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Eric Broekaert passed away shortly after the XVIth European Working group on Drug-Oriented Research (EWODOR)-conference in Rome on 28 September 2016. He was one of the great TC pioneers in Europe, who founded the first TC for addictions in Belgium (De Kiem) and co-founded the European Federation of Therapeutic Communities and EWODOR. He was a respected Professor of “Orthopedagogics” at Ghent University and a Member of the Editorial Collective of Therapeutic Communities: the International Journal of Therapeutic Communities. The paper aims to discuss the overview of the career of Eric Broekaert.

In this obituary, the authors provide an overview of his career, major achievements and theoretical, methodological and integrative ideas, clustered around four typologies: university professor and scholar; manager and source of inspiration; TC pioneer and believer, and integrative thinker.

Besides his obvious merits as a TC researcher and advocate, one of his major theoretical contributions has been the introduction of the holistic, integrative approach and the idea that diverse types of interventions, as well as methodological approaches can alternatively go together.

He regarded TCs as the ultimate integration of various educational and therapeutic approaches to promote growth and quality of life among severely disadvantaged populations, such as drug addicts and children and adults with emotional and behavioural disorders.

This paper aims to report the findings of an evaluation study concerning the Central Registration Points (CRPs) for drug users in Belgian prisons. CRPs support drug users to link with community-based services.

The study applied a multi-method approach that involved an exploratory literature review; a secondary analysis of the CRPs’ databases; a qualitative study of the perceptions of a diverse sample of stakeholders with regard to the functioning of CRPs; and a prospective registration study.

One-third of the clients never attended an outpatient or residential substance abuse service before prison entry. This illustrates that the CRPs managed to reach clients who were not previously reached by (substance abuse) treatment services. All interviewed actors emphasized the added value of the CRPs in terms of informing, contacting, motivating and referring prisoners with a substance abuse problem.

Based on the research findings, two issues seem to be of paramount importance in the successful practice of CRPs: the confidentiality and specific expertise on (substance abuse) treatment. Given the complex situation of drug users in prison, an independent positioning and categorical assistance with drug-specific expertise seem to be essential.

CRPs can be considered to be one of the “building blocks” that contribute to high-quality care and continuity of care for drugs users in detention.

The purpose of this paper is to explore risk and protective factors for alcohol use among school-going adolescents in Montevideo (Uruguay).

A self-report survey was administered to 331 school-going adolescents in Montevideo (Uruguay) (M_age=13; SD=0.05), using the alcohol screening instrument of the Uruguayan National Drug Board to assess adolescents’ alcohol use (yes/no), a screening instrument for psychopathology and resilience (the adolescent self-report) and a socio-demographic questionnaire.

Logistic regression analyses identified antisocial behaviour, substance use and negative emotionality (F2), disruptive and dysregulated behaviour (F8), higher age and recent death of a close relative as risk factors, while the number of close friends was identified as a protective factor for past year alcohol use (yes/no). No straightforward relationship was found between schools and the risk for the past year alcohol use. In addition, age, F2, F8 and recent death of a close relative appeared to be the most robust predictors.

The study was the first in Uruguay to relate adolescents’ alcohol use to risk and protective factors. Given the cross-sectional nature of the study, causal relationships could not be determined.

The study provides preliminary recommendations for policy makers and other stakeholders involved in youth affairs on core elements to focus on school-, community- and family-based alcohol prevention programmes for adolescents.

Given the scarce literature on alcohol use disorders (AUD) and their treatment in developing countries, this paper aims to explore motivation levels and their correlates among alcohol service users in two residential treatment centres in Kampala, Uganda. This study how motivation levels of Ugandan alcohol service users compare with those from American studies; and the specific factors affecting internal and external motivation in the Ugandan context.

The motivation for treatment was measured among 100 individuals entering AUD treatment using the Texas Christian University (TCU) Treatment needs and Motivation scale. The WHOQoL–BREF, Addiction Severity Index–6 and Hopkins Symptoms Check List–37 were used to measure addiction severity, quality of life (QoL) and psychopathology, respectively. Correlates of motivation were identified using linear regression analyses.

Ugandan service users demonstrated low treatment motivation in the treatment needs a domain. While addiction severity (recent heavy alcohol use) and participating in private treatment were associated with higher internal and external motivation, deterioration in physical and environmental QoL, depressive symptoms and lower education were linked with higher internal motivation.

Different elements affect domains of treatment motivation, requiring attention for clients’ unique needs as influenced by their background, addiction severity, QoL, psychological needs and contextual factors (e.g. treatment setting). Further studies are needed to explore additional correlates of motivation for treatment among alcohol service users in Uganda and to assess the longitudinal impact of motivation on treatment outcomes.

Although motivation has been extensively studied, clinicians are challenged in understanding and explaining motivational dynamics given the multiplicity of factors influencing change-related decisions and behaviours and the diversity in substance-using populations. This need is even bigger in non-Western societies as cultural differences may require differential therapeutic management. This is one of the first studies measuring motivation for AUD treatment in a low-income country and offers insight for understanding motivation dynamics in similar settings.

The purpose of this paper is to investigate the possible impact of a randomised controlled trial on the therapeutic environment of participating therapeutic communities (TCs).

The authors compared the environment in four democratic day TCs involved in a randomised trial (experimental TCs) with a similar democratic day TC not involved in the trial (the control TC) by administering the Community Oriented Environment Scale (COPES) to 28 TC members.

