Outcome Evaluation of Therapeutic Community Model in Iran

Document Type : Original Article

Authors

1 Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

2 Kerman Social Security Organization, Kerman, Iran

3 Research Center for Social Determinants of Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

4 Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background
Evaluation of treatment programs in addiction field is a prerequisite to improve the quality of care. This study aimed to investigate the effectiveness of Therapeutic Community (TC) program in Iran.
 
Methods
Individuals who had voluntarily enrolled in the TC center within a period of seven years, from early 2005 to late 2011, entered the study. Those who successfully completed the 14-week residential course were considered as ‘completers’. They were subsequently called in for urine test and interviews using Maudsley Addiction Profile. Urine test was conducted to determine if they were positive for heroin, opium, methadone, methamphetamine, bupronorphine, hashish, and tramadol.
 
Results
A number of 378 individuals with mean (± SD) age of 32.5 ± 7.8 enrolled in the TC program during the study period, 240 individuals of whom completed the 14 weeks course (69.0%). At the end of the sixth year, 22% of the participants were in abstinence. Physical and mental health in abstainers proved to be of better conditions than those of non-abstainers (P<0.05).  
 
Conclusion
Considering the TC outcome in other countries, it seems that TC maintains an acceptable effectiveness in Iran. Prospective controlled studies are warranted to investigate the outcomes in more details.

Keywords

Main Subjects


1. UNODC. World Drug Report 2012. Vienna: United Nations Office on Drugs and Crime; 2012. doi: 10.1590/s1413-81232012001200029
2. Nakhaee N, Divsalar K, Meimandi MS, Dabiri S. Estimating the prevalence of opiates use by unlinked anonymous urine drug testing: A pilot study in Iran. Subst Use Misuse 2008; 43: 513–20. doi: 10.1080/10826080701772348
3. NIDA. Therapeutic Community : What is a Therapeutic Community? Bethesda, MD: National Institute on Drug Abuse; 2002.
4. UNODC. Evaluation of Substance Use Treatment Programmes. Vienna: United Nations Office on Drugs and Crime; 2009. doi: 10.1590/s1413-81232012001200029
5. Malivert M, Fatséas M, Denis C, Langlois E, Auriacombe M. Effectiveness of therapeutic communities: A systematic review. Eur Addict Res 2012; 18: 1–11. doi: 10.1159/000331007  
6. Marlatt GA, Gordon JR. Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press; 1985. doi: 10.1093/bjsw/bcl044
7. Marsden J, Gossop M, Stewart D, Best D, Farrell M, Lehmann P, et al. The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome. Addiction 1998; 93:1857–68. doi: 10.1046/j.1360-0443.1998.9312185711.x
8. Afshari R, Zare I, Moeen L. [The effect of group schema therapy approach in improvement of B category personality disorders for substance dependents]. Journal of Psychological models and Methods 2011; 1: 19–35.
9. Autrique M, Vandeplasschen W, Broekaert E, Sabbe B. The drug-free therapeutic community: Findings and reflections in an evidence-based era. Therapeutic Communities: The International Journal of Therapeutic Communities 2008; 29: 5–15.
10. Miller WR, Sorensen JL, Selzer JA, Brigham GS. Disseminating Evidence-Based Practices in Substance Abuse Treatment: A Review with Suggestions. J Subst Abuse Treat 2006; 31: 25–39. doi: 10.1016/j.jsat.2006.03.005
11. Johnson K, Pan Z, Young L, Vanderhoff J, Shamblen S, Browne T, et al. Therapeutic community drug treatment success in Peru: a follow-up outcome study. Subst Abuse Treat Prev Policy 2008; 3: 26. doi: 10.1186/1747-597x-3-26
12. Abdollahnejad MR. Follow-Up evaluation of Tehran Therapeutic Community. Therapeutic Communities: The International Journal of Therapeutic Communities 2008; 29: 57–75.
13. Darke S, Campbell G, Popple G. Retention, early dropout and treatment completion among therapeutic community admissions. Drug Alcohol Rev 2012; 31: 64–71. doi: 10.1111/j.1465-3362.2011.00298.x
14. Fernández Hermida JR, Secades Villa R, Fernández Ludeña JJ, Marina González PA. Effectiveness of a therapeutic community treatment in Spain: a long-term follow-up study. Eur Addict Res 2002; 8: 22–9. doi: 10.1159/000049484
15. Van Stelle KR, Blumer C, Moberg DP. Treatment retention of dually diagnosed offenders in an institutional therapeutic community. Behav Sci Law 2004; 22: 585–97. doi: 10.1002/bsl.602
16. Dekel R, Benbenishty R, Amram Y. Therapeutic communities for drug addicts: prediction of long-term outcomes. Addict Behav 2004; 29: 1833–7. doi: 10.1016/j.addbeh.2004.01.009
17. Carroll JF, McGinley JJ. An agency follow-up outcome study of graduates from four inner-city therapeutic community programs. J Subst Abuse Treat 2000; 18: 103–18. doi: 10.1016/s0740-5472(99)00036-7
18. aZiaaddini H, Nasirian M, Nakhaee N. Comparison of the efficacy of Buprenorphine and Clonidine in detoxification of opioid-dependents. Addict Health 2012; 4: 79–86.