Accessibility of treatment programs for addicted women.

Accessibility of treatment programs for addicted women. Anja Schillebeeks and Güler Bingölo, TC De Spiegel, Belgium ICCA Limassol 2008 De Spiegel has 3 departments: - ambulatory - detox (residential, 6weeks) - TC (residential, 18 months) Multidisciplinary staff Starting point: underrepresentation of addicted women in treatment programs - De Spiegel - Flanders - European (EMCDDA: 2006→20%) Geslachtsverdeling Ambulant N=1026 100% 80% 60% 40% 20% 0% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 jaar vrouw man Geslachtsverdeling Residentieel N=1297 100% 80% 60% 40% 20% 0% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 jaar vrouw man % vrouwen per behandelvorm 30% 25% 20% 15% 10% 5% 0% 1997 1998 1999 2000 2001 jaar Medisch Sociale Opvangcentra Dag- en sessiecentra ambulant Behandelingscentra Crisiscentra 2002 2003 2004 2005 2006 OBJECTIVES 1.determine specific obstacles women face to enter (residential) treatment programs 2. propose methods to increase the accessibility 3. improve success rate METHODS 1. interviews in different medical and menthal health facilities 2. compilation of 3 committees: - evaluation of our own womencentered treatment (+ other TC’s) - feedback from experts RESULTS 1. OBSTACLES - In accessibility - In treatment programs • • • • • • • Motherhood/pregnancy Social obligations (family, partner) Minority stress Judicial system Stigma Failure to recognise substance abuse in time Insufficient cooperation between different services • Bad image of residential programs • Additional psychological disorders 2. IMPLICATIONS • Methods to increase the accessibility • Methods to improve the retention 2.1 Methods to improve the accessibility (1) • Sensitisation – – – – Need for training Early detection of substance abuse Mental health services Development of a good “care-system” with better cooperation between • Ambulatory and residential services • Drug treatment programs and other mental health services Methods to improve accessibility (2) • Ambulatory – Cooperation with other services for pregnant women and young mothers – Presence of a physician – Seperate location for men and women • Residential – Image problem – Mother and child together in TC – Support contacts with clean social network 2.2 Methods to improve the retention 3 basic principles: - working within groups - integral treatment - staff attitude Women-groups : ambulatory • Organise women-specific activities and groups (minority stress) Women-groups: residential • Create seperate space and time for women by weekly group, monthly day, private corner, activities (minority stress) • Gender centred approach of the group of male residents Women-groups: benefits • • • • • • • Self-help (support, identification, role modeling) Setting limits Learning to accept positive feedback Self-esteem Sexuality/body-image Interaction with male residents Interaction with other women Integral treatment • Eating disorders (bulimia) and traumatised sexuality (PTSD) need specific understanding and coaching • Adaptation of specific therapeutic tools for treatment of the BPD • Pay attention to selfdestructive relationships (addiction to love) • Less confrontation in general • Individual therapy Staff attitude • Understanding typical survival strategies and canalisation into constructive behaviors • Respect in language of staff and residents • Fight prejudices about women • Understanding the impact of the minority position • Understanding gender connected problems • Do not project your own ambitions • Gender centred approach for both sexes GRAPHICS De Spiegel Results of the implementation of these methods in the residential program Applications vs Admissons Applications vs Admissions of Women in TC 40% 30% 20% 10% 0% Admissions Applications 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 year Applications vs Admissions of Men in TC 120% 100% 80% 60% 40% 20% Paul Van Deun Admissions Applications 0% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 year De Spiegel, Belgium Admissions and Completion Percentage Admissions by 100% 80% 60% 40% 20% 0% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 year women men Percentage Completion by 100% 80% 60% 40% 20% 0% 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 year De Spiegel, Belgium women men Paul Van Deun Retention Stay in Program Retention Women '05-'07 N=16 vs '99-'01 N= 12 100,0% 80,0% 60,0% 40,0% 20,0% 0,0% 05-'07 N=16 99-'01 N=12 0 30 60 90 12 0 15 0 18 0 21 0 24 0 27 0 30 0 33 0 36 0 39 0 42 0 45 0 48 0 51 0 54 0 57 M 0 ee r Retention Men '05-'07 N=56 vs '99-'01 N= 67 100,0% 80,0% 60,0% 40,0% 20,0% 05-'07 N=56 99-'01 N=67 Paul Van Deun 0,0% De Spiegel, Belgium 0 30 60 90 12 0 15 0 18 0 21 0 24 0 27 0 30 0 33 0 36 0 39 0 42 0 45 0 48 0 51 0 54 0 57 M 0 ee r CONCLUSION • • • • • Need for sensitisation Need for training Need for network formation Integral treatment Gender approach for women and men Thank you for your attention! Contact: – Anja Schillebeeks: anja.schillebeeks@despiegel.org – Güler Bingölo: guler.bingolo@despiegel.org