The Israel Society for the Prevention of Alcoholism
The Israel Society for the Prevention of Alcoholism
4 Nordau Street
Ramat Gan 52464
This paper describes the profile of the Israel Society for the Prevention of Alcoholism (ISPA), which is a nation-wide, public, non-profit association. It portrays various aspects of ISPA treatment and rehabilitation facilities—the residential treatment center, the rehabilitative hostel and the ‘warm home’ for homeless alcoholics. It depicts ISPA prevention activities, prevention materials and its usage of the media, and deals with ISPA involvement in policy issues. The paper also addresses the research reality of ISPA and its scientific journal, and refers to the society's structure and its future.
The Israel Society for the Prevention of Alcoholism (ISPA) (http:www.ias.org.ukispa) is a nation-wide public non-profit association. It was founded in 1976 in order to develop and advance research, prevention, policy and treatment of alcoholism in Israel. In 1996 ISPA joined the European Council for Alcohol Research Rehabilitation and Education (EUROCARE), which is an advocacy organization for the prevention of alcohol-related harm in Europe, and in 2000 was accepted into the European Network Connecting Telematic Methods with Alcohol Prevention (PREVNET). ISPA is also a member of the Consortium of European Alcohol Research Centers (CEARC). This paper describes ISPA's three departments: treatment and rehabilitation, prevention, and policy and research, as well as ISPA's structure and its future.
TREATMENT AND REHABILITATION
Since its foundation the association has developed services for the treatment of alcoholics and their family members, and established three unique public in-patient treatment facilities which serve the entire population of Israel (Weiss 1995).
The residential treatment center
In 1982 it established the residential center in Ramat Gan (30 beds, including three beds for women), which was the first of its kind in Israel (Michaely et al. 1989). It still remains today (2002), with its 30 beds the only public residential treatment facility in Israel, in spite of the fact that in 2002 the Israeli population has increased to about 6 500 000 inhabitants, of whom about one million are immigrants who had come to Israel in the 1990s from the former Soviet Union. This facility is located in the center of Ramat Gan, a city near Tel Aviv, in the center of the country. However, it is housed in an old building, which some decades ago used to be a hotel. The sign ‘Nordau Hotel’ is still there in order to reduce the objections of neighbors, who would prefer it to be either isolated in settings away from other people or moved to a disadvantaged neighborhood in another urban setting. The building is wretched and poor, with a ruined infrastructure more suited, perhaps, to third world countries than a country which is considered to be developed. The undesirable and unpleasant conditions make seeking help for treatment less desirable than it would otherwise be, and most of the treated alcoholics are extremely poor. In any case, 30 beds are not enough. The Ministry of Health supports the treatment in the residential center. However, for each bed of an alcoholic it pays much less than for the bed of a patient suffering from another physical or mental illness in a general hospital. Thus, less money is allocated for the adequate care and management of alcoholism. ISPA has succeeded recently in convincing the Ministry of Health to support in part 30 more beds for alcoholics, but has so far not succeeded in finding an adequate facility in order to transfer the residential center to a more pleasant building and to allocate enough money for this purpose. ISPA staff in this center include a physician (the director of the center), a psychiatrist, nurses, social workers and ‘dry’ alcoholics. The residential treatment center provides long-term treatment for a period of up to 3 months (behavioral–cognitive therapy) and short-term treatment (detoxification) for a period of up to 2 weeks. Both programs provide individual therapy, group therapy and family therapy, along with medical care. In addition, the center offers four programs for recovered alcoholics: a club, which operates once a week for social support and help in coping without drinking; a graduates’ group, which meets once a month; 1-day treatment for those who need urgent support to prevent relapse; and Alcoholics Anonymous meetings once a week. A hotline is available 24 hours a day.
In 2001 95 alcoholics (91 males, four females) participated in the long-term program and 222 (194 males, 28 females) in the short-term program. About 38% of patients were Arab alcoholics, and the percentages of immigrants from the former Soviet Union were 24% in the long-term program and 56% in the short-term program, making immigrants the largest group treated in the center (40%) (Markevitch 2002).
The rehabilitative hostel
The second in-patient facility, the rehabilitative hostel (10 beds), was established in 1990 in Jerusalem for lonely and unemployed recovered alcoholics. The director of the hostel is a criminologist, and the staff consists of social workers. It is supported by the Ministry of Labor and Social Affairs and provides for up to 1-year housing and vocational assistance in addition to continued alcoholism treatment. In 2001 a group of 23 men were treated in the hostel, of whom 87% were Jewish, and 30% came from the former Soviet Union (Simon & Levi 2002).
The ‘warm home’
The third in-patient facility, the ‘warm home’ for homeless alcoholics (13 beds), was established in 1994 in Petach Tikva, a city near Tel Aviv . The director of this facility is a social worker, and the rest of the staff are also social workers. It is supported by the Ministry of Labor and Social Affairs and deals with the rehabilitation of homeless alcoholics, who stay there for up to a year. In 2001 a group of 20 men were treated in the ‘warm home’, of whom 95% were immigrants ‘with no religion’ from the former Soviet Union (Simon & Levi 2002).
