Essential elements of treatment: a comparative study between European and American therapeutic communities for addiction

Perceived effectiveness of therapeutic community model as a rehabilitation approach for Sri Lankan individuals with substance use disorder

Purpose

This study aims to evaluate the perceived effectiveness of residential treatment which follows the therapeutic community (TC) model for Sri Lankan individuals with substance use disorder (SUD).

Design/methodology/approach

A descriptive cross-sectional study was carried out in two selected residential treatment centers which follow the TC model as a rehabilitation approach. All the clients of the selected residential treatment centers were invited to take part in the study and data were collected from 75 consented male participants using an interviewer-administered questionnaire. The perceived effectiveness of the residential treatment was assessed using the Treatment Effectiveness Assessment instrument. Data were analyzed using descriptive statistics.

Findings

Most of the participants were Sinhalese (98.7%, n = 74) with a mean age of 27.0 ± 6.0 years. The average duration in which participants stayed at selected centers was 8.0 ± 4.0 months. Most of the participants reported that the encouragement during the program was sufficient (89.3%, n = 67), psychological support was satisfactory (89.3%, n = 67), freedom (69.5%, n = 52) and facilities were adequate (76.0%, n = 57) within the program. A higher proportion of participants said that the counselors and program guides were friendly (80.0%, n = 60), and participants were allowed to communicate with their family with restrictions (92.0%, n = 69). The mean perceived effectiveness score (score range 1–40) was 34.0 ± 7.0 and the four domain scores (score range 1–10) were substance use (9.0 ± 2.0), health (8.0 ± 2.0), lifestyle (9.0 ± 2.0) and community (9.0 ± 2.0). The majority (88.0%, n = 66) of the participants perceived a high level of treatment effectiveness.

Originality/value

There is a paucity of empirical evidence on effectiveness of TC model for individuals with SUD in South Asian countries including Sri Lanka. The findings of this study highlight that the participants perceived higher effectiveness of the residential treatment which follows the TC approach for Sri Lankan individuals with SUD.

The therapist, the group and I: how therapeutic alliance moderates the effect of group cohesion on outcomes

Purpose

This study aims to investigate whether the influence of group cohesion on the outcomes depended on the levels of the therapeutic alliance.

Design/methodology/approach

Sixteen individuals with a substance use disorder who were undergoing treatment in a therapeutic community responded to therapeutic alliance, group cohesion, craving and outcomes measures after every therapeutic small group session for a period of six weeks. Data analysis was performed using hierarchical linear modeling.

Findings

Results indicate that the effect of group cohesion is stronger when there is a high therapeutic alliance between resident and therapist.

Originality/value

Even on group interventions, to enhance group cohesion effects on outcomes, therapists must foster higher therapeutic alliance levels. The findings point out the importance of studying the effect of common factors on outcomes.

Investigating the factor structure of a translated recovery-orientation instrument in inpatient treatment for substance use disorder

BACKGROUND

Recovery has been outlined as a process of change through which involvement and empowerment enables individuals to reach their goals and aspirations. Recovery self-assessment (RSA) is an instrument that has been acknowledged as an applicable measure of recovery-orientation in services for people with mental health problems or substance use disorder (SUD). This study aimed to translate RSA from US English to Norwegian and to investigate the factor structure of the translated version (RSA-N).

METHODS

A translate/back-translate procedure was used. Confirmatory factor analysis (CFA) was applied to investigate the factor structure of RSA-N in a sample of clinicians (n = 407) working in inpatient SUD treatment facilities.

RESULTS

The results suggested that the hypothesised five-factor structure originally obtained by the developers showed an inadequate fit with the current data sample. RSA-N was modified and restructured by removing twelve misfitting items and combining factors with high covariance using data from one subsample. The alternative three-factor structure yielded an acceptable fit for the data from a second subsample. Acceptable alpha coefficients, suggesting good internal consistency, supported the adequacy of the three-factor structure.

CONCLUSIONS

Results from the present study are in line with previous findings, which have failed to replicate the hypothesised five-factor structure without modifications. Knowledge about the degree to which SUD services are recovery-oriented may contribute to SUD services' pursuit of establishing an inpatient treatment environment that fosters change and development of inpatients. The present study's findings imply RSA-N's potential as an instrument to assess recovery-orientation in inpatient SUD treatment.

