Sedqa - Agency Against Drug and Alcohol Abuse
Report for 1996


The second year of sedqa’s operations was marked by substantial increases of clients using the care services, rapid expansion of prevention programmes, increased cost effectiveness, improvement in quality control and recruitment of professional staff.

Sedqa is currently providing treatment and care services to circa 700 clients every month. This does not only include substance abusers, but also their families and significant others who seek our services. The quality and accessibility of the various services continued to improve and evidence of this is not only the increased frequency of service utilisation, but also the positive results that ensued from our evaluation and overview exercises that are regularly conducted for each service. This approach will be further strengthened by the introduction of a structured outcome monitoring system and standard diagnostic tools during 1997.

However, 1996 will be especially remembered for the launching of various prevention programmes particularly those targeting primary and secondary school pupils. A nine year school based prevention programme was introduced in all private and state schools. Manuals for every school teacher were prepared and distributed. Most of the teachers have undergone basic training on this manual. No less than 25,000 school children would have gone through this programme in 1996/97 scholastic year. Concurrently, extra curricular programmes and parental skills programmes continued to enhance the realisation of the global approach strategy. This concept was translated in concrete terms with the introduction of community based prevention programmes, workplace programmes and the media. The first drug and alcohol campaign was also launched during 1996 with over 600 slots appearing on two local TV stations.

The recruitment of professionally trained personnel continued, although we are still facing shortage of experienced staff on the local labour market. In spite of this, sedqa ‘s staff are highly trained. Six have at least a Masters degree while forty-seven staff members hold at least a university diploma or first degree. During 1996, three staff members pursued further post-qualification training in the addictions field. Undoubtedly, the staff remains sedqa ‘s greatest asset. Sedqa personnel have gained a reputation for dedication, professionalism and loyalty enabling a marked difference in the lives of our clients abusing drugs and alcohol as well as in societal perceptions towards substance abuse and substance abusers. An emphasis on quality, coupled with professionalism, had a direct effect on the cost effectiveness of our services. Unit costs have gone down on all major programmes. We expect this trend to continue by improving our already good cost control structure, thereby releasing resources to introduce new programmes.

The profile of the drug problem remained high throughout 1996. However, the impact of the various interventions are being felt. The general public is much more aware about the drug problem and interested in open debate. People want to be involved and want to do something about it. These pro-active attitudes are encouraging and appear to be gaining momentum. The drug problem is now viewed as a national problem beyond parochial and political interests. The concept of the global approach and idea of togetherness is steadily becoming a reality. However, realism and objectivity are certainly very important factors in this sector. We are still learning and gaining experience. We are still at the early stages of building sustainable services that are able to respond adequately to the changing needs of the clients. Therefore, sustained investment in personnel and training is the key factor for cost effective programmes that can have a lasting impact on the drug and alcohol problem in Malta.



K.A.D.A. was set up primarily for the purpose of recommending policies and general strategies to be adopted by the Government in combatting drug and alcohol abuse, to create appropriate fora for discussion on such policies and strategies, to oversee the quality of services and to encourage initiatives in the fields of research, education and training.

K.A.D.A., which brings together experts and operators coming from government departments, voluntary organisations and the professions, is chaired by Magistrate Dr. David Scicluna. During 1996, K.A.D.A. met seven times.

The Commission has three Advisory Boards, one dealing with Prevention chaired by Rev. Fr. Savio Vella, one with Treatment and Rehabilitation chaired by Dr David Cassar and the other with Illicit Trafficking chaired by Mr Herbert Agius. All three Chairmen sit on the Commission thereby contributing to co-ordination between the respective sectors.

One of K.A.D.A.’s first priorities, since its inception, was to review the national policy in the drug sector. In its document submitted to Government, K.A.D.A. has emphasised a drugs and alcohol policy which (while maintaining a strict stance against the legalisation of drugs) aims to enhance positive attitudes, an intersectoral approach with the active participation of all members of society and international co-operation. K.A.D.A. has also endorsed the setting up of the Spark programme for young offenders and a variety of prevention programmes for young drug offenders and a variety of prevention programmes initiated by sedqa. It is also in the process of formulating proposals for amendments to existing legislation.

The Advisory Boards have provided important fora for the cross-fertilisation of ideas and objectives, enhanced co-operation and co-ordination of activities, the monitoring of the effectiveness of prevention, treatment and rehabilitation programmes, and collaboration in law enforcement operations. Furthermore, both governmental and non-governmental organisations represented on the Boards provide sedqa’s Research and Evaluation Team with valuable statistics on a monthly basis which are being evaluated every quarter. Such regular evaluation of trends allows for a more proactive, policy-making approach and facilitates networking between various agencies in the drugs sector.

The "Comprehensive Multidisciplinary Outline of Future Activities in Drug Abuse Control" adopted in 1987 by the United Nations Conference on Drug Abuse and Illicit Trafficking is still endorsed by K.A.D.A. as a formidable basis for the continued development of anti-drug strategies.


Already in 1986, Malta’s drug laws had been amended to introduce severer penalties for drug traffickers, freezing and forfeiture of assets, the concept of conspiracy to sell or deal in drugs, and limitations in the granting of bail to persons charged with a trafficking offence. In 1994, the Dangerous Drugs Ordinance 1939 was further amended, introducing the possibility of coerced treatment, controlled delivery and financial investigations and extending the definition of a trafficking offence to include even an offer to sell or deal. These amendments also provide for the control of precursors and increases in punishment in the case of trafficking in or within a 100-metre perimeter of a school, youth club or centre or any place where young people habitually meet, or where a drug has been supplied to a minor, a woman with child or a person following a programme for cure or rehabilitation from drug dependence. The Prevention of Money Laundering Act was also promulgated in 1994.

1996 saw Malta acceding to the 1988 United Nations Convention against Illicit Trafficking in Narcotic Drugs and Psychotropic Substances. Regulations were enacted regarding the extradition of individuals for the trafficking offences as are indicated in the Convention to such countries that are Parties to the Convention and with which Malta does not already have extradition arrangements in this respect.

