TCIE 4 The Service Context (Spain)

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IV. The service context of therapeutic communities. Examples of different treatment methods, what type of patients are tipically admitted to TCs, and how TCs fit into a comprehensive health care system.

First of all I would like to make a clear statement: the great majority of TCs, more than 70 % of those created in the eighties and still existing in Spain today, were born from the spirit of service and solidarity with the unfortunate people in our society and their families. They were not created for financial profit reasons nor out of the State\'s or the Autonomous Region\'s financial security services. They were created through individual\'s entities\' and private institutions\' attitude of service. It is true that throughout time they demanded public support to be able to survive and that they have often received it.

At this moment the centers that created the TCs. TCs for adolescents, TCs for persons with methadone treatment, TCs for women with children, etc. are receiving requests by public institutions for some of their specific programs. The National Plan On Drugs (PNSD) created in 1985, has given directions on a national level, but the truth is that public financing against drug addictionss depends on the Autonomous Regions Government or on the Municipal Government. The support from the PNSD for the TCs has been mainly for research purposes and through the PNSD it has been possible to receive national grants from the MAS or the MTAS. That is why the TCs communicate with the Health Care Departments of the Regional Governments, sometimes named social welfare – depending on the region – and with the Coordinator of Drug Policy in each Autonomous Government.

Profiles of clients admitted at the TC. (ASPH Reports, other TCs.)

Traditional TC At first TCs were created as an answer to the epidemic episode of heroine addiction. Today the profile of the clients is (using as reference the study on the different Proyecto Hombre Baleares programs, perfectly valid extrapolation) (1): 89,3 % are men, and the average age is 29 years old, heroine and cocaine abusers, and abusers of these two drugs simultaneously, 30,5 % of them use it via injection. The average age of starting heroine and cocaine use is around 20 years old. 68,7 % are single and 24 % are living together with their boyfriend/girlfriends. 59,5 % of the clients have received some kind of treatment before. 40,5 % of the clients have been accused of some kind of crime and 29,8 % have been convicted, 14,5 % have been in prison on preventive conviction and 16,8 % as convicts. 19,8 % are waiting for a veredict. 10\'9 % have been sent to hospital due to psychiatric problems.

Therapeutic Community with methadone takers

80 % are men, the average age is 32,67 years old, mainly heroine abusers or users of heroine in combination with other drugs, 65 % are using via injection. The average time of heroine and cocaine abuse is 17 years and the average time of consumption of both is 10 and a half years. 80 % are single and 20 % lived with their boyfriends/girlfriends before the treatment. 90 % have received treatment before with an average of 3 treatments. 75 % have been accused of some kind of crime, 5 % have been in prison as preventive convicted and 25 % as convicted. 20 % are waiting for some veredict. 25 % have been sent to hospital due to psychiatric problems and 12,5 % receive a Government psychic disability allowance.

Adolescent- youth programs

In these programs 83,3 % of the clients are men with an average age of 19 years old. They started cannabis abuse at the age of 14,2 years old and alcohol abuse at 15,5 years old. 80 % call for treatment due to cocaine abuse, having started at the average age of 16,4 years old and with a 2 years and a half period of abuse approximately. 16,7 % have sometimes injected the drug. All of them are single living usually with their parents or with other relatives. For 33,3 % it is their second drug treatment programme. 33,3 % are convicted and 16,7 % have been in preventive prison.

Evening programs

86,9 % af the people attending the evening programs are 29,45 years old men. 86,5 % call for treatment due to cocaine abuse or cocaine together with alcohol abuse. The age of beginning alcohol abuse is about 14,19 years old and 21 in the case of cocaine. The average time for alcohol abuse is 9 years and for cocaine 6,10 years. Only 3 % have injected the drug and mainly the drug is sniffed. 47,5 % are single and 41,4 are living with their boyfriends/girlfriends. 18,2 % have done some previous treatment. 5,1 % of the clients have been in preventive prison and 1% have been convicted. 6,1 % have been have been sent to hospital due to psychiatric problems.

Addiction and Behavior Recovery Centers

83,3 % of the clients of these centers are men with an average age of 36,55 years old. The percentage of people asking for help due to heroine and cocaine problems is similar and 36 % in the two cases. 8 % are asking for help to overcoming cannabis addiction and 21 % for other drug addictions. The age of alcohol and cannabis abuse starts at about 15 years old, cocaine starts at 17,8 years old and cocaine starts at 18,8 years old. The average time of abuse all through life is over 10 years: they have experienced alcohol problems during an average of 15,73 years, cannabis problems during 15,36 years, heroine problems during 11,73 years and cocaine problems during 10,70 years. These facts show the evident coincidence of several of these drugs during long lifetime periods. 75 % have sometimes injected the drug and this is the prefered way in the case of heroine. 18,32 % use injected cocaine but the usual way is sniffed. 67 % are single and 16,6 % are living together with their boyfriends/girlfriends. 75 % have undergone some treatment. 41,6 % have been in prison sometimes for crimes but 16,6 % have been convicted. Half of them have been sent to hospital due to psychiatric problems and a third part receive a psychic disability allowance. All these programs and TCs have a common objective: a change in lifestyle, and their aim is the treatment of the specific disorder. Starting from these data it is obvious that the different therapeutic instruments are adapted to the different programs and profiles and also to each client\'s process.

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