Treatment Programs, Centers, and Organizations: an Historical Perspective

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TREATMENT PROGRAMS, CENTERS, AND ORGANIZATIONS: AN HISTORICAL PERSPECTIVE

The development of treatment programs for the age-old problem of drug and alcohol abuse has been a fairly recent phenomenon. Most formal treatment programs were founded in the latter half of the twentieth century; the mid-1960s were a period of significant focus on U.S. social programs. Growing out of President Lyndon B. Johnson's Great-Society strategy was a new way of viewing the community's capacity to take ownership of its social problems, develop collaborative strategies, and heal its own wounds. Toward that end, a new lexicon emerged—community-based, storefront, and streetworker —to identify but a few terms. The programs that evolved from this movement employ a variety of treatment philosophies; some treatment centers target a specific gender, ethnic, or age group. This article presents an over-view 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) was established in 1949; it 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 rehabilitation programs (main headquarters in Center City, Minnesota, with additional facilities in Illinois, Minnesota, New York, and Florida) providing Minnesota Model treatment for thousands of adult alcoholic, drug-dependent men and women each year. Hazelden offers accredited distance learning programs for addiction studies, and in 2000, granted its first master of arts degrees in Addiction Counseling.

Residential treatment consists of an open-ended stay lasting an average of twenty-eight days. Primary rehabilitation is done by a staff of trained counselors who are also working their own programs of recovery. During the first week of primary rehabilitation, the staff concentrates on problem identification, guided by assessments of psychological, spiritual, health, social activities, and chemical-use profiles. After the client's problem is identified, an individual treatment plan is formulated both for and with the client. Goals, objectives, and methods are identified in the treatment plan and progress in meeting these expectations is monitored. Treatment at Hazelden is integrated with the principles of Alcoholics Anonymous.

SYNANON

Founded in 1958 by Charles E. Dederich, Synanon pioneered a breakthrough approach to the treatment of drug dependence. Using some of the approaches he had personally experienced in Alcoholics Anonymous, a mixture of self-reliance and Buddhist philosophies, and his own bombastic interpersonal style, Dederich shaped a self-help organization that grew from a small storefront in Santa Monica, California, to over 2,000 members in multiple residential settings across the United States by the early 1970s. The organization amassed considerable wealth, and as it became more self-sufficient, Synanon members began to consider their process a religion. By the mid-1970s, the organization was engaging in controlling and even violent practices against its members, including forced vasectomies and abortions. The whole system also began to have increasingly violent interactions with outsiders—including intimidation and actual physical assaults. The organization, so lauded in the press during its early years, became an object of national criticism. Then Dederich reversed his earlier position of shunning chemicals and began to drink. In 1978, he was indicted for conspiracy to commit murder, and the court instructed him to vacate leadership. A small cadre of members still venerated him until his death in 1997. Synanon ceased its drug-treatment programs in the 1980s and is no longer involved in any human-service business.

Controversies aside, the methodologies developed and refined by Synanon became the precursor for the drug-free Therapeutic Community approach. This strategy has proven significantly effective for both Adolescents and adults, regardless of the types of drug they use.

The salient ingredients pioneered at Synanon remain fundamentally intact in drug-free therapeutic communities in the United States and elsewhere. These fundamental ingredients fall into four major categories: (1) behavior management and behavior shaping, (2) emotional and psychological life, (3) ethical and intellectual development, and (4) work and vocational life. Within each of these categories, elaborate sets of techniques use deliberate but artful dissonance and confrontation as major tools for changing behavior.

DAYTOP VILLAGE (ALSO DAYTOP FOR A DRUG FREE WORLD)

Daytop Village, Inc. (54 West 40th Street, New York, NY 10018; 212-354-6000), which began in 1964, had its roots in a research project conducted by Alex Bassin and Joseph Shelly of the Probation Department of the Second Judicial District of the Supreme Court of New York. They were awarded a grant from the National Institute of Mental Health to initiate a new approach for treating drug-addicted convicted felons. This new approach would offer an alternative to incarceration, in the form of a residential treatment center modeled roughly after Synanon. The founders of Daytop Village included Dr. Daniel Casriel, David Deitch, a former Synanon director, and Monsignor William B. O'Brien, a Roman Catholic priest.

