1. THERAPEUTIC COMMUNITIES
The value of long-term programs in treating addiction
Gisela Rodríguez-Hansen
Good afternoon, as my colleague mentioned it earlier, my name is Gisela Rodríguez and I work as a psychologist at Can Parellada therapeutic community (TC).
It is a pleasure to be here and to be able to share our experiences.
I will present the work carried out by Dianova at Can Parellada’s therapeutic community.
I will review the reasons why, in the field of addiction treatment, time is a critical factor to achieve long-term rehab and successful reintegration.

2. Connections with Major International Organizations
Long-Term Addiction Treatment in Therapeutic Communities
Connections with Major International Organizations
The Dianova Network
Canada
Chile
Slovenia
Spain
Italy
Nicaragua
Portugal
Sweden
Switzerland
Uruguay
USA
Dianova network is an umbrella organization that operates in 11 countries of Europe and the Americas, developing innovative initiatives in the fields of education, youth, addiction prevention & treatment and in the area of social and community development. Dianova member organizations implement different intervention approaches with a variety of methods and means. Its main goal is to help people adopt healthier lifestyles and to promote self-reliant communities.
Dianova International, it is an NGO with ECOSOC special consultative status and is affiliated to several international bodies.

3. Dianova Spain www.dianova.es
Long-Term Addiction Treatment in Therapeutic Communities
Dianova Spain
Dianova España headquarters are located in Madrid and we run four therapeutic communities.

4. 1. Prevention and experiential learning programs
Long-Term Addiction Treatment in Therapeutic Communities
1. Prevention and experiential learning programs
2. Outpatient and residential programs for adolescents with behavioral disorders and/or substance abuse.
I would like to present you the the various programs and services offered by Dianova España.
First, we develop prevention programs and experiential learning activities for teenagers. These are frequently school-based activities carried out by open discussion between students and our center’s professional staff. Also these activities can take place at Can Parellada, where students meet with our residents to learn their life experiences to eventually help them avoid resorting to drug use or other risky behaviors.
Also, Dianova España offers residential and outpatient programs for adolescents facing substance abuse or behavioral disorders.
Third, we provide outpatient and residential programs for adults with addiction and/or comorbid mental disorders.
3. Outpatient and residential programs for adults with addiction problems and/or associated disorders

5. Why long-term treatment?
Long-Term Addiction Treatment in Therapeutic Communities
Why long-term treatment?
Evaluation
Neurologic stabilization
Healthy life-styles
Social and community integration
Indicator for successful social rehabilitation
Long-term treatments are crucial for the following reasons:
First of all, it takes time to assess the overall problems that the residents are going through and to design an adequate Individualized Treatment Plan. For example, an accurate diagnosis of patients that suffer associate disorders may not be made before a six-month abstinence period has elapsed. It is difficult to make a diagnosis sooner, as symptoms can be easily confused.
Secondly, a relatively long period of time is required to help the brain stabilize and recover. It takes 48 months for primates for overcomer neurological impacts caused by drugs.
Third, residents need time to acquire healthy life-styles which can not be made from one day to another; it takes time.
Last but not least, the only indicator for successful rehabilitation is the length of treatment (George De Leon et all).
For all this time is important.
Planificación Estratégica Hospital San José de Melipilla | Contexto Externo

6. Can Parellada T.C. Residential and Outpatient Program for adults
with substance abuse and/or associated disorders
Let me now introduce Can Parellada, a long-term residential therapeutic community for adults.
Can Parellada is located 40km north from Barcelona in a beautiful natural environment.
All our residents enter on a volunteer basis or pressured by different circumstances and they all sign a contract agreement once admitted.

7. Intervention model Therapeutic Community
Long-Term Addiction Treatment in Therapeutic Communities
Intervention model
Therapeutic Community
Holistic, biopsychosocial and educational approach
Individualized educational & therapeutic programs
Average duration 6-9 months
Outpatient follow-up
Can Parellada is a Therapeutic Community run by an interdisciplinary team grounded on a comprehensive biopsychosocial and educational approach.
Programs are individualized in order to meet each person’s specific needs and expectations.
The average duration of the program is between six to nine months.
After having completed the residential program, residents have the possibility to enroll in aftercare outpatient services for a period of up to one year. During this period, they are provided with guidance, support and individualized psychological counseling while adapting to a drug-free life.
Residential and outpatient services are carried out in close relationship and coordination with the public health and social services.
(Residents can enter the program on a private basis or be referred to the center’s subsidized places. At Can Parellada therapeutic community there is 22 subsidized places by the Generalitat de Catalunya – which is the name of the regional government of Catalonia’s autonomous community. In that particular case, patients likely to take advantage of the therapeutic community treatment model are referred by outpatient services through the region’s health and social services network)

