Pillars of Success
Studied psychologist and head of department at CONTACT Foundation
In the 1980s when drugs were seemingly everywhere and parents couldn’t take their children to parks for fear their children would step on heroin needles, Switzerland decided to try a different approach to their drug problem. Now, forty years later, Simone Schär talks about the country’s collaborative effort and Switzerland’s Four-Pillar Policy. Simone Schär is a studied psychologist and head of department at CONTACT Foundation. To work with people who use or abuse substances was always something, Simone says, that fascinated her. After working seventeen years in the repressive system of the incarcerated (carceral) environment, Simone wanted to see how the totally different approach of harm reduction works. Through the collaboration and cooperation of the public, treatment professionals, law enforcement, and politicians, Swiss crime is down, drug usage is down, drug-related death is down, infectious disease is down, and the parks and streets are relatively free of drug use and drug paraphernalia. Simone can be reached at [email protected], and information about CONTACT can be accessed at https://www.contact-suchthilfe.ch/fr/contact-fondationaideaddiction/ (The website is in French and German.)
[Jaunty Guitar Music]
Mike: Welcome everyone. This is Avoiding the Addiction Affliction, a series brought to you by Westwords Consulting. I'm your host, Mike McGowen.
Mike: We've had numerous conversations in the past about how other countries and cultures deal with substance use and abuse, and today we're gonna have another one of those conversations.
Mike: Before I introduce our guest, I want to thank our great friend Karyn Vanheijningen, for her help in arranging this today. I'm delighted to have as our guest. Okay, I'm gonna butcher this. I'm gonna butcher it. Simone Schär from Contact Foundation in Bern Switzerland. I'm gonna have Simone say her name in a minute so you can see how bad I butchered that.
Mike: Simone is a studied psychologist and head of department at Contact Foundation. To work with people who use and abuse substances was always something Simone says that fascinated her. I can identify with the next part. After working 17 years in the repressive system of the incarcerated environment, she wanted to see how a totally different approach of harm reduction works.
Mike: As you'll hear, she's convinced that this should be an important approach in drug policies in every nation around the world. Welcome, Simone.
Simone: Hi, Mike.
Mike: Okay. Say your name for us all.
Simone: It's Schär, but it's really not a common name in English speaking countries, so.
Mike: No, it's not.
Simone: You did very well.
Mike: Well, we'll call you Simone and call it a day for now.
Simone: Yeah. [laugh]
Mike: Well, you know, why don't you start a little bit by giving us a history of the organization you work for? The Contact Foundation.
Simone: Yeah, thank you. Well, Contact Foundation is the center of expertise in harm reduction in the Canton. Like Canton is like the states in in other countries of Bern. So our goal is to decrease negative effects of drug use for individuals and society.
Simone: And this year we got to celebrate our 50th birthday. So we have a very long tradition in harm reduction. Yes, it all started in the seventies. We started with street work and ambulatory drug counseling services in different cities in the state of Bern. As a result of increasing drug use in Switzerland, especially heroin was a big problem at that time.
Simone: And in the 1980s there was like, really a heroin epidemic in Switzerland. There were a lot of open drug scenes that started to spread throughout our country. You could see a lot of people consuming in public places in parks so everyone could see them. It was really a problem for the whole society, and there were increasing health and social issues and consequences such as HIV, hepatitis, homelessness and marginalization.
Simone: And you really, you could watch, you could see drug users getting worse and worse every day. And this happened right in front of the public's eye. And the news about the drug scenes spread around the world, at that time we were even on CNN because like one of the most famous drug scenes was in the city of Bern.
Simone: And that was very special at that time cuz it was just a few feet away from the government building, so.
Mike: That's always embarrassing.
Simone: Really special situation. [laugh] well, everywhere around Switzerland were these large police operations and repeated evacuations of the open drug scenes and but also social medical systems was provided, but still this did not help to get the drug users off the streets.
Simone: So, in response, or better opposite to this repression and exclusion in criminalization of drug users. Well, we tried something different and in 1986 we opened the first drug consumption room in the world. That means people could come there with the substances they wanted to use, with the drugs they wanted to use were protected, got medical and social care.
Simone: And in 1987 this was legalized by the city of Bern. So.
