how interior design can support drug and alcohol rehabilitation centers

How Interior Design Can Support Recovery in Drug and Alcohol Rehabilitation Centers

A Thesis Submitted to the Faculty of the Interior Design in Partial Fulfillment of the Requirements for the Degree of Master of Fine Arts in Interior Design at Savannah College of Art and Design

Liliana Hasbun Abel Savannah, GA

Liliana Hasbun | SCAD © © May 2018 Helena Moussatche, Ph.D., Committee Chair Christina Gonano, M.F.A, Committee Member Angelo Lagares, Committee Member

Dedicated to my brother

Liliana Hasbun | SCAD Š

Acknowledgements

All my professors have influenced me in one way or another into becoming a professional designer. For this thesis, my professors whom I admire: Helena Moussatche and Ricardo Navarro, guided me into creating this thesis. Special Thanks to Helena for not only being my Committee Chair, but for also encouraging me and teaching me with passion and understanding. Thanks to my second committee member Christina Gonano for her amazing feedback and positive attitude. Special thanks to Angelo Lagares for supporting me in this thesis and for helping people suffering from substance abuse disorder. Evidently, I couldn’t have done this without my family and close friends. Thanks to them, I am here today. Thanks to my aunt Tetei who was the first interviewee. Thank you for being available for interview, for being there to answer all my questions and for supporting me every time I needed.

Liliana Hasbun | SCAD Š

Table of Contents List of Figures ............................................................................................................................... 1 Abstract ......................................................................................................................................... 3 Introduction ................................................................................................................................... 4 Establishing the Narrative: Patient............................................................................................ 4 Establishing the Narrative: Therapist........................................................................................ 8 Framing the problem ................................................................................................................. 9 Literature Review Part I .............................................................................................................. 15 More Details about the Problem ............................................................................................. 15 Demonstrating the Problem: The Existing Therapeutic Point of View Regarding Addiction Behavior. ................................................................................................................................. 18 Deeper Understanding: An Addict’s Brain ............................................................................. 18 Understanding Behavior Patterns of People Suffering From Addiction: Anti-social Behavior. ................................................................................................................................................. 20 Existing Methods to Treat Addiction in U.S. Drug and Alcohol Rehabilitation Centers ....... 21 Population in Rehabilitation Centers: Introverts and Extroverts ............................................ 23 Key Element for Recovery Regarding Any Personality Type: Introspection......................... 24 Literature Review Part II ............................................................................................................ 27

Liliana Hasbun | SCAD Š Interior Design Factors that Can Support the Recovery Process in Drug and Alcohol Rehabilitation Centers ............................................................................................................. 27 Supporting a Sense of Privacy in Public Spaces for Introverts and Extroverts ...................... 29 Supporting Emotional Wellness through the Physical Environment ...................................... 32 Supporting Wellness at the Neurobiological Level through the Physical Environment ........ 33 Healing Through the Physical Environment ........................................................................... 35 Contextualizing the Problem: Conclusions from the Literature Review .................................... 36 The Gap: Physical Environment vs. Social Environment ....................................................... 36 Research Question ...................................................................................................................... 38 Contextualizing the Problem................................................................................................... 38 Methods....................................................................................................................................... 41 Constructivist Worldview ....................................................................................................... 41 Population/Participants ........................................................................................................... 42 Research Findings ....................................................................................................................... 43 Open-Answer Interviews ........................................................................................................ 43 Case Studies ............................................................................................................................ 45 Photo-elicitation ...................................................................................................................... 46

Conclusion on Findings and Literature Review...................................................................... 49 Discussion ................................................................................................................................... 53 Design Proposal .......................................................................................................................... 56 Client ....................................................................................................................................... 70 Design Application ................................................................................................................. 71 Conclusion .................................................................................................................................. 79 References ................................................................................................................................... 81 Glossary: Defonition of Terms ................................................................................................... 85 Appendices .................................................................................................................................. 86 Appendix 1: Findings from the Interview Patients and therapists .......................................... 86 Appendix 2: FF&E .................................................................................................................. 87 Appendix3: Finishes Schedule ................................................................................................ 92 Appendix 4: Well Building Guidelines Used ......................................................................... 93 Appendix 5: Floor plan Axonometric of Drug and Alcohol Rehabilitation Center ............... 94 Appendix 6: Final Board Images ............................................................................................ 95 Â

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List of Figures Figure 1: The disconnection between interior design and the current therapies offered to treat addiction behavior (author’s image) ........................................................................................... 12 Figure 2: The methodical path to obtain the physical conditions that may enhance the existing drug and alcohol rehabilitation centers (author’s image). .......................................................... 14 Figure 3: Explaining how interior design can possibly support addiction behavior (author’s image). ........................................................................................................................................ 15 Figure 4: The recovery process for people suffering from addiction behavior problems and the phase in which this research is going to be based upon (author’s image). ................................. 17 Figure 5: The pharmacological effects of drug abuse potently stimulate neural pathways normally mediating reward-based learning resulting a powerful learning process and enduring changes in motivated behavior (Philibin et al., 2011) ................................................................ 19 Figure 6: The components of comprehensive drug abuse treatment (NIDA, 2012). .................. 22 Figure 7. Arcehtypal Landscape Spatial Conditions (Messervy, & Abell, 2007). .................... 29 Figure 8: Spatial configuration for optimal territorial hierarchy (Lang, 1987). ......................... 31 Figure 9: Research question and how it connects to other subjects (author’s image). ............... 38 Figure 10: A graphic representation of the early findings from open answer interviews (author’s image). ........................................................................................................................................ 44 Figure 11: A graphic representation of the findings from open answer interviews (Author’s image). ........................................................................................................................................ 44

Liliana Hasbun | SCAD © Figure 12: A graphic representation of the findings from open answer interviews (Author’s image). ........................................................................................................................................ 45 Figure 13: Case studies and the lenses used (Author’s image). .................................................. 46 Figure 14: Findings for “wellbeing” (Author’s image). ............................................................. 47 Figure 15: Findings for “self-love” (Author’s image). ............................................................... 48 Figure 16: Findings for “hope” (Author’s image). ..................................................................... 49 Figure 17: Overall findings (Author’s image). ........................................................................... 54 Figure 18: Overall findings-Design Principals (Author’s image)............................................... 54 Figure 19: .................................................................................................................................... 55 Figure 21: .................................................................................................................................... 57 Figure 23: .................................................................................................................................... 59 Figure 25: .................................................................................................................................... 61 Figure 27: .................................................................................................................................... 64 Figure 29: .................................................................................................................................... 66 Figure 31: .................................................................................................................................... 69 Figure 33: .................................................................................................................................... 72

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Figure 35: .................................................................................................................................... 74 Figure 38: .................................................................................................................................... 76 Figure 40 ..................................................................................................................................... 79 Figure 42: .................................................................................................................................... 91 Figure 44: .................................................................................................................................... 93 Figure 46: .................................................................................................................................... 95 Figure 48: .................................................................................................................................... 98 Figure 50: .................................................................................................................................. 101 Figure 52: .................................................................................................................................. 102 Figure 54: .................................................................................................................................. 103 Figure 56: .................................................................................................................................. 104

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Abstract How Interior Design Can Support Recovery in Drug and Alcohol Rehabilitation Centers Liliana Hasbun Abel © May 2018

Substance abuse disorder is a complex neurological disorder that causes negative effects on the wellbeing of the affected person and their surroundings. People suffering from this chronic disease usually recover at drug and alcohol rehabilitation centers. A total of 14,000 specialized rehabilitation centers (NIDA, 2012) are available in the U.S. The research made in this study concluded that the therapeutic community that treats substance abuse disorder disregards the physical environment as a form of therapy when inevitably; the physical environment affects our behavior and neurobiology. This is why the purpose of this study is to demonstrate how the physical environment can be a meaningful tool during the recovery process of patients. The therapies offered in drug and alcohol rehabilitation centers mainly focus on emotional healing, introspection and socialization. How can the physical environment support introspection and enhance the current therapies offered at drug and alcohol rehabilitation centers in the U.S.?

Interior design theories that can potentially support the existing recovery model are Biophilic Design, Proxemic Theory, Emotional Design, The Power of Place and the Archetypal Landscapes. The findings from the research and the mentioned interior design theories, gave specific interior physical conditions that support recovery at a subconscious/physical level.

These spatial conditions can facilitate neurobiological balance, physical movement, socialization, introspection, motivation, positive emotions, self-love, hope, focus and knowledge at a subconscious level. This outcome is achieved through specific spatial conditions that include shapes, colors, lighting, materials and sounds. The design proposal of these specialized spatial conditions, are most needed in transitional areas. This is why the design proposal of this thesis gravitates towards the creation of seven Restorative Nodes. The prototypes are designed to perform in any type of drug and alcohol rehabilitation center.

Liliana Hasbun | SCAD ©

Keywords: recovery, addiction, drug, alcohol, rehabilitation, emotional, biophilia, introspection, restorative, node, design.

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Introduction Establishing the Narrative: Patient Diary Entry June 2014: My mom and dad don’t love me as much as they love my other three elder siblings.

Since I can remember, they have never paid attention to me. This is why I decided to live abroad and do whatever I want. A year ago, I got married to a foreigner and went to live in his country. Tomorrow, I will give birth to my first baby! I am worried that I haven’t been able to hold a stable job. But I am not the problem; no one understands me, and everyone is against me.

Well, anyways, changing the topic to something more important: Tomorrow I’ll finally be able to get high! Since I found out about the pregnancy, I haven’t been using drugs or alcohol but, after tomorrow, finally, I will be able to. Getting high is the best thing ever, these nine months have been so miserable without drugs.

Liliana Hasbun | SCAD © Diary Entry July 2014:

I’ve decided to name my daughter Lila. She is the most beautiful thing I’ve ever seen. I love her so much! Everyone says I should quit drugs, but I need to use my drugs because that is the only way I know of having fun! And I am sure Lila wants me to be happy. That doesn’t mean I am a bad mom. I am being responsible because I’ll be high at home when my baby is asleep. Everything will be fine; I am in control of when I want to get high.

Diary Entry July 2016: Lila is two years old now, and I haven’t had a stable job. I don’t understand why! I have a Bachelor’s degree and I went to the best cooking school; I am a Chef with a bachelor’s in Hospitality Services. Another problem is that now I am a divorced mom. Life is getting harder and no one understands me, and no one helps me. It doesn’t really matter because I have

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everything under control. I live in a first world country that is safe and provides free education and free healthcare. Also, we live close to my ex-husband’s house. My family is also there for me, even though we don’t live in the same country, they send me money. Since Lila is two now, I’ve been getting high even if she is awake. This is how I feel happy, and I need to be a happy mom.

