A brief moment of glory: the impact of the therapeutic community movement on the drug treatment systems in the UK

The introduction of concept-based therapeutic communities, based upon the model pioneered by Charles Dederich with the Synanon community in California, was a significant development in the evolution of drug treatment provision in the UK. For a short period in the 1970s, these communities enjoyed unparalleled influence in the development and direction of treatment approaches across the whole spectrum of services. This article considers the developments in psychiatry and social care that prepared the ground for that phenomenon. In addition, the article considers the subsequent demise in the importance of therapeutic communities to the direction of drug policy and the implications that this might have for future development of residential treatment services.     

An introduction to research on the social impact of the therapeutic community for addiction

An introduction to the issue of research on the social impact of the Therapeutic Community for Addiction (TC) is presented. The TC is argued to originate in 1957 in the California utopian community of Synanon, although earlier antecedents are recognised. The direct scientific influence on the development of Synanon is documented and traced to the discipline of sociology and the social research tradition. The breaking with the authoritarian style of Synanon is seen as a key process in the evolution of the TC. Social innovations created by the TC movement include interracial and interethnic living groups as well as the instilling of democracy in the relations of caring in the state institutions and the civil society. The issues of after-care and the re-entry phase of the TC client to society are seen as the point where the social impact of the TC can begin to be traced. The integration of the TC into larger treatment systems is discussed, both in its positive and negative consequences to the social movement. Historical research needs to be extended beyond familiar sources into the 'grey literature' of TCs and their umbrella organisations. Also, the need to go beyond research that provides an understanding of the past history of the TC is acknowledged. A call for present-oriented sociological research on the impact of the TC on the social networks of clients in re-entry and on socially excluded segments of society that would revitalise the movement is concluded.     

Social epidemiologic comparisons in a European cohort of substance-dependent therapeutic community clients: a case-oriented analysis

A case-oriented analytical approach compared the index national case of France with the typical European outcome, other European cases and American results on social epidemiological indicators. Modal distributions were found to be most similar between the French sample and the total European sample on most social network items in a European therapeutic community cohort ( n =723). The characteristics of the American and our sample were also found to be strikingly similar. Network size varies mainly with the number of substance-dependent contacts reported by the client. Southern European clients have been living with their parents while northern clients have been living alone. Spending most of the time with drug-using friends is not related to developing intimate relationships and a counterbalance to a situation of peer loneliness. The importance of looking at the function of social network relations in risk networks in harmonising European policy is emphasised.     

Determining socio-demographic predictors of treatment dropout: results in a therapeutic community

This article presents a study of a number of socio-demographic factors that predict treatment dropout from a residential substance use disorder programme in Spain ( Proyecto Hombre Therapeutic Community). A sample of 430 patients (173 who completed treatment and 257 who dropped out of treatment) was assessed at entry to the therapeutic community programme in order to collect information on socio-demographic characteristics of the participants. According to the results obtained, factors that predicted treatment dropout included younger age, male gender and previous treatment history in the Proyecto Hombre therapeutic community. Patients with these characteristics were at significantly greater risk of dropping out of treatment. The implications of these results for further research and clinical practice are commented upon.     

How do substance abusers and their significant others experience the re‐entry phase of therapeutic community treatment: a qualitative study1

Transition to re‐entry (aftercare) is a stressful event for therapeutic community residents. While several authors agree on the importance of social support during reintegration, few studies have focused on the experiences of re‐entry clients themselves and their significant others during this period. Using a case‐study design, the present study examines the re‐entry process of four TC‐residents and three of their social network members during a six‐month period, starting at the time of their transfer to the halfway house. Clients and their significant others have mixed feelings about the reintegration period, although both are mainly positive. Clients report difficulties in leaving behind the TC‐mentality and building up a stable social network; they are surprised about the frequent contacts with substance (ab)use in mainstream society. Significant others misjudge clients’ feelings about transition and relapse. Many significant others have a positive attitude towards the use of substances. The tendency in mainstream society to increasingly accept the use of substances intensifies clients’ need for early guidance in building up stable supportive networks. Significant others need well‐grounded information on the reintegration process and on relapse.     

Compulsory Income Management in the Northern Territory – evaluating its impact

Australia has been experimenting with constraining the ways in which welfare recipients can spend their income support payments, limiting their ability to access cash and purchase some products. The policy objectives include to reduce spending on alcohol, gambling, pornography and tobacco in favour of meeting ‘basic’ family needs, especially for children, to limit the scope for financial harassment, encourage pro‐social behaviours, and build financial capabilities. In the logic of the programs these outcomes are expected to be manifest at the individual, family and community levels. The policy has primarily impacted on Indigenous Australians as a result of its geographic targeting, although a recent report has recommended a more stringent version of the program be introduced universally to all welfare recipients other than the aged. The largest of these experiments is ‘New Income Management’ in the Northern Territory, which has had more than 35,000 participants since its introduction in 2010. This article reports on the key findings of the major independent evaluation of New Income Management commissioned by the Australian Government.     