Furthermore, the Dangerous Drugs Ordinance was again amended to introduce life imprisonment as the maximum punishment for a trafficking offence and to provide for the procedure to be followed for the enforcement of investigation orders, temporary seizure orders and confiscation orders issued by judicial or prosecuting authorities outside Malta as well as in respect of co-operation to suppress illicit trafficking at sea. The manufacture, transport, or distribution of any equipment or materials knowing that they are to be used in or for the cultivation, production or manufacture of a dangerous drug has been made a criminal offence punishable as a trafficking offence.

The efficacy of penal legislation goes a long way towards the suppression of illicit trafficking. It is thus the maxim to continue evaluating and strengthening existing legislation with a view to close up loopholes by which drug traffickers and their accomplices may escape prosecution and conviction.



The cornerstone of sedqa's research strategy is its rapid information feedback system introduced towards the end of 1994. This allows for the ongoing monitoring and analysis of significant trends in treatment, rehabilitation and prevention. Emphasis is also made on monitoring trends in the criminal justice sector. Some of the most salient features of these trends in 1996 included the following:

Number of Syringes distributed from Health Centres as Reported by Primary Health Care (January 1996 - December 1996)


Other than producing the now firmly established monthly and quarterly data reports, one the major priorities of the RET throughout 1996 has been the formulation of a service evaluation and outcome monitoring exercise for the various entities within sedqa entrusted with detoxification, residential and community-based treatment. The target date for the completion of this comprehensive formulation exercise is set for June 1997. It is expected that the evaluation process will consist of:


Throughout 1996 the Research and Evaluation Team also commissioned a study investigating problems related to the industrial sector. This research study effected by Drs Noel Vella and Mark Gauci from the Health and Occupational Safety Unit focused on assessing attitudes of managerial staff from local manufacturing industries towards alcohol and drug abuse at the workplace.

The survey, conducted in April 1996 and its findings officially presented in December 1996, involved a sample of 764 managers from 250 companies in Malta and Gozo. One of the most salient features of this report was that whilst the majority of respondents considered drug use as unacceptable (88%) and harmful (86%), only fifty percent of mangers surveyed considered occasional drug use as having lasting effects. Moreover, 8.5% of those surveyed claimed that they had used drugs in the past and 5% stated that they knew workers within their company who took drugs at work. This figure rose to 13.6% for workers who took drugs away from work. 21% knew workers who drank alcohol at work, whilst this figure doubled to 43% for alcohol consumption off work. It was also interesting to note that 56.4% of managers felt that there is need to introduce pre-employment drug testing on workers. 92% of the total number of managers tested felt that there is a need to increase workers’ awareness with regard to the effects of drugs and alcohol use.

Apart from the elaboration of findings, the study’s final report entitled "Drugs and Alcohol in the Workplace: The Managerial Perspective" also includes a discussion of the implications of research results. This study has certainly continued to consolidate sedqa’s fact-finding efforts in the drug and alcohol sector.


Another major project embarked by the RET in 1996 was the quantification of data on alcohol consumption trends emanating from the 1995 national census. Over a hundred tables comparing alcohol use amongst the Maltese population to other variables were formulated. This tabulation exercise involved consideration for various demographic criteria, including, age, gender and regional distribution of respondents and social stratification indicators such as educational attainment, literacy rates and income and occupational status demarcation criteria.

The tables with different variables were presented to the Central Office of Statistics. The processing of relevant data is still in its computation phase and final results are expected by June 1997.

As in previous years, throughout 1996, the Research and Evaluation Team at sedqa also assisted in a series of quantitative and qualitative studies on drug-related issues undertaken by students from the University of Malta following diverse academic courses. The main role of the RET in these projects is a supervisory one, with RET expertise assisting and monitoring project formulation and implementation. Some of the studies in progress throughout 1996 included:

Following completion of this survey’s data collation phase, the RET is assisting in the definition of cross-tab cases. This study is being effected by Ms Jeanette Calleja in the process of her B.Ed. dissertation and involves a survey assessment of substance abuse consumption patterns amongst 400 school children aged between 9 and 10 years of age.
  • A Preliminary analysis of the links between Habitual drinking and Alcoholism in Malta
  • This year the RET also assisted Mr Christian McCarthy (a social anthropology student, from the University of East London) in a study on teenage habitual drinking and alcoholism in Malta. The final paper entitled "Toward an Understanding of the relationship between Teenage Habitual Drinking and Alcoholism" was the end product of a preliminary, exploratory study conducted by Mr McCarthy on the potential links between alcoholism and habitual teenage drinking in Malta.

    Although the study’s findings suggest that there is no single determinant of alcoholism, dysfunctional family dynamics and peer-pressure appear play a very influential part in the development of alcohol dependency. Moreover, research results indicate that alcohol is used as a substitute for unrewarding lives. This study, albeit, a preliminary project, highlights the necessity of undertaking further analyses of the socio-cultural, psychological determinants of alcohol abuse.

    This is a BA (Hons.) Social Administration dissertation project undertaken by Mr Alexander Miruzzi under the direct supervision of RET senior executive staff. This study examines the effectiveness of existing systems to combat the problem of drugs in Malta and to propose ways of how such attempts may be consolidated and upgraded. This study will include a small scale survey of the Maltese security forces who are in the front-line of the "war against drug trafficking". The data and information elicited from this field research will help outlining adequate management and administrative policies to enhance the efficacy of drug enforcement agencies. Throughout 1996, Mr Trevor Crockford, a second year student of B.Pharm (Hons.) started effecting a research study assessing indicators of the extent and nature of MDMA (Ecstasy) abuse in Malta. This shall help the identification of patterns of recreational drug abuse in Malta and to delineate possible future directions for prevention methodologies.
    INTERNATIONAL PROJECTS Sedqa, through the RET, is participating in an on-going census study on Treatment Demand by the Pompidou Group (Council of Europe). The aim of this census is to examine the quality and comparability of treatment demand data in various European countries on a longitudinal basis. All the relevant data for 1995 was compiled and presented at the 25th meeting Group of Epidemiological Experts in Drug Problems in Strasbourg, 27 November 1996. Throughout 1996 the RET was engaged in the formulation of national reports that were presented at the 24th and 25th meetings of the Group of Epidemiology Experts in Drug Problems (Pompidou Group - Council of Europe). The reports highlight aspects relevant to indigenous drug policy issues and research findings on drug-related problems in Malta. The RET also compiled the UNDCP annual reports addressing national drug-related trends. Corroboration between the RET at sedqa and the Council of Europe’s Group of Epidemiological Experts in Drug Problems was further manifested throughout 1996 in a questionnaire exercise delineated potential information users of Pompidou data in Malta.

