Author – Irma Kakhurashvili
In recent years the state opioid substitution therapy program has expanded in Georgia, however there are fewer positive developments in the area of psychosocial rehabilitation. According to Georgian experts, without a psychosocial component, the treatment of people who suffer from an addiction is unstable, and their abstinence from taking drugs or alcohol is short-lived. As practice shows, it is quite possible to solve this problem, and the first steps have already been taken – with the support of the project “Bridging the Gaps: Health and Rights for Key Populations”, representatives of non-governmental and governmental agencies came together to develop the model of psychosocial rehabilitation.
What is happening today?
Georgian experts believe that the country has little experience in the field of rehabilitation. Moreover, it does not even have properly trained specialists. Therefore, work on the model of psychosocial rehabilitation is timely and necessary. According to experts, the state should be more concerned about access to rehabilitation services, which are extremely important on the path to recovery. Drug use and drug addiction in Georgia is a growing problem. The number of injecting drug users in the country exceeds 52 thousand (Assessment of the number of injecting drug users in Georgia, Public Union “Bemoni” and Curatio International Foundation, 2017).
Currently there are three-day rehabilitation centers operating in Tbilisi on the basis of a mental health and drug prevention center – they are funded by the State Program for the Treatment of Drug Addicts and are aimed at the rehabilitation of those who participate in substitution therapy programs. There are two other day centers, also in Tbilisi, which mainly exist with donor support.
It should be noted that psychosocial rehabilitation projects in Georgia have always been short-term, financed only by foreign donors and without any continuation. For example, one such short-term project was the South Caucasus Anti-Drug Program (SCAD), funded by the United Nations Development Program (UNDP). Within this program a day rehabilitation center was established at the Institute of Narcology, which was financed for some time after the completion of the project by the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria.
Center “Tanadgoma”
Thanks to international donor support from the Ministry of Foreign Affairs of the Kingdom of the Netherlands and the European Union, as well as with the technical support of the ICF AIDS Foundation East-West (AFEW-Ukraine), a stationary rehabilitation center was opened in 2016 in the Kakheti region.
A program with free rehabilitation services for people addicted to drugs and alcohol was launched by the Information Medical and Psychological Center “Tanadgoma”, as part of the project “Bridging the Gaps: Health and Rights for Key Populations”. Its duration ranges from 30 days to 3 months. The center works according to the “12 steps” program, using cognitive-behavioral therapy and art therapy. The rehabilitation process is intense and filled with various psychological and physical activities.
This Center could become an example of effective cooperation between government agencies and the resources and professionals at an existing public organization that provides free services to those in need at the expense of the state. Unfortunately, the government does not prioritize the treatment of people with drug and alcohol addictions sufficiently, and lacks the willingness to allocate appropriate funds. This may mean that when the funding of international donors ends, the program will cease to exist and people will again find themselves without the necessary assistance.
More than 50 people have undergone rehabilitation at the center since its foundation. Interest in the program is steady, and now its leadership is trying to improve the quality of services by introducing other evidence-based approaches to rehabilitation.
David, a former client of the center, says: “I got all the rehabilitation services for free, and it was very important to me. At the Center, I had the opportunity to reassess my life. Addiction is not only a physical, but also a psychological problem that cannot be solved by detoxication alone. Such centers are necessary.”
The concept – hope for a better future
Since autumn 2019, several active public organizations and government agencies have been involved in the development of the model of psychosocial rehabilitation within the framework of the “Bridging the Gaps: Health and Rights for Key Populations” project, including representatives of the Center for Mental Health and Drug Prevention and the Parliamentary Health Committee.
With the support of the project, within several months the specialists worked through the existing national protocols and guidelines. They discussed the issues of how to involve patients in the treatment and rehabilitation process, what should be the physical environment of a person in the institution, the qualifications of personnel, etc. The experts agreed that drug addiction treatment and rehabilitation is a long and complex process, and patients often need multifaceted assistance, including physical and mental health, social functioning, education, employment, etc. This is possible only through an integrated model of care – when the service is provided on an agreed and collaborative basis by government, society and civil society organizations, such as in Ireland, where a separate document on rehabilitation was developed. It describes approaches to integrated care and collaboration between institutions.
The model of psychosocial rehabilitation is like this document, which not only describes the situation in the field of psychosocial rehabilitation in Georgia over the past years, but also includes calculations of the costs to the state for provision of such services. The model considers specific approaches to psychosocial assistance, namely the approaches proposed by the European Monitoring Center for Drugs and Drug Addiction (EMCDDA). There is also a review of international experience in which rehabilitation is considered as an integral part of treatment.
The price of a new rehabilitation model
As experts say, the duration of psychosocial rehabilitation should be on average 6 months. For the first 3 months, services can be provided both in inpatient and outpatient form. The second three-month rehabilitation period takes place in an outpatient program.
According to the model, it is assumed that the potential inpatient center will serve 60 patients over a year. The cost of one patient service is 1700 GEL (approximately 460 euros). The cost of one full year of service in a stationary rehabilitation center is 300,000 GEL.
The authors of the model say, the potential outpatient center will serve 120 patients per year; the cost of one patient’s service is 500 GEL (approximately 135 euros). The annual cost of service in an outpatient rehabilitation center is 180,000 GEL.
The concept states that it is advisable to open 5 inpatient and 15 outpatient rehabilitation centers in the country. If these centers are fully operational, 4,200,000 GEL will be required from the state budget (1,500,000 for inpatients and 2,700,000 for outpatients). In total, both types of rehabilitation centers will serve 2,100 patients per year. It will be possible to reach this mark in about 3 years (by 2023). In the budget for 2020, it is necessary to allocate 1,500,000-2,000,000 GEL, part of which will be directed to the training of specialists.
A group of specialists within the “Bridging the Gaps: Health and Rights for Key Populations” project is currently working on outpatient and inpatient rehabilitation standards, which will be sent to the Ministry of Health for further consideration.
If the Ministry leaves the new concept and standards without due attention, it will affect not only the health of (drug) users, but also the life of society. So far, even in this period leading up to the election, questions about drug policy and psychosocial services are not included in any party program. Continued financial support from donors is therefore even more important due to the precarious position of the state.
Maka Gogia, head of harm reduction programs in Georgia, has said: “For any harm caused by drug use, it is necessary to include a full course of psychosocial rehabilitation so that the person can gradually recover from all the damage they have received on a psychological or physical level. They should have the main thing – the desire to control themselves and plan the future without addiction. Substitution therapy, detoxication or needle exchange programs alone cannot be the only solution for the drug user, as these programs must complement each other. It is also important to have a multifunctional group of specialists who have the appropriate competences and can help the person in need.”
