Strengthening the Treatment and Rehabilitation Infrastructure, Demand Reduction and Prevention of Substance Abuse in Northern Cyprus
Abstract
In this study, the data of many sources/institutions working on cigarettes, alcohol and other psychoactive substances were used in Northern Cyprus by using the document analysis technique. In order to carry out a comprehensive study, official institutions and non-governmental organizations were called through the Anti-Drug Commission Presidency and the data they had were reached. Anti-Drug Commission's studies were examined under 4 themes. These themes were handled as Community-Based, School-Based, Law Enforcement/ Justice-Based and Health Care-Based intervention studies. As a result of this study it is seen that "Northern Cyprus Drugs and Addiction Report 2021" aims to provide an overview of the drug situation, which is necessary to develop effective actions for today's problems, by contributing to the creation of a healthier and safer society against drugs and addictions in Northern Cyprus.
Keywords: Substance abuse, Northern Cyprus, treatment, rehabilitation, demand reduction, prevention
Introduction
Substance abuse is associated with significant morbidity and mortality, and leads to socioemotional problems, negative social impact including homelessness, family disruption, crime, unemployment (Kamenderi et al., 2021; McLeod & Uemura, 2012; World Health Organization, 2012). Because it is a complex and relapsing condition that requires long-term care effective prevention of substance abuse involves risk factors for substance use, such as substance abuse by parents, family circumstances, peer pressure, school or work life, lifestyle reasons and socioeconomic factors (Dematteis et al., 2017).
As in the whole world, the issue of using, selling and breeding illegal drugs is a serious health and legal problem in Northern Cyprus. Non-governmental organizations in Northern Cyprus have been conducting many awareness studies on illegal drugs for years. However, this global issue, which poses serious threats to future generations, has not yet been addressed as a state policy. Pressures from different quarters made it compulsory to include the issue of Combating Drugs on the agenda of the 30th Government established on September 02, 2013 in the Northern Cyprus, and as a result of these efforts, on September 3, 2014, with the decision of the Council of Ministers no. Y(K-I) 1670-2014, under the umbrella of the Prime Ministry. Anti-Drug Commission (ADC) was established. Its aim is to protect the youth, their families and students at universities in Northern Cyprus, to prevent drug trafficking and to accelerate efforts to combat addiction.
Drug Enforcement Commission; It consists of the Ministries of Health, National Education, Interior, Labor and Security, Economy, Tourism, Culture and Sports, as well as the Office of the Chief Prosecutor, two universities and three non-governmental organizations. At the request of the Northern Cyprus Prime Ministry, a representative member from each of the institutions and organizations listed above has been appointed by the member institutions for the Anti-Drug Commission. The Commission on Combating Drugs consists of a total of 15 members, including the representative of the Prime Ministry. Each of these members are people who deal with addiction, carry out studies and work in different institutions.
Method
This article is based on the qualitative research approach. One of the data collection techniques in qualitative research is document analysis. In this study, the data of many sources/institutions working on cigarettes, alcohol and other psychoactive substances were used by using the document analysis technique. In order to carry out a comprehensive study, official institutions and non-governmental organizations were called through the ADC Presidency and the data they had were reached. In addition, the studies conducted and published on the internet in Northern Cyprus were also accessed from sources such as the Norhtern Cyprus Courts web page. 17 scientific articles published between 1999-2014 on the Northern Cyprus sample, 8 reports published between 2003-2008, 2000-2004 and 2010-2014 Police Headquarters data, 2006-2014 Center for the Archive of Drug Studies in Northern Cyprus Prison data, 2000-2004 and 2010-2013 State Court data, 1996-2004 and 2010-2014 Barış Psychiatric Hospital data, 2014 Social Services Department data, 2000-2003 and 2010-2014 State Laboratory data were used. Some of this data is taken from previous published reports. Since the raw data obtained were based on information that was not systematically recorded before, it made it difficult to perform statistical analysis. In a scattered way, the data obtained from different sources were first placed in excel tables. Afterwards, it was tried to create tables and graphs reflecting the situation especially in recent years for each institution. Anti-drug Commission's studies were examined under 5 themes. These themes were handled as Community-Based, School-Based, Law Enforcement/Justice Based and Health Care-Based intervention studies.
Results
Results is presented as four sub-titles related with the themes obtained from document analysis.
