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Introduction
“Treatment research has been asking the wrong questions in the wrong way” (Orford, 2008, p. 875). This is the sobering conclusion of a study investigating research approaches in the field of addiction treatment. According to Orford (2008), the way in which treatment effects and interventions are studied and conceptualized has not been helpful to treatment planners or therapists: Therapeutic relations and treatment processes have been neglected in favor of a focus on techniques. Moreover, service users’ points of view have been largely ignored.
Research on the drug-free Therapeutic Community (TC) suffers from comparable shortcomings. TCs are drug-free environments where people with addictions live together to promote recovery in terms of an identity change (De Leon, 2000). The TCs’ focus on identity change is considered being a requisite for long-term recovery. Surprisingly, however, the background rationale for aiming at identity change to treat substance addiction, and the way in which the TC’s apparatus procures this desired change has not sufficiently been clarified: “little is understood in terms of why and how TCs work” (De Leon, 2000, p. 5). Evidently, this lack of understanding has led to a growing call for qualitative process research (e.g. Broekaert et al., 1999; De Leon, 2000, 2010; Oxford Science Meeting, 2008; Ravndal, 2003).
While De Leon (2000) already suggested that TC research should study which components of the treatment contribute to long-term recoveries, in our perspective, this can only be realized by also taking into consideration the person’s identity-related problems beyond his/her craving for drugs. The present study aims at gaining further insight into TC-related processes of change by investigating the connection between the TC residents’ identity-related problems, the dynamics of TC life, the residents’ process of change and the treatment outcome. To this end, we investigated outcomes and processes as reported by former TC residents and by applying Lacanian psychoanalytic theory on identity formation/change to interpret the narratives (e.g. Le Poulichet, 1987, 2011; Vanheule and Verhaeghe, 2009). While several researchers have started to address the topic of recovery from substance addiction in relation to changes in identity (e.g. Best et al., 2016), our attempt is to learn more on the process leading to such change in TCs. In the next parts, we will explain why we consider...