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Summary: It is widely recognised that young people in out-of-home care are often involved in a complex process of culminating disadvantage and exclusion. Investing in the core ingredients of social inclusion (participation and interpersonal relationships) while still in care can counterbalance ongoing exclusion processes. In this article, we explore how early work experiences (before the age of 18) can play a role in this. Findings: A thematic analysis was performed on interview data from 74 young adults in six countries. Several elements promote community participation (gaining financial autonomy, gaining a feeling of independence, and being able to contribute as a worker) and help to develop a sense of belonging (striving for normality and building long-lasting social connections). Early work experiences also contribute to personal growth (building capabilities and shaping the future). Applications: This article highlights how early work experiences have the potential to promote social inclusion for out-of-home care-experienced young people and serve as gateway experiences for both educational and work trajectories. Entry into the world of work should not be postponed until the age of 18. Caregivers can play a role in motivating young people to work while still being in care and helping them to find a job. The experiences gained during these early work experiences can also have a place in the care process. [ABSTRACT FROM AUTHOR]

Objective: Attention deficit hyperactivity disorder (ADHD) is common among adult patients with a substance use disorder, yet often goes undetected. This is a qualitative study to explore implementation barriers to a guideline developed in Belgium for the recognition and treatment of ADHD in adult patients with substance use disorder and to gain a better understanding of the strategies to overcome these barriers. Methods: Focus groups were conducted with caregivers and patients to explore experiences with comorbid substance use disorder and ADHD. The barriers reported in these focus groups became the subject of further study in focus groups with addiction professionals (physicians, psychiatrists, and psychologists) who had tried the guideline and with psychiatrists specializing in addiction but without experience with ADHD. Results: Our analysis revealed a number of barriers to the implementation of this guideline, including lack of information from the family, pressure from patients and caregivers to make an ADHD diagnosis, and the potential for abuse of ADHD medication. Furthermore, diagnostic instruments for ADHD have not been validated in people with substance use disorder. Although patients with ADHD are usually treated in an outpatient setting, patients with ADHD comorbid with substance use disorder are difficult to identify in an outpatient setting for various reasons. Finally, there is a lack of specific ADHD expertise in substance use treatment organizations. Conclusions: Despite the availability of an approved guideline for recognizing and treating adult ADHD in patients with a substance use disorder, underdiagnosis and inadequate treatment still persist. As in general substance use treatment, medication only plays a supportive role in the treatment of substance use disorder with comorbid ADHD. An integrated approach and further improvements in the competence of practitioners may help to reduce the resistance to diagnosing ADHD in substance use treatment centers. Practitioners who specialize in addiction medicine and therapists without medical education view the problem from different perspectives and therefore each group needs specific information and training. Targeted interventions need to be developed to keep these patients in treatment. [ABSTRACT FROM AUTHOR]

Objective:Attention deficit hyperactivity disorder (ADHD) is common among adult patients with a substance use disorder, yet often goes undetected. This is a qualitative study to explore implementation barriers to a guideline developed in Belgium for the recognition and treatment of ADHD in adult patients with substance use disorder and to gain a better understanding of the strategies to overcome these barriers. Methods:Focus groups were conducted with caregivers and patients to explore experiences with comorbid substance use disorder and ADHD. The barriers reported in these focus groups became the subject of further study in focus groups with addiction professionals (physicians, psychiatrists, and psychologists) who had tried the guideline and with psychiatrists specializing in addiction but without experience with ADHD. Results:Our analysis revealed a number of barriers to the implementation of this guideline, including lack of information from the family, pressure from patients and caregivers to make an ADHD diagnosis, and the potential for abuse of ADHD medication. Furthermore, diagnostic instruments for ADHD have not been validated in people with substance use disorder. Although patients with ADHD are usually treated in an outpatient setting, patients with ADHD comorbid with substance use disorder are difficult to identify in an outpatient setting for various reasons. Finally, there is a lack of specific ADHD expertise in substance use treatment organizations. Conclusions:Despite the availability of an approved guideline for recognizing and treating adult ADHD in patients with a substance use disorder, underdiagnosis and inadequate treatment still persist. As in general substance use treatment, medication only plays a supportive role in the treatment of substance use disorder with comorbid ADHD. An integrated approach and further improvements in the competence of practitioners may help to reduce the resistance to diagnosing ADHD in substance use treatment centers. Practitioners who specialize in addiction medicine and therapists without medical education view the problem from different perspectives and therefore each group needs specific information and training. Targeted interventions need to be developed to keep these patients in treatment. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate whether European and American therapeutic communities (TCs) for addiction, both traditional and modified, share a common perspective on what is essential in treatment using the Survey of Essential Elements Questionnaire (SEEQ). The European sample ( N == 19) was gathered in 2009. For the American sample ( N == 19), we used previously published research data. Despite comparable perspectives, European traditional TCs ( N == 11) scored significantly higher than their American predecessors ( N == 11) on four SEEQ domains. Cluster differences were more pronounced in Europe than in America. [ABSTRACT FROM AUTHOR]

