The following mandate for the Group of Experts on Demand Reduction was drawn up at the twenty-first regular session of CICAD: "The purpose of the Group of Experts on Demand Reduction will be to provide technical expertise, facilitate cooperation among countries, and submit recommendations to the Commission on implementing the lines of action that derive from the Anti-drug Strategy in the Hemisphere. The Group will be made up of national experts in different aspects of demand reduction, and hence experts may vary with the subject considered.

The priority subjects of demand reduction include:

1. Performance of a diagnosis of drug use, epidemiological studies, systems of information (such as SIDUC) and of surveillance and monitoring, and biomedical, clinical, psychosocial, epidemiological, ethnographic and anthropological research.
2. Prevention and education models and programs involving community participation designed both for the population at large and for specific groups at special risk of becoming users.
3. Models and programs of intervention to address the adverse health and social consequences of drug abuse.
4. Measures for the treatment and rehabilitation of persons addicted, and their reintegration into the community.

Taking part in the first meeting of the Expert Group on Demand Reduction were delegates from Antigua and Barbuda, Argentina, Brazil, Canada, Chile, Colombia, Costa Rica, Dominica, Ecuador, Guatemala, Honduras, Jamaica, Mexico, Panama, Paraguay, Peru, Trinidad and Tobago, the United States, Uruguay, and Venezuela.

Also taking part in the first meeting of the Expert Group on Demand Reduction as observers were representatives from Finland, France, Germany, Greece, the Netherlands, Russia, and Spain.

The Inter-American Children's Institute and the Pan American Health Organization took part in the meeting as specialized organizations of the OAS.

A list of the participants in this meeting is attached as an Appendix to this Final Report (CICAD/DREX/doc.6/97)

The inaugural session was held at 9:30 a.m. on July 29, 1997 in the Las Americas room of the Kempinski Hotel in Buenos Aires, Argentina. Mr. David Beall, Executive Secretary of CICAD and Dr. Julio C. Araoz, Secretary of State of the Secretariat of Programming for Drug Abuse Prevention and Drug Trafficking Control of Argentina (SEDRONAR), declared this Expert Group Meeting open.

During the first session candidates were nominated for the following offices: Chair, Vice Chair and Second Vice Chair. Uruguay proposed Dr. Alfredo Miroli of Argentina as Chair. Put to the vote, the motion was accepted unanimously. Honduras, seconded by Ecuador, proposed Dr. Haydee Rosovsky of Mexico as Vice Chair. This, too, was accepted unanimously. For the office of Second Vice Chair, Chile, seconded by Argentina, proposed Dr. Alberto Scavarelli of Uruguay, who was elected unanimously.

After electing the officers of the meeting, representatives made presentations regarding the status of demand reduction in their respective countries within the framework both of CICAD's mandate and implementation of the Anti-Drug Strategy in the Hemisphere. The main recurrent topics in the presentations made by the different countries in the region were:

• Research
• Evaluation
• Communications strategies
• Standards of care in drug treatment and rehabilitation
• Model approaches in treatment and rehabilitation
• Mobilizing community participation
• Institution - building
• Designing of laws to facilitate demand reduction
• Self-management and sustainability of preventive programs
• Horizontal cooperation between countries and joint activities by groups of countries
• Prevention programs geared to young people
• Prevention programs in prisons
• Programs for high-risk groups
• Training of professional staff in prevention and drug addiction
• Roles of different members of society in the work of prevention
• Establishment of support networks
• Documenting experiences and information
• The etiology of addiction

Seven working sessions were held, and it was also decided to form three working groups to draft recommendations on the following topics:

1. Research and Evaluation
2. Prevention, Treatment, Rehabilitation and Reintegration into Society
3. Strengthening of National Liaison Offices. Communications strategies.

The closing session was held at 5:00 p.m. on August 1, 1997 in the Las Americas Room of the Hotel Kempinsky in Buenos Aires, Argentina. Mr. David Beall, Executive Secretary of CICAD, and Dr. Julio C. Araoz, Secretary of State of Argentina of SEDRONAR, closed this meeting of the Group of Experts on Demand Reduction.