Simone: Early, we had these rooms where people could come and consume their drugs in, in like a safe space and get them off.
Mike: So instead of using, I think when you mentioned using out in public, are you talking about that infamous place that people talked about?
Mike: Needle Park, I think it was called.
Simone: Needle Park was more the one in Zurich that was the, the biggest city. But that one in Bern was really special because it was just really a side of the government building, so.
Mike: Oh, that is great. That is great. I, you know, back around that same time Simone, we had a president who actually bought a bag of cocaine.
Mike: Well, he didn't, but he had an aid by a bag of cocaine across the street from the White House. So.
Mike: Again, very embarrassing.
Mike: Let's go to the to the decision to say, all right, this isn't working right.
Mike: And if it's not working, let's try something else.
Mike: Well, there had to be resistance to opening a using room.
Simone: Of course. [laugh]
Mike: And how did the resistance get countered? How, because you're still going in 1980 something. This is 40 years later, 35 years later that you're doing this.
Simone: Yeah. I think it's nearly 40 years later now. Yeah, in 1986, the first room was open, so, yeah. Well, I think in the end, people in society understood that the, the way we were going before didn't work.
Simone: So we, we trying, we had these police operations. They tried to, to take the people away from these scenes and just as they closed one, another one popped up and. Well, they stayed in the streets and it was really, I, I remember when I grew up in the, in the 1990s, in the beginning of the 1990s if you would go to, to a public park, your mother would tell you, wait, we have to check if there are needles on the ground.
Simone: It's really.
Simone: So dangerous. You could see people using drugs everywhere. So it was really a social issue and. Politics, some of the politics began to understand and also a part of of society began to understand the way we treated people up to now doesn't work. And our main goal is to get them off the streets.
Simone: And as as we started with these harm reduction facilities or, or supplies, we could see an improvement. We could see people going away from the streets. We could see people going to these rooms to, to use their drugs, and we could also see the, the, that their health got better. The social issues could get, we could also like they, they went down.
Simone: We could help them also in this part. And, and I think that was, that was the thing that really convinced people in the end. And it took some courageous politicians as well. I mean, in 1991, it was a government decision that we start with this harm reduction as one of our pillars in drug policy.
Simone: That was really early, right in, in, in history. So it also, we have, we were lucky to have these courageous politicians.
Mike: I, I wanna get to the four pillars in just a minute, but let's talk about how the harm reduction rooms work. First of all who owns the, the building? And how is it, how's the building funded where the people come in and use?
Simone: Yeah. So these drug consumption rooms are one part of the harm reduction system. I think that those are the most. I think that's what people really know about us, but we also do a lot of other things.
Simone: But the houses usually are owned by the cities that we work in and our services are financed by the state.
Simone: So it's like we are independent in the end, so we offer our work and then the state pays us for doing our work, and the cities give us the building where we can put these drug consumption rooms in.
Mike: Now, they, they must have made the determination at some point that that's cheaper for them than all of the other things that they were trying to do to reduce drug usage.
Simone: Yeah, it is in the end.
Mike: How do people get their drugs?
Simone: Well, [laugh] they still buy it in the street.
Mike: So it's the, the drug buying hasn't changed.
Simone: Changed a little bit. So we have like this possibility that in small, just to, to your own use, you can also sell and buy them. Like in the patio of the houses we run.
Simone: So that's, that's a better thing. But to getting drugs is still illegal in Switzerland actually. So it's not that you are allowed to buy drugs, you don't have a, a legal system where you can legally buy drugs, but we have this consumption rooms where you can legally consume your drugs. So it's a bit [laugh] [inaudible].
Mike: Hey, yeah.
Mike: And, and, and how the, how are the rooms staffed? Do you have people there in case something goes wrong?
Simone: Yeah, we have people, we have social workers who work there to get more of this part of, of of the problems to talk with them, to help them with, with work or housing or whatever they need. And then we also got like how do you call them healthcare workers.
Simone: Who work there. So always someone there who knows what to do when all are trained in how they have to react if there's an overdose or anything. So everyone is trained in that, everyone who works there.
Mike: So there's an opportunity when people come in to use that staff who knows what they're doing, have conversations with them so that they can address some of the issues going on.
