European Addiction Training Institute

Ernst Buning

Wim Buisman

 November 1998

Ernst Buning (1953) is a clinical psychologist and director of Quest for Quality BV (Q4Q). Up to December 1999, he was a senior staff member of the Bureau International Affairs of the Amsterdam Municipal Health Service (GG&GD). He started working in the drug field as an outreach worker in 1977. In 1979, he was asked to set up the methadone by bus project. He co-ordinated this project for two years and was then given a staff position at the Drug Department of the Amsterdam Municipal Health Service. He held this position for 10 years. In this period he was involved in setting up numerous project, doing research and evaluation (for example the evaluation of the Amsterdam needle exchange), developing Aids prevention measures and assisting in the development of the Amsterdam drug policy. In 1992, Ernst Buning set up the Bureau International Affairs. To date, he is involved in giving consultation and advice, workshops and training. He is one of the founders of the International Harm Reduction Association and co-ordinator of Euro-Methwork, a forum for methadone providers in the European Region. He is one of the initiators of the Latin American Travelling Seminar.

Wim Buisman

Wim R. Buisman, Head of the European Addiction Training Institute, is the Managing Director of International Programmes. He is a member of the Project Management Team of Phare Technical Assistance to Drug Demand Reduction. Within this project he is also Technical Supportive Coordinator of the sub-regional project on Innovative Drug Education.
Wim Buisman is a psychologist with in-depth knowledge and experience in strategies, methodologies and programmes for demand reduction and drug prevention, in particular related to those based on education and mass media communication.
He is also chairman of the Drug Education Section of the International Council on Alcohol and Addiction (ICAA). Wim Buisman is an experienced lecturer and trainer and has conducted substance abuse education for health professionals. He has been consultant to the Council of Europe, UNDCP, UNESCO and WHO Europe.

Part I: Ingredients of a local drug policy

1. Introduction

Part II: Practicalities for organising a training

1. Introduction

 

2. Practical steps

• The Balance
• Active involvement of participants
• The attention span
• Language problems in case of guest speakers
• The group process

Summary

 Foreword

We are very pleased to present this handbook on local drug policy training. This handbook is based on the experience we have had with three courses on local drug policy organised by the European Addiction Training Institute (EATI). In the preparation of these courses and in our contacts with participants, we came across numerous interesting things that we thought would be worthwhile sharing with others, in particular two groups:

1. Local drug policy makers
2. Organisers of local training

We hope that part I of this handbook, that describes ingredients of a local drug policy, will be inspiring to the first group (local drug policy makers). During the three courses EATI organised on local drug policy, we heard many interesting examples of local drug interventions and we facilitated numerous stimulating debates on the various aspects of local drug policy. We believe that this information is valuable to those who are involved in drug policy making and we would like to share our experience with them.

We hope that the complete handbook (part I as well as part II, which describes the practicalities of organising a training) will facilitate the second group (organisers of local training) in their work. EATI is involved in the organisation of international courses with participants from various countries and its objective is not to organise local or regional courses. However, with sharing EATI’s international experience with others, we hope that it will be easier for local course organisers to go ahead and take steps in organising a local training.

Since EATI is always interested in ameliorating its services, we would very much appreciate receiving your comments. Also, if you need any concrete suggestions regarding a local course you are planning, we would be pleased to see whether we can assist you.

We hope you will enjoy reading this handbook and we wish you a lot of success in your work!

Ernst Buning & Wim Buisman

Amsterdam, The Netherlands

November 1998

Introduction

Although the major framework of drug policy might be developed in international arenas such as the United Nations, WHO, European Union and on a national level by parliament, local authorities strongly tend to take more control over their local drug policy. A good example of such a movement was the creation of the European Cities on Drug Policy (ECDP) in 1990. In the first meeting of the ECDP the so- called ‘Frankfurt resolution’ was adopted. One of the statements was: "Drug users live, for the most part, in large cities or gravitate to the cities because that is where they find the market, the drug scene and facilities for help. Consequently, it is the larger cities which are primarily affected, but their influence on drug policy is modest and stands in stark contrast to the burden they must bear". As a result of this, a group of cities was formed which clearly indicated that –since the burden of drug abuse was felt most by the local community- local authorities should be in control in developing their own drug policy.

This development has lead to a situation in which many local policy makers have to be trained in drug policy and facilitated in sharing information and expertise with other local policy makers. They will have to develop a tailor made approach that best fits the specific local situation, but they can still learn a lot from others and there is no need to ‘invent the wheel all over again’.

When EATI was created in 1994 by the Jellinek, Amsterdam, the following objectives were formulated:

• To cultivate and exchange expertise and scientific knowledge about addiction at a European level
• To improve the quality of interventions in the fields of treatment, prevention, policy and research

Creating tailor-made courses for local drug policy makers originating from different European countries, fitted very well within the framework of the above objectives. Three courses were organised: the first in Zandvoort, the Netherlands in September 1996, the second in Barcelona, Spain, in December 1997 and the third in Hilversum, the Netherlands in May 1998. The third training focused specially on a local policy on XTC. The total number of participants in these three courses was 35. Participants originated from various countries both in Western and Central/Eastern Europe. In all courses, the participants were asked to do ‘homework’ in which they described the specific local situation and the policy developed in their city or region. During the course they were asked to present their ‘homework’ in the group and discuss it among the participants. This generated a lot of very interesting information, which has been used in this handbook.

Part I of this handbook will discuss the ingredients of a local drug policy. Basically, every drug policy needs to pay attention to 4 issues:

1. Supply reduction at a local level means that active selling of drugs by drug users and drug dealers is reduced through interventions of the criminal justice system.
2. Demand reduction refers to education and prevention and to create of an overall climate in the city, which is positive for young people and will assist them in functioning well without the abuse of drugs.
3. Drug free treatment has to be available for those problematic drug users who want to stop. It often concerns expensive facilities with a high relapse into drug use. Nevertheless, drug free facilities should always be part of a drug intervention system.
4. Harm-reduction refers to interventions, which aim at assisting drug users to reduce the harm they cause to themselves and others. In practice, it often means the provision of substitute drugs such as methadone and the provision of clean needles and syringes, for example through an exchange system.

Based on the above 4 points, we describe how a local drug policy could be created. We will discuss the process of formulating the objectives. This is a process in which many actors are involved and –sometimes- conflicting interests occur. Before defining the objectives, one should have a clear picture about the local drug problem. This picture can be obtained through a fact-finding mission. Furthermore, scientific data from the international literature on drugs should be used when defining the objectives.

Once the objectives are clear, the next step is defining the instruments to implement the policy. It should be determined what influence the policy makers have, what legal boundaries they face and how support can be obtained. The third step is the implementation, where one has to make sure that networks are used, the media are involved in a supportive way, the public is informed and involved and that training is given if needed. The last step is the evaluation and monitoring. This is absolutely necessary to ensure that the implemented policy is effective.

Part II of this handbook is meant for people who are developing training. We provide them with many practical tips on how to organise training. Of course, these are only suggestions and in a local setting it might be necessary to do this in a different manner. We discuss the general outline of the course, topics that could be discussed, what to expect from your trainers and speakers and how to recruit the participants. We also look at conference facilities and what could be done after the training to optimise the effect of the training. Of course training is only effective if participants are constructive and the group functions well. We discuss a number of issues that influence the climate in the group, such as finding a right balance in the topics and the input of participants, factors that influence the span of attention and the group process.

Ingredients of a local drug policy

1. Introduction

• Supply reduction
• Demand reduction
• Drug free treatment
• Harm-reduction

1. The objectives

1. The actors

• The local politicians
• The community
• Helping agencies
• The local criminal justice system
• Drug users
• Policy makers

1. Fact finding

• Present drug situation
• The work force
• The budget
• Rapid Assessment

1. Using Scientific data

1. The instruments

• Influence of policy makers
• Legal boundaries
• Getting support
• The police
• The helping system
• Research institutes

• Making the network work
• The role of the media
• Informing the public
• Training
• Spending money wisely

5. Evaluation and Monitoring

1. Introduction

When considering further development of the local response to the drug issue, one can look at it from different perspectives. However, certain points will always be part of the policy. They are:

1. Reducing the supply of drugs, by taking action against drug dealing
2. Reducing the demand for drugs through education and information
3. Assisting those who have become problematic drug users to become drug free through counselling, psychotherapy, pharmaco-therapy, detoxification etc.
4. Assisting those who are not willing or capable of giving up drug use to reduce the harm they cause to themselves and others by providing clean needles and syringes, providing methadone or other (substitute) drugs, test party drugs, peer education, outreach work etc.

