Working With the Marginalized in Poland

04/18/2015 08:47 am ET | Updated Jun 18, 2015

Until the 1970s, drug addicts didn't exist in Poland -- at least not officially. In those days, drugs were expensive and the supply was limited, so the Polish state could hide the problem by giving a different label to the small number of addicts. But then heroin became more readily available, in part as a byproduct of domestic poppy farming (poppy seeds are a key ingredient in the Polish strudel known as makowiec). And addiction started to grow. By the mid-1980s, heroin use - along with glue-sniffing, marijuana, and speed - had grown to epidemic proportions.

In the 1970s, psychologist Marek Kotanski began a new kind of treatment for drug users that emphasized group therapy and other practices considered innovative at the time. He eventually created the organization MONAR (Youth Movement against Drug Addiction) to address the growing problem. Later, as social problem proliferated in Poland, Kotanski created organizations to address HIV-AIDS and homelessness. He died in a car crash in 2002.

In 1990, I visited MONAR in Warsaw where clinical psychologist Danuta Wiewiora introduced me to the various facets of the organization. When I returned to Poland 23 years later, she was still working for MONAR. I caught up with her on her vacation at the Polish seaside town of Rowy.

I asked her what had changed over the last quarter century in terms of MONAR's work. "There was a kind of border between society and homeless people or drug users," Wiewiora told me. "It was a different group. Now, there are plenty of people in our society addicted to something. Some are addicted to drugs, but very few to heroin. The majority of them are addicted to so-called recreational drugs. The level of their problem is rather high. Very often they are students, good workers, managers, your friends, people you pass on the street. Now there is no distinct group of drug users. A lot of people are using different drugs at different levels. Very few use hard drugs. The majority use marijuana, amphetamines, cocaine, Xtasy, a lot of designer drugs. It's a part of youth culture now."

With HIV-AIDS, meanwhile, Poland initially made considerable headway in addressing the problem. "For 10-15 years, Poland was seen by other countries as a good prevention policy maker," Wiewiora explained. "The level of new HIV-infected people was growing only by about 10-15 percent a year. Also, all the doctors were very well trained, with all the new knowledge and drugs for AIDS patients. In Poland, everyone is treated for free even with all the antiretroviral drugs. It's covered by the ministry of health. The number of AIDS or HIV seriously infected people is growing. Now, close to 20,000 people that we know are infected. But probably it's two or three times more who are infected and they still don't know. There are anonymous counseling centers in every big city - free of charge."

Unfortunately, the situation has changed. "Now the number of HIV infected number is growing again by about 1,000 per year," she continued. "Last year, it was 1,500 probably. There's no money for prevention. Everything is spent on treatment, on the medical drugs. Also, and this is happening in other countries, people stopped being afraid of HIV because it could be treated. And so, it's growing."

As it did in the 1980s, MONAR continues to employ former addicts as part of its team of psychologists and therapists. MONAR was not supposed to be like a bureaucratic NGO. It wanted to change people's lives: not just the clients but everyone who became involved with the organization.

"One of my colleagues had been one of the clients in our movement," Wiewora told me. "He was a heavy heroin drug user. He was infected with HIV, hepatitis C, hepatitis B. Twenty years ago, he was a like a skeleton, just bones and skin. Now, he has a family, and he's on our board of members. He runs a very good center. He finished his studies and his training. He overcame hepatitis C, which was not easy. Now he's over 40, close to 50. He's a mountain climber. He's a marathon runner. He's in very good shape, and he gets a lot of respect from other people. He's come the longest way of anyone I've ever seen. He's also my good friend."

The Interview

How did you become involved in this work?

I am a clinical psychologist, and I started my training in therapy. I worked for a couple years for a good American project in Warsaw. It ended, and I was looking for work. I never dreamed of working with drug users. But some of my friends came to work at MONAR. One day I went to MONAR and asked if they had work. And Marek Kotanski said yes. Then he asked, "Do you love me?" That was the question he asked everyone. And I said, "Sure, why not?"

I stayed for 30 years. That's how it happened. At this time there was not so many trained psychologists and therapists cooperating with MONAR. It was 50/50: people coming up through the program and people who were prepared professionally.

What was your feeling when you first started working there?

I was full of good will. But I didn't know how to work with that kind of client. I was trained by my colleagues, by the ex-drug users who were working with MONAR. But it took a long time for me to understand what specifically this work was.

Did you make any mistakes at the time?

A lot! With this group of clients, you have to understand when the drug user is talking to you and when a real person is talking to you. If you believe in some sentences or words produced by the drug user, you're in trouble. You need to be very careful and understand when the real person is in front of you. This is the real training: to understand these two personalities.

Can you give me any examples of these two personalities?

The drug user will say almost anything, will promise you anything. They have a lot of hope that the treatment can be done in one day. I would never say that this part of the personality is lying. It's just another reality for this person. But if you believe them, if you trust the drug user personality, you cannot help this person. But if you try to build up a real relationship that is therapeutic, a good relationship full of trust but that recognizes these two different people, and if you discuss a lot of things, then maybe together you can find a solution. It takes time. But it's more important to build up a good relationship full of real trust, even if it's hard for this other person.

Also, I myself need to be as open as I can be. I don't pretend to be someone who knows better. But it's takes a long time to feel ready to build up this kind of relationship.

When we talked in 1990, the number of drug users and homeless people seemed liked a lot. But now when you look back 23 years -


It's still a great number. What was different: there was a kind of border between society and homeless people or drug users. It was a different group. Now, there are plenty of people in our society addicted to something. Some are addicted to drugs, but very few to heroin. The majority of them are addicted to so-called recreational drugs. The level of their problem is rather high. Very often they are students, good workers, managers, your friends, people you pass on the street. Now there is no distinct group of drug users. A lot of people are using different drugs at different levels. Very few use hard drugs. The majority use marijuana, amphetamines, cocaine, Xtasy, a lot of designer drugs. It's a part of youth culture now.

So, the problem has become much more widespread.

Yes.

That must make the work of MONAR more difficult.

Yes and no. Since the beginning of 1990s, we've created a lot of new centers. Now we have over 30 centers for drug addicts. Some of them are also for alcoholics. And there are close to 100 live-in centers for homeless people. But they are not really homeless people like what we saw in 1989-90. These are new homeless people. We reached a breaking point in Poland when we moved from a Communist country to this new capitalism. With these political changes, there were a lot of social changes. Before, even if many people did not have much money, they had safety and stability. You could find work. You were sure of your work, from when you started until retirement. Now, there are plenty of people without work, or they have part-time work or occasional work. It's hard to manage this. Some of these people are failures rather than homeless. That's the difference.

There are still some homeless at the train station.

Yes.

Because they don't want to go to the live-in centers?

To read the rest of the interview, click here.