Residential rehabilitation centres.


These are, as the title suggests, residential units often based in large houses either in the countryside or sometimes in the outskirts of large towns and cities. In virtually all cases they operate on a basis of complete abstinence for an extended period of rehabilitation. Although each individual centre has its own unique blend of theory and practice they tend to fall into one of several main categories.



The 'concept' TCs (Therapeutic Communities).

These were based on a personal regrowth concept originally derived from the 'Synanon' communities in the United States. In its original US form the internal regimes could be quite harsh with residents undergoing sustained verbal and psychological assault until they acknowledged their personal responsibility for their life situation.

Once this acknowledgement was achieved the work could begin of gradual regrowth of self and self respect until the resident was ready to take their place in the world as a responsible and contributing citizen. Whilst a resident of the TC each person would take on work programmes and programmes of self analysis sometimes conducted one-to-one but more often in quite confrontative 'encounter' groups.

The UK 'concept' houses.
The UK versions of these 'concept' houses were never as harsh or dogmatic in style as their US counterparts. Over the last ten years and particularly since the AIDS epidemic the concept houses have considerably softened their style and most now tailor individual treatment packages for their clients with extensive use of key worker systems.

Despite this there is still widespread use of therapeutic groups, peer support and sometimes peer confrontation. These are linked to rigorous work programmes which challenge the individual to take responsibility for themselves and often for the well being and comfort of others.

Results.
Typically programmes will last from six months to a year. Although most concept houses have a high turnover of clients in the first month, most of those who stay longer than three months will go on to an extended or indefinite period of abstinence.



12 step - 'Minnesota Model' Communities.

These are based on the 12 steps to recovery first promoted by the organisation Alcoholics Anonymous (AA). These communities espouse a similar 'disease model' of addiction to AA and recommend that their residents continue their 'recovery' after leaving the communities by regular attendence at AA or NA (Narcotics Anonymous) meetings.

The work on the programme will consist of both indiviual counselling and group psychotherapy with an emphasis on confrontation of destructive addictive behaviours. Residential programmes rarely last longer than three months.

Minnesota model communities are run by both charitable and for profit agencies. Some of them can be quite expensive as virtually all the costs have to come from client fees.



Christian therapeutic communities.

These use a wide variety of methods similar to other communities but also have some religious content. In many of the christian houses this is muted but some of them are very evangelical.




Funding.

Funding for most residential units is based on payments made either by the individual concerned or more often by their social services department after an assessment of need and suitability to benefit from the service offered. This assessment is undertaken by the local authority's assessors although sometimes they commision this work from local drug agencies. These are relatively new funding systems and sometimes there are serious problems finding funding for some clients and in some areas. Funding in all areas is limited and in some areas runs out for the last few months of every financial year.