Amphetamine‐Type Stimulants: Development of a Treatment Protocol Page 30 © Lynne Magor‐Blatch & James A. Pitts: <strong>Odyssey</strong> <strong>House</strong> McGrath Foundation 2008‐2009
2. Therapeutic Communities Amphetamine‐Type Stimulants: Development of a Treatment Protocol The Australasian Therapeutic Communities Association (ATCA, 2007), with member agencies in Australia and New Zealand, provides the following definition of a Therapeutic Community: A Therapeutic Community is a treatment facility in which the community itself, through self‐help and mutual support, is the principal means for promoting personal change. In a therapeutic community, residents and staff participate in the management and operation of the community, contributing to a psychologically and physically safe learning environment where change can occur. In a therapeutic community, there is a focus on the biopsychosocial, emotional and spiritual dimensions of substance use, with the use of the community to heal individuals and support the development of behaviours, attitudes and values of healthy living. Therapeutic communities (TC) were first established in the United Kingdom and United States more than 50 years ago, coming from two different models, but converging in practice during the 1970s. In general, TCs are illicit drug and alcohol‐free residential settings that use a hierarchical model with treatment stages that reflect increased levels of personal and social responsibility (NIDA, 2002). In the UK, and especially within prison and youth TCs, a democratic model is also used. These have some important differences to the more usual hierarchical model most commonly employed within US and Australasian TCs (Rawlings, 1999). 2.1. Program context The Australian and New Zealand experience have some important differences to the overseas model, and particularly the USA experience, since each are developed within a harm minimisation framework. Therefore, an important component of Australian and New Zealand TCs is the development of harm minimisation strategies, including education, designed to reduce the risk to the person, their family and the broader community. ATCA member agencies are cognisant of the public health risks of transmission of HIV and in particular of Hepatitis C (HCV) and the need to include safe sex, safe needle use and health education messages to clients. While TCs generally have a goal of abstinence from alcohol and illicit drugs, this is promoted within the context of reducing harm, including harmful use of alcohol. In Australasia, TCs generally consider that an abstinence‐based program does not preclude prescribed medication. Many residents and clients of TCs will be on anti‐depressant, anxiolytic or anti‐psychotic medications, and some may also be on stable or reducing doses of pharmacotherapies (methadone and Buprenorphine). TCs differ from other treatment approaches principally in their use of the community, comprising treatment staff and those in recovery, as key agents of change. This approach is referred to as ‘community as method’. TC members interact in structured and unstructured ways to influence attitudes, perceptions, and behaviours which are considered to be associated with substance use. In addition to the importance of the community as a primary agent of change, a second fundamental TC principle is ‘self‐help’. Self‐help implies that the individuals in treatment are the main contributors to the change process. © Lynne Magor‐Blatch & James A. Pitts: <strong>Odyssey</strong> <strong>House</strong> McGrath Foundation 2008‐2009 Page 31