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Chapter 11
Drug and alcohol abuse
as a social phenomenon
Emilis Subata
Drug use: background. During the Soviet period,
The changes which began in 1990 affected the use of the use of illegal drugs, like many other negative narcotics in Lithuania as well as in other Central and social phenomena, was not publicly acknowledged in Eastern European (CEE) countries. Drug use began to Lithuania. The terms ‘illegal drugs’ (hereafter spread among young people as a manifestation of a referred to as drugs) and ‘legal drugs’ are used to dif- western style of life.Other factors also played an impor- ferentiate narcotic substances and materials accord- tant role, particularly the opening up of markets, the ing to their legal status and the purpose they are increase in trafficking, ineffective legislation and law being used for. In this sense, for example, alcohol and enforcement, and the growing standard of living.
tobacco belong to the category oflegal drugs, while medications Drug use in the European
Drug use in Lithuania became an
Union and in Lithuania: preva-
expression of youthful ‘protest’ at
lence and ‘driving forces’. The
the end of the 1970s, beginning
of the 1980s.
Fewer school age children in Lit-
huania had tried drugs at least
once than in most of the other
Western, and Central and Eastern
European countries.
At that time the use of narcotics was not related to ple, in 1995 only 3% of pupils in Lithuania, compared youth culture and leisure. As it had somewhat earlier with 42% in Great Britain and 41% in the USA, had in Western Europe, drug use in Lithuania became an expression of youthful ‘protest’ at the end of the1970s, and the beginning of the 1980s. However, only However, more recent studies show that the number several hundred followers of the belated ‘hippy’ cul- of those who try drugs is growing rapidly, and that in ture in Lithuania used poppy seed derivatives intra- this respect, Lithuania is catching up to Western venously. Often, due to their limited numbers, drug countries. According to studies carried out in Vilnius users were considered emotionally disturbed, and in 1998 (A.Davidaviãienò, 1998), 19.8% of pupils of were therefore treated in psychiatric hospitals. On the the same age group had tried marijuana, 8.3% ecsta- other hand, in society drug addicts were denounced sy, and 4.3% amphetamines. Both in Western and looked upon as publicly dangerous criminals.
European countries and in Lithuania, the majority of Drug users were severely punished and incarcerated, students try smoking marijuana and hashish. The which in turn contributed to the tendency for the public is understandably concerned with such situa- spread of narcotics use in prisons and among former tion, especially as some drugs can cause poisoning 158 CHAPTER 11
Drug and alcohol abuse as a social phenomenon
Pupils aged 15-16 year who tried illegal drugs, 1995 (%)*
Marijuana
Any other
other hallu-
cinogens
Reports by the Ministry of theInterior on confiscated narcoticmaterials confirm that these The manufacture, trade and use
of drugs are essentially global
phenomena affected by market
market and their prevalence. Therefore, integrated Lithuania, and subsequently the fields of poppies measures affecting both supply and demand need were destroyed in order to limit drug supply.
to be undertaken in order to limit the use of drugs However, the dynamics of confiscated poppies indi- and their inflicted harm upon society.
cates that their production is still prevalent in Lithuania, and that opiumextracts derived from poppystraw remain the most predom- Experts estimate that drugs confiscated make up approximately 10% of the total of the illegal drug trade. Confiscation is dependent on many factors, such as the operation and success of law and order institutions in apprehending large consignments of narcotic sub- stances. Nevertheless, the amount of drugs seized gives some indica- tion of the development of the drug market. In 1996 alone, 659,653 kg. of marijuana, 5,467 kg. of heroin, 32,262 kg. of cocaine and 3,501 kg. of amphetamines were confiscated in the EU. These figures mark a significant increase from 1991, whose corresponding figures totalled 372,661 kg., 6,020 kg., 16,505 kg., and 872 kg., respectively.
