Bridging the Gap Between Research and Practice in Therapeutic Communities (TCs) for Addictions

Abstract

Therapeutic communities (TCs) are well-known as a treatment modality and can be found in a variety of populations and settings, including addicts, as well as children and young people, individuals with personality disorders and learning disabilities, prisons and hospitals (see Boyling, 2009; De Leon, 2000; Kennard, 1998; Vanderplasschen, Vandevelde, & Broekaert, 2014). The term therapeutic community was first used by the British psychiatrist TomMain (1946), who was involved in the so-called Northfield Experiments (see Vanderplasschen, Vandevelde, De Ruysscher, Vandevelde, & Broekaert, 2017), where soldiers suffering from shell shock and war neuroses after the Second World War were treated by using group processes therapeutically (Harrison & Clarck, 1992). From that time forwards, the term therapeutic community has been linked to a range of treatment traditions and approaches that essentially share the “idea of using all the relationships and activities of a residential psychiatric centre to aid the therapeutic task” (Bridger, 1985, p. 60). One of these traditions is commonly referred to as drug-free or hierarchical TCs, also called concept(-based) TCs or TCs for addictions (Vanderplasschen et al., 2014). These TCs were developed in the 1960s as intensive inpatient-type programs to get people off drugs and to provide a complete break from their past lifestyle. Numerous residential programs for addicts have been modelled after this original concept and also drug-free TCs themselves have evolved and beenmodified to address the needs of specific groups, such as adolescents, mothers with young children, incarcerated substance abusers, or persons with co-occurring mental disorders. Community as method has been identified as the core and common mechanism across TCs (De Leon, 1997). It has been described as “teaching individuals to use the context of community life to learn about themselves” (De Leon, 2000, p. 93) and refers to peer and staff relationships, social roles, the social structure, group process and daily activities. Two years ago we agreed to prepare a special issue of the Journal of Groups in Addiction and Recovery (JGAR) on TCs. This decision was inspired by a series of