Csaba Mihaldinecz

Csaba founded the Leo Amici Foundation in 1991 to change medical and social prejudices against drug addicts and alcoholics. He is creating a humane, safe, and creative environment for treatment which builds self-confidence and reinforces the assumption of personal responsibility. His private institution has become a model in Hungary for substance abuse rehabilitation.

To combat the inhumane treatment of people with dependencies and to raise public (and government) awareness, Csaba has introduced a new type of care in the rehabilitation of alcoholics and drug users. He focuses on long-term care designed to reintegrate patients into a productive, community existence, which is the precise opposite of the prevailing detoxification procedures.

Csaba's original forms of therapy involve parents and families in the process as supports to addicted clients, use theater and preventional performances in schools, employ former addicts to lead therapy sessions, and place rehabilitated clients in jobs. According the clients Csaba serves, the program works because addicts become involved in a community in which they can regain trust and confidence in themselves, and this is unique in Hungary.

Csaba's treatment has proven much more effective than state-run institutional treatment programs, with a success rate some fifty times higher. As a result of his lobbying (and of his program's unequivocal success), the government has agreed to cover his clients' costs, and has begun referring clients to his center.

Since 1989, Hungary has become a transit country for drug distribution from Asia to Europe, and has seen an alarming increase in its own substance abuse statistics. Hungary faces a dramatic deepening of the problem of drug addiction, alcoholism, and the related social problems (crime, domestic violence, unemployment). At the same time, preventative and rehabilitative care is deteriorating because of the decrease in government funds allocated to healthcare.

Counting family members, there are at least 1,000,000 people indirectly affected by alcoholism in Hungary today. Drug addicts number an estimated 30-40,000 in the country, but figures are not as accurate as in the estimation of alcoholics. Drug use is also a more hidden activity, not only because of stigma associated with it but also because a new, very punitive law enacted in 1998 criminalizes all drug-related activity. This law reflects and encourages the prevalent social attitude that drug users are dangerous criminals.

The Hungarian healthcare system suffers from an increasing lack of financial resources. Hospitals and other state institutes are only able to offer low-quality services, and doctors are severly underpaid. There are only 150 beds officially allocated for drug abusers in the entire country. These institutions practise detoxification and other short-term treatments based on chemical solutions and individual psychiatric treatment. There is no follow-up or group therapy. It is estimated that only 1 percent of addicts treated by these institutions recover.

Csaba began working in a state-run institution as a social worker attached to medical teams. He witnessed first-hand the social consequences of addiction in families, and was determined to find alternatives to the state's approach to rehabilitation. In 1993, he met representatives of the Italian Leo Amici Foundation, whose methods impressed him, and he left the state to begin adapting the foundation's approaches in Hungary.

Csaba located his model institution in south-western Hungary, in Komlo, which is an old mining city hard hit by unemployment and poverty, where growing drug addiction and alcoholism have followed economic hardship. This was Csaba's first constituency as a worker in the state-run institution and he knows this region and the people's problems intimately (he began work here in 1986). With the help of the local government, he was initially granted the right to buy a piece of land on very favorable terms. This cooperation with local authorities has developed into a strong partnership. (The mayor of Komlo found that his city was becoming increasingly well-known as the reputation of Csaba's foundation increased throughout Hungary.) Csaba's institution was constructed in 1992 on the ruins of a state run sports club and the center now covers seven hectares of farm and woodlands. Csaba has traveled to both Italy and France to learn about new, successful methods of therapy which he then customizes to fit the Hungarian.

Csaba's staff, which began with five members and is now 17 large, includes: eight volunteer university students, one lawyer, one psychiatrist, one intern, five program coordinators (three of them are former addicts and patients) and one administrator. The concrete programs include the following:

1. Group Therapy: This program provides clients with a carefully structured, non-threatening environment in which their personalities are able to strengthen and develop. There are two themes of the group meetings: 1) to relinquish controlling behavior in order to be open to new attitudes, and 2) to change the role of drugs or alcohol in the individual's life, to show what the individual has lost through drugs and how honestly to express feelings.

2. Work Therapy: The foundation employs patients to help with animal breading (goats, chickens, rabbits, etc.), gardening, working with metal and wood, bricklaying-masonry, and participating in school education programs. This program helps build the institute itself.

3. Employment: the foundation also prepares its patients to find jobs. In exceptional cases, the center sends them to cooperating workplaces. Csaba is planning to start a new Employee Assistance Program in the future: he wants to convince the old employers of his clients to take them back after completing the program.

4. Family Group Training: Csaba has recognized from the start that families must be involved in the rehabilitation effort and must themselves be taught to sustain an environment in which patients will not revert to drug use. His center therefore conducts training workshops that involve parents and patients in collective discussion and therapy.

5. Theater Therapy: Csaba's foundation adapted the idea of the theater from the Italian organization, but Csaba transformed it with the help of a French theater director to included more psychological and movement techniques. Every patient participates in the theater group work. This program works very efficiently for hard-core addicts which most treatment centers have given up on. Common theater and related dancing and singing activities gives the opportunity to express aggression, fear, pain, happiness and to overcome obstacles raised by inhibitions. One performance was given for the Hungarian Parliament in January, 1997 and groups also perform in theaters as well as in primary and secondary schools, universities and youth groups around the country. Performances are scheduled according to invitations and all costs met by the inviting organizations. These theater plays involve the student trainees as well as the clients. The audience is aged 14+ years and varies in size from 20-500. Since 1996 30-35 performances/year have been given so far and this therapy has already spun-off in other cities where former clients have initiated similar initiatives based on Csaba's model.

