Addiction Treatment and Recovery Ventures

in Yekaterinburg, the North Urals and Ivanovo

 

When French surgeon and neuroanatomist Paul Broca first named a part of the human brain as the Limbic Brain, and when Dr. Paul McLean, an evolutionary neuroanatomist and research scientist at the National Institute of Mental Health, later said the human brain is not made up of two brains but three distinct divisions or sub-brains, and when, still later, Thomas Lewis, M.D. and two other colleagues expounded on these theories with their beautifully written book, A General Theory of Love, little did any of them know that their discoveries would be the basis of a wonderful set of exchanges with Russian narcologists, addiction specialists, educators and others interested in the treatment and recovery of persons suffering from addictive diseases.

 

But that is what happened in the fall of 2006 when I traveled to Russia with a group representing the National Peace Foundation (NPF)1.

 

Deborah Cantrell, an experienced counselor and talented trainer with the Redfern Student Health Center at Clemson University in South Carolina joined me for the 10 day trip to Moscow, Yekaterinburg and Ivanovo where we worked with over 100 people who were eager to expand their knowledge so as to better serve clients, students and patients in matters relating to substance addiction.  Using Moscow as our base of operations, we familiarized ourselves with the problems associated with substance abuse in Russia and what had been done by various entities, including this specific NPF project which had been ongoing for 5 years.

 

Deborah’s task was to introduce an assessment tool called the UNCOPE2, developed by Dr. Norman Hoffmann.  It was a late substitute for the SASSI which was determined to be too culturally sensitive and difficult for use in Russia without significant modification. The UNCOPE was translated into Russian and distributed to the participants, which helped facilitate its use as a training instrument. 

 

My task was to assess the possible adaptability of a training model I had developed in the US to the various constituencies with which we would work in Yekaterinburg and Ivanovo.  The Addiction Fellows Model3, based on the Resonance Organizational Training Method, © by James M. Van Hecke, Jr., had been the structure for two successful training ventures in the US, the North Carolina Addiction Fellows Program and the South Carolina Addiction Fellows Program.  Central to this model is the concept of limbic resonance which derived from the early work of Broca and McLean and was made manifest in the work of Tom Lewis and his colleagues in their seminal book.

 

Leaving Moscow we flew to Yekaterinburg, the third largest city in Russia with a population over 1 million.  Recognized as the capital of the Urals, it is two time zones east of Moscow.  In 1918, Tsar Nicholas II and his family were killed here.  Ural State Technical University, founded in 1920 as one of a number of technical universities to train the newly empowered masses, is now the largest such institution and was the site of our first training.

We were met on the campus, by the Vice-rector for extra academic activity, Alexander Ponomarev, who hosted a dinner complete with numerous toasts.  Toasting, I came to understand, plays a crucial role in Russian meals and it is done with everything from vodka to juice.  Vodka and wine were the elixirs chosen for this meal. 

 

With every introduction of a new person or expression of hopes and desires for the upcoming training came a toast.  There were about 10 people present for the dinner and a lot of hopes and desires, so there were many toasts!  This actually took getting used to as our sole purpose for the trip was to work in the area of substance abuse.  I wondered that night if substance abuse included spirits used in making toasts.

 

Actually vodka plays a big role in substance abuse in Russia as does heroin, especially in the Ural Mountains where Yekaterinburg is located.  Heroin is shipped in from Afghanistan and wrecks havoc with the Russian citizens of this region.  Russian interdiction practices are more selective and more severe than in the United States.  Rumors of “immediate justice” are commonplace but the aftermath of the drug use is devastating.  The result is an urgent need for treatment services and that is what we were here to help facilitate.

 

The training at Ural State Technical College took place in the Student Center, known as “Zvyozdny.”  It was not much to look at and the roads to it were full of potholes.  We arrived at what seemed to be the back door and walked up some rickety stairs to a dark hallway that surprisingly led to a nicely furnished room that accommodated our training very well.  We were not sure who our audience would be but it turned out that of the 60 people in attendance, 30 were educators representing secondary schools, 15 were administrators, teachers and students in the university (various disciplines with an interest in addictions) and15 were addiction professionals (in the broadest definition of that term with some of these being people in recovery who represented Rehabilitation Centers).

