"We are the most important point for social interaction for our clients."
Alternative I has been a crucial part of the addiction support system in Leipzig for 27 years. In 2018, the institution participated in an expert exchange on harm reduction in Thailand and received a delegation from Myanmar in the context of a study trip initiated by the GPDPD. Anna Wegener, an addiction therapist and head of the institution, and Karsten Kriebitzsch, a streetworker, have been working at Alternative I for many years. In this interview, they talk about the problems their clients are confronted with on an everyday basis, the central role of low-threshold services, and - of utmost relevance - the impact of the COVID pandemic on the lives of drug users who are living on the streets.
GPDPD: The addiction counseling and treatment center Alternative I is located in Leipzig. What is the reality regarding drug use there?
Karsten Kriebitzsch (KK): We are mainly working with clients who have polytoxicomaniac drug use patterns. That is to say, they use not only one but many substances, at times even simultaneously. Many of them use Crystal Meth.
Did the situation change during the COVID-19 pandemic?
KK: This period has led to insecurities and anxiety among our clients. Many institutions had to limit or stop their services. Therefore, the much-needed support could not be sufficiently guaranteed, which especially affected people who live on the street. It was difficult for them to acquire financial resources and food.
Anna Wegener (AW): The city of Leipzig reacted very quickly during the crisis and set up emergency sleeping facilities, which could be used free of charge and without any access restrictions. In addition, three meals a day were provided for residents by the social welfare office. The cooperation with the authorities was mostly very positive and requests were processed quickly and in an unbureaucratic manner.
AW: But now it’s more difficult to find the way back to normality again. Our clients often face multiple problems. To name an example: Hardly anyone has a bank account. Many clients receive unemployment benefits through checks. To cash in a check, however, they are required to provide an ID. Unfortunately, often they have either lost their ID or it was stolen from them. To acquire a new one, our clients need an appointment at the city hall. This can only be booked online at the moment. Since it is still complicated to get personal appointments at offices and institutions, this currently requires additional time and effort.
KK: In addition, with our acceptance-orientated approach, it is difficult for us to fully restore low-threshold access, as we have to adapt our work to the existing corona regulations. This especially affects street work.
Who visits your institution most frequently? What kind of difficulties are they confronted with?
KK: The average age in our institution is between 30 and 40 years. The main drugs are alcohol, cannabis, crystal meth, heroin and benzodiazepines. Our clients inject and/or inhale mainly (except for alcohol). Scene members and social workers represent the most important point of social interaction, as there is often no contact to family or friends who do not use drugs.
AW: The most relevant problems are the lack of affordable housing, the lack of health care and financial difficulties. These issues were already affecting the lives of our clients even before the pandemic.
What is the main goal of your work?
AW: Our goal is to provide life and survival support for people who need it. We are available 24-hours a day for the clients as well as for their relatives and friends, to assist them throughout personal crises and to provide advice. Through our safer-use offer, we want to help minimise the spread of infectious diseases and risky drug use behavior.
How do you achieve that?
KK: Our facility offers round-the-clock crisis intervention. Our contact café with food and hygiene offers is open daily, we provide an emergency sleeping place, we exchange and give away clean drug use equipment, we provide addiction counselling and other services. We offer a post box and telephone service for non-residents. Our facility is also a general shelter for our clients.
How do you implement the concept of harm reduction?
AW: We give and exchange clean syringes, needles and pumps according to the quality standards of the German AIDS-Hilfe. Furthermore, we offer expert advice on safer use and we also have education and training courses held regularly for our specialist staff.
Can you name examples of how people profit from your work?
AW: People find accommodation for the night in our facility. We arrange and accompany them to medical care and to state institutions. They receive advice and support in order to develop new perspectives. We see small changes as a success, for example, when clients use clean needles, bring their used equipment back for disposal, no longer sleep on the street but use overnight accommodation instead, have health insurance, take care of their health concerns and become important to themselves again. The amount of drug use equipment that has been exchanged and spent, such as syringes, needles and pumps, has been steadily rising for years.
Alternative I is also doing street work. Is the offer well accepted?
KK: Many people are interested in our services. Some people use our bus stop times to structure their day. The city administration and the law enforcement authorities are appreciating our work and see social work on the street as a valuable offer. There are always critical voices, as expectations and realistic prospects often diverge. Yet, this is part of our work and also provides us with suggestions for critical reflection and improvement.
What is the cooperation between the city and law enforcement agencies like?
KK: From our point of view, the cooperation between us and the city as well as law enforcement institutions has improved over the years. Our work is viewed positively and valued more. Transparency and respectful communication with each other are essential. There is always potential for improvement in this area. An important part of social work is to represent the interests of the addressees and to create appropriate offers together with all those involved.
You advised addiction support experts from Thailand and Myanmar and exchanged views with them in Leipzig. What are your experiences, and how have you benefited from them?
AW: The interest shown by the experts from abroad has had a lasting positive influence on the city's view of our institution and its services. Of course, we were also able to see that despite all the difficulties, drug policy here is very much geared towards the needs of the clients. The range of help available is well developed.
What is your most frequent task during this pandemic?
KK: It is particularly important to support our clients, to reduce their anxiety and to give them the feeling that they are not being left alone with their problems, despite the fact that we cannot offer the same services as before. From our point of view, it is necessary to ensure that the services are fully available again.
Will the current situation change your work permanently?
AW: We are concerned that budget cuts might be enforced in the field of social work. We fear that in spite of the urgent need of these services, this would restrict us in our ability to implement our plans to expand our range of services.
The "Alternative" - since 1993 an integral part of the outpatient addiction support system of the city of Leipzig - works with drug users who have multiple problems throughout the course of their often long-term drug use. The concept integrates low-threshold, risk-reducing support, offers to develop and promote motivation for change as well as preparation and mediation to further support services. These offers aim at providing clients with a ‘way out,’ to stay abstinent or to stabilize them. The assistance is being implemented at two locations with graduated focal points of care. It comprises three interlocking acute care areas - a contact point, an emergency sleeping area as well as crisis intervention in the form of low-threshold addiction-specific socio-educational interventions).