Mike: I like that. That would be rewarding. Have you? I, I would, I would enjoy those conversations I think.
Simone: Some of them enjoy them, some of them them don't, so.
Mike: Right. I suppose it's like everything else.
Mike: Well talk about Switzerland's, if you don't mind the, they're your four pillar drug policy.
Simone: Yeah. So before the 1990s, we had like the three pillars that was prevention, repression, and treatment. So, everything was about abstinence. It was clear if someone had a problem with using drugs, if they got addicted, it was clear they had to get treatment, they had to be abstinent. That was was the only way to go.
Simone: But after we saw with opening these rooms, there also is a possibility for something else. In 1991, Swiss government decided to add a fourth pillar. That's the pillar of harm reduction. And at this time, it was mostly like survival ed, so we wanted people to survive. Switzerland didn't want them just to let them die.
Simone: They wanted to provide something so that even people who can't or won't stop using for whatever reason. So we accept that and we try to help you not to die.
Mike: And manage the rest of the life. Right.
Simone: Yeah. That's it.
Mike: Do, do you also provide you know, in the United States we have Suboxone and Vivitrol and the other substances, if, if somebody wants to get off of the stuff.
Mike: We have medical assisted treatment. We have inpatient, outpatient. Is that part of the treatment pillar?
Simone: Yeah, part of the treatment pillar. So one part is if someone really wants to get abstinent to stop using, but we also have the, the substitute treatment. So [inaudible] is a, a big thing. And what was really special also, and it also started in the 1990s, is we also give diamorphine it's called, I think in English.
Simone: It's a, a sort of heroin to people that are highly addicted, so you can get subscribed to form of heroin if you are highly addicted to heroin.
Simone: Yeah. And that's really, I think that's really special that you don't find it in, in many countries. So it's not only the substitution, but also a form of heroin that can get legally distributed to you if you are addicted, if you are in treatment to stabilize yeah.
Simone: Your health situation.
Mike: Under the assumption, "Hey, some people just aren't gonna quit."
Mike: Might as well make it safer.
Simone: Yeah, that's it. That's it. And you can see there are also people who live a normal life. They go to work every day. They have a home, they have family and just like one or two or three times, it depends on how much they need.
Simone: Times a day they go to, to this service where they get their diamorphine, and can, can do their shoots and stay stable and healthy.
Mike: I'll ask the million dollar question here. Who pays for all of that?
Simone: So, treatment for drug addiction in Switzerland is paid by the insurance, health insurance.
Mike: Private health insurance?
Simone: No. So in Switzerland you have to have health insurance. Everyone has to have one. So even people living from social ed get social get health insurance. And it is part not of the private parts of the, the one that everyone has. If you are addicted to drugs, if a doctor says you are addicted, that's a treatment that you need.
Simone: It is paid by health insurance.
Mike: Wow. And that's part of the government funded?
Mike: Healthcare as well. I wanted to mention that because for those people listening who aren't aware, Switzerland, I hope you don't mind me saying this, Simone, is not exactly an incredibly liberal country.
Simone: Not in every part. No [laugh].
Mike: I mean that's the whole Swiss bank account thing, and, you know, you're, you're viewed as a very conservative society. Yet you've made these decisions that in the United States we would consider fairly liberal.
Simone: Yeah, and I'm actually not sure if we will make the same decisions today.
Simone: I, I think it was really the state we were in. This like hopelessness and it was seen or it could be seen by whole society. The big problem we have with these drug users. And we wanted to change something also, not only like to. To give harm or to reduce the harm for individuals, but whole society.
Simone: So you can go out to parks again, you don't have to look at people dying in the streets. You can feel safe again. So it was not, it's not only something for the individuals, but it's also something for everyone.
Mike: Well, and it it's working right.
Simone: And it's working. Yeah.
Simone: Yeah. We can show that for, yeah. As I said, nearly 40 years now.
Mike: I, I think I read that crime is down.
Simone: Yeah, yeah. Crime associated to drug use went down. Yeah.
Mike: So I was struck by what you just said. I'm not sure we would do it today. We do live in an ever-changing culture all over the place. Are you getting resistance now?
Mike: Are there people that want to do away with the system?
