{"id":39175,"date":"2026-09-19T09:57:11","date_gmt":"2026-09-19T07:57:11","guid":{"rendered":"https:\/\/drogriporter.hu\/?p=39175"},"modified":"2026-09-19T09:57:12","modified_gmt":"2026-09-19T07:57:12","slug":"take-responsibility-breaking-the-silence-on-abuse-in-greek-drug-treatment","status":"publish","type":"post","link":"https:\/\/drogriporter.hu\/en\/take-responsibility-breaking-the-silence-on-abuse-in-greek-drug-treatment\/","title":{"rendered":"\u201cTake Responsibility\u201d: Breaking the Silence on Abuse in Greek Drug Treatment"},"content":{"rendered":"\n

I entered a residential therapeutic community in Greece expecting care, understanding and a way out of addiction. What I encountered was a culture in which humiliation, confrontation and submission could be presented as treatment. Years later, working in harm reduction and drug policy, I encountered the same institution again \u2014 this time as one of the most powerful voices shaping how Greece understood addiction and recovery. A guest article by Marios Atzemi<\/strong>s, a leading Greek HIV activist and harm reduction expert. <\/p>\n\n\n\n\n\n\n\n

In 2009, I needed help.<\/p>\n\n\n\n

My choices were extremely limited. Access to opioid substitution treatment through OKANA involved an extraordinary waiting list, which at the time stretched into years. The other major public abstinence-oriented programme in Athens, 18 ANO, required people to remain outside its residential structure and attend preparatory groups for months before admission , remaining sober<\/p>\n\n\n\n

KETHEA PAREMVASI, one of the residential therapeutic communities of KETHEA(Center for Therapy of Dependent Individuals ) \u2014 for decades one of Greece\u2019s most respected and influential drug-treatment organisations \u2014 offered a more immediate route into residential treatment.<\/p>\n\n\n\n

So I went there.<\/p>\n\n\n\n

I was not choosing between competing philosophies of addiction treatment. I knew little about those debates. I was a person with a problematic  drug  use problem looking for help.<\/p>\n\n\n\n

I expected humanity. Understanding. Safety.<\/p>\n\n\n\n

One of my first memories after entering the community is of seeing a resident running with a ball of yarn hanging from his neck. Older members were shouting at him: \u201cKouvari, ton nou sou!\u201d \u2014 roughly, \u201cBall of yarn, watch yourself!\u201d<\/p>\n\n\n\n

I remember wondering where I had arrived.<\/p>\n\n\n\n

I would understand soon enough.<\/p>\n\n\n\n

<\/a>\u201cTake responsibility\u201d<\/strong><\/h2>\n\n\n\n

During my time at KETHEA PAREMVASI in 2009 and 2010, I personally experienced or witnessed practices that today I find difficult to describe as anything other than degrading and abusive.<\/p>\n\n\n\n

Residents could be subjected to prolonged sleep deprivation through night duties and exhausting tasks. People could be required to carry heavy objects \u2014 stones or even a bowling ball \u2014 for extended periods as punishment or as a \u201cconsequence\u201d. Humiliating symbolic objects could be hung from a resident\u2019s body: balls of yarn, alarm clocks, a baby\u2019s pacifier.<\/p>\n\n\n\n

Some people had to perform ordinary tasks while holding raw eggs that they were forbidden to break.<\/p>\n\n\n\n

There were aggressive confrontation groups in which one person would be placed at the centre while others shouted at, insulted and humiliated them. Homophobic insults could be directed at gay men or men who had sex with men.<\/p>\n\n\n\n

Residents whose behaviour was labelled \u201cself-destructive\u201d could be ordered to dig a hole presented to them as their own grave.<\/p>\n\n\n\n

But a list of practices does not fully explain what it was like to live inside that environment.<\/p>\n\n\n\n

The essential point was that these practices were given therapeutic meaning<\/strong>.<\/p>\n\n\n\n

Humiliation did not have to be called humiliation. It could be called a \u201cconsequence\u201d. Submission could become a commitment to treatment. Aggressive confrontation could be justified as breaking through denial.<\/p>\n\n\n\n

