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4. Treatment Services in Lebanon

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TABLE OF CONTENTS Preamble ..................................................................................................................................................................................................... 4 MedNET-Pompidou Group ......................................................................................................................................................................... 6 Acronyms .................................................................................................................................................................................................... 8 Definitions ................................................................................................................................................................................................. 10 Chapter I .................................................................................................................................................................................................... 17 Executive Summary ............................................................................................................................................................................... 17 1 Aims of Study .................................................................................................................................................................................. 17 2 Key Findings .................................................................................................................................................................................... 17 3 Key Recommendations ................................................................................................................................................................... 21 Chapter II ................................................................................................................................................................................................... 29 Project Background ............................................................................................................................................................................... 29 Introduction and Aims ........................................................................................................................................................................... 30 Chapter III .................................................................................................................................................................................................. 35 Methodology ......................................................................................................................................................................................... 35 Primary Data Collection ..................................................................................................................................................................... 35 Secondary Data Collection ................................................................................................................................................................. 59 Chapter IV ................................................................................................................................................................................................. 63 Study Findings ....................................................................................................................................................................................... 63 2 Results Of Primary Data Analysis ....................................................................................................................................................... 63 Results Of Secondary Data Analysis ................................................................................................................................................ 228 Chapter V ................................................................................................................................................................................................ 249 Discussion of Findings ......................................................................................................................................................................... 249 1. Demographic characteristics of Substance Users ....................................................................................................................... 249 2. Clinical characteristics of substance users .................................................................................................................................. 250 3. Substance use cases .................................................................................................................................................................... 261 4. Treatment services in Lebanon ................................................................................................................................................... 262 5. Factors related to the initiation, maintenance, and treatment of substance dependence ....................................................... 269 6. Referrals ....................................................................................................................................................................................... 273 7. Legal implications of substance use ............................................................................................................................................ 274 8. Role of Ministries in the substance use field ............................................................................................................................... 279 9. Funding in the matter of substance use ...................................................................................................................................... 279 Discussion of Recommendations Proposed by the Study Samples .................................................................................................... 282 Limitations ........................................................................................................................................................................................... 286 Chapter VI ............................................................................................................................................................................................... 290 Key Recommendations ........................................................................................................................................................................ 290 References .............................................................................................................................................................................................. 303 Appendices .............................................................................................................................................................................................. 305 3 PREAMBLE Technical Team: Karen Estefane (Head of Research.Email:[email protected]) Chantal Chedid (Project Coordinator.Email:[email protected]) Maissam Nimer (Research Assistant) Consultancy Experts: Donna El Sayed Nizar Saghieh Field Workers: Raya Haidar Dina Al-Faour Partners: Association Justice et Miséricorde (AJEM) Bonheur du Ciel Jeunesse Contre la Drogue (JCD) Nusroto, Cénacle du Fils de l’Homme Soins Infirmiers et Développement Communautaire (SIDC) 4 Support Team: Dr Lilian Ghandour Sami Mahmoud Ahmad Saleh Joseph Estefane Ahmad Sobhi Abu Mohammad Souha Bawab Mohamad Hussein Fadi Hallisso Special thanks to: Mount Lebanon Hospital and Dr Ramzi Haddad Saint Georges Hospital and Dr Ely Karam Notre Dame de l’Espérance 5 MEDNET-POMPIDOU GROUP The overall objective of MedNET is to promote co-operation, exchanges and two-way transfer of knowledge between countries of the southern rim of the Mediterranean and Pompidou Group European states (North-South and South-North exchanges), as well as between countries of the Mediterranean themselves (South-South exchanges). The objective is to improve the quality of drug policy implementation in all participating countries, with an emphasis on greater awareness of the cultural factors influencing intervention policies. The setting up and development of the network: The Pompidou Group first turned its attention to the Mediterranean region in 1999, when it held a conference in Malta on "co- operation in the Mediterranean region on drug use". The first project in the region was the school survey of alcohol and other drug consumption (the MedSPAD survey: Mediterranean School Survey Project on Alcohol and Other Drugs). School surveys were conducted in the cities of Algiers and Rabat in 2005, followed by national surveys in Lebanon and Morocco in 2009. In 2006, a feasibility study carried out at the initiative of France and the Netherlands culminated in the setting up of the Mediterranean network of co-operation on drugs and addiction (MedNET) and in the Pompidou Group's commitment to coordinate and manage the network. The network was initially set up for a period of one year (2006-2007), after which it was assessed. Its flexibility was commended, and the network has subsequently continued its activities, coordinated by the Pompidou Group. Subsequently, MedNET activities have expanded steadily
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