Diary Entry August 2016: I hit rock bottom. I got so high, I put my 2-year-old daughter’s life at risk. I got high two days ago while I was in my bed and I almost died. I couldn’t move for two days, and I don’t know how Lila survived those two days without food or adult supervision, because Lila and I are the only ones living in my apartment. I still can’t move my lower body, but I can move my upper body. I am going to call my parents and tell them I need to go to rehab.

Diary Entry August 2017:

Liliana Hasbun | SCAD © I finished phase one of the rehab program: Medical Detox. It was so hard, I wanted to

escape the detox, but I had something more significant than me making me stay and getting clean: my baby Lila. After the detox, we went through what the doctors call phase two. This phase lasted about three weeks. I have a total of five weeks now in the rehab program! Now, I am moving to the final part: phase three. I am so proud of myself because finally, I’ll be a good mom for Lila. I miss her so much! It hasn’t been easy, but it is worth it.

Phase two was so disciplined, scheduled, and emotionally hard. While I was there, my days were getting up early, going to group therapies, individual therapies, exercising, going to lectures, and socializing. Oh, and once a week we would have a field trip to the beach.

My daily alarm was set at 6:00 AM. I had to make the bed and clean my room, which I shared with a female roommate. After that, I had to sign a sheet. This was so that the

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supervisors could check if we woke up and cleaned. They would later come and check the room. My bedroom was so basic: twin beds, plain walls, one window, low ceilings and simple furniture. I didn’t really care because, while I was going through phase two, my body was so tired and exploited from the bad life I used to have that I didn’t really think about comfort.

Then I would get ready and go to the dining room and have breakfast with all the other patients of the program. Food was good; it was a very wholesome and healthy food. We had thirty minutes for breakfast; we would seat in tables of four people so we could chat while we eat.

When breakfast time was over, we would go to group therapy. It lasted three hours because each person of the group would talk. Sometimes we had to confront one another, and it would get so dramatic. People would shout and cry and all those emotions affected me. I didn’t really like the group therapy; for me, it was just a waste of my time. I preferred to talk one to

Liliana Hasbun | SCAD © one and have a meaningful conversation, not the whole drama nonsense thing. I didn’t really

learn anything from those types of group therapies. When it was finally over, we had thirty minutes of downtime and then we would go to the dining room again to have lunch. Those thirty minutes of downtime were my favorite part of the day because I was discovering myself.

I liked to go on top of a tree and listen to music, all by myself, but the therapists wouldn’t let me! They thought I was trying to harm myself. I wish I could have more time at the top of the trees by myself. It made me feel at peace. If I had had more time to do this, my recovery process would have been much shorter, because I would finally understand my emotions and who I am.

After downtime, we went to the same dining room. This time it was for a whole hour, thank God. I was able to eat calmly and chat with the people I liked the most. I wanted to seat

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alone, but there was no place to seat apart, and the therapists wouldn’t let me. But, at least, I could choose with whom I wanted to talk to. After lunch, we would go to another group therapy in which everyone was falling asleep! Of course! After waking up at 6:00 AM and having lunch, who wouldn’t sleep? This group therapy was best for me because it was calmer than the first one, obviously.

After this, we would have one hour either for exercise time or to one therapy with the psychologist. When this hour culminated, we had 30 minutes of downtime, my favorite part of the day! I would try again to get on top of the tree and be alone. When the second downtime was over, we had another type of group therapy for 3 hours. Therapies were always in the same boring room: plain walls, plain floors, no windows, a whiteboard and a fluorescent light that wouldn’t stop flickering. We had to fold and put back the iron chairs that we sat on during the meetings.

Liliana Hasbun | SCAD © After this boring time was over, we had dinner in the same dining room for one hour.

Then, we had to go back to our bedrooms, and we had one more hour to get ready to sleep because at 10:00 PM the lights went out. We were not able to have any type of electronic gadgets, phones or computers, and no flashlights, so there was nothing else to do other than sleep or talk to your roommate in the dark.

Every day was basically like this, except on Fridays, because we would go on a field trip to the beach. I hated being on the bus with all the other patients. They had such big personalities! They were always shouting and making some drama. I was just there observing them, and waiting for the time when I didn’t have to share the same place with them. During phase 2, my emotions were very unstable; I could feel happy one minute and the next minute start crying. Seeing my friends going through the same thing as I gave me strength and a sense

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of community support. When I had these explosions of feelings, I liked looking at the river from a big window we had.

Instead of so many group meetings, I would have preferred to start an educational program because it would have given me a motivation to go insert myself back into real life.

Also, it is something that I can use to earn money once I am back into supporting my daughter.

It would have given me more motivation to keep going on with the recovery process.

Having to spend time with people I didn’t want to be with, and pushing myself to be disciplined and true to myself, made me learn how to live life sober. This process made me appreciate and accept my family and myself. It also helped me to confront life as it is, understand that feeling down, angry, or irritated is part of life; and, it is okay to have these feelings. Now I am entering phase 3 of the program. This phase is less disciplined, and I won’t be under constant surveillance. It is more of a real life-like experience before I finish the

Liliana Hasbun | SCAD © program.

Establishing the Narrative: Therapist Diary Entry August 2017: I have been working on this rehabilitation center for ten years now. I have been observing and analyzing the patients so that I can improve the therapies. I have come to the conclusion that patients need to feel included, accepted and supported; no judging is allowed.

They have to always be in the presence of people because, if they are alone, they become melancholic and depressed. This is why they need to be always with other people so that they can mutually lift each other up.

Both exercise and nutrition are very important, as well as the medications we give them because all these elements promote a proper chemical balance in their bodies. An addict’s brain

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is chemically imbalanced; their brain suffers the reward deficiency syndrome, depression, and anti-social behavior. So we, as therapists, attack these problems with behavior and experience through the social environment, not the physical environment, because they just need essential things in the facility.

I have a new patient that is here because she put the life of her 2-year-old daughter at risk. I see that she is more of an observer type of personality. She doesn’t like to be the center of attention. On her downtime, she keeps getting on top of trees, and we fear she might harm herself. We have to constantly make her get down. She needs to participate more in the group therapies; maybe she will feel more included and will stop trying to get away by climbing up a tree.

The success rate of the patients has been increasing since we started this model, called the Florida Model. It is a residential program that consists of a detox phase, Phase 2 and then

Liliana Hasbun | SCAD © Phase 3. Patients are monitored 24/7 during this learning process. In this behavioral therapy, they learn about abstinence by participating in group therapies, one to one treatments, physical exercises, and lectures. But, something is missing, I am still thinking about how the success rates can go even higher. I know there has to be a way to improve this approach. Maybe it is through the physical environment; the external stimuli that the patients receive.

Framing the problem Addiction is a complex neurological disorder that provokes negative outcomes on the wellbeing of the affected person and their surroundings. The World Health Organization (WHO) reports that 5.4% worldwide is affected by drug and alcohol abuse. The Substance Abuse and Mental Health Services Association (SAMHSA, 2012) reports that in 2014, 22.5 million people (12 years and older) in the U.S. needed treatment for a drug or alcohol use

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problem. Drug and alcohol addiction is linked to criminality, low productivity in the workplace, and incites negative consequences on the quality of life of the addict, their family, and close ones. These unfavorable behaviors cost the American society approximately $200 billion in criminal justice, healthcare, and workplace productivity, the Office of National Drug Control Policy (ONDCP) reported in 2007. According to CASA (2012): In 2010, the United States spent $43.8 billion to treat diabetes which affects 25.8 million people, $86.6 billion to treat cancer which affects 19.4 million people and an estimated $107.0 billion to treat heart conditions which affect 27.0 million people, but only $28.0 billion to treat addiction which affects 40.3 million people (p. 12).

Not enough resources are allocated to undertake addictive behavior therapies; in consequence, only deprived treatment is available for the people who need addiction therapy in the US. There are 14,500 specialized drug and alcohol rehabilitation centers in the US (NIDA,

Liliana Hasbun | SCAD © 2012) that behold opportunities for improvement because studies have shown that 40-60% of

the times, people backslide into addictive behaviors again (NIDA, 2012). The presented data suggest that the current therapeutic approaches for addictive behavior can be further improved, but how? This is why the purpose of this study is to filter interior design’s body-of-knowledge, and thus define physical environmental factors that can possibly enhance the existing recovery process of the residential treatment during phase two in drug and alcohol addiction rehabilitation facilities.

Existing addiction behavior therapies could possibly be innovated with the support of interior design theories since the existing addiction behavior solutions are still scattered as CASA (2012), shows in his research regarding the gap in addiction medicine between science and practice:

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The prevention and reduction of risky substance use and the treatment of addiction, in practice, bear little resemblance to the significant body of evidence-based practices that have been developed and tested; indeed, only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works (National Center on Addiction and Substance Abuse, 2012, p. 13).

There is a need for innovative solutions as these addiction professionals explain: “...it is important to understand the neurobiological basis of behaviors characteristic of addiction in order to identify novel mechanisms that lead to better treatments” (Philibin, Hernandez, Self, & Bibb, 2011, p. 1). Other researchers such, as, Pruett, Nishimura, and Priest (2007), have found holistic approaches to address the addictive behavior, as they show in one of their research: “One alternative approach that seems to offer promise in the treatment of addiction is the practice of meditation, which exists in many forms” (p. 71). Both, the holistic and the

Liliana Hasbun | SCAD © pharmaceutical approaches have a notable gap in their therapeutic examination: to consider the physical environment as part of the solutions for addiction behaviors.

The Substance Abuse and Mental Health Services Administration of the US (SAMHSA, 2007) only provides a splash of generalized guidelines about how the physical environment affects the wellness of people suffering addiction. But there exists clear evidence regarding the dominance of the physical environment over a person’s behavior and wellbeing. Gallagher (2007) refers to the ideas of Hoefer: “The biology of behavior concerns the four elements of molecule, cell, organ, and organism, and the physical environment is important from the simplest level up through any stage of development” (p.16). Given the circumstances, if SAMHSA is overlooking the power of interior design, it is understandable that incongruence exists between the interior design theories and the existing therapies offered at the common

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drug and alcohol rehabilitation programs. This divergent naturally surfaced the research question for this thesis: how can the current therapies delivered to the in-patients inhabiting drug and alcohol rehabilitation centers in the U.S. perform prominently if accompanied by a suitable interior design?

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Figure 1: The disconnection between interior design and the current therapies offered to treat addiction behavior (author’s image) After analyzing the existing literature from the therapeutic community that tackles the current addiction behavior therapies in addition to interviewing former in-patients and therapists; opposing viewpoints were noted amongst them. Therapists do not take into consideration the physical environment as part of the therapies, while the patients unconsciously have an emotional and neurobiological connection with the interior space. So, inevitably the interior spatial conditions will play an important role in the therapeutic process, as Norman (2005) clarifies:

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Emotions are inseparable from and a necessary part of cognition. Everything we do, everything we think is tinged with emotion, much of it subconscious. In turn, our emotions change the way we think and serve as constant guides to appropriate behavior, steering us away from the bad, guiding us toward the good (p. 7).

