1. Elizabeth Halpern Addiction Therapy 2015 Florida, USA August 03-08, 2015

2. The dual commitment of a naval outpatient clinic of the Brazilian Navy specialized in chemical dependency: both with the patients and the institution 4th International Conference and Exhibition on Addiction Research & Therapy August 3-5, 2015 Florida, USA

3. Elizabeth Halpern PhD in Mental Health FEDERAL UNIVERSITY of RIO DE JANEIRO Psychiatry INSTITUTE Post-doctoral student and scholar of the Psychiatry Institute, UFRJ Frigate-Commander of the BRAZILIAN NAVY Health Department Chief NAVY CENTRAL HOSPITAL

4. CEDEQ The creation of the Center for Chemical Dependency – CEDEQ – is a pioneer initiative of the Brazilian Navy, unparalleled amongst the Brazilian Armed Forces.

5. Research central objective and methods Objective Investigate the influence of the naval organization in the construction of the patients’ alcoholism Methods Ethnography in the CEDEQ Participant observation in two therapeutic groups Open-ended interviews with patients Single-case study

6. Some Results of the Major Study Main result : Institutional issues participate in the construction of the patients’ alcoholism. Further results : The existence of a double commitment of the CEDEQ, both with the patients’ treatment and the institutional needs and goals.

7. Therapeutic Commitment

8. The therapeutic approach is based on the principles of the Twelve Steps of Alcoholics Anonymous and Behavioral techniques, focusing on: Rehabilitation; Achievement of sobriety.

9. Patients are seen as responsible for their "illness“; The team usually states that they will never be "cured“. Therapeutic Commitment

10. MILITARY Commitment

11. Therapists and patients are committed to the naval system because the CEDEQ is part of the military structure; It is an extension of their working space, a place where they share the same codes, rules, and language. MILITARY Commitment

12. This Clinic partially reproduces the institutional view that blames individuals for their deviant acts derived from alcohol addiction; The CEDEQ must keep the administration informed about their therapeutic status; Confidentiality is mostly preserved, but some aspects have to be reported: absences, frequency, relapses, and discharges. MILITARY Commitment

13. Results Expected/common subjects Certain subjects usually emerge along the therapy: Relationships / family / love and sex; Financial problems; Self-realization / dreams / obstacles; Addictive behaviors / symptoms.

14. Results Predominant subjects Relationships with superiors / colleagues /subordinates; Career / complaints / failures / accomplishments; Daily routine / maneuvers / deployments; Heavy / risky / boring duties. The predominant topics discussed are related to the working journey:

15. Results Crucial “ordinary issues” HOWEVER, “Ordinary issues” may be central to the therapeutic process, though they may be seen as trivial and be overlooked : Before / during / after the group sessions, patients spend a time explaining the reasons for being absent / late / withdrawals, due to working needs / problems / obstacles, frequently presenting medical waivers or duty rosters.

16. Results Crucial “ordinary issues” By doing so, they expose the peculiar aspects that they are facing that reveal the correlation between their medical condition (alcoholism) and the working journey: I’ve missed in the last session because everyone had to prepare the barracks for an inspection. I know that my treatment is important, but the pressure in the Battalion is great. My colleagues think I go to CEDEQ to avoid the hard work.

17. Alcohol and Navy Libation in the naval workplace is a cultural tradition. They usually began to drink since their admission in the Navy: Every Friday is happy hour on board. In every corner, near the Battalion, there is a bar ! My colleagues invite me to drink every day.

18. The esprit de corps usually requires the consumption of alcoholic beverages among colleagues to execute tasks: Alcohol and DAILY TASKS Those who work embarked know the ‘cleaning system’: scrubbing and cleaning all day long when we arrive at the port! Then, the chief distribute ‘cachaça’ to help us finish the job.

19. They are always referring to Navy: concerns, desires, failures, disputes, and fellowships/ It is like an “addiction”, both loving and hating it; Brazilian Navy and drinking practices are central themes of their lives, their first and major interest. THE MAIN SUBJECT: NAVY

20. The dual commitment helps to understand the peculiarities of the organization that contribute to the emergence of these patients’ alcoholism. Conclusion

21. Despite all the shortcomings of the naval life, the Brazilian Navy is a haven in the face of innumerable existing difficulties in Brazil.

22. Limitations of the Study Because the consumption of alcohol in the Brazilian Navy is an innovative and delicate subject to be studied, the CEDEQ and its patients were the best choice available ; Further studies with a larger sample should be carried out to investigate in which extent the institution contributes to “construct” the naval contingent's alcoholism.

23. OBRIGADO! THANK YOU!

24. Addiction Therapy 2016 Website: addictiontherapy.conferenceseries.com Meet the eminent gathering once again at Addiction Therapy 2016 Miami, USA October 06-08, 2016