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Therapeutic Communities

The therapeutic community refers to a range of residential approaches to the treatment of substance abuse and addiction. Although most therapeutic communities share essential components, several variations of the approach exist. A typical therapeutic community involves a drug-free residential setting in which the staff and residents work together to encourage movement through a series of hierarchical treatment stages. Each new stage represents individual growth and increased responsibility. This entry explores essential components of therapeutic communities as well as current modifications of the approach, including its use with special populations. Further, the entry includes a discussion of factors related to the effectiveness of therapeutic communities.

Basic Principles

The ultimate goal of therapeutic communities is lasting lifestyle change for the participants. An assumption of the therapeutic community philosophy is that substance abuse is deviant behavior caused by incomplete personality development and skills deficits. As such, therapeutic communities strive to assist residents in the development of social, economic, and educational skills and facilitate prosocial change in substance abuse-related attitudes and behaviors. Two principles, community as method and self-help, are employed to aid in the accomplishment of these goals. Community as method refers to the purposive socialization of participants through both formal and informal interactions with other residents and staff members. Because therapeutic communities are residential in nature, participants spend most of their time and have most of their needs met on site. The other residents and the staff, then, compose the community in which participants live. Norms that discourage alcohol and other drug use and participation in prosocial behavior are developed via group processes in the community. Newer members are socialized to the group norms through daily unstructured interaction (e.g., eating dinner or doing laundry) with residents and staff in the living unit as well as through structured group meetings and therapy sessions. Punishment and reward systems are central in helping residents adopt and internalize community norms. Members who adopt prosocial attitudes and behavior regarding substance abuse are rewarded with community acceptance and access to social privileges. Further, when members drift toward antisocial attitudes or behaviors, community norms are reinforced via loss of privileges, responsibility, and acceptance.

The self-help approach of therapeutic communities focuses on the resident as a primary agent of change. As members progress through the hierarchical stages of treatment, they are expected to take on new roles and to model appropriate behavior for their fellow residents. Members take control of their situation by learning and adopting concepts of "right living" and "acting as if." Right living refers to behaviors which facilitate responsible and ethical ways of living. Acting as if refers to behaving in ways that correspond with the ways in which one should or would like to live as opposed to behaving in ways associated with how one used to live.

Stages of Treatment

As mentioned above, therapeutic communities are based on a hierarchical treatment model in which participants move through different stages. The first stage of treatment lasts approximately 30 days and consists of induction and early treatment. During this time, the resident is expected to assimilate to community life as he or she is introduced to important community policies and procedures. In this early stage, the resident is asked to participate in various self-assessment processes. The resident begins to learn about the nature of addiction and hopefully commits to recovery as he or she works to gain the trust of fellow residents and staff members. This stage of treatment may be especially important to the success of therapeutic communities. In at least one documented case, induction was related to retention such that getting rid of this phase of treatment reduced the likelihood of long-term retention in the program.

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