It can be concluded that the interior design of the current drug and alcohol rehab centers is not completely addressing the emotional and neurobiological needs of the in-patients during their recovery process. CASA (2012) explains that this detachment happened because of the lack of “Providing quality care to identify and reduce risky substance use and diagnose, treat and manage addiction requires a critical shift to science-based interventions and treatment by health care professionals: both primary care providers and specialists” (p. 13).

A solution for this disengagement between the existing rehabilitation model and the patient’s emotional needs will be proposed with evidence-based data and theories on how the

Liliana Hasbun | SCAD © physical environment affects neuroplasticity1 and behavior. Which are the emotional needs of the patients? How can physical space facilitate introspection? How can people feel they have a choice of privacy in a public area? How can this space provide the experiences we find in nature inside a rehabilitation program? How can this spatial experience chemically balance their body during the recovery process? Are the therapies employed in rehab centers supported by the physical environment or just the social environment?

This is why the primary focus of the literature review for this thesis is to obtain scientific data from the neurobiology field, evidence-based facts from psychology studies and also, interior design theories that can support the findings obtained from the clinical fields.

Interior design theories such as Proxemics, The Power of Place, Emotional Design, Biophilic

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Design and Archetypal Landscapes have the characteristics needed to find the missing links that can perhaps enrich the drug and alcohol rehabilitation centers in the United States of America.

Under the constructivist worldview research approach, the conclusions from the review of literature will dictate the methods that will be used to obtain findings that can potentially interlace all the scattered knowledge concerning addiction behavior.

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Figure 2: The methodical path to obtain the physical conditions that may enhance the existing drug and alcohol rehabilitation centers (author’s image).

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Literature Review Part I More Details about the Problem Addiction is a chronic disease embodied by various symptoms such as loss of selfcontrol, depression, anxiety, memory loss and compulsive behaviors. The physical environment is a potent tool that may trigger positive or negative addiction behaviors. The physical conditions of an interior space can affect our emotions, thoughts and body chemistry; therefore, it can cause cravings for substance abuse, as Norman (2005) found: “Some objects evoke strong, positive emotions such as love, attachment, and happiness” (p. 7). Furthermore, Norman explains that “Attractive things do work better—their attractiveness produces positive emotions, causing mental processes to be more creative, more tolerant of minor difficulties” (p.

60). So, how can the physical environment be a source of positive emotions during phase two of the in-patient recovery process?

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Figure 3: Explaining how interior design can possibly support addiction behavior (author’s image).

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A review of the body of knowledge from the therapeutic community that treats addiction behavior indicates that the field does not consider the physical environment as part of the therapy. When the therapeutic researchers mention the environment, it is solely focusing on the social environment; the society around the addict. This review of the literature will present that, inevitably, the physical environment affects the patients and the social environment. For example, these therapeutic researchers refer solely to the social environment: Whereas biological, psychological and environmental factors---such as impairments in the brain’s reward circuitry, compensation for trauma and mental health problems, easy access to addictive substances, substance use in the family or media and peer influences--play a large role in whether an individual starts to smoke, drink, or use other drugs.

(CASA, 2012, p. 20)

Liliana Hasbun | SCAD © The demands of a physical environment that accommodates the emotional needs of the

patients during the phase two of drug and alcohol rehabilitation centers will come to light in this review of literature. Connections between neurological studies, psychological studies, and interior design theories are purposefully constituted in order to show that most therapies that treat addictive behavior are interrelated with the physical environment. Is there a way of incorporating the interior design theories and the existing therapeutic approaches? Can this intermix possibly provide a proper interior design solution that enhances the therapies? CASA (2012) explains in the findings: Addiction prevention and treatment are for the most part removed from routine medical practice. Instead of addressing addiction, the medical field primarily has focused its efforts on treating the secondary and tertiary complications of addiction, allowing the

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public health epidemic to advance unchecked (p. 16).

In consequence of the absence of this multidisciplinary connection between different fields of knowledge, the existing models of in-patient treatment for drug and alcohol rehabilitation centers in the USA have a missing link between neurobiology and psychology.

This missing link is the common ground between them: The physical environment. For the purpose of this study, only current short-term residential treatment in the USA will be explored, specifically phase two. This short-term treatment consists as intensive and disciplined therapy, as Adler, Brady, and Mello (2012) explain: “…residential treatment model consisted of a 3- to 6-week hospital-based inpatient treatment phase followed by extended outpatient therapy and participation in a self-help group, such as AA” (p. 34).

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Figure 4: The recovery process for people suffering from addiction behavior problems and the phase in which this research is going to be based upon (author’s image).

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Demonstrating the Problem: The Existing Therapeutic Point of View Regarding Addiction Behavior.

What is drug addiction? According to Li, Mao, & Wei (2008) “Drug addiction, [is] defined as the loss of control over drug use, or the compulsive seeking and taking of drugs despite adverse consequences’’ (p.28). A behavior is categorized as “addictive” when a person becomes emotionally dependent on substances in order to feel “good.” It tends to become an enslaving state of mind, because it is a vicious cycle between high and low, for example pleasure and depression. This is caused by a chemical imbalance in the brain, as Wakefield and Leshner agreed (as cited by Zhou et. al, 2016, p. 1) that: “Drug addiction is often referred to as a chronic brain disorder characterized by compulsive and uncontrollable drug seeking tendencies and usage, paired with the emergence of a negative emotional state when drug access is prohibited.”

Liliana Hasbun | SCAD © CASA (2012) explains that this chemical imbalance in the brain is influenced by our

emotions and beliefs, meaning that the external factors from the social environment can encourage an addictive behavior; but he does not address the physical environment as an influencer of emotions: “Environmental influences can exacerbate existing genetic, biological and psychological risks for substance use, further increasing the chances that an individual will engage in risky substance use, sometimes to the point of addiction” (p. 24).

Deeper Understanding: An Addict’s Brain Reward Deficiency Syndrome (RDS). According to Volkow et al. (2007) (as cited by Li et al., 2016, p.01) “The neurobiology3 of drug addiction involves dysfunctions in specific neural pathways and neuropsychological pathology.”

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Figure 5: The pharmacological effects of drug abuse potently stimulate neural pathways normally mediating reward-based learning resulting a powerful learning process and enduring changes in motivated behavior (Philibin et al., 2011)

Liliana Hasbun | SCAD © The evidence (Figure 5) shows that the chemical imbalance that promotes the addictive

behavior is the production of glutamine instead of dopamine during the reward process. This reward cycle is the responsible for triggering cravings for drug use as the image shows. This chemically imbalanced cycle is called the Reward Deficiency Syndrome (RDS). The social environment that we are exposed to affects our flexible brain.

The therapeutic community is very aware of this fact; they used the social environment as therapy in their rehabilitation programs. Schmidt stated (as cited by Bibb et al., 2011, p. 2) that: “Triggers of relapse during abstinence include re-exposure to the drug itself, environmental drug-associated cues, stress, or some combination of these factors.” No data is shown on how the physical environment affects the Reward Deficiency Syndrome.

Contrastingly, Gage (2003) explained the importance of the physical environment in the

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neurobiological aspect: …we also know that environment dramatically influences brain development, from early stages to a full-grown organ. We have accepted this fact for a long time in the neurosciences - as we grow and develop, the environment can play an important role.

While the blueprint is there, defining what the extent of the structure will be, the environment plays a very important role in the final product. (p. 2) Understanding Behavior Patterns of People Suffering From Addiction: Anti-social Behavior.

Another symptom of people suffering from uncontrollable substance abuse is not only the Reward Deficiency Syndrome but also Antisocial Behavior. This is a consequence of polysubstance consumption at abusive levels. This is why the professionals that treat patients in

Liliana Hasbun | SCAD © drug and alcohol rehabilitation centers in the U.S. use various types of group therapies (that will be mentioned later) and continuously force the patients to socialize and be in the presence of

other people as much as possible. This is a method used to extinguish the drug-seeking behavior.

The inpatient recovery programs impose constant human interaction with the purpose of making the patients learn through behavior how to socialize, as Li, Mao, & Wei (2008) stated: “It has been estimated that genetic factors contribute to 40–60% of the vulnerability to drug addiction, and environmental factors provide the remainder.” (p. 28). This suggests that, possibly, the social experiences that the therapy provides will inevitably affect the patient’s brain development during the recovery process while attending a drug and alcohol rehabilitation center. The review of literature from Anti-Social Behavior revealed no sensibility is shown regarding the interior physical environment and its effects on social or antisocial behavior. Yet,

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the Biophilic Design Theory proves that: …the physical environment can have a positive, neutral or negative effect on an individual, and responses may differ with the user’s health baseline; the frequency and duration of the experience; socio-cultural norms and expectations; the user’s experience up to that point; and how the individual perceives and processes the experience.

(Andrews et al., 2014, p. 71) What is the stimulus that triggers the drug-seeking behavior? Is it related to the physical environment? Is the physical environment able to activate a correlation with the past experiences of the users? Does the physical environment trigger a depressive state in which the affected ones search for substances to inhibit their emotions? Interior Design theories that support a positive emotional state for the patient during the recovery process will be further

Liliana Hasbun | SCAD © discussed.

Existing Methods to Treat Addiction in U.S. Drug and Alcohol Rehabilitation Centers To address the neurobiological and behavioral problems that an addict’s brain suffers (Reward Deficiency Syndrome, the Anti-Social Behavior, and compulsiveness), the therapists found that the most effective way to improve the human body at a physical and mental level is through behavioral and cognitive therapy; no drug or anything can be more beneficial for brain development. Every experience shapes the brain; it can be negative or positive. Depending on how we behave, we can shape our brains into becoming a drug addict or not as Malvaez, Barrett, Wood, and Sanchis-Segura (2009) proposed: “One potential mechanism that may produce long-lasting behavioral effects is: stable changes in cellular function leading to stable changes in neuronal plasticity.” (p. 7). No relationship was presented between the physical environment and its effects on behavior.

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Subsequently, Hyman (as cited by Malvaez et al., 2009, p. 4) expanded that “In the addicted state, the acute psychoactive effects alone do not maintain drug-related behavior; rather, drug-related stimuli trigger drug-seeking behavior through associative learning.” What is the stimulus that triggers the drug-seeking behavior? Is it related with the environment and how the user relates to it? Does it connect with the past experiences of the user?

Liliana Hasbun | SCAD ©

Figure 6: The components of comprehensive drug abuse treatment (NIDA, 2012).

The therapists use behavior therapy as the first step in changing the way the patients think and act. The existing drug and alcohol in-patient treatment program break the existing behavior patterns originated in patients. There are two types of residential treatment offered at rehabilitation centers in the U.S.; long-term or a short-term residential treatment. These

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treatments fall under two models: The Florida Model (residential-like facility) or the Traditional Model (hospital-like facility). Usually, the therapies provided during both models are not personalized to the individual’s type of personality, past experiences or culture. Nevertheless, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture” (NIDA, 2012, p.

