In 1966, New York City's mayor, John V. Lindsay, recruited Efren Ramirez, M.D., a San Juan psychiatrist, to coordinate the city's narcotic treatment programs.

Ramirez had already developed systems of community engagement, protracted client induction processes, and treatment approaches similar to those of Daytop Village. Daytop staff became a resource for Ramirez as he set out to expand the city's response to a growing heroin epidemic. It was Ramirez, trained in the Jones model, who persuaded Daytop to use the term therapeutic community to describe itself.

Ramirez was soon joined by Mitchell S. Rosenthal, M.D., who had headed an alcohol and drug treatment unit at the U.S. Naval Hospital in Oakland, California, where he had introduced many structural and group characteristics of Synanon. Ultimately, Ramirez made Rosenthal his deputy commissioner for treatment.

The convergence shaped by Ramirez became a major force for expanding the TC model in New York City. Daytop lent staff to each of the treatment leaders in Ramirez's group. This rich mix led to the development of Odyssey House (Judy Densen Gerber), Phoenix House (Rosenthal) and the expansion of Samaritan (Richard Pruss). By the end of 1968, Daytop staff had also contributed to a second wave of TC development with Gateway in Chicago, Gaudenzia in Philadelphia, and the Village in Miami.

Further expansion followed: Marathon House in New England, Integrity in New Jersey, Walden House in San Francisco, the Mendocino Family, and Abraxas. Participation in marathon therapy as TC training in authenticity, expiation, and commitment inspired many visitors to the Intensive Training Institute, developed at Daytop's Swan Lake facility, to emulate part, or all, of this early TC model. Subsequently, TCs spread to Sweden, Germany, and Great Britain. By the mid-1970s, the World Federation, led by Msgr. W. B. O'Brien of Daytop, had started programs in Italy, the Netherlands, and Southeast Asia, which, in turn, influenced further expansion into Spain, Portugal, and Brazil.

During the 1960s, leading researchers, such as O. Hobart Mowrer and Abraham H. Maslow, applauded early TC initiatives and contributed ideas as well as methods. At the start of the 1970s, outcome and follow- up studies done at Phoenix House by George DeLeon and others provided an academic and research base to the movement, bringing increased credibility and recognition.

By the end of 1974, 15,000 persons were being treated in TCs. In 1976, a Therapeutic Communities of America (TCA) planning conference sponsored by the National Institute on Drug Abuse (NIDA) brought first, second, and third wave post-Synanon groups together. Discussions focused on such issues as size, fidelity, working with various different populations, and the discreet needs of women with children.

In the 1980s, training in drug abuse treatment methods, supported by the U.S. State Department, brought the TC to Southeast Asia, South Asia, and East Central Europe. TCs were developed in Slovakia, the Czech Republic, Hungary, Slovenia, and Poland. The TC approach is now found not only throughout the Americas, but also in such Muslim countries as Malaysia, Afghanistan, Pakistan, and Bangladesh and in Lebanon, Israel, China, South Africa, India, Thailand, Vietnam, and Cambodia.

Key enduring principles have survived, along with certain features of program structure, daily schedule, small-group work, and the development of social responsibility and compassion. In most programs, the role of the leader--regardless of the size of the unit, program, or system--still influences what principles are emphasized or downplayed, although many European programs and some American ones have adopted a far more egalitarian Jones-like approach.

Not so curiously, the older leadership bemoans many current practices, the dilution or drift from earlier models. Newer practitioners, educated more broadly and with less doctrinaire backgrounds, applaud the utilization of new science-driven practices. To remain relevant, the movement must applaud history, use the key enduring principles, and also embrace new practices. It is no longer a belief system with some techniques found wanting, or at worst destructive. It is and can proudly refer to itself as a model of value, proven in the treatment of addictive disorders, and capable of developing character and survival competencies for many, regardless of the culture in which it is found.

References:

1) Jones, Maxwell. 1953. The Therapeutic Community: A New Treatment Method in Psychiatry. New York: Basic Books.

2) Knibb, Michael A. 1987. The Qumran Community. Cambridge Commentaries on Writings of the Jewish and Christian World 200 BC to AD 200, Vol. II. Cambridge,England: Cambridge University Press.

3) McNeill, John T. 1951. History of the Cure of Souls. NewYork: Harper & Brothers.

4) White, William L. 1998. Slaying the Dragon. Bloomington,IL: Chestnut Health Systems.

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