Treatment in therapeutic communities: the experience of Lisbon and Tagus Valley Region
Background: The therapeutic communities are a treatment response, complementary to the outpatient treatment Centers of the Division for Intervention on Addictive Behaviors and Dependencies of the Regional Health Administration of Lisbon and Tagus Valley. This Division is responsible for the clinical evaluation, approval and payment of the admissions of patient in private therapeutic communities, sent by public outpatient treatment centers or mandatory court order.
This paper aims to characterize the admissions of people with psychoactive substance abuse or dependency in therapeutic communities from Lisbon and Tagus Valley Region during a period of five years.
Method: Retrospective analysis of the admissions files of 3123 patients from Lisbon and Tagus Valley Region that were admitted between 01/01/2014 and 31/12/2018 in private therapeutic communities with a contract with the State, totalizing 3959 admissions. This retrospective analysis is based on the admission procedures that includes clinical proposal file (beginning age of substance use; main substance use, physical and/or mental co-morbidity, type of treatment program and the therapeutic community chosen), monthly reports of therapeutic communities on the maintenance of the treatment and reports of discharges (date and motive). This analysis comprehends the universe of all patients admitted in private therapeutic communities, 82% are men and the mean age is 40 years, varying between 13 and 74 years old.
Results: This analysis allowed to know the type of treatment program according the main substance of abuse. The most frequent was the program for illicit substances, for example heroin and/or cocaine, followed by the program for users with problems related with alcohol. The average number of admissions in therapeutic communities per patient is 1.3, with a maximum of 7 admissions. The average length of treatment time was 293 days. This analysis also allowed to assess the adherence to treatment program, which showed differences according with therapeutic community’s model and with the type of program and main substance of abuse or addiction.
Conclusions: This results show the importance not only of the choice of the type of program treatment, but also of the choice of the therapeutic community’s model, according with the main substance abuse of the patient, to obtain a higher adherence to treatment. It promotes the reflection on this therapeutic response and the challenges that people with psychoactive substance abuse or dependency put to professionals in the area of treatment and social reintegration, as well as to promote a better perception of therapeutic communities and their responses to the needs and challenges of the patients.