FIVE months after Michael’s death the cigarette burns are still on the arm of his mother’s sofa – constant reminders of a tragedy.
As his mother, 49-year-old Janet Paraskeva, mourns a son gone forever, she is also trying to cope with the debts of 60,000 euros she spent trying to keep him alive.
The day I interview her, she sits where her son always sat, nervously picking at the holes he made. “This is where Michael used to sleep during the day, he spent a lot of time just lying here and made the burns mark when he dropped a cigarette,” she says.
When Michael died of an overdose last October aged 20, Janet had spent more than two years fruitlessly seeking cure after cure – both government supported and private – to try and wean him off drugs.
His life ended, as such lives far too often do, with a spell in prison after he was caught stealing money to feed his addiction.
A mere two weeks after his release, he was dead: his body overloaded with a lethal combination of subscription and illegal drugs – Rohypnol, Prozac, Valium and heroin
A framed photograph of Michael standing on a table and set apart is the first thing you notice as you enter Janet’s house. He was a good-looking young man, and the image now sits in pride of place, dominating the family in death as he did in life.
Janet is not only bereft but also very, very bitter. For each time she asks herself what more she could have done to save her son, she asks the same of the medical authorities.
“Michael wanted to stop but couldn’t without professional help.
Everything we tried would only really work if proper support was there after he had treatment, and that’s not available here in Cyprus,” she says. “There has to be a place where these young people can go and be held long term in a secure, safe, and caring atmosphere until they can kick the habit, then have professional back up when they leave.
“The doctors, psychiatrists and psychologists seem to have no concept of the horrors families go through trying to live with an addict, that’s what we are forced to do unless the addict volunteers to be treated. Then the doctors prescribe strong medication, the addict is not strictly supervised and takes these along with illegal drugs. It becomes a vicious circle where no one can have any control over the situation.”
While programmes are in place to treat straight-forward drug addicts, it is far, far harder to treat addicts who also suffer from underlying psychiatric problems, which some of Michael’s doctors insisted he had.
This combination is known as dual diagnosis, and in Cyprus only the Athalassa mental institute is supposedly equipped to deal with these cases.
Aside from the paucity of this level of care, to this day Michael’s family is unclear whether a dual diagnosis was correct in his case.
Some specialists said yes, others no.
All his mother knows is that at 13, Michael was a popular, outgoing boy. After 14, when he secretly started smoking marijuana, he became increasingly withdrawn. He was 16 when Janet found out and tried talking to him.
“All he would say was that there was a problem with his brain and wanted to see a doctor,” says Janet. “Looking back I think this was just an excuse to get onto some medication, but I was ignorant then so we went to see a psychiatrist.”
Michael had a brain scan which showed some disturbances but that was put down to over use of drugs. At 17 he went into the army and the family hoped that the regime would help.
“He lasted two weeks before being released as he had become increasingly agoraphobic,” she says. The psychiatrist then put him on anti-depressants, but the family couldn’t afford to keep paying the 30 pounds (51 euros) twice a week to send him there. In any case, after six months of treatment, the family made a depressing discovery. Michael had moved on to taking cocaine and then heroin. And with this the outbreaks of physical violence started.
Janet became scared of leaving him at home with her two other sons and two daughters while she went to work.
“Every time I left for work, I felt I was sitting on fire all the time. One night he threw the television across the room, so I was forced to call the police. When the officers arrived they warned me that if I filed a complaint my son would have to go to court, but they did suggest a clinic in Limassol to go to.”
He was accepted at the clinic as a voluntary patient. The treatment was free, but he lasted just five days. Janet then heard of a place in England which offered promising results for addicts, so with money borrowed from relatives she went there to see if they would take Michael, but they wouldn’t take him until he was clear of prescription drugs. To do that she put Michael into another local clinic to enrol in a week’s detoxification programme at a cost of one thousand pounds.