    Throughout last year, sedqa’s RET was also responsible for overseeing and updating library resources at sedqa’s national prevention centre. Several students, sedqa staff and professionals in the area regularly make use of the Agency’s library which has an abundance of updated literature on a myriad of drug-related issues, including aids prevention, licit drug use and WHO and UNDCP updates.

    When the word " primary prevention" is applied to the addictions field, it refers to a long-term process whereby programmes in several sectors, targeting the total population, are initiated with the specific objective of dissuading the demand and consumption of alcohol and other drugs in society.

    Primary prevention is considered as a long-term, arduous process. Iit is aimed at socialising individuals within behavioural parameters that advocate healthy life-styles. This can prove to be a mammoth task as it may entail confronting traditional cultural attitudes that condone licit drug and alcohol use and more contemporary societal trends that may, in part, convey the acceptability of recreational drug use.

    These prevalence of such attitudes in Malta was clearly reflected in the results of the ESPAD survey conducted locally in March 1995. This survey sought to examine the attitudes and habits with respect to certain substances and leisure time activities among school children born in 1979. It was effected simultaneously in 30 European countries, including Malta.

    The most prevalent use and abuse of substances observed amongst the respondent population was alcohol. Only 8% of 16 year olds (boys and girls) had not had consumed alcohol at least once in their lives. This is a strong reflection of the acceptance of alcohol within our society and indeed, within our families. Moreover, 50% of 16 years old students actually report taking alcohol on 20 or more occasions in their lives. More than one third of the respondent group recorded being drunk at least once over the previous 12 month period. 5% (1 in 20) of the total number of respondents reported drinking beer almost daily. 7% reported drinking liquors almost daily. ‘Binge drinking’ (more than 5 drinks in a row) was also quite common.

    Alcohol drinking was reported to start at quite an early age in children. 33% stated that they had their first beer at age 11, whilst 2 of every 5 students (41%) claimed to have consumed wine before this age. Also notable were trends related to tobacco and drug misuse.

    Cigarettes are experimented with by more than 1 of every 2 students (55%). 13% report this to have taken place by the age of 11. Most of those who smoke are reported to have consumed their first cigarette before the age of 14 years.

    Daily smoking is a general tendency between 13 and 15 year olds. This trend holds true for both boys and girls. 15% report smoking at least one cigarette per day while another (important) 16% report smoking just one on a daily basis - and thus also at risk of taking up the habit in a greater way.

    The ESPAD survey further substantiated trends related to illicit drug consumption previously noted in the 1991 Caritas/Pride study. Both studies attest a low-age threshold for experimentation with illicit drugs. The so-called "soft drugs" are often the first to be tried out. In the ESPAD study, 8% of the respondent group reported experimentation with Marijuana or Hashish at least on one occasion.

    A new and worrying trend is the finding that inhalants or solvents constitute the most commonly abused drug amongst secondary school attendees in Malta. 17% report at least one time experimentation (boys and girls), 5% on more than 5 occasions. Fortunately, few students (<1%) actually report regular recent inhalant use (that is, on more than 10 occasions in previous 30 days).

    The other notable trend relates to the use of tranquillisers or sedatives. Approximately 8% reported to have used these drugs illicitly (12% report these to have been medically prescribed).

    Experimentation with other drugs is also a threat. 2% report lifetime use of Ecstasy (mostly <5 occasions). Figures for other drugs include 1% for both amphetamines and crack, 2% for cocaine and a considerable 13% reported having mixed alcohol with various pills on at least 1 occasion. Overall, just over 10% of the male cohort and 7% of the female cohort recorded having experimented with illicit drugs by the age of 16 at least once.

    This data has provided the direction for sedqa’s primary prevention strategy. From the outset it was decided that the Agency’s prevention programmes should not only aim at providing information about potentially harmful psycho-active substances but also to instil a strong conviction in people that drug use is not conducive to healthy life styles. As a result, it was also decided that sedqa’s primary prevention strategy is to initiate programmes very early in the lives of individuals and to sustain the effort for a long period of time. In this way one hopes to influence the opinion and attitudes of individuals so that they make informed and positive decisions when confronted with decisions related to alcohol and other drugs. In this respect, sedqa has prepared a nine year educational programme which will be extended to include kindergarten and the Junior College.

    The second consideration that one has to keep in mind when speaking about primary prevention is that it has to permeate through diverse sectors to be effective. Our strategic plan targets the family, schools, local communities, professionals, the media, leisure time and the work-place. Naturally, programmes in these areas have been prioritised according to the availability of human and financial resources, expertise, co-ordination with other agencies and other considerations. For the past year, schools, the media, communities and the work-place, in this order, have been our top priorities.

    As the national co-ordinating agency for drug and alcohol services in Malta, sedqa's primary objective is to execute policy precepts prioritised by the Government of Malta. At present, Malta's drug prevention policy emphasises a comprehensive strategy aimed at securing demand reduction. This does not exclude consideration of other important policy objectives, such as harm minimisation and addressing the needs of more specific high-risk or drug-using categories. However, any revision of the direction of national policies requires empirical reflection on the quantity, quality, longevity, sustainability and measurable outcomes of prevention programmes. Considering that our prevention strategy is still in its infancy, it is still premature to contemplate major changes to the direction of the broad objectives of our national drug prevention policy. Moreover, any prevention programme has to be evaluated in the short term and more appropriately, in the long-term to ensure an informed, decision-making process.

    We shall now review the progress of various initiatives taken by sedqa targeting areas that may be deemed essential for the realisation of a comprehensive primary drug prevention policy.

    The Family

    Parental Skills Programmes

    Following last year's pilot programmes and the subsequent evaluation, the Agency, launched its parental skills training programme Inrabbu 'l Uliedna Ahjar. By December 1996, 47 courses were initiated and conducted. These included 29 courses aimed for parents of under twelve year-old children and 18 courses for parents of teenage children. Furthermore, 10 of these courses were held in Gozo. A total of 845 participants followed and conducted these programmes and an average of 18 participants were present for each course.

