Integration: Too Much of a Bad Thing?

ABSTRACT

Integrated and/or multidisciplinary working has become a central guiding principle of addiction treatment throughout the Western world. Indeed, the notion has become virtually synonymous with good practice in intervening in a complex disorder like addiction. There has been surprisingly little analysis or evaluation of the efficacy of this approach. Rather, it is effectively taken for granted that integrated and/or multidisciplinary working is without question a “good thing.” But for complex interventions such as the therapeutic community, it is equally possible that these developments can threaten the underlying principles of the approach. This short literature review considers three areas of integrated working: integrating professional staff into therapeutic community teams; integrating new treatment approaches into existing therapeutic community frameworks; and the issue of therapeutic communities co-working with other treatment services with different philosophies and working practices. The work originated in an evaluative study of a network of Scottish addiction treatment services and the initial findings are that although there are some advantages to broadening the horizons of the therapeutic community movement, there is equally a danger of undermining some core principles.

KEYWORDS:

• Co-working
• fidelity
• integration
• therapeutic community

Notes

1 The list of terms provided here is not exhaustive. A number of other terms were used in various combinations and specific search terms were used to locate “gray” publications by known agencies or individuals.

2 DrugScope's Drugdata Online Library ceased operation in November 2014. This search accessed the remaining data base which continued to be a significant resource.

3 A small number of publications were included that lay outside these parameters where their inclusion was felt to provide an important historical perspective.

4 This is another concept expounded by De Leon and refers to a state of prosocial positive citizenship. De Leon argued that this—rather than sobriety—is the ultimate goal of the TC; with abstinence being merely a side effect.