In the beginning of the 70's first therapy models from the USA, Great Britain and Scandinavia arrived. Because of the special meaning of the opiate dependence, strong physical dependence and associated physical withdrawal, large health endangerment by overdosing or injection-conditioned risks of infection, among other things with hepatitis C or HIV, more socially, more scholastically and more vocationally delinquency, above all therapy for opiate dependents drop out is represented.
It has to be differentiated between altogether four therapy forms:
- ambulatory therapy
- stationary long-term therapy, medicine-supported, in therapeutic communities,
- substitution therapy
- mutual-help groups of former drug-dependent people
- Ambulatory therapy includes: Drug advisory boards, urban, universitary or welfare organizations with interdisciplinary teams of psychologists, pedagogues and social workers, who advise young opiate addicts, care for them and if necessary bring them into special therapy facilities, ambulatory care with urine controlling and assistance for social and vocational rehabilitation.
- Therapeutic "chains" with medically cared for withdrawal and following therapy in therapeutic communities, as well as assistance to the rehabilitation, stationary long-term therapy in special facilities, frequent in form of a "therapy chain", in the following steps: physical withdrawal in a special hospital station, usually one year's curing phase in therapeutic community under medical or psychological guidance, social therapy, behavior-therapeutic or psychotherapeutic support according to trained specialists, aftercare group houses and assistance for school and vocational reintegration.
- Substitution: Medicine-supported and/or substitution therapy since 1991 accompanied after the NUB guidelines of the federal committee of the physicians and health insurance companies certified Methadone treatment of opiate addicts in special medical practices.(see substitution).
- Mutual-help groups for drug-dependent people or their family members, under guidance of former drug-dependants. A reintegration into the open society is not always aimed at, but self-sufficiency by own production communities (p.e. "Synanon").
The WHO lexicon defines therapeutic communities as a "structured environment in which individuals with psychoactive substance use disorders live in order to achieve rehabilitation."
Such communities are often specifically designed for drug-dependent people; they operate under strict rules, are run mainly by people who have recovered from a dependency, and are often geographically isolated. Therapeutic communities are characterized by a combination of "reality testing" (through confrontation of the individual's drug problem) and support for recovery from staff and peers. They are usually closely aligned with mutual-help groups such as Narcotics Anonymous, often in a so-called "Halfway house" (Synonym: recovery home), a place of residence that acts as an intermediate stage between an inpatient or residential therapeutic program and fully independent living in the community.