1. The following agreements were reached during the meeting:

MODUS OPERANDI OF THE EXPERT GROUP ON DEMAND REDUCTION

1. The group will be open to any country wishing to take part.
2. The Chair will rotate among the members of the group.
3. National Delegates participating in this Expert Group should not only be highly knowledgeable, but also have the capacity to make commitments in order to achieve the necessary consensus, and hold positions that enable them to participate in or take leadership in national decision-making.
4. The group will draft recommendations to be approved at the regular sessions of CICAD.
5. The group will meet periodically, at least twice a year.
6. The group will make the best possible use of technical resources for communication.

The representatives of the countries of the Americas attending the Meeting of the Expert Group on Demand Reduction of the Inter-American Drug Abuse Control Commission (CICAD) of the Organization of American States (OAS) in Buenos Aires, Argentina agreed on the following:

To endorse the Final Report of the Rapporteur of the Inter-American Symposium on Drug Abuse Prevention, held in San José, Costa Rica, in May, 1997, given that it falls within the scope of the broader framework set forth in the Anti-Drug Strategy in the Hemisphere, which calls for a balanced approach to the problem of drug abuse, and gives a renewed priority to demand reduction.

The representatives acknowledge and congratulate the Executive Secretariat of CICAD for its work in preparing for and running this Meeting of the Expert Group on Demand Reduction and for the document outlining Projects (EN/PROG/w3/ES/demand.htm).

They also agreed that:

• Drug abuse is a problem that affects the individual and the development of nations and peoples, and one that is growing, with increasingly global ramifications. Stronger international cooperation is needed to tackle it.

• This issue calls for a global, multidisciplinary, and comprehensive approach, in which demand reduction and supply reduction are considered complementary and harmonious aspects of one and the same strategy. While taking into account the domestic laws and specific circumstances of each member country, that strategy will combine the efforts and know-how of the different disciplines, professions, technical specialties, and approaches involved in the problem.

• It is necessary to refine methodological tools and methods of formative evaluation, process evaluation, outcome evaluation, and particularly, applying both quantitative and qualitative methods, in order to ensure that the various prevention activities undertaken are really efficient and effective in terms of results.

• The information and training on specific and non-specific prevention imparted in both formal and informal education systems needs to be improved.

• There is a need to promote and foster active community participation, given its key importance in developing prevention plans and programs.

• Epidemiological research is also needed, both general and specific, at the national and at the regional level, in order to detect quantities and types of consumers, as well as the conditioning factors favoring or protecting against consumption, be they social, economic, local, regional, national, etc.

• Qualitative research can help improve the design and execution of specific prevention and treatment programs once higher-risk groups and spheres of treatment have been identified.

• Statistical data have to be compiled in prevention and treatment programs using a standard (SIDUC type) form, with an additional sheet attached (to be processed separately) addressing a program's specific local requirements.

• State coordination (at various different levels), as well as that of non-governmental and private sector organizations, should be encouraged, given that the whole community is not only involved in the problem but also shares responsibility for solving it.

• Societies are morally bound to provide early diagnosis, timely treatment, and rehabilitation and to furnish addicted persons with the means of breaking the habit of drug abuse and live a freer, healthier, and more productive life.

• Differentiated treatment indications should be promoted, in accordance with the degree of complexity, theoretical approaches, the goals pursued in treatment, and the particular set of human resources available.

• Efforts must be made to guarantee all patients comprehensive medical and psychological care, following a preliminary diagnosis by professional staff using generally- accepted standards (DMS-IV, ICD 10).

• Forms of communication (such as SITCOD) have to be used much more extensively to allow member countries to share their experience, successes, difficulties, failures, and know-how.

• It is necessary to underscore the need for certain essential strategic factors in demand reduction, such as:

The existence of specific State bodies in each country (Councils, Secretariats, etc.) with full powers and the ability to coordinate and harmonize the numerous different programs and activities being carried out in this field by state, non-governmental, and private-sector entities.

The design and execution of a specific national policy and plan, consisting of systematic, comprehensive, consistent, and long-term activities aimed at improving a community's quality of life. Here it would help if CICAD were to approve a "Model Master Plan", adapting for specific conditions in the Americas the one drafted by UNDCP.

The drafting and application of national drug legislation dealing with the changing, many-sided, and complex aspects of this issue.

