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Chapter 32. Therapeutic Communities

George De Leon, Ph.D.
DOI: 10.1176/appi.books.9781585623440.359790

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Therapeutic communities (TC) for substance abuse appeared a decade later than did therapeutic communities in psychiatric hospitals pioneered by Maxwell Jones and others in the United Kingdom (Jones 1953). The term therapeutic community evolved in the psychiatric hospital setting, although the two models arose independently. The TC for substance abuse emerged in the 1960s as a self-help alternative to existing conventional treatments. Recovering alcoholic and drug-addicted individuals were its first participants/developers. Although its modern antecedents can be traced to Alcoholics Anonymous and Synanon, the TC prototype is ancient, existing in all forms of communal healing and support.

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Table Reference Number

The therapeutic community (TC) is a unique social-psychological approach to the treatment of substance abuse and related disorders. The primary "therapist" and teacher in the TC is the community itself, consisting of peers, who serve as role models of successful personal change, and staff members, who serve as rational authorities and guides in the recovery process.

The TC serves the substance abusers with the highest severity of substance abuse disorder, social deviancy, and psychological problems. For some, treatment involves rehabilitation, or relearning a positive lifestyle. For most, treatment involves habilitation, or learning a positive lifestyle for the first time.

Today, the term therapeutic community is generic, describing a variety of short-term and long-term residential programs, as well as day treatment and ambulatory programs that serve a wide spectrum of drug-abusing and alcohol-abusing patients. These modified TC programs retain the essential elements of "community as method," while incorporating other evidence-based psychological and pharmacological practices.

The effectiveness and cost benefits of the TC have been documented in a number of studies, including those involving special populations of substance abusers, such as adolescents, individuals with co-occurring mental illness, criminal justice cases, and the homeless treated in special settings such as correctional facilities, halfway houses, and psychiatric hospitals. These studies demonstrate reductions in drug use, criminality, and psychiatric symptoms and increases in employment and prosocial behaviors. Research documents a consistent relationship between longer retention in treatment and positive outcomes.

The cross-fertilization of personnel and methods between traditional TCs and mental health and human services portends the evolution of a new TC: a general treatment model applicable to a broad range of populations for whom affiliation with a self-help community is the foundation for effecting the process of individual change.

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Traditional therapeutic communities (TCs) differ from one another in which of the following ways?
2.
The traditional TC can be distinguished from other major drug treatment modalities in all of the following ways except
3.
The TC perspective consists of interrelated views of the disorder, the person, recovery, and right living. With regard to recovery, which of the following statements concerning the therapeutic community's view of recovery is false?
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