Dianova Italy has been developing a special module for alcohol and polysubstance addiction for over 15 years
By Ombretta Garavaglia (Dianova Italy) – Before discussing the intervention proposed by Dianova, it is necessary to briefly review the characteristics of the alcohol-dependent person in the residential context of the therapeutic community, generally characterised as the place of “treatment” for drug users. In fact, alcohol dependence has always been treated mainly on an outpatient basis or through self-help groups (Alcoholics Anonymous).
A residential treatment programme for people with alcohol dependence
However, over the course of time, and on the basis of the experience of other services, it became necessary to devise an intervention model in a residential setting, in order to facilitate the reception of people with alcohol issues but who are unable to achieve abstinence in outpatient services. Such a step is also culturally important in terms of society’s view of the phenomenon of alcohol dependence, an issue that is often underestimated or associated only with people on the fringes of society with a propensity to drink like a fish.
The module for people with alcohol or polysubstance dependence in the Dianova Community in Cozzo was created following a training programme that involved professionals from different residential facilities, whether private or public. The main objective was to develop a residential treatment programme for people with alcohol dependence
Objective: achieving the highest degree of self-reliance
From 2004 to date, this constantly evolving module has been developed through an approach requiring a synergy with public services. Interventions are person-centred and operate in a circular way using all the available tools from the different fields (education, psychology, health and social care).
These tools are instrumental to achieve individual goals and consistent with the achievement of the highest possible degree of self-reliance.
As in all of Dianova Italy’s communities, the programme uses the ICf- Recovery toolset, which allow for a global vision of the beneficiaries’ problems and needs. In particular, all the critical issues underlying the development of alcohol dependence are contextualised, analysed, addressed and elaborated within the context of the person’s history.
Building an individual treatment pathway
These aspects are explored in depth in order to build an individual treatment pathway that defines objectives and timeframes through the participation of various stakeholders: the allocated practitioner, the group of peers, and the remainder of the team. In addition, the specificity of the residential setting allows the person to experience new behavioural modes, to exchange their experience with others in daily activities, and to achieve the intended objectives. Additionally, an individual psychotherapeutic intervention is carried out, as well as the EMDR psychotherapy method since 2016.
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The importance of families, “the place to go back to”
Families play a fundamental role; it is important to note that during the treatment process, there are a number of scheduled interviews, in which family members are expected to be involved, together with the person in care. The aim of such intervention is to raise awareness on the main issues and to work on the process of change, especially when faced with dysfunctional relational dynamics within the family. Moreover, the family often represents the place to “go back to” at the end of the treatment process; it is therefore essential that they be aware of the role they have to play in offering more protective risk-free behaviours.
Deconstructing misconceptions about alcohol
Among the tools used in the programme, groups play a critical role and are formed during the various phases of the treatment process. The first group, or “Informative Group” consists of people who have just embarked on the programme; it is led by an educator and aims to train and inform on factors related to problematic substance use by addressing various issues, such as misconceptions about alcohol, health, cultural, social and clinical factors, but also to trigger a debate on personal perception of the issues related to alcohol dependence.
Implement alternative prevention strategies
The same group of people will subsequently participate in the “Specialist Group”, which is led by a psychologist and aims to work on the individual aspects related to one’s personal issues with alcohol and on any trigger leading to alcohol use, in order to encourage alternative behaviours and/or strategies.
It is also important to emphasise that having this specific intervention in support of alcohol dependent people within the community also helps other residents to develop a greater awareness of their own relationship with alcohol, which is often underestimated within one’s own experience with dependence.
In addition to what has already been described, the community offers a number of additional tools instrumental to the programme, including workshops, experience groups, in-house and outside activities, etc.
For people who have alcohol dependence issues, the risk factors are numerous and diverse, one of the most important being the outside environment.
Alcohol is very much present in everyone’s daily life: an aperitif with colleagues after work, the company dinner, a toast to celebrate an achievement, family parties… all situations that can make a person recovering from alcohol or other addiction feel inadequate and out of place, when in fact they should feel confident with their choice, without having to exclude themselves from the convivial context in order to protect themselves.
The specificity of the protected environment of the community
In light of these specific factors, the process includes several outings outside the protected environment of the community. This is in order to address the challenges that will have to be faced once the time in the community is over, and to help the alcoholic to understand the need of accepting complete and continuous abstinence, to be pursued after the programme comes to an end. This is another aspect that appears to be critical because people are convinced that they can go from being dependent to becoming “social drinkers” capable of managing alcohol responsibly, which we believe is not possible.
In conclusion, it should be emphasized that the issue of alcohol dependence requires specific attention due to a number of reasons.
Firstly, alcohol use is accompanied by many stereotypes, myths and false beliefs that are passed on over time. Secondly, the problem of dependence is often identified late because of the easy availability of alcohol and the and the widely legitimised contexts of alcohol use.
As a result, the person and those around them tend to underestimate the problem and postpone seeking help. It is precisely on the basis of these observations and to better address the problem that the Cozzo community programme has been developed.