With that he was also promised three months post-psychological support. “But this wasn’t a secure clinic. He had his mobile phone with him so he just dialled up his friend’s numbers and they delivered drugs to him. He was buying heroin while he was being treated.”
One night he was so ill from mixing his drugs he had to be rushed from the clinic to the general hospital for treatment. A few days later the doctor in charge recommended he should be admitted to the Athalassa mental institute in Nicosia.
“After he was admitted I phoned to speak to him, but was told he wasn’t available. Eventually my husband visited and found Michael in a terrible state. He had had some sort of spasm and had bitten his tongue, and it had swelled so much it was ballooning out of his mouth.
“We immediately took him out of there and for six weeks his tongue was black with an infection. After that experience Michael was always terrified of ever returning and would shake with fear if we ever mentioned the word Athalassa.”
Despite her son’s previous diagnoses, Janet insists that the staff there told the family Michael didn’t have the psychological problems associated with dual diagnosis, and “he was just an addict”. The director of Mental Health Services has so far refused to answer questions put in writing (at their request) by the Sunday Mail on this crucial aspect of Michael’s care.
At Athalassa’s suggestion, the family says, they then tried another private treatment for Michael: the Weizmann detoxification programme in Israel. Once again, the family borrowed money.
“We came back after ten days, but as there was no place for him to go to get counselling or aftercare therapy, he was once again at home with nothing to do and started taking drugs again.”
The family tried getting him into the church-run Ayia Skevi centre in Limassol which offers free treatment for Cypriots but, unlike Athalassa, they said he did indeed have underlying psychiatric problems and they couldn’t accept addicts with dual diagnosis. “Even when I told them that most addicts do have psychological problems if they are on cocaine, heroin and prescription drugs they still didn’t accept him,” says Janet.
Appeals to the Anti-Drug Association and a drug help charity also failed, says Janet.
By then time was rapidly running out for Michael.
A clinic in Limassol had put him on a new drug called Subutex which prevents withdrawal symptoms by stimulating the opiate receptors in the brain and so reduces the desire to take drugs such as heroin and methadone. “This was to be our breakthrough drug, one Michael was taking every day. We dared to hope,” says Janet.
But his past was catching up with him. Like so many addicts, Michael stole to pay for his addiction. “He had stolen from everyone in the family. The only jewellery I have left is the necklace around my neck,” says Janet.
When family ‘funds’ ran out, he turned to crime. In 2008, Michael was arrested following a break in at a shop. His court case came up just after he had started taking Subutex. The judge sentenced him to seven months in jail of which he served three.
According to the family, not only did the prison fail to oversee his taking of the prescription drug, but they also insist that while he was prison Michael had easy access to a ready supply of heroin every three days.
A mere two weeks after Michael’s release from prison, he was dead. By the time he died he was taking more than 20 Rohypnol a day plus Prozac, Valium and heroin.
Shortly before his death, Michael had told his mother: “Better if I died so I won’t be any more trouble to you.”
“Yes, I feel betrayed by the so-called system that’s supposed to be able to help people like my son. I have debts of over 60,000 euros all spent in an effort to get professional help to try and keep my son alive,” says Janet.
“No one seems able or even willing to accept that there is a huge problem in this country. Mothers like me are having to go through this hell on their own. Where is the psychological support, the aftercare service? More importantly, where are the trained professionals who know about and understand addiction who can set up places for these young people to go to, places that don’t cost a fortune?
“I now have to live with myself wondering what else I could have done, where else we could have gone. His sisters mourn, his brothers mourn, and we all feel that in the end we failed him.”
The addicts that fall through the cracks
By Alexia Saoulli
DRUG addicts with underlying psychiatric problems, or dual diagnosis, are falling through the net because there are limited services and programmes to help them.
Michael Paraskeva, 20, died from an overdose last year despite his family’s relentless efforts to find the right treatment for their son.
Although specialists disagreed over whether dual diagnosis was an accurate description of Michael’s condition, much of the treatment he was offered, or perhaps more accurately, refused, was based on that assumption.
