Geneva, 9 April 1999 (RFE/RL) -- Many harm-reduction efforts focus on concrete strategies that can be employed to minimize the risks associated with the use of certain drugs -- needle exchange or methadone maintenance programs, for example.
Such efforts are simply strategies or programs, however. They cannot explain why different drug users often incur different risk levels in their consumption of the same drug.
Drug harm-reduction experts meeting recently in Geneva decided to pay particular attention to that question, with special emphasis on the social and psychological factors that may encourage users to engage in different risk levels of drug consumption. Several of the experts argued that a better understanding of these factors could help improve drug users' social and psychological conditions and contribute to the reduction of drug-related harm and risk.
Yvet Cheung -- a sociologist with the Chinese University of Hong Kong and a specialist on the spread of AIDS in Asia -- said this is what is known among harm-reduction workers as improving "social capital":
"What it means is that if we want to increase a person's social capital so that that person would have more resources for his or her own use to help them stay away from drugs after treatment, they would -- apart from designing programs that can help them integrate into the family -- find jobs and so on. ... At a more macro-level, on a community level, it is advisable for us to push for certain actions or certain processes that should happen at a collective level so that a community can bring about more resources in order to be utilized by individual people in a community, including drug users or those needing help because of their drug behavior."
Cheung said a community rich in social capital will probably better understand drug use and abuse and will be less discriminatory toward people with, or recovering from, drug problems. Likewise, he said, addicts with more personal social capital will, through treatment, be able to enhance their sense of self -- or what some specialists call "self-efficacy" -- a key factor in helping them avoid the risk of relapse or other negative behavior.
But Cheung warned of the high incidence of relapse among drug addicts. He said that research has clearly shown that -- after apparently successfully completing treatment programs -- many former addicts return to drug use and abuse.
There is far less knowledge among harm-reduction experts, however, about what drives a person to begin using hard drugs in the first place. In particular, there is very little scientific evidence available about drug users' fateful first injections. But Wouter De Jong, a drug abuse expert from the Netherlands, says all intravenous drug users (IDUs) exhibit similar characteristics.
"Most are between 20 and 25 [years of age] and male. Sharing of drugs and [drug] equipment is the norm ... not sharing in this part of the world [Asia] is almost considered more or less a deviant act. There are cultural reasons for that -- as an expression of solidarity-- but also because of scarcity and general economic poverty. There are female IV drug users, most of whom are prostitutes. And there is a general mobility among the IDUs in the region .... for example, in Kyrgyzstan, which is near the border of Afghanistan, they go to Osh to buy drugs. And of course the other form of mobility is through prisons, where users meet and later contact each other on getting out to use or buy more drugs."
De Jong said that another important shared characteristic is that most first-time intravenous drug users will shoot up [that is, inject] again less than two days after their initiation into the world of intravenous drugs. He said that nearly 60 percent of them cited a disturbing or stressful family event as the main reason for beginning their drug use.
Further, some experts say, a strong fatalism tends to govern the activities of many drug addicts, particularly in Russia and parts of Central and Eastern Europe. This social phenomenon among users in these regions is what researcher Jean-Paul Grund calls the "doom-and-gloom" heritage of the Communist mentality.
"There's really sort of a no-future attitude that goes along with it [drug use]. Also, the opening of [formerly closed] borders exposed people to more information, much more information from the West -- the global MTV culture with all its references to flashy drug use as well. So, use of drugs is something that is very attractive and they don't get much experience in these cultures with [the harm from] a number of drugs. From Kazakhstan to Macedonia, for example, there has been indigenous opium use for many decades from a medicinal standpoint -- for the elderly and those in pain. But the general information [on drug harm] has been lost."
Tamara Kuzmanovic of Belgrade agrees that a sense of hopelessness often leads to drug use. She says it is a familiar story that was played out daily in her hometown throughout the Croatian and Bosnian wars of the early 1990s. Now, in her view, it is happening again in Belgrade as NATO bombing raids continue against Yugoslavia.
"Numerous threats of bombardment, the proximity of armed conflict, impoverishment and inability to influence the decision of the authorities creates a feeling of helplessness, despair and general apathy among the population. So, in this context, it is not at all surprising that the medication with the highest sales in the country are actually sedatives and anti-depressants. In addition, Yugoslavia also lies on one of the main roads for transporting drugs from the East to the West, and this makes it a growing market for the drug lords. Everything points to the fact that drugs and other forms of addiction will continue to spread if urgent measures are not taken."
Kuzmanovic also said that official statistics show drug addiction in Yugoslavia is now nearing epidemic proportions. Authorities in Belgrade -- a city with a population of 1.5 million -- estimate the number of addicts there at around 30,000, while Yugoslavia as a whole has 100,000 addicts among its 10 million inhabitants. The largest number of the addicts are hooked on heroin. The youngest among them is believed to be a 14-year-old who began his opium use at the age of seven.
(This is the fifth and final piece in a series by RFE/RL's Lisa McAdams on the global fight against drug-related harm. She attended a harm-reduction conference late last month in Geneva.)