8. Interdisciplinary team
Long-Term Addiction Treatment in Therapeutic Communities
Interdisciplinary team
2 Management staff
1 Psychiatrist
1 Physician
1 Nurse
2 Psychologists
1 Social Worker
6 Social educators
5 Educational Assistants
1 Administrative staff
37 vacancies
19 experienced professionals
Biopsychosocial and educational approach
Our therapeutic community can take care of 37 in-patient persons and our interdisciplinary staff has 19 professionals.

9. User Profile 2015 (n=93) www.dianova.es
Long-Term Addiction Treatment in Therapeutic Communities
User Profile 2015 (n=93)
In 2015, a total of 93 people have been taken care of.
In General, there were more men than women between 31 and 51 years old and most of them had no income in the economical area.
The next slides will detail patients’ profiles in That year a total of ninety-three people have been taken care of in the program.
As regards gender, we had more men than women. Related to age variable, the majority of the people are between 31 and 51 years of age. As regards the economic situation, we can see that 54 per cent of patients, that is more than half of them, have no income. Over the past few years and as a result of the economic crisis in our county, a growing number of people without income have been requesting our services.
Only 2.8 per cent have a regular job and 2.35 per cent receive specific unemployment benefits for the disadvantaged. Another 4.4 per cent have unknown sources of income.

10. User Profile 2015 (n=93) www.dianova.es
Long-Term Addiction Treatment in Therapeutic Communities
User Profile 2015 (n=93)
Most patients are polydrug abusers. However this chart only reflect the primary drug that has motivated the treatment. As you can see it is alcohol and cocaine.
Besides, 40 per cent were diagnosed according to DSM-IV with one or more psychiatric disorders, namely mood disorder, personality disorder and psychotic disorders.

11. Long-Term Addiction Treatment in Therapeutic Communities
User Profile 2015 (n=93)
Here we can see the various reasons for discharge; 39 per cent completed their therapeutic program within 9 months of stay.

12. Program: stages and goals
Pre-admission Phase
Program information (Social Worker) Assessment of the case Motivational interview
2 weeks
Detoxification & Integration
Adaptation to program and peer group
Detoxification and psychiatric stabilization
1-2 months
Rehabilitation
Medical and psychiatric care
Psychological, educational, and occupational therapy
Personal , social and relational development
4-5 months
Pre-insertation
Social integration through training or leisure activities
Money Management
Leisure Management
3 months
Let´s get into the program stages and objectives.
Stage 1: pre-admission
The person contacts us and our social worker informs him/her about the program and collects information about medical records, social situation and their psychological profile through a motivational interview.
The therapeutic team will assess whether the program is adequate to the person and if it indicates detoxification in the center or in the hospital. This stage lasts around 2 weeks.
Stage 2: Detoxification and early Integration
The main goals people have to work are their adaptation to the program and to the group of peers; detoxification; psychiatric stabilization; recovering health habits necessary to a full physical recovery.
This stage generally lasts 1 to 2 month after the person has been admitted in the TC.
Stage 3: Rehabilitation
The content of the rehab program concentrates in the in-depth work on oneself. This is the core of the rehabilitation process which takes from 5 to 6 month.
The resident in recovery meets with the center’s psychologist and an educator or social educator in order to establish his or her Individual Therapeutic Plan. The main are areas of intervention are
Health
Personal and social development
Reinforcement of family relationships
Leisure activities
Relapse prevention
Vocational training
Advice on Legal situations
This is the core of the process, we will get into detail on the next slide.
Stage 4: Pre-insertation
Before finishing the treatment, residents get to work on different objectives in order to be prepared to re-integrate in the society. For example on social integration, work autonomy, leisure management.
Once they accomplish the Individual Treatment Plan, residents get the therapeutic discharge.

13. Program Activities: medical area
Long-Term Addiction Treatment in Therapeutic Communities
Program Activities: medical area
Medical and psychiatric care
Health Education program class group
Alongside the rehabilitation process, we work on different program activities.
From the medical area: given the frequent occurrence of addiction-related mental and physical disorders, the program requires specialized medical and psychiatric care. During the first three months, a health education program is developed so as to prevent risk behaviors which usually come along with substance abuse. Residents are provided with information and prevention on sex education, and transmission of drug-related infectious diseases, overdose prevention, pharmacology and addiction-related psychiatric disorders among others. They also get medical attention if needed and psychiatric attention on a regular basis to monitor medication compliance.

