We are here too – involvement of close persons into the TC WHITE LIGHT I programme

We are here too –involvement of close persons into the TC WHITE LIGHT I programme Dr. Josef Radimecky, Ph.D., MSc. WHITE LIGHT I, TC, MUKAROV & Dpt. OfAddictology, 1stFoM, CHU 14th EFTC Conference, Prague, Czech Republic

Content • TC WHITE LIGHT I – brief introduction • Model of involvement of close persons of residents • Rationale for involvement of close persons • Research – do close persons benefit from their involvement into the process of treatment too? • Summary and discussion we are here too

CR - demographic data Population – 10 251 000 • Females - 5 248 000 • Males - 5 003 000 • PDUs -39 000 • PAUs - 300 000 Age groups: • 0 – 14 yrs. – 1 514 000 • 15 – 49 yrs. – 5 135 000 • 50 – 59 yrs. - 1 540 000 Area (km2) – 78 866 • Regions – 14 • Districts – 73 GNP – 3 220,3 bill. CZK • GNP/1 P. – USD 13 856 TC WL I Prague development of Czech TCs

TC WHITE LIGHT I. • established in October 2013 (20th anniversary) • in small village (25 km from towns, 100 km northern from Prague) • house – former farm (garden, animals, fields, workshop) • capacity – 15 beds (flexible in proportion male vs. female – recently 7 : 8) • residents – dg dependence (ICD), serious health/social probs, destroyed family relations, age 15+ (average age – 24,9 years/ 10 years ago – 21,3) • 80 % methamphetamines users & opioids, 83 % IUD, HCV 30 %, 40 % crime • programme – 6 – 8 months, 4 phases, annually 37-45 residents, 2/3 complete full programme (16 p.a.), drop-outs mostly after 2/3 of the programme (6 p.a.) • staff – 7 - social w., addict., pedag., psychologist + PT training; 1 vocational w. we are here too

Environment we are here too

Structured programme of TC we are here too

History of relatives involvement • 1997 – groups for family members/close persons • monthly – visits‘ day • 1998 – family counseling • monthly – visits‘ day – opportunity not used by family members of all residents • 1999 – stays of residents‘ close persons in TC (individually) • „Family“ weekends – since June 1999 • every 3 months from Friday to Sunday • 58 weekends - 512 residents + 1077 close persons • continual evaluation and up-date of the programme • statistics – steady increase in retention and completion we are here too

Family weekend programme we are here too

Packing and move for family weekend we are here too

Arrival to recreational setting we are here too

Joint groups we are here too

Separated group of residents we are here too

Separated groups - topics we are here too

Psychodrama we are here too

Breaks we are here too

Sport/BBQ we are here too

Club – theatre performance/games we are here too

Topics of family counseling Development of topics in relation to phases of the treatment process: • maping of roles and relations in family (various techniques – e.g. drawing of the family island, joint drawing, family statue etc.); • family‘s taboo/-s (with the use of thematic drawing, statue building and/or psychodrama); • fears related to future after TC completion and/or to relaps The topics however vary individually with respect to family situation and needs we are here too

Family island we are here too

Rationale for involvement of close p. • research supports involvement of close persons of DUs with dependency into their treatment (Kaufman a Kaufman, 1992; Kooyman, 1993; Toumbourou, 1994; Simpson et al., 1997); • difficulties to involve close persons in „village-based“ TCs (Kooyman, 1993) – see slide using of opportunities • key benefit – success in achieving changes in behaviour of people with dependency: • increase in retention rates & motivation of residents resulting in their increased activity in the treatment; • increase in group cohesion among TC‘s residents; • increase in mutual trust and cooperation btw. residents, their close persons and staff members. we are here too

Rationale for involvement of close p. • Benefits for close persons involved in treatment process: • stimulation of their interest to seek support in self-help groups at their home place - to get an understanding of drug use, to receive support and achieve relief; • stimulation of undecided close persons to take part in TC programme for close persons; • increase in mutual support among close persons of residents as well as between close persons and drug users; • increase of trust in respect to TC treatment programme – support and relief. we are here too

Rationale for involvement of close p. • Involvement of close persons – significant factor improving effectiveness of treatment programmes results (Institute of Medicine, 1990) • Family therapy – efficient form of treatment for adult & adolescent users of drugs and alcohol(Stanton, 1997) • Seeking expert help at an earlier stage of D/A use (Yates, 1988) • Higher rate of engagement of residents in treatment & higher retention rate (De Leon, 1984) • Significant decrease of substance use after treatment completion (Simpson, 1986) • Improvement by residents in an array of behavioral indicators – e.g. crime, education/jobs, relations (Yandoli, 1990) we are here too

