The prison-based Therapeutic Community: Resident recommendations for program improvement.

INTRODUCTION: The prison-based Therapeutic Community (TC) is widely used within correctional institutions to address substance use disorders (SUDs). While most evaluations of the prison-based TC find the program to be effective, recent mixed evidence and the continued surge of the opioid crisis call for deeper investigation into program operations, barriers to engagement, and sources of treatment effect heterogeneity. Notably lacking from prior evaluations, and critical to our understanding of variable program engagement, is first-hand experiences and perceptions from program participants. METHODS: To assess prison-based TC resident perceptions of the program and their recommendations for improvement, we utilize data from the Therapeutic Community Prison Inmate Network Study (TC-PINS), a longitudinal data collection effort conducted in one prison-based TC unit within a Pennsylvania state prison. Specifically, we assess resident responses to the open-ended item "What can the TC do better?" Analyzing 470 responses to this question by 177 residents, two independent coders identified seven substantive categories of recommended changes or improvements to their TC program. RESULTS: Residents provided tangible recommendations for improvement of their prison-based TC program based on their experiences and perceptions. Importantly, a number of their recommendations directly counter the intended model of the TC, which highlights imperative issues underlying the translation of the TC model within the prison environment. Resident suggestions include enhanced structure, increased individualization, expanded curriculum, stricter enforcement of rules, and improved or more experienced staff. Additionally, many question the coercive nature of TC program participation within this prison system. CONCLUSIONS: Resident recommendations for program improvement unveil important sources of treatment effect heterogeneity and highlight tangible program changes that can be implemented to reduce barriers to treatment engagement. We provide suggested changes to this prison-based TC based on resident perceptions and discuss both the importance and relative ease of eliciting this critical participant feedback.

The Functional-Cognitive and Sensory Treatment (F-CaST) to improve rehabilitation outcomes of individuals with substance use disorder: a study protocol for a mixed-method randomized controlled trial.

BACKGROUND: Substance use disorder (SUD) is associated with executive function (EF) deficits and sensory modulation dysfunction (SMD). Yet, these deficits are not addressed therapeutically. This study aims to examine the effectiveness of the Functional-Cognitive and Sensory Treatment (F-CaST) compared to standard care to improve everyday performance and behavior and length of stay at the therapeutic community (TC) in individuals with SUD. In addition, to assess the improvement in EF, sensory modulation, participation, self-efficacy, life satisfaction, and use of strategies within and between groups. Satisfaction with F-CaST will also be assessed. METHODS: Forty-eight participants from a community of men in a TC, aged 18-45 years will be randomly allocated to (i) F-CaST-(experimental group) providing sensory and EF strategies for improving daily function; (ii) standard care (control group) as provided in the TC. Assessments will be conducted by assessors blind to group allocation at 4 time points: T1- pre-intervention; T2- post-intervention; T3- 1-month follow-up; and T4- 3-month follow-up. Primary outcome measures will be everyday performance, assessed by the Canadian Occupational Performance Measure (COPM), behavior and length of stay in the TC; secondary outcome measures will assess EF, SMD. Semi-structured in-depth qualitative interviews will be conducted at T1, T2 and T4. DISCUSSION: We hypothesize that F-CaST will lead to improved everyday performance and longer length of stay in the TC, compared to the control group. If F-CaST will prove to be effective, cognitive and sensory strategies may be incorporated as an adjunctive intervention in SUD rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05647863 Registered on 13 December 2022, https://classic. CLINICALTRIALS: gov/ct2/show/NCT05647863 .

Intervention diversity predicts social rehabilitation indicators at discharge in Therapeutic Communities.

