We frequently receive inquiries from students who are asked to write a paper on drugs, addiction or the political framework as part of their education. Here we provide answers to the most frequently asked questions and recommend literature and links for further information.
Arud is a non-profit organization founded in 1991 by dedicated physicians and other addiction professionals to provide a medical response to the closure of the open drug scenes.
With its two locations in Zurich and Horgen and around 130 employees, Arud is one of the largest institutions in Swiss addiction medicine. The close cooperation between the departments of psychiatry/psychotherapy, general medicine/infectious diseases and social work ensures optimal care for our patients.
Arud is also an FMH-recognized training center for future specialists (psychiatry and psychotherapy, general internal medicine) and a practice training organization for future social workers. It runs its own research and evaluation department.
Arud was founded in 1991 by physicians and others involved in the field of addiction as a non-profit association and this was given the name: Working Group for a Low-Risk Approach to Drugs (in german: Arbeitsgemeinschaft für einen risikoarmen Umgang mit Drogen). Years later, the name was changed to Arud Center for Addiction Medicine.
Arud offers comprehensive and individualized therapy to people affected by addiction. The "everything under one roof" offer is appreciated by many: psychiatry and psychotherapy, internal medicine, family doctor services and social work are located at one site.
Not everything can, but does not have to be taken advantage of. Arud also specializes in the treatment of hepatitis C, HIV and other infectious diseases, and also offers those affected adequate treatment here, regardless of whether or not there is an addiction problem.
As an FMH-certified training center for psychiatry and psychotherapy and general internal medicine, Arud trains and educates specialists in the field of addiction.
Since the damage caused by the use of psychoactive substances is largely determined by the political and social framework, Arud is committed to addiction policy at the national and international level to promote a sensible, low-harm approach to legal and illegal drugs.
In 1991 as a response to the closure of the open drug scene in Zurich.
Our approach is not primarily abstinence oriented. We approach our patients openly and without bias. We respect their personal destinies and life plans and accept that the use of psychoactive substances or non-substance-related addictive behavior may also be part of it.
If the achievement of abstinence is desired by the patients, we naturally support them on this path.
Active use in no way precludes therapy, because for many of those affected the thought of immediately giving up use completely is very frightening. Instead of stopping consumption immediately, often aiming for a more controlled form or reducing consumption is a reasonable goal. Sustainability is important to us, which is why we set the goals together with those affected and also factor possible relapses into the therapy.
Arud is a non-profit organization. We bill our services through the health insurance companies like other medical practices/clinics.
About 2,000 patients.
Yes, patients register themselves for therapy or are referred to us with their consent by other specialized agencies, institutions or by (family) doctors working in the practice.
Half of the patients come to Arud because of heroin addiction, the other half because of:
- Cannabis, alcohol, tobacco, cocaine, drug addiction.
- Party/designer drugs and other substances
- Non-substance related addictions such as sex addiction, online addiction ...
- For hepatitis C treatment, regardless of addiction.
A look at our waiting rooms confirms what we - and science - keep saying: addiction can affect anyone and everyone, regardless of income, age or background.
At Arud, there are people who are homeless, as well as sufferers who own multiple properties. People in trainer pants as well as suits. Housewives, fathers, welfare recipients, managers, etc.
The cliché of a neglected addicted person, who can be seen to be addicted, only corresponds to about 10% of those affected by addiction.
We basically speak of "psychoactive substances" or simply "substances". Drugs usually refer to illegal substances, although a great many people are addicted to legal substances such as tobacco and alcohol.
The substances are classified according to their harmfulness and the colors in the respective bar provide information about what. So e.g.: Harm to the body, or to society, etc.
That is individual for each patient. Depending on the initial situation, addiction, medical history, etc., it can be that someone comes to Arud for 2-3 conversations, has been in therapy for 2-3 years or has been with us for more than 20 years.
There is not one program that we can impose on all patients and then they are cured. Addiction is a combination of various complex factors: physical, genetic and social - therefore each therapy and its duration is individual.
Arud works with Motivational Interviewing:
For this we would first have to define success: For many, it's abstinence. But that is difficult to measure, we would have to monitor our patients after they leave Arud until the end of their lives. And that is not really close to reality.
