| Photo by Jon Tyson on Unsplash
(First of 5 part series)
The TC: A Timeline
In the 1950s, heroin addiction was considered a terminal condition, meaning, “once an addict is always an addict,” which defined the prevailing belief about addiction. Condemned to either rot in prison or hospital or die in the streets, such was the addict’s fate. Then Synanon, the originator of TC for addiction, came along in 1958 and proved that heroin addicts could give up heroin, recover, and lead productive, sober lives. It was revolutionary, and the therapeutic community for addiction was born. Synanon and its founder, Chuck Dederich, were sensational for what they had achieved when the medical-scientific community failed. Synanon was a fringe, anti-professional organization, refusing to hire the services of medical professionals. Members were not called patients or clients. They were called residents. The late Lewis Yablonsky, a sociologist-criminologist, was the first professional to allow an inside look at Synanon. He published his account 1967 in a best-selling book, Synanon: The Tunnel Back.
What was Synanon’s secret? Addicts living in a structured community practicing self-help and mutual help to give up drugs, re-socialize, and rebuild themselves.
Synanon did not focus on the drug as the real root of the addiction problem; instead, they blamed it on the addict’s flawed thinking and way of life. Modern TCs shared this perspective. Life in TC was difficult, contrary to what one might think. It was regimented and required opening oneself to the scrutiny of others, openness to feedback, and complete honesty about one’s life story. It was an attempt at reconstructing a personal narrative based on a deep understanding of what drives one’s addiction. Because the early TCs believed that the defenses an addict had built around his dysfunctional behavior, thinking, and feeling had been deeply entrenched in his addict personality, they used intrusive and often harsh methods to break them down. It was brutal, but the sense of belonging and emotional support extended to residents mitigated such a harsh approach. The community became a refuge, so to speak, to the embattled residents who were trying to find themselves.
One of Dederich’s beliefs was that society was corrupt and not a healthy place for rehabilitated addicts to return to. Synanon became a closed TC, where you are in for life once you sign up. He also believed that only an addict could help another addict recover from addiction. This explained the early TCs’ practice of having only ex-addicts as program directors and counselors. Not everyone agreed especially professionals who came to Synanon to learn its method. Many had established TCs patterned after Synanon. Although they adopted many of the treatment methods developed by Synanon, their treatment goal was to reintegrate addicts back into society, a daunting task they learned later. Synanon, which became not only a successful drug treatment program but also a business venture led by an autocratic leader, eventually got entangled with serious legal battles that led to its downfall. However, its pioneering work and legacy as the first therapeutic community for addiction lived on. The drug abuse landscape continued to change from heroin to crack cocaine and now synthetic narcotics, such as fentanyl. Likewise, the TC had its trials, and now it must adapt to the changing times to remain relevant.
“Then Synanon, the originator of TC for addiction, came along in 1958 and proved that heroin addicts could give up heroin, recover, and lead productive, sober lives. It was revolutionary, and the therapeutic community for addiction was born.”
The first-generation therapeutic communities that sprang from Synanon proliferated and became part of mainstream drug treatment in the United States by the late 60s. These TCs enjoyed federal and state funding during the 70s and 80s but did not follow an established standard TC practice. Although they all adhered to the essential elements of the TC, each had its unique variations of the TC as practiced in Synanon. Some of the large TCs in the U.S. Northeast were Phoenix House, Odyssey House, and Daytop Village. These TCs continued to believe that only addicts could help another addict recover, and all their program directors were ex-addicts. Professionals, such as nurses, medical doctors, psychologists, social workers, etc., were hired as auxiliary staff but not to run the program. This practice changed in the 90s because of state and licensing bodies’ requirements for operating and getting program funding. TCs were required to have professionals and licensed staff play major roles in program management. However, frontline staff who supervised the day-to-day TC program operations remained largely the domain of the ex-addict staff. Phoenix House started training professionals to be TC clinical staff as early as the 80s.
Daytop Village, which the late Msgr. William O’Brien founded and became one of the largest first-generation TCs, operating several residential and outpatient programs in New York City and upstate New York. It had a major role in TC’s dissemination worldwide. It was David Deitch, an ex-Synanon member hired by Msgr. O’Brien, as Program Director in 1962, brought the TC to the first Daytop House. After he left Daytop, he earned a Ph.D. in clinical psychology and played an important role in spreading the TC worldwide. He was a professor who wrote several peer-reviewed articles on TC. He had conducted TC training in Europe and wrote a TC curriculum that Daytop International used to teach TC. Daytop International received over a decade of funding from the U.S. State Department’s International Narcotics and Law Enforcement Affairs (INL) drug demand reduction program. Under this funding contract, more than 50 countries received training on the TC.
By the first decade of 2000, Daytop struggled for survival despite efforts to expand its services to capture more clients. There was a dichotomy in TC programming, with Daytop International as its international arm, teaching the TC model overseas with fidelity. Meanwhile, as practiced in its various houses in the U.S., the TC got diluted because of organizational weaknesses and funding regulatory demands. In 2016, Daytop Village morphed into Daytop- Samaritan Village after being absorbed by Samaritan Village, a much smaller TC. I left Daytop International in 2008 and moved to Phoenix House after seeing the writings on the wall. (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.
