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JOACHIM KöERKEL

Germany,

Joachim Körkel ermöglicht drogenabhängigen Menschen einen selbstbestimmten Weg aus der Sucht, indem er sie zur eigenverantwortlichen Senkung ihres Drogenkonsums ermutigt.

This profile below was prepared when Joachim Körkel was elected to the Ashoka Fellowship in 2009.

INTRODUCTION

Joachim, a trained psychologist who has been working in the field of rehabilitation for 20 years, is finding solutions for drug abusers to lead a self-disciplined life. While leading an alcohol detoxification center early in his career, Joachim found that immediate and total withdrawal created too high of a barrier for many addicts. He therefore began KISS, a program that lowers barriers to entry for rehabilitation, emphasizes positive personal motivations for change, and has proven effective in guiding drug users towards self-controlled lives, and ultimately, to abstinence. KISS is now active in two major German cities (Frankfurt and Hamburg) and is starting to spread to Austria and Switzerland.




THE NEW IDEA

Equipped with insights into the strengths and weaknesses of alcohol reduction programs that he has put into action in Germany since 1999, Joachim launched the KISS program in 2005. KISS is a behavioral self-control program with the goal of enabling people with multiple uses of illegal and legal drugs to reduce their drug intake step by step. KISS consists of two individual assessment sessions and 12 weekly group or individual sessions conducted by one or two KISS trainers. Within the program future drug addicts learn to monitor and record their drug intake day after day in a consumption diary, to set weekly consumption goals, to use individualized reduction strategies, to cope with high-risk situations and lapses/relapses. Besides the consumption diary KISS participants receive working and information sheets to support the learning process.

Throughout the KISS program and in accordance with KISS’s spirit of self-determination of program participants is appreciated and strengthened and people are welcome to participate irrespective of the severity of their drug problem (misuse, dependency), the kind and number of substance(s) they want to tackle and the speed of change they choose.

In the run-up to KISS, potential clients are contacted in informal cafés of drug treatment centers, safe injection rooms, accommodation centers for the homeless, or counseling centers. In conversations that respect self-determination and avoid resistance (“Don’t tell me what I have to do!”) intrinsic motivation for change is set free by use of the diverse methods of “Motivational Interviewing” (Miller & Rollnick, 2002). Driven by their own motivation, addicts then work within the KISS program to reduce their consumption and regain control of their lives.

In a scientific study with random allocation of skid row drug addicts to a KISS group or a waiting-list control group (WL) the effectiveness of KISS could be demonstrated: During the 4 months of KISS treatment there were nearly no drop-outs (10 percent). At end of treatment KISS participants had reduced their total drug intake by 30 percent (WL: 4 percent), raised the number of abstinent days by 19 percent (WL: 3 percent) and spent 36 percent less money (-244 Euro) for drugs (WL: 3 percent) than at the beginning of the study. Beyond that only 12 percent of KISS participants but 24 percent of WL needed costly inpatient detoxification treatment. In a 6-month follow-up all program effects persisted and a remarkable number of participants had moved to abstinence from one or another substance (e.g. 13 percent from heroin, 17 percent from cocaine, and 28 percent from tranquilizers). In sum KISS helps drug addicts to reduce their drug intake and to save drug related expenditures. For society this means a cut in treatment costs, drug-related crime, and prostitution.




THE PROBLEM

Substance abuse and addiction is a major medical, social, and economical problem in Germany, as in the wider European Union. Nearly 20 percent of Germans consume amounts of alcohol that are risky or harmful to the individual and society, and 8 percent have a serious alcohol problem. However, only 5 percent of alcoholic dependent adults actually seek professional abstinence-oriented help to overcome their addiction.

