programs are non-professional, generally low-
cost communal homes that provide supportive,
substance-free living environments to
individuals attempting to establish or maintain
sobriety.^392 Homes may be democratically run
or hierarchically structured with house managers
in charge of other residents. Typically,
participation in additional aftercare services* is
encouraged or required.^393
Therapeutic Communities. The TC model, used
primarily but not exclusively with the justice
population, is a highly structured residential
program that requires a long-term commitment
(six to 24 months).^394 It is based on mutual
support principles and incorporates behavior
modification techniques, education classes and
residential job duties.^395 This approach aims to
re-socialize the patient to a substance-free,
crime-free lifestyle through peer influence,
personal responsibility and skill training.^396 TC
participants commonly include individuals with
relatively long histories of addiction,
involvement in serious criminal activities and
significantly impaired social functioning.^397 The
mutual support aspect of TCs operates on a
hierarchical basis; patients who have been
involved in the program longer provide support
and serve as role models for newer patients.^398
A large, national study found that patients
enrolled for at least 90 days in a TC† were
significantly less likely to have used cocaine (28
percent vs. 55 percent), tested positive for drug
use (19 percent vs. 53 percent), reported daily
alcohol use (9 percent vs. 15 percent) or have
spent time in jail (24 percent vs. 54 percent) a
year after program participation than those who
spent fewer than 90 days in the program.^399 The
year following successful TC completion
showed lasting effects along several indicators
compared to the year prior to TC entry: the rate
of weekly cocaine use fell from 66.4 percent to
22.1 percent; weekly heroin use, from 17.2
percent to 5.8 percent; heavy alcohol use, from
40.2 percent to 18.8 percent; illegal activity,
from 40.5 percent to 15.9 percent; less than full-
- Not defined.
† Long-term residential programs, most of which
were TCs.
time employment, from 87.6 percent to 77.0
percent; and reported suicidal thoughts, from
23.6 percent to 13.2 percent.^400For patients with co-occurring mental health
disorders, a Modified Therapeutic Communities
(MTC) model takes into account patients’
psychiatric symptoms,‡ potential cognitive
impairments and reduced levels of functioning
due to substance use, including poor control
over urges and short attention spans. MTCs are
more flexible, less intense and more
individualized than standard TCs.^401Sober Living Houses. Sober Living Houses
provide a substance-free living environment for
individuals with addiction involving alcohol,
illicit drugs and controlled prescription drugs.
No formal treatment services are provided but
residents are mandated or strongly encouraged
to participate in mutual support programs and
must comply with house rules which include
maintaining abstinence, paying rent,
participating in house chores and attending
house meetings.^402 Failure to comply with these
rules results in dismissal from the home.^403One study of the combination of participating in
a sober living house and receiving outpatient
treatment interviewed participants within their
first week of entering the houses and again at
six-, 12-, and 18-month follow-ups.§ The study
found significant improvements over time on
measures of alcohol and other drug use, arrests
and employment.^404The Oxford House Model. Oxford House,
founded in 1975, is one of the most prevalent
and well-studied examples of communal-living
environments of this nature.^405 Unlike sober
living houses, they encourage but never mandate
participation in mutual support programs.^406
Typically, eight to 15 residents of the same sex
live in each home. Most recently have received
detoxification or some form of treatment and
many have been homeless or spent time in jail at‡ Although care is not medically-supervised.
§ The average length of stay in the sober living
houses was over five months but there was
considerable variation.