The therapeutic community (TF) for the treatment of substance abuse and addiction has been in existence for approximately 40 years. In general, TFs are drug residential facilities that use a hierarchical model with treatment stages that reflect an increased level of personal and social responsibility. Peer influence, mediated through various group processes, is used to help individuals learn and adapt to social norms and develop more effective social skills.

TFs differ from other treatment approaches primarily in the way they use the community of treatment staff and those in recovery as key agents of change. This approach is often referred to as “community as method”. Members of TFs interact in structured and unstructured ways in order to influence attitudes, perceptions and behaviours associated with substance use.

For whom?

Many of the people associated with a TF have a history where their social functioning, their educational/work skills, their positive communities and family ties/relationships have been disrupted due to their substance use. For them, recovery and rehabilitation – that is, relearning or reestablishing healthy functions, skills and values as well as regaining physical and emotional health – are key. Other TF residents have never acquired a functional lifestyle. For those people, TF is their first experience of living in a “proper” way. Improvement for them involves qualification – that is, learning for the first time the behavioural skills, attitudes and values associated with a socialised life.

In addition to the importance of the community as a primary agent of change, another fundamental TF principle is “self-help”. Self-help suggests that people in treatment are the main contributors to the change process. “Mutual self-help” means that the individual also takes partial responsibility for the recovery of their peers – an important aspect of one’s own treatment.

How beneficial are therapeutic communities in treating substance abuse?

For three decades, NIDA has conducted several large studies aimed at increasing scientific knowledge about the outcomes of substance abuse treatment as it is typically conducted in the United States. These studies collected baseline data from more than 65,000 people who were “admitted” to publicly funded treatment facilities. They included a range of TF programmes and other types of programmes (e.g. methadone maintenance, outpatient drug-free treatment, short-term residential treatment and detoxification programmes). Data were collected at enrolment, during treatment and in a series of follow-ups focusing on outcomes that emerged 12 months, or later, after treatment.

Who receives treatment in a therapeutic community?

TFs treat people with a wide range of substance use problems. Those in treatment often have other severe problems such as multiple substance dependencies (addictions to various drugs), attachment to the criminal environment and thus the justice system, lack of positive social support, mental health problems (e.g. depression, anxiety, PTSD as well as antisocial and other personality disorders).