Therapeutic Communities: Another Option

Therapeutic communities (TC’s) were started in the 1960’s and have continued to this day, though in a much altered form. Therapeutic communities are drug-free residences, where recovering addicts live for months, or years, to learn how to live a life free from drugs.

Since the inception of TC’s over forty years ago, there have been major differences between various therapeutic communities, but the basic concept is the same. The influence of the community helps the addict learn new life skills in important areas of function, including communication, education, social skills, acceptance of responsibility, and job skills. The community consists of both patients and staff, with some overlap. Some TCs have staff members who were previously patients. Many TCs reward the resident addicts with different levels, corresponding to their progress acquiring basic life skills. Duration of treatment at a TC has varied. Since people progress in their recovery at different rates, the amount of time needed to learn and apply skills differs.  In the past, most opioid addicts stayed in TCs eighteen to twenty four months, but now, with reduced funding, many have been reduced to six to twelve months. This is still a long time for the addict to be away from home and for this reason is not acceptable to many addicts.

The first therapeutic community, Synanon, was started by a recovering addict, named Charles Dederich, in 1958. He had originally been helped by Alcoholics Anonymous, but was still searching for meaning in his life and started a discussion group to aid that search. (1) A group of people trying to recover from drug addiction were drawn to Dederich, who has been described as exceptionally charismatic. The group moved into his apartment. Later, as the group expanded, a clubhouse was rented and became a place where addicts could both go through drug withdrawal (without the help of medications), and live together as a community of recovering people. This group held meetings that used brutal honesty as a means of breaking through psychological resistance. Physical violence wasn’t allowed, but all nature of verbal abuse was dispensed, in the name of helping the addict. Other recovering addicts were leaders of the Synanon meetings.

 Over time, Synanon expanded in numbers and in locations. They were touted as having high success rates, but the data they released was misleading. Because of the harsh confrontational tactics, many addicts dropped out, early in their treatment. Eventually, the focus of Synanon shifted towards retaining addicts in the Synanon community indefinitely, and its leader Dederich became despotic, leading the organization towards what he saw as a utopian society. (2)

As time passed, Synanon became more cultish and redefined itself as a religion by 1974. Dederich, becoming ever more paranoid, began to demand proof of loyalty from group members. He became lavishly and conspicuously rich, at the expense of the other members, and generally behaved in an increasingly unstable manner. Finally, he was arrested in 1978 for the attempted murder of a lawyer for one of Dederich’s opponents in a lawsuit. Dederich pled nolo contendere to the conspiracy to commit murder, by placing a rattlesnake in the lawyer’s mailbox.

Though Synanon ended in ignominy, some of the people involved took the positive aspects of what they had found in Synanon and established different types of therapeutic communities. Some of the more successful were Daytop Village, Phoenix House, and Delancey Street Foundation. These newer versions of therapeutic communities intended to treat the addict, then return him back to his or her community. These organizations also hired professionals, as well as ex-addicts, as counselors. Because most accepted federal money, they also had to abide by monitoring guidelines, which kept them accountable and adherent to more mainstream methods.

Therapeutic communities have claimed high success rates, with around ninety percent of graduates achieving drug abstinence at one year, but only a small percentage actually stay through all stages of treatment and graduate. Many TC’s screen out many candidates during the admission process, and of the addicts they do accept, around half leave their TC during the first year. The patients who do stay through all phases of treatment at their TC have shown marked reductions in drug use and criminal activities, and have an increased likelihood of gainful employment. Successful outcomes are correlated with length of time in treatment. (3)

One criticism of therapeutic communities has been the potential for abuse of power. With their strict hierarchal structure, those in a position of respect could do much damage if their power is misused, as occurred with Synanon. Also, with the long amount of time required for treatment, the cost may be prohibitively high. In the 1960’s, the amount spent on one patient in a therapeutic community could finance three addicts on methadone maintenance treatment or drug-free outpatient counseling. (2)

 Therapeutic communities continue to operate around the world in sixty-five countries and have been shown to be effective at treating some of the sickest addicts. (4) TCs have been shown to reduce drug use, unemployment, criminal activity, and help with mental health issues. TCs have in common the basic concepts of using community to help people change behaviors. They tend to have structured activities and help the patients address problems in all areas of their lives. The approaches used may differ in different cultures, but the concepts remain the same. In the United States, around three to four thousand people residing in therapeutic communities say that opioids were their primary drug. (4)

1. Lewis Yablonsky, The Tunnel Back: Synanon, (New York, The Macmillan Company, 1965).

2. William L.White, Slaying the Dragon: The History of Addiction Treatment and Recovery in America, (Bloomington, IL, Chestnut Health Systems, 1998) pp 241-244.

3. National Institute on Drug Abuse, Research Report Series: Therapeutic Community, http://www.drugabuse.gov/ResearchReports/Therapeutic/default.html

4. Gregory C. Bunt, Britta Muehlbach, and Claire Moed, “The Therapeutic Community: An International Perspective,” Substance Abuse 39 (2008): 81–87.

 

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3 responses to this post.

  1. Posted by db89g23 on July 30, 2011 at 12:48 am

    I already feel like an addict, trying to get more … but it is so variable at low doses, it drives me crazy. I don’t know if I’ll feel fine that day, or be going into withdrawals. I will just talk to him about it, if he sees it as addictive behavior, I guess it is. I am an addict, after all.

    Reply

  2. Posted by db89g23 on July 30, 2011 at 1:54 am

    NOT speaking of snorting either, that would be straight up abuse.. just better sublingual methodology than what he instructed me to.

    Reply

  3. I am a child of Synanon. Dad went 1962 1964. Santa monica, 23 riverside drive nyc, 249 green farms rd westport ct and Tannersville, ny left went into sales fuller brush, ditto div bell & howell, apeco opened business office machine’s 1970- 1981 lived a ckean sober life raised wife 2 chuldren very successfull in business & life…mps

    Reply

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