And one instruction was repeated relentlessly:<\/p>\n\n\n\n

\u201cTake responsibility.\u201d<\/strong><\/p>\n\n\n\n

Responsibility was central to the moral universe of the community.<\/p>\n\n\n\n

We were expected to take responsibility for our addiction. For our behaviour. For our attitudes. For our resistance. For the way we reacted to what was being done to us.<\/p>\n\n\n\n

Often, the demand to \u201ctake responsibility\u201d came immediately before punishment, confrontation or humiliation.<\/p>\n\n\n\n

At the time, I did not possess the conceptual language I have today to analyse this environment. I was not a harm-reduction activist or a drug-policy advocate. I was a person with a serious drug problem who had entered an institution whose authority I had every reason to trust.<\/p>\n\n\n\n

And there was another extraordinarily powerful message: this programme could save your life.<\/p>\n\n\n\n

When somebody left the therapeutic community, returned to heroin use and subsequently died, residents could be gathered together and informed of the death.<\/p>\n\n\n\n

Whatever the intention, the lesson for those of us remaining inside was difficult to miss.<\/p>\n\n\n\n

Leave, and you may return to drugs and die.<\/p>\n\n\n\n

Stay, submit to the programme, and you may survive.<\/p>\n\n\n\n

That is important to remember whenever somebody asks why a person in such an environment did not simply walk out.<\/p>\n\n\n\n

<\/a>Discovering that abstinence did not require humiliation<\/strong><\/h2>\n\n\n\n

It took me time to understand what had happened to me.<\/p>\n\n\n\n

One of the experiences that changed my perspective came later. After being diagnosed with HIV and with the help of friends, I eventually entered 18 ANO, another abstinence-oriented treatment programme in Athens.<\/p>\n\n\n\n

I could hardly believe the difference.<\/p>\n\n\n\n

There was psychotherapy. There were art groups. There was an effort to understand an individual\u2019s history, vulnerabilities and particular needs.<\/p>\n\n\n\n

I experienced something I had not believed possible in addiction treatment: sensitivity.<\/p>\n\n\n\n

I was treated as a human being with a unique personality rather than as part of a uniform mass that had to be broken down and reconstructed.<\/p>\n\n\n\n

This distinction is important because I know how easily the present controversy can be absorbed into an old ideological conflict.<\/p>\n\n\n\n

I have spent years working in harm reduction. But my criticism of what I experienced at KETHEA is not an argument against abstinence.<\/p>\n\n\n\n

Nor is it an argument that therapeutic communities cannot help people. Some former residents say KETHEA profoundly changed or saved their lives. Their experience is theirs, just as mine is mine.<\/p>\n\n\n\n

What my subsequent treatment taught me was something much simpler.<\/p>\n\n\n\n

Abstinence did not require humiliation.<\/p>\n\n\n\n

Therapy did not require degradation.<\/p>\n\n\n\n

And helping somebody change did not require first breaking that person down.<\/p>\n\n\n\n

<\/a>From resident to drug-policy advocate<\/strong><\/h2>\n\n\n\n

Over the following years, my relationship with the drug field changed completely.<\/p>\n\n\n\n

I became involved in HIV activism, patient advocacy, harm reduction and the rights of people who use drugs. Eventually I became involved in drug policy itself, participating in national and international networks and policy discussions.<\/p>\n\n\n\n

And in that world I encountered KETHEA again.<\/p>\n\n\n\n

This time I was not a resident inside one of its communities. I was sitting at tables where addiction treatment and drug policy were being discussed.<\/p>\n\n\n\n

What struck me was the extraordinary distance between the institution I remembered from the inside and the institution I encountered in public life.<\/p>\n\n\n\n

KETHEA was never simply a treatment provider.<\/p>\n\n\n\n

It had accumulated enormous social, political and moral authority in Greece. Prominent people from politics, academia, culture and public life had participated in its governing structures. Its representatives were active in international drug-policy and therapeutic-community forums.<\/p>\n\n\n\n

Its public image was overwhelmingly one of success, expertise and moral legitimacy.<\/p>\n\n\n\n

I repeatedly encountered claims about KETHEA\u2019s exceptional success.<\/p>\n\n\n\n

I cannot offer a scientific evaluation of those claims, nor is that the purpose of this article. I can only say that the triumphant public narrative did not correspond to the complicated reality I remembered.<\/p>\n\n\n\n

