Therapeu(c*Communi(es:*The*Interna(onal*Journal*of*Therapeu(c*Communi(es Samaritan(Village(Veterans(Programs:(Chemical(Dependence(Treatment(for(Veterans(in(a(Therapeu:c(Community( Carol&Davidson& Ar(cle*Informa(on: To(cite(this(document: Carol(Davidson,((2008),(“Samaritan(Village(Veterans(Programs:(Chemical(Dependence(Treatment(for(Veterans(in(a( Therapeu:c(Community”,(Therapeu:c(Communi:es:(The(Interna:onal(Journal(of(Therapeu:c(Communi:es,(Vol.(29(Iss( 1(pp.(96K107 This(copy(is(allowed(for(personal(use(only.((For(addi:onal(copies(please(email:(post@therapeu:ccommuni:es.org For*Authors Emerald(Group(Publishing(currently(publishes(Therapeu:c(Communi:es:(The(Interna:onal(Journal(of(Therapeu:c( Communi:es.((If(you(would(like(to(write(for(this(publica:on,(please(see(the(Author(Guidelines(here.( About*Emerald*www.emeraldinsight.com Emerald(is(a(global(publisher(linking(research(and(prac:ce(to(the(benefit(of(society.(The(company(manages(a(porVolio( of(more(than(290(journals(and(over(2,350(books(and(book(series(volumes,(as(well(as(providing(an(extensive(range(of( online(products(and(addi:onal(customer(resources(and(services.( Emerald(is(both(COUNTER(4(and(TRANSFER(compliant.(The(organiza:on(is(a(partner(of(the(Commiaee(on(Publica:on( Ethics((COPE)(and(also(works(with(Por:co(and(the(LOCKSS(ini:a:ve(for(digital(archive(preserva:on. www.therapeuticcommunities.org Samaritan Village Veterans Programs: Chemical Dependence Treatment for Veterans in a Therapeutic Community Carol Davidson ABSTRACT: Veterans are a special population that will benefit from chemical dependence treatment in an environment that addresses both the inherent strengths and clinical challenges associated with their military service history. Samaritan Village has a network of services that includes two residential therapeutic community pro- grams for veterans. Both programs serve male veterans who have problems such as substance abuse, homelessness, health, mental health, vocational, family, and criminal justice system issues. The programmatic culture is enhanced by veterans-specific services including an emphasis on veterans’ pride and camaraderie, and co-located treatment for Post Traumatic Stress Disorder (PTSD). Combat trauma frequently results in PTSD, and the incidence of substance abuse among traumatized veterans is signi- ficant. Therapy groups promote recovery by providing support for the processing of unexpressed memories, cognitive reframing of experience, the development of affect regulation skills, member- ship in a recovery-based support network, and the ability to build toward a future life that has meaning and purpose. As American veterans return home from Operation Enduring Freedom and Operation Iraqi Freedom, the need for enhanced awareness of their needs will be crucial within the field of human services providers. Background The aftermath of America’s long involvement in Vietnam brought an unprecedented level of professional, academic, and socio-cultural attention to the psychological ravages of war and the readjustment problems encountered by returning combat veterans. While the mental health community endeavored to explicate the essential features of a previously unspecified disorder associated with battlefield trauma, veterans gradually began enrolling in chemical dependence treatment services within the network of existing programs. Carol Davidson LCSW, CASAC is at Samaritan Village, New York, USA. E-mail: [email protected] therapeutic communities, 29, 1, spring 2008 © The Author(s) Carol Davidson 97 In 1996, Samaritan Village acquired funding from the New York State Office of Alcoholism and Substance Abuse Services to open a residential therapeutic community for 48 male veterans in Manhattan. Samaritan Village has a history that encompasses more than four decades of service to the greater New York metropolitan area, and an abiding commitment to the therapeutic community tradition in which the organization is rooted. The scope and breadth of treatment modalities currently integrated within the agency’s roster of programs includes both residential and outpatient facilities that address chemical dependence, co-occurring disorders, homelessness, vocational deficits, health issues, interpersonal and family dynamics, criminal justice mandates, and the myriad life challenges associated with recovery. In 2006, in recognition of ten years’ success of the Samaritan Village Veterans Program, and in anticipation of the needs of veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom, funding was awarded to open a second veterans’ facility; subsequently, The Ed Thompson Veterans’ Center began operations in Richmond Hill, NY. The therapeutic community represents a microcosm of society in which deeply personal issues such as