For example, the volume of marijuana confiscated in the EU increased from 160 tonnes in 1985, to 742 tonnes in 1994, but hasremained stable over the last three years. The amount of confiscated heroin grew from 1.9 tonnes in 1985, to 4.6 tonnes in 1990, but hasremained stable at approximately five tons since then. The volume of cocaine grew from one tonne in 1985, to 32 tonnes in 1996, while seized amphetamines increased from 263 kg. in 1985 to 872 kg. in 1991, and then to 3.5 tonnes in 1996. Marijuana found in EU coun- tries usually comes from Africa, and cocaine from South America; synthetic drugs (amphetamines) are manufactured in Western Europe, and later in Poland and the Baltic countries.
small group of drug-dependentindividuals, are beginning to Confiscated drugs*
* National Report Lithuania, PHARE Project on Drug Information Systems, 1998, Ministry
(e.g., the Netherlands) toleratethe use of marijuana, or posses-sion of it in small quantities for With the growth in the standard
of living, Lithuania, like the other
Baltic countries, is gradually
becoming a market for new drugs.
EU countries as well as Lithuania
have signed all three United Na-
tions drug control conventions.
not given separate legal note,criminal convictions are applied Drug control legislature. Drug control laws
in case of possession. In Spain, drug use is punish- throughout the EU and Lithuania have both similari- ties and differences. EU countries as well as Lithuaniahave signed all three United Nations drug control con- Illegal drug possession (outside of medicinal or sci- ventions (the 1961 Single Convention on Narcotic entific purposes) is punishable in all EU countries, Drugs; the 1971 UN Convention on Psychotropic but the latter differ in their attitudes concerning the Substances; and the 1988 UN Convention Against the reasons for possession. Some countries take into Illegal Trafficking in Narcotic Drugs and Psychotropic account whether it is a small amount for personal Substances). These conventions strictly regulate the use, while others treat any volume of drugs as a circulation of drugs and psychotropic substances.
criminal offence. Nearly all countries apply less Taking into account recommendations made by the severe penalties (e.g., probation) if a drug-depend- EU, in 1997 the parliament passed a Law on Money ent individual is undergoing voluntary treatment.
Laundering, and in 1998 a Law on the Control ofDrugs and Psychotropic Substances. Based on recom- EU countries are unanimous in applying very strict mendations by the EU PHARE programme, a Law on penalties for trafficking in drugs. For example, in the Control of Precursors - substances used in the France a small drug dealer can be sentenced for up manufacture of illegal drugs – was adopted in 1999.
to five years in prison, with a maximum penalty fortrafficking of up to 30 years. Penalties in Sweden are As a result, all EU countries and Lithuania classify narcotic and psychotropic substances on the basis ofUN conventions. In addition, some countries classify The use of drugs in Lithuania is punishable by substances according to their medicinal use and dan- administrative measures, with a maximum fine of ger to health, as well as on the basis of applicable 1,000 LTL (US $250). The illegal manufacture, pur- penalties. Penalties in Ireland, Italy, Spain, the chase, or possession of narcotic substances with no Netherlands and Great Britain are based on the type intent to sell is punishable by imprisonment for up of narcotic substance, while in the other EU coun- to three years; possession with intent to sell is pun- tries, drug-related crimes are treated as equally pun- ishable by imprisonment for up to 15 years (and ishable crimes regardless of the substance. But even with repeated offences, up to 20 years). Although the in the latter case, sentences are usually handed down share of drug-related crimes relative to the total on an individual basis, taking into account many fac- number of solved crimes is not large, their number tors, including the danger of the substance involved.
160 CHAPTER 11
Drug and alcohol abuse as a social phenomenon
In Lithuania, if the amount of drugs confiscated is Mortality related to drug and toxic substance addiction
small (for one’s own use) and the offence has been (per 100,000 population)
made for the first time, the court’s sentence ondetention is usually postponed on the condition that the person enters a treatment programme. But treat- ment programmes are not accessible everywhere.
