Side event: The versatility of Therapeutic Communities

Side event organised by Dianova International, Kethea and Proyecto Hombre Association

Rowdy Yates (President of the European Federation of Therapeutic Community – EFTC)

EFTC is a drug free network founded in Germany in 1981. It’s the largest recovery network in Europe with over 70 member organistations in 28 countries. It also incorporates a scientific network , the European Working Group on Drugs Oriented Research (EWODOR).

What joins therapeutic communities (TC) is that all use the bio-psychosocial model. Bio-psychosocial models see drug or alcohol misuse as the result of complex interaction between the drug, the social situation and the psychic health of the individual.

A good intervention should:

  • Drug – reduce or eliminate drug use, develop skills for managing cravings, parallel disorders etc.
  • Set – improve self-esteem, encourage resilience, support efforts to assist the recovery of others
  • Setting – encourage changed environments, communities, activities etc.

Therapeutic Communities are possibly the only interventions to systematically implement responses to these three elements.

The TC methodology should balance between the residents’ hierarchy, structured floor-work – attainable goals, adjustable pressure and challenges and the group-work, morning meetings, evening meetings, encounters – challenging the system, challenging behaviour and attitudes.

On the versatility of TC: TC can be adjusted at the micro level (adjusting to the needs of each individual member, changes in position in the structure, responsibilities) and also at the macro level (we can make a structure more or less shallow or extensive, alter frequency of groups, alter feedback arrangements/rules., etc.). If fact the TC model has been successfully adapted to the following populations: adolescent drug/alcohol users, unattached migrant children, offender (in-prison) populations, post prison-release populations, ethnic minorities, single gender groups, co-occurring mental illness populations, etc.

Oriol Esculies (Association Proyecto Hombre, Spain)

Association Proyecto Hombre is composed by 27 foundations and 210 facilities in Spain. Last year over more than 17000 people were served by the organization.

He will present the versatility of TC by presenting different modalities of TC that they have in Spain by providing concrete examples and photos:

  1. Drug dependant women with children: 15% of the clients are women. They are always a minority in treatment. They have multiple and specific needs. They are even more stigmatized than men. Addicted women often avoid treatment because they reject separating from their children. Much progress has been made in introducing the gender perspective into the treatment of addictions. Nonetheless, this is not enough
  2. Protection Center for Minors: Adolescents’ misusers are one of the most fragile populations. Therapeutic Communities are effective for adolescents but we had to modified methodologies and goals. What they have done is to; shorten the length of treatment (6-9 months) and being less strict rules in order to reduce drop out; focus on emotional empowering and skill-building instead of merely achieving drug-free; put into treatment activities such as sport, nature, art, new technologies and involve parents as key referents.
  3. Alcohol Therapeutic Community: 39% clients referred alcohol as the main substance of abuse. Alcohol is a legal substance, part of our culture&history, affordable, advertising everywhere. Therefore, running away from alcohol environments becomes impossible and we should empower themselves to live with it. Profile: older people, diseases, high prevalence of Depression.
  4. Therapeutic Community for Co-Occuring disorders: 31% Co-occuring disorders (in 2015): Personality Disorders, Anxiety, Depression, Schizophrenia, Eating Disorders. Combination between a full participation in the structure, community life and mutual help of a Therapeutic Community, counting on prescribed drugs, psychiatric monitoring, adapted goals. Dual Diagnose TCs strengthen aftercare and follow-up services, assuming that social reintegration will be partially accomplised, and they become also critical in reducing relapsing episodes.
  5. In-prison Therapeutic Community: Proyecto Hombre works in 36 prisons. 5 In-prison TCs in separated wings (they don’t mix with other offenders or drug dealers). When the offenders reach the third part of the sentence, the treatment continues in another TC outside prison, preparing them for social reintregration.
  6. Half-way shelters: These are for people living on the street have a high prevalence of drug or psychiatric disorders. They stay away from health services. They don’t access to treatment. Half-way shelters brings closer housing, food, caring, activities, primary care. Later, some of these clients will be referred to Therapeutic Communities

How are these adaptations achieved?

