# Transcript: Addictive substances and their regulation

## Description

At the May breakfast, you won’t learn about the types of addictions, how they develop, or their impact on human health, because the internet and bookstores are full of that information. Instead, you’ll find out why the topic of regulating addictive substances is so complex, why it’s impossible to successfully address and solve this issue today without understanding and knowing its history. You’ll learn about the complicated relationships between different parties, their perspectives on regulation, and why prevention is so challenging. At the same time, you’ll have the chance to reflect on how much this topic does (or doesn’t) concern you and whether you can or want to (not) deal with it.



Who is Michal Miovský?



Michal Miovský is a clinical psychologist and psychotherapist. He graduated in single-subject psychology from the Faculty of Arts at Masaryk University in Brno and completed postgraduate studies at the Faculty of Arts at Palacký University in Olomouc. In 2005, he habilitated in clinical psychology at Palacký University in Olomouc, and in 2012 he was appointed professor at Charles University, also in clinical psychology. After the merger of the PK Center for Addictology and the Department for Addiction Treatment at the General University Hospital (U Apolináře), an independent Clinic of Addictology was established (January 2012), where he still serves as head of the clinic. Since 2008, he has continuously served as vice-dean of the 1st Faculty of Medicine at Charles University in Prague for non-medical study programs. From 2016 to 2018, he was president of the International Society of Addiction Journal Editors (ISAJE). In 2016, he became a founding member of the International Consortium of Universities for Drug Demand Reduction (ICUDDR), where, after the official registration of this international organization in 2017, he was elected its very first president.



Since 2021, he has served as a board member of the International Society of Substance Use Professionals (ISSUP). He is a member of the scientific council of Charles University in Prague and served as a member of the scientific council of the Czech Minister of Health from 2018 to 2022.