Depending on the philosophy of the decision-makers, the situation in the city, the reaction of the population and the press, one of the above points might be highlighted more than other points. It is possible to write separate chapters about all the above points. However, this is not within the scope of this handbook. We will therefore only make some brief remarks on every point.

Supply reduction

Supply reduction is the responsibility of the criminal justice system. Certain substances are forbidden or forbidden in certain situations (alcohol and driving) and the role of the police is to make sure that that these substances are not used and that they are not available. It is believed that there is a correlation between the availability of a substance, the quantity of consumption and the amount of substance related problems. Thus, the assumption is that if it is easy to buy alcohol (for example in pubs, supermarkets, gas stations) more people will drink and more people will develop problems with alcohol. This assumption is based on a society with an ‘external locus of control’, where the behaviour of people depends on ‘top-down’ rules and regulations. In a society with a stronger emphasis on ‘internal locus of control’, the behaviour of people depends on individual’s deliberations whether something should be done or not. Supply reduction might have less of an impact in such society and demand reduction (prevention and education may be more effective)

Demand Reduction

Demand reduction is often an underdeveloped area in local drug policy, often referred to as ‘prevention’. In practice, many people think of prevention as ‘hanging up a poster’, handing out a booklet or showing a video film. Demand reduction should be much more. It is extremely important to spend energy on drug prevention, since the old saying ‘prevention is better than cure’ still holds. So what could be part of a local drug policy?

First, one should find out who are already involved in this area. Perhaps schools, youth workers, parents are doing something. Sometimes it is co-ordinated, but most of the time it is not. It is done ‘ad hoc’, without a long-term strategy, without systematic feedback etc. etc. It is important to keep the parties involved and not to scare them off by telling them they are not doing a good job.

The job of the local policy is to make them co-operate and to develop a logical framework for the prevention.

An important issue in the late nineties is the way information is processed by youngsters. They are bombarded by information at school, through television, Internet and through video games etc. etc. Information about drugs has to compete with all that other information. Furthermore, today’s youngsters have become very critical and assertive. Don’t give them information, which can not be substantiated, since you will lose your credibility!

Another important issue to consider is the fact that many youngsters might skip from ‘one island of reality’ to another island. Almost the same way they do in the computer and video games. Every reality has its own behaviour and its own rules. So one can use XTC on a Saturday night and dance until the early morning and be back at school on Monday and work hard to get good grades. It is important not to stigmatise such a person as an XTC junkie and label him/her as problematic. On the other hand one has to be very alert to see whether the occasional recreational use of drugs does not become problematic use.

A last issue we would like to discuss is the creation of a positive environment. If youngsters grow up in a positive environment it is less likely that they will get involved in damaging behaviour. In The Netherlands, the Government has introduced a curriculum "Taking care of yourself’. This is compulsory in every secondary school. It concerns two lessons per week in the first year of secondary school. In these lessons, 12 and 13 year olds learn to cook a healthy meal, discuss personal hygiene, talk about group pressure, do role-plays and receive information about alcohol, tobacco and illegal drugs and discuss this. Overall, these lessons help youngsters to be better prepared for society.

Another measure taken by the Dutch Government was the introduction of the Young Work Guarantee Plan (JWGP). Every young person who has left school and who has not found a job within six months is entitled to get a job through the JWGP. These are just two examples from the Netherlands. Other countries have similar programmes. At a local level, policy makers can benefit from such centrally introduced schemes. For further information about drug prevention we refer to the ‘Handbook Prevention, alcohol, drugs and tobacco’ published in 1998 by the Pompidougroup of the Council of Europe and Jellinek Consultancy (edited by Dr. Jaap van der Stel, assisted by Deborah Voordewind, ISBN 90 74037089).

Drug free treatment

Every drug policy should have a ‘chapter’ on what to do for drug users who want to stop using drugs. It can be outpatient or in-patient treatment or a combination of the both. Sometimes medication is used for a short period of time to help combating the withdrawal symptoms. During treatment, the client receives psychotherapy, takes courses and is assisted to find a job. Drug free treatment is reasonably successful for those persons who finish the treatment (about 50% stays clean). However it should be mentioned that only 10% of drug users are interested in following drug free treatment. So it could be said that for 50% of that 10% (=5% of total group) the treatment is successful. Does that mean that it should not be done? We think there is a clear place for drug free treatment. Even a failed treatment could have positive effects on the person and may ameliorate the chance of success of a second attempt. Within the available budget, not all the money should go to the above 10%. The ninety-percent of drug users who don’t want to stop should be cared for. This can be done in harm reduction projects.

Harm-reduction

The philosophy of harm-reduction has been introduced on a large scale when it was realised that Aids became a greater threat to society than drugs. It was believed that drug users could spread HIV to the general population through unprotected sex. With the argument that the general society should be protected, measures to reduce the spread of HIV among drug users could be introduced with little resistance from the general public. The main examples of harm reduction measures are the provision of methadone and clean needles and syringes. Lately, another harm-reduction measure has been introduced regarding the so-called ‘party drugs’. In some countries, pills can be tested at big dance festivals. There are pros and cons towards this testing (see chapter on legal boundaries).

This rest of this chapter discusses a number of issues that could be part of a course on local drug policy. We will look at:

1. How to define clear objectives of a local policy
2. Which instruments are available and can be created?
3. How is the policy implemented and who are possible allies?
4. How is the policy monitored and evaluated in order to make sure the objectives are reached?

We will use examples from various courses organised by EATI. In practice, you might want to use some of these examples or come up with other examples that are better suited to the specific needs of your group. You may want to ask your guest-speakers to elucidate certain aspects of the above mentioned points. Participant’s specific experience and expertise can be used as well in discussing the above issues.

2. The objectives

In this paragraph we will first discuss the various actors involved in defining the objectives. Subsequently, we will discuss the need to collect factual information in a ‘fact-finding’ mission. Finally, we advise you to scan the scientific literature to be well prepared for the discussion and in order to avoid the process of defining the objectives becoming too emotional and ideological.

2.1 The actors

The process of defining objectives for a drug policy is a complicated one and involves a number of actors. It is of the utmost importance that the actors develop their points of view based on concrete information and not solely on emotions and ideology.

Examples of actors involved are:

• Local politicians
• The community
• Helping agencies
• The local criminal justice system
• Drug users
• Policy makers

Every actor has his own agenda and interest and the interests between different groups may clash. We will discuss the interests of the various actors and factors they might like to see incorporated in a local drug policy.

The local politicians

The drug issue is only a small part of the overall responsibility of local politicians. Their main interest is to make their city a pleasant place to live and work. Inhabitants of the city should feel safe. To ensure sufficient jobs, business should consider the city as a good place to settle down. Shopkeepers should feel that this place is a place where they can do good business. The drug issue can endanger all these aspects: shop keepers threaten to close their shops if there are too many drug users hanging around and their customers stay away; inhabitants of certain neighbourhoods start complaining they don’t feel safe in their homes and that they are being harassed by drug users and drug dealers; big companies don’t want to settle in the city because the city has a bad reputation. These are the main concerns of local politicians. Of course some may also be worried about the social and health situation of individual drug users and the spread of Aids, but in most cases this will be secondary to the issue of the overall liveability of the city.

The community

More and more, the community plays a role in shaping local drug policy. They may have had to put up with nuisance cause by drug users and drug dealers for a long time and then one day they will have had enough. In some cities neighbourhood organisations have even been violent to drug users and drug dealers, creating their own vigilance and acting as police, judge and executor of the ‘penalty’. These sorts of developments are very dangerous and jeopardise democratic society. Nevertheless, it is understandable. Especially when local politicians and decision-makers have neglected the drug problem for too long, things might get out of hand. It is no wonder, that the reactions of neighbourhood representatives are often very emotional and sometimes hardly based on first hand experience. In one situation, inhabitants of a city marched into the city hall and emptied a bucket of needles and syringes on the desk of the local alderman. They claimed they had found these needles and syringes in the streets and in alleys. It turned out, that the needles were of a type never used by drug injectors. Some people had bought these needles, made them dirty and told other people they had found them in the street.

