of the population. Co-operation will be the key to success.
Stockholm and Sweden as a whole are by no means unaffected by the currents in international drugs policy. There are many unsettling tendencies, not least among them rising drug use among youth. We are working intensively with method development and discussions of co-operative efforts are being held at all levels. Stockholm is not going to give up the fight against drug abuse and we intend to improve our tools for responding to the threat in new ways.

 
 
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