Rationale for involvement of close p. • First impression that treatment programme makes on close persons (Stanton, 1982) • Involvement of close persons at an early phase of treatment (De Leon, 1984) • To achieve positive results – presence of all close persons of the resident doesn‘t seem to be necessary • Support for close persons of DUs who didn‘t enter treatment so far – self-help groups (Straussner, 1994) • sharing • psychological support • advice provision from peers (Toumbourou, 1994) we are here too

Opportunities to involve close persons we are here too

Research about CP involvement • Reason – curiosity – do close persons of our residents also benefit from the programme developed and designed for them in our TC? • Methodology • retrospective study - quantitative & qualitative approach • respondents (n=212) – participants of programme for CP • informed consent – collection of anonymous data for research purposes signed by admission of resident • data sources (period 2006-2010): • evaluation questionnaires for close persons (every 3 months) – close & open questions • semi-structured interviews with close persons we are here too

Research questions Do close persons benefit from their involvement into the treatment programme of TC? If yes: • what particular benefit do they attribute to their involvement into the programme? • which part of the programme do they percieve as the most useful? • did they miss anything in the programme provided by TC, and if so, what? we are here too

Efficient therapeutic factors (Yalom, 1995) we are here too

Findings • Close persons who took part in the programme of TC perceive their involvement as definitelly beneficial for them. • 1 respondent – sign that they may percieve their involvement as further torment: • „Too much groups. Sometimes it is torment for parents who suffered a lot during all those years.“ • 12 % of family members (annually about 5 out of 42 missed any of family member – mostly their husband/father) – they also likely do not percieve their potential involvement as beneficial. we are here too

Subjectively perceived benefits • new infos – use of drugs, consequences, how to solve drug related probs, treatment and after-care, relaps; • identification of maladaptive patterns in family functioning – weaknesses in communication, mutual relations, borders, rules – & steps towards change; • non-realized/new abilities and/or skills for improvement of quality of life of individuals or families; • safe environment – to admit unpleasant reality, to get support to actively take part in solving of family problems; • support and advice (instructions) how to solve problems from other programme participants with similar experience; • hope and faith – it is possible to solve recent problems therefore it has sense to invest in their solution. we are here too

Subjectively most useful parts of programme Family counseling Joint groups Family groups Free time Clubs Morning meetings we are here too

Subjectively most useful parts of programme • „In family counseling we opened and discussed topics that we would never open at home without an expert help.“ • „It is interesting to see how other parents and their childred inter-act in group meetings. It is great lesson for me and my son.“ • „I can say that the groups give me kind of instructions of how to proceed further.“ • „Hope that is what they [groups] gave me. Especially when I can see mother and her son who already completed the programme and it seems that it works among them.“ • „In free time we have enough time do speak each others, and to further discuss topics we opened in family counseling.“ • „I liked the club. I relaxed, laughed and had some fun after a long period of time.“ we are here too

What did they miss in the programme? Family member Better relations among participants More time for therapy Fully satisfied No idea we are here too

Discussion – room for improvement • Family counseling – recently most useful, at the beginning of the programme the most feared by all participants • Call for an increase of time for therapy – esp. for more family counseling sessions vs. limited capacity of the staff • Time between individual family counseling sessions seems to play an important role in achievement of changes • Missed family members – 12 % of participants – attempts to motivate them via present family members and residents – part of them attend the next family weekend • Better relations between programme participants – it also depends on recent composition of the group of residents and their close persons, also on weather, food etc. we are here too

Discussion – limits of findings • number of respondents (n=212) vs. number of residents of 11 TCs (about 550 p.a.) – limit application of findings • needs of close persons and residents may change during the treatment process (Kooyman, 1993) as well as in changing times • e.g. recent increased public awareness about specific topics (publication, media, internet); • factors influencing success in PDU/PAU treatment: • personality & style of work of the staff (age, skills, experience, relation with parents) – differences in various TCs in the Czech Republic; • quality & attractiveness of individual programme for close persons; • environment of programme delivery; • recent composition of the group of residents and their close persons; we are here too

Thank you for your attention! Department of addictology – research and education in risky and dependent behavior www.addictology.org Dr. Josef Radimecky, Ph.D., MSc. Department of Addictology 1st Medical Faculty, Charles University in Prague, CR E-mail: radimecky@adiktologie.cz Mobile: +420 724 240 778 & TC WHITE LIGHT I Mukarov 53 411 45 Ustek www.wl1.cz we are here too

We are here too – involvement of close persons into the TC WHITE LIGHT I programme