CONTENTS

Abstract: One hundred residents undergoing treatment for severe drug and/or alcohol addiction were asked to complete the Hospital Anxiety and Depression Scale at the time of admission. Follow-up was obtained from sixty-eight residents six months later. The group average anxiety scores on admission and at follow-up were 11.5 and 7.3 respectively and, for depression, were 7.1 on admission and 3.4 at follow-up. The percentage with moderate or severe anxiety on admission was 53%, decreasing after six months to 12%. For depression, 19% were classified as moderately or severely depressed at admission but at six months this figure had fallen to zero. The results indicate significant improvement in both variables over time but also reveal that anxiety continued to remain high for a small number of subjects.

EDITORIAL

If I was a story teller — and how I envy those who are — I would probably begin this editorial with a tale about the intricate relationships between two mythical groups of crafts-people, perhaps goldsmiths. Each group would be struggling in a different part of the kingdom to create something of great value - possibly an image of a longed-for paradise, with which they could then appease their feared god and secure the safety of the whole kingdom.

I would represent each group as being aware of the other’s existence, and each sending emissaries to the other with genuine offers of help and collaboration, and yet the two groups would somehow remain in a state of unnecessary rivalry and envy. The added complication would be in the way that the rivalry would operate:

Group A would be wishing that Group B would show the way to Group A, while Group B would wish for the reverse, hoping that Group A would take the lead and create the perfect object — even though Group B would perhaps not agree that it was the perfect object after all. The two groups would be painted as conscientious and well-meaning, although each member of each group would also be torn between membership of that group and a primary loyalty to his or her own ‘family’ group, where he or she would be preoccupied for most of the time. Every now and then the still-unappeased god would reach down from the sky or up from the sea (or wherever these gods lurk) and destroy one of those little ‘family’ groups with strange curses, great ferocity and no warning. What a struggle life would be in that kingdom!

The skill of the story would lie, not in setting up the scenario - any fool can do that - but in using the parable to envisage some sort of denouement to this symbiotic logjam. Something would happen which would enable the participants to realise some underlying truth about their struggle, or some surprising alternative to their familiar tensions. Out of this unexpected resolution, the image of paradise would presumably emerge and the kingdom would be saved.

That is what stories can do: they enable us to step outside of our most familiar and ingrained difficulties and see them through fresh eyes. The solutions which they offer may be fanciful or even idiotic, but they may at least remind us that there is no problem which has no solution, just as every motorway jam eventually gets unblocked. Because the story is fictional, none of us need get hurt in the process, and if we dislike the message we can safely ignore or even ridicule it as just a fiction’. If we do like the story, however, we may feel inspired or emboldened to import the unlikeliest of solutions into our own equivalent struggles, in the hope that we will achieve similar relief from difficulty. Whatever we do with it, the story also has its own intrinsic value, and if nothing else it may divert us for a moment from our struggle.

Since I am not a story-teller, however, I will not be able to pursue this particular tale, although I would invite any creative readers to complete the story, or even to create a new story which might take the theme in a new direction. Perhaps we do not need a denouement after all, as sometimes it is just the act of creating the story which unfreezes the pack-ice. A different sort of story-telling is the camp-fire ‘round’, in which each participant takes a turn and leads the narrative into new territory. In these stories there is rarely a single story-line or simple denouement — in fact if one is offered it is usually greeted with disappointment and rejection by the rest of the company, and the next storyteller reverses the apparent solution and with a single bound ensnares the characters in new tangles. Would it be possible to apply this model in print, via the journal, newsletter or website? Now that would be a work of golden wonder.

By now most readers will probably have long since departed into the body of the journal, while those few remaining may either have applied the story to their own situations or have wondered what particular electrical storm has overtaken the editor this time. If I had time, I would certainly explain all, but sadly I have been too busy at the editorial group’s ‘Awayday’ to do any more, and because of family commitments I did not even manage to get to the ATC Steering Group’s valuable recent meeting to review the past and envisage the future. If only I was not so busy!

Finally let me recommend the papers in this issue: it is a particularly rich set of papers which not only embody the art and the science of therapeutic community practice, but which also convey something of the spirit of the enterprise. The powerful lived experience of service users in TCs is reported in two of the papers, while another conveys the complicated network of relationships between service users, staff, leaders, and local communities. There are themes of paradox, vulnerability, support through transition and the long journey through treatment to connectedness, and painstaking research into the effects of the work. Therapeutic communities have in the past sometimes been said by their critics to offer unrealistic utopias in a harsh world. At their best I would say they offer realistic utopias, and that is what we have been about in putting together this issue. Let’s give utopia — and paradise — a good name.

Adrian Ward
Editor

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