DETOX: Architecture of Drug Addiction Rehabilitation Thesis

DETOX Architecture of Drug Addiction Rehabilitation

Saad AlAmeri 1045596

Department of Architecture, College of Engineering, Abu Dhabi University December 2018

A C K N O W L E D G M E N T S I am very grateful to Professor Apostolos Kyriazis, in the Department of Architecture, for his expert advice, guidance, and encouragement throughout this difficult project.

CONTENTS I N T R O D U C T I O N ............................................................................. 1 P R E C E D E N T S T U D I E S ............................................................... 5 1.

Rehabilitation Centre Groot Klimmendaal

2.

Storstrøm Prison

3.

Sister Margaret Treatment Center

4.

Vejle Psychiatric Hospital

5.

P r e c e d e n t S t u d i e s S u m m a r y ................................ 49

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......................................................... 14 ................. 30

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S I T E A N A L Y S I S ............................................................................ 52 D A T A C O L L E C T I O N A N D A N A L Y S I S .................. 63 I.

Background

II.

Drug Addiction Rehabilitation Centers

III.

Design Features for Stress Reduction

IV.

Space Standards & Ergonomics

V.

Design Codes & Regulations

............................................................................. 63 ............. 73

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............................... 84

.................................... 118

U S E R S F E E D B A C K ................................................................. 129 P R O G R A M M I N G ........................................................................... 138

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

E S T I M A T E D B U D G E T .............................................................. 146 P R E L I M I N A R Y D E S I G N ....................................................... 147 S U M M A R Y .......................................................................................... 155 B I B L I O G R A P H Y ........................................................................... 158 A P P E N D I X ........................................................................................ 169

I N T R O D U C T I O N Drug Abuse and addiction is spreading like cancer among the UAE youth.

The number of deaths from drug abuse is on the rise (Dajani, 2016). The UAE has been following the global trend of decriminalizing drug abusers and classifying drug abuse as a mental disease. Even though till this day consuming illegal drugs is a criminal offence and conviction results in a mandatory sentence of 4 years‘ imprisonment, revisions in 1995 and 2005 introduced the clause that provides for treatment and rehabilitation (AlGhaferi, et al., 2017).

The National Rehabilitation Center was established in Abu Dhabi in 2002.

The majority of cases the center receives involve addicts in the 20-30 age group (Rasheed, 2016). People from the UAE and GCC countries were the most implicated in drug crimes. In 2014, a total of 770 people involved in drug cases, among them 341 people from GCC countries, 106 Arabs and 323 foreigners (Barakat, 2014). The Federal National Council had expressed concern about a lack of rehabilitation center beds and specialists, and weak educational programs in schools. 379 students were found using drugs in 2013, among them 160 Emiratis. Dubai member Afra Al Basti asked Sheikh Saif to take the initiative to provide more rehabilitation centers, as the trend was growing, even among women

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

(Dajani, 2016).

Stigma surrounding rehabilitation centers is a worldwide dilemma. The British singer Amy Winehouse sang ―They tried to make me go to rehab, I said, no, no, no.‖ she later died from alcohol poisoning at the age of 27.

The issue of stigma is even worse in the conservative society of the UAE. 25% of patients in the NRC were brought in by the Ministry of Interior (Rasheed, 2016), and a trend of seeking abroad rehabilitation centers is common among Emiratis. Each year, between 45 and 75 Emiratis travel to seek a specialized resort in Thailand to receive drug and alcohol rehabilitation. To UAE nationals, the promotion of anonymity granted by overseas rehabilitation resorts is the best alternative in a region where drug addiction is still taboo (Clarke, 2015).

Rehabilitation centers are considered mental health facilities, with typical treatment programs lasting between 4 to 8 weeks. Inpatients in mental health facilities are more susceptible to self-harm, and aggression (Bowers, et al., 2011). The traditional way in which some rehabilitation centers are designed contribute to increasing stress and pose a danger to the wellbeing of both patients and staff (Unwin, 2003) (Edge, 2003) (Seaward, 2011). Studies show that satisfaction with mental health facilities declines progressively during the treatment period (Potthoff, 1995), and satisfaction results in the patient's interest to continue to be treated (Sapmaz, et al., 2012).

The project objectives are to design a rehabilitation and reintegration center for drug and alcohol addicts which will be able to destigmatize, treat, and reintegrate drug abuse patients into the society. In addition, it aims to aid in the prevention of future addiction cases, and spread awareness in the community, especially among the youth. Through the use of architectural design, the project aims to create an environment which increases the satisfaction of patients with the treatment and reduces their 2

INTRODUCTION

stress. The design will address concerns regarding the satisfaction, safety, and functionality of the rehabilitation facility.

The design of the drug rehabilitation center poses multiple risks. Even though the authority‘s stance regarding the subject is clear, it‘s unknown how the targeted users and community‘s attitudes towards the center will be, since the subject is still surrounded with social stigma and prejudice.

For example, are the community and families‘ of the inpatients willing to use the facilities provided by the center? And are the patients willing to participate in public and group activities inside the center? Other questions include designing the program of the center, how much area does the center need? How many patients should it accommodate? And how functions relate to each other? And more questions of this sort. To answer the various questions and challenges regarding the design of the addiction rehabilitation center, a mixture of various research methods were used.

First are the precedent studies. Precedent studies are very crucial in multiple ways. They give different points of view to solve the same risks and challenges posed by the project. They help the design program to take shape. They clear how the organization of the spaces and functions should be. They give an example of which materials, color, and design elements to be used, and they can show how faulty design can impact the users of the center.

The second tool is site analysis. Site analysis is an important research tool in architectural design. Every site is different in its challenges, risks, opportunities, and advantages. The architect should be able know how to get the best of the site through the site analysis by the study of its topography,

accessibility,

demographics,

weather,

sun

exposure,

surrounding architecture, legal zoning and building codes, natural elements, etc. the site is one of the most important elements in creating a conceptual design of the building.

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The third tool is literature review which gives a strong foundation for evidence based design mainly through research papers and articles.

Literature review also includes; design theories, authorities and public opinions, statistics, practiced design elements, and most importantly standards and international codes regarding the building function. The literature review includes multiple forms of literature such as; books, ebooks, magazines, papers, article, websites, interviews, etc.

The fourth and last research tool is the survey. Since the social stigma and prejudice creates an obstacle in finding and surveying the users of the center (drug addicts), the survey instead focuses on the community‘s attitudes towards rehabilitations center. For instance, the survey explores how different demographics of the community are willing to use public facilities in the rehabilitation center and interact with its users.

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PRECEDENT STUDIES Precedent cases don‘t necessarily reflect the immediate function of the research project; instead they focus more on the impact of the project and other elements which may relate to the research project. For example, a building which helps reintegrate its users whether or not they were drug addicts would be helpful as a precedent study since it focuses on the main objectives of the research project. Other cases could focus on rehabilitation, destigmatization, and accommodation of the users.

As mentioned earlier the selection of the precedent cases doesn‘t strictly follow the same user‘s typology. For instance, the projects selected can resemble the users of the research project in demography or social status and stereotype. For example, a case which handles stigmatized group of users could shed a light on the way architectural design can help such individuals.

The precedent studies are as following: 1- Rehabilitation Centre Groot Klimmendaal - The Netherlands 2- Storstrøm Prison – Denmark 3- Sister Margaret Smith Addictions Treatment Center - Canada 4- Vejle Psychiatric Hospital - Denmark

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2.1 Rehabilitation Center Groot Klimmendaal

Figure 1 Rehabilitation Center Groot Klimmendaal, retrieved from Archdaily.com

Location: Arnhem, the Netherlands.

Date: 2011 Architect: Koen van Velsen Total area: 14000.0 m2 Project background: the project was awarded Building of the Year 2010 by the Dutch Association of Architects, winner of the first Hedy d‘Ancona Award 2010 for excellent healthcare architecture, winner of the Arnhem Heuvelink Award 2010 and winner of the Dutch Design Award 2010 public award and category commercial interior (Etherington, 2011).

Project significance and impact: The project offers an unconventional approach of designing healthcare institutions. The building offers a pleasant and comforting experience to its users.

Keywords: Rehabilitation, healthcare, wellbeing, nature, sustainability

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The design of a reintegration and rehabilitation center for drug and alcohol addicts poses a problem of social stigma and repulsion of such centers.

The design aims to change the stereotypical image of rehab centers and create a welcoming and comforting environment for its users. The Rehabilitation Center Groot Klimmendaal for physical limitations tackles this problem through its design. First, the architecture of the building disowns the typical healthcare center design. The building is cladded with brown anodized aluminum panels which, despite of its size, makes the building dissolve within its surroundings. Second, the design of the center highlights the healing capacities of nature. Sited inside the forest of Arnhem in the Netherlands, the curtain walls and generous glass use in its faรงade invite the forest inside the building, giving its user a constant view of nature. Third, the building hosts multiple leisure and recreation facilities such as, a fitness center, a gym, and a theatre in its entrance level. The community is allowed to use the facilities and thus helping the patients with their reintegration process. Finally, the interiors of the building emphasize on reducing the patients anxiety and distress through the use of diverse but subtle colors.

Figure 2 Rehabilitation Centre Groot Klimmendaal main entrance, retrieved from Google maps.

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2.1.1 Context / Site and surroundings

Figure 3 Satellite location of Groot Klimmendaal along with pictures of neighboring buildings, Source: Landsat / Copernicus, and processed by the author.

Residing within the forests of the Netherlands, Rehabilitation Center Groot Klimmendaal hides between the trees like a quiet deer. It blends with its surrounding landscape and architecture and is accessible by a street with bicycle and pedestrian paths. The street feeds multiple institutions mostly dedicated for the children and people with disabilities. The center follows the massing and heights of surrounding buildings and appears to have the darkest shade of brown in the area. It may be explained by the attempt to camouflage the building.

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2.1.2 Scale and spatial/form relationships

Figure 4 the columns’ organization in the level 0 plan of Groot Klimmendaal Rehabilitation center, retrieved from dezeen.com and processed by the author.

The plan of the center is rectangular, which starts with a small footprint of 110x30m and grows to reach 160x30m at upper levels.

The high length to width ratio increases the surface area and thus exposes the interiors of the building to the forest, and provides natural light to most of the rooms inside. In addition, the building hosts double and triple heights plus atriums at different levels, further increasing the amount of natural light entering the building and visually connecting different levels with each other.

The structure of the center is irregular and diverse. Most of the columns are reinforced concrete with a different arrangement between exterior and interior columns. However, the columns in the southern façade are instead inclined steel columns adding aesthetics to the double height area.

Figure 5 Interior corridor and swimming pool, retrieved from dezeen.com

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2.1.3 Functional analysis and circulation

Figure 6 Floor Plans of Rehabilitation Center Groot Klimmendaal, retrieved from dezeen.com and processed by the author.

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Figure 7 Vertical layering of the program of Rehabilitation center Groot Klimmendaal, retrieved from dezeen.com and processed by the author.

2.1.4 Environmental considerations

Figure 8 Light diagram of level 3 plan, retrieved from dezeen.com and processed by the author.

The use of energy is reduced by the compact design of the building, and the design of the mechanical and electrical installations. Most notably, the thermal storage (heat and cold storage) contributes to the reduction of energy consumption. The choice of selecting sustainable building materials, and materials requiring little maintenance for floor finishes, ceilings and facade cladding, result in a building which can be easily maintained and with a long lifespan (Etherington, 2011).

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Figure 9 Groot Klimendaal rehabilitation center, circulation of the building comes with a rich experience of double heights, light wells, and diverse colors.

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Perhaps one of the most notable characteristics of the Groot Klimmendaal is its use of striking yet subtle colors. With The notion of color theory, the center implements diverse array of colors and shades in its interiors, creating a visually arousing yet comforting environment.

Figure 10 Color Palettes of Groot Klimmendaal rehabilitation center, produced by the author.

Figure 11 Groot Klimmendaal rehabilitation center, sports facility entrance, retrieved from koenvanvelsen.com

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2.2 Storstrøm Prison

Figure 12 Storstrøm Prison, activity building, retrieved from Archdaily.com

Location: Gundslev, Denmark.

Date: 2017 Architect: CF Möller Client: The Danish Prison and Probation Service Total area: 32000.0 m2 Project background: Storstrøm Prison is Denmark‘s second-largest maximum-security prison, is meant to evoke feelings of a small provincial village. Housing 250 inmates, the prison is meant to be rehabilitative while allowing prisoners to avoid the loss of social skills that comes with institutionalization (Hilburg, 2017).

Project significance and impact: Storstrøm Prison will be the setting for the worlds most humane and re-socializing closed prison, with architecture which supports the inmates‘ mental and physical well-being and also ensures a secure and pleasant workplace for employees (ArchDaily, 2017).

Keywords: Prison, humane, wellbeing, safety, sustainability

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Drug addiction is classified as a mental disease. 32.4% of psychiatric inpatients engage in aggressive behavior or violence (Bowers, et al., 2011).

Based on this notion the design of the reintegration and rehabilitation center for drug and alcohol addiction should address the issue of safety and security. Although different in function, the case of Storstrøm Prison demonstrates a balance between security and humane design. With an accommodation and reintegration program, the prison presents a design similar to that of the rehabilitation center. The prison objective is to be less institutionalized and more like a village, thus placing the inmates in a familiar and friendly environment.

Storstrøm Prison is organized around central community buildings and laid out more like a campus than a traditional prison. The four prisoner wings and maximum-security hall are sited in such a way as to mimic the urban fabric of the surrounding villages and form streets and squares, softening the transition between open societies to a prison. The designers chose to keep with the Scandinavian tradition of encouraging reform among inmates rather than enacting harsh punishment (Hilburg, 2017).

C.F. Møller chose to work different materials into each of the buildings on the site based on their programming. The five wings have been given a patterned brick façade, the activity building is a mix of concrete panels and glass, and the workshop building is clad in steel panels and concrete. The concrete is also embossed with a circular pattern throughout the campus in an attempt to keep the walls from feeling too institutional (Hilburg, 2017).

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Figure 13 Storstrøm Prison Layout, retrieved from Archdaily.com

2.2.1 Context / Site and surroundings

Figure 14 Satellite location of Storstrøm Prison along with pictures of neighboring areas, Source: Landsat / Copernicus, and processed by the author.

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Located on the Danish island of Falster, Storstrøm Prison is surrounded by multiple low density fragmented villages. The choice of the location is probably for the sake of security, since it has one access to the Sydmotorvejen Street. Moreover, its closest village is one kilometer away.

The neighboring villages are extremely low in density with traditional Scandinavian architectural features such as pitched roofs. The concept of the prison reflects this fact by housing multiple wings and halls, each one acting like a small village of its own. The color of the exteriors of the prison rhymes with the color palettes of the surrounding villages by the use of earthly colors such as beige and grey.

2.2.2 Scale and spatial/form relationships

Figure 15 Storstrøm Prison layout, retrieved from ramboll.com

The design of the Storstrøm Prison in Gundslev, Denmark echoes the structure and scale of a small provincial community to stimulate the urge and ability to rejoin society after serving a prison sentence (Malone, 2017).

The different buildings of the prison take on different shapes, notably the circular plan of the activity building and the polygon shape of the workshop building. However, the designs of the wings which accommodate the prisoners are the planned in a radial arrangement. The standard branch of each wing is about 39x18 m. this design emphasizes on the importance of daylight to the wellbeing of the prisoners. Each cell 17

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feature a big horizontally tilted window which allows full exposure to daylight while catching a view of the surrounding landscape.