More importantly, I began to understand how difficult it was to challenge that narrative.<\/p>\n\n\n\n

I experienced this myself in policy discussions. KETHEA had become such a dominant voice in the Greek debate on addiction that questioning its treatment philosophy or practices could be interpreted almost as questioning recovery itself. At times, the discussion seemed less like a pluralistic debate between different approaches to treatment and more like a self-reinforcing monologue about what addiction was, what people who used drugs needed and what successful treatment should look like.<\/p>\n\n\n\n

As somebody working in harm reduction, I also saw how readily questions about treatment ethics could be displaced into the old ideological battle between abstinence and harm reduction.<\/p>\n\n\n\n

But over time I noticed something else that reminded me strongly of the world I had known inside the community.<\/p>\n\n\n\n

The institution appeared to possess a remarkably self-protective explanation for different outcomes.<\/p>\n\n\n\n

If somebody completed the programme, endured its demands and remained abstinent, this could become evidence of the programme\u2019s success.<\/p>\n\n\n\n

But if somebody left because they could no longer tolerate what was happening?<\/p>\n\n\n\n

The model had not necessarily failed them.<\/p>\n\n\n\n

They had failed the model.<\/p>\n\n\n\n

They had not tried hard enough. They had not been ready. They had resisted treatment.<\/p>\n\n\n\n

They had not \u201ctaken responsibility\u201d.<\/p>\n\n\n\n

It was a logic in which success could belong to the institution while failure could remain with the individual.<\/p>\n\n\n\n

<\/a>The day I had to say it in court<\/strong><\/h2>\n\n\n\n

Years later, the two parts of my life \u2014 the former resident and the drug-policy advocate \u2014 collided.<\/p>\n\n\n\n

Grigoris Vallianatos, a prominent Greek human-rights and gay-rights activist, publicly raised allegations about abusive practices within KETHEA. Members of KETHEA\u2019s employees\u2019 association took legal action against him for defamation.<\/p>\n\n\n\n

Vallianatos was convicted at first instance.<\/p>\n\n\n\n

I appeared at the trial as the only defence witness who came to court to testify from direct personal experience of the practices being discussed.<\/p>\n\n\n\n

For me, this was no longer an ideological argument about treatment models.<\/p>\n\n\n\n

I described what I had experienced at KETHEA PAREMVASI. I spoke about the punishments, the humiliating objects, the confrontation groups, the sleep deprivation and the digging of a grave presented to a resident as his own.<\/p>\n\n\n\n

And during my testimony I was asked two questions that have stayed with me.<\/p>\n\n\n\n

Why didn\u2019t you leave?<\/p>\n\n\n\n

Why didn\u2019t you speak at the time?<\/p>\n\n\n\n

I recognise a court\u2019s responsibility to test evidence and question witnesses. But I also recognised something deeply familiar in those questions.<\/p>\n\n\n\n

We have heard variations of them in many other contexts of abuse.<\/p>\n\n\n\n

Why did she stay?<\/p>\n\n\n\n

Why didn\u2019t he report it?<\/p>\n\n\n\n

Why did they wait years before speaking?<\/p>\n\n\n\n

Institutional authority, dependency, fear, shame and vulnerability are among the reasons people may remain silent.<\/p>\n\n\n\n

In residential addiction treatment there is another layer: the institution may exercise extraordinary authority over a person at one of the most vulnerable moments of their life.<\/p>\n\n\n\n

We had been taught that our survival might depend on accepting that authority.<\/p>\n\n\n\n

<\/a>From \u201cscience fiction\u201d to \u201cpsychodrama\u201d<\/strong><\/h2>\n\n\n\n

The reaction when these experiences finally entered public discussion has been almost as revealing to me as the original practices.<\/p>\n\n\n\n

Initially, representatives defending the old KETHEA model publicly dismissed allegations such as these as \u201cscience-fiction scenarios\u201d.<\/p>\n\n\n\n

Then the language began to shift.<\/p>\n\n\n\n

When I appeared on television describing what I had personally experienced, the president of the employees\u2019 association subsequently invoked the idea of \u201cpsychodrama\u201d in discussing such practices.<\/p>\n\n\n\n

