Projecte Vida: Andorra lacks relapse protocol and restricts access to addictions care

The association Projecte Vida published a technical analysis this week that criticises Andorra’s public addictions care circuit for lacking a documented protocol to manage relapses and for operational practices the group says amount to “systematic expulsions” from the Day Hospital for seven days after a relapse. The report is based on the Ministry of Health’s written responses to parliamentary questions and data from the 2024 National Health Survey (ENSA).

Projecte Vida notes the ministry’s written reply of 12 November 2025, signed by Health Minister Helena Mas, which states that relapses “form part of the usual patterns of evolution and the rehabilitation process.” The association argues that this acknowledgement has not been translated into an operational procedure. Without a written protocol, it warns, decisions about treatment after a relapse are left to local practice and risk arbitrariness at a time when patients may be most clinically vulnerable.

The report cites international guidance from UNODC and WHO that relapses should not trigger punitive measures but should prompt therapeutic adjustments, reinforced support and continuity of clinical follow‑up. Projecte Vida points out that addictive disorders are chronic and relapsing — commonly cited relapse rates range from 40% to 60% — and argues services should prioritise continuity of care rather than interruption.

The analysis also highlights deficiencies in the service’s registration system. Projecte Vida says the current database records as “first visits” any contact occurring after six months without active follow‑up, without distinguishing new cases from re‑engagements. The association contends this practice conceals dropouts, motives for return, real duration of care processes and treatment outcomes, undermining realistic evaluation of the care pathway.

Projecte Vida criticises the limited opening hours of the public addictions service — Monday to Friday, 08:30–16:30 — noting there is no evening, night or weekend coverage. It says this schedule excludes people with rigid or precarious working hours, such as cleaners, construction workers and staff in hospitality and retail, reducing accessibility for groups already at higher risk. Citing ENSA 2024, the report highlights higher levels of emotional distress (39.8%) and poor self‑perceived health (33.1%) among women working in those sectors, along with greater difficulties accessing specialists and more frequent renunciations of visits for scheduling or financial reasons.

The association also raises concerns about the absence of gender‑specific protocols in the public addictions circuit. It warns that women in socioeconomically vulnerable situations are both at greater risk and less able to comply with a rigid system, making them disproportionately affected by expulsions after relapse.

Projecte Vida expresses apprehension about the new National Plan for Addictive Behaviours (PNCD), announced in July 2025 but not yet deployed. The group says the planned participation model — allocating only two places among roughly twenty organisations — makes meaningful involvement unlikely. It also flags terminological confusion between substance dependences and behavioural addictions and notes that behavioural addictions have not been formally integrated into the plan.

In conclusion, Projecte Vida calls for a formal, written relapse‑management protocol; revisions to the registration system to distinguish re‑engagements from first‑time patients and to capture abandonments, reasons for return, care duration and outcomes; extended opening hours to improve access; gender‑sensitive protocols; and clearer, more inclusive participation mechanisms in the national plan. The association frames these measures as necessary to align practice with international standards and to avoid arbitrary responses in care.