3). No evidence was presented on how the physical environment addresses a person’s past experiences, culture, and identity.

The National Institute on Drug Abuse (2012) offers an explanation of each of the different therapies offered at rehabilitation centers. Yet, only the ones that have a distinct relation to the physical environment are noted, such as Reward System/Cognitive Behavioral Therapies, Exercise, Medication Management/Pharmacotherapy, Addiction Education, Group

Liliana Hasbun | SCAD © Therapies, 12 Step Facilitation Therapy, Contingency Management Interventions, Motivational Incentives, Counseling, Alternative Therapies: Yoga, Meditation, and Massage Therapy.

In NIDA’s descriptions regarding these therapies, it is evident that the therapists are not taking into consideration the physical environment when interior design affects these therapies as Hoefer (cited by Gallagher, 2007, p.15), explain: “The biology of behavior concerns the four elements of molecule, cell, organ, and organism, and the physical environment is important from the simplest level up through any stage of development.”

Population in Rehabilitation Centers: Introverts and Extroverts In today’s Western culture, there is an insufficient understanding of the introvert personality type. There is a misconception between shyness and introversion: “Shyness is the fear of social disapproval or humiliation, while introversion is a preference for environments

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that are not over stimulating. Shyness is inherently painful; introversion is not” (Cain, 2012, p.12). This is why drug and alcohol rehabilitation centers are asking introverts to behave like extroverts; because society views extroversion as an emotionally stable person, as Cain (2013) explains: “We live with a value system that I call the Extrovert Ideal—the omnipresent belief that the ideal self is gregarious, alpha, and comfortable in the spotlight” (p.247).

The whole therapeutic structure of the drug and alcohol rehabilitation centers of the U.S. is about forcing patients to interact with each other, speak out, and to find comfort in social encounters. This is happening because “Extroversion is an enormously appealing personality style, but we’ve turned it into an oppressive standard to which most of us feel we must conform” (Cain, 2012, p. 255). It is time to consider catering to different personality types during treatment because introverts and extroverts have different tolerance to external stimuli, and depending on the ambiance, it can have a positive or negative impact.

Liliana Hasbun | SCAD © Cain (2012) explains that: “…Introverts and extroverts often need very different levels

of stimulation to function at their best” (p. 124). Up to what extent can these external simulant agents guide patients to connect with themselves, provide a restorative space and thus, facilitate the recovery process? A clue for an effective spatial solution to support an optimal recovery process in drug and alcohol rehabilitation centers is not to isolate a person nor obligate patients to socialize and interact, but possibly find a balance between the traits of each personality. This outcome may be obtained through the Interior Design Proxemics Theory.

Key Element for Recovery Regarding Any Personality Type: Introspection Current therapeutic approaches are leading to introspection. The study confirms that meditation affects the emotional wellbeing and chemical balance of our bodies. To have enough time for introspection is one of the most important components of the recovery process.

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Heath (as cited by Nishimura et al., 2007, p. 80) explains that different types of meditation, such as walking meditation or static meditation, can facilitate introspection. He adds that to achieve introspection, another mental effort is required: one must practice “mindfulness (awareness or watchfulness)” and that that “is the process of paying attention to how one experiences each daily occurrence.”

A study by Witkiewitz and Bowen (as cited by Bowen & Vieten, 2012, p. 246) shows how an introspection-based therapy called “Mindfulness-Based Treatment for Substance Use Disorders” (MBRP) is more effective than “Treatment-as-Usual” (TAU): Results showed that participants in MBRP, compared to TAU, had greater reductions in craving following the 8-week intervention period, which in turn partially mediated significantly greater decreases in substance use 2 months following the intervention.

MBRP participants also reported greater increases in awareness and acceptance.

Liliana Hasbun | SCAD © Additionally, MBRP appeared to have an effect on the relation between depression and

craving, wherein they showed a decrease in the strength of the relation between depressive symptoms and subsequent craving, whereas TAU participants did not.

They clarified the importance of meditation during the drug and alcohol rehabilitation process: Through both mind-fullness meditation and cognitive behavioral practices, clients would learn to recognize cognitive patterns, and begin to identify and mitigate problematic behavioral reactions. The combination of increasing awareness through mindfulness practices and strengthening Relapse Prevention skills would enhance clients’ abilities to recognize and cope with high-risk situations. (Bowen & Vieten, 2012, p. 246) How can the physical environment support and motivate introspection? The next part of the review of literature will showcase possible theories that can facilitate introspection,

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mindfulness, and calmness.

Liliana Hasbun | SCAD ©

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Literature Review Part II Interior Design Factors that Can Support the Recovery Process in Drug and Alcohol Rehabilitation Centers Supporting Introspection through the Physical Environment Interior design theory 1: Mind journeys and places with archetypal landscapes.

Bowen & Vieten (2012) share their research about mindfulness-based intervention for addictive behaviors: …unlike most cognitive behavioral methods, mindfulness does not involve the evaluation of cognitions as either rational or distorted, and does not attempt to change or dispute thoughts. Instead, one is taught to simply observe thoughts, note their impermanence, and relate to them as mental events rather than as necessarily accurate reflections of the truth. (p. 254)

Liliana Hasbun | SCAD © This is proof that during the recovery process from addiction behavior, people tend to be

more successful when they discover and understand their thought patterns. This is why providing contemplative spaces that motivate introspection are perhaps beneficial for drug and alcohol rehabilitation centers. To produce this experience, Messevy (2007) provides us with guidelines in order to create strolls and mind journeys. She first explains that a beginning and end point must be marked. Then one should plan the journey thinking of the angles of the landscape views and determine if the trail is going to be straight or curved, etc. Messervy (2007) explains in a meticulous fashion what a mind journey is: As you concentrate on a focal scene, you feel as if you were one with it. After a while, this image loses its literal quality and becomes abstract- you transcend the image and,

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by extension, the world. After such a reflective experience, you come away refreshed, perhaps more centered, tranquil and joyful, ready to face the outside world. (p. 10) Overcoming addictive behavior requires internal work for all types of personalities. It is learning to accept and understand one’s internal world. This is why the Archetypal Landscape Theory can possibly support recovery through the physical environment. Once the patients have interlocked all the pieces of their internal selves, then healing can begin and thus the continuation of their recovery process.

Messevy (2007) explains that contemplative spaces are very powerful, and they can affect our emotions. We can have one of these emotional landscapes for a specific task: to reflect, to dwell, etc. We as designers can take advantage and use this knowledge to guide an emotional journey that supports introspection, peace, hope and motivation for those

Liliana Hasbun | SCAD © participating in addictive behavior recovery process. There are different types of feelings we

can achieve depending on the configuration of the elements and space as Messevy (2007) explains: Emotional Landscape Archetypes: 1. The Sea - Withinness: comes from our first moments as a living being, in our mother’s womb. We were immersed in a soft liquid world making us feel peaceful solitude. This feeling can be explained for example when we feel surrounded by something pleasing such as trees or water.

2. The Cave - Inside to outside: Gives a feeling of secureness and tightness, we attracted to spaces that can provide us with a snuggling feeling like nooks, a pergola, a playhouse, a porch or even a hug.

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3. The Harbor - Enclosure with a view: It is a space that provides a protection approximately of 180-degrees. We can discover the world by being safe and relaxed because we are not fully vulnerable.

4. The Island – “Awayness”: We should feel we are the center of a space, watching a horizon line. It is a 360-degree view.

5. The Mountain – “Upness”: This can be a source of solitude, high places become a place where we can find enlightenment, inner peace and wisdom.

6. The Sky – “Beyondness”: Sea or sky can represent the value of the life cycle and how it is an endless spiral.

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Figure 7. Arcehtypal Landscape Spatial Conditions (Messervy, & Abell, 2007).

Supporting a Sense of Privacy in Public Spaces for Introverts and Extroverts Interior design theory 2: Proxemic theory. Proxemic theory may support the behavioral therapies implemented in drug and alcohol rehabilitation centers because it takes into account the layout of the physical environment concerning the user’s mental boundaries of

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private space. These spatial conditions can possibly be a mechanism for the emotional wellbeing of the patients. This theory takes into account how to reduce the spatial opportunities for anti-social behavior, how crowding affects negatively a person’s emotions, and the different types of mental boundaries that can be implemented in the interior spaces to support the feeling of personal space. “There is a correlation between our ability to call an area our own and our psychological comfort with it and our willingness to look after it” (Lang, 1987, p. 156).

In the current drug and alcohol rehabilitation centers, the therapeutic approach is to find comfort in social encounters and to teach patients how to live in a community and support one another. But this mandatory social interaction can possibly turn into an over-stimulating environment and cause negative emotional effects on the users since “Crowded conditions lead to negative behaviors because they are related casually to social overload” (Lang, 1987, p. 147).

These negative behaviors happen because “Crowding is associated with a feeling of lack of

Liliana Hasbun | SCAD © control over the environment” (Lang, 1987, p. 147). One must not confuse that crowding and the amount of people in a space are related because “density, on the other hand, does not seem to be casually linked to such behaviors” (Lang, 1987, p. 147).

Betchel (as cited by Lang, 1987, p. 147) explains that crowding is when the users feel invaded in their personal internal world by exterior agents that they cannot control, such as noise or proximity: The important factors are that behavior settings should not be over manned —that is, the number of people should be appropriate for the standing behavior—and that people should have sufficient personal space and territorial control over what is important to them.

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HOW INTERIOR DESIGN CAN SUPPORT RECOVERY

To consider this theory as part of the current addiction behavior therapies can possibly facilitate the therapeutic process: The ability of the layout of the environment to afford privacy through territorial control is important because it allows the fulfillment of some basic human needs: the need for identity, the need for stimulation, and the need for security. (Lang, 1987, p. 148) The physical environment can provide a sense of personal space through psychological boundaries such as materiality change, lighting change, spatial formations, furniture arrangements, or spatial layout. “Personal space refers to an area with an invisible boundary surrounding the person’s body into which intruders may not come” (Lang, 1987, p. 147). When the physical environment cannot provide a deeper sense of personal space, then “other behavior mechanisms to maintain privacy such as eye contact and conversation are avoided” (Lang, 1987, p. 147). How can the physical environment provide comfortable levels of personal space,

Liliana Hasbun | SCAD © coping with the existing therapies?

“The hierarchy of territories from public to private that Newman found necessary to enable people to establish control over the environment is shown” (Lang, 1987, p. 154).

Figure 8: Spatial configuration for optimal territorial hierarchy (Lang, 1987).