In another city, angry citizens marched to a house of a drug dealer and were yelling and shouting and threatening to come and get the ‘dealer’ out. It turned out they had the wrong flat and the person living there had nothing to do with drugs at all!

In giving these examples, it is not to say that neighbourhoods have no problems with drug users and drug dealers. On the contrary, what it does demonstrate is how desperate some people get when they have the feeling that nobody wants to listen to them.

The objective of inhabitants is to live in a nice neighbourhood where they feel safe to go out and where their children can walk around without risking being confronted with (injecting) drug users, drug pushers or criminals.

Helping agencies

Helping agencies focus more on the interest of individual drug users and general public health issues. Roughly, helping agencies can be divided into two categories:

1. Agencies which expect their clients to adapt to what is being offered;
2. Agencies which adapt their services to the demands of the drug taking population

Agencies in the first category are mainly so-called ‘high-threshold’ facilities with good quality services for a relatively small group of people. They have a clear and limited objective (for example: this year we want to treat 50 people to become drug free) and they are satisfied when they reach their objective. The ‘big’ world outside is not so important as long as there are sufficient people who are interested in what they have to offer. For them it is important to have a waiting list, so ‘business’ is ensured.

Institutes in the second category are mainly so-called ‘low-threshold’ facilities and/or public health oriented institutes. They try to reach as many people as possible, they offer the sort of care that active drug users appreciate (outreach services, provision of methadone, provision of needles and syringes), often referred to as ‘harm-reduction’. In formulating their objectives they will look at the ‘big’ world and thus include issues such as drug related nuisance in neighbourhoods, public health aspects (prevention of the spread of Aids, Hepatitis, Tuberculosis and other infectious diseases) and the management of day-to-day life of individual drug users whilst accepting that they are still using drugs.

It is not to say that one category is ‘better’ than the other. In most cities, both sorts of interventions are available. When developing the objectives of the local policy, both views should be incorporated.

The local criminal justice system

The local criminal justice system (police, public prosecutor, and juridical system) will have public order as their first objective. However, in many cases they realise that solving the problem in one area of the city just moves it to another part. More and more, the criminal justice system is trying to work with the helping system and neighbourhood representatives to try to manage the problems together (integrated approach). Such an integrated approach means that the criminal justice adapts its objectives from ‘just public order’ to ‘public order and care for drug users’. ‘The police as social worker’ may create new and confusing situations in the city. Some may argue that it would be better to stick to one’s own trade, whilst others indicate that policemen know the drug users well and that their intervention is more effective than the one of a social worker who is ‘never there when you need him’.

Drug users

Drug users themselves should be part of the process in developing the objectives of a local drug policy: they are the main actors and a policy will probably not work if one has not listened to what they had to say. Because drugs are illegal and in some places the use of drugs is also a criminal offence, it is sometimes hard to get drug users involved in policy making. They are afraid to come out and be identified as user of illegal drugs. Sometimes drug users are too occupied with getting drugs and don’t want to give priority to being involved in policy making. Another problem in involving drug users is that they are often dependent on doctors and helping agencies. They might be afraid that they would be kicked out of treatment if they are too critical. Although this might not be a real threat, the fear alone that this could happen can be enough for drug users to stay quiet.

Drug policy objectives for drug users will include: using drugs for a reasonable price and good quality, being able to get clean needles and syringes, being able to use drugs in a ‘hassle-free’ environment, getting sufficient financial support to eat and live, being treated as a human being and not as a ‘junky’, getting help if needed.

Policy makers

The policy makers have the difficult job in keeping all the actors happy and at the same time ensuring that a good quality policy is developed. They will have to analyse the various ingredients brought forward by the different actors and use this for a list of draft objectives.

In summary, the different actors might bring up the following ingredients for the formulation of the objectives of the local drug policy:

• Ensuring a safe environment
• Creating an attractive environment for business
• Securing the image of a ‘nice’ city
• Preventing youngsters to start with drugs
• Reducing harassment and nuisance caused by drug dealers and drug users
• Reducing drug related crime
• Offering good quality treatment to assist drug users to quit
• Getting in touch with active drug users and assisting them to reduce the harm they cause to themselves and others (including the spread of infectious diseases)
• Having safe-places to use drugs
• Reducing the price of illegal drugs and ameliorate their quality
• Ensuring easy access to methadone and clean needles and syringes
• Treating drug users as human beings and not as outcasts

2.2 Fact-finding

Once the wishes of the various groups are known, it is time to get a better picture of the ‘real’ situation. Before one can formulate the final objectives of a policy, one should know exactly what is going on in the city. This means a ‘fact-finding’ mission has to be done, collecting as much information as possible. The following questions should be addressed:

1. What is the present situation regarding ‘drugs’ in the city? How many people are using drugs, which drugs are being used, what is the profile (or profiles) of drug users, which problems are associated with the use of drugs? Is there a trend in terms of growing, stabilisation or declining of the numbers of drug users, new drugs on the market, new patterns of drug use?
2. How many people are presently working in the drug field and what is the potential of involving others (hospitals, general practitioners, institutes of social work, universities etc.)?
3. What is the present budget, how is it spent and who has influence on how the money is used. Which activities take place in the drug field that are not paid through the budget?

This fact-finding mission is not a scientific activity and should be done in a relatively short period of time. Of course there is a risk that certain information is not accurate. In which case, part of the objective of the drug policy should be to set up a proper monitoring system.

In the following paragraphs we will elaborate on the various components of the fact-finding mission.

Present drug situation

It is important to have a good picture of the present situation regarding the use of drugs.

Sometimes, the image of the ‘drug problem’ in a city is created by a fraction of drug users who live a very unstable and chaotic life, are homeless, have psychiatric problems, suffer from medical diseases. There may just be a handful of these people, but since they are so visible, they present the dominant image of the ‘drug problem’. It is important to put things in the right perspective. There are a number of methods available to estimate the number of drug addicts, based on existing data. One of the methods used in Amsterdam, has been the ‘capture-recapture’ method. With this method, three numbers are compared:

1. the number of people who receive methadone from general practitioners, the Amsterdam Municipal Health Service and the CAD,
2. the number of heroin addicts arrested by the Amsterdam police and
3. the number of people who were both in group (1) and (2).

The following formula is used:

Group (1) x Group (2) = estimated number of heroin addicts in Amsterdam

Group (3)

This method can be used on different subgroups (male/female, various age groups, various nationalities etc.).

Another method is the ‘snow-ball’ technique: drug users are asked to mention the number of other drug users they know and their characteristics. Subsequently, they are asked to help to make contact with a number of other drug users etc. They are also asked whether they have been in hospital, have been arrested by the police, have taken an overdose, have had contact with a specific institute etc. Subsequently, they can be asked how many drug users they know and how many of them have been arrested by the police etc. When this question is asked to a large number of people, one can calculate an average percentage of drug users who have been in a particular situation. For example, if –according to the information from the sample- an average of 20 percent of drug users had been arrested by the police in a particular year and the police records indicate that they have arrested 2,000 drug addicts in that year, you may use this as an indication that there might be 10,000 drug users in the city.

Another important indication might come from the helping agencies.

• How many people are in treatment, how many on the waiting lists?
• is there a possible overlap between waiting lists of different institutes?
• do they exchange information?
• how many needles and syringes do pharmacists sell?
• how many needles and syringes are handed out in needle exchange programmes?
• how many people are receiving methadone?

Most of these data will be readily available.

If systematic collection of data about HIV infection is done, this might be a useful indicator as well. One should be aware that HIV sero-prevalence studies might have selected a specific subgroup of drug users and therefore one should be careful to extrapolate these data to the whole group.

Data from the criminal justice system are also important: how many arrests were made, which percentage was drug related and how many different persons were involved?

