Coerced and voluntary drug treatment in a therapeutic community

Abstract

This study examines outcomes of long-term treatment for drug abuse in a residential therapeutic community setting. It attempts to analyse whether voluntary and coerced admissions to a therapeutic programme yield divergent outcomes. Expert literature reveals that supporters of voluntary treatment maintain that the person needs to have personal motivation to change, as treatment will not be effective otherwise. Whilst those sustaining coerced treatment argue that coercion is as good as any other means of motivation. For the purpose of this study, relapse prevention, decreased criminality, sustained occupational activity and ability to uphold interpersonal relationships are considered the main indicators of therapeutic treatment outcomes. The research design is based on qualitative methodology where in depth interview data is analysed with reference to the findings of parallel studies in the field. The study was undertaken with twelve (N=12) persons who completed the all phases of the drug rehabilitation programme offered at Santa Maria, a drug residential therapeutic community run by Sedqa. Findings revealed that outcomes of treatment in the two categories of clients were quite similar but in the case of coerced clients motivation was frequently lacking especially due to the fact that most clients still had pending court cases that might lead to a prison sentence. The interviews revealed that was the rate of lapse or relapse especially due to the use of alcohol on completion of the programme was common amongst both coerced and voluntary clients. The study concludes by examining the strengths and weakness of the programme followed by a series of recommendations for the amelioration of services especially in relation to relapse during the last phase of the programme. More detailed evaluations are also recommended.