Treatment Programs, Centers, and Organizations: A Historical Perspective

Drug and alcohol abuse are age-old problems, but the development of treatment programs occurred fairly recently. Most formal treatment programs were founded in the second half of the twentieth century. Many came about because of an increased focus on social programs during the mid-1960s. In that period, President Lyndon B. Johnson created a policy called the Great Society, which stressed that communities should take responsibility for social problems and learn how to solve them. As a result of Great Society policies, new terms such as "community-based" and "storefront" (referring to programs that operated out of storefronts in various communities) emerged. The programs that developed from this time forward took varying approaches to treatment for substance abuse. This article presents an overview of some significant drug and alcohol abuse treatment programs, centers, and organizations.

Hazelden Foundation

Hazelden (PO Box 11, CO3, Center City, MN 55012–0011; 800–257–7810), established in 1949, was one of the pioneering programs that developed the approach to treatment that is now widely known as the Minnesota Model. Today, the private, nonprofit Hazelden Foundation operates residential (live-in) rehabilitation programs. The main headquarters is located in Center City, Minnesota, with additional facilities in Illinois, Minnesota, New York, and Florida. The programs offer Minnesota Model treatment for thousands of alcoholics and drug-dependent men and women each year. In 2000 Hazelden granted its first master of arts degrees in the field of addiction counseling.

The stay at a residential treatment center lasts an average of twenty- eight days, but there is no time limit. Rehabilitation is done by a staff of trained counselors who are also working on their own programs of recovery. The staff identifies each person's needs and designs an individual treatment plan, with the individual helping to determine the best course of treatment. Treatment at Hazelden makes use of the beliefs and strategies of Alcoholics Anonymous.

See Organizations of Interest at the back of Volume 3 for address, telephone, and URL.

Daytop Village

Daytop Village, Inc. (54 West 40th Street, New York, NY 10018; 212–354–6000), which began in 1964, was developed to treat convicted felons who were addicted to drugs. This new approach offered an alternative to imprisonment, in the form of a residential treatment center, based on an approach called the therapeutic community, developed by a group known as Synanon. This approach has proven highly effective for both adolescents and adults, regardless of the types of drug they use. It involves four basic types of treatment: (1) behavior management and behavior shaping, (2) emotional and psychological life, (3) ethical and intellectual development, and (4) work and vocational life. By the mid-1970s, Daytop was also offering separate, nonresidential programs to adults and adolescents.

The Daytop treatment system views drug dependence as the result of a mix of factors: a person's education, medical history, emotional and spiritual life, and social influences. Treatment, according to the Daytop model, must attend to all of these factors. Many successful treatment programs have been built on a foundation of Daytop ideas.

Marathon House

In 1966 social workers for Progress for Providence (Rhode Island) became concerned about a growing community presence of heroin, heroin dealers, and addicts. After training at Daytop Village, representatives from Progress for Providence established Marathon House, the first New England-based therapeutic community, in Coventry, Rhode Island, in October 1967. Later, additional treatment facilities, including one for male adolescents, were opened throughout New England. In 1999 Marathon became an affiliate of Phoenix House.

Phoenix House

Founded in 1967, Phoenix House (164 W. 74th Street, New York, NY 10023; 212–595–5810) is a therapeutic community program that developed out of the treatment approach begun at Synanon. Phoenix House provides drug-free residential and outpatient treatment for adults and adolescents, plus intervention and prevention services. Phoenix House operates programs in prisons and homeless shelters. It is one of the largest nongovernmental, nonprofit drug-abuse service agencies and has a 1–800–COCAINE substance-abuse information and referral service.

Haight-Ashbury Free Clinic

The Haight-Ashbury Free Clinic (558 Clayton Street, San Francisco, CA 94117; 415–487–5632) was founded in June 1967 by doctors and community volunteers to provide medical services for the waves of young people, known as hippies, who came to San Francisco during the "summer of love." These young people often lived in crowded, unclean conditions, and many contracted respiratory, skin, and sexually transmitted diseases. The Free Clinic offered an alternative to the established medical care system. Counselors at the Free Clinic viewed health care as a right, not a privilege, and provided services without charge and without criticism of the patients' lifestyle. The Free Clinic developed ways to treat addiction to heroin, sedative-hypnotics , stimulants , and psychoactive drugs. Haight-Ashbury Free Clinics, Inc. provides community medical services to the working poor, the unemployed, and the homeless.