## Transcript

**[00:00:00]** Subtitles created by JohnyX http://johnyxcz.blogspot.com

**[00:00:30]** Good morning to everyone who came here to the Magenta Experience Center.

**[00:00:37]** Good morning to everyone watching us live.

**[00:00:41]** Welcome to another Brain & Breakfast.

**[00:00:44]** Greetings to all the libraries, companies, and schools where we are broadcasting.

**[00:00:48]** Today’s topic is very important to me, so I’m really looking forward to it.

**[00:00:55]** I want to point out at the start that for those watching live,

**[00:01:02]** a QR code will appear a few times that will take you to our newsletter,

**[00:01:11]** called Shortcut, so you don’t miss anything

**[00:01:16]** we do within the Red Button network.

**[00:01:19]** You’ll also see the beautiful Magenta Experience Center logo,

**[00:01:23]** which we thank for hosting us, and also T-Mobile.

**[00:01:29]** I want to note that the breakfasts are interactive, and always have been.

**[00:01:36]** So please, try to take your mobile phones,

**[00:01:40]** put down your breakfast and coffee for a moment.

**[00:01:45]** Enter, this time the hashtag is Brain Breakfast,

**[00:01:50]** which means go to slajdu.com, the hashtag is Brain Breakfast,

**[00:01:55]** and we’ll try the first question, which is traditional at the start.

**[00:02:03]** If this is your first breakfast, try voting for us for a moment,

**[00:02:11]** if you can get there, Brain Breakfast hashtag,

**[00:02:15]** yeah, it’s loading, I see no, no, no.

**[00:02:23]** Great, I’m very happy about that, I’m always happy,

**[00:02:27]** when there are more people who weren’t than were,

**[00:02:32]** because it means our bubble is expanding, and that’s great.

**[00:02:38]** So now I’ll welcome our guest today.

**[00:02:45]** Our guest today is Professor Michal Mijovský.

**[00:02:48]** Professor, please come join us here.

**[00:02:51]** I welcome you here.

**[00:02:52]** Good morning.

**[00:02:53]** Good morning.

**[00:02:55]** The topic will be about addictive substances,

**[00:02:59]** and we agreed with the professor

**[00:03:02]** that the first thing we’ll do is

**[00:03:06]** ask you a control question,

**[00:03:09]** which we will ideally evaluate at the end.

**[00:03:12]** The question that is already running now is

**[00:03:15]** Have you noticed the government proposal to legalize cannabis

**[00:03:20]** and other currently illegal substances?

**[00:03:24]** There are several options, from whether you completely missed it,

**[00:03:29]** to whether you have registered it in some way,

**[00:03:32]** or whether you support it or not.

**[00:03:34]** We'll do an internal poll

**[00:03:37]** and then come back to it.

**[00:03:39]** And the professor said he would refer to it a bit.

**[00:03:42]** So I'll give you the imaginary chair.

**[00:03:45]** Here it is.

**[00:03:46]** I'm looking forward to this topic.

**[00:03:48]** The chair is yours.

**[00:03:49]** Looking forward to it, thanks.

**[00:03:50]** Thank you.

**[00:03:51]** Good morning.

**[00:03:53]** I have to say, I'm pleasantly surprised,

**[00:03:55]** because when I looked at the start,

**[00:03:58]** at the hour, I thought,

**[00:04:00]** it can't be possible that someone would come this early,

**[00:04:03]** on a weekday, to a public discussion

**[00:04:06]** or to a format like this.

**[00:04:08]** So this is a big surprise for me

**[00:04:10]** and at the same time, since I didn't know the whole event at all,

**[00:04:14]** I started googling and asking around.

**[00:04:16]** And when I found out that even the city I'm from,

**[00:04:19]** has a library that cooperates,

**[00:04:21]** I was completely surprised,

**[00:04:23]** because I thought it was basically

**[00:04:25]** a local Prague affair

**[00:04:27]** and suddenly I realized it isn't

**[00:04:29]** a local Prague affair at all.

**[00:04:31]** So first of all, thank you very much for the invitation

**[00:04:33]** and the opportunity to say a few words on the topic.

**[00:04:37]** At the same time, I should probably say at the start,

**[00:04:40]** that this topic I chose today,

**[00:04:43]** is not the first time I've brought it to a public discussion,

**[00:04:46]** and the very first impulse,

**[00:04:49]** where I tried to formulate something for myself

**[00:04:52]** and maybe in some understandable form,

**[00:04:55]** hopefully for someone else,

**[00:04:57]** was TEDx in 2019.

**[00:05:00]** And back then, from some feedback,

**[00:05:04]** I had the impression that I might not have been completely clear.

**[00:05:08]** Why talk about regulation, why even talk about it,

**[00:05:12]** that this is not a topic that politicians alone could decide on,

**[00:05:17]** or that it is not just a topic

**[00:05:19]** that experts should comment on

**[00:05:21]** and based on their recommendations, politicians should then raise their hands

**[00:05:25]** and say this is how it will be, or this is how it won't be.

**[00:05:28]** Actually, I realized back then from the first feedbacks

**[00:05:32]** that I was also hitting a barrier,

**[00:05:35]** one we are used to,

**[00:05:38]** one we are used to touching on,

**[00:05:40]** that we play on quite often,

**[00:05:42]** but I feel we do very little for them

**[00:05:44]** and that is that in the public space

**[00:05:46]** we usually conduct discussions on crucial topics insufficiently.

**[00:05:50]** It's a repeated reflection, we all know about it,

**[00:05:53]** we all always recall

**[00:05:55]** how amazing it is in Switzerland

**[00:05:57]** and how great it is when people are involved

**[00:06:00]** in fundamental social issues,

**[00:06:02]** sometimes even expressing themselves in direct voting,

**[00:06:06]** and at the same time, when the whole society is somehow activated

**[00:06:10]** to take a stance and people somehow show

**[00:06:14]** what they want or don't want.

**[00:06:16]** Yes, it's about tradition, about some degree of personal responsibility

**[00:06:20]** and experiencing that responsibility.

**[00:06:22]** And it's not something we are used to in our region.

**[00:06:26]** So I actually realized

**[00:06:28]** that one of the few ways I could contribute to this

**[00:06:31]** is not to be frustrated and complain about it alone,

**[00:06:35]** but that maybe I could try to do something myself.

**[00:06:37]** So this series of public discussions,

**[00:06:40]** which I decided for myself

**[00:06:42]** that I want to go through, started with that TEDx

**[00:06:46]** and at the same time has simple milestones,

**[00:06:50]** because then COVID suddenly broke out shortly after.

**[00:06:53]** And in the middle of COVID, we agreed on inviolables,

**[00:06:57]** that we could actually try to repeat something like that.

**[00:07:01]** Try to push the topic a little further,

**[00:07:04]** give it a bit more space.

**[00:07:06]** And so that almost two-hour program was created,

**[00:07:09]** when suddenly I realized it seems,

**[00:07:11]** so that it was more understandable.

**[00:07:13]** And that led up to what we have today.

**[00:07:16]** Of course, there were some minor things in between,

**[00:07:19]** but this was the fundamental shift

**[00:07:23]** that everything evolved into,

**[00:07:25]** because the change in context means, actually from 2019,

**[00:07:29]** when maybe no one really understood

**[00:07:32]** why I was talking about the approaching moment

**[00:07:34]** when society would have to address this topic.

**[00:07:37]** And probably I didn't really reach

**[00:07:41]** a wider audience at that time.

**[00:07:43]** So the change in context might make

**[00:07:46]** what I tried to say back in 2019

**[00:07:48]** with that whole presentation more understandable.

**[00:07:51]** This topic is not simple at all, and precisely because

**[00:07:54]** it's not just medical, not just healthcare,

**[00:07:57]** not even just social,

**[00:08:01]** not just educational or school-related.

**[00:08:04]** It affects everything in society.

**[00:08:06]** And at the same time, as you probably all suspect,

**[00:08:09]** once money gets involved,

**[00:08:12]** the direction changes a bit

**[00:08:15]** and is driven by this factor,

**[00:08:19]** often in surprising ways for ordinary people

**[00:08:23]** who are used to living in their own bubble.

**[00:08:27]** But suddenly, it's money and big companies

**[00:08:30]** that start to fundamentally influence what happens.

**[00:08:33]** And that's actually what's happening right now,

**[00:08:37]** for example, around cannabis.

**[00:08:39]** As long as cannabis was a topic in our Czech society,

**[00:08:41]** associated with teenagers, rebellion,

**[00:08:45]** and an alternative lifestyle,

**[00:08:49]** the topic seemed socially hard to accept,

**[00:08:52]** and lobbying groups logically showed little interest.

**[00:08:57]** But suddenly, the times changed, the industry entered this topic,

**[00:09:01]** and we see a shift in the narrative.

**[00:09:03]** And we also see that the topic, which seemed polarizing

**[00:09:09]** only from an ideological perspective,

**[00:09:20]** So suddenly, the polarization looks a bit more complicated.

**[00:09:24]** And one of the main factors driving this right now

**[00:09:28]** is precisely the expected money, the expected entry,

**[00:09:32]** or rather the entry has already happened, so we should rather talk about the development

**[00:09:36]** of the cannabis business.

**[00:09:39]** And suddenly, there is a completely new phenomenon here,

**[00:09:43]** which has changed the coat, changed the narrative in the public space,

**[00:09:47]** and at the same time, it is also important to say that we have probably

**[00:09:51]** historically moved the furthest ever in public discussion,

**[00:09:56]** political discussion about what to do with cannabis and addictive substances.

**[00:10:00]** And now it doesn't matter at all,

**[00:10:03]** the main proponents of this process

**[00:10:06]** will probably resent me for this, but I basically don't care

**[00:10:09]** whether this attempt they are making now

**[00:10:12]** succeeds in what they wish for, meaning,

**[00:10:15]** whether a fundamental legislative change happens or not,

**[00:10:18]** the important thing is that it has never gone this far before,

**[00:10:21]** and at the same time, it is so far that it exposes

**[00:10:24]** the very basic issues

**[00:10:27]** connected with the regulation of addictive substances,

**[00:10:30]** meaning, for example, that we have here a system

**[00:10:33]** existing for about 60 years or after those 60 years

**[00:10:36]** intensively shaped system

**[00:10:39]** of addictive substance regulation

**[00:10:42]** in our Western world where we live,

**[00:10:45]** and at the same time, it is also something

**[00:10:48]** where this is the first time this system

**[00:10:51]** is clearly collapsing,

**[00:10:54]** it was never very functional,

**[00:10:57]** but on the other hand, its dysfunction has become absolutely striking

**[00:11:00]** in the last two decades,

**[00:11:03]** meaning this shift is completely striking,

**[00:11:06]** it is clear on many levels,

**[00:11:09]** and actually this shift is represented

**[00:11:12]** or pushed by phenomena

**[00:11:15]** we all live with,

**[00:11:18]** meaning the internet, online sales,

**[00:11:21]** what actually causes border permeability

**[00:11:24]** and our inability to actually apply and use

**[00:11:30]** the original standard regulatory tools.

**[00:11:33]** Simply because today contraband

**[00:11:36]** at the level of someone carrying it on planes

**[00:11:39]** and having it on them and swallowing it similarly,

**[00:11:42]** it's clear that it still exists, but increasingly

**[00:11:45]** it's actually something that shifts more into romantic detective stories,

**[00:11:48]** that we watch on Netflix and HBO and the like.

**[00:11:51]** And it actually becomes very elusive

**[00:11:54]** and what is even more fundamental about it,

**[00:11:57]** is where our technological capabilities have moved today

**[00:12:00]** in the development of these substances,

**[00:12:03]** in the possibilities of creating modifications of these substances,

**[00:12:06]** so the traditional original world,

**[00:12:09]** as we knew it more than 20 years ago,

**[00:12:12]** is actually a memory.

**[00:12:15]** When you start regulating a substance,

**[00:12:18]** but within a few days it is possible to create its analogues,

**[00:12:21]** and those analogues cannot be added that quickly

**[00:12:24]** to the lists of regulated substances,

**[00:12:27]** and at the same time your technological capabilities not only allow you to produce it

**[00:12:30]** and produce huge amounts extremely cheaply,

**[00:12:33]** but mainly to get it to market extremely quickly,

**[00:12:36]** the possibilities are so huge that against that,

**[00:12:39]** where the original system stands, which we have built as a society for 60 years,

**[00:12:42]** it actually has no chance.

**[00:12:45]** It is impossible for something like that to be caught.

**[00:12:48]** And the widening gap is so fast,

**[00:12:51]** so effective, that it actually pushes us to

**[00:12:54]** look at whether we can continue like this,

**[00:12:57]** and what is obvious about it

**[00:13:00]** and what will be the red thread of my talk today,

**[00:13:03]** is that the costs it causes us

**[00:13:06]** are becoming absolutely unbearable.

**[00:13:09]** If we persist at this level,

**[00:13:12]** then the impact on public budgets

**[00:13:15]** will become even more disastrous than it has been so far.

**[00:13:18]** And mind you, we live in a society

**[00:13:21]** where, for example, the costs of

**[00:13:24]** the criminal justice system,

**[00:13:27]** meaning at the moment when we punish users,

**[00:13:30]** we send them to serve sentences, often for

**[00:13:33]** periods comparable to

**[00:13:36]** paragraphs for serious bodily harm and similar,

**[00:13:39]** or even murder, which is something that

**[00:13:42]** represents not only huge costs but also

**[00:13:45]** enormous human tragedies, because we actually send

**[00:13:48]** often people who are in their productive years,

**[00:13:51]** often many fully functional, and cannabis has become

**[00:13:54]** just a symbol of that huge mutual misunderstanding.

**[00:13:57]** A misunderstanding that

**[00:14:00]** started in the 1930s, but I will get to that later.