Figure 16 Storstrøm prison, standard wing, retrieved from divisare.com

Cells are gathered in units of four to seven cells arranged around a social hub. The cell units have access to a living room area and a shared kitchen, where the inmates prepare their own meals. Living rooms are decorated in colors that are ―less institutional‖ and structurally integrated artwork can be found throughout (Malone, 2017).

Figure 17 Storstrøm prison, standard wing, living room, retrieved from divisare.com

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To minimize the institutionalized appearance of the prison, the exterior design features recessed facades and pitched roofs. The facades of the wings, the visitors department and the gate building incorporate lightcolored bricks, while the activity building features concrete panels and glass, and the workshop building has steel panels accompanied with concrete (Malone, 2017).

Figure 18 Storstrøm prison, inmates walking by the workshop building, retrieved from divisare.com

Figure 19 Storstrøm prison site plan, retrieved from floornature.com

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Figure 20 Storstrøm prison, activity building elevation, retrieved from floornature.com

Figure 21 Storstrøm prison, workshop building elevation, retrieved from floornature.com

Figure 22 Storstrøm prison, standard wing elevation, retrieved from floornature.com

2.2.3 Functional analysis and circulation Even though the prison is designed to be less institutionalized and humane, it doesn‘t compromise security. It divides prisoners into wings and each wing into units of 3-7 cells with a shared living room and kitchen for each unit. Limiting the numbers of inmates in each unit, gives greater opportunity for social bonding between inmates, decreases cases of aggression and mass rebellion, and eases the staff management of the inmates. Moreover, staff stations are positioned to facilitate visual surveillance of the inmates in multiple units. The design of the cell features curved angles creating the possibility to view the whole cell from its entrance, and minimizing the risk of self-harming. Common areas such as the activity building and the workshop building control the circulation of the inmates by dividing the corridors with doors; which control the numbers of inmates in each area.

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Figure 23 Storstrøm prison, standard wing’s plan and section, retrieved from architectural-review.com, and processed by the author.

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Figure 24 Storstrøm prison, activity building’s plan and section, retrieved from architectural-review.com, and processed by the author.

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Figure 25 Storstrøm prison, workshop building’s plan and section, retrieved from architectural-review.com, and processed by the author.

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Figure 26 Storstrøm prison, special security wing plan, retrieved from floornature.com, and processed by the author.

Figure 27 Storstrøm prison, cell plan, retrieved from archdaily.com

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Figure 82 Storstrøm prison, cell, retrieved from floornature.com

2.2.4 Environmental Considerations The Storstrøm prison incorporates sustainable design. For instance, 30-40% of the energy consumption of the prison comes from a solar cell system located at the ground level. The prison also features LED lighting in the indoors facilities which reduces the energy consumption and demand. In addition, rainwater is drained and diverted to a local watercourse south of the prison. In cases of heavy rain, rainwater levels are adjusted by leading the water into an artificial lake to protect the watercourse from overflow (Ramboll, 2017). Moreover the design incorporates durable and easily maintained materials in the facades and interiors.

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Figure 29 Storstrøm prison, standard wing’s light diagram plan, retrieved from architectural-review.com, and processed by the author.

The prison creates visually stimulating external and internal environments. The facades feature mixtures of materials and colors such as, concrete and steel panels, and light colored bricks.

In several places, concrete panels feature a circular pattern, to break the monotonous surface. Inside the buildings, the four colors - yellow, orange, green and blue - contribute to the positive atmosphere and variation in the buildings, which are also used in the cell departments. The colors used on walls and floors help to eliminate the institutionalized atmosphere. This is apparent in the communal areas. The cells are in neutral colors, so that the inmates can decorate their cells as they wish (DIVISARE, 2017).

However, the use of color in the cell departments is used as a marker of each unit, since each department features a single color.

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Figure 30 Color Palette of Storstrøm prison, produced by the author.

Figure 31 Storstrøm prison, connection of 2 cell departments, retrieved from archdaily.com

Figure 32 Storstrøm prison, a large mural by John Koerner at the gym hall, retrieved from archdaily.com

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Figure 33 Storstrøm prison, church, retrieved from archdaily.com

Figure 34 Storstrøm prison, courtyard, retrieved from archdaily.com

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Figure 35 Storstrøm prison, bronze sculpture by Claus Carstensen, retrieved from ramboll.com

Figure 36 Storstrøm prison, outdoor sports yard, retrieved from archpaper.com

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2.3 Sister Margaret Smith Addictions Treatment Center

Figure 37 Sister Margaret Smith Addictions Treatment Center, retrieved from Google Maps

Location: Thunder Bay, Ontario, Canada Date: 2009 Architect: Kuch Stephenson Gibson Malo Architects and Engineer + Montgomery Sisam Architects Client: St. Joseph‘s Care Group Total area: 4830 m2 Project background: The Sister Margaret Smith Addictions Treatment Centre provides residential and non-residential services for the treatment of addictions including drug and alcohol, gambling and eating disorders, among others (ArchDaily, 2011 A).

Project significance and impact: The Centre has been designed to support the Core Values of the St. Joseph‘s Care Group which are; compassionate and holistic care, dignity and respect, faith based care, inclusiveness, truthfulness and trust. Inspired by these values, the design creates a clear sequence of spaces which offer a variety of relationships to the exterior landscape. The healing quality of natural light has been a prime consideration throughout the design (ArchDaily, 2011 A).

Keywords: Addiction, Faith, Health, Rehabilitation, Sustainability

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Figure 38 Spiritual room, Sister Margaret Smith Addictions Treatment Center, retrieved from ArchDaily.com

The center is organized around an organizing spine called the Hall of Recovery. It acts as an introduction to the building which welcomes the clients into a calm and welcoming setting. The building is organized around two courtyards, one for residential patients and one for nonresidential patients. The courtyards help in adding a safe space where clients can enjoy natural elements as part of their healing process. The spiritual space has been designed in a circular form to be respectful of the aboriginal community, who make up a large portion of the client population (ArchDaily, 2011 A).

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2.3.1 Context / Site and surroundings The center is located on a larger campus of care in a low-rise residential area. Its design blends in terms of colors, materials, and massing with the neighboring architecture which mostly consists of single family houses of a 2 floors height. The center is easily accessible by the community and is located next to public spaces and green areas such as The International Friendship Gardens.

Figure 39 Satellite image of Sister Margaret Smith Addictions Treatment Center location, Source: Landsat / Copernicus

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Figure 40 Neighboring houses north of Sister Margaret Smith Addictions Treatment Center, retrieved from Google Maps

Figure 41 The International Friendship Gardens near Sister Margaret Smith Addictions Treatment Center, retrieved from Google Maps

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2.3.2 Functional analysis and circulation

Figure 42 Sister Margaret Smith Addictions Treatment Center plan, retrieved from politesi.polimi.it

The residential program is divided into 15 beds for females, 15 beds for males and 10 beds for youth, including children as young as 13 years. The residential programs and non-residential programs have separate entrances to protect the privacy of each. Non-residential programs include private and group therapy rooms, gymnasium, spiritual room, crafts room and administration (Davies & Stephenson, 2013).

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Figure 43 Sister Margaret Smith Addictions Treatment Center section, retrieved from politesi.polimi.it

The youth residential component provides accommodation for both young men and women in the same space. It is laid out so that the bedrooms open directly into the living area. This has been done to provide care and protection to adolescents, who are prone by their very condition to inappropriate and compulsive behavior. It further gives the feeling of a large communal house for the 40 days that they are undergoing treatment (Davies & Stephenson, 2013).

2.3.3 Environmental Considerations Sister Margaret Smith Addictions Treatment Centre embraced the principles of sustainable design from the onset, particularly as it related to the mission of providing holistic care. It was understood early on that a healthy building environment can be an essential part of the healing process and that environmental stewardship equates to compassionate care for all. A fully integrated team approach using the defined standards of LEEDÂŽ was used (ArchDaily, 2011 A).

The project embodies five key sustainable design strategies which are; ample glazing to provide daylight and access to views, building footprint that respects the site ecology, water reduction through intelligent landscaping and selection of low-flow fixtures, energy reduction through the use of a high-performance envelope and advanced building technology, 35

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and communication of sustainable vision through integrated sustainable design meetings (Davies & Stephenson, 2013).

Figure 44 large round roof window, Sister Margaret Smith Addictions Treatment Center, retrieved from ArchDaily.com

The project‘s holistic sustainable intentions are most evident at the main hall of the building known as the Hall of Recovery which organizes the 36

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three main components of the program in a dignified, calm, welcoming and comforting setting. Three large round roof windows, providing streams of natural light, represent the Windows of Hope: one for each of the mind (therapy rooms), body (gymnasium) and soul (spiritual space).

Low-maintenance native seed mixes and sodding were chosen to reduce the need for irrigation and seasonal replanting. Through a series of bio swales and storm retention ponds, the site, whose pre-development imperviousness was less than 50%, was designed to not increase the rate and quantity of storm water and to remove 80% of annual postdevelopment total suspended solids and 40% of annual post-development total phosphorous from storm water (Davies & Stephenson, 2013).

Figure 45 Hall of Recovery, Sister Margaret Smith Addictions Treatment Center, retrieved from ArchDaily.com

Sister Margaret Smith employs double- and triple-glazed low-e windows within a superior building envelope to optimize energy performance. Wall assemblies and roof assemblies with high R-values were specified and occupancy and daylight sensors were incorporated. A high albedo roof, which complies with energy star requirements, reduces the heat island effect (Davies & Stephenson, 2013).

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Figure 46 Courtyard, Sister Margaret Smith Addictions Treatment Center, retrieved from ArchDaily.com

Creating a place of true healing meant that light and air were highly considered during the design process. The building was designed around two courtyards to allow light to penetrate to over 75% of regularly occupied spaces. In conjunction with a shallow floor plate and interior glazed partitions, this allows over 90% of regularly occupied spaces to have views to the outdoors (Davies & Stephenson, 2013).

Sister Margaret Smith Addictions Treatment Centre‘s philosophy of holistic care is to create a balance between mind, body and soul. It approaches the mind through learning programs and addiction treatment, the body through providing physical activities in its facilities, and the soul through providing spirituality. It also emphasizes the role of light and nature as therapeutic elements through its courtyards. The center embraces sustainable design as an integral part of healing through providing a healthy building environment.

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Figure 47 Activity courtyard, Sister Margaret Smith Addictions Treatment Center, retrieved from ArchDaily.com

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Figure 48 Corridor, Sister Margaret Smith Addictions Treatment Center, retrieved from ArchDaily.com

Figure 49 Color palette of Sister Margaret Smith Addictions Treatment Center, produced by the author.

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2.4 Vejle Psychiatric Hospital

Figure 50 Vejle Psychiatric Hospital, retrieved from Archdaily.com

Location: Nordbanen 5, 7100 Vejle, Denmark Date: 2017 Architect: Arkitema Architects Client: Region of South Denmark Total area: 17000.0 m2 Project background: The new psychiatric hospital opened in the Danish city of Vejle. Since the opening, the hospital has registered a 50 percent decrease in physical restraint and it is widely acknowledged for its healing architecture (ArchDaily, 2018).

Project significance and impact: In mid-June the hospital won the Mental Health Design category at the European Healthcare Design Awards 2018 in competition with mental health buildings from all over the world (ArchDaily, 2018).

Keywords: Psychiatry, Mental, Health, Activity, Sustainability

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Figure 51 Courtyard in Vejle Psychiatric Hospital, retrieved from Archdaily.com

The psychiatric hospital design focuses on the experience the patients live.

The design elements of the hospital aim to reduce stress and anxiety for both patients and employees, which is apparent through the decrease of the physical restraint of patients. In a drug addiction rehabilitation center, where violent and aggressive behavior is an anticipated occurrence, a design which elevates stress and prompts feelings of relaxation and comfort is crucial. The psychiatric hospital also highlights the importance of physical activity and access to nature as a part of the healing process.

This is done by ensuring natural light throughout the building, easy access to nature and outdoor spaces, transparent wards with easy overviews, and a well thought layout (ArchDaily, 2018).

2.4.1 Context / Site and surroundings The Hospital is placed at the bottom of a forest covered hillside. The layout of the hospital takes full advantage of the site by creating smaller square masonry building units that twist from another, which makes room for prolonging the surrounding nature into the spaces between the

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buildings. The building breaks down the scale to merge with the landscape and thereby match the surroundings and create opportunities for the patients to enjoy nature (ArchDaily, 2018). Surrounding the hospital are low height residential buildings, which makes the hospital easily accessible to the general public.

Figure 52 Satellite image of Vejle psychiatric hospital site, Source: Landsat / Copernicus

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Figure 53 Landscape of Vejle Psychiatric Hospital, retrieved from Archdaily.com

2.4.2 Program, spaces, and functions

Figure 54 The Foyer, Vejle Psychiatric Hospital, retrieved from Archdaily.com

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Figure 55 Vejle Psychiatric Hospital floor plans, retrieved from Archdaily.com

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The layout of Vejle psychiatric hospital creates a smooth transition between private and communal bubbles, from private patient‘s rooms to public areas with the foyer, multi-purpose hall and training facilities. Inbetween various types of rooms give patients the freedom to withdraw in peace and quiet and observe everything else that is going on around them until they feel ready to join in (Troldtekt, 2017).

2.4.3 Environmental Considerations

Figure 56 Private patient's room, Vejle Psychiatric Hospital, retrieved from Archdaily.com

Focusing on the importance of light‘s healing capacity; the hospital is designed with special focus on both natural and artificial light. The hospital features glass panels and interior courtyards which bring ample daylight into the building. Withdrawn ceilings and interior glass help light reach further into the building. Moreover, color therapy is integrated throughout the building for calming recovery, sleep support, elimination of depression, and preservation of a natural circadian rhythm for staff and patients (ArchDaily, 2018).

46

PRECEDENT STUDIES

Figure 57 Sports hall, Vejle Psychiatric Hospital, retrieved from Archdaily.com

Figure 58 Color palette of Vejle psychiatric hospital, produced by the author

The Vejle psychiatric hospital is another case of disowning the image of stigmatizing institutionalized healthcare architecture. The design creates inviting homelike environments for patients and staff, from its use of materials to the generous use of colors. The hospital stresses the importance of physical activities through its sports and gym halls, and the importance of nature through its layout and multiple courtyards, which also invites ample daylight inside the building. The layout of the hospital eases the navigation of patients and staff alike, making it easier for patients to get used to circulating around the hospital on their own. The design provides privacy and autonomy to patients by 47

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

providing multiple areas with gradual exposure to the other community, giving each patient the freedom to engage with others accordingly. Moreover, the hospital is placed in the heart of the city, this helps destigmatize the hospital and its users and also welcome the community by being easily accessible, thus easing the reintegration process of the patients with the rest of the community.

