Therapeutic communities are drug-free residential settings where a hierarchal model is used in regards to the treatment stages and with each stage increases the level of personal and social responsibilities and freedoms. These residential settings allow for peer interaction and influence which will hopefully help individuals in recovery learn and assimilate the social norms present within the household and ultimately learn to develop effective social skills. Therapeutic communities feature treatment staff and those who are in active recovery. Those admitted to these therapeutic communities have a history of substance abuse and behaviors that have eroded family ties as well as communities.
The people that receive treatment is these communities are people with substantial substance abuse problems that may also have other co-existing issues such as addiction to multiple drugs, criminal activity, and mental health issues among others. Traditionally, the average length of stays in a therapeutic community ranged from 18 to 24 months. However, due to restrictions in funding for these programs, stays have been reduced and the creation of other alternatives to the resident treatment model are created to fill the void. A solid predictor of treatment success is the duration of stay, and even with a stay of ninety days treatment outcomes are significantly better than patients who have shorter stay periods.
Treatment in a therapeutic community can be thought of comprising three stages. The first stage is the introduction to the community and early treatment. The resident learns the rules and expectations and a personal assessment of self, circumstances and needs takes place. This occurs within the first thirty days. From this initial period the primary treatment phase begins and there is a structured model of progression in place. With that progression there are increasing responsibilities placed on the individual with expectations of better attitudes and perceptions. From there a re-entry strategy and plan can be developed for the person’s re-entry back into society.
For the person who is part of the therapeutic community, they are expected to follow and adhere to the behaviors and structural norms that comprise the community itself. The norms are reinforced with rewards and punishments with the purpose of developing self-control and responsibility. As the person progresses through the therapeutic community, they are given increasingly important roles and responsibilities. People in these residential programs are expected to become active role models in the process, guiding new entrants by example. This is accomplished in-house through individual and group therapy, role-playing and peer sessions.
Daily life in a therapeutic community consists of a myriad of activities designed to keep the participant engaged and working towards new ways of thinking and living. It can include house meetings, groups, twelve step meetings, recreation, scheduled personal time and counseling sessions. The National Institute on Drug Abuse (NIDA) outlines four main types of activities:
- Clinical Groups—encounter groups and retreats which use a variety of therapeutic approaches.
- Community Meetings—daily house meetings and groups which are used to reinforce house rules and functioning of the therapeutic community.
- Vocational/Educational Activities—provide work, communication, and interpersonal skills training.