The addicts who may be forced to go it alone

A long with the rest of the health sector, the government's sweeping cuts have hit programs to treat drug addiction. Treatment centers, therapeutic communities and units where users can get clean needles and have blood tests are all facing closure, while staff are being laid off as funds dry up. Social workers say that the nationwide support network created during the 1980s, when widespread use of heroin in Spain gave the country one of the fastest-growing drugs-related AIDS rates in Europe, is in danger of collapsing. Heroin is no longer the problem it once was, but other substances have taken its place, and addiction remains a problem.

"I would be dead," says Clara, now in her 30s, who overcame alcoholism thanks to professional help. At the age of 22 she began drinking heavily, and soon began smoking cannabis and snorting cocaine, spending the next 13 years "living at night." One day, she realized she had hit rock bottom, and asked for help. "It was for my children," she says.

She agreed to enter a therapeutic community in her home region of Aragón, which she says "gave me my life back." The center, known as El Frago, was set up in 1986, but its funding has been cut, and it now faces closure, although the regional health authority says that this will only happen if "an alternative" is found. "If they close it, then they will be taking away from people the chance to change their lives, like I was able to change mine," says Clara.

June 26 was the United Nations' International Day Against Drug Use and Illicit Trafficking, but it passed by largely unnoticed. Drug use is on the rise again, according to a UN report. The number of users in the world has risen by 18 percent since 2008, in large part due to population increases, according to the UN.

In Spain, heroin use has not risen, but it has been replaced by the abuse of alcohol and sleeping tablets, as a survey carried out by the Health Ministry showed. "The crisis has not stopped addicts from taking drugs; it's simply made them look for cheaper substances," says Ignacio Calderón, director of the Foundation for Help Against Drug Addiction (FAD).

The UN warns that while the number of illicit substances is growing, addiction treatment is waning. "There are huge gaps in the services being offered," it says. Of the 211,000 people who died from drug-related problems around the world in 2011, "only one in six had received treatment the previous year," says the UN report. In Spain, the cuts are threatening treatment and prevention programs, which are considered the best way to tackle addiction, as Health Ministry surveys among users highlight.

Other, cheaper, substances have replaced heroin, and addiction remains a big problem

The Health Ministry's spending on its National Drugs Plan (PNSD) for this year has been cut by 20 percent on 2012, which in turn was 28.5 percent less than the previous year. José Oñorbe, the PNSD's deputy director, says the reduction will be comprised of funding generated by the sale of seized drug assets. He says that most of the money will be spent on prevention and awareness programs rather than treating addicts, a responsibility he says falls to regional governments, which are in charge of their own healthcare systems.

In the majority of cases, the regional governments in Spain have responded to spending cuts by leaving the treatment of drug users to charities, a task they have been carrying out since the 1980s in tandem with the public health system. But charities working with drug users say that the state is reducing its role at the same time as it is cutting funding. Their workload is heavier than ever, and they must do what they can with less and less money. Some treatment centers have already had to close.

Miguel del Nogal is a psychologist who has been working with drug users for two decades. He says that there has been a sharp decline in services and resources over the last three years. The result, he says, is the closure of treatment centers, meaning that addicts are increasingly being treated in hospitals.

"The ideal way to help addicts is through psychologists, therapists, social workers and doctors," he says. But the cuts are making this multi-disciplinary approach harder and harder. "In Aragón's El Frago, the social workers and psychologists have all been let go," says one worker at the center.

Del Nogal says that the quality of treatment being offered to drug addicts is suffering as a result. "Without psychologists the system is running on three wheels," he warns. He says that a multi-disciplinary approach "is more necessary than ever. Heroin can at least be replaced by methadone, which is not a drug, but a substitute. There is no equivalent for other drugs," he says, such as cocaine, which is the most popular illegal substance in Spain. The Mankind Project, a charity that works with addicts, says that almost a third of people who come seeking help are cocaine addicts.

Joan Carles March, a lecturer at Andalusia's Public Health School, and an expert in treating heroin addiction, agrees with Del Nogal.

"The big problem is that people think that drug addiction can be treated with pharmaceuticals alone. But addicts need psychological support, legal help and social networks, and these are being dismantled," he says.

March says that the multi-disciplinary approach works, even with heroin addicts: "We have seen that for one in three patients where methadone has not worked - even after five or six treatment programs — working in groups with therapists and psychologists, and providing support does."

