THE DEVELOPMENT OF "CONCEPT" HOUSES IN GREAT BRITAIN AND SOUTHERN IRELAND 1967 - 1976 David Warren-Holland

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THE DEVELOPMENT OF "CONCEPT" HOUSES IN GREAT BRITAIN AND SOUTHERN IRELAND 1967 - 1976

David Warren-Holland

David Warren-Holland is founder and director of training at GCT Ltd (Groupwork Consultation & Training). David received his groupwork training at the Phoenix Institute NY, and also Europe and Great Britain. This covered a variety of social group/therapeutic models. He was a pioneer in the drug rehabilitation field, and was responsible with others for the early growth and development of two therapeutic communities in this country. For the last sixteen years David has worked as a social groupwork tutor/trainer in the health services, education and local authority settings, the voluntary sector, and probation service.;


Paper presented to the Cropwood Round-Table Conference December 1977


This paper is an attempt to sketch the growth and development in Great Britain and Ireland of therapeutic communities for ex-drug abusers along 'Concept' lines. The most important of these programmes' philosophies relate to the nature of drug taking, drug dependency, the therapeutic process and the nature of the ex-drug abuser. Within the communities, the aspects of the total philosophy are referred to collectively as the 'Concept' which is this:


To provide total rehabilitation for an individual in an existential context by challenging that which is positive and normal in him so that he can eventually overcome that which is distorted and sick in his own personality. Addiction as a way of life is merely a symptom. (1) (2)


Each project has been greatly influenced by the American rehabilitation programmes for ex-addicts, e.g. Synanon, Daytop, Phoenix House New York.


In 1968 the Ministry of Health published a circular stressing the need for long rehabilitation for ex-drug abusers. The Concept Houses were part of the response to this need. The programmes are based on the premise that drugtaking is a symptom of underlying problems. Anyone admitted into a community must be drug-free as the Concept assumes that an individual's reliance on chemical substances prevents his reaching solutions to these problems. Withdrawal from drugs, although essential, is only a preliminary to the tackling of the problems themselves.


The concept of self-help is vitally important to this process. We believe it essential the ex-addict be given ample opportunity to help himself in his own recovery and to assume responsibility for his life. Treatment of the ex-addict as helpless and incapable deprives him of this opportunity and panders to his manipulative and irresponsible behaviour.


The organisation of each House is based on a highly structured hierarchy, creating the maximum number of responsible posts with constant pressure on residents to seek responsibility and to exercise it with self-awareness and concern for others. Failure to do so results in demotion through the hierarchy. In this way a dynamic is generated within the community in which each person feels free to express deep concern for other members.


The first three months of treatment enable a resident to concentrate on total involvement in the community. A new resident is given intense orientation on the House concepts and on the day-to-day activities; understanding and familiarity develop rapidly. From the outset, a high level of standards is demanded of the resident and there is a clear expectation that he behave in a responsible fashion. To comply with this expectation a new resident will apply himself to the concept of 'Act as If', a form of role playing aimed at development of self control. He will begin to use Encounter Groups, i.e. the Synanon Encounter or 'game', as an outlet for his frustrations and other emotions. Gradually, with the help of others, awareness of himself and of his environment will begin to develop from which he gains insight into his personality.


The first two Houses in Great Britain commenced within a very short time of one another. In 1968 Alpha House began, followed in 1969 by Phoenix House, London, then by the Ley Community, Suffolk House, Coolemine; and finally by Culverlands. This last, though a Concept House, is set up specifically for recidivists. Each of the six Houses is independently funded. Although each has a number of distinctive features they are sufficiently similar to be described as Concept Houses, and have formed an association called the Association of Concept Based Therapeutic Communities. Association members meet every two-three months to the mutual benefit of staff and residents. There is a magazine, annual jamborees, week-end staff workshops, with Houses cooperating on external projects such as skiing, football, etc. There is a healthy combination of competition and support.


Each programme has independently taken its own direction and it would be a major task indeed to analyse in detail the various histories. This paper can only give a flavour of the developments which took place.


