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THE TC FOR ADDICTIONS

EFTC CONFERENCE PRAGUE 2013 The state of TC treatment in Europe: development, availability and current practices across the EU Eric Broekaert , Stijn Vandevelde, Wouter Vanderplasschen.

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THE TC FOR ADDICTIONS

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  1. EFTC CONFERENCEPRAGUE 2013 The state of TC treatment in Europe: development, availability and current practices across the EU Eric Broekaert , Stijn Vandevelde, Wouter Vanderplasschen

  2. RETROACTAEWODOR Conference, Thessaloniki, Greece 2012WFTC Conference, Bali, Indonesia 2012 The Community of CommunitiesAnnual Forum 2013

  3. THE TC FOR ADDICTIONS Essentials: community as educational process Essentials: community as method Golden Sixties FruitfulSeventies Stabilizing Eighties ChallengingNineties EmergingTwoThousands

  4. THE TC FOR ADDICTIONS ESSENTIALS: COMMUNITY AS EDUCATIONAL PROCESS • Meaningful social interaction aiming at a transitional process of growth and development of the whole person, his family and primary network, based on differences and diversity between participants striving for inclusion by using intuitive understanding and rationally structured methods within an adapted milieu.

  5. THE TC FOR ADDICTIONS ESSENTIALS: COMMUNITY AS METHOD • “A methodrefers to the activities, strategies, materials, procedures and techniques, that are employed to achieve a desired goal.” De Leon, G. (2000). The Therapeutic Community: Theory, Model, and Method. New York, Springer Publishing Company, p 92.

  6. THE TC FOR ADDICTIONS ESSENTIALS: COMMUNITY AS METHOD • “Plans or procedures followed to accomplish a task or attain a goal. Method implies a detailed, logically ordered plan.” Houghton Mifflin Company (2009). The American Heritage Dictionary of the English Language, Fourth Edition. Houghton Mifflin Company.

  7. Golden Sixties SYNANON: THE FIRST THERAPEUTIC COMMUNITY

  8. Golden SixtiesTHE RAISING OF COUNTER CULTURES Example: The raise of the hippie movement: Love and flower power cultus associatedwith the start of recreative drug use Example: HaightAshberry and the Vondel Park become open sleeping drug using spots forhundreds of youth.

  9. Golden Sixties • Ronald Laing, Thomas Szasz, David Cooper, Jan Foudraine and Kees Trimbos lay the basis for the anti-psychiatricmovementthatcontestscategorialdiagnostics; earnings of pharmaceuticalindustry and largepsychiatricinstitutions. • Laing at the Philadelphia association and Cooper at villa 21 support therapeuticcommunities.

  10. Golden Sixties • A pleafordeinstitutionalization starts • Basagliastrivesfor the closure of psychiatrichospitals • Foucaulttakes a radicalsocialcriticalposition • Community mental health services gotpromoted

  11. FruitfulSeventies • The humanpotentialmovement and the manyforms of humanisticpsychologybasedonexistentialphilosophy blossom • The Esaleninstitute at Big Sur groupsnewhumanapproaches and is influencedbyEasternthoughts • Frits Perls, Carl Rogers, Abraham Maslov, influence the therapeuticCommunitymovement

  12. Fruitful SeventiesDISAPPOINTMENT WITH FAILING PSYCHIATRIC TREATMENT • Example: TC Emiliehoeve (Netherlands) breaks with Maxwell Jones type of TC because of bad results and relapses of residents • Example: TC De Kiem quits clinique because of overestimated believe in detox, medication and classic residential treatment.

  13. Fruitful Seventies DEVELOPMENT AND EXPLOSION OF THE TC IN « WESTERN » EUROPE

  14. Stabilizing EightiesFOUNDATION OF EFTC • Founded in 1978 and formalized in 1981 on the initiative of a group of therapeutic communities for residential drug treatment, the EFTC is a European federative organization supporting the psycho-pedagogical approach helping drug addicts to return to a drug free life style and to become contributing members of the wider community.

  15. Stabilizing EightiesFOUNDATION OF EWODOR • EWODOR (the European Working Group on Drugs Oriented Research) was founded in 1983 to provide a forum within which researchers in the field of drug/alcohol treatment, prevention and policy could share research experience and expertise; compare procedures, methods and results; and subject their work to peer examination. • Real start of a scientific forum for the TC and EFTC

  16. Stabilizing EightiesFORERUNNER OF A RECESSION • At the end of the eighties the reduction of payment of taxes to governments in the USA, led to a drop of investments in building homes and introduced the 1990 economic recession, which touched Europe and its rich investments in social welfare.

  17. ChallengingNinetiesKNOCKING AT THE DOOR OF WELFARE • During the nineties the antipsychiatric and deinstitutionalizationmovement, community mental health and civilrights meet eachotherunder the pressure of economic crisis. Thisleads to an accent on efficiency, efficacy, partialization of care and individualisation. The group as method comes underpressure.