Community-Based Interventions
Community-Based Interventions ranged from simple (e.g., community garden; Cozens et al., 2005; McCabe, 2014) to complex initiatives that comprised a package of prevention programs (Hogue et al., 2002; Kondo et al., 2018; Kuklinski et al., 2015; Moore et al., 2017; Smokowski et al., 2016). Some Community-Based Interventions contained examples of research designs used to evaluate community-level impact of comprehensive prevention programs and such examples include comparative interrupted time series and multiple baseline designs (Farrell et al., 2003).
A State Policy regarding drugs and addictions in the Turkish Republic of Northern Cyprus was implemented in 2014 with the establishment of the Anti-Drugs Commission (ADC) under the Prime Ministry. "As a result of the globalization movements in the world, smuggling of addictive illegal substances has turned into a regional and international crime, not just a national problem, to protect the youth in our country and the students who choose our island to study at our universities, to prevent drug trafficking and to accelerate the efforts to fight addiction in our country". In order to carry out the policy, a step was taken to form an Anti-Drug Commission under the Prime Ministry, with the decision of the Northern Cyprus Council of Ministers on September 3, 2014, within the framework of the proposal numbered 1670-2014. The duties and powers of the ADC are as follows:
- To work towards reducing the supply and demand of drugs with the aim of diminishing them.
- Carrying out studies to ensure that measures are taken to prevent those at risk and tendency to use drugs.
- Conducting information giving activities
- Strengthening the existing institutional structures (in terms of infrastructure, qualifications, expert personnel, research, education and service) for the treatment and reintegration of addicts in the acute and chronic stages, and the existing in the treatment and rehabilitation services of individuals who have become addicted. To work on eliminating deficiencies as soon as possible.
- Establishing committees and carrying out studies in order to make legal regulations on the subject (separating the phenomenon of smoking-seller from each other, making addicts benefit from treatment and rehabilitation services instead of being sent to prisons, and taking measures to reintegrate the said people into society, based on the expert's report, following the completion of the penalty period)
Regarding the above-mentioned issues:
The (ADC) may establish committees and working groups on the subjects it will determine; In addition, if it deems necessary, it may invite representatives of the relevant ministry or other public institutions and organizations and other non-governmental organizations to receive information and participate in its work. In this way, it is seen that the fight against addiction system has a dynamic structure with the feature of continuous self-development and is open to new restructurings in order to quickly find solutions to new problems that may arise like in the case of COVID-19 pandemia (Zaami et al., 2020).
As an indicator of the related dynamic structure, apart from the members determined by the decision of the Council of Ministers; Cyprus Turkish Medical Association, Association of Self Employed Physicians; Cyprus Turkish Psychological Association; Psychological Counseling and Guidance Association, Media Ethics Committee, Broadcasting High Board, Press Council, Journalists' Association and Journalists' Association and voluntary participants joined the ADS. These new participations with high motivation increased the working momentum and improved the functionality of the ADC during the Covid-19 pandemic.
In 7-8 April 2015, in order to share the goals, it has set with the society and to determine a roadmap by taking the opinions of all segments the ADC held the “1. Northern Cyprus Fight Against Drugs Workshop” was organized. Representatives of the Ministry of Justice, Ministry of Health, Ministry of Family and Social Policies, Ministry of Interior Security General Directorate and Turkish Green Crescent contributed a great value to the Workshop, where nearly 150 organization representatives and experts participated and presented their opinions and suggestions. The decisions taken at the workshop have been an important guide in the development of the ADC strategy and action plans. In order to realize the goals determined within the framework of this strategy and action plan, a "Legal Studies Committee" was formed to strengthen the legal infrastructure, a treatment and rehabilitation center, a counseling center and a "Scientific Study and Training Committee" for education and prevention studies. Thus, the commission has become more comprehensive.
Accordingly, the Northern Cyprus Prime Ministry Anti-Drug Commission ALO 1191 Addiction Counseling and Support Line Center, which was put into service on 26 June 2019, on the World Day Against Drugs, was established. When the call rates are analyzed in the light of the data of ALO 1191 Addiction Counseling and Support Line between 26/06/2019- 26/06/2021 below, it has been determined that the highest call rate is 48% of the calls and needs assessment consultancy and support. Other Call Rates respectively; addiction (16%), substances (11%), treatment (6%), emergency numbers (3%), craving, suspicion and approach (2%), emergency, prevention, slippage, probation, technology addiction, gambling, It was determined that general information, information about alcohol, information about substance addiction, information about smoking and tobacco addiction (1%) were consulted.
