Different Strokes for Different Folks: results of a small study comparing characteristics of a therapeutic community population with a community drug project population

This paper reports the findings of a small study undertaken in Scotland and England. A small sample of 50 drug treatment service users was interviewed using the Maudsley Addiction Profile (MAP) and Lucid Adult Dyslexia Screening (LADS). Half of the sample was resident in a therapeutic community (TC), whilst the other half were attending a community drug project and, almost exclusively, receiving long-term prescriptions for methadone. Whilst the main intention of the study was to explore the prevalence of dyslexia amongst treatment seeking populations, this paper examines the differences found between the users of the two treatment types. The TC population was significantly more likely to have been injecting prior to treatment, were using a more extensive range of drugs and were more likely to report psychological health problems, including suicidal ideation. The paper examines whether current UK policy on residential treatment is responsible for these differences and what these findings might mean for both treatment delivery and estimating the cost-benefits of treatment interventions

A Brief History of British Drug Policy, 1950-2001

Following the establishment of the so-called “New British System” (based on the recommendations of the Rolleston Committee in 1926), numbers of recorded opiate and cocaine addicts fell significantly in the early 1930s and remained stable and at a relatively low level for the next two decades. It was in the latter part of the 1950s that reports of a new drug “epidemic” began to circulate. Concerns centred on the use of drugs by ethnic minorities, notably black West Indians and Africans in ‘blues clubs’ and visiting black American musicians in jazz clubs. Once again the drugs epidemic was associated with jazz (“jungle”) music and colour. By the end of the 1960s, young white teenagers had become involved too and the world had seen the student riots in Paris; the birth of Swinging London with its attendant Merseybeat; the hippy revolution in San Francisco; and a growing youth protest, both in the USA and Britain, over western military involvement in Vietnam. Politicians and journalists invariably associated these events with the use of drugs by young people. Over the last four decades of the 20th Century, the use of drugs by young people (and the attendant treatment industry) has grown exponentially and the focus has moved from individual treatment to public health and infection control to the current preoccupation with drugs/crime connection. This brief history attempts to summarise these developments in a short article chronicling the major milestones and events

Community energies under-evaluated: Drug initiatives on the margins

This article draws together an effectiveness review of community responses to drug concerns and supplementary interviews with key informants. Despite accessing nearly 300 publications relating to initiatives, there is a paucity of published evaluative evidence. The literature does provide a greater amount of information about initiatives that are delivered into the community as opposed to initiated by the community. Community-led responses have taken a number of approaches. To assess the current evidence on ‘what works?’, we have defined community responses to drug problems under five banners - self-help groups, parents’ groups, residents’ groups, community development groups and diversionary activity groups - for ease of discussion. There are a number of commonly identified elements that exist in successful and sustainable initiatives which are discussed

Integration: Too Much of a Bad Thing?

Integrated and/or multidisciplinary working has become a central guiding principle of addiction treatment throughout the Western world. Indeed, the notion has become virtually synonymous with good practice in intervening in a complex disorder like addiction. There has been surprisingly little analysis or evaluation of the efficacy of this approach. Rather, it is effectively taken for granted that integrated and/or multidisciplinary working is without question a “good thing.” But for complex interventions such as the therapeutic community, it is equally possible that these developments can threaten the underlying principles of the approach. This short literature review considers three areas of integrated working: integrating professional staff into therapeutic community teams; integrating new treatment approaches into existing therapeutic community frameworks; and the issue of therapeutic communities co-working with other treatment services with different philosophies and working practices. The work originated in an evaluative study of a network of Scottish addiction treatment services and the initial findings are that although there are some advantages to broadening the horizons of the therapeutic community movement, there is equally a danger of undermining some core principles

The development of the therapeutic community in correctional establishments: a comparative, retrospective account of the 'democratic' Maxwell Jones TC and the 'hierarchical' concept-based TC in prison

Background: The corrections-based therapeutic community (TC) is one of the most described treatment modalities for (substance abusing) incarcerated offenders. The origins and development of the therapeutic community have been traced back to two independent traditions: the American hierarchical concept-based TC and the British “democratic” Maxwell Jones-type TC. Both branches have developed independently, targeting different people and tackling diverse problems. Aims: To demonstrate that there are clear and undeniable similarities between the ‘two’ prison-based therapeutic communities. Method: A comparative historical review of the literature and a critical discussion and comparison. Results: The links between the democratic and hierarchic therapeutic communities are summarized under five headings: social learning and behavioural modification; permissiveness and modeling; democracy and hierarchy; communalism and community as method; reality testing and ‘acting as if’. Conclusions: The ‘two’ correction-based therapeutic communities are on converging pathways. Far from being oppositional models, they can be regarded as being complementary

An examination of the reliability and validity of the recovery capital questionnaire (RCQ)

Aims and Background Recovery capital refers to the resources people can call upon to initiate and sustain alcohol and drug problem resolution. Measuring this phenomenon could help an individual better understand their strengths as well as gauge the impact of any interventions designed to improve recovery capital and / or reduce addiction severity. This study aimed to test the internal consistency, stability reliability, criterion-related concurrent validity and content validity of the Recovery Capital Questionnaire (RCQ). Setting and participants Participants (n = 173) accessing community based addiction treatment (n = 108) and residential treatment (n = 65) in England and Scotland completed the RCQ at two time-points one week apart (n = 102) to test stability reliability, and also completed the RCQ alongside measures of quality of life and resilience (n = 152). Content validity was assessed by seven subject matter experts with content validity ratio and index calculated. Findings Cronbach’s Alpha values (internal consistency) included: social α = 0.52 (0.40–62); physical α = 0.73 (0.66–0.78); human α = 0.85 (0.82–0.88); community α = 0.85 (0.82–0.88); RCQ Total α = 0.88 (0.85–90). RCQ stability reliability (r = 0.89) and ICC (0.88) were calculated. Content Validity Index statistic of 0.91 was calculated. Correlations between relevant domains within the RCQ and WHOQOL Bref were found to include: r = 0.44, 0.59, 0.66 and 0.40. Correlations between RCQ and CD-RISC scores were calculated (r = 0.65). Conclusion The Recovery Capital Questionnaire was found to possess good overall internal consistency and stability reliability. Content validity was found to be strong and the RCQ demonstrated good concurrent validity with a measure of quality of life and a measure of resilience

The Fife Drug Court in Action: The First Six Months

First paragraph: Drug Courts were initially established in the USA in the late 1980s by sentencers who were frustrated at the limited range and effectiveness of existing measures for dealing with those whose offending was related to the misuse of drugs. Drug Courts aim to reduce drug misuse and associated offending by offering treatment based options outwith the traditional court setting. Drug Courts are now also operational in a range of other jurisdictions, including Australia, Canada and Ireland