Gateway Foundation

In 1968 the not-for-profit Gateway Houses Foundation became the first therapeutic community in Illinois. Modeled on Daytop Village, it was established as a residential setting in which former drug addicts could help other drug abusers find a way to live drug-free, useful lives in the community. Outpatient programs were also developed for individuals who did not need long-term residential treatment. The agency changed its name to Gateway Foundation in 1983 to better describe the services offered. Gateway also offers community-based education and prevention programs.

The therapeutic community remains the core of Gateway's programs. Individuals participate in support groups that use the Twelve Steps during and after treatment. Gateway Foundation's successful treatment center within the Correctional Center of Cook County (the largest U.S. county jail) resulted in treatment programs for inmates in other Illinois and Texas prison programs. Treatment for all Gateway clients includes work and social-skills development, continuing education, and employment counseling.

Oxford House

Oxford House, Inc., is a movement of halfway houses, or transitional homes that help recovering individuals make the transition from in- patient treatments to a less-structured life. Oxford Houses do not receive financial support from the government. The first Oxford House was established in Silver Spring, Maryland, in 1975, in response to a decision by the state of Maryland to save money by closing a publicly supported halfway house. The men living in it decided to rent and operate the facility themselves. Operated democratically, residents of the house determined how much each would have to pay to cover expenses, developed a manual of operations, and agreed to evict anyone who returned to substance use. The concept spread, and by 2000 there were approximately 350 houses in North America.

Each Oxford House makes use of AA and Narcotics Anonymous (NA) strategies, though the houses are not connected to those two organizations. Individuals can remain in residence as long as needed to become sober. The average length of stay is thirteen months.

See Organizations of Interest at the back of Volume 3 for address, telephone, and URL.

Second Genesis, Inc.

Second Genesis, Inc. (7910 Woodmont Avenue, Suite 500, Bethesda, MD 20814; 301–656–1545), is a long-term, residential and outpatient rehabilitation program for adults and teenagers with substance abuse problems. Founded in Virginia in 1969, Second Genesis operates residential therapeutic communities and outpatient services in Maryland, Virginia, and Washington, D.C. Second Genesis admits adults, women and their young children, and teenagers.

The Second Genesis residential program has been described as a school that educates people who have never learned how to feel worthy without hurting themselves and others. Through highly structured treatment, Second Genesis combines the basic values of love, honesty, and responsibility with work, education, and intense group pressure to help correct the problems that prevent people from living by these values. Discovering self-respect in a family-like setting, residents are taught to replace behavioral problems and substance abuse with positive alternatives.

Walden House

Walden House (520 Townsend Street, San Francisco, CA 94103; 415–554–1100) is a therapeutic community that began in San Francisco. It offers residential facilities for adults and adolescents, a day treatment program, outpatient services, and a nonpublic school and training institute. Walden House is a highly structured program designed to treat the behavioral, emotional, and family issues of sub- stance abusers. The heart of Walden House is a long-term residential treatment program in several phases. All of the household tasks, groups, and seminars promote responsibility and emotional growth. Walden House emphasizes self-help and peer support.

Founded in 1969 as a response to the drug epidemic of the 1960s, Walden House has grown into one of the largest substance-abuse programs in California. The program pioneered the use of alternative treatments with substance abusers, for example, herbs, diet, and physical exercise. Walden House has designed many special programs to treat particular populations, including clients with AIDS, homeless people, minorities, pregnant women, mothers, and clients referred from the criminal-justice system as an alternative to imprisonment.

Operation PAR

Operation PAR, Inc. (Parental Awareness & Responsibility) is a therapeutic community founded in 1970 by Florida state and county officials and a concerned parent. In the years since its founding, PAR has developed one of the largest nonprofit systems of substance-abuse education, prevention, treatment, and research in the United States. At present, PAR operates more than twenty-five substance-abuse programs in nineteen locations in Florida. The program targets individuals who behave in aggressive and antisocial ways as a result of substance abuse. The facility is an important alternative to imprisonment for criminal courts throughout central Florida. Approximately 70 percent of clients have histories of significant involvement with the criminal-justice system. PAR offers individual and group counseling, AA and NA support groups, educational services, job training and a job placement program, work experience, recreational therapy, and parenting therapy and classes.