The Representatives also agreed on the need for a system for providing periodic information regarding implementation of the Anti-Drug Strategy in the Hemisphere, and proposed:

1. Promoting national information systems
2. Developing and extending SITCOD
3. Studying the possibility of creating an Epidemiological Observatory similar to the European Union's.

The Expert Group recommends that CICAD should make the Group responsible for monitoring implementation of the Anti-Drug Strategy in the Hemisphere as far as demand reduction is concerned, in the same way that the Expert Group on Money Laundering was entrusted with the task of following up on agreements reached at the Summit of the Americas.

At the same time, CICAD should explore the possibility of tapping funds for demand reduction programs and activities available under already existing lines of credit and programs, which the IDB and World Bank grant member countries for purposes that may be compatible with this task.

To facilitate application of the principles agreed on, the following working groups were established to monitor the handling and implementation of the following proposals and priorities:

Group A: Research and Evaluation

Group B: Prevention, Treatment, Rehabilitation, and Re-incorporation into Society.

Group C: Institutional Matters.

The proposals and priorities emanating from these Groups' work are as follows:

The following should be regarded as suggestions, since each country is at a different level of execution.

1. It was decided that it would be advisable to identify some highly qualified professionals in each country, to enhance the technical excellence of the Expert Group. We understand drug abuse to be caused by a set of factors -- social, cultural, psychological, biological, and anthropological. The group should therefore support, suggest, and advise on research carried out in the different disciplines, thereby facilitating a comprehensive approach in prevention and care.
3. The Group of Experts on this subject shall cooperate with CICAD on the following:

Assess on a regular basis the updating of the EPI-SIDUC system in light of the trends and changes that may be observed in drug use, population groups involved, and other trends that may be relevant in member states.

Carry out training and refresher courses on research and evaluation considered to be necessary in the different countries.

Identify epidemiologists and specialists in different disciplines in each country to ensure adequate use of information.

Identify suitable ways of ensuring that the information is properly understood, absorbed and used by the community.

Accompany and, where necessary, advise on qualitative and quantitative research activities, as requested by individual countries.

1. Adopt the EPI/SIDUC system, since it is sufficiently flexible to incorporate the surveys and/or variables that each country considers important for its own purposes.
2. Conduct research and preliminary diagnoses for each country as a pre-requisite for the design and implementation of educational and prevention strategies for different populations, and also conduct research in drug treatment and rehabilitation centers, in order to determine changes in drug abuse trends and to assess the effectiveness of therapies.
3. Set up and/or strengthen national databases on institutions concerned with drug abuse prevention and care, and on epidemiological studies and/or surveys. It was suggested that one of the functions of the Expert Group should be to recommend criteria for achieving technical excellence at both the national and international level in: epidemiological research, rational use of resources, appropriateness and so on, of the research, and also to advise, upon request, on the setting up of ethics committees in each country responsible for authorizing epidemiological studies requested by outside institutions.
4. Establish criteria for the evaluation and assessment of impact, based on comparable program and activity indicators. Periods recommended could range from one to three years.
5. Recommend the coordination and rationalization of the various research activities underway within each country.
6. Strengthen a hemispheric information network regarding research, projects, and prevention and other activities.

PREVENTION:

• It was agreed to take the document entitled "Recent Trends in Drug Abuse Prevention" into account. This paper deals with topics presented and discussed by experts at the Inter-American Symposium held in Costa Rica in May 1997.
• It was agreed to take the matter up again at a future meeting.

TREATMENT:

• Given that there exists no single model for treatment and rehabilitation, the use of a variety of programs and approaches should be promoted in each member country, documenting and validating them.
• Minimum standards of care must be set for treatment centers, in order to improve quality and respect the human rights of patients.
• Special treatment programs for minors should be promoted, in addition to specific programs for women that take the gender perspective and women’s special needs into account. Treatment programs for prisoners should also be promoted.
• Programs must match the socio-cultural and ethnic diversity of each country.
• Efforts should be made to foster the creation and strengthening of networks and levels of care, understanding networks to be a synergy of resources and a joining of efforts.
• Training programs for professional staff and health workers and others working in the field of the addictions are needed.
• Primary health care personnel must be trained in techniques for early diagnosis, motivation to undergo treatment, and appropriate referral systems. Also needed are educational and training programs and refresher courses, for the staff of general and specialized hospitals and health centers, regarding toxicological emergencies associated with illicit drugs, within a comprehensive, multidisciplinary approach.
• There is also a need to promote programs designed to enhance the patient’s re-incorporation into society and the work place, and follow-up care.
• Indicators of efficiency and effectiveness should be defined for each type of treatment and program. CICAD is requested to circulate the different instruments used by different countries so far.
• Courses on the addictions should be included in graduate and postgraduate curricula for professional staff and health workers.
• CICAD is requested to compile a bibliography of validated treatment models and programs for both English and Spanish speakers.
• More opportunities must be developed for exchanges of information and training among the different countries in the areas of diagnosis, treatment, rehabilitation, and re-incorporation into society.
• There was agreement on the need to set minimum requirements for graduate and post-graduate courses, specialized diploma courses and other technical and professional training, which should, insofar as possible, be approved both by the specific national authority and by the pertinent education authorities.