Within the framework of these calls, approximately 226 people, including addicted individuals and their families, were included in the Psycho-Social Support Program established under the Prime Ministry Anti-Drug Commission. Psycho-social support continues to be provided to addicted individuals and their families participating in the program on a regular basis. When the reasons for the counselees' application are examined, they come to the fore as "desire for treatment, desire to quit the substance, support during abstinence and crisis intervention, prevention, probation training, support during probation, family counseling and social support". Considering the gender distribution of the people included in the ADC Psychological Support Program in 2020, it was determined that 10% were female and 90% male. When the age ranges of the individuals included in the Support Program were examined, it was seen that those aged 15-24 were 76, those aged 25-34 were 105, those aged 35-44 were 55, those aged 45-54 were 8, and those aged 55 and over were 14 is seen (mostly in the 25-34 age range). When the aforementioned data are evaluated in a general framework, it shows that clients of all ages apply confidently to the Commission's Psychosocial Program.
In the distribution of addiction types of the people included in the ADC Psychological Support Program, it is seen that 34 clients apply for support only alcohol use, 63 clients only for drug use, 128 clients for alcohol, drugs and drug (multi-substance) use, 35 clients without substance use, and 6 clients only for gambling addiction. As can be seen, multiple substance use is at a much higher rate than other addictions.
After determining the needs during the interviews, 75 individuals who applied to the ADC Psychological Support Program only for treatment, 34 individuals who applied for treatment and social support, 24 applied only for family support, 9 individuals who applied for social support and support during the court process, and probation training. It was determined that there were 115 applicants for It is observed that the number of people who apply to the program for treatment voluntarily increases every year.
Foreign nationals who apply to the ADC Psychosocial Support Program, which has well-equipped specialists working without discrimination of religion, language, race and sect, both who have a legal process due to drug addiction or who apply to overcome the addiction syndrome they have experienced even though they do not have a legal process, can also benefit from the program applied to Northern Turkish Cypriots and Turkish citizens. they use the English version of the same. When the nationalities are examined, it is seen that 110 Northern Turkish Cypriots nationals, 40 Turkish citizens, 50 Northern Cyprus - TR nationals and 46 Third Country citizens benefit from the Psychosocial Support Program. 10 people were not included in the data because they did not specify their nationality. In general terms, it can be said that the ratio of Northern Cyprus and third country citizens, as well as Northern Cyprus citizens, constitutes an important value.
Considering the educational status of the individuals who applied to the ADC Psychological Support Program only for treatment, it is seen that there are 95 people who have completed high school, 56 people who have completed secondary school, 54 people who have completed primary school and university, and 7 people who have not completed any school and are literate. Although the applicants to the ADC psychosocial support program due to addiction problem are mostly high school graduates, it is noteworthy that secondary school and primary school graduates cannot be underestimated. It can be seen that there is an addiction problem among university graduates. Looking at the marital status distribution of the related individuals, it is seen that there are 178 Single, 54 Married, 15 Divorced, 8 Separated and 3 Widowed. There are 8 people who stated their marital status as other. Singles rank first among the individuals included in the ADC Psychosocial Support Program. Considering the total number of married, widowed, divorced and estranged individuals, it can be said that the addiction problem also negatively affects the family business, which cannot be underestimated. Considering the distribution of child assets of the individuals included in the program, it is seen that there are 193 (73%) people who do not have children, and 73 (27%) people who have children. Considering that addictions experienced during marriages negatively affect children as well as spouses, it can be said that the rate of 27% cannot be underestimated. For this reason, holistic psychosocial support is provided not only to individuals but also to families, who are included in the ADC Psychosocial Support Program. In addition, the existence of Probation processes of the program participants was examined. Accordingly, it is seen that 150 people do not have a Probation process, and 115 people have a probation process. When these data are examined, it can be said that due to the trust created, people who do not have a legal process for drug offenses also apply to the ADC Psychosocial Support Program with confidence. Considering the entire support process, it is possible to say that the applicants are provided with a holistic approach, regardless of their race, religion, gender, age, educational status and probation status, in a way that covers the whole family as much as possible.
