RESIDENTIAL

TREATMENT OF
SUBSTANCE USE
DISORDERS
Practice Committee Consensus Report
April 2013

Core Therapeutic
Elements and
Their
Relationship to
Effectiveness

Executive Summary
The Affordable Care Act (ACA) requires coverage of substance use disorder (SUD) care, identifying
SUD services as one of the laws Essential Health Benefits (EHB). As more discretion has been given
by the Department of Health and Human Services (HHS) to states to define the EHB, it will be most
important to work at the state level to ensure that individuals with mental illness and substance use
disorders receive quality care within a full continuum of evidenced-based care.
Addiction is a chronic health condition and can be successfully managed over time like other chronic
conditions. Residential treatment is a more intense service within the continuum of care with levels
responsive to the conditions of the patient.
The described core elements and therapeutic processes presented in this paper, together with the
Patient Placement Criteria developed by the American Society of Addiction Medicine (ASAM) are the
basis of the following description of residential treatment:
Residential Treatment is a normative, pervasive environment supporting a 24 hour-per-day
culture and milieu of beliefs and ideology, which value respect for the inherent goodness of the
individual, the capacity to change, personal responsibility, and the reliance on the treatment
community as a therapeutic agent.

Core Elements
1. Structure and stability
2. Safety and separateness
3. Therapeutic conditions and processes
Central to the continuing evolution of residential treatment is a commitment to the principles of selfmanagement of a chronic health condition. Within the normative pervasive environment of the
residential setting the community is a therapeutic agent where patients are empowered to manage
their health. Disease control and outcomes depend on patients using effective self-management.
Support includes acknowledging the patients' role in their care, fostering a sense of responsibility for
their health, using proven programs that provide emotional support and strategies for living with
chronic illness. Providers and patients work collaboratively to define barriers, set priorities, establish
goals, create treatment plans, and solve problems. Goals include sustaining abstinence, preparing for
triggers, improving personal health and social functioning, and engaging in continuing care.

Conclusions
1. The effectiveness of residential treatment is embedded in how the core elements of this safe,
separate, secure, and stable environment respond to the needs of individuals with deficits in
cognitive, social, interpersonal, emotional, and/or coping skills.
2. These individuals come from environments that are unstable, chaotic, abusive, and/or toxic,
and need a regimented, supportive, stable environment to habilitate or rehabilitate.
3. Individuals with more severe dysfunctions exhibit impulsivity, deficient anger management,
hostile/violent acting out, and/or resistance/antagonism to limits. They need an
environment which manifests respect, capacity to change, and personal responsibility within a
communal setting. The communal setting represents a microcosmic representation of the
larger society and provides the social context to alter thinking, feelings, and behaviors.
4. Treatment interventions are matched to a persons readiness to change and it is critical that
this individualized treatment matching occurs to assure that residential treatment is not
under-utilized or over-utilized.
1

Residential Treatment of Substance Use Disorders

Core Therapeutic Elements and Their Relationship to Effectiveness
Introduction
Alignment with Health Care Reform
The Affordable Care Act (ACA) requires coverage of substance use disorder (SUD) care, identifying
SUD services as one of the laws Essential Health Benefits (EHB). With the ACAs strong coverage
provisions, millions more Americans will have better access to the SUD care and supports they need
to become and remain well. Work to define which services are covered in each of the EHB categories
continues at the federal level and in the states. As a field we are moving forward to assure full
coverage for mental illness and substance use disorders. We have seen, so far, the strong
commitment from the federal Department of Health and Human Services (HHS) to make mental
health (MH) and SUD care a top priority. As more discretion has been given by HHS to states to define
the EHB, it will be most important to work at the state level to ensure that individuals with mental
illness and substance use disorders receive quality care within a full continuum of evidenced based
care.
To support this inclusion there is significant evidence of the
effectiveness of residential treatment which is compiled by the
report Adult Residential Treatment for Substance Use Disorders:
Summary of the Evidence (Reif et al, Institute for Behavioral
Health, Brandies, 2010).
There is also support of the
the Practice Committee
effectiveness of residential treatment in the extensive seminal
was given the charge to
research completed in 1974 by Sells and Simpson (Sells and
compile a consensus report
Simpson 1980) and follow- up studies (Simpson and Sells 1982).
for SAAS on the how and
There also seems to be, in the professional literature, an
why of residential
identification of the core elements of residential treatment that
treatments effectiveness,
correlate with its effectiveness. However, it is less clear how and
which would further
why these core elements are effective and why they need to
support its inclusion as a
occur for some individuals in the environment of a residential
part of the continuum of
setting. This report will summarize these core elements and
care for the treatment of
some correlation to their possible therapeutic effectiveness.
substance use disorders.
There is still work to do to support the inclusion of residential
treatment in the EHB. It is in this context that the Practice
Committee was given the charge to compile a consensus report
for SAAS on the how and why of residential treatments effectiveness, which would further support
its inclusion as a part of the continuum of care for the treatment of substance use disorders.
The intention of this report is to gain a consensus that supports the evidence base of the core set of
services and structured activities which have been described in the good and modern adult
residential treatment setting (SAMSHA, OBrien 2010). This report also emphasizes that addiction is a
chronic health condition which can be successfully managed over time like other chronic health
conditions. Residential treatment is a level of more intense care within the continuum of care with
2

