A Therapeutic community (TC) is a common form of long-term residential treatment for substance abuse disorders. Residential treatment for substance abuse disorders was first initiated in the late 1950s.
The idea for the treatment came out of the self-help recovery movement and included such groups as Alcoholics Anonymous. Some of these groups became self-supporting and the residences were run democratically. The basic premise of these communities was to support abstinence and recovery from drug abuse.
The first Therapeutic Community was the Synanon residential rehabilitation community, founded in 1958 in California. The success of the Synanon Community during the 1960s, caused the first generation of TCs to spread throughout the United States. Today the Therapeutic Community approach is in use in over 65 countries around the world.
Historically, the Therapeutic Community approach was a mutual self-help alternative to medically oriented strategies designed to address the addiction problem. The treatment has traditionally not allowed participants to use any type of medication, including methadone. However, over the last 30 years, attitudes within the TCs have gradually evolved, reflecting changing social attitudes toward addiction treatment and the scientific recognition of addiction as a medical disorder.
As our understanding of the addiction has grown so has the Therapeutic Communities approach and many address a participants other health issues along with their substance abuse disorder and are incorporating a more comprehensive medical treatment to support participants in receiving medications for their addiction treatment and for any psychiatric disorders they may be experiencing.
Today TCs also offer short-term residential or outpatient day treatment in addition to traditional long-term residential treatment and have become an important part in long term addiction recovery.
TCs have also had to adapt to address the varying treatment needs of different populations. In the 1990s, TCs emerged to address the needs of people with psychiatric disorders as well as homeless individuals, women, and children.
As the number of those suffering with addictions rose during that same time period, correctional institutions saw a huge gap in the prison population and had to begin incorporating in-prison TCs, usually in separate housing units, as well as communities that were available for those reentering society after prison with the goal of reducing both drug use and recidivism.
In its initial stages Therapeutic Communities were run primarily by peers who were also in recovery. However, now in response to the changing needs and environment of drugs and alcohol in our society, most now have a professional staff with substance abuse counseling or mental health training, some who are in recovery themselves or otherwise seeking alternative treatment for alcohol addiction.
The programs often have medically trained professionals including psychiatrist consultants, nurses, and methadone specialists as staff members, and most offer medical services on-site. According to a national survey of these programs, more than half of Therapeutic Community staff members are in recovery and many have earned certifications in addiction counseling at the bachelors or masters-level degrees.
Therapeutic communities focus on the whole person and an overall lifestyle change, not just abstinence from drug use. This approach recognizes the chronic, relapsing nature of substance abuse disorders and holds the view that these lapses are opportunities to learn the underlying nature of a person’s addiction.
Recovery is a gradual, ongoing process of cognitive change through a range of clinical interventions. The TC approach allows program participants to advance through the stages of treatment while setting personal objectives that will further them along the way.
This type of recovery orientation is very different from an acute-care model, which focuses on interrupting drug use to help the patient to attain a state of abstinence during treatment episodes rather than focusing on an overall lifestyle change.
TCs approach is to encourage participants in examining their personal behavior in order for them to engage in conscious living based on honesty with oneself and family, taking responsibility for one’s decisions, doing the hard work it takes to recover, and having the willingness to learn. As participants progress through the various stages of recovery, they are able to assume greater personal and social responsibilities in their communities.
The goal for a TC participant is to graduate from the program not only as a drug-free person but also one who is employed, in school or in some kind of job training. It is not uncommon for program participants to progress in their recovery to take on leadership and staff roles within the TC.
TCs follow the concept of “community as method,” with active participation in group meetings and activities that help to drive individual change and attainment of therapeutic goals.
Promoting an emphasis on social learning and mutual self-help, participants take on some of the responsibility for their peers’ recovery. This aid to others is seen as an important part of changing oneself.
A major component of a TC recovery process is recognizing the need for options and ongoing support once the residential treatment program is completed in order to help them avoid relapsing to drug use and encouraging them to live a healthy, drug free life.
Relapse prevention is a standard part of most addiction treatment programs. They are aimed at increasing the awareness of triggers and help to build coping skills both to reduce the likelihood or frequency of relapse and its severity if and when it does occur.
As a person moves toward the completion of a TC program, they are connected with aftercare and self-help groups in the community to assist them in maintaining a conscious living lifestyle.