Moreover, life is very dynamic, with ups and downs, and it is human that people affected by addiction seek support from a specialist several times in their lives. As with all mental illnesses, see the next question: Why does someone become an addict?
For us, it is much more important that people's quality of life and health improve and that we can support those affected in the long term. It is normal - and planned into the therapy - that someone can have relapses, even years later. Our treatment is designed for the long term.
Sometimes, however, it is already a success if a person who, for example, repeatedly overdoses when using, survives thanks to the therapy. In general, any harm that can be averted through therapy is a success. In addiction medicine, we speak of harm reduction.
A success can be, for example: - When someone revisits the arud when they relapse and gets help. - when someone feels better thanks to the therapy - if someone is able to reach his or her consumption goal - when unemployed persons can work again - when a previously undiagnosed illness is recognized, such as ADHD or burnout.
Thus, there are no fixed numbers or quotas, but the feedback from patients and the demand for therapy at Arud from new patients makes us optimistic that our work is helpful for those affected. It is great when someone stops coming to Arud because the person no longer needs us. But there is nothing reprehensible at all if someone does therapy several times because of their health condition or visits Arud for a longer period of time.
Addiction / dependence
Addiction is a coming together of many different components. People who use at risk do so for a variety of reasons. Whether someone loses control over consumption or not depends on several factors:
- Dependence potential of the substance
- Health status of the person
- Pre-existing mental health conditions (depression, ADHD, burnout, schizophrenia, anxiety disorders, trauma)
- Social environment (the current one, but also how someone grew up)
- Genetic factors
Medical conditions differ and so do people's lives, with or after therapy. For example, someone may be in therapy with Arud for 2 years and never have a problem with addiction after that. Other people have been in therapy with us since Arud was founded 30 years ago. And still other people suffer from mental illnesses such as ADHD or depression - it is "normal" that episodes will occur several times in life where professional help is advisable.
Often, repeated and uncontrolled use is an attempt at self-medication. It can be, for example, that someone suffers from depression and the consumption "helps" to endure this. Few people seek help because addiction is a taboo subject in our society and those affected are still condemned.
Here, too, the answer is not clearly black and white: addicted yes, addicted no. We like to explain it as a spectrum: it starts with abstinent and ends with addicted. There is a lot in between. Not everyone who consumes regularly is addicted, and not everyone who consumes only occasionally is healthy.
For example, even monthly binge drinking can cause permanent liver damage without someone being addicted, and we are talking about high-risk consumption here. Even with this, it is advisable to get professional help.
Below you can see five factors that could be an indicator to see a professional: WHO defines addiction based on six criteria, at least three of which must be true over a period of time:
- strong craving
- reduced ability to control the amount, onset or cessation of use
- physical withdrawal symptoms when consumption is stopped or reduced
- development of tolerance5. Neglect of other interests
- persistent use despite obvious negative effects.
Yes. According to the WHO, addiction is also a dependence disease. In the majority of all cases, addiction is preceded by other mental illnesses or dependence develops through an attempt to self-medicate.
The development of problematic or dependent use and behavioral addictions is contributed to by many factors over which those affected have no control and which they did not choose. Dependent use and behavioral addictions are categorized as mental illnesses.
This is individual and different for all people. Depending on personality, mental state, life circumstances and substance.
Substitution therapy (OAT)
Substitution therapy is now called opioid agonist therapy (OAT).
Substitution means "replacement." The basis of OAT is the replacement of contaminated street heroin with pharmaceutically manufactured drugs. Consumption does not take place on the street, but in a protected, medical setting.
- Those affected have no withdrawal symptoms and therefore no more pressure to obtain drugs
- Users consume pure substance, in a medical setting, handed out by a professional a professional
- Problems with consumption or health are quickly recognized by the staff and can be can be discussed and treated straight away
- Users know what dose they are consuming (on the street this is impossible and dangerous).
- Structured daily routine and social contact for those affected
- Improve health of users
- Regulated distribution instead of black market
- Less drug-related crime
- Create safer environment for inhabitants of e.g. a city
OAT is also a life-sustaining measure and reduces the incidence of overdose to a minimum. For many users, OAT is the first step back into a regular life and helps to regain a foothold in society.
The dose and frequency of use are determined with physicians and specialists in collaboration with the users as part of the therapy and are continuously reviewed, always with the patient in mind, what is most appropriate for their health and well-being.