levels of intensity responsive to the conditions of the patient. The report will also strongly urge the
field to arrive at a consensus in which there is a standardization of the levels of care which balance:

the need to individualize care to the needs, strengths, severity of brain dysregulation and
resulting functional deficits of the individual, their status within the progression and/or
remission of the chronic conditions
the matched intensity and frequency of the essential care services and structured
activities (the dosage)
the required credentials and ratio of staff to the patient population.

The confirmation of evidenced based practices of the core services and the balanced standardization
of the levels of care are necessary to support a reasoned and consistent payment structure.

Definitions and Terminology

This report primarily uses the definitions and description of both the ASAM Patient Placement Criteria
and the NIDA Principles of Drug Addiction Treatment as sources for defining residential treatment.
We limited our focus to ASAMs Level III (non-hospital residential).
Level III programs offer organized treatment services that feature a planned regimen of care
in a 24 hour residential setting. Treatment services adhere to defined policies, procedures, and
clinical protocols. The defining characteristics of all Level III programs is that they serve individuals
who, because of their specific functional deficits , need safe and stable living environments in order
to develop their recovery skills (ASAM PPC -2R)
The National Institute of Drug Abuse (NIDA) Principles of Drug Addiction Treatment defines residential
treatment as follows:
Short-term residential programs provide 24 hour per day intensive but relatively brief
treatment typically based on a modified 12-step approach. Long-term residential treatment
provides care 24 hours a day, generally in non-hospital settings. Addiction is viewed in the
context of an individual's social and psychological deficits, and treatment focuses on
developing personal accountability and responsibility as well as socially productive lives.
Treatment is highly structured. with activities designed to help residents examine damaging
beliefs, self-concepts, and destructive patterns of behavior and adopt new, more harmonious
and constructive ways to interact with others.
There is significant confusion about the language used to distinguish between clinical residential
treatment and other supportive forms of residential housing which provide an important part of the
continuum of care supporting some individuals needs for a stage of their recovery. Some authors
have suggested clarifying terminology for clinical residential treatment as non-hospital inpatient
services. This report is concerned that this new terminology will only add further confusion with the
mix of another term for clinical residential treatment as distinct from a supportive form of housing.
Therefore throughout this study we will continue to use the terminology residential treatment of
substance use disorders.

Scope of Consensus Report and Method of Study

The committee completed a limited survey of the literature to identify the core elements of
residential treatment which seem to correlate to its effectiveness. In our survey the core elements
are foundational to a residential treatment environment. They are foundational in the sense that
they are the necessary and sufficient conditions of the residential environment, which are responsive
to the needs and functional deficits identified in the ASAM Patient Placement Criteria for residential
levels of care for both adults and adolescents. They are also the necessary and sufficient conditions
for the various therapeutic processes and outcomes to occur. Those foundational core elements are:
Safety and Separateness, Structure and Stability. The next section summarizes the characteristics of
the core elements and the therapeutic process that occur with the environment that these core
elements support.