Abstract: According to the EUPRIS-study on mental health in prisons (2007), available data on mental disorders in prison are scarce. Therefore, this study aims at summarizing and discussing the available knowledge on incarcerated mentally ill offenders concerning: (1) the screening and assessment for detecting mental health; (2) the psychiatric expertise in order to evaluate the mental status; and (3) the development and provision of forensic psychiatric treatment and care. These findings will be applied to the current situation in Belgium, which is a particularly interesting case. Belgium is currently facing difficulties concerning a large population of interned mentally ill offenders residing in correctional establishments. Implications with regard to the penal code, general or mental health legislation, screening, assessment, and treatment could deliver interesting viewpoints on how this problem could be tackled more effectively. Therefore, the findings will be discussed with reference to the international scientific and policy debate, focusing on ethical implications. [Copyright &y& Elsevier]

Background Although numerous studies recognize the importance of social network support in engaging substance abusers into treatment, there is only limited knowledge of the impact of network involvement and support during treatment. The primary objective of this research was to enhance retention in Therapeutic Community treatment utilizing a social network intervention. Aims The specific goals of this study were (1) to determine whether different pre-treatment factors predicted treatment retention in a Therapeutic Community; and (2) to determine whether participation of significant others in a social network intervention predicted treatment retention. Design, setting and participants Consecutive admissions to four long-term residential Therapeutic Communities were assessed at intake ( n = 207); the study comprised a mainly male (84.9%) sample of polydrug (41.1%) and opiate (20.8%) abusers, of whom 64.4% had ever injected drugs. Assessment involved the European version of the Addiction Severity Index (EuropASI), the Circumstances, Motivation, Readiness scales (CMR), the Dutch version of the family environment scale (GKS/FES) and an in-depth interview on social network structure and perceived social support. Network members of different cohorts were assigned to a social network intervention, which consisted of three elements (a video, participation at an induction day and participation in a discussion session). Findings Hierarchical regression analyses showed that client-perceived social support ( F1,198 = 10.9, P = 0.001) and treatment motivation and readiness ( F1,198 = 8.8; P = 0.003) explained a significant proportion of the variance in treatment retention (model fit: F7,197 = 4.4; P = 0.000). By including the variable ‘significant others’ participation in network intervention’ (network involvement) in the model, the fit clearly improved ( F1,197 = 6.2; P = 0.013). At the same time, the impact of perceived social support decreased ( F1,197 = 2.9; P = 0.091). Conclusions Participation in the social network intervention was associated with improved treatment retention controlling for other client characteristics. This suggests that the intervention may be of benefit in the treatment of addicted individuals. [ABSTRACT FROM AUTHOR]

Abstract: There is empirical evidence that treatment motivation and readiness are closely linked to retention. Several instruments have been developed to measure these concepts; such instruments can reliably assess the stages of motivation and readiness, and predict treatment retention and outcome. However, limited efforts have been undertaken in Europe to translate those instruments and to determine their reliability and validity. In this study, the psychometric properties of a Dutch translation of the Circumstances, Motivation, Readiness, and Suitability (CMRS) scales by De Leon and Jainchill [Journal of Psychoactive Drugs 8 (1986) 203–208] and the shortened CMR Intake Version are illustrated in a Flemish sample of therapeutic community residents (n = 207). Exploratory factor analyses confirm three CMR subscales, although confirmatory factor analysis reveals only a moderate fit for both the CMRS and the CMR. In contrast, the predictive power of the instrument is strong, specifically for 1-year retention. Significant correlations were found between CMRS measures and age, drug severity, legal referral, and social problems. It is concluded that the Dutch translation of the CMRS and the CMR can be employed as a valid indicator of treatment motivation and readiness, although additional research concerning factorial structures is needed. [Copyright &y& Elsevier]

