The Relationship Between Duration of Treatment in a Therapeutic Community for Drug Abusers and Subsequent Criminality

Wilson, Stephen; Mandelbrote, B. M.

doi:10.1192/bjp.132.5.487

Cited by 21 publications

(7 citation statements)

References 5 publications

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“…De Leon 1973;. Although similar studies were carried out in some UK concept-based therapeutic communities (Ogbourne and Melotte 1977;Wilson and Mandelbrote 1978), the trend for such work there did not continue. In the USA however, evaluation research became central to the therapeutic community movement in the community (De Leon 1994) and in prisons (Wexler 1997).…”

Section: Historical Antecedentsmentioning

confidence: 98%

A Culture of Enquiry: Research Evidence and the Therapeutic Community

2004

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This paper presents data from a systematic review and meta-analysis of 29 published studies of therapeutic community effectiveness using controls, including 8 randomised control trials. Metaregressions suggest that the two types of therapeutic community, democratic and concept-based, and the age of the study, are the key sources of heterogeneity in the collection of studies analysed.Otherwise, heterogeneity is low and the meta-analysis confirms the effectiveness of therapeutic community treatment with overall summary log odds ratio for the 29 studies of -0.512 (95% ci -0.598 to -0.426).Keywords systematic review, meta-analysis, therapeutic communities, effectiveness, evidence Historical antecedentsThe literature on therapeutic communities refers mainly to democratic psychiatric settings, originating in Britain during the second world war, or to concept-based houses, originating in the USA in the late 1950s. The early literature on British therapeutic communities was descriptive, usually single case studies, and penned by therapeutic community practitioners themselves, rather than impartial or rigorous evaluations (e.g. Jones 1952;Bion 1960; Foulkes 1948; Main 1946;Harrison 2000); this sort of 'practitioner research' continues today (Black 1999;Coombe 1995).The literature then moved to more sociological, anthropological studies of therapeutic communities, conducted by outsiders (e.g.Rapoport 1960). Although more impartial, these studies were not always well received by practitioners (Jones 1968), a negative reaction itself then studied by sociologists (Rapoport & Manning 1976). However, Rapoport's study of the Henderson Hospital in England became recognised as a seminal text on democratic therapeutic communities, and some of it's classifications, for example the four 'pillars' of democratisation, permissiveness, reality confrontation and communalism were regarded as criteria to be achieved 2 and standards to maintain. These criteria have been reworked recently to fit in with contemporary democratic therapeutic community practice (Haigh 1999). Subsequently, there were some comparative, again sociological, studies (Bloor, McKeganey & Fonkert 1988), but more recently there has been a growing body of evaluative research in the UK on the effectiveness of the democratic therapeutic community, particularly in mental hospitals and prisons (Chiesa & Fonagy 2000; Chiesa, Iacoponi & Morris 1996;Cullen 1994;Marshall 1997;Newton 1997;Shine 2000;Warren & Dolan 2001).In the United States, a different type of therapeutic community -the 'concept house' -emerged, with the founding of Synanon by Charles Dederich, and then Daytop Village, aimed at the treatment of drug addicts. Here again, the early literature was descriptive, but also anthropological and sociological, and mainly written by outsiders to the therapeutic community, more interested in organisational than practice issues (Yablonsky 1965;Sugarman 1974). However, the focus of therapeutic community literature in the USA changed quite quickly, from the early 1970s...

