ATS Literature Review, Consultations & Trial - Odyssey House

Amphetamine‐Type Stimulants: Development of a Treatment Protocol
Wexler (1995) suggests that the major goal of a TC for a substance using population is to alter
fundamental negative beliefs about oneself and one’s unhealthy lifestyle and to develop a greater
sense of self‐efficacy and control through increased responsibility. In defining TCs for substance
users, De Leon (1995) suggests that TCs “…provide a total environment in which transformations in
the drug users’ conduct, attitudes and emotions are fostered, monitored and mutually reinforced by
the daily regimen” (cited in Gowing, Cooke, Biven & Watts, 2002: 41).
Over the past 50 years the therapeutic community has gained recognition as an effective
intervention approach for a range of client groups. These include substance users in a variety of
settings, including community and prison‐based programs; families with children and adolescents.
This has resulted in the traditional TC approach being tailored to meet the specific needs of each of
these population groups. In the United States, the TC modality has been divided into three sub‐
categories:
• Traditional TCs (1‐3 years duration), which are defined by a goal of total re‐socialisation,
and which place high demands on residents, utilising confrontational methods and
imposing sanctions for behaviour modification;
• Modified TCs (6‐8 months duration), which are characterised by a goal of developing
practical skills, and which place moderate treatment demands and sanctions on residents.
These TCs include programs targeted at specific groups or treatment needs (e.g., drug
using mothers, adolescent drug users, clients with comorbidity or co‐occurring disorders).
Modified TCs have been shown to be particularly effective in correctional institutions
(McCollister & French, 2000); and
• Short‐term TCs (3‐6 months duration), which are distinguished by a goal of providing skills
to allow the client to survive in society and re‐establish family relationships, and which
place moderate to high treatment demands upon residents.
Hence, while TCs were originally based around lengthy periods of stay, in the past two decades
short‐term residential and outpatient programs have been developed. There is also a continuing
trend for both TCs and 12‐step approaches to be used in conjunction with other treatment
approaches (both pharmacological and psychosocial).
In 2002 the ATCA published Towards Better Practice in Therapeutic Communities (Gowing, et.al.,
2002) and included in that document an extensive outline of the essential elements of therapeutic
community programs in Australia and New Zealand. In 2003, a set of Service Standards for TCs were
developed, and at that time formed the basis of the ATCA accreditation process. This process is
currently being redefined through the National Standards for Therapeutic Communities (AOD), a
project which is developing standards for TCs through funding from the Australian Government’s
Department of Health and Ageing. These standards will fit within a national framework.
Shine and Morris (2000) in their review of the Grendon Programme (a prison‐based TC in the United
Kingdom) highlight three issues that they consider are ‘crucially important’ to the continued use of
TCs as an intervention model for substance users:
1. That therapeutic communities need to be responsive to the evolving organisational
environments in which they are established.
2. Therapeutic communities need to be pro‐active in their approach to exploring and
implementing evidence‐based practice.
3. There is a need for therapeutic communities to develop and ascribe to theoretical models of
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