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.     

Research in the concept‐based therapeutic community – its importance to European treatment research in the drug field1

The concept‐based therapeutic community (TC) has been more scrutinised than almost every treatment model in the drug field except for methadone maintenance treatment. Important reasons for emphasising research right from the beginning were financial and/or ideological. Because of strong, ideological reasons and because of extensive research, the American TC movement has had a great impact on the treatment field of drug abusers in Europe. However, independent of the TC movement, at the same time the European treatment field also initiated several important research projects. In particular the Scandinavian countries were active in process studies with a qualitative approach. For different reasons this research tradition in Scandinavia was never considered important in the international research society. In recent years this has changed, and there is now a consensus about the need for more process evaluation and phenomenological research to complement the large body of quantitative studies in the treatment field. Probably both American and European treatment research has contributed to the preservation of the best from the original TC models and a renunciation of the more destructive elements.     

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.     

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.     

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.     

Resilience for dropout students with depression in secondary schools in Hong Kong: parental attachment,hope and community integration

ABSTRACT

The objective of this qualitative research is to better understand school dropout students with depression in Hong Kong and how they overcome their adversities. Three girls and five boys participated in the study. The results showed that the Hong Kong cultural context was affected by school competition and the effect of mental health labelling. Jaspers’ phenomenology was utilised to understand the phenomenon of school dropout and depression. The findings illustrated the importance of secure parental attachment, substitute secure attachment, hope, supportive environment and community integration in helping dropout students with depression to overcome adversities. A resilience model for school dropouts with depression is proposed for improving professional practice in Hong Kong.     

Evaluation of therapeutic play: a challenge for research

There is increased pressure on practitioners offering therapy to troubled children to provide evidence of efficacy of their interventions. However, current research has not yet provided the necessary evidence. There are considerable difficulties creating a quantitative research design which excludes all relevant variables and produces unequivocal data. Quantitative research, which mainly takes the form of narrative case studies, provides ample anecdotal evidence, but there is, as yet, no comprehensive review of these data nor clear conclusions drawn. It is also necessary to consider the purpose of a narrative case study: few claim to be objective or provide a comparative analysis of a given intervention. None of the research currently available includes the opinions of experiences of children.     

社会组织化:构筑国家与社会良性关系的关键

构筑国家与社会的良性关系是现代社会民主发展的基本要求,也是构建社会主义和谐社会的内在要求。对发展中国家而言,构筑国家与社会的良性关系,问题往往不在于国家力量的不足,而在于社会自主力量的有限。规范组织和发展社会力量,提高社会组织化程度,增强社会自主性,提高社会自治能力,是我国构筑国家与社会良性关系、实现社会和谐的关键。     

The therapeutic alliance in context: Institutional factors that impact social work with families

The therapeutic alliance is among the factors associated with positive results in therapy and has been extensively studied in psychotherapy. However, it has received less attention in social work and family intervention. Considering that such intervention occurs mainly within the framework of institutions and public policies, this article aims to identify the contextual factors that facilitate or hinder the therapeutic alliance between family members and social workers within the child protection system, taking the Chilean protection system as a case study. This longitudinal study followed six professional–caregiver dyads for 11 months using various qualitative techniques. The facilitating factors included the strengths approach of the child protection agency, family participation, a friendly work environment, and external supervision from a senior social worker. Among the obstacles were the high numbers of cases per professional, the undervaluing of their work, excessive workloads, stigma towards the system, and the mandatory nature of services. Facilitating factors were linked to the initiatives of the protection agency, while limitations were related to the type of welfare system. Similar obstacles and facilitators were found at the international level regardless of the kind of child protection system. The study concludes with recommendations for decision-makers and social worker educators.     

Effects of a Therapeutic Community on Korean Substance Abusers in Prison

ABSTRACT. This study tested the effectiveness of a therapeutic community (TC) intervention on imprisoned Korean substance abusers. Volunteer participants from 2 Korean prisons were randomly assigned to either the experimental group (n = 24) with the TC intervention or a control group (n = 24) with optional supportive sessions. Pretest and posttest data were collected on measures of abstinence self-efficacy and problem-solving skills. Participants in the TC intervention showed significant increases in abstinence self-efficacy and problem-solving skills, whereas those in the control group did not. The differences in abstinence self-efficacy for the TC were found for 2 of 3 subscales: Problem-Solving Confidence and Approach-Avoidance Style but not Self-Control. Further study is needed to replicate these findings with larger Korean prison populations and to establish the relationship between these skill dimensions and subsequent drug use and criminal recidivism for this population. Nevertheless, the findings suggest potential benefits of using a TC intervention with imprisoned Korean substance abusers.     

Evaluating community care in Scotland: critical reflections on a study of policy implementation

The paper describes the reality of evaluating the implementation of the reforms in community care in Scotland in 1993. In doing so it reports a trajectory familiar to evaluative researchers: the presentation of problems at the design stage, and their imperfect solutions; the emergence of delays in implementation, causing modifications to plans and timetable; discoveries made during the research which affected the hopes invested in the original design, and the adoption of pragmatic solutions; the outcome of the research and its reception. The paper ends with some critical reflections on the study and on evaluative research in general. It is suggested that evaluative research occupies a middle ground which results in the inevitability of compromise, queries whether there is truly an audience for uncompromised evaluation, and argues for the continuation of dialogue after completion as a guard against the ephemerality to which evaluation is often prone.     

