| Photo by Colin Davis on Unsplash
Third of 5-part series
Major Shifts in the Field of Addiction
In the closing decades of the 20th century, we saw major paradigm shifts that had a significant societal impact, including the field of addiction.
In the 1990s, coinciding with a shift in the view of addiction by medical science and the rise of crack cocaine as the major substance of abuse in America and other parts of the world, government funding for the TC declined. The scientific community had re-defined addiction as a “brain disease,” arguing that chronic drug use could alter the structures and functions of the brain that underlie addictive behaviors. Addiction treatment shifted its focus to behavioral health and shorter treatment terms. TC, with a longer behavioral-psychosocial treatment approach, focused on helping drug users develop skills to live a drug-free, criminal-free, and productive lifestyle, was deemed unsustainable.
The 90s saw a rise in TC admissions with psychiatric co-morbidities besides substance abuse. Such an increase came with the popularity of poly-drug use, particularly mixing crack cocaine, marijuana, alcohol, and other substances. Combining substances with opposing psychoactive effects on the brain hastened the structural and functional degradation of the user’s brain. A similar phenomenon happened in the Philippine drug scene in the 70s when heroin was suppressed, and drug users turned to cough syrups with codeine and a mix of other drugs.
READ: Part 1 – The Therapeutic Community (TC) for Addiction: An Issue of Relevance
By the 1980s, the rise in psychiatric co-morbidities among drug users showed among those admitted to drug treatment programs. Soon, amphetamine had supplanted narcotics use, and the practice of abusing cocktails of drugs among users continued, hastening psychiatric co-morbidities among users even today.
“The TC saw a rise in admission to treatment among middle-class whites from small, rural communities, supplanting addicts from the ghettos who usually populate the TCs. The influx of criminal justice clients in TC helped sustain it, but the pressure for TCs to adapt to new realities in the addiction field continued to mount.”
In the U.S., the criminal justice clients referred by such offices as the Parole and Probation and the court system filled the beds of TCs in the ’90s and early 2000s, and this continues today. Along with the demographic shift was a geographic shift of clients entering treatment when prescription narcotics abuse in the U.S. reached epidemic proportions. The TC saw a rise in admission to treatment among middle-class whites from small, rural communities, supplanting addicts from the ghettos who usually populate the TCs. The influx of criminal justice clients in TC helped sustain it, but the pressure for TCs to adapt to new realities in the addiction field continued to mount.
While the community-based not-for-profit TCs such as Daytop declined, even after reducing treatment time for clients, prison-based TCs were thriving. The prison TC initiative had more traction after several outcome studies of prison-based TCs unequivocally found that exposure to TC reduced criminality and drug use and increased productive behaviors among released prisoners. Outcome studies conducted in prison-based TCs were major sources of support for the TC. It became clear that even among coerced prison inmates who had undergone a substantial amount of time in TC produced better outcomes. (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.
