Interview with Carlos Arena, psychiatrist, Head of the Alcohol Treatment Program (Center of Cozzo, Dianova Italy)
My name is Carlos Arena, at Dianova I’m sort of an old-timer because I’ve been here for quite a long time. I’m a psychiatrist; I used to work in various psychiatric hospitals before such institutions were closed. Subsequently, I have worked in a number of psychiatric services implemented as a result of the psychiatric reform introduced in Italy through the Basaglia Act. I have also been the head of the mental health department of Casale Monferrato. After my retirement, eight years ago, I joined Dianova Italy’s therapeutic team in Cozzo, as head of the alcohol treatment program.
How was this program born?
The program’s been implemented eight years ago. At the time, we’d come to realize the importance of helping those with alcohol dependence related problems not only through rehabilitation and treatment activities but also by providing living spaces and offering them different opportunities. Before that, they were only proposed a follow up from their home, which would barely suffice given the wide availability of this substance.
Who can apply to the program?
The alcohol treatment program is both for “simple” profiles, that is to say people addicted to alcohol only, and polydrug users profiles, i.e. people who abuse alcohol in combination with other drugs. We’re dedicated to helping those who are currently undergoing harsh life experiences, given that alcohol abuse is often associated with depression, as well as social isolation, relational difficulties and the worsening of personal relationships. We try to help them rebuild their identity.
According to the law of the Lombardy region, a psychiatrist must be present in this type of program. At present, 14 out of 49 places are accredited and the program is complete.
What are the program’s objectives?
First of all, the user’s personality profile is drawn. We actually believe that there is no addiction per se, only addicted individuals. Group therapy is essential throughout the program and during the reintegration phase. In the program’s early years, some friction or squabbles might have occurred between polydrug users and alcoholics, but now both groups are dedicated to supporting each other.
I for one am the contact person for residents, but they may also speak with other staff members, including psychologists and educators. The program consists of three stages: the information stage, dedicated to explain the various social and psychological facets of alcohol, the treatment stage, with an objective of rebuilding patients’ personality and, the reintegration stage towards a successful re-entry of the individual back into his or her community, with adequate support from the group.
What tools do you utilize in the program?
The cognitive-behavioral dimension is critical. Also important is the role of the group in giving residents more and more sense of responsibility and accountability, while allowing for constructive dialogue and enabling them to accept criticisms and confrontation from other people. With respect to relationships, we use the MMPI Minnesota test, a very reliable personality questionnaire which helps shed some light on the individual’s relationship difficulties.
What distinguishes Dianova from other programs?
I’d say it is probably the educational and practical dimension, with personal interviews and group activities with educators, but also the physical and theatrical expression activities. The latter elements of course take each resident’s individual trajectory into account, as mentioned in his or her individualized treatment plan.
And what about the staff?
The staff is composed of a definite number of people as required by the certification accorded by the Lombardy region. In addition, a multidisciplinary team is also involved in the alcohol program, as well as in the educational section. This is a diversified team comprising graduates in social sciences and social psychology, which allow them to address the sphere of social and family difficulties.
The Alcohol program also addresses the issue of relapse, which is considered less as a drama, (as would be the case with other drugs), than as a tool to improve the individual treatment process.
What are the outcomes of the program?
Given the number of references from other services, the module is almost always complete. We work in close relation with the region’s public addiction services, to whom we send reports on a regular basis and ask to come and visit us so as to witness the treatment process and to keep contact with residents.
In the future, we hope to develop vocational training courses – such as bakery and horticulture workshops – essential for effective rehabilitation. After their reintegration former residents maintain relations with the community, following the psychological interviews which complete their reintegration process.
It is very important to supporting them during this stage, since the process of change they have accomplished is seldom recognized by the outside world as it should. They may also face discrimination. Separation from the program can be a difficult period for them and we want to support them in the best way possible.
Number of users currently present in program: 12 men, 2 women
Average age: 40
2 users in emergency intake
3 users in reintegration process