They exist only in big cities. Often there are waiting lists both to drug-free rehabilitation and substitu- tion treatment programmes. In order to improve the rehabilitation process of illegal drug users and to keep them out of prisons, there needs to be better co-ordination between the law enforcement andhealth care sectors.
tis C remains a serious health risk in most Western Drug use and health: an EU and Lithuanian pro-
European countries (e.g., approximately 92% of file. The most frequent appeals for medical treat-
intravenous drug users in Sweden, and up to 70% in ment in the countries of the EU come from opiate France are infected with hepatitis C).
users (from 70 to 95%), with the exception ofSweden and Finland where figures are 3 4.8% and Drug-related morbidity has increased in Lithuania 39%, respectively. Approximately 5% of all patients during the last decade from 46 cases per 100,000 pop- in the EU come because of cocaine use, and about ulation in 1995 to 77.5 cases in 1998.In the EU, besides 10% because of marijuana. Approximately 1-2% of drug-dependent individuals, there are from 120 to 550 all patients require treatment for amphetamine, regular drug abusers per 100,000 population, while in ecstasy, LSD and other hallucinogen addiction. A Lithuanian similar survey data is not available.
number of EU countries have much higher percent-ages of such patients including Finland (39.5%), According to the State Mental Health Centre in Sweden (20%), and Great Britain (14%). Heroin is Vilnius, of the 2,715 drug dependent individuals the most frequently used intravenous drug in the registered in 1998 in Lithuania, 1,989 (73.2%) used EU; along with heroin, amphetamines are also used opiates (poppy straw extracts; heroin less frequently), intravenously in Northern European countries and while 477 (17.6%) used a variety of different drugs including opiates. Poppy strawextract thus continues to be the Unlike the countries of the EU,
the majority of registered drug
dependency cases (over 90%) in
Lithuania are intravenous drug
treatment use drugs in this manner. Intravenous use There were 27 registered marijuana dependent indi- is frequently connected with death caused by over- viduals (0.9%) 10 hallucinogen users (0,3%), and dosing, and to HIV and hepatitis infections trans- ferred via needles and syringes. As other forms ofheroin usage become more popular, the proportion of Unlike the countries of the EU, the majority of regis- intravenous heroin users in the general heroin user tered drug dependency cases (over 90%) in group is decreasing in the EU. For example, in certain Lithuania are intravenous drug users They make up areas in Belgium and the Netherlands, only 10-15% a high risk group which can easily transfer AIDS and of all heroin addicts use the drug intravenously. The hepatitis B and C. According to the Lithuanian AIDS majority of drug-related deaths in the EU are con- Centre, between 1997 and September 1999, the num- nected to intravenous heroin intoxication, though ber of HIV cases among intravenous drug users grew there are also frequent alcohol and barbiturate poi- from one to 91 (and accounted for 51.41% of all HIV sonings. The number of deaths due to drug poison- cases). According to 1998 data from the Vilnius ing increased during the period from 1980 to 1990; Public Health Centre, approximately 19% of hepatitis after 1990, the number of deaths either stabilised or C cases in Vilnius are individuals infected via intra- has been diminishing in most EU countries.
venous drug use. The number of drug-related deathshas also grown in Lithuania over the last years.
The number of HIV-infected drug users is alsoeither decreasing or is stable in nearly all EU coun- Most EU countries, having had longer exposure to tries. Among those using intravenous drugs, hepati- illegal drug misuse, developed consistent and Morbidity related to drug and toxic substance addiction by substance consumed
Persons registered with
Total no. of persons registered
preventive and anonymous
with preventive and anonymous
care institutions in 1998
care institutions by the
end of the year
the EU, a public health approachwas adopted in order to counterthe marginalisation of drug comprehensive drug policies and widely accessible users. According to this approach, the aim of the treatment and social services. Due to continuous edu- treatment and social services was to establish con- cational campaigns, intravenous drug use in the long tact with the largest number of illegal drug users.
