A DAY IN THE LIFE

In view of International Day Against Drug Abuse and Illicit
Trafficking on Monday, Fiona Galea Debono mingles with heroin addicts,
who are struggling to keep clean, while delving into the "serious"
problem of substance abuse Malta is facing in a world governed by
instant gratification.

There is an air of serenity on entering San Blas, the secluded
residential drug rehabilitation centre, located in the countryside.
The birds are singing and the plants in the driveway are pruned and
thriving. It is an unexpectedly good vibe.

Although that feeling of tranquillity enjoyed by the passer-by may not
be shared by the 25 residents, who are coming to grips with drug
addiction and attempting to rebuild their wrecked lives, San Blas is,
nonetheless, a good environment to cut off from the big bad world
beyond its gates and try to focus on the feat ahead.

It is a safe haven for its clients... so much so that the first
"request" by three female peers - the opportunity to leave their
confines for the first time in six months to spend four hours at the
beach - has proved to be daunting and an anti-climax.

"We felt like aliens... We didn't utter a word to each other... We
were constantly looking at our watches... I was worried sick about my
kids, but I couldn't share my feelings... Nobody considered us... I
felt under pressure to have a good time... I thought: is this what
life is all about? Is this what pleasure is supposed to be?"

Sitting in a circle in a group session, the residents open up about
the ordeal of facing "dangerous" society in small supportive groups
for the first time in ages. They are inundated with issues and are
trying to deal with them.

"Because they used drugs in the formative years of their lives, they
stopped developing mentally and emotionally, and have the same defence
mechanisms of 10-year-olds. Now, their characters have to be remoulded
from scratch, their values re-instilled and their self-esteem built.
They have to learn that life is not about instant gratification; like
children are taught, they have to learn how to wait," explains
Mariella Balzan, the coordinator of the Caritas New Hope drug
rehabilitation programmes and services.

But they are getting there, thanks to a solid support network at San
Blas.

Earlier on in the day, Tom* is sitting in the middle of the room,
expressing his feelings to the rest of the group. He is moving from
the residential to the three-month semi-residential phase after being
clean for a year. He is going to miss his mates and he knows that the
more he distances from the refuge of San Blas, the harder it is going
to be to cope. The semi-residential programme is the transitional
phase between being in a protected cocoon and moving back into harsh
reality. But he is being provided with the necessary tools to tackle
it, and he knows he has the responsibility to set an example and show
the others that they can make it too.

"I never thought I'd make it... I took a lot from here; I believe in
myself, I can control some of my anger and I've removed some of the
discomfort I feel... Keep your wits about you," he warns the friends
he is leaving behind to an emotional applause and their supportive
camaraderie.

As Tom is moving on, others are moving in. Shirley*, 21, is waiting at
the gates, with a massive suitcase, her mother, her aunt, two cousins
and her son in tow. The child is the reason why she has decided to try
and clean up her act... even though the bond between them may not be
that strong as is typical of a drug user's "me, myself and I" state of
mind.

"It was all about me. I never really felt like him around," she
admits, now aware that her son can be taken away from her if she does
not complete the programme.

This is not Shirley's first attempt. "Had I stuck it out, I'd have
been OK by now," she says with remorse. "The more you remain out
there, the harder it gets."

While the contents of her suitcase are being checked, Shirley caresses
the unsightly swellings in her arms as she talks about her topsy-turvy
life; her sister, who is in a worse state; and her junkie boyfriend,
the father of her son, with whom she does not really have a
relationship, but just used drugs.

"I've been with him since I was 14, and when I got pregnant shortly
after, I remained clean. But when I had the baby, I went straight on
to smack. I was curious to know what he was feeling and I asked him
for some. I wanted to know what was so nice about it... and I have
never stopped since."

Shirley has just emerged from Mount Carmel Hospital, where she spent
three weeks - the only way she could stay clean to enter San Blas.
"Somehow, I felt comfortable there," says a jittery girl, who has seen
more than she should have in her short life but, at the same time,
needs to grow up. Her maturity and her inner strength will be built on
over the course of the programme - that is, if she does not decide to
split.