Streetcornerworkers and outreach workers often have a lot of relevant information they can share with you. However, some of them might not collect information as systematically as researchers. It would therefore be advisable to invite them to a meeting and ask them to tell you how the drug problem is developing, which trends they see, if there are new drug users etc. One may collect more information in 2 hours talking to streetcornerworkers and outreach workers than one would by contracting expensive researchers and/or reading thick official reports.

If possible, drug users themselves should be used as a source of information. Again, they could be invited to a meeting (like the streetcornerworkers and the outreach workers).

Amsterdam has introduced ‘ANTENNE’. With this assessment instrument, qualitative as well as quantitative data are collected at schools and through ‘panels’ of drug users. Since the same method is used over a period of years, trends can be assessed. The outcomes of ‘ANTENNE" have proofed to be very valuable for the policy planners in Amsterdam. For more information we refer to the various publications.

The work force

It is important to have a clear picture of the number of people who are working directly or indirectly with the drug issue. All helping agencies can be asked to give an indication about their work force in this field (paid professional, management, volunteers). The criminal justice system could indicate the percentage of time they spend on the drug issue and how many of their staff is involved in it. Universities should be contacted to find out if research is done on the drug issue and if ‘drugs’ are part of the training of students, and if so, how many people are involved. Polytechnic schools for nursing and social work can be asked to indicate which percentage of the training involves the drug issue. Neighbourhood organisations can be asked to indicate which percentage of their activities is aimed at the drug issue. Finally, one should calculate the number of persons involved in the policy making.

It will probably turn out that there is a whole ‘army’ of people involved in the drug field. This is of crucial importance when developing a local policy. All these people could contribute to the success of the policy as long as they are involved in the right way!

The budget

Part of the fact-finding mission is the available budget. First of all it will concern the budget which is clearly labelled as ‘drug budget’. It is possible that this budget is earmarked by the central government. Besides the typical ‘drug budget’ there will be other budgets which might be available, such as a budget for renovation of run-down neighbourhoods, a budget for increasing safety, a budget to fight poverty and unemployment etc.

The objectives of the policy can be adjusted to the available budget, or one can try to raise sufficient money to meet with the objectives of the policy. In some cases it is advisable to design short and long-term objectives and to set priorities within the available budget.

Rapid Assessment

Recently, Gerry Stimson and colleagues have been working on a publication for the World Health Organisation on ‘Rapid Assessment’. The ‘Draft for field testing’ entitled "The Rapid Assessment and the response guide on injecting drug use" was publish din February 1998 (for more information email: balla@who.ch ). Rapid Assessment both assesses the drug problem (systematic appraisal of the type, depth and scope of the problem) as well as the resources (funds, people, buildings, knowledge).

The advantage of rapid assessment is its speed, its cost effectiveness and the possibility to work with existing data. Those involved in the rapid assessment make use of a wide variety of sources and check these sources constantly during the process. This means that a maximum relevance can be obtained for interventions and practical issues. Goal is to be adequate rather than reaching a scientific perfection.

We recommend this book for those who want to have a better idea about the local drug situation.

2.3 Using scientific data

To define well-balanced objectives, information from scientific research has to be included. It concerns the relative risks of various drugs, general morbidity and mortality rates related to certain substances. Proper use of these data, should lead to including alcohol and tobacco in the local drug policy, since –according to research- these two substances are still the main ‘killers’. Data about the use of cannabis products, the relative risk of so-called ‘soft-drugs’ and the possibility that the use of soft drugs leads to the use of hard drugs can be found in scientific articles and will turn out to be useful in debates about the local drug policy. It should be noted that scientific data are often multi-interpretable or not conclusive, which can mean that everybody is giving the explanation that best suits their opinion. A good example is data from research regarding the effects of the exchange of needles and syringes. Data from Europe and Australia clearly indicate that needle and syringe exchange schemes manage to attract drug injectors, reduce risky behaviour and do not lead to an increase in drug injecting. However, these data were not conclusive regarding the effect on the containment of the HIV epidemic. This has been used (or abused) by American policy makers to refuse support for needle and syringe exchange schemes in the USA.

Based on the wishes provided by the various actors involved, information collected in the ‘fact-finding’ mission and scanning of scientific literature, one should be able to draw-up the first draft objectives for the local drug policy.

3. The Instruments

In this paragraph we will discuss the instruments that policy makers have at their disposal. We will look at the influence of policy makers, legal boundaries for the implementation of planned actions and winning the support of the actors involved.

Influence of policy makers

The influence of policy makers will depend strongly on the political situation and the size of his/her budget. It seems that the influence of the policy maker is linearly related to the size of the budget.

A policy maker who is very close to a well-known politician may realise that he/she has extra influence. However, if the politician is not re-elected, the policy maker loses his/her influence instantly. In some cities, the policy makers are independent of their political bosses. They may ‘survive’ many political changes. The advantage is that they can develop a very good expertise. The disadvantage is that they will be more ‘set in their ways’ and less likely to quickly introduce changes based on a different political point of view.

Policy makers should be aware of their position and look for an optimal strategy to fit their own situation and work best for implementing the objectives.

Legal boundaries

Some objectives may not be possible to put in practice because of legal boundaries. For a long time the prescription of heroin seemed to be impossible due to legal problems. However, the Swiss authorities found a way of dealing with this issue and to date, the prescription of heroin as a scientific experiment is implemented or planned in a number of countries. In some countries, the provision of clean needles and syringes was impossible because of legal obstacles. Sometimes laws had to be changed or the police had to ‘turn a blind eye’.

In some countries the police can set priorities in consultation with the public prosecutor. In that case, they can decide to ignore minor offences (such as the possession of small quantities of drugs) and concentrate on bigger issues, such as large-scale dealing, heavy crime, major nuisance caused by drug dealers etc. In other countries, the police is not allowed or not willing to set priorities and act every time they are aware of illegal activities. This could lead to the bizarre situation that the police harass users of marihuana and leave big heroin dealers alone.

In some countries, the testing of tablets at major dance events has been introduced. This is a good example of working with legal boundaries. In all countries, tablets containing xtc or other stimulants such as amphetamine are illegal. In some countries it is believed that negative effects of ‘party drugs’ are caused by bad quality drugs and improper use of these drugs. By providing the test-service, they hope to ban bad drugs from dance parties and be able to communicate with the users and get some prevention message across. The police is asked to leave them alone, whilst with active police involvement nobody would have their tablets tested. People who are against ‘testing’ argue that testing gives the wrong message to youngsters (as if it is okay to use drugs as long as the quality is okay) and that the police can ban the availability of drugs at a dance party.

Getting support

The objectives of local drug policy can only be realised if one secures the co-operation of the various actors in het field. The police, helping agencies and research institutes will provide the main instruments for the implementation of the policy.

The police

The police force should be willing and capable of co-operating in the realisation of the objectives. They must have sufficient staff and the staff’s attitude should be in line with the general objectives. For example if a city decides to on introducing a harm-reduction policy and opens so-called ‘user rooms’, it should be a hundred percent clear that the police will not interfere with this policy and leave such ‘user rooms’ alone.

It might be necessary to offer the police additional training to ensure that policemen have the information and attitude which goes along with the philosophy of the local drug policy.

The helping agencies

Helping agencies have to be willing to devote their time in such a way that the objectives of the policy can be reached. This may mean that the budget has to be reallocated to new projects and new interventions. It might also mean that other activities which were useful in the past but less relevant today, lose financial support. It will mean that some staff will have to be re-trained to do other work. Sometimes they might find it difficult since they are ‘set in their ways’ and ‘believe’ one type of treatment is the only and best solution. It is important to label their attitude as a positive commitment and involve them in the changes as much as possible, so they feel part of the process.

Sometimes helping agencies will ask for more resources to fulfil the demands of the politicians. They should be requested to come up with solid proposals in which they indicate what they do with the present budget, how they can use the present budget for new developments and how much they need for new activities.

Research institutes

Research institutes (often part of a university) can play a very important role in collecting data and providing feedback to policy makers. They can do a lot of things within their own budget. For the University it is important to ‘serve’ society and –besides- ‘dry’ scientific research to provide information which has an immediate impact on the policy making process.

