This article originally appeared in the Winter 2020 issue of Advances in Addiction & Recovery.
By Diane Sevening, EdD, LAC, MAC, NAADAC President
Substance use disorders (SUD) and mental health disorders (MHD), including co-occurring or co-morbidity disorders, are not only a concern in North America but are also a concern throughout the world. As many of you know, NAADAC co-sponsored a professional exchange with National Council for Behavioral Health and World Learning in Kosovo on May 18–24, 2019. This trip provided opportunities for touring parts of Kosovo and meeting with the Minister of Health, the General Secretary of the Ministry, Director of the Mental Health Department, the Chief of the Minister’s Cabinet aide, the Director, Secretariat of Strategies, Ministry of Internal Affairs, the U.S. Ambassador, the Director of the Psychiatric Clinic and staff, the Executive Director of the Labyrinth Center, the Director of the Mental Health Center in Gjilan Municipality, and the Director of Streha Rehabilitation Center.
The available treatment and treatment protocols for MHD and SUD in Kosovo differ from the available treatment and treatment protocols in the United States. There are three levels of care for MHD and SUD in Kosovo (primary, secondary, and tertiary), and the first point of contact for any patient with SUD and/or MHD in Kosovo is the family medicine doctor. Primary care includes the free family medicine centers; secondary care involves psychiatric wards and hospitals, integration homes, and the Center of Rehabilitation for Chronic Mental Health Disorders; and tertiary care includes the psychiatric clinics, the Center for Children and Adolescents, and forensics. Each of the levels of care works to improve health, reduce stigma, and allow patients to become self-sufficient. Currently, of patients diagnosed with addiction diseases, approximately 2% receive inpatient treatment at the psychiatric clinics. Marijuana and heroin are the predominantly used drugs in Kosovo, and methadone is the primary treatment provided for heroin addiction. Alcoholism is not believed to be a common problem, but this is not known for sure since it may be under reported due to the cultural norm of family members taking care of each other. Kosovo is planning to develop a center or institution for addiction diseases that can also provide an addiction diseases database. All government officials and healthcare providers with whom we met emphasized the importance of having highly educated and trained addiction professionals employed at this center of institution to provide treatment to the individuals who would receive treatment.
All professionals providing therapeutic services are required to have at least a Master’s degree and be licensed in their respective profession. The main providers for SUD in Kosovo are medical doctors, psychiatrists, psychologists, and social workers. Currently, the universities do not provide any specific education for addiction professionals, but the professionals providing SUD services are increasingly recognizing the need for higher education specializing in addiction studies and addiction-specific licensure for addiction professionals. The individuals with whom we spoke consistently identified maintaining and funding appropriate treatment facilities, addressing the workforce shortage, and professional development as some of the key challenges that they face.
While in Kosovo, we had the opportunity to visit the Labyrinth Center, an outpatient facility, and Streha Rehabilitation Center, an all-male residential facility. Both facilities took unique approaches to treatment, education, and sustainability, and both facilities face a common problem that we also see in the United States: difficulty in finding qualified professional SUD staff.
The Labyrinth Center, established in 2002, deals with the prevention of drug and alcohol abuse, the treatment of addiction to drugs and alcohol, and the reduction of drug-related damages. Labyrinth has three centers across Kosovo in Prishtina, Gjilan, and Prizren. This outpatient program employs professionals in the fields of medicine and psychology and provides counseling, psychotherapy, pharmacotherapy, methadone holding therapy, ambulatory opiate drug detoxification, and rapid tests for drug detection in the body. The facilities also provide information and education for drug users as well as for the general public, with a special focus on young people, about drugs and the risks accompanying their use and/or abuse. The Labyrinth Center facilities are currently treating approximately 2,300 patients, though qualified SUD professionals are difficult to find, creating a workforce shortage in providing competent and necessary care.
Streha Rehabilitation Center is a professional rehabilitation center for people addicted to narcotic substances. Established in 2007 to create a peaceful and convenient environment for all people in need, its goal is to care for people addicted to drugs, train them for a free and independent life, and integrate them back into social life. The facility is located in a beautiful rural setting in Gjilan and offers a home environment with therapeutic conversations, various lessons, practical work, leisure, sports, music, art, and other activities. Streha therapy is done without medication and can last approximately 12 to 18 months. They currently have six beds for males aged 18 and over and their average patient is 35 years old. All residents are expected to join in farming the land, and the vegetables, fruits, and herbs that are harvested are shipped to various regions in Kosovo and other surrounding countries to fund the program. Streha’s leadership would like to expand the program and recognize the need to have a similar program for women but the inability to find and hire sufficient qualified SUD professionals is a barrier to adding beds and growing the program.
The individuals in this delegation represented different areas of the United States with diverse backgrounds and professional expertise. It was exciting to get to know each other and share our professional and personal experiences realizing our common goal is providing the best care possible for the patients and constituents we serve through education, intervention, prevention, and treatment. It was equally gratifying to engage with our counterparts from the other side of the world and learn that we face many of the same challenges and many of the same goals. This was a very memorable experience for me and wish to thank NAADAC for providing this opportunity to continue and develop international relationships.
Diane Sevening, EdD, LAC, MAC, is an Assistant Professor at the University of South Dakota (USD) School of Health Sciences Addiction Counseling and Prevention Department (ACP), has over 35 years of teaching experience, and is a faculty advisor to CASPPA. In addition to serving as NAADAC President, Sevening is also a member of the South Dakota Board of Addiction and Prevention Professionals (BAPP) and Treasurer of the International Coalition for Addiction Studies Education (INCASE). Her clinical experience involves 7 years as the Prevention and Treatment Coordinator Student Health Services at USD, Family Therapist at St. Luke’s Addiction Center in Sioux City, IA for 1 year, and 2 years as clinical supervisor for the USD Counseling Center. Sevening has been the Regional Vice President for NAADAC North Central Region, the Chair of the Student Committee for NAADAC, and an evaluator for the National Addiction Studies Accreditation Commission (NASAC), and is currently a member of the NASAC board of commissioners.