The Modified TC for the patients with dual diagnosis. research and movies presenting the programme of this therapeutic community

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1 The Modified TC for the patients with dual diagnosis research and movies presenting the programme of this therapeutic community

2 We are OK! the preresidential programme members present the TC values - movie Description of the programme Andrzej May-Majewski lecture Adrenalin instead of heroin TC Familia on Survival Camp - movie

3 We are OK! the preresidential programme members present the TC values - movie

4 Description of the programme The Modified TC for the patients with dual diagnosis Andrzej May-Majewski lecture

5 The rainbow as a symbol of our hope, we brought to Oxford

6 The reasons for the co-existence: a)attempts of self-treatment, b)using psychoactive substances as a form of prevention of a mental illness, c)using psychoactive substances to make friends more easily, d)using psychoactive substances to release oneself from the side-effects of medicines.

7 Types of double disorders: original psychiatric disorders with recurring addiction (a self-treatment hypothesis), original substance abuse with recurring symptoms and changes, a co-existing mental disorder and substance abuse independent origin.

8 American doctor Kathleen Sciacca treating patients with dual diagnosis divided into 4 types: 1. Patients with serious mental disease and substance addiction. 2. Substance addicted patients with personality disorders. 3. Substance addicted patients with acute psychiatric symptoms resulting from substance addiction: hallucinations, depression and the others. 4. Substance addiction, mental disease and different combinations of organic syndromes. Organic syndromes may result from substance abuse or occur regardless of it.

9 In camp conditions we feel...

10 that we are equal.

11

12 Continuity of the treatment model for the patients with dual diagnosis within the Familia programme in Gliwice, Poland Psychiatric ward Dual diagnosis therapy ward preresidential programme TC Detoxification centre Support group for psychiatric patients Psychiatric counselling Support group Double trouble Counselling for addicts and their family DAY WARD for double diagnosis patients I'm a shizophrenic?? Support group for people addicted to drugs I'm a drugaddict Rehabilitation ward residential programme TC Hostel The out-patients post rehabilitation programmes A patient freely moves between different therapeutic programmes (A patient is led by the same therapeuthic team)

13 A patient in our TC may be on the following stages 1. Informative up to 14 days. 2. Preresidential up to 10 weeks. 3. Residential from 6 to 12 months, or a charge of the therapeutic community up to 6 months. 4. Having completed the residential stage, a programme-leaving may become a volunteercounsellor, and in the future staff counsellor. However, having graduated from university he/she may also become a leading specialist.

14 Preresidential Programme on the Dual Diagnosis Therapy Ward up to 10 weeks A patient's aim Programme aim To minimise a patient's suffering resulting from the psychiatric disorder To escape from the consequences of addiction: - legal - health - family, etc. Full detoxification. Stabilization of the psychiatric state. The entire diagnosis: -psychiatric, -psychologic, -addiction. Motivation to participate in developmental rehabilitation programme through education, honesty training, learning how to take responsibility, coping the model of senior community members: a) residents, b) volunteer counsellors, c) staff counsellor Strategic self-analysis and preparation of the Individual Therapy Plan Aims for the stay on the rehabilitation ward. The strategic analysis is: the analysis SWOT, which is the analysis of strong and weak points, chances and threats the analysis of the key factors of the therapy success

15 Residential Programme Rehabilitation Ward 6-12 months A patient's aim Programme therapeutic aim To be a happy person; 1. To widen the diagnosis of talents. the one who is loved and able to love, developing own interests 2. To initiate the development of different spheres eg.: and talents intelectual, artistic, sports, social, family and the others. 3. To increase the abilities of taking responsibility for: own treatment, therapeutic community and other community members, own whole life. 4. To carry out strategic analysis and prepare the aims and tasks for Individual Development Plan to be realised for 6 months within out-patient's postrehabilitation programme.

