11th EFTC European Conference on Rehabilitation and DrugPolicy . Ljubljana- Slovenia – 2007.

1. 11th EFTC European Conference on Rehabilitation and DrugPolicy .Ljubljana- Slovenia – 2007. Phoenix House Haga – Norway. Some recent research indicators of positive treatment outcome.

2. Organisation • Phoenix House Haga is a small drug free therapeutic community. • Located in South Eastern Norway, approximately 68 kilometres south east from Oslo. • Primary residential treatment capacity is 35 beds. • In addition we have 3 re-socialisation / re-entry houses. Two are close to the main community, the other in the closest local town, 3 kilometres away.

3. Organisation • The programme has a board of directors • Is a not for profit foundation • Regional Health Authority East are allocated 22 places in the residential programme • Other beds are purchased by various regional health authorities throughout the country.

4. Target Group • The target group is young men & women • Key issues are, frenquent & dependent drug use, disfunctional family, loss of education prospects, loss of friends, unemployment. • Who require long term residential treatment • From 2004 the primary treatment is 12 months. • The age range is 18 – 30 yrs • Admissions are accepted according to Pargraph 12, of the justice system.

5. Mental health concerns • People with serious mental health problems are not part of this target group. • However, it is unaviodable that some persons have additional co-morbity problems. • There have been instances where mental health issues emerge after admission. • Phoenix House Haga has an excellent cooperation with the local district psychiatric team. • Consultant psychiatrist – 24 hrs cover. • General physician for all members • Regular dentist

6. Some examples of co-morbidity, over recent years: • ADHD • Schizophrenia • Tourette’s syndrome • Eating disorders • Reading & writing problems • Depression • Social anxiety issues. • Sexual abuse trauma

7. Through close working relationship • With specialist agencies and support staff • Many of those residents are graduates of the programme • Living drug free lives. • Each community member has an individual treatment - action plan. • Action plan continues through primary & post primary treatment

8. Ideology • Phoenix House Haga is a 3rd generation therapeutic community.( Broekaert) • The model ’Community as Method”( De Leon) is modified for the realities of the Norwegian culture, traditions and individual needs. • Our historical roots can be found in both the U.S.A and Europe.

9. Values • Central to the value system is respect for the individual • Belief in the persons inner capacity for positive growth • Equality for each person, regardless where they may be within the structure of the organisation. • The strength of the community itself, as a tool for change. • The capacity of individuals to help others, whilst helping themselves.

10. Recovery • The fundamental principles of the recovery paradigim are published ( De Leon) • The essential elements required for recovery are within existing literature (Kooyman) • Recovery invloves self and mutal self help • Consistent motivation • Involvement of the individual in his / her own process • Social Learning • An understanding that treatment is an important episode, in recovery. • Treatment is a beginning – not an end.

11. Primary Treatment Goals at Phoenix House Haga. • Develop new effective cognitive strategies to constructively tackle risk situations, unpleasent emotions & challenges • Without resorting to substance abuse. • Experience a longer period of drug freedom than previously. • Keep a healthy distance from former drug using friends and criminals and the value system of the street. • Resumed education ( to high school/college) where needed.

12. Replace former destructive alliances with a healthy constructive lifestyle. • Develop a value system for a life without substance abuse ( right living) • Develop a good relationship with non drug using persons • Where possible re-establish relationship with the family of origin • Develop the foundation of a social network, before entering the re-socialisation phase.

13. Form a realistic strategy regarding economic debts • Begin negotiations with creditors where needed. • Have experienced voluntary work opportunities, prior to re-socialisation phases. • Engage in constructive free time activities, which often contribute to enhancing a new social network. • Have developed the ability to be responsible through the community structure. • Be able to deal with employment challenges in a new independent employment situation.

14. Integrated Re-socialisation Phases. • Cultural differences. • In Norway treatment laws discourage integrated re-socialisation phases provided by the treatment progamme. • Each individual is expected to return to the home kommune / municipality, for post treatment support. • Phoenix Haga does not accept this regluation as effective. • Treatment and Recovery Alliances have formed during primary treatment. • The alliance continues effectively during post primary treatment • Phoenix House Haga provides re-socialisation / re-entry support for up to 5 years, post primary treatment.

