A side event organized by Dianova International, Proyexto Hombre and Kethea, in the course of the 58th session of the Commission on Narcotic Drugs in Vienna. March 2015.

1. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
Co-Morbidity & Therapeutic
Communities
Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
www.dianova.org www.dianova.es
Adjusting Treatment Modalities for Better
Treatment Efficiency
Challenges Meet Current Tools
Gisela Rodríguez-Hansen

2. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
Canada
Chile
Slovenia
Spain
Italy
Nicaragua
Portugal
Sweden
Switzerland
Uruguay
USA
Connections with Prominent International Organizations

3. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
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

4. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
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

5. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
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

6. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
Population in Dianova Italy - 2015
183 users
AXIS I disorder
diagnosis
39,9%
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)

7. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
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

8. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
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
TwoOptions

9. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
 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

10. Side Event – Commission on Narcotic Drugs – March 2015
Commitment | Solidarity| Tolerance | Internationality… A Network of Values
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)

11. www.dianova.org
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
www.dianova.es
Thank You!