Experiences of residents in a therapeutic community model of drug addiction treatment in a mental hospital in Ghana

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To manage this menace, the Therapeutic Community model for Substance Used Disorders was introduced in Ghana about a decade ago as an alternative to other existing strategies. However, the effectiveness of this treatment modality for drug addiction in Panteng Mental Hospital and Accra Psychiatric Hospital has not been scientifically studied. Objective: This study, therefore, sought to explore the experiences of drug addicts or residents enrolled in the Therapeutic Community programme toward recovery from drug addiction. Method: This research employed an explorative-descriptive design. Participants (N=20) were enrolled purposively sampled and recruited into the study. Face-to-face interviews were conducted using a semi-structured guide and data were analyzed using Colaizzi’s descriptive phenomenology data analysis process. Results: Two main themes emerged from the data: “Why I stayed” ( Motivation ), and “All things are new” (Life transformation ). The study pointed out that residents or participants mainly expressed positive experiences in the programme, including experiencing a sense of belongingness, enhanced self-esteem/self-worth, and most importantly, developing hope of a life free of addiction. Conclusion: In conclusion, the study found that participants in the Therapeutic Community (TC) program generally had positive experiences and believed in its effectiveness for recovery. Factors such as a relaxed environment, supportive staff, and interactions with other residents contributed to their positive experience. The study discovered that motivation, a conducive environment for care, structured program activities, and relationships among residents were key factors that motivated participants to stay and actively participate in the therapeutic community program. These factors fostered hope and a sense of belonging, ultimately contributing to their recovery journey. However, participants expressed the need for self-actualization, which they hoped to achieve after completing the program and reintegrating into the community. Addiction Experiences Residents Recovery Therapeutic Community Introduction Internationally, there is increasing concern about illicit drug supply, agile trafficking networks, alarming proportions of harmful alcohol consumption, and illicit drug abuse which is mounting and linking global crises, posing challenges to health care and law enforcement responses. According to the United Nations Office on Drugs and Crime 2023 report, in 2021, the number of drug users reached over 296 million globally, marking a 23 percent rise compared to the preceding decade. Over 10 years, the prevalence of drug use disorders has surged to 39.5 million individuals, representing a significant 45 percent rise [ 1 ]. In 2017, after the drug was abused, Fentanyl, and its analogues, over 47, 000 addicts died in the United States of America and 4, 000 in Canada. The synthetic opioid, tramadol, which has been used for decades as a painkiller, is the most abused in West, Central, and North Africa [ 2 ]. Other drugs abused include cannabis, karts, cocaine, heroin, and alcohol. Adolescent populations are particularly susceptible to drug use and also have more severe consequences from substance use disorder in certain countries. Within Africa, a significant majority of individuals receiving medical treatment consist of 70 percent who are below the age of 35 [ 1 ]. In Ghana, the use of illegal drugs and alcohol has been classified as endemic, and current WHO data suggest that the prevalence of alcohol consumption is 23.3%, with an alcohol per capita (APC) of approximately 20ltrs [ 2 ]. The same can be said of illegal drug usage, as they are less reported despite the documented surge in quantity transited through the country [ 3 ]. Illicit drug use is undeniably a social issue because its addiction is a problem that affects the user, family, and friends and has a social impact on the community [ 4 ]. Drug abuse is a complex problem in mental health that is frequently linked with problems in different aspects of life such as unemployment, homelessness, relationship disputes, court issues, and medical comorbidity [ 5 , 6 ]. Addiction is widely recognized as a chronic relapsing disorder where recovery is possible. Addiction comprises biological, psychological, and social components requiring multifaceted treatment [ 7 ]. The problem of illicit drug use has remained an issue of public concern, and its implications for the health systems, community, and family are enormous. Global leaders have also implemented the Sustainable Development Goal (SDG) 3 Objective 5 aimed at improving the treatment and prevention of drug abuse, including the abuse of narcotics and excessive alcohol consumption. Like many other countries, Ghana signed its commitment to achieve the SDGs and has therefore instituted measures to curb the menace. Relatively recent developments are programmes to treat substance misuse and addiction/dependence. In Ghana, there are over 70, 000 illicit drug addicts aged between 15–50 years [ 3 ], and care for addiction centres are just a few in Ghana [ 8 ]. In Ghana, faith healing was the most patronized treatment option for drug addicts before the emergence of residential treatment centers, and most clients were treated at churches or prayer camps, or traditional healing centers before attending the Korle Bu Addictive Diseases Unit [ 2 ]. People Who Use Drugs (PWUD) are viewed as 'cursed' or 'unholy,' leading to the prevalence of pseudo therapies as religious afflictions that resolve substance-abuse disorders. The government, non-governmental organizations (NGOs), and private entities established drug treatment programs that focused on rehabilitation, which run either in-patient or out-patient services. According to [ 2 ], “three major mental hospitals, which includes Accra Mental Hospital, Ankaful Mental Hospital, and Pantang Mental Hospital, and three Teaching hospitals, namely, Korle-Bu Hospital, Komfo Anokye Hospital, and Tamale Hospital were made available in Ghana in running addiction programs including community psychotherapy and detoxification clinics”. Bird and colleagues found out in 2019 that they employed the 12-Step Rehab Approach, which leans towards spiritual health where participants must submit to a higher power, which in the case of Ghana, is the Christian God [ 2 ]. All these approaches failed to solve the problems of addictions among drug addicts which led to the introduction of TC in Ghana. According to Broekaert, TC is defined as a drug-free community in which individuals with addiction and other psychological health issues live together in a coordinated and structured way to facilitate improvement and make a drug-free life possible outside the community [ 9 ]. Therefore, to address a person's substance abuse as well as their social and psychological challenges, the therapeutic community uses "community as a method," which is its basic difference [ 10 ]. Despite the different definitions, the pillars of the therapeutic session are self-help and mutual assistance. Residents are primarily responsible for achieving personal development, achieving a more rewarding and responsible life, and ensuring the community's welfare. The TC program is voluntary, and the residents are not supposed to be kept in the program through force or against their will [ 11 ]. The concept of Therapeutic Community (TC) was introduced in Ghana by Mrs. Pearl Addison in the year 1973 at Accra Mental Hospital. According to Pantang Mental Hospital’s Drug Addiction Rehabilitation Centre, the concept of Therapeutic Community in Drug Addiction management was introduced in Ghana by Nelson Carson from the Philippines in the year 2009, September 9th at Pantang Mental Hospital [ 12 ] as a treatment modality to help addicts recover and live meaningful lives. The approach was initiated as a treatment modality at the Accra Mental Hospital in March 2019. TC in Ghana has taken a clinical perspective and not a public health perspective [ 13 ], and offers only residential or in-patient services, with a duration ranging from six (6) months to twelve (12) months. Most people who enrol in drug addiction programs have expectations of recovery and gaining control of their lives following the treatment. However, many studies have reported relapse incidents following discharge from various programs such as Alcoholics Anonymous and 12 Steps [ 14 – 16 ]. This necessitated the TC program's introduction in Ghana about ten (10) years ago [ 12 ], With the many reported successes of the TC program globally [ 17 ], it presented another opportunity to provide a treatment intervention to clients who needed to break their addiction to drugs in Ghana. However, since the inception of the TC program in Ghana, there has been limited insight into the extent to which the program has impacted recovery from addiction [ 18 , 19 , 20 ]. Published studies on how the program is structured to address the needs of patients in the Ghanaian context, the experiences of residents, and the successes chalked have been almost non-existent in the Ghanaian context, hence this study sought to explore the experiences of residents enrolled in the Therapeutic Community Model of Drug Addiction treatment program in the Ghanaian setting and to unearth the impact of the program on the residents' journey towards recovery from drug addiction. Materials and Methods Study design An explorative-descriptive study design [ 21 ] was employed to unearth the experiences of persons enrolled in the TC rehabilitation program in Ghana. The study was conducted between June 2021 and March 2022. The population of the study comprised patients who had been enrolled in the TC program in one of three Mental Health hospitals in Ghana. The setting was selected because the Drug Treatment and Rehabilitation Centre has treated over 300 residents or patients and has been running the TC program for about ten years at the time of data collection. We used a semi-structured interview guide designed to be sensitive and non-threatening, thus encouraging residents to talk freely about the issues they feel pertinent to their recovery experiences. The Drug Treatment and Rehabilitation Centre has a bed complement for 32 residents (Male-22 and Female-10). Recruitment and sample A resident was eligible to participate in the study if he or she had enrolled in the program for at least two months, in the lucid interval at the time of data collection and could consent to participate in the study. Their records indicated progress in care and the therapist or nurses who provided care signed off that the client could participate in the program. To recruit participants, the assistant ward-in-charge acted as a gatekeeper to inform the residents about the study because of the Covid-19 situation and 15 out of the 24 eligible participants agreed to participate in the study. Meetings thereafter were scheduled with the participants for informed consent to be obtained and interviews to be conducted on a phone call because of the COVID-19 pandemic with the assistant ward-in-charge's help through a staff. Purposive sampling approach applied in this study was suitable for the study because the targeted population has similar characteristics; drug addicts enrolled in the TC rehabilitation program and shared similar experiences within the program as they were all in residence at the Hospital. Data collection Data were collected from 15 participants over the telephone with individual participants at their convenient appointed time in the evenings after their day sessions, using a semi-structured interview guide. Each interview lasted between 25–40 minutes intervals per participant. The data were saturated when we reached the 15th participant; hence there was no need to increase the number of participants for additional interviews. The background information was collected to maintain the participants' confidentiality, and pseudonyms were assigned to participants to maintain their anonymity. Participants were asked open-ended questions to allow enough time to express themselves. The questions were probed where necessary, and participants were allowed to ask questions for clarification. Responses were then audiotaped, replayed later, and transcribed verbatim. All observations during the data collection were