In addition to alcohol abuse, drug abuse is another significant problem in Germany. Roughly 6 percent of the German population consume illegal drugs (cannabis: 2.4 million; other illegal drugs: 0.65 million). About 175,000 of the adult population are addicted to heroin or crack cocaine/cocaine powder. The consumption of these drugs is mostly combined with other drugs, like tranquilizers, cannabis, alcohol, and tobacco (i.e. mean number of drugs consumed by German skid row drug addicts: 5.3). The overwhelming majority of these polydrug users are not able and/or not willing to live completely drug free. In contrast to that reality medical programs (e.g. methadone maintenance therapy) and drug rehabilitation programs require complete abstinence from all illegal and legal substances (excluding tobacco). As a consequence of this “abstinence fundamentalism” most drug consumers do not enter treatment or do not strive for abstinence within treatment—or are dismissed from treatment when actual substance use is detected.

So a central problem in the German drug treatment system is a lack of programs that give professional support if a drug misuser/addict is willing to cut down substance use but not willing to live totally abstinent from all drugs. To fill this gap Joachim developed the program KISS.




THE STRATEGY

Joachim’s approach to address drug-use problems in Germany includes empowering drug addicts to cut down their substance use (in the form of the KISS program), training health care staff to apply the KISS program, and obtaining the financial support of health insurance companies and communities, as well as the political and public support of treatment facilities, politicians, and the media.

A close partnership could already be established with some cities and large low threshold treatment centers. The most important partner in this respect is the Integrative Drogenhilfe Frankfurt on the Main which runs several harm reduction facilities (i.e. safe injection rooms, accommodations for homeless drug addicts, counseling, work programs, substitution treatment, and others). Joachim and his team implemented KISS in these facilities so that drug addicts can diminish their drug intake whenever they feel uncomfortable with their actual drug use.

Joachim was able to widen the reach of his program through Quest Academy, a specialized training institution for social workers, psychologists, physicians, and therapists. Joachim built up the Quest Academy together with two other colleges. He is its senior advisor and develops training curricula, materials for trainers (assessment and training manuals) and clients (i.e. self-help manuals, consumption diaries and so on), and material for public relations (i.e. homepage, interactive drug consumption self-tests, flyers, and posters). The Quest Academy is a financially sustainable way of providing the core training needed to learn his KISS approach. In a 7 days training future KISS trainers acquire the necessary knowledge and skills to administer the manual-guided KISS program. So far, more than 350 addiction treatment providers from Austria, Germany, and Switzerland have been educated as KISS trainers. Joachim focuses more and more on the broad implementation of KISS, the refinement of its methods, and the adaptation of his program to other groups of addicts. In addition to the outreach at harm reduction centers, Joachim works with the media to disseminate his ideas and programs.




THE PERSON

Joachim finished his studies in psychology and sport science at the University of Heidelberg with a PhD in psychology. Afterwards he concentrated on clinical psychology and finished two therapeutic apprenticeships (i.e. Behavior Therapy and Gestalt Therapy). Since 1984 he has been working in the field of substance abuse treatment and research, beginning as head of the department of psychotherapy of an alcoholism rehabilitation center (1984 to 1988).

There, as in most German rehabilitation centers, patients relapsing during treatment were dismissed under the assumption that they did not really want to live abstinent. Joachim questioned this stereotype and introduced an alternative conceptualization of relapse where drinking behavior is regarded as an attempt to cope with difficult life situations. As a consequence, relapsing patients were no longer dismissed from treatment but received special treatment elements for relapse analysis and learned of new coping mechanisms.

Recognizing that changing the field requires the credibility of academic research, Joachim accepted a professorship in psychology in 1988 at the Lutheran University of Applied Sciences, Nuremberg. He conducted several studies where he could demonstrate that self-controlled substance reduction can be a successful response to overcoming addiction not only in theory, but also in practice. Since 1999 he has developed programs for controlled drinking and together with the Quest Academy more than 500 professionals have been trained as trainers for controlled drinking. Besides his lecturing responsibilities Joachim has written several books and manuals for alcohol relapse prevention.

Although much of his work as a professor is related to the KISS program, Joachim feels that concentrating full-time on KISS will bring his work to a new level, allowing him to change paradigms and broaden the treatment approaches in the addictions field.




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