The rules have to be respected - clients have to be drug-free and on
no more than 20mg of methadone to enter San Blas. Shirley is in, and
seems to have all the intentions to stay, but Brain's* story has a
twist.

He turns up from the Harm Reduction shelter in Floriana, accompanied
by his parents, junkie wife and baby girl, ready to turn over a new
leaf... but not so fast! His urine is not clean, and although he
insists that he has not touched a drug in days, he is asked to return
to where he came from. His tail is between his legs, his parents look
tired and are not amused, but he is determined to be back soon.

Meanwhile, urine checks on all the men in the shelter are ordered to
see whether drugs have infiltrated it.

Such traumatic incidents are the order of the day at San Blas, but the
staff is trained and experienced to take them in their stride and
tackle them with professional ease and expertise. Feedback is an
important part of the process and is shared regularly.

John* has relapsed, they learn, and together they strategically plan
what action to take. Analysing the troublemakers, they have sniffed
out a bad apple in the group, who is pulling everyone down with him.
He is their next target and they start from scratch.

They also discover that Paul*, who is in the re-entry phase of the
programme, has been drinking. He justifies that he can only go through
this if he allows himself one night a month of partying. After all,
what else is there to life? What is there to look forward to? He is
given a good talking to and put on the straight and narrow again. It
is too early, he is told. He still has to build himself up.

Music emanates from one of the rooms. The residents have dance
practice for the upcoming graduation ceremony. They seem into it and
have the enthusiasm of schoolchildren - not what you would expect from
former junkies, who are used to heavier forms of entertainment. But
their efforts and levels of discipline are not satisfying and they are
told point blank. They listen attentively and try again...

Mary* is not up for it and she keeps back, so she is asked to leave
the room. "I do not want anyone to pull the motivation of the others
down. It is bad for them," says the coordinator.

"Isn't that why I take what I take," Mary retorts under her breath.
"To be able to feel comfortable!"

Later in the day, a meeting is held in the courtyard of the first-base
Community Services in Floriana, which offers the Drop In and Outreach
programmes. The backgrounds and situations of the clients who are
being treated individually are assessed, and they are referred to the
appropriate services. The facilitators seem like they are talking
about their own children, while keeping that rational detachment that
only professionals can afford.

The stories that surround these lost sheep are mind-blowing, if not
downright scary, but that is the way it is. Not everyone has a stable
family background - or, in some cases, any form of stability in their
lives for that matter.

"Michael* has just overdosed," the team is informed, following a phone
call. It's all in a days work... Harm reduction

The living room of the Caritas Harm Reduction shelter for homeless
drug users in Floriana is like a scene from Trainspotting. Stoned
bodies are sprawled on the sofa; some are as high as a kite; none are
looking anything close to healthy, or clean. These are the real thing!
The difference between the people in this room and those in San Blas -
even merely from a physical point of view - is evident at first glance.

And it is not surprising. These are, after all, the serious junkies,
heroin addicts, with nowhere to live and a spate of legal, mental,
social and health problems on their plate. Here, they are given a
temporary shelter, kept off the streets, fed and offered the
possibility to shower.

The unit, which opened a year ago, is popular among the addicts, and
is a success story in its own right. Casual conversations are held in
this living room - the first point of contact and the start to roping
them in.

It is for those who are not ready, or do not want to stop getting
high, explains Ms Balzan. They can come in on 100mg of methadone if
necessary and their urine can be "dirty", but here, harm is reduced.
Nerves are sensitive and some of these people are so chaotic that they
need to be stabilised. This is already a start...

Meanwhile, upstairs, a bunch of guys, far from a picture of health,
are deciding what to cook for dinner.