4. Implementation

After defining the objectives and getting a clear picture about the instruments one has available, it is time to implement the new policy.

We will discuss a number of issues:

1. Making the network work
2. The role of the media
3. Informing the public
4. Training
5. Spending money wisely

Making the network work

As mentioned before, there are a number of actors in the drug field. Since they may have different interests, there might be a fertile ground for conflicts. It is in nobody’s interest if energy is wasted in emotional fights. Everybody should be taken seriously and be heard. If their point of view is not accepted, it should be clear why not. There are many different techniques to make a network work. Basic ingredients are: mutual respect, providing everybody with sufficient information, be open to suggestions, be willing to listen, be clear, be patient. Of course the various actors are not equal. The head of police will have more influence that the mother of a drug user. However, for the implementation of the drug policy, they are both needed.

You may have to organise regular meetings with the various actors involved. In Frankfurt, they have had very good experience with ‘Monday Morning Sessions’. These sessions involved local politicians, policy makers, police, justice, neighbourhood representatives and even staff of a bank which was close to the drug-scene.

The role of the media

The media can play a crucial role in local drug policy. The drug issue always provides sufficient interesting material for the media to write something or to make an item on television or radio. It is important that drug policy makers make proper use of this interest. It is important that there is a good rapport between the policy maker and the media. It means that they have to respect each other, accept that they have different responsibilities and agree that they have to make clear deals. One deal can be "I scratch your back, you scratch mine". We would like to mention a number of ‘rules’ in contact with the media:

• If you have a scoop, you can only give it to one journalist
• Never break an embargo
• If an interview is given to a journalists of a newspaper, ask to read it before publication
• Don’t let yourself be tempted to say things you are not allowed to say or you can not prove
• Stay close to the facts and prevent opinions and emotions
• Give other people credit

Informing the public

A very important part of the implementation is informing the public. This should be done in various ways:

• Informing the local community leaders ‘face-to face’
• Providing information through local media
• Distributing written information ‘door to door’
• Organising information evenings

It is probably advisable to use all the above methods, but start with the ‘face-to face’ meeting with the community leaders. They will give you feedback on your plans and will advise you regarding the best methods to inform the public. The public should not be taken by surprise when they hear in the media that a drug centre will be open in their community. So it is important to develop a good strategy for informing the public and take your time to do that. It is also important that the people who give the information (for example at a ‘information meeting’) know what they are talking about, have sufficient influence in the hierarchy and give the public the idea that they are taken seriously. It should always be possible to make some changes. To inform a community with a ‘fait accompli’ is asking for trouble. If you leave some issues for discussion, you have something to negotiate and communities will feel that they have influence (and they have in fact). For example the fact that a clinic is coming in the neighbourhood could be a fact that is not to be discussed. However, the exact location and the exact opening times can still be discussed.

Training

We have already talked about the importance of training police and helping agencies. It is important to spend time and money on this. During the training you can develop new enthusiasm and motivate people to spend energy in accomplishing the set objectives. The training should be short and practical. It should also be aimed at large groups of people rather than just targeting two or three people. If a new drug policy is introduced, it is advisable to organise a one-day conference, which is opened by the Mayor or another leading politician. It should be covered by the media and there should be sufficient room for interaction between various ‘actors’ and discussion. Such a conference should always have a social aspect to it as well, for example with a reception afterwards.

Spending money wisely

One can only spend money once. Setting clear priorities is important. Always try to find other sources before you give money for a specific project. Most interventions need to be done for a number of years. Make sure you are capable of ensuring the continuity. If you don’t have money for a longer period of time, actors should know very well that it concerns a one-time support.

5. Evaluation and Monitoring

Once the drug policy is implemented, it should be clearly monitored and evaluated. This is why the objectives should be operationalised and be phrased in such a way that they can be evaluated. Some objectives may be evaluated in clear numbers. For examples if you wanted to reach 500 drug injectors in the needle exchange, it is just a matter of counting. It will be more difficult to measure whether drug users are actually treated as human beings. How do you do this?

Most objectives will be possible to evaluate. Some examples:

• Crime figures
• Overdose rates
• Number of drug users in prison
• Amount of drugs confiscated
• Number of complaints
• Aids figures

These data should be collected systematically and published in such a way that it makes sense to the media and the general public. People don’t like ‘juggling with data’. If certain objectives were not reached, it should be recognised and measures should be proposed to reach the objective or if the objective was too high, this should be recognised as well.

Practicalities for organising a training

1. Introduction

 

2. Practical steps

• General outline of the course

• The topics
• The trainers
• The external experts/ guest speakers
• The participants
• The location
• The budget
• The reader
• Homework
• After the training
• The social programme

• The balance
• Active involvement of participants
• The attention span
• Language problems in case of guest speakers
• The group process

1. Introduction

In part II of this handbook we will describe the practicalities of organising a training. In chapter 2., we describe concrete practical steps that should be taken. We first describe the importance of making a time-table and a general draft outline of the course. This should be done at least 6 months before the course starts and will be the framework for the months that follow. The general outline should be checked with colleagues and some potential participants to make sure that one is on the right track. Once the general outline is acceptable, the various parts of the outline can be further developed, such as: securing the budget, selecting the topics, the trainers, finalising the date, booking hotel accommodation and the meeting room, selecting guest speakers, selecting potential participants, and making sure that everything can be done within the available budget. A social programme can be drafted and attractive events, which take place in your city and which your participants would like to see, should be considered. And when the date of the course is approaching, the participants should be contacted personally and asked to do ‘homework’. During the course the organiser should be available for practical questions, support of the trainers etc. and after the course, one should make sure that feedback is received not only from the participants, but also from guest speakers and trainers. This information is important in ameliorating future courses.

In the chapter 3 of this part of the handbook we will discuss how to create an optimal climate in the group in order to facilitate the learning and interaction. We will discuss the balance in the programme, methods to ensure an active involvement of the participants and keeping their attention. We will also discuss the issue of language in case you work with invited speakers who don’t speak the language of the participants. Finally, we will discuss various aspects of the group process.

The aim of this part of the handbook is to help training organisers in the process of developing a course. It will give concrete guidance in the various steps to take. Where appropriate, we have included checklists. These are our checklists and just suggestions. It may be that these checklists need be adjusted to suit one’s own situation. It will be the course of the local organiser and the success of it will depend on his/her creativity and commitment. He/she may have to do all the hard work, but remember, if it is a success, he/she will get all the credits!

2. Practical steps

General outline of the course

The first step to take is to make a time-table and a rough sketch of the course. In this sketch you describe:

1. a list of the various topics you would like to discuss in this course
2. a list with possible trainers
3. a list of various persons you could invite as guest speakers
4. the profile of the participants you would like to see in your course
5. a list of possible locations with the pros and cons of each location
6. a preliminary budget proposal

In this first outline you try to make a preliminary ‘ideal’ programme (with het various times in it, day 1 from 9.30 to 11.00 etc.) which includes the following points:

• Input from external sources, such as guest speakers
• Input from participants
• Discussions between participants
• Digestion of information, discussion and feedback
• Informal meetings and social programme

This first draft should be discussed with a number of colleagues to see whether you are ‘on the right track’.

The topics

The issue of local drug policy can include many different aspects. It concerns a good care system for drug users on the one hand, but it should also focus on the quality of life in the city and the impact of the drug problem for ‘non-drug users’, such as inhabitants of problematic neighbourhoods, parents, partners and children of drug users. This can be discussed within the framework of the dilemma ‘Public health or public order’. Although these two are not mutually exclusive, it is obvious that some policy makers choose to put more emphasis on one or the other.

Another important topic when discussing local drug policy is the issue of ‘exclusion’. Often some drug users with clear ‘anti-social’ behaviour are excluded from main stream society. They can be found in inner city areas or in run-down suburbs. They often have no place to live, have bad health, lots of social problems and create nuisance to their environment. It is this group of drug users who make the drug problem visible and who are often the reason why politicians take action.

Another topic to discuss could be the role of research. Especially the interaction between policy and research is very interesting and important. Who decides what should be researched and what is done with the information researchers provide?