14. Program Activities: Social and personal development
Individual psychotherapy
Relapse prevention group sessions
“Brain & Addiction” group sessions
Group Psychotherapy
The field of social and personal development is treated from two aproaches: through individualized psychotherapy treatment and group therapy.
Another therapeutic session is dedicated to relapse prevention. The group works on issues related to substance abuse prevention: identifying craving, identifying at-risk and trigger situations, how to deal with these situations, etc. Residents share with each other while learning to cope with various situations.
In addition, a special learning module is provided in two sessions.
This module, called “Brain & Addiction” is designed to show how addiction changes the brain, leading to lasting change in learning, motivation and pleasure.
In group therapy they address issues related to interpersonal relationships and issues they can share in the group.

15. Meetings with social worker Social skills group training
Educational groups
Meetings with social worker
Social skills group training
In the same line, in the educational groups, a number of group dynamics are prepared to work on coexistence with social relationships objectives, depending on the needs at the moment.
Those spaces allows the free expression of opinions and ideas in order to resolve any conflicts or disagreements that may arise in the TC daily life.
Moreover there are social skills group training where residents not only receive a theoretical framework of social skills, but also practical advice and training in order to act more assertively. Sessions include the following themes: verbal communication, non verbal communication, conflict resolution, how to say no in some situations, empathy, active listening, etc.

16. Occupational workshops
Long-Term Addiction Treatment in Therapeutic Communities
House maintenance
Occupational workshops
Occupational activities: In addition of the daily maintenance of the house, they may also participate in house activities such as painting, gardening, cooking, laundry and sewing.
Residents can be entrusted with a specific task, which he or she will be responsible for, within the community. Both occupational activities and responsibilities encourage residents’ personal understanding and growth.

17. Artistic workshops Yoga www.dianova.es
Long-Term Addiction Treatment in Therapeutic Communities
Artistic workshops
The community has a number of spaces dedicated to leisure activities. Facilities include indoor gym, swimming pool, TV room, library and computer room, soccer and volleyball fields, and ceramics workshops.
Workshops in body self-expression or handcrafts like yoga or pottery have provided them more control in emotion management.
Yoga

18. Sports and Leisure Activities
Long-Term Addiction Treatment in Therapeutic Communities
Sports and Leisure Activities
To help with the management of leisure time and to learn having fun without resorting to drugs at Can Parellada we organize sport and leisure activities in and outside of the center.
These activities may include soccer, volleyball, cultural visits, for example visiting museums, going to cinema or hiking.

19. Internal & External Training Courses
Long-Term Addiction Treatment in Therapeutic Communities
Internal & External Training Courses
Driving Lessons
English classes
Computer courses
One of the objectives of the program is to provide our residents with training and knowledge.
As regards indoor training activities, our TC has a computer room where residents may use for leisure purposes or to get familiar with these technologies.
There is a volunteer teacher who can provide language classes addressed to residents that are referred from Dianova centers in other countries.
As regards outside of the center, during the pre-reintegration stage they can do depending on their needs for their future life. Some examples are in the slide: driving lessons, computer courses, sport or entertainment.

20. Social and professional re-insertion
Long-Term Addiction Treatment in Therapeutic Communities
Social and professional re-insertion
In order to prepare the pre-insertation of the residents into the community, we address is the residents’ social and vocational development.
As we know, most people who choose to enter a TC have a social environment mostly related to substance use. During the preparatory stage to reintegration, residents are encouraged to meet new people and create new social circuits through the leisure activities or training courses they may undertake during this phase, as I’ve mentioned before.
It is a delicate but crucial moment, where people are at high risk of relapse, since many substance abusers have socializing difficulties.
Another crucial aspect is to support residents with the job search, especially for those who live, or want to stay in the area. There is also the possibility for them to go to work while returning to the center to spend the night – while still being counseled by the center’s staff to face any difficulty that may arise.
Due to the economic crisis, the job search phase has become more difficult than previous years. For this reason, in some cases, we advise people to pursue with vocational training courses or to work as volunteers, so as they can keep on working on their social and relational goals while still being busy.

21. www.dianova.org www.dianova.org www.dianova.org www.dianova.es
An NGO with Special Consultative Status to the ECOSOC
Representing civil society to the Organization of American States
Official Partner of the UNESCO (Consultative Status)
Member of the European Forum on Drugs