Person‐centredness in the community care of older people: A literature‐based concept synthesis

‘Person‐centredness’ is a ubiquitous term, employed in modern care services to signify policies and practices that attend to the uniqueness of each individual user. Despite being highly regarded in older adult community care services, there is much ambiguity over its precise meaning. Existing reviews of person‐centredness and its attributes have tended to focus on the medico‐nursing literature, neglecting other interpretations, such as those relevant to community social care. A new literature‐based concept synthesis reported here identified 12 common attributes within the broad themes of ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’. The review also contrasts how these attributes are applied across different interpretations of person‐centredness. The article argues that not all attributes necessarily pull in the same direction, and that older adults may require them to be delivered in different ways than they are to younger people. Thus, a ‘one‐size‐fits‐all’ approach should be discouraged in community care. Key Practitioner Message: ? ‘Person‐centredness’ is open to multiple interpretations, causing difficulties for services trying to gauge performance and quality; ? Three themes are central to person‐centred services: ‘understanding the person’, ‘engagement in decision‐making’ and ‘promoting the care relationship’; ? A ‘one‐size‐fits‐all’ approach to applying person‐centredness is to be discouraged.     

Different problems – same treatment. Swedish juvenile offenders in community‐based rehabilitative programmes

Ginner Hau H, Smedler A‐C. Different problems – same treatment. Swedish juvenile offenders in community‐based rehabilitative programmes Int J Soc Welfare 2011: 20: 87–96 © 2009 The Author, Journal compilation © 2009 Blackwell Publishing Ltd and the International Journal of Social Welfare. Young delinquents may be regarded as children in need of rehabilitation or as offenders deserving of consequences proportional to the committed crime. The focus has increasingly been on the latter, while research shows that individual risk assessment is essential for effective rehabilitation. This study explored self‐reported history of antisocial behaviour among Swedish male offenders 15–17 years of age (n= 189) who were sentenced to participate in rehabilitative programmes conducted by local social services. Antisocial behaviour was extensive and, according to a principal component analysis, consisted of three dimensions: (i) adolescent delinquency; (ii) violence and theft; (iii) drug‐related crimes. Using cluster analysis, the participants were divided into four subgroups representing different levels and characteristics of delinquency, which explained 73 per cent of the variance in antisocial behaviour. The conclusion is that assignment to rehabilitative programmes appeared unrelated to subgroups, i.e. to risk level. Organisational obstacles to an evidence‐based practice are discussed.     

‘Sex is violence’: African‐American parents' perceptions of the link between exposure to community violence and youth sexual behaviours

In Chicago, African‐American youth experience disproportionately high rates of exposure to community violence. Growing evidence documents that such exposures are related to youth sexual behaviours. This qualitative study seeks to illuminate the various ways in which violence and sex are intertwined in the lives of African‐American youth. Analysing data from four focus groups (N = 54), major themes indicated that parents linked community violence with: (i) influencing youth sexual interests and opportunities for having sex; (ii) specific notions of youth sexual identities and social status; (iii) increased gang involvement and sexual initiations; and (iv) girls' grudges and their sexual concurrency with boys. These findings suggest that addressing these specific issues is important in parent‐centred and community‐grounded interventions aimed at reducing risky sexual behaviours among African‐American youth.     

Participatory research meets validated outcome measures: Tensions in the co‐production of social care evaluation

Funding for care service research is increasingly subject to the satisfaction of two requirements: public involvement and adoption of validated outcome tools. This study identifies competing paradigms within these requirements and reveals significant challenges faced by researchers who seek to satisfy them. The focus here is on a study co‐produced between academic researchers and people with experience of adult social care services. It examines to what extent research studies can conduct high‐quality public involvement and genuine co‐production of knowledge, whilst attempting to produce quantifiable outcome scores. Findings add to debate around how to incorporate diverse perspectives in research, which may draw on incommensurate accounts of validity and reliability. Findings also highlight constructive attempts by academic and co‐researchers to make the combination of approaches work in the field. These small scale acts of researcher agency indicate some scope to combine the two approaches in future research studies. However, conclusions foreground the importance of broader awareness of how tensions and power imbalances related to this combination of approaches play out in social policy research practice.