Promote, in national bodies responsible for drug demand reduction, coordinated and integrated activities compatible with the Anti-Drug Strategy in the Hemisphere.

Promote and strengthen the development of information systems that will provide the basis for coordinated decision-making at the national and regional levels.

Strengthen demand reduction activities by consolidating and fostering coordination mechanisms among different areas of government and by establishing dynamic relationships with non-governmental bodies.

Encourage optimum use of resources obtained via technical and financial assistance at the national, regional, and international level with a view to extending the capacity of national agencies involved in demand reduction activities.

Promote the dissemination and application of fund-raising mechanisms for demand reduction projects and programs, including follow-up and evaluation.

Develop national strategies to ensure the transparent and effective use of assets confiscated from drug trafficking and related offenses, and their use in activities compatible with the Anti-Drug Strategy.

Disseminate in each member country and in other societies news of the drafting and adoption of the Anti-Drug Strategy in the Hemisphere and of the establishment of the Expert Group on Demand Reduction.

Develop in our countries sound communications policies to promote the principles of the Anti-Drug Strategy.

Promote among the various sectors working on the design and dissemination of prevention materials the adoption of principles compatible with the demand reduction policy put forward in the Anti-Drug Strategy in the Hemisphere.

Develop mechanisms to encourage more responsible and objective handling of information about drugs in the mass media, with due respect for each member country's domestic legislation, and in general guaranteeing freedom of the press and freedom of expression.

Carry out workshops/training seminars for journalists and editors, and produce manuals/papers providing the media with objective and reliable data/know-how regarding drugs, while stressing the importance of responsible information in prevention efforts.

Put research and survey findings in simple language both for the media and the public at large, avoiding using -- whether by deed or omission, voluntarily or involuntarily -- partial or out-of-context information.

Draw up marketing strategies to develop and disseminate material in the form of attractive user-friendly messages stressing healthy life styles.

Foster agreements with the mass entertainment industry to handle directly or indirectly violent or drug consumption topics in a responsible manner, avoiding under emphasis on these negative forms of behavior. Efforts should be made not to transmit videos, films, TV series etc with such scenes at times when children and young people might be watching.

Draw up basic criteria ensuring that the content of prevention spots meets proven standards of effectiveness and take international experience into account. Such advertisements should be adapted to the problems faced by each community and the age group they are addressing. They should avoid stigmatizing drug users and drug addicts or alcoholics. Messages or spots based on terror, or that confuse the general public, should be avoided, and the use of famous people as role models should be weighed prudently.

Develop methods, techniques, and strategies for researching and assessing the impact of prevention campaigns, based on models looking at initial diagnoses, and process and impact analysis and employing various techniques such as key informants, focus groups, K.A.P. {Knowledge, Attitudes and Practices} studies, content analysis of the press, and so on.

Round out the messages and material by promoting health life styles; combine such messages with other problems related to substance abuse, such as risky sexual behavior and/or violent or high-risk activities.

Foster the participation of students, journalists, and editors in the design and follow-up of prevention campaigns. Work out ways of ensuring that prevention spots are transmitted in the most appropriate media and at the right times.

Recommend that the Executive Secretariat of CICAD publish materials prepared within the Anti-Drug Strategy framework as a way of facilitating exchanges of information and the experience gained in member states and elsewhere regarding matters to do with the consumption of alcohol and other drugs (AOD) and which constitute member states' contributions to the data base administered by the Secretariat.