addiction, poverty, racism, sexual abuse, domestic violence, and HIV/AIDS emerged both as a focus of treatment for the individual client and as a reflection of the trends and challenges that existed within the external culture. At Samaritan Village, Vietnam veterans who sought treatment of their chemical dependence problems in the 1980s were met by clinical teams who had expertise in addictions treatment, but little specific knowledge about combat trauma, Post Traumatic Stress Disorder, health issues associated with Agent Orange exposure and/or other war-related injuries and illnesses, or the vast bureaucracy associated with military discharge codes and related entitlements. Combat veterans were often secretive, detached, irritable, preoccupied, and sometimes explosive. The therapeutic community environment provided both structure and nurture, but it was clear that the population posed specific challenges for which there was a paucity of knowledge to draw upon. Change develops organically within the therapeutic community, and the origins of expertise in veterans’ services began to emerge from within the extended family of the organization. Ed Thompson, a clinical staff team member at a residential facility, was a Korean War veteran. Combat veterans began to seek him out as a confidant and a role model. Over time, Thompson developed a ‘veterans’ club’, a specialized therapy group, and a linkage system for veterans in the other Samaritan Village facilities. Subsequent clinical experience, independent study, consultation with the professional community, and input from the client population contributed to a growing body of knowledge and techniques for treating veterans’ issues within a therapeutic community milieu. Program overview The veterans’ programs are long-term, residential therapeutic communities for the treatment of chemical dependence. The criterion for admission is a primary 98 therapeutic communities, 29, 1, spring 2008 problem of alcoholism/substance abuse and a willingness to participate fully in the therapeutic community modality. Samaritan Village has chosen to define the term ‘veteran’ as simply indicating prior military service. Unlike the official government Veterans Administration system, military discharge codes are not used to determine admissions eligibility. This distinction has proved to be crucial in providing a treatment option for veterans who are not eligible for VA services. Prospective residents are admitted through a central intake facility where they participate in orientation activities and initial evaluations for health, mental health, vocational and other biopsychosocial issues which may be a focus of treatment. Diagnostic tools, including the ‘Life Events Checklist’ and the ‘Clinician Administered PTSD Scale for DSM-IV’, are utilized within the assess- ment process. Co-occurring disorders, including PTSD, and other mental health issues are identified and incorporated into a preliminary treatment plan. The intensive case management and enhanced mental health services available within the veterans’ programs allows for the inclusion of prospective clients whose multi-dimensional problems might traditionally have disqualified them from the therapeutic community setting. Upon transfer to one of the veterans’ programs, residents remain at that site for the duration of their residential treatment stay, including Re-Entry. The typical length of stay is about one year. Residents achieve eligibility for completion by successfully achieving a series of individualized, sequential treatment goals and developing a viable plan for independent living and Continuing Care. Veterans who are employable may attend vocational training while in treatment, and will ‘transition out’ to the workplace in fields ranging from food services to building maintenance, driving, security, human services, or other skilled jobs. A smaller percentage of the population resume civil service, technical, or professional careers. Both veterans’ programs are currently designed to treat male residents exclusively. (The special needs of female veterans will be best served in a stand- alone facility, which is a matter for future consideration due to the significant role of women in combat at this time.) Client demographics reflect a population that is generally middle-aged, with multiple prior treatment episodes and/or incarcerations. More than half of our residents have a co-occurring mental health diagnosis, including both combat and non-combat-related PTSD as well as a range of affective, personality, and psychotic disorders. Most of the residents have lengthy substance abuse histories, with heroin, crack cocaine, and alcohol as primary drugs of abuse. Common health problems within the population include diabetes,