Antonio José, a 26-year-old from Seville, says that therapy saved him. "I was taking anything I could get my hands on: cocaine, joints, alcohol, pills.... I started taking ecstasy when I was 15. My teenage years were a nightmare. You end up isolated from those who love you, and the only thing you can think about is getting money to buy more drugs. That's why I started dealing," he says. Six years ago he decided to seek help, and says that he has been clean for two years, and has managed to hold down his job in a bar.

But Antonio José's road to abstinence has been long and hard, and took four years of therapy, along with periods of addiction, a sense of failure and new starts. He says that he couldn't have done it without the help of Arpial, a charity based in Andalusia that works with around 200 young people, and which is struggling financially.

"We have always had problems with money," says the head of Arpial, Pedro Catalán. The charity relies heavily on former users such as Antonio José to volunteer their services and to share their experiences. Antonio José says that he is "very proud" that he has managed to kick the habit, but insists that he could not have done it alone. "We are lying to ourselves when we say we can," he says.

In Andalusia, social workers have protested against what they call the "dismantling" of programs to help addicts. Funding from the Socialist Party-controlled regional government has been cut by 45 percent this year.

Charities and NGOs working with drug users say that they are used to funding problems. Asfedro, an association that operates in Galicia, almost closed earlier this year after three decades. The regional government had to intervene to avoid bankruptcy. But other organizations are not so lucky, and have staged public protests to raise awareness of the threat their work faces. In Asturias, the ADSIS Foundation says that its work in the Villabona prison, where drug abuse is rife, is endangered, and it has posted a petition on the Change.org website to call attention to its plight, and to oblige the regional government to continue funding it.

Even the larger, well-established charities are being hit by the cuts. The Atenea Foundation's budget was cut by a third for this year, says its vice president, Alfonso Ramírez. "People do not seem to be so worried about this problem anymore, and there is a sense that drugs are no longer dangerous. This is a matter of government policy, so there is always the danger that we will ignore this issue," he says, while warning: "Demand for drugs is as great as ever."

Drug abuse is now a private problem; it is largely invisible"

Francisco Recio, the director of the Mankind Project — which is one of the biggest such charities in the country, helping around 20,000 people a year — agrees. "There are more people than ever taking drugs, but they are not in the street with a needle hanging out of their arm," he explains. "Drug abuse is now a private problem; it is largely invisible. Politicians are only interested in issues that frighten voters, as happened in the 1980s," he says, adding that if the state stops funding, then centers will close down or look to the private sector. "But the truth is that businesses are not that keen on being associated with helping drug addicts."

Professionals working with drug addicts, as well as academics and other experts, all agree that the cuts are in danger of bringing about the collapse of a model that has proven its worth over the last three decades. Nobody is being turned away as of yet, but the waiting lists in centers offering treatment and advice are longer and longer. "The quality of treatment is declining," says Miguel del Nogal.

Joan Carles March says that when he asks his patients how the crisis is affecting them, "almost all point to delays and reduced access to help." Del Nogal says that these obstacles mean that more patients will slide back into regular drug abuse because they are not under proper supervision.

"The idea is to help them at exactly the moment when they are vulnerable," he explains. "Providing assistance to drug users is about motivation. When they have taken the step of asking for help, there are strategies to encourage them to continue in therapy. But if you tell them to come back in a month, the most likely outcome is that they will not return."

Easy access to resources is the key, he says, pointing out that it takes most addicts around 10 years before they will seek professional help.

One way to avoid long waiting lists is to use a privately run center — but that's beyond the means of most addicts, especially in the context of the current crisis. This is something that Carmelo Ciudad, who looks after a close family member addicted to amphetamines, knows only too well. He was able to send his relative to a therapeutic community. Ciudad, a teacher, says that his family could not have afforded to cover the costs of private treatment, and does not know what he would have done if it hadn't been for charity-run institutions.

"If these sick people are not in a specialist center, then they will go elsewhere: a hospital or prison, neither of which is a solution."

The Red Cross has also had its funding reduced and has been forced to close two centers in Madrid. The move, which has affected two other associations working with drug users, means that 1,200 patients will now become the responsibility of local hospitals, whose resources are already overstretched.

Jesús Hernández, who runs the Red Cross Health Plan, believes that the crisis is having other negative effects on patients, which are greater than those caused by the closures. He points to "the cuts to payments to people to allow them to gradually reintegrate in society, or that help them find work."

Antonio José says that his personal fight against drug abuse hasn't really been about forgetting the past — "I know what I did, even if it was the drug addict in me that did it" — but rather looking to the future. His only concern right now is to hold onto his job and to start a family with his partner.

Clara also knows what rejection is like. "I'm not ashamed to be open about my addiction," she says. But for the moment, she prefers to remain anonymous. "A lot of people have no idea about what I've been through."