Presentation Transcript

1. The “Evidence” Crisis & the future of TCs14th EFTC CONFERENCEPRAGUE

   Rod Mullen Amity Foundation rmullen@amityfdn.org USA
2. Current situation Most of us in this room have had a pretty tough time in the past 3-4 years. Economic depression world-wide—which has affected nearly all of our organizations. Tough times, closing of services, compromises for survival…. And yet—we have had hard times before. It is important for all of us to, as was said in the Civil Rights movement, “keep our eyes on the prize.”
3. Arguments for Evidence Based Practices Treatment should be: the kind of progressive, systematic improvement over time that has characterized successful parts of our economy and society throughout the twentieth century, in fields such as medicine, agriculture, transportation, and technology. The most important reason for the extraordinary advances in medicine, agriculture, and other fields is the acceptance by practitioners of evidence as the basis for practice, and particularly the randomized controlled trial that can establish ‘‘beyond reasonable doubt the effectiveness (or lack thereof) of treatments intended for applied use.” Some proponents go as far as to say that any practice not based solely upon scientific knowledge (RCT) is inferior and should ultimately be banned.
4. Evidence Based Increasingly in the USA and Europe there is a demand that publically funded methodologies are “evidence based.” And, particularly in the US & Europe, TCs are being increasingly marginalized. While the demand for EBP seems at best important (public funds should be used intelligently) and at worst innocuous, in the case of TCs it may be a dangerous or even disastrous path. Research in social science is, to date, best in determining causal relationships in very simple situations which do not reflect the complexity of ordinary life.
5. Evidence Based Practice:“if problem is A, solution is B”
6. But: THIS is the TC
7. What WE DO The reductionist scientific paradigm lends itself to causal relationships that are relatively simple---particularly single interventions that can be easily reproduced and/or measured in a lab. The TC is real life—complicated, multivariate, messy, difficult to exactly replicate, and impossible to subject to laboratory conditions. But the TC is also powerful and effective in dealing with the most challenging problems in the most devastated populations—as hundreds of studies have shown and the evidence of our senses has demonstrated for over five decades.
8. The Wrong Audience? Can we EVER satisfy the social scientists (excluding our tireless and dedicated TC researchers) who are in competition with the physical scientists for their own credibility as “real” scientists—but whose interest in relevance to the real world, public good and public policy is often marginal? Can we consider that we may be speaking to the wrong audience? Or at least that we should consider engaging other audiences?
9. Our World: The Faustian Bargain More freedom=more alienation, loneliness, loss of social capital, more crime, mental illness, poverty, addictions, etc. More economic progress & perceived “wealth”=increased differentiation between haves & have nots. Poverty of relationships, poverty of the spirit, environmental destruction, global warming, etc. More technology & science=longer lives, greater knowledge, “one world” orientation. But also erosion of communities (the crucible for human values); and the eroding of family, and living vicariously—the Lonely Crowd, Bowling Alone, friendship studies, etc.
10. Point of No Return Global Warming & other environmental looming catastrophes---we can’t go back to some presumed idyllic period where we lived with nature (Hobbs’ described it as “nasty, brutish, and short.”) Nor can we go back to traditional communities—the genie has long since left the bottle Much of the uproar in the Middle East is attempting to put the genie back in the bottle & stifle the inevitable change towards a more universal “one world” culture and the subsequent loss of traditional community norms (eg Sharia law, cliterecorectomy). So if we can’t go back, we MUST go forward….
11. Intentional Community:the Role of the TC TCs have proven to be robust and universal TCs accept the chaos and rapid change of the modern world—but teach “right living” and promote moral education and moral growth. (Methadone & other drugs may or may not be effective—but none of them can claim to promote moral growth, empathy, self-understanding or community building—they deal with symptoms) TCs are fundamentally inclusive and integrative because they are intentional—formed for that purpose—we build social capital, we build community
12. Origins of the US TC TCs in the US developed at a time of major social change—the Civil Rights movement, the Anti-Vietnam War movement, the student movement, the Women’s movement. A time when the entire country was in social upheaval, and TCs were part of the response to the social conditions of the times. We are again in a time of world-wide social upheaval on issues of major importance to our future The PRINCIPLES of the TC have, particular at this point in historical evolution, a much broader application than amelioration of substance abuse for our societies….
13. Coming out of the closet… The TC is really a revolutionary approach---intentional community--trying desperately to hide in a conventional suit—so that government bureaucrats who have no interest in or understanding of community will appreciate us and provide funding. But much as we try cloak ourselves as “mainstream”, we are seen as unconventional (because we are!). Perhaps it is time to come out of the closet? Can TCs play a larger role? What would it be? And do we have the courage to explore it?
14. Social Capital Examples Country Clubs, Gated Housing & Gangs Civil Rights Movement & Therapeutic Communities

15. Arrogance?

    Is it arrogant for us to say, to proclaim, to believe that the TC model, principles and practices are important for our world? Beyond addiction treatment? To have a better world, we must re-discover community, respect community, and re-build authentic, modern, intentional communities throughout the world.
16. Aristotole “The man outside the polis (community) is either a God or a Beast.”
17. IF........ If we want our world to be a better place If we want our young people to be inspired by the power of the human spirit If we want social/political leadership that understands the dynamics of change If we want leadership that recognizes the value of community If we want heroic leadership THEN, fellow TC practitioners, we need to raise our expectations, broaden our self definition, open our doors, and allow what we have learned to permeate our societies…..
18. The difference between what we do and what we are capable of doing would suffice to solve most of the world's problems. - Mohandas K. Gandhi
19. Question Is there a larger purpose for the TC above and beyond being an “evidence based practice” for the treatment of addictive (mostly substance abuse) disorders?
20. The Question And, if so, does the obsessive/compulsive desire to PROVE that the TC “works” and is “evidence based” to obtain funding divert practitioners from considering those larger purposes? And promoting them? And does our narrow focus really subvert our intention to draw younger, vibrant, idealistic, creative people (with potential to have a major influence on society) into the therapeutic community “movement”?
21. TuumEst(it’s up to you……) Unless we, those who know the TC, those who are daily witness to the power of community, break out of the “please love us, please fund us” begging bowl for government funding we will continue to be marginalized—in favor of interventions that are simple, less complex, and far less effective. We need to seek out those in our localities, in our countries, and worldwide who will resonate to the power of the therapeutic community to achieve real change….
22. “Is the system going to flatten you out and deny you your humanity, or are you going to be able to make use of the system to the attainment of human purposes?” ―Joseph Campbell