Core Elements
Structure and stability are supported by an environment which includes the following major
characteristics:
Daily regimen of scheduled and structured activities:
Group therapy
Reflective time
Individual therapy
Community meetings
Didactics
Recreational/physical activities
Meals
Defined policies, procedures and clinical protocols
Specified roles for staff, residents, and family members
Predictable times to practice recovery and coping skills
Safety and separateness are supported by an environment which provides:
Safety from:
Alcohol and other drugs
Dominant drug culture
Drug places
Chaos
Safety to:
Practice recovery and coping skills
Controlled experiential community environment separate from larger society and from the
drug using culture to which many patients belong
Microcosmic representation of a larger society providing a social and interactive context
to alter thinking, feelings, and behaviors
4

Therapeutic conditions and processes that occur within the residential environment that seem to
correlate to its effectiveness include:
Structures and regimens that support a recovery environment and related behaviors and skills
Sufficient stability to prevent and minimize relapse
Treatment and community structure to practice and integrate recovery and coping skills
Community and treatment settings built upon residents imitative tendencies to learn through
reciprocal role modeling by both peers and staff
An environment built upon the social nature of persons
Encouragement of progress which is dependent on reciprocal interaction in a safe and
separate community setting
A separate community as a means of personal, and in some cases spiritual, transformation
which requires a shift from the self-centeredness of ones personal identity, which is
characterized by addiction thinking, feeling, and behaving, to letting go to a power
greater than oneself
Healing not in isolation, but in communion with others

Residential treatment is intended to be individualized though varied

levels of care and intensity to the functional deficits identified in the
In the residential
ASAM Patient Placement Criteria. The core elements and
treatment environment
therapeutic processes described above are responsive to the
an individuals
functional deficits for patients who meet the ASAM Level III
functional cognitive
placement criteria. These deficits cumulatively support the need for
deficits require
a safe and separate environment which has structure, stability and a
treatment that is
degree of predictability. Throughout a review of these functional
primarily slower paced,
deficits are clear indications of the need for a separate environment,
more concrete and
stronger and consistent structure to support the application and
repetitive in nature.
practice of recovery skills. While all levels of treatment do respond
to the dysregulation of brain systems caused by addiction to
psychoactive substances, the characteristic of this dysregulation, and
resulting functional deficits, is more intense and continual in individuals who need a separate
environment to develop and practice their recovery skills. Therefore, in the residential treatment
environment an individuals functional cognitive deficits require treatment that is primarily slower
paced, more concrete and repetitive in nature. The daily regimens, the structured patterns of
activities, are intended to restore cognitive functioning and build behavioral patterns within a
community. In addition to cognitive functional deficits this safe and stable environment with the
community as a therapeutic agent is also responsive to emotional, social, and interpersonal deficits
identified in these criteria. Some of these deficits are the results of trauma which require
competencies of trauma informed care in both individual and focused group interventions.
Structured group activities and communal living provide the opportunity for learning and practicing
new skills in all these areas of significant dysfunction. Social learning within the normative
environment occurs through modeling new skills and the practicing of new skills which is responsive
to the individuals chaotic environment and often isolated self-centeredness.
5

ASAM Patient Placement Criteria:

Level 111.1 Functional deficits and needs include:
Problems in the application of recovery skills
Lack of connectivity to the world of work, education, and family life
Person in pre-contemplation who is living in an environment too toxic to permit
treatment in an outpatient basis
Need a supportive environment for receiving discovery rather than recovery services.
Level III.3 Functional deficits and needs include:
Person for whom the effects of substance use disorders is so significant that he/she results in
a level of impairment for which outpatient services are not feasible or effective
Functional deficits are primarily cognitive and can be temporary or permanent which require
treatment at a slower pace, more concrete and repetitive until cognitive impairment subsides
Responsive to a person with such severe deficits in interpersonal and coping skills that
treatment focuses more on habilitation rather than rehabilitation
Level III.5 Functional deficits and needs include:
Person with significant social and psychological problems who can benefit from the
treatment community as a therapeutic agent
Functional deficits: chaotic, often abusive, non supportive interpersonal relationships
More serious or lengthy criminal history
Limited or significantly sporadic work and educational history
Treatment interventions are matched to a persons readiness to change:
For some it is discovery
For some it may focus on maintaining abstinence and preventing relapse
For some it is preventing a return to antisocial behavior
For some it is developing a sense of personal responsibility and positive character
change
For some it is habilitative
For some it is rehabilitative
Anti-social value systems characterized by:
Impulsivity, deficient anger management skills
Hostile or violent acting out
Resistance and antagonism to limits or problems with authority
Hyperactivity and distractibility
(ASAM PPC-2R). (2001)