INTRODUCTION: The Therapeutic Community Model narrows the gap in substance use disorder's network of assistance in Brazil by offering residential treatment to socially vulnerable populations. Due to a historical lack of evidence-based approaches, the government has established treatment guidelines and has been trying to implement training and monitoring methods. METHOD: This study analysed real-world data from the monitoring system implemented in the largest network of institutions receiving public funds in the State of Sao Paulo. Data came from 8109 records of individuals admitted between 2014 and 2016 in 48 institutions. RESULTS: Results showed that less than half of the sample was exposed to at least one therapeutic activity from each of the recreational, spiritual, educational and selfcare intervention domains, as proposed by the national guidelines. Social rehabilitation outcome (SRO) defined by housing and self-support at discharge was reported by 21 % of the sample, who stayed in residential treatment for 82.6 days in average. More than half completed the therapeutic programme while 27.3 % dropout. Treatment duration and the diversity of the interventions offered were significantly associated with SRO when mutually adjusted. Chances of SRO increased nearly 5 times when residents were offered the full range of intervention domains, even when controlling for treatment duration. Treatment duration increased chances of SRO in a dose-response manner with a threefold increase for stays up to 90 days and over 9 times for stays longer than 90 days. CONCLUSION: Our findings offer evidence to promote treatment guidelines compliance and to pave the way for the implementation of monitoring systems for this modality of treatment in Brazil and abroad.

Integration of Hepatitis C and Addiction Treatment in People Who Inject Drugs: The San Patrignano HCV-Free and Drug-Free Experience.

Injection drug use represents an important contributor to hepatitis C virus (HCV) transmission, hence therapeutic communities (TCs) are promising points of care for the identification and treatment of HCV-infected persons who inject drugs (PWIDs). We evaluated the effectiveness and efficacy of an HCV micro-elimination program targeting PWIDs in the context of a drug-free TC; we applied the cascade of care (CoC) evaluation by calculating frequencies of infection diagnosis, confirmation, treatment and achievement of a sustained virological response (SVR). We also evaluated the risk of reinfection of PWIDs achieving HCV eradication by collecting follow-up virologic information of previously recovered individuals and eventual relapse in drug use, assuming the latter as a potential source of reinfection. We considered 811 PWIDs (aged 18+ years) residing in San Patrignano TC at the beginning of the observation period (January 2018-March 2022) or admitted thereafter, assessing for HCV and HIV serology and viral load by standard laboratory procedures. Ongoing infections were treated with direct-acting antivirals (DAA), according to the current national guidelines. Out of the 792 individuals tested on admission, 503 (63.5%) were found to be seropositive for antibodies against HCV. A total of 481 of these 503 individuals (95.6%) underwent HCV RNA testing. Out of the 331 participants positive for HCV RNA, 225 were ultimately prescribed a DAA treatment with a sustained viral response (SVR), which was achieved by 222 PWIDs (98.7%). Of the 222 PWIDs, 186 (83.8%) with SVR remained HCV-free on follow-up (with a median follow-up of 2.73 years after SVR ascertainment). The CoC model in our TC proved efficient in implementing HCV micro-elimination, as well as in preventing reinfection and promoting retention in the care of individuals, which aligns with the therapeutic goals of addiction treatment.

Understanding Peerness in Recovery-Oriented Mental Health Care.

Emotional and interpersonal support systems are fundamental to recovery-oriented support programs. Peerness represents the quality of shared lived experience that enhances such support programs. Through peerness, providers of formal peer support (FPS) strategically disclose their lived experience to help service recipients reach their goals. FPS disclosure is limited compared with the kind of free sharing in mutual support programs, with FPS focusing on information that specifically helps service recipients on their recovery journey. Peerness has additional value for shared experiences relevant for diversity, equity, and inclusion efforts. This Open Forum also considers where peerness conceptually fits into research of recovery-based services.

The psychiatric work villages in Israel: a micro working community.

This paper examines the psychiatric work villages in Israel, which have so far had little historiographic attention. In the 1950s and 1960s, four work villages were established for people with psychiatric disabilities. They were intended to create a long-term rehabilitative alternative to the common hospitalization practice. These villages were organized around employment in various branches of farming and also offered recreational and cultural activities to alleviate the patients' loneliness and to create a community life. The villages echoed central values of the new country: labour, manufacturing, cooperativity, and cultural and community life. I will discuss the similarities between the psychiatric work villages and earlier, mostly Western, psychiatric therapeutic models, such as moral treatment and the therapeutic community model.