A fourth example of a topic, which could be discussed in this course, is the role of the media. The media play a very important role in the perception of the public of the drug issue. The public’s feeling of safety, the appreciation of living in a particular city or neighbourhood not only depends on concrete first hand experiences inhabitants have had, but also on things they hear and read in the media. The influence of the media on policy making should be an integral part of any local drug policy.

The trainers

A good selection of trainers is crucial for the success of your course. Trainers should have a range of qualifications that are not so easy to find in one person. They should be knowledgeable in the field of local drug policy making, they should not be too ‘set in their ways’ and be flexible, so that they are open to different points of view. They should be excellent communicators, willing to listen well, but also to intervene when the group-process is moving in a direction that is not constructive. They should be aware of the input of the individual participants, the group process and make sure that everybody gets out of the course what he or she expected.

Since all these qualifications are difficult to find in one person, it is advisable to work with two trainers. If possible a male and a female. They can divide the work according to their specific qualifications. Needless to say, they have to work well as a team, prepare the course well together and have a very clear division of labour.

It is advisable to appoint someone for the logistics (contacts with hotel, audio-visual aids, coffee and tea breaks etc. etc.), so that the trainers don’t have to worry about these things.

The external experts/ guest speakers

The external experts/ guest speakers should be contracted about 4 months before the course. They should be well known in the field, be attractive and entertaining speakers and be capable of communicating with relatively small groups. Their presentation should on the one hand contain information and on the other hand provoke the audience to discuss the issues concerned. They have to be prepared to make written material available to the organisers beforehand. They have to be willing to be committed to participate at least one whole day in the course. In this way, you prevent that they ‘fly in and out’ and leave the group with lots of unanswered questions. It is advisable to try to involve them in the informal part of the course as well.

The course organisers should brief the guest-speakers beforehand on the specific content and nature of the presentation. This can be done in writing and further discussing things over the telephone.

Another issue to consider is the synergy between the different experts/ guest speakers who are invited. There should be a balance in terms of:

• Different fields of expertise
• Different regions or different parts of the city
• Gender (male-female)

Sometimes an expert you would like to invite might not be available and therefore you should have a back up. The unavailable expert might give you a suggestion for an alternative speaker. Although this might work very well, it is a good idea to double check with someone else in order to see if the suggested person has the right qualifications.

In the first contact with the external expert, details of the finances should be clearly discussed. Travel costs and hotel costs (if the person stays more than one day) and the costs of food should be borne by the organisers. The honorarium will depend on the qualifications of the invited expert. This is a negotiation between the organisers and the invited expert. It is important that the final agreement regarding the finances is clear to all parties involved.

The participants

In our experience it has not been easy to find the right participants for this specific course on local drug policy. In every country local drug policy is developed in a different manner. Some countries have a centralised policy, leaving little or no space for local initiatives, whilst other countries have a completely decentralised policy, leaving all the responsibilities for the drug policy to authorities at a regional or municipal level. This means that addressing the target group is different in every country. Most of the civil servants working with drug policy on a local level have also other responsibilities than ‘drugs’. They neither have the time, nor the budget to participate in a one-week course.

The issue of the target group is an important one. You can develop a very good course, but if there are no participants, all your work was in vain. It is therefore advisable to show your general outline to some local policy makers to see whether they would, in principle, be interested in participating in such a course.

It is also advisable to check the date of local elections. Before local elections, policy makers will not take a course. However, after the elections, you may have a lot of ‘new faces’ in the drug policy field, especially in countries where politicians appoint policy makers. So three to six months after a local election is a perfect period for offering a course.

Another way of targeting possible participants is following the news and seeing which cities have severe problems with the drug issue. For example you may find issues in the news about neighbourhoods refusing new facilities in their area. It could be advisable to send a letter to the city hall and check with the local policy maker whether he or she would be interested in a course on local drug policy.

The right number of participants for this course is between 12 and 16. If you are in the fortunate position, where there are more applicants than places, there are a number of ways in which the selection could be done:

1. Based on ‘first come first served’. This is a very fair system and nobody will question it. However, it does not mean that you will get the best input and create an optimal synergy between the participants
2. Based on needs. In this case individuals with little experience but great many responsibilities will get priority. This choice will mean that there will be little opportunity to make use of the expertise in the group. Since this is very important, one should be careful with this choice and always make sure that there are also some more experienced local policy makers in the group.
3. Based on expertise and background. This is a sort of ‘dream scenario’ for the course organisers and trainers. They look at the specific background of the applicants and try to match a perfect group, trying to find a balance between experience in different sub-areas, balance in gender and balance in country of origin. The advantage is that there will be a very good group, which is optimally geared for learning and interaction. On the other hand the disadvantage is that the course might get an ‘exclusive’ character.

If their are guest speakers who speak English, there should either be translation facilities or the participants should have a good working knowledge of English language.

The location

It is very important to choose the right location for the course. Often the available budget and the choice of the hotel are the main factors when choosing a particular location. This is not the best way to do it. Often the hotel is fine, but the meeting rooms are not ideal.

Of course in practice one should be willing to ‘poor some water in the wine’. It is important that the meeting rooms are checked beforehand by someone who has experience with this. If you have doubts, you can ask the hotel to give you a reference of someone who has used that meeting room.

The budget

Before you take definite steps to organise the course, you should be sure about the budget. In most cases, you will have to rely on financial support from an agency, your government, the European Commission etc. A course with only a few participants is very expensive.

After you have made the budget, you can calculate the costs for the participants. This is the total budget minus the money received from subsidies divided by the number of participants.

The Reader

Participants should receive a Reader about two weeks before the course starts. The Reader has two purposes:

1. To put the participant in the right mood for the course and prepare him/her for the discussion which will take place
2. To be used after the course as reference-book

The trainers and the course organisers make a selection of relevant articles. Make sure the information is recent and relevant to the local situation. It should not be too long and too complicated, since nobody will read it. The Reader should have between 80 and 100 pages (including the outline of the training programme, list of participants etc.). Each article should be clearly presented in a recognisable way (for example with coloured pages between the articles).

Other points for the Reader are:

1. Address of organiser should be clearly printed on the first or second page (with telephone, fax and e-mail numbers)
2. Clear table of contents
3. Foreword by the trainers briefly describing the choice of the articles
4. If possible, every article should have a reference address

If possible, the programme information should be included in the Reader. This has the advantage that everything is in one book and information will not get lost. Disadvantage is that ‘last minute changes’ can not be printed.

If information about the course is included, it should mention:

• The programme of the course (time table, topics, names of guest speakers etc.)
• List of participants (full address with telephone, fax and e-mail)
• List of trainers (full address with telephone, fax and e-mail)
• List of guest speakers (full address with telephone, fax and e-mail)

Examples of articles used in EATI Readers:

• The effects of Harm Reduction in Amsterdam, Ernst Buning & Giel van Brussel. In: European Addiction Research 1995;1:92-98
• Drug Use and Drug Policy in Europe, Karl Heinz Reuband. In: European Addiction Research 1995, 1 32-41
• City Hall and House, guidance for use by local authorities concerning large-scale manifestations and party drug use. Dutch Ministry of Health Welfare and Sports, April 1995
• Drug prevention in The Netherlands: an integrated approach, Ernst Buning, Hettie Rensink and Marjolein Bron. Presentation at ‘Substance Misuse prevention education, International Conference for exchange of information on best practice’ November 20/21, 1996, Dublin, Ireland
• Drug education: Programmes and Methodology, an overview of opportunities for drug prevention, by Wim Buisman, UNESCO, Paris, January 1995
• Aids prevention with injecting drug users in the former West Germany, a user-friendly approach on a Municipal level, Heino Stover and Klaus Schuller . In: The reduction of drug related harm, 1991
• Drug Nuisance Policy, Fact sheet no 6, Dutch Ministry of Health
• Drug policy: should the law take the back seat? Virginia Berridge. In: The Lancet, Volume 347, February 3, 1996
• Open Drug Scenes: A Cross-National Comparison of Concepts and Urban Strategies, R Bless, D.J. Korf, M. Freeman. In: European Addiction Research 1995, 1 128-138
• New trends in synthetic drugs in the European Union: epidemiology and demand reduction responses, Paul Griffiths, Louisa Vingoe and Karl Jansen, EMCDDA, November 1997

Homework

All participants should be requested to do homework before they come to the course. This forces them to focus on the course and is very important for ensuring sufficient input in the training. The contents do the homework is a ‘red thread’ through the programme. It is possible to ask certain participants to put more emphasis on specific point. For example, if a policeman is participating he/she could be asked to focus on public order issues. A doctor could be asked to focus on medical problems etc. Part of the homework will be the formulation of the expectations of the training. Most of the participants will be extremely busy with their day to day work and will probably only start to think about the course the moment they step into the plane, train or car. Sending the Reader beforehand and by asking them to prepare homework they might start thinking about the course earlier. This is important. The clearer ideas the participants have about the possible outcome of the course, the better they will learn. This will prevent frustrations and will be beneficial for all parties involved.

