Resident Self-Governance in Social Model Recovery Programs
Borkman, Thomasina, Contemporary Drug Problems
The current paper focuses on resident self-governance, in theory and in practice, in California social model recovery programs. Social model programs are derived from AA 12-step/12-tradition philosophy and have adopted the belief held in AA that persons in recovery must take responsibility for their own recovery, not just in speech but in action. Social model programs put this conviction into practice with formal mechanisms for resident self-governance that give residents opportunities for responsibility. This is considered vital practice for taking responsibility outside the relatively secure confines of the social model program. Resident self-governance is a distinctive feature of social model, and literature from social model leaders has emphasized the transfer of AA principles of egalitarian power-sharing and rotating leadership to a programmatic setting. How resident selfgovernance actually works, and how it is reconciled with a nonprofit parent agency that must maintain some hierarchy for purposes of efficiency and to satisfy legal and funder requirements, is explored through reference to the two social model programs that were studied in the Social Model Process Evaluation project.
This paper focuses on governance processes, especially those by the "client" residents at Mustang River and Twelve Willows, the two social model programs in the process evaluation project. The philosophy of client/participant involvement in agency governance in social model programs stems from their roots in the democratic practices of Alcoholics Anonymous groups; this philosophy coincides with related developments in mainstream human services. The idea of client/consumer involvement in decision-making in health and social services has developed into a significant value since the 1960s, stemming from the civil rights movement, the war on poverty, the women's movement, and the consumer rights movement, among others; federal guidelines mandated patient and consumer involvement on review boards and other structures (Bordt, 1997; Weitz, 1996).
The potential problems of having client/consumer power shared with professionals or bureaucrats in an agency setting can range between two extremes. At one extreme the clients grab control or "run the asylum," as in the movie One Flew Over the Cuckoo's Nest. At the other extreme is sham client governance in which professionals allow the appearance but not the substance of patient involvement in decision-making. Between these extremes are varying degrees of delegation of decision-making to clients, with checks and balances provided by staff oversight.
Maxwell Jones popularized the idea of therapeutic communities in the 1950s with his experiments with patient-run groups in British mental institutions; the term "therapeutic community" became associated with the idea of democratic patient decision-making within an agency. To many observers Maxwell Jones's therapeutic communities signified shared power, with patients having meaningful authority in a context of staff oversight. However, Jones's therapeutic community was controlled by the top-down hospital bureaucracy. The patient-run groups at the bottom of the hierarchy operated within a limited sphere of trivial decision making (e.g., choices of leisure time activities). By 1976, in The Maturation of the Therapeutic Community, Jones made clear that patient-run groups existed at the staff's pleasure; when staff objected to their direction or decisions, Jones advised staff to simply terminate the groups. By the 1970s, Jones openly wrote that in effect therapeutic communities in mental hospitals constituted sham governance. Sham governance also occurred frequently in the 1960s and 1970s in "review boards" and other bureaucratic structures that were federally mandated to have patient/consumer involvement (Hasenfeld, 1992).
Another version of therapeutic communities (TCs) was independently developed in the U.S. drug treatment field, originating from the self-help program Synanon (De Leon, 1994) in the 1960s. …