The Therapeutic Community (TC) for Addiction: An Issue of Relevance

DARE, the world’s largest and most comprehensive prevention education program, launched a record 212 new programs in 2022 throughout 39 states and Canada | Photo courtesy of DARE International

(Second of 5 part series)

For years, there was a dearth of TC literature on how the TC worked. If someone wanted to learn the TC, he had to observe or go through the TC program with TC residents as his teacher. In the early days, the TC was disseminated this way. However, the subjective nature of experiential learning is easily corrupted by personal bias, especially for laypeople. This practice has led to hybrid TCs worldwide, with elements that may or may not conform to the TC philosophy.

Even as late as the 90s, very few professionals could claim to be TC experts because of the nebulous nature of its knowledge base. For someone to truly know and understand the workings of the TC, he must be familiar with the overlapping categories of TC tools or methods and the underlying theoretical principles. One must also know the art and science of implementing “community-as-method,” as how George De Leon described the TC. Organizing such a knowledge base with experiential and cognitive components and articulating them in an understandable narrative was not easy. The early anti-professional stance that the TC took had deprived it of the intellectual resources needed to develop and articulate its model and theoretical base.

READ: Part 1 – The Therapeutic Community (TC) for Addiction: An Issue of Relevance

Most of the literature on TC was research studies on its effectiveness. Because of program variations among TCs, comparative studies were difficult to do. This trend continued until George De Leon, a psychologist who started in TC at Phoenix House in the mid-60s, published an academic book describing the practices of the Concept-Based TC or TC for Addiction. He was also credited with conducting the first large-scale, longitudinal TC outcome studies at Phoenix House in the 1970s, which became the gold standard for other TC research studies.

De Leon’s book, Therapeutic Community: Theory, Model, and Method, came out in 2000 and was a hit. It became a popular reference for TC. It was his own perspective of what made up the nuts and bolts of the TC. He explained the whys of many TC practices and some hows. It was a landmark work, but a little late. It was understandable because there were considerable variations in how the TC “tools” were practiced from one TC to the next. These included inconsistencies in using TC terminologies. The lack of standard practice to guide TC program implementation resulted in rampant innovations in TC practice that were inconsistent with TC’s philosophy.

By the time De Leon’s book came out, there were already books and articles on TC written in Europe, mainly from the United Kingdom and by professionals familiar with the psychiatric TC model known as the Democratic Therapeutic Community, a TC developed by social psychiatrists for psychiatric patients. Several of them became familiar with and were influenced by the American TC, largely by Daytop, Phoenix House, or Odyssey House.

In 1975, during an international conference, Msgr. O’Brien led the founding of the World Federation of Therapeutic Communities (WFTC) in Thailand. It became a government vehicle and non-government drug program for advocacy and dissemination of TC on the world stage. If Daytop and Phoenix House TCs had widespread influences in European TCs, the Drug Abuse Research Foundation (DARE) in the Philippines was the premier TC in Asia. Patterned after Daytop TC, DARE, established in 1971 by the late Bob Garon, was the oldest TC in Asia and influenced the adoption of TC in the region.

Government and non-government drug programs readily adopted it. In the Philippines, the Department of Health (DOH) rehabilitation centers, the Parole and Probation Administration (PPA), the Bureau of Jail Management and Penology (BJMP), the Bureau of Prisons (BUCOR), and several private rehabilitation programs have been using the TC model. A similar trend has happened in several Asian countries. Following the lead of the WFTC, regional TC federations were established in Europe, Asia, Latin America, and the Oceanic countries. (TO BE CONTINUED)

ABOUT THE AUTHOR   Dr. Fernando B. Perfas is an addiction specialist who has written several books and articles on the subject. He currently provides training and consulting services to various government and non-government drug treatment agencies regarding drug treatment and prevention approaches. He can be reached at fbperfas@gmail.com.