Gregory Bunt

Orientation Toward Spirituality and Self-Help Approaches in the Therapeutic Community

Abstract Although Alcoholics Anonymous and other Twelve-Step interventions are among the most widely utilized self-help options by persons with chemical dependency, little is known concerning whether this approach should be integrated with non-spirituality based self-help approaches. The purpose of this study was to assess the extent to which clients receiving inpatient treatment in a residential therapeutic community (TC) felt that spirituality based interventions should be featured in TC treatment. Three hundred twenty-two members of the Daytop TC completed a survey assessing personal orientation to spirituality and attitudes towards spirituality based treatments. The majority of clients believed that the TC program should feature spirituality more in treatment. Nearly half agreed that the Twelve-Step (AA) approach should be more a part of TC treatment. Preference for Twelve-Step meeting interventions was positively correlated with past attendance at Twelve-Step meetings. Personal spiritual orientation to life was positively correlated with endorsement of spirituality based interventions in TC treatment. These findings highlight the importance of integrating treatment approaches which address the spiritual needs of TC residents.

Preference for Spirituality and Twelve-Step-Oriented Approaches Among Adolescents in a Residential Therapeutic Community

Abstract This study sought to determine which adolescents being treated for substance use in a residential Therapeutic Community (TC) would endorse spirituality and Twelve-Step-oriented approaches as part of their treatment. By identifying individual difference characteristics associated with preference for spirituality and Twelve-Step-oriented approaches, integrated substance abuse treatments can be targeted to appropriate subgroups of adolescents. A total of 181 adolescents completed a survey assessing their substance use and attitudes toward spirituality and Twelve-Step-oriented approaches that was similar to a survey completed by 322 adults in the same residential TC program. In the adolescent sample, three spirituality-related characteristics—perceived connectedness to others, frequency of prayer, and spiritual orientation to life—were associated with preference for both spirituality and twelve step oriented approaches being featured more in TC treatment. Adolescents were less likely than adults to express a preference that both approaches be featured more in TC treatment.

The Therapeutic Community: An International Perspective

ABSTRACT The Therapeutic Community (TC) for drug-free substance abuse treatment can be found in more than 65 countries around the world, reflecting the global scope of substance abuse and addiction. This article describes some of the historical developments from an American-based to an international treatment model with professional associations on every continent. Possibly the two most important TC principles are outlined; i.e., the role of the treatment community as the primary agent of client change and the distinct therapeutic structure. While these two principles define the TC and can be found in programs around the world, the model leaves sufficient room to adapt practices and interventions to the respective culture. Examples of cultural adaptations are briefly described in this article.

The role of social cohesion among residents in a therapeutic community

According to the Therapeutic Community (TC) treatment approach, social affiliation with the drug-free peer community is the basis for patients initiating therapeutic change. A total of 322 TC residents were assessed with regard to social affiliation, acceptance of TC philosophy, perceived benefit of program components, level of depression, and length of time in treatment. Residents exhibited a higher level of affiliation with TC members than with untreated substance abusers they knew outside the program. Being female, and separated from a spouse, were each associated with a higher level of TC member affiliation. After controlling for sociodemographic characteristics, two variables emerged as unique significant correlates of affiliation: perceived benefit for recovery of TC treatment was associated with greater TC member affiliation, whereas level of depression was inversely correlated. These findings are interpreted in relation to the goals of the TC process and to implications for treatment.

Spiritual Orientation among Adolescents in a Drug-Free Residential Therapeutic Community.

Clinically, the treatment of substance abuse has relied on the Twelve Steps model, which is heavily focused on issues of spirituality. Adolescents may have cognitive and developmental issues that preclude them from taking advantage of the Alcoholics Anonymous (AA) model. To this end, we examined the spiritual orientation and spiritual behaviors among adolescent substance abusers in a drug-free residential therapeutic community (TC). One hundred and eighty-six adolescent clients of a drug-free residential therapeutic community were given a self-report questionnaire about their substance abuse and attitudes toward spirituality. The adolescents had a mean Spiritual Orientation Score of 21.48, reflecting a significantly lower level of spiritual orientation than adults in a similar setting. Also, adolescents who were heavy marijuana users were less spiritual than those adolescents who used marijuana less. Spirituality and affiliation with religious institutions may be considered a protective factor because they represent more conventional beliefs and attitudes and indicate a stronger social bond to conventional society.

An exploratory study of spiritual orientation and adaptation to therapeutic community treatment.

ABSTRACT The purpose of this study was to determine the extent to which spiritual orientation was associated with adaptation to therapeutic community treatment. Spiritual orientation was assessed by the Spirituality Self-Rating Scale, a measure consistent with the conceptualization of spirituality typically reflected in Alcoholics Anonymous members’ views. Spiritual orientation was positively correlated with acceptance of therapeutic community principles and clinical progress. Further assessment of spirituality related characteristics and their relation to treatment outcomes is important in informing the design of interventions aimed at improving progress in the therapeutic community, particularly those aspects involving the relative value of integrating the 12-Step group approach in therapeutic community programs.

Gang membership and subsequent engagement into a drug free therapeutic community.

Abstract The purpose of the present study was to assess the relationship of history of gang involvement to engagement in Therapeutic Community (TC) treatment. Residents (N = 222) at two Daytop facilities completed a survey assessing sociodemographic characteristics, prior gang involvement and multiple aspects of TC functioning. Residents with prior gang involvement (21%) were younger and less educated than those without prior gang involvement. Although gang involved residents were more likely to achieve a high work role status in the program they scored lower on multiple indicators of engagement in treatment including acceptance of Daytop philosophy and TC clinical progress.

Do Hispanic Patients Adapt as Well to a Residential Therapeutic Community as Do Members of Other Ethnic Groups

There has been increasing interest in developing interventions for the treatment of substance abuse that takes into consideration the individual’s cultural values and norms. Guidelines for interventions targeted to Hispanic substance abusers have emphasized consideration of values related to allegiance to the family (Familismo) and gender appropriate role behavior (Machismo and Hembriso) (1). Participation in a therapeutic community (TC) may pose challenges for Hispanic patients because the program involves yielding to social pressure from the TC community to adopt its social norms and self-disclosing personal information—behavioral requirements that may conflict with culturally sanctioned behaviors specific to the Hispanic culture. Ethnic groups who are numerical minorities within the TC program may also experience difficulty in adapting to treatment (2). In order to assess whether there were ethnic differences in pretreatment characteristics

New perspectives in the legal psychiatry of cocaine-related crimes

The legal criteria for the insanity defense as it applies to cocaine-related crimes remains elusive because of cocaines unique spectrum of effects on human thought and action. This paper discusses the literature relevant to cocaine and forensic psychiatry/psychology, and summarizes the results of a survey of forensic psychiatrists on the topic of drug-induced psychosis. A conceptual framework is posited for the expert witness to distinguish the separable effects of cocaine on human behavior and to clarify their relationship to criminal responsibility.