Figure 59 Dining hall, Vejle Psychiatric Hospital, retrieved from Archdaily.com

Figure 60 Corridor, Vejle Psychiatric Hospital, retrieved from Archdaily.com 48

PRECEDENT STUDIES

2.5. Summary & Conclusion Table 1 Comparative table of the cases studied Precedent Case

Rehabilitation

Storstrøm

Sister Margaret

Vejle

Centre Groot

Prison

Smith Addictions

Psychiatric

Treatment Centre

Hospital

Klimmendaal Year

2011

2017

2009

2017

Architect

Koen van

CF MĂśller

Kuch Stephenson

Arkitema

Gibson Malo

Architects

Velsen

Architects Country

The

Denmark

Canada

Denmark

Mental health

Prison and

Addiction

Mental

rehabilitation

Probation

rehabilitation

health

Area

14000 m2

32000 m2

4830 m2

17000 m2

Location

City outskirts

Far from

Close to city center

Close to city

Netherlands Function

treatment

the city

center

Levels

6

2

2

2

Horizontal

Circular

Radial

Circular

Circular

60 inpatients

250

40 inpatients

90

circulation Accommodation capacity Approx. m2 per

inmates

inpatients

233 m2

128 m2

120 m2

188 m2

20%

25%

15%

15%

6%

5%

9%

2%

resident Approx.

Accommodation% Approx. activity facilities% Exterior color palette

Interior color palette

49

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

Precedent Case

Rehabilitation

Storstrøm

Sister Margaret

Vejle

Centre Groot

Prison

Smith Addictions

Psychiatric

Treatment Centre

Hospital

Normal /

Men / Women /

None

Maximum

Adolescents

Klimmendaal Residential

None

segregation

security Patients per Unit

__

7

15 / 10

15

Single bedrooms

✓

✓

✓

✓

Living rooms

✓

✓

✓

✓

Courtyard

✓

✓

✓

✓

Gym/Fitness

✓

✓

✓

✓

Library/ Education

✗

✓

✓

✗

Workshops

✗

✓

✗

✗

Restaurant/Cafe

✓

✗

✗

✓

Swimming pool

✓

✗

✗

✗

Theatre

✓

✗

✗

✗

Clinic

✓

✓

✗

✓

Prayer rooms

✗

✓

✓

✗

The study of the previous precedent cases gave superb examples of healing architecture. Though some of them didn‘t directly reflect the function of the research project, they gave crucial lessons in terms of the role of design in relation to mental health. Those are some implementations from the precedent studies on the design of the reintegration and rehabilitation center for drug and alcohol addicts: a. Minimizing the institutionalized appearance of the building to destigmatize its users. b. Featuring recreational facilities accessible to the community to reintegrate the patients. c. Featuring workshops and classroom to help patients in their reintegration process. d. Integrating natural daylight through design. e. Implementing spirituality as part of the healing process.

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PRECEDENT STUDIES

Using colors, natural elements, and art to reduce the patients‘ distress. g. Accommodating the patients in private rooms to reduce their distress and respect their privacy. h. Dividing patients rooms into smaller units to reduce incidents of violence. i. Positioning staff stations in a way to maximize surveillance. j. Minimizing sharp corners to reduce risk of self-harm. k. Using durable and easily maintained materials. f.

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S I T E

A N A L Y S I S

The site of the project should follow the following criteria; it should be accessible to the community by various means, it should follow the zoning regulations set by Abu Dhabi‘s municipality, it should be located near areas with mixed uses, and it should be located in an area where users can enjoy environmental and natural elements.

3.1 Site Selection Criteria Based on the previous criteria, the selected site is near Al-Raha Beach and adjacent to Yas Island. According to Abu Dhabi Urban Planning Council‘s Land Use Frame work (2007) this area will be dedicated for health care institutions in 2030. The site is next to the intersection between Sheikh Khalifa bin Zayed Highway (Abu Dhabi – AlFalah Road) and Sheikh Zayed bin Sultan Street (Abu Dhabi – Al Shahama Road) making it fairly accessible to the community. In addition, it‘s located next to low-medium residential and mixed-used retail areas making the rehabilitation and reintegration center a part of a larger community. Perhaps the greatest advantage of this site is its location on the water channel between Yas Island and the main land, giving the user the opportunity to enjoy the

SITE ANALYSIS

waterfront which will further lessen the institutionalized atmosphere of the center.

Figure 61 Site Location. Retrieved from Plan Abu Dhabi 2030 by ADUPC and processed by the author.

The whole area is currently undeveloped with the adjacent shores of Yas Island occupied by labor camps and warehouses. The location is further narrowed to an area in front of a port in the water channel. The specific orientation of the plot is in an effort to maximize the view on the western half of Yas Island which hosts theme parks and multiple recreational destinations.

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ARCHITECTURE OF DRUG ADDICTION REHABILITATION

Figure 62 Site Location, Source: Landsat / Copernicus, and processed by author.

3.2 Topography & Natural Elements The site features a hill at a maximum elevation of 13 m at north to a minimum of 2 m at south. However, the southern half of the plot is relatively flat at an elevation of about 3 m above sea level, giving more favorable circumstances to locate the structure on the southern part of the plot.

54

SITE ANALYSIS

Figure 63 the plot featuring the hill, produced by the author.

Figure 64 North-South cross section of the plot, Source: Landsat / Copernicus, produced by author using Google Earth.

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ARCHITECTURE OF DRUG ADDICTION REHABILITATION

Figure 65 Satellite image of the plot with an overlay layer of contour lines produced by author. Source: Landsat / Copernicus

The site and the route leading to it are surrounded by unattended yet thick patches of trees and greenery organized in a pattern. Those trees are remnants of previous farms.

Figure 66 Route leading to the site, produced by the author.

3.3 Environmental Analysis The plot has an east-west longitudinal axis. Since the average wind direction in the UAE is from Northwest with an average speed of 38 Km/h

56

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the main axis of the plot receives direct wind most of the year (WindFinder, 2018).

Figure 67 Wind direction distribution in the UAE, retrieved from WindFinder.com

Figure 68 Sun Path, produced by author

3.4 Zoning & Plot Regulations The site doesn‘t have any natural elements that could provide shades.

However, according to maximum height regulations by ADUPC (2007) the health care area with its neighboring residential area at the west has maximum height of 20 m which gives the plot the possibility of receiving some shade from its neighbors.

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Figure 69 Maximum building heights, retrieved from Plan Abu Dhabi 2030 by ADUPC.

Figure 70 Open public space, retrieved from Plan Abu Dhabi 2030 by ADUPC and processed by author.

In regard to open public spaces, the site as a part of the airport district will be accessible to a future desert public park to the north and to community and recreational open spaces in Yas Island to the west.

58

SITE ANALYSIS

3.5 Accessibility

Figure 71 Transportation framework: transit, retrieved from Plan Abu Dhabi 2030 by ADUPC and processed by author.

Figure 72 Transportation framework: roads, retrieved from Plan Abu Dhabi 2030 by ADUPC and processed by author.

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ARCHITECTURE OF DRUG ADDICTION REHABILITATION

Figure 73 Site plan showing the current access routes to the plot, processed by the author.

Currently the main access to the site is through Sheikh Zayed bin Sultan Street through Al-Bahia. However, there will be a Metro light Rail crossing near the site in the future (ADUPC, 2007). The future plans of the ADUPC will give the possibility to access the site with various transportation options such as public buses, metro, and cycling.

3.6 Architectural Language Since the whole area is currently empty its quiet difficult to predict how the architectural language of the future neighboring structures will be.

However, is quiet plausible that the residential area that will be located on the shores of Yas Island west of the site will be resembling similar 60

SITE ANALYSIS

residential projects, for example the residential buildings in Al-Bandar area.

Figure 74 Al-Bandar Marina, Al Raha, Abu Dhabi, retrieved from uaezoom.com

Al-Bandar is a luxurious residential and commercial area in Al Raha, Abu Dhabi. The architectural language of the area is a contemporary design of concrete structures with glass facades. The color template of the architecture is shades of blue and brown. Blue being the glass facades and brown being the stone cladded facades.

3.7 Conclusion The site presents many design challenges. First of all a hill takes around half of the plot. Second, the lack of development around it makes predicting its surrounding environment speculative. Third, the lack of the development of the transportation infrastructure, mainly the roads, makes it hard to assume that it will stay the same till the near future, and at last, its longitudinal axis directly faces the north-western wind of the UAE. However, the site offers many advantages. For example, its location near the intersection of the Sheikh Khalifa Highway and Sheikh Zayed Street makes it easily accessible, it has waterfront views from the west and south, it surrounded by naturally grown greenery, and its location on the channel

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ARCHITECTURE OF DRUG ADDICTION REHABILITATION

between the Yas Island and the mainland land creates multiple opportunities.

Figure 75 View of the water channel near the site, produced by the author.

Figure 76 Remnants of previous farms around the site, produced by the author.

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D A T A

C O L L E C T I O N

The complex design of the drug addiction rehabilitation center goes through many layers starting from the individual to the physical structure.

A solid understanding of the phenomenon of addiction and its psychological, biological, and social dimensions is essential in relating to drug addiction victims and creating a suitable environment to heal them.

To succeed in the design of the rehabilitation center, the architect should understand the mentality of drug addicts and try to walk in their shoes and get in touch with their circumstances, feelings, and agony. Moreover, the design of a drug addiction rehabilitation facility requires a deep understanding of the medical process of the treatment, and at last; the thorough study of rehabilitation centers as a building type and its architectural dissection of its functions, codes, standards, and regulations.

4.1 Background Drug abuse is when individuals use legal or illegal substances in ways they shouldn‘t. They might take more than the regular dose of pills or use someone else‘s prescription. They may abuse drugs to feel good, ease

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

stress, or avoid reality. But usually, they‘re able to change their unhealthy habits or stop using altogether (WebMD, 2018).

Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences. The initial decision to take drugs is voluntary for most people, but repeated drug use can lead to brain changes that challenge an addicted person‘s selfcontrol and interfere with their ability to resist intense urges to take drugs (NIDA, 2018 A).

4.1.1 Biology of addiction As individuals continue with addictive habits or substances, the brain adapts. It tries to re-establish a balance between the dopamine surges and normal levels of the substance in the brain. To do this, neurons begin to produce less dopamine or simply reduce the number of dopamine receptors.

The result is that the individual needs to continue to use drugs, or practice a particular behavior, to bring dopamine levels back to "normal."

Individuals may also need to take greater amounts of drugs to achieve a high; this is called tolerance (Sheikh, 2017).

Without dopamine creating feelings of pleasure in the brain, individuals also become more sensitive to negative emotions such as stress, anxiety or depression. Sometimes, people with addiction may even feel physically ill, which often compels them to use drugs again to relieve these symptoms of withdrawal.

Eventually, the desire for the drug becomes more important than the actual pleasure it provides. And because dopamine plays a key role in learning and memory, it hardwires the need for the addictive substance or experience into the brain, along with any environmental cues associated with it — people, places, things and situations associated with past use.

These memories become so entwined that even walking into a bar years 64

DATA COLLECTION

later, or talking to the same friends an individual had previously binged with, may then trigger an alcoholic's cravings (Sheikh, 2017).

Brain-imaging studies of people with addiction reveal other striking changes as well. For example, people with alcohol, cocaine or opioid-use disorders show a loss in neurons and impaired activity in their prefrontal cortex, this erodes their ability to make sound decisions and regulate their impulses.

Many people don't comprehend why or how other individuals wind up dependent on drugs. They may mistakenly think that drug users lack moral standards or self-control and that they could stop their drug consumption just by deciding to. Actually, drug addiction is a mind boggling malady, and quitting normally takes more than good intentions and a strong will.

Drugs change the brain structure in manners that make quitting hard, even for the individuals who want to. Luckily, scientists know more than ever about how drugs influence the brain and have discovered treatments that can enable individuals to recover from drug addiction and have productive lives (NIDA, 2018 A).

4.1.2 Causes of Addiction Some people are more susceptible to extreme neurobiological changes than others, and therefore more susceptible to addiction. Not everyone who tries a cigarette or gets morphine after a surgery becomes addicted to drugs.

Similarly, not everyone who gambles becomes addicted to gambling.

Many factors influence the development of addictions, from genetics, to poor social support networks, to the experience of trauma or other cooccurring mental illnesses.

Addiction is a bio-psychosocial disorder. It's a combination of genetics, neurobiology and how that interacts with psychological and social factors.

The speed each drug can get into the brain, and its power in activating 65

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

neural circuits, determines how addictive it will be. Some modes of use like injecting or snorting a drug make the drug's effects almost immediate.

Contemporary research in the neurobiology of addiction points to genetics as a major contributing factor to addiction vulnerability. It has been estimated that 40–60% of the vulnerability to developing an addiction is due to genetics (Goldman & Ducci, 2005). Additionally, genetics play a role on individual traits, which may put one at increased risk for experimentation with drugs, continued use of drugs, addictions, and potential for relapse. Some of these individual personality traits, such as impulsivity, reward-seeking, and response to stress, may lead to increased vulnerability to addiction (Kreek, et al., 2005).

A major environmental factor that increases vulnerability to developing addiction is availability of drugs. Additionally, other environmental factors come into play, such as socioeconomic status and poor familial relationships, and have been shown to be contributing factors in the initiation and continued use of drug abuse (Volkow & Li, 2005).

Neurobiology again plays a role in addiction vulnerability when in combination with environmental factors. The main risk of chronic stressors contributing to vulnerability is that they can put the brain in a compromised state. External stressors such as financial concerns and family problems can, after repeated exposure, affect the physiology of the brain (Sinha, 2017).

Previous research has examined the increased risk of substance use initiation during adolescence. Many factors have been identified as being associated with increased risk of substance use during this period of development

including

individual

differences,

biological,

and

environmental factors (Fergusson, et al., 2008). Rat studies provide

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DATA COLLECTION

behavioral evidence that adolescence is a period of increased vulnerability to drug-seeking behavior and onset addiction (Wong et al., 2013).

4.1.3 Drug Addiction Treatment Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs. The general intent is to enable the patient to confront substance dependence, if present, and cease substance abuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse. Treatment includes medication for depression or other disorders, counseling by experts, and sharing of experience with other addicts (Schaler, 1997).

Detoxification (Detox) is a process, to rid the body of a toxic substance.

Non-medical Detox refers to the fact that the body will rid itself of drugs (including alcohol). Medical Detox refers to a wide variety of detoxification techniques used by the medical professional. These techniques range from simple observation by professionals while an individual rids itself naturally to medical intervention. This may include tranquilizers or other drugs that reduce the symptoms caused by the withdrawal from the addictive drug. (Department of Veterans Affairs, 2008) Effective treatment addresses the multiple needs of the patient rather than treating addiction alone. In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction (NIDA, 2018 B). The National Institute on Drug Abuse (2018 B) recommends detoxification followed by both medication and behavioral therapy, followed by relapse prevention. Effective treatment must address medical and mental health services as well as follow-up options, such as community or family-based recovery support systems. Whatever the

67

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

methodology; patient motivation is an important factor in treatment success.

Outpatient behavioral treatment includes a wide variety of programs for patients who visit a behavioral health counselor on a regular schedule.

Most of the programs involve individual or group drug counseling, or both.

These programs typically offer forms of behavioral therapy such as; cognitive-behavioral

therapy,

multidimensional

family

therapy,

motivational interviewing, and motivational incentives. Treatment is sometimes intensive at first, where patients attend multiple outpatient sessions each week. After completing intensive treatment, patients transition to regular outpatient treatment, which meets less often and for fewer hours per week to help sustain their recovery (NIDA, 2018 B).

Those who receive inpatient treatment typically struggle with cravings and should be monitored around the clock to prevent relapse. This is especially important for individuals who are dependent on a particular substance and can‘t go more than a few hours without it. While enrolled in this program, the nursing staff monitors clients 24/7. Inpatient residential rehab involves an extended time period for treatment, regardless of the substance.