written in the researcher’s field notes during the phone interview, which helped the researcher cross-check and validate the transcripts during the data analysis. Data analysis The audiotaped recorded interviews were transcribed verbatim. The transcripts were cross-checked, edited, and validated by listening to audio files and comparing them with field notes to ensure they matched the participants' unique contexts and responses. A manual analysis of the information collected in this research was carried out using Collaizzi’s Phenomenological analysis [ 22 ] format as a guide. Ethical aspects The study was approved by the Institutional Review Board of the University of Cape Coast ID (UCCIRB/CHAS/2020/80) and Pantang Mental Hospital’s Institutional Review Board (PMH-IRB). The study procedures followed the ethical considerations outlined in the Helsinki Scientific Research Declaration. Results Participants’ demographic and clinical characteristics The sample was young with the majority of them below 40 years (12/15). Most of the participants were males (13/15) and married (8/15). All the participants were West African nationals with the majority (13/15) being Ghanaian nations. The number of years clients were addicted to drugs ranged between two and thirty-five years with the average years of addiction being ten years. Out of the 15 residents, only a few residents (3/15) had an experience of attending a different rehabilitation program prior to enrolling in the TC program. A slight majority of the participants (9/15) had been enrolled in the program for three months or more. All the residents (15/15) had family support throughout their addiction journey. The characteristics are presented in Table 1 . Refer to Table 1 . Table 1 Participants’ demographic and clinical characteristics Respondent’s ID Age (Years) Sex Marital status Nationality Years of addiction Family support R01 47 M Married Ghanaian 25 Yes R02 22 M Single Ghanaian 11 Yes R03 58 M Married Ghanaian 35 Yes R04 46 M Married Ghanaian 25 Yes R05 25 M Single Liberian 5 Yes R06 35 M Single Togolese 6 Yes R07 33 M Married Ghanaian 17 Yes R08 23 M Single Ghanaian 9 Yes R09 40 M Single Ghanaian 25 Yes R10 36 F Married Ghanaian 3 Yes R11 24 M Married Ghanaian 10 Yes R12 30 M Single Ghanaian 2 Yes R13 25 M Married Ghanaian 8 Yes R14 36 F Single Ghanaian 7 Yes R15 28 M Married Ghanaian 8 Yes Themes The analysis yielded two main themes with various subthemes that addressed the participants' experiences while enrolled in the TC program and the program's impact on the participants' recovery. The two main themes that emerged were “Why I stayed” (Motivation) and “All things are new” ( Life transformation) . Why I stayed (MOTIVATION) The theme presents the resident’s motivation for enrolling, remaining, and fully participating in the TC program. Three sub-themes emerged from the narratives, and they were, the push to enroll; I stayed because, and beholding the possible future . The Push to Enrol Most of the participants had battled with the addiction over many years and had tried to personally overcome the addiction without success. The residents reported many factors underscoring their decision to enrol in the study. From the narratives, most of the participants recounted a feeling of helplessness as the main reason for enrolling in the program. This feeling overcame them when they failed to break the addiction despite the efforts, they committed to it. The feeling of helplessness often preceded an episode of relapse into addiction. A 54-year-old married man explained that: “I couldn’t do it all by myself, I have tried before and it was the same result, just a week or probably less than that and I will be back to the same position [relapse]. So, I thought I needed help, maybe some help will get me further than before.” R03 Some participants’ enrolment in the TC program was self-initiated, self-motivated, and done willingly. “I came here willingly to treat my addiction.” R12 However, for other participants, their enrolment in the TC program was initiated by family members who watched them struggle with the addiction and made efforts to assist the participants in accessing help. A participant recounted that: “My family was supporting me; they gathered hope and brought me here.” R09 I stayed because Participants described the positive experiences that underscored their reasons for remaining in the TC program and learning to overcome their addiction to drugs. The factors that emerged from the narratives included a conducive environment for care, the structure of the program, and relationships built among residents. For some participants, the residential nature of the program was useful as this diminished access to the external world as well as to their source of the drugs. A Resident or participant indicated that: “The place is locked out from getting your choice of drugs.” R04 Another participant further explained that: “The confinement alone is good for me, because I tried so many times in the house, I couldn’t stop, I had some [drugs] in the house and because I had access to it [drugs], I stop a little then I go back. But here [TC residence], because of the confinement, there is no way you will get it. R14 Another consideration from the participants was that, although the program was residential, the physical environment was structured to be homey and welcoming and did not give the impression of confinement. Another feature that enhanced the participant’s experience in the program was the structure of the program itself. For most of the participants, the various activities undertaken in the program accentuated the structured nature of the program and were suited to promoting recovery. For some others, the therapeutic focus of the program was insightful and impactful. Beholding the possible future A concept that emerged throughout the narratives was hope. The majority of participants reported observing other residents who outside the program struggled with addiction, successfully exhibiting signs of recovery. Hence, for R05, whose cause of addiction was curiosity and peer pressure, observing others succeed boosted his confidence in the program and gave him a ray of hope for his own recovery. He said: “I came to meet some of my friends I knew from outside [the TC program] and they are doing well now. Outside of the TC environment [we were] very close from doing everything together and he got his recovery after leaving the TC program. Even though recovery is a lifetime work, he is actually doing well and that also motivates me” R05 This hope garnered from observing others succeed motivated some of the participants to commit fully to the program and explore the available options. “It has really influenced my recovery because the community has taught me… how to get recovery so they [those who have recovered] are the backbone of my recovery . ” R07 The communal nature of the program which allowed for the residents with some strengths to assist those who were struggling enhanced their self-esteem and was highlighted in many participants’ narratives. ” We also learn from each other because we believe everybody have something great in them.” R13 All things are new” (Life transformation). The theme discussed changes residents witnessed or observed in their lives while enrolled in the Therapeutic Community program. Five sub-themes emerged from the narratives, which reflected their transformation experiences, and these are presented as gaining insight, taking back the reins of life, becoming emotionally matured, social changes, and spiritual changes. Gaining Insight This sub-theme presents the psychological transformations experienced by residents while in the TC program. It was evident from the narratives that participants expressed becoming enlightened, resulting in behaviour modifications and personal reflections. For some participants, their involvement in the TC program has brought them an awareness of the impact of illicit drug use on their lives and livelihood. This awareness included the physiological implications of illicit drug use. An excerpt of the participants’ narratives explains this perception: “I have learnt that when I take the drug it affects things in my brain like neurons… and I don’t have control over myself and my actions” R15 “We have learnt... it [drug addiction] is a disease that changes the brain so you can go mad” R12 For most of the participants, this awareness resulted in the nurturing of empowerment among the program residents. Through their involvement in the program, the participants identified their innate capacity and willpower to resist the urge for illicit drug use. A participant, R14, explained that: “I now know the power I carry [within me] to overcome the drug. Also, it has given me a certain tool to reuse my life again.” R14 Further to this, the analysis revealed that most participants had gained some sense of self-worth that empowered them through the program. Several of the participants felt good and deserved to be treated with respect. The narratives revealed that this psychological transformation resulted in behaviour change for most of the participants. This change in behaviour was a significant sign of recovery. These changes experienced by the participants reportedly prompted them to reflect on their lives before enrolling in the program and the transformation they witnessed. Taking back the reins of life This sub-theme presents the attitudinal changes that participants felt had occurred in their lives while on the program. The change included maintaining personal hygiene and developing a sense of duty and punctuality. This gave the participants a sense of control over their lives. The study showed that almost all the participants had issues maintaining their personal hygiene while battling addiction. However, the structure of the TC program allowed them to develop a routine that made basic activities such as bathing a part of their daily lives. R007, a 40-year-old man, who has been addicted to drugs for 25 years recounted: “The previous time [before enrolling into TC], I can even wake up from bed and don’t even bath then I go outside and do whatever. It will take me 2 days where I have not even put water on me. Here, I bath two times a day. Here, we bath morning and evening. It can even take me about three days whereby I’ve not put chewing stick in my mouth but here I paste two times a day, morning, and evening”. R09 For many participants also, who otherwise described themselves to be lazy, being in the program nurtured in them a sense of responsibility toward work. A few of the participants explained that the TC program had transformed their lives by teaching them to respect time, which gives them a sense of purpose. This sense of purpose they believed would prevent relapse when they exited the program. “Before I wasn’t here, I was lazy. But here, in TC, it’s not a bed of roses, it entails hard work. So, if you are a very lazy person, you are always going to be very active, working harder and as you stay here for some time, you will get adjusted to it naturally, then it becomes part of you. So, laziness is out.” R12 “ They are helping me to be time conscious so that I will not be able to go back to drugs again.” R11 “Punctuality is now part of my life.” R15 Becoming emotionally matured From the narratives, several of the clients developed positive ways to express their emotions. The program offered several anger management sessions, which were deemed very useful by most residents who reportedly battled with anger issues, violent behaviours, and verbal aggression when they enrolled in the program. These participants developed self-control and learned to express their anger more acceptably and maturely. Thus, a 33-year-old military man, whose cause of addiction was attributed to anger problems, he explained that: “For me I have problem with anger, so I’m doing anger management at the moment, and they have taught me a lot that it is ok to get angry, but it shouldn’t lead to aggression. So, as of now, when I get angry, I take my time to go through the issue and all of that so I don’t burst out and I don’t keep things within me because I’ve learnt that the more you keep on piling emotions one day you might just burst out over a trivial issue.” R07 The study revealed that the majority of the participants were happy and content with the behaviour change in various aspects of their lives. This culminated in a sense of accomplishment. A participant whose cause