Methadone maintenance treatment in Therapeutic Communities:  a long practice experience in Spain
Traditionally, the TC model would have had three basic characteristics: <ul><li>Drug free community </li></ul><ul><li>Grou...
What is  the TC “Casa Oberta”  (“open house”)?
Casa Oberta TC
 
What is the TC “Casa Oberta”? <ul><li>Projecte Home Balears created and began the management of the TC “Casa Oberta” (“Ope...
<ul><li>This center is a publicly-owned entity and it belongs to the Insular Governement of Mallorca  </li></ul><ul><li>Th...
<ul><li>It is a TC since it admits: </li></ul><ul><li>  ►   users who are treated with    methadone   </li></ul><ul><li>  ...
What’s the differential inflexion point with respect to other substitutes maintenance programs?   In this TC we propose to...
<ul><li>Throughout its 13 year existence, the TC “Casa Oberta” has demonstrated that the models of TC together with the pr...
<ul><li>Methadone maintenance programmes can  be reinterpreted as a stepping-stone towards programmes of medium to high re...
<ul><li>As well as CASA OBERTA TC, in Spain there are at least 3 other programmes pertaining to organizations of  Proyecto...
The profile of users   <ul><li>The profile of users who are treated  </li></ul><ul><li>is very problematical  </li></ul><u...
<ul><li>They have : </li></ul><ul><li>  ► a long history of drug use   </li></ul><ul><li>  ► a high incidence of chronic i...
<ul><li>78% are polyconsumers, the principal drugs being heroin and cocaine  </li></ul><ul><li>About 60% were heroin users...
1996-2008 RESULTS   <ul><li>443 people have received treatment during these 13 years   </li></ul><ul><li>20% have achieved...
RECENT RESULTS <ul><li>Between 2007 and 2008, 78% of the people to whom methadone was administered managed to reduce initi...
<ul><li>We can affirm that a programme with  </li></ul><ul><li>medium to high requirements in the  </li></ul><ul><li>Thera...
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3!! C A S A O B E R T A Presentación Ponencia Tomeu Català La Haya 09

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3!! C A S A O B E R T A Presentación Ponencia Tomeu Català La Haya 09

  1. 1. Methadone maintenance treatment in Therapeutic Communities: a long practice experience in Spain
  2. 2. Traditionally, the TC model would have had three basic characteristics: <ul><li>Drug free community </li></ul><ul><li>Group therapy </li></ul><ul><li>Physical separation from </li></ul><ul><li>social-urban environment </li></ul>
  3. 3. What is the TC “Casa Oberta” (“open house”)?
  4. 4. Casa Oberta TC
  5. 6. What is the TC “Casa Oberta”? <ul><li>Projecte Home Balears created and began the management of the TC “Casa Oberta” (“Open House”) in June 1996 </li></ul><ul><li>This therapeutic Community has characteristics that make it special : </li></ul>
  6. 7. <ul><li>This center is a publicly-owned entity and it belongs to the Insular Governement of Mallorca </li></ul><ul><li>The users accede to this TC, managed by a private entity as Proyecto Hombre, through the deriving public services </li></ul><ul><li>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 </li></ul><ul><li>Casa Oberta TC admits three different types of residents: </li></ul>
  7. 8. <ul><li>It is a TC since it admits: </li></ul><ul><li> ► users who are treated with methadone </li></ul><ul><li> ► users with a dual pathology </li></ul><ul><li> ► And also users with a drug-free treatment </li></ul>
  8. 9. 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
  9. 10. <ul><li>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 </li></ul><ul><li>For this, the general concept of harm reduction has to be understood as a first step and not the last </li></ul><ul><li>From the beginning at the TC “Casa Oberta” both models, drug free community and treatment/ reduction of methadone have coexisted </li></ul>
  10. 11. <ul><li>Methadone maintenance programmes can be reinterpreted as a stepping-stone towards programmes of medium to high requirement </li></ul><ul><li>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 </li></ul>
  11. 12. <ul><li>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 </li></ul><ul><li>In at least 13 of TCs of organizations in all Spain and belonging to Proyecto Hombre Association, a dmittance of users who take methadone is allowed </li></ul>
  12. 13. The profile of users <ul><li>The profile of users who are treated </li></ul><ul><li>is very problematical </li></ul><ul><li>and socially unstructured </li></ul>
  13. 14. <ul><li>They have : </li></ul><ul><li> ► a long history of drug use </li></ul><ul><li> ► a high incidence of chronic illnesses </li></ul><ul><li> (especially hepatitis C and HIV) </li></ul><ul><li>And, what is more : </li></ul><ul><li> ► One in three users has been in prison </li></ul><ul><li> ► Over half of them present psychiatric problems </li></ul>
  14. 15. <ul><li>78% are polyconsumers, the principal drugs being heroin and cocaine </li></ul><ul><li>About 60% were heroin users </li></ul><ul><li>And approximately half of all users had taken methadone/LAAM before being admitted to the TC </li></ul>
  15. 16. 1996-2008 RESULTS <ul><li>443 people have received treatment during these 13 years </li></ul><ul><li>20% have achieved a therapeutical discharge (which implies social reinsertion) </li></ul>
  16. 17. RECENT RESULTS <ul><li>Between 2007 and 2008, 78% of the people to whom methadone was administered managed to reduce initial doses </li></ul><ul><li>One in five people (21.3%) stopped using methadone completely </li></ul><ul><li>25% of interns were given a therapeutical discharge </li></ul><ul><li>Amongst these graduates more than half were methadone programme users who had reduced their methadone intake to zero </li></ul>
  17. 18. <ul><li>We can affirm that a programme with </li></ul><ul><li>medium to high requirements in the </li></ul><ul><li>Therapeutical Community is perfectly </li></ul><ul><li>compatible with the instrumental </li></ul><ul><li>dispensation of methadone, without </li></ul><ul><li>this betraying the spirit that inspired </li></ul><ul><li>and continues to inspire the drug-free TC </li></ul>

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