Simone: We still got some [inaudible] first. It's not, at least we always have to explain what we are doing or why we are doing what we are doing. So I think like, one part of this well-functioning system was also, we kind of did our own graves. [laugh] You see, it's a bit too much maybe, but as people can't see the drug users anymore in the streets, they are not aware of the problem.
Simone: So problem awareness is an important part to get a new courageous way to, to get money to explain to society why you do what you do. And now people are not on the streets or not in, at least not in this big amount as they used to be. You don't find syringes in every park or everywhere you go.
Simone: People growing up in the 2000s, 2010s. Don't remember these scenes. Like I was like the last generation [laugh] seeing people dying in the streets. So I think like the awareness is not the same as it as it used to be. And that's what makes it difficult for us sometimes to explain why we still do harm reduction.
Mike: That's fascinating. And so you still need courageous visionary people.
Simone: Yeah. Yeah. We still do. Yeah.
Mike: And one of the, in. I think I read that in 2014, your federal council expanded the pillars into a national addiction strategy as well.
Mike: So they actually built upon the four pillars. How did they do that?
Simone: So it, it was like a national health strategy and one part of it was, was the addiction part. And, well, one thing was that they started, or we started to like make a, a difference be between how people use. So a lot of people use drugs or I think alcohol is the most used. [laugh]
Simone: And they don't ever have a, a really problem with them.
Simone: So you can use drugs like in a low risk kind of way. Then there are people that use drugs in a risky kind of way, and then there is addiction. So the main goal was to tell not every one of these people need the same thing. So it's not only we wanna do these four pillars, but we also want to like give the, the, the support everyone needs.
Simone: Depending on how they consume and also depending on what they consume, because there are drugs who, who make you independent more on a mental way and others. It, it's more like the body really react if you don't get any. So the strategy was more to like find a way for every form of consumption with every drug, like to find the individual intervention or prevention or whatever is needed.
Mike: How do you go about identifying the vulnerable people and then reaching out to them?
Simone: Yeah, I think that's the hardest part. [laugh]
Simone: To really, because that's one of the, the main goals also to like this early detection and early intervention.
Simone: It's really hard to identify, but we have these services where everyone either you work in a professional setting as, for example, a school social worker or something like that, or also as a parent or another relative or caregiver or whatever you are, you can go to the service and tell them. "I think there's a person who could have a problem with using drugs." It doesn't depend if they're minor or, or if they are adults. And then these services have like to start interviewing the people. If it is a minor, they have to start interviewing the parents. They look at the surroundings and they try to to find out, out if it's really like that, if that person could be at risk.
Simone: To, to get even addiction or, or anything, and then provide the services they need.
Mike: So here's what we have for you.
Simone: In the end, it's still their decision if they follow the recommendations or not.
Simone: We do not force them, but. Yeah, there are recommendations that tell you, okay, maybe you could use this part, this organization, you could go there.
Simone: That's where you could get help for this and that. And the other one, maybe they say, well, there that you can go. That's a situation of treatment that you can get a substitution because you're already at that part or at that end of, of your addiction. So let they try to, to find. The right services for them.
Mike: You mentioned school social worker. What's the age at which you can walk into a harm reduction room? Is it, is the age 21? Is it 18?
Simone: As in Switzerland, you get to be, how do you call it...
Simone: An adult. It's 18, so.
Simone: Yeah, it's 18.
Mike: So at what age can you buy alcohol?
Simone: Well, it depends. Wine and beer you can buy at 16 and all the other stuff at 18.
Mike: Yeah. We get asked all the time, or I do. What age do you think the drinking age should be in the United States and my kind of cynical answer is well. I think it should be 19 if you have a high school diploma. I think it should be 75 if you don't have one. So.
Simone: [laugh] Okay.
Mike: In other words, if, if you're, if you're bright enough to figure it out, then maybe lower the age.
Mike: And, and so how, how much prevention is done in your schools about the dangers of some of these substances?
Simone: Well, there are programs at schools. It's not. I think also there, it's not as much as it used to be when the problem was bigger or was, was more seen in society, but there are programs we also offer some part of that where you can ask us to come to your school and talk about drugs and talk about what we see.