Programs typically last 30–45 days, or longer, depending on each client‘s needs. Clients are required to stay at the facility for the entirety of the program, including overnight. Although there is no single treatment that‘s right for everyone, inpatient rehab is one of the most effective forms of care for drug and alcohol addiction (The Recovery Village, 2018).

Detoxification has been thought of as appropriate "treatment". When the patient relapses, as most do sooner or later, the treatment is regarded as a failure. However, contrary to commonly held beliefs, addiction does not end when the drug is removed from the body (detoxification) or when the acute post drug taking illness dissipates (withdrawal). Rather, the underlying addictive disorder persists, and this persistence produces a 68

DATA COLLECTION

tendency to relapse to active drug-taking. Thus, although detoxification can be successful in cleansing the person of drugs and withdrawal symptoms, detoxification does not address the underlying disorder, and thus is not adequate treatment (O‘Brien & McLellan, 1996).

Addictive disorders should be considered in the category with other disorders that require long-term or life-long treatment. Treatment of addiction is about as successful as treatment of disorders such as hypertension, diabetes, and asthma, and it is clearly cost-effective. As with treatments for these other chronic medical conditions, there is no cure for addiction. At the same time, there are a range of pharmacological and behavioral treatments that are effective in reducing drug use, improving patient function, reducing crime and legal system costs, and preventing the development of other expensive medical disorders (O‘Brien & McLellan, 1996).

4.1.4 Connection as Treatment Many studies suggest strong link between social connection of the individual and their susceptibility to drug addiction. They propose that it is possible that some people are more prone to addiction because they obtain less pleasure through natural routes such as from family, work, friendships and romantic relationships which could explain why they are more thrillseeking, or ―stimulus hungry‖ (Davis & Loxton, 2013).

For example, a study to determine the effect of housing conditions on morphine self-administration, rats isolated in standard laboratory cages and rats living socially in a large open box were given the choice of morphine in solution and water. Results showed that the isolated rats drank significantly more morphine solution than the social rats (Alexander, et al., 1978).

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Another example which supports the social connection factor is the case of Vietnam War veterans. 35% of service members in Vietnam had tried heroin and as many as 20% were addicted. However, in a finding that completely overthrew the accepted beliefs about addiction, researchers found that when soldiers who had been heroin users returned home, only 5% of them became re-addicted within a year, and just 12% relapsed within three years. In other words, approximately nine out of ten soldiers who used heroin in Vietnam eliminated their addiction nearly overnight (Robins, 1993).

A research studying social factors of initial use of illicit drugs suggests that disruption of normal child-parent relationships, lack of involvement in organized groups, and few effective peer relationships may have been predisposing factors in some individuals initiating use of illicit drugs.

Research also suggests that socialization to nontraditional norms, parental modeling of licit and illicit drug use, involvement with drug-using peers, and positive experiences with drugs may have been important factors in initial use for other individuals (Gorsuch & Butler, 1976).

4.1.5 Stigma .A stigma is an attribute, behavior, or reputation which is socially discrediting in a particular way: it causes an individual to be mentally classified by others in an undesirable, rejected stereotype rather than in an accepted, normal one. Stigma is a complex phenomenon that affects not only the stigmatized person but also those who associate with him or her.

Stigma is a special kind of gap between virtual social identity and actual social identity (Goffman, 1963).

Campbell and Deacon (2006) describe three forms of Stigma. Overt or external deformities such as; leprosy, clubfoot, cleft lip or palate and muscular dystrophy. Known deviations in personal traits like being

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DATA COLLECTION

perceived rightly or wrongly, as weak willed, domineering or having unnatural passions, treacherous or rigid beliefs, and being dishonest, for example, mental disorders, imprisonment, addiction, homosexuality, unemployment, suicidal attempts and radical political behavior. Tribal stigma like affiliation with a specific nationality, religion, or race that constitute a deviation from the normative, for instance, being African American, or being of Arab descent in the United States after the 9/11 attacks.

The stigmatized suffer from status loss and discrimination. Members of the labeled groups are subsequently disadvantaged in the most aspects of life chances including income, education, mental well-being, housing status, health, and medical treatment. Thus, stigmatization by the majorities, the powerful, or the "superior" leads to the bothering of the minorities, the powerless, and the "inferior" (Frosh, 2002).

Stigma is increasingly recognized to have a major impact on public health interventions. Occasionally, this impact is positive, but usually stigma and (fear of) discrimination lead to delay in presentation to the health services, prolonged risk of transmission, poor treatment adherence and increased risk of disability and drug resistance (Heijnders & Meij, 2006). Although there are effective mental health interventions available across the globe, many persons with mental illnesses do not seek out the help that they need.

Only 59.6% of individuals with a mental illness, including conditions such as depression, anxiety, schizophrenia, and bipolar disorder, reported receiving treatment in 2011 (Corrigan, et al., 2014).

Stigma is even harsher on people with drug addiction compared to those with mental illness. A study on a random sample of the US population found that people labeled with drug addiction are viewed as more blameworthy and dangerous compared to individuals labeled with mental

71

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

illness who, in turn, are viewed more harshly than those with physical disabilities (Corrigan, et al., 2009).

Addiction has largely been seen as a moral failing or character flaw, as opposed to an issue of public health (Barry, et al., 2014). Substance use has been found to be more stigmatized than smoking, obesity, and mental illness (Phillips & Shaw, 2013). Substance use related addictions are found to be more stigmatized than behavioral addictions such as gambling, sex, etc. (KonkolĂż Thege, et al., 2015). However, Stigma is reduced when Substance Use Disorders are portrayed as treatable conditions (McGinty, et al., 2015). Acceptance and Commitment Therapy has been used effectively to help people to reduce shame associated with cultural stigma around substance use treatment (Lee, et al., 2015).

Many strategies have been used to combat stigma at three levels.

Intrapersonal level; Interventions aim at changing characteristics of the individual such as knowledge, attitudes, behavior, self-concept, improving self-esteem, coping skills, empowerment, and economic support.

Individual counseling and cognitive behavioral therapy is often mentioned as an important strategy to decrease stigma (Corrigan & Calabrese, 2005) (Heijnders & Meij, 2006).

Interpersonal level, strategies include awareness and educational campaigns, and Community Based Rehabilitation which is a strategy within community development for the rehabilitation, equalization of opportunities and social integration of the people concerned (WHO, 2002).

The organizational and institutional level; Interventions at this level aim at organizational change to modify health and stigma related aspects of an organization. This can be achieved through training programs, which increase knowledge of the disease and other health issues and of the impact of stigma on the lives of individuals. Another strategy is the

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DATA COLLECTION

development of new policies within the organization, like offering voluntary counseling and testing services to HIV-positive employees (Heijnders & Meij, 2006).

4.2 Drug Addiction Rehabilitation Centers Drug and alcohol addiction rehabilitation centers are a subtype of mental health facilities dedicated to heal substance dependency. They are residential treatment facilities which offer 24-hour structured and intensive care, including safe housing and medical attention. They work to provide medical support of drug detoxification and prevention of relapse.

Residential treatment facilities may use a variety of therapeutic approaches, and they are generally aimed at helping the patient live a drug-free, crimefree lifestyle after treatment (NIDA, 2018 B). However, rehabilitation was more about the reassuring and supportive attitude of staff and the creation of connections with ordinary life to prevent isolation, than the provision of facilities (Shephed, 1991).

In the 1950s, the discovery of anti-psychotic drugs orientated mental health care towards the hospital setting. Yet, as the limitations of drug treatments became apparent, together with the need for long term care for chronic cases or relapse episodes, new questions were raised about institutionalization within the hospital environment. This trend of the ‗normalization theory‘ replaced hospitals by experimental residential facilities located in the community. Helping to reduce the stigma associated with mental illness, this concept dedicated that the mentally ill should have the same rights as able members of the community and be enabled to participate in the ordinary life of the community. This meant that architecturally, environments bearing the least possible resemblance to hospital settings, and located in the community, were considered the optimum setting for the care of the mentally ill (Chrysikou, 2014).

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Following the trend of normalization of mental health facilities, a study in 1996 documented that the degree to which a building is perceived as homelike or institutional affects the behavior of both staff and resident.

Residents of buildings perceived a more institutional were found to have significantly more stereotypical repetitive and significantly fewer independently generated behaviors. The reverse was found in the settings perceived by parents, staff, and residents to be more homelike. Which suggest that the environment to affect people's action both directly by creating expectations and actions and indirectly by affecting expectations of and actions toward others (Thompson, et al., 1996).

Even though mental health facilities should resemble homelike environment, they should address the issue of the diversity of its users‘ conditions and symptoms. Normal accommodation has different connotations from the environment found in a typical family home.

Moreover, service users could be divided into two groups: agitated and aggressive, and the depressed and withdrawn (Davis, et al., 1979).

Many new approaches were tested to fight stigma related to drug abusers through the architectural design. For example, in Copenhagen, drug consumption center H17 designed by PLH Arkitekter did not create signage and installed a concealed side entrance. However, this approach has confused some to the point that tourists sometimes mistake it for an art gallery (Sayer, 2017).

4.3 Functions & Design features for stress reduction The drug rehabilitation center should also address the issue of violence and safety within its environment. Drug addicts as mental illness inpatients can behave in aggressive and antisocial behaviors. Studies revealed that 32.4% of psychiatric inpatients engaged in aggressive behavior or violence, and 50% of all aggressive incidents in psychiatric units involve physical

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DATA COLLECTION

violence (Bowers, et al., 2011). This means that creating a comforting and stress relieving environment is essential in this case to reduce incidents of violence, and even self-harm and suicide.

The concept of therapeutic architecture does not suggest that the architecture by itself has the capacity to heal patients, but rather, architectural manipulation of structures and space can allow for other environmental factors such as sound, color, views, smell and light all of which contribute to a therapeutic environment to be prominent for healing purpose. For instance, drug patients who are suffering from mental stress and fatigue can feel better if they occupy spaces that have favorable colors, wide windows that allow them to view outside, and spaces that restrict noise that would be considered loud (Morgenthaler, 2015).

The physical and symbolic environment has a significant impact on the patients. There is a high correlation between life satisfaction and overall health. Satisfaction creates happiness conditions in people and resulting in the patient's interest to continue to be treated (Sapmaz, et al.,). On the contrary, some studies confirm that the traditional way in which some rehabilitation centers are designed contribute to increasing stress and pose a danger to the well-being of both patients and staff such as exceeding noise due to high population of patients and staff, small rooms especially for inpatient facilities, poor lighting, and small spaces (Seaward, 2011) (Edge, 2003) (Unwin, 2003).

Researchers studying how factors such as time passed admission can influence suicide rates reported that almost half of suicides take place within the first 3 days of admission. Their research suggests improvements to the ward environment to increase staff supervision and decrease patient distress especially during admission and the first days of hospitalization.

(Hunt, et al., 2013)

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It was also found that the design of a newer hospital with environmental features in the stress-reducing design bundle decreased the use of chemical (compulsory injections) and physical restraints substantially (21%) compared to the old hospital it replaced (Ulrich, et al., 2012).

4.3.1 Home-like characteristics Providing home-like characteristics is widely recommended as best practice design for psychiatric hospitals and long term care facilities. A study in a Norwegian psychiatric ward found that decorating a seclusion area in a home-like increased the satisfaction and reported well-being of patients, especially women (Vaaler et al., 2005).

Another study of a renovated club, hospital wing, and facility built for drug and alcohol treatment. Found that satisfaction declined with all three facilities progressively during the 4-week treatment period due to absence of familiar features such as posters, paints photographs, and collectibles.

The patients indicated they missed their beds, chairs, and pets from home.

Spaciousness, views to the outside, and privacy were the most positively received elements of the new space. Least-liked were lack of carpeting, color scheme, lack of comfort, and particularly the quality of the bed. Lack of recreational equipment was also mentioned as problematic (Potthoff, 1995).

Unfortunately, most facilities are denied of minimum amenities. Because of that addicts residing for long periods of time in these facilities are often in sleep or suffer from boredom, depression and fatigue (Mirzaei, et al., 2010).

4.3.2 Private Patient Rooms Providing single bedrooms may be the most important design intervention for reducing stress and thereby aggression in inpatient psychiatric wards.

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The number of persons sharing a bedroom, bathroom, or cell strongly correlates with higher crowding stress and lower privacy, perceived control, more disagreements with roommates, more illness complaints, and social withdrawal (Ulrich, et al., 2012). When it comes to infectious diseases, a study showed that single bed rooms and good air quality substantially reduce infection incidence and reduce mortality (McManus, et al., 1992).

Situations whereby, two patients are sharing the same room may be uncomfortable for some individuals depending on their personalities. It is also worth noting that drug addicts are susceptible to high stress levels and low moods (Seaward, 2011). Moreover, researchers comparing patient rooms ranging from singles to 12-bed dormitories, concluded that the higher the number of occupants per bedroom, the higher the percentage of isolated passive behaviors (Ittelson, et al., 1970).

A two-bed room forces a social intimacy that may be intimidating and detrimental to interaction. researchers and concluded that, activity type rather than mathematical density should dictate room size, private rooms will be used most frequently, the use of the room and interactive behaviors decreases as the number of beds per room increases, and that two-person rooms require more than double the space required for a one-person room (Wolfe, 1975).

Patients‘

rooms

should

be

well

equipped

to

receive

visitors.

Approximately half of all visits (49%) took place in the patient room. family members spent considerable time at their relative‘s bedside, most of them up to several hours a day. Family members, who saw themselves as ―close‖ to the patient, had the most positive effects on patients‘ mental status (Astedt-Kurki, et al., 1997).

4.3.3 Sports and recreational facilities

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Addiction treatment is a multidisciplinary process, therefore successful treatment about addiction requires paying attention to the architecture and design environment of addiction treatment centers on side the medical and psychological interventions.

Studies showed that providing high quality sports and leisure facilities such as; gym hall, swimming pools, living spaces, green spaces, etc. have high positive correlation with variables such as addicts‘ satisfaction, happiness, self-esteem and anxiety plus shorter treatment period (Hajlooa, et al., 2016) (Huisman, et al., 2012). Suitable environment is also a sign of respect to the addicts and to encourage them to quit drug addiction (Parvizi, et al., 2004).

4.3.4 Smaller Ward Patient Group Size Researchers suggest limiting the number of large shared spaces to reduce the chance of violence (Shepley & Pasha, 2013). A research on nonpsychiatric residential settings such as student dormitories and apartment buildings has found that smaller population sizes on floors, corridors, or units (approximately 12-18 persons at full occupancy) are associated with lower perceived crowding and more interpersonal contacts and helping behavior, than floors or units of comparable spatial density but large populations. (Baum & Davis, 1980) When spatial density is controlled for, students living on longer corridors with larger floor populations tend to report having fewer friends and acquaintances than those living on short corridors with smaller populations.

Also, smaller ward population sizes in psychiatric hospitals foster control and help prevent crowding stress by enabling patients to more easily regulate their personal spacing and relationships with others in shared spaces such as dayrooms and eating areas (Ulrich, et al., 2012) 4.3.5 Furniture arrangement 78

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Providing movable seating in dayrooms, lounges, and other shared spaces in psychiatric wards enhances the patient‘s capability to regulate personal space and interactions with others, achieve control, and reduce stress (Sommer, 1969). Seating patterns exerted a powerful control over the amount of social interaction among patients in a dayroom setting.

Arrangements with chairs positioned shoulder-to-shoulder along the dayroom walls strongly suppressed social interaction. By contrast, arranging chairs around small tables in the middle of the room increased interaction, especially among socially inclined patients (Holahan, 1972 ).

