‘Reality Check’ is a series started by the Guyana Chronicle to highlight different social issues, which stretches across culture and other divides and impacts the lives of the Guyanese people.
–    Understanding a need and meeting it halfway
IT always starts with ‘just one’ drink or smoke, or one of any other potentially harmful indulgence before that harmless indulgence becomes more – often times a temporary escape from the daily stresses of life – and marks the beginning of a downward spiral, which for many is a journey that ends on the streets.
However, a point to be noted is that the story of Substance Abuse involves many variables. Health Minster Dr. Leslie Ramsammy contends that this situation is a complex one throughout the developing world, one that has not seen the level of investment and emphasis it should have.
“We have never taken into consideration that there are people who need our help, who need care because of substance abuse, because of mental illnesses…we need to change that paradigm. There is need for a robust paradigm shift in Guyana, in the Caribbean, in the developing countries and globally,” he said at a recent forum where he addressed substance abuse.
The World Health Organization (WHO) has defined substance abuse as the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.
One of the most common ‘substances’ is alcohol, and as early as 2002, the WHO estimated that around 140 million people were alcohol-dependent and another 400 million suffer alcohol-related problems.
Currently, the WHO estimates that there are 76.3 million persons with alcohol use disorders worldwide; at least 15.3 million persons who have drug use disorders; and injecting drug use reported in 136 countries, of which 93 report HIV infection among this population.
Psychoactive substance use can lead to dependence syndrome – a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include:
•    A strong desire to take the drug;
•    Difficulties in controlling its use, persisting in its use despite harmful consequences,
•    A higher priority given to drug use than to other activities and obligations,
•    Increased tolerance, and
•    Sometimes a physical withdrawal state
A combination of these oftentimes results in a life on the streets, but the Health Minister acknowledged that people are on the streets for many reasons, other than substance abuse.
According to him, it has been assumed that all people living on the streets are there because of two reasons, two extremes; economic problems or mentally illness.
Ramsammy stressed that while in some cases this is the correct assertion, street dwelling is a problem compounded by substance abuse.
“We must not think that it is a straight line; that it starts with substance abuse then leads to mental illnesses then economic problems and leads to people on the streets… it doesn’t always work that way,” he said.
The WHO’s position is that policies which influence the levels and patterns of substance use and related harm can significantly reduce the public health problems attributable to substance use, and interventions at the health care system level can work towards the restoration of health in affected individuals.
Ramsammy acknowledged that much is left to be desired in the area of training, since much is lacking in formal training programmes to address substance abuse.
He added that another area of support that is lacking, in the move to address substance abuse, is at the level of different agencies.
The Health Minister said, “When I speak about institutional arrangements I am not speaking about hospitals alone, or psychiatric institutions alone. I am also talking about places where we provide certain services like our convalescent homes… where people are, like the Palms and Non-Governmental operated homes…These are the institutional arrangements that we need to strengthen.”
The WHO estimates that for every dollar invested in drug treatment, seven dollars are saved in health and social costs.
Ramsammy said, “We have failed in the past because we have not met people in their own setting.”

HALFWAY POINT
With support from the Ministry of Health, the Phoenix Recovery Programme, a non-governmental organisation, is looking to bridge the divide and advance ‘Street Based Interventions’.
Coordinator of the Programme, Mr. Clarence Young, in an invited comment, told the Guyana Chronicle that Phoenix, with its experience in dealing with substance abuse and treatment for the same, is well-positioned to advance this intervention.
The Street-Based Interventions are expected to target five communities in Greater Georgetown initially, before moving to other areas in Guyana.
On Monday, Phoenix Recovery Programme spearheaded a two-day training workshop focused on minimizing the social and health consequences of persons suffering from substance abuse disorders. The workshop was facilitated by Dr. Marcus Day of the Caribbean Drug Research Institute, who is also Director of the Caribbean Harm Reduction Coalition.
Young stated that the training was a precursor to the intervention and stressed that at the end the level of awareness was significantly improved, as well as the recognition of the diverse circumstances surrounding street dwelling.
“It is never as simple as people think the situation to be…it is mental illness, rejection from families, as well as substance abuse, among other things…these people needs our assistance,” he said.
The Programme Coordinator explained that involved in the programme are Phoenix staffers, other stakeholders and persons who have been victims of substance abuse and are progressing well with their recovery.
Young pointed out that to make the intervention, street dwellers will have to be lured into interaction.
“We think we can handle this because we have experience treating people in similar circumstances…it is not going to be without its problems,” he said.
The Programme Coordinator stressed that this is a need and Phoenix Recovery, as part of their mandate, is responding to it.
Phoenix Recovery’s primary intention is to decrease drug demand and abuse in Guyana and advances efforts on the assertion that ‘drugs respect no one, have no barriers, and affect every stratum of our society’.

Treatment and rehabilitation support is available for men and women and the Programme’s funding is provided by the United States State Department, through the Catholic Relief Services, as well as other supportive agencies.
Phoenix also works in collaboration with the Psychiatric Clinic at the Georgetown Public Hospital Corporation to ensure clients receive other necessary support.
The Recovery Project, located at Lot 90, Block CC, Mon Repos on the East Coast Demerara, was founded in August 2002.