This article discusses the use of residential therapeutic communities (TCs) to help addicts recover. The European and American antecedents of the TC and the model's further evolution and dispersion are described. The increasing openness of the TC toward the outside world and its changed attitude toward family involvement have played important roles in the evolution of the TC. In this context, the article also pays attention to the family approach in the early TC and the major family therapeutic schools that influenced the model, specifically contextual therapy. A renewed attention to its humanistic roots can preserve the TC from becoming just another substance abuse treatment modality. However, good functioning of the TC as humanistic organization also requires openness, professionalism, and scientific input. Those elements are as safeguards against destructive charismatic leadership and insularity. [ABSTRACT FROM AUTHOR]

Family therapy takes a special position in the therapeutic community for substance abusers (TC). In the early therapeutic communities, the family of origin was not considered as important for the substance abuser's recovery process, and was even labelled as part of the problem. It was only in the 1970s that the TC acknowledged the significance of family involvement in treatment. Nowadays, the contextual vision of Ivan-Boszormenyi-Nagy seems to have a strong impact on family counselling activities in Belgian TCs. In this article, the integration of contextual thinking in the TC is discussed. By means of a case study, it is shown that there are some clear parallels between the treatment evolutions in family counselling and the peer group community. The central position of trust both in contextual therapy and the TC treatment model is an important common ground for stimulating integration. Some obstacles that can disrupt this integration process are discussed. [ABSTRACT FROM AUTHOR]

This article aims to search for a specific female, psychiatric profile based on a large European sample of substance dependent clients (828) entering therapeutic communities. First, all six areas of functioning of the EuropASI were included, using the composite scores to search for gender differences. Next, the ''psychiatric'' status section was selected for further study. A binary logistic regression was performed with gender as the dependent variable, and nine individual psychiatric items, country, and age as predictors. According to this model a number of problem variables could be identified as being reported more often by women than by men in therapeutic community treatment. Women are more likely to report serious depression, problems in understanding, concentrating or remembering, being prescribed medication, and serious thoughts about suicide; they have also attempted suicide more often than men. Women find treatment for these psychological problems more important than their male counterparts. They also have a more severe history of abuse. Women in therapeutic communities may need specific treatment interventions for their more severe psychiatric needs. [Copyright &y& Elsevier]

Transition to re-entry (aftercare) is a stressful event for therapeutic community residents. While several authors agree on the importance of social support during reintegration, few studies have focused on the experiences of re-entry clients themselves and their significant others during this period. Using a case-study design, the present study examines the re-entry process of four TC-residents and three of their social network members during a six-month period, starting at the time of their transfer to the halfway house. Clients and their significant others have mixed feelings about the reintegration period, although both are mainly positive. Clients report difficulties in leaving behind the TC-mentality and building up a stable social network; they are surprised about the frequent contacts with substance (ab)use in mainstream society. Significant others misjudge clients’ feelings about transition and relapse. Many significant others have a positive attitude towards the use of substances. The tendency in mainstream society to increasingly accept the use of substances intensifies clients’ need for early guidance in building up stable supportive networks. Significant others need well-grounded information on the reintegration process and on relapse. [ABSTRACT FROM AUTHOR]

Background: Recent research suggests a concerning trend of non-suicidal self-injury (NSSI) and suicidal behaviors emerging at younger ages (as early as age 12). Early onset of NSSI is linked to more severe outcomes. While universal school-based prevention programs have shown promise in addressing suicidal behaviors, there is limited research on their effectiveness in preventing NSSI onset among adolescents. This study aims to evaluate the efficacy of a universal prevention program in schools for NSSI and mental complaints while enhancing resilience and mental health in 11–14-year-old adolescents. Methods: In total, 329 Flemish secondary school students (55.6% female), aged 11 to 14 years, participated in a 4 h classroom universal prevention, with a focus on emotion regulation, mental health, and specific strategies to prevent NSSI and reduce stigma. For both the intervention and control group (N = 124), a pre-, post-, and one-month follow-up questionnaire was administered, containing reliable and valid measures for NSSI and suicidality, emotion regulation, help-seeking behaviors, well-being, and psychological distress. Results: The prevention program effectively reduced NSSI and psychological distress, particularly for adolescents with a history of NSSI. Conclusions: These findings support previous research on the effectiveness of school-based programs in reducing mental complaints and suggest promising outcomes for NSSI prevention. [ABSTRACT FROM AUTHOR]

