Feature

Two years ago at a conference in Johannesburg, South Africa, psychologist Rick Rawson, PhD, was talking to colleagues from Uganda and Congo about the developing substance abuse treatment programs in their countries. The men told Rawson, the associate director of the University of California, Los Angeles's Integrated Substance Abuse Program (ISAP), that they were following the U.S. model of separating substance abuse treatment from primary and mental health care.

"I said, 'If we could start from scratch, we wouldn't do it that way,'" Rawson recalls. "I realized that they were beginning to spend resources on a treatment model that we're now trying to change."

The conversation sparked an idea for Rawson: to hold a conference for substance abuse treatment workers from developing countries and discuss integrating drug treatment into those countries' mental health, social welfare and criminal justice systems.

Rawson, who for the past 10 years has helped build relationships between Palestinian, Israeli and Egyptian substance abuse experts, particularly wanted to bring together specialists from Middle Eastern countries.

The conference became a reality last September when 60 substance abuse treatment experts from 22 countries gathered for three days in Istanbul, Turkey. Representatives came mainly from the Middle East, but also from as far away as Uganda, Kenya and Slovenia, among other places.

"Bringing everyone together gave us all a chance to get familiar with the nature of the problems in each others' countries, the nature of the treatment available there and fruitful topics for collaborative research," Rawson says.

Cooperative strategies

The conference goal was twofold, according to conference organizer Darren Urada, PhD, an ISAP research associate. One aim was to share information about substance abuse treatment delivery systems. But a second goal was to "bring together these countries to have them develop cooperative strategies to battle a common enemy, which is substance abuse," Urada says.

Initial funding for the conference came from the United States Institute of Peace, a federal program that promotes peace-building around the world. Eventually the conference also garnered support from the World Health Organization, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration and many other groups, and organizers expanded the geographical reach to include developing countries around the world.

At the conference, representatives from 18 countries gave presentations about the state of their drug-treatment facilities and programs.

"There are many similarities between the problems countries in the region face, but also important differences," explains conference attendee Richard Isralowitz, PhD, of Ben Gurion University in Israel. For example, "The drug problem is probably more prevalent in Israel than for Palestinians," he says. "But Palestinians are more in need of resources to deal with it."

In addition, representatives from the United States, Finland, Switzerland and other countries spoke about their countries' drug-treatment experiences. Rawson, for example, discussed the disadvantages of the current U.S. system of separate drug treatment and primary health-care centers-for example, the fact that primary health-care providers often miss signs of substance abuse, and that many people who could benefit from substance abuse treatment don't have access to it. He and others also discussed topics such as integrating substance abuse services into social welfare systems, evidenced-based substance abuse and the link between infectious diseases and substance abuse.

Overall, Rawson says, the conference offered a chance for attendees to meet, make connections and share expertise. "There was a lot of interaction and cross-cultural discussions," he says.

Next steps

Those connections have already begun to bear fruit, leading to joint research projects. Isralowitz, for example, recently submitted a grant proposal to the United States Agency for International Development to work with a Kenyan contact he met at the conference and bring drug abuse monitoring research to that country.

Also at the conference and at a November follow-up meeting in Cairo, representatives from Iran presented information about outcomes from their new "triangular clinics," which combine methadone treatment, antiretroviral treatment for HIV and treatment for other communicable diseases.

Such clinics are extremely unusual in the Middle East, Rawson says, where conservative governments generally don't support methadone treatment. "The Iranians have been tremendously courageous in the face of a volatile political situation," Rawson says.

And the Iranian results have been so positive, he says, that treatment providers from elsewhere in the Middle East would like to bring similar programs to their countries.

"I've been going to Egypt for five years," he says, "and they always said methadone treatment would never happen here. This is a revolutionary change."