Why do drug abusers leave the therapeutic community? Problems with attachment and identification in a hierarchical treatment community

Abstract

High drop-out rate is a major problem in all kinds of treatment modalities for drug abusers. With regard to the hierarchical therapeutic community, which is a very popular treatment model for substance abusers, the one year retention rate of 8-30% indicates that relatively few clients complete the programme. Attachment to and identification with co-residents, staff, and the treatment programme, are corner stones in the ideology of the hierarchical therapeutic community model. The retention rate of 8-30% may therefore indicate that the majority of clients have problems with attachment to and identification with each other and adherence to the programme. We therefore conducted a process-oriented and qualitative study, where we followed different samples of clients, in interaction with each other and with the staff, from intake until they dropped out or completed the programme. We wanted partly to evaluate how the actual model provided the conditions for learning new role behaviour, attachment to and identif...