**[00:14:03]** This whole thing is the framework,

**[00:14:06]** this whole thing is the context in which I wanted to

**[00:14:09]** try to start today's topic and

**[00:14:12]** at the same time, quite logically, I will start

**[00:14:15]** by pointing out that

**[00:14:18]** the phenomenon does not concern some small group,

**[00:14:21]** because what we considered in the 1990s

**[00:14:24]** to be a very small group, and where the attention

**[00:14:27]** was traditionally greatest, actually

**[00:14:30]** the attention is paradoxically most drawn

**[00:14:33]** epidemiologically to the absolutely smallest group

**[00:14:36]** of substance users in the population,

**[00:14:39]** and we very often forget that the topic

**[00:14:42]** is widespread and essentially

**[00:14:45]** touches all social groups, and it is to such an extent

**[00:14:48]** and in such numbers that it is impossible

**[00:14:51]** to create the boundary of us and them,

**[00:14:54]** because from different perspectives and with different substances

**[00:14:57]** it affects practically everyone.

**[00:15:00]** Many of you, as I noticed, at least

**[00:15:03]** had tea or coffee this morning, I did too.

**[00:15:09]** Even though actually

**[00:15:12]** my point for the introduction is that

**[00:15:15]** we don't have to talk about it, still

**[00:15:18]** at least a small mention that it's good to realize

**[00:15:21]** that these are still addictive substances and that

**[00:15:24]** we have a business from them, that we use them daily,

**[00:15:27]** actually doesn't change that fact at all.

**[00:15:30]** You might object, for example,

**[00:15:33]** the measure of social danger,

**[00:15:36]** health hazards and social impacts is, for example,

**[00:15:39]** very low here, but once you start using these criteria,

**[00:15:42]** you find that for many other substances these criteria

**[00:15:45]** are also very tricky, yet we handle those substances

**[00:15:48]** very differently than, for example, with

**[00:15:51]** caffeine. It's also good to realize

**[00:15:54]** and it's great that our society has undergone a transformation,

**[00:15:57]** which seemed 20 years ago

**[00:16:00]** absolutely incredibly unlikely.

**[00:16:03]** That is, that we could change

**[00:16:06]** not only the narrative but especially people's behavior

**[00:16:09]** towards tobacco, towards nicotine,

**[00:16:12]** and at the same time, what happened

**[00:16:15]** a decade earlier, in some countries

**[00:16:18]** even two decades earlier in Northern Europe,

**[00:16:21]** is something we have gone through in the last decade,

**[00:16:24]** and it's amazing to see that it is possible.

**[00:16:27]** This means that even a highly conservative society

**[00:16:30]** regarding addictive substances, like Central Europe,

**[00:16:33]** is a society that managed to make

**[00:16:36]** such a shift, and at the same time you see

**[00:16:39]** that today the majority prevailing attitude

**[00:16:42]** is basically a negative stance

**[00:16:46]** towards tobacco use, and at the same time, people

**[00:16:49]** even resist it, meaning smoking at stops

**[00:16:52]** and smoking in public spaces where it is banned,

**[00:16:55]** often leads to strong negative reactions. Today no one

**[00:16:58]** is really surprised by raised eyebrows,

**[00:17:01]** where, with few exceptions, even in restaurants or common

**[00:17:04]** rural pubs, it basically is no longer a phenomenon

**[00:17:07]** that is completely common, widely tolerated,

**[00:17:10]** and overlooked; it simply became a topic.

**[00:17:13]** That the tobacco industry found other ways,

**[00:17:16]** that it took hold and created and launched

**[00:17:21]** perhaps the biggest revolution since tobacco legalization in Europe,

**[00:17:25]** meaning since tobacco became

**[00:17:30]** a commonly tolerated drug in European society,

**[00:17:33]** we are probably experiencing the biggest revolution

**[00:17:39]** From this moment on, it is a fact, but on the other hand, I believe

**[00:17:43]** that it is precisely on this that many of those

**[00:17:47]** sensitive issues can be demonstrated, including, for example, the criteria

**[00:17:50]** I mentioned, simply because the huge revolution

**[00:17:53]** in the rise of smokeless tobacco is exactly something

**[00:17:57]** that represents a topic which is no longer just about reflecting

**[00:18:01]** on the health impacts, but suddenly also about reflecting on

**[00:18:04]** how we should view it from a regulatory perspective,

**[00:18:07]** how we should view it from the perspective of helping those people

**[00:18:10]** who become addicted to nicotine and at the same time

**[00:18:14]** also from the perspective of public health costs

**[00:18:17]** and public expenses in general, simply because it is changing.

**[00:18:20]** They are changing very radically, because smokeless tobacco

**[00:18:23]** brings a completely different perspective and completely different impacts

**[00:18:27]** than what we were used to with classic tobacco,

**[00:18:30]** which was inhaled in the form of something that first burns

**[00:18:34]** and then we inhale the smoke.

**[00:18:38]** It is also good to realize that we have in society,

**[00:18:41]** which counts just under ten and a half million,

**[00:18:44]** a huge number of people who are beyond the threshold

**[00:18:49]** of what we call low-risk drinking.

**[00:18:52]** That means something that brings with it a significantly increased

**[00:18:58]** share of those health and social impacts,

**[00:19:01]** potential health and social impacts,

**[00:19:04]** and at the same time it seems that it is gradually changing

**[00:19:10]** and becoming available information that to be harmed by alcohol,

**[00:19:14]** you don't have to be addicted to it.

**[00:19:17]** That means it is important to separate these two things

**[00:19:20]** and that it is not true that first you are addicted

**[00:19:23]** and then alcohol harms you, but alcohol actually harms you

**[00:19:26]** at relatively very low doses, which can still be far from

**[00:19:30]** what we diagnostically call alcohol addiction.

**[00:19:34]** Which is, by the way, a very important point,

**[00:19:36]** because the number we are talking about is very high

**[00:19:39]** and it is necessary to realize that among those ten and a half million

**[00:19:42]** there are, of course, infants and very elderly people.

**[00:19:46]** In other words, having over a million people

**[00:19:49]** who actually drink riskily is a huge part of the population.

**[00:19:53]** A topic that completely faded away in the post-revolution atmosphere,

**[00:20:00]** warning labels disappeared, many doctors actually stopped being so cautious

**[00:20:05]** for some medications, for prescribing certain drugs.

**[00:20:10]** At the same time, teaching and dectology or addiction in the medical curriculum

**[00:20:16]** was a topic that gradually eroded. Just to give you an idea, we're talking about something

**[00:20:21]** that in six years of study for doctors or future doctors represents

**[00:20:27]** on average about one day. That means you study for six years

**[00:20:32]** and have roughly one day to learn about a phenomenon

**[00:20:37]** which, based on prevalence estimates, represents roughly

**[00:20:41]** three and a half million potential patients in the Czech Republic.

**[00:20:45]** So, that proportion is exactly what partly explains

**[00:20:50]** why, for example, doctors' vigilance is somewhat lower and actually reflects

**[00:20:55]** the clinical and public health underestimation of this topic.

**[00:21:00]** This means it is again a systemic issue and a topic connected

**[00:21:05]** to resources. Nearly 900,000 people use medications

**[00:21:09]** that can cause or do cause addiction,

**[00:21:13]** which is simply a huge number, and at the same time, it is a phenomenon that is still

**[00:21:17]** very little named, very hidden, and very little

**[00:21:21]** implicitly addressed clinically. For example, it is mainly associated

**[00:21:25]** with older age. In younger age groups, it is more about

**[00:21:29]** stimulant drugs, especially students in performance-oriented fields.

**[00:21:34]** There we would find many very interesting topics, but primarily the issue

**[00:21:38]** is linked rather to older age, and for example, the mere fact

**[00:21:42]** that our field basically lacks any specialized facilities

**[00:21:47]** for patients aged 60 or 65 and older is actually an answer

**[00:21:52]** or one of the answers demonstrating the huge underestimation

**[00:21:56]** of this topic. By the way, what we are slowly and cautiously starting to call

**[00:22:00]** future gerontoadjectology is actually one of the biggest topics,

**[00:22:04]** which currently has to wait because we have focused

**[00:22:08]** and continue to focus mainly on developing pediatric and adolescent care,

**[00:22:11]** which was also missing in our field, so it is something

**[00:22:17]** that is looming because it concerns a large number of people in the population.

**[00:22:23]** Cannabis is a topic I will repeatedly return to today,

**[00:22:26]** because it is a litmus test for the whole process,

**[00:22:30]** but at the same time, it is necessary to realize that the 300,000

**[00:22:34]** or 300 to 400,000 people who use it in a risky way

**[00:22:39]** are again a fairly large group in the population and also a group

**[00:22:44]** that, unlike the previous ones, actually moves

**[00:22:47]** in a very sensitive zone beyond the law. Cannabis is still not legal,

**[00:22:53]** and the fact that we have a division between amounts smaller than small

**[00:22:58]** and amounts larger than small has still not caused

**[00:23:03]** cannabis to be legal, and at the same time, it is important to realize,

**[00:23:07]** that this topic actually resonates in society and will be a major issue.

**[00:23:11]** which is presented for young adults. Therefore, it is probably understandable,

**[00:23:15]** why some political parties targeting young adults,

**[00:23:19]** are going in this direction, and at the same time this topic has gradually become

**[00:23:23]** a major political issue and will become even bigger. It is also not negligible,

**[00:23:28]** that in our field there is a huge number of people who have problems with gambling.

**[00:23:33]** The 90s were associated with those, from today's perspective,

**[00:23:38]** slot machines and flashing lights and throwing in five crowns,

**[00:23:43]** and similar. Today it has changed, again it is a question of technology,

**[00:23:47]** the cost of that technology, the availability of that technology, and it must be said,

**[00:23:51]** that the pressure is enormous, the development is extremely fast.

**[00:23:55]** Covid accelerated it even more, and the acceleration is so great,

**[00:24:00]** that it can be expected that in the next ten years this phenomenon will transform

**[00:24:05]** to such a huge extent that it will likely change our entire field of addictology.

**[00:24:09]** In terms of the main diagnoses that people will come with.

**[00:24:13]** And again, it will mainly be connected with the development and availability of those technologies,

**[00:24:19]** and how close it will move to us. Since we are talking about

**[00:24:23]** the brain and breakfast today, the closer it gets to the brain, the faster and cheaper it will be.

**[00:24:27]** When I started this introduction a moment ago

**[00:24:32]** with the smallest group, this is the smallest group. It may scare most people the most.

**[00:24:36]** Many people who do not usually come into contact with this field

**[00:24:41]** and with these users may realize it in the morning when they come to their car

**[00:24:45]** and find the rear window broken. Or during the day.

**[00:24:51]** These are the small moments when they realize or can realize the contact

**[00:24:56]** a bit more with our field. In any case, this group,

**[00:25:00]** although the most visible and probably the most emotionally perceived

**[00:25:05]** and discussed in the 90s, and at the same time associated with high risks,

**[00:25:10]** such as the spread of blood-borne diseases and so on, nevertheless,

**[00:25:14]** it is important to know that from the perspective of all these topics and groups,

**[00:25:18]** this user group is epidemiologically the smallest.

**[00:25:23]** When you add it all up and look at overlaps, we are really talking about

**[00:25:29]** an estimated three to four million people who would deserve at least

**[00:25:33]** a brief intervention. By the way, this is something every healthcare worker is legally

**[00:25:38]** obliged to perform, meaning every healthcare worker working in the system

**[00:25:42]** should confront their patient with the question of whether they use or do not use

**[00:25:48]** and what addictive substance they use, and in case of a positive response to this question,

**[00:25:52]** the healthcare worker should perform a brief intervention. This is something mandated

**[00:25:58]** by law 65 and something that, for example, has no implementing regulation,

**[00:26:03]** and is not part of the usual curriculum, so today we are gradually

**[00:26:07]** catching up and providing these courses to individual healthcare groups.

**[00:26:11]** we are currently trying to deliver mainly through online means,

**[00:26:15]** because, for example, a large part of medical faculties do not have such a simple course

**[00:26:19]** in their curriculum and do not train young doctors to be able

**[00:26:25]** to fulfill this legal obligation, and logically it does not only concern doctors,

**[00:26:29]** it concerns all medical fields, because the law simply states

**[00:26:33]** that every healthcare professional must do it. I would just quietly add,

**[00:26:37]** that every social worker should also know it, and it would be good

**[00:26:41]** if, for example, colleagues in institutional education and care knew it.

**[00:26:46]** For example, the 8,500 children represented

**[00:26:50]** by this institutional system are children who...

**[00:26:54]** It would be hard to find any who would not deserve a brief intervention.

**[00:26:58]** So, that is basically the introduction and what we are talking about,

**[00:27:02]** because everything I will talk about next is something

**[00:27:06]** that is important to be reflected in this framework, in this context.

**[00:27:10]** I very often get the question,

**[00:27:14]** it is very often discussed, where did this come from,

**[00:27:18]** where did this come from, why is it so widespread, how is it possible

**[00:27:22]** that it accelerates like this, and so on. We do not know.

**[00:27:26]** There is no such point. We only know where it transformed,

**[00:27:30]** meaning where we can catch certain, I would say,

**[00:27:34]** checkpoints for us, where in the development of human culture

**[00:27:38]** there are some important moments that accelerated the permeability

**[00:27:42]** of addictive substances and the use of addictive substances,

**[00:27:46]** there is none. And there is none because addiction is also described in animals.

**[00:27:52]** And it is not only a problem of mammals.