 

Where Deborah and I had both fashioned our presentations for what we knew to be addiction professionals in America, we now faced a very diverse audience with a wide range of familiarity and understanding of even the most basic terms relative to addictions.

But audiences like this have a way of surprising you. Their universal hunger for knowledge about addictions and their passion for working with students or clients where addiction was an issue made them ready vessels and the “limbic resonance” of which Tom Lewis writes so beautifully became the tool by which a connection was made and information passed from one culture to another, resulting in a very basic but true understanding of sometimes difficult concepts.

 

Working through an interpreter was difficult.  I had to pace myself to speak slowly and to stop after a few sentences, so establishing a “train of thought” or using idioms, dialect and cadence quickly became a no-no.  One time I attempted to use a favorite poem of mine and delivered it from memory with the rhythm and passion that it evoked in me, but the essence of it was lost in the interpretive process.  The next day, attempting another poem, I simply handed a copy to the interpreter who read it to the class in Russian, so I had no idea if the “truth” or power of the poem was even communicated.

But a connection between us was made when I realized that I was not getting through to the audience, that they clearly were not grasping how fundamental concepts of brain chemistry allowed for an understanding at the gut level among humans.  So I told them a story to illustrate what I meant.  I told them about a group of addiction professionals in North and South Carolina who are engaged in a leadership training and professional development program called the Addiction Fellows Program.  I explained that I had written to these Addiction Fellows before leaving America and told them that I would be meeting on this particular day with similar professionals in Yekaterinburg and to please remember them in their thoughts and prayers at the designated hour---as their Russian colleagues were struggling with the same issues their American counterparts were and needed to feel their support.  That morning, before leaving the hotel to come to the university, I had received over a dozen emails from Fellows telling me they had thought, prayed and journaled about their new unmet friends.  As I relayed that very human story it became so quiet in the room you could only hear deep breaths and tears began to form in what, only moments before, had been the distant eyes of uncomprehending minds.

 

Something had happened and it changed the atmosphere in that classroom for our remaining time together.  What was it?    It was limbic resonance.  It was what Broca and McLean started and what Tom Lewis put words to.   It was the essence of the program that I had come to Russia to assess its applicability to this audience.  It works between a mother and her child, two lovers, a teacher and a student, a therapist and a client and even in a group of people, when connections are made.  It is one of the most powerful forces in all of human nature and, as we are just coming to understand its importance and impact in the field of human relations in general and counseling in particular, it was as true and evident that day as any physical object you could touch. As it became understood by all, we then spent the rest of our time together learning from each other with a degree of respect and caring that was not present just a short while before. 

 

It was a moment I will never forget, not only for the power of what happened in that room but for the lesson it taught me—that real understanding happens not on an intellectual level but on a feeling level.  Brain scientists tell us this is true, that our limbic brains influence our neocortical brains far more profoundly than the reverse.  Indeed, without limbic resonance the best therapies and modalities are not successful.

 

As a result of our newly found sense of connection, the depth and quality of the exchanges between us improved.  Their questions to us were penetrating and delivered with passion and they eagerly awaited our answers.  The concerns of the education group were not much different than what we would have in the United States: issues around youth smoking, and beer drinking (canned beer is apparently a relatively new phenomenon in Russia), how to make busy parents partners in the prevention process, how to deal with the mix of a small number of students with “bad habits” and a much larger group of students without those habits, the rise of new addictions such as gambling and internet etc….)

 

 

Later in our time in Yekaterinburg I met with staff from rehabilitation centers from the North Urals for an open and frank discussion of the issues that were causing them concern in their work.  These rehabilitation centers would be similar to what we know as therapeutic communities (TCs) in America--long-term residential programs, largely peer-run by people in recovery.  There was a faith element to each of these centers; for they had modeled their programs after a Teen Challenge program someone had seen in America.  They did not seem to have as evangelistic a mission as Teen Challenge but it was their faith and their recovery that had caused them to confront their addictions amid the rugged weather and conditions in the northern Urals and the political intransigence of a government that did not understand or support the ideal of recovery.