Through behavior observation, researchers investigated how the physical environment impacted social organization and behavior, whether there were variations in staff and patient use of space, and whether room designation or furniture arrangement impacted behavior. They found that, patients heavily used the dayroom and TV room in addition to the hallway adjacent to the nurses‘ station or window, patients frequently used areas with furniture, and that staff often sequestered themselves in the nurses‘ station or the adjacent hallway (Fairbanks, et al., 1977).

4.3.6 Daylight Exposure Designing buildings to provide higher exposure to natural light, compared to low exposure, reduces depression and fosters shorter inpatient stays for depressed patients. Assigning psychiatric patients with serious depression to rooms having higher daylight shortens stays compared to placing similar patients in rooms that receive less daylight or are always in shade (Ulrich, et al., 2012).

A study in 2017 found that patients exposed to an increased intensity of sunlight experienced less perceived stress, marginally less pain, took 22% less analgesic medication per hour, and had 21% less pain medication costs (Dhingra, 2017) . Another study found that patients had shorter

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hospital stays when staying in sunny rooms compared with dimly lit rooms (Beauchemin & Hays, 1996).

Patients treated in sunny rooms had an average stay of 16.6 days compared with 19.5 days for those in dim rooms. Moreover, there was significant difference between women and men. Mortality in both sexes was consistently higher in dim rooms (Beauchemin & Hays, 1998).

4.3.7 Nature views & accessibility Viewing nature fosters rapid reduction of stress. Physiological restoration from stress is evident, for instance, in reduced blood pressure and changes in cardiac activity. These and other beneficial physiological changes are accompanied by increased positive emotions and reduced levels of negatively-toned feelings such as anxiety and anger (Ulrich, 1991) (Ulrich, et al., 1991). Moreover, patients assigned to rooms with a window view of nature (trees), compared to matched patients with windows overlooking a brick wall, had better emotional well-being, endured fewer stress-related minor complications such as persistent headache, suffered less pain, and had shorter stays (Ulrich, 1984).

Studies in general hospitals indicates that patients and visitors who use gardens report reduced stress, improved emotional well-being, and higher satisfaction with care quality. Gardens in hospitals not only provide stressreducing nature views, but if well designed reduce stress through other established mechanisms. For example, a garden that is accessible to patients improves emotional well-being by increasing exposure to daylight, and promotes control and stress reduction by providing a calming and enticing getaway from familiar interior ward spaces. A garden designed with seating choices additionally provides patients with attractive places either to seek privacy or socialize (Ulrich, et al., 1999).

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Reducing noise levels lowers stress in non-psychiatric inpatients as evidenced, for example, by reduced blood pressure. Other research on nurses in non-psychiatric facilities has found that noise reducing design measures lower staff stress, annoyance, perceived work demands and pressure, and may help reduce burnout (Ulrich, et al., 2012). For healthcare facility design, consideration should be given to providing sound-absorbent ceilings and other measures that shorten RT and reduce noise propagation, thereby increasing speech discrimination among older patients and possibly older staff (Huisman, et al., 2012).

4.3.9 Art Art has been proven to have an impact on the reduction of stress in psychiatric patients. One group of researchers studied the relationship between art displays and patient anxiety in an acute-care psychiatric unit, found a significant positive correlation between presence of realistic art displays and anxiety reduction (Nanda, et al., 2010).

Other studies in general hospitals have consistently found that the great majority prefer and respond with positive emotions to representational nature art, but dislike abstract artwork and images displaying emotionally negative or challenging subject matter. Patients have positive feelings and reactions with respect to nature art and prints, but have negative reactions to ward artwork that was abstract or could be interpreted in multiple ways.

There were many incidents where psychiatric patients had physically attacked several ward artworks, all of which displayed abstract subject matter and styles (Ulrich, 1991). A study of elderly psychiatric patients found that placing a large realistic nature print in a ward lounge substantially reduced the number of injections given for aggressive behaviors (kicking, hitting, biting) and agitation (Nanda, et al., 2010).

4.3.10 Color as a Therapy

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From ancient times, color has always been believed to be influential on the human psyche. Many researchers have studied the impact of colors and their combinations on the people. Some claim that colors closely related on color wheel, shall be used together to create a feeling of harmony. Yellows, Oranges and Red-oranges, Blues and violets are some of the suitable combinations (Dhingra, 2017).

Complementary Colors are the ones on the opposite sides of the color wheel. These colors offer the greatest contrasts, so their effects are bold and dramatic- Violet and yellow, Blue and Orange, Red and Green.

Specific qualities have been linked to specific colors. For example, Violet, blue, and green stress reduction, pink‘s soothing effect, yellow‘s nervousness, orange increasing appetite and well-being, and red stimulating power (Dhingra, 2017).

Studies on various colors divulge that bright colors increase blood pressure, autonomic functions and pulse rate directing outward attention. In contrast, dark and softer colors create calm effect directing inward attention (Chrysikou, 2014). However, there were no significant findings to determine that anxiety levels, lengths of stay, or medication requests were dependent upon the color of the patient‘s room (Edge, 2003).

4.3.11 Smoking rooms Smoking bans may lead to challenges in psychiatric wards, more specifically because of higher prevalence of disruptive behavior as well as higher rates of smoking among psychiatric inpatients. (Lasser et al., 2000) Evidence is also available that assumes a direct link between assaultive behavior and smoking bans. Setting limits, such as denying off-site privileges or restrictions on cigarettes, were found to provoke aggression (Chou, et al., 2002).

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Researchers recommend the smoking room to be, embedded in a psychiatric unit, ventilated to the outside air, and only available to psychiatric inpatients for a maximum of one cigarette per hour (Crockford, Kerfoot, & Currie, 2009).

4.3.12 Dayrooms Dayrooms and common areas encourage social interaction and promote sense of community. Staff observation of the dayrooms should be facilitated and spaces used by patients should be close to the nursing station. A mix of seating arrangements that support social interaction should be located between different groups of patients. Smaller activity spaces including the dayroom create stronger sense of community (Shepley & Pasha, 2013).

4.3.13 Way-finding Studies in general hospitals of patients and visitors have found that difficult way finding elicits stress (Carpman & Grant, 1993). Therefore, design approaches that promote easy way finding in psychiatric hospitals may lessen stress (Ulrich, et al., 2008).

4.3.14 Safety & Staff Surveillance Staff visual access to patients is recommended at all times, especially individuals at risk of suicide, self-harm, or aggressive behavior. Physical objects and design features that can be exploited by aggressive or suicidal patients should be eliminated or safeguarded (Bowers, et al., 2012) Locating stations in front of day rooms and providing large observation windows encourage staff to leave stations more frequently and spend increased time with patients in day rooms (Gross, et al., 1998). Skillful design and siting of staff stations, in addition to enhancing observation of

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day rooms, also can enable good visibility of other ward locations found to be frequent sites of assaults, including corridors and dining rooms (Chou, et al., 2002).

Safety measures in landscaping recommend; trees are to be located away from the buildings to prevent access to building roofs, landscape or decorative rocks that can be thrown and injure staff or other patients should not be used, and outdoor furniture should be deliberately integrated with hard landscape; such that they cannot be tampered as well as cannot be moved to create barricades or stacked upon to allow climbing over into windows or onto buildings (Dhingra, 2017).

4.4 Space standards & Ergonomics Rehabilitation centers are types of specialized hospitals. The number of specialist hospitals is growing fast because of the increasing focus on individual types of treatment or medical fields: casualty, rehabilitation, allergies, orthopedics, gynecology, etc. Also included in this category are special clinics dealing with, for example, cancers, skin problems, lung conditions, psychiatric disorders, and the like. In turn, these feed residential rehabilitation centers, nursing homes, special schools and old people's homes (Neufert, et al., 2012).

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4.4.1 Human Ergonomics

Figure 77 Body measurements, Architect's Data

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Figure 78 Disabled Measurements, https://static.un.org

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4.4.2 Planning Orientation: The most suitable orientation for treatment and operating rooms is between northwest and north-east. For nursing

ward

facades,

south to south-east is favorable: morning

pleasant sun,

minimal

heat build-up, and little requirement shading,

for

mild

sun

in

the

evenings. East and west facing

rooms

comparatively

Figure 79 Staff zone organizational map, retrieved from architect's data

have deeper

sun penetration, though less winter sun. The orientation of wards in hospitals with a short average stay is not so important. Some specialist disciplines might require rooms on the north side so that patients are not subjected to direct sunlight (Neufert, et al., 2012).

Form: The form of a building is strongly influenced by the choice of access and circulation routes. It is therefore necessary to decide early on whether to choose a spine form with branching sections (individual departments), or whether circulation will be radially outwards from a central core (Neufert, et al., 2012).

The vertical arrangement within a hospital should be designed so that the functional areas - care, treatment, supply and disposal, access for bedridden

patients,

service

yard,

87

underground

garage,

stores,

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

administration, and medical services - can be connected and accessed most efficiently (Neufert, et al., 2012).

An effective arrangement would be as follows: Top floor: helipad, air-conditioning plant room, nursing school, laboratories.

2nd/3rd floor: wards 1st floor: surgical area, central sterilization, intensive care, maternity, children's hospital Ground floor: entrance, radiology, medical services, ambulance, entrance for bedridden patients, emergency ward, information, administration, cafeteria Basement: stores, physiotherapy, kitchen, heating and ventilation plant room, radio-therapy, and linear accelerator Sub-basement: underground garage, electricity supply (Neufert, et al., 2012).

Figure 80 Functional vertical organization, Architect's Data

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4.4.3 Structural grid The constructional grid must provide a precise guide as well as allowing for differentiation of areas for the main functions, support functions and vehicular traffic. A comparison of the individual operational areas and the rooms they require should result in a structural grid which is suitable for all functions. The various operations centers can be planned most appropriately with a column grid spacing of 7.20m or 7.80m. Smaller construction grids are problematic because large rooms (e.g. operating theatres) which must be free from internal columns are more difficult to accommodate (Neufert, et al., 2012).

4.4.4 Circulation Corridors: Corridors must be designed for the maximum expected circulation flow. Generally, access corridors must be at least 1.50m wide.

Corridors in which patients will be transported on trolleys should have a minimum effective width of 2.25m. The suspended ceiling in corridors may be installed up to 2.40 m. Windows for lighting and ventilation should not be further than 25m apart. The effective width of the corridors must not be constricted by projections, columns or other building elements.

Smoke doors must be installed in ward corridors in accordance with local regulations (Neufert, et al., 2012).

Doors: When designing doors the hygiene requirements should be considered. The surface coating must withstand the long-term action of cleaning agents and disinfectants, and they must be designed to prevent the transmission of sound, odors and draughts. Doors must meet the same standard of noise insulation as the walls surrounding them. A doubleskinned door leaf construction must meet a recommended minimum sound reduction requirement of 25dB. The clear height of doors depends on their type and function: normal doors 2.10-2.20m vehicle entrances, oversized

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doors 2.50m transport entrances 2.70-2.80m minimum height on approach roads 3.50m (Neufert, et al., 2012).

Stairs: For safety reasons stairs must be designed in such a way that if necessary they can accommodate all of the vertical circulation. The relevant

national

safety

and

building regulations will, of course, apply. Stairs must have handrails on both sides without projecting tips.

Winding

staircases

cannot

be

included as part of the regulatory staircase provision. The effective width of the stairs and landings in essential staircases must be a minimum of 1.50 m and should not exceed 2.50 m. Doors must not constrict the useful width of the landings and, in accordance with hospital regulations, doors to the staircases must open in the direction of escape. Step heights of 170 mm are permissible and the minimum required tread depth is 280 mm. It is better to have a rise/tread ratio of 150:300 mm (Neufert, et al., 2012).

Lifts:

Lifts

transport

Figure 81 Standards, Architect's Data

people,

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medicines, laundry, meals and hospital beds between floors, and for hygiene and aesthetic reasons separate lifts must be provided for some of these (Neufert, et al., 2012).

In buildings in which care, examination or treatment areas are accommodated on upper floors, at least two lifts suitable for transporting beds must be provided. The elevator cars of these lifts must be of a size that allows adequate room for a bed and two accompanying people; the internal surfaces must be smooth, washable and easy to disinfect; the floor must be non-slip. Lift shafts must be fire-resistant (Neufert, et al., 2012).

One multipurpose lift should be provided per 100 beds, with a minimum of two for smaller hospitals. In addition there should be a minimum of two smaller lifts for portable equipment, staff and visitors: clear dimensions of lift car: 0.90 x 1.20 m clear dimensions of shaft: 1.25 x 1.50 m 4.4.5 Clinic & Care areas Outpatient clinic: The location of outpatient treatment rooms is of particular importance. Separation of the routes taken by outpatient emergencies and inpatients should be given consideration early in the planning process. The number of patients concerned will depend or the overall size and technical facilities of the hospital. Where there are a consistently high number of outpatients a separate area can be created away from the other hospital operations (Neufert, et al., 2012).

Care of the mentally ill: The variable nature of mental illness results in a requirement for open and closed wards (for those in need of slight care and those who are seriously ill and possibly violent). The two types need to be accommodated when planning and setting up care units. Large areas are required for day-rooms, dining rooms and rooms for occupational and group therapy, because patients are not confined to bed. Small care units 91

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(up to 25 patients) should have short circulation routes and provide good observation points for nursing staff. A homely design should always be used to give patients a feeling of well-being.

Figure 82 Psychiatric ward, Architect's Data

Function and structure: The individual care areas in a hospital are attached to the specific medical faculties (e.g. surgery, medical, accident and emergency etc.,) and therefore need to be planned as separate units.

Essentially, they cater for pre- and post-operative patients who must stay in the hospital for observation and recovery. The patients' basic bodily functions are routinely tested on the wards but more extensive examination is carried out in separate treatment rooms. Each station must have at least one assistant doctor's room and two doctor's rooms in which minor examination and treatment can be carried out (Neufert, et al., 2012).

The hierarchical hospital structure, in both medical and nursing domains, must be reflected in the planning (e.g. separate rooms for station supervisors, assistant doctors, and senior doctors).

Layout of rooms: Medical rooms and washrooms should be accessed from the main station corridor which must be easily supervised from the

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glazed nurses' workstation to prevent unauthorized entry. The logistics of delivering patient care is an important factor in the cost-effectiveness of the department so it is desirable to plan the necessary supply and disposal rooms for medicines, linen, refuse, food etc. centrally in groups around the nurses' workstation (Neufert, et al., 2012).

Nursing teams: Each station (18-24 patients) is served by an independent nursing team which has full responsibility for patient care. As the nurses' workstation has to be constantly occupied, it is sensible to plan a direct connection to the nurses' kitchenette and rest room (Neufert, et al., 2012).

One-to-one nursing care is very much the exception nowadays and the rising costs of such provision mean that it is unlikely to be feasible in the future (Neufert, et al., 2012).

Figure 83 Nurses work area, Architect's Data

Patient rooms: The patients' beds must be accessible from three sides and this sets the limits for the overall room sizes. The smallest size for a onebed room is 10 m2; for a two- and three-bed room, a minimum of 8m2 per

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bed should be allowed. The room must be wide enough for a second bed to be wheeled out of the room without disturbing the first bed (minimum width 3.20 m). Next to each bed must be a night table and, where appropriate, towards the window there should be a table (900 x 900 mm) with chairs (one chair per patient).

