NIATx principle #4: Getting ideas...from outside the country

June 26, 2014

Kim Johnson
NIATx Deputy Director
ATTC Co-Director (WI)

Those of you on the NIATx Facebook page know that I recently went to St. Petersburg, Russia, as part of a team put together by Stanley StreetTreatment and Resources (SSTAR), a treatment program in Massachusetts and Rhode Island. We were there working on a white paper about disseminating mobile health applications in Russia and the United States. While we were there, we presented at a conference with our Russian colleagues on the possible uses of mobile applications with people with behavioral disorders.

We toured a psychiatric hospital, three addiction treatment sites, and a couple of mobile outreach vans. What was most interesting to me was how much the treatment systems are alike. What seem like differences sometimes are really issues of translation. For example, the people that do the work of counselors and social workers in the U.S. are called psychologists in Russia, and the people they call social workers are people we would call recovery support specialists or something like that. Sometimes the language barriers were the biggest obstacle to seeing how much alike the two systems are.

One of the mobile vans used
for harm reduction and to
engage high-risk drug users.

But, I’m guessing you are more interested in what is different. So, given that language may have clouded my understanding, here are things that I thought were interesting differences.

First, the substance abuse providers envy our medical model! They do not have access to buprenorphine or methadone and have only begun to use Vivitrol. So while we lament the low utilization of medication and study mechanisms for increasing access to medication, they think we look good in comparison.

What I admired about their system was the strong focus on rehabilitation. Both their mental health system and substance abuse treatment system work with patients to help them develop skills and interests so that they can lead fuller lives through work and recreation.

Waiting area in a St. Petersburg
treatment facility. Look familiar?

The day we visited two addiction treatment facilities, most of the patients were participating in a citywide sports tournament, where the patients from the 18 treatment districts competed against each other in sports like soccer. What a great idea! Wouldn’t it be fun if you could organize a competition with other treatment programs in your area? Even if it was a bowling league or something where you didn’t have to worry so much about liability and injuries.

The Russian system does not have our version of confidentiality. If you want privacy or confidential treatment, you can pay for treatment yourself, and one of the sites we visited had both private pay and public patients. The driver’s license issue is interesting. In Russia, if you enter the public addiction treatment system, you lose your driver’s license for three years and may have repercussions at work. I think most see the potential loss of a driving license as a huge barrier to treatment entry. And it may be, because I didn’t discuss it with any patients. But our hosts did not see it that way. In Russia, in order to initially obtain a driving license, you have to have a sign off from a Narcologist (Addictionologist), a psychiatrist, a neurologist, and an eye doctor. One of the sites we visited primarily served people trying to get their licenses, so they did brief assessments and that was it. Since proving you do not a have a substance use or psychiatric disorder that would inhibit your ability to drive is part of getting your license, in the Russian mind losing it for having a substance use problem seems natural, not restrictive. When we talked about Russia treating driving as a privilege the response was “Nyet!” They didn’t see it that way. They were astounded by how easy it is to get a driver’s license here and how difficult it is to lose it (especially here in Wisconsin, the only state in the nation where a first time DUI is not a criminal offense!)

We had some time for sightseeing. One
of our stops was at the summer
palace of Peter the Great, Peterhof.

I wish we had more opportunity for international exchanges. In Europe, geographic proximity allows for easier exchange between countries, but how many of us have even been to a program in another state, let alone another country? Anyone else been to Russia and want to comment on their impressions? How about other countries? Think of the NIATx principle “Get ideas from outside the organization or field” and extend that to treatment systems in other countries. What do they do that would be fun to implement here? 

Kimberly Johnson, NIATx Deputy Director and ATTC Network Coordinating Office Co-Director served for seven years as the director of the Office of Substance Abuse in Maine. She has also served as an executive director for a treatment agency, managed intervention and prevention programs, and has worked as a child and family therapist. She joined NIATx in 2007 to lead the ACTION Campaign, a national initiative to increase access to and retention in treatment. She is currently involved in projects with the ATTC Network and NIATx that focus on increasing implementation of evidence-based practices, testing mobile health applications, and developing distance learning programs for behavioral health.