of addiction was inferiority complex reported that: “When I lay my bed, I feel very proud of myself... Am feeling proud of myself.” R08 Social changes This sub-theme describes the social changes and interpersonal relationships that were fostered among residents. From the narratives, many participants who struggled to relate with other people before enrolling in the program had gained social skills that enabled them to relate better with different people. A 47-year-old teacher, recounted that: “I’ve been able to actually socialize. Back in addiction, I was somebody who was actually anti-social you know… because our genre of choice, was not actually permitting us to socialize.” R07 Other participants elucidated that the social learning activities, especially the social meetings, has given them a platform to boost their morale and gain the confidence to be assertive and communicate well among people. “ I was a shy person but since I came here, the group meetings have built me up like I can stand in front of people and talk with confidence , ” R05 Spiritual changes This sub-theme emerged with two main concepts: participants embracing religion. The TC program offered the participants to explore spiritual issues and embrace all religions. A participant reported that: “They are always teaching you about the word of God … to make sure that anything you do; you have to consult God first.” R12 From the narrative, participants who explored the religious component of the program developed religious habits that gave them purpose and hope. R009, a 25-year-old student revealed: “Even now I can wake up and pray. I was not the type of person who pray every morning. Now, what am experiencing, I also thank God. I know once he has started, He will put me to a better end. Everything spiritual that goes on here, I like it.” R09 Except from another participant: “ I will stay far away from drugs, and I will go to church to pray.” R06 Discussions This research explored the experiences of clients or residents enrolled in the TC program and its impact on the residents' journey toward recovery from drug addiction in the Ghanaian setting. Two main themes with eight subthemes were revealed, after the analysis was found that, participants had positive experiences in the TC program, which motivated clients or residents both in Ghana and from other African countries to enrol, stay, and participate fully in Ghana because Ghana is among the only three countries using TC program to treat drug addiction in Africa. The study also revealed a novel finding in the program where Religion or spirituality in the program was identified as an important element to aid recovery. Today, the patient experience is widely recognized as an independent component of health care quality. According to the framework by Oben [ 23 ], on patient experience, understanding the humanity of patients is the essential basis upon which all good patient-centred experience initiatives should be developed. This researcher further argued that "patient" begins in the center, indicating that the person is not always a patient (not an addict) and becomes one with the onset of illness (becomes an addict) [ 23 ]. The residents expressed their experiences as motivational factors that encouraged them to enrol, stay and participate actively in the TC program. My findings revealed that most of the participants before their enrolment into the TC program had battled with the addiction over many years and had tried to personally overcome the addiction without success. According to National Coalition for the Homeless [ 24 ], breaking an addiction is difficult for anyone, especially for homeless substance abusers. To begin with, motivation to stop using substances may be low. Miller and Rollnick [ 25 ] reported that motivation helps individuals overcome their ambivalence about making difficult changes to their lifestyles. Helping clients affirm their own motivation increases the chance that they will stick to a particular strategy for behavioural improvement. Most of the participants recounted a feeling of helplessness as the main reason for enrolling in the program. Motivation and desire to change are consistently correlated with increased help-seeking, and treatment. This finding is also consistent with De Leon [ 15 ] who indicated in the TC perspective that an addicted person is considered emotionally frail and immature but with the potential to change positively. The majority of the participants described positive experiences that motivated their reasons to remain in the TC program and overcome their addiction to drugs. The factors mainly were a conducive environment for care, the structure of the program, and relationships built among residents in the program. Motivation is a part of the human experience, and nobody is unmotivated [ 25 ]. The study reveals that the conducive environment for care, the structure of the program, and the relationships built among residents in the program motivated the participants to access hope, which triggered them to change willingly and gain recovery. The sense of motivation birthed hope in the lives of many participants. From the study, hope succeeded in motivating many of the participants to commit fully to the program and explore the options available to recover. Wiles et al [ 26 ] explained that hope increases the outcomes of treatments for many health conditions, including mental health issues [ 27 , 28 ]. In the treatment of addiction, hope encourages patients to move from the stage of hesitation to the stage of decision-making, which leads to a positive change and thus leads to recovery. From the results, it was also found that some residents observed others succeed in their recovery, which gave them a glimpse of hope. Shaver [ 29 ] emphasised that participation in self-help organizations like TC makes residents feel useful, strengthens their confidence, and positively affects their network of social relationships when they experience hope. From the findings, although some participants-initiated enrolment, family support was an important component for others. It was reported by Roozen et al. [ 30 ] that family members could play an important role in the understanding of the issue and acceptance of care by the abusers if they have adequate education and treatment for themselves. For other participants, the physical environment was structured to be homey. The TC learning environment has been made just like homemade or homelike and it is very conducive for all activities like socialization, sports, and entertainment. The TC learning environment is confined and everything you will need in your daily activities can all be found there, and Monitoring is high. Some scholars have asserted that delivering timely and attentive treatment produces a compassionate [ 31 ], and caring hospital [ 32 ], an atmosphere that reflects and is patient-centered on the quality of service and service experience. Globally, the TC program has been established to be an effective treatment modality for drug addicts [ 15 ]. The study’s findings show that TC impacts participants' lives as they witness or observe significant transformations physically, psychologically, emotionally, socially, and spiritually. The study’s findings are in congruence with other studies that reported on this treatment modality [ 32 ]. Wu [ 33 ] and Selby [ 34 ], found that the programme brought restoration of health, physical, social, psychological, and emotional well-being to the drug addicts, their families, and communities. Dekel, Benbenishty, and Amram [ 35 ] also affirm that participants enrolled in the TC show remarkable progress in drug abuse, criminal activity, and mental health symptoms. Several studies [ 36 , 37 ] further assert that the transformation was particularly true of residents enrolling in treatment with the most severe problems. From the study, the participants' transformation was possible through activities that allowed for knowledge sharing on drug addiction and the road to recovery. Primarily, the philosophy of knowledge sharing is a method designed to acquire information from others. Pulakos et al [ 38 ] maintained that knowledge sharing pertains to preparing clear information, know-how to interact with others to promote people, problem-solving, and developing new ideas. This knowledge gained enlightened residents to develop coping strategies that help them manage potential future problems in their addiction journey, modify their behaviour, and lead to behaviour change or recovery in the form of living a sober life. De Leon et al [ 39 ] mentioned that the development of skills necessary to manage and communicate feelings was an important measure of sustaining recovery. From this study, the majority of the participants learned to manage their anger and relate with others. These life skills are essential for sustaining their gains against addiction. In this study, many participants gained their freedom through social learning activities, especially during social meetings. This gave them a platform to develop good interpersonal relationships, gain social confidence to be assertive, and communicated well among people. Some participants also observed a tremendous transformation in their lives in the form of improvements in their self-esteem. Increased self-esteem promotes self-efficacy and self-efficacy leads to relapse prevention. The findings from this study are in line with Cheung et al [ 40 ] who found that 9 individuals out of 21 drug addicts studied succeeded in abstaining from using the drug because they had high self-confidence due to work satisfaction and stable income in their lives. Self-efficacy thus helps addicts learn some successful coping strategies that avoid or decrease the risk of relapse of addicts. The study also identified a novelty finding, discussing a religious dimension of transformation in the TC program. The study revealed that many residents established some form of religious routine that was attributed to faith through the influence of the program activities. Although this was not a regular practice in TC programs, the Ghanaian socio-cultural environment may have necessitated its incorporation in the activities in this study setting. Having said that, the program could be said to have addressed the biopsychosocial-spiritual needs of the participants who enrolled which gave them purpose and hope in their journey towards recovery. Overall, this study found that the participants had positive experiences in the TC program, which motivated them to enrol, stay, and participate fully and encouraged the resident to learn to transform their lives, live in sober life, develop new attitudes and behaviours, which manifested physically, psychologically, emotionally, socially, and spiritually with the hope to live in sobriety after they have been integrated back to the society. Limitation of the Study Overall, this study had some methodological limitations. Firstly, the researcher recognizes that in using a qualitative explorative, descriptive research design, this study's findings cannot be generalized but may apply to only settings similar to the study area. Therefore, the researchers ensured that strategies that maintain rigor, such as an adequate audit trail, were firmly instituted throughout the data collection and analysis to ensure trustworthiness in the findings and replicate the study in similar settings. Secondly, the empirical literature on experiences among residents enrolled in the Therapeutic community in Africa, particularly Ghana was very limited. The lack of extensive research on Ghana and Africa's area compelled the researcher to copiously review the global studies available and rely on experience in general health and nursing practice to meet the current study's objectives. The researcher, however, asserts that this situation facilitates and inspires more researchers into the therapeutic community. Abbreviations TC: Therapeutic Community. SDG: Sustainable Development Goal Declarations Ethics approval and consent to participate The Institutional Review Board of the University of Cape Coast ID (UCCIRB/CHAS/2020/80) and Pantang Mental Hospital’s Institutional Review Board (PMH-IRB) approved the study. The study procedures followed the ethical considerations outlined in the Helsinki Scientific Research Declaration. All the participants in this study signed an informed consent to participate. Consent for publication Participants provided informed consent for publication. Availability of data and material The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests . Funding No funding was obtained for this study. Authors' contributions Each of the authors made contributions to the conceptualization and design of the study. KL and SW were responsible for material preparation, data collection procedures, data analysis, IRB approval, and the initial draft of the manuscript. SA and EA participated in the literature search, data collecting, and manuscript revision. Every author provided feedback on the previous drafts of the manuscript. The final manuscript was read and approved by all of the authors. Acknowledgements None. References United Nations Office on Drugs, Crime (UNODC). World Drug Report 2023. Bird L. Domestic Drug Consumption in Ghana: An under-Reported Phenomenon. Global Initiative Against Transnational Organized Crime .; 2019. Narcotics Control Board of Ghana (NACOB). Illicit substance abusers in Ghana. 