This article draws attention to the relevance of young care leavers' exercise of agency as one possible key ingredient in overcoming barriers to engagement in work. Several previous studies show difficulties in entering adult life, both in relation to higher and further education as well as entrance into work life. The article analyses interviews with young adults from six countries, who have spent at least part of their childhood and youth in out‐of‐home care and the results indicate that the care leavers have the ability to make plans and set up goals for the future that they in many cases are able to achieve or at least are striving for over time. In many instances, they show a strong motivation, for example, to educate themselves pursuing their goals. To support this transition of young care leavers, it is important to listen to 'successful' cases such as the ones presented. [ABSTRACT FROM AUTHOR]

The study aims to map the treatment perspectives of international experts on treating mentally ill offenders (MIO) in a forensic psychiatric centre (FPC) using the Delphi method. The four-round Delphi study reveals high conformity on the proposed treatment-related issues. However, some points of divergence remain. Three controversies underpinning these disagreements are discussed. The first regards the treatment and control debate, the second concerns the dual role of assessment in forensic mental health care and the third describes potential entry conditions for treatment in a FPC. Further research is needed to scientifically underpin the above mentioned debates. In this regard, the study suggests a close collaboration between practitioners and researchers. [ABSTRACT FROM AUTHOR]

Aims: It is the goal of this study to investigate the first development of the drug-free therapeutic community (TC) in Europe. The paper aims at systemizing information, scattered all over Europe and is the first stage in an ongoing study to record the development of the European TC movement and its influences. Design: After a study of the grey (hidden) literature, TC pioneers and experts per country were contacted to further elaborate the first findings. Subsequently, a preliminary summary of our findings was published in the Newsletter of the European Federation of Therapeutic Communities (EFTC), inviting additional information and corrections. The authors completed the results for this article with relevant first-hand information, obtained through interviews with European pioneers. Findings: The findings are summarized under three topics: chronology, interconnections and European identity. It was found that from 1968 until 1989, a new therapeutic approach arose all over Europe, modeled after Synanon, Daytop and Phoenix House, New York, through Phoenix House, London and Emiliehoeve in the Netherlands. Therapeutic communities were established in Belgium, Finland, Germany, Greece, Ireland, Italy, Norway, Spain, Sweden and Switzerland as well. These communities were closely-knit and interconnected in their reaction against psychiatric and methadone treatment. The European TCs developed an own identity compared to the American ones. Conclusions: The European TCs adapted the model of their American predecessors to their own culture, influenced more by milieu-therapy and social learning. Instead of harsh behaviorism, more emphasis was placed on dialogue and understanding. Professionals occupied a more pivotal role and took over the dominant position of ex-addicts. Research, executed by TC professionals gradually entered the TC. A generic network of TC connections, through which the development evolved, was uncovered, and clear regional trends can be observed. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Accessible summary In Belgium some adults with learning difficulties live with their siblings and siblings-in-law., The authors of this article listened to siblings-in-law, trying to understand how they felt about this living together., This article seems to be important for those persons with learning disabilities who give a lot about their sisters and brothers., Summary There is a lack of international research focusing on how the siblings-in-law of adults with a learning disability experience their commitment to provide support. Using narrative research, the authors have aimed to gain an insight into the perspectives of 14 siblings-in-law (living in the Flemish part of Belgium) about the decision to live together with a family member who has a learning disability. The decision to live together usually begins with a crisis. However, the decision process is a complex mechanism; it involves dynamics and events within a family (between family members both with and without blood relationships) and is intensified by experiences within a society that holds different views about families and disability. We are aided in gaining a deeper understanding of this complex process by considering interpretations based on the contextual framework of Boszormenyi- Nagy. [ABSTRACT FROM AUTHOR]

Although Synanon has been extensively studied, attention has seldom been paid to the question of how the many ex-members who left Synanon before or at its dissolution 'survived' their community and indoctrination, and how they now evaluate their involvement. This article explores how ex-members react to their previous affiliation to Synanon, the cradle of the therapeutic community (TC) for addiction. A series of critical incidents, following Synanon's public proclamation restyling itself as a religion, which led to the dismantlement of Synanon, are highlighted and contrasted with the achievements of the movement. For this research study, we used a social constructivist methodology. Following qualitative snowball targeted sampling, open interviews and text analysis, 14 statements, representing the main reactions, were retained. These served as the basis for a web-based survey. It was found that ex-Synanon members still believe in the positive realizations of their experience. On the other hand, they are not blind to the negative aspects of this time but tend to deny, or perhaps do not know, that the proclamation to become a religion was in fact initiated by the inner circle and that this was the start of the dismantling of the organization's value system and the introduction of strange and inappropriate behaviour. The article emphazises the potential powerful and long-lasting effects of 'community as method' as a means of indoctrination of values. It endorses the opinion that the drug-free concept-based TC operates within the framework of an effective belief system that encourages and reinforces behavioural change. It is therefore critically important to ensure that present-day TCs remain open to the views and expectations of society. [ABSTRACT FROM AUTHOR]

