The Effective Solution to Long-Term Addiction: Classic Therapeutic Communities
There is a potent, effective, but unfortunately forgotten solution to tackling long-term addiction. You likely have not heard of it. This model is known as “Classic Therapeutic Communities” (CTCs). In May, our team from The Other Side Academy hosted a group of founders and leaders implementing this approach in Hawaii, North Carolina, British Columbia, Washington, Arizona, and Utah. We gathered in Salt Lake City, Utah for our second conference to share best practices and discuss ways of accelerating the reemergence of this unique model.
Three of the characteristics that make Classic Therapeutic Communities unique includes:
1) These programs are intentionally built to be long-term (typically two-years min.) It takes time and intentional practice to break bad habits and tendencies of a previous life. In a committed, therapeutic community, the staff and students can focus on doing the right thing daily and building new, productive habits—without a rushing to meet a deadline.
2) These models are self-reliant, which means they are able to provide services no cost to participants and are funded largely by social enterprise businesses. The social enterprises also provide the real-life opportunity where new life skills are honed.
3) Each community is peer-led. They are not run by traditional clinicians. Instead, individuals who are a part of the community are responsible for holding each other accountable, mentoring each other, and developing leadership skills to drive transformation in the lives of individuals around them. Each person has been through the same experience, is relatable and demonstrates an example-in-action for others.
While this approach is harder to find today, it has proven it's effectiveness.
This peer community approach flourished from the 1960s to the 1980s as evidence accumulated that they were significantly more effective than “professionalized” forms of therapy for some clients. Long-term sobriety rates were often three to five times higher than for those treated in 60 or 90-day 12-step based programs run by clinicians.
And yet, by the turn of the century, there were only a handful left.
Long-term sobriety rates were often three to five times higher than for those treated in 60 or 90-day 12-step based programs run by clinicians.
What We Forgot
We are not at the beginning of the opioid epidemic. Heroin has been around for a couple of centuries. And widespread concern about opiate abuse has swelled periodically since its discovery. As heroin use increased in concert with the hippie movement of the 1960s, the world scrambled for solutions. Many began to despair that hard-core drug addiction was incurable. In fact, dismal outcomes from available treatment options caused practitioners to progressively lower the bar in defining “success.” Eventually, even tiny reductions in drug use frequency were considered sufficient cause for claims of efficacy. Forgive the metaphor, but full sobriety became little more than a pipe dream. For example, a daily heroin user who abstained on Sundays was cause for celebration and the treatment method that got him there was declared effective.
Then, in the midst of the gloom, a new hope emerged from quirky self-help communities. Eschewing the belief that drugs were the problem, early innovators of CTCs argued that long-term addiction was fundamentally a problem of disconnection. Thus, participants learned to live in a large self-reliant family – one that demanded extraordinary levels of selflessness, honesty, humility and mutual responsibility – as the primary therapy. The assumption was that the best way to learn to live in a healthy community was to practice living in a healthy community – for a long time. Individuals were promised that if they would “act as if” they were a decent, honest, capable human being, they would eventually become it.
And evidence began to accumulate that not only did the approach work, but for long-time users it appeared far more effective.
In one of the most rigorous addiction recovery studies ever conducted, Dr. George DeLeon found that 88-92% of those who completed a two-year stay at Phoenix House (one of the early CTC innovators) were employed, crime free and completely abstinent two years later. Successive studies gave credence to the idea that focusing on “whole person change” rather than simply getting off drugs was substantially more effective for the chronic criminal-addict and that this model was more effective at bringing about this whole person change than any other intervention studied for the long-term criminal addict.
The Downward Spiral
Early CTCs prized self-reliance. They believed that a real community is one that requires its members to solve real-life problems; problems like generating income, cooking meals, fixing roofs, confronting freeloaders, and resolving the myriad conflicts that inevitably emerge when a bunch of criminals and drug addicts run a house together. Solving real-life problems in an environment of raw and instantaneous feedback accelerated personal growth. In fact, as non-addicts began to discover the kind of authentic community residents were creating, thousands of them began seeking ways to get the benefit of being part of a CTC.
And then the movement lost its way. Leaders of CTCs began accepting large government grants offered to help them accelerate their growth. With an influx of subsidies, the communities no longer needed to be self-reliant. Residents began focusing more on traditional rehab activities like classwork, workshops and talk therapy. They began to act more like patients and less like community peers. Soon government began intruding on the model itself. It demanded that CTCs adopt practices that were inconsistent with their natural community approach. It pressured them to hire professional staff. And, inevitably, it began to complain that two-years (the typical minimum stay) was too long, even though all the clinical research showed that longer programs were more effective in bringing about whole person change.
Soon, “Therapeutic Communities” emerged that were run by licensed professional staff, required only a few months stay, and were funded largely by outside players. Today, there are a number of programs that call themselves Therapeutic Communities, but have little resemblance to the early model and typically act no differently than a traditional drug rehabilitation program. This is why The Other Side Academy is differentiating our model by calling ourselves a “Classic Therapeutic Community.” We believe the chronic failure of current rehabilitation options for long-term addicts is evidence that the classic model is needed more today than ever before.
Recovering the Recovery Industry
Which brings us to the gathering in Salt Lake City. Participants in this historic conference have demonstrated that CTCs are as relevant and as effective today as they were in the 1960s and 70s. The opioid crisis has affected individuals and families in all strata of society—but none moreso than those who have been trapped in the cycle for decades. Fortunately, organizations like The Other Side Academy, TROSA, John Volken Academy, Habilitat and Red Barn Farms are reestablishing the kind of long-term, self-reliant, peer-run communities that have proven effective in the past.
Here is just an example of their impact:
- The Other Side Academy in Salt Lake City, Utah and Denver, CO - Over 90% of two-year graduates are employed, housed, and sober.
- TROSA in Durham, North Carolina - Nine out of ten program graduates remain sober one year after completing treatment.
- Habilitat in Kaneohe, HI - Success rate is 3x the national average.
Their goal is to not only reintroduce this important option to those who need it, but also to inoculate it against the destructive intrusions that overcame it in the past. Core to the concept of CTCs is that what is right for the client is right for the program. The best way to learn self-reliance is to practice self-reliance. And financial self-reliance is both the best client therapy and the best way to inoculate the program against forces that would induce toxic change.
It’s time to reclaim the past, and this time, make it last.