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The different aspects of addiction and the Therapeutic Community approach Martien Kooyman MD, PhD 50% of heroin addicts were involved in criminal behaviour before they used their first drug Addiction is a chronic relapsing disease Is addiction is a chronic relapsing disease? Is it chronic? Long term drug use ( excl. unknown ) 100 90 80 70 60 50 40 30 20 10 0 start 20% Deceased 20% Problem use 20% Integrated use 40% Abstinent 5 year follow-up 10 year 15 year follow-up follow-up 20 year follow-up Cramer & Schippers, 1994 Recovery rate in the literature Alcohol dependence: 60% Psychiatric disorder: 39% Schippers (2006) Is it a relapsing condition? Is addiction a disease? If addiction is not a chronic relapsing disease, what is addiction? Addiction is a self inflicted disorder with multiple causes Definition of addiction Addiction is a self-continuing harmful process resulting from the loss of control over adaptive behaviour which then itself becomes a problem heriditary biological trauma family Addiction peer group social Possible causal factors in addiction heriditary biological trauma family Addiction peer group social Possible causal factors in addiction The addict who comes to treatment has a low self esteem and an unabillity to sustain intimate relationships orientation methadone T.C. Triple-Ex detox T.C. Mistral re-entry T.C. Emiliehoeve day centre project 4 Therapeutic communities will never solve the total drug problem. They are however part of the solution.