Beliefs and attitudes towards treatment methods and anti-drug policies of addiction treatment providers in the Russian Federation

Speaker: Mikhail Torban (St. Petersburg Psychoneurological Scientific Research Institute Named after Bekhterev, Russia).

Over the past 15 years drug abuse and addiction in the Russian Federation has reached epidemic proportions and has spawned a syndemic of infectious diseases including HIV, hepatitis B, hepatitis C, and tuberculosis. The only legal providers of drug treatment in Russia are state addiction treatment dispensaries and clinics, still using Soviet practices of drug treatment. Chief narcologists (addiction treatment specialists) are deeply involved in the control of anti-drug policies and drug-treatment related interventions and practices in their regions, and also act as influential experts for Russian government. The study presented here, the first to collect and analyze data from chief and junior narcologists, was undertaken to describe the practices, knowledge, beliefs, attitudes towards treatment methods and anti-drug policies of active addiction treatment specialists in urban areas of 10 Russian regions; Qualitative interviews were conducted with drug user treatment service providers (N=40) in Krasnoyarsk, Moscow Region, Pskov, Saint-Petersburg, Volgograd, Bryansk, Chelyabinsk, Magnitogorsk, Novgorod, and Orenburg. Study participants reported very poor outcomes of existing drug treatment practices (only 11.3% of their patients remain drug-free for one year after treatment). Study participants identified major challenges in service provision for drug using the population, including lack of resources, rehabilitation programs, and social support. Narcologists (especially chief narcologists) showed negative attitudes toward substitution therapy and harm-reduction approaches: OST has been rated as the least effective treatment of all by chief narcologists’ group. They also demonstrated ambivalent attitudes toward compulsory treatment and client registration; The results of our research showed that addiction treatment providers were engaged in cognitive dissonance; They rated the proven social effects of OST highly, while nevertheless refusing to admit positive effects of OST as a treatment. Although narcologists (including chief narcologists) widely recognized the failure of their current approaches, there seems to be little desire to explore alternatives, even when there is strong medical evidence and international support for these options. Better training in – and strong advocacy for – use of treatment methods with scientifically proved effectiveness is necessary on both a regional and local level.

CV: Mikhail Torban – Employment: 2003-2004, psychiatrist, City Mental Clinic, St.Petersburg, Russia; 2004-2006, narcologist, St.Petersburg Psychoneurological Scientific Research Institute Named after Bekhterev; 2006-present, research fellow at the Department of Addictions, St. Petersburg Psychoneurological Scientific Research Institute Named after Bekhterev. Current position: research fellow, Department of Addictions, St. Petersburg Psychoneurological Scientific Research Institute Named after Bekhterev.