“We need to encourage research institutions to move from exploring whether the TC works (we already know it does!!) to a focus on how it works (and how we might make it work better)”
Rowdy Yates is Honorary Senior Research Fellow at the Faculty of Social Science, University of Stirling, Scotland. He has worked in the substance misuse field for over forty years and, prior to this appointment, he was the director and co-founder of the Lifeline Project; one of the longest established drug specialist services in the UK.
He is the current Executive Director of EWODOR (the European Working Group on Drugs Oriented Research), President of the European Federation of Therapeutic Communities (EFTC), Chair of Recovery Academy UK and a former member of the Scottish Government’s Drug Strategy Delivery Commission. In 1994 Mr. Yates was awarded the Order of Member of the British Empire (MBE) for services to the prevention of drug misuse.
What has lead you to dedicate your life to the field of substance misuse and addiction?
I stopped using drugs in 1969. Up until then, I had been a guitarist in a number of bands (often getting kicked out of bands because of my behaviour) and a dedicated consumer of methedrine (a kind of injectable amphetamine popular back then) and heroin. I’d had a number of attempts at getting clean and this time I was determined to make it work. I started going to Alcoholics Anonymous (bear in mind, there were almost no drug treatment services or NA meetings then). The problem was that AA then didn’t really understand other addictions and they very politely told me that I had come to the wrong place.
By chance I met another ex-addict in the same position so we agree to start our own support group. Within a fairly short time, we had a group of five. One of our group was an avid reader and he insisted that we read a new book by Lew Yablonsky. This was Tunnel Back about his time at Synanon; the first TC. Over the next few weeks, we all read the book and decided we could copy the approach that Yablonsky described.
I knew a helpful local priest and he agreed that we could rent an empty rectory (priest’s house) for one shilling (I think that’s about €0.09 now) per year. We moved in and for the next year we ran our own TC – based on nothing more than our understanding of that book!! In 1971, our group merged with another recovery group, Eros, led by the South African psychiatrist, Eugenie Cheesmond. The new organisation was called Lifeline.
I worked with them for around 20 years as a volunteer, paid worker, manager and CEO. I left Lifeline in 1993 to be Director of the Scottish Drugs Training Project (SDTP) at University of Stirling. This was an organisation offering in-service training to the drug and alcohol treatment field. In 2001 when the SDTP closed down, I became a member of the faculty specialising in teaching and researching in the addictions. Then in 2016, I retired but kept up my involvement with the therapeutic community. So over the course of my working life, I had the privilege of experiencing the drug treatment field as a customer/client, a worker, a manager, a researcher and a teacher!
What are the strengths of the TC model?
Obviously, there are many ways by which people with addictions achieve long-lasting recovery. We should always remember that the majority of them do so without using formal treatment or even informal support systems like AA and NA. That alone should remind us that humility is an important quality!! But even though there are so many pathways out of addiction, I would not have spent most of my life involved with TCs if I didn’t think that TCs were the best way. If we accept the bio-psychosocial model of Zinberg and Engels, then the therapeutic community is the only treatment intervention to systematically implement a comprehensive response to that framework theory.
The bio-psychosocial model argues that addiction is the interaction of three domains: the biological – this includes genetic predisposition, cravings, tolerance, drug-related physical harm, co-occurring disorders etc.; the psychological – low self-esteem, anti-social behaviour, poor impulse control etc.; and the social – unhealthy social networks, a lack of recovery-supporting relationships, poor educational attainment, poor employability etc. If this is true then an effective intervention will need to be able to improve/increase people’s resources in all three domains.
The TC does this systematically. It restores good physical health, teaches positive responses to cravings, encourages effective management of co-occurring disorders. It improves self-esteem through goal-achievement, impulse control and celebrating success and good behaviour.
And it sets about restoring broken relationships and offering positive peer relationships. That’s a very impressive package. Remember, all of this is about an educational approach to teaching pro-social behaviour. It’s not about abstinence or sobriety – that is merely a side-effect. And because it’s a largely self-help approach, it has an extraordinary capacity to be sustainable long after the treatment period.
As a representative of the TC model in Europe, how would you assess its situation nowadays? In your opinion, what are the major challenges for the TC model?
Unfortunately, the last two decades of neo-liberal, monetarist politics across most of Western Europe have seen the marginalization of residential treatment in general and residential rehabilitation for addiction in particular. This has had two damaging effects. Firstly, it has put pressure on treatment times (whilst still expecting short residencies to deliver long residency results!). And secondly, it has made it more difficult to access residential treatment. In most Western European countries it has become a treatment of ‘last resort’ to be offered only when numerous community-based, or out-patient, interventions have been tried and failed. Largely this has been because methadone-maintenance seems cheap and effective and because residential rehabilitation has been seen as much more expensive.
In fact, a number of studies which have examined total costs to the state (and not just the immediate treatment costs) have found that TCs are significantly cheaper.
One of our great failings in the past decade is the fact that we haven’t argued this point strongly enough. So I think the major challenge for the TC movement in the coming years is to learn from each other and promote our successes better (in most TCs our retention rates have increased dramatically in the past two decades and yet critics still continue to cite the poor retention of the 1980s) and argue the cost case more effectively.
What is the role of EFTC?
I am extraordinarily proud of the work of the European Federation of Therapeutic Communities (EFTC). I believe it is without doubt the most active, most vibrant of the TC federations. The EFTC hosts an active Facebook page, a well used and effective electronic discussion list, hosts a biennial conference and has its own scientific wing (EWODOR – the European Working group on Drugs Oriented Research) which, in turn, hosts its own annual symposium. We are the largest and longest established recovery network in Europe with membership from over 70 organisations in 28 countries and associate members in Israel, Lebanon, Columbia, USA and Japan.
All of this has been totally self-funded since 1981 – no EU monies and no national funding at all. I think that’s a very proud record. For the future, I think we will need to do more on arguing the case for longer treatment and defending ourselves against the continuing cost arguments. With the emergence of new drug treatment networks in Eastern Europe, EFTC members will inevitably be called upon to share their experience with emerging TCs there. Finally, I would see our long term mission to move beyond the narrow confines of addiction treatment.
Really, the association of TC methodology with addictions is largely an historical accident. I can see an excellent opportunity for TC methodology to be applied in other areas – with women who have been trafficked for the sex industry; unaccompanied migrant children; former child-soldiers in Africa etc (indeed, some of this is already happening). That is a challenge I think we can rise to. But we can only do this through a thorough understanding of how a TC works; how the different elements fit together and interact with each other.
Sadly, this is an area we know precious little about because the past fifty years of TC research has largely been focussed on outcomes (usually drug consumption and criminal activity outcomes). So we need to encourage research institutions to move from exploring whether the TC works (we already know it does!!) to a focus on how it works (and how we might make it work better).