Effective factors of addiction treatment communities in Peru, Nicaragua and Czechia

Purpose

This paper aims to explore the effective factors that influence the treatment of drug addiction in therapeutic communities (TCs) and to determine its essential elements in the Peruvian, Nicaraguan and Czech context.

Design/methodology/approach

The qualitative data were collected during semi-structured interviews with inpatients/clients of seven TCs based in Peru (Takiwasi), Nicaragua (Centro de Especialiades en Adicciones, Centro de Rehabilitación del Alcohólico y Adicto a Otras Drogas and Albergue de Miembros Adictos en Recuperación) and the Czech Republic (Renarkon, Sejrek and Kladno-Dubi). All 90 interviews were manually transcribed, and content analysis was performed. Codes were created using the grounded theory method.

Findings

The effective factors of TC, treatment in Peru, Nicaragua and Czechia are identical in conditions such as the presence of a personal therapist, the use of psychotherapy and the importance of group cohesion. In Peru, the administration of medicinal plants and diet was perceived as a principal part of the treatment. Nicaraguan TCs were specific for practicing 12 steps. In Czechia, an emphasis is put on the therapeutic program, workshops and leisure activities. Spirituality and religion play a main role in the Peruvian and Nicaraguan TCs only.

Originality/value

The current study presents a unique insight into the factors considered effective by inpatients/clients of TCs in different socio-cultural contexts.

The role of the admission phase in the Italian treatment setting: A research on individuating shared practices in psychotropic substance users' communities

There are various and diversified ways of admission of a substance user into a therapeutic community. When these ways result from actions that are inconsistent with the general objective of the service, they may lead to adverse outcomes that substantially impact both therapeutic interventions efficacy and services efficiency. Consequences are multiple, concerning the substance user, other users of the service, professionals working at the service, and the center's relationships with the service network to which the center belongs. This study aims to define and share major interactive and organizational problems concerning the admission process at CEAL accredited structures and to define and standardize a protocol of procedures aimed at managing and supervising the admission process, through specific and commonly agreed indicators. The research was carried out according to the focus group methodology and involved sixty directors of various health communities offering residential services for substance use treatment. The research was guided by a focus group moderator. The research has made it possible to identify the biases and errors in the admission process and selected those practices shared by the therapeutic communities and conducive to generating positive outcomes. The findings in the definition of a procedure, complete with precise indicators that are applicable across the therapeutic communities and to the shared activities that constitute and are conducive to the success of the admission process.

"The Whole Is Greater Than the Sum of the Parts": Prison Staff Perceptions of Domestic Violence Rehabilitation Programs

This qualitative study is part of a mixed methods research project that examined the effectiveness of the primary rehabilitation program for domestic violence offenders in the Israeli Prison Services-the "House of Hope." The quantitative part of the study showed that the "House of Hope" program was effective in reducing recidivism among participating inmates. The purpose of this qualitative study was to describe the rehabilitation program according to the perspectives of the program staff. For this purpose, semistructured interviews were conducted with the department staff during the study as well as with past directors. The qualitative findings suggested that the success of the program probably stemmed from a synergistic combination of several components, for example, identifying the characteristics of domestic violence offenders and adjusting treatment programs to their needs, along with exposure to psychological treatment in varied therapies (cognitive behavioral therapy, psychoeducational, and psychodynamic) and formats (group therapy and individual therapy) during a 1-year stay in a hierarchical therapeutic community. Other components mentioned are staff professionalism, stability, and the program's location in a therapeutic-oriented prison that is architecturally designed and built to create a less stressful environment for the inmates and the staff.

Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America

OBJECTIVE

In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries.

DESIGN

A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru.

METHODS

A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study.

RESULTS

Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances.

CONCLUSIONS

The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America

Background

In Latin America, substance related disorders are highly prevalent and one of the treatment strategies is the Therapeutic Communities (TCs), however, in Latin America there is scarce data about this treatment strategies, their quality, drop-out rates and patient satisfaction.

