Detoxification unit of the addictions department at the Psychiatric Hospital of Thessaloniki: a prototype unit in Greece. Admissions data, completion rates and referrals to other programmes, 1996–2004

Background

The Detoxification Unit is a residential facility, part of the integrated Programme for Substance Users' Treatment and Rehabilitation at the Psychiatric Hospital of Thessaloniki, and remains the only Detoxification Unit in Greece. This integrated Programme delivers a therapeutic continuum and attempts to cover the needs of various populations through a flexible, interconnected network of multi- dimensional services that includes: Counseling Station, Detox Unit, Therapeutic Community, Out-patient Programme, Dual Diagnosis Unit, Rehabilitation, Relapse Groups.

There's a waiting list for admission and the waiting time is three weeks, in average, in which period patients attend the Counseling Station. The Detox Unit provides support, (medication and psychotherapy) and preparation for transferring to further treatment (residential therapeutic community or out-patient services of the same or other programmes) for 15 patients. Main substance of use is heroin. Length of stay is 21 days and the treatment involves individual supportive therapy, insight-oriented and social skills group-therapy, relapse prevention training, physical activities, health-educational groups, parents-groups.

Materials and methods

This is a retrospective archives trial. We have studied all records of the Unit from the opening day in 1996 until 2004.

Results

There was a total number of 2117 admissions in the years 1996–2004, an average 235 every year. 89.7% were men and 10.3% were women. 1078, that is 50.9%, of the total number completed the 21 days of stay and 1039, 49.11% left prematurely. 51.1% of those having completed the 21 days were men and 49.7% were women. 22.8% of the ones that haven't completed were discharged on the grounds of discordance to the facility's curriculum and set of rules. 76.5% left against professional advice, 0.6% were discharged on medical grounds and 0.1% were discharged for other reasons.

Median length of stay was 14.12 days. 90.9% of the ones having completed the 21 days attended the preparation groups to enter the residential therapeutic community. 2.8% returned to the Rehabilitation Unit (they were originally participants of this last phase of the Programme that have relapsed). 2.5% were transferred to our out-patient programme "ARGO", 1.4% attended other out-patient programmes and 2.1% didn't follow any treatment. 70.6% of all admissions originate from Thessaloniki and 29.4% from other areas of the country.

Discussion

The completion rate of 50.9% is comparable with the american [1] and british [2] standards in absolute numbers. Taking the length of stay in account however, our limit was 21 days comparing with 4 days [1], indicates a much higher completion rate.

Long-term, integrated programmes with emphasis on psychotherapy are the rule in Greece (be it substitution/maintenance programmes or abstinence oriented ones). This attitude has infiltrated professionals and patients and it shows in the number of persons transferring to further treatment, 98% of the ones having completed the 21 days.

There is an obvious trend to transferring to out-patient facilities (ARGO started in 1998 and another ambulatory modality in 2003).

The very low percentage of female admissions, 10%, doesn't necessarily represent the actual ratio of male/female users. (According to the Greek Focal Point of EMCDDA the ratio of men to women seeking help from treatment programmes is 5:1. Women seeking help in our Counseling station represented 13.7% of the total in 2004). A women's programme would undoubtedly lift some of the obstacles that hinder women users from seeking help. A unit like that is in our immediate plans, starting next year.

One third of our admissions comes from other parts of the country, indicating the pressing need for more residential detoxification facilities.