 

Again, their issues were no different that their counterparts in American therapeutic communities or even more traditional treatment centers.  There were concerns around how to organize and motivate a staff, how to maintain control of the clients when all were not on the same page at the same time, issues of medication management and how to create cooperation and communication among like-minded treatment programs.  All of a sudden these committed men and women in recovery looked into the eyes of their colleagues in the room, most of whom were strangers to each other, and realized they were limbically resonating with each other.  It was a perfect example of the miracle of a 12-step group when everyone grasps the truth of a particular point.  It was powerful.

 

Russians are very proud people who love their country.  They have a rich legacy in the arts and one of the nights we were in Yekaterinburg we went to a refurbished concert hall, which was stunningly beautiful, to see a performance by the Yekaterinburg Ballet.

My experience with ballet is very limited but I was mesmerized by the men and women performing on stage before me.  I was later told that this is one of the very best ballet troupes in all of Russia.  I could not dispute that.

 

We flew back to Moscow for a short day of sightseeing and then took an all-night train to Ivanovo.  This city of a half-million people is an old textile town that has suffered the same fate as cities in the American South who have lost their textile businesses to foreign competition.  It was known as the “city of brides” because women came to Ivanovo to work in the textile mills and seek mates. 

 

We traveled all night, arriving in Ivanovo at 4am.  We were met by our hosts who somehow knew which sleeper car we were on and were standing outside our room when we opened the doors.  They loaded our bags into a couple of cars and took us to the home, now a city museum, of a man who helped start the Russian revolution in 1917.  We were to sleep for a few hours before they picked us up for our one-day training experience at Ivanovo State University.  I had hardly closed my eyes on the train and was still keyed up, so I worked on my presentation and took the first shower, well before dawn and before anyone else in our party arose.

 

 

 

 

We were picked up about 8:30 am and driven to the university where we gathered for breakfast in a very nice campus dining room.  We then walked across campus to the newly refurbished Student Health Center, modeled after the Redfern Student Health Center at Clemson University in Clemson, SC.  It is a source of much deserving pride by our hosts, a state-of-the-art facility that offers comprehensive, holistic services, including normal medical concerns plus mental health and substance issues on the campus.  Faculty and students from the university were joined by men and women from the community who dealt with addictions, including the local narcologist, a psychiatrist of some renown in the area.

 

The students, mostly counseling majors, were eager to learn and to share their own experiences with alcohol and drugs on the campus.  They asked many questions and were never at a loss for words.  Our interpreter worked overtime with this group.  The professionals on the other hand were as serious and dour as their counterparts in Yekaterinburg until they too came to understand the concept of limbic resonance.  This group in Ivanovo became a possible site/use of the Addiction Fellows Model, as a community collaborative. 

 

One of the exercises I did with the groups in Yekaterinburg and Ivanovo, similar to that done with the Addiction Fellows in the Carolinas, was to give each participant a name badge on which was printed in Russian, under the line for their name, what I thought was “Substance Abuse Visionary.”  I came to find out that there is not good translation for that and what we had prepared actually said “Healer.”  How appropriate—and a far more accurate description of these professionals who work to heal the brokenness of body and soul of people suffering from addictive diseases.

 

The narcologist, with whom I initially wondered if we would ever connect, actually became a friend.  He joined us later that evening in a social setting at a local private school.  It was an experience that I will never forget.  We sat outside around a fire and talked, with little interpretation but quite a bit of understanding, before moving inside to a feast that was offered at a long table set up in a huge upstairs foyer.  Toasts, of course, were plentiful with wine as the drink of choice.  At one point our hosts, a dynamic husband and wife team who led the school, began singing songs and we Americans were serenaded with beautiful music.  We responded with an American folk song and then a long and torturous goodbye began and we all cried at having to part company. 