That shift matters.<\/p>\n\n\n\n

There is an important difference between saying that an allegation belongs to the realm of fantasy and suggesting that what is being described should instead be understood within a therapeutic framework.<\/p>\n\n\n\n

I will leave others to interpret that change in language.<\/p>\n\n\n\n

What I found even more familiar was another response that appeared in the public discussion.<\/p>\n\n\n\n

The message, in essence, was that addiction treatment is not a playground. Some comments suggested that people making such complaints were simply people who had failed to make it through treatment.<\/p>\n\n\n\n

There it was again.<\/p>\n\n\n\n

The same logic I remembered from inside the community.<\/p>\n\n\n\n

If you could not endure it, perhaps the problem was not what was being done to you.<\/p>\n\n\n\n

Perhaps the problem was you.<\/p>\n\n\n\n

<\/a>When the person speaking becomes the problem<\/strong><\/h2>\n\n\n\n

After I testified and later spoke publicly, much of the response did not focus on the practices I had described.<\/p>\n\n\n\n

It focused on me.<\/p>\n\n\n\n

My professional work in harm reduction became part of the argument. One public statement portrayed me as effectively having been \u201crecruited\u201d for a television report, associated my work with ideas of \u201cfunctional\u201d or \u201cmild\u201d drug use, placed the word \u201ctorture\u201d in quotation marks and questioned why I, among thousands of former KETHEA members, had supposedly been selected to speak.<\/p>\n\n\n\n

This is precisely why the distinction between treatment philosophy and treatment ethics matters.<\/p>\n\n\n\n

Whether carrying a bowling ball as punishment is therapeutic does not depend on my position on harm reduction.<\/p>\n\n\n\n

Whether making somebody dig what is presented as their own grave is acceptable treatment does not depend on my position on drug policy.<\/p>\n\n\n\n

Whether humiliation is ethical does not depend on whether the person describing it later became an activist.<\/p>\n\n\n\n

The fundamental question remains:<\/p>\n\n\n\n

Did these practices occur, and if they did, were they acceptable treatment?<\/strong><\/p>\n\n\n\n

And I was not the first person to raise concerns.<\/p>\n\n\n\n

Years before the present controversy, former KETHEA therapist and psychologist Katerina Konidari had spoken publicly about hierarchy, abuses of power, humiliation and practices including pacifiers and collective verbal confrontation.<\/p>\n\n\n\n

The silence was therefore never absolute.<\/p>\n\n\n\n

The more interesting question is why such accounts struggled for so long to disturb the dominant public image of the institution.<\/p>\n\n\n\n

<\/a>An older therapeutic tradition<\/strong><\/h2>\n\n\n\n

Only later, through reading and through my professional involvement in the field, did I begin to understand that some of what I had experienced belonged to a much older history of addiction treatment.<\/p>\n\n\n\n

The Greek therapeutic-community tradition has documented historical links with the American Daytop model. Daytop itself emerged from a therapeutic-community tradition heavily influenced by Synanon.<\/p>\n\n\n\n

This history needs to be approached carefully.<\/p>\n\n\n\n

Synanon, Daytop and KETHEA were not identical organisations. Nor am I suggesting that every practice used in Greece was mechanically imported from the United States.<\/p>\n\n\n\n

But the genealogy matters.<\/p>\n\n\n\n

Earlier therapeutic-community models placed extraordinary emphasis on confrontation, hierarchy, behavioural control and the reshaping of the individual through the community. Practices that would now immediately raise serious ethical questions could be rationalised as ways of breaking through denial, forcing personal responsibility or reconstructing a supposedly dysfunctional personality.<\/p>\n\n\n\n

A 1972 US federal court decision involving a Daytop-based programme documented public humiliation, collective verbal attacks and degrading symbolic practices, describing aspects of the programme it examined as \u201cdehumanizing and demoralizing\u201d.<\/p>\n\n\n\n

Decades later, when I began reading about this history, some of what had seemed incomprehensible during my treatment became recognisable.<\/p>\n\n\n\n

