TREATMENT APPROACH The principal treatment modality in the Recovery Clinic program is peer-based self-help. It is used to promote a sense of mutuality among the patients and a goal of abstinence. From the outset of their exposure to the program, peers are led to understand that conduct of the therapy is primarily in the hands of the group under the leadership of its abstinent senior patients. Professionals, however, carry out evaluation and counseling, prescribe psychiatric medication (psychiatrist only), and assume some leadership functions. Peers spend most of the time in conjoint activities in a large day room. Roles assigned to them include contacting new patients in the inpatient service of our facility and orienting them to the program, confronting peers' maladaptive defenses and drug use, and promoting an orientation toward drug-free community adaptation. Most therapeutic groups are managed by peers who have been in the program for at least several months. In these groups, communication is frank but supportive. Although disruptive behavior and evidence of drug use is openly confronted, the tone, as modeled by the professional staff, includes a respect for the psychological limitations of patients and an acknowledgment that some have serious psychiatric disorders.
TARGET AUDIENCE
This training manual is primarily targeted to addiction counselors and masters level counselors with limited experience in addiction. It provides essential information about peer-led clinic treatment for drug abuse. The manual may also be useful to doctoral level professionals in addiction care who want more specific training in the TC model. It is recommended that the maximum number of participants in this training be set at 12.
CONTEXT FOR MANUAL DEVELOPMENT
Input was solicited from each and every treatment provider associated with the program as well as senior peers (i.e., participating patient group leaders) with particular emphasis placed on developing operational definitions for acceptable behavior in treatment. This manual is focused on common knowledge and expectations of the treatment providers and senior peers rather than specialized expertise of any one type of treatment provider. Input from the following disciplines was represented in the final version of this manual: social work, psychology, psychiatry, addiction counseling, and nursing. The input of senior peers was particularly helpful in ensuring that training materials were clear, free of professional jargon, and respectful of patient concerns. We have identified 7 primary competency areas, incorporating training goals in this curriculum consistent with the Board of Directors of the Therapeutic Communities of America (Kerr, 1986 in De Leon & Ziegenfuss, 1986).