TC members’ views of the real psychosocial environment at the experimental TC and control TC showed similar high levels for spontaneity, autonomy and personal problem orientation and similar intermediate levels for practical orientation and staff control. The TC members at the experimental TC rated significantly higher levels for order and organisation and clarity, while members at the control TC rated a significantly higher level for involvement.

The study provided no evidence of a significant adverse impact on the culture of democratic day TCs due to participation in a randomised trial. This finding answers one of the most common arguments in the debate on the ethics of RCTs in TCs.

Even though there is much information available with regard to the development of the therapeutic community (TC) for addictions in Europe, little is known about the particular situation in Denmark.The paper aims to discuss this issue.

In order to address this dearth, the methodology of the following historical account is largely based on an interview and personal contacts with Hanne Holm Hage-Ali, current director of TC Opbygningsgården and star witness of the development of TC in Denmark.

In 1971, the Freetown “Christiania”, Copenhagen, where TC Opbygningsgården started up, was based on communal, anarchic and hippie ideas and values. In the beginning, TC Opbygningsgården was not well accepted by TC pioneers promoting the classic hierarchical TC, as it was seen as a social experiment with anti-authoritarian roots. Later, in its turn, it became influenced by TCs Veksthuset and Phoenix House Haga, Norway, which were part of the common European TC movement. At this moment, TC Opbygningsgården functions as a well-accepted member of the European Federation of Therapeutic Communities.

The interview revealed information that it is line with current trends in and challenges for TC throughout Europe, as outlined in a recent EMCDDA study: TC in Europe can be considered as “children of the late sixties”; TCs are embedded in the anti-psychiatric movement, existentialism and the promotion of alternative community living; European TC leaders had different origins and professional background; and the TC never belonged to one religion or ideology. The common human value system always transcended the different visions.

This paper aims at addressing the dearth in knowledge on the development of TCs in Denmark.

The purpose of this paper is to summarize the main findings and conclusions of four separate studies on treatment in therapeutic communities (TCs) for addictions.

The first two studies address the core characteristics of the TC approach: a study on the workable and destructive elements of the Synanon model; and a comparative study on the essential elements of TCs for addictions in Europe and in the USA. The final two studies highlight clients’ perceptions of the TC treatment process in relation to retention: a study on clients’ first month perceptions of the TC treatment process and the influence of fixed and dynamic client factors; and a longitudinal study on changes in clients’ perception of the TC treatment process and the impact of motivation, psychological distress and cluster B personality traits.

The first study showed that Synanon’s therapeutic and pedagogical methods are still highly valued despite its negative reputation. The results of the second study suggest that while traditional TCs operate as concept-based TCs in Europe, modified TCs might differ in the extent to which they apply the core principles and elements of the TC approach. The third study provides evidence that suitability for treatment is a very important predictor for clients’ first month perceptions of the community environment. The fourth study shows that with time in treatment clients develop more profound perceptions regarding the essence of TC treatment.

Finally, implications for clinical practice, general limitations and some concrete recommendations for future research are presented in this paper.

The PhD summary study contributes to the existing literature on TC treatment.

Problem solving courts are a result of the therapeutic jurisprudence movement. Drug treatment courts (DTCs), for instance, aim to divert substance using offenders away from the criminal justice system (CJS) to (drug) treatment services. DTCs are associated with reduced criminal offending and substance use. Psychosocial outcomes of DTCs, such as employment, health and family relations, received only little attention. The paper aims to discuss these issues.

This paper focuses on the outcomes regarding substance use and psychosocial variables of a Belgian DTC situated in the Ghent region, which were investigated by a naturalistic evaluation study with a pre- post-design using judicial files.

The results show that Ghent DTC clients were diverted to drug treatment and financial counselling services. Next the Ghent DTC produced beneficial outcomes regarding employment. Contrary to criminal offending (De Keulenaer and Thomaes, 2013), substance use was not significantly reduced in the Ghent DTC sample. Yet more compliance with opioid maintenance treatment was observed. Information on more client centred outcomes such as health and social relations was lacking, precluding a full outcome measurement of psychosocial variables.

Future DTC studies should address more client centreed outcomes by gathering information through DTC clients and treatment services instead of solely relying on judicial data sources. In addition, DTCs should develop a clear and uniform registration system regarding these outcomes.

Since the therapeutic jurisprudence movement continues to expand, discussion regarding the roles and tasks of the CJS as well as treatment and counselling services is vital. Each actor should maintain its own role and task, regarding monitoring and substantive work, to insure a “problem solving approach” that is in line with the recovery philosophy.

Deviant behavior was punished during the middle ages. In the seventeenth century, people were locked up in asylums. A first step towards humanization was taken by the founders of the moral treatment movement in the nineteenth century, but it declined at the end of that century. What we today call “milieu therapy” represents a new phase in treating mental illness and deviance. After the Second World War, the therapeutic community (TC) method was widely implemented in Europe, but the needs of different target populations were not dealt with equally. The paper aims to discuss these issues.

In this contribution, the treatment needs of diverse populations of female drug abusers are addressed. Selected literature and research findings for women in mixed and gender-specific treatment are presented.

The conclusion is that we need a women and family perspective in substance abuse treatment and research. Moreover, a holistic and multidisciplinary treatment approach is needed since so many factors and aspects are involved.

Treatment programs should focus on long-term lifestyle changes and be tailored to the specific needs of diverse target populations. Modified TCs for women and men with children and/or dual diagnosis are definitely the future for TCs.