STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

THERAPEUTIC COMMUNITIES

This type of treatment is directed at abstinence in people with serious addiction problems (repeated failures in less intensive treatments, poor impulse control, serious legal problems, under social support, etc.), providing care 24 hours a day in non-hospital residential centres, located in places removed from hazardous environments for drug use.

In these communities, residents adhere to strict rules of conduct, systematically reinforced by contingencies (reinforcement or punishment), with the aim of developing self-control and individual responsibility. Highly structured routine activities are added, to counteract the chaotic lifestyle typical of the residents and teach them to plan, set goals and acquire responsibilities. Another component is changing patterns of negative thinking and behaviour through individual and group therapies1 (in professional communities). There are various models (approaches) of therapeutic community for drug addicts:

• "Life communities" in which, in addition to any professional support and on the basis of certain moral or religious approaches, self-help is conceived as a space where people with drug dependence or social exclusion problems (they are usually open to other groups) can start a new life.  
• The professional therapeutic community conceived as a holistic institution that can complete the processes of rehabilitation and social inclusion in people with drug dependence. The self-help, group and occupational dimensions also have prominent roles in the educational-therapeutic programme at these centres.
• The professional therapeutic community conceived as a resource integrated into broad networks of care, responsible for tackling certain objectives in the treatment process for a limited period of time, for people who have difficulty undergoing outpatient treatment for individual, family or social reasons.

Although these models (approaches) often coexist, as welfare policies are consolidated and public resources to treat drug dependence are expanded, it is common for "life communities" to lose importance in favour of professional communities integrated in care networks, with a wide and diversified supply of resources.

Therapeutic communities emphasise the person’s "resocialisation", and carry out comprehensive treatments that (in professional centres) include psychological, medical and educational interventions, aimed at developing suitable lifestyles for standardised social environments. They offer highly structured intensive treatment programmes, in which the entire community (including the other residents, staff and the social context) become agents of change, along with self-help, to influence attitudes, beliefs, perceptions and behaviours associated with drug use. In the professional type, the multifactorial and interdisciplinary approach and the temporary nature of the stay (usually 6 to 12 months) are also highlighted.

 

Reference:

1 Becoña E and Cortés MT. (2011). Manual de adicciones para psicólogos especialistas en psicología clínica en formación [Manual on addictions for psychologists in training specialising in clinical psychology]. Barcelona: Socidrogalcohol.