Suchergebnisse

This volume provides a comprehensive review of the essentials of the Therapeutic Community (TC) theory and its practical "whole person" approach to the treatment of substance abuse disorders and related problems. Part I outlines the perspective of the traditional views of the substance abuse disorder, the substance abuser, and the basic components of this approach. Part II explains the organizational structure of the TC, its work components, and the role of residents and staff. The chapters in Part III describe the essential activities of TC life that relate most directly to the reco

Therapeutic community (TC) studies are reviewed to assess the effects of legal referral on treatment retention and outcome. The main findings reveal little evidence for differential outcomes between legally referred and non-legally referred clients in TCs, although legal referrals to TCs remain longer in treatment than do "voluntary" clients. Thus, there is an indirect relationship between legal referral and outcome which is mediated through retention in treatment. Issues are discussed which have confounded interpretation of research on the efficacy of compulsory treatment, e.g., definitions, client perception of pressure, implementation of legal referral procedures and the complexity of the recovery process itself. It is hypothesized that legal pressure can have a limited but potent role in the recovery process for appropriately identified substance abusers.

The therapeutic community (TC) has become an established treatment approach serving thousands of substance abusers in community, institutional, and other settings. This article summarizes the research that contributed to the acceptance and growth of TCs and laid the groundwork for the establishment of TCs for substance abusers in correctional settings. The TC knowledge base has contributed to the revival of a rehabilitation philosophy in correctional policy, which is described in the second section. The reflections of the authors who have collaborated for about 40 years are provided at the end of the paper.

Passages is a day treatment model based on therapeutic community (TC) methods adapted for methadone maintained clients. The goal of the program is to reduce cocaine use and injection, other drug use, and high-risk sexual behavior. The Passages approach is grounded in a recovery-oriented perspective in which methadone is a prescribed medicine that can facilitate a self help, recovery process. Preliminary evaluation findings on over 500 research participants indicate greater differential improvement in drug-risk behavior and psychological status for the Passages clients who remained 6 months in the program compared to non-Passages clients. Though awaiting controlled studies, the present study demonstrated the feasibility of integrating methadone maintenance and TC-oriented day treatment in methadone clinics; and provided evidence for the effectiveness of the Passages program in reducing risk behavior and improving psychological functioning among seriously dysfunctional substance abusers.

This article examines the relationships among experiences of childhood abuse, psychiatric disorders, self-reported victimization, and violent behavior, with a focus on gender differences. Data were obtained from treatment entry and 5-year post-treatment interviews of 446 adolescent clients in therapeutic community (TC) drug treatment programs throughout the United States and Canada. Fifty-eight percent of the sample indicated that they engaged in serious violent behaviors (e.g., beatings, threatening or using weapons against other people, or violent crimes such as assaults, rapes, murders) in the 5 years following their separation from TC treatment. Multivariate logistic regression analyses revealed that victimization in the posttreatment period was the most significant factor associated with violent behavior, and pretreatment childhood abuse experiences and psychiatric disorders were not significantly related to the odds of violent behavior. There were significant gender differences in self-reported victimization and violent behavior. The findings suggest that violence in young adulthood for males is related to increasing involvement in violent lifestyles that include drug trafficking, while violence among females is associated with the social and psychological consequences of drug involvement and victimization. High rates of violent involvement and victimization among former adolescent clients suggests the utility of incorporating interventions such as safety-oriented strategies for females or interventions that address involvement in the drug use lifestyles (i.e., use and dealing) for both males and females into residential treatment to reduce the likelihood of future violence.

Psychosocial treatment research studies encounter obstacles to random assignment (RA). Used together, two procedures offer an alternative to the standard RA design. First, sequential assignment (SA) may create less opposition from administration, staff, and clients. SA operates on the principle that limited bed availability, a common treatment consideration in the field, determines assignment of clients to conditions. Second, treatment-as-usual (TAU) represents an alternative type of control condition. Some clients on the waiting list will, before a slot opens up and they enter an experimental condition, be absorbed into the existing treatment system, in which the amount and type of treatment they receive can vary widely. Substituting SA and TAU for the standard RA design may introduce methodological impurities including certain limited biases.