16 TABLE of the key factors of the therapy success in Therapeutic Community 'Familia' The key factors of the therapy success in Therapeutic Community 1. Ability to receive information 2. Not looking for 'shortcuts' 3. Sensitivity 4. Tendency to stay in therapeutic contact 5. Awareness of losses caused by addiction 6. Realizing one s own helplessness against the disease 7. Responsibility 8. Openness 9. Conscientiousness 10. Being hard-working 11. Teamwork abilities 12. Developing talents 13. Ability to define one s own problems 14. Honesty 15. Possibility to keep in touch with the family 16. Ability to ask for help 17. Ability to avoid obliging agreements 18. Ability to develop empathy 19. Ability good doing 20. Action to improve social and legal situation Total Importance Assessment 1-5

17 The research results of the correlation between the key factors of the therapy success in the therapeutic community for patients with dual diagnosis Familia and the psychiatric and addiction symptoms.

18 Is there a connection between the key factors of success of the patient's therapy within the therapeutic community and the symptoms of the addiction to psychoactive substance in accordance with ICD-10?

19 The main Key factors of success in our TC decreasing the addiction symptoms honesty, development of talents.

20 Is there a connection between the key factors of success of the patient's therapy within the therapeutic community and the psychiatric symptoms included in the areas SCL-90?

21 The main key factors of success decreasing paranoid symptoms 0,45 0,4 0,35 0,3 0,25 0,2 0,15 0,1 0,05 0 Realizing one's own helplessness against the disease Ability to avoid obliging agreements Honesty Responsibility

22 The main key factors of success decreasing the psychoticness 0,35 0,3 0,25 0,2 0,15 0,1 0,05 0 Ability to avoid obliging agreements Realizing one's own helplessness against the disease Responsibility Awareness of losses caused by addiction Honesty

23 The main key factors of success in our TC decreasing fear responsibility, awareness of losses resulting from addiction.

24 The main key factors of success in our TC decreasing depression responsibility, realising own helplessness against the disease.

25 Our research shows that the most important factors of the success of a patient's therapy within a community are: honesty, responsibility, development of talents and interests. It is very importent, in therapeutic work with patients, to make a patient feel helpless against his / her own disease (psychiatric and addiction)

26 There is a conspicious link between the growth of the key factors and reduction of the following symptoms included in the areas SCL-90: paranoid symptoms psychoticness depression fear

27 The key factors that have the biggest influence on the reduction of symptoms included in the areas of SCL-90 honesty, responsibility, realising one's own helplessness against the disease considered to be a psychiatric disease in connection with addiction.

28 Conclusions The key factors of the therapeutic community success beneficially influence both addiction treatment and improve a patient's psychic state.

29 Second generation classic therapeutic community Modified specialised therapeutic community for the patients with mental disorders 1) In philosophy - helpless to deal with my addiction 1) In philosophy - Helpless to deal with my diseasse It is a new identification eg. narcoschizophrenia 2) Preresidential stage in the Center / Rehabilitation 2) Preresidential stage on the Therapy Ward 3)Therapeutic staff: Addiction therapy specialist Addiction Therapy Instructor staff counsellor 3) Therapeutic staff: a) Psychiatrists, psychologists, b) The clergy, artists, teachers / addiction thearapy specialists, all of them with artistic skills, c) Psychiatric nurse addiction therapy instructor d) Addiction Therapy Instructor staff counsellor 4) Work with emotions: - Confrontation encounter groups 4) Work with emotions: - Confrontation encounter group - Support encounter group - Encounter groups participated by the leading therapist as the patient's alter ego - Psychodrama - Psychogame 5) On the Rehabilitation Ward TC members are: residents 5) On the Rehabilitation Ward TC members are: residents or charges of the therapeutic community. 6) Lack of Individual Therapy Plan 7) Taking psychotropic drugs sporadically 8) Dominated by work in support and intervention groups and groups connected with education and employment. 6) They realise Individual Therapy Plan 7) Every patient takes psychotropic drugs 8) Dominated by work in sections developing talents and interests, whereas the support and intervention groups are still maintained

30 Adrenalin instead of heroin TC Familia on Survival Camp - movie

31 Thank you for your attention

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