3!! C A S A O B E R T A Presentación Ponencia Tomeu Català La Haya 09
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Transcript of 3!! C A S A O B E R T A Presentación Ponencia Tomeu Català La Haya 09
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Methadone maintenance treatment in Therapeutic Communities:
a long practice experience in Spain
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Traditionally, the TC model would have had three basic characteristics:
• Drug free community
• Group therapy
• Physical separation from social-urban environment
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What is the TC “Casa Oberta”
(“open house”)?
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Casa Oberta TC
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What is the TC “Casa Oberta”?
• Projecte Home Balears created and began the management of the TC “Casa Oberta” (“Open House”) in June 1996
• This therapeutic Community has characteristics that make it special :
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• This center is a publicly-owned entity and it belongs to the Insular Governement of Mallorca
• The users accede to this TC, managed by a private entity as Proyecto Hombre, through the deriving public services
• Casa Oberta is an Urban TC: A TC can carry out its work in a satisfactory manner participating in a social and urban environment, which allows for an interrelationship with the local community: voluntary work and participation of TC residents in village activities
• Casa Oberta TC admits three different types of residents:
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• It is a TC since it admits:
► users who are treated with methadone
► users with a dual pathology
► And also users with a drug-free treatment
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What’s the differential inflexion point with respect to other substitutes maintenance
programs?
In this TC we propose to go further than just the harm reduction, offering the possibility of following a personal
growth program within the atmosphere of a Therapeutic
Community
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• Throughout its 13 year existence, the TC “Casa Oberta” has demonstrated that the models of TC together with the programmes of methadone maintenance can be both compatible and complementary
• For this, the general concept of harm reduction has to be understood as a first step and not the last
• From the beginning at the TC “Casa Oberta” both models, drug free community and treatment/ reduction of methadone have coexisted
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• Methadone maintenance programmes can be reinterpreted as a stepping-stone towards programmes of medium to high requirement
• It opens up the possibility of treating in the TC, those persons not capable of giving up drugs without the initial support of a methadone programme
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• As well as CASA OBERTA TC, in Spain there are at least 3 other programmes pertaining to organizations of Proyecto Hombre Association that specifically integrate the therapy of methadone maintenance/reduction
• In at least 13 of TCs of organizations in all Spain and belonging to Proyecto Hombre Association, admittance of users who take methadone is allowed
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The profile of users
The profile of users who are treated is very problematical
and socially unstructured
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• They have: ►a long history of drug use ►a high incidence of chronic illnesses (especially hepatitis C and HIV)
• And, what is more : ►One in three users has been in
prison ►Over half of them present
psychiatric problems
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• 78% are polyconsumers, the principal drugs being heroin and cocaine
• About 60% were heroin users
• And approximately half of all users had taken methadone/LAAM before being admitted to the TC
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1996-2008 RESULTS
• 443 people have received treatment during these 13 years
• 20% have achieved a therapeutical discharge (which implies social reinsertion)
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RECENT RESULTS• Between 2007 and 2008, 78% of the people to
whom methadone was administered managed to reduce initial doses
• One in five people (21.3%) stopped using methadone completely
• 25% of interns were given a therapeutical discharge • Amongst these graduates more than half were
methadone programme users who had reduced their methadone intake to zero
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We can affirm that a programme with medium to high requirements in the Therapeutical Community is perfectly compatible with the instrumental dispensation of methadone, withoutthis betraying the spirit that inspiredand continues to inspire the drug-free TC