A line to a Methadone site, Kiev, Ukraine

Pavel Kutsev, the leader of Drop-in Center, a non-profit organization dealing with issues of people living with drug addiction, recently shared his opinion about the effectiveness of work of drug addiction rehabilitation centers. Pavel begins by criticizing some of the work of existing rehab centers:

Today in Ukraine almost any rehab center is above all a mechanism for many people to earn money including corrupt bureaucrats who “help” others acquire licenses and paperwork. Often these entrepreneurs attempt to look altruistic, but under this cover of charity there is always a desire just to earn money …

Although he criticizes some of the work of rehab centers in general, Pavel also shared a positive experience related to the rehabilitation his wife went though in one of the government clinics:

In the middle of 1990's my wife had the chance to go through rehabilitation. As a reward for my excellent article about an effective rehabilitation clinic for a newspaper, my wife was taken in to its rehab program. She was very reluctant to go there at first, but after the program's duration of a month she did not want to leave.

It was a government clinic … Rooms with bathrooms for two people, TVs…

There were wo weeks of detoxication with buprenorphine and other pretty good medications, sauna, water therapy, massage and a gym. A day was filled with events including art-therapy, modeling, paintings, group therapy… Good food, vitamins and with medical tests and treatment of joint pain and arthritis, even dental help… (By the way, in 1997 it cost only $200 per month plus fees for dentistry.) If a person wanted to be a part of any social programs of the center he even could earn a little money there. It was a good deal. After working for half of a year with the center you could save the same amount of money that you spent on the rehabilitation. Many former addicts became staff members of the center. Some of them learned foreign languages and now work in similar programs in the USA, Australia, and Europe.

This was honest social entrepreneurship. I remember my conversation with the head of the center, Dr. Galich. He shared his dream of introducing substitution therapy for people who can not be rehabilitated at the time, those who had 30 years of drug use and a handful of incurable deceases. Dr. Galich also talked about his plan of introducing a kind of a reward program. If a patient agrees to be tested for drugs once every other week for a year and all these tests would are negative, then the person receives twice as much cash back as he spent on the rehab program. The reality is that only 10 out of 100 stay off drugs after the rehab program, so it was a good incentive for patients and still a good business [for the clinic]. I would say it was a good approach both from an ethical and economic standpoint. I am sure this practice would work very effectively.

At the end of the post Pavel notes that, along with substitution therapy programs, government and social entrepreneurs should further develop rehabilitation programs:

To be constructive: substitution therapy should be provided for everybody who needs it without regards to restrictive “moral principles” of some people, a lot of pointless talks of some politicians and just ignorance.

In addition to investing in substitution therapy, we need investments in rehab centers such as what I describe above, centers which would not just take the money from patients, but use the money to achieve their goals. Sustainability and self-sufficiency should be a part of any social program.