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Supporting Emotional Wellness through the Physical Environment Interior design theory 3: emotional design. “Emotions are inseparable from and a necessary part of cognition. Everything we do, everything we think is tinged with emotion, much of it subconscious” (Norman, 2005, p.7). The current therapies for addiction behaviors address this emotional need through the social environment, but as it was shown previously in part I of the literature review, the current therapies are overlooking the physical environment when it comes to the therapeutic method. Norman (2005) explains the importance of the emotions for our overall wellbeing and how the things we see and hear can affect our emotions: “…our emotions change the way we think, and serve as constant guides to appropriate behavior, steering us away from the bad, guiding us toward the good” (p. 7).

As we can see, emotions are important when it comes to behavior. How can this theory support the behavioral therapies offered during the recovery process of the patients if “…now

Liliana Hasbun | SCAD © we have evidence that aesthetically pleasing objects enable you to work better” (p. 10). Then Norman (2005) continues explaining that “We like attractive things because of the way they make us feel” (p. 48).

Can there be an emotional environmental language that the majority of the patients perceive as positive? Norman (2005) explains that: “Emotions reflect our personal experiences, associations, and memories. Our attachment is really not to the thing, it is to the relationship, to the meanings and feelings the thing represents” (p. 48). He then explains a common emotional perspective amongst humanity that we perceive as positive: Warm, comfortably lit places, temperate climate, sweet tastes and smells, bright, highly saturated hues, "soothing" sounds and simple melodies and rhythms, harmonious music and sounds, caresses, smiling faces, rhythmic beats, "attractive" people, symmetrical

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objects, rounded, smooth objects, "sensuous" feelings, sounds, and shapes (p. 21).

Supporting Wellness at the Neurobiological Level through the Physical Environment Interior design theory 4: The power of place.

According to Gallagher (2007), Throughout history, people of all cultures have assumed that environment influences behavior. Now modern science is confirming that our actions, thoughts, and feelings are indeed shaped not just by our genes and neurochemistry, history and relationships, but by our surroundings (p. 20).

The concept of surroundings that Gallagher is referring to is the physical environment, so if interior design is able to affect the patient’s actions and thoughts, could it enhance the

Liliana Hasbun | SCAD © existing therapies offered in drug and alcohol rehabilitation centers? In order to determine how, one must expand on the subject: Climate may not determine behavior or culture, but it can influence them by setting up limitations. Body temperature is controlled by cardiovascular rhythms. Our state of mind can influence it. Cold is a stimulant and heat is a sedative. (Gallagher, 2007, p. 30) A simple element such as the temperature of the interior physical environment can influence the patient’s recovery process dramatically, so why is the therapeutic community overlooking these facts? Another element that Gallagher (2007) analyzes in his book is light.

Chapter one explains that the light we absorb from the sun, moon or artificially produced light can also influence behavior, circadian rhythm, menstrual cycles, and emotions. He also discusses light therapy and its relation to depression and mania. Which is the appropriate illumination for a drug and alcohol rehabilitation center? Which type of fixture or natural light

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is adequate to enhance the recovery process? This is why the Well Building Standards will be used as a solution in this thesis.

Another topic explained by Gallagher (2007) is that “…we all seek a comfortable level of arousal from our settings…” (p. 20). As an example he adds, “Over the course of a day, a week, and a year, most of us seek places that provide different degrees of stimulation” (p. 20).

This theory can be implemented in the interior physical environment by providing restorative spaces. How can this sense of recuperation be addressed with the vast majority of patients, regardless of their culture or personality type? A step closer to finding this answer is that “Nature is not only a source of immediate physical beauty, but also a treasure trove of symbols and values on which we all rely” (Gallagher, 2007, p. 210).

This does not mean that there should be scattered elements of nature randomly placed in

Liliana Hasbun | SCAD © the interiors because (Gallagher, 2007, p. 213) “… the best way for people to maintain an even

keel is by having a mixture of short- and long-term restorative experiences…” Then Kaplan (as

cited by Gallagher, 2007, p. 213) adds, “…it’s a serious error to equate wilderness and nature.”

In this pursuit of the ideal drug and alcohol rehabilitation center, we can conclude that the physical environment has to be purposefully designed to restore and heal. It is evident that the physical conditions that the built environment provides can affect a person’s overall wellbeing, from biological to psychological. The Power of Place theory verifies that these conditions are temperature, light, colors, textures, and a choice to select within the space the different levels of arousal and levels of toxicity.

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Healing Through the Physical Environment Interior design theory 5: biophilic design. Biophilia is an Interior Design Theory that connects the users to nature through the physical environment. This connection supports healing at all levels as Van den Berg et al. explains (cited by Andrew et al., 2014, p.64), “This collected evidence leads us to deduce that good biophilic design could have a number of positive impacts. Some of these include enhance productivity and performance and have a positive impact on attention restoration and stress reduction…” Hartig (as cited by Andrew et al., 2014, p.64), also states that biophilic design can “increase positive emotions and reduce negative emotions.” Utilizing a biophilic design approach in the interior of a recovery facility can possibly support the emotional and neurobiological healing of the patients.

People going through the recovery process could benefit regardless of the location in

Liliana Hasbun | SCAD © which the drug and alcohol rehabilitation centers are placed because it gives interior spatial solutions. In the research conducted by Andrew et al. (2014), simple yet meaningful findings

that support the patient’s emotional well-being were pointed out: “This body of research suggests that visual connections to even small instances of nature can be restorative; an important finding given the limitations on and demands for space within urban and interior settings” (p. 65).

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Contextualizing the Problem: Conclusions from the Literature Review The Gap: Physical Environment vs. Social Environment From the existing therapeutic data regarding addiction behavior, there is a vague specification about the physical environment and its relation to the existing addiction behavior therapies. The current interior spaces in drug and alcohol rehabilitation centers in the U.S. simply address function and basic human needs. The behavioral therapy activities that the therapeutic community provides in drug and alcohol rehabilitation centers is clearly dependent on the setting, but the therapists are not aware of how powerful this setting can be to enrich the therapy.

Below is a list of the generic and oversimplified guidelines provided by SAHMSA (2016) to achieve wellness through interior design for people suffering substance abuse

Liliana Hasbun | SCAD © behavior. These suggestions are not fully connected to the vast evidence that the body of knowledge of the interior design discipline has provided: •

Accessing clean air, food, and water.

•

Preserving the areas where we live, learn, and work.

•

Occupying pleasant, stimulating environments that support our wellbeing.

•

Promoting learning, contemplation, and relaxation in natural places and spaces.

•

Look in magazines or online and find styles you like best so that you’re comfortable in your living space.

•

Do you organize your workspace from time to time and add things that make you happy?

•

Is your living space filled with styles and textures you enjoy?

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•

Get recycling bins for your home—they may be free from your town.

•

Explore the “green” aisles at home improvement stores; they often have energy-efficient light bulbs and other products.

Another example that represents the level of awareness that the therapeutic

community has over the physical environment according to O’ Brien (as cited by Barett, 2009, p. 4) “Relapse to compulsive drug use is more readily triggered by exposure to cues such as paraphernalia, places, or people previously associated with drug use.” Does this mean that there is a drug-place association? How does the physical environment trigger each patient differently to use drugs and/or alcohol?

From the review of literature it was concluded that the majority of the therapists do not examine the physical environmental conditions as part of the therapeutic approach, when in

Liliana Hasbun | SCAD © fact, the physical environment directly affects the users, as Gallagher (2007) explains: “Like those other living things, our structure, development, and behavior rise from a genetic foundation sunk in an environmental context.” (p. 16).

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Research Question The first part of the review of literature determined that the existing therapeutic methods that treat addiction use the social environment as part of the therapy, disregarding the physical environment as part of the treatment. Only a slight awareness about the importance of the interior spatial conditions exists in the present drug and alcohol rehabilitation centers of the U.S. In the second part of the literature review, interior design theories that can possibly enhance the existing methods to treat addiction were presented. So which elements from the presented interior design theories could probably enhance the existing treatments offered during the residential program in drug and alcohol rehabilitation centers in the U.S.?

Liliana Hasbun | SCAD ©

Figure 9: Research question and how it connects to other subjects (author’s image).

Contextualizing the Problem Suffering from substance use disorder is not only an issue for the affected one but also for that person’s social and physical atmosphere. Even though there are a numerous amount of therapies offered in the residential treatment of drug and alcohol rehabilitation centers in the U.S., there is still room for improvement and innovation, as CASA (2012) informs: “America’s failure to prevent risky use and effectively treat addiction results in an enormous array of health

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and social problems such as accidents, homicides and suicides, child neglect and abuse, family dysfunction and unplanned pregnancies” (p. 10). They explain that this failure happened because “In many ways, America’s approach to addiction treatment today is similar to the state of medicine in the early 1900s” (p. 11).

Today, there exists enough multidisciplinary evidence-based knowledge regarding addiction behavior solutions, but this understanding has not being grappled with enough by the current therapists that handle drug and alcohol rehabilitation centers in the U.S. CASA (2012) explains: “Unlike other diseases, we do little to effectively prevent and reduce risky use and the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care” (p. 2). In consequence, this scattered knowledge between different disciplines indicates a demand to be linked. One of these overlooked missing links is the physical environment.

Liliana Hasbun | SCAD © The prevention and reduction of risky substance use and the treatment of addiction, in

practice, bear little resemblance to the significant body of evidence-based practices that have been developed and tested; indeed only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.

(CASA, 2012, p. 13) To find innovative ways on how the interior space can potentially affect the patient’s well-being and behavior during the recovery process, these main elements were investigated: addiction behavior at a neurological level; Reward System Syndrome, Anti-Social Behavior, and neuroplasticity. Also, from the psychological approach, other topics that are related to the physical environment were analyzed such as; different spatial and emotional needs of introverts and extroverts, behavioral therapy, and meditation. Moreover, the existing therapies provided in

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 drug and alcohol rehab centers that are directly linked to the physical environment were presented.

After analyzing the therapeutic data and interior design theories, the pertinent subjects were merged in order to obtain advantageous spatial suggestions that may support the recovery process while inhabiting drug and alcohol rehab centers. Data was found on how the spatial conditions affect our bodies at a chemical level, how the interior space can facilitate introspection, how interior design provides emotional wellness for introverts and extroverts, and how to achieve restorative settings. This review of literature dissected the characteristics of the interior spaces trying to connect different disciplines through a common ground: improve the in-patient treatment for addictive behaviors in the U.S. through the physical environment.

An interior physical environment intentionally designed to pursue a remedy for addictive behaviors utilizing the phenomenological properties of the physical environment can

Liliana Hasbun | SCAD Š be the missing link that may enhance the rehabilitation process of the in-patients attending drug and alcohol rehabilitation centers in the U.S. In order to concretize this innovative design solution, research was conducted regarding the existing deficiencies of the current therapeutic system.

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Methods Constructivist Worldview After stating the research question, a triangulation of methods to obtain qualitative answers was the process used to determine the findings. The methods used are under the constructivist worldview because it provides an organic and natural path towards the findings.

“The goal of the research is to rely as much as possible on the participants’ views of the situation being studied” (Creswell, 2013, p. 37). These findings are located by analyzing the patterns from the data collected.