run has lost much of its appeal given the dangers of For this purpose specific ‘low threshold’ pro- possible overdose and HIV and hepatitis transmis- grammes were developed, e.g., drop-in centres, out- sion. Intravenous drug use is considered as typical for reach work conducted by street workers, nightshel- “junkies” and is not attractive for the younger genera- ters, mobile-buses, etc. Usually these services pro- tion. These are the reasons why the number of regis- vide advice on HIV prevention, treatment opportu- tered drug addicts (particularly intravenous) is stable nities and health education. Sometimes clean nee- or even falling. In Lithuania however, injecting drug dles and syringes, alcohol pads and condoms are provided as well. These pro-grammes often facilitate drug Reducing the demand for
Questions regarding the preven-
drugs: prevention, individual
tion of drug use are gradually
health care, social integration.
being included in education pro-
grammes for the development of
healthy lifestyle skills in secon-
dary schools.
to providing favourable conditions for the harmo- In 1995, more attention was given to the social nious and productive development of every individ- needs of these marginalised people; there was a ual, to guaranteeing their social security and integra- broader application of out-patient health care and tion, as well as how successfully it fights against drug rehabilitation, including methadone treatment pro- trafficking. However, specific programmes for the grammes. Out-patient substitute treatment pro- prevention of drug use and the treatment/rehabilita- grammes have been operating in Vilnius, Kaunas and Klaipòda since 1995, and in Druskininkai since1998. In 1998, there were 493 individuals undergo- Questions regarding the prevention of drug use are gradually being included in education pro- Lithuania. In most EU countries, substitution treat- grammes for the development of healthy lifestyle ment is widely accessible - to 28,700 individuals in skills in secondary schools. A recent predominant Great Britain, 56,700 in France, and 60,000 in trend has been to expand drug prevention meas- Germany. Of the CEE countries, only Slovenia and ures beyond threats about the consequences of Lithuania provide a more extensive form of this drug use. There has been a greater orientation treatment; the other CEE countries are carrying on towards developing students’ social and interactive with experimental methadone programme proj- skills, and the fostering of independent and ects. In Lithuania, approximately 800 - 900 of the 2,800 officially registered drug-dependent individ-uals had access to treatment and rehabilitation Intravenous drug users in Lithuania continue to be through the substitute programme - mostly in the the most impoverished and socially marginalised major cities of Vilnius, Kaunas and Klaipòda.
162 CHAPTER 11
Drug and alcohol abuse as a social phenomenon
Alcohol-dependency related morbidity*
* Data from the Health Information Centre, (SAM system).
Also in 1997, an anonymousconsultation and needle/syringereplacement office was opened Alcohol has become more acces-
sible to the public in terms of pla-
ce, time and price.
viduals who have misgivings about health care insti- of alcohol-related consequences affecting the health tutions, are being provided to drug users with the of the population. These negative trends reached aim of stopping the spread of HIV. Provisions for the their peak in 1994-95 and have started to decline replacement of needles and syringes were also estab- over the last few years. However, current indicators lished. By the beginning of 1999, there were various related to alcohol abuse remain significantly higher needle/syringe exchange programmes operating in Vilnius, Klaipòda, Druskininkai and Panevòzys.