Daytop's primary effort was long-term residential treatment, but by the mid-1970s, day-care models had been implemented, as well as discrete adult and adolescent programs. During the mid-1980s, Daytop expanded its program to include working adults—both after work and during special employer-contracted daytime hours. In the late 1980s Daytop instituted special programs for pregnant women.

The basic assumption underlying the Daytop treatment system is that drug dependence is a mix of educational, biomedical, emotional, spiritual, and psychosocial factors—and the treatment environment must attend to all of these. This philosophy serves as the basis for many successful treatment programs.

MARATHON HOUSE

In 1966, streetworkers for Progress for Providence (Rhode Island) began to acknowledge a growing community presence of Heroin, heroin dealers, and addicts. Representatives from this organization pursued training with Daytop Village, seeking technical assistance to establish a Providence-based initiative. Marathon House, the first New England-based Therapeutic Community, was established in Coventry, Rhode Island, in October 1967.

In successive years, additional facilities were opened in Massachusetts and Connecticut. A facility for Adolescents in Middletown, Rhode Island, began operating in 1970. While relatively short lived, it laid the groundwork for those modified therapeutic communities Marathon currently operates throughout New England. In February 1971, Marathon acquired a historically significant property in Dublin, New Hampshire, the Dublin Inn. In the 1990s, this facility became the center for three distinct Marathon programs: the original New Hampshire adult therapeutic community, the Lodge at Dublin, a facility for male adolescents, and the Alcohol Crisis Intervention Unit, a small social-setting detoxification facility. 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) was a second-generation Therapeutic Community (TC) program that developed from the treatment approach originated 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 correctional facilities 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 David E. Smith, M.D., with the help of other physicians from the University of California Medical School at San Francisco 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, unhygienic conditions and were vulnerable to respiratory, skin, and sexually transmitted diseases. The Free Clinic offered an alternative to an established medical care system that members of the Counterculture saw as difficult to access, dehumanizing, unresponsive, and often judgmental about their nontraditional lives. The clinic's philosophy included beliefs that health care is a right, not a privilege, and that it should be free and nonjudgmental.

The free clinic became a source of innovative drug-abuse treatment, where many health professionals received their early field training, and treatment approaches were developed for the Detoxification of Opioid, Sedative-Hypnotic, stimulant, and Psychoactive drug abusers. Today, Haight-Ashbury Free Clinics, Inc., provides a full spectrum of community medical services to an ethnically mixed population of the working poor, the unemployed, and the Homeless.

GATEWAY FOUNDATION

In 1968, Gateway Houses Foundation was incorporated as a not-for-profit corporation and 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.

The early years of treatment experience demonstrated that not all of those entering Gateway needed long-term residential treatment. Programs were devised or modified to fit the specific needs of the individuals served. The agency adopted the name Gateway Foundation in 1983 to better symbolize the services offered. To extended care (residential, long-term treatment), Gateway added outpatient (both intensive and basic), detoxification, and short-term treatment, as well as community-based Education and Prevention Programs.

The therapeutic community remains the core of Gateway's programs. Participation in Twelve-Step support groups are the client's mainstay 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 correctional programs. Treatment for all Gateway clients includes work and social-skills development, continuing education, and employment counseling.

OXFORD HOUSE

The autonomous halfway-house movement of the 1990s, Oxford House, Inc., owes its momentum to J. Paul Molloy, who in 1975 established the first Oxford House in Silver Spring, Maryland. The stimulus for this first house was 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. When the first Oxford House found itself with a surplus of funds, the residents decided to use the money to rent another house and expand the concept. Each subsequent house followed suit. There are now separate houses for men and women. In 2000, there were approximately 350 houses in North America.

While not affiliated in any way with AA or Narcotics Anonymous (NA), the principles of these groups are integral to the operation of each Oxford House. Individuals can remain in residence as long as needed to become stably sober. The average length of stay is thirteen months.

Although a recovery house can be self-run and self-supported without being an Oxford House, if it wishes to affiliate, it must file an application for a charter with Oxford House, Inc. (9314 Colesville Road, Silver Spring, Maryland 20907). Oxford House, Inc., a nonprofit corporation, does not own property, but helps groups wanting to start a new house.