2014. Sartor R. The social impact of drug abuse on community life. Med Law. 1991;10(2):205–8. Brooner RK, King VL, Kidorf M, Schmidt CW Jr, Bigelow GE. Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry. 1997;54(1):71–80. Storbjörk J. The social ecology of alcohol and drug treatment: Client experiences in context (Doctoral dissertation). In: Centrum för socialvetenskaplig alkohol-och drogforskning (SoRAD). 2006. Plagenz VL. The Lived Experience of Nurses Working in a Modified Therapeutic Community. University of Nevada, Las Vegas; 2015. Published online . Published online 2015. http://dx.doi.org/10.34917/8220153. Dordoye, E. Recovery in Ghana. National Institute on Drug Abuse. National Institute of Drug Abuse. 2012. Broekaert E. Therapeutic communities for drug users: description and overview. In: Therapeutic communities for the treatment of drug users. Jessica Kingsley Publishers; 2001. p. 29–42. De León, A. (1997). The Tejano Community, 1836-1900 . Southern Methodist University Press. Ottenberg D, Broekaert E, Kooyman M. What cannot be changed in a Therapeutic Community”. In: Broekaert E, Van Hove G, editors. Special Education Ghent 2: Therapeutic Communities Ghent: vzw OOBC. 1993. Pantang Annual Report. Annual Performance Review. 2018. Roberts M, Mogan C, Asare JB. An overview of Ghana’s mental health system: results from an assessment using the World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS). Int J Ment Health Syst . 2014;8(1):16. doi:10.1186/1752-4458-8-16. Broekaert E, Vandevelde S, Schuyten G, Erauw K, Bracke R. Evolution of encounter group methods in therapeutic communities for substance abusers. Addict Behav . 2004;29(2):231-244. doi:10.1016/s0306-4603(03)00092-3. De Leon G. The Therapeutic Community . New York: Springer Publishing Company; 2000. doi:10.1891/9780826116673. National Treatment Agency. Models of Care for Treatment of Adult Drug Misusers: Update 2006 .; 2006. www.nta.nhs.uk. Van de Ven AH, Sminia H. Aligning Process Questions, Perspectives, and Explanations. In: Constructing Identity in and around Organizations . Oxford University Press; 2012:306-320. doi:10.1093/acprof:oso/9780199640997.003.0012. Perfas FB. Deconstructing the Therapeutic Community: A Practice Guide for Addiction Professionals . Hexagram Publishing; 2012. Perfas Fernando B. Therapeutic Community: Past, Present, and Moving Forward . Hexagram Publishing; 2014. Rawlings B, Yates R. Therapeutic Communities for the Treatment of Drug Users . 1st edition. London: Jessica Kingsley; 2001. Sandelowski M. What’s in a name? Qualitative description revisited. Res Nurse Health . 2010;33(1):77-84. doi:10.1002/nur.20362. Colaizzi, P. F. Psychological research as the phenomenologist views it. 1978 Oben PM. Understanding the Patient Experience: A Conceptual Framework. Journal of Patient Experience . Published online 2020:1-5. National Coalition for the Homeless. Why are people homeless. 2009. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd edition. The Guilford Press; 2012. Wiles R, Crow G, Heath S, Charles V. The Management of Confidentiality and Anonymity in Social Research. Int J Soc Res Methodol . 2008;11(5):417-428. doi:10.1080/13645570701622231. Stickley T, House DM. The British research evidence for recovery, papers (inclusive). Part One: a review of the peer-reviewed literature using a systematic approach. Published online 2006. doi:10.1111/j.1365-2850.2010. 01662.x. Werner S. Subjective well-being, hope, and needs of individuals with serious mental illness. Psychiatry Res . 2012;196(2-3):214-219. doi: 10.1016/j.psychres.2011.10.012. Shaver KG. The Attribution of Blame: Causality, Responsibility, and Blameworthiness . 1985th edition. Springer; 2012. Roozen HG, De Waart R, Kroft P. Community reinforcement and family training: An effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction . 2010;1729(10). Birkelien NL. A strategic framework for improving the patient experience in hospitals. J Healthc Manag. 2017;62(4):250-259. doi:10.1097/JHM-D-17-00071 Leon GD. Therapeutic communities for addictions: A theoretical framework. International journal of the addictions. 1995;30(12):1603-1645. Selby, H. Drug addiction and its effects on the family. The Chronicle . 2011. Wu LT. Substance abuse and rehabilitation: responding to the global burden of diseases attributable to substance abuse. Subst Abuse Rehabil. 2010;2010(1):5-11. doi:10.2147/SAR.S14898. Dekel R, Benbenishty R, Amram Y. Therapeutic communities for drug addicts: prediction of long-term outcomes. Addict Behav. 2004;29(9):1833-1837. doi:10.1016/j.addbeh.2004.01.009. De Leon G. Is the therapeutic community an evidence-based treatment? What the evidence says. Therapeutic communities . 2010;31. Vanderplasschen W, Colpaert K, Autrique M, et al. Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. Scientific World Journal . 2013; 2013:427817. doi:10.1155/2013/427817. Pulakos ED, Dorsey DW, Borman W. Hiring for Knowledge-Based Competition. 2003; Vol 1067. De Leon G, Melnick G, Kressel D. Motivation and readiness for therapeutic community treatment among cocaine and other drug abusers. Am J Drug Alcohol Abuse. 1997;23(2):169-189. doi:10.3109/00952999709040940. Cheung CK, Lee TY, Lee CM. Factors in successful relapse prevention among hong kong drug addicts. J Offender Rehabil . 2003;37(3-4):179-199. doi:10.1300/J076v37n03_10. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4006733","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":285968167,"identity":"b95c3cc3-a797-4e4c-9a07-0c2546cdfd30","order_by":0,"name":"KWEKU EWUSIE ORLEANS LINDSAY","email":"data:image/png;base64,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","orcid":"","institution":"University of Cape Coast","correspondingAuthor":true,"prefix":"","firstName":"KWEKU","middleName":"EWUSIE ORLEANS","lastName":"LINDSAY","suffix":""},{"id":285968174,"identity":"ce1c1025-52e5-4755-ac15-86fcf937fe51","order_by":1,"name":"SANDRA FREDA WOOD","email":"","orcid":"","institution":"Arizona State University","correspondingAuthor":false,"prefix":"","firstName":"SANDRA","middleName":"FREDA","lastName":"WOOD","suffix":""},{"id":285968175,"identity":"878d836f-9726-4fdd-8a78-57e65a5c2165","order_by":2,"name":"Susanna Aba Abraham","email":"","orcid":"","institution":"University of Cape Coast","correspondingAuthor":false,"prefix":"","firstName":"Susanna","middleName":"Aba","lastName":"Abraham","suffix":""},{"id":285968180,"identity":"0074c4f9-4cae-4266-93cd-dbff9e98d868","order_by":3,"name":"Aidoo Ebenezer Ato Kwamena","email":"","orcid":"","institution":"University of Iowa","correspondingAuthor":false,"prefix":"","firstName":"Aidoo","middleName":"Ebenezer Ato","lastName":"Kwamena","suffix":""}],"badges":[],"createdAt":"2024-03-02 14:46:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4006733/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4006733/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12888-024-06179-z","type":"published","date":"2024-10-18T15:57:36+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67148969,"identity":"b434107f-781f-4220-9656-3850685ea0ee","added_by":"auto","created_at":"2024-10-21 16:10:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":621630,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4006733/v1/3a98d30b-13e2-4472-b43e-1a198025501d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Experiences of residents in a therapeutic community model of drug addiction treatment in a mental hospital in Ghana","fulltext":[{"header":"Introduction","content":"\u003cp\u003eInternationally, there is increasing concern about illicit drug supply, agile trafficking networks, alarming proportions of harmful alcohol consumption, and illicit drug abuse which is mounting and linking global crises, posing challenges to health care and law enforcement responses. According to the United Nations Office on Drugs and Crime 2023 report, in 2021, the number of drug users reached over 296\u0026nbsp;million globally, marking a 23 percent rise compared to the preceding decade. Over 10 years, the prevalence of drug use disorders has surged to 39.5\u0026nbsp;million individuals, representing a significant 45 percent rise [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 2017, after the drug was abused, Fentanyl, and its analogues, over 47, 000 addicts died in the United States of America and 4, 000 in Canada. The synthetic opioid, tramadol, which has been used for decades as a painkiller, is the most abused in West, Central, and North Africa [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Other drugs abused include cannabis, karts, cocaine, heroin, and alcohol. Adolescent populations are particularly susceptible to drug use and also have more severe consequences from substance use disorder in certain countries. Within Africa, a significant majority of individuals receiving medical treatment consist of 70 percent who are below the age of 35 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Ghana, the use of illegal drugs and alcohol has been classified as endemic, and current WHO data suggest that the prevalence of alcohol consumption is 23.3%, with an alcohol per capita (APC) of approximately 20ltrs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The same can be said of illegal drug usage, as they are less reported despite the documented surge in quantity transited through the country [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Illicit drug use is undeniably a social issue because its addiction is a problem that affects the user, family, and friends and has a social impact on the community [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Drug abuse is a complex problem in mental health that is frequently linked with problems in different aspects of life such as unemployment, homelessness, relationship disputes, court issues, and medical comorbidity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Addiction is widely recognized as a chronic relapsing disorder where recovery is possible. Addiction comprises biological, psychological, and social components requiring multifaceted treatment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe problem of illicit drug use has remained an issue of public concern, and its implications for the health systems, community, and family are enormous. Global leaders have also implemented the Sustainable Development Goal (SDG) 3 Objective 5 aimed at improving the treatment and prevention of drug abuse, including the abuse of narcotics and excessive alcohol consumption. Like many other countries, Ghana signed its commitment to achieve the SDGs and has therefore instituted measures to curb the menace. Relatively recent developments are programmes to treat substance misuse and addiction/dependence.\u003c/p\u003e \u003cp\u003eIn Ghana, there are over 70, 000 illicit drug addicts aged between 15\u0026ndash;50 years [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and care for addiction centres are just a few in Ghana [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In Ghana, faith healing was the most patronized treatment option for drug addicts before the emergence of residential treatment centers, and most clients were treated at churches or prayer camps, or traditional healing centers before attending the Korle Bu Addictive Diseases Unit [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. People Who Use Drugs (PWUD) are viewed as 'cursed' or 'unholy,' leading to the prevalence of pseudo therapies as religious afflictions that resolve substance-abuse disorders.