In the interviews with the individuals, the needs were tried to be determined and the following data were obtained within the scope of support areas. The number of individuals applying to the ADC Psychological Support Program only for treatment was 75, the number of individuals applying for treatment and social support was 34, the number of individuals applying only for family support was 24, the number of individuals applying for social support and support during the court process was 9, and the number of individuals applying for probation training was 115. It is observed that the number of people applying to the program for treatment voluntarily increases every year.
Foreign nationals who apply to the ADC Psychosocial Support Program, which has well-equipped specialists working without discrimination of religion, language, race and sect, both who have a legal process due to drug addiction or who apply to get rid of the addiction syndrome they have experienced even though they do not have a legal process, can also benefit from the program applied to Northern Cyprus and Turkish citizens. they use the English version of the same. When the nationalities are examined, it is seen that 110 Northern Cyprus Turkish nationals, 40 Turkish citizens, 50 Northern Turkish Cypriots- TR nationals and 46 Third Country citizens benefit from the Psychosocial Support Program. 10 people were not included in the data because they did not specify their nationality. In general terms, it can be said that the ratio of Northern Cyprus and third country citizens, as well as Northern Cyprus citizens, constitutes an important value.
Considering the educational status of the individuals who applied to the ADC Psychological Support Program only for treatment, it is seen that there are 95 people who have completed high school, 56 people who have completed secondary school, 54 people who have completed primary school and university, and 7 people who have not completed any school and are literate. Although the applicants to the ADC psychosocial support program due to addiction problem are mostly high school graduates, it is noteworthy that secondary school and primary school graduates cannot be underestimated. It can be seen that there is an addiction problem among university graduates. Looking at the marital status distribution of the related individuals, it is seen that there are 178 Single, 54 Married, 15 Divorced, 8 Separated and 3 Widowed. There are 8 people who stated their marital status as other. Singles rank first among the individuals included in the ADC Psychosocial Support Program. Considering the total number of married, widowed, divorced and estranged individuals, it can be said that the addiction problem also negatively affects the family business, which cannot be underestimated. Considering the distribution of child assets of the individuals included in the program, it is seen that there are 193 (73%) people who do not have children, and 73 (27%) people who have children. Considering that addictions experienced during marriages negatively affect children as well as spouses, it can be said that the rate of 27% cannot be underestimated. For this reason, holistic psychosocial support is provided not only to individuals but also to families, who are included in the ADC Psychosocial Support Program. In addition, the existence of Probation processes of the program participants was examined. Accordingly, it is seen that 150 people do not have a Probation process, and 115 people have a probation process. When these data are examined, it can be said that due to the trust created, people who do not have a legal process for drug offenses also apply to the ADC Psychosocial Support Program with confidence. Considering the entire support process, it is possible to say that the applicants are provided with a holistic approach, regardless of their race, religion, gender, age, educational status and probation status, in a way that covers the whole family as much as possible.
School-Based Interventions
Some school-based interventions focused on school-based crime/violence and substance use, and some interventions were more global in nature and others included some factors such as emotion regulation, self-esteem, and communication. According to education levels there was a wide range of ages of program participants including preschool (e.g., Dubas et al., 1998), elementary school (e.g., Flay, 2014), middle school (e.g., Guo et al., 2015), and high school (e.g., Stacy et al., 2002).
Data continues to be collected for school-based interventions in the Northern Cyprus. In a study carried out in primary schools, it is emphasized that an important database for prevention programs to be prepared in the future is tried to be created in order to reduce the frequency of psychoactive substance use. As a result of the study on the use of psychoactive substances, the lifetime prevalence of psychoactive substances use among primary school students in the Northern Cyprus was found to be 1.2% (Çakici et al., 2017). This rate was found to be 5.8% in the study conducted among secondary school students (Çakıcı et al., 2001) and 10.0% in the high school study (Eş, 2015).
It was stated that the "Personal and Social Skills Development Guide", which aims to serve as a guide for guidance teachers, has been developed in cooperation with the Ministry of National Education and Culture and the Prime Ministry Anti-Drugs Commission, and that the booklet will be applied to the 9th grades in the first place, and its impact on students had been monitored. “Educational Guides” on substance use were shared with schools associated with an earlier study performed in 2000 (Danışmanlık, D. A. Ü. P., & Merkezi, A. 2015).