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, under the direction of Dr. Sidney Shankman, Second Genesis is a nonprofit organization operating residential Therapeutic Communities and outpatient services that serve Maryland, Virginia, and Washington, DC. 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 deficits and substance abuse with positive alternatives. The Mellwood House facility in Upper Marlboro, MD, provides residential treatment for women and their young children, offering children's services, vocational counseling, parenting classes, and anger management workshops. In 1998, Second Genesis opened adult and adolescent outpatient programs, providing group and individual therapy, educational services, and DWI/DUI counseling.

WALDEN HOUSE

Walden House (520 Townsend St., San Francisco, CA 94103; 415-554-1100) is a comprehensive Therapeutic Community (TC), which began in San Francisco, CA. It consists of 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 substance abusers.

The heart of the Walden House TC is a long-term residential treatment program, consisting of a series of phases from orientation to aftercare. Within the TC, all the household tasks, groups, and seminars promote responsibility and emotional growth. The activities are part of an integrated array of therapeutic experiences, in which residents continuously see themselves in a context of mutual support. The philosophy of Walden House emphasizes self-help and peer support.

Founded in 1969 by Walter Littrell 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 incarceration.

OPERATION PAR

Operation PAR, Inc. (Parental Awareness & Responsibility) was founded in 1970 by Florida State Attorney James T. Russell, former Pinellas County Sheriff Don Genung, County Commissioner Charles Rainey, and Shirley Coletti, 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. Operation PAR's Therapeutic Community (TC) has been in continuous operation since 1974. The program targets individuals who are severely dysfunctional and who exhibit antisocial behaviors as a result of substance abuse. The facility is an important alternative to incarceration for criminal courts throughout central Florida. Approximately 70 percent of clients have histories of significant involvement with the criminal-justice system.

Overall services provided by PAR TC include individual and group counseling, counseling groups for special populations, AA and NA support groups, on-site educational services, vocational training and a job placement program, work experience, recreational therapy, and parenting therapy and classes. In April 1990, services were expanded to include residential living, called PAR Village, for the children of maternal substance abusers.

PROJECT RETURN FOUNDATION, INC.

Project Return Foundation, Inc. (10 Astor Place, 7th Floor, New York, NY 10003; 212-979-8800), a nonprofit, nonsectarian, multipurpose human-services agency, operates several New York City residential drug-free (RDF) Therapeutic-Community (TC) programs. The agency was founded in 1970 as a self-help and community center for substance abusers by two recovering addicts, Carlos Pagan and Julio Martinez. Project Return also operates a women's and children's treatment center, allowing children to remain with addicted mothers during treatment.

Under the leadership of president Jane Velez the agency diversified significantly. Project Return also operates an outreach, anti-AIDS education/prevention program, a medically supervised, drug-free outpatient program, and a modified TC-oriented health-related, facility for substance abusers who are HIV and symptomatic. The latter service is administered jointly by Project Return Foundation, Inc., Samaritan Village, and H.E.L.P., Inc. In total, nearly 1,000 men and women receive daily treatment and rehabilitative services through programs administered by Project Return Foundation, Inc.

All of Project Return's RDF TC programs are run according to the same clinical principles—they provide comprehensive, holistic, individualized treatment and rehabilitative services to the residents through interdisciplinary treatment teams. Interdisciplinary teamwork spans the entire length of stay in the TC programs, from admissions to discharge.

ABRAXAS

The Abraxas Foundation was started in Pennsylvania in 1973, in response to Requests for Proposals (RFP) from the Governor's Council on Drug and Alcohol Abuse. Abraxas's founder, Arlene Lissner, had been the deputy clinical director for the State of Illinois drug-abuse treatment system. There were two mandates to the RFP: (1) that a drug-treatment program be devised to directly serve the juvenile and adult justice system, and (2) that the program would utilize a then-abandoned U.S. forest-service camp, Camp Blue Jay, within the Allegheny National Forest. The original proposal stressed the development of a comprehensive program incorporating intensive treatment, education, and, of particular importance, a continuum of care to assist residents to reenter through regional reentry facilities. After an initial attempt to use only a behavioral approach, a Therapeutic Community (TC) model was implemented.