The fitted cupboards (usually against the corridor wall) must be capable of being opened without moving the beds or night tables. In new buildings, the wet cells should be located towards the inside, off the station corridor, because future renovations will most likely make use of the external walls as the means of extending the existing areas (Neufert, et al., 2012).

Figure 84 Patient ward, Architect's data

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Figure 85 Patient rooms layout, Architect's Data

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Equipping the patient room: Around the walls there should be a strip made of plastic or wood (at least 400-700 mm above floor level); to protect the wall from damage caused by the movement of beds, night tables and trolleys. Similar strips should be included in the station corridors.

Figure 86 patient room equipment, Architect's Data

The patients' cupboards must be large enough to store all of the belongings they have with them. It is best to have a suitcase locker over the cupboard

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and a lockable valuables section within the cupboard itself.

A coin-

operated locking system is recommended because keys often get lost. A lockable staff cupboard for medicines should also be planned for. Hinges which allow doors to open through 135 degrees should be fitted to all cupboards (Neufert, et al., 2012).

The room doors must be 1260 x 2130 mm in size and a design which gives a noise reduction of at least 32dB should be considered. The closing mechanisms must be overhead and the door furniture should be designed to suit the needs of patients and staff carrying trays (Neufert, et al., 2012).

Whether each patient room is equipped with a shower often depends on the financing of the project. However, a wash-basin and WC are today standard in new buildings. Attention must be paid to the heights of the wash-basin and the WC: the wash-basin needs to be roughly 860 mm from the floor to allow wheelchairs underneath and the WC for wheelchair users should have a seat height of about 490 mm. Each station must also have additional WCs for staff, visitors and wheelchair users (Neufert, et al., 2012).

Consulting room: For future flexibility the size of a standard consulting room should be around 12 m². However, the absolute minimum recommended area is 8 m². The patient/client will be positioned between the practitioner and the door during consultation. Consideration may be given to altering the layout to position the practitioner between the patient/ client and the door for staff safety (Department of Health, 2013 A).

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Figure 87 Consulting room, HBN 00-03

Kitchenette: A mini kitchen is an open area for preparing snacks and beverages that may be added to another space within staff, patient or visitor areas. Limited amounts of dry goods and refrigerated items will be stored here (Department of Health, 2013).

Figure 88 Figure 85 Kitchenette space requirements, HBN 00-03

Non-clean workroom: Each care area station must have a workroom, approximately 10m2 in size, for handling soiled materials. The room will 98

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contain a sink and sluice, preferably in stainless steel, and fully tiled walls are recommended (Neufert, et al., 2012).

Nurses' work area: The nurses' workstation should be situated in a central position and requires a size of about 25-30 m2. The corridor wall must be glazed, but fireproofing is also a consideration so it is advisable to consult the fire officer and fireproofing specialists (Neufert, et al., 2012).

Station doctor: The station doctor must be provided with a 16-20 m2 room in which to examine patients. In addition to a desk, there should be ample shelving and an examination couch, on which the doctor can rest when on-call (Neufert, et al., 2012).

4.4.6 Staff & Administration

Figure 89 Staffing per inpatients, Architect's Data

Rooms for administration should be connected by corridor to the entrance hall and be close to the main circulation routes. A suitable route to the supplies area must also be planned.

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The following requirements are based on a one hundred-bed occupancy level. In the administrative area, 7-12 m2 per member of staff should be planned. Rooms for dealings with patients and relatives need to be connected to reception (entrance hall), admissions and accounts (25m2), the cash-desk (12 m2) and accounts (12 m2) (Neufert, et al., 2012).

Figure 90 Administration Area, HBN 00-03

Admin area: This area is suitable for full-time office-based staff. For sizing continuous use open plan administration areas (with six or more workstations) an allowance of 5 m² per workstation may be used.

For briefing purposes, open-plan offices with eight or more workstations may be sized at 6.6 m² per workstation. This allows for the following; space for the workstation, one interview room (4 places) for every 16 workstations, one quiet workspace for every 16 workstation, one breakout space for every 16 workstations, one photocopy/printing room, with multifunctional printer/copier and storage for paper/printing supplies, for every 32 workstations (Department of Health, 2013).

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Figure 91 Open plan office sizes table, HBN 00-03

Office: Single-person offices should only be provided where full-time access to workstations and constant privacy are required. Offices may be used for discussions and informal interviews as well as clinical administration tasks (Department of Health, 2013).

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Figure 92 Single-person office, HBN 00-03

Staff communication base: A staff communication base is a workstation, typically with a split-level counter, intended as a clinical management base within a clinical area. It should provide good observation of the clinical area served. Staff emergency call facilities should be provided at the desk.

Access to a safe room/space must be provided behind the base to ensure staff safety. Space around the base should ensure free movement of traffic when someone is standing in front of the base.

The recommended minimum working width for a member of staff at the base is 800 mm per person.

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A width of 1200 mm per person is generally only required for prolonged use but has been included in the examples for flexibility (Department of Health, 2013).

Figure 93 space requirements for staff communication base, from HBN 00-03

Pantry/refreshment room: This room is for preparing snacks and beverages. Limited amounts of dry goods and refrigerated items will be stored here. It may be located in staff, patient or visitor areas. Hand rinsing facilities must be provided wherever food is being prepared (Department of Health, 2013).

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Figure 94 Pantry, from HBN 00-03

4.4.7 General Areas Reception desk: A reception desk is similar to a staff communication base except that; it has particular emphasis should be placed on the design of the desk to encourage patients and visitors to approach the base, including children, additional consideration may be placed on providing privacy screens at the reception desk to assist with patient confidentiality. A reception desk should be located so that it commands a clear, unobstructed view of the entrance and waiting area and access routes to clinical areas.

The 1200 mm working width will be required as more prolonged use will be expected, as well as registering patients and making appointments.

Clinical administration work will also take place here. Public access to clinical areas will be controlled from the reception desk (Department of Health, 2013).

Waiting Area: Waiting areas should be close to the clinical or work area served and WC facilities. Main waiting areas should be adjacent to the main reception desk. Steps should be taken to ensure chairs cannot be used

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as potential weapons either by fixing chairs to the floor or to each other. 10% of waiting places to be suitable for people in wheelchairs; a children‘s play area based on 10% of the number of main waiting places and sized at 2 m² per child (with a minimum space for three children) (Department of Health, 2013).

Additional rooms needed include: an office for the administrative director (20m2), a secretarial room (10m2), an administrators' office (15 m2, possibly in the supply area), a nurses' office (20m2), a personnel office (25 m2) and central archives (40 m2, possibly in the basement with a link to the administration department via stairs).

According to requirements, the plan should also provide: duty rooms for matron and welfare workers, a doctors' staff room and consulting rooms, a messenger room, a medical records archive, specialist and patients' libraries, and a hairdresser's room (with two seats) (Neufert, et al., 2012).

Main entrance: General traffic goes only to the main entrance; for hygiene reasons (e.g. risk of infection), special entrances are to be shown separately. The entrance hall, on the basis of the open-door principle, should be designed as a waiting room for visitors. Today's layouts are more like that of a modern hotel foyer, having moved away from the typical hospital character.

The size of the hall depends on bed capacity and the expected number of visitors. Circulation routes for visitors, patients and staff are separated from the hall onwards. The reception and telephone switchboard (12m2) are formed using counters, allowing staff to supervise more effectively.

However, it must be possible to prevent public access from reception to inner areas and main staff circulation routes.

The entrance hall should also contain pay phones and a kiosk selling tobacco, sweets, flowers and writing materials. Short routes to outpatients, 105

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and the wards should be planned and these must be free of general traffic.

An examination room for first aid (15 m2), a washroom (15m2), an anteroom (10m2), standing room for at least two stretchers, and a laundry store should be included in an area where they are accessible directly beyond the entrance (Neufert, et al., 2012).

Archive and store rooms: A short route between archives and work areas is advantageous but generally difficult to provide. One possibility is to locate them in the basement and have a link by stairs. Distinctions should be made between store and archive rooms for files, documentation and film from administration (Neufert, et al., 2012).

Communal rooms: Dining rooms and cafeteria are best situated on the ground floor, or on the top floor to give a good view, must have a direct connection to the servery. The connection to the central kitchen is by goods lift, which is not accessible to visitors. Consider whether it is sensible to separate visitors, staff and patients. Nowadays, the dining areas are often run by external caterers and the self-service system has become generally accepted (Neufert, et al., 2012).

Prayer rooms: These should, preferably, occupy a central location, at the intersection of internal and external circulation routes, but outside the care, treatment and supply areas. This allows access for employees, visitors and inpatients. When planning rooms to cater for spiritual needs in hospitals, it is essential to consider space requirements for wheelchair users and those who are bedridden (Neufert, et al., 2012).

Pharmacy: In medium-size and large hospitals the pharmacy stocks prescriptions and carries out examinations under the management of an accredited pharmacist. In the design the following rooms are necessary: dispensary, materials room, drug store, laboratory and, possibly, an issue desk. If necessary, also include herb and dressing materials rooms,

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demijohn and acid cellar, and a room in which night duty personnel can sleep. The dispensary and laboratory should contain a prescription table, a work table, a packing table and a sink. The storage of inflammable liquids and acids, as well as various anesthetics, means appropriate safety measures are stipulated for the walls, ceilings and doors. The pharmacy must be close to lifts and the pneumatic tube dispatch system (Neufert, et al., 2012).

Figure 95 Pharmacy for medium sized hospital, Architect's Data

Clean supply room: This room is effectively a store for sterile supplies and consumables. Empty supplies trolleys and dressings/instruments trolleys will be held here and restocked for distribution to wards and clinical areas. It is not for storing medicines. Where clean supply rooms are used and medicines storage/ preparation is required outside clinical rooms, each clean supply room should be supported by a series of medicine store/preparation rooms (Department of Health, 2013 A).

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Figure 96 Clean supply room, HBN 00-03

Central bed unit: From the point of view of hygiene and economy, every hospital should contain a bed unit, in which the appropriate staff strip down, clean, disinfect and make up the beds. A complete bed change is required for new admissions, patients after 14 days as an inpatient, after operations and deliveries, as well as after serious soiling. The size of the bed unit depends on the number of nursing beds in the hospital: for about 500 inpatients a bed unit for 70 beds should be provided. The functional demarcation requires a clean and non-clean side, separated by the bed cleaning room, mattress disinfecting room and staff lobby. For carrying out repairs, a special workshop, approximately 35 m2, should be situated in the close vicinity, as should the laundry and store for clean bedding, mattresses etc. If machines are to be used to clean the bed frames and mattresses, the specific requirements of the equipment must be taken into account at an early stage (e.g. demands for floor recesses, clear heights) (Neufert, et al., 2012).

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Figure 97 Central Bed unit, Architect's Data

Laundry provision: Figures for the amount of dirty dry washing generated per bed per day vary between 0.8 and 3.0kg. The following sequence of work is preferred in the laundry: receipt, sorting, weighing, washing, spinning, beating out, mangling or drying (tumble dryer), pressing (if possible high pressure steam connection), ironing, sewing, storage, issue. The laundry hall consists of a sorting and weighing area (15m2), laundry collection room under laundry chutes from the wards, wet working area (50m2), dry working area (60m2), detergent store (10m2), sewing room (10m2) and laundry store (15m2) (Neufert, et al., 2012).

Meal provision: Providing the patients with proper nutrition places high demands on food preparation since the required amounts of protein, fat, carbohydrates, vitamins, minerals, fiber and flavorings often vary. The dominant food provision systems are those which rationalize the individual phases of conventional food preparation (preparatory work, making up, transporting, distribution). Preparation of normal food and special diets takes place separately. After preparation and cooking the meals are put

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ARCHITECTURE OF DRUG ADDICTION REHABILITATION

together on the portioning line. The portioned trays are transported with the supply trolleys to the various stations for distribution. The same trolleys are used to transport the used crockery back to the central washing up and trolley cleaning unit. Staff catering consists of about 40% of the total catering demand. The staff dining room should be close to the central kitchen. A division into separate rooms for domestic staff, nurses, clerical staff and doctors could be considered in a large hospital but, again, for economic reasons, these rooms must be near to the main kitchen. For small and medium-size hospitals this type of division is not recommended (Neufert, et al., 2012).

4.4.8 Sports & Recreation Fitness room: For 40-45 users a room size of at least 200 m2 is needed.

Clear room height for all rooms should be 3.0 m. For an optimum doublerow arrangement of machines, the room should be at least 6m wide. To allow clear supervision of all training, the room length needs to be 15m or less. The minimum room size of 40 m2 is suitable for 12 users.

The lifting area should be no smaller than 4 x 4m and on a strong wooden base, with markings in chalk. The floor must not be sprung because weight-lifters require a solid footing. The largest diameter of weight plate is generally 450mm. The weight of plates for one-handed exercises range up to 15 kg; for two-handed exercises, the plates are up to 20 kg in weight (Neufert, et al., 2012).

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Figure 98 Fitness room plan, Architect's Data

Swimming pool:

Figure 99 Changing room layout, Architect's Data

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Figure 100 Swimming pool, Architect's Data

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4.4.9 Seminar Room A 32 m² group room furnished for use as a seminar room can accommodate 24 people including one wheelchair user, plus the practitioner at the front of the room. An overhead projector and, in larger seminar rooms, public address system may be provided. For sizing seminar rooms, the following allowances may be used; 4–5 m² for desk and equipment for practitioner at front of room; 1.2 m² per stacking chair; 4 m² per wheelchair space (Department of Health, 2013).

Figure 101 Seminar room, HBN 00-03

For optimum vision of the screen, rows of seats should be staggered; a maximum of five seats in the front row is recommended for an 1800 mm wide screen. The distance from the front row to the screen should be twice the width of the screen or a minimum of 3000 mm. in large rooms, the bottom of the screen may need to be raised (Department of Health, 2013).

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Figure 102 Space requirements for seminar activities, HBN 00-03

4.4.10 Restaurant Before any restaurant or inn is built, the organizational sequence should be carefully planned. It is essential to establish what meals will be offered, and at what quality and quantity. It is necessary to decide whether it will be a-la-carte with fixed or changing daily menus, plate or table service, self-service or a mixed system. Before deciding on the layout, it is 114

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important to know the anticipated numbers and type of clientele and the customer mix.

Figure 103 Restaurant space requirements, Architect's Data

The main room of a restaurant is the customers' dining room, and the facilities should correspond with the type of operation. A number of additional tables and chairs should be available for flexible table groupings.

A food bar may be installed for customers who are in a hurry. Large dining rooms can be divided into zones. The kitchen, storerooms, delivery points, toilets and other service areas should be grouped around the dining room, although toilets can be on another floor (Neufert, et al., 2012).

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Figure 104 Restaurant layout, Architect's Data

Figure 105 Restaurant's table arrangement, Architect's Data

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Figure 106 Kitchen space requirements, Architect's Data

About 10-15% of the kitchen area should be reserved for offices and staff rooms. Kitchen staff must be provided with changing rooms, a washroom and toilets. If more than ten staff are employed, rest and break rooms are required. Changing and social rooms should be close to the kitchen to avoid the staff having to cross unheated rooms or corridors. More than 6m2 should be provided for the changing room (Neufert, et al., 2012).

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4.5 Local and international design codes and regulations 4.5.1 UAE Fire and Safety Code Means of Egress: A continuous and unobstructed way of travel from any point in a building or structure to a public way consisting of three separate and distinct parts: The exit access, the exit and the exit discharge.