Effectiveness of the Therapeutic Community Model in Addiction Treatment: A Retrospective Pilot Study in French Prisons.

BACKGROUND: In France, addiction care in prison usually consists of nurses' interventions, medical care and socio-educational programs, but new alternatives have arisen, namely the therapeutic community (TC) model. This pilot study aims to evaluate the effectiveness of this prison-based TC in comparison with classic and socio-educational care offered in French prisons. METHODS: To compare these three types of prison-based care, two detention centers' files were screened for use of multiple drugs, willingness to participate and absence of psychiatric comorbidities incompatible with group therapy. A custom questionnaire was built based on the fifth version of the Addiction Severity Index. It investigates medical status, employment and support, primary addiction status, legal status, social/familial status and psychiatric status through various items. RESULTS: Our sample only consisted of male repeat offenders with a mean age of 37.7 ± (9.1) years. Primary addiction status improvement was observed for all care studied but was more important in TC than in classic care. Self-esteem and social/familial status saw significant improvement throughout TC care. CONCLUSIONS: The TC model represents an alternative to classic and socio-educational care in French prisons. More studies are needed to assess the extent of the benefits provided on both the medical side and economic side.

Duration of stay and rate of subsequent criminal conviction and hospitalisation for substance use among young people admitted to a short-term residential program.

INTRODUCTION: This study examined the association between program duration and rate of criminal conviction and hospitalisation for substance use up to 15 years later among young people admitted to a short-term residential program for drug and alcohol use. METHODS: Data were derived from linked administrative records of all clients referred to a modified therapeutic community for young people from January 2001 to December 2016 in New South Wales, Australia (n = 3059). Cox proportional hazards regression analyses examined the rate of conviction (separately for any offence, violent offence, non-violent offence and administrative offence) and hospitalisation for substance use, up to 15 years post-program among young people who attended treatment for 1-29 days, 30-59 days, 60-89 days and 90-120 days. RESULTS: Thirty days or more in treatment was independently associated with a lower rate of conviction for any offence and a non-violent offence, as well as hospitalisation for substance use, while 60 days or more was associated with a lower rate of conviction for a violent and administrative offence, relative to those who spent 1-29 days in the program. Additional months in the program were also associated with reduced rates of conviction and hospitalisation, although 90-120 days appeared to confer no additional benefits than 60-89 days. DISCUSSION AND CONCLUSIONS: At least 60 days may be the minimum duration needed for short-term, therapeutic community programs to reduce the risk of conviction across all crime types and hospitalisation for substance use.

Neurocognition of females with substance use disorder and comorbid personality disorder: Divergence in subjective and objective cognition.

At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = -.91), self-reported executive function (d = -.87), processing speed (d = -.40), delayed verbal memory recall (d = -.39), premorbid functioning (d = -.51), and cognitive screening performance (d = -.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = -.67) and poorer shifting performance (d = -.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.

Innovation in mental health care: Bertram Mandelbrote, the Phoenix Unit and the therapeutic community approach.

Bertram Mandelbrote was Physician Superintendent and Consultant Psychiatrist at Littlemore Hospital in Oxford from 1959 to 1988. A humane pragmatist rather than theoretician, Mandelbrote was known for his facilitating style of leadership and working across organisational boundaries. He created the Phoenix Unit, an innovative admission unit run on therapeutic community lines which became a hub for community outreach. Material drawn from oral histories and witness seminars reflects the remarkably unstructured style of working on the Phoenix Unit and the enduring influence of Mandelbrote and fellow consultant Benn Pomryn's styles of leadership. Practices initiated at Littlemore led to a number of innovative services in Oxfordshire. These innovations place Mandelbrote as a pioneer in social psychiatry and the therapeutic community approach.

Auricular acupuncture for sleep quality in participants with mental and behavioral disorders due to prior multiple drug use: a retrospective consecutive case series.