"Personal and Social Skills Development Guide", was prepared to serve as a guide for teachers, has been developed in cooperation with the Ministry of National Education and Culture and the Prime Ministry Anti-Drugs Commission, and that the booklet will be applied to the 9th grades in the first place, and its impact on students had been monitored. “Educational Guides” on substance use were shared with schools.
At the university level, YODAK has included the subject of drugs, which it believes to pose a serious threat to university students, among its studies. Higher Education Planning, Supervision, Accreditation and Coordination Board (YODAK) was established in 1993 in order to plan the rapidly growing higher education institutions in Northern Cyprus, carry out accreditation procedures, direct their activities and ensure coordination among higher education institutions. The primary theme of the YODAK Anti-Drug Coordination Committee, which started in October 2007 and convened seven times in total until May 2008, is the fight against addiction, and later on, under the title of Social Risks, it works on activities that can be done in university environments to prevent sexually transmitted diseases (Danışmanlık, D. A. Ü. P., & Merkezi, A. 2015).
School-based studies are handled formally and extensively: Studies have been initiated to include education on addictions, which is one of the main goals in formal education, into the curriculum. In this framework, as the first step, the Education Program Working Group was established in 2015 under the “Scientific Study and Education Committee”. This working group has created the “Personal and Social Skills Development Guide” for the prevention of drug use, which will be included in the curriculum for 9th and 10th grade students. The guide started to be implemented in pilot schools in the 2016-2017 academic year, and was put into practice in the 2017-2018 academic year.
Studies at primary and secondary school level: It was carried out with the Working Group, which was formed for the realization of students' life skills training programs. In line with this purpose, after a series of meetings, a draft study on the "Conscious Life Education Program" was prepared. However, this draft study, which was prepared in 2015, could not be carried forward due to the frequent changes in government and the different perspectives of the senior managers in the Ministry of National Education and Culture. However, with the work of the committee formed in the new period, it is aimed to complete and implement the education program for primary and secondary schools.
Law Enforcement/Justice-Based Interventions
Law enforcement and justice-based interventions are those in which law enforcement officers, offenders, or individuals who are incarcerated are the targets of the intervention where programs aim to decrease individual engagement in crime/violence and substance use like in the case of policing strategies. That are a potentially effective law enforcement/justice-based intervention to decrease crime/violence and substance use on a community level (Bates et al., 2015; Mazerolle et al., 1998).
Experts working in the Anti-Drug Commission Psychosocial Support Program also provide education services on addictions, which are required by law, to convicts included in probation within the framework of the Law on Probation on Drug Addicts and Users. Citizens of foreign countries who apply to the Anti-Drug Commission Psychosocial Support Program, which has well-equipped specialists working without discrimination of religion, language, race and sect, who have a legal process due to drug addiction, or who apply to get rid of the addiction syndrome they are experiencing without a legal process, are also offered to Northern Turkish Cypriots and Turkish citizens. The English version of the same program is used. The trainings in question, stipulated by the Probation Law, are carried out by the experts of the Prime Ministry Anti-Drug Commission.
The Probation Board has made a decision to provide training to probation officers stipulated by the Law on Probation on Drug Addicts and Users No. 28/2016. At the meeting chaired by the Prime Ministry Undersecretary and Chairman of the Probation Board, Hüseyin Amcaoğlu, it was approved that the training given in paragraph 3/c of article 11 of the law be given by the Prime Ministry Anti-Drug Commission.
Persons on probation within the framework of the decision taken go to the Prime Ministry Anti-Drug Commission in order to fulfill their educational obligations stipulated by the law and undergo training on addictions, which consists of 12 sessions. The application consists of 6 stages; The first stage is individual interview, the second stage is individual support program, the third stage is group therapies, the fourth stage is family interviews, the fifth stage is preparation for social life and the sixth stage is follow-up and support.
Probation is a modern understanding of execution, and states that 332 young people benefited from this law until the end of 2020, after the law was passed. It is aimed that the experts are fully equipped to provide the necessary training and that the individuals who have been trained will be included in the Commission's Psychosocial Support Program in line with their needs, and to provide the necessary support for the treatment and rehabilitation processes of those in need. Until today, 1560 hours of Probation training have been given, and those who are still in the process and who will benefit from probation and will start this process, continue to be trained. It was observed that 23 of these people were foreigners and 42 of them were Turkish. The main rationale of the project is to re-establish relations with the family, adapt to the society, become productive again, meet all the urgent needs of shelter, nutrition, clothing, health, education, if any, and reintegrate them into the society, as well as continuing the substance addiction treatments after the individuals' evacuation.
