Therapeutic Communities for Addictions: A Review of Their Effectiveness from a Recovery-Oriented Perspective

Abstract

Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

Declaração Universal sobre Bioética e Direitos Humanos: referência para vigilância sanitária em comunidades terapêuticas

“…Both types of facilities emphasize rehabilitation and the reinsertion of users into society. It is worth noting that abstinence may only be a resource for obtaining employment or improving personal well-being, which may, in turn, contribute to an individual's renewed participation in community activities and social inclusion 18 .…”

“…As the component of the health system with the broadest crossover into law, health surveillance must promote studies and research that assess TC adherence to SUS principles and guidelines 37 . For this task, we recommend that health surveillance include bioethical parameters in its evaluations of TCs to create a more coherent vision of their social role as a state entity and, at the same time, to encourage a culture of routine evaluations in TCs 18,38 .…”

Posttraumatic stress disorder in a therapeutic community for substance use disorders: an evaluation of the influence

“…The scope of this review was wider than presented in Smith, Gates, and Foxcroft (2006), but the overall conclusions regarding the quality of research was similar. Vanderplasschen, et al (2013) focused on studies that were longitudinal and used a prospective controlled design. A total of 30 papers published between 1980 and 2012 were included, and described 16 studies, all of which were conducted in the United States.…”

“…Post program follow-up ranged from 6-24 months in most studies, but some studies had follow-ups of over 36 months. This review by Vanderplasschen et al (2013) contained multiple findings which expanded the TC knowledge base. First, when comparing outcomes, the difference between treatment conditions (treatment as usual, different TC types, case management, and probation) reduced with time in treatment.…”

“…Research has established the effectiveness of the TC to treat SUD (Vanderplasschen et al, 2013), but had little or no reference to PTSD. This research will be discussed in depth later in the current thesis (see Chapter 2).…”