BACKGRUOUND: Poor sleep quality is associated with psychoactive substance abuse/addiction/withdrawal. Auricular acupuncture (AA) is a nonpharmacological method used for the treatment of sleep disturbances. This study aimed to examine the quality of sleep before and after AA in participants with mental and behavioral disorders due to prior multiple drug use in the therapeutic community. METHODS: This was a consecutive case series of 27 participants (25 male [92.6%]). The median age was 35.0 years (interquartile range [IQR], 29.0-37.2 years), methadone/buprenorphine were not used, and the participants were treated with AA (median number of treatments, 15.0 [IQR, 12.0-18.0]) during a median period of 51.0 days (IQR, 49.0-51.0 days) according to the National Acupuncture Detoxification Association (NADA)-Acudetox protocol. Sleep quality was determined using the Pittsburgh Sleep Quality Index (PSQI), a self-rated questionnaire that assesses sleep quality and disturbances over a 1-month interval. RESULTS: The global PSQI score dropped (indicating better sleep quality) by a median of 3.0 points (IQR, 0.0-8.0 points) after treatment. In the multivariate logistic regression analysis, with an increase in global PSQI score during AA by 1 point, there was a 0.73-fold reduction in the risk of poor sleep quality post-AA (adjusted odds ratio, 0.73; 95% confidence interval, 0.52-1.01; p<0.055; Nagelkerke's R2=0.66). CONCLUSION: The results revealed a positive effect of AA (by the NADA-Acudetox protocol) on sleep quality (as measured by PSQI) among participants in a treatment center with mental and behavioral disorders due to multiple drug use.

Classic Text No. 133: 'Maxwell Jones and the Therapeutic Community', by David Millard (1996).

This text was David Millard's departing gift to a field to which he had contributed for 30 years, as practitioner and later as Lecturer in Applied Social Studies and editor of the International Journal of Therapeutic Communities. Charting the chronology of Maxwell Jones's career as a world-renowned psychiatrist and therapeutic community pioneer, Millard contrasts Jones's contribution at Mill Hill with Tom Main's at Northfield. Jones's most distinctive contribution was allowing patients to become auxiliary therapists and freeing nurses from the nursing hierarchy. Focusing on a subset of therapeutic communities in adult psychiatry, Millard's paper is not an academic history of therapeutic communities as such. The roles of happenstance and positive deviance are demonstrated in the way change occurs in therapeutic communities. The 'charisma question' is briefly explored.

Effectiveness of social-therapeutic treatment for serious offenders in juvenile detention: A quasi-experimental study of recidivism.

Due to legislative changes in Germany, there has been an increasing expansion of social-therapeutic facilities for juvenile offenders over the past 15 years. Social therapy comprises an eclectic mix of psychotherapeutic, educational, vocational, and recreational measures in a milieu-therapeutic setting to reduce recidivism of high-risk violent and sexual offenders. This study examined the effectiveness of social-therapeutic treatment on post-release recidivism among juvenile offenders. The sample included male offenders (n = 111) of the juvenile detention center in Berlin, Germany, aged 14-22 years, who were convicted of a violent (94%) or sexual offense (6%). Seventy-three subjects admitted to the social-therapeutic unit were compared to an offense-parallelized control group (n = 38) from the regular units using a propensity score based matching procedure. Initially, the groups did not differ with respect to risk (i.e., Level of Service Inventory - Revised) or risk-related characteristics (e.g., age). Subsequent Cox regression analyses revealed no average treatment effect on recidivism. Since the results indicated that the control group was not untreated, differential treatment effects were examined in a second step. School and vocational trainings had an effect on recidivism. The findings are discussed in light of the challenges in evaluating legally mandated offender treatment.

Mindfulness-based interventions in inpatient treatment for Substance Use Disorders: A systematic review.

