Milieu is French for the social environment. It is a form of therapy that takes place in therapeutic communities. In addition, people believe it to be effective in treating personality disorders and behavioral problems.
They base the therapy on one premise. They believe changing the environment of a person can trigger positive change. As a result, the therapy encourages self-care and the development of social skills.
Usually, they deliver milieu therapy in residential settings. They believe therapeutic community residential treatment as the best way in treating people with substance abuse disorders. This is according to A Guide to Substance Abuse Services for Primary Care Clinicians from the National Institute of Health. Furthermore, they think it would also be good for treating co-occurring mental issues, and severe psychosocial adjustment problems.
What is the Milieu Therapy Approach to Treating Substance Abuse?
Milieu therapy takes a unique approach to dealing with people’s substance abuse disorders. The following shows three things. First, it defines the approach and the underlying principles. Second, it defines the ideal candidates for this treatment. Third, it talks about the therapy modalities.
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- The Community as the Key Agent of Change: The community includes the healthcare and wellness staff at the treatment facility and those going through the recovery process. In this approach, they regard every interaction as a chance for therapeutic action and peer influence. As a result, this can be a powerful catalyst for change. This community also creates a safe, supportive environment. This is where a person can go about the changing process without fears, holdbacks, and distractions.
- Reliance on Self-Help: Milieu therapy hinges on the active participation of the person. They expect the subject to take charge of his or her recovery. This person is responsible for his or her behavior. Self-help makes way for independent living, builds self-esteem, and imparts the feeling of being in control of one’s life.
- Assignment of Progressively Increasing Levels of Responsibilities: They expect people in recovery to contribute to the upkeep of their environment. In this case, it is the facility where they are undergoing the therapy. First, the staff will assign them specific duties. After, the tasks will increase gradually. As a result, they will become more comfortable in many things. They include assuming roles of responsibility, following directions, and maintaining accountability.
- Focus on Changing Mindsets and Modifying Behavioral Responses: The focus of this milieu therapy is to strike at the root causes of the substance abuse disorder. They are the unhealthy coping mechanisms and destructive behavioral responses. First, the treatment staff guides the person to identify the negativity in them. Then, they work on these themselves to remedy the issues. Of course, it is with support from the healthcare personnel.
- Employment of Structured and Unstructured Methods of Therapy: It’s true, there are structured and rigidly-defined methods of the treatment. However, the community also employs unstructured ways to bring about positive change. Sometimes, the way develops naturally in response to some actions. They may be improper behaviors and attitudes that the subject displays in recovery.
- Individualized Treatment Plans: The success of this milieu therapy approach rests much on each unique treatment plan. They expect each person to take charge of their own treatment. Therefore, it’s critical that they go through processes and procedures they are comfortable with. For instance, a person may first receive psychiatric counseling for a personality disorder. This is before he or she takes part in various activities. They include structured community meetings, interact with peers, and can contribute meaningfully. People with less disruptive disorders may not need these counseling sessions before the treatment.
What are the Techniques of Milieu Therapy?
- Community support
- Peer role modeling
- Social learning
- Psychiatric support
- Remedial education
- Family counseling
In milieu therapy, positive change takes place in the community. In addition, they also happen through the community. The community includes a cast of characters. First, they are the healthcare professionals who are providing the treatment. Then, there are the supporting staff. Finally, there are the other people in recovery.
The community supports a person in recovery by:
- Setting an example to emulate (peer role modeling)
- Teaching interpersonal and functioning skills important for socialized living (social learning)
- Managing or treating co-morbid mental health disorders (psychiatric support)
- Educating the person about the condition and healthier coping strategies (remedial education)
- Helping family members support their loved ones on the journey to recovery (family counseling)
Why May an Addicted Person Need Milieu Therapy?
- Learning to rely on one’s inner strengths to bring about positive change
- Developing healthier adaptive coping strategies
- Taking part in positive social interactions and foster connections that influence change
- Learning interpersonal skills
- Facilitating seamless social rehabilitation
Learning to Rely on One’s Inner Strengths
We need to teach a person how to tap into his or her internal resources to glean healing vibes. This is the overarching goal of milieu therapy. In fact, the buzz words here are autonomy and personal responsibility.
First, they insist on self-care. Then, they focus on building a sense of responsibility by taking care of one’s environment. As a result, this will increase one’s self-worth.
A person will feel empowered. This is because the person can take charge of what is going on around. The person will learn to recognize and rely on one’s inner strengths. Consequently, this paves the way for the creation of healthier coping strategies.
