Harrison M Trice

Therapeutic Communities Therapeutic communities (TCs) are drug-free residential treatment facilities for drug and/or alcohol addiction. TCs emerged in the 1960s as a self-help alternative to the conventional medical and psychiatric approaches being used at that time.

Most traditional TCs have similar features, including their organizational structure, staffing patterns, perspectives, rehabilitative regimes, and a twelve- to eighteen-month duration of stay. They differ greatly, however, in size (30-600 beds) and client demography. Most people entering TCs have used multiple drugs-including Tobacco, Marijuana, Alcohol, Opiods, pills, and, recently, Cocaine and Crack-cocaine. In addition to their substance abuse, most TC clients also have a considerable degree of psychosocial dysfunction (Jainchill, 1994). In traditional TCs, 70 to 75 percent of clients are men, but admission for women is increasing. Most community-based TCs are integrated across gender, race/ethnicity, and age. Primary clinical staff are usually former substance abusers who were rehabilitated and trained. Other staff are the professionals who provide medical, mental health, vocational, educational, family-

More than 500 women from Synanon communities throughout California shaved their heads to symbolize acceptance of equal responsibility—with Synanon men—for the management and operation of the therapeutic communities. Oakland, February 27, 1975. (© Bettmann/CORBIS)

counseling, fiscal, administrative, and legal services.

Traditional TCs share a defining view of substance abuse as a deviant behavior, which may be attributed to psychological factors, poor family effectiveness, and, frequently, to socioeconomic disadvantage. Drug abuse is thus seen as a disorder of the whole person and recovery as a change in lifestyle and personal identity. As part of the recovery process, TCs seek to eliminate antisocial attitudes and activity, develop employable skills, and inculcate prosocial attitudes and values. This TC view of recovery is based upon several broad assumptions: the client's motivation to change, the client's main contribution to the change process (self-help), the mediation of this recovery through peer confrontation and sharing in groups (mutual self-help), the affirmation of socially responsible roles through a positive social network, and the understanding that treatment is a necessarily intense ''episode'' in a drug user's life.

Diverse elements and activities within the TC foster rehabilitative change. Junior, intermediate, and senior peer levels stratify the community, or the family. The TC's basic program elements, consisting of individual counseling and various group processes, make up the therapeutic and educative elements of the change process. The daily activities, including morning meetings, seminars, house meetings, and general meetings facilitate assimilation into the community as a context for social learning. Clients are oriented into the program during the orientation-induction stage. They progress through the primary treatment stage of the program by achieving plateaus of stable behavioral change. Client development reflects their changing relationship with the community, characterized as compliance, conformity, and commitment. Finally, reentry represents the final program stage where the skills needed in the greater social environment are fostered through increased self-management and decision making.

The effectiveness of the traditional long-term residential TC, as described here, has been well-documented (De Leon, 1997, 2000). Today, TCs include a wide range of programs serving diverse clients who use a variety of drugs and present complex social/psychological problems. Client differences, clinical requirements, and funding realities have all encouraged the development of modified residential TCs with shorter stays (3, 6 and 12 months) as well as TC-oriented day treatment and outpatient models. Most traditional TCs have expanded their social services or incorporated new interventions to address the needs of special populations such as adolescents, mothers and children, homeless, mentally ill chemical abusers, and prison inmates. In these modifications the cross-fertilization of personnel and methods from the traditional TC, mental health, and human services portends the evolution of a new therapeutic community.

BIBLIOGRAPHY

De Leon, G. (2000). The therapeutic community: Theory, model, and method. New York: Springer Publishing Company.

De Deon, G. (Ed.). (1997). Community as method: Therapeutic communities for special populations and special settings. Westport, CT: Greenwood Publishing Group, Inc.

JAINCHILL, N. (1994). Co-morbidity and therapeutic community treatment. In F. M. Tims, G. De Leon, & N. Jainchill (Eds.), Therapeutic community: Advances in research and application. National Institute on Drug Abuse Research Monograph 144. Publication no. 94-3633 (pp. 209-231). Rockville, MD: National Institute on Drug Abuse.

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