There was a history behind these ideas.<\/p>\n\n\n\n

That history did not make them therapeutic.<\/p>\n\n\n\n

<\/a>Responsibility cannot flow in only one direction<\/strong><\/h2>\n\n\n\n

This brings me back to the phrase that followed us everywhere.<\/p>\n\n\n\n

Take responsibility.<\/strong><\/p>\n\n\n\n

It was not simply an instruction. It expressed an entire moral logic.<\/p>\n\n\n\n

Responsibility flowed downwards.<\/p>\n\n\n\n

The resident was responsible for his addiction.<\/p>\n\n\n\n

For his behaviour.<\/p>\n\n\n\n

For his attitude.<\/p>\n\n\n\n

For his resistance.<\/p>\n\n\n\n

For his inability to adapt.<\/p>\n\n\n\n

For leaving.<\/p>\n\n\n\n

For relapse.<\/p>\n\n\n\n

For failure.<\/p>\n\n\n\n

And yet, when former residents began describing what had been done to them in the name of treatment, responsibility suddenly became remarkably difficult to locate.<\/p>\n\n\n\n

More than fifteen years have passed since I was in KETHEA PAREMVASI.<\/p>\n\n\n\n

I have heard denials.<\/p>\n\n\n\n

I have heard our experiences reframed.<\/p>\n\n\n\n

I have heard arguments about treatment being difficult.<\/p>\n\n\n\n

I have heard criticism directed at those of us who speak.<\/p>\n\n\n\n

What I have heard remarkably little of is:<\/p>\n\n\n\n

We did this.<\/strong><\/p>\n\n\n\n

We believed it was therapeutic.<\/strong><\/p>\n\n\n\n

We now understand that it could cause harm.<\/strong><\/p>\n\n\n\n

We are sorry.<\/strong><\/p>\n\n\n\n

That silence matters to me.<\/p>\n\n\n\n

Not because I expect an institution to condemn every aspect of its history. Not because I believe everybody who worked within KETHEA was abusive. And not because I deny the experiences of people who believe they were helped there.<\/p>\n\n\n\n

It matters because accountability cannot be a therapeutic principle imposed exclusively on the person seeking help.<\/p>\n\n\n\n

If responsibility is meaningful, it must apply most strongly to those entrusted with power over vulnerable people.<\/p>\n\n\n\n

<\/a>Treatment is not exempt from human rights<\/strong><\/h2>\n\n\n\n

This story extends beyond KETHEA and beyond Greece.<\/p>\n\n\n\n

For much of the history of modern addiction treatment, people who used drugs were regarded as people who needed to be corrected \u2014 confronted, disciplined, controlled and sometimes humiliated before they could change.<\/p>\n\n\n\n

Their suffering could be interpreted as resistance.<\/p>\n\n\n\n

Their refusal could be interpreted as denial.<\/p>\n\n\n\n

Their departure could be interpreted as failure.<\/p>\n\n\n\n

This became possible partly because people who use drugs were not always granted the same assumptions about autonomy, dignity and informed consent that we increasingly expect elsewhere in healthcare.<\/p>\n\n\n\n

My years in harm reduction taught me a radically different starting point.<\/p>\n\n\n\n

Meet people where they are.<\/p>\n\n\n\n

Listen to them.<\/p>\n\n\n\n

Respect their autonomy.<\/p>\n\n\n\n

Keep them alive.<\/p>\n\n\n\n

Do not make dignity conditional upon abstinence.<\/p>\n\n\n\n

None of this means abandoning treatment or recovery.<\/p>\n\n\n\n

It means recognising that recovery cannot be built by erasing the person whose life is supposedly being recovered.<\/p>\n\n\n\n

<\/a>Breaking the silence<\/strong><\/h2>\n\n\n\n

I have spent much of my adult life working in HIV, harm reduction, human rights and drug policy.<\/p>\n\n\n\n

I never imagined that, so many years after leaving KETHEA PAREMVASI, I would have to return publicly to what happened there.<\/p>\n\n\n\n

Doing so has not been easy.<\/p>\n\n\n\n

But I also feel pride.<\/p>\n\n\n\n

Pride that people who went through treatment programmes can describe their experiences without automatically accepting the institution\u2019s interpretation of what happened to them.<\/p>\n\n\n\n

Pride that lived experience is increasingly recognised as knowledge rather than dismissed as an inconvenient anecdote when it challenges professional authority.<\/p>\n\n\n\n