Health Care-Based Interventions
Healthcare settings are an ideal venue for patients at emergency departments, health clinics, or doctors’ offices are a captive audience, often with long wait times. Because, computer-, television-, or literature-based interventions for these patients has the potential to reach a large audience and often, substance users, perpetrators, and/or victims of violence seek treatment at emergency rooms or doctors‟ offices and brief interventions implemented in these settings might help change their behavior and/or plant a seed for patients to seek future treatment or support. Moreover, healthcare settings have highly qualified and trained individuals like doctors, nurses, social workers who can assist with intervention administration. Therefore, there are many resources in healthcare settings to help patients find follow up services or treatment options (U.S. Department of Health and Human Services, 2016).
The number of studies informing and raising awareness about illegal substance use, organized by Non-Governmental Organizations (NGOs) has increased especially in recent years. These organizations include Cyprus Turkish Mental Health Association, Cyprus Turkish Medical Association, Barış Psychiatric Hospital, and Pembe Köşk Psychiatric Hospital.
Cyprus Turkish Mental Health Association (Kıbrıs Türk Ruh Sağlığı Derneği/RUSAD) Cyprus Turkish Mental Health Association has been conducting studies on drug use since 1980. The association organizes various seminars, conferences, TV and radio programs within the scope of non-formal education (Danışmanlık, D. A. Ü. P., & Merkezi, A. 2015).
Cyprus Turkish Medical Association (Kıbrıs Türk Tabipleri Birliği/KTTB). The Cyprus Turkish Medical Association was established in 1956 by forming a founding member of 20 Turkish Cypriot physicians and veterinarians. The Union carries out studies on social issues in many fields. The Union has organized many scientific publications, panels and conferences on substance use, especially since 1996 (Danışmanlık, D. A. Ü. P., & Merkezi, A. 2015).
It is observed that the number of inpatients treated at Barış Psychiatric Hospital (Barış Ruh ve Sinir Hastalıkları Hastanesi/BRSHH) between 1996-1999, 2000-2003 and 2011-2014 due to alcohol and drugs has increased over the years. As can be seen in Figure 1 below, the number of people receiving treatment for excessive alcohol use has decreased recently, while the number of people receiving treatment for substance abuse has increased over the years (Danışmanlık, D. A. Ü. P., & Merkezi, A. 2015).
Pembe Köşk Psychiatric Hospital. Within the framework of the work that the Commission has been involved in since 2016, a historic step was taken by signing a protocol envisaging patient referral between Pembe Köşk Psychiatric Hospital and the Ministry of Health with a decision taken by the Council of Ministers on September 26, 2019. Our substance-addicted youth and children, who were referred to Pembe Köşk Psychiatric Hospital by the Barış Mental and Neurological Diseases Hospital Board affiliated to the Ministry of Health, within the framework of the quota determined in accordance with the signed protocol, have started to receive treatment and rehabilitation services here and have gained serious benefits.
According to this Protocol, 80 percent of the treatment costs of the patients referred to Pembe Köşk are covered by the state. The Prime Ministry Anti-Drugs Commission established an Alcohol and Substance Addiction Treatment Center (AMATEM) within the Ministry of Health in order to overcome the problem caused by the inability to provide adequate service to substance addicts who apply in the current physical conditions of Barış Nervous and Psychiatric Hospital took a determined stance on the establishment of an AMATEM at the state level, which is a great expectation of the society, the capacity in treatment and rehabilitation will be moved to a much better point.
Discussion and Conclusion
In this study, "Northern Cyprus Drugs and Addiction Report, 2021" aims to provide an overview of the drug situation, which is necessary to develop effective actions for today's problems, by contributing to the creation of a healthier and safer society against drugs and addictions in Northern Cyprus.