Alpha House was the first Concept House to open in Great Britain. In 1967, due to the recommendations of the Brain Committee which led to a change in the law, it became clear the St James Hospital in Portsmouth would be obliged to take over the management of all heroin addicts in the city from the doctors who were then prescribing for them. A British psychiatrist, recognising that America had something to offer with regard to information in relation to the drug problem, persuaded the Regional Hospital Board to send him to America, mainly to the New York area for three weeks (3). He returned with the hope that a full-scale Regional Unit would be a feasible possibility if a pilot scheme could be made to work in Britain. Due to the help and understanding of colleagues at St James in 1971 it became a regional project under the administration of Hampshire Social Services Department. It has since moved to a larger house near Droxford, still under the Social Services umbrella, and has grown from a unit with six residents to one with twenty-five to thirty people.


The House had several objectives but the most important ones achieved proved that Alpha could function effectively without a medical director and that ex-addicts could be valuable staff members. Staff were sent to America for training and the House modified to suit the British culture. The House is now staffed by professionally trained people, including several ex-addicts.


Phoenix House. In the same year, 1968, again in response to the British Ministry of Health circular which stressed a need for special after-care hostels for drug abusers, another British psychiatrist - the Director of the Addiction Research Unit in London - visited America to discuss methods with experts there. The two main places researched were Daytop Village and Phoenix House, New York. On his return to Britain, several meetings were arranged with staff of the Addiction Research Unit and the Attlee Foundation. Interest was aroused to the extent that the Attlee Foundation funded a Senior Psychiatric social worker's return to New York to observe rehabilitation approaches first hand. Further funding was then obtained from the London Boroughs Association, a block grant provided and planning permission granted on 1 Eliot Bank, Forest Hill, a property in SE 23, London. Several valuable lessons were learned, one being that the setting up of drug rehabilitation centres involves allaying the many fears of the local population (4).


The Attlee Foundation also funded two Americans, one an ex-addict and graduate of Phoenix House, New York, to come over and take up clinical posts as Director and Assistant Director of the project, with the Senior Psychiatric social worker as Co-Director. Simultaneously, a withdrawn British addict was sent to Topic House, New York, for rehabilitation with the intention that on his return he would become a trained ex-addict staff member. The community opened with four residents and completed its first year with an average of fifteen to sixteen residents. At this time there were difficulties involving the adaptation of the programme to the British culture. The American staff left, and perhaps one of the most valuable phases through which Phoenix House passed was the ability to survive and achieve its present position with the benefits of mutual support from, and cooperation with other projects. Phoenix is now a thriving community presently with a British staff, successfully growing to its present number of between 30-35 residents, and has many graduates, some of whom at this time are directors of therapeutic communities outside the British Isles. People from many parts of the world have sought advice and received training from Phoenix House.


Suffolk House. In 1969 a British psychiatrist from the Drug Unit at St Bernard's Hospital, London, acquired £44,000 from the City Parochial Foundation and with administrative help from the Helping Hand Organisation a house in Middlesex became a second-stage extension for people who had been withdrawn in the St Bernard's drug unit. A Senior social worker was employed on a full-time basis to run the house, group methods were used and eventually it was felt that more effective development of the House would be encouraged by independence from the hospital. Another staff member was employed and although the House was structured and had various different types of groups, it was decided that ways should be found of improving their techniques.


In 1970, visits were made to the two other Concept Houses in existence in England, Phoenix House in London and Alpha House in Portsmouth, the staff taking part in Encounter Groups and various other techniques. Realising their methods had marked similarities to the Concept Houses, they subsequently decided to make Suffolk House more Concept orientated. It therefore took little adjustment for Suffolk to become a Concept House.


Suffolk then joined the Association for Concept Based Therapeutic Communities in England at its first meeting. The House has now been in existence for seven years and although it has survived many changes during that period, the significant factor is that there have always been residents in treatment, as well as people graduating from the programme. The House now has four staff and an ex-addict Director and Assistant Director and is effectively functioning as a Concept Community.