**[00:27:56]** That means, it is not only mammals that have this peculiarity,

**[00:28:00]** and we find it even at lower evolutionary levels.

**[00:28:06]** And at the same time, a small digression. It is so fascinating,

**[00:28:10]** a little researched topic, that we can still expect

**[00:28:14]** quite large, I dare say maybe even turbulent,

**[00:28:20]** discoveries in science. I am absolutely thrilled when, for example,

**[00:28:24]** because we are a very small country that rarely influences world science,

**[00:28:28]** I am absolutely thrilled that we have colleagues here,

**[00:28:32]** who do basic research, for example, on insects.

**[00:28:36]** And one of my colleagues, Jirka Dvořáček, director at the psychiatric hospital Červený dvůr,

**[00:28:42]** is part of a group that recently published in one of the prestigious journals

**[00:28:46]** a very remarkable concept of a collective reward system.

**[00:28:52]** Rewarding system, which we all actually have in our brains.

**[00:28:55]** And thanks to which it is one of the basic things,

**[00:28:58]** that when you learn about addiction, when you learn about addictology,

**[00:29:01]** So we actually explain this to students, and they described this phenomenon

**[00:29:05]** at the level of insects, and it is a very remarkable phenomenon,

**[00:29:09]** which may be more appreciated in science in the future.

**[00:29:12]** It is truly a very groundbreaking, interesting matter,

**[00:29:15]** just a small digression that in such a small country as ours,

**[00:29:19]** we have such very interesting achievements,

**[00:29:22]** which significantly exceed the borders of the Czech Republic and even Europe.

**[00:29:27]** At the same time, it is good to realize that animal models

**[00:29:31]** can really help us a lot in finding answers,

**[00:29:35]** whether from the perspective of genetics, because the genetics of addiction

**[00:29:38]** is by no means a closed chapter.

**[00:29:41]** We can expect many very interesting discoveries there.

**[00:29:44]** And biological factors related to addiction are something

**[00:29:47]** into which, not by chance, huge resources have been invested in the last two decades,

**[00:29:50]** not only related, for example,

**[00:29:53]** to brain research and what, in the 1990s, for example,

**[00:29:57]** the American Institute on Drug Abuse,

**[00:30:00]** led by Nora Volkov, one of the most visible representatives,

**[00:30:05]** brought and caused the rehabilitation of this topic in biomedicine,

**[00:30:09]** so I believe that in the next one or two decades,

**[00:30:13]** we can definitely expect very interesting advances.

**[00:30:17]** At the same time, I think this is something that deserves great respect, and the pendulum

**[00:30:21]** that actually swung in the mid-20th century toward the area

**[00:30:26]** of a strongly sociologizing and social perspective,

**[00:30:30]** is now starting to settle a bit, and we are beginning

**[00:30:34]** to realize with greater respect that yes, at the beginning, the biologization

**[00:30:39]** of the view on addiction was really significant, and indeed the biological

**[00:30:43]** medical model of addiction, as it was formed in the first half

**[00:30:47]** of the 20th century, was really an overly strong emphasis

**[00:30:51]** and actually an inadequate emphasis on this topic.

**[00:30:55]** On the other hand, in the second half of the 20th century,

**[00:30:58]** we experienced the opposite extreme, and I believe that now

**[00:31:02]** we are moving into a space where balance can bring

**[00:31:06]** a very important shift, a very important

**[00:31:11]** corrective moment, that it is important to respect

**[00:31:18]** all factors and you cannot just choose

**[00:31:21]** one or the other based on what you enjoy or what is trendy,

**[00:31:24]** where the money is, or what looks like a very

**[00:31:28]** attractive concept at the moment. At the same time, I would also like to point out

**[00:31:32]** that in the development of human culture, we have experienced stages,

**[00:31:37]** in which addictive substances played and still play a very fundamental role,

**[00:31:42]** a very fundamental cultural role, a religious role, becoming part

**[00:31:46]** of our rituals. The use after battles is not just one of those

**[00:31:53]** phenomena closer to us, but it is necessary to truly realize,

**[00:31:57]** that throughout history there is almost no human culture or community

**[00:32:01]** where addictive substances did not play some role,

**[00:32:05]** where they did not have a fixed place and where they did not somehow

**[00:32:11]** play an important role in the life of that society.

**[00:32:15]** At the same time, it is also possible and important to say that only at the moment,

**[00:32:20]** when what we later started to call the state and the arrangement

**[00:32:24]** corresponding to that state setup emerged, meaning,

**[00:32:28]** that we stopped living as tribes, this was exactly the moment,

**[00:32:31]** when I mentioned those checkpoints a few tens of minutes ago,

**[00:32:35]** this was one of those checkpoints, because even the oldest cultures,

**[00:32:39]** such as the Egyptian culture or some others,

**[00:32:42]** with a higher degree of organization brought along

**[00:32:45]** these topics and at the same time the first attempt to regulate these topics

**[00:32:49]** and introduce some first, primarily moral,

**[00:32:53]** because here we could already identify what

**[00:32:55]** we later started to call the moral model of addictions,

**[00:32:58]** the beginnings of this moral model

**[00:33:01]** can be found already in these first civilizations.

**[00:33:06]** It may also be good to say that the existence of these substances,

**[00:33:10]** their anchoring and the way they were used and ritualized,

**[00:33:14]** were precisely something cultivated for hundreds,

**[00:33:17]** in some cases thousands of years and had a strong connection.

**[00:33:22]** That means it was not in our current understanding,

**[00:33:25]** where you could do whatever you wanted, switch substances,

**[00:33:28]** and use them in any context, this was not the case,

**[00:33:32]** and even crossing those boundaries was in many of those cultures

**[00:33:36]** actually punished very harshly.

**[00:33:40]** For example, even then comparable to the most severe

**[00:33:44]** violations we call laws.

**[00:33:47]** Meaning something comparable, for example, to serious

**[00:33:50]** bodily harm or murder.

**[00:33:53]** It is also good to realize that in the past we had phases

**[00:33:59]** when finances entered this in a very fundamental way,

**[00:34:04]** a very harsh, aggressive way and where we actually

**[00:34:08]** used tools that from today's perspective,

**[00:34:13]** and when you look at how it was possible to obtain heroin as a medicine

**[00:34:19]** and to get something like this completely legally through doctors and pharmacies,

**[00:34:26]** that this is actually something that should be,

**[00:34:31]** in the context of the 20th and 21st centuries, a very important moment,

**[00:34:36]** because we have it behind us, but we don't have it behind us,

**[00:34:39]** we still have it present here.

**[00:34:41]** Basically, if you look at addictive substances,

**[00:34:44]** which are imprinted at the level of medicine that we use,

**[00:34:48]** the whole spectrum of what we call street drugs,

**[00:34:52]** meaning substances that sedate, slow down, calm,

**[00:34:57]** or substances that speed up, energize, help better manage stress,

**[00:35:02]** the entire spectrum we have on the street,

**[00:35:05]** we have the entire spectrum in the form of those medicines.

**[00:35:09]** And at the same time, when I took heroin as a reminder,

**[00:35:14]** it's good to notice that what accelerated 20 years ago

**[00:35:19]** in the United States and later got the name as a concept

**[00:35:24]** the big opioid crisis, is something that has small echoes in Europe,

**[00:35:29]** and the rise of synthetic opioids is actually something,

**[00:35:33]** and the high consumption and growth of that consumption is something present.

**[00:35:37]** And although the phenomenon is not as huge and probably won't be,

**[00:35:41]** I knock on wood, but nothing indicates it will or can reach the scale

**[00:35:46]** like in the United States, it is still present in Europe,

**[00:35:50]** and it will be something we will have to fight with, because it is clear,

**[00:35:54]** that with a slight delay it is starting to manifest,

**[00:35:58]** and whether Germany or some other countries in Europe,

**[00:36:01]** simply already have problems with this phenomenon today.

**[00:36:07]** Maybe, again, I allow myself a small critical remark,

**[00:36:11]** this is again one of the legacies of where medicine actually pushed

**[00:36:15]** these topics out of its center, stopped paying attention to them,

**[00:36:19]** and doctors basically stopped being prepared for the fact

**[00:36:22]** that this is something they will struggle with.

**[00:36:25]** And it doesn't matter what specialization they do.

**[00:36:28]** Our patients, addiction patients, are across specializations,

**[00:36:33]** and it no longer holds true, that's exactly it,

**[00:36:37]** how it was hidden by the most visible groups,

**[00:36:41]** it no longer applies that it only concerns traditional diagnoses,

**[00:36:45]** and that our colleagues in internal medicine would meet them most,

**[00:36:49]** whether due to liver problems or other complications,

**[00:36:53]** typically colon cancers and similar.

**[00:36:56]** But at the same time, there are specializations that might surprise you more,

**[00:37:00]** and these can be, for example, dentists and similar, where even with child patients

**[00:37:04]** There are clinically visible differences for them that are clear.

**[00:37:08]** In those children who are identifiable and who represent

**[00:37:12]** actually a risk population that can be detected early, for example,

**[00:37:16]** and something clinical can be started with them. This is also a consequence,

**[00:37:20]** is this some kind of connection that is good to see in this context.

**[00:37:24]** It wasn't just heroin that had such charming advertising

**[00:37:28]** only a few decades ago and was actually promoted

**[00:37:32]** also for use by children. It was also cocaine.

**[00:37:36]** It's something the pharmaceutical industry might prefer to forget

**[00:37:40]** and acts like it doesn't concern them, but it does.

**[00:37:44]** At the same time, today's pharmaceutical industry has more and more substances,

**[00:37:48]** and it's all really just about the labels

**[00:37:52]** and what causes or doesn't cause an emotional reaction in people.

**[00:37:56]** That cocaine drops were something we actually once

**[00:38:00]** recommended for use even in children.

**[00:38:04]** By the way, the price of those substances is also interesting.

**[00:38:08]** This is just a kind of gender aside

**[00:38:12]** for some light amusement, but on the other hand maybe not entirely,

**[00:38:16]** especially regarding how easy it was to shift

**[00:38:20]** some of those topics, some of those narratives so that women

**[00:38:24]** in the household would be happier, more playful,

**[00:38:28]** and yet function and fulfill their role as women in the household.

**[00:38:32]** And really as something we wouldn't consider heavy sexism,

**[00:38:36]** something that would be socially absolutely unacceptable,

**[00:38:40]** it actually became part of the time and was part

**[00:38:44]** of official advertising campaigns and leaflets of this kind.

**[00:38:48]** Even further supported to achieve that effect with substances

**[00:38:52]** similar to primitive methamphetamine or amphetamine.

**[00:38:56]** That means these were substances very close to this group

**[00:39:00]** or belonged to this group, to be precise.

**[00:39:04]** So this is one of the checkpoints of my presentation.

**[00:39:08]** I mentioned that I want to return repeatedly to cannabis and that I would like

**[00:39:12]** to stop at it several times because cannabis is actually an incredibly

**[00:39:16]** sensitive indicator of misunderstanding in regulatory measures

**[00:39:20]** and in the handling of addictive substances.

**[00:39:24]** The leaflet in the middle is closely linked to a late 1930s film,

**[00:39:32]** which was a cult classic for generations of teenagers in the United States

**[00:39:36]** and not only in the United States, Reefer Madness,

**[00:39:40]** which actually served as part of the campaign that created the cannabis issue.

**[00:39:47]** It is important to realize that cannabis was not an issue until the 1930s.

**[00:39:51]** Even the United States was one of the main opponents in the 1920s to strict regulation of cannabis.

**[00:39:58]** Yes, it was included on international lists,

**[00:40:00]** so when Egypt proposed it in the early 1920s,

**[00:40:02]** it was rejected.

**[00:40:05]** Only to become a major issue ten years later,

**[00:40:07]** manufactured artificially into a big topic,

**[00:40:10]** and one of the key factors driving this process, paradoxically,

**[00:40:12]** was alcohol prohibition.

**[00:40:14]** It's important to connect these dots,

**[00:40:17]** because the link to alcohol prohibition

**[00:40:20]** and the huge tragedy the United States experienced during that time

**[00:40:22]** is something crucial to reflect on,

**[00:40:24]** since without it you can't understand

**[00:40:26]** how something that had been largely insignificant until then,

**[00:40:29]** and remained a minor social issue afterward,

**[00:40:31]** became such a symbol and major topic.

**[00:40:34]** It became such a big issue that the scientific community,

**[00:40:36]** whether medical professionals or researchers,

**[00:40:38]** collaborated to the extent that in the 1950s and 60s,

**[00:40:40]** you can find scientific statements claiming

**[00:40:43]** that cannabis had no medical potential at all,

**[00:40:46]** even though its effects were already known and studied at that time.

**[00:40:48]** Still, experts were willing to endorse such statements.

**[00:40:51]** Meanwhile, the following decades in the latter half of the 20th century

**[00:40:53]** only confirmed and petrified this unfortunate process

**[00:40:55]** and misunderstanding,

**[00:40:58]** how we created such a big symbol

**[00:41:01]** and why many countries started to

**[00:41:31]** basically locking up mostly young people

**[00:41:33]** or young adults, economically active people

**[00:41:36]** and why it became such a lucrative business

**[00:41:39]** for American prisons, simply

**[00:41:41]** and especially private prisons in America.