Taken in general “Drug Abuse Prevention” related studies have a multidimensional structure. Social contexts of prevention applications can include drug abuse prevention curricula in schools (social-influence approaches, psychological inoculation, social resistance skills training, competence-enhancement approaches). In research-based family interventions for the prevention of substance abuse (family-strengthening interventions, behavioral parent training, family skills training or behavioral family therapy, in-home family support, family interventions that address risk and protective factors, effective family-focused interventions, effectiveness of science-based programs with diverse populations, relative effects of family-focused versus child-focused interventions, community-focused drug abuse prevention, drug abuse prevention in the workplace). Subjects such as (anti-drug-abuse policies as prevention strategies, supply and demand reduction, levels of prevention policy, use of prevention programs to enhance policy) can be included in prevention as social control. Five basic themes were used in order to summarize and organize the study in an understandable way. These themes were handled as Community-Based, School-Based, Law Enforcement/Justice-Based, Health Care-Based intervention studies and Interventions Implemented in Multiple Locations studies and were included in the discussion section in the same order.
In the Community-Based theme related to the distribution of addiction types of the people included in the ADC Psychological Support Program, it is seen that most clients applied for alcohol, drugs and drug (multi-substance) use. This situation shows that the use of multiple substances, which has been increasing alarmingly around the world, has started to be a serious risk factor in Northern Cyprus in parallel with a recent study (MacMillan et al., 2022) which can be related to the COVID-19 pandemic.
The COVID-19 pandemic in the whole world has had a significant impact on the way individuals supply, obtain and use illicit drugs and it would threaten many vulnerable individuals’ physical and mental well-being (Dietze & Peacock, 2020; Garcia et al., 2022; Holland et al., 2021; Price et al., 2022). These impacts may differ by substance and region according to different groups of people who use drugs. For example, pandemic restrictions on mass gatherings are more likely to impact use of substances commonly consumed in social settings like 3,4-methylenedioxymethamphetamine (MDMA) and cocaine, than in private settings like heroin and cannabis. There is also concern that in pandemic conditions where illicit substance supply differs people turn to other drugs as a substitute or complement. These findings can inform region-specific public health interventions and highlight the need for timely and comprehensive illicit drug usage data, especially amidst concurrent crises such as COVID-19.
Therefore, ADC Psychosocial Support Program should cover a wide range of spectrum of applicants with different chancing needs according to pandemic. So that fight against addiction system should have a dynamic structure with the feature of continuous program development and is open to new restructurings in order to quickly find solutions to new problems that may arise like in the case of COVID-19 pandemic (Zaami et al., 2020).
Related with School-Based interventions the data obtained from this study showed that generally the education level of individuals with drug use or addiction was from high school or equivalent, and most of them did not have a job and were unemployed. It was also determined that those who had been convicted of drug charges had completed high school or an equivalent, had no career, and were jobless. Studies also have shown that substance use mostly begins during adolescence (Çakıcı et al., 2001; Thatcer & Clark, 2008; TUBİM, 2014) and that young people who are introduced to drugs in this period develop addiction in the future (Griffin & Botvin, 2010). All these studies emphasize the importance of preventive and informative approaches to be applied in school environments.
Students and younger generations are at a significant risk of using drugs. Studies have indicated that a school that respects the roles of teachers’ and acknowledges the significance of the learning environment would succeed in terms of students' morale and dedication to abstaining from drug use (Moreira et al., 2015; Razali & Madon, 2016). Drug prevention at school requires cooperation between several school elements that could include crime/violence and substance use, and some interventions were more global in nature and others included some factors such as emotion regulation, self-esteem, and communication. However, it was determined that the studies were interrupted by government changes. Approaches that will be added to the curriculum need to be continuously developed and the continuity of their implementation should be ensured in a way that is separate from the policies of existing governments. Only motivated teachers in the light of this continuity, can collaborate with parents, students, and other school personnel to foster a drug-free learning environment. Additionally, school-based educational and preventive programs should be handled in accordance with the levels of the students, and the studies starting from primary school should be carried out for each class. In addition to the preperation of educational and preventive programs, it has been determined that the teachers and guidance teachers who will implement the program need to be carefully trained through in-service training.
According to the Law Enforcement/Justice-Based interventions, it was observed that programs aim to decrease individual engagement in crime/violence and substance use on a community level. It has been observed that the necessary legal regulations are included in order to achieve this aim. The importance of legal regulations in coping with addiction is supported by many other studies (Bates et al., 2015; Mazerolle et al., 1998). In this way, awareness-raising training programs for students, teachers, families and society in the fight against drugs will have the chance to keep going on a continuous basis.