    This response is a reflection of the prioritisation of drug prevention among parents and of their interest to gain, and improve, parenting skills. The Agency is also planning to increase the number of courses as a result of their increasing demand. Sixty-six new facilitators, are, in fact, expected to start parental skills instruction shortly.

    Thus, members from the community, various organisations and schools will be able to organise and implement parental skills programmes. Throughout 1996 various parental skills courses were successfully facilitated by members of voluntary organisations, such as the Cana Movement and Moviment Era Gdida, various schools and local community associations. In fact, 45% of parental skill programmes throughout 1996 were co-ordinated following a demand from particular communities and organisations whilst 38% were co-ordinated through schools. The remaining 17% were organised directly by sedqa’s prevention team in response to demands made by the general public as a result of media coverage of parental skills programmes or on recommendation by participants who had already followed one of the Agency’s courses.

    A formal evaluation exercise effected at the end of each course heightened the need to develop a parent’s manual in Maltese. The Agency immediately reacted to this feedback and introduced a Maltese version of the manual in January 1997.

    The Agency also developed its own video clips in Maltese addressing characteristics of the local family context. These will replace the American videos which were previously being used during the courses.


    Programmes in the Primary School Sector:

    Secondary School Programmes:
    The Community

    Sedqa’s strategic drug prevention plan emphasises the development of community prevention programmes. The community prevention approach is defined as "the wick to find specific solutions adapted to local needs.....if you want, however, to act in a community perspective , a certain number of conditions have absolutely to be respected" ( E. Servais - Before It’s too Late, 1988). One of the most crucial of these conditions is that preventive action must open itself to the entirety of the local community. This implies trying to actively involve all age groups, all life spheres, all social levels and, of course, the mobilisation of local associations and above all local authorities, such as, the local councils. sedqa recognises the strength and potential of the local government to support prevention community-based programmes and moreover, to promote a substance abuse free culture amongst community members. In 1996, the community dimension of sedqa’s prevention programmes received added impetus with closer liaison with local councils and several community-based organisations.

    The Work-Place
      The Media

    The role of the Communications Department at sedqa is to co-ordinate the Agency’s public and media relations and to implement social marketing campaigns aimed at making the general public more aware of the services offered by sedqa, and how to access them.

    Given the Agency’s social concerns, marketing sedqa’s services necessitates a different approach from business marketing strategies. The Agency’s promotional campaigns are directed towards sustaining the goals of sedqa’s primary prevention policy interventions.

    These do not only prioritise the provision of information about potentially harmful psycho-active substances. Rather, they are also an attempt to convince as wide an audience as possible that drug and alcohol use are not conducive to healthy living.

    To achieve this aim, the Communications Department makes extensive use of the media available on the local market, including newspapers and radio and television stations. The use of these media requires careful planning to exploit their utilisation to the maximum. Commercial advertising often depicts licit drug consumption behaviours, such as alcohol use, in a positive context without negative consequences, or with positive rewards. The challenge is to ensure a clear representation of potential health risks associated with substance abuse.

    Business Weekly    
    Malta Independent
    Sunday Times
    The Times
     Name of Series
    Radio Station 
    Inrabbu ’l uliedna Ahjar Radju Malta 1
    Appuntament ma` sedqa Radju Malta 1
    Hajjithom? Hajjitna? Super 1 Radio
    Inrabbu `L Uliedna Ahjar RTK 
    Servizzi ta` sedqa DJ Radio (Community Radio)
    Servizzi ta` sedqa Smash 
      Training for Professionals

    Sedqa’s involvement in the drugs sector is guided by an active recognition of the need for ensuring on-going training for all human service professionals engaged in related areas. Throughout 1996 two major events characterised this process; the Agency’s annual national conference and a one-day seminar examining research-related issues. In both instances, the major objective was bringing professionals together to analyse and discuss current trends and thus ascertaining close familiarisation with contemporary service-delivery, research and policy-making standards.

    Between 1-2 March 1996, sedqa organised its annual national conference at the Jerma Palace Hotel in Marsaskala. The conference, entitled "Malta -- A Microcosm of the Mediterranean Region" was extremely well attended with strong representation from all the sectors related to the addictions field. Three hundred sixty foreign and local participants attended the conference, which included four plenary sessions and a series of workshops that focused on various issues.

    The conference was characterised by the participation of a number of foreign experts in substance abuse related areas, including Prof Wallace Mandell, Chairman of the Department of Mental Hygiene at the John Hopkins University, Baltimore, USA; Dr Salman Rawaf, Director of Clinical Standards, Merton, Sutton and Wandswoth Health Authority, UK; Mr Hussein Rassool from St. George’s Hospital Medical School, London, UK; Dr Ketil Bentzen, Chairman of the Permanent Correspondents of the Pompidou Group (Council of Europe) and Mr Christopher K. Luckett, Head of Drugs Division and Secretary to the Pompidou Group (Council of Europe). Dr Edward Fenech Adami, former Prime Minister of Malta and a number of cabinet ministers also attended the conference.

    Research Seminar

    On 3 May 1996 at the Galaxy Hotel in Sliema, sedqa through its Research and Evaluation Team, organised a one-day seminar entitled "Current Perspectives in Research on Drug and Alcohol Abuse in Malta." This seminar emphasised a series of research-focused issues, particularly the importance of exchanging information, the harmonisation and standardisation of data collection techniques, timely reporting and recent international initiatives in the area of epidemiological research. The seminar was very well attended and attracted participation from various agencies and sectors that have an active interest in the collation and dissemination of epidemiological data.



    Secondary and tertiary drug prevention strategies specifically target high-risk and habitual, drug-using population categories. As these target groups are distinct in nature, secondary and tertiary drug prevention programmes, although inter-related, operate through different rationales and operational methodologies.

    Secondary prevention programmes aim at minimising opportunities for drug abuse particularly those most at risk. They involve identifying high risk population categories and developing project initiatives that deviate or divert the potential drug user toward pro-active, normative behaviour.

    On a long-term basis, tertiary drug prevention models seek to dissuade habitual drug users from continued drug use. Tertiary prevention initiatives encourage abstinence through community-based and residential services that provide opportunities for treatment, rehabilitation and societal re-integration. A comprehensive drug prevention strategy at the short term, however, must also aspire to secure symptomatic control through detoxification programmes and to minimise the health risks associated with drug abuse both for the individual and society. Methadone programmes, syringe distribution and aids prevention are all initiatives guided by a harm reduction philosophy that emphasise risk-awareness and safer-drug use.