**[00:41:43]** So answering that again,

**[00:41:46]** what the money was behind it and how the money was involved,

**[00:41:49]** is very important to understand the context.

**[00:41:53]** By the way, to this day,

**[00:41:55]** these are my photos,

**[00:41:58]** the one on the right is a photo by Jirka Doležal.

**[00:42:02]** My colleagues and I

**[00:42:05]** organized a large meeting of academics

**[00:42:09]** who focus on education and training

**[00:42:12]** of people working in addictology,

**[00:42:14]** and we held it in Peru.

**[00:42:16]** And the first thing that greeted me,

**[00:42:18]** when we flew to Peru for the reception,

**[00:42:20]** was a bowl of coca leaves.

**[00:42:22]** I found it quite charming

**[00:42:24]** and fitting in the context,

**[00:42:26]** that we came there to talk about clinical preparation

**[00:42:28]** of professionals working in addictology,

**[00:42:31]** and practically every hotel had

**[00:42:34]** such a bowl, and it was not regulated,

**[00:42:36]** so you could just come,

**[00:42:39]** open it, and take as many

**[00:42:41]** coca leaves as you wanted.

**[00:42:43]** I think that's quite

**[00:42:45]** charming also in the

**[00:42:47]** understanding of those paradoxes,

**[00:42:49]** including the paradoxes we could find

**[00:42:51]** for example in the Middle East, where we imposed

**[00:42:53]** alcohol, while their traditional

**[00:42:55]** substances were obviously opium

**[00:42:57]** and cannabis,

**[00:42:59]** so we also explained to them

**[00:43:01]** that their issue is alcohol,

**[00:43:03]** and today you can see the devastating,

**[00:43:06]** the devastating process that is there

**[00:43:08]** mobile with alcohol

**[00:43:10]** and the contradiction it traditionally

**[00:43:12]** has caused in that culture from the start.

**[00:43:16]** So, it raises the question,

**[00:43:18]** whether there is any solution.

**[00:43:20]** It probably wouldn't be

**[00:43:22]** quite appropriate if I

**[00:43:24]** represented a pessimistic view here

**[00:43:26]** that there is no reasonable solution.

**[00:43:28]** I believe there is some

**[00:43:30]** reasonable solution, but what is essential

**[00:43:32]** is the second question.

**[00:43:34]** That means, how could we

**[00:43:36]** arrive at that solution

**[00:43:38]** and at the same time what should we pay attention to,

**[00:43:40]** because there are many different buts.

**[00:43:44]** What I find very, very nice in my field

**[00:43:46]** is, I allowed myself this bon mot

**[00:43:48]** probably used

**[00:43:50]** thousands of times

**[00:43:54]** in various contexts, but still

**[00:43:56]** the 50 shades, as it

**[00:43:58]** surrounded our

**[00:44:00]** film world, but at the same time

**[00:44:02]** I like it as an original parallel

**[00:44:04]** because adektology

**[00:44:06]** has just as many shades.

**[00:44:08]** And as I mentioned, the basic

**[00:44:10]** axis between the health and

**[00:44:12]** social perspective and the actual

**[00:44:14]** flip of these two extremes during

**[00:44:16]** the 20th century,

**[00:44:18]** is just a simplifying scheme,

**[00:44:20]** simply because never

**[00:44:22]** from adektology have the other

**[00:44:24]** topics disappeared, meaning including for example

**[00:44:26]** cultural influences,

**[00:44:28]** including also religious and other influences that are linked

**[00:44:34]** actually practicing a certain religion

**[00:44:36]** and using a certain substance in its context.

**[00:44:38]** All of that logically belongs

**[00:44:40]** to our field.

**[00:44:42]** By the way, when we mapped out

**[00:44:44]** everything you can study in addictology

**[00:44:46]** today worldwide, we even

**[00:44:48]** discovered fields that today

**[00:44:50]** specialize not only in

**[00:44:52]** public health perspective on addictology,

**[00:44:54]** but even within it

**[00:44:56]** in economics

**[00:44:58]** and addictions, meaning today you can

**[00:45:00]** study a university program that is

**[00:45:02]** actually an economics-focused field

**[00:45:04]** on addictions in addictology.

**[00:45:06]** That means,

**[00:45:08]** I think it beautifully

**[00:45:10]** represents the range,

**[00:45:12]** the wide spectrum of fields that

**[00:45:14]** you have to take into account.

**[00:45:16]** And I repeat again, it is encouraging

**[00:45:18]** to experience this renaissance

**[00:45:20]** in this field precisely from the perspective

**[00:45:22]** of balance and the fact that it is starting

**[00:45:24]** to become credible that we have to combine it.

**[00:45:26]** What is happening

**[00:45:28]** behind the scenes is not only that we try

**[00:45:30]** to communicate and settle among ourselves.

**[00:45:32]** That means we talk about

**[00:45:34]** where we have actually reached in science.

**[00:45:36]** Because what is happening all around us,

**[00:45:38]** the widening gap

**[00:45:40]** between where science has reached

**[00:45:42]** and what we can translate from that science into practice.

**[00:45:44]** And actually,

**[00:45:46]** instead of moving us forward,

**[00:45:48]** we face situations where many

**[00:45:50]** people believe the earth is flat

**[00:45:52]** and their numbers are growing.

**[00:45:54]** We face a situation where you have no problem

**[00:45:56]** getting into a car or a plane

**[00:45:58]** and you believe it won't crash on you,

**[00:46:00]** that it will get you where you want to go.

**[00:46:02]** You take medicine that you expect

**[00:46:04]** will help you. And yet,

**[00:46:06]** suddenly you consider another area

**[00:46:08]** like vaccination

**[00:46:10]** to be ineffective, something

**[00:46:12]** that doesn't work. Suddenly the rules,

**[00:46:14]** these so-called rules, the same world,

**[00:46:16]** just don't exist.

**[00:46:18]** Usually, you can somehow

**[00:46:20]** integrate that contradiction, hold both views,

**[00:46:22]** and suddenly we are in a situation

**[00:46:24]** where we doubt something

**[00:46:26]** that we have actually

**[00:46:28]** cultivated for centuries.

**[00:46:30]** Science has certain rules.

**[00:46:32]** Of course, it can be manipulated.

**[00:46:34]** Of course, it can be corrupted.

**[00:46:36]** Our field is one of those

**[00:46:38]** that has suffered the most from this.

**[00:46:40]** We had colleagues who, in the early 70s,

**[00:46:42]** were not ashamed to take money

**[00:46:44]** to publish articles claiming

**[00:46:46]** that smoking on airplanes

**[00:46:48]** could not affect anyone else,

**[00:46:50]** because there is air conditioning,

**[00:46:52]** so everything is fine.

**[00:46:54]** At the same time, just a decade or two earlier,

**[00:46:56]** studies were published

**[00:46:58]** claiming that nicotine could not have

**[00:47:00]** certain devastating effects,

**[00:47:02]** and these were signed by renowned doctors at the time.

**[00:47:04]** Our field has been very sensitive

**[00:47:06]** to these issues

**[00:47:08]** and still is today.

**[00:47:10]** There are specially created

**[00:47:12]** extraordinary criteria,

**[00:47:14]** by which we evaluate scientific work

**[00:47:16]** in addictology, and those criteria go well beyond

**[00:47:18]** the basic ethical standards

**[00:47:20]** and norms we use in science.

**[00:47:22]** Precisely because we realized

**[00:47:24]** how vulnerable we are,

**[00:47:26]** that we realized

**[00:47:28]** how easy it is to penetrate the expert community

**[00:47:30]** and how easy it is to influence

**[00:47:32]** especially young, beginning researchers,

**[00:47:34]** simply because at that time

**[00:47:36]** it is the hardest

**[00:47:38]** to start your career,

**[00:47:40]** to get your first grants, to have your first prestigious articles,

**[00:47:42]** and simply to build a career in the best sense of the word,

**[00:47:44]** so precisely for that reason

**[00:47:46]** they are the most vulnerable,

**[00:47:48]** and that is exactly why the industry naturally targeted them.

**[00:47:50]** So that is where it was most often broken through.

**[00:47:52]** But this is something that is evolving,

**[00:47:54]** for example, just the fact that we have created

**[00:47:56]** a higher standard means that

**[00:47:58]** for example, as journal editors,

**[00:48:00]** we inform each other

**[00:48:02]** about certain cases,

**[00:48:04]** we share information about those cases

**[00:48:06]** and we raise the standard

**[00:48:08]** of checking the articles that come to us

**[00:48:10]** for the journal.

**[00:48:12]** We actually have here, the left

**[00:48:14]** slide represents that today we already have

**[00:48:16]** a forum where, for example, academic institutions

**[00:48:18]** together have a forum where they meet,

**[00:48:20]** we talk about how we train

**[00:48:22]** not only young researchers in addictology,

**[00:48:24]** that is, at the level of doctoral programs,

**[00:48:26]** but also how we train the clinical part,

**[00:48:28]** which we were supposed to present,

**[00:48:32]** how to actually bring quality standards into it,

**[00:48:36]** because, for example, many of these fields train specialists

**[00:48:38]** focused narrowly on a specific area

**[00:48:40]** and then they are unable to cope in practice,

**[00:48:42]** because the diversity of services

**[00:48:44]** is much greater and the needs in the field

**[00:48:46]** are different from what

**[00:48:48]** the university equips them with.

**[00:48:50]** So you graduate in a field focused

**[00:48:52]** only on treatment,

**[00:48:54]** but in practice we also have harm reduction,

**[00:48:56]** risk and damage minimization,

**[00:48:58]** and prevention, and people often

**[00:49:00]** move there like bull in a china shop.

**[00:49:02]** So these are the things

**[00:49:04]** we have moved towards. We have

**[00:49:06]** huge professional societies

**[00:49:08]** at national and international levels.

**[00:49:10]** For example, the one on the right is currently globally

**[00:49:12]** the largest professional society representing today

**[00:49:14]** over 30,000 people worldwide.

**[00:49:16]** There is huge progress forward

**[00:49:18]** and something that should help

**[00:49:20]** bridge the gap between science

**[00:49:22]** and what the field today

**[00:49:24]** represents, knows, and can do

**[00:49:26]** and what we transfer into practice,

**[00:49:28]** because the gap is

**[00:49:30]** very deep.

**[00:49:32]** I chose one topic,

**[00:49:34]** which is very striking,

**[00:49:36]** very painful as a typical representative

**[00:49:38]** for our, not only

**[00:49:40]** Central European, but pan-European

**[00:49:42]** functioning of the field,

**[00:49:44]** and that is prevention.

**[00:49:46]** Where, for example, preventive science has reached

**[00:49:48]** absolutely incredible milestones.

**[00:49:50]** Today we test preventive programs

**[00:49:52]** using standard

**[00:49:54]** experimental models.

**[00:49:56]** Something that, say, 30, 40, 50 years ago

**[00:49:58]** would have been absolute sci-fi.

**[00:50:00]** Today it's standard, which means that if you don't use an experimental model to test those interventions,

**[00:50:07]** you can only publish it in Matřídůvka,

**[00:50:09]** because a major journal won't accept it anymore.

**[00:50:14]** But what does that mean for practice?

**[00:50:16]** Paradoxically, nothing at all.

**[00:50:18]** In practice, we use methods, procedures, tools that were developed in the 70s and 80s,

**[00:50:26]** we wrap them in new technologies and pretend it's something really new.

**[00:50:31]** Many providers of preventive programs can't explain to you,

**[00:50:37]** why their intervention should work in practice,

**[00:50:40]** why children should respond positively in terms of changing their behavior or attitudes.

**[00:50:45]** At the same time, many directors still act as if,

**[00:50:50]** such phenomena don't exist in schools.

**[00:50:54]** Today, after so many published studies, you basically see,

**[00:51:00]** that for example, with alcohol, a quarter of children

**[00:51:04]** already use alcohol with some regularity around age 15.

**[00:51:08]** A third regularly use tobacco products,

**[00:51:12]** and you commonly find nicotine pouches in elementary school bathrooms.

**[00:51:16]** And unfortunately, this is a standard phenomenon.

**[00:51:19]** And yet some still dare to think it doesn't exist in schools.

**[00:51:23]** But this is an important moment to actually talk about these things

**[00:51:28]** and show that, for example, we have simply fallen behind here.

**[00:51:31]** But we haven't just fallen behind here in the Czech Republic, we've fallen behind across Europe.

**[00:51:35]** For example, for 30 or 40 years across Europe, we've been trying to advance prevention.

**[00:51:44]** And only six years ago did we manage to agree on

**[00:51:48]** what the minimum knowledge, skills, and competencies are,

**[00:51:52]** so that a person can use these methods with children and work with them,

**[00:51:56]** what the minimal training actually is.

**[00:51:59]** That is only six or seven years old.

**[00:52:01]** It simply took us that long.

**[00:52:03]** At the same time, many countries in Europe, for example,

**[00:52:06]** have reached this agreement at the European level,

**[00:52:09]** but haven't noticed it yet at the national level.

**[00:52:12]** That means many countries in Europe haven't started implementing it yet,

**[00:52:15]** or the implementation is happening in such a way

**[00:52:17]** that someone somewhere is discussing it in government offices

**[00:52:20]** and various ministries in different countries,

**[00:52:23]** but real implementation isn't happening.

**[00:52:26]** That means the curriculum, the European curriculum for prevention,

**[00:52:29]** for example today, it is not commonly used to

**[00:52:32]** have a checkpoint, some verification,

**[00:52:36]** a check that the person working in prevention with children

**[00:52:40]** has the appropriate training,

**[00:52:42]** the necessary knowledge, skills, and competencies.

**[00:52:45]** The e-prev platform is, by the way, one of the revolutionary things

**[00:52:48]** we have reached after 23 years of development work on this,

**[00:52:53]** where we realized,

**[00:52:55]** that society as a whole has moved into the digital age

**[00:52:59]** and we in prevention are still printing brochures

**[00:53:02]** and holding local seminars talking about these issues.

**[00:53:06]** We use online education almost minimally,

**[00:53:09]** and we hardly integrate it, for example,

**[00:53:11]** into the preventive tools themselves,

**[00:53:13]** meaning into the preventive programs.

**[00:53:15]** In fact, digitalization has reached a very low level there.