The importance of legal regulations, inspections and social cohesion for an effective fight against drugs is indisputable in the Northern Cyprus as in the world. It is known that there has been a serious increase in crimes committed within the scope of drug activities in recent years. Crimes committed within the scope of illegal drug activities, which are seen as one of the biggest threats to the future in many countries, are also among the most serious crimes in our country. On the other hand, the effective operations organized by the Narcotics and Smuggling Prevention Directorate under the General Directorate of Police in recent years, especially for drug suppliers and dealers, provide serious hope for the future.
It has been learned that within the framework of Health Care-Based Interventions, special sections of the hospitals are processed for medication-assisted treatment. It is stated that the use of illegimite drugs can be prevented with the pharmacotherapy approach, prevents relapse, improves health, and reduces the risk for death (Korthuis et al., 2017). In this study, conducted in 2017, various intervention approaches are discussed. When the collected data were reviewed, it was seen that the variety of Health Care-Based interventions in the Northern Cyprus was more limited. However, it may be important to apply addiction interventions as individualized as possible. It is seen that approaches such as Practice-Based Models Office-Based Opioid Treatment, One-Stop Shop Model, the integrated prenatal care model for primary and prenatal care for pregnant women are included in the literature. Additionally, Systems-Based Models, Medicaid Health Home Model, and interventions such as Hub-and-Spoke Model and Southern Oregon Model were mentioned (Korthuis et al., 2017). These data draw attentions to the need for more comprehensive intervention programs.
In the fight against drugs, supply is a holistic process that requires effective simultaneous struggle with the fields of prevention-education and treatment-rehabilitation. In order for the work carried out in this context to be successful, it is imperative that all institutions and organizations and even the society act jointly. While this obligation pushes our institutions to work in a scientific way, it ensures that the acquired knowledge and experience is transferred to the stakeholders and institutions. In this direction, it is continuous to act with unity and solidarity. Based on the data presented in the report, it will facilitate the integration of individuals into society and prevent them from returning to substance use, by carrying out the necessary studies in cooperation with the Social Services Department and the Labor Department in order to reintegrate these people into society and to prevent them from returning to substance use, and by supporting them in finding a job.
The importance of legal regulations, inspections and social cohesion for an effective fight against drugs is indisputable in the Northern Cyprus as in the world. To the extent that the entry, distribution and accessibility of drugs into the country are prevented, it will be possible to reduce the use of drugs and the related individual and social harms. The importance of legal regulations, inspections and social cohesion for an effective fight against drugs is indisputable in the Northern Cyprus as in the world. To the extent that the entry, distribution and accessibility of drugs into the country are prevented, it will be possible to reduce the use of drugs and the related individual and social harms.
Social interventions and policies to be developed, psychosocial support program, strengthening the treatment and rehabilitation capacity in both the public and private sectors without delay is the most important step to be taken in terms of accessibility to treatment. In addition, the social adaptation center prepared to strengthen the functionality of the individual, and the integration of the individual into the society (job, food, education, asylum services) should be provided.
In this way, the person will take the step that will improve basic life skills and ensure a healthier life and order. In addition, it is thought that providing vocational training courses by conducting special studies through the social adaptation center during the rehabilitation process for non-professional individuals, gaining a profession by continuing these courses, increasing their self-confidence, correcting and developing their own behaviors.
Individual needs are determined and the long-term continuity of the rehabilitation process gains importance in this direction. Individuals should be supported by the outpatient rehabilitation process involving clinical psychologists and social workers who are experts in the field of addiction to alcohol and substance addicts and those at risk of addiction. Individual psychotherapy methods, individual interviews or group therapies should be applied and individuals should be supported with special programs tailored to their needs. Social support studies should be carried out for the individual to reconstruct his social life with social support, and the restructuring of social life, which is the most important part of the treatment process, should be ensured.
Prevention programs play a very serious role in the fight against substance addiction, with the function of delaying the age of onset of substance use and making it difficult to start other substances (Botvin & Griffin, 2004). Therefore, it seems possible to keep individuals completely away from substance addiction, thanks to the life skills to be gained at an early age through prevention programs. As citizens of this country, we all have a duty to protect our children and youth, especially our children, against the drug problem, which poses a great danger in our country and in the world. Families are at the forefront of the measures that can be taken in this regard. It is known that family-oriented studies are important in prevention programs developed against substance use (Lochman & Van Den Steenhoven, 2002). Based on this view, the awareness-raising activities initiated by the ADC on drugs and addictions should be increased and continued.
Acknowledgements
The author(s) declare that there is no conflict of interest.
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