Excerpt from “Therapeutic communities for treating addictions in Europe”, a document from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), by Wouter Vanderplasschen, Stijn Vandevelde et Eric Broekaert
(…) The TC was introduced in Europe at the end of the 1960s and 1970s in the United Kingdom and was often used as an alternative for psychiatric treatment. It matured during the 1980s and spread all over Europe. Throughout the 1990s, its rise was interrupted because of problems with charismatic leadership in some TCs, a lack of evidence of their effectiveness from randomized controlled trials and a general tendency in society to cut down on residential care. The rollout of opioid substitution treatment (OST), a means of fighting the HIV epidemic, in many cases was accompanied by a reduction in treated cases and treatment facilities in TCs.
Europe learnt much from the USA when setting up TCs. Synanon, Daytop and Phoenix House were either copied or adapted to national situations. During the early history of TCs, the US TC programmes were mostly built on strong self-help principles, including identification with older ex-addicts, whereas the TC movement in Europe from the beginning was set up by professionals with backgrounds in psychology, education or pedagogy.
However, there were also national experiences and traditions that influenced developments. In the Czech Republic, for example, old TC traditions in alcohol treatment were the main source of national developments. In several countries, TCs set up by charismatic leaders developed into sect-like organisations, which led to legal steps being taken and a loss of public funding. (…) Possible ways to prevent the exposure of TCs to charismatic leadership would be by arranging the financing of TC programmes by public authorities rather than by private resources, alongside the enforcement of quality control in TCs by external bodies.
As the concept of a standard TC matured, it was modified to address the needs of special populations. For instance, confrontations in encounter groups are not appropriate for psychotic residents and dually diagnosed individuals, and modified TC approaches were developed for these populations in Belgium, the Czech Republic, Spain and Poland. The observation that not many women graduated from TCs led to the introduction of programmes for addicted mothers and children whereby mothers follow TC treatment during the day and spend the rest of the time with their child(ren) in a TC annex. Prison TCs began to be implemented in Europe (e.g. in the United Kingdom) and could present a notable niche for future modified TCs in other countries. Similar approaches to modified TCs are also available for homeless and adolescent substance abusers.
For many years, the TC movement has been considered to be opposed to psychiatric or methadone maintenance services. Recently, TCs have involved themselves in integrative treatment systems. This implies a focus on coordination and continuity of care to improve effectiveness and efficiency. It involves taking on board alternative approaches from outside the TC movement, in accordance with the needs of residents and their specific diagnoses. TCs work closely with the mental health care system; sometimes TCs even share premises with other therapeutic departments.
Therapeutic communities for treating addictions in Europe: evidence, current practices and future challenges (EMCDDA, Lisbon, April 2014) download document
XVI International EWODOR Symposium
The Therapeutic Community, a tool for empowerment
22 – 23 September 2016, Roma (Italy)