Integration: Too Much of a Bad Thing?

Integrated and/or multidisciplinary working has become a central guiding principle of addiction treatment throughout the Western world. Indeed, the notion has become virtually synonymous with good practice in intervening in a complex disorder like addiction. There has been surprisingly little analysis or evaluation of the efficacy of this approach. Rather, it is effectively taken for granted that integrated and/or multidisciplinary working is without question a “good thing.” But for complex interventions such as the therapeutic community, it is equally possible that these developments can threaten the underlying principles of the approach. This short literature review considers three areas of integrated working: integrating professional staff into therapeutic community teams; integrating new treatment approaches into existing therapeutic community frameworks; and the issue of therapeutic communities co-working with other treatment services with different philosophies and working practices. The work originated in an evaluative study of a network of Scottish addiction treatment services and the initial findings are that although there are some advantages to broadening the horizons of the therapeutic community movement, there is equally a danger of undermining some core principles