TandC Associates, LLC

In the late 1980′s, clubhouse staff observed the phenomenon of members’ “spinning their wheels” in the Transitional and Supported Employment Programs.  In discussions within many clubhouses and with other clubhouses’ staff, concerns began to be raised about the use of TE wages for alcohol and drug use, and potential substance dependence.  Those of us who were deeply committed to giving as many members as possible the gratification of earning wages after years of unemployment due to mental illness were dismayed at accusations being hurled: “You are ‘enabling’ your members’ dependence!!”  So, we had to take a deeper look at what might indeed be transpiring.

Initially, some administrations rejected further investigation on the basis that it was inappropriate to ask what members did in their apartments after program hours, much as staff didn’t wish to have their privacy intruded upon.  Other administrations began a thoughtful inquiry, starting with staff caseload reviews of known substance use by members, then expanding it to screening at Intake – not to exclude but rather to evaluate the need for supportive services in this area for the clubhouse community.

Three examples in New Jersey – Prospect House (East Orange), The Club (Piscataway) and Harbor House (Paterson) and one in New York – Fountain House (NYC) – all began screening services at Intake in place, with varying levels of support.  The Club was the first to initiate a MICA unit in the early 1990′s, much to the consternation of other clubhouses.  Questions were seriously posed about establishing a structured therapeutic treatment in the non-clinical clubhouse setting.

Still in the 1990′s, Prospect House (PH) continued its screening at Intake, but didn’t exclude members who had a history of substance use so long as they weren’t “abusing” currently.  PH members who came to the program under the influence of substance(s) were encouraged to seek help at local detoxification programs.  Harbor House (HH) as of 1991 not only screened for substance use at Intake, but provided transportation to daytime AA meetings:  In Montclair (Tuesday’s at the YM/WCA and Thursday’s a Methodist Church) with a Friday daytime meeting in St. Joseph’s Hospital Resource Library nearby the clubhouse.  At HH, members who came to program under the influence of substance were sent home for the day, and would be met with individually upon their return for one-to-one counseling and encouragement to address their substance use.  At Fountain House, the Intake Unit not only screened applicants for need of supportive services, it began to provide education about substance use informally in small group discussions.

By 1994, Harbor House initiated a survey of its members and staff about substance use by membership.  The results were dramatic: Overall, fully 30% of HH members were identified as either using substances, or having a history of significant substance abuse.  The consensus was that HH staff urgently needed education about substance use and dependence, and a CADC should be hired to facilitate these services for members.  As of March 1995, the HH Program Director and a Social Worker (himself, undisclosed “in recovery) visited The Club, where the Executive Director had advocated the MICA Unit’s development there.  Within six months, HH members had their own “Double Trouble” support services, based in the Clerical Unit, with 12-Step Speakers booked to present in a closed meeting to be held downstairs in the Intake Unit during the Thursday Evening Recreation Program.

By this time in the mid-1990′s Fountain House also had weekly 12-Step meetings in the Evening Social/Recreational Program, with doors closed in the rear of the First Floor, off Reception.  Because it was not in the Day Program, and no attendance was to be taken, anonymity was preserved as best as possible.

Some time after the 1996 opening of Fountain House’s Store Front (located nearby on the southeast side of West 49th Street near Ninth Avenue) the Outreach services for members who attended these 12-Step meetings transferred there.  Non-members such as residents in Clinton House on West 48th Street were welcomed.  Thus, the problem of true anonymity was solved, and any concerns about “therapy” in the clubhouse was removed for once and for all from Fountain House.

By 1998, Howie “The Rap” Vogel was an articulate consumer advocate who had been active in establishing a program of “Double Trouble in Recovery, Inc. (DTR)” based on the 12-Step Model.  He was invited to present it at an annual conference hosted by the Coalition of Voluntary Agencies in New York City.  Mental health consumers and their advocates were inspired by Howie, and invited him to present at their agencies.  One such group was based at Staten Island University Hospital Outpatient Psychiatric Services (SIUH-OPS).  Some of the SIUH-OPS mental health consumer advocates  were also members at Skylight Center, a clubhouse located in the St. George area of Staten Island.  One member in particular, Ted Laikin, a Member on the Skylight Center Board of Directors, was persistent in his encouraging the administration of Skylight Center to hear directly from Howie “The Rap” about DTR. The meeting was scheduled in March of 1999, and to its credit Skylight’s administration immediately approved the initiation of a member committee to proceed. to investigate the feasibility and need for DTR at Skylight.  

After six months of inquiry, positive response, and careful program development, the first “Double Trouble” meeting was held in September of 1999 at Skylight Center.  Again, in the evening – this time in the Membership Office on the first floor of one side of Skylight Center on Tuesday’s, when no evening program was held.  Moreover, this DTR meeting would be open to non-members as there were no mid-week DTR meetings in Staten Island at that time.  A responsible staff worker would remain on the other side of Skylight Center and close down the building after being informed that everyone else had departed at the end of the meeting.  The group decided to collect $1.00 from anyone who wished to contribute in order to be able to buy coffee and some cake or cookies for refreshment.

Over the years, more and more clubhouse communities recognized the concommitence of mental illness and substance use.  The clubhouse population, like the whole United States population, continues to suffer from the effects of substance abuse or dependence.  On the website for the National Institute for Alcohol Abuse and Alcoholism, current statistics (updated in April of 2012) are the same:  29% for “heavy drinkers” (two drinks every day) for both men and women – only 1% less than the HH membership survey in 1994.

The National Institute for Drug Addiction published its National Survey on Drug Use and Health (NSDUH) conducted in 2010, yielding its findings that 8.7% (22.1 million) of Americans 12 years old and older were diagnosed according to DSM-IV criteria with substance dependence or abuse.  However, in a follow-along survey at the FH Store Front (2006-2009), the reported 60% rate of past and/or current history of substance use would more likely be accurate, as respondents to anonymous surveys tend to under report; whereas in the FH Store Front survey, data were gathered from systematically updated medical records.

Furthermore, the NSDUH survey results document that the incidence for HIV+/AIDS is higher within this group than the population in general.  Thus, there is a clearly delineated need for substance abuse education and supportive services such as DTR within the clubhouse community at large.  It would be of interest to find out how many other clubhouses now provide such programs of education, prevention and support in this area.

The good news is that at least one clubhouse, Fountain House, these services have been continued through the Store Front, which in 2010 moved to West 37th Street, between 9th and 10th Avenues, and is now known as the Sidney Baer Center.  Once more, the core principle that the clubhouse model is an ever evolving response to the valid needs of its membership, as propounded by John Beard, Executive Director of Fountain House (1956-1982)

Again, we at TCA invite your feedback in the comments section below or you may address your remarks to tandcassociate@gmail.com.