  • Research: what do our residents need? Our main tool: publication of the Observatory which is funded by Spain’s National Plan on Drugs.
  • 8 commissions of experts in order to create knowledge and create new programs or adapt the ones we have already.
  • Training center: if we have the knowledge and know what to do, how do we transfer this knowledge? We conduct trainings; online courses, masters degree, etc. In 2016 we reached 2.522 trainees.
  • Dissemination: annual national conferences, press conferences, and a magazine called Proyecto.

Lucia Goberna (Dianova International):

She presents an innovative program that Dianova Spain has developed to treat addiction and/or mental health problems among migrants.

Dianova is an international NGO operating in the Americas, Europe, Asia and Africa. Dianova’s members carry out social, health and humanitarian programs and projects in order to promote personal self-reliance and social progress. As of 2015, Dianova served almost 26,000 beneficiaries and 34 facilities.

Dianova Spain that has been helping people in need for 35 years, working in the fields of addictions, youth and education.  Since 2014, given the pressing needs originated by the arrival of migration flows to Spain, Dianova Spain has been working as well with migrants as a vulnerable population. It has done so, by a program of humanitarian aid and another one on International Protection Program.

The national authorities realized that there was a need to offer treatment asylum seekrs/refugees with mental health problems and/or addictive behaviors and launched an open call to manage a Special Protection Center. Dianova Spain has been selected to manage the Special Protection Center (SPC) for a period of time of 15 months. The project started on July 2016.

At the SPC we offer 12 places, for both women and men and we work on the reception phase, which lasts for 6 up to 9 months. The program is financed by the Ministry of Work and Social Affairs of Spain throughout the EU Asylum, Migration and Integration Funds (AMIF) and is co-financed by Dianova.

The SPC is located in a typical Catalan countryside house in a village located 25 km from Barcelona. In the same property we also manage an addiction TC for adults. Both centers are in the same location but both programs are placed in separated buildings and the beneficiaries of both programs do not coexist.

At SPC we cover the following services: basic necessities, physical and mental health care, legal counselling, job and life skills training and aftercare service delivery. We count with an interdisciplinary team that speaks English and French and preferably Arabic.

Experience so far. The majority of cases are from people who have been discharged from public health services, as well as beneficiaries with behavioral and adaptation problems. The beneficiaries presented in some cases addictive behaviors such as binge use of cannabis and alcohol.

Until now, they have only been men, aged from 19-44 years, from different nationalities (ranging from Guinea to Syria) who arrived to Spain at least a year ago without any family member. We have migrants who are in the procedure of seeking for asylum and others who have already been granted asylum and thus are formally refugees.

Given the beneficiaries particularities, we have noted the following issues to consider:

  • Drug use is generally not perceived as being a problem of beneficiaries of asylum programs and therefore treatment services have usually not been developed in relation to their needs;
  • Cultural barriers:
    • Language: providing services in different languages, communication among the beneficiaries
    • Conceptions of migrants: in some cases, the beneficiaries are not aware of their diseases as these are not commonly recognized as such in their countries of origin. This hinders their adherence to treatment.
    • Ethnocentric approaches of the intervention: that are based in premises such as Cognitive-Behavioural Therapy that might not be so successful among these beneficiaries because they are not used to express their feelings so openly. Therefore, it is recommended to use therapies that are more adapted to their understanding and which will bring better outcomes.

The TC is a supporting structure that allows for 24/7-control basis, it offers integral attention by an interdisciplinary group of professional.  Moreover, the TC model, which is based on principles such as shared responsibility, peer education, established scheduled daily activities, and therefore it empowers its beneficiaries and thus, facilitates the completion of the treatment.

A last thought on the versatility of TC: The TC model has innovated and has opened new programs for new target groups. In many cases, the innovation comes from treating similar pathological disorders that were already treated in TC that may have a different origin. These require similar therapeutic interventions adapted to the specific needs of the beneficiaries. The TC model can and should be adaptable to other target groups, susceptible of revision, assessed and adjustable.

Phaedon Kaloterakis (KETHEA)

KETHEA was established 1983 in Greece and counts with over 100 units. Phaedon screened a short movie: “Prometheus Bound” of a prison in Greece where they provide services of different kinds of addiction, gambling or internet addiction. This program is an innovative one within the correctional unit.

In the 7-minutes video, people there acknowledge that it’s an opportunity for a better life for them.

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