The Non Govermental Organization (NGO) «Kvinnekollektivet ARKEN» «I entered as a girl

1. The Non Govermental Organization (NGO) «Kvinnekollektivet ARKEN» «I entered as a girl – I left as a woman» Sissel Larsen Høibråthen – Group therapist Kristin Kongelf – Group therapist 30 yearsofexperience in treatingwomen struggeling with addiction using knowledge from the 12-step program

2. GenerAL INFORMATION We are located in Oslo – the capital of Norway Wearecelebrating 30 years, thisyear We have 10 treatment places in cooperation with the Department of Health in Southeast Norway Arken is an NGO ARKEN is nonreligious We only admit, and treat, women struggling with addiction Our patients arefrom the age of 23 years and upwards. Average age is 34 years. The majority have additional diagnoses The majority have a varityofchallenges – eatingdisorders, self harm and so on ARKEN is a full-time treatment program and the average treatment lasts for about 9 months We build on a 12-step treatment methodology – “The Minnesota model” ARKEN is a treatment program without DAT (drug-assisted treatment with methadone/subutex/ subuxone)

3. primarytreatment • PrimaryTreatment: • Group therapy • Mandatory/individualtreatmenttasks • Lectures (psychoeducative) • Individualcounselling • Art and expressiontherapy • Exercise/Meditationwith a physiotherapist • Mandatorymeetingswith AA (alcoholicsanonymous) and NA (narcoticsanonymous) twice a weekwhereyoushareexperiences, strenght and hope. • «Relapseweek» - preventingrelapse program • Weekend «off» – out to pratice a sober life • The stay is intensive and has a structure that is mandatory.

4. Grouptherapy- GOALS: • Sharing experiences and identifying with others • Learning to empathise witheachothers • Recognisethe tendency to escapepainful experiences by usingalcohol and drugs • Learning to understand and expresstheirneeds, thoughts and emotions directly – as clean and sober • Learning to identify feelings/situations that leads to relapse • Acceptance and openness to share scary and shamefulexperiences and thoughts • Practicingbetter ways of relating to others. • Consciousness around different roles – roles through life - being a role model - motherhood etc. • Handling conflicts – and practicing direct communication • Learn to solve problems • Moving from secrets to openness – and from silence to sharing • We are working to help the women identify mechanisms of mental defence (like denial, repression and projection)

5. Ideology - values Our method are based on knowledge from the 12-step-program The AA ideology consists of a system of ideas , understanding and attitudes about addiction and how someone with addiction can have a better life without alcohol and drugs All human beings have the capacity for change Our treatment model are based on our view of addiction as an disease/disorder but one that is treatable - through total absence – not medication!! The patient will learn about the dynamics of addiction – it is a complex problem that adresses all aspects of the patient’s life To learn the patients about themself and others, we use daily grouptreatment At ARKEN total absence from all narcotics and alcohol is mandatory

6. knowledge from the 12-step-program • The treatment is especially aimed at changing addictive behaviour • Treatment happens through a lifestyle program, from the self-help movement combined with professional knowledge. • Group treatment with others in similar situations is widely used within 12-step programs • The staff working with this kind of treatment often have experience based competence – 1/3 of our staff has this kind of competence – «ex-users» • The focus is to «Give back responsibility»! • The treatment’s main goal is to provide a better quality of life parallel to abstaining from all addictive substances. We are helping the individual to discover and develop their own attitudes that can lead to a lifestyle that suits them. In this, the treatment has long-term aims besides simply abstaining from drugs. • In treatment we help the patient recognise their own situation and take consequences of their own actions. As a result, the patient can change their attitudes and behaviours, letting them actively choose a life of sobriety. • During the 12-step program, relatives of patients are also involved and recieve psychoeducative training. The goal is to create healthier family relations in a dysfunctional family system.

7. ARKEN specialises in - and onlyaccept – women • Demographic: Women suffering from chronic substanceabusewheretheconsequences are serious (socially, physically, psychologically, ethically/morally) • The women are often struggling with additional challenges tied to sexual assault, violence and attachment issues. • The women are taught to value their own worth, and changesneeds to be made in several – often all – areas of their lives. • The womenareencouraged: • to examine their own lives • to feeltheiremotions • to set limits • to ask for help • to choosetheir own behaviours • to take chances • to not look too far into the future (one day at the time) • to take responsibillity for their own lives • to go from object to subject

8. Our focus is: • All human beings/women have theability to change • Wewantthewomen to be active in theirown life- to take responsibility for theirownlife and to focusontheself (feelings, thoughts, needs) • Womenwithexperienceofsexualabuseoften have a lot of different problems relating to genderroles, adaption to men and beeing a victim. • The womenareshielded from entering negative and dysfunctionalrelations to men whentheyare in treatment. • Weareoffering an alternative to earlierexperiences – our male staff are positive rolemodels, wheresafety and predictability is a key • Safety and trust areimportant for developinghealthyrelations

9. New experiences with female relations, recognition and acceptance from otherwomen. Our focus in theraphy is to acceptemotions– feeling/crying will not kill you The relations to staff is essential in treatment, and it is therefor very important thatemployees are emotionally present, thatthey offer honest support and usestheir own experiences. Weuse an engaged staff, with varied experience and thatgives a clear message of hope To give hope, Arken usetheself-helpgroups and learnthepatients to look for similaritiesinsteadofdifferences.

10. USER SURVEYS • 70% completethetreatment • Our last user survey in 2011: Showedthat 64,6% ofourpatientsthatfullfilledourtreatment program weretotally sober. • The survey alsoshowedthat 87,5% were sober ifweincludedtheonesthat used (probably alkohol) 2-3 times a month

11. ALCOHOLICS ANONYMOUS (AA) og Narcotics Anonymous (NA) The Meetings • The 12-step ideology and their self help groups provides a clear path to change • In the self-help groupsyoushare experiences, strenght and hope. • Through this, the patients are working on their common problem, as well as help each other to recovery • AA/NA’s function in theaftercare/post treatment and onwards in restoration/recovery– vs. loneliness The core of the program is the 12 steps. We focus on the first four: • Acknowledge that you are powerless • Admit that you need help • Act on the above, this means that you: • Ask for help • Accepts help • Definition of an illness/disease/disorder by WHO: • Diagnosable • Primary • Progressive • Chronic • Lethal • No-blame illness • Familial • Treatable

12. STAFF • 6 group terapists • Experience across a variety of subjects (practical, psychologist, counselling, relevant major subjects and ex-users) • Health Department • Psychiatrist one day a week • Nursing Staff Monday – Thursday • Psychologist working 60% - including group theraphy • Physiotherapist (individual and group), working 1/2 days a week • Administration

13. MOTIVATION The patient’s motivations are very varied. We can sustain motivation by: • Focusing on the patient’s resources • Respecting choices • Giving responsibility • Setting requirements • Not underestimating EMPOWERMENT «Empowerment is a process that is essential to: • Strengthen and activate ones ability to satisfyown needs • Solving ones own problems • Collecting the necessary resources to take control over ones own life» (S. Talseth, 1997)