Inpatient treatment for Substance Use Disorder (SUD), such as Therapeutic Communities and Residential Treatment has been used to test the effect of Mindfulness-Based Interventions (MBI) over different outcomes. Although there is evidence of the effectiveness of MBIs, little is known about the particularities that the place may have in the outcomes. The main objective of this Systematic Review was to evaluate the effectiveness of MBIs for SUDs performed in the inpatient context. PubMed, Web of Science and PsycInfo were used for the search. Quantitative and qualitative studies with no control, usual treatment or other active comparator intervention for SUDs inpatient treatment from 1980 to 2020 were included. From 21 selected studies, 18 were quantitative and 3 qualitative; 12 studies were RCT. Most samples were comprised with women. Based on characteristics of outcomes, we were able to divide them into: Substance Use and Associated Outcomes, Stress, Impulsivity e Evaluation of the MBI protocol. Results suggest that stress assessment is a determining factor for treatment success in these settings. Regarding substance use, although several outcomes have been assessed, the most remarkable results were craving reduction and improvement in treatment adherence. There is evidence that MBIs in inpatient settings benefited those who participated in the experimental groups on some outcomes, such as stress and substance use. Little is mentioned about the impact of the environment over the outcomes and short follow-ups were a relevant limitation of most of the studies. Future assessments must increase follow-up time and evaluate the relationship between the context and the MBI.

The Impact of Therapeutic Community Gardening on the Wellbeing, Loneliness, and Life Satisfaction of Individuals with Mental Illness.

BACKGROUND: literature on the mental health benefits of therapeutic community gardening is not specific to individuals with mental illness and reports short-term outcomes. The impact of the coronavirus pandemic on intervention effectiveness is also unknown. This study examined the impact of therapeutic community gardening prior to and across the pandemic on the wellbeing of individuals referred for support with their mental illness. METHODS: garden members (n = 53; male = 36, female = 17) aged 47.38 ± 13.09 years reported their wellbeing at baseline and four follow-up points (FU1-FU4) across the pandemic. RESULTS: there was significant quadratic growth in wellbeing (-1.248; p < 0.001) that varied between genders (p = 0.021). At baseline, male wellbeing scores were significantly lower (p = 0.020) than the UK population norm, but there were no significant differences at any other follow-up point. Female wellbeing was significantly lower than the UK population norm at baseline (p < 0.001), FU1 (p = 0.012) and FU2 (p < 0.001), but not FU3 and FU4. CONCLUSION: therapeutic community gardening can improve and maintain the wellbeing of individuals with mental illness, even when wellbeing is deteriorating nationally. Future research should further demonstrate the long-term and cost-effectiveness of interventions.

Responding to the COVID-19 outbreak as a therapeutic community in a forensic psychiatric ward in Japan-A reconsideration of the role of therapeutic community in disasters.

The global impact of COVID-19 outbreak on psychiatric hospitals and prisons is unfathomable and unprecedented, and information is needed on how best to mitigate widespread infection whilst safeguarding the community's well-being. This study reports on how the staff and patients in a forensic psychiatric ward in Japan worked together during the COVID-19 outbreak as a "therapeutic community." The "Non-Three Cs" Karaoke Project, with infection prevention guidelines designed by inpatients, was safely conducted and its humor released the staff and patients' anxiety and tension. Through these discussions, the patients and staff gained a better understanding of viruses, transmission routes, countermeasures, and coping with stress. The study highlights the importance of disclosing information to inpatients, conducting open discussions, and involving patients in the prevention and management of infectious diseases. This report is the world's first report showing a concrete example of the therapeutic community's significance during the COVID-19 outbreak. It is an experience that offers an opportunity to reconsider the significance of the therapeutic community, in which patients are seen as a presence that brings change, strength, growth, and creativity into the therapeutic setting. We believe that such an approach in a future disaster would lead to an increase in the patients' problem-solving ability, and recovery and autonomy after discharge could be promoted. A shared difficult situation can be an opportunity to build a therapeutic alliance and make a difference.

Healing journeys: experiences of young Aboriginal people in an urban Australian therapeutic community drug and alcohol program.

