Therapeutic communities (TC) are types of residential treatment programs that provide long-term solutions for people in recovery from different types of substance use disorders and other forms of mental illness.
The traditional approach was based on the residential treatment model, with both clients in the program and treatment providers living in the same environment. Some of the more modern forms of therapeutic communities have taken on a day-program format, where people interact with the treatment environment during the day and then return to their residences at night.
Traditional residential treatment programs will typically last for 30 to 90 days, whereas therapeutic communities are extended periods of treatment that are typically 12 to 18 months or longer.
Traditionally, therapeutic communities offer structured living environments for their clients. If you are in a TC, you will live in an environment with other clients in the program. More than half of the staff working there are reported to be in recovery themselves or have certification in addiction counseling.
Therapeutic communities offer a holistic approach to recovery that focuses on addressing and altering issues with your overall lifestyle (sometimes referred to as a recovery orientation). Other residential treatment programs tend to focus on abstinence-based recovery and acute issues with substance use disorders, and less so on other personal issues.
The TC program looks at recovery as a gradual process of change and assumes that having a substance use disorder means you have a chronic relapsing condition that needs long-term treatment. Relapses and lapses are considered part of the recovery process.
You are encouraged to learn from your mistakes. Although lapses and relapses are not supported by treatment providers, they are considered part of the process of recovery and not an indication of failure.
TC programs are designed to give you higher levels of responsibility for your recovery and for contributing to the recovery of others as you continue through your treatment.
They have the goal of addressing your issues with substance abuse, helping you achieve and maintain abstinence, and bettering yourself at work, school, and in other areas of your life. You will be expected to participate in group activities that emphasize learning and cooperation with others to achieve social goals.
The TC approach conceptualizes that having a substance use disorder affects all areas of your life. Substance abuse breaks down your family ties, community ties, social skills, and gradually wears down your ability to function at work, school, and in your personal relationships. A therapeutic community attempts to have you reestablish and relearn skills and abilities that address all areas of your life.
In some cases, people may have been so devastated by the consequences of their substance abuse that they need to habituate or even relearn skills and values associated with healthy living. This requires a highly structured daily routine that has clearly stated goals.
The community as a method component of TC programs allows people to live together in a residential setting that is drug-free. This approach can even be used in shelters or prisons where the program is implemented.
The approach is designed to get you involved and interacting with others with similar needs and goals as a mechanism to help you change your own identity and lifestyle.
Mutual help through positive social interaction, bonding with others, and support from others is a primary mechanism of change.
As mentioned above, traditional TC programs involved communities where both clients and treatment providers lived together, but some of the more modern manifestations of TCs utilize these principles in an intensive outpatient treatment environment.
Simply watching and attempting to model someone else may not help you change your behavior. The notion of “pull-ups,” or corrective reminders between peers, is designed to add to the social learning approach used in a TC.
Pull-ups are very specific guidelines that come from other community members and therapists to help you change yourself in a more focused and proactive manner. Pull-ups are also consistent with the cognitive-behavioral approach used by many therapists.
TC therapists will typically adopt a cognitive-behavioral approach. This means they will focus on how your thinking and beliefs relate to your actions. By identifying beliefs, expectations, and other thoughts that are flawed and contribute to dysfunctional behavior, your therapist can help you restructure beliefs and thoughts to change your behavior.
The motivational interviewing approach that is used in many TC programs assumes that everyone is at a different stage in their willingness and readiness for change. The TC approach attempts to identify where you are in relation to your willingness, understanding, and readiness for change and then work with you from that point.
The TC approach utilizes many different activities and interventions to help you recover from your substance use disorder as well as to address other areas of your life. These include:
Many people who are involved in therapeutic communities later go on to continue in the programs as mentors and even therapists if they are qualified.
The goal of a TC program is to eventually get you to be able to leave the treatment community and re-enter the larger community drug-free.
Therapeutic communities will usually offer aftercare, such as counseling and other programs, that you can continue with to remain focused on your recovery. Traditionally, people could stay in a TC for as long as they felt they needed to, often between 18 and 24 months. Today, insurance limitations may reduce the length of stay in these programs to less than 12 months.
It is best for you to remain in some type of ongoing program after your insurance coverage expires. Research indicates that the longer a person participates in treatment, the better their long-term outcome will be.
Research studies have found that TC programs offer a substantial improvement in recovery from substance use disorders as well as mental health disorders. They even demonstrate a reduction in criminal behavior in participants in prisons or those in treatment because of the court system.
One of the biggest challenges to any substance use disorder treatment program is keeping someone in the program, and TC programs are no different. Dropout rates in treatment programs for substance use disorders are highest in the early stages of the program. When TC programs require that individuals live and be treated in the same community with treatment providers and other clients, it may reduce the tendency for someone to drop out of the program early.
Standard residential treatment and therapeutic communities are equivalent in terms of their overall success rates. You might be better suited for a TC if:
(July 2015) What Are Therapeutic Communities? National Institute on Drug Abuse. Retrieved April 2019 from from https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities
(January 2013) Therapeutic Communities for Addictions: A Review of Their Effectiveness from a Recovery-Oriented Perspective. The Scientific World Journal. Retrieved April 2019 from from https://pdfs.semanticscholar.org/c2a5/78a8129234274b412307dccd616268ec6428.pdf
(2014) Therapeutic Communities for Treating Addictions in Europe: Evidence, Current Practices and Future Challenges. European Monitoring Centre for Drugs and Drug Addiction. from https://www.researchgate.net/profile/Wouter_Vanderplasschen/publication/261834646_Therapeutic_communities_for_the_treatment_of_addictions_in_Europe/links/0c960535981c43253d000000/Therapeutic-communities-for-the-treatment-of-addictions-in-Europe.pdf
(2015) The American Psychiatric Textbook of Substance Abuse Treatment. American Psychiatric Publishing. from https://books.google.com/books?hl=en&lr=&id=7nLBBwAAQBAJ&oi=fnd&pg=PT11&ots=kvhUUu2KuP&sig=_CeOOEeLpqZB13rfJrgzKLHJuhM#v=onepage&q&f=false
(April 2013) Verbal feedback in therapeutic communities: Pull-ups and reciprocated pull-ups as predictors of graduation. Journal of Substance Abuse Treatment. Retrieved April 2019 from from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556212/
(Winter 2010) Therapeutic communities in United States' prisons: effectiveness and challenges. Therapeutic Communities. Retrieved April 2019 from from http://www.dldocs.stir.ac.uk/documents/31(2).pdf#page=67
(Summer 2010) Is the therapeutic community an evidence-based treatment? What the evidence says. Therapeutic Communities. Retrieved April 2019 from from http://www.dldocs.stir.ac.uk/documents/31(2).pdf#page=14