Privileges and sanctions constitute an interrelated system of community and clinical management through behavioral training. The management of the community is the responsibility of peers and staff. This chapter details the formal system of community privileges and sanctions prescribed by staff and the informal system of verbal affirmations and correctives implemented primarily by peers. Privileges are used to promote individual socialization and personal growth. It confirms the resident’s overall personal autonomy and ability for self-management. Money is a major problem in the lives of substance abusers. However, money difficulties also reflect social and psychological problems among substance abusers in therapeutic communities (TCs). Sanctions may be grouped into verbal correctives and disciplinary actions. Sanctions promote community awareness and peer self-management and maintain social order through addressing individual and collective infractions. Sexuality is approached differently from the other rule-governed behaviors in the TC.
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Community is the primary means of teaching and healing in the therapeutic community (TC). This chapter presents an overview of the four main facility-wide community meetings, namely, morning meeting, seminar, and house meeting, and general meeting, as organized components of the daily regimen. The common purpose of the main meetings in the TC is to enhance the perception of community among the participants. These differences reflect community and clinical management as well as psychological considerations. Each meeting focuses on a specific component of community business and clinical transactions involving a large number of residents. This provides oversight of the physical security of the house and facilitates assessment of overall clinical status of the residents. Changes in individual or collective mood, attitude, and behavior can be quickly detected within a single day’s observation. Overall the various meetings are essential for efficient community as well as clinical management of the facility.
In the therapeutic community (TC), surveillance means supervision and management of the orderliness and safety of the physical environment, as well as the health and conduct of the social environment. This chapter describes the main facility-wide surveillance activities of the general inspections (GI), the house run, and urine testing, actions implemented in the management of the community. The GI is a useful community and clinical management activity. The house run is the main system of surveillance in the TC. In terms of management goals, house runs permit early detection of potentially larger problems such as those related to fire, sanitation, and security. However, its fundamental clinical purpose is to assess the status of individuals in terms of self-care, self-management, and their relationship to the community. The main urine test procedures used by most TCs are unannounced random urine screens and incident-related testing procedures.