Beyond the “black box” of the Therapeutic Community for substance abusers: A participant observation study on the treatment process

Debaere, Virginie; Vanheule, Stijn; Inslegers, Ruth

doi:10.3109/16066359.2013.834892

Cited by 14 publications

(7 citation statements)

References 36 publications

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“…The first is that residents will react to peers in a more prosocial manner than to staff (Bell, 1994; De Leon, 2000; Stevens, 2013). The second is that TC residents interact in such a way as to maintain a cooperative and safe environment (Debaere, Vanheule & Inslegers, 2014; Pearce and Pickard, 2012). This is a salient issue for TCs; the heavy dependence on peer support means that trust in peers and the social climate of the unit are primary predictors of retention (Carr & Ball, 2014; Mandell, Edelen, Wenzel, Dahl & Ebener, 2008).…”

Section: Introductionmentioning

confidence: 99%

A network of helping: generalized reciprocity and cooperative behavior in response to peer and staff affirmations and corrections among therapeutic community residents

Doogan

Warren

2017

Addiction Research & Theory

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Background Clinical theory in therapeutic communities (TCs) for substance abuse treatment emphasizes the importance of peer interactions in bringing about change. This implies that residents will respond in a more prosocial manner to peer versus staff intervention and that residents will interact in such a way as to maintain cooperation. Method The data consist of electronic records of peer and staff affirmations and corrections at four corrections-based therapeutic community units. We treat the data as a directed social network of affirmations. We sampled 100 resident days from each unit (n = 400) and used a generalized linear mixed effects network time series model to analyze the predictors of sending and receiving affirmations and corrections. The model allowed us to control for characteristics of individuals as well as network-related dependencies. Results Residents show generalized reciprocity following peer affirmations, but not following staff affirmations. Residents did not respond to peer corrections by increasing affirmations, but responded to staff corrections by decreasing affirmations. Residents directly reciprocated peer affirmations. Residents were more likely to affirm a peer whom they had recently corrected. Residents were homophilous with respect to race, age and program entry time. Conclusion This analysis demonstrates that TC residents react more prosocially to behavioral intervention by peers than by staff. Further, the community exhibits generalized and direct reciprocity, mechanisms known to foster cooperation in groups. Multiple forms of homophily influence resident interactions. These findings validate TC clinical theory while suggesting paths to improved outcomes.

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Section: Introductionmentioning

confidence: 99%

A network of helping: generalized reciprocity and cooperative behavior in response to peer and staff affirmations and corrections among therapeutic community residents

Doogan

Warren

2017

Addiction Research & Theory

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“…For instance, recreation rooms are small and lack hidden corners and furniture is placed such that individuals will be in close proximity and face one another (De Leon, 2000; Hawkins & Wacker, 1986). Constant interaction with peers is also necessary since residents must maintain the community, they do so in teams, and they do so according to a rigorous schedule (Debaere, Vanheule, & Inslegers, 2014). …”

Section: Introductionmentioning

confidence: 99%

Semantic Networks, Schema Change, and Reincarceration Outcomes of Therapeutic Community Graduates

Doogan

Warren

2016

Journal of Substance Abuse Treatment

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Background Therapeutic community (TC) clinical theory assumes that peer interaction forms a framework for social learning that will displace ingrained cognitive schema that underlie substance abuse. There has been no direct test of this hypothesis. Methods We analyzed the content of a large corpus of written affirmations (pushups) and corrections (pull-ups) exchanged between 2,342 male TC graduates. We encoded the content of the written communications as semantic networks of words, in which words that appear in the same brief document are connected and are referred to as word combinations. Loss of combinations and gain of combinations each measured an aspect of change in word combination patterns across time. These measures were used in a multivariable Cox model to predict the hazard of reincarceration for residents while controlling for race, age, score on the Level of Service Inventory-Revised and the total number of pushups and pull-ups sent to peers. Results Residents’ reincarceration risk varied significantly with changes in word combinations used over the course of treatment. The implications of the model were visualized to reveal the complicated nature of the interaction terms included in the model. The visuals suggested that residents who changed their expression patterns the least – lost and gained few word combinations – had the highest reincarceration risk after graduation. Conclusions The results suggest that TC success, in terms of increasing time to reincarceration, depends on how residents change their interaction patterns through the treatment process. Merely interacting with others does not explain success; but whether those interactions change does explain outcomes, which may imply more fundamental changes are occurring.

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“…The ten study participants (seven men and three women; average age 32 years, range 26-42) belonged to a peer group from the Belgian TC Trempoline four years prior to this study (the first author had also been part of that group during a participant observation study, see Debaere et al, 2014). At that time, the group consisted of 26 residents.…”

Section: Methodsmentioning

confidence: 99%

Identity change in a drug-free Therapeutic Community: a Lacanian interpretation of former residents’ perspectives on treatment process and outcome

Debaere

Verhaeghe

Vanheule

2017

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Purpose In drug-free Therapeutic Communities (TCs), people with addictions live together in order to achieve recovery in terms of a modified drug-free lifestyle. Central to the TC approach is the assumption that this shift is only achievable when “identity change” has taken place. However, this claim has rarely been addressed in TC research. Further insight into the nature and realization of such identity change might help to understand how this community approach contributes to long-term recovery. The paper aims to discuss these issues. Design/methodology/approach The present qualitative interview study explores the perspectives of ten former TC residents on their treatment and their process of change. To organize the interview data, Lacanian psychoanalytic theory on identity formation/change is used as a framework. Findings The common thread in the participants’ process of change is presented in three parts: their life before, in and after the TC. The substeps within these parts are illustrated with several quotes. Originality/value The findings highlight the value of innovative qualitative research designs to address the many challenges to addiction treatment research. A Lacanian reading of the data makes it possible to describe the subjective logic of the process of change in the TC, focusing on how substance (mis)use functions as an attempted solution in dealing with identity issues. By linking crucial TC ingredients such as the TC law and TC tools to the process of the identity change, a new reading of this long-term group approach is achieved.

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Beyond the “black box” of the Therapeutic Community for substance abusers: A participant observation study on the treatment process

Cited by 14 publications

References 36 publications

A network of helping: generalized reciprocity and cooperative behavior in response to peer and staff affirmations and corrections among therapeutic community residents

A network of helping: generalized reciprocity and cooperative behavior in response to peer and staff affirmations and corrections among therapeutic community residents

Semantic Networks, Schema Change, and Reincarceration Outcomes of Therapeutic Community Graduates

Identity change in a drug-free Therapeutic Community: a Lacanian interpretation of former residents’ perspectives on treatment process and outcome

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