\u003c/p\u003e \u003cp\u003eThe government, non-governmental organizations (NGOs), and private entities established drug treatment programs that focused on rehabilitation, which run either in-patient or out-patient services. According to [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], \u0026ldquo;three major mental hospitals, which includes Accra Mental Hospital, Ankaful Mental Hospital, and Pantang Mental Hospital, and three Teaching hospitals, namely, Korle-Bu Hospital, Komfo Anokye Hospital, and Tamale Hospital were made available in Ghana in running addiction programs including community psychotherapy and detoxification clinics\u0026rdquo;. Bird and colleagues found out in 2019 that they employed the 12-Step Rehab Approach, which leans towards spiritual health where participants must submit to a higher power, which in the case of Ghana, is the Christian God [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. All these approaches failed to solve the problems of addictions among drug addicts which led to the introduction of TC in Ghana.\u003c/p\u003e \u003cp\u003eAccording to Broekaert, TC is defined as a drug-free community in which individuals with addiction and other psychological health issues live together in a coordinated and structured way to facilitate improvement and make a drug-free life possible outside the community [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, to address a person's substance abuse as well as their social and psychological challenges, the therapeutic community uses \"community as a method,\" which is its basic difference [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite the different definitions, the pillars of the therapeutic session are self-help and mutual assistance. Residents are primarily responsible for achieving personal development, achieving a more rewarding and responsible life, and ensuring the community's welfare. The TC program is voluntary, and the residents are not supposed to be kept in the program through force or against their will [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe concept of Therapeutic Community (TC) was introduced in Ghana by Mrs. Pearl Addison in the year 1973 at Accra Mental Hospital. According to Pantang Mental Hospital\u0026rsquo;s Drug Addiction Rehabilitation Centre, the concept of Therapeutic Community in Drug Addiction management was introduced in Ghana by Nelson Carson from the Philippines in the year 2009, September 9th at Pantang Mental Hospital [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] as a treatment modality to help addicts recover and live meaningful lives. The approach was initiated as a treatment modality at the Accra Mental Hospital in March 2019. TC in Ghana has taken a clinical perspective and not a public health perspective [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and offers only residential or in-patient services, with a duration ranging from six (6) months to twelve (12) months.\u003c/p\u003e \u003cp\u003eMost people who enrol in drug addiction programs have expectations of recovery and gaining control of their lives following the treatment. However, many studies have reported relapse incidents following discharge from various programs such as Alcoholics Anonymous and 12 Steps [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This necessitated the TC program's introduction in Ghana about ten (10) years ago [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], With the many reported successes of the TC program globally [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], it presented another opportunity to provide a treatment intervention to clients who needed to break their addiction to drugs in Ghana.\u003c/p\u003e \u003cp\u003eHowever, since the inception of the TC program in Ghana, there has been limited insight into the extent to which the program has impacted recovery from addiction [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Published studies on how the program is structured to address the needs of patients in the Ghanaian context, the experiences of residents, and the successes chalked have been almost non-existent in the Ghanaian context, hence this study sought to explore the experiences of residents enrolled in the Therapeutic Community Model of Drug Addiction treatment program in the Ghanaian setting and to unearth the impact of the program on the residents' journey towards recovery from drug addiction.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eAn explorative-descriptive study design [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] was employed to unearth the experiences of persons enrolled in the TC rehabilitation program in Ghana. The study was conducted between June 2021 and March 2022. The population of the study comprised patients who had been enrolled in the TC program in one of three Mental Health hospitals in Ghana. The setting was selected because the Drug Treatment and Rehabilitation Centre has treated over 300 residents or patients and has been running the TC program for about ten years at the time of data collection.\u003c/p\u003e \u003cp\u003eWe used a semi-structured interview guide designed to be sensitive and non-threatening, thus encouraging residents to talk freely about the issues they feel pertinent to their recovery experiences.\u003c/p\u003e \u003cp\u003eThe Drug Treatment and Rehabilitation Centre has a bed complement for 32 residents (Male-22 and Female-10).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eRecruitment and sample\u003c/h2\u003e \u003cp\u003eA resident was eligible to participate in the study if he or she had enrolled in the program for at least two months, in the lucid interval at the time of data collection and could consent to participate in the study. Their records indicated progress in care and the therapist or nurses who provided care signed off that the client could participate in the program. To recruit participants, the assistant ward-in-charge acted as a gatekeeper to inform the residents about the study because of the Covid-19 situation and 15 out of the 24 eligible participants agreed to participate in the study.\u003c/p\u003e \u003cp\u003e Meetings thereafter were scheduled with the participants for informed consent to be obtained and interviews to be conducted on a phone call because of the COVID-19 pandemic with the assistant ward-in-charge's help through a staff. Purposive sampling approach applied in this study was suitable for the study because the targeted population has similar characteristics; drug addicts enrolled in the TC rehabilitation program and shared similar experiences within the program as they were all in residence at the Hospital.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e Data were collected from 15 participants over the telephone with individual participants at their convenient appointed time in the evenings after their day sessions, using a semi-structured interview guide. Each interview lasted between 25\u0026ndash;40 minutes intervals per participant. The data were saturated when we reached the 15th participant; hence there was no need to increase the number of participants for additional interviews.\u003c/p\u003e \u003cp\u003e The background information was collected to maintain the participants' confidentiality, and pseudonyms were assigned to participants to maintain their anonymity. Participants were asked open-ended questions to allow enough time to express themselves. The questions were probed where necessary, and participants were allowed to ask questions for clarification. Responses were then audiotaped, replayed later, and transcribed verbatim. All observations during the data collection were written in the researcher\u0026rsquo;s field notes during the phone interview, which helped the researcher cross-check and validate the transcripts during the data analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe audiotaped recorded interviews were transcribed verbatim. The transcripts were cross-checked, edited, and validated by listening to audio files and comparing them with field notes to ensure they matched the participants' unique contexts and responses. A manual analysis of the information collected in this research was carried out using Collaizzi\u0026rsquo;s Phenomenological analysis [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] format as a guide.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eEthical aspects\u003c/h2\u003e \u003cp\u003e The study was approved by the Institutional Review Board of the University of Cape Coast ID (UCCIRB/CHAS/2020/80) and Pantang Mental Hospital\u0026rsquo;s Institutional Review Board (PMH-IRB). The study procedures followed the ethical considerations outlined in the Helsinki Scientific Research Declaration.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u0026rsquo; demographic and clinical characteristics\u003c/h2\u003e \u003cp\u003eThe sample was young with the majority of them below 40 years (12/15). Most of the participants were males (13/15) and married (8/15). All the participants were West African nationals with the majority (13/15) being Ghanaian nations. The number of years clients were addicted to drugs ranged between two and thirty-five years with the average years of addiction being ten years. Out of the 15 residents, only a few residents (3/15) had an experience of attending a different rehabilitation program prior to enrolling in the TC program. A slight majority of the participants (9/15) had been enrolled in the program for three months or more. All the residents (15/15) had family support throughout their addiction journey. The characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Refer to Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eParticipants\u0026rsquo; demographic and clinical characteristics\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespondent\u0026rsquo;s ID\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e(Years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNationality\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYears of addiction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFamily support\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLiberian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTogolese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGhanaian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eThemes\u003c/h2\u003e \u003cp\u003eThe analysis yielded two main themes with various subthemes that addressed the participants' experiences while enrolled in the TC program and the program's impact on the participants' recovery. The two main themes that emerged were \u0026ldquo;Why I stayed\u0026rdquo; \u003cem\u003e(Motivation)\u003c/em\u003e and \u0026ldquo;All things are new\u0026rdquo; \u003cb\u003e(\u003c/b\u003e\u003cem\u003eLife transformation)\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eWhy I stayed (MOTIVATION)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe theme presents the resident\u0026rsquo;s motivation for enrolling, remaining, and fully participating in the TC program. Three sub-themes emerged from the narratives, and they were, \u003cem\u003ethe push to enroll; I stayed because, and beholding the possible future\u003c/em\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe Push to Enrol\u003c/h2\u003e \u003cp\u003eMost of the participants had battled with the addiction over many years and had tried to personally overcome the addiction without success. The residents reported many factors underscoring their decision to enrol in the study. From the narratives, most of the participants recounted a feeling of helplessness as the main reason for enrolling in the program. This feeling overcame them when they failed to break the addiction despite the efforts, they committed to it. The feeling of helplessness often preceded an episode of relapse into addiction. A 54-year-old married man explained that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I couldn\u0026rsquo;t do it all by myself, I have tried before and it was the same result, just a week or probably less than that and I will be back to the same position [relapse]. So, I thought I needed help, maybe some help will get me further than before.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR03\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome participants\u0026rsquo; enrolment in the TC program was self-initiated, self-motivated, and done willingly.