Developing Healthier Coping Strategies
A person may harbor negative thinking patterns. As a result, this may influence how he or she responds to addiction triggers. For instance, crises may fuel an already low sense of self-worth.
Frustration and a sense of worthlessness may make the person reach for a drink. This way, the subject will experience the classic euphoric high. In this case, this person has to learn healthier ways to deal with stress. Furthermore, they need to do that without falling into the trap of self-pity.
During the treatment period, a counselor helps a person identify these negative beliefs. After, they will teach him or her how to cope with addiction urges healthily. A person may also learn healthy coping strategies from his or her peers.
Taking Part in Positive Social Interactions
During milieu therapy, an individual takes part in one-on-one counseling sessions, group activities, and peer-to-peer interactions. In milieu therapy, every social interaction is an opportunity for something. First, they can discover something more about themselves. Second, they can learn a new skill. Third, they can find support and solace. Finally, something might inspire them.
Learning Interpersonal Skills
Positive social interactions and the connections these foster provide opportunities for many good things. First, they rebuild trust. Second, they regain the ability to have faith in something.
Finally, they relearn how to connect with another human being. This will happen in a respectful and meaningful way. In the process, the person learns interpersonal skills. These are valuable skills. Moreover, they will eventually pave the way for the integration into mainstream society.
Facilitating Seamless Social Rehabilitation
The staff will try to rehabilitate the person into the society. Ultimately, that is the goal of any substance abuse treatment program. This way, he or she can function independently and live responsibly. The various components of milieu therapy help a person in many ways. They will regain their physical and mental health.
Then, they will learn healthy functioning skills. As a result, they will know what it takes to live an ordered life. Furthermore, they can develop values that help them fulfill personal and professional responsibilities. In the end, they can remain addiction-free.
Milieu Therapy Case Studies
This is one of the earliest studies on milieu therapy. It clearly notes the psychosocial improvement milieu therapy brought about in a group of young offenders. The sample group exhibited improvement in the following areas:
- Decrease in delinquent tendencies
- Improved ability to take part in group activities
- Increased willingness to accept responsibilities
- Improved self-esteem
This was according to the findings of this study in the Journal of Criminal Law and Criminology.
This study proved the effectiveness of milieu therapy. It was able to bring about lasting positive change. They did it by addressing the root causes of behavioral disorders. The findings encouraged scientists to explore the possibility of using milieu therapy. This way, they can treat persons with substance abuse disorders. Since then, there have been several studies on the effectiveness of milieu therapy among people with substance abuse issues.
The National Institute on Drug Abuse (NIDA) reported the findings of the Drug Abuse Treatment Outcome Study (DATOS). They carried out a study on diverse sets of population. First, it was people with a dependence on a variety of substances of abuse. Second, it was people with and without psychiatric disorders.
Finally, it was people with and without a history of criminal behavior. According to this report, successful completion of a milieu therapy program came with several positive outcomes. These people reported less alcohol, cocaine, and heroin use. They had less unemployment, improved markers for depression (less suicidal thoughts). Furthermore, there was less indulgence in criminal behavior.
The Scientific World Journal summarizes the findings of 16 studies on the effectiveness of milieu therapy. It was the basis of a review article. About two out of three studies have concluded that milieu therapy leads to significantly better recovery outcomes. This was at their first follow-up instance. The parameters for evaluation were substance use, criminal behavior, and mental well-being. Moreover, it also included their employment and workplace performance, and quality of interpersonal relationships.
One of the major areas of research in this regard has been on prison inmates. The effectiveness of milieu therapy has made it the primary treatment modality for substance abuse in prisons. This is according to the findings of a study published in the Journal of Psychoactive Drugs. In fact, it happened across the US. Most prisons have intensive and well-developed residential programs. They also have 12-Step substance abuse treatment programs in place. Milieu therapy complements both these treatment modules.
They have adopted this treatment approach in more than 65 countries. On the surface, this doesn’t sound like much. However, consider the fact that its introduction was only in the 1950s. As a result, this may be the greatest example of the effectiveness of milieu therapy.
They include those with comorbid psychiatric disorders, homeless individuals, adolescents, and women. The success of milieu therapy also rests on certain facts.
First, the treatment model seeks to bring about lasting change. Second, they don’t want to only cure the addictive disorder. Finally, they want to improve the chances of sustaining the sobriety.