The Availability of Integrated Care in a National Sample of Therapeutic Communities

Abstract

Therapeutic communities (TCs) for substance abusers are oriented toward changing the entire person as a means for facilitating a drug-free future. This vision parallels ideas such as integrated care for the treatment of co-occurring substance abuse and psychiatric conditions. The extent to which integrated services are available in TCs has not been documented. Using data from a national sample of 345 TCs, this paper examines the availability of integrated care in TCs and the structural and cultural characteristics of TCs that offer integrated care. The results indicate that a substantial portion of TCs in this sample admit clients with co-occurring disorders (70.7%), and as many as half of the TCs offer integrated care. TCs that offer integrated care show increased use of professional staff, individual psychotherapy, and a less confrontational milieu, but notably, retain many of the “essential elements” of the traditional TC model.

Exploring Diversification as A Management Strategy in Substance Use Disorder Treatment Organizations

“…Finally, greater referral source diversification was related only to greater average utilization of medication-assisted treatment. This may occur because referral source diversification may reflect the growing awareness of the comorbidity of alcoholism and addictions with psychiatric and medical disorders (Abraham, Knudsen, & Roman, 2011;Dye et al, 2012). Therefore, as referral sources are more diversified, treatment centers are required to care for clients with diverse needs including co-occurring disorders, such as depression and anxiety, for which pharmacotherapies are the preferred treatment.…”

“…In either case, it is likely that greater diversity of treatment alternatives will be accompanied by increased patient census and offering higher levels of comprehensive care. Providing a greater variety of treatment modalities and services may also require a wide variety of employee skills both to provide clinical services and maintain relationships with external providers of clinical and wrap-around services (Dye, Roman, Knudsen, & Johnson, 2012). Considering these previous results, the second study hypothesis is:…”

Possible Tensions Between Individual Needs and Collective Treatment Methods for Substance Use Disorders and Addiction

“…This is an interesting finding, and it shows how the therapeutic communities are adapting and possibly evolving towards a more individual treatment position through a greater use of professionals and various therapeutic interventions within the therapeutic community model (i.e. psychotherapy) and decreasing the confrontational aspect traditionally emphasised in such treatment (Dye et al, 2012). In other words, the increased focus on and awareness of individual treatment needs call for an increased understanding that such needs require individual treatment arrangements.…”

“…Thus, treatment plans and the therapeutic arrangement of the environment to facilitate change should be adjusted from the starting point of identified needs on an individual level. For instance, by using national data from a range of therapeutic communities in the United States (n = 345), Dye et al (2012) found that a great portion of the therapeutic communities in the sample admitted clients with various co-occurring disorders. In addition, approximately 50% of the therapeutic communities report that they provide integrated care or treatment.…”

Opioid Use in the Twenty First Century: Similarities and Differences Across National Borders

“…TCs have been modified over time to address the changing needs of new participants and special populations [66], such as psychotic and dually diagnosed individuals [67], prisoners [68], women [69], and homeless and adolescent substance abusers [70]. Many TC now include professionals with training in substance abuse counseling and/or mental health along with the traditional peers in recovery model [71] and allow the use of medications, including methadone [72]. Though generally on the decline, TC continue to be particularly well established in Southern, Central, and Eastern European countries, with approximately two-thirds of European TC being in Italy (~800 out of ~1,200) [73].…”