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I came here willingly to treat my addiction.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR12\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHowever, for other participants, their enrolment in the TC program was initiated by family members who watched them struggle with the addiction and made efforts to assist the participants in accessing help. A participant recounted that:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;My family was supporting me; they gathered hope and brought me here.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR09\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eI stayed because\u003c/h2\u003e \u003cp\u003e Participants described the positive experiences that underscored their reasons for remaining in the TC program and learning to overcome their addiction to drugs. The factors that emerged from the narratives included a conducive environment for care, the structure of the program, and relationships built among residents.\u003c/p\u003e \u003cp\u003eFor some participants, the residential nature of the program was useful as this diminished access to the external world as well as to their source of the drugs. A Resident or participant indicated that:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The place is locked out from getting your choice of drugs.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR04\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAnother participant further explained that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;The confinement alone is good for me, because I tried so many times in the house, I couldn\u0026rsquo;t stop, I had some [drugs] in the house and because I had access to it [drugs], I stop a little then I go back. But here [TC residence], because of the confinement, there is no way you will get it.\u003c/em\u003e \u003cb\u003eR14\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Another consideration from the participants was that, although the program was residential, the physical environment was structured to be homey and welcoming and did not give the impression of confinement.\u003c/p\u003e \u003cp\u003eAnother feature that enhanced the participant\u0026rsquo;s experience in the program was the structure of the program itself. For most of the participants, the various activities undertaken in the program accentuated the structured nature of the program and were suited to promoting recovery. For some others, the therapeutic focus of the program was insightful and impactful.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eBeholding the possible future\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eA concept that emerged throughout the narratives was hope. The majority of participants reported observing other residents who outside the program struggled with addiction, successfully exhibiting signs of recovery. Hence, for R05, whose cause of addiction was curiosity and peer pressure, observing others succeed boosted his confidence in the program and gave him a ray of hope for his own recovery. He said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I came to meet some of my friends I knew from outside [the TC program] and they are doing well now. Outside of the TC environment [we were] very close from doing everything together and he got his recovery after leaving the TC program. Even though recovery is a lifetime work, he is actually doing well and that also motivates me\u0026rdquo;\u003c/em\u003e R05\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eThis hope garnered from observing others succeed motivated some of the participants to commit fully to the program and explore the available options.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;It has really influenced my recovery because the community has taught me\u0026hellip; how to get recovery so they [those who have recovered] are the backbone of my recovery\u003c/em\u003e.\u003cem\u003e\u0026rdquo;\u003c/em\u003e \u003cb\u003eR07\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e The communal nature of the program which allowed for the residents with some strengths to assist those who were struggling enhanced their self-esteem and was highlighted in many participants\u0026rsquo; narratives.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026rdquo; We also learn from each other because we believe everybody have something great in them.\u0026rdquo;\u003c/em\u003e\u003cb\u003eR13\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cb\u003eAll things are new\u0026rdquo; (Life transformation).\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe theme discussed changes residents witnessed or observed in their lives while enrolled in the Therapeutic Community program. Five sub-themes emerged from the narratives, which reflected their transformation experiences, and these are presented as \u003cem\u003egaining insight, taking back the reins of life, becoming emotionally matured, social changes, and spiritual changes.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eGaining Insight\u003c/h2\u003e \u003cp\u003eThis sub-theme presents the psychological transformations experienced by residents while in the TC program. It was evident from the narratives that participants expressed becoming enlightened, resulting in behaviour modifications and personal reflections.\u003c/p\u003e \u003cp\u003eFor some participants, their involvement in the TC program has brought them an awareness of the impact of illicit drug use on their lives and livelihood. This awareness included the physiological implications of illicit drug use. An excerpt of the participants\u0026rsquo; narratives explains this perception:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;I have learnt that when I take the drug it affects things in my brain like neurons\u0026hellip; and I don\u0026rsquo;t have control over myself and my actions\u0026rdquo;\u003c/em\u003e \u003cb\u003eR15\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;We have learnt... it [drug addiction] is a disease that changes the brain so you can go mad\u0026rdquo;\u003c/em\u003e \u003cb\u003eR12\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor most of the participants, this awareness resulted in the nurturing of empowerment among the program residents. Through their involvement in the program, the participants identified their innate capacity and willpower to resist the urge for illicit drug use. A participant, R14, explained that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I now know the power I carry [within me] to overcome the drug. Also, it has given me a certain tool to reuse my life again.\u0026rdquo;\u003c/em\u003e\u003cb\u003eR14\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFurther to this, the analysis revealed that most participants had gained some sense of self-worth that empowered them through the program. Several of the participants felt good and deserved to be treated with respect. The narratives revealed that this psychological transformation resulted in behaviour change for most of the participants. This change in behaviour was a significant sign of recovery.\u003c/p\u003e \u003cp\u003eThese changes experienced by the participants reportedly prompted them to reflect on their lives before enrolling in the program and the transformation they witnessed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTaking back the reins of life\u003c/h2\u003e \u003cp\u003eThis sub-theme presents the attitudinal changes that participants felt had occurred in their lives while on the program. The change included maintaining personal hygiene and developing a sense of duty and punctuality. This gave the participants a sense of control over their lives.\u003c/p\u003e \u003cp\u003e The study showed that almost all the participants had issues maintaining their personal hygiene while battling addiction. However, the structure of the TC program allowed them to develop a routine that made basic activities such as bathing a part of their daily lives. R007, a 40-year-old man, who has been addicted to drugs for 25 years recounted:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The previous time [before enrolling into TC], I can even wake up from bed and don\u0026rsquo;t even bath then I go outside and do whatever. It will take me 2 days where I have not even put water on me. Here, I bath two times a day. Here, we bath morning and evening. It can even take me about three days whereby I\u0026rsquo;ve not put chewing stick in my mouth but here I paste two times a day, morning, and evening\u0026rdquo;.\u003c/em\u003e\u003cb\u003eR09\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor many participants also, who otherwise described themselves to be lazy, being in the program nurtured in them a sense of responsibility toward work. A few of the participants explained that the TC program had transformed their lives by teaching them to respect time, which gives them a sense of purpose. This sense of purpose they believed would prevent relapse when they exited the program.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Before I wasn\u0026rsquo;t here, I was lazy. But here, in TC, it\u0026rsquo;s not a bed of roses, it entails hard work. So, if you are a very lazy person, you are always going to be very active, working harder and as you stay here for some time, you will get adjusted to it naturally, then it becomes part of you. So, laziness is out.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR12\u003c/b\u003e\u003c/p\u003e\u003cp\u003e \u003cb\u003e\u0026ldquo;\u003c/b\u003e \u003cem\u003eThey are helping me to be time conscious so that I will not be able to go back to drugs again.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR11\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Punctuality is now part of my life.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR15\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eBecoming emotionally matured\u003c/h2\u003e \u003cp\u003eFrom the narratives, several of the clients developed positive ways to express their emotions. The program offered several anger management sessions, which were deemed very useful by most residents who reportedly battled with anger issues, violent behaviours, and verbal aggression when they enrolled in the program. These participants developed self-control and learned to express their anger more acceptably and maturely. Thus, a 33-year-old military man, whose cause of addiction was attributed to anger problems, he explained that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;For me I have problem with anger, so I\u0026rsquo;m doing anger management at the moment, and they have taught me a lot that it is ok to get angry, but it shouldn\u0026rsquo;t lead to aggression. So, as of now, when I get angry, I take my time to go through the issue and all of that so I don\u0026rsquo;t burst out and I don\u0026rsquo;t keep things within me because I\u0026rsquo;ve learnt that the more you keep on piling emotions one day you might just burst out over a trivial issue.\u0026rdquo;\u003c/em\u003e\u003cb\u003eR07\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe study revealed that the majority of the participants were happy and content with the behaviour change in various aspects of their lives. This culminated in a sense of accomplishment. A participant whose cause of addiction was inferiority complex reported that:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When I lay my bed, I feel very proud of myself... Am feeling proud of myself.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR08\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eSocial changes\u003c/h2\u003e \u003cp\u003eThis sub-theme describes the social changes and interpersonal relationships that were fostered among residents. From the narratives, many participants who struggled to relate with other people before enrolling in the program had gained social skills that enabled them to relate better with different people. A 47-year-old teacher, recounted that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I\u0026rsquo;ve been able to actually socialize. Back in addiction, I was somebody who was actually anti-social you know\u0026hellip; because our genre of choice, was not actually permitting us to socialize.\u0026rdquo;\u003c/em\u003e\u003cb\u003eR07\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Other participants elucidated that the social learning activities, especially the social meetings, has given them a platform to boost their morale and gain the confidence to be assertive and communicate well among people.