By 1988, all Abraxas facilities had focused their target populations solely on adolescents and had become gender specific. For example, Abraxas V in Pittsburgh was developed as an all-female residential facility. In 1990, an intensive project known as Non-Residential Care was developed to provide community-based transitional services to youngsters returning to Philadelphia after placement in state institutions. The success of this project led to its expansion to Pittsburgh. Inspired by the Non-Residential Care model, Supervised Home Services was developed later that year as a nonresidential reentry service for youngsters returning to Philadelphia from Abraxas's residential programs.

Education has been an integral part of the philosophy of treatment since Abraxas's inception. 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 in recognition of the tremendous difficulty troubled adolescents have returning to public high schools. Abraxas has also extended its programming to include families of origin: The Abraxas Family Association meets in chapters throughout Pennsylvania and West Virginia to offer education, group counseling, intervention, and referral work to the families of clients.

INSTITUTE ON BLACK CHEMICAL ABUSE (IBCA)

Founded in 1975, the Institute on Black Chemical Abuse (2616 Nicollet Avenue S, Minneapolis, MN 55408; 612-871-7878) is an open-membership organization that provides culturally specific programs and client services for the African-American community. IBCA defines cultural specificity as the creation of an environment that encourages and supports the exploration, recognition, and acceptance of African-American identity and experience, including the unique history associated with being African American 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. Services are provided in assessment and intervention for outpatient treatment and after-care, black co-dependency issues, home-based support, and for pregnant women and young children.

IBCA's efforts in the community provide training and prevention resources to educate those who face the problems of substance abuse. The Technical Assistance Center (TAC) offers training workshops, program consultation, and resource materials on African Americans and substance abuse. TAC also educates and trains clergy members working with these issues in the community. The IBCA prevention programs have involved school and business leaders in social-policy 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, tax-exempt, volunteer membership organization located at 850 Seventh Avenue, New York, NY 10019; 212-397-4197. JACS was established as a result of work done by the Task Force on Alcoholism and Substance Abuse of the Federation of Jewish Philanthropies of New York (UJA-Federation).

JACS provides support programs and conducts retreats enabling recovering Jewish substance abusers and their families to enhance family communication, and reconnect 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.

In addition to conducting retreats and support programs, JACS provides community outreach programs. These programs disseminate information to educate and sensitize Jewish spiritual leaders, health professionals, and the Jewish community about alcoholism and substance abuse, and about the effects of Alcoholism and drug dependence on Jewish family life.

SOCIETY OF AMERICANS FOR RECOVERY (SOAR)

Society of Americans for Recovery (600 E. 14th Street, Des Moines, IA 50316; 515-265-7413) was founded by Harold E. Hughes, a former governor and senator from Iowa. It is a national grass-roots 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 lobbies to fight the stigma that society places on alcoholics and addicts, and it advocates and lobbies for more and better 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 chemical dependency 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 drug dependencies as chronic 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 chemical dependency affects the family unit, the center has created the family-treatment program, a five-day intensive process that includes education and individual and group therapy. The center's staff also addresses the fact that women have traditionally been hidden chemically dependent people, so their treatments for women differ from those for men.

(See also: Alcohol- and Drug-Free Housing ; Amphetamine Epidemics ; Appendix III, Volume 4: State-by-State Treatment and Prevention Programs ; Association for Medical Education and Research in Substance Abuse ; Civil Commitment ; Coerced Treatment ; Ethnic and Cultural Relevance in Treatment ; Ethnicity and Drugs ; Halfway Houses ; Jews, Drugs, and Alcohol ; Lysergic Acid Diethylamide ; Pregnancy and Drug Dependence ; Prevention Movement ; Prisons and Jails: Drug Treatment in ; Sobriety ; Substance Abuse and AIDS ; Treatment/Treatment Types ; Treatment Alternatives to Street Crime ; Treatment, History of ; Treatment In the Federal Prison System ; Vulnerability as Cause of Substance Abuse: Race ; Vulnerability as Cause of Substance Abuse: Sexual and Physical Abuse )

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Alfonso Acampora

Arlene R. Lissner

Daniel S. Heit

David A. Deitch

David E. Smith

David J. Mactas

Ethan Nebelkopf

Faith K. Jaffe

J. Clark Laundergan

Jane Velez

Jerome F. X. Carroll

Jerome H. Jaffe