Ley Community. In August 1970 a British psychiatrist set up a drug unit along traditional therapeutic community lines for the Oxford Region. It was housed in a modern building attached to Littlemore Hospital and the accommodation was shared by alcoholics, each group in separate units in the same building.


In October 1971 an ex-addict graduate of Phoenix House in New York, who had previously worked at Phoenix House, London, joined the staff and the community radically altered to Concept lines. It became difficult as the programme developed to have both units in the same building and eventually a hostel outside the hospital was obtained. A Voluntary Organisation was created to finance the project and subsequently registered with the Oxford County Council under Section 36 of the National Assistance Act, 1948. This Organisation was managed by a Committee which included representatives from the Psychiatry, Probation and Social Services. Finance was obtained partly from a block deficiency grant from the Home Office and partly through payment of residents' fees by the Supplementary Benefits Department, and contributions from Local Authorities under Section 12 of the 1965 Health Service and Public Health Act. Having spent two years in the hospital, senior residents were transferred to the hostel, junior residents remaining at the hospital unit - the hostel not being large enough for everyone to sleep there at night (6).


There have been many changes and developments since but the community is thriving and successful, producing people able to live a constructive life style after many years of drug taking. A significant factor is that this community has also admitted and had some success with recidivists and sex offenders, neither group having previously had a drug problem.


Coolemine. The idea of setting up a Therapeutic Community in Dublin for the rehabilitation of drug addicts was first considered by an Irish lord when he was in London during the winter of 1971/72 to study facilities for rehabilitation there. Subsequently, while surveying the situation in Dublin, he met the Programme Manager, Psychiatric Services of Eastern Health Board, who gave support and encouragement to the project. That there was a serious need for active rehabilitation of drug abusers was made clear by the Government Working Party Report of 1971 and later the Report of the Irish Council of Churches and indeed it was obvious to all those worried and alarmed about the increase of drug abuse among the young.


In June 1972 another visit was made to London, this time solely for the purpose of visiting Phoenix House with a view to recruiting trained recovered addicts. Two ex-addict graduates of Phoenix House, London, then joined the staff of Coolemine and a detailed survey of the drug scene in Dublin was made. It was at this time that contact was made by the Drug Abuse Committee of Junior Chamber, Dublin, who were also interested in, and indeed working towards, the setting up of a facility in the drugs field.


Thus the practical problems of establishing a community were considered. In September 1972 Coolemine Lodge was offered for use as a Therapeutic Community with the cooperation of the Dublin Corporation and it was decided to proceed with the project. At the beginning of January 1973 the staff moved into the house and on the 2nd April the first resident was brought in after much help had been received in furnishing and fitting out the House. Three years later, Coolemine Community is now firmly established and has fulfilled its promises of providing ex-drug abusers with an alternative way of life (7).


Culverlands. The latest project to be opened in Great Britain received its first resident in September 1975 and exists for those who do not have a drug problem. The British psychiatrist who directed the Alpha project was seeking a role in related work and after much discussion with staff and graduates of Alpha House, the following proposal was submitted to:


(1) Regional Hospital Board (Hampshire);

(2) Chief Probation Officer of the Probation Committee.


The main points of this proposal were that the basic Concept-based programme should be relevant to the needs of people with disturbed personalities who do not use drugs, e.g. Alpha House, which has never set out to treat drug abuse as such, regarding it as a symptom of a disturbed immature acting-out personality. Most Alpha residents have records of recurrent crime such as theft, fraud, minor (and sometimes major) violence. These records can be regarded as independent of the symptom of drug abuse - although it is admitted that some thefts have been solely to obtain either drugs or money to buy drugs. Therefore, it could be argued that recidivists are an identifiable group for whom it would be viable to set up a Concept-based programme.


It was suggested that the following groups of people could be offered help:

(a) People currently before the Courts - as an alternative to prison.

(b) As an alternative to people in danger of breaching their Probation Orders.

(c) People with criminal records who are not currently before the Courts but whom, in the opinion of a social worker, probation officer, psychiatrist or of themselves are inevitably expected to be in trouble again.

