Therapeutic community

Therapeutic communities are supervised communal drug-free living situations for opioid and nonopioid drug abusers. Because substance abuse is viewed as a disorder of the whole person, the goal is a dramatic alteration of the addict s entire lifestyle (DeLeon 1985). Addicts are expected to five in these communities for 6—18 months. Therefore, they are not indicated for people who have a strong intimate relationship or stable employment. The community is a surrogate fam- 

At present, many clients ate teferred by the courts and thus are required to complete treatment. Anothet tecent change has been that entrants appear to be more depressed and less intelligent and to have more behavioral problems than in the past (DeLeon 1985). Even in the past, when chents had to demonstrate high levels of motivation to gain admission, dtopout tates wete high (DeLeon 1985). About 50% of patients drop out within the first 3 months, and only about 15% of entrants complete a year of treatment. 

High dropout rates notwithstanding, those who stay in treatment have excellent results. Clients remaining for 90 days or more do better than dropouts on legitimate employment, number of arrests, self-reported drug use, and antisocial behavior these results hold true at 1- and 5-year follow-ups (Bale et al. 1984 DeLeon 1985). However, some research showed a negative correlation between duration of residence and outcome, particularly for clients with extensive psychiatric symptoms, who do comparatively poorly in therapeutic community settings (McLeUan 1986). 

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Outpatient drug-free programs, like therapeutic communities, seek to achieve abstinence without the use of psychoactive medication. Programs range from unstructured drop-in centers with discussion groups and recreational activities to organi2ed day treatment programs. 

Bale RN, Zarconc VP, VanStone WW, et al Three therapeutic communities a prospective controlled study of narcotic addiction treatment process and two-year follow-up results. Arch Gen Psychiatry 41 185—191, 1984 Ball JC, Ross A The Effectiveness of Methadone Maintenance Treatment. New York, Springer-Verlag, 1991... 

DeLeon G The therapeutic community status and evolution. Int J Addict 20 823-844, 1983... 

I do not have the space to develop and assess this proposal here. I am sure it is unsatisfactory as it stands, but it does have some appeal. The concept it identifies is an important one, and makes sense of many of our practical concerns. Compulsive behavior tends to disrupt one s life in ways that are very difficult to control without help. It is this characteristic that elicits sympathy. It is this characteristic that is of interest to the therapeutic community. (Indeed, this is what creates that community.)... 

Synanon, a therapeutic community for treating drug addiction, is founded by Charles Dederich. A number of similar groups follow. 

Mosher, L. (1996). Soteria A therapeutic community for psychotic patients. In P. Breggin, E. Stern, (Eds.), Psychosocial approaches to deeply disturbed persons (pp. 43-58). New York Haworth Press. 

Effectiveness of Therapeutic Community and Outpatient Drug Treatment... 

DeLeon, G. (1984). The therapeutic community Study of effectiveness. NIDA Treatment Research Monograph 84. Rockville, MD National Institute on Drug Abuse. 

DeLeon, G. (1995). Therapeutic communities for addictions A theoretical framework. International Journal of the Addictions, 30, 1603-1645. 

THERAPEUTIC COMMUNITY ADVANCES IN RESEARCH AND APPLICATION. Frank M. Tims, Ph.D. ... 

Types of treatment vary. The most intensive and expensive is in-patient carein a hospital or residential program. The least intensive and expensive is day or evening out-patient care. Therapeutic communities and halfway houses fall somewhere in between. Choice of treatment will partly depend on severity of the child s need, and partly on what parents are able to afford. Upon what does a successful outcome to treatment most depend Probably the most important variable affecting how well a program works is how hard the patient works at the program being offered. 

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