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This article examines the impact of violence on individuals and communities pursuant to drug use and sales activities. It presents case study material from individuals that engaged in the opioid recovery process, and importantly, were able to desist from criminal activities, many of them potentially violent in nature. The article begins with a discussion of Victimology, within the contexts of drug use leading to violence or contributing in some way to the plight of the victim. It reflects on various self reported issues and concerns as expressed by four study participants. If one is to examine violence in its various forms, one needs to consider the victim. After all, violence and violent acts, in essence, require that there be a protagonist of some sort, but also a victim. All too often, the victim’s role in these activities is overlooked or given perfunctory consideration. In many cases, the players in these episodes sometimes don’t even realize they are also victims within a structural framework, that is, “they fall victim to the only opportunities at their disposal…” One of the study’s goals was to see how abstaining from drug use affected desistance and engagement in violent activities and the data suggest that indeed, the heroin crime connection also occurs in reverse. In this light, this article portrays a snapshot of some of the tools that enable ex-offenders re-entering various communities to experience successful prolonged abstinence, and avoid further involvement with the criminal justice system, as well as the danger and violence present within the drug dealing hierarchies.

Therapeutic communities posit favorable treatment outcomes by relying on the community as the healing agent (Deleon 2000). Active treatment participation and treatment tenure are two domains that are positive predictors of positive treatment outcomes over time. Some of the more important domains that remain to be thoroughly investigated in international research on therapeutic community (TC) treatment outcome studies are the underlying effects of culture on the treatment process. Cultural components play a significant role, as also reported by various TC participants over the years (such as the effects of health literacy on sustaining abstinence from drug use over the long term, Tiburcio 2008). In recent years, health literacy has taken on a significant role in order for individuals to readily understand their needs (Schillinger et al 2002; Jorm et al 1997); or as pertains to feeling shamed in the process (Parikh et al 1996). As these and other studies suggest, the cultural competence of the providers is equally important. To our knowledge the “International TC Study” and findings presented herein constitute one of only a few studies that have conducted investigations comparing therapeutic community treatment modifications internationally, from the perspective of the participants themselves and which consider cultural components of this process. One key advantage of the resulting Qualitative datasets and analyses is that it not only includes residents’ perspectives, and staff experiential elements, but importantly, incorporates staff debriefings about their respective interactions at each of the international treatment modalities, presenting well rounded depictions of each of these milieus. To that end, the data examined here presents an enhanced portrait of the provider-patient treatment dynamic, and lends voice to the various aspects of treatment participation in light of these cultural issues, and from the perspective of providers, as well as the participants.