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003e\u0026ldquo;\u003c/b\u003e\u003cem\u003eI was a shy person but since I came here, the group meetings have built me up like I can stand in front of people and talk with confidence\u003c/em\u003e,\u003cb\u003e\u0026rdquo; R05\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSpiritual changes\u003c/h2\u003e \u003cp\u003eThis sub-theme emerged with two main concepts: participants embracing religion. The TC program offered the participants to explore spiritual issues and embrace all religions. A participant reported that:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;They are always teaching you about the word of God \u0026hellip; to make sure that anything you do; you have to consult God first.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR12\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFrom the narrative, participants who explored the religious component of the program developed religious habits that gave them purpose and hope. R009, a 25-year-old student revealed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\u0026ldquo;Even now I can wake up and pray. I was not the type of person who pray every morning. Now, what am experiencing, I also thank God. I know once he has started, He will put me to a better end. Everything spiritual that goes on here, I like it.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR09\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eExcept from another participant:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eI will stay far away from drugs, and I will go to church to pray.\u0026rdquo;\u003c/em\u003e \u003cb\u003eR06\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussions","content":"\u003cp\u003eThis research explored the experiences of clients or residents enrolled in the TC program and its impact on the residents' journey toward recovery from drug addiction in the Ghanaian setting. Two main themes with eight subthemes were revealed, after the analysis was found that, participants had positive experiences in the TC program, which motivated clients or residents both in Ghana and from other African countries to enrol, stay, and participate fully in Ghana because Ghana is among the only three countries using TC program to treat drug addiction in Africa. The study also revealed a novel finding in the program where Religion or spirituality in the program was identified as an important element to aid recovery.\u003c/p\u003e \u003cp\u003eToday, the patient experience is widely recognized as an independent component of health care quality. According to the framework by Oben [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], on patient experience, understanding the humanity of patients is the essential basis upon which all good patient-centred experience initiatives should be developed. This researcher further argued that \"patient\" begins in the center, indicating that the person is not always a patient (not an addict) and becomes one with the onset of illness (becomes an addict) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe residents expressed their experiences as motivational factors that encouraged them to enrol, stay and participate actively in the TC program. My findings revealed that most of the participants before their enrolment into the TC program had battled with the addiction over many years and had tried to personally overcome the addiction without success. According to National Coalition for the Homeless [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], breaking an addiction is difficult for anyone, especially for homeless substance abusers. To begin with, motivation to stop using substances may be low. Miller and Rollnick [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] reported that motivation helps individuals overcome their ambivalence about making difficult changes to their lifestyles. Helping clients affirm their own motivation increases the chance that they will stick to a particular strategy for behavioural improvement. Most of the participants recounted a feeling of helplessness as the main reason for enrolling in the program. Motivation and desire to change are consistently correlated with increased help-seeking, and treatment. This finding is also consistent with De Leon [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] who indicated in the TC perspective that an addicted person is considered emotionally frail and immature but with the potential to change positively.\u003c/p\u003e \u003cp\u003e The majority of the participants described positive experiences that motivated their reasons to remain in the TC program and overcome their addiction to drugs. The factors mainly were a conducive environment for care, the structure of the program, and relationships built among residents in the program. Motivation is a part of the human experience, and nobody is unmotivated [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The study reveals that the conducive environment for care, the structure of the program, and the relationships built among residents in the program motivated the participants to access hope, which triggered them to change willingly and gain recovery. The sense of motivation birthed hope in the lives of many participants. From the study, hope succeeded in motivating many of the participants to commit fully to the program and explore the options available to recover. Wiles et al [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] explained that hope increases the outcomes of treatments for many health conditions, including mental health issues [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In the treatment of addiction, hope encourages patients to move from the stage of hesitation to the stage of decision-making, which leads to a positive change and thus leads to recovery. From the results, it was also found that some residents observed others succeed in their recovery, which gave them a glimpse of hope. Shaver [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] emphasised that participation in self-help organizations like TC makes residents feel useful, strengthens their confidence, and positively affects their network of social relationships when they experience hope.\u003c/p\u003e \u003cp\u003eFrom the findings, although some participants-initiated enrolment, family support was an important component for others. It was reported by Roozen et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] that family members could play an important role in the understanding of the issue and acceptance of care by the abusers if they have adequate education and treatment for themselves.\u003c/p\u003e \u003cp\u003e For other participants, the physical environment was structured to be homey. The TC learning environment has been made just like homemade or homelike and it is very conducive for all activities like socialization, sports, and entertainment. The TC learning environment is confined and everything you will need in your daily activities can all be found there, and Monitoring is high. Some scholars have asserted that delivering timely and attentive treatment produces a compassionate [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], and caring hospital [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], an atmosphere that reflects and is patient-centered on the quality of service and service experience.\u003c/p\u003e \u003cp\u003eGlobally, the TC program has been established to be an effective treatment modality for drug addicts [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The study\u0026rsquo;s findings show that TC impacts participants' lives as they witness or observe significant transformations physically, psychologically, emotionally, socially, and spiritually. The study\u0026rsquo;s findings are in congruence with other studies that reported on this treatment modality [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWu [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and Selby [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], found that the programme brought restoration of health, physical, social, psychological, and emotional well-being to the drug addicts, their families, and communities. Dekel, Benbenishty, and Amram [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] also affirm that participants enrolled in the TC show remarkable progress in drug abuse, criminal activity, and mental health symptoms. Several studies [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] further assert that the transformation was particularly true of residents enrolling in treatment with the most severe problems.\u003c/p\u003e \u003cp\u003eFrom the study, the participants' transformation was possible through activities that allowed for knowledge sharing on drug addiction and the road to recovery. Primarily, the philosophy of knowledge sharing is a method designed to acquire information from others. Pulakos et al [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] maintained that knowledge sharing pertains to preparing clear information, know-how to interact with others to promote people, problem-solving, and developing new ideas. This knowledge gained enlightened residents to develop coping strategies that help them manage potential future problems in their addiction journey, modify their behaviour, and lead to behaviour change or recovery in the form of living a sober life.\u003c/p\u003e \u003cp\u003eDe Leon et al [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] mentioned that the development of skills necessary to manage and communicate feelings was an important measure of sustaining recovery. From this study, the majority of the participants learned to manage their anger and relate with others. These life skills are essential for sustaining their gains against addiction. In this study, many participants gained their freedom through social learning activities, especially during social meetings. This gave them a platform to develop good interpersonal relationships, gain social confidence to be assertive, and communicated well among people.\u003c/p\u003e \u003cp\u003eSome participants also observed a tremendous transformation in their lives in the form of improvements in their self-esteem. Increased self-esteem promotes self-efficacy and self-efficacy leads to relapse prevention. The findings from this study are in line with Cheung et al [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] who found that 9 individuals out of 21 drug addicts studied succeeded in abstaining from using the drug because they had high self-confidence due to work satisfaction and stable income in their lives. Self-efficacy thus helps addicts learn some successful coping strategies that avoid or decrease the risk of relapse of addicts.\u003c/p\u003e \u003cp\u003eThe study also identified a novelty finding, discussing a religious dimension of transformation in the TC program. The study revealed that many residents established some form of religious routine that was attributed to faith through the influence of the program activities. Although this was not a regular practice in TC programs, the Ghanaian socio-cultural environment may have necessitated its incorporation in the activities in this study setting. Having said that, the program could be said to have addressed the biopsychosocial-spiritual needs of the participants who enrolled which gave them purpose and hope in their journey towards recovery.\u003c/p\u003e \u003cp\u003eOverall, this study found that the participants had positive experiences in the TC program, which motivated them to enrol, stay, and participate fully and encouraged the resident to learn to transform their lives, live in sober life, develop new attitudes and behaviours, which manifested physically, psychologically, emotionally, socially, and spiritually with the hope to live in sobriety after they have been integrated back to the society.\u003c/p\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLimitation of the Study\u003c/h2\u003e \u003cp\u003eOverall, this study had some methodological limitations. Firstly, the researcher recognizes that in using a qualitative explorative, descriptive research design, this study's findings cannot be generalized but may apply to only settings similar to the study area. Therefore, the researchers ensured that strategies that maintain rigor, such as an adequate audit trail, were firmly instituted throughout the data collection and analysis to ensure trustworthiness in the findings and replicate the study in similar settings.\u003c/p\u003e \u003cp\u003eSecondly, the empirical literature on experiences among residents enrolled in the Therapeutic community in Africa, particularly Ghana was very limited. The lack of extensive research on Ghana and Africa's area compelled the researcher to copiously review the global studies available and rely on experience in general health and nursing practice to meet the current study's objectives. The researcher, however, asserts that this situation facilitates and inspires more researchers into the therapeutic community.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eTC: Therapeutic Community. SDG: Sustainable Development Goal\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Institutional Review Board of the University of Cape Coast ID (UCCIRB/CHAS/2020/80) and Pantang Mental Hospital’s Institutional Review Board (PMH-IRB) approved the study. The study procedures followed the ethical considerations outlined in the Helsinki Scientific Research Declaration. All the participants in this study signed an informed consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants provided informed consent for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach of the authors made contributions to the conceptualization and design of the study. KL and SW were responsible for material preparation, data collection procedures, data analysis, IRB approval, and the initial draft of the manuscript. SA and EA participated in the literature search, data collecting, and manuscript revision. Every author provided feedback on the previous drafts of the manuscript. The final manuscript was read and approved by all of the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eUnited Nations Office on Drugs, Crime (UNODC).\u003cem\u003e \u003c/em\u003eWorld Drug Report 2023.\u003c/li\u003e\n\u003cli\u003eBird L. \u003cem\u003eDomestic Drug Consumption in Ghana: An under-Reported Phenomenon. Global Initiative Against Transnational Organized Crime\u003c/em\u003e.; 2019.\u003c/li\u003e\n\u003cli\u003eNarcotics Control Board of Ghana (NACOB). 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An overview of Ghana\u0026rsquo;s mental health system: results from an assessment using the World Health Organization\u0026rsquo;s Assessment Instrument for Mental Health Systems (WHO-AIMS). \u003cem\u003eInt J Ment Health Syst\u003c/em\u003e. 2014;8(1):16. doi:10.1186/1752-4458-8-16.\u003c/li\u003e\n\u003cli\u003eBroekaert E, Vandevelde S, Schuyten G, Erauw K, Bracke R. Evolution of encounter group methods in therapeutic communities for substance abusers. \u003cem\u003eAddict Behav\u003c/em\u003e. 2004;29(2):231-244. doi:10.1016/s0306-4603(03)00092-3.\u003c/li\u003e\n\u003cli\u003eDe Leon G. \u003cem\u003eThe Therapeutic Community\u003c/em\u003e. New York: Springer Publishing Company; 2000. doi:10.1891/9780826116673.\u003c/li\u003e\n\u003cli\u003eNational Treatment Agency. \u003cem\u003eModels of Care for Treatment of Adult Drug Misusers: Update 2006\u003c/em\u003e.; 2006. www.nta.nhs.uk.\u003c/li\u003e\n\u003cli\u003eVan de Ven AH, Sminia H. Aligning Process Questions, Perspectives, and Explanations. In: \u003cem\u003eConstructing Identity in and around Organizations\u003c/em\u003e. Oxford University Press; 2012:306-320. doi:10.1093/acprof:oso/9780199640997.003.0012.\u003c/li\u003e\n\u003cli\u003ePerfas FB. \u003cem\u003eDeconstructing the Therapeutic Community: A Practice Guide for Addiction Professionals\u003c/em\u003e. Hexagram Publishing; 2012.\u003c/li\u003e\n\u003cli\u003ePerfas Fernando B. \u003cem\u003eTherapeutic Community: Past, Present, and Moving Forward\u003c/em\u003e. Hexagram Publishing; 2014.\u003c/li\u003e\n\u003cli\u003eRawlings B, Yates R. \u003cem\u003eTherapeutic Communities for the Treatment of Drug Users \u003c/em\u003e. 1st edition. London: Jessica Kingsley; 2001.\u003c/li\u003e\n\u003cli\u003eSandelowski M. What\u0026rsquo;s in a name? Qualitative description revisited. \u003cem\u003eRes Nurse Health\u003c/em\u003e. 2010;33(1):77-84. doi:10.1002/nur.20362.\u003c/li\u003e\n\u003cli\u003eColaizzi, P. F. Psychological research as the phenomenologist views it. 1978\u003c/li\u003e\n\u003cli\u003eOben PM. Understanding the Patient Experience: A Conceptual Framework. \u003cem\u003eJournal of Patient Experience\u003c/em\u003e. Published online 2020:1-5.\u003c/li\u003e\n\u003cli\u003eNational Coalition for the Homeless. Why are people homeless. 2009.\u003c/li\u003e\n\u003cli\u003eMiller WR, Rollnick S. \u003cem\u003eMotivational Interviewing: Helping People Change.\u003c/em\u003e 3rd edition. The Guilford Press; 2012.\u003c/li\u003e\n\u003cli\u003eWiles R, Crow G, Heath S, Charles V. The Management of Confidentiality and Anonymity in Social Research. \u003cem\u003eInt J Soc Res Methodol\u003c/em\u003e. 2008;11(5):417-428. doi:10.1080/13645570701622231.\u003c/li\u003e\n\u003cli\u003eStickley T, House DM. The British research evidence for recovery, papers (inclusive). Part One: a review of the peer-reviewed literature using a systematic approach. Published online 2006. doi:10.1111/j.1365-2850.2010. 01662.x.\u003c/li\u003e\n\u003cli\u003eWerner S. Subjective well-being, hope, and needs of individuals with serious mental illness. \u003cem\u003ePsychiatry Res\u003c/em\u003e. 2012;196(2-3):214-219. doi: 10.1016/j.psychres.2011.10.012.\u003c/li\u003e\n\u003cli\u003eShaver KG. \u003cem\u003eThe Attribution of Blame: Causality, Responsibility, and Blameworthiness\u003c/em\u003e. 1985th edition. Springer; 2012.\u003c/li\u003e\n\u003cli\u003eRoozen HG, De Waart R, Kroft P. Community reinforcement and family training: An effective option to engage treatment-resistant substance-abusing individuals in treatment. \u003cem\u003eAddiction\u003c/em\u003e. 2010;1729(10).\u003c/li\u003e\n\u003cli\u003eBirkelien NL. A strategic framework for improving the patient experience in hospitals. J Healthc Manag. 2017;62(4):250-259. doi:10.1097/JHM-D-17-00071\u003c/li\u003e\n\u003cli\u003eLeon GD. Therapeutic communities for addictions: A theoretical framework. International journal of the addictions. 1995;30(12):1603-1645.\u003c/li\u003e\n\u003cli\u003eSelby, H. Drug addiction and its effects on the family. \u003cem\u003eThe Chronicle\u003c/em\u003e. 2011.\u003c/li\u003e\n\u003cli\u003eWu LT. Substance abuse and rehabilitation: responding to the global burden of diseases attributable to substance abuse. Subst Abuse Rehabil. 2010;2010(1):5-11. doi:10.2147/SAR.S14898.\u003c/li\u003e\n\u003cli\u003eDekel R, Benbenishty R, Amram Y. Therapeutic communities for drug addicts: prediction of long-term outcomes. Addict Behav. 2004;29(9):1833-1837. doi:10.1016/j.addbeh.2004.01.009.\u003c/li\u003e\n\u003cli\u003eDe Leon G. Is the therapeutic community an evidence-based treatment? What the evidence says. \u003cem\u003eTherapeutic communities\u003c/em\u003e. 2010;31.\u003c/li\u003e\n\u003cli\u003eVanderplasschen W, Colpaert K, Autrique M, et al. Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. \u003cem\u003eScientific World Journal\u003c/em\u003e. 2013; 2013:427817. doi:10.1155/2013/427817.\u003c/li\u003e\n\u003cli\u003ePulakos ED, Dorsey DW, Borman W. \u003cem\u003eHiring for Knowledge-Based Competition. \u003c/em\u003e2003; Vol 1067.\u003c/li\u003e\n\u003cli\u003eDe Leon G, Melnick G, Kressel D. Motivation and readiness for therapeutic community treatment among cocaine and other drug abusers. Am J Drug Alcohol Abuse. 1997;23(2):169-189. doi:10.3109/00952999709040940.\u003c/li\u003e\n\u003cli\u003eCheung CK, Lee TY, Lee CM. Factors in successful relapse prevention among hong kong drug addicts. \u003cem\u003eJ Offender Rehabil\u003c/em\u003e. 2003;37(3-4):179-199. doi:10.1300/J076v37n03_10.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Addiction, Experiences, Residents, Recovery, Therapeutic Community ","lastPublishedDoi":"10.21203/rs.3.rs-4006733/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4006733/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn Ghana, the use of illegal drugs and alcohol has been classified as endemic. To manage this menace, the Therapeutic Community model for Substance Used Disorders was introduced in Ghana about a decade ago as an alternative to other existing strategies. However, the effectiveness of this treatment modality for drug addiction in Panteng Mental Hospital and Accra Psychiatric Hospital has not been scientifically studied.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study, therefore, sought to explore the experiences of drug addicts or residents enrolled in the Therapeutic Community programme toward recovery from drug addiction.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis research employed an explorative-descriptive design. Participants (N=20) were enrolled purposively sampled and recruited into the study. Face-to-face interviews were conducted using a semi-structured guide and data were analyzed using Colaizzi’s descriptive phenomenology data analysis process.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTwo main themes emerged from the data:\u003cstrong\u003e \u003c/strong\u003e“Why I stayed” (\u003cem\u003eMotivation\u003c/em\u003e), and “All things are new” \u003cem\u003e(Life transformation\u003c/em\u003e). The study pointed out that residents or participants mainly expressed positive experiences in the programme, including experiencing a sense of belongingness, enhanced self-esteem/self-worth, and most importantly, developing hope of a life free of addiction.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn conclusion, the study found that participants in the Therapeutic Community (TC) program generally had positive experiences and believed in its effectiveness for recovery. Factors such as a relaxed environment, supportive staff, and interactions with other residents contributed to their positive experience. The study discovered that motivation, a conducive environment for care, structured program activities, and relationships among residents were key factors that motivated participants to stay and actively participate in the therapeutic community program. These factors fostered hope and a sense of belonging, ultimately contributing to their recovery journey. However, participants expressed the need for self-actualization, which they hoped to achieve after completing the program and reintegrating into the community.\u003c/p\u003e","manuscriptTitle":"Experiences of residents in a therapeutic community model of drug addiction treatment in a mental hospital in Ghana","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-04 11:41:08","doi":"10.21203/rs.3.rs-4006733/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-28T04:21:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-13T23:24:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42286113440040945988112806201814484865","date":"2024-06-13T21:11:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-30T17:00:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198935824857816211675468603906797695690","date":"2024-05-21T12:26:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-21T12:20:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-21T12:15:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-04-01T02:33:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-01T02:30:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychiatry","date":"2024-03-02T14:43:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bpsy","sideBox":"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bpsy/default.aspx","title":"BMC Psychiatry","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a1a9934f-2b09-486b-9b6a-dce1a737940c","owner":[],"postedDate":"April 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-10-21T16:02:11+00:00","versionOfRecord":{"articleIdentity":"rs-4006733","link":"https://doi.org/10.1186/s12888-024-06179-z","journal":{"identity":"bmc-psychiatry","isVorOnly":false,"title":"BMC Psychiatry"},"publishedOn":"2024-10-18 15:57:36","publishedOnDateReadable":"October 18th, 2024"},"versionCreatedAt":"2024-04-04 11:41:08","video":"","vorDoi":"10.1186/s12888-024-06179-z","vorDoiUrl":"https://doi.org/10.1186/s12888-024-06179-z","workflowStages":[]},"version":"v1","identity":"rs-4006733","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4006733","identity":"rs-4006733","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}