Long-Term Addiction Treatment: Past, Present & Future of the Therapeutic Communities

The 80's have seen an explosion of the number of residential resources to treat substance abusers after the heroin epidemic had spread, triggering a social emergency situation. In 1986, the Spanish association of therapeutic communities was created to promote a professional community model. Since then, such treatment facilities have evolved over the years to become a state-of-the-art quality model, grounded on intensive and comprehensive care, tailored to each person's needs and expectations. 

The characteristics of substance abusers are often determined by a combination of various persons within a same individual.  These features may include behavioral, emotional cognitive or social symptoms; they may also be related to the individual's integration in one's environment, or include somatic or even psychological and psychiatric components. Addiction is a complex, multi-facetted and multicausal phenomenon which demands comprehensive, biopsychosocial and educational strategies of the kind found in the therapeutic community (TC) model of treatment.  This treatment model is nowadays deemed to be the only, integrated approach to addiction treatment capable of addressing most of the aspects that need to be taken care of within an individual. 

English lessons at Can Parellada Meeting and Music One-on-one follow up meeting at Can Parellada Outings in Can Parellada

The C.T. The TC model addresses the various issues people or their families may be confronted with, which may also have played a role in, or be affected by, the onset and maintenance of addiction and related disorders. This work is grounded on a comprehensive, holistic approach, from the pre-admission phase, when people initiate their therapeutic and motivational process; through the intake and integration phase, when they learn to live drug free and overcome their difficulties by the means of a residential, protected environment after an adequate assessment of their needs and subsequent treatment by the center's interdisciplinary staff; to the ultimate, pre-reintegration stage, which helps transpose these achievements to people's own social and community environment, so as they may pursue their treatment in an outpatient resource. 

In recent years, we have been severely affected by a profound crisis which has caused unprecedented shutdowns and indiscriminate budget cuts among third sector's social and healthcare facilities. Therapeutic communities have been concerned especially, without due attention to their vital role in today's society.

In addition, this reality has ignored dramatically the fact that widespread unemployment and lack of resources can only give rise to a resurgence of addiction related disorders, much beyond the prevailing levels in the last decade.  As a matter of fact, the various resources available within the treatment network cannot be reduced to mere outpatient, maintenance or risk reduction programs – and all the less since the latter were also subject to budget cuts. 

Despite all these arguments, despite this treatment model's well known efficiency, therapeutic communities are in danger of extinction, for a whole set of reasons described by Domingo Comas in a 2011 paper: "Therapeutic Communities in Spain: Expansion & Crisis": 

  • Their dependence upon political decisions (which are not always based on criteria of need or efficiency), while they are still not fully integrated  in the regional communities' resources portfolio; 
  •  Their dependence on public grants, which have decreased dramatically in time of crisis
  •  As mentioned above, Domingo Comas already referred to a shift in approach following a 2008/2011 report on addiction treatment models presented by a joint committee with senate and congress representatives, and according to which: "addiction related disorders are "chronic and recurring conditions", resulting from genetics, which can only be alleviated through proper medication… Thus implying that "biological factors" make any social reintegration almost impossible.  From that very moment, therapeutic communities, as efficient treatment models, in addition to their ultimate purpose – reintegration – had turned out to be "useless". 

Furthermore, as stated in the title of this article, TC is a long term model of treatment. And this is where the rubber hits the road, because in today's society most people are immersed in a culture of immediacy, as if we only needed to wave a magic wand to get immediate solutions to all of our problems. In substance abusers' culture of addiction, everything is organized around their need for immediacy; all life is condensed to immediate need to maintain drug supply, sustain drug use and avoid consequences of use. And at the same time people tend to reject a model which has proved highly effective, because it happens to be a "long term" treatment model, such as is the case for TCs. 

As a psychologist and professional addiction counselor, I would like to say loudly and clearly that it is essential to preserve therapeutic communities as an integral part of our healthcare network and as a resource which over the years has proved efficient to help overcome addiction and give hope to all those who want to redirect their lives and live drug free. Beyond political or administrative issues, what should prevail only is the clinical efficacy of a given model of treatment.

  • Esther Martos Azcutia
  • Psychologist and Addiction Counselor
  • Recipient of a Master of Arts degree in Clinical Psychology
  • Cinical Director of Dianova's addiction progral – Can Parellada TC, Dianova Spain