**[00:53:19]** Very little funding goes into it.

**[00:53:21]** So this is one of the answers, I hope,

**[00:53:23]** positive answers, and we are trying

**[00:53:26]** to use what the digital age offers,

**[00:53:29]** meaning that the infrastructure really supports

**[00:53:32]** and connects with the target groups.

**[00:53:37]** However, this brings me to the main point,

**[00:53:40]** which I started in the second half of the presentation,

**[00:53:43]** and that is the regulation itself,

**[00:53:45]** because prevention is an important part of it,

**[00:53:48]** and it is something I dare to call one of the biggest weaknesses,

**[00:53:52]** but at the beginning I mentioned several times in various hints

**[00:53:55]** that the view on addictive substances

**[00:53:58]** is not always straightforward,

**[00:54:00]** for example in the sense that

**[00:54:02]** no one doubts that caffeine

**[00:54:06]** is probably something you shouldn't touch.

**[00:54:09]** On the other hand, when you start comparing substances

**[00:54:12]** based on clearly defined criteria,

**[00:54:15]** their health, social dangers, and so on,

**[00:54:20]** you suddenly realize

**[00:54:24]** that the dividing line between legal and illegal

**[00:54:28]** is actually somewhat shaky,

**[00:54:31]** and does not really reflect what we know about those substances

**[00:54:34]** and that there are substances that are extremely dangerous,

**[00:54:38]** highly dangerous, health-wise, socially,

**[00:54:41]** criminologically, criminally.

**[00:54:44]** And we all participate in this in the sense that

**[00:54:47]** the state taxes them, makes a lot of money from them,

**[00:54:51]** I mean alcohol, and we all pretend

**[00:54:54]** that it's okay. And other substances, which for example

**[00:54:57]** do not reach the same parameters of such values,

**[00:55:01]** you can go to jail for, and you can go to jail

**[00:55:08]** resonated with the case of the Kordys couple,

**[00:55:11]** which I noticed was repeatedly,

**[00:55:14]** a very strongly commented topic,

**[00:55:17]** it actually showed quite clearly.

**[00:55:20]** It had a certain aftertaste,

**[00:55:23]** that it wasn't the typical user case,

**[00:55:26]** because they really handled it at a level of something

**[00:55:29]** that supported them or at least represented

**[00:55:32]** a significant income for them, which means in this sense,

**[00:55:35]** this example is a bit far-fetched

**[00:55:38]** precisely because of this aftertaste of that part.

**[00:55:41]** However, on the other hand, it is probably clear to everyone

**[00:55:45]** that the punishment they received does not correspond to the degree

**[00:55:49]** of that socially dangerous activity and that it is

**[00:55:52]** very inadequate. So, for example, despite this aftertaste,

**[00:55:55]** which I had towards this example, I was one of those

**[00:55:58]** who supported them simply receiving a pardon,

**[00:56:01]** and at the same time I believe there are many other cases

**[00:56:04]** where people deserve that pardon and that it is something

**[00:56:08]** that could accelerate the public discussion,

**[00:56:11]** because this is truly unsustainable. Nevertheless,

**[00:56:14]** I believe that with these substances it should in no way be possible

**[00:56:17]** to handle them in that way,

**[00:56:21]** meaning I am definitely not, for example, personally

**[00:56:24]** an advocate of the model that

**[00:56:27]** we could call it some kind of treatment

**[00:56:30]** and that they deliver something like that to people,

**[00:56:33]** because not only them, but many others who do this,

**[00:56:36]** have no qualification for something like that.

**[00:56:39]** And that is a big problem. And for people to get treated

**[00:56:42]** and they were helped by these substances,

**[00:56:45]** we have created standard tools.

**[00:56:49]** We have a system that prepares and verifies,

**[00:56:52]** whether someone is professionally qualified to handle such substances.

**[00:56:56]** And we have a system that can, at some point,

**[00:56:59]** when we take just a few simple steps,

**[00:57:02]** create an appropriate framework for something like this,

**[00:57:05]** the appropriate context, and we don't have to face

**[00:57:08]** risky situations where people calling themselves

**[00:57:11]** various shamans and the like, and now without any

**[00:57:14]** pejorative connotations, simply,

**[00:57:18]** are uncoordinated, uncontrolled,

**[00:57:22]** without any preparation, expertise, or backups,

**[00:57:26]** which means something that must protect the health and safety

**[00:57:29]** of those undergoing such experiences,

**[00:57:31]** so that something like this can happen safely.

**[00:57:33]** This whole issue actually merges all of this together.

**[00:57:36]** That means it is something where, on one hand,

**[00:57:39]** the inadequacy of the punishment is glaringly obvious

**[00:57:42]** and represents inefficiency and something

**[00:57:45]** that is unsustainable and extremely costly, and on the other hand,

**[00:57:48]** it simultaneously points to topics for which precisely

**[00:57:51]** we create the entire higher education system,

**[00:57:54]** the training of healthcare workers, the certification of facilities,

**[00:57:57]** which we register and try to

**[00:58:00]** monitor in some way.

**[00:58:03]** So if we have these tools, then let's simply use them,

**[00:58:06]** bring them in, and let them serve the cause.

**[00:58:10]** At the same time, it is important to notice, as shown on the slide on the right,

**[00:58:14]** that it is important to notice that both extremes today,

**[00:58:18]** the data is clear, are something that is inefficient

**[00:58:23]** and dangerous. It leads us into a dead end.

**[00:58:27]** That means, if we have gone through such painful experiences,

**[00:58:31]** like the practically decade-long alcohol prohibition

**[00:58:34]** in the United States, in the 1980s, the then Soviet Union tried it

**[00:58:37]** with an even bigger fiasco.

**[00:58:40]** Generally, prohibition models are highly dangerous.

**[00:58:43]** Look today at some countries, some nations in the Far East,

**[00:58:46]** Asia, where you can still be executed today,

**[00:58:49]** in this day and age, for something like that. These are the data,

**[00:58:52]** which we have collected or had available for 150 years

**[00:58:57]** and clearly show that this is not the way. But we also have enough

**[00:59:01]** data to know that not regulating, not monitoring,

**[00:59:05]** not trying to create control tools is just as ineffective

**[00:59:09]** and just as dangerous, meaning it is user-oriented,

**[00:59:13]** meaning it supports an increase in the number of users and the extent of

**[00:59:17]** usage in the population, and that is also an effect we don't want,

**[00:59:21]** because we can't afford it. We live in a time, specifically in the Czech Republic,

**[00:59:25]** we still live in a time when the healthcare system is basically

**[00:59:28]** a socialist system. For a simple reason,

**[00:59:32]** there is no link, in fact there is no link

**[00:59:37]** between what you put into the system

**[00:59:41]** and your level of responsibility for your health,

**[00:59:45]** what you can get out of it, meaning in this line actually

**[00:59:49]** that link does not exist, meaning you can behave

**[00:59:53]** very responsibly and contribute to the system

**[00:59:57]** and in the end you get the same as the person next to you who

**[01:00:00]** automatically harms themselves, harms people around them,

**[01:00:03]** passive smoking and so on, passive smoking.

**[01:00:06]** And basically there is no link between that, everyone is entitled to the same.

**[01:00:09]** That is incredibly demotivating

**[01:00:12]** and logically dysfunctional. At the same time,

**[01:00:15]** they do not advocate for the extremes, where

**[01:00:18]** for example, the United States despite Obamacare

**[01:00:21]** and all the other things that started to change there,

**[01:00:24]** do not represent something we would want to move towards either.

**[01:00:28]** And it is probably unacceptable to imagine a situation

**[01:00:31]** where even the middle class, or that the middle class

**[01:00:34]** would have trouble paying health insurance

**[01:00:37]** and expensive diagnoses and so on. We probably don't want to go there.

**[01:00:40]** On the other hand, some degree of link

**[01:00:43]** between your behavior and your responsibility for yourself

**[01:00:46]** and what you can get back from the system,

**[01:00:49]** will have to be introduced in the future,

**[01:00:52]** because again it will be unaffordable

**[01:00:55]** and it will lead to corruption, which is actually something

**[01:00:58]** we experienced before 1989. It is something

**[01:01:01]** that is still part of the healthcare system today and the pressure is huge.

**[01:01:04]** And at the same time it is unaffordable.

**[01:01:07]** That means it will reduce quality

**[01:01:10]** and it will actually bring this kind of

**[01:01:13]** unfairness among people, because it doesn't matter how you behave,

**[01:01:16]** in the end, you all have exactly the same.

**[01:01:19]** What is even more important about this,

**[01:01:22]** is the realization that if these two poles

**[01:01:25]** are something that doesn't work,

**[01:01:28]** something we have scientific evidence for that it doesn't work,

**[01:01:31]** then at the same time it's good to know

**[01:01:34]** that the space between these two extremes is large.

**[01:01:37]** There are many different options

**[01:01:40]** and these options are not predetermined.

**[01:01:43]** That means we don't know which exact combination,

**[01:01:46]** which position is functional. So again, I allow myself

**[01:01:49]** to emphasize that all the steps,

**[01:01:52]** all the radical changes that await us,

**[01:01:55]** which we will probably face, which we will be forced to take,

**[01:01:58]** should be done reflectively

**[01:02:01]** and we should constantly ask and verify

**[01:02:04]** whether it works or not

**[01:02:07]** and possibly adjust our actions,

**[01:02:10]** because there is no scenario that is predetermined,

**[01:02:13]** that is correct. There is no such thing.

**[01:02:16]** And that is actually the conclusion I am heading towards.

**[01:02:19]** It is something that, precisely because of the number of people,

**[01:02:24]** cannot happen only in Strakovka.

**[01:02:30]** That is, it cannot be that a group of people

**[01:02:35]** representing addictology and related fields,

**[01:02:39]** the closest ones, come and say, dear members of parliament,

**[01:02:44]** this is the solution, this is the grail that should now pass

**[01:02:49]** the lower and upper chambers and everything will be fine.

**[01:02:52]** There is simply no such thing. And even the MPs themselves

**[01:02:57]** are just people. Few of them are abstinent,

**[01:03:02]** whether in relation to alcohol or other substances.

**[01:03:05]** By the way, these are big scandals in some countries.

**[01:03:10]** I recall Italy and their provocation with stimulants,

**[01:03:15]** or some others. It's just something present.

**[01:03:20]** The politicians we elect reflect ourselves and they live

**[01:03:25]** with us in this shared space. And that's not the only reason

**[01:03:29]** why it's so important to realize

**[01:03:34]** that they can't decide it there. The important thing about it is,

**[01:03:38]** is that it will impact the wallets of every one of us.

**[01:03:43]** And in all areas. It will affect whether

**[01:03:46]** you find your cars with smashed windows.

**[01:03:50]** Whether you always have to hold onto your wallets.

**[01:03:53]** Whether walking through the center of Prague, Brno, or Ostrava

**[01:03:57]** will be frightening because there will be an unnecessarily high number of people

**[01:04:02]** who will rob you of your wallet, your payment card,

**[01:04:06]** or even threaten you by pushing you

**[01:04:09]** or doing something even worse.

**[01:04:11]** This is something that can be regulated.

**[01:04:13]** An example can be very bold programs in Canada

**[01:04:17]** or Switzerland, where, for instance, the introduction of a tool

**[01:04:20]** that only came onto the scene 50 years ago

**[01:04:24]** and caused strong emotional reactions even among doctors,

**[01:04:28]** I mean substitution therapy,

**[01:04:30]** has shown that, for opioid users,

**[01:04:36]** who are very dependent and whose environment is strongly tied

**[01:04:40]** to the production and distribution chain with high prices

**[01:04:44]** and the customers' attachment to the system,

**[01:04:47]** there is something we can almost eliminate.

**[01:04:50]** We can eliminate it very effectively.

**[01:04:53]** And these tools show through their results

**[01:04:56]** that they can eliminate not only these social impacts,

**[01:05:01]** but also the criminal ones.

**[01:05:03]** Meaning, for example, you can influence crime levels in a given area by tens of percent.

**[01:05:06]** This is something simply incomparable

**[01:05:09]** to anything from several decades ago

**[01:05:13]** and where the level of evidence is really significant.

**[01:05:16]** Today, there are hundreds of studies from various countries around the world

**[01:05:19]** that show the effectiveness and safety of these tools

**[01:05:22]** and at the same time show that it doesn't cost much money.

**[01:05:26]** That is the charm of this.

**[01:05:31]** The charm of addictology is

**[01:05:33]** that we are one of the truly cheapest fields,

**[01:05:35]** because if you look at our field in terms of what we need, our equipment,

**[01:05:38]** we have almost nothing.

**[01:05:41]** Most of the devices we use

**[01:05:44]** are basically monitoring tools during treatment,

**[01:05:51]** but we actually don't use any specific tools

**[01:05:53]** otherwise very much.

**[01:05:55]** Or they are very cheap.

**[01:05:57]** It's clear that biofeedback and similar things are being promoted,

**[01:06:00]** but these are simply not expensive items.

**[01:06:03]** Medications? We have very cheap medications.

**[01:06:05]** Those used in addiction treatment

**[01:06:07]** and at the same time for many things

**[01:06:09]** we actually don't have causal pharmacotherapeutic treatment.

**[01:06:12]** Substitution is actually the most radical example

**[01:06:15]** of effective pharmacotherapeutic treatment in our field,

**[01:06:18]** but you won't find many similar parallels.

**[01:06:21]** So we are actually very cheap.

**[01:06:24]** Most of the drugs for development, for production

**[01:06:27]** are extremely cheap.