Methods

Based on a previous study in 5 Latin American countries, the TCs who had a score equal or higher than 9 according to the De Leon criteria which are some fundamental items that the TCs should meet, were selected to carry out a descriptive and retrospective study of qualitative and quantitative characteristics of the TCs.

Results

Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were “Requesting a professional qualification to former addicts that belonged to the program” and “Work as part of the therapeutic program”. Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws.

Conclusion

The user satisfaction with TCs, in terms of infrastructure and quality are quite high, as the fulfillment of essential quality items, however, the follow up information to evaluate effectiveness of the treatment is poor or in some cases unknown.

Working in a therapeutic community: exploring the impact on staff

Purpose

The purpose of this paper is to explore the impact working in a therapeutic community (TC) has on staff practice and personal development.

Design/methodology/approach

Eight female members of staff who work in the TC participated in semi-structured interviews. Interviews were recorded and transcribed. Thematic analysis was used.

Findings

The findings of this paper show three superordinate themes: confidence gained within TC; the staff impact of the intensity of TC; and staff value for specific TC principles.

Research limitations/implications

Limitations include researcher bias as both authors work in the TC and/or in the service. Reasonable adjustments were made in order to account for this.

Practical implications

Implications for future research include understanding and supporting the needs of staff and further exploration of the impact of staff working within TCs for people diagnosable with emotionally unstable personality disorders.

Originality/value

The research was carried out at one of the longest running TCs for people with emotional instability in the country. It offers a unique opportunity to garner the views of staff members with up to 27 years of experience. Findings may be of value to practitioners, administrators, policy makers and researchers interested in therapeutic communities.

Saudi addiction therapeutic communities:Are they implementing the essential elements of addiction therapeutic communities

Objective:

To investigate whether Saudi therapeutic communities (TCs) implement essential elements of TCs.

Methods:

This is a cross sectional study where the author visited all of the Saudi addiction TCs between September and December 2014. At least one week was spent in each TC, attending many therapeutic activities, reviewing patient files and program documents, and interviewing directors, treating teams and residents. At the end of each visit, a short version of the Survey of Essential Elements Questionnaire (SEEQ) was conducted, which is a reliable tool to evaluate the essential elements of TCs.

Results:

In 2014, there were only 5 TCs in Saudi Arabia. All of them were traditional TCs for adult male residents. The average total score was 3.72 out of 5 on the SEEQ. Regarding the 6 dimensions of the SEEQ, the TCs scored 4.15 on the TC perspective, 3.72 on the agency treatment approach and structure, 4.40 on community as therapeutic agent, 2.60 on educational and work activities, 3.50 on formal therapeutic elements, and 4.3 on process. There were no significant differences in dimensions scores among the 5 Saudi TCs.

Conclusion:

In general, all of the Saudi TCs scored fairly high on the SEEQ, which may reflect a sufficient implementation of the TC as a therapeutic model. Educational and work activities lagged behind the other dimensions and should be improved and re-evaluated.

Knowledge displays: Soliciting clients to fill knowledge gaps and to reconcile knowledge discrepancies in therapeutic interaction

OBJECTIVE

To examine knowledge displays (KDs), a practice by which Therapeutic Community (TC) professionals exhibit previous knowledge about their clients' circumstances and experiences.

METHODS

Conversation analysis is used to examine 12 staff-led meetings recorded in Italy (8 in a drug addiction TC; 4 in a mental health TC).

RESULTS

The TC professionals use KDs within broader sequences of talk where they solicit their clients to share personal information and where the clients provide insufficient or inconsistent responses. In these circumstances, the staff members employ KDs to pursue responses that redress emerging knowledge gaps and discrepancies regarding the clients' experiences or circumstances.

CONCLUSION

KDs allow the staff members to achieve a balance between respecting their clients' right to report their own experiences and influencing the ways in which they report them. KDs help to reinforce the culture of openness that is central to many forms of therapeutic interaction, to forward the therapeutic agenda and to expand the staff members' knowledge of the clients' experiences and circumstances.

PRACTICE IMPLICATIONS

KDs can be used to solicit clients to share personal information. This paper illustrates core features that underlie the function of KDs (where they are used and how they are constructed).

Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.