Disproportionately high numbers of Aboriginal young people access residential alcohol and other drug programs in Australia. While demand is high, these programs often have low numbers of Aboriginal staff. Residential programs, however, generally offer supports that reflect features of Aboriginal health care - holistic, group-based, connected to local communities, and addressing determinants of health. The qualitative research outlined in this paper was a collaboration between a mainstream residential therapeutic community program and two Aboriginal community-controlled organisations, and Aboriginal young people and researchers, with Aboriginal research leadership. It used an Aboriginal healing framework to understand the experiences of 12 young Aboriginal people in the program, triangulated with 19 key informant interviews. This provided an opportunity to understand how Indigenous knowledge about healing related to mainstream programs and the experiences of Aboriginal young people. This moves beyond individualist and deficit-focused conceptions of youth alcohol and drug use and centres Aboriginal cultures as healing. Findings point to the need for critically self-reflective mainstream organisations, a larger Aboriginal workforce with leadership roles, partnerships with Aboriginal Elders and organisations, and an investment in Aboriginal community-controlled alcohol and other drug services.

Effects of social skills training for drug users under treatment / Efeitos do treinamento em habilidades sociais para usuários de substâncias em tratamento / Efectos del entrenamiento en habilidades sociales para usuarios de sustancias en tratamiento

The Social Skills Training (SST) presents satisfactory results in different clinical and non-clinical populations. The objective of this study is to evaluate the effects of SST on the perception of quality of life of drug users under treatment in post-intervention and follow-up conditions. It is a quasi-experimental study. The instruments used in the study were: CHASO, EMES-M, Extensive Interaction Semi-structured Test and WHOQOL. The study sample was composed of forty male drug users who participated in SST in a Therapeutic Community. The results indicate a statistically significant increase in the ability of defending rights, dealing with and keeping calm upon criticism, with medium effect size on the ability to refuse requests, refuse drugs and quality of life (psychological domain). SST was found to contribute to the development of specific social skills and as a complementary strategy in the Therapeutic Community. (AU)

O Treinamento em Habilidades Sociais (THS) apresenta resultados satisfatórios em populações clínicas e não clínicas. Objetiva-se avaliar os efeitos do THS na percepção de qualidade de vida e habilidades sociais de usuários de substâncias em tratamento nas condições de pós-intervenção e follow-up. Trata-se de um estudo quase-experimental. Os instrumentos utilizados foram: CHASO, EMES-M, Teste Semiestruturado de Interação Extensa e WHOQOL. Participaram 40 homens usuários de substâncias que participaram do THS em uma Comunidade Terapêutica. Os resultados apontam para um aumento estatisticamente significativo nas habilidades de defesa de direitos, enfrentar e manter a tranquilidade diante das críticas, com tamanho de efeito médio nas habilidades de negar pedidos, recusar a droga e qualidade de vida (domínio psicológico). Identifica-se que o THS contribui no desenvolvimento de habilidades sociais específicas, sendo uma estratégia complementar do tratamento na Comunidade Terapêutica. (AU)

El Entrenamiento en Habilidades Sociales (EHS) proporciona resultados satisfactorios en poblaciones clínicas y no clínicas. El objetivo de este estudio fue evaluar los efectos del EHS en la percepción de la calidad de vida y las habilidades sociales de los usuarios de drogas bajo tratamiento en condiciones de post-intervención y seguimiento. Se trata de un estudio cuasi-experimental Los instrumentos utilizados fueron: CHASO, EMES-M, Test Semiestructurado de Interacción Extensiva y WHOQOL. La muestra del estudio se compuso por cuarenta varones usuarios de drogas que participaron en el EHS en una Comunidad Terapéutica. Los resultados apuntan a un aumento estadísticamente significativo en la capacidad de defensa de derechos, afrontar, mantener la tranquilidad frente a las críticas, con un tamaño de efecto promedio en la denegación de peticiones, rechazo de drogas y calidad de vida (dominio psicológico). Se comprueba que el EHS contribuye al desarrollo de habilidades sociales específicas como una estrategia complementaria de tratamiento en la Comunidad Terapéutica. (AU)

Thinking of Harm Reduction and Reducing Harm in a Chinese Therapeutic Community for Drug Users.