    Sedqa’s global drug prevention approach takes into account all these divergent aspects and is continually upgrading the level and type of its care service delivery to secure that the needs of both high risk and habitual drug users are addressed. The Agency has also recognised the need to provide community-based and outreach services to drug users to ensure a wider client base.

    Building on the Care Services’ significant accomplishments in 1995, the Agency’s main thrust in the treatment sector last year centred around the consolidation of a holistic approach, the improvement of systems and procedures for delivery of services and the organisation of human resources and service structures.

    The needs presented by drug using clients to care providers are multidimensional. The problems for which they seek help are often complex, with somatic, physiological, social, legal, psychological and psychiatric ramifications. A growing understanding of the drug and alcohol problem and a more pro-active response to the multidimensional needs of the drug/alcohol abusing clients has led to the development of a more comprehensive approach to drug/alcohol care at sedqa. In several countries the bio-psycho-social model was adopted. This was a development upon the traditional medical/psychiatric model. Physical dependency on a substance is now seen as just one of the problems to be considered when designing a care plan for a client. sedqa’s Care Services have also adopted this model. This entails the availability of a variety of professional disciplines that give comprehensive care within an integrated continuum of services that offers, contact, support, treatment, rehabilitation and aftercare. The organisational structure of the service delivery units within the Care Services Division reflects this bio-psycho-social continuum.

    Sedqa’s Care Services are broadly subdivided between Drug and Alcohol Care Services. The biggest challenge in this sector has been to achieve the right balance between service expansion and cost-effectiveness. The trend for de-centralisation within the Agency’s care services is proving both efficient and cost effective. While each unit manages its own fixed budget, output is increasing steadily, thus contributing to reduced unit costs. At Komunita‘ Santa Maria, for example, unit costs have gone down to LM12.42 per bed night from LM37.60 in 1993.

    One should also note that during the period being reviewed, the drugs rehabilitation programme was assessed and amended with the result that the average duration for those who completed the programme, doubled from 163 days to 321 days. At Dar Impenn, a change in the treatment system brought about a reduction in unit cost from LM 52.15 to LM38.01 per bed night. Similar observations may be forwarded for individual contacts and group contacts at Dar Zerniq. While in 1995 one group contact cost LM1.72, in 1996 this went down to LM1.29. However, a comprehensive appraisal of these units requires a more detailed analysis of the diverse services pertaining to sedqa’s Care Services Division.

    Drug Care Services   

    Drugs Community Services

    Concerted efforts have been undertaken by sedqa to consolidate community-based, outreach and family services. Data records reporting on non-residential service delivery denote a relative consistency in the volume of client groups utilising community-based services. Apart from their cost-effectiveness, community-based services facilitate, inter alia, the drug user’s possibility of retaining employment, thereby sustaining the livelihood of dependants within his or her family structure.

    Clients utilising Drug Community Services are generally self-referred or referred by peers. Family Services

    Sedqa’s Family Services constitute another cornerstone of its community-based drug service delivery. The aim of the Family Services is to assess, support and offer therapy to families having a complexity of needs emerging from drug abuse. While all the service delivery units of the Agency maintain links with relatives or significant others of clients in care, families needing specialised or long-term interventions are referred to the Family Team. Home visits, support, counselling and group psychotherapy are provided. Families are also encouraged to participate in parallel to the therapeutic process of the drug/alcohol dependent.

    Out-Patient Drugs Detoxification

    One of the longest-standing services in the drug sector in Malta, the Detox Out-Patient Centre aims at attracting and assessing drug abusers and to provide medical, social and psychological treatment to a diversity of clients. Medical treatment is given to drug dependents on a drop-in basis or by appointment. Patients are detoxified and stabilised by pharmacological treatment while withdrawal symptoms are managed by substitute therapy. Physical complications are concurrently addressed. In addition, clients are offered social support, and support counselling. They are motivated and assisted to proceed to further treatment and rehabilitation in other therapeutic programmes.

    The above diagrams highlight the contention of a consistent, rapid growth in this sector. This marked population expansion is evident both on a short-term basis and on a more longitudinal time frame. Detox Outpatient records attest that in 1996 the total number of Detox Outpatient Centre attendees reached 3561, implying an average monthly frequency of 297 attendees. These observations attest that the total attendee population at the Detox Out-patient Centre in 1996 recorded a 65% increase over the previous year. In 1995, a total frequency of 2154 attendees was recorded, accounting for a monthly average frequency of 180 attendees per month.

    The available records also divulge that the average number of known detox outpatient attendees increased from 156 attendees per month in 1995 to 253 attendees per month in 1996; an increment of 62% or 97 attendees in real terms. This attendee frequency takes into account re-occurring patterns of individual client contact. Thus, it is important to note that the volume of attendees being referred to cannot be equated with the number of individual clients in contact with the Detox Outpatient Centre. Separate records are, in fact, maintained for each client on a regular basis. These attest that the number of individual clients increased from 505 clients in 1995 to 635 clients in 1996, implying an increment of 25.7%. Collectively, these observations provide compelling evidence for the precept of an invariable and conspicuous increase in the number of clients attending the Detox Outpatient Centre at St. Luke’s. The following factors may be forwarded as potential explanations for this marked, emphatic increase:

    The regional distribution trends for detox clients remains focused around the inner harbour region, particularly Valletta and Cospicua and other strongly urbanised residential areas such as Qormi, B’Kara and Mosta and Naxxar. Also indicative is the strong concentration of this client group in the Gzira-Sliema-St Julians region.
    In-Patient Drugs Detoxification

    Detox in-patient programmes are largely intended for the provision of a controlled, residential environment for the detoxification process; thereby aiming to monitor symptomatic behaviour and to act as an antecedent to the rehabilitation process. While being treated for withdrawal symptoms, patients are provided the appropriate psychological support. They are also motivated and assisted to proceed to the next stages of treatment and rehabilitation.

    190 substance abusers were admitted to the Detox In-patient centre at Dar Impenn throughout 1996. This implies an increment of 29 admissions over the previous year, where 161 admissions were recorded. Moreover, 101 clients successful completed their detoxification programme in 1996, recording an increase of 40 clients over the previous year. In 1995, 61 clients managed to successfully complete their detoxification programme. In-patient detox records also attest that the programme splitee rate increased from 52 cases in 1995 to 73 cases in 1996. This may be expected given the significant increase in the number of clients following in-patient detox programmes last year. 

