Modified therapeutic community for co-occurring disorders: A summary of four studies

Abstract

This paper summarizes results from four research studies (N=902) that examined the effectiveness of the modified therapeutic community (MTC) for clients with co-occurring disorders (most with severe mental disorders). Significantly better outcomes for MTC were found across four E vs. C comparisons on 23.1% (12 of 52) of primary outcome measures of substance use, mental health, crime, HIV risk, employment and housing. Study limitations included the potential for selection bias, limited measurement of program fidelity and insufficient examination of the relationship between treatment dose and outcome. Future research should emphasize clinical trial replications, multiple outcome domains and further development of continuing care models. Given the need for researchbased approaches, the MTC warrants consideration when program and policy planners are designing programs for co-occurring disorders. KeywordsCo-occurring disorders; substance abuse; severe mental disorder; modified therapeutic community BackgroundThe modified therapeutic community (often abbreviated as "modified TC"; for consistency and the reader's convenience, "MTC" has been used throughout this paper) was developed in the early and mid-1990s as a treatment model and approach for those whose substance use Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript disorders co-occurred with mental disorders. The MTC approach described in this paper was based on the theoretical framework of the standard TC model, as documented in previous publications (e.g., De Leon, 2000), and adapted to treat individuals with co-occurring disorders (De Leon, 1993; Sacks, De Leon, Bernhard, & Sacks, 1997;Sacks, Sacks, & De Leon, 1999). The core principles and methods of the TC that are especially relevant to the treatment of co-occurring disorders include: providing a highly structured daily regimen; fostering personal responsibility and self-help in managing life difficulties; using peers as role models and guides with the peer community acting as the healing agent within a strategy of "community-as-method" (the community provides both the context for and mechanism of change); regarding change as a gradual, developmental process and moving clients through progressive treatment stages; stressing work and self-reliance through the development of vocational and independent living skills; and promoting prosocial values within healthy social networks to sustain recovery.Although most of the key elements, structure, and processes of the standard T...

Relación entre la comorbilidad psicopatológica y las variables de resultados en dependientes de cocaína tratados en comunidad terapéutica

“…Experiencias previas la avalan en cuanto a la eficacia en el tratamiento de estas personas y en cuanto a los beneficios coste-efectivos (De Leon et al, 2000;Sacks, McKendrik, Sacks, Banks y Harle, 2008b;Van Stelle y Moberg, 2004;Van Stelle et al, 2004). En este sentido, distintos señalan que las CTs adaptadas a personas con comorbilidad psicopatológicas deben partir de un modelo integral que se distinga de las CTs tradicionales en dos aspectos fundamentales: mayor flexibilidad y mayor intervención individualizada (De Leon, 1996;Sacks, Banks, McKendrick y Sacks, 2008a;Sacks et al, 2010). Además, Es importante que los datos de este estudio se interpreten y se extrapolen con la suficiente cautela.…”

Posttraumatic Stress Disorder, Health Problems, and Depression Among African American Women in Residential Substance Use Treatment

“…13 Literature suggests that racial minority women with SUDs are especially vulnerable to the effects of trauma due to more limited social and economic resources. [14][15][16] Childhood interpersonal and sexual trauma among racial minority women is high (51% and 49%, respectively). 17 Black women, in particular, may be more likely than white women to experience childhood maltreatment and domestic violence, and to develop PTSD symptoms following trauma exposure.…”

Comorbilidad psicopatológica en consumidores de cocaína en tratamiento ambulatorio

“…A la luz de los resultados, y de acuerdo con otros trabajos, nos parece esencial tratar a estos pacientes integradamente, es decir, que se garantice el abordaje de la adicción y otras psicopatologías de forma conjunta. Sería necesaria la creación de modelos de atención integrados desde una perspectiva individualizada y flexible (Sacks, Banks, McKendrik y Sacks, 2008).…”

“…Por último, resaltar el valor que podría tener el diagnós-tico de comorbilidad psicopatológica en correspondencia al éxito terapéutico y la necesidad de diseñar estrategias para alcanzar mejorar la intervención en los dispositivos asistenciales (Sacks et al, 2008).…”