Modern Therapeutic Communities for Addiction

communitygrassContrary to what readers may have thought, TCs remain widely utilized, especially for certain populations of substance misusers. Developed as alternatives to traditional treatments, maligned in the past for demeaning and punitive interventions, Dr. George DeLeon argues that modern therapeutic communities, with flexible treatments and lengths of stay, are exactly right for promoting “right living” and producing positive outcomes with respect to reduction in substance misuse, fewer legal problems, improvements in employment status and overall psychosocial status….Dr. Richard Juman

Over the past 50 years, the Therapeutic Community (TC) for addiction has evolved from a modality which played a marginal role in the treatment world to one that is now considered to be one of the core components of the substance misuse treatment continuum. Over this period of time, the nature of the treatment and services provided by TCs has also evolved. My guess is that a number of readers have a perception of TCs that is based on some interventions and practices that occurred decades ago and doesn’t reflect the evolution of the “TC Model.”

Modern TCs serve a wide diversity of clients and problems; they have new staffing compositions, have reduced the typical duration of residential treatment, have reconsidered their treatment goals and, to a considerable extent, have adapted and modified the therapeutic approach itself. Unfortunately, although TCs have evolved, the view of them among the public, policymakers and other members of the treatment community has not necessarily kept pace, and so the role of contemporary therapeutic communities in the spectrum of addiction treatments remains unclear.

In the absence of an informed view of the TC, historical perceptions and misperceptions of this significant treatment modality tend to persist, to everybody’s detriment. It is imperative that addiction professionals educate themselves about the advances and applications of the contemporary TC in serving special populations in various settings. Additionally, it’s critical that greater linkages are forged between TCs and the broader field of addiction psychology. The Therapeutic Community is a unique social-psychological approach to treating addiction (”community as method”) that addresses the whole person. This includes focusing on the complex psychological injuries that are associated with addiction and launching a recovery process defined by identity change.

TC programs have been implemented worldwide for over five decades; globally, it is conservatively estimated that there are over 3,000 TCs operating in hospitals, prisons, juvenile centers, outpatient programs and other community-based settings. TC programs have been implemented in Europe, Asia, Africa, Latin America, and the Middle East. And despite the ethnic, social-political, and religious differences that are encountered across these various cultures, TCs retain their essential elements and effectiveness in a way that is universal.