Improving social psychiatric treatment in residential programmes for emerging dependence groups in Europe: cross-border networking, methodological innovations and substantive discoveries

A mini-symposium series of papers presenting the results of the European Commission-supported Biomed II project is introduced. The project accomplished a cross-border scientific networking engaging 31 European residential treatment programmes. The results showed that scientific development is best served by a flexible bureaucratic approach. 'Old' science and the 'new' science ways of working were balanced. 'History' and 'social networks' are the key concepts signalling the project knowledge gains. A treatment sample (N=723) was extracted from a database of 1028 current European cases. Non-drug-specific characteristics are as important as drug-specific characteristics in distinguishing emerging dependence groups. The project networking created a process that increased the level of involvement of science and the service communities. To sustain the gains of the project, a reaching out of existing European treatment services to extended family and friendship networks with a history of dependence-related problems will be required.     

Coping Strategies and Relapse of Substance Abusers: A Case Study of the Therapeutic Community Program in Indonesia

The present study examined the ability of people with substance‐dependence problems to cope with stressful events and refrain from resuming alcohol drinking and the use of drugs. This study specifically examined the length of time that substance abusing‐residents spent in a state‐owned, residential‐based therapeutic community program at Lembang‐Bandung, West Java, Indonesia. A study sample of 68 residents completed a questionnaire with four sections. The results of this study showed no significant differences in the scores rating the coping behavior of the residents according to the length of stay in the program. This study also found no significant differences in the Coping Behavioral Inventory scores of the residents according to the level scores of total Coping Strategy Inventory. It is important for social workers to understand the relationship between the length of stay of residents and their ability to cope so that they can effectively engage in intervention work with individuals with substance‐dependence issues who participate in the therapeutic community.     

Defender, spokesperson, therapist: representing the true interest of the client in therapeutic law

The aim of this article is to analyse the role of the legal representative in therapeutic law, specifically in Swedish administrative court hearings relating to compulsory care. Data are collected from three types of cases where a health or social welfare authority argues that it is necessary to apply coercion to a citizen: the Care of Young Persons (Special Provisions) Act, the Care of Alcohol and Drug Abusers (Special Provisions) Act and the Compulsory Psychiatric Care Act. The data consist of audio-recordings from 39 hearings, supplemented by 28 interviews with participants in these hearings, and court documents. Three primary roles of the legal representatives are identified: defender, spokesperson and therapist. We show how the primary role of the attorney becomes that of the spokesperson, but also that the role of the therapist takes precedence over that of the defender.     

Community sidelined: The loss of community focus in differential response

Differential response (DR) first emerged as one component of a child welfare paradigm that emphasized the need to engage communities in supporting families and children. However, the role of community in differential response has received little attention in recent literature. We examine the intellectual history of these ideas, tracing changes in the framing of community engagement in relation to DR over time. We find that attention to community has been sidelined by an increasingly narrow definition of DR that focuses on the existence of an alternative approach to engaging with screened in families, rather than the building of community support networks. There is currently no clear and explicit theoretical framework connecting community engagement to DR. We find that the absence of such a framework has given rise to a series of conceptual debates about the definition and purpose of DR. The development of a literature that elucidates the topic of community engagement in DR may serve to resolve some of these debates.     

Noncompletion of Evidence-Based Parent Training: An Empirical Examination Among Families of Children in Foster Care

Child welfare have historically experienced high dropout rates. As evidence-based interventions (EBIs) spread to the child welfare field, treatment noncompletion could interfere with successful outcomes. Using a mixed methods approach, this study investigated the differences between completers and noncompleters, and reasons for treatment noncompletion of an EBI for families of children in foster care. The sample comprised 315 families randomized to receive Parent Management Training, Oregon Model (PMTO). Researchers examined clinicians' discharge notes to explore reasons for noncompletion. Using data collected from a battery of assessments, bivariate logistic regression compared completers and noncompleters on demographics, socioeconomic factors, children's social-emotional functioning, and parents' functioning. About one third of families were noncompleters. Single fathers and parents with lower socioeconomic status were more likely to drop out. By contrast, parents with lower functioning on child behavior and parenting trended toward higher completion rates. Formidable challenges were parental substance abuse and mental illness. Results suggest parent training may require tailoring for specific subgroups and pairing with strategies for enhancing early engagement and reducing treatment barriers. Future research is needed to include parents' views on noncompletion and to more closely examine the influence of specific factors, such as severity of parental mental illness and substance abuse.     

Socialization in the Context of Risk and Psychopathology: Maternal Emotion Socialization in Children of Incarcerated Mothers

Children of incarcerated mothers are at increased risk for psychological, social, and emotional maladaptation. This research investigates whether perceived maternal socialization of sadness and anger may moderate these outcomes in a sample of 154 children (53.9 percent boys, 61.7 percent Black, M age = 9.38, range: 6–12), their 118 mothers (64.1 percent Black), and 118 caregivers (74.8 percent female, 61.9 percent grandparents, 63.2 percent Black). Using mother, caregiver, and child report, seven maternal socialization strategies were assessed in their interaction with incarceration‐specific risk experiences predicting children's adjustment. For sadness socialization, the results indicated that among children reporting maternal emotion‐focused responses, incarceration‐specific risk predicted increases in psychological problems, depressive symptoms, increased emotional lability, and poorer emotion regulation. For children who perceived a problem‐focused response, incarceration‐specific risk did not predict outcomes. There were no significant interactions with incarceration‐specific risk and perceived maternal anger socialization strategies. These results indicate a critical need to examine how socialization processes may operate differently for children raised in atypical socializing contexts.