This research has been narrowed down to only analyze the phase two of the residential treatment of drug and alcohol rehabilitation centers in the U.S. Phase one is the medical detox; this phase lasts a maximum of two weeks, then the patient moves to phase two. This is where

Liliana Hasbun | SCAD © they go to different therapies throughout the day while being monitored 24 hours, seven days a week. During phase two, patients have a strict schedule with a minimum of free time because they are learning through guided behaviors how to overcome addiction. They are not allowed to be alone or to use electronic devices. The last phase is similar to phase two, but patients have more freedom because they are learning how to be on their own so that they can adjust to real life.

The first method used was the open-ended and in-depth interview. During the interviews, narratives about their experiences during phase two of the drug and alcohol rehab center were retrieved. “Narrative research is a design of inquiry from the humanities in which the researcher studies the lives of individuals and asks one or more individuals to provide stories about their lives.” (Creswell, 2013, p. 42). To get a different point of view about the experience in drug and alcohol rehab centers, not only the ex-inpatients were interviewed but

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also a therapist that treats addiction.

Photo-elicitation research consists of collecting images from the participants. As Creswell (2013) explains: “Have participants take photographs or videotapes (i.e., photo elicitation), and then interview them about the materials.” (p. 243). In this case, participants were asked to show a symbolic image of what wellbeing, self-love, and hope means to them.

Also they were asked for a phrase or a short explanation about the image chosen. Common patterns between them are going to be studied.

The third research method used to triangulate the research question was case studies. A total of four American in-patient drug and alcohol rehabilitation centers ranging from low to high-cost were visited. In order to examine the rehab centers, interior design theories will be used as lenses. “This lens becomes a transformative perspective that shapes the types of questions asked, informs how data are collected and analyzed and provides a call for action or

Liliana Hasbun | SCAD © change” (Creswell, 2013, p. 98).

Population/Participants A total of ten participants were interviewed. Nine of these participants are former inpatients that attended drug and alcohol rehabilitation centers in the U.S. All of them have different personality types, nationality, age, gender, and cultures. The remaining participant is a therapist that currently works at various drug and alcohol rehab centers in the U.S.

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Research Findings Open-Answer Interviews The research from the interviews compared the in-patient’s point of view with the therapist’s point of view. Both in-patients and therapists agreed that discipline, small group interaction, and exercise are necessary for the recovery process. The therapists stated that large group social interactions and monotonous activities are positive for the recovery process, while the in-patients said it was not necessary. The in-patients expressed that they needed things that the therapists said were not necessary for an optimal recovery process, such as more downtime, time outside the clinical environment, more nature views, and comfortable furniture, and a more stimulating environment. One patient interviewed said that when a fight broke out he felt relieved from the monotony of his therapies and sterile environment. For the therapist what

Liliana Hasbun | SCAD © matters the most is the therapy, not the physical environment. Nevertheless, the physical environment affects the patients profoundly; it is where they remain most of the time. In conclusion, the patients said they desired more contact with normal life, more views of the vastness of nature and a home-like setting where they can have purposeful introspection. How can interior designers reconcile these two different points of view to create an optimal physical environment for treatment?

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Figure 10: A graphic representation of the early findings from open answer interviews (author’s image).

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Figure 11: A graphic representation of the findings from open answer interviews (Author’s image).

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Figure 12: A graphic representation of the findings from open answer interviews (Author’s image).

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Case Studies

A total of four drug and alcohol rehabilitation centers were visited and analyzed. No pictures were allowed; notes and sketches were made on the spatial conditions of the physical environment. The research covered rehabilitation centers of all costs: going from the statefunded ones to the most expensive ones. Interior design theories were used as lenses to find physical environmental patterns. The conclusions are that all of them provide a physical environment that addresses the basic function of the space.

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Figure 13: Case studies and the lenses used (Author’s image).

Photo-elicitation

Liliana Hasbun | SCAD © The in-patients were asked to send a symbolic image of each of the following subjects:

wellbeing, self-love, and hope. The images had to be accompanied by a phrase of how that image represents each subject. The conclusion is that nature connects them to a positive mindset. Also, human interaction demonstrating affection and support was dominant. These images also portrayed that they don’t feel alone; they feel loved, appreciated and part of a community. Overall findings show that tones of blue are prevalent, literal images of nature are predominant, a focal point is present, soft gradients and horizontality are noticed in every image.

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Liliana Hasbun | SCAD ©

Figure 14: Findings for “wellbeing” (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 15: Findings for “self-love” (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 16: Findings for “hope” (Author’s image).

Conclusion on Findings and Literature Review By connecting the literature review and the findings, an enrichment of the mindful and phenomenological aspects of interior spaces can apply to the interior design of in-patient drug and alcohol rehabilitation treatment centers. Robinson and Berridge (as cited by Malvaez et al., 2009, p. 3) noted that “Understanding the molecular and neural mechanisms underlying the

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consolidation, persistence, and re-emergence of drug-seeking behavior is crucial for the improvement of treatments for drug addiction.” The Archetypal Landscape Theory (Messervy, 2007) could facilitate important components needed during the recovery process: introspection and mindfulness.

Bowen & Vieten (2012) explain the importance of meditation during the drug and alcohol rehabilitation process: Through both mind-fullness meditation and cognitive behavioral practices, clients would learn to recognize cognitive patterns, and begin to identify and mitigate problematic behavioral reactions. The combination of increasing awareness through mindfulness practices and strengthening Relapse Prevention skills would enhance clients’ abilities to recognize and cope with high-risk situations. (p. 246)

Liliana Hasbun | SCAD © Creating a setting that facilitates introspection in drug and alcohol rehabilitation centers is a

complex challenge because it has to be done without separating the patient from the group.

Messervy (2007) provides seven spatial configurations that assist mind journeys. Utilizing introspective techniques through the physical environment could possibly enhance the recovery process offered in drug and alcohol rehabilitation centers. The technique that Messervy (2007) offers a stroll experience, and it can be used during walking meditation addiction therapy because it “…is the practice of walking slowly and purposefully, experiencing one's footsteps and one's breathing all the while” as Heath explained (cited by Nishimura et al., 2007, p. 80).

Another significant finding is that the physical environment can support the neurological balance of the “Reward System Deficiency Syndrome” by implementing spatial conditions that encourage the production of dopamine during the recovery process. This is possible because the Power of Place theory (Gallagher, 2007) demonstrated that the interior

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spaces that provide proper levels of illumination, accurate use of textures, worthy views of nature, and appropriate levels of noise have the power to create restorative spaces that encourage dopamine production, hormonal balance, and positive emotional reactions and thus, form part of the wellbeing of the patients. The patients interviewed said they needed to feel relaxed, in a home-like setting, and to have an awareness of the present moment. The Power of Place theory can provide optimal spatial conditions that are able to connect the patient’s emotional needs and the current therapies.

“Antisocial behavior” is another addiction behavior symptom that the therapists try to extinguish by delivering group therapies, imparting communication skills, and harvesting peer support. While attending drug and alcohol rehabilitation centers, patients said they wanted more downtime, but they were not allowed to be isolated. The Proxemic Theory (Lang, 1987) could meet the patient’s emotional need for personal space, and at the same time keep patients from

Liliana Hasbun | SCAD © being isolated. The theory shows how to provide mental boundaries of privacy through spatial layout and physical environmental elements such as textures, colors, furniture arrangement and height.

The brain is constantly mutating and adjusting itself, and the physical environment affects this “never-ending” process as Gage (2003) defends: “Changes in the environment change the brain, and therefore they change our behavior” (p. 2). This is proof that interior design can provide spaces that stimulate chemical balances at the biological level. Spaces can be specifically designed to support important positive brain chemicals. Another theory that can promote this emotional wellbeing is the Emotional Design Theory (Norman, 2005). He provides guideless for physical elements that facilitate the emotional wellbeing of the majority of human beings, regardless of their background:

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Warm, comfortably lit places, temperate climate, sweet tastes and smells, bright, highly saturated hues, "soothing" sounds and simple melodies and rhythms, harmonious music and sounds, caresses, smiling faces, rhythmic beats, "attractive" people, symmetrical objects, rounded, smooth objects, "sensuous" feelings, sounds, and shapes. (p. 21) During the photo-elicitation research method, patients presented emotionally positive images. These images have in common nature, a focal point, horizontality, blue tones, soft gradients, and vertical patterns that represent oneness or self. The drug and alcohol rehabilitation facilities within the study do not address the emotional wellbeing of the patients from the standpoint of the physical environment; they only address it through the social environment. The Emotional Design theory in conjunction with the study’s interviews and

Liliana Hasbun | SCAD © photo-elicitation findings can enhance therapies in drug and alcohol rehabilitation centers. By choreographing the interior journey with positive emotional experiences that can be supported

by biophilic design, in-patients could possibly benefit at a neurological level throughout their recovery process.

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Discussion In order to address these findings in the physical environment of drug and alcohol rehabilitation centers, the Well Building Standard guidelines will drive the design. The guidelines encompass the interior design theories included in the review of literature: Biophilic Design, Emotional Design, Proxemic Theory and The Power of Place. These standards provide specific features that support recovery. The Well Building Standard takes into consideration the adverse effects of stress: Chronic stress adversely impacts the body, from the nervous to the cardiovascular system. Substance addiction is one of the most damaging manifestations of stress, combining the toxicity of the substance itself with the mental distress associated with the social stigma of the disease (Stress and Addiction Treatment Well Building Standard, 2017)

Liliana Hasbun | SCAD © From the Well Building Standard, only some of the sections will be implemented in the

design of phase two of the drug and alcohol rehabilitation center proposed in this thesis: biophilia, beauty and mindful design, comfort, accessible design, exterior noise intrusion, internally generated noises, thermal comfort, olfactory comfort, visual lighting design, circadian lighting design, day light modeling, light at night, interior fitness circulation, drinking water promotion, and education space provisions.

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Figure 17: Overall findings (Author’s image).

Liliana Hasbun | SCAD ©

Figure 18: Overall findings-Design Principals (Author’s image).

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Figure 19: Overall

findings-Design Principals (Author’s image).

Liliana Hasbun | SCAD ©

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Design Proposal In order to design specialized prototypes that can be implemented in drug and alcohol rehabilitation centers during phase two, a series of Restorative Nodes are proposed to turn transitional spaces (hallway or a generic space) into purposeful transitional experiences. The purpose of these nodes is to support the patients positively at the psychological level in each transition between therapies during their recovery process.

Liliana Hasbun | SCAD ©

Figure 20: Revamped

user Journey (Author’s image).

