96 research outputs found
The rise and fall and rise again of the therapeutic community
No full textPurpose Therapeutic communities (and many other residential services) have been effectively marginalised in recent years with the increasing popularity of community-based outpatient responses to a variety of social issues including addiction, learning difficulties, mental health issues, etc. The paper aims to discuss this issue. Design/methodology/approach This has inevitably led to a low profile and has resulted in a lack of knowledge about therapeutic communities and how the methodology differs significantly from other approaches. Findings This situation is beginning to change in a number of fields and it is important that the therapeutic community movement adapts its methodology to the needs of their respective client groups and clarifies its approach (and the efficacy of that approach) to funders and service commissioners. Originality/value This paper is a personal contributionOutput Type: Editoria
Therapeutic Communities: Can-Do Attitudes for Must-Have Recovery
No full textThe therapeutic community (TC) in the United Kingdom was built out of a merging of the democratic TC tradition pioneered by Maxwell Jones and others immediately after the Second World War and after the American drug-free TC originating in the Synanon experiment in the late 1950s. This latter tradition traces its roots back through the mutual-aid fellowship Alcoholics Anonymous (AA). This article examines how AA principles were adapted for the TC and how this new approach impacted upon the early drug treatment network in the United Kingdom. The evidence base for TC methodology is briefly described along with a short analysis of the marginalization of the approach in the past two decades and the future possibilities for modified TCs for special populations
A Brief History of British Drug Policy, 1950-2001
No full textFollowing the establishment of the so-called “New British System” (based on the recommendations of the Rolleston Committee in 1926), numbers of recorded opiate and cocaine addicts fell significantly in the early 1930s and remained stable and at a relatively low level for the next two decades. It was in the latter part of the 1950s that reports of a new drug “epidemic” began to circulate. Concerns centred on the use of drugs by ethnic minorities, notably black West Indians and Africans in ‘blues clubs’ and visiting black American musicians in jazz clubs. Once again the drugs epidemic was associated with jazz (“jungle”) music and colour. By the end of the 1960s, young white teenagers had become involved too and the world had seen the student riots in Paris; the birth of Swinging London with its attendant Merseybeat; the hippy revolution in San Francisco; and a growing youth protest, both in the USA and Britain, over western military involvement in Vietnam. Politicians and journalists invariably associated these events with the use of drugs by young people. Over the last four decades of the 20th Century, the use of drugs by young people (and the attendant treatment industry) has grown exponentially and the focus has moved from individual treatment to public health and infection control to the current preoccupation with drugs/crime connection. This brief history attempts to summarise these developments in a short article chronicling the major milestones and events
Different Strokes for Different Folks: results of a small study comparing characteristics of a therapeutic community population with a community drug project population
No full textThis paper reports the findings of a small study undertaken in Scotland and England. A small sample of 50 drug treatment service users was interviewed using the Maudsley Addiction Profile (MAP) and Lucid Adult Dyslexia Screening (LADS). Half of the sample was resident in a therapeutic community (TC), whilst the other half were attending a community drug project and, almost exclusively, receiving long-term prescriptions for methadone. Whilst the main intention of the study was to explore the prevalence of dyslexia amongst treatment seeking populations, this paper examines the differences found between the users of the two treatment types. The TC population was significantly more likely to have been injecting prior to treatment, were using a more extensive range of drugs and were more likely to report psychological health problems, including suicidal ideation. The paper examines whether current UK policy on residential treatment is responsible for these differences and what these findings might mean for both treatment delivery and estimating the cost-benefits of treatment interventions
A brief moment of glory: the impact of the therapeutic community movement on the drug treatment systems in the UK
No full textThe introduction of concept-based therapeutic communities, based upon the model pioneered by Charles Dederich with the Synanon community in California, was a significant development in the evolution of drug treatment provision in the UK. For a short period in the 1970s, these communities enjoyed unparalleled influence in the development and direction of treatment approaches across the whole spectrum of services. This paper considers the developments in psychiatry and social care that prepared the ground for that phenomenon. In addition, the paper considers the subsequent demise in the importance of therapeutic communities to the direction of drug policy and the implications that this might have for future development of residential treatment services
Investigating a Structural Model of Addiction Stigma related to Student Perceptions towards Persons Addicted to Heroin
No full textHeroin addiction is inclined to arouse fear, rejection and discriminatory behavior among the general public. Evidence shows that the public perceives heroin as harmful and addictive. Heroin is ranked as the most stigmatized condition.
While there is robust literature on mental illness stigma, there is limited research concerning addiction-related stigma. There are very few standardized stigma measures related to perceptions toward persons addicted to heroin.
The overall aim of the dissertation was to validate an attribution measurement model toward persons addicted to heroin and to determine its psychometric properties. The dissertation’s study employed an adapted 7-factor measurement model (Corrigan et al., 2002) to examine stigmatizing perceptions towards persons addicted to heroin. This is the first study to systematically evaluate model fit by implementing Exploratory Structural Equation Modeling (ESEM).
