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Volume 28, Issue 1 (spring 2007)


Rowdy Yates, Eric Broekaert and Stijn Vandervelde

ABSTRACT: No abstract.


Pioneering in the First Drug-Free Therapeutic Community in The Netherlands

Martien Kooyman

ABSTRACT: The author describes in this paper how he, as a doctor prescribing methadone to drug abusers, discovered the existence of drug-free therapeutic communities when he attended a play performed by residents of Daytop Village. With the knowledge that treatment of addiction is possible he started in The Hague in 1972 the drug-free therapeutic community Emiliehoeve. The initial democratic model that proved to be open to manipulation by the residents was replaced by the hierarchical structured model of the American therapeutic communities. In this paper he describes how he learned from consultants from these therapeutic communities and how he struggled with the paraprofessional-professional conflict, with abuse of power and the threat of influences from a sect. Learning from mistakes, changing what did not work and keeping what cannot be changed, the Emiliehoeve therapeutic community grew and became a role model for many programmes in Europe.

The Early History of the Ley Community – Personal Accounts

Peter Agulnik and Stephen Wilson

ABSTRACT: No abstract.

A TC on the Border of Two Cultures

Georges van der Straten

ABSTRACT: No abstract.

The Development of Drug Abuse and Addiction Services in Israel

Eitan Sela

ABSTRACT: No abstract.


Transatlantic Dialectics: A Study on Similarities and Dissimilarities in Approaches to Substance Abuse Problems in the United States and Europe

Eric Broekaert, Kathy Colpaert, Veerle Soyez, Wouter Vanderplasschen and Stijn Vandevelde

ABSTRACT: Similarities as well as differences can be observed between Europe and the United States regarding the organisation of substance abuse prevention, treatment and policy. These issues were addressed during the EWODOR Symposium, which took place in Blankenberge (Belgium) in September 2005. This paper describes the complex, underlying social and ideological background to this transatlantic comparison from a historical perspective, focusing on the changing roles and positions of TCs in Europe and the United States. A number of themes are discussed here, e.g. the origins of TCs; the increasing importance of treatment evaluation and evidence-based research; the introduction of methadone as a therapeutic means; and harm reduction initiatives. In their conclusions, the authors refer to an evolution that is taking place on both sides of the Atlantic towards comprehensive or integrated treatment systems, whereby harm reduction practitioners collaborate in mutual understanding with therapeutic communities and other drug-free treatment modalities.

Women in Residential Drug-free Treatment: How to Use a Bottom-up Strategy and a Prediction of Completion Instrument to Prevent Early Dropout

Mads Uffe Pedersen

ABSTRACT: In Denmark women in drug-free residential treatment have proved to have significantly more psychosocial problems and a significantly higher dropout rate from treatment than men. The question is raised whether or not it is adequate to treat all the women with the same method, this method being an evidence-based one. It is suggested that instead we have to implement strat-egies that make it possible to identify different target groups with different needs and different risks of leaving treatment before planned. This strategy is defined as a bottom-up strategy. A prediction of completion instrument identifying such a specific target group of women is presented and the rationale behind such an instrument is discussed. It is concluded that it certainly is possible to develop a prediction of completion scale with a very strong prediction power and that such an instrument with advantage could be developed at a local level.

Seeking Desistance in the Community: Drug Users’ Experience of the Criminal Justice System

Gillian Squirrell

ABSTRACT: This paper focuses on policy developments within the UK criminal justice system and its links with treatment in working with substance-using offenders. The paper focuses on a dynamic area. Policy developments to improve access to treatment and to develop treatment opportunities are to be praised. Yet there are tensions where policies mandate treatment and mandate it to serve a criminal justice rather than public health agenda. Tensions are experienced by drug agencies as they try to work to criminal justice-funded agendas. There are risks of further excluding drug users who are drawn into a net-widening of the criminal justice system and who are subject to initiatives and policy change for which the evidence base often lags behind the speed of change.

The paper begins to unpick some complex issues and invites the reader to listen to some commentary on current practice and suggested policy changes offered by substance users and ex-users.

Dealing with Multiple and Frequent Service Utilisation in Substance Abuse Treatment: Experiences with Coordination of Care in Residential Substance Abuse Agencies in the Region of Ghent, Belgium

Wouter Vanderplasschen, Bert Mostien, Alphonse Franssen, Kurt Lievens, Jessica De Maeyer and Eric Broekaert

ABSTRACT: Frequent and multiple service utilisation is a well-known problem in residential substance abuse treatment and traditional agencies have proven to be relatively ineffective for this population. Given the lack of cooperation between treatment agencies, two alternative interventions that aim to improve coordination and continuity of care were implemented: structural inter-agency care coordination and intensive case management. Based on interviews with case managers and care coordinators and 20 clients who participated in one of both conditions, we explored how the persons directly involved themselves experienced these interventions.

Intensive case management was very much appreciated by clients, especially the comprehensive and client-oriented approach, while care coordinators – rather than clients – identified various advantages of inter-agency care coordination. We conclude that both interventions may be – for specific purposes – important additions to the existing residential agencies, if they are well integrated in a comprehensive network of services and if some prerequisites concerning implementation are addressed.


Application of Cognitive-Behavioural Therapy in a Therapeutic Community for Drug-Dependent Individuals

Peter Vassilev and Teodora Groshkova

ABSTRACT: This paper describes the establishment of TC Phoenix in Bulgaria. The paper describes the process of founding and developing a classic hierarchical TC and the contribution of this initiative to the TC movement. The authors, in addition, elaborate their introduction of cognitive-behavioural therapeutic techniques and examine the ways in which the two models can be adjusted to complement each other.

Ten Years of the Therapeutic Community, Casa Oberta (Open House)

Bartomeu Català

ABSTRACT: This paper describes the origins of a distinct client population of the TC Casa Oberta, which was established by Projecte Home Balears in June 1996. This organisation is a publicly-owned entity belonging to the Gobierno Insular of Mallorca. The TC has a number of characteristics that make it quite distinctive. In the first place, it is a harm reduction TC, since it admits not only users who are treated with methadone or users with a dual pathology, but also users wishing for a drug-free treatment. What makes Casa Oberta different from other substitute-prescribing maintenance programmes is the fact that in this TC we propose to go further than just the harm reduction; offering the possibility of following a personal growth programme within the atmosphere of a Therapeutic Community. This type of community unites the two therapeutic approaches: the one of the drug-free TC together with the harm reduction programmes based on substitutes maintenance.

Cultural Reviews

Lesley Day and Denis Flyn (Eds.) (2003) The Internal and External Worlds of Children and Adolescents: Collaborative Therapeutic Care. Published by Karnac, pp.288, price p/b Paperback £19.99, 9781855759282. Reviewed by John Diamond.

Lavinia Gomez (2005) The Freud Wars – An Introduction to the Philosophy of Psychoanalysis. Published by Routledge, pp.210, price p/b Paperback £17.99, ISBN: 1-58391-711-X. Reviewed by John Gale.

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