It is important to note that ISPA established and operated both the governmental in-patient system and the governmental out-patient system in the Jewish and Arab sectors from 1976 to 1991. In 1991, due to bureaucratic conflicts [the success of ISPA in treating alcoholics in the ambulatory centers (Michaely et al. 1989) was not an issue in this matter], the governmental treatment system was divided into two sections. The in-patient section remained under the operation of ISPA, and the ambulatory section (11 out-patient centers established by ISPA until 1991) was taken from ISPA and transferred to a new public non-profit organization—the Association for the Development of Social Services (Weiss 1995). Indeed, there is some cooperation between the two associations, but the fact that two societies deal with alcoholism treatment is neither beneficial to the alcoholics nor to the public alcohol treatment system.
PREVENTION AND POLICY
Each school year, under the supervision of the Ministry of Education, ISPA conducts about 1000 workshops for junior and senior high school students, which take place in schools or at the residential treatment center. The duration of each workshop is 4 hours, and the workshops are carried out in classes with up to 40 participants. Thus, ISPA is active among 40 000 students each year. The workshops serve as an additional enrichment activity to the preventive work undertaken by teachers in schools. The workshops are carried out by 26 ISPA trained tutors (social workers, psychologists, sociologists), five actors and 10 trained ‘dry’ alcoholics (at least 2 years of abstinence). The workshops are paid by the schools to cover the cost of the tutors and actors, as no governmental budget is available through the Ministry of Education for special alcohol education in schools. Therefore, all schools that enroll in the workshops are considered well established, because they can afford (the parents can afford) to provide the workshops for their students. Thus, due to lack of support from the government, schools in disadvantaged areas do not participate in these activities, although they sometimes need them more than students in wealthy regions. There are seven types of workshops: ‘me and my body’ workshop for the 7th grade, ‘alcohol myths’ for the 8th grade, ‘basic workshop’ for the 9th−10th grades, ‘alcohol and me’ for the 10th grade, ‘alcohol and violence’ for the 10th−11th grades, ‘alcohol and driving’ for the 12th grade and ‘alcohol, parents and adolescents’ (for students and their parents) for the 11th−12th grades. The workshops are evaluated each year by the ISPA research department (Gefen & Weiss 2002).
In addition, the association provides lectures for parents in various communities and for workers in various work-places, as well as special prevention activities in Kibbutzim (Weiss 1990, Weiss 1993) and in villages throughout the country. These activities are supported by schools or by municipalities. ISPA also offers training services to professionals from the fields of education, health and welfare. It arranges seminars in cooperation with universities, and holds an annual conference aimed at professionals in order to reinforce awareness about problems associated with alcohol abuse. The conference has a different topic each year, such as ‘alcohol and women’, ‘alcohol and sex’, ‘alcohol and violence’, ‘alcohol and adolescents’, ‘alcohol and culture’, etc.
ISPA cooperates with other organizations in order to advance prevention. For example, in 1999 ISPA cooperated with the Ministry of Health in producing a fetal alcohol syndrome poster (Weiss 2000b). It cooperated in 2002 with the Israeli Police in conducting prevention activities in youth entertainment areas during weekend nights, distributing stickers and T-shirts and measuring the blood alcohol concentration (BAC) levels among youngsters leaving public houses. In 2002 the Society also began cooperation with the Anti-Drugs Authority (governmental agency) concerning prevention in work-places.
ISPA publishes prevention materials (such as kits, posters, stickers, leaflets, pamphlets) for youngsters, parents, soldiers (Weiss & Gefen 2000), workers and drivers. Most of the materials are in Hebrew, but materials in Arabic, Russian and Amharic are also available (Weiss 1994). Each year ISPA organizes competitions in high schools concerning the creation of posters and stickers in the alcohol domain, and each year there is a different topic. The poster and sticker which win first place are produced by the schools and ISPA distributes them among thousands of students and in public places. Every year the association also produces a special kit for classes which participate in ISPA workshops. The kit includes leaflets, posters and stickers, a pamphlet for teachers, which includes instructions for 10 lessons to be implemented by the teacher after ISPA workshops and a colorful pamphlet, ‘Facts you should know’, which encompasses answers to 29 questions about alcohol. Thousands of copies of the latter were produced by the Ministry of Education to be distributed among students during 2003. Since 1988 ISPA has encouraged the use of the interdisciplinary educational prevention curriculum ‘Alcohol and drunkenness’, which has been published by the Society, Haifa University and the Ministry of Education (Moore & Weiss 1985; Weiss & Moore 1988; Yanai & Weiss 1994).
It is important to note that the objective of all ISPA prevention activities and publications in the Jewish sector is to induce moderate, controlled and responsible drinking and not abstinence (Weiss 1988).
In 2002 ISPA succeeded in its efforts to produce a 30-second public service announcement concerning alcohol and driving. The broadcast airtime for this message was donated free of charge by the commercial television network ‘Telhad’. In addition, the production and broadcast airtime of the ISPA awareness radio message were donated free of charge by one of the Israeli radio channels, ‘Galei Zahal’. Furthermore, ISPA constantly attempt to insert alcohol-related topics into daily newspapers and magazines in order to increase awareness about alcohol problems, especially following alcohol-related accidents and crimes. In addition, ISPA staff members speak on radio programs and appear on television. The association also offers consultation to schools, which produce alcohol-related video programs to be used during prevention activities.