A total of 657 Sociology students were analyzed over four stages: questionnaire review by expert panel, pilot-test, validation and replication. The study tested multiple incremental models and successfully determined that the results met multiple goodness-of-fit indices.
Through ESEM, Sociology-Social Control students supported the hypothesis that the adapted 7-factor attribution measurement model would fit data. The model included: Personal Responsibility, Pity, Anger, Helping Behavior, Dangerousness, Fear and Social Distance factors. Adequate power and sample size was demonstrated to support acceptance of the null hypothesis.
In addition to conducting Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), ESEM tested the psychometric properties of the attribution measurement model. Implementing maximum likelihood extraction with oblique geomin rotation using Mplus software, the Sociology-Social Control students’ validation and replication datasets showed an excellent model fit to the data.
Results confirmed support for the superiority of the ESEM solution. The ESEM attribution measurement model fit better than the CFA model. Compared to the ESEM model, elevated factor correlations found in the CFA model were caused by the exclusion of meaningful cross-loadings.
Strong psychometric properties for the ESEM attribution model were evidenced, with good internal consistency and excellent test-retest reliability. The factor structure was replicable across the two groups of Sociology-Social Control students. Adequate ESEM incremental and convergent validity was supported by the simultaneous examination of the Social Distance scale and the Personal Consequences of Criminal Stigma measures with the measurement model. In the replication sample, familiarity demonstrated less stigmatizing perceptions than the SOC313 Course.
Our findings highlight marked differences between the Sociology-Social Control students and the general population’s perceptions of heroin addicts. The Sociology-Social Control students are not afraid of persons addicted to heroin, nor do they hold them responsible for their condition.
To conclude, the study provides newly validated measures with adequate reliability to allow investigators to assess other students’ level of addiction stigma. It is anticipated that the dissertation’s study will lead to further comparative psychometric testing with healthcare students that are directly involved with the care and treatment of persons addicted to heroin to provide a better understanding of the factorial structure of the attribution measurement model. Longitudinal data is also needed to examine our model and how levels of perceptions change over time
An exploration of the psychometric properties of the recovery capital questionnaire
No full textBackground: Successive Scottish strategies and guidance have placed emphasis upon addiction treatment provision to involve an assessment of strengths and assets, known as recovery capital. A psychometrically sound assessment tool will be pivotal in underpinning a strengths-based approach to providing addiction assessment and treatment. The study investigated the psychometric properties of the Recovery Capital Questionnaire.
Methods: The sample (n=173) included people accessing community based addiction treatment (n=108) and residential treatment (n=65) in England and Scotland. Equivalence reliability was investigated using Cronbach’s alpha (n=173) and stability reliability was investigated using a retest methodology with approximately one week between tests (n=102). Content validity was assessed using Lawshe’s content validity ratio and index and seven subject matter experts. Criterion related concurrent validity was examined alongside a measure of quality of life and a measure of resilience. Construct validity was examined via exploratory factor analysis. Results: The Recovery Capital Questionnaire was found to possess good overall equivalence reliability (α = 0.88) and stability reliability (r = 0.89) and ICC (0.88). Content validity was found to be strong (CVI = 0.91). The following correlations were found: RCQ Social Capital and WHOQOL social domain (r = 0.44); RCQ Physical Capital and WHOQOL Physical domain (r = 0.59); RCQ Human Capital and WHOQOL Psychological domain (0.43); RCQ Community Capital and WHOQOL Environment domain (0.40); RCQ Total and WHOQOL Overall QOL (r = 0.53); RCQ Total and WHOQOL satisfaction with health (r = 0.44); and RCQ Total and resilience total (r = 0.65), demonstrating good concurrent validity. Exploratory factor analysis indicated a four factor solution. Recovery capital was found to correlate with length of time in recovery and participants self-identifying use as problematic. Conclusion: The RCQ has been found to be a reliable and valid assessment of the strengths and assets which can be called upon to initiate and sustain the resolution of alcohol and other drug problems
Community energies under-evaluated: Drug initiatives on the margins
No full textThis article draws together an effectiveness review of community responses to drug concerns and supplementary interviews with key informants. Despite accessing nearly 300 publications relating to initiatives, there is a paucity of published evaluative evidence. The literature does provide a greater amount of information about initiatives that are delivered into the community as opposed to initiated by the community. Community-led responses have taken a number of approaches. To assess the current evidence on ‘what works?’, we have defined community responses to drug problems under five banners - self-help groups, parents’ groups, residents’ groups, community development groups and diversionary activity groups - for ease of discussion. There are a number of commonly identified elements that exist in successful and sustainable initiatives which are discussed
- …
