Strategies and treatment - Sample Essay

 

The primary goal of the TC is to foster personal growth (Butt, 1990) through a process of global change that includes abstinence from drug use, elimination of antisocial behaviour, the expression of prosocial attitudes and behaviours, the acquisition of social and living skills, and the development of employability, (Butt, 1990; Nielsen & Scarpitti, 1997; Mattick & Hall, 1993; De Leon, 1994).

Staff members working in a TC consist of either lay counselors (ex-addicts) (White, 1991), a range of professionals that include social workers, psychologists, and psychiatrists (Cancrini, De Gregorio & Cardella, 1994) or a combination of both (Butt, 1990). The relatively few staff members monitor and evaluate resident’s status, supervise groups, assign and supervise job functions, and oversee house operations (De Leon, 1994). Residents are responsible for their daily living requirements, maintaining their living quarters, and assisting in the general upkeep of the TC (Nielsen & Scarpitti, 1997).

Contemporary TCs usually adopt a non-medical approach (Hall, Chen & Evans, 1995), offer programs ranging from 3mths to 18mths duration (Ghodse, 1995), operate on a 24 hour live-in basis, and conduct random urine testing (Charuvastra, Rehmar, Paredes & MCBride, 1989). TCs provide the individual with a structured drug-free environment and clear boundaries (Nielsen & Scarpitti, 1997; Butt, 1990) so as to encourage individual responsibility for the self and group responsibility for the community (Blake, Millard & Roberts, 1984). In addition, there is a defined system of rewards for good behaviour (e. g., privileges) and punishments (e. g. , sanctions and penalties) for not adhering to community guidelines (Ghodse, 1995; De Leon, 1994; Butt, 1990).

Although the TC fosters a trial and error learning process in which the individual can fail safely (De Leon, 1991b), any infringement of the cardinal rules (no violence, no stealing, no sex, no drugs) often results in immediate discharge (Butt, 1990; Glaser, 1981). Rehabilitation and recovery unfolds as a developmental process that occurs in a social learning setting, and often involves stages of sequenced incremental learning as the individual progresses through various phases (e.g. , orientation, primary treatment, graduation, re-entry, and aftercare) in the program (De Leon, 1994).

Although individual counseling is usually available to assist residents in resolving underlying or core issues that led to their drug abuse, there is usually an emphasis on group methods (Nielsen & Scarpitti, 1997). De Leon (1994) suggests that the most important mechanism for change is the community of peers who confront their fellow resident/s (in encounter groups) when old values and behaviours are displayed, provide positive and negative reinforcements to elicit appropriate behaviour, and serve as role models.

The principal goal for the individual is re-entry into society (Hall, Chen & Evans, 1995) however “relapse is the rule across all treatment approaches” (De Leon, 1994, p. 1225) and usually occurs within the first 90 days (Butt, 1992). In an effort to reduce relapse individuals are, depending on their level of progress, allowed day, overnight, and weekend leave so as to experience and overcome high-risk situations, and reintegrate back into mainstream society (Butt, 1992).

In addition, the majority of TCs provide additional support through aftercare programs that include re-entry or halfway houses (De Leon, 1991b), and emphasise the use of self-help groups such as AA, and NA (Troyer, et al. ; 1995; Butt, 1990). Wexler’s (1995) suggestion that AA is primarily a support model whereas the TC is a self-help intervention model warrants some thought given that both treatment interventions adopt similar practices. TCs and AA both advocate abstinence, are peer based programs that employ confrontational techniques within a group format, and view the individual as being responsible for their own recovery.

In addition, TCs and AA adopt similar theoretical approaches, provide a drug-free environment for social interaction, and emphasise learning new skills. While it would also appear that the majority of individuals who access AA and TCs are experiencing severe drug (Condelli & Hubbard, 1994; Weiss et al. , 2000), and alcohol problems (Tonigan, Toscova & Miller, 1996), TCs appear to acknowledge the uniqueness of each individual. In AA, all members follow the same regime whereas individual differences are recognized in TCs through specific treatment plans that change the emphasis, not the course, of their experience in the TC (De Leon, 1994).

TCs also distinguish individuals along dimensions of psychological dysfunction and social deficits rather than according to drug-use (e. g. , alcoholics versus social drinkers) patterns (De Leon, 1994; Jarvis, Tebbutt & Mattick, 1995). In contrast to AA, TCs usually have exclusion criteria (e. g. , psychopathological disorders) so as to ensure a safe and predictable environment for residents, especially in relation to female residents. However, unlike AA, the majority of TCs in Australia are not a viable alternative for some women who have children.

Although the research from studies indicates positive outcomes with AA (Tonigan, Toscova & Miller, 1996; Timko et al. , 2000; Mann, et al. , 1991), and TCs (Page & Mitchell, 1988; Simpson & Sells, 1990, cited in Platt, Husband & Taube, 1991), both treatment interventions are difficult to evaluate due to significant methodological constraints, and the influence of extraneous variables. AA has been criticised for its lack of client monitoring and treatment evaluation, and the use of non-professionals helping people who may have severe psychological disorders (Major, 2000).

In contrast, TCs have been accused of providing a pseudo-environment where residents risk becoming dependent on the TC itself, and delay the chance to implement what they have learned (Butt, 1990). In addition to the limitations associated with self-report data, TCs experience high attrition rates (De Leon & Schwartz, 1984) and encounter difficulties in locating ex-residents during follow-up studies (Charuvastra, et al. , 1989), whereas controlled trials on the effectiveness of AA are difficult as AA insists on anonymity, and membership is voluntary so no one can be turned away (White, 1994).

It is evident from the literature discussed throughout this paper that the boundaries between AA, and TCs programs are somewhat blurred. While there were notable similarities and differences between AA and TCs, the AA program could be considered somewhat disempowering as members view themselves as being in a constant state of recovery that requires life-long vigilance (Troyer et al. , 1995). Fortunately, AA is widespread, easily accessed, and cost nothing to attend (Saunders, 1998).

Although the evidence to support the effectiveness of either approach appears somewhat tentative, the diffusion (e. g., settings, countries) of AA (Makela, 1991), and TCs (Cancrini, Gregorio & Cardella, 1994) suggests that these two interventions are considered to be, at least for some individuals, viable options for the treatment of alcohol and drug abuse.

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