disorders. However, these communities have func-
tioned well in correctional settings and seem to be well
designed to serve the needs of inmates with severe sub-
stance use disorders who are motivated to change their
behavior.Substance Abuse Treatment
Within Therapeutic Communities
Therapeutic communities are commonly used in cor-
rectional institutions to treat substance use disorders
and other life problems. Therapeutic communities
operate under the assumption that substance use is a
consequence of a dysfunctional lifestyle that requires
a holistic treatment solution to facilitate change.
Holistic healing occurs within a highly structured peer
milieu that seeks righteous living without substance
use. In therapeutic communities, the interpersonal
interactions within the context of communal living are
considered to be the mechanism for treating substance
use. The community models appropriate behavior for
individual members, serves to correct the behaviors of
individuals when they are inappropriate, and shapes
changes in individuals. The historical roots of thera-
peutic communities for substance abuse can be traced
to the Synanon community.
Therapeutic communities often include group work
and may provide opportunities to participate in 12-step
support groups. However, therapeutic communities
differ from traditional treatment in that they view
engaging in everyday life activities within the context
of the community as a critical part of the healing
process. For example, treatment involves engaging in
work activities that benefit the community. In correc-
tional institutions, staff and senior community mem-
bers assume mentorship roles for the junior members
of the community. They often function as closed com-
munities, operating as independently of their surround-
ings as possible, and frequently require junior
members of the group to limit exposure to events out-
side the community until they reach a certain level of
maturity in the program.
Emphasis is placed on the importance of social
relationships and reciprocal social support among par-
ticipants and staff in the therapeutic community which
can contribute to persistence in treatment engagement
and better treatment results. Encouraging friends and
family to participate in treatment also has been used
to enhance social support with positive results among
therapeutic community participants. Following treatment,participants often report improved relations with
friends and family.Research on
Therapeutic Communities
Data concerning the efficacy of therapeutic communi-
ties are somewhat sparse, and interpretation of results
is complicated by the lack of a standardized model,
which makes comparisons across sites difficult.
Therapeutic communities can work well for people
who have severe substance use problems and would
benefit greatly from treatment in a highly structured
environment. Researchers examining the efficacy of
therapeutic communities in the United States and
Europe have found evidence that inmates, homeless
people, adolescents, older adults, and certain ethnic
minority groups may benefit from participation.
Positive outcomes have included lower levels of dis-
tress, drug and alcohol use, and criminal involvement
among participants. In addition, there is evidence that
participation may enhance self-esteem, promote the
taking of prescribed medications as directed, lead to
gainful employment, and increase social and coping
skills. Relapse prevention strategies and aftercare
have been used to improve the efficacy of therapeutic
communities’ intervention in substance use disorders.
Evidence suggests a positive relationship between
the length of association with therapeutic communi-
ties and successful outcomes after treatment.
Motivation to participate in therapy and change cur-
rent behavior patterns commonly is related to better
treatment retention and less drug use after treatment.
Participants in therapeutic communities often report
greater motivation to change and higher satisfaction
with treatment than people in other types of substance
abuse treatment. However, these results may be con-
founded with self-selection biases since members
choose to join these communities and participation
requires a high degree of commitment.
Differential treatment outcomes associated with gen-
der have been found. Because of these differences, some
researchers have suggested that it may be helpful to use
gender-specific treatment strategies. Women commonly
enter therapeutic communities with lower levels of
social functioning than men. They may exhibit evidence
of greater psychological distress, often including suici-
dality and trauma histories, which need to be addressed
in treatment. After participation in therapeutic commu-
nities, many women experience less victimization byTherapeutic Communities for Treatment of Substance Abuse——— 803T-Cutler (Encyc)-45463.qxd 11/18/2007 12:44 PM Page 803