**[01:06:29]** In other words, what I'm trying to say is

**[01:06:32]** that on one hand we have a field

**[01:06:34]** that doesn't cost society too much money.

**[01:06:37]** The costs are not too high.

**[01:06:39]** At the same time, the effectiveness is quite high

**[01:06:42]** and society is moving increasingly faster

**[01:06:46]** towards a point where many of these phenomena

**[01:06:49]** will represent a very calamitous impact

**[01:06:54]** on public budgets.

**[01:06:56]** Again, I want to, and I return to the very beginning,

**[01:06:59]** say that this is actually something that should be part

**[01:07:02]** of public discussion, should be part of some reflection,

**[01:07:06]** and we all should simply participate in it,

**[01:07:09]** so that it doesn't happen that in Strakovka, as in the last 30 years,

**[01:07:13]** a lot of laws were passed very quickly

**[01:07:16]** and then we all looked at some things

**[01:07:19]** and maybe that contributes to the collective huge frustration

**[01:07:22]** and dissatisfaction and that negative mindset.

**[01:07:25]** On the other hand, I believe this is exactly the moment

**[01:07:33]** meaning we shouldn't take too big

**[01:07:36]** radical steps into the unknown.

**[01:07:39]** At this moment, I can't foresee the consequences

**[01:07:42]** of the government proposal, which we actually submitted

**[01:07:45]** and it will soon probably be the subject of our discussion,

**[01:07:49]** the main question for today.

**[01:07:52]** On the other hand, I am absolutely sure

**[01:07:54]** that the process should not be too fast and should be

**[01:07:57]** actually phased, and at each phase of the process

**[01:08:01]** we should not only discuss it publicly

**[01:08:04]** in the public space and pay attention to it,

**[01:08:06]** because it concerns all of us and involves huge amounts of money

**[01:08:08]** and major impacts on each of our lives,

**[01:08:11]** but precisely because there is no

**[01:08:14]** well-trodden path here. By the way, the proposal represents

**[01:08:17]** one of the most radical ideas,

**[01:08:19]** one of the most radical concepts,

**[01:08:21]** that if placed at the government level in any country.

**[01:08:25]** For example, in Europe, there is no country

**[01:08:27]** that has a comparable proposal.

**[01:08:30]** Even the resonating Netherlands does not have such a form.

**[01:08:33]** There is still that gray zone where

**[01:08:36]** production and distribution are something tolerated,

**[01:08:40]** but it does not have the form contained

**[01:08:43]** in our government proposal.

**[01:08:45]** That means it is truly something where, in my opinion,

**[01:08:48]** and deep conviction, we are at the threshold of something,

**[01:08:51]** which should actually take years, at least years,

**[01:08:54]** and where it should have defined phases,

**[01:08:57]** and at the same time, where it is hard to see much beyond

**[01:08:59]** one or two phases,

**[01:09:01]** and where at every boundary there should be

**[01:09:04]** discussion, looking at the data,

**[01:09:07]** interpreting the data precisely because

**[01:09:09]** the interpretation is not simple at all.

**[01:09:12]** And very often the interpretation cannot be narrowed down to

**[01:09:16]** some high-ranking official coming and authoritatively saying,

**[01:09:20]** this is how it is and this is how it isn't,

**[01:09:22]** because for many of us it will be a question of

**[01:09:24]** how we want it to be,

**[01:09:26]** because there is more than one possible model.

**[01:09:29]** And it may be good to say at the end,

**[01:09:33]** this does not mean that one of the models is bad

**[01:09:37]** and the other is good.

**[01:09:39]** It is more about how we want it

**[01:09:41]** and how it will suit the company.

**[01:09:43]** At the same time, they repeat under that pressure,

**[01:09:45]** what the company will be able to afford economically,

**[01:09:48]** because of the recession,

**[01:09:50]** I'll use the word recession, probably economists would resist,

**[01:09:53]** but on the other hand, simply what we are witnessing,

**[01:09:55]** the huge price increases

**[01:09:57]** and the incredible inflation

**[01:09:59]** is true.

**[01:10:00]** It's something that will crush us now and will continue to crush us for several years.

**[01:10:05]** Under these circumstances, it seems really inappropriate to me

**[01:10:09]** not to consider this factor and pretend it simply doesn't affect this area.

**[01:10:15]** Thank you very much for your attention, thank you for your time,

**[01:10:18]** that you came, and we can move on to the second part, straight to the questions. Thank you.

**[01:10:31]** So I'll move a bit closer to you.

**[01:10:33]** If I may,

**[01:10:35]** or we'll do it like this, like this.

**[01:10:37]** Thank you very much for the introduction.

**[01:10:41]** Whenever you speak,

**[01:10:44]** and I've heard many interviews, we even talked about it,

**[01:10:47]** I have huge respect for this topic,

**[01:10:50]** really huge.

**[01:10:53]** And somehow it runs through my mind,

**[01:10:56]** that maybe many people

**[01:11:00]** come into the discussion with a fixed opinion.

**[01:11:03]** And I wonder,

**[01:11:06]** what would actually have to happen

**[01:11:09]** to move it forward a bit.

**[01:11:12]** Now I'll give a specific example.

**[01:11:15]** I think most of us would agree

**[01:11:18]** that giving heroin to a child

**[01:11:21]** is not really OK.

**[01:11:24]** But then when I sit somewhere in summer

**[01:11:27]** on a bench at a restaurant,

**[01:11:30]** I see many parents giving their children a sip of beer,

**[01:11:33]** as if it were normal.

**[01:11:36]** And then I come across places where people say

**[01:11:39]** OK, here is some non-alcoholic

**[01:11:42]** hopped drink and this is OK.

**[01:11:45]** And then I meet parents who say

**[01:11:48]** like none of that, they don't drag my child here

**[01:11:51]** and they have a glass.

**[01:11:54]** So the gray area is huge

**[01:11:57]** and I'm actually thinking about what to do about it.

**[01:12:00]** Because the topic, which you are the bearer of and took

**[01:12:03]** on your shoulders,

**[01:12:06]** so why is it so strange like this?

**[01:12:09]** Is it because of the addictive substances themselves?

**[01:12:12]** It's a very complicated question.

**[01:12:15]** And at the same time.

**[01:12:18]** It's quite clear that a discussion like this

**[01:12:22]** probably won't throw anyone off their game.

**[01:12:25]** So you come here with some opinion

**[01:12:28]** and maybe I'll upset some of you,

**[01:12:31]** maybe I'll amuse some of you,

**[01:12:34]** but the likelihood that your stance would dramatically change it,

**[01:12:37]** is not very high.

**[01:12:40]** Because the format we have, maybe fortunately,

**[01:12:43]** doesn't have the potential to affect you

**[01:12:46]** in such a radical way.

**[01:12:50]** Although I look young,

**[01:12:53]** I've been in the field for quite a long time.

**[01:12:56]** And among the interesting things I've noticed,

**[01:12:59]** which have their charm,

**[01:13:02]** when we started in the first half of the 90s

**[01:13:07]** with nonprofits and field services and so on,

**[01:13:11]** the rejecting attitudes

**[01:13:14]** and the huge amount of bias,

**[01:13:17]** prejudice, and stigmatization of the field

**[01:13:20]** were so enormous that at the level of local politicians

**[01:13:23]** we found very little support.

**[01:13:27]** And what was very interesting about them

**[01:13:30]** was where the turning point was and where we got more support from them.

**[01:13:33]** And that was suddenly the moment when it concerned

**[01:13:36]** either their children, their wives, husbands,

**[01:13:39]** fathers, mothers, and suddenly we got support

**[01:13:45]** to such an extent that my jaw dropped.

**[01:13:48]** I remember, for example, when we were building

**[01:13:51]** a day care center in Brno,

**[01:13:54]** actually meant back then, as many were being closed

**[01:13:57]** Those kindergartens, the older ones will remember,

**[01:14:00]** it was like a wave when the city districts

**[01:14:03]** simply got rid of those kindergartens and there were no children,

**[01:14:06]** and they were figuring out what to do about it.

**[01:14:09]** But to close a kindergarten like that

**[01:14:12]** required an incredible amount of courage

**[01:14:15]** from the local politician. I remember back then,

**[01:14:18]** it was in Řečkovice, and it really took

**[01:14:21]** long, long months of going around and persuading people,

**[01:14:24]** and then it took the courage of the then deputy mayor,

**[01:14:27]** who was deeply convinced. He said,

**[01:14:30]** I know this will cost me a lot of points,

**[01:14:33]** but I think we deserve to have this here,

**[01:14:36]** and I'm ready for the petitions, I'll go with you on this.

**[01:14:42]** It's an outpatient large day care center with a substitution center.

**[01:14:45]** I mean, we have something else, it's the center of Brno,

**[01:14:48]** like the center of Prague, and the outskirts,

**[01:14:51]** because Řečkovice is somewhat the outskirts of Brno,

**[01:14:54]** so suddenly there was an uproar about giving methadone here,

**[01:14:59]** and things like that. We even had a very strong

**[01:15:02]** component for the Roma community back then,

**[01:15:05]** and that was really strong stuff in the nineties.

**[01:15:08]** And I just want to demonstrate with this,

**[01:15:11]** how personal changes, attitudes are influenced,

**[01:15:15]** and that it usually comes from a big impact.

**[01:15:18]** That means, very rarely in my professional career,

**[01:15:21]** and even as a person, have I encountered someone

**[01:15:24]** who radically changed their opinion

**[01:15:27]** without some significant impact.

**[01:15:30]** Something had to happen that was so close,

**[01:15:33]** so confrontational, that it

**[01:15:36]** forced the person to see it completely differently.

**[01:15:39]** Or there was a completely different radical worldview,

**[01:15:42]** for example based on faith or other things,

**[01:15:45]** which influenced the view on

**[01:15:48]** who a service is intended for, whether I can want and support it,

**[01:15:51]** even if it doesn't bring me many political points.

**[01:15:54]** And that's actually what I'm getting at with your question.

**[01:15:58]** I think, on one hand, it's maybe good

**[01:16:02]** that attitudes can't be influenced so quickly,

**[01:16:05]** because I think it also protects us a bit.

**[01:16:08]** We're really talking about such a radical transformation,

**[01:16:11]** such a huge shift that has no historical parallel,

**[01:16:14]** I believe, and especially by deciding about it,

**[01:16:18]** by choosing whether we want it or not.

**[01:16:21]** Meaning, it won't happen as some other internal process,

**[01:16:25]** some other catastrophe that would facilitate it.

**[01:16:28]** It will probably happen because we say we want it or we don't.

**[01:16:32]** And I am deeply convinced that it should be very gradual

**[01:16:36]** and that we shouldn't make such harsh revolutionary changes,

**[01:16:40]** because usually when there's a revolution, blood is shed.

**[01:16:44]** And I think the natural development, the natural shift,

**[01:16:51]** something that matures and at the same time something you can control,

**[01:16:55]** something you can verify and possibly pull the brake on in time,

**[01:17:00]** is very important, and maybe we shouldn't rush into it

**[01:17:04]** just because we're very excited,

**[01:17:07]** seeing the somersaults made by generations before us

**[01:17:10]** and countries that decided on some radical solutions,

**[01:17:13]** so caution is appropriate and caution is not a mistake.

**[01:17:18]** And I can even imagine that within the spectrum of solutions,

**[01:17:23]** we will look for much richer, more diverse models,

**[01:17:28]** than those we have so far put on paper and commented on.

**[01:17:32]** Because I tell this to our students too, and it's a kind of motto for me,

**[01:17:36]** especially in the context when we talk about services we develop,

**[01:17:41]** where it's amazing to see the growth and overall richness

**[01:17:46]** that clinical practice represents.

**[01:17:48]** That diversity is something that protects us.

**[01:17:52]** It works in nature, it works reliably, it's proven,

**[01:17:56]** it's well tested, so we are not afraid of diversity,

**[01:18:00]** because uniformity, on the contrary, is something dangerous,

**[01:18:04]** something dysfunctional, something that can lead us into a dead end.

**[01:18:09]** I think those charming parallels, which you can all look at,

**[01:18:13]** today Brave New World is very well done,

**[01:18:17]** it's one area that isn't really sci-fi anymore.

**[01:18:23]** And likewise, when you look at the reality of people being shot or hanged

**[01:18:26]** for using something, for ruining their health,

**[01:18:29]** or allowing someone else to ruin their health,

**[01:18:32]** I think these are really big reminders,

**[01:18:35]** and we truly are not afraid to look for different solutions

**[01:18:42]** and try it out for a while. It's appropriate, it's a huge change.

**[01:18:48]** Maybe now I'll get to the results.

**[01:18:51]** If the director could show it, that would be great.

**[01:18:56]** It turns out that 25% of people say no, it went over my head,

**[01:19:01]** the absolute majority, no details, I don't know, 46%.

**[01:19:05]** I noticed and support 22%, and I noticed and strongly oppose 8%.

**[01:19:11]** I don't know what that says about our bubble,

**[01:19:13]** because you probably have these here, but if you could just simply comment on it.

**[01:19:20]** Actually, the majority of those who registered, know something about it

**[01:19:25]** and support it, is very likely linked to the fact

**[01:19:30]** that people who watch this and participate here

**[01:19:33]** are probably people who want to know something about these things.

**[01:19:36]** Just the fact that you invest this much time in it

**[01:19:39]** will distinguish you, and it will distinguish you very significantly.

**[01:19:43]** That means it's clear that probably in the population

**[01:19:47]** these two groups will be closer to each other.

**[01:19:50]** That means they will be similarly sized.

**[01:19:52]** Although so far the support for the liberalizing trend

**[01:19:57]** is currently very high in the population.