Harm is a concept that permeates behavioral and public health discourses on addiction. Examining addiction recovery services in settings beyond the OECD led me to the question: What does harm mean in an un-urban, un-Western, and un-democratic space? While some emphasize the human rights potential of reducing harm, others speak to the violence of cure. My ethnographic research in a Therapeutic Community (TC) for drug treatment in Southwest China pushed me to consider how the potential for reducing the harms of illegal substance use balance with the complex psychological demands of cure. The alliance linking Sunlight Therapeutic Community with the provincial drug abuse institute and a foreign NGO was fragile. At the TC, they had difficulty weaving the Western psychological construct of the singular self through the Chinese scaffolding of institutional and cultural practices around the group. In thinking with the concepts of harm and reducing harm, I move across time and space to consider how current tensions link to and reflect: 1) the historical harms of opium imperialism; 2) reducing harm in translation; and, 3) reducing harm in the recent psycho-boom.

¿Qué variables facilitan el alta terapéutica en servicios residenciales de tratamiento de las drogodependencias? Estudio en dos comunidades terapéuticas en Cataluña / What variables facilitate therapeutic discharge in residential drug treatment services? A study in two therapeutic communities in Catalonia

La retención en el tratamiento residencial de drogodependencias es el mejor predictor deléxito terapéutico. Quienes finalizan sus tratamientos con una alta terapéutica (AT) presentanuna mejor evolución en su tratamiento integral que quienes no lo hacen. El objetivo de esteestudio fue analizar las variables relacionadas con el alta terapéutica (u otros motivos no deseados de salida precoz del tratamiento) en dos comunidades terapéuticas (CT) profesionales enCataluña. La muestra estuvo conformada por las personas que iniciaron tratamiento en las CTentre marzo de 2018 y marzo de 2020. Para ello se hicieron comparaciones de medias, varianzas y tablas de contingencia. Se ajustó un modelo de regresión logística binaria para determinarvariables predictoras relacionadas con el AT. De 223 pacientes, un 32,8% consiguieron AT. Losdependientes de cocaína y de heroína presentaron un menor número de AT, contrariamente alos consumidores exclusivos de alcohol. Quienes tenían antecedentes de tratamientos previospresentaron un mayor riesgo de abandono. Las personas que refirieron peor estado de saludgeneral, peor calidad de vida, mayor ansiedad, peor estado de ánimo, mayor puntuación en STAI(rasgo o estado), mayor puntuación en el inventario de depresión de Beck o mayor impulsividadobtuvieron menos AT. En conclusión, se identificaron algunas variables capaces de pronosticaruna mayor posibilidad de altas terapéuticas en el tratamiento residencial de las adicciones. Losdías en tratamiento, la percepción de la calidad de vida y el diagnóstico exclusivo de dependenciade alcohol resultaron las variables que mejor predijeron, de forma independiente, el AT. (AU)

Retention is the best predictor of therapeutic success in community-based substance abusetreatment. Those that finalize the treatment having therapeutic discharge (TD) have best resultsafter the treatment than those who don’t get the TD. The objective of this study was analysedvariables related with TD (or another drop-off reasons) in two professionalized therapeuticcommunities (TC) in Catalonia (Spain). The sample included people who started treatment inthe TC between March 2018 and March 2020. Median and variances comparison and contingence tables were performed. A logistic regression was adjusted to determine variables with capacity to predict TD. 223 patients were included and the 32,8% had TD. Patients with exclusivelyalcohol-dependence diagnose had more TD than patients with diagnoses of cocaine-dependence and heroin-dependence. Those who had previous experiences of treatment were riskierof drop-off. Patients who referred worst health status and quality of live, more anxiety, worstmood situation, more punctuation in the STAI test, more punctuation in the Beck depressioninventor or more impulsivity, had less TD. In conclusion some variables with capacity to predicthigh probability of TD in community-based substance abuse treatment were identified. The timespent under treatment, perception of quality of live and the diagnose of alcohol-dependenceexclusively were independent variables that predict better the TD. (AU)