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Section: Historical Antecedentsmentioning

confidence: 98%

A Culture of Enquiry: Research Evidence and the Therapeutic Community

2004

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“…This no doubt accounts for the high rate of early dischargeapproximately one-third of admissions discharge themselves within the first month. Secondly, in a follow-up study of all residents admitted in the first 2 years, a significant association was found between staying in the programme for longer than 6 months, and reduced criminality and drug injection after leaving (Wilson & Mandelbrote, 1978;Wilson, 1978). This indicates that real changes in behaviour, generalized beyond the programme, do take place.…”

Section: Interpretations Of Changementioning

confidence: 97%

“…Eighty residents whose intellectual level was assessed on admission on the WAIS obtained a mean IQ of 108.6, SD 11.1. Details of drug use for the first two years' admissions are reported elsewhere (Wilson & Mandelbrote, 1978). The predominant pattern was of polydrug abuse including opiates and taking by injection.…”

Section: Sample and Proceduresmentioning

confidence: 99%

The modification of personality disturbance in a therapeutic community for drug abusers

Kennard¹,

Wilson²

1979

British Journal of Medical Psychology

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Two personality questionnaires, the MMPI and 16PF, were administered routinely to drug abusers admitted to a newly established hierarchical type of therapeutic community. Questionnaires were repeated at 6 and 12 months with those residents who remained. Comparison of the results with other studies suggests that drug abusers admitted to different treatment centres display a recognizable pattern of personality disturbance, characterized by a combination of neurotic, psychopathic and psychotic elements and an unusual degree of willingness to admit to socially undesirable traits. Twenty-five per cent of residents stayed longer than 6 months. They showed a significant reduction in measured personality disturbance, and at 1 year anxiety was the only outstanding indication of disturbance. The relationship between these results, possible sources of bias and other indices of behaviour change is discussed.

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“…In some cases, the founding directors of the TC combined their practical, therapeutic work with their own academic development [61][62][63] . Some researchers like Wilson, Mandelbrote, Uchtenhagen and ZimmerHöffl er already published in highly qualifi ed peer-reviewed journals [54,57,64] . In an extensive review study on the design and effectiveness of TC research in Europe between 1980-1997, there were found no European evaluation and outcome studies indexed in the ISI Web of Science, besides the American ones.…”

Section: Discussionmentioning

confidence: 99%

The Third Generation of Therapeutic Communities: The Early Development of the TC for Addictions in Europe

et al. 2005

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Aims: It is the goal of this study to investigate the first development of the drug-free therapeutic community (TC) in Europe. The paper aims at systemizing information, scattered all over Europe and is the first stage in an ongoing study to record the development of the European TC movement and its influences. Design: After a study of the grey (hidden) literature, TC pioneers and experts per country were contacted to further elaborate the first findings. Subsequently, a preliminary summary of our findings was published in the Newsletter of the European Federation of Therapeutic Communities (EFTC), inviting additional information and corrections. The authors completed the results for this article with relevant first-hand information, obtained through interviews with European pioneers. Findings: The findings are summarized under three topics: chronology, interconnections and European identity. It was found that from 1968 until 1989, a new therapeutic approach arose all over Europe, modeled after Synanon, Daytop and Phoenix House, New York, through Phoenix House, London and Emiliehoeve in the Netherlands. Therapeutic communities were established in Belgium, Finland, Germany, Greece, Ireland, Italy, Norway, Spain, Sweden and Switzerland as well. These communities were closely-knit and interconnected in their reaction against psychiatric and methadone treatment. The European TCs developed an own identity compared to the American ones. Conclusions: The European TCs adapted the model of their American predecessors to their own culture, influenced more by milieu-therapy and social learning. Instead of harsh behaviorism, more emphasis was placed on dialogue and understanding. Professionals occupied a more pivotal role and took over the dominant position of ex-addicts. Research, executed by TC professionals gradually entered the TC. A generic network of TC connections, through which the development evolved, was uncovered, and clear regional trends can be observed.

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The Relationship Between Duration of Treatment in a Therapeutic Community for Drug Abusers and Subsequent Criminality

Cited by 21 publications

References 5 publications

A Culture of Enquiry: Research Evidence and the Therapeutic Community

A Culture of Enquiry: Research Evidence and the Therapeutic Community

The modification of personality disturbance in a therapeutic community for drug abusers

The Third Generation of Therapeutic Communities: The Early Development of the TC for Addictions in Europe

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