15. Treatment outcome / evaluation 1997-2002. • The first external evaluation of Phoenix House Haga was conducted between September 2005 – April 2006. • From 1997 – 2002: 202 persons were admitted. • 92 available for interview from Phoenix data. • The regional health authority for Eastern Norway contributed significantly towards the cost. • The evaluation was conducted by Patrick Verde & Bente Vindedal from AIM Researchbasedconsulting – Oslo, Norway. www.aim.no • Deputy administrative director, Ms. Solfrid Finstad acted as project co-ordinator, on behalf of Phoenix House Haga.

16. Objectives of the evaluation • The objectives were two-fold from the researchers’ perspective: • How or if treatment at Phoenix Haga impacted on the community members. • Establish the key elements of the programme on the overall objective of rehabiltiation, and establish where added resources could be applied to improve effectiveness.

17. Phoenix House Objectives • Our objectives were similar: • Discover what could be enhanced in primary residential treatment. • Validate the need for Integrated Re-Socialisation Phases. • Develop evidence based external research regarding these issues. • Form the groundwork for a new cost effectiveness study.

18. Comparison with other recent research in Norway • Researchers chose to compare with • Sirus Report 4/ 2003 ”What benefit, for who and at what cost”? Ravndal et al. • ”Life after the treatment community”, Halvor Fauske 2004. • This is a study of a treatment collective called ”Sollia”, covering a period 1997 -2004. • 52 persons were interviewed from Sollia. • 92 from Phoenix Haga sample.

19. Age and Gender • The majority of Phoenix residents are below 30 yrs. • Sollia and Cost Benefit have clients with slightly higher age range, 31 yrs average. • Both the Phoenix and Sollia samples show a female population of approx 22 % • The cost benefit study is approx 30%

20. Age difference

21. Substance Abuse • There is one significant difference between the Sollia group and those from Phoenix Haga • Sollia group are primarily Heroin users • Phoenix group itself, are approx equal in that 40% used Heroin • The the others from Phoenix used a variety of stimulants as drug of choice

22. Preferred drug before admittance

23. Onset of problematic drug use • On average both the Sollia group and Phoenix sample have a drug career of about 10 yrs pre – treatment. • Of the Phoenix group about half devloped a drug problem between the ages of 15 – 20 yrs. • 1 in 5 began before 15 yrs. • Almost equal number after 20 yrs of age.

24. Age of problem drug misuse.

25. Crime. • The data indicates that up to between 32 – 50% of Phoenix group have served prison sentences. • Fairly equally distributed in jail time served. • 3 months or less • 3 -12 months. • More than 12 months. • Cost benefit survey shows an average of 14 months.

26. Interesting Indications • Clear advantage to join the community at Phoenix after 2000. • Female residents seem to have better prognosis. • Over 30 yrs seems to be a disadvantage. • Drug debut between 15 -20 yrs shows good prognosis. • Stimulant abusers seem to do better than opiate. • Paragraph 12 conditions enhance prognosis. • Unpaid drug debts enhance re-socialisation.

27. Rehabiliation results. • The follow up interviews show • Almost 80% are not using drugs at follow up, this includes those few who are receiving substitution treatment. • 68% are abstinent or have very moderate alcohol comsumption. • Approx 40% are teetotal.

28. Comparison – Phoenix – Sollia – last 6 months

29. Cost benefit – last 6 months • The cost benefit survey shows • In that group from residential treatment, approx 26% were drug free at the time of follow up. • The Phoenix data indicates a higher number, though there are ”comparability” issues to consider. • 20% of drop outs from primary treatment, receive methadone. • 6.5% of those who completed primary treatment.

30. Degree of complete rehabilitation.

31. Summary. • The treatment programme is effective. • Rehabilitation results are beyond the average of the cost benefits survey ( Sirus 2003). • Effect due to: Key Points. • A sytematic residential treatment where all the aspects contribute: ”Community as Method”. • An Integrated Re-socialisation Programme. Offering Extended Support. • Key Worker & Peer Group. • An Aftercare which works as intended.

32. Climbing the mountain