While the XVIth EWODOR symposium opens today in Rome on the theme of the empowerment process in therapeutic communities, Dianova publishes an editorial which points out that therapeutic communities have successfully adapted to new needs and have an essential role to play in national health systems
Since their inception in the 50s, the therapeutic community (TC) treatment model for addictions have had a rapid development, at first in North America, then in Europe, before giving way gradually to outpatient programmes, opioid substitution treatment and harm reduction interventions.
Modern TCs offer a long-term residential programme (from three months to over a year) for people dependent on drugs or alcohol. They provide residents with a safe and drug-free environment in which the community itself plays an essential role. The recovery process takes place not only through the interventions of professionals (psychologist, psychiatrist, therapist), but also, and essentially, through the restructuring components associated with peer pressure and positive role-modelling. As residents progress through the stages of recovery and comply with the community’s rules, they assume greater personal and social responsibilities. As residents become more involved in their process of change they gradually regain confidence in themselves and their capabilities and progress towards resocialization and self-reliance.
TCs are particularly suited to those who happen to be unable to benefit from outpatient programmes because of desocialization, associated psychiatric disorders or prior treatment failures.
Moreover, the genuine success of opioid substitution treatment (methadone, buprenorphine) should not should not mask the problems inherent in this type of treatment: substance misuse of diversion (injection, resale), opposition to this treatment approach from some patients, or difficulties related to co-occurring psychiatric disorders. The various experiences which, among others, have been conducted by Dianova (e.g. in Canada and Spain, with or without an objective of withdrawal) suggest that TCs may also provide a solution to these problems: patients in substitution treatment could benefit from the comprehensive care provided by the therapeutic community with no negative impact on other residents or the group dynamics.
Over the last thirty years, the TC treatment model has changed, sometimes specialized, to adapt to the ever-changing clinical profiles of those demanding treatment. They have integrated professional resources as well as recognized psychosocial approaches including cognitive behavioural therapy and motivational interviewing – while perpetuating their own therapeutic project based on “community as a method”. These modified TCs can respond effectively to increasingly complex treatment needs, for which outpatient treatments (psychiatric comorbidities) or substitution treatment programmes (multiple drug use, new psychoactive drugs, non-adherence to treatment project) are sometimes poorly equipped.
With their comprehensive care of the whole person (therapeutic, social and family components, vocational project, preparation for reintegration), modern TCs have an essential role to play in national health systems, and at the very least for the sake of diversifying the supply of healthcare services.