These efforts have resulted in somewhat better con- Consumption of alcohol and tobacco is higher tact with drug users on the social fringes, and in the among the rural population. Traditions of drinking slower spread of HIV infection in Lithuania than in heavily, which were formed over a period of several the neighbouring countries of Latvia, Russia and decades after the war, became stronger when ‘home Belarus. The number of HIV-infected intravenous brew’ alcohol became more widespread and accessi- drug users reached 181 in Latvia in the beginning of ble. The rural population remains the principal mar- 1999, (compared with 67 in Lithuania), while in ket for illegal alcohol. In 1997-98, the incidence of Kaliningrad (Russia) and Svetlogorsk (Belarus) alcohol-related psychoses in the countryside was since 1996, an HIV epidemic spread widely through nine times greater than in the city. At the same time, needles and syringes with thousands of new cases.
latent alcoholism was more prevalent in the city thanin rural areas. This indicator, however, is just as Alcohol abuse in Lithuania and the European
much a reflection of the number of people seeking Union. The prevalence of alcohol abuse and its
treatment. More people are seeking help and regis- trends and consequences for society have changed tering with alcohol treatment institutions in the city, over the last decade. Important developments have where this service is located. Such institutions are taken place since 1990, when the state abandoned its much less accessible in rural areas, therefore the monopoly on the manufacture and sale of alcohol.
indicator of alcohol dependency is lower.
Alcohol has become more accessible to the public in Alcohol abuse has been accompanied by an increas- terms of place, time and price. The advertising of ing suicide rate, especially among rural males of alcohol, previously prohibited, is now active and working age. The number of suicides began to widespread. The existence of contraband liquor has decrease in 1997, however, approximately 70% of increased the accessibility to alcohol even further.
suicides are related to chronic alcoholism, depres- Crucial changes in alcohol supply have coincided with the fundamental social changes related to mar-ket reforms. The emergence of unemployment, Morbidity indicators in the majority of Central and poverty and homelessness, and weakening social Eastern European countries which are related to guarantees have made many people feel socially alcohol abuse are still much higher than analogous excluded and insecure regarding their future.
indicators in Western European countries.
Alcohol abuse control policies. The prevalence of
The state is adopting legal and economic measures to alcohol abuse is determined both by the supply and limit the supply of alcohol. The strict control of illegal demand of alcohol. Supply means accessibility in alcohol could be the most effective tool for decreasing terms of price, place and time, including access for the supply of alcohol. A system of licensing for the minors. Demand is determined by tradition and retail and wholesale of alcohol, which involves a fair- A law on alcohol control passed
by parliament in 1995 defines
the principles of state policy
measures directed towards the
prevention of alcohol abuse.
measures directed towards the prevention of alco- of a free market, and because private business is hol abuse. It regulates economic and legal meas- gradually pushing the use of alcohol out of the work ures for alcohol supply and demand, monitors a place. According to statistics, expenditure on alcohol system of excise and import, licensing of sales and has slowed significantly; in 1998, it came to 2.7% of the prohibition of advertising. A State Tobacco and all urban, and 4% of rural, household expenditure.
Alcohol Control Board was cre-ated to monitor the implemen- Traditionally popular in Lithuania,
strong alcohol has partially given
way to wine and beer.
law states that the health care, rehabilitation and another mode of alcohol use: frequent (several integration into society of individuals who abuse times a week, or even daily) but smaller quantities or are dependent on alcohol must be available and of wine or beer. Changes in people’s habits, accom- state-supported (free of charge). Unfortunately, panied by the transition to weaker alcohol, could be this important statement has not been implement- significant in the further reduction of alcohol abuse.
ed yet. Alcohol dependency treatment or rehabili-tation programmes exist only in several large As noted in the 1998 annual National Health Review cities, which have dependency centres or special issued by the National Health Centre, approximately departments in hospitals. These usually provide 1,000 people still die each year due to alcohol abuse.
de-toxication services, short in-patient rehabilita- More than a 1,000 are injured because of drunk tion treatment and family therapy. Once primary driving. Meanwhile, only several dozen people die mental health centres with dependency psychia- each year from illegal drug use. Although alcohol trists have been established in smaller towns, abuse is more prevalent, the attention given to prob- accessibility to medical and social assistance for lems related to drug abuse (prevention, treatment the population should increase. It is likely that gen- and rehabilitation) at the state and municipal level eral practitioners will play a major role in alcohol is significantly higher than that given to the preven-

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