Table Of ContentMiroslav Horák
Nahanga Verter
Substance
Use Disorders
Treatment in
Therapeutic
Communities
A Cross-Cultural Approach
Substance Use Disorders Treatment in Therapeutic
Communities
Miroslav Horák • Nahanga Verter
Substance Use Disorders
Treatment in Therapeutic
Communities
A Cross-Cultural Approach
Miroslav Horák Nahanga Verter
Department of Languages Department of Regional
and Cultural Studies and Business Economics
Mendel University in Brno Mendel University in Brno
Brno, Czech Republic Brno, Czech Republic
ISBN 978-3-031-16458-3 ISBN 978-3-031-16459-0 (eBook)
https://doi.org/10.1007/978-3-031-16459-0
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Acknowledgments
Here, we would like to thank all those who supported us during the preparation of
this book. Firstly, for accepting our book proposal and for constant support by his
excellent team during the preparation of manuscript, Bruno Fiuza, Editor of
Behavioral, Health, and Social Sciences, Springer, Latin America. Secondly, our
supervisors from Charles University, Prof. RNDr. Stanislav Komárek, Dr., Faculty
of Science, Department of Philosophy and History of Science, and PhDr. Marek
Halbich, Ph.D., Faculty of Humanities, Department of General Anthropology. Our
colleagues from the Masaryk University, PhDr. Athena Alchazidu, Ph.D. (Language
Center) and Mgr. Martin Čuta, Ph.D. (Faculty of Science, Department of
Anthropology), were immensely supportive during the manuscript preparation. We
would also like to express our sincere thanks to doc. Ing. Kristina Somerlíková,
Ph.D., for selfless help with the statistical data analysis.
The reviewers’ comments on the first version of our book were precious in terms
of publication improvement. Namely, they were provided by PhDr. Veronika
Kavenská, Ph.D., Takiwasi, Center for the Rehabilitation of Drug Addicts and
Research on Traditional Medicines; doc. RNDr. Tatiana Bužeková, Ph.D., Comenius
University in Bratislava, Faculty of Arts, Department of Ethnology and Museology;
and doc. PhDr. Oldrich Kašpar, CSc., University of Pardubice, Faculty of Arts,
Department of Social and Cultural Anthropology.
The data collection and processing needed to perform fieldwork was based on
financial support from several projects. We participated either as lecturers or
researchers. The European Commission, the Ministry of Education, Youth and
Sports, Czech Republic, and the Internal Grant Agency of the Faculty of Regional
Development and International Studies, Mendel University in Brno, subsidized our
activities. Specifically, the implemented projects were the following:
1. Improvement of Professional Competences of Students of Bachelor Study
Program International Development Studies Through the System of Practical
Internships in Developing Countries (reg. No.: CZ.1.07/2.2.00/28.0257)
vii
viii Acknowledgments
2. Strengthening Competitiveness of MENDELU Graduates in the Field of
Development Cooperation and Management of Natural Resources in the Third
World (reg. No.: CZ.1.07/2.4.00 /17.0028)
3. Erasmus+ KA1
4. Research on Retention of Inpatients in Therapeutic Communities in the Czech
Republic, Peru, and Nicaragua (reg. No.: 2/2014)
5. Effectiveness of the Community Treatment of Drug Addiction in Cross-Cultural
Perspective (reg. No.: 3/2015)
6. Sociocultural Aspects of Drug Addiction Treatment (reg. No.:
FRRMS_IGA_2017/002)
At this point, we would like to thank prof. Dr. Ing. Libor Grega for allowing us
to participate in the first three mentioned projects. In addition to valuable experience
in leading internships for students in Latin American countries, we had the opportu-
nity to research Nicaragua and Peru. Other projects allowed us to carry out a similar
investigation in the Czech Republic.
Our sincere thanks also go to all former or current directors and therapists of the
therapeutic communities where the research was conducted: Bc. Jan Sobotka from
Sejřek; Mgr. Jana Mirkova from Kladno-Dubí; Mgr. Aneta Kalusová from Renarkon;
Luisa Telleria, Javier Ley, and David Stadthagen González from Centro de
Especialidades en Adicciones (CEA); Roland Guevarro from Centro de
Rehabilitación del Alcohólico y Adicto a Otras Drogas (CARA); David Espinoza
from Albergue de Miembros Adictos en Recuperación (AMAR); and Jacques
Mabit, MD, from Takiwasi. The support of Fabio Friso (Área Comunicaciones
Takiwasi) is acknowledged for kindly providing references from the internal data-
base of the Center that could be compared with the results of the performed system-
atic literature review.
We would also like to thank all the students who helped us with the data collec-
tion and transcription of interviews. The students are Ing. Wanda Vozáryová, Ing.
Karolína Tichá, and Ing. Kristína Mikulová. Without their participation, timely
completion of the manuscript would not have been possible.
Finally, we would like to express our special gratitude to all the informants for
their unselfish participation in the research.
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Overview of the Research Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Outline of the Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2 Theoretical Approaches to SUDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Concepts Related to SUDs and Their Treatment . . . . . . . . . . . . . . . . . . 8
Theoretical Models of Substance Use . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3 Characteristics of Investigated TCs. . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Integrative (Syncretic) Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Religious Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Biosocial Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Conservation Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
CEA, CARA, and AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Renarkon, Sejřek, and Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4 Qualitative Methods in the Research on SUDs . . . . . . . . . . . . . . . . . . 35
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Research Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Research Paradigms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Data Collection Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Coding Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Methods of the Statistical Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . 40
Systematic Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
ix
x Contents
5 Results of the Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Model of the Grounded Theory Paradigm . . . . . . . . . . . . . . . . . . . . . . . 46
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
6 Effective Factors of the Treatment in TCs . . . . . . . . . . . . . . . . . . . . . . 51
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
7 Finding Motivation in Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Theories of Motivation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
8 Family and Substance Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
9 Spirituality and Religion in SUDs Treatment . . . . . . . . . . . . . . . . . . . . 135
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
10 Substance Use from the Cross-Cultural Perspective . . . . . . . . . . . . . . 163
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
CEA, Cara, Amar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
11 Previous Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Contents xi
12 Etiology of Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
13 Treatment Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
14 Treatment Rules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
15 Group Cohesion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
16 Impact of Substance Use on the Study or Work. . . . . . . . . . . . . . . . . . 297
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
17 Therapeutic Choice in the SUDs Treatment . . . . . . . . . . . . . . . . . . . . . 321
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
18 Gender Differences in Treatment of Substance Use Disorders . . . . . . 345
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Takiwasi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346
CEA, CARA, AMAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Renarkon, Sejřek, Kladno-Dubí . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