  18. ChallengingNinetiesKNOCKING AT THE DOOR OF WELFARE • The complexity of substanceabuse disorders requires a more outspokenprofessionalism. Biology and farmacologygainmonumentum. Ex-addicts become a smaller part of the solution. Prisons and compulsorytreatmentcome at the foreground.

  19. ChallengingNinetiesKNOCKING AT THE DOOR OF WELFARE • TC reactby putting accent on special target groupssuch as dual diagnosis, prisoners, homeless, mothers and children etc. • TC starts integratingmethadonetreatment in it’s programs and positionthemselves vis-à-vis harmreduction. • Encountergroupslosetheirharshcharacter and become forums of dialogue.

  20. ChallengingNinetiesKNOCKING AT THE DOOR OF WELFARE • Synanon dismantels in 1991 because of financialreasons and the increasingpathology of it’s charismatic leader Chuck Dederich. • Dederich dies in 1999 because of heart and lungfailure.

  21. EmergingTwoThousandsWHAT FUTURE FOR THE THERAPEUTIC COMMUNITY? • The TC as a provider of services: • Prevention services: information and active engagement in schools • Community mental health services: daycentres and harmreduction • Residential services: structuredtherapeuticcommunities • In prison services: therapeuticcommunities in prisons • Family services: support and placements at home • Educational services: formation, training and skills .

  22. EmergingTwoThousandsWHAT FUTURE FOR THE THERAPEUTIC COMMUNITY? • Government pressure for continued and constant funding, resulted in the closedown of some TCs, the reduction of treatment length, or the number of beds per TC. • France is a clear exception in this sense, as TCs for addictions have only been re-established recently. • The capacity of TCs varies a lot, but is usually between 15 and 25 residents per TC. • The number of places for drug addicts in therapeutic communities in Europe can be estimated to be over 15 000 beds. • In most countries the length of TC treatment / programs varies between 6 and 12 months. • Vanderplasschen, W., Vandevelde, S & Broekaert, E. (in press). Therapeutic communities for addictions in Europe. Available evidence, current practices and future challenges for recovery-oriented treatment in therapeutic communities for drug addicts.

  23. EmergingTwoThousandsWHAT FUTURE FOR THE THERAPEUTIC COMMUNITY? • TCs for addiction are spread all over Europe – though not equally • 0ver 1200 TCs were identified across Europe, but this number is largely biased by the huge number of TCs in Italy (n=798) . • The number of TCs is low (<5) in the majority of countries. • It is a well-established treatment modality in most Southern and some Eastern European countries. Vanderplasschen, W., Vandevelde, S & Broekaert, E. (in press). Therapeutic communities for addictions in Europe. Available evidence, current practices and future challenges for recovery-oriented treatment in therapeutic communities for drug addicts.

  24. EmergingTwoThousandsWHAT FUTURE FOR THE THERAPEUTIC COMMUNITY? • EFTC has spread all over Europe covers 25 countries and more than 40 services. • Strong developments in the Easternparts of Europe, after the fall of the wall. • Growth in the South of Europeunder impuls of ‘project man’ and Christian humanism • Differences in the West of Europewheresomecountriessustain, butothersunderpressure of closure, mostlybecause of financialrestraints.

  25. EmergingTwoThousandsWHAT FUTURE FOR THE THERAPEUTIC COMMUNITY?Vanderplasschen, W., Vandevelde, S & Broekaert, E. (in press). Therapeutic communities for addictions in Europe. Available evidence, current practices and future challenges for recovery-oriented treatment in therapeutic communities for drug addicts. • Realisation of the dangers of charismatic leadership • Example:The Patriarch in France • Multiprofessional • Example: Lars Bremberg in Sweden was a Journalist Martien Kooyman in The Netherlands is a Psychiatrist • IntegratedTreatmentsystems • Example: Collaboratibetween TC, hosptals and othertreatmentmodalities in the East of Flanders in Belgium • Development in EasternEurope • Florishing TC in Poland and the ChechRepublic • A wide range of threatmentmodalities • Example: PhoenixhouseFutures in Englandfunctions as a provider of services • Volonteers • Example: The imporace of volonteers in Spain .

  26. EmergingTwoThousandsWHAT FUTURE FOR THE THERAPEUTIC COMMUNITY? • The TC in anEvidenceBasedarea • Evidence and hierarchy “the golden standard” • A lack of randomizedcontrolled trials ArchieCochrane: Low evidence found for: • Therapeutic Communities (Smith et al., 2005) • Self-help Groups (McKay et al., 2004) • Cue Exposure (Conklin & Tiffany, 2002)

  27. EmergingTwoThousandsWHAT FUTURE FOR THE THERAPEUTIC COMMUNITY? • WouterVanderplasschen – The therapeutic community for addictions in Europe: available evidence and future challenges

  28. THE TC FOR ADDICTIONS And to end: Together we make a stand!

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