In order to assort the spatial conditions that each of the different nodes need, an examination of a patient’s typical journey during phase two was made. This journey ranges from the moment in which the patient is admitted to the rehabilitation center until the patient goes to sleep. However, the design proposal is solely focusing on the transitional spaces during the phase two of the recovery process. This design delimitation portrays the findings of this study. It was concluded that a total of seven Restorative Nodes are needed during the transitional spaces of the recovery process. All the nodes described ahead are using the physical

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patterns that were discovered during the interviews of the research. These patterns were abstracted and translated into three-dimensional spatial conditions that could possibly reinforce the subconscious messages and ideas needed for an optimal recovery process.

Liliana Hasbun | SCAD ©

Figure 21: Revamped

user journey and how each stage connects to the need of interior design theories (Author’s image).

Figure 22: A

graphic representation of the spatial solution (Author’s image).

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The first node is called the Welcoming Restorative Node because it is the first transition between the patient’s current life situation and the recovery program. It was concluded that in this transitional moment, patients have the need to feel welcomed, secured, and motivated. In order to facilitate this emotional state, a combination between the spatial conditions of the “harbor” from the Archetypal Landscapes Theory (Messevry, 2007) and the findings from the images obtained from the photo-elicitation of the word “hope” and “wellbeing” is proposed. It is also important to add the water factor to this space; it can be real or simulated (furniture, fixtures or finished that have water patterns, light projections that simulate water, screens or artwork that show literal images of water.) In this case, a pendant light fixture with water pattern is specified. In the design of this space, the circular element that was placed at the end of the hallway is not fully shown from the entrance view in order to provoke curiosity and motivate the patients to keep walking. The walls have a gradient effect that simulates the sky

Liliana Hasbun | SCAD © (abstracted from photo-elicitation findings). Wood and vegetation are present in order to correlate with the Biophilic Design theory.

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Liliana Hasbun | SCAD ©

Figure 23: A

prototype of the Welcoming Restorative Node 1(Author’s image).

The second node is called the Motivational-Restorative Node because this the moment when patients need external factors that support focus, acceptance, and self-evaluation. In order to provide a physical environment that facilitates these emotional needs, the theory of Emotional Design and the findings from the photo-elicitation of the words “wellbeing” and “hope” are merged. A three-dimensional water patterned metal sheet provides the spatial conditions that connect to the findings and biophilic design. A Lighting fixture that embodies

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the horizon and reflectance of the sea and sky in added. Also flexible furniture that integrates live plants is proposed. For a mesmerizing visual element, a levitating built in pot plant is suggested. All these spatial conditions create the effect of being submerged in water. The furniture specified is a flexible one. This decision was made in order to give the patients the choice to decide different levels of arousal and human contact. The furniture includes live plants in order to correlate with Biophilic Design theory and the Well Building Guidelines.

Liliana Hasbun | SCAD ©

Figure 24: A

prototype of the Motivational Restorative Node 2 (Author’s image).

The third node is designed to support the patient’s cognitive growth. This is why it is named the Educational Restorative Node. During this part of the day, patients are looking for answers by questioning their inner-self, by absorbing information or doing anything that

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provokes them to grow internally. This is why this node facilitates reading, contemplating or socializing in a dynamic way. One of the types of furniture proposed has a built-in bookcase.

Other experiences of seating are provided as well such as flexible and stackable stools, and a wall-hanged chair. An indirect focal point is added through wood art. Floor lamps with a fun design that resembles plants are added to help patients read. The ceiling has the water element because a water pattern shaped metal sheet is placed on to the ceiling. A side volume that connects with the finding of “well-being” is added.

Liliana Hasbun | SCAD ©

Figure 25: A

prototype of the Educational Restorative Node 3 (Author’s image).

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The fourth transitional experience is called the Restful Restorative Node; it intends to help the patients rest or contemplate because during this transition, patients go from lunchtime to the next therapy. The majority of the patients that were interviewed said that they couldn’t concentrate on the therapies imparted after lunch because they felt sleepy. This is why a communal recharging space is proposed. It contains furniture that facilitates a relaxed position, plants surrounding the user, a reflective metallic artwork that simulates water, and a metal sheet that has water patterns in the ceiling.. In this node, it is also incorporated the triangular side volume in different angles.

Liliana Hasbun | SCAD ©

Figure 26: A

prototype of the Restful Restorative Node 4 (Author’s image).

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The fifth node is called the Re-centering Restorative Node 5 because in this moment of the day, patients may have the need to go back to their inner world and find a balance between all the information they received during the day. To support this emotional process, shadow art is going to be implemented creating an environment that changes throughout the day and can possibly facilitate contemplation and focus. Vegetation is placed in all possible views of this node because patients need contact with nature in order to ground themselves and re-center. If there is no access to exterior views, a spatial condition that creates exterior light is proposed.

Flexible and stackable furniture is provided. Another experience provided by the selection of furniture is a sense of enclosure. Accessories that resemble the findings from the photo elicitation can be found: human contact, water, and fractal patterns.

Liliana Hasbun | SCAD ©

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Liliana Hasbun | SCAD © Figure 27: A

prototype of the Re-centering Restorative Node 5 (Author’s image).

The sixth transitional experience is called the Grounding Restorative Node 6. This node facilitates the emotional process of accepting reality. This is why a central focal skylight (real or engineered) will be the center of radially shaped or arranged furniture, with the presence of real vegetation and water. In case that water is not being used, materials or lighting effects that simulate water can be an alternative. For the design proposal of this space, light fixtures that simulate water are specified. Side volumes obtained from the findings of “well-being” and “self-love” are applied in the space. The purpose of these spatial conditions is to facilitate a positive emotional state while patients are walking from therapy to therapy during this part of

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the day. It is a short transition, but these spatial qualities have the power to provoke a worthy introspection.

Liliana Hasbun | SCAD ©

Figure 28: A

prototype of the Re-centering Restorative Node 6 (Author’s image).

The last node will be the transition between the therapy areas and the residential area.

From the findings and the literature review, it is concluded that it is valid to create a stroll in

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which patients can see an eye-catching vertical shape that represents “self-love.” This vertical shape was abstracted from the research done regarding the photo-elicitation. This spatial feature could possibly create a subconscious sense of identity, uniqueness, self-worth and inner strength. This last node is called the Contemplative Restorative Node 7.

Liliana Hasbun | SCAD ©

Figure 29:

A prototype of the Contemplative Restorative Node 7 (Author’s image).

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Other spatial qualities that add significance to the nodes are the use of Communication Walls (finding from interviews). This non-verbal communication medium should be used in at least two of the transitional spaces. The reason behind this outcome is that it opens communication and support at another level. The Communication Walls should provoke the questioning of feelings, because this is one of the most important aspects of the recovery process: understand feelings and emotions. A total of five messages are proposed in this thesis: -Message one: What Made Me Feel…

-Message two (next to books): Did this new knowledge help me?

-Message three (at the smoking area): Did this cigar resolve my problems?

-Message four: Breathe in…retain for four seconds…breathe out…repeat -Message five: Trust this moment -Message six: To feel is to live

Liliana Hasbun | SCAD © Another solution for the Re-Centering Restorative Node 6 is proposed through the use of one of the findings: Communication Wall. The radial entrance to the node gives a mental illusion of being in a different space. This circular form follows the findings from “hope” and also follows the theory of Emotional Design. A literal image of water is placed in the wall not only to connect with the findings but also to connect with the biophilic design principle. The spatial conditions proposed provide mental privacy to the patients and facilitates a moment of introspection and self-growth, while the image of water, the presence of plants and the circular shapes support a subconscious positive emotional state for the users.

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Figure 30:

The second prototype of the Re-Centering Restorative Node 6 (Author’s image).

Liliana Hasbun | SCAD © The Last Restorative Node prototype is another solution for the Contemplative

Restorative Node. The design decisions follow the same design principles that the Contemplative Restorative node defends. This second approach is proposed to demonstrate spatial variety while using the same design principles. Patients said that treatment was very monotonous and tiresome. To resolve this negative emotional state but at the same time not

interfering with the therapeutic methods, motivating and intriguing spatial conditions can be applied throughout the space. The design proposal in this particular space, artwork that simulates water is used in a vertical way in order to connect with the findings of “self-love.” In the floor design, a path that reaches the artwork is created. This flooring is acid stained concrete with tones of blue to create a water-like effect.

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Liliana Hasbun | SCAD ©

Figure 31: The

second prototype of the Contemplative Restorative Node 7 (Author’s image).

In drug and alcohol rehabilitation centers finishes should be safe for the users and at the same time have a connection to the patterns and colors found in nature. The research made in this thesis validated some of the biophilic design guidelines that can be beneficial in drug and alcohol rehabilitation centers:

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[1] Visual connection with nature, [2] Non-visual connection with nature, [3] Nonrhythmic sensory stimuli, [4] Access to thermal and airflow variability, [5] Presence of water, [6] Dynamic and diffuse light, and [7] Connection with natural systems (Ryan et al., 2014, p. 64).

For the design proposal of this thesis, it was concluded that these finishes will be used in the built environment and in furniture: real wood, materials that simulate wood, resin with real vegetation impregnated, resin or plastic with water patterns, and any material or furniture that has “Biomorphic forms and patterns, [9] Material connection with nature and [10] Complexity and order.” (Ryan et al., 2014, p. 64). All the finishes, furnishings and equipment meet the hospitality codes for interiors. They should be easy to clean and apt for mid transition areas.

The interior design proposal will implement the following ideas explained by Ryan et al.

Liliana Hasbun | SCAD © (2014). Interior volumes and structure should use the “Fractal geometries with a mid-range dimensional ratio (broadly speaking, D=1.3-1.8)” (p. 68). He keeps expanding that fractal geometry can also be used in finishes and decoration (as explained before) such as “artwork (from realism to abstract); in building materials (e.g., wood grain, stone) for exposed structure elements” and “interior finishes…” (p. 68) In this case, only literal images of nature will be proposed. This decision was made based on the research findings.

Client The client is a mid-price rehabilitation center in Florida, U.S. In this drug and alcohol rehabilitation center, a maximum of ninety patients are admitted at a time. Patients from any culture and any background are admitted with the condition to have at least a beginning level of English. There are approximately 70 people utilizing the space at the same time.

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Design Application An existing drug and alcohol rehabilitation center located in Florida, U.S. is going to be used to showcase the application of this thesis. The design solutions proposed are not only based on the conclusions of this study, but also a simple and low-cost solution. This decision was made in order to facilitate the implementation of the spatial conditions regardless of the amount of resources available. The list of specifications of materiality, finishes, furniture and equipment are provided in the appendix.

Liliana Hasbun | SCAD ©

Figure 32:

Floor plan Axonometric (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 33:

Welcoming Restorative Node (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 34: Re-Centering

Restorative Node (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 35: Contemplative

Restorative Node (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 36:

Contemplative Restorative Node (Author’s image).

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Figure 37: Re-Centering

Restorative Node (Author’s image).

Liliana Hasbun | SCAD ©

Figure 38: Restful Restorative Node (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 39: Motivational

Restorative Node (Author’s image).