    The higher admission and success rates, particularly in the latter half of 1996, may be attributed to the introduction of the Naltrexone-based ROD (Rapid Opiate Detoxification) treatment regime introduced at Dar Impenn in mid-June 1996. Between July to September 1996, for example, there were 15 splitees compared to 20 cases in the previous quarter. Moreover, in the third quarter 1996, 35 clients completed the detoxification process, denoting an increment of 106% (18 more clients in real terms) over the preceding term.

    A strong proportion of clients at Dar Impenn, pertain to the 20-24 and 25-29 age groups, denoting a prevalence of habitual use and high dependency rates amongst relatively low age population categories. No significant variations were registered over the time frame under consideration in the gender distribution of this cohort, with the residents at Dar Impenn remaining a predominantly male client group. Follow-up services are an essential part of the successful outcome of inpatient detoxification programmes. In 1996, 50% (51 clients) of the total number of clients completing detoxification programmes were referred to therapeutic, residential centres. Other referrals were made to, inter alia, sedqa’s community services, and Mt. Carmel Hospital. In 1995 a higher proportion of referrals (82%, 50 clients in real terms) were made to therapeutic communities. These changes in referral patterns are indicative of the growing importance of community-based oriented services that are continuously widening the range of their target population.
    Drugs Community Based Rehabilitation Programme

    This is a rehabilitative programme intended to provide individual support and to ensure the community re-integration of clients completing physical detoxification and who have support from their immediate environment. Clients are assisted in preventing relapse. The programme caters for regular individual and group counselling, social activities and after-care sessions. Families are also strongly involved in the programme’s therapeutic process.

    It is clear, that in spite of its recent formal introduction in October 1996, this service is providing active support to detoxified clients. A total of 37 clients were following community-based follow up early this year. Also indicative is the high retention rate (73%) of the programme and the diversification of the referral process.

    Drugs Residential Rehabilitation Programme - Komunità Santa Marija

    Komunita’ Sta Marija is a residential centre that provides a therapeutic, rehabilitative environment for motivated drug abusers. The centre provides opportunities for behaviour modification and stresses the necessity of the re-integrative process of residential treatment. It comprises two main units; the Merhba (Orientation) Unit and the Formazzjoni Unit. The centre also includes a re-entry unit that is aimed at facilitating the community re-integration process. In the re-entry process, courses are provided in various skills to cope with every day living. Assistance is given to solve any pending employment, housing, legal, family and inter-relational problems.  

    The average number of clients at the Merhba at Sta. Marija increased from an average of 8 clients per month in 1995 to 10.5 clients per month in 1996; thereby registering a 31.5% increase over these last two years. Particularly notable is the marked upward shift registered in September 1996 which recorded a modal frequency of 14 clients. This high frequency rate was also maintained throughout the last quarter of 1996.  

    Comparative analysis of programme status records for the Merhba Unit also denote upward shifts in the number of new admissions and programme completions. New admissions increased to 59 in 1996 from 35 in 1995. A total of 22 residents completed the Merhba programme in 1996, registering a marginal, yet, significant increase over 1995 where 20 residents completed the Merhba phase of the Sta Marija residential programme.  

    Similar trends may be observed at the Formazzjoni Unit. Admission frequency at this unit increased by 23.5% (7 more clients in real terms) in 1996 over the pervious year. Equally notable is the increase registered in the average number clients remaining in the programme. In 1996 a monthly average of 8.2 clients was recorded, with the fourth October to December quarter registering a modal average score of 12 clients per month. On the other hand, in 1995, the average number of clients in the Formazzjoni Unit totalled 7.1 clients per month. Over these last two years therefore, the average number of clients remaining in the Formazzjoni programme has registered a significant 15.5% increase.  

    These shifts are clearly indicative of the positive impact of recent staff consolidation efforts at Sta. Marija. The introduction of ROD treatment at In-patient level and its adequacy as a symptomatic treatment tool has also contributed to the significantly higher retention rate registered throughout recent months at Sta. Marija. Other important developments in this area have included the introduction of a lower threshold approach and the restructuring of the Merhba and Formazzjoni units.

    A strong proportion of clients following residential treatment denote strong representation of the 20-24 and 25-29 age groups. However, one may also observe, particularly in the last quarter of 1996, that the number of clients pertaining to the 14-19 cohort appears to be gaining momentum. The client population at Sta. Marija has remained an essentially male client group. One may note however, that a relatively higher number of female clients were admitted to the Merhba programme between November and December 1996. Over this bi-monthly period female client admissions accounted for 21% (6 clients in real terms) of the total admission frequency.
    Youth Programme - Spark

    Spark is intended to provide alternative experiences to young persons denoting symptoms of drug/alcohol related problems. It is mainly a socio-educative programme that is preceded by a series of preparatory sessions on individual and group basis.

    Preparations were undertaken in 1996 for the development of a secondary prevention programme for high-risk, male adolescents . The setting up of the programme included a seminar-based workshop for professionals held on 16 November 1996. The seminar, aimed at creating awareness amongst professionals on secondary prevention issues, was very well attended and was characterised by a highly-charged and animated debate amongst those present. These included members of parliament and the judiciary, magistrates, social workers, probation officers and high-ranking police officials. The various points of discussion raised throughout this seminar proved fruitful for programme formulation efforts. This programme-building exercise culminated in the official launching of the piloting phases of the Spark programme in January 1997.

    Support Services to CCF

    Inmates with drug and/or alcohol related problems who are resident at the Substance Abuse Therapeutic Unit (SATU) are provided with individual counselling, group therapy, social skills, health care, occupational activities, and adult education sessions by sedqa staff. The Agency accepts referrals to its own alcohol and drug services. More recently, sedqa also came into an agreement with the prison authorities to offer similar support to YOURS (Youthful Offenders Unit for Rehabilitative Services). This unit was specifically set up to offer a segregated, therapeutic environment for young prison inmates.