Methadone, buprenorphine, morphine or L-polamidone.
This therapy is identical in principle to OAT, but the medication used is pharmaceutically produced heroin: called diaphine. Heroin Assisted Therapy was first offered worldwide as a scientific trial by Arud 3 years after OAT was introduced, at the urging of various experts. This because not all people respond well to OAT medications. And therapy is most effective when the drug is well tolerated and there is no longer a craving for street heroin. In studies (among others by Arud) it could be proven that heroin-assisted therapy is as effective as OAT and thus heroin-assisted therapy had become established.
According to Swiss law: existence of opioid dependence by means of a urine sample.
According to Swiss law: - Two years of opioid dependence - Minimum age 18 years - Residence in the canton of Zurich - Two treatment attempts with other methods (medically indicated exceptions are possible)
Medically speaking, OAT and heroin-assisted therapy are the same in principle. Unfortunately, there is a lot of prejudice against heroin as a drug due to historical and political reasons, therefore the legal requirement for a heroin assisted therapy is more restrictive than for an OAT.
This is stigmatizing and burdensome for affected individuals who respond better to heroin-assisted therapy. Diaphine may not be given along with it, such as methadone for 3 weeks or for vacation stays. So patients have to come to Arud every day several times a day. This is an enormous burden for someone who works or does not live nearby. In addition, patients have to take other medication during vacation stays, which in turn can have very unpleasant physical side effects.
From a medical point of view, the difference in handling makes no sense. Specialists should be allowed to select the best possible product for a therapy based on the patient and the tolerability of the medication. Unfortunately, however, the topic is not very interesting for today's politicians and therefore the demands of the medical community to finally put an end to this stigma are not heard much by those responsible.
During an initial consultation, a urine sample is taken to determine whether opioid dependence is present. Afterwards, depending on the chosen substitute (drug), a therapy can be started immediately. At Arud, a psychological and physical check-up is carried out and then the dose is determined together with a doctor.
Patients then come to Arud regularly to receive the medication and, if appropriate, for further therapy measures.
Most patients prefer their medications in tablet form, but there are those who still use injections.
Arud patients don't consume more, but they consume more cleanly. The dose is largely determined by the addict, and they tend to adjust it downward if possible or remain stable at the amount that allows them to live as symptom-free a life as possible.
Certain of our patients are so psychologically, physically and socially damaged and impaired by their history that they may need treatment for the rest of their lives.
OAT protects their lives and provides the foundation for further therapeutic services: Patients receive social work, psychological and medical support. This improves the health of those affected and enables most of them to regain a foothold in society and have a regular daily routine.
In this respect, it is true that certain people will never have a substance- or drug-free life.
People who are healthier and do not have to obtain their substance illegally cost the government less:
- less acquisitive crime
- police have less control effort
- less damage because of impure substances
- Treatment at Arud helps the majority of users to reintegrate into society and, in the first or second stage society and to be active in the first or second job market.
No. Arud is in favor of decriminalizing the use of all substances - in other words, making consumption non-punishable. However, in order to protect the population, especially young people, certain regulations must apply. This is possible by means of market regulation.
Market regulation specifies: ... who is allowed to grow the substance ... may sell ... may consume
The example of alcohol illustrates this very well: Market regulation ensures that the substance is pure and can only be legally purchased in designated places. Young people are not allowed to consume and the state finances prevention through taxes levied on the turnover of sales.
All this together is much more effective than prohibition.
Which drugs are legal and which are prohibited has changed again and again over time: depending on the cultural context, moral ideas and financial as well as power-political interests of the rulers.
No. People have consumed psychoactive substances for thousands of years. Every form of society in this world consumes psychoactive substances.
Repression is the enforcement of regulations and laws, in the most extreme case of prohibitions. In terms of drug policy, this means prosecuting cultivation, sale, and consumption. Prohibitions have proven to be ineffective, even counter-productive. Nevertheless, tons of heroin and cannabis are smuggled into Switzerland, sold and consumed. Crucially, a large part of the substances is contaminated and thus very harmful to health. Consumers are pushed into illegality.
Recommended links and literature about the "Platzspitz" era:
Small, compact & informative book.
Gives a great insight into the Platzspitz era.