Addicts with severe psychiatric problems often have nowhere else to go but to Nicosia’s psychiatric hospital in Athalassa, the Anti-drugs Council admits.
“There are few facilities that deal with psychiatric problems. All drug users have some form of psychiatric problem, but there are some severe cases where no place other than Athalassa is equipped to deal with them,” said Eva Symeonidou, officer of the Executive Secretarial at the Anti-drugs Council.
“Sometimes the ones who end up at Athalassa do so because the primary problem is not their addiction but their psychiatric problem which needs to be dealt with first and then the addiction. These drug users are usually identified by a psychiatrist,” she said.
The problem is further hindered by the fact that the Health Ministry refuses to send patients for treatment abroad because of available services on the island. Patients are normally only sent abroad if there is no available treatment in Cyprus.
But, according to the Council, apart from these cases of dual diagnosis, there is a good system in Cyprus for drug users which has been evaluated by German experts both involving the public and private sectors.
Another drug treatment expert added: “Unfortunately another factor that is important is the will to get better. Sometimes drug users are forced into treatment by their families or the courts but they have to want to be here for the programmes – which are often very intense – to work.”
“There is a complete treatment continuum here,” said Symeonidou.
Ayia Skevi is one of the top clinics offering inpatient care for drug addicts, and one of the clinics Michael’s family says was unwilling to help him due to his double diagnosis.
“The psychiatric problem could be the reason [the addict] uses each time,” said a spokeswoman from Ayia Skepi.
“It depends on the nature of the psychiatric problem a drug user has if we can take them into our community. Is it depression, anxiety, personality disorders? Can they live in the community taking the right medication from an external psychiatrist? In some cases the patient has such severe problems that they can’t be kept in an inpatient environment and can’t cooperate with other people, which could be detrimental to other drug users’ treatments,” she said.
“There is a scientific evaluation of the drug user before he goes to the community to determine this,” she added.
In Michael’s case the Athalassa stage of his treatment was central.
His family insists that during his time there, they were told Michael did not have underlying psychiatric problems and that “he was just an addict”.
The Sunday Mail contacted Athalassa on this very point. We were told to send a letter of permission from Michael’s family and fax our questions, which we did, including one which asked whether it was true officials had said Michael had no underlying problems. If it was, why then could Michael not be eligible for treatment at other inpatient centres? If he did have underlying problems, why did Athalassa discharge him so readily?
Athalassa has so far failed to answer these questions.
Another crucial aspect of Michael’s tragedy was his treatment whilst in prison.
Central Prisons deputy warden Eleni Vatiliotou said there was a very good programme at the prisons but that it was only on a voluntary basis.
In other words drug users had to identify themselves to the prison authorities of their own volition and undergo treatment.
“Most of them do this,” said Vatiliotou.
She said addicts were overseen by a prison psychiatrist who prescribed medication to help with their detoxification. The programme was made up of a team of psychologists, occupational therapists and psychiatric nurses, she said.
“It’s a very good team and they do a lot of good work,” she said.
“If someone has a private doctor overseeing them they can apply for permission for that doctor to visit them in prison,” she added.
Vatiliotiou said a lot of addicts improved with the help of the prison’s team but unfortunately once they were released from jail many slipped back into their old habits.
“You need a specialised centre to overcome drug addiction. We provide a sort of patch job,” she said.
Nevertheless the prisons are currently in the process of getting tenders to build a multidisciplinary unit at the prisons which would include a specialised drug unit and to deal with psychiatric patients, she added.
But no one was willing to comment on the family’s insistence that Michael had easy access to heroin during his three months there.
- A complete list of services and programmes is available from the Anti-drugs Council website. These include outpatient treatment programmes for adolescents and family, counselling centres, detoxification units, outpatient treatment programmes, inpatient treatment programmes, substitution treatment, drop-in centres, and family programmes.
www.ask.org.cy