    At November 1996, a total number of 14 inmates (circa 6% of the total prison population) were following on-going rehabilitation at the Malta prisons. The consistency in the number of inmates following SATU programmes is primarily due to a low drop-out rate, indicating positive client motivation and the assimilation of normative behavioural patterns. The efficacy of the multi-disciplinary therapeutic team at the SATU is certainly another key consideration in this regard.

    Alcohol Care Services

    Sedqa’s Alcohol Care Services, based at Dar Zerniq, aim to attract and respond to the needs of alcohol abusers and their families by providing support at community levels. Observations in this section shall be categorised in terms of the diverse groups in contact with sedqa’s Alcohol Community Services.

    Alcohol Community-Based Day Rehabilitation Programme

    This programme caters for the social, psychological and emotional needs of clients and co-clients. Day participants are offered group and individual support. Group psychotherapy is provided to problem drinkers, their relatives and significant others. Clients also benefit from occupational and social activities and follow-up and aftercare sessions.

    The total number of new clients reported to have been in contact with the alcohol community-based day residential programme in 1996 fell to 115 clients from 131 clients in 1995. This denotes that the number of new clients is characterised by a declining trend if one takes into consideration a longitudinal time frame. These data contrast with incidence trends for the number of known clients attempting to re-establish contact with the alcohol community-based Day Rehabilitation Programme. Data records attest that these increased to 192 clients in 1996, from 120 clients in 1995; therefore implying an increment of 60%. Although higher frequency scores are becoming more pronounced for the younger age groups, the age distribution of the day ACS client population is strongly concentrated within adult, middle-aged groupings. Significant observations may also be made when taking into account the gender distribution of new day clients at Dar Zerniq between 1995 and 1996. In 1996, the female cohort accounted for 30% (40 clients in real terms) of the total number of new day clients. This indicates a significant increase over the previous year, where 23% (27 clients in real terms) of the total new day client population were women.

    One may also observe analogous trends with regard to the gender distribution of known clients in contact with the Alcohol Community Day Residential Services. The female client cohort accounted for 36.5% (70 clients in real terms) of the total number of known clients in 1996; implying a significant increment over 1995, where 27.5% (33 clients in real terms) of the total known day population were women.

    In 1996, a total of 682 sessions were effected at Dar Zerniq. This denotes an increment of 250 sessions over 1995, where a frequency rate of 432 sessions was recorded. The rationale of sedqa’s Alcohol Care Services at Dar Zerniq emphasises the role of the partner/spouse and family of the abuser in the rehabilitative process. This modus operandi is clearly reflected in the data. One may observe, for example, that throughout 1996 greater emphasis was made on sessions involving both the client and his or her partner. This type of sessions accounts for 12% of the total number of sessions effected throughout 1996. This denotes a marginal, albeit significant increase over 1995, where client and partner sessions accounted for 10% of the total number of sessions. Groups and individual-based sessions continue to account for the major proportion of sessions at sedqa’s Alcohol Care Services.

    Records for the type of sessions conducted over 1996 indicate that a strong emphasis is placed on support counselling, which remains the ACS’s prevalent treatment strategy. Dar Zerniq also continues to be the major base for ACS operations, although one may note a significant increase in the number of sessions carried out at Mt. Carmel Hospital throughout 1996.

    Alcohol Residential Rehabilitation Programme

    This programme provides a stabilisation period to clients with severe dependency problems. The duration of stay is adapted to the client’s individual needs. Residents also benefit from the therapeutic programme offered to clients within the day programme.

    Sedqa records register a significant decrement in the number of clients following residential treatment between 1995 and 1996. Throughout 1995, 11.75 clients per month were following residential treatment for alcoholic dependency. This contrasts with the monthly average of 8 residents per month recorded in 1996. An evaluation study effected this year assessing operational and policy issues related to sedqa’s alcohol residential programme, has however, heightened encouraging treatment outcome results and a low relapse. The following table extracted from this evaluation study examines the impact of the alcohol residential rehabilitation programme on twelve former participants of the residential programme. It is clear that such factors must be borne in mind when attempting to interpret such data.  

    Type of Client
    No impact
    Don’t know/no answer
    Preventing relapse
    Leading an alcohol- free life
    Leading a structured life
    Developing occupational skills
    Exlporing self
    Acquiring positive values
    Learning academic subjects
    Relating better with others
    Improving lifestyle
    Leading a healthier life
    Integrating better in society

    Since its inception, sedqa has given priority to the training and personal development of its employees. It believes that human resources play a very important role in ensuring a quality service. Driven by this conviction, sedqa’s Training Department has developed training courses tailored to suit the client’s needs and sponsored employees to participate in other training activities on the Island and abroad.
    Funding our research and training activities

    So as not to rely solely and wholly upon Government funds sedqa is always on the lookout to tap funds which may help it to fulfil its training needs. Funds through the Council of Europe have been made available for employees to utilise for their training abroad.

    Training Policy

    An official Training Policy has been drafted and approved by the Agency’s management team during 1996. The aim of the policy is to establish guidelines for the Training Department, the Management and course participants. These guidelines ensure equitable distribution of training opportunities between employees.

    Induction Training

    All new employees undergo an induction course before they start off on their job. The aim of induction training is to introduce recruits to all staff and explain to them the objectives of their respective unit and of all the other units within the Agency. Detailed descriptions of unit functions, client profiling systems, symptoms of misuse, the nature of the Agency’s therapeutic interventions, procedures and staff roles are also given.  

    Intermediate Course in Carework

    Following the positive outcome of the first "Intermediate Course for Careworkers" effected in 1995; last year the training department organised a more specialised and intensive course for careworkers. The course consisted of a series of formal lectures by experts in different fields, a placement and a number of tutorials addressing the personal needs of each participant. Together with the pool of sedqa’s careworkers, two participants from other agencies in the field were invited for this training programme. 

    Student Placements

    Sedqa has built a reputation for offering useful and worthwhile placements for University students pursuing a career in the welfare professions. Throughout the last academic year the Agency provided placements for students from the Institute of Social Work, the Psychology Department, the Institute of Health Care and the Institute of Youth Studies. During these placements students worked closely with their field supervisors and key workers in the different units of the Agency. In 1996 sedqa also hosted three students from Germany and two from Romania.