Means of Egress consists of vertical and horizontal travel which can be intervening room spaces, doorways, hallways, corridors, passageways, balconies, ramps, stairs, elevators, enclosures, lobbies, horizontal exits, courts and yards (Ministry of Interior, 2011).

Doors: Every door and door assembly shall be designed and constructed so that the way of egress travel is obvious and direct. Other features such as dĂŠcor and windows that have the potential to be mistaken for doors shall be made inaccessible to the occupants by barriers or railings.

Door openings in means of egress shall be not less than 915 mm in clear width. Where a pair of doors is provided, not less than one of the doors shall provide not less than 915 mm clear width opening. No door into a means of egress, when fully opened, shall project more than 180mm into the required width of an aisle, corridor, passageway, or landing (Ministry of Interior, 2011).

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Figure 107 Minimum clear width with permitted obstructions, UAE Fire and Safety Codes of Practice

Figure 108 Minimum required width, UAE Fire and Safety Codes of Practice

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Ramps: All ramps serving as required means of egress shall be of permanent fixed non-combustible construction. The ramp floor and landings shall be solid and without perforations. Ramps shall have landings located at the top, at the bottom, and at doors opening onto the ramp. Every landing shall have a width not less than the width of the ramp.

Where the ramp is not part of an accessible route, the ramp landings shall not be required to exceed 1220 mm in the direction of travel, provided that the ramp has a straight run. Any changes in travel direction shall be made only at landings. Ramps and intermediate landings shall continue with no decrease in width along the direction of egress travel (Ministry of Interior, 2011).

Figure 109 Ramp specifications, UAE Fire and Safety Codes of Practice

Stairs: Stairs, whether interior or exterior to a building, serve multiple functions, allowing normal occupant movement among floors of building, providing egress during emergencies and fires and facilitating rescue and fire control operations by Fire fighters.

The minimum width clear of all obstructions, except projections not more than 114 mm at or below handrail height on each side. The stair width requirement is based on accumulating the occupant load on each story the stair serves. The total cumulative occupant load assigned to a particular stair shall be that stair‘s share of the total occupant load. For downward 120

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egress travel, stair width shall be based on the total number of occupants from stories above the level where the width is measured. For upward egress travel, stair width shall be based on the total number of occupants from stories below the level where the width is measured.

Stairs shall have landings at door openings. Stairs and intermediate landings shall continue with no decrease in width along the direction of egress travel. Every landing shall have a dimension, measured in the direction of travel that is not less than the width of the stair. Landings shall not be required to exceed 1220 mm in the direction of travel, provided that the stair has a straight run. Stair treads and landings shall be solid, without perforations (Ministry of Interior, 2011).

Figure 110 Stair specifications, UAE Fire and Safety Codes of Practice

Figure 111 Headroom, UAE Fire and Safety Codes of Practice

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Exit Discharge or Discharge from exit is defined as providing building occupants with a safe path of travel from an exit to a public way. This path of travel might be inside or outside a building and can be achieved through an exit passageway.

The width of an exit passageway shall be adequate to accommodate the aggregate required capacity of all exits that discharge through it. Exits shall terminate directly, at a public way or at an exterior exit discharge.

Yards, courts, open spaces, or other portions of the exit discharge shall be of the required width, size and open to the sky above to provide all occupants with a safe access to a public way. An exit passageway can be extended from the exit staircase shaft to qualify as direct discharge (Ministry of Interior, 2011).

Figure 112 Extension of Exit Staircase to meet with travel distance requirements, UAE Fire and Safety Codes of Practice

The number of means of egress shall be sufficient to accommodate the occupant load and complying with the travel distance requirements. Where more than one exit is required from a building or portion thereof, such exits shall be remotely located from each other and shall be arranged and constructed to minimize the possibility that more than one has the potential to be blocked by any one fire or other emergency condition.

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Figure 113 Exit specifications, UAE Fire and Safety Codes of Practice

The minimum separation distance between two exits or exit access doors in a sprinklered building shall be not less than one-third the length of the maximum overall diagonal dimension of the building or area to be served.

This distance shall be half the diagonal for non-sprinklered buildings.

Where more than two exits or exit access doors are required, at least two of the required exits or exit access doors shall be arranged to comply with the minimum separation distance requirement. The balance of the exits or exit access doors shall be located so that, if one becomes blocked, the others shall be available (Ministry of Interior, 2011).

Figure 114 Measurement of diagonal distance of room or space, UAE Fire and Safety Codes of Practice

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Figure 115 Requirements for Arrangement of Means of Egress

4.5.2 International Building Code International Building Code (IBC) separates fire alarm requirements by what is referred to as a ―Use Group.‖ Manual fire alarm systems and an automatic fire detection system are required in Group I occupancies.

Manual stations in patient sleeping areas of Groups I-1 and I-2 can be eliminated if located at all nurse‘s stations or other constantly attended staff locations. A supervised, automatic smoke detection system is mandated for waiting areas open to corridors (ICC, 2012).

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Figure 116 Supervised occupancy codes and regulations section I, IBC

Figure 117 Supervised occupancy codes and regulations section II, IBC

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4.5.3 Estidama Estidama, which means ‗sustainability‘ in Arabic, is the initiative which will transform Abu Dhabi into a model of sustainable urbanization. The Pearl Rating System for Estidama aims to address the sustainability of a given development throughout its lifecycle from design through construction to operation. The Pearl Rating System provides design guidance and detailed requirements for rating a project‘s potential performance in relation to the four pillars of Estidama. The Pearl Rating System is organized into seven categories that are fundamental to more sustainable development. These form the heart of the Pearl Rating System; Integrated Development Process, Natural Systems, Livable Communities, Precious Water, Resourceful Energy, Stewarding Materials, and Innovating Practice (ADUPC, 2010).

Figure 118 Energy efficient building requirements, Estidama

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Figure 119 Onsite renewable energy requirements, Estidama

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Figure 120 Outdoor thermal comfort requirements, Estidama

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U S E R S

F E E D B A C K

An important part of an architectural design is getting feedback from its users, to learn how the different users have different objectives and desires in every case. However, in the case of this project it‘s difficult to directly interview or surveys the users (drug addicts), since the social stigma and prejudice creates an obstacle in finding and surveying the users of the drug addiction rehabilitation center. Instead, the survey conducted focuses on the community‘s attitudes towards rehabilitation centers. For instance, the survey explores how different demographics of the community are willing to use public facilities in the rehabilitation center and interact with its users.

5.1 Background and Objectives Social stigma surrounding rehabilitation center and psychiatric institutions in general could pose an obstacle in the success of the rehabilitation center, since one of its objectives is to help the inpatients reintegrate with the society. For this reason, a survey was conducted to get the feedback of the UAE community in order to understand how the community is willing to interact with the drug addiction rehabilitation center.

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

5.2 Methodology The survey under the title of UAE Community Attitudes towards Drug Addiction Rehabilitation Centers was conducted on 100 citizens and residents of the UAE. The Survey was created via Surveymonkey.com and taken through a link to reach out to the community. The survey questions and answers were written in both English and Arabic simultaneously in order to facilitate answering the survey for members of the society who aren‘t bilingual or fluent in English or Arabic. The survey link was distributed through different social media platforms, and answering it wasn‘t mandatory nor in exchange of any money or service.

The Survey consisted of 10 multiple choice questions, the first three of which are demographic questions focusing on nationality, age, and gender.

The other questions focused on the participants‘ attitudes and thoughts about addiction rehabilitation centers. For example one of the questions was ―What‘s your attitude towards living near a drug addiction rehabilitation center?‖ another question was ―Will you use the amenities provided by the rehabilitation center (Gym, Swimming pool, restaurant, etc.) if it was available to the public?‖ and ―Will you visit a relative or a friend receiving treatment at an addiction rehabilitation center?‖ The questions were carefully written in order to prevent any bias in the form of the questions. For example instead of asking ―Do you mind living near a rehabilitation center?‖ the question was reframed as ―What‘s your attitude...‖ which is more neutral than ―Do you mind?‖

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Figure 121 Survey respondents’ demographics: Nationality, SurveyMonkey.com

Figure 122 Survey respondents’ demographics: Age group, SurveyMonkey.com

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Figure 123 Survey SurveyMonkey.com

respondents’

demographics:

Gender,

5.3 Results According to the results, social stigma surrounding addiction rehabilitation centers aren‘t as bad it was presumed. In average, 14% of Respondents indicated that they have some level of stigma about addiction rehabilitation centers. For example, only 9% of the respondents said that they object to living near an addiction rehabilitation center, 23% said they won‘t use amenities provided by the rehabilitation center, 15% said that they won‘t visit a friend receiving treatment at the center, and 9% said they won‘t attend family therapy sessions for a relative. However, when asked why you think some drug addicts prefer receiving treatment abroad 57% said because fear for reputation, 14% because of legal consequences, and 11% said because of poor medical care in the country.

When searching for differences among different demographics it was noted that females were more likely to list fear for reputation as a leading cause to seeking treatment abroad at 76% and more likely to say they 132

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won‘t use amenities provided by the rehabilitation center at 29%. However, they were more likely to visit a friend receiving treatment at 78% compared to 68% of the average result, and more likely to attend family therapy session at 80% compared to 69% of the average result. From these observations we can interpret that females are more aware of the social stigma yet they are more likely to help a relative or a friend in spite of that.

Other than females there were no notable differences seen between the major demographic groups, however, since some categories such as others in nationality and +50 in age groups had few respondents, comparing their results to the average answers won‘t be accurate.

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Figure 124 Results for questions 4-10, Surveymonkey.com

5.4 Conclusion The results of the survey show that the community of the UAE is overall accepting of the drug addiction rehabilitation centers. Unlike what was predicted, the stigma surrounding the rehabilitation center is relatively mild, and the community is welling to use the facility and visit inpatients who are receiving treatment there.

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One of the limitations of the survey is that it doesn‘t represent all age groups and ethnicities since 91% are between 19-39 years old, and 95% of them are of Arab nationalities.

Moreover, the study fails to test self-stigma of the drug addicts themselves, since most of the respondents believe that fear for reputation is a major cause for seeking treatment abroad. This could hint that even if society isn‘t stigmatizing them, the addicts themselves could be under the effect of self-stigma which could prevent them from seeking treatment inside the country or at all.

Since other rehabilitation centers have been receiving welling inpatients it‘s safe to assume that the rehabilitation center will be receiving both in and outpatients and wouldn‘t be totally deserted. This survey also reassured that a huge chunk of the community is open to help drug addicts receiving

treatment

and

reintegrate

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them

within

the

society.

P R O G R A M M I N G The project objectives are to design a rehabilitation and reintegration center for drug and alcohol addicts which will be able to destigmatize, treat, and reintegrate drug abuse patients into the society. In addition, it aims to aid in the prevention of future addiction cases, and spread awareness in the community, especially among the youth. Through the use of architectural design, the project aims to create an environment which increases the satisfaction of patients with the treatment and reduces their stress. The design will address concerns regarding the satisfaction, safety, and functionality of the rehabilitation facility.

To fulfill the project objectives the center should have these main functions; Treatment area, Educational area, and publicly accessible sports and recreational area. These main functions require multiple supportive areas such as; inpatient accommodation, administrative area, nurses‘ area, utilities, storage, technical areas, etc. The functions and areas listed in the program are based on precedent studies and space standards sources such as Architect’s Data (Neufert, et al., 2012).

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

6.1 Design Brief

Drug Addiction Rehabilitation Center Space

Type

NSM

Number

Total

of Units

NSM

Comment

Entrance Reception

Open

9 m2

1

9 m2

Visible from the entrance

Waiting Area

Open

38 m2

1

38 m2

Separation between men and women

Children

Open

10 m2

1

10 m2

playing area

Adjacent to the waiting area

Cafe

Semi-open

100 m2

1

100 m2

Gift Shop

Semi-open

100 m2

1

100 m2

Pharmacy

Semi-open

220 m2

220 m2

Has exterior entrance

Rest room

Closed

15 m2

2

30 m2

Prayer room

Closed

30 m2

2

60 m2

Total + Circulation

567 + 20% = 680 m2

Clinic Consultation

Closed

12 m2

3

36 m2

Closed

12 m2

5

60 m2

Therapy room

Closed

12 m2

5

60 m2

Group therapy

Closed

27 m2

2

54 m2

Closed

18 m2

4

72 m2

room Treatment room

room Station Doctor room

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PROGRAMMING Examination

Closed

9 m2

2

18 m2

Closed

22 m2

1

22 m2

room Patient’s lounge

Next to senior doctor’s office, domestic environment

Staff

Semi-open

5 m2

1

5 m2

Semi-open

25 m2

1

25 m2

communication base Nurses workstation Station

Direct corridor surveillance

Closed

20 m2

1

20 m2

Closed

10 m2

1

10 m2

Closed

10 m2

1

10 m2

Plant room

Closed

8 m2

1

8 m2

Rest room

Closed

15 m2

2

30 m2

Storage

Closed

12 m2

1

12 m2

Pharmacy Clean workroom Non-clean workroom

Total + Circulation

442 + 30% = 580 m2

Inpatient accommodation Inpatient room

Dayroom

Closed

Semi-open

22 m2

90

40 m2

9

1980

Domestic

m2

environment

360 m2

Domestic environment

Kitchenette

Semi-open

15 m2

9

135 m2

Staff room

Closed

15 m2

18

270 m2

Doctor room

Closed

15 m2

9

135 m2

Nurses

Semi-open

20 m2

9

180 m2

workstation

Direct corridor surveillance

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Cleaning room

Closed

5 m2

9

45 m2

Storage

Closed

12 m2

9

108 m2

Rest room

Closed

15 m2

18

270 m2

Total + Circulation

3483 + 30% = 4530 m2

Administration & Staff area Director’s

Closed

20 m2

1

20 m2

Closed

10 m2

1

10 m2

Closed

15 m2

1

15 m2

Nurses’ office

Closed

20 m2

1

20 m2

Personnel’s

Closed

35 m2

1

35 m2

Meeting room

Closed

20 m2

2

40 m2

Security

Closed

11 m2

1

11 m2

Closed

40 m2

1

40 m2

office Secretarial office Administrator’s office

office

control center Archive room

Linked to work area

Printing room

Closed

6 m2

1

6 m2

Staff Lounge

Closed

25 m2

2

50 m2

Kitchenette

Semi-open

15 m2

1

15 m2

Locker room

Closed

16 m2

2

32 m2

Rest room

Closed

15 m2

2

30 m2

Prayer room

Closed

30 m2

2

60 m2

Equipment

Closed

12 m2

1

12 m2

room Total + Circulation

396 + 20% = 480 m2

Public Area Gym

Closed

250 m2

140

1

250 m2

PROGRAMMING Restaurant

Semi-open

150 m2

2

300 m2

Library

Semi-open

100 m2

1

100 m2

Salon

Closed

35 m2

1

35 m2

Sports Hall

Closed

200 m2

1

200 m2

Swimming pool

Closed

200 m2

1

200 m2

Supermarket

Semi-open

150 m2

1

150 m2

Prayer room

Closed

30 m2

2

60 m2

Rest room

Closed

15 m2

4

60 m2

Total + Circulation

1355 + 30% = 1760 m2

Educational Area Multi-purpose

Closed

60 m2

1

60 m2

Workshop

Closed

40 m2

3

120 m2

Classroom

Closed

50 m2

4

200 m2

Storage

Closed

15 m2

1

15 m2

Rest room

Closed

15 m2

2

30 m2

Hall

Total + Circulation

425 + 30% = 550 m2

Technical Area and Utilities BMS room

Closed

9 m2

1

9 m2

Ground floor

Central bed

Closed

350 m2

1

350 m2

Kitchen

Closed

330 m2

1

330 m2

Laundry

Closed

160 m2

1

160 m2

Storage

Closed

50 m2

1

50 m2

15 m2

1

15 m2

Ground floor

Closed

2 m2

5

10 m2

All floors

Service Lift

Closed

12 m2

3

36 m2

All floors

Mechanical

Closed

60 m2

1

60 m2

Basement

unit

Electrical Room Garbage room + chute

room

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Water pump

Closed

25 m2

1

25 m2

Basement

AC equipment

Closed

25 m2

1

25 m2

Basement

Generator

Closed

25 m2

1

25 m2

Ground floor,

room

has exterior door

Transformer

Closed

75 m2

1

75 m2

room

Ground floor, has exterior door

Telephone

Closed

4 m2

1

4 m2

Ground floor

Closed

50 m2

1

50 m2

Basement

room Water Tank Total + Circulation

1224 + 30% = 1590 m2

Basement Parking Parking

Closed

15 m2

140

2100 m2

Total + Circulation

2100 + 45% = 3050 m2

Total Area Total NSM

13220 m2

12% Structure

1590 m2

Total GSM

14810 m2

142

PROGRAMMING

Figure 125 Design Brief Chart

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ARCHITECTURE OF DRUG ADDICTION REHABILITATION

6.2 Bubble Diagram

Figure 126 Drug Addiction Rehabilitation Center bubble diagram, produced by the author

144

PROGRAMMING

6.3 Proximity Matrix

Figure 127 Drug Addiction Rehabilitation Center proximity matrix, produced by the author

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E S T I M A T E D

B U D G E T

According to Arabian Business (2017), the UAE Average cost for a single square meter is $1,726 which is equivalent to 6339 Emirati Dirhams for an average quality. The drug addiction rehabilitation center approximate gross area is 15000 m² (rounded to the nearest thousand). This means that the total construction cost is approximately 94,500,000 AED. However, this doesn‘t include earth-work and landscaping.