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Liliana Hasbun | SCAD ©

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Figure 40:

Re-Centering Restorative Node (Author’s image).

Conclusion

Simple spatial conditions have the power to affect a person’s emotional and physical wellbeing.

The findings of this study concluded that in the existing drug and alcohol

rehabilitation centers in the U.S. a disconnection exists between the patients’ emotional needs and the therapies that are currently offered. The therapeutic community disregards the built environment as part of the therapy, but the patients expressed that recovery is an internal emotional effort and that they needed spatial conditions that facilitate introspection. They also expressed a need of an ambiance that supports and guides them into a positive emotional state of mind. These objectives were translated into spatial qualities using the photo-elicitation made in this study, Biophilic Design theory, Emotional Design theory, Archetypal Landscape theory and The Power of Place Theory.

Liliana Hasbun | SCAD © A clear and simple evidence-based abstraction (regarding the physical conditions

needed in drug and alcohol rehabilitation centers) was applied to an existing rehabilitation in order to showcase the spatial qualities that can serve as prototypical guidelines for future application in other rehabilitation centers. My recommendations to the current therapists are to use the spatial conditions as part of the therapy. I invite the therapeutic community that treats substance abuse disorder to merge interior design theories with the current therapies because it can be a powerful outcome. In this thesis, only the transitional spaces were studied but there is much more to study in other areas of drug and alcohol rehabilitation centers.

The interior design solution found in this thesis that embodies the findings is the creation of Restorative Nodes5 and implement them in transitional areas. This answer fills in the gap between the existing treatments in the US and the emotional needs of the patients. It is a solution that acts like a common ground between two different points of view: patients and

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therapists. The built environment is a powerful tool that can be used to interlock the emotional needs of the patients and the existing treatment in order to have an optimal recovery process.

6

Another finding found in this study is the creation of a Communication Wall.

Understanding feelings are key during the recovery process. This Communication Wall works as treatment for the Anti-Social Behavior because it facilitates non-verbal communication. The activities that this prototype promotes are to express and understand feelings. This collective activity provokes internal questioning, growth and empathy to anyone who participates or sees the Communication Wall. It caters to both introverted and extroverted patients. Which specific messages and activities are most effective for the Communication Wall? This is an opportunity for the therapeutic community to further expand this research question.

Another future study can be made with the same ex-inpatient interview and photo-elicitation that was created in this thesis. This questionnaire can be carried out in other countries and

Liliana Hasbun | SCAD © cultures. These new findings can be overlapped with the existing evidence found in this thesis

in order to conclude if there is a universal truth that promotes efficiently the emotional wellbeing for people suffering substance abuse disorder.

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References Adler, M. W., Brady, K., & Mello, N. K. (2012). Principles of drug addiction treatment: A research-based guide (Third edition). National Institute on Drug Abuse, 12(4180). doi:10.1037/e686332012-001 Bowen, S., & Vieten, C. (2012). A compassionate approach to the treatment of addictive behaviors: The contributions of Alan Marlatt to the field of mindfulness-based interventions. Addiction Research & Theory, 20(3), 243-249. doi:10.3109/16066359.2011.647132 BW, D. (2013). Have we hatched the addiction egg: Reward deficiency syndrome solution system™. Journal of Genetic Syndromes & Gene Therapy, 04(04). doi:10.4172/21577412.1000136 Cain, S. (2012). Quiet: The power of introverts in a world that can't stop talking. New York,

Liliana Hasbun | SCAD © NY: Random House, Inc.

Calienes, E., Carmel-Gilfilen, C., & Portillo, M. (2016). Inside the mind of the millennial shopper: Designing retail spaces for a new generation. Journal of Interior Design, 41(4), 47-67. doi:10.1111/joid.12085 Carroll, M. E., & Smethells, J. R. (2016). Sex differences in behavioral dyscontrol: Role in drug addiction and novel treatments. Frontiers in Psychiatry, 6. doi:10.3389/fpsyt.2015.00175 Creswell, J. W. (2013). Research design: Qualitative, quantitative & mixed methods approaches. New York, NY: SAGE Publications.

Dopamine. (n.d.). Retrieved from https://www.merriam-webster.com/dictionary/dopamine

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Gage, F. H. (2003). Neuroscience and architecture. Retrieved from http://anfarch.org/wpcontent/uploads/2013/11/2004-02-01-Fred-Gage-Lecture-AIA-03-compressed.pdf Gallagher, W. (2007). The power of place: How our surroundings shape our thoughts, emotions, and actions. New York: Harper Perennial.

Gesler, W. M. (2003). Healing places. Lanham, MD: Rowman & Littlefield.

Hernandez, L. M., Blazer, D. G., & Institute of Medicine (U.S.). (2006). Genes, behavior, and the social environment: Moving beyond the nature/nurture debate. Washington, DC: National Academies Press.

Lang, J. (1987). Creating Architectural Theory: the Role of the Behavioral Sciences in Environmental Design. New York, NY: Van Nostrand Reinhold.

Li, C., Mao, X., & Wei, L. (2005). Genes and (common) pathways underlying addiction revealed by combining and analyzing candidate gene lists from multiple technology

Liliana Hasbun | SCAD © platforms. PLoS Computational Biology, preprint (2007), e2. doi:10.1371/journal.pcbi.0040002.eor Malvaez, M., Barrett, R. M., Wood, M. A., & Sanchis-Segura, C. (2009). Epigenetic mechanisms underlying extinction of memory and drug-seeking behavior. Mammalian Genome, 20(9-10), 612-623. doi:10.1007/s00335-009-9224-3 Messervy, J. M., & Abell, S. (2007). The inward garden: Creating a place of beauty and meaning. Piermont, NH: Bunker Hill Pub. National Center on Addiction and Substance Abuse. (2012). Addiction medicine: closing the gap between science and practice. New York, NY: National Center on Addiction and Substance Abuse at Columbia University.

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Neurobiology. (n.d.). Retrieved from https://www.merriamwebster.com/dictionary/neurobiology Neuroplasticity. (n.d.). Retrieved from https://www.merriam webster.com/dictionary/neuroplasticity Norman, D. A. (2005). Emotional design: Why we love (or hate) everyday things. New York: Basic Books.

Philibin, S. D., Hernandez, A., Self, D. W., & Bibb, J. A. (2011). Striatal signal transduction and drug addiction. Frontiers in Neuroanatomy, 5. doi:10.3389/fnana.2011.00060 Pruett, J. M., Nishimura, N. J., & Priest, R. (2007). The role of meditation in addiction recovery. Counseling and Values, 52(1), 71-84. doi:10.1002/j.2161007x.2007.tb00088.x Ryan, C. O., Browning, W. D., Clancy, J. O., Andrews, S. L., & Kallianpurkar, N. B. (2014).

Liliana Hasbun | SCAD © Biophilic design patterns: Emerging Nature-Based Parameters for Health and Well-

Being in the Physical Environment. International Journal of Architectural Research: ArchNet-IJAR, 8(2), 62. doi:10.26687/archnet-ijar.v8i2.436 Stress and Addiction Treatment, Well Building Standards. (2017). Retrieved May 31, 2018, from http://standard.wellcertified.com/mind/stress-and-addiction-treatment Well Building Standards Substance Abuse and Mental Health Services Administration. (2016). Creating a healthier life: A step-by-step guide to wellness (SMA-16-4958). Retrieved from SAMHSA website: https://store.samhsa.gov/shin/content/SMA16-4958/SMA16-4958.pdf

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Vidoni, E. D., & Boyd, L. A. (2009). Preserved motor learning after stroke is related to the degree of proprioceptive deficit. Behavioral and Brain Functions, 5(1), 36. doi:10.1186/1744-9081-5-36 Volkow, N. D., Fowler, J. S., Wang, G., Swanson, J. M., & Telang, F. (2007). Dopamine in drug abuse and addiction. Archives of Neurology, 64(11), 1575. doi:10.1001/archneur.64.11.1575 Zhou, Y., Zhao, M., Zhou, C., & Li, R. (2016). Sex differences in drug addiction and response to exercise intervention: From human to animal studies. Frontiers in Neuroendocrinology, 40, 24-41. doi:10.1016/j.yfrne.2015.07.001

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Glossary: Defonition of Terms Neuroplasticity1: … neuroplasticity, the capacity of the brain to develop and change throughout life, something Western science once thought impossible (Neuroplasticity, n.d., para. 1).

Neurobiology2: A branch of the life sciences that deals with the anatomy, physiology, and pathology of the nervous system (Neurobiology, n.d., para. 1).

Dopamine3: It’s game like interface rewards engagement, delivering a dopamine boost when users accrue likes and responses, training users to indulge behaviors that win affirmation (Dopamine, n.d., para. 2).

Restorative Node4: Finding from this thesis. Specific spatial conditions that support an emotional and physical restorative experience.

Liliana Hasbun | SCAD © Communication Wall5: Finding from this thesis. Specific non-verbal messages and activities that promote the understanding and acceptance of feelings.

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Appendices Appendix 1: Findings from the Interview Patients and therapists

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Figure 41: Data

Visualization Analysis from Interviews (Author’s Image).

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Appendix 2: FF&E

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Figure 42: Specifications

(Author’s image).

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Appendix3: Finishes Schedule

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Figure 43: Finishes

Schedule (Author’s image).

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Appendix 4: Well Building Guidelines Used

Figure 44:

Well Building Guidelines (Author’s image).

Liliana Hasbun | SCAD ©

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Appendix 5: Floor plan Axonometric of Drug and Alcohol Rehabilitation Center

Liliana Hasbun | SCAD ©

Figure 45: Axonometric

(Author’s image).

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Appendix 6: Final Board Images

Liliana Hasbun | SCAD ©

Figure 46: Well

Building Standard and Biophilic Design Guidelines Used in design Proposal (Author’s image).

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Figure 47:

Adjacency Diagram of Drug and Alcohol Rehabilitation Center (Author’s image).

Liliana Hasbun | SCAD ©

Figure 48:

Explanation of Restorative Nodes (Author’s image).

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Figure 49:

User Journey (Author’s image).

Liliana Hasbun | SCAD ©

Figure 50:

Archetypal Landscape Physical Condition Abstraction (Author’s image).

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Figure 51: Power

of Place Physical Condition Abstraction (Author’s image).

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Figure 52:

Emotional Design Physical Condition Abstraction (Author’s image).

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Figure 53:

Proxemic Theory Physical Condition Abstraction (Author’s image).

Liliana Hasbun | SCAD ©

Figure 54:

Biophilic Design Physical Condition Abstraction (Author’s image).

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Figure 55: Physical

Conditions Abstraction (Author’s image).

Liliana Hasbun | SCAD ©

Figure 56: Communication

Wall Physical Conditions Abstraction (Author’s image).

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Liliana Hasbun | SCAD ©

Figure 57: Explanation of Restorative Nodes (Author’s Image).