The request for homework should include a list of things you want the participants to describe. The homework should be no more than two written pages and the participant should be prepared to make a short oral presentation as well and/or present the information on a ‘Poster’. It is even possible to organise an informal ‘get-together’ before the conference, where participants put up their Posters on the wall and walk around, read and discuss.

Participants should receive a written request for making their homework, including the deadline for submission. All homework can be photocopied and made available to the participants.

After the training

Most of the people working in the drug field are completely absorbed in their work. Although they are likely to have all sorts of ‘good intentions’ during the course, these ‘good intentions’ might be forgotten soon after the course. This is the reality and it would be too naive to think that you could change this pattern. However, you can build in a number of mechanisms to try to maintain a longer lasting effect of the course. Each course should have an evaluation form. It is best to ask the participants to fill this in during the last session. Of course these results are coloured: hopefully everybody is ‘high’ and very enthusiastic about the course, the group, the invited speakers, the trainers etc. So they will give positive feedback. After returning home and going back to their jobs, participants might become more critical and lose some of their original enthusiasm. This is the moment where you should contact them again. First you can write a letter, saying that you would like to speak with them and check out the right time so that they can pay sufficient attention and are not distracted. You can use a checklist; for example, using the same form you used for the feedback.

You should first ask them how they feel about the course two weeks later. After their general answer you can go more into detail, following the questions of the feedback form.

If there is a great discrepancy between the first and the second rating, you can discuss that and ask for the reason.

The best possibility to create an ongoing and lasting process is to invite someone to come back to another training or a follow-up training with the same group. In practice, this is very difficult, since people often change jobs or are not allowed by their superiors to participate in another course.

You can also include them in your networks and make sure they receive important mail, announcements of conferences and meetings, In some cases, you might want to ask a participant to be a trainer or guest speaker in another course.

About 6 months after the course, you can contact them again to find out how they have been able to integrate what they learned from the course. You have to be very precise, otherwise you will end up with a lot of general and vague information. You should also accept that it is difficult to indicate exactly what was learned in one course, since it is always a process and one learns things all the time in many different settings.

So far, we have been talking about feedback from the participants. If you intend to organise more courses, it is also very important to ask the trainers and guest speakers for feedback. With them you will have a 'business-like' deal (you paid them for their work), so you can claim more time for feedback than you might want to do from the participants. It is best to have a ‘face to face’ meeting with the trainer(s). The guest speakers could be interviewed by telephone.

The social programme

When people go to a course, they also need to relax. If they don’t, they will have problems with the intake of information. In the next chapter we will discuss this further. In this chapter we will briefly consider the social programme. Although the social programme is always on a voluntary basis, it should be attractive enough so that everybody will want to participate. This is very beneficial for the group process.

The minimum the course organisers have to provide is:

• Welcome drinks
• Farewell dinner

If possible it would be very good to include a cultural activity as well, for example a visit to a concert or a museum. If there are sport events (for example a football match) some participants might be interested. If the course takes place during an international sport event, you have to realise that some participants will go to their hotel room to look at a match.

There should be at least one afternoon free, since many people wish to do some shopping, for example to buy present for their family and friends. If the course takes place in a city where the participants have not been before, they want to do some sight seeing. Some cities provide one-hour round trips by bus or boat. It is advisable to include this, for example in the lunch break.

The costs of the social programme should be limited for the participants. They will not mind paying for the entrance to a museum, but if they are expected to pay 50 US$ for a concert, you might find that some participants will not join the group.

3. Creating an optimal climate for learning

In this chapter we describe how the course organisers and the trainers can create an optimal atmosphere for learning. We will discuss the following issues:

1. Balance between the various components of the training
2. Active involvement of the participants
3. Keeping the attention span
4. Managing the language problems
5. Group process (working with resistance, dominance of one or two group members, prevention of scape-goating)

It is very important to pay good attention to the atmosphere, since this may make the difference between a successful course and an unsuccessful course.

The Balance

The course has various components that should be tuned to each other. It concerns:

• Introduction by trainers
• Introduction of participants
• Presentations by guest speakers
• Short presentations by participants
• Role play
• Discussions
• Site visits to project in city
• Video presentations
• Evaluation and feedback

The introduction by the trainers should be short. On the one hand the participants should know who the trainers are, but they will learn more about them during the training, so 5 minutes per trainer is ample time.

The introduction by the participants has two components: a short introduction in the plenary session (maximum 1 minute per person) and a longer introduction in sub-groups (maximum of 10 minutes per person). In the next paragraph more information is provided about this aspect of the course, since it concerns the active involvement of the participants.

The presentations by the guest speakers should be spread over the course. The maximum length of a presentation is 45 minutes. The content should be up-to-date, interesting, well presented (slides, overheads, video) and inviting for further discussion. Subgroup meeting should always happen before and after such plenary sessions (sandwich formula)

All participants are expected to present their work. This should be limited to 15 minutes per person in subgroups followed by another 15 minutes for questions and discussion. So if you plan two sessions (each 90 minutes with three subgroups), all participants can present their work.

At least one 90-minute session should be spent on a role-play. It is best to do this on the third day, since the attention span is the lowest in the middle of the course and a role play is a good instrument to have everybody alert and involved (see paragraph below).

There should be sufficient space for discussion. Asking people to present ‘for’ and ‘against’ can structure discussions, by voting etc. etc. There should be at least two 30-minute discussion sessions per day

In some cases, it is possible to organise site-visits to projects in the city where the course is organised. This is always very much appreciated by the participants. It can be seen as a little break away from the course. Participants make a link between what they are learning in the course and what they see in practice during the site visit. The next day, the trainers can integrate the experience of the site-visit in the course.

Video presentations should be kept short. Thirty minutes is the maximum for a course of this nature. If people like to see long videos, it is sometimes a good idea to propose this before or after a session or in the lunch break.

The last session of the course should be devoted to the evaluation and feedback. This is very important, since the participants can compare their expectations with what they have learned in the course. This session should also be used to create a positive atmosphere, where people get enthusiastic and are encouraged –once back home- to put into practice what they have learned during the course.

Active involvement of participants

Within 15 minutes after the course has started, the participants should all say something. This could be a very short introduction, such as "I am … and I come from ..country and I’m working….". Later on there should be space for longer introductions.

The first morning could be used for the introduction of the participants and their expectations of the course. After the short introduction in the whole group, the group can be split up in small subgroups. A method often used is to ask someone else to report in the plenary session on another participant: in a subgroup, person ‘A’ introduces him/herself. Person ‘B’ who is in the same subgroup is asked to make notes and –once back in the plenary group, person ‘B’ is asked to introduce person ‘A’.

Of course it is important that the information presented is correct. So after person ‘B’ has introduced person ‘A’, there should always be an opportunity for person ‘A’ to give some additional information.

Another way to ensure active involvement is the ‘homework’. In chapter II we discussed the importance of requesting participants to do homework. The homework can be presented in smaller groups (for example groups of 4 or 5 persons).

It is best if everybody has presented his or her homework by the end of the second day.

Another opportunity to involve the participants is via a role-play. This can be a small role-play in front of the whole group, or it can even be role-plays where all the participants are involved.

In some of the EATI courses, role-plays were done presenting a ‘press conference’. The situation: a city wants to open a number of centres for drug users; neighbourhoods are protesting. The mayor of the city gives a press conference with the head of police and the head of the health services.