6. Prevention Program: This program gradually developed out of the theater performances. As the group was invited to schools, the foundation and the teachers recognized that this was a very efficient way to approach children to discuss drug problems. After the performances the actors, who are credible in the eyes of the students, discuss drugs and abuse.

7. Training for Students: Social work and sociology training in Hungary requires practical experience, and the universities have arrangements with facilities such as homes for the elderly, etc. to provide students with this opportunity. Csaba created relationships with several universities and is now consistently recruiting student volunteers. Forty-eight students were already trained in addiction therapy at Csaba's center in a 3-5-month-long training program. They were also taken to Italy to visit the Leo Amici Center in a van bought with the support of the European Phare program. This training has greatly increased the national awareness of and respect for the program, giving it a broader impact in Hungary as a whole.

8. Half-Way House: Csaba is building a half-way house for five to six recovering addicts. The house is situated in a terrace with other residential buildings near to the center. The house is important both as an innovative model for Hungary and to discourage relapse rates among clients leaving therapy.

9. Parents Group and Theater: Csaba has always believed that parents and relatives should be involved in any sustainable rehabilitation effort. In 1996, parents and relatives participated 80 times in a course which ran twice a month and which has been running since. Consequently, parents established their own theater group and performed together with their addicted children.

10. Education: The foundation developed close links with the Down Town School (a special school for young people labeled deviant). The patients at the therapy center attend the school for tuition and exams and teachers also travel to Komlo to educate the students. This way, the foundation permits the young people to continue their studies and gain qualified employment when their therapy finishes while at the same time encouraging their integration into society. Students are also taught practical survival strategies: cooking, householding, bill paying, etc. Clients who have the desire to study are able to go to a downtown school and complete their interrupted high school education. Those clients who are in the beginning of the program and not allowed to leave the center's territory are visited by teachers one weekend per month.

11. Positive Challenges Club: Csaba is planning to continue raising awareness of his work throug this new initiative which involves the clients and local young people in commonly organized cultural events, open discussions, etc. with the support of the local businiess community and parents.

Almost all of these elements are unique to the Hungarian program, and have been developed by Csaba. The original Leo Amici foundation (in Italy) offers many fewer services to its patients.

Compared to the one percent success rate of state- institutions, Csaba has documented that about 50 percent of people leaving his institution have continued drug-free to lead successful and productive lives. Since 1993, the foundation has treated 102 addicts. Out of this 102, 22 left before completing his program and of the rest about 40 quit drugs completely. Approximately 20-22 young people become the part of the program per year. He is able to monitor his success by maintaining what he says is an essential link, a constant "bridge" between his institution and the clients its serves throughout their lives. His old clients and the trained social worker and sociology students are also spreading his ideas through the country, which serves to strengthen the center as a model for successful care.

Another center is already being established in Budapest. Csaba convinced the Budapest government to allocate money for this and the Ministry of Youth and Sport has promised to aid in the expansion of the center. The new center is planned to open in 2003. In the beginning, it would accept 10 patients and 3-4 old clients would become counselors and manage the daily activities.

The Hungarian Leo Amici Foundation was invited and became the member of the Alps-Adriatic Assembly, a forum which implements programs on a regional level. Csaba established cooperation with a Czech organization in Brno. The Czech organization is in the process of adapting Csaba's theater therapy. Romanian and Ukrainian organizations knows about Csaba's work and they send clients to him (2 Romanians and 3 Ukrainians). He is also in contact with the Blue Cross in Triest, Italy and with Con-Job in Munich, Germany. Now Csaba is trying to find a Romainian partner who could adapt his model.

In the mid-1990s, Csaba and other professionals in this field lobbied to change the law on healthcare insurance, so that now the National Health Insurance pays for the services he provides, and the amount of support paid per person tripled in November 1997. This legal change was a vital step for Csaba's organization, making it fundamentally sustainable. The Ministry of Health and Welfare now recommends him to parents calling for information about child addiction. The foundation's other financial sources include the individual fees for services, the Hungarian ministries of Health and Welfare, the European Union and other foundations.

Csaba is the son of an alcoholic father and he was labeled an unreformable deviant as a child by school authorities. His schools sent him to psychiatric institutes, where he personally experienced the stifling atmosphere of state-run institutions. Later, he became a water authority environmentalist, but because of the impact of his previous experiences, he began to work in a psychiatric institute first as an administrator later as a social worker. In the early nineties, his home town was devastated by unemployment, and he watched the community gradually descent into alcohol abuse. He visited many families where he faced poverty and drug addiction, and was determined to find new ways of providing support for these people.

By chance, he met a group of Italian young people at a dance festival in Hungary. They had been drug addicts, and introduced him to the work of the Leo Amici Foundation. Csaba was impressed by elements of the idea, and felt they could be combined with his own vision to create a unique Hungarian program.