**[01:20:00]** By the way, allow me a very brief sociological detour,

**[01:20:04]** but we are really used to criticizing ourselves a lot, putting a lot of

**[01:20:08]** negative labels on ourselves and so on,

**[01:20:12]** but I think we rarely realize that the Czech population

**[01:20:16]** is actually a highly liberal population, meaning that

**[01:20:20]** what we live here in Central Europe is actually a fairly highly liberal

**[01:20:24]** setting, and anyone who travels even a little more

**[01:20:28]** has to logically notice that, and I think

**[01:20:32]** that is a great achievement and at the same time it is not something...

**[01:20:36]** We really have a lot of negatives and things we could say

**[01:20:40]** are part of our national character in a nutshell,

**[01:20:44]** and without a doubt that includes a somewhat grumpier,

**[01:20:48]** more tense social atmosphere, a certain greater degree of frustration and anger,

**[01:20:52]** and now actually in this post-COVID period you can see

**[01:20:56]** that many people in this society, but on the other hand it still doesn't deny

**[01:21:00]** the very important fact that we are actually quite liberal.

**[01:21:04]** You see it in attitudes toward minorities. And despite the fact that

**[01:21:08]** there is still a huge number of people in society who have

**[01:21:12]** a hard time dealing with this topic, on the other hand there is a huge number of people

**[01:21:16]** who actually represent a very liberal worldview,

**[01:21:20]** very liberal opinions, and our legislation actually reflects that very well.

**[01:21:24]** You see it in relation to, for example, sexual minorities and so on,

**[01:21:28]** but also in the overall atmosphere in society.

**[01:21:32]** And it's not just a question of Prague, not just Brno,

**[01:21:36]** or just Ostrava, the big cities, Olomouc. It also concerns

**[01:21:40]** medium-sized cities, meaning, for example,

**[01:21:44]** if you look at the Eastern Bloc, for me

**[01:21:48]** it's very refreshing to return, hopefully our neighbors will forgive me,

**[01:21:52]** but for me it's refreshing to return from Slovakia,

**[01:21:56]** Hungary, or Poland, because the situation there is

**[01:22:00]** very different, and it seems very dangerous to me,

**[01:22:05]** you see it in exceptions among doctors and so on,

**[01:22:11]** especially regarding abortion topics,

**[01:22:14]** which is a very important litmus test in society,

**[01:22:17]** you see it in the aging Hungarian society,

**[01:22:20]** these are frightening things, and I think, going back to this,

**[01:22:25]** I believe that maybe the Czech Republic could be

**[01:22:29]** an incubator where we might allow ourselves,

**[01:22:33]** a bit of experimentation, to be a bit more progressive,

**[01:22:37]** to stop waiting for the Germans to do it first, as we are historically used to,

**[01:22:42]** like, look, they already have it, and we're still

**[01:22:45]** behind the times, so maybe we could sometimes do something

**[01:22:49]** before the Germans or Austrians do, and stand by it,

**[01:22:55]** because this is about self-confidence,

**[01:22:58]** reflecting our confidence to dare something like this and handle it. At the same time,

**[01:23:01]** I’ll allow myself a shortcut: Czech addictology is really quite advanced,

**[01:23:06]** anything we do internationally,

**[01:23:11]** it’s clear that in areas heavily influenced by economics,

**[01:23:16]** we can’t always be among the first,

**[01:23:21]** we have biomedical research,

**[01:23:24]** and in addictology, there will still be a long way to catch up. But on the other hand,

**[01:23:27]** from a clinical and academic perspective,

**[01:23:30]** for example, where we have reached, colleagues

**[01:23:33]** abroad sometimes don’t quite believe it, and I think

**[01:23:36]** that even in terms of drug policies, the Czech Republic

**[01:23:40]** could afford to be a pioneer in some areas,

**[01:23:44]** but again, I repeat, I think the high degree of caution

**[01:23:48]** and a certain conservatism and the requirement that everything be

**[01:23:52]** verified step by step and that there is space

**[01:24:04]** I for maneuvering or stopping, I think that should be

**[01:24:08]** an automatic and important requirement.

**[01:24:12]** I have many topics that I want to discuss.

**[01:24:16]** Fortunately, there will be a discussion,

**[01:24:20]** which I will tell you about later, when and how,

**[01:24:24]** but I will get to one that we mentioned,

**[01:24:28]** as a parent, you talked about a critical age,

**[01:24:32]** which is really formative for the child and so on,

**[01:24:36]** try to say just a little to the parents mentioned here,

**[01:24:40]** how to actually approach it?

**[01:24:44]** Certainly, in relation to when I gave the example here

**[01:24:48]** of our weakness, which is prevention, even though for example

**[01:24:52]** many things we created in prevention are now being exported

**[01:24:56]** abroad, but with frustration, because these are things we

**[01:25:00]** wanted to implement here. Thank you. This is one of those things

**[01:25:04]** we end up exporting. For example, we exported our quality system.

**[01:25:08]** It really caused a big stir abroad when colleagues

**[01:25:12]** found out that something they are now discovering and trying to implement

**[01:25:16]** at national levels, we have 20 years of development behind us,

**[01:25:20]** including very successful testing and so on.

**[01:25:24]** To your question, yes, this is a weakness that we are able to

**[01:25:28]** make great progress on in a relatively short time

**[01:25:32]** and for example, the basic reflection that children are most

**[01:25:36]** influenced between the ages of 11 and 16 means

**[01:25:40]** we should invest resources precisely into a system that

**[01:25:44]** targets children between 11 and 16 years old. In other words, in practice,

**[01:25:48]** for example, in terms of addiction prevention

**[01:25:52]** and generally risk behavior prevention, you have relatively very

**[01:25:56]** little room to do anything before the age of ten.

**[01:26:00]** That means it is really more about upbringing matters

**[01:26:04]** about health, relationship to the body, and similar issues, of course appropriately

**[01:26:08]** to the different age levels of children up to ten years old,

**[01:26:12]** and real prevention in terms of these tools that are tested

**[01:26:16]** and shown to be effective starts at age 10 or 11,

**[01:26:20]** and that is where the majority of public funding investment should be,

**[01:26:24]** and at the same time, this is exactly

**[01:26:28]** the moment when these tools help compensate

**[01:26:32]** and catch up on what failed in the family.

**[01:26:36]** On the other hand, it does not replace the family.

**[01:26:40]** That means it is still some kind of compensatory aid

**[01:26:44]** and nothing more than a compensatory tool. That means in no case

**[01:26:48]** does it diminish the parents and their responsibilities,

**[01:26:52]** their involvement and their role. It only means that here we provide

**[01:26:56]** something that can help them,

**[01:27:00]** but it does not replace them. And at the same time, it might also mean

**[01:27:04]** that if we were to invest in children between 11 and 16 years old,

**[01:27:08]** the main resources for prevention,

**[01:27:12]** we are mainly talking about the second half of elementary school,

**[01:27:16]** or roughly the transition between 4th and 9th grade,

**[01:27:20]** this is the age where we should be most active in terms of prevention.

**[01:27:24]** Where we have a huge debt is with the parents.

**[01:27:28]** For example, the topic of parental competencies is a topic

**[01:27:32]** that our society has significantly neglected.

**[01:27:36]** You can see it, for example, in the rather wild concepts

**[01:27:40]** that my generation and the one below me have,

**[01:27:44]** who crossed over the year 1989.

**[01:27:48]** They entered parenthood with the belief

**[01:27:52]** that children should have everything available and similar, until we actually produced a generation

**[01:27:56]** that thinks the world will cater to them,

**[01:28:00]** they will get everything, everything is automatic, and everything will be painless.

**[01:28:04]** A generation that does not fight for its position, a generation

**[01:28:08]** that does not fight with us for those positions. My generation still experienced

**[01:28:12]** that those 10 or 20 years above me, we naturally fought with those

**[01:28:16]** men or women above us.

**[01:28:20]** We fought over who would have the say, who would lead the workplace,

**[01:28:24]** and it was clear that generational change was part of the task.

**[01:28:28]** But here suddenly no one fights.

**[01:28:32]** No one wants to dethrone you and they even say,

**[01:28:36]** we are glad you are there, let's play well like this and we will work with you like this

**[01:28:40]** at the workplace. That's strange. There is no competition.

**[01:28:44]** There is simply, to narrow it down, give me a name,

**[01:28:48]** there is simply a lack of testosterone.

**[01:28:52]** That is something that will get us into trouble.

**[01:28:56]** Now I will relate it back. It is about our parental competencies

**[01:29:00]** and it is actually about something where the pendulum needed

**[01:29:04]** to swing to the other side, so that we now say and discover

**[01:29:08]** Matějíček and other great Czechoslovak child psychologists,

**[01:29:12]** that children need boundaries,

**[01:29:16]** that it is normal for children to experience frustration, that they cannot have everything,

**[01:29:20]** and that of course punishments must be handled very carefully,

**[01:29:24]** but that some form of punishment at some point is absolutely appropriate

**[01:29:28]** and that children won't raise themselves

**[01:29:32]** and that the reminiscence of educational concepts from the 60s and 70s

**[01:29:36]** is simply nice. NM it's a bit about those 50 years

**[01:29:40]** like somewhere else. So that's part of the answer

**[01:29:44]** and part of it is that we obviously can't put all the resources

**[01:29:48]** just into the children, because children are raised by someone

**[01:29:52]** and for example, it's not entirely uninteresting to critically say,

**[01:29:56]** that for example, in the Czech Republic we lack parental primacy.

**[01:30:00]** programs. Many things have failed for parents. We tried to adapt

**[01:30:05]** some foreign programs here because it didn't work. So this is a debt,

**[01:30:10]** a a huge one in prevention, especially programs focused

**[01:30:14]** on parents and parental competencies are something we will have to push

**[01:30:18]** radically further, because there is a huge gap in the market here.

**[01:30:23]** So, now I'll do something I don't do very often and do it like this,

**[01:30:30]** normally we would move behind a paywall now and you would buy the rest for 5 euros

**[01:30:37]** and continue the discussion. But we won't go behind a paywall here

**[01:30:42]** and all the things there, whether it's about sugar, or whether it's

**[01:30:46]** about other things, or about how social networks work and these things,

**[01:30:50]** addictions within addictions.

**[01:30:55]** So let's take the first six. So I would like to thank you

**[01:31:03]** for the, let's say, first part. For me, it was a very nice kickoff,

**[01:31:09]** and I hope we will continue. So once again,

**[01:31:15]** thank you.

**[01:31:18]** And for you, please try to put on the slide now how you liked it.

**[01:31:28]** Five stars means it was amazing, one star means I aged

**[01:31:33]** or I really got nothing out of it.

**[01:31:37]** I'm very interested in the word you put in the rating.

**[01:31:42]** Please try to give one word, from that we make a word cloud,

**[01:31:47]** I'm very interested.

**[01:31:50]** So, moving on, something is already loading there, we'll let it run for a moment,

**[01:31:56]** so thank you very much. I would be very glad, again we encourage,

**[01:32:03]** that chatting and inspiration is nice, but even better is

**[01:32:08]** when we turn something into concrete practice.

**[01:32:12]** A middle step between that is sharing these things with someone,

**[01:32:16]** talking about it, reflecting, so try, whether at work,

**[01:32:20]** or wherever you are now in the library, try to chat with someone,

**[01:32:24]** what it gave you, what was an aha moment, and plan something

**[01:32:29]** you will do, that would be really great. As I announced well in advance,

**[01:32:34]** we will do this reflection here coincidentally on Children's Day,

**[01:32:40]** On June 1st after lunch, at one o'clock, we'll get together and really open up the topics

**[01:32:48]** that you just wrote down here, so definitely register at redbutton.edu,

**[01:32:54]** don't let it slip. I just want to remind you

**[01:33:00]** that within the Red Button network we do a whole range of other things,

**[01:33:04]** for example, we have a book of the month, Dan Garmont was one

**[01:33:09]** who suggested the book of the month for May, so check it out at rbkniha.cz.

**[01:33:16]** At the same time, May is the month of self-development at redbutton.edu.

**[01:33:21]** I feel like this somewhat relates to what we're talking about,

**[01:33:25]** and it also ties into Tomáš Šepek's lecture

**[01:33:29]** about the Minister of Health and prevention and so on.

**[01:33:31]** So enjoy May, the month of self-development.

**[01:33:35]** And since we're talking about this, I often get the question,

**[01:33:40]** but I just don't have time to educate myself at all,

**[01:33:43]** I'm just going full speed, you came today and said

**[01:33:45]** that times are fast. For everyone

**[01:33:49]** who is somewhat interested in education topics,

**[01:33:54]** and wants to take it further, we created this nice page,

**[01:33:57]** called Trends in Education, and by coincidence on the 30th

**[01:34:02]** we will have a webinar on how to find time for education.

**[01:34:07]** So this might not apply to you, since you're here watching,

**[01:34:10]** but you can recommend it to your colleagues.

**[01:34:13]** The next Brain and Breakfast will somewhat relate to self-development.

**[01:34:17]** As a swimmer, I'm really excited

**[01:34:22]** that on June 22nd, Abertali Bernardová accepted the invitation.

**[01:34:26]** If you don't know this lady, look up what Ocean 7 means,

**[01:34:31]** it's like the holy grail of long-distance swims.

**[01:34:37]** She is the first Czech and the tenth person to have done it.

**[01:34:42]** So the topic is: we can do more than we usually dare to admit.

**[01:34:46]** I'm really looking forward to it. Once again, a reminder,

**[01:34:50]** if you don't want to miss anything important from the Red Button network,

**[01:34:54]** make sure to register. Thanks to Magenta for the space.

**[01:34:57]** Thank you for coming and thank you for watching.

**[01:35:00]** Have a great day, see you and goodbye.

**[01:35:04]** Thank you.