All the participants receive a clear role (including the sort of personality they are supposed to portray). At least two participants are designated as observers.

The role-play is video taped and later the participants can see the ‘result’ of the press conference. On the occasions this method was used in EATI courses, it turned out to be extremely successful in bringing up issues of concern and stimulating the discussion. It also helped some members to overcome a passive role.

In the final session, the participants are asked to give feedback. The trainers will make use of the goals each participant set for him/herself and the participants will be asked to refer to these goals.

In general, it could be said that for at least 50% of the time, participants should be actively involved (discussions, presentations, doing assignments etc.)

The attention span

The attention span will fluctuate during the day. This is normal. On mornings, most people have sufficient attention, unless they went to bed far too late and had too much to drink. During courses in hotels ‘away from home’ it often happens that people don’t follow their usual routine. They stay up longer than they would at home and drink more than they normally do. The course makes them tired (especially paying attention and talking in a language that is not their own). In combination with a late night (heavy) dinner and more alcohol than usual, attention may not be optimal in the first few hours of the following morning. So plan something exciting for the first hour. After the coffee break, people will be ready to listen to a presentation. This can be a technical and difficult presentation, but should not last any longer than 45 minutes. Then there should be a break. As soon as the discussion starts, the attention span will go up again. The moments after lunch are also very difficult, as people are still digesting their food and feel that their eyes are becoming very heavy whilst listening to a presentation. It is best to go outside and visit a project and then come back and listen to another presentation.

A role-play after lunch also works well.

The golden rule is to have sufficient change in the programme in terms of speakers, topics and involvement. If possible there should be a change at least every 45 minutes and a real break every 90 minutes. In this break people can have a coffee or tea, go to the washroom and –in case they smoke- have a cigarette.

Sometimes some ‘die-hard’ likes to continue working longer. This is not a good idea. The course should last no longer than 6 working hours (3 in the morning and 3 in the afternoon). If some people want to work longer, they should do this elsewhere and not in the meeting room, since participants who can not absorb anymore information, might feel obliged to stay. The trainer should be very clear in this regard.

Language problems in case of guest speakers

The charm of Europe is its diversity in cultures and variety of languages. When inviting a guest speaker, one may chose an expert who can not communicate in the native language of the participants. In official meetings of the European Commission, translators facilitate the participants and everybody can speak their own language. In the sort of course we discuss in this handbook, we assume that there is no money for such translations. Therefore we have to make do with our own communication talents. The trainers should bring up the issue of the language before introducing the guest speaker. If the guest speaker speaks English and the participants don’t have English as their mother tongue, the guest speaker should be asked to speak slowly and everybody should be willing to help each other in case one gets stuck with the language (for example when asking questions or in the discussion). If a participant really has a problem with expressing him or herself in English, someone could be asked to translate. However, this should only be done in exceptional cases, since it slows down the group and is not very beneficial for the group process.

The group process

"If the group is lousy, the course will be a failure". There are many ways for a group to turn into a ‘lousy’ group. Although nobody wants this to happen and nobody wants to waste a week, it can still happen that the processes in a group turn a direction in which conflicts, misunderstandings and frustrations are the main ingredients. This can be prevented if the trainers are alert and act at the right moment. We would like to present some possible problems and ways to handle them.

Resistance Working in the drug field is not easy: results are often minor and it is almost impossible to please everybody. Since there is no simple solution available, it is easy for ‘outsiders’ to criticise the work done by experts in the drug field (including drug policy makers). To protect oneself, many people in the drug field present their point of view in a firm way: "This is what I am thinking, don’t dare to question it". They might not be open to critical remarks, so they take such remarks as an attack on their work, their beliefs etc. The trainers have to be very alert on this and have to rephrase remarks, that might be seen as negative and critical, into more positive remarks. For example by saying that these remarks were made out of curiosity and involvement rather than from an intention to attack the other person. When one participant has a point of view, which is very different from the points of view of the other participants, it might be helpful to organise a small role-play where two participants are asked to defend the point of view of the other. This can be done as a game with a winner. In this case you create a ‘win-win’ situation. You either win the discussion (that is good for your ego) or you lose the discussion but then your point of view has won). Such a public debate is also good for the other participants to realise that there are more ways of approaching the issue.

What to do when a group member dominates all the discussions? Everybody recognises this kind of people: they have an answer to every question, an opinion about every issue raised and they would like to take over the role of the trainer. There are certain things the trainer should NOT do. One is to start a public fight with this person. This will divide the group. Another thing not to do is to ignore the person. The more the person is ignored, the more attention he/she will ask. One way of handling it is to involve the group and ask them to react. For example you could say to dominant person ‘A’: "Thank you person ‘A’ for your comments. They show your involvement with this topic. I would like to hear the opinion of the other group members. Maybe it is a good idea to check them out". Subsequently, you ask all the other members of the group. Even if everybody answers in less than a minute, it will mean that person ‘A’ is quiet for about 10 minutes. Another possibility is to give person ‘A’ specific jobs to do, for example writing things on the board, being in charge of the remote control of the video, putting overheads on the projector, helping someone with a translation, going to the reception to ask for another round of coffee etc. etc. And if you are lucky, person ‘A’ might turn into a useful aid and a pleasant member of the group.

What to do when one person in the group becomes the scapegoat? ‘Scapegoating’ happens in front of our noses and we can hardly stop it. The person who becomes the scapegoat seems to have a perfect sense of triggering off the process and some members in the group will grab it as hungry lions. It might start with one person expressing an opinion, which is not ‘politically correct’. For example, a person might say that a high number of Aids cases among injecting drug users is a good thing, because it will reduce the number of drug users. It is very important that the trainer immediately intervenes when someone makes a statement like that. First of all, it should be made clear that we are living in a free world and that everybody is entitled to his or her own opinion. On the other hand, it should be made clear that we assume that basic human rights are also applicable to drug users. If this is brought out in a friendly and open manner, it should trigger off a discussion with pros and cons and the person who made the statement will be in the position to bring it with some more nuances. This will solve the problem for that moment. If the same person does something else to become the scapegoat, it might be necessary for the trainer to use methods of meta-communication and discuss with the participants what is happening. In most cases this solves the problem.

Summary

This Handbook on local drug policy training is based on the experience of the European Addiction Training Institute (EATI) with three international courses on local drug policy. In these courses, experts were invited as guest speakers and participants from various European countries shared their expertise and experience. Since EATI acknowledged that the experience gathered in these courses was very rich and that such courses would be beneficial to local groups as well, it was decided to produce a handbook in order to disseminate this information to a larger public.

This handbook is meant for two groups: (1) local drug policy maker and (2) training organisers.

To facilitate the readers, the handbook is divided into two parts. Part I describes the ingredients for a local drug policy and is meant for both policy makers and training organisers. Part II is more specifically aimed at the training organisers and has a lot of concrete and practical information.

Part I gives with a brief description of necessary elements of a drug policy, i.e.

1. supply reduction,
2. demand reduction,
3. drug free treatment
4. Harm-reduction.

When developing local drug policy, it is important to formulate clear objectives. Many actors –sometimes with conflicting interests- are involved in this process. In formulating of the objectives, it is also necessary to have accurate information concerning the use and abuse of drugs in one’s city. There are many techniques for collecting qualitative and quantitative data in a relatively quick and easy manner. Part I also describes the instruments needed for the implementation of a drug policy and the support one needs from various networks and the public.

Part I is largely based on the information provided by participants and guest speakers of the three courses on drug policy organised by EATI.

Part II is much more practical and describes the various elements needed to set up and run a good course. It has a number of concrete checklists, which organisers of training can ‘tick off’. Possible topics to include in the course are:

• ‘public order versus public health’
• exclusion
• the role of research
• the role of the media.

An important issue in the EATI training has been to request participants to do ‘homework’. In this homework, participants describe their local situation, including interventions. They are also required to indicate the expectations of the training. After the course, an evaluation should take place to facilitate the organisers in ameliorating future service. In part II, it is also described how an optimal climate for a productive training can be created. The programme should be balanced and ensure good and constructive input from the participants. Another important issue is attention span. Various factors that could influence attention span are mentioned and certain aspects of the group process are discussed.