Adjusting Drug Treatment Programs for better Efficiency. #CND58 Vienna

Side Event – Commission on Narcotic Drugs – March 2015

Commitment | Solidarity| Tolerance | Internationality… A Network of Values

Co-Morbidity & Therapeutic Communities



www.dianova.org www.dianova.es

Adjusting Treatment Modalities for Better Treatment Efficiency

Challenges Meet Current Tools

Gisela Rodríguez-Hansen



Canada Chile Slovenia Spain Italy Nicaragua Portugal Sweden Switzerland Uruguay USA

Connections with Prominent International Organizations



Therapeutic Communities: Original Framework

Alternative to traditional psychiatric hospitals & clinics

Drug-free (TC’s trademark identity)

Self-help and mutual help were the original tools

Peer-operated community (e.g. Synanon and Le Patriarche)

No scheduled reintegration plan



TC: Intervention Model

Holistic, biopsychosocial and educational approach

Acquisition of healthy lifestyles

Individualized educational & psychologichal goals

Average duration 6-9 months

Multidisciplinary team

Outpatient post-treatment follow-up

Adequate educational and therapeutic environment



Evolution (Last Decades)

New, different clients

New substances of abuse

New psychopathological profiles

2 decades increasing % of co-morbidity in TC

Need for change or adaptation of TC methodology



Population in Dianova Italy - 2015

183 usersAXIS I disorder

diagnosis39,9%

AXIS II disorder diagnosis

47,5%

Axis I and II diagnosis

12.6%

AXIS I disorder AXIS II disorder

Mood disorder 39,7% Borderline personality 32,2%

Anxiety disorder 21,9% Antisocial personality 20%

Schizophrenia 13,7% Avoidant personality 8%

Classification based on the Diagnostic & Statistical Manual of Mental Disorders (DSM IV)



Our “New” Clients: Some Traits of Users with Co-Morbidity

Low awareness of mental disorder

Passive attitude and poor autonomy in daily tasks

High cognitive and social impairment

Heavy history of hospitalization

‘Different’ reaction to frustration: less tolerance

Low adjustment to changes in daily routines

Side effects of medications interferes with daily activities



Changes in the Intervention Model: Dealing with Increasing Co-Morbidity in TCs

• Both users live in the community

Integrative Model

• Reserved for users with dual pathology

Specific co-morbidity

Model

Two

Opti

ons



Adjusting programs to new profiles

Providing specific training to multidisciplinary teams

Dealing with conflicts arising from the coexistence of both users’ profiles

High dropout rates due to sense of routine and lack of motivation

Staff burnout due to simultaneous work with both profiles

Challenges Identified to Integrative Model



Changes in the Intervention for Co-Morbidity Approach

Increase in the frequency of individual tutoring

Adjustment of program’s intensity to patient's abilities and capacities

Different program schedule, pace and intensity

Phase shifts depending on the achievement of objectives

Supervision of activities including leisure time

Implementation of specific groups (i.e.medication)

www.dianova.org

An NGO with Special Consultative Status to the ECOSOCRepresenting civil society to the Organization of American States

Official Partner of the UNESCO (Consultative Status)Member of the European Forum on Drugs

www.dianova.es

Thank You!

Adjusting Drug Treatment Programs for better Efficiency. #CND58 Vienna

Presentations & Public Speaking

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