P R E L I M I N A R Y

D E S I G N

The design starts by dissecting the site and understanding the opportunities and challenges it offers. The site offers wonderful views, and by having a rough idea of the various entrances of the site, it creates an image of what the building foot print will look like. In addition, the site‘s shape and dimensions dictate the main circulation axis of the building. Moreover, with the help of the data collected the layering of functions and structure of the building become easier to determine.

The main objective of the project is providing an attractive environment for both the community and patients while offering privacy of the patients.

The concept revolves around creating smaller wards (3 wards per floor) and semi enclosed courtyards, both of which are essential in creating a comfortable atmosphere of the building. It also addresses an important element to keep in mind, which is providing ample light and views featuring natural elements to the inpatient. Crucial details which can reduce significant amounts of mental distress and amplify psychological well-being.

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

8.1 Site Response

Figure 128 Waterfront views and entrances of the site, produced by the author

Since the project aims to create an appealing and calming environment for its users, the design should take into consideration the views surrounding the site, mainly the water front views that it has from two directions; South, and West. Moreover, an important part of the preliminary design is to decide the access points of the site. In this project, 4 distinct entrances are considered; a clinic entrance, a public entrance, a staff entrance, and a supply. The entrances are located based on the projected layout of the functions. For example, public facilities are projected to be located at the

148

PRELIMINARY DESIGN

southern part of the site, mainly because it has the longest waterfront which will help attract the general population. On the other hand, the staff and supply entrances are located in the northern part of the site since it doesn‘t enjoy a waterfront. The clinic entrance is located on the eastern part of the site, since it‘s the quickest entrance to reach and to emphasize it since it‘s the main entrance where out and inpatients with their visitors access.

Figure 129 Main building and circulation axis, produced by the author

The orientation of the building will follow the main East-West orientation of the site. This orientation gives an advantage of having a large percentage of the façade facing north and south, which limits the amount of direct sunlight getting inside the building. The circulation within the building shall be as simple and easy to navigate as possible; to lower the patients‘ distress, and eases access to both the patients and staff.

Protruding from the main axis are sub axes creating semi-enclosed courtyards.

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8.2 Design Rationale

Figure 130 8 x 8 m structural grid of the project, produced by the author

According to Neufert, et al. (2012), a suitable structural grid for a health care building is of between 7.2 - 7.8 meters. Accordingly a structural grid of 8 meters between the centers of columns will be used for the project.

This span isn‘t too small and will not disrupt important functions, or too large that it will require unnecessary steel reinforcements.

Level

Functions

Fourth Floor

Inpatient accommodation

Third Floor

Inpatient accommodation

Second Floor

Inpatient accommodation

First Floor

Educational, Public Facilities, Administration

Ground Floor

Clinic, Administration, Public Facilities, Mechanical

Basement

Car parking, Mechanical Areas Figure 131 Vertical Functional layout of the program

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PRELIMINARY DESIGN

The maximum height limit of the plot is 20 meters which allows for 6 levels including the basement. The program is organized vertically between the levels. The ground and first floor will host the clinic, educational area, Public facilities, and administrative area. The top 3 levels are dedicated for the inpatient accommodation. This layering ensures that the inpatients have some privacy and control of their exposure to the general public. Basement parking was specifically chosen to allow most of the landscape to be used and enjoyed by the users, since exposure to nature is essential for the mental well-being of the rehabilitating patients. Finally, mechanical areas and utilities are spread-out among the floors but mostly concentrated in the basement and ground floor.

Figure 132 Building placement on the site, produced by the author

The built up area will cover approximately 20% of the plot‘s area. This low built to inbuilt ratio of the plot area is permissible outside the main land of Abu Dhabi. More importantly, the large inbuilt area creates the opportunity

to

host

outdoor

activities

institutionalized atmosphere of the facility.

151

which

will

reduce

the

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

The building will be placed approximately at the North of the plot near the center. The placement creates a buffer between different parts of the landscape. It‘s also placed at the center as compromise between the proximity of the various entrances and the opportunity to enjoy the views.

8.3 Graphics and Processing Drawings

Figure 133 Reorienting, conceptual sketch produced by the author

The idea behind the concept comes from the recommendation of the literature and practice studied to create small wards hosting between 6-12 inpatients. From this, three branches diverged from the main axis of the project. Each branch hosts one ward at a single level, which adds up to three separated wards per level. These wards are connected from the middle to allow flexibility of staff and supply movement and in cases of emergencies.

However, having the patients‘ wards perpendicular to the main access creates the problem of difficulty catching the waterfront views. Thus, the wards will be oriented to create 30° degrees with the main axis of the building; this will allow the patients rooms to capture and enjoy the views.

152

PRELIMINARY DESIGN

Figure 134 3D conceptual sketch, produced by the author

Figure 135 Preliminary Section, produced by the author

Figure 136 Ground floor preliminary plan, produced by the author

153

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

The functions are logically placed so that the main entrance is the closest to the street with the administration directly linked to the reception, and the clinic is connected to the waiting area of the entrance. The public amenities are located at the south western part of the plan to ensure its proximity to the sea and the views. On the hand the mechanical area and the clinic are located at the northern part of the plan since it doesn‘t provide any kind of view. The linear design of the plan ensures the penetration of ample light inside the building, which is a key element in stress relief and psychological well-being.

154

S U M M A R Y The issue of drug abuse and addiction has been reaping more lives each year in the UAE. The need for more drug addiction rehabilitation centers was expressed by the Federal National Council. This book follows the architectural design process of a Drug Addiction Rehabilitation Center in Abu Dhabi, the UAE. To answers the various questions haunting the design of the center; multiple methods were used, which are; precedent studies, site analysis, literature review, and a survey conducted on the UAE community.

The precedent cases studied were; Rehabilitation Centre Groot Klimmendaal, Storstrøm Prison, Sister Margaret Smith Addictions Treatment Center, and Vejle Psychiatric Hospital. Though some of them didn‘t directly reflect the function of the design project, they gave crucial lessons in terms of the role of design in relation to mental health. Some implementations from the precedent studies are; minimizing the institutionalized appearance of the building, featuring recreational facilities accessible to the community, featuring workshops and classrooms, integrating natural daylight through design, implementing spirituality as part of the healing process, using colors, natural elements, and art, accommodating the patients in private rooms, dividing patients rooms into smaller wards, and maximizing staff surveillance.

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

The chosen site is an undeveloped coastal area adjacent to the western shores of Yas Island. The ADUPC dedicated the area for health care with a maximum height limit of 20 meters. However, the site presents many design challenges. First of all a hill takes around half of the plot. Second, the lack of development around it makes predicting its surrounding environment speculative. Third, the lack of the development of the transportation infrastructure, mainly the roads, makes it hard to assume that it will stay the same till the near future, and at last, its longitudinal axis directly faces the north-western wind of the UAE. However, the site offers many advantages. For example, its location near the intersection of the Sheikh Khalifa Highway and Sheikh Zayed Street makes it easily accessible, it has waterfront views from the west and south, it surrounded by naturally grown greenery, and its location on the channel between the Yas Island and the mainland land creates multiple opportunities.

The literature review covered multiple aspects of the subject. It started by defining addiction, its causes, and treatment, and stressed the important role of social connection in the prevention of addiction and relapse. It also discusses the stigma surrounding the subject. After covering the background of the subject it starts digesting drug addiction rehabilitation center as type of building, its historical development, and many features and elements which contribute to its success in reducing the stress of its users, such as; homelike characteristics, private patient rooms, sports and recreational facilities, small patients‘ wards, furniture arrangement, daylight exposure, natural views, noise reduction, art, color, smoking rooms, dayrooms, easy circulation, and safety. The literature then goes further into ergonomics and space standards related to the buildings functions.

The survey under the title of UAE Community Attitudes towards Drug Addiction Rehabilitation Centers was conducted on 100 citizens and residents of the UAE.

The Survey consisted of 10 multiple choice

questions, the first three of which are demographic questions focusing on nationality, age, and gender. The other questions focused on the 156

SUMMARY

participants‘ attitudes and thoughts about addiction rehabilitation centers.

The results of the survey show that the community of the UAE is overall accepting of the drug addiction rehabilitation centers. Unlike what was predicted, the stigma surrounding the rehabilitation center is relatively mild, and the community is welling to use the facility and visit inpatients who are receiving treatment there. However, the study fails to test selfstigma of the drug addicts themselves, since most of the respondents believe that fear for reputation is a major cause for seeking treatment abroad. This could hint that the addicts themselves could be under the effect of self-stigma which could prevent them from seeking treatment inside the country or at all.

The program was created with the help of the literature review and the precedent studies. The program consisting of eight major parts which are; the entrance, clinic, inpatient accommodation, administration, educational area, utilities and technical area, public amenities, and the basement parking

is expected to be around 15,000 m², with an estimated

construction cost of approximately 94 million AED. Eventually, the design phase starts by focusing of the views offered by the site and its access points. Moreover, with the help of the data collected the layering of functions and structure of the building became easier to determine. The concept revolved around creating small wards (3 wards per floor) with semi enclosed courtyards. It also addresses an important element to keep in mind, which is providing ample light and views featuring natural elements to the inpatient. Crucial details which can reduce significant amounts of mental distress and amplify psychological well-being.

157

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A P P E N D I X UAE Community Attitudes towards Drug Addiction Rehabilitation Centers Survey 1. Nationality/ ‫الجٌس٘خ‬ o o o

GCC National/ ٖ‫خل٘ج‬ Arab National/ ٖ‫عشث‬ Other/ ٓ‫أخش‬

2. Age group/ ‫الفئخ العوشٗخ‬ o o o o o

15 - 18 19 - 29 30 - 39 40 - 49 50+

3. Sex/ ‫الٌْع‬ o o

Male/ ‫رمش‬ Female/ ٔ‫أًث‬

ARCHITECTURE OF DRUG ADDICTION REHABILITATION

4. Are you aware of any drug addiction rehabilitation centers in the UAE? / ‫ُل أًذ علٔ علن ثإٔ هي هشامز أعبدح رأُ٘ل هذهٌٖ الوخذساد فٖ دّلخ االهبساد ؟‬ o o

Yes/ ‫ًعن‬ No/ ‫ال‬

5. What’s your attitude towards living near a drug addiction rehabilitation center? / ‫هب ُْ هْقفل رجبٍ السني ثبلقشة هي هشمز إعبدح رأُ٘ل إدهبى‬ ‫الوخذساد ؟‬ o o o

I don’t mind/ ‫ال أهبًع‬ I object/ ‫أعزشض‬ Not sure/ ‫لسذ هزأمذ‬

6. Will you use the amenities provided by the rehabilitation center (Gym, Swimming pool, restaurant, etc.) if it was available to the public? / ، ‫ُل سزسزخذم ّسبئل الشادخ الزٖ ْٗفشُب هشمز إعبدح الزأُ٘ل (صبلخ ألعبة سٗبض٘خ‬ ‫ الخ) إرا مبًذ هزبدخ للعبهخ ؟‬، ‫ هطعن‬، ‫هسجخ‬ o o o

Yes/ ‫ًعن‬ No/ ‫ال‬ Maybe/ ‫هوني‬

7. Will you visit a relative or a friend receiving treatment at an addiction rehabilitation center? / ‫ُل سززّس قشٗت أّ صذٗق ٗزلقٔ العالج فٖ هشمز‬ ‫إعبدح رأُ٘ل الوذهٌ٘ي ؟‬ o o o

Yes/ ‫ًعن‬ No/ ‫ال‬ Maybe/ ‫هوني‬

8. If your relative is receiving treatment at the rehabilitation center, will you attend family therapy sessions? / ‫إرا مبى قشٗجل ٗزلقٔ العالج فٖ هشمز‬ ‫ ُل سزذضش جلسبد العالج العبئلٖ ؟‬، ‫إعبدح الزأُ٘ل‬ o o

Yes/ ‫ًعن‬ No/ ‫ال‬ 170

APPENDIX

o

Maybe/ ‫هوني‬

9. If you have a relative who suffers from drug addiction, will you suggest receiving treatment in the country? / ‫إرا مبى لذٗل قشٗت ٗعبًٖ هي‬ ‫إدهبى الوخذساد ُل سزقزشح علَ٘ رلقٖ العالج داخل الذّلخ؟‬ o o o

Yes/ ‫ًعن‬ No/ ‫ال‬ I don’t know/ ‫ال أعلن‬

10. What do you think is the reason why some drug addicts prefer receiving treatment abroad? / ‫ثشأٗل هب ُْ السجت الزٕ ٗذفع ثعض هذهٌٖ الوخذساد‬ ‫إلٔ رلقٖ العالج خبسج الذّلخ؟‬ o o o o o o o

Poor medical care in the country/ ‫سْء العٌبٗخ الطج٘خ فٖ الذّلخ‬ Fear for reputation/ ‫الخْف علٔ السوعخ‬ Legal Consequences/ ‫رجعبد قبًًْ٘خ‬ Lack of drug addiction rehabilitation centers/ ‫عذم رْفش هشامز إعبدح‬ ‫رأُ٘ل إدهبى الوخذساد فٖ الذّلخ‬ Breaching the patient’s confidentiality/ ‫اًزِبك سشٗخ الوشٗض‬ High prices of treatment/ ‫غالء أسعبس العالج‬ Other (please specify) ________________________________________________________________________

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