Project Return Foundation, Inc.

Project Return Foundation, Inc. (10 Astor Place, 7th Floor, New York, NY 10003; 212–979–8800) is a nonprofit human-services agency that operates several New York City programs following the therapeutic community approach. The agency was founded by two recovering addicts in 1970 as a self-help and community center for substance abusers.

Project Return also operates an anti-AIDS education/prevention program; a medically supervised, drug-free outpatient program; and a facility for substance abusers who are HIV-positive. In total, nearly 1,000 men and women receive daily treatment and rehabilitation services through programs run by Project Return Foundation, Inc.

Abraxas

The Abraxas Foundation was founded in Pennsylvania in 1973 to offer drug treatment to individuals in the state's juvenile and adult justice system. The state required that the program use a then- abandoned U.S. forest-service camp, Camp Blue Jay, within the Allegheny National Forest. By 1988 all Abraxas facilities served male or female adolescents. For example, Abraxas V in Pittsburgh was developed as an all-female residential facility. In 1990 a project was developed to provide community-based services to youths returning to Philadelphia from state institutions. The success of this project led to its expansion to Pittsburgh.

From its beginnings, Abraxas has made education an essential part of its therapeutic community treatment. The Abraxas School, a private high school on the Abraxas I treatment campus, offers a full curriculum of courses and special educational services for the resident population. Alternative schools have been developed in Erie and Pittsburgh because of the tremendous difficulty troubled adolescents have returning to public high schools.

Institute on Black Chemical Abuse (IBCA)

Founded in 1975, the Institute on Black Chemical Abuse (2616 Nicollet Avenue South, Minneapolis, MN 55408; 612–871–7878) is an organization that provides programs and services for the African- American community. IBCA seeks to encourage and support the exploration, recognition, and acceptance of African-American identity and experience, including the unique history of African Americans in the United States and the role that racial identity plays in drug dependence. Programs are designed to address the devastating effects of the drug-abuse problem on this community. IBCA offers outpatient treatment and home-based support.

IBCA's efforts in the community include education and prevention for people who face the problems of substance abuse. IBCA also educates and trains clergy members working with these issues in the community. The IBCA prevention programs have involved school and business leaders in programs aimed at establishing community awareness of substance-abuse issues. The Drug Free Zones program, in particular, has received national recognition.

Jewish Alcoholics, Chemically Dependent Persons and Significant Others Foundation, Inc. (JACS)

JACS is a nonprofit volunteer membership organization (850 Seventh Avenue, New York, NY 10019; 212–397–4197). JACS provides support programs and conducts retreats for recovering Jewish substance abusers and their families. These programs aim to strengthen family communication and reconnect individuals with Jewish traditions and spirituality. The programs are designed to help participants find ways in which Judaism can assist their continuing recovery. Participants and rabbis explore the relationship between Jewish spiritual concepts and Twelve-Step programs. JACS also provides community outreach programs offering information on alcoholism and substance abuse to Jewish spiritual leaders, health professionals, and the Jewish community.

Society of Americans for Recovery (SOAR)

Society of Americans for Recovery (600 E. 14th Street, Des Moines, IA 50316; 515–265–7413) is a national organization of concerned people whose aim is to prevent and treat dependence on alcohol and other drugs, and to educate the public about substance abuse and about its successful treatment. The organization sponsors regional conferences throughout the country and publishes a newsletter. The organization tries to fight the negative stereotype that society forms of alcoholics and addicts, and it supports lobbying for more funding of treatment. It also encourages people to learn more about addictions and recovery and to meet others who are active in communities on behalf of substance-abuse issues.

Betty Ford Center

This eighty-bed hospital for recovery from dependence on drugs or alcohol was named in honor of President Gerald Ford's wife, who was treated successfully and who promotes such therapy. The center is located southeast of Palm Springs, California, on the campus of the Eisenhower Medical Center. The staff at the center views alcoholism and other types of dependence as long-term, progressive diseases that will be fatal if they are not treated. The program at Betty Ford is designed so that patients learn to become responsible for their own actions and recovery. Because substance abuse affects the family, the center has created the family-treatment program, a five-day intensive process that includes education and individual and group therapy.