Core characteristics, treatment process and retention in therapeutic communities for addictions: a summary of four studies

Abstract

If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. AbstractPurpose -The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions. Design/methodology/approach -The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients' perceptions of the TC treatment process in relation to retention: a study on clients' first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients' perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits. Findings -The first study showed that Synanon's therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the second study suggest that while traditional TCs operate as concept-based TCs in Europe, modified TCs might differ in the extent to which they apply the core principles and elements of the TC approach. The third study provides evidence that suitability for treatment is a very important predictor for clients' first month perceptions of the community environment. The fourth study shows that with time in treatment clients develop more profound perceptions regarding the essence of TC treatment.Research limitations/implications -Finally, implications for clinical practice, general limitations and some concrete recommendations for future research are presented in this paper. Originality/value -The PhD summary study contributes to the existing literature on TC treatment.

Qualitative study of welcome houses: a recent initiative designed to improve retention in therapeutic communities

“…Since these individuals share a similar profile to those who are most likely to leave residential treatment services prematurely (Darke, Campbell & Popple, 2012;Goethals et al, 2015;Joe, Simpson & Broome, 1998;Keen et al, 2001;Meier, 2005;NICE, 2007;National Treatment Agency, 2012;Ravndal & Vaglum, 1994), it would seem that the WH initiative was appropriately catering for those least likely to complete treatment and therefore most in need of support.…”

“…Anecdotal evidence suggests that WHs have led to longer residential treatment stays and higher treatment completion rates (Vandevelde, 2014). However, there has been no empirical research exploring 'how' WHs might have achieved this (Goethals et al, 2015).…”

“…Created as a 'first' stage of treatment, WHs aim to provide new TC clients with a relatively 'gentle' introduction to life within the community; the expectation being that this will better prepare them for the demands of treatment and ultimately improve treatment retention (Goethals et al, 2012;Goethals et al, 2015;Vandevelde, 2014). The WH stage has similar assimilation objectives to the traditional TC 'induction' or 'orientation' stage (Condelli, 1994;De Leon, 2000;Goethals et al, 2012;Harrison et al, 2007); yet, unlike the induction stage, WH residents do not participate in all activities of the daily TC programme straightaway (De Leon, 2000).…”

“…Reasons for non-completion include clients' poor motivation, low expectations of treatment success, heavier substance use on treatment entry, limited attachment to the programme ideology, lack of identification with other residents or staff, as well as insufficient counselling (Darke, Campbell & Popple, 2012;Goethals et al, 2015;Joe, Simpson & Broome, 1998;Keen et al, 2001;Ravndal & Vaglum, 1994). In contrast, factors that have been associated with good TC retention include clients' social conformity, successful detoxification prior to treatment, previous episodes of successful treatment, being inducted into the TC, and the existence of strong therapeutic alliances between staff and residents (Darke, Campbell & Popple, 2012;Harrison et al, 2007;Keen et al, 2001;Lang & Belenko, 2000).…”

Iterative categorisation (IC) (part 2): interpreting qualitative data

“…In a later study of a new innovation in residential treatment, Tompkins et al . [41] explored how welcome houses [42], which provide a relatively gentle introduction to the structured, rule‐bound approach of therapeutic communities, affected treatment retention. The differentiating process, when applied to their descriptive analyses, suggested that welcome houses increased retention amongst people who had never been in residential treatment previously or who had complex needs.…”