The above core elements and therapeutic processes lead the committee to the
following description of residential treatment:
Residential Treatment is a normative, pervasive environment supporting
a 24 hour-per-day culture and milieu of beliefs and ideology, which value
respect for the inherent goodness of the individual, the capacity to
change, personal responsibility, and the reliance on the treatment
community as a therapeutic agent. 6

Conclusions
5. The effectiveness of residential treatment for both adults and adolescents is embedded in
how the very characteristics of core elements of this safe, separate, secure, and stable
environment respond to the needs of individuals with significant functional deficits in their
cognitive, social and interpersonal, and emotional functioning and coping functions. The
functional deficits are identified by ASAM Patient Placement Criteria.
6. These individuals more often come from environments that are unstable, chaotic, abusive and
toxic, and therefore they need a regimented, supportive, stable environment in which to learn
and practice through interventions that habilitate or rehabilitate.
7. Individuals with more severe dysfunctions often exhibit impulsivity, deficient anger
management, hostile and violent acting out, and resistance and antagonism to limits.
These individuals need a normative, pervasive environment which manifests respect, the
capacity to change and personal responsibility within a communal setting. It is this communal
setting that represents a microcosmic representation of the larger society that provides the
social context to alter thinking, feelings, and behaviors.
8. Treatment interventions are matched to a persons readiness to change and it is critical that
this individualized treatment matching occurs to assure that residential treatment is not
underutilized or over utilized.
This is consistent with The Six Aims of High-Quality Health Care from the Institute of Medicine:

Safe - avoiding injuries to patients from the care that is intended to help them.
Effective - providing services based on scientific knowledge to all who could benefit and
refraining from providing services to those not likely to benefit (avoiding underuse and
overuse, respectively).
Patient-centered - providing care that is respectful of and responsive to individual patient
preferences, needs, and values and ensuring that patient values guide all clinical decisions.
Timely - reducing waits and sometimes harmful delays for both those who receive and those
who give care.
Efficient - avoiding waste, including waste of equipment, supplies, ideas, and energy.
Equitable - providing care that does not vary in quality because of personal characteristics
such as gender, ethnicity, geographic location, and socioeconomic status.
IOM, 2001:56.
The duration of care is dependent on the individual progress and any of the following needs of the
patient:

For some it is discovery

For some it may focus on maintaining abstinence and preventing relapse
For some it is preventing a return to antisocial behavior
For some it is developing a sense of personal responsibility and positive character change
For some it is habilitative
For some it is rehabilitative
7

Central to the continuing evolution of residential treatment

will be a commitment in practice to the principles of selfmanagement of a chronic health condition. Within the
normative pervasive environment of the residential setting
the treatment community becomes a therapeutic agent
through which patients are empowered and prepared to
manage their health and health care. As such, treatment
must:

Emphasize the patient's central role in managing their

health
Use effective self-management support strategies that
include assessment, goal-setting, action planning,
problem-solving and follow-up
Organize internal and community resources to provide
ongoing self-management support to patients

All patients with chronic illness make decisions and engage in

behaviors that affect their health (self-management). Disease
control and outcomes depend to a significant degree on the
effectiveness of self-management.

Effective treatment
attends to multiple needs
of the individual, not just
his or her drug abuse. To
be effective, treatment
must address the
individual's drug abuse
and any associated
medical, psychological,
social, vocational, and
legal problems. It is also
important that treatment
be appropriate to the
individual's age, gender,
ethnicity, and culture.

Effective self-management support means more than telling

NIDA 2009 Principles of Drug
patients what to do. It means acknowledging the patients'
Addiction Treatment: A Research
Based Guide
central role in their care, one that fosters a sense of
responsibility for their own health. It includes the use of
proven programs that provide basic information, emotional
support, and strategies for living with chronic illness. Self-management support can't begin and end
with a class. Using a collaborative approach, providers and patients work together to define
problems, set priorities, establish goals, create treatment plans and solve problems along the way.
The therapeutic goals are to sustain abstinence, understand and prepare for triggers, improve
personal health, improve social functioning, and as needed engage in continuing care as needed in
outpatient treatment, recovery housing, recovery management and support services. NIDA in its
Principles of Drug Addiction Treatment clearly states the need for integration of care for persons with
substance use conditions.
In 2006 the Institute of Medicine (IOM) published the third report of the Quality Chasm Series,
Improving the Quality of Health Care for Mental and Substance Abuse Conditions (National
Academies Press 2006). In this report they strongly recommend the integration of care for mental
and substance use problems with other general co-occurring health care conditions and illnesses. The
IOM reports recommendation for the coordination and integration of care is foundational to
understanding and improving the quality of health care.