    Placements at "Comunita Incontro"

    All careworkers at the Agency’s "Komunita’ Santa Marija" participated in a two week placement at one of the Comunita Incontro centres in Sicily. As the Agency’s drug residential programme is also inspired by Don Pierino Gelmini’s Comunita Incontro rationale, our careworkers require were given the opportunity to acquire experience in these communities. Last year the Agency’s unit leaders also participated in a leadership course in another community in Italy.

    Outreach Skills

    Four community workers from the Drugs Community Team were sponsored on placement in the United Kingdom. The APA Project at Tower Hamlets, Druglink in Wakefield and Phoenix House in Sheffield provided a valuable setting for learning outreach skills. Each participant was closely supervised by experienced personnel from the organisations with which the placement was organised.  

    Skills Training Course for Correctional Officers

    An inter/intrapersonal skills course was organised for correctional officers based at the Substance Abuse Therapeutic Unit within the Corradino Correctional Facility. Correctional officers from other divisions of the prison were also invited for this course. This training programme complimented other training initiatives undertaken as part of the prison reform which heightens the importance of correctional officers in the rehabilitative process of prison inmates.  

    Advanced Regional Seminar by DEA

    Building upon the success of a similar course held in 1995; Malta hosted another, more advanced DEA seminar last year. Twelve local participants and eighteen foreign nationals from diverse Mediterranean countries attended this advanced regional seminar. The seminar had two primary aims; one was to disseminate knowledge acquired in the USA amongst colleagues in the Euro-Mediterranean region, and, secondly, to facilitate networking between key professionals in the area.

    Community Service Scheme

    Five students coming from the Psychology Department and the Institute of Social Welfare spent their summer work phase with the Agency. While helping with administrative duties, the students were given the opportunity to observe our professionals whilst carrying out their duties.  

    Postgraduate Diplomas and Degrees

    The Agency has always encouraged advanced education for its employees. Two employees were sponsored for further training this year. A Social Worker from the Drugs Community Services is currently undergoing a Diploma in Substance Misuse with University of East Anglia and a placement with Lifespan in Cambridge. A Psychology graduate is also in UK pursuing a one-year, full time course leading to an MA degree in Counselling Psychology. Throughout 1995/96, the Agency also sponsored a medical officer to undergo further studies in the addictions area. The candidate successfully completed an MSc programme in Addictive Behaviour at St.George’s Hospital Medical School, London, UK. This course of studies included the presentation of a dissertation entitled "Prevalence of Childhood Sexual Abuse in Maltese Substance Abusers attending Services".  

    Training in First Aid

    With the collaboration of the Malta Red Cross Society a basic course in First Aid has been implemented. Fourteen members of staff from various units and departments within the Agency received instruction on first aid in case of injury or at work.  

    Telephone Helping Skills

    Community workers from the Drugs Community Services, Alcohol Community Services and Dar Impenn have received training on how to render an effective service to our clients over the telephone. This skill-based course has helped the workers to respond better to those using this service and to manage abusive or phoney calls. The participants also proposed innovative measures to ensure smooth referral.


    Administration back up had to face considerable challenges particularly because of the growing needs of an expanding organisation handling major structural projects without increasing personnel in this section. The major projects were the setting up of the National Centre for Prevention at Sta. Venera. This focal point houses the Prevention Team and has conference facilities for meetings. This premises was connected to Dar Gubbio, which houses the Drug Community Services and thereon benefiting from economies of scale. The Centre was officially inaugurated on 27 August 1996 by the then Prime Minister, the Hon. Dr. Edward Fenech Adami. During July, the then leader of opposition and present Prime Minister, the Hon. Dr. Alfred Sant, toured sedqa’s facilities. Other major projects included the refurbishing of the training centre at Luqa. This facility provides sleeping quarters for 30 people, and a dining and group work area. Peer Leadership Training is conducted during the weekends thus sparing the costs of hiring an alternative venue.  

    The previous St. Mary Hospital which currently houses the Komunita’ Sta. Marija Drug Rehabilitation Service, was given a thorough facelift with new bathroom facilities, an extension of the existing kitchen and a landscaping project. The I.T. section started giving limited support to PC users at the Agency. It is envisaged that this function will increase in importance during 1997 by better hardware and software maintenance and installation and staff training. During 1996, sedqa continued its investment in I.T. hardware. In fact LM18000 were invested in information technology during the foregoing year.


    Financial control procedures adopted by the Agency during the past two years were consolidated this year with the implementation of a cost centre financial analysis and monitoring of eventual variances. This has permitted the Agency to adopt a degree of decentralisation, whereby unit coordinators are managing their own budgets resulting in increased efficiency, cost effectiveness and awareness.  

    Financial controls have also been strengthened with the commissioning of a report entitled "A Comparative Report on Service Costs and Utilisation". Although some reference to the salient aspects of this report has been made elsewhere, it is worth re-emphasising that Komunita’ Sta. Marija, Dar Impenn and - have all registered a considerable drop in unit cost as compared to 1993. This encourages management even further to continue to strive for more cost awareness across the Agency and will update the report commissioned this year annually.  

    The Agency’s main source of funding takes the form of a government grant, which in 1996 amounted to Lm 720,000. The recurrent expenditure for 1996, totalling Lm700,000 was apportioned in the following manner:


    Staff Development  

    During 1996 sedqa continued with its recruitment programme putting emphasis on qualified personnel. Out of a total compliment of 92 full and part timers, 53 have at least a diploma or first degree, and 6 have at least a Master’s degree. All the other staff have been trained for the role that they fulfill. The limiting factor remains the shortage of qualified personnel, particularly, social workers. However in a space of two and a half years, sedqa managed to put together a professional, multi-disciplinary team that ensures that our clients are provided with a holistic service. The following pie chart denotes the diverse qualifications of sedqa’s staff.

    a = Psychiatry, Psychology, Sociology, Forensic & Human Resources;     b = Medicine;  
    c = Nursing;     d = Counselling;     e = Pedagogy;      g = Accounting;     h = Communications; 
    i = Care Work and Unit Leaders;     j = Community Work & OT;     k = Secretarial;  
    l = Research;     m = Prevention Clerical;     n = Administration Clerical;     o = Industrial 
    Since its inception the Agency has provided four bursaries leading to Masters degrees or their equivalent. This trend shall continue in the years to come to ensure that these services are sustained by professional practice. It is planned that during 1997 an employee appraisal system will be introduced. This should assist management in its future manpower planning and career development.
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