Therapeutic communities: a treatment alternative for many but not all

Therapeutic communities (TCs) provide the most comprehensive form of drug abuse treatment and offer an established route of recovery from all forms of drug abuse. They employ 24-hour-a-day residential treatment that optimally lasts for 15 or more months. The goal of treatment is return of the client to society as a drug-free and productive member. Rehabilitation is viewed as global and involves efforts to remedy chronic social, economic, and educational deficits. Drug abuse is perceived as a disorder of the whole person, and treatment based on social learning and self-help. Clients suitable for treatment are most often chronic drug abusers with some degree of psychological dependency. Criminal involvement (unless it includes a history of violence, sexual abuse, or arson) is considered behavior that can be addressed within the TC. Suitable candidates often show signs of social dysfunction, anti-social behavior, dysfunctional family relationships, an inability to maintain interpersonal relationships, and acute or chronic dysfunction in the workplace or in mainstream academic settings. The TC is capable of treating clients with a considerable range of emotional disturbance-including even profound character disorder, but frank psychiatric illness has typically been recognized as a cause for exclusion. Outcome studies show a long-term success rate of more than 75% for those who complete treatment, and a maximum to moderate success rate among half of the clients who drop out. However, attempts to determine characteristics of those clients most likely to succeed have not proven very revealing.