Effective Treatment Options – The European Experience Moscow November 2009 The Czech Republic in the heart of Europe EU model – evidence based n nOut of 100% of people who tried drugs, only 10% get to chronicle stage n nThere are two significant subgroups n —Primary mental health problems - up to 50% — —Socially deprived and/or excluded group — nDrug problem is a bio-psycho-social (BPS) one – medical diagnostics are not enough. Need for an ASSASSMENT approach Conformance of the successful programme Evidence-based (3 Bs) nBalanced Timetable nTherapy work (Therapy groups and individual) nManual work nFree time nBalanced Approach nMultidisciplinary team – different professional backgrounds - balance medical, psychological, educational and social care. Only 5 – 9% purely medical interventions nInternal and external staff (some activities useful to have handled by external staff, e.g. certain therapy, psychiatrists and other specialists, team supervision) nClear team protocols and procedures nManagerial standards (recruitment, passing information, team work, team building, individual training plan nHealth care Conformance of the successful programme Evidence-based (3 Bs) nBalanced approach to physical and mental wellbeing nCo morbidity problems nMental health (eating, sleeping disorders, depression, anxiety, other mental health problems, personality disorders) nPhysical health (transmittable diseases – HIV/AIDS, liver diseased – Hepatitis, dental problems…) nHealthy life style (nutrition and physical activities) The ALPHABET of the EU model today nAbstinence vs. individual client nBPS model of work nCommunity cooperation (meaning local public services, professionals as well as general public) nDifferences to be taken into consideration – different drugs, different cultures, races, social status… nEarly detection!!! – dealing with the syndrome of the hidden population (low number of problematic drug users come to high care services alone – 70% of our clients stop using without TC help) n — THE ALPHABET of the EU model today nFocus on a process - treatment is not necessarily always abstinence based in all stages, more person/individual plan centred, working through Motivational Interviewing nGaining professionalism —success rate among those entering high care treatment is approx. 60 – 70% of measurable changes in the TC —reaching Minimum Standards! = understanding: balance between HEART and MIND = combining the two: high motivation of staff but clear protocols, procedures and rules! n n n — European model - THE GREAT Qs ??? nCaring for topics such as: nTimed entry – client prepared, assessed and referred from a community based (out patient) project (drop in like) - success doubled!!!; nCo morbidity (are all our clients fit for the TC „hard line“, day top like programmes, can they all abstain); nWho should be our clients & when; nMotivation, premature drop out, after care; nIndividual planning – client is a co-author; nClear standards, protocols & procedures of the TC attached clearly to their school of thinking – therefore measurable outcomes; nMultidisciplinary approach – (medical, psychological, educational, social, self support…“spiritual?“); nCommunity awareness - Information campaign aimed at -Drugs awareness = Challenging the public attitude lowering risk behaviour among IDUs, working through Motivational Interviewing -towards IDUs and HIV positive people — Theoretical background BPS model nAssessment – process of drug problem development: n —History of a drug use n —Stages of drug problem — —Development of awareness of the drug problem n —Co morbid problems n —Indication to effective intervention n n n Implementing motivational interviewing philosophy in the assessment - Stages of the awareness of client’s own situation Cyklický diagram Meditative stage Pre-meditative stage Maintenance stage Stage of action Stage of decision making Theoretical background – BPS model nWhat do we work with? Is it only drug addiction/dependency? —Withdrawal – physical addiction —Craving - psychological —Flashbacks —Overdoses —Social context issues – changes in traditional social structure = family, education, job situation, peer environment/socializing —Chaotic life style —Criminal behavior —Risky behavior in drug use, sex… —“Spiritual emptiness…” — Theoretical background – forms of interventions nMedical n nPsychological n nEducational n nSocial n nSelf-support n nSpiritual European model today BPS model in practice nIntegrating both abstinence and Harm Reduction model = services run different programs = indication for services/interventions depend on: —Good assessment of individual client situation = case management – work with a care plan in the community —Possibility of (clients) choice nClient has a right to be the co-author nDrug demand reduction policy/strategy has to reflect the need of: —Service Users —Service Providers —Service Donors Network of Services Working with a drug user is a process nPrevention Centre nLow threshold centre Drop-in centre (inc. Club “Sklenik”) nStreet work/out reach (inc. Synthetic drugs prevention) Prevention and HR Treatment Other services nDay care (inc. Methadone programme) nPsychiatric clinic nTherapeutic community nAfter-care centre nSkills learning and supporting employment n n nDrug services in prison nSkills learning center nPastoral (spiritual) care nSelf-support groups and advocacy n Our values… nRegard for human life nAssistance and support for people nPrimary human ethical principles based on the European culture nTolerance, respect and equal opportunities nOpenness nTrust nInnovation and creativity nProfessionalism and professional ethics nTeam work nTransparency nPerseverance and courage n n n…and the determination to survive each day as it comes Jindrich Voboril “Therapeutic community is institutionalized treatment based on structured programme….though it should be process oriented. In other words, it is not the form which makes the treatment but understanding”