Peter's* the-worse-for-wear image belies a potentially gorgeous face,
which has finally failed to withstand the ravages of substance abuse.
Yes, after 13 years of messing around, the drugs have taken their toll
and it is time to consider quitting.

Why now? Peter has hit rock bottom and he knows it. He always worked
and had a roof on his head, but the situation seems to be changing,
and here he is, together with other boys who have almost thrown their
lives away, but may be just in time to pick up the pieces.

They are on different levels of methadone and when they manage to wean
these down to 20mg and are clean, they can consider entering the San
Blas programme.

There is a long waiting list to enter this shelter, but not enough
space. And the same set-up is required for the women who, as yet, do
not have such a service at their disposal.

Funds are required to expand the Harm Reduction service, but
government financing has been the same for the last 15 years, Ms
Balzan points out.

* Names have been changed to protect the persons' identities. A
'serious' drug problem

Malta is facing a "serious" drug problem, says Ms Balzan. Drugs are
readily available and people are starting young.

"Plus, we are now moving into the era which Europe experienced about
20 years ago, of the mature, chronic relapsers, who are entering their
40s, are still doing heroin and will never stop. Both areas are growing.

"And we have not even calculated the increasing number of adolescents
who are using drugs but think they do not have a problem: they do not
take drugs on a daily basis, but binge at the weekends. We cannot
count these because they do not seek help, they do not get arrested,
they do not get sick and they do not overdose."

Expressing her concern for these young adolescents, Ms Balzan calls
for the need to research what is going on in society. "What is
happening in the lives of these 13-year-olds? Why are they drinking
and getting high? What are their expectations? How are they being brought up?

"Slowly, we are also witnessing an increase in the number of homeless
people, or those who are living in very poor conditions. In 10 years'
time, I envisage a serious problem of homeless drug users and their
families, whom they pull down with them."

For Ms Balzan, drug addiction is a consequence of other problems or
sicknesses - mental health, child abuse and, in particular, family
issues, which play a massive role. "I am not saying that if a kid
takes drugs, it means the parents are bad; but the support makes a
difference as to whether they stop and remain clean."

After 18 years in the field, Ms Balzan has also noticed an increase in
the number of clients on medication due to mental illness, including
depression, anxiety and personality disorders. (However, this could
also be a result of the fact that such conditions are being recognised
more due to better assessment tools.)

The Caritas programme's success is not measured on the basis of
whether a person becomes totally clean, lands a job and never sins
again, she says. "If we get someone off the streets today, feed him
after three days of not eating, sit with him and start engaging him
into becoming more stable, that is success. If, instead of sharing
needles, someone has been educated not to do so; if he has kids and we
have helped him stabilise and bother to feed them, that is a success.
If someone does half a programme, but at least is only smoking and
drinking, and stops taking heroin, cocaine and ecstasy and beating up
his wife, that is a success. He will come back in two years, but it is
a first step."

The number of people who complete the programme and actually graduate
may not be high, although compared to other therapeutic communities in
Europe, the success rate is above average. And once they do, a good 80
per cent remain clean. Whatever the case, they live better within
society, and so do their families. Facts and figures

Compiled by the National Focal Point for Drugs and Drug Addiction,
the 2005 national report on the drug situation in Malta shows that in
2004, the vast majority of clients in treatment (86 per cent),
although having a history of poly-substance abuse, used heroin as a
primary drug.

The estimated number of problematic drug users in Malta, defined
as "current daily heroin users", is about 1,500 to 1,700, aged between
15 and 64. Compared to other EU countries, Malta ranks on the high
side, indicating that heroin use is still a major problem here.

Cocaine and cannabis are the most popular secondary drugs among
registered clients in treatment.

In 2004, 1,525 treated individuals were reported by every
treatment agency - Sedqa, Caritas, Oasi, the Substance Abuse
Therapeutic Unit and the Dual Diagnosis Unit at Mount Carmel Hospital.

The majority of clients in treatment come from the southern
harbour region (six per 1,000) and the northern harbour region (four
per 1,000).