ISPA offers advice on legal and legislative matters concerning alcohol, and its representatives take an active role in the meetings of the ‘drugs and alcohol’ committee of the Israeli parliament; it has initiated alcohol regulations based on research (Weiss 1997, 1999), but has not succeeded in bringing the majority of parliament to support alcohol regulations such as alcohol advertisement regulations, random breath-testing, 0% BAC for young drivers, increase in alcohol taxes and prohibiting the supply of alcoholic beverages to minors in supermarkets and grocery stores, in addition to pubs and clubs where the supply is prohibited. ISPA, which fights for public health, does not have the resources and power that the strong and rich alcohol industry has. ISPA also offers advice to the Ministry of Health. As a result, in August 2002 ISPA succeeded in its aim to remove from the shelves of all supermarkets, grocery stores and kiosks the bottles of a dairy's milk-based beverage with a 2% alcohol content, in order to protect children and pregnant women. It was the first dairy in the world to develop a beverage of milk and alcohol. The society also cooperates with the Israeli Police concerning the enforcement of existing alcohol regulations, but this cooperation does not fulfill existing needs due to lack of resources.
The research reality
ISPA initiates research in the alcohol domain, serving as the main alcohol research institute, sometimes cooperating with universities and hospitals in Israel and abroad as can be seen, for instance, in various publications (Amit et al. 1999; Weiss et al. 1999, 2000, 2001). All applications from the ISPA for research support from the Israeli government, especially from the Ministry of Health, as well as from public and private funds, have so far been rejected. Therefore, all ISPA research projects in the last 18 years have been conducted voluntarily. However, this does not interfere with the reality that almost all Israeli research in the field of alcohol in the social, epidemiological, preventive and therapeutic domains has been conducted within the framework of the ISPA, which has supported financially only the research staff's working hours. Therefore, most of the Israeli scientific–professional publications concerning alcohol stem from the Society, encompassing approximately 200 articles in Hebrew and 100 items in English (papers published in the foreign professional literature). ISPA helps students from universities as well as professionals in identifying scientific resource materials concerning alcohol. They approach ISPA through the website and by telephone. The association publishes a newsletter four times a year.
The scientific journal
In July 2000 ISPA published the first scholastic, professional peer-reviewed journal to appear in Israel in the addiction domain. Alcohol in Israel—Interdisciplinary Scientific Journal appears biannually and publishes papers in Hebrew (along with English summaries) on sociological, psychological and biomedical aspects of alcoholism and alcohol research, provided that the original papers make a new contribution to knowledge in the field. It also accepts papers dealing with the relationship between the consumption of alcohol and other addictions. The journal aims to educate, inform and advance alcohol research in Israel, to serve the national scientific and clinical communities and enhance the quality of debate. The editorial board includes six Israeli members from universities and hospitals, well known as experts in various aspects of the alcohol domain. The production resources of the journal stem mainly from advertisements for medicines used for the treatment of alcoholism. The journal has adopted the Farmington Consensus (1997), and its editor has joined the International Society of Addiction Journal Editors (ISAJE) (Edwards & Babor 2001).
THE SOCIETY's FRAMEWORK AND ITS FUTURE
The working team of ISPA includes about 60 people—a physician, a psychiatrist, a scientist (who also serves as the editor of the scientific journal), a prevention coordinator, an administrative manager and two secretaries; the remainder are social workers, nurses, prevention tutors and trained ‘dry’ alcoholics. The Society's board of directors includes a chairman and 10 members and a treasurer (volunteers). ISPA also employs a controller and a lawyer. There are no criteria for membership. The members pay about US$10 per year, receive all ISPA publications and announcements, and pay only part of the fee of the ISPA annual conference. The members are professionals or recovered alcoholics and most of them volunteer for ISPA activities. The current membership is small (about 100 members), and the membership list is not publicly available.
As a non-profit organization, the society sources of income (payments from the Ministry of Health and the Ministry of Labor and Social Affairs for the treatment centers, and payments from schools for prevention workshops) barely cover the costs. There are myths in Israeli society that Moslems do not drink and that alcoholic Jews do not exist. The Jewish and Arab Israeli public does not consider alcoholism to be a major problem, in spite of the fact that alcohol abuse and alcoholism is a serious and growing problem among Jews (Weiss 2000a) and Arabs (Weiss et al. 2002). They do not generally donate contributions towards the battle against alcohol abuse, and because of stigma (Link & Phelan 2001) it is impossible to obtain contributions from the wealthy or even from those people whose family members suffer from alcoholism. Thus, the economic situation of the Society has reached a point (at the end of 2002) in which resources will actually determine its faith. There is a need to find resources in order to maintain all ISPA's fields of operation, increase its target populations in the prevention domain and enlarge the scope of the treatment system and research possibilities.