And pride that addiction treatment can finally be subjected to the same standards of evidence, ethics, accountability and human rights that we demand in every other field of healthcare.<\/p>\n\n\n\n

The appeal in the Vallianatos case is due to be heard on 23 September 2026. I do not know what the court will decide.<\/p>\n\n\n\n

But whatever happens in that courtroom, the story no longer begins and ends there.<\/p>\n\n\n\n

Something has already changed.<\/p>\n\n\n\n

For decades, KETHEA enjoyed an extraordinary public reputation in Greece. For many people, its name became almost synonymous with recovery, commitment and hope. That image was so powerful that accounts such as mine could be dismissed, marginalised or explained away without seriously disturbing it.<\/p>\n\n\n\n

That is no longer the case.<\/p>\n\n\n\n

Practices that once remained largely hidden inside therapeutic communities have now been described publicly. Former residents have spoken. Former professionals have spoken. Practices involving humiliation, punishment and aggressive confrontation are no longer something that can simply be confined behind the walls of a treatment programme and protected by its reputation.<\/p>\n\n\n\n

The public image has been fractured.<\/strong><\/p>\n\n\n\n

This does not mean that every allegation has been established in court, nor does it invalidate the experiences of people who believe KETHEA helped them. It means something more fundamental: the institution can no longer expect its reputation alone to settle the question of what happened inside its communities.<\/p>\n\n\n\n

And no court decision can make that public conversation disappear.<\/p>\n\n\n\n

For years, we were told to take responsibility.<\/p>\n\n\n\n

Responsibility for our addiction.<\/p>\n\n\n\n

Responsibility for our behaviour.<\/p>\n\n\n\n

Responsibility for our resistance.<\/p>\n\n\n\n

Responsibility when we failed.<\/p>\n\n\n\n

I accept the principle.<\/p>\n\n\n\n

Responsibility matters.<\/strong><\/p>\n\n\n\n

But it cannot stop at the door of the therapeutic community.<\/p>\n\n\n\n

The people who designed these practices, the professionals who implemented them and the institutions that defended them must also be capable of looking back and asking what was done in the name of treatment.<\/p>\n\n\n\n

For years, the burden of explanation was placed on people like us.<\/p>\n\n\n\n

Why did you not leave?<\/p>\n\n\n\n

Why did you not speak?<\/p>\n\n\n\n

Why did you not succeed?<\/p>\n\n\n\n

Perhaps the questions should now travel in the other direction.<\/p>\n\n\n\n

Why were people seeking treatment subjected to humiliation?<\/p>\n\n\n\n

Why were such practices considered therapeutic?<\/p>\n\n\n\n

Why were those who could not tolerate them so easily blamed?<\/p>\n\n\n\n

And why, after all these years, is it still so difficult to hear a simple acknowledgement of responsibility from those who exercised power over us?<\/p>\n\n\n\n

Humiliation was not responsibility.<\/p>\n\n\n\n

Submission was not recovery.<\/p>\n\n\n\n

Degradation was not therapy.<\/p>\n\n\n\n

No therapeutic objective \u2014 including abstinence \u2014 can justify humiliation, coercion or abuse.<\/p>\n\n\n\n

People who use drugs do not surrender their human rights when they enter treatment.<\/p>\n\n\n\n

Whatever the Court of Appeal decides, the silence has already been broken. What happened inside these communities is now part of the public record and the public debate. The image of an institution beyond questioning has been irreversibly challenged.<\/p>\n\n\n\n

They taught us to take responsibility.<\/strong><\/p>\n\n\n\n

It is time they did the same.<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

I entered a residential therapeutic community in Greece expecting care, understanding and a way out of addiction. What I encountered was a culture in which humiliation, confrontation and submission could be presented as treatment. Years later, working in harm reduction and drug policy, I encountered the same institution again \u2014 this time as one of the most powerful voices shaping how Greece understood addiction and recovery. 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What I encountered was a culture in which humiliation, confrontation and submission could be presented as treatment. Years later, working in harm reduction and drug policy, I encountered the same institution again \u2014 this time as one of the most powerful voices shaping how Greece understood addiction and recovery. 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