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Fourth of 5-part series
Motivational Interviewing and Cognitive-Behavioral Therapy became the favored treatment approaches in treating addiction during this period. Many addiction professionals took the training and certifications but struggled with incorporating the practice into the TC treatment structure. Lacking a good grounding on the TC, many contributed to diluting the TC practice further.
A major study started in 1995 called Adverse Childhood Experience (ACE) Study established how traumatic experiences early in life had lasting effects on the physical and mental health of victims later in life. Post-traumatic stress disorder (PTSD) was not anymore confined to war veterans but included women and children who suffered from chronic physical and emotional abuse. Those who suffered from significant traumatic experiences were at a higher risk of substance abuse, besides other medical and mental health disorders. Research has established that a substantial number of patients in drug treatment had a history of trauma, especially among women. They rarely responded well to traditional treatment and were susceptible to re-traumatization when exposed to an unsafe treatment environment.
Although the concept of trauma-informed care started in 1970 as an important condition for treating veterans with severe trauma, its practice was not envisioned as a general requirement in mental health services until late in the 90s. By 2001, it became standard practice required of all mental health services, including drug treatment programs.
All these factors coalesced to challenge some of the long-held beliefs of TC about addiction, drug users, and treating addiction. A survey of drug users in the general population found that 75% have experienced psychological trauma in their lives. The number might even be higher among those who enter drug treatment programs. Experience has taught me that TC residents with significant trauma experiences, especially women, do not do well in treatment.
“There is a short supply of motivation among drug users to quit drug use and work on long-term recovery. Many enter treatment under coercion either by their family, job, or the criminal justice system. To benefit from treatment, resistance to getting help must be overcome.”
READ: Part 1 – The Therapeutic Community (TC) for Addiction: An Issue of Relevance
In the early days of DARE TC, we had very few women completing treatment. Those with severe traumatic experiences before and during their years of drug use presented a plethora of behavioral and psychological issues. Those with serious sexually related trauma presented psychosomatic symptoms and were prone to sexually acting-out behaviors, which disrupted the treatment environment. Unaware of the complexities of traumatic experiences, some methods used to “correct” their behaviors might have aggravated their conditions. We now know that the feeling of “safety” is a necessary condition for treating traumatized clients.
There is a short supply of motivation among drug users to quit drug use and work on long-term recovery. Many enter treatment under coercion either by their family, job, or the criminal justice system. To benefit from treatment, resistance to getting help must be overcome. To complicate further the treatment of substance abuse disorder, a significant number of criminal justice clients referred to TCs were predisposed to criminality, driven either by their substance use, personality, or both. Criminal thinking and addictive thinking are like twins, challenging to distinguish from one another. Both dysfunctional thinking patterns must be reversed for the person to have a decent chance of giving up drug use and a criminal lifestyle.
Given all these challenges, what does the TC already have, and what adaptations should it embark upon to remain relevant and sustainable as a drug treatment model?
A peer-driven TC where staff lead from behind is achievable through a training agenda that combines experiential and didactic methodology to teach the dynamic, living community and how it works as “community-as-method.” (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.