Mental and substance use problems rarely occur in isolation

Mental, substance use and general health problems and illnesses are frequently intertwined
Coordination of all these types of health care is essential to improved health outcomes,
especially for chronic illnesses
(IOM 2007)
8

None of the findings of this report are new. They do however strongly support why residential
treatment is effective for those who have more severe functional deficits and require a safe and
secure environment in which to learn and practice recovery skills.
There is strong evidence that treatment within this level of care can be individualized to the needs,
strengths, social supports systems and recovery progress of the patient.

Appendix
Bibliography
ASAM Placement Criteria and Matching Patients to Treatment. (2010) David Mee-Lee, MD and Gerald
D. Shulman MA, MAC, FACATA(ASAM, Principles of Addiction Medicine, Chapter 27).
DeLeon , G., Recent Research Into Therapeutic Communities, , Principles of Addiction Medicine, 3rd
edition, (2003), Chevy Chase, Maryland: American Society of Addiction Medicine.
Drug and Alcohol Service Providers Organization of Pennsylvania, Legal Brief: Inpatient Non-Hospital
Addiction Treatment and the Affordable Care Act, Heller, G. December 2011.
Garnick, D.W., Horgan, C., Acevedo, A., McCorry, F., and Weis-ner, C. Performance Measures for
Substance Use Disorders What Research is Needed? Addiction Science and Clinical Prac-tice. (2012).
Published online at http://www.ascpjournal.org/content/7/1/18/abstract
Institute of Medicine (2006), Improving the Quality of Health Care for Mental and Substance-Use
Condition: Quality Chasm Series. Washington DC: National Academy Press.
Kurth, D.J., Therapeutic Communities, Features of a Modern Therapeutic Community, Principles of
Addiction Medicine, 3rd edition, (2003), Chevy Chase, Maryland: American Society of Addiction
Medicine.
McLellan A.T., McKay, J.R. (2009). Evidenced Based Clinical Practices Within and Across Continuum of
Addiction Treatment (ASAM Principles of Addiction Medicine, Chapter 25).
Mee-Lee D, Shulman, G.D., Fishaman, M, et al., ASAM Patient Placement criteria for the Treatment of
Substance Use Disorders, 2nd Edition-revised (ASAM PPC-2R). (2001) Chevy Chase Maryland: American
Society of Addiction Medicine.
NIDA: Principles of Effective Treatment, NIH Pub Number: 12-4180
Published: October 1999, Revised: December 2012
http://www.drugabuse.gov/publications/principles-drug-addiction-treatment
OBrien, W.B., Perfas, F.B., The Therapeutic Community, Lowinson, J. H., Ruiz, P., Millman, R. B., and
Langrod, J. C. (Eds.). (2004). Substance Abuse: A comprehensive textbook. Baltimore, MD: Lippincott
Williams & Wilkins.

Reif, S., Horgan, C.M., Quinnn, A.E., Granick, D.W., Hodgkin, D. Adult Residential Treatment for
Substance Use Disorders: Summary of the Evidence, (2010) Brandeis University.
S. B. Sells & D. D. Simpson (Eds.). (1976). The Effectiveness of Drug Abuse Treatment: Vols. 3-5.
Cambridge, MA: Ballinger.
S. B. Sells & D. D. Simpson, The Case for Drug Abuse Treatment Effectiveness, Based on the DARP
Research Program, British journal of Addiction 75 (1980) 117-131.
SAMSHA, Models of Adult Residential Substance use Disorder Treatment, 2010 (Paper prepared as
summary of Adult Residential Treatment Expert Panel Convened in August 2010).
SAMSHA. OBrien J (Draft 2010): Description of a Good and Modern Addiction and Mental Health
Service System which can be accessed at the following website:
http://www.samhsa.gov/healthReform/docs/good_and_modern_12_20_2010_508.pdf
Simpson, D.D., Sells, S.B., Effectiveness of Treatment for Drug Abuse: An Overview of the DARP
Research Program, Advances in Alcohol and substance Abuse, (1982).
Willenbring MD. (2009) Spectrum of Alcohol Use Disorders Continuum of Care (ASAM, Principles of
Addiction Medicine, Chapter 23).