Simone: Well, we have one part where we also do it's a part of nightlife. We also you can bring your drugs and we test them. So we're really up to date what is happening right now [laugh] in this area. So we go to schools and explain and talk about the risks. That's, that's what you do. Yeah. And it's especially I think the most important thing is really to identify who could be at risk and who needs what at what point.
Mike: And then offer it to 'em.
Mike: How does law enforcement view the whole issue? Because it, it seems like they would, before you started this, they would've been spending a lot of time and resources on this, and now they're not. But are they supportive? Are they, how's, how do they view it?
Simone: They are nowadays. [laugh] Yeah. Well it, in the beginning it was kind of a fight between police and the harm reduction kind of working people.
Simone: So yeah, they didn't really get why we are doing what we are doing. So, but today we have a really good co-working with police actually in the cities we work. They see what we are doing. They're glad that we are doing what we are doing because, so people are not on the street. They know where they are.
Simone: It's all controlled. Someone's there to help them if they need help. So even they understand the importance and, and yeah, that what we are doing is really great. So. No, no, no. Today's really even police understand.
Mike: Well, and, and so if, if I get this right, and you know, I'm obviously making a point here. We in the United States right now, we have a very, I'm sure you know, we have a very contentious culture.
Mike: And there's no cooperation. But you've managed to work something that the coalition between the public treatment professionals, law enforcement, and the politicians.
Mike: Enough of them are on the same page that you're actually getting things done that help.
Simone: Yeah. Yeah, that's true. So we also, I mean there is evidence, they did studies with evidence-based. So we do works. We could, we could show to, to all of them that it's not only us talking and some good-hearted people who want to help the others and don't know what they do. So we could really show that if there is a positive effect and people get better and we have a decrease in drug consumption, we have a decrease in HIV, in hepatitis, as you said, in criminality, in social problems.
Simone: So yeah, we could show that.
Mike: I'm rubbing my eyes for those of you who [laugh] are listening I should ask you, because we've done several of podcasts with individuals who have lost loved ones to fentanyl. Is fentanyl an issue in Switzerland?
Simone: Not that it is in America. It just gets to start a little bit right now, but it's not that big of a problem up till now.
Simone: We, we are always like listening and, and also reading what is happening in the US to be prepared if it really should start here. But at the moment, it's not that big of a problem. No.
Mike: Why do you think that is?
Simone: [laugh] It's not that easy to answer actually. Well, I think for one we do not have as much doctors who really prescribe it that much. I think it's not really such a thing in Switzerland. And maybe because what we have, our system works as it works and we have this epidemic with heroin.
Simone: Maybe we are more aware, I don't know.
Simone: Or. I, I can't really tell actually why we don't have to. Well, I'm glad we don't have it.
Mike: Yeah, that's a, that's a knock on wood as we say here.
Mike: Well, I, I'll let you, I'll let you close this out by just asking you an easy question. What do you like best about what you do since you worked in the prison system, or we call it prison system originally, and now you're doing prevention basically. What do you like best about what you do?
Simone: Yeah, that you can really see the effect that you have on people and on society. That you can see that it helps and I think like to be open-minded for some people, a treatment, abstinence is the way to go, but there others that will not follow this way and that's okay, but they're still part of our society.
Simone: You can't just put them away and like, yeah, they will not. They will not disappear. So do something for them. Try to help them, try to be there and listen, and it helps. It, it works.
Mike: That's great.
Mike: For those of you who are interested in learning more, I'm gonna put a link to the Contact Foundation on the podcast.
Mike: Now, I gotta tell you, it's in either French or German. Get over yourself. But you can, you can put it into a translator and get the English translator. [laugh]
Simone: [laugh] Yeah, yeah. We're still working our English version so.
Mike: That's, that's okay. We don't always have to be the center of the universe.
Simone: Okay. [laugh]
Mike: It's all right.
Mike: Okay. And also Simone's contact information as well. Simone, thank you so much for joining us today. I really, really appreciate it.
Simone: Thank you, Mike.
Mike: And for those of you listening, listen in next time. We're gonna talk about more of these issues as a way of bringing a little bit of education to our listening audience.
Mike: And as Simone would say, cooperation is the way to go. So stay safe and stay open. Stay open to other people's opinions.
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