1. Welcome to A-Senteret!

2. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Part of «The City Mission », founded in 1855 CM: running 40 different projects, 1200 employees, 1350 volunteers, A-senteret founded in 1957 Since 2004 fully funded by the regional Health Authority (State ), before 2004: Local Authority. So: privatly owned but on contract with HA, non-profit 2004: TSB= Specialised interdisciplinary treatment for substance abuse/addiction A-Senteret:

3. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Hva er A-senteret? 45 employees, Outpatient:12, Inpatient: 24 (half of these parttime) Outpatient: 7.475 yearly consultations, Inpatient: 20 beds (7.300)

4. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Our work: Assessment of referrals Outpatient treatment Inpatient treatment Supervision/Information/Lectures

5. Alcohol in Norway (SIRUS): Most people drink alcohol (87%) 2009: 6,70 l alcohol sold per adult (Finland 10,0) 10% consumes half of the total consumption Over the last 15 yrs consumption has increased by 40% We still binge drink on weekends but continental drinking patterns has also emerged Around 1.5 million Norwegians are affected by high alcohol consumption A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

6. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Alcohol in Norway (SIRUS): 50-150 000 children affected by parents alcohol- /drugproblems 50- 100 000 spouses/partners affected 2010: 414 deaths caused by alcohol, high consumption over a long period of time (317 male,97 female), this is only a fraction of all deaths that fully or in part are caused by alcohol 2011: 6788 admissions to somatic hospitals with alcohol related underlying diagnosis (4678 male, 2110 female) 2010: 23000 patients in TSB treatment, 36% inpatient

7. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg A-senteret – understanding, ideology and methods Psychological perspectives Medical perspectives Social perspectives Spiritual /existential perspectives No «one fits all approach» Motivational interviewing, mentalization, psychodynamic, mindfullness, cognitive ….

8. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Outcomes: Increased quality of life Changes in use /consumption of alcohol/drugs Relapse prevention

9. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Who can receive treatment at A-senteret? People with problems related to use of alcohol, illegal substances or medication People with problems as above combined with mild or moderate psychiatric illnesses Relatives/ people who are being affected by anothers dependency/alcohol problems

10. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Patient population at A-senteret

11. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Patient population at A-senteret

12. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Referals from: General Practitoners, medical doctors Local Authorities, social welfare office Other parts of the Health Service, Specialist

13. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Assessment of referrals Assessment of statutory rights to health services/treatment within TSB Outcomes: statutory right, treatment without statutory right, refusal Assessment team: psychologist, social worker and medical doctor (Interdisciplinary) Guidlines from Directorate of Health

14. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Outpatient unit Examination and further assessment Individual treatment plan Time in, and intensity of, treatment varies with individual needs Individual therapy Couple and/or family sessions External liaison and collaboration Internal interdisciplinary collaboration In addition: Group therapy or course for some patients

15. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Outpatient groups: Awarness group Womens group Course in how to cope with depression and prevent relaps Gay/lesbian group Course in Mindfullness and stressreduction Psychoterapy group Transition group/follow-up from in-patient

16. A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg Outpatient groups Information course Mindfullness/Stressreduction course Group for adult children of parents with alcohol- /drugproblems Group for spouses/partners

17. Inpatient unit 20 patients in the unit 7 days a week but most have weekend leaves 3 social workers, 3 nurses, 3 psychologists, 2 doctors and the unit leader Main treatment method is group therapy Patients have 2 individual consultations/ week A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

18. Inpatient unit- treatment phases Assessment phase Preparation phase Admission to the inpatient unit Treatment planning Treatment phase Termination phase Follow-up A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

19. Inpatient unit- structure Private rooms Morning meeting (mandatory) Group therapy x 6 per week (mandatory) Daily chores assigned to all patients Expectation that everyone is back on the unit 2230 Most patients are on weekend leaves No addictive medications are distributed We expect that patients abstain from alcohol and drug use during treatment Cooperation with referrers, GP’s, other specialists A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

20. Detox before admission All patients has to be detoxified of all substances before admission to the inpatient unit This leads to different detox facilities and length of time which is discussed in the preparation phase. Also possible with 5 days of alcohol testing/ urine samples before admission A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

21. Group treatment at the inpatient unit Mandatory group treatment 6 times per week Monday: Mentalization/ psychodynamic based groups Tuesday: Physical activity group and Mindfulness based group Wednesday: Psychoeducational group with focus on psychological health Thursday: Physical activity group Friday: Psychoeducational group with focus on addiction, change process, high-risk situations, relapse Also other, optional groups: Yoga, Physical activity, Art therapy A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

22. Why group treatment? People with addictions often have problems when it comes to healthy attachments Group psychotherapy work both with the difficult relationships, and in them Participants use each other to improve their understanding of their own and others mental processes -> improved relationships A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

23. Why group treatment? Patients in groups Can get a sense of belonging and a installation of hope Participate w/o use of substances in social setting which improves social skills and interpersonal functioning Experience that some of their problems are universal Get to help others in their treatment Can learn from others mistakes and successes A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

24. Individual treatment All patients has an individual therapist assigned from the beginning Patients are presented and discussed at team meetings which ensures that interdisciplinary aspects are taken into consideration When necessary, team members with other backgrounds complement the individual therapist A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

25. Individual treatment In the treatment phase, family members including children are often invited Contact is also established with the workplace Termination date is set at the beginning and planning for life afterwards start already in the treatment planning stage Individual therapists has different theoretical backgrounds and adapt to patients needs A-Senteret 13 september 2013E.S.Hubbuck/A.Ekberg

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