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