The article Rod refers to is a summary of the evidence base for American drug-free TCs in the International Journal of Therapeutic Communities by George De Leon.. Although it only covers US research it can nevertheless be regarded as a seminal 'state-of-the-art' piece. You can find it in the Scottish Addiction Studies online library at:
or you can go straight to the article at:
I haven't read the EMCDDA report yet - I'll do that in the next few days. But my assumption would be that it is yet another report which examines the relative paucity of randomised control trials (RCTs) and effectively dismisses a huge number of other sorts of studies. It wouldn't be the first. There's a Cochrane review and a Dutch meta-analysis from about 5 years ago: both of which say something similar.
My problem with this is that in general terms the RCT is probably unsuitable for an extremely complex intervention like a TC. And as a researcher I really object to this cavalier dismissal of a huge number of perfectly good outcome studies - which in almost every case suggest significant behavioural and health-related improvements post TC intervention.
It's worth noting that Eric Broekaert and Wouter Vanderplasschen are currently working on a new EMCDDA publication on European TCs which is likely to offer a more tempered view of the current evidence base.
Overall, I do feel that there is a great deal of cynicism about the whole business of abstinence-based recovery (and not just TCs). I'm not sure why this should be but it's probably significant that it stems mainly from medical researchers. For a more balanced view of the evidence you could check out Best et al's Research for Recovery which was commissioned a couple of years ago. As with the De Leon article you can download it from the SAS online library. Or check out the many reports on recovery in the William White Archive (again you can find a link in the
The truth is that despite the strident cynicism, the evidence for long-term methadone maintenance is not at all as robust as many would have us believe. Drop-out rates are not that much better than residential rehabilitation and although results are good in terms of reductions in illicit drug use and offending, unlike abstinent recovery, these behaviours are very rarely eliminated and re-employment rates are very poor in comparison to recovery-oriented treatments.
You need to look at the "evidence based" issue of the TC Journal published a couple of years ago-- particularly the first article, which addresses this
Rod Mullen, President & CEO
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Hello everyone!
The report clearly states that there aren't any conclusive evidence with regards to drug free TC treatment of opiate addicts:
"Cognitive behavioural interventions have shown some effectiveness with opioid users, but evidence is not sufficiently robust to allow the identification of which intervention is the most effective. There is no conclusive evidence on the effectiveness of drug-free therapeutic communities."
I would very much appreciate some comments on this particular statement in the EMCDDA report.
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Sincerely, Kenneth Arctander Johansen
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