Committee Members
Michael Reagan, Chair, Chief External Relations Officer, Cherry Street Health Services, MI
Susan Blacksher, MSW, MCA, Executive Director CA Association of Addiction Recovery Resources
Charles Bush, Program Manager, Clearview Recovery Center, MS
Cinda Cash, former Executive Director, Connecticut Women's Consortium, Inc.
John Coppola, MSW, Executive Director, NY Association of Alcoholism and Substance Abuse Providers, Inc.
John Daigle, Consultant, FL
Dick Dillon, CEO, Innovaision, LLC, MO
Sheila North, M.A., M.F.T., Executive Director, DePaul Treatment Centers, OR
Constance Peters, MSPA, VP for Addiction Services, Association for Behavioral Health MA
Art Schut, CEO, Arapahoe House Inc., CO
Bill Stauffer, LSW, CADC, Executive Director, PRO-A, PA

For more information on this report or other SAAS documents:

Go to the SAAS website www.saasnet.org
Contact Becky Vaughn, CEO at bvaughn@saasnet.org or 202.546.4600
10

Core Therapeutic Elements of Residential Treatment of Substance Use Disorders

Residential Treatment is a normative pervasive environment supporting a 24 hour-per-day culture and milieu of beliefs and ideology which
values respect for the inherent goodness of the individual, the capacity to change, personal responsibility and the reliance on the treatment
community as a therapeutic agent. The following four core elements are identified in the literature and correlated with its effectiveness
although is less clear how and why they are effective.

Varied Levels of Care and Intensity Responsive to

Persons with the Following Needs and Functional
Deficits (ASAM Patient Placement Criteria)

Structure and Stability

Daily regimen of scheduled activities:
Meals
Community meetings
Didactics
Recreational/physical
Reflective time
Group therapy
Individual therapy
Defined policies procedures and clinical protocols
Specified roles for staff, residents and family
Predictable times to practice recovery
and coping skills

Level 111.1 Functional deficits and needs include:

- Problems in the application of recovery skills
-Lack of connectivity to the world od work, education, family life
- Person in "pre-contemplation" who are living in an environment "too toxic" to permit treatment in
an outpatient basis

Level 111.3 Functional deficits and needs include:

- Person for whom the effects of substance use disorders are so significant that they result in a level of
impairment for which outpatient services are not feasible or effective
- Functional deficits are primarily cognitive and can be temporary or permanent which require treatment at a slower
pace , more concrete and repetitive until cognitive impairment subsides
- Responsive to person with such severe deficits in interpersonal and coping skills that treatment focuses more on
"habilitation " rather than "rehabilitation"
Level 111.5 Functional deficits and needs include:
- Responsive to needs of persons with significant social and psychological problems who can benefit from the treatment
community as a therapeutic agent
- Functional deficits : chaotic, often abusive, non- supportive interpersonal relationships
- More serious or lengthy criminal history
- Limited or significantly sporadic work and educational history
-Treatment interventions are matched to person's readiness to change :
For some it is "discovery"
For some it may focus on maintaining abstinence and preventing relapse
For some preventing a return to antisocial behavior
For some it is developing a sense of personal responsibility and positive character change
For some it is "habilitative"
For some it is "rehabilitative"
-Anti-social value systems characterized by:
Impulsivity, deficient anger management skills
Hostile or violent acting out,
Resistance and antagonism to limits, problems with authority
Hyperactivity and distractibility

11

Safety and Separateness

Safety from:
Alcohol and other drugs
Dominate drug culture
Drug places Chaos
Safety to:
Practice recovery and coping skills
Controlled experiential community
environment separate from larger society
Microcosmic representation of larger
society providing a social context to alter
thinking, feelings, behaviors

Therapeutic Processes and Outcomes

-Structured recovery environment
-Provides sufficient stability to prevent and minimize
relapse
-Provide treatment and community structure to practice
and integrate
recovery and coping skills
-Community and treatment settings build upon residents
imitative
tendencies to learn through role modeling
-Build upon the social nature of persons (Social
Learning, Social control, Stress and Coping, Theories)
-Development is dependent on reciprocal interaction in a
safe and separate community setting.
-The use of a separate community as a means of personal
and spiritual transformation requires a shift from the
self-centeredness of the personal identity, which
characterizes addiction thinking, feeling and behaving
to "letting go" to a power greater than oneself
-The resident finds healing not isolation but in
communion with others