The experience of drug-dependent adolescents in a therapeutic community

Introduction and Aims. Drug treatment programs for adolescents are now more widespread with some evidence of success. However, there has been little in-depth exploration of factors that may encourage or hinder program completion. This ethnographic study of an adolescent therapeutic community aimed to provide insights into the experience of the adolescent residents. Design and Methods. Four months of participant observation at a program for drug-dependent adolescents in a metropolitan city in Australia. Twenty-one residents (15 boys and six girls) aged between 14 and 18 years participated, comprising all residents admitted during the study period. Results. Vocational Education and Art Therapy are activities that universally engaged residents whereas frustration was evident in Journaling-a core program activity. Group sessions were often used to set up or dismantle social cliques, although they were also useful to expose difficult inter-personal relationships. The risk of residents 'taking off' was heightened during breaks from program activities when strong emotions surfaced. Discussion and Conclusions. There needs to be a more central role for creative and vocational activities in adolescent programs and a variety of ways for them to document their journey. Group encounters need to be skilfully facilitated by staff to handle fluid inter-personal dynamics and residents need support outside of formal program time to minimise drop-out. The concept of a navigation-engagement continuum is discussed and the need to see treatment as a series of encounters that may be 'successful' despite 'non-completion'. This study gives adolescents a voice in program evaluation which may help improve retention. [Foster M, Nathan S, Ferry M. The experience of drug-dependent adolescents in a therapeutic community. Drug Alcohol Rev 2010; 29; 531-539]