There is a lack of research illustrating the extent of psychiatric problems in European TCs. Furthermore, there is a need to obtain more insight into gender differences concerning comorbidity in the TC population. In an attempt to respond to previous shortcomings, three specific goals were formulated for the current study. The primary aim was to explore the lifetime prevalence of affective disorders in European TC clients. The second aim was to focus on related gender differences. And finally, client characteristics measured by the EuropASI were related to mood and anxiety disorders measured by the SCID-I. Nine out of ten substance abusers treated in a European TC program have an affective disorder. Gender differences are noted for two anxiety disorders: men have more obsessive-compulsive disorders; women have more post-traumatic stress disorders. The study illustrates that not only gender but also other client characteristics should be taken into account when organizing treatment. [ABSTRACT FROM AUTHOR]

This article describes the different phases of the development and implementation of the Videotaped Addiction Challenge Tool (VACT, initially termed the Video Addiction Challenge Test). This instrument employs a video depicting the `average life-story' of a resident of a Therapeutic Community for substance abusers. The video film is used as a clinical method for assessment and individual treatment planning, and as a research instrument that gives care-givers a deeper insight into the residents' personal characteristics and treatment requirements at any given moment in the Therapeutic Community. The article reports the results of administering the VACT to 38 residents (31 male and 7 female) at the De Kiem Therapeutic Community in Belgium. Detailed description of the procedure and its principles assures reliability and makes accurate reproduction possible. The validity of the instrument was tested by comparing, characteristic by characteristic, the results of the VACT, life-story and social anamnesis. The correspondence between the VACT and the life-story was 94% and between the VACT and the social anamnesis, 98%. The VACT has also contributed new information not measured by other instruments. Content analysis of this information shows that TC residents are characterised by negative communication between parents, negative communication with father, an unhappy childhood, child maltreatment or abuse, and relational problems due to drug abuse. Residents reported feelings of inferiority and suicidal thoughts and/or suicide attempts. Many new residents also reported sexually related problems such as abortion, sexual abuse, prostitution and shyness. There were no specific female problems; men reported sexual abuse as often as women. The implementation of this new instrument leads to a more methodical approach. It is, however, also more time-consuming and can be a problem for staff who tend to give priority to immediate action and direct problem-solving. [ABSTRACT FROM AUTHOR]

In 1981, a "research-practice" breakthrough was realized through the foundation of the European Federation of Therapeutic Communities (EFTC). Since its foundation EFTC regularly organized conferences and symposia. A few years later (in 1983), the European Workshop On Drug policy Oriented Research (EWODOR) was established at the Erasmus University in Rotterdam, including a special section devoted to the therapeutic community (TC). The authors examined the proceedings of all meetings organized by EFTC and EWODOR. The major topics presented throughout the last 20 years are highlighted in a chronological selection and these presentations largely focus on the challenges of the TC and the state of the art regarding scientific knowledge. In this overview only those authors who published articles in scientific journals indexed in the "Web of Science" (Institute for Scientific Information—ISI) were retained. Although research has never been the primary consideration in TCs, it played a far from negligible role in its development. Research findings prompted innovations and thus often provoked resistance, but on the other hand they functioned as a catalyst between the necessity of a belief system and the reality of society. The role of "grey" literature and the availability of information through the Internet will become more and more important in the communication between researchers and practitioners. [ABSTRACT FROM AUTHOR]

By statistical analysis of client data it is shown how past or current network information together with other knowledge assesses treatment needs. The main findings are as follows. The client’s previous exposure to addicts in the family has almost no influence on his or her present contacts with addicts in daily life. About 30% of the clients have experienced addicts both in family and among friends, about 30% have only family exposure, about 20% have neither kind of exposure, and about 20% have no family exposure but have current exposure to addicts. Exposure to addicts in family implies a higher risk of severe need for professional intervention than no such exposure. For the clients with no family exposure but with current exposure to addicts there is, somewhat surprisingly, a lower risk than for the other three categories of clients. This effect seems to be mainly because the psychiatric status of these clients is somewhat better than for those in the other three categories. The effect disappears if we look solely for drug addiction intervention needs; then there is a clear increase in relative treatment needs for the categories with previous or present addiction exposure compared to those without. [ABSTRACT FROM AUTHOR]