|
SUBUTEX SUBSTITUTION PROGRAMME
Structure of the Programme (Main Principles):
- high threshold
- prescription of Subutex® under the condition of regular attendance to the centre
- relatively fast lowering of the dosages; clear objective – abstinence
- systematic care – holistic approach (employment services, social counselling, intensive co-operation with physicians etc.)
- group psychotherapy for clients on very low dosages of Subutex®
Phases of the Programme – Main Characteristics
Phase 0 – Introductory Phase (4 weeks)
Procedure: 2 to 4 one-to-one meetings
Objectives: verifying client's indication for the programme and provision of legal Subutex® (on prescription)
Phase I – Motivational Phase (3 months)
Procedure: case management, individual planning, motivational group (once a week), guarantor sessions (once a month)
Objectives: stabilising client's situation
Phase II – Therapeutic Phase (3 - 12 months)
Procedure: group psychotherapy (once a week), guarantor sessions (once a month)
Objectives: client's abstinence from illicit substances, starting changes in client's lives – relationships, free time, lowering the dosages of substitution
Phase III – Individual Psychotherapy (6 - 12 months)
Procedure: individual psychotherapy (once a week), guarantor sessions
Objectives: client's abstinence from illicit substances, further lowering the dosages of substitution, changes in client's life style towards peaceful life in abstinence
Phase IV – After Care (3 - 12 months)
Procedure: one-to-one sessions
Objectives: maintaining client's abstinence; changes in client's life style
ADDITIONAL SERVICES - CHARACTERISTIC
Social Counselling
- counselling of social-law and labour-law problems
- stabilisation of client's social situation
SUPPORTED EMPLOYMENT FOR CLIENTS IN THE SUBUTEX® SUBSTITUTION TREATMENT
- for stabilised clients in substitution treatment
- support and help in finding a job or training
-social work, labour law counselling, carrier counselling, co-operation with employers, financial benefits etc.
CO-OPERATION WITH PHYSICIANS:
- information exchange concerning clients' attendance and other substantial circumstances
- prescribing Subutex for relatively short periods of time (1 week) – at least in the beginning of the programme
- regular contact with a client
- individual plan – planned decrease of dosages; the date of planned ending of the programme
- informing about changes in client's individual plan
- prescription of Subutex after two meetings with a counsellor in the centre and on the basis of therapeutic contract
- pause in prescription in case of breaking the rules of the programme
TRENDS:
- prescription of Subutex® and lowering its dosages is just one part of the whole therapeutic process
- objectives change in respect to the phase of the programme – harm-reduction in the
beginning; psychotherapy and social rehabilitation in later phases
- importance of social re-integration
- working with partners – users
- the question of timing – when are the clients ready to abstain? -> Maintenance phase.
Supported Employment for Clients in the Subutex Substitution Programme RESTART
PRESUMPTIONS:
- clients with regular employment are more successful in the treatment
- clients in the substitution treatment are disadvantaged in the open labour market
TARGET GROUP:
- clients in the substitution programme in Counselling Centre for Youngsters and Families
- clients of substitution programmes in other institutions
SPECIFIC GOALS:
- finding a job on the open labour market
- integrating into society
- increasing the effectiveness of substitution treatment
GLOBAL GOALS:
- destigmatising the target group in the society
- equalising opportunities on the labour market for people with addiction problems
- decreasing unemployment and increasing the number of taxpayers in the region
STRUCTURE OF THE PROGRAMME:
Phase 0 – DECISION MAKING
introducing the programme, rules of co-operation
Phase I - PLANNING
individual plan, strategies
Phase II - SEARCHING
training skills in order to get a job, helping to find an appropriate job
the goal – signing an employment contract and entering employment
Phase III - MAINTENANCE
support after entering employment
Phase IV - CONCLUSION
evaluation; ending the co-operation; plans for the future
ADDITIONAL SERVICES:
- co-operation with employers
- labour law counselling
- social work and counselling
- free internet for clients
- finding training, education
- co-operation with client's family
- support at the workplace
EFFECTS:
- the client adopts a regular day schedule
- the client gets used to work load and responsibility
- the client gains more independence
- the client learns to communicate with his colleagues and with his boss
- thanks to the job the client has contacts with "ordinary" people and can re-integrate into "ordinary" life
- the client develops his/her social skills
- the client has the chance of professional growth
|