(d) People on parole from prison.

(e) People on normal release from prison.


Such a project required funding from several sources, in particular from both the Home Office and the Health Service (8). The Regional Hospital Board and the Probation Committee voted for the project in the autumn of 1973 and it was to have opened in the summer of 1974. The project, however, was delayed for a year due to a financial crisis which has since worsened, forcing the Health Authorities to withdraw their financial contribution. Fortunately, the Home Office, keen to see the project go ahead, decided to pay the entire costs and Culverlands was able to open in September 1975.


To summarize, suffice to say that over the eight years since the development of the 'Concept' methods in Great Britain the projects which have established themselves have proved effective not only in the rehabilitation of the long term drug abuser, but also have much to offer others with symptom related problems, e.g. recidivists, sex offenders, etc.


A particular question of interest and discussion has centred around the term 'success'. Historically, residents who have left before completion of these types of programmes were often considered failures. It is now recognised that individuals who enter a community and then leave in a shorter period of time than deemed advisable may nevertheless have benefited considerably. Research projects attached to several of these programmes indicate that a significant percentage of these individuals continue to lead industrious lives, either reducing or altogether discontinuing their drug use. Alternatively, there is a decrease in the number of criminal offences committed. The programmes do not suit all individuals. Consequently, there is a high drop-out rate, particularly in the early stages, but those who do complete treatment show remarkable change from the self-destruction they had once exhibited.


When these communities were first established the client group was drawn mainly from what could be said to be hard drug users. Today, this is far less so, referrals are more likely to resort to a variety of drugs and may readily substitute alcohol when the drug of choice is unavailable. There would also appear to be a less mystical relationship between the addict and his drugs than was assumed in the past, and drug abuse can more clearly be seen as a manifestation of some underlying problem. Drug use has been described as 'a search for valid personal experience'. This is perhaps over-simplification of the situation but it also proposes a solution; in that we recognise that the drug user comes with a problem and not a sickness - these therapeutic communities have offered, and continue to offer, an alternative way of life to a large number of human beings whose prognosis had previously been considered hopeless.


REFERENCES


1. Attributed to RAMIREZ by BENNET, B. (May, 1969) 'The Concept' An Answer to Addiction, Washington Monthly. [return to text]

2. OGBOURNE, A. & MELOTTE, C. Two Therapeutic Communities for Former Drug Users: Theory and Practice (Unpublished).[return to text]

3. CHRISTIE, I. (1973) Octopus - Five Houses Journal. [return to text]

4. KOSVINOR, A. (1973) Unwanted Neighbours. International Journal of Addictions. [return to text]

5. WARREN-HOLLAND, D. & S. (1976) The Featherstone Lodge Project Phoenix House. One Method of Rehabilitation, Third International Conference on Alcoholism and Drug Dependence, Liverpool 1975. Published under the title: Alcoholism and Drug Dependence - a Multidisciplinary Approach. Plenum Press. [return to text]

6. McCABE, J. & WILSON, S. Ley Community - A Rehabilitation Programme for Drug Dependent Offenders (Unpublished). [return to text]

7. Acknowledgements to the Coolemine Annual Report 1974/75. [return to text]

8. Acknowledgements to Dr. I. Christie, Director, Culverlands House. [return to text]


LIST OF CONCEPT HOUSES


ALPHA HOUSE, Droxford, Hampshire - Funded by Hampshire Social Services Department

LEY COMMUNITY, Cumnor, Oxford - Funded by Isis Hospital Group. Liaises with Social Services Department and Probation Service.

PHOENIX HOUSE, Forest Hill, London -Funded by London Boroughs Association. Sponsored by Attlee Memorial Foundation.

SUFFOLK HOUSE, Uxbridge, Middlesex -Funded by Helping Hand Organisation

COOLEMINE LODGE, Clonsilla, Dublin -Funded by Eastern Health Board, Drug Abuse Committee of Junior Chamber, Dublin.

CULVERLANDS, Wickham, Hampshire - Funded by Home Office, Great Britain.

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