Therapeutic communities offer a highly structured and supportive environment for people with substance use disorders. They promote behavior changes through participation in the community dynamic, group therapies, vocational and academic education, and the development of coping strategies.
- Therapeutic communities are a form of substance use disorder treatment that helps people learn skills to maintain their recovery and return to life in the community.
- They can be very effective for many people and can reduce relapse rates and the risk of criminal activity.
- They are highly structured, often involving a full day of therapeutic activities, community responsibilities, and skill development.
What is a therapeutic community?
A therapeutic community (TC) consists of individuals with substance use issues within a structured and supportive environment. This promotes the recovery process and encourages individuals to support one another, build social connections, and work toward reintegrating into society.
TCs often involve living full-time in a facility, where the residents are the primary members of the community. They work together to create lifestyle changes and develop emotional and practical skills. [1]
TCs tend to be highly structured, helping individuals feel a sense of responsibility for themselves and the community, which aims to enable long-term changes in attitude and behavior. Individuals contribute to the group dynamic, practicing healthy social skills and developing strategies to improve their recovery. [2]
How therapeutic communities work
The goal of the therapeutic community is to rehabilitate the individual, ensuring that they are prepared and able to live in the community. Skills developed within the TC aim to help the individual maintain their recovery by learning how to manage any triggers faced within their home environment.
TCs involve a group of individuals, generally between 25-50 people, living 24 hours a day in a residential facility. TCs utilize a highly structured environment, often including up to 12 hours of sessions per day, such as classes, training, or seminars for the development of practical and academic skills, individual and group therapies, and vocational development and practice.[3]
The idea is that individuals are busy with rehabilitative activities, providing them with a role and purpose. This helps reduce relapse triggers such as boredom, cravings, disruptive behaviors, and chaotic interactions while providing a sense of reward and achievement. These activities provide a basis for life in society, improving self-efficacy and the ability to utilize coping strategies.[2][4]
Therapeutic communities are primarily governed by non-professionals, often who have utilized a TC for their own addiction rehabilitation. Medical staff, mental health professionals, or social workers are also likely to be involved, providing specific services and guidance within the TC.[2]
TC programs often last over 15 months, although some programs may be as short as two months. Research suggests that longer treatments can provide better outcomes.[2][3]
Effectiveness of therapeutic communities
Research shows that TCs can have a positive impact on recovery outcomes. One study indicates that over three-quarters of those who utilize a full TC program have long-term successful outcomes.[2][4]
Positive outcomes of therapeutic communities include:
- Reduced likelihood of returning to substance use.[1][5]
- Reduced likelihood of committing drug-related offenses or being incarcerated.[1][6]
- Better employment and psychological functioning.[1]
- Reduced depression symptoms.[7]
- Improved social functioning and fewer drug-using peers.[7]
However, TCs might not be a suitable treatment for all, such as those with co-occurring severe mental health issues who require a more comprehensive treatment approach. [2] Additionally, some research suggests that the effectiveness of TCs can differ between genders, with women potentially experiencing more negative consequences from this approach than men. [8]
Types of therapeutic communities
- Community-based residential: Residential TCs are based in the community and allow individuals to live long-term within the facility to receive highly structured treatment with continuous supervision. [4]
- Day or outpatient: These TCs offer less intensive care and can be utilized during the day. Individuals continue to live at home, attending either for a whole day of structured treatment (day TC) or part-time for less intensive therapeutic activities within the therapeutic community (outpatient). [5]
- Prison: TCs can be accessed within certain correctional facilities and reportedly every US state holds at least one prison-based TC. These TCs operate within the prison but allow individuals to live apart from the rest of the prison population in order to create a supportive and rehabilitative environment. [1][6]
Therapeutic community vs. Traditional rehab
Both TCs and rehab are treatments for substance use disorders that involve staying at a facility with others, receiving treatments and group therapy, and being supported by professionals.
However, rehab is a shorter treatment program, typically lasting 30-90 days, while TC programs often last for over a year. Rehab may be the first step in treating an individual’s addiction, while a TC might be more appropriate following a treatment program when the individual is in the recovery stage.
Residents at a TC are more involved with managing the environment and dynamic of the group, with individuals helping one another and developing skills needed to help them return to life in the community. [2]
Who can benefit from a therapeutic community?
People who are eligible for and would benefit from a therapeutic community include: [2][3][4]
- People with a history of chronic drug use
- People who have completed the detoxification process but may continue to experience signs of psychological dependency
- People who have been involved in non-violent drug-related crime, such as theft
- People with impairments in social, professional, academic, or interpersonal functioning
- Adolescents whose drug use cannot be safely managed in the home or alternative environments
- People who do not have co-occurring severe mental health concerns such as psychosis or severe depression, as this may not be adequately managed in this environment and could impact others.
Challenges and limitations of therapeutic communities
Potential challenges and limitations of therapeutic communities can include:
- Following a return to the community after living in a TC, people may continue to require aftercare and therapeutic intervention long-term, to help prevent relapse.
- Shared living spaces can lead to difficulties with maintaining privacy or a supportive environment.
- People may become triggered by others or circumstances that occur in the group.
- The transition from TC living to community living may be challenging for some people, especially those who have been in residential treatment for some time.
- TCs may not address other issues such as mental health conditions, which can lead to negative consequences.
How to find a therapeutic community program
People can find local therapeutic community programs by speaking to their primary care physician or substance use disorder specialist. Additionally, searching the Recovered Rehab Directory can help find local centers that offer TC programs.