 

I did not know you could become so close so quickly.  We shared a commitment in our work and a passion, too.  We also shared something more basic, and there were no words or translation adequate enough to explain it to any of us.  Instead of letting us leave for the train station by taxi, they left the dirty dishes behind and everyone took us to the train station where they carried our bags from the car to the train.  We were all in tears as we left each other, knowing that for a short time at least, we had come to know strangers from half a world away and the experience had changed our lives.

 

 

I knew something special had happened but I did not know how special until, months later, as I gathered with 50 Addiction Fellows from North and South Carolina and told them the story of my trip to Russia.  They were touched at a very deep and personal level and felt the connection to a group of people they did not know at all.  The good news is some of the people from Yekaterinburg and Ivanovo may become part of an Addiction Fellows Program there and will take a future trip to the United States where they will surely meet some of the same people who supported them through thought, prayer and journaling….as they still do today.

 

As we look back over the five years of this American-Russian partnership, much has been accomplished.  There have been numerous trips by American experts to Russia to provide addiction training and reciprocal trips to the United States to observe collaborative efforts here.  The net result of all this has been that several hundred professionals in Russia have been exposed to and trained in theory and practice of addiction prevention, treatment and recovery.  Valuable connections, both professional and personal, have been made between the two countries.  The National Peace Foundation, led by Sarah Harter, former national president of the American Association of University Women (AAUW),and Olga Bessolova, her Russian counterpart and a human resources consultant to SUAL, a Russian aluminum company and principal financial backer of this addiction treatment endeavor, have been the driving forces behind this effort.

 

What needs to happens now?  We should leverage the success of the first five years with an aggressive and systematic plan to move this addiction technology transfer program to another level.  There needs to be a structured curriculum put in place with a training regimen that provides for a culturally sensitive yet internationally recognized training program resulting in the award of a credential for successful completion of the work. 

 

The use of the Addiction Fellows Model as the structure for this training is currently being considered.  A community collaborative in Ivanovo, an educational consortium in Yekaterinburg and the rehabilitation centers of the northern Urals could become separate Addiction Fellows Programs.  There would be at least two trips to Russia in 2007 using American trainers proficient in the subjects of the new curriculum and then a trip to the United States for representatives of those three groups.  Trainings would take place at Duke University and the University of North Carolina as well as other sites in the Carolinas.  Discussions are underway with Duke, UNC, foundations and other public and private funding sources about funding and support of this initiative.

 

It is a small step towards addressing a huge problem, but as Alcoholics Anonymous says, one person at a time, one day at a time.  Broca, McLean and Lewis would be pleased.

 

 

 

 

 

 

References:

 

This project is an outgrowth of a partnership established in 1991 between American and Russian        professionals and emerging Russian civic organizations to develop programs within the Russian Federation in response to needs that have emerged since the breakup of the Soviet Union.  In 2001 the National Peace Foundation, headed by Sarah Harder, with funding provided by Russia’s SUAL Corporation, through its agent Olga Bessolova, initiated a National Peace Foundation Project on Addiction in the Russian Federation.  Many trips to Russia by American “experts,” led by Dr. Corinne Gerwe of Clemson University, have resulted in the transfer of knowledge to hundreds of Russian professionals interested in the problems of addiction in their country.  Clemson University has provided significant leadership to this effort including sending numerous professionals (Gerwe, Abernathy, Keller, Gainor, Cantrell) to Russia, hosting a Russian delegation and exchanging letters of collaboration with universities in Russia.

 

For information about UNCOPE please go to www.evinceassessment.com/UNCOPE_for_web.pdf

 

Addiction Fellows Model

Based on Resonance Organizational Training Method ©James M. Van Hecke, Jr. 2003-06

Key Elements:

 

3-year grant from The Duke Endowment for the North Carolina Addiction Fellows Program

2006            Interim-year grant for NCAFP by NC Attorney General’s office

2006-08       3-year grant from The Duke Endowment for the South Carolina Addiction Fellows Program

 

Possible expansion of NCAFP:

 

Interest in using the Addiction Fellows Model: