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On the threshold of hope

May 1, 2009
by Rick Wessling, AIA
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The design of alcohol and drug treatment facilities can support patients' recovery

When a person makes the courageous decision to enter a drug and alcohol treatment facility, he/she is literally crossing a threshold from shame to hope. Architecture, landscaping, and interior design have the power to support a treatment program's goals through their influence on patients' perceptions of care providers and themselves. A well-designed facility makes a subtle, yet profound, statement about the organization's commitment to treating the whole person-physically, emotionally, and spiritually-and its respect for patients' dignity and security. Design plays an equally important role in enabling the provider to adapt facilities in response to changes in patient populations and treatment programs, thereby supporting the organization's long-term financial success.

Several design principles, in particular, are key to supporting contemporary approaches to alcohol and drug treatment:

  • Balance between privacy and public interaction

  • Opportunities for fellowship and learning with peers

  • Connections with the natural world

  • Effective transition spaces between patient populations at different points on the care continuum

  • Appropriate gender separation

  • Distinctions between the spaces for primary and extended care

  • Flexibility for changes in patient populations

  • Patient, staff, and visitor security

First impressions

The transition to treatment begins when the patient enters the site for the first time-the moment a person crosses from the world of addiction to the realm of hope. Patients and families form their first impressions of the facility upon registering. Using natural materials, such as wood, stone, and slate, in finishes and furnishings as well as incorporating water and fire elements help to create a warm, residential feeling rather than an institutional or clinical appearance. At the same time, design restraint avoids going “over the top” and creating a resort atmosphere.

For example, at Hazelden Springbrook, an adult residential treatment facility in Newberg, Oregon, the main entrance lobby and registration area of buildings scheduled to be completed/renovated early next year will set the tone. The space will be characterized by a warm and professional reception area with private waiting spaces for patients and loved ones. Large expanses of glass with translucent scenes of Northwest woods will balance a sense of openness with the need for patient privacy (as seen in the current lobby, figure 1). The new space will be professional and inviting, not clinical. In addition, fireplaces in several locations within the new facility will create an inviting residential atmosphere, and natural stone surrounding the fireplaces will be carried through to the building's exterior.

Figure 1. Hazelden Springbrook's current lobby features translucent scenes to balance openness and privacy. Photographer: Peter Eckert
The registration and other public spaces used by family members and other visitors need to create opportunities to socialize within a managed environment. A public lounge or a large lobby can be designed and furnished to create areas where two to four people can sit and have a quiet conversation in relative privacy. A comfortable environment also is created by selecting soft, neutral colors and carefully using patterned fabrics and floor coverings, as bold colors and complex designs might disturb some patients.

Living with peers

Patient living areas must be designed to enable patients to live, learn, and experience fellowship with their peers. Thus, residential units must create distinctive zones for patients in primary treatment and those in an extended treatment program, while also providing opportunities for positive, well-managed interaction between the sexes and among those at various stages of recovery.

In many cases, men and women live in the same building, and the layout must be designed to separate them in separate wings or floors, with further distinctions for primary and extended care. Each population needs living areas for relaxation, small group meetings and, in some cases, preparing snacks and beverages. These spaces should create a warm, homelike atmosphere in which patients can relax comfortably (figure 2). They also should be places that allow people to develop relationships with others going through the same experiences and that allow individual contemplation without promoting isolation. Each treatment community space should be arranged to prevent interruptions by patients from other treatment units.

Figure 2. This rendering of the gathering and living space at Hazelden Springbrook shows the importance of creating an inviting and residential feel. Large windows allow ample light in and provide views of the outside. The space has several places to gather. Rendering by Mike Munson

Different patient populations should have opportunities to interact under supervision in lecture rooms and common dining rooms. Designers can create a sense of place for each sex or treatment level, for example, by creating an L-shaped room with separate seating areas. Also important is creating staff-only zones so they can relax and interact informally with their colleagues.