TCs first formally appeared in 1958 as an alternative rehabilitation for those suffering from SUDs in the United States, though their philosophy has existed as far back as World War II [f n value=22] Jones, M. (1953). The therapeutic community: a new treatment method in psychiatry. Shortly following the second world war, British psychologists promoted efforts to bridge the patient populations in the hospital back into their community, in order to support reintegration of traumatized soldiers back into society. It was at this time that the term "therapeutic community" was officially coined 23.
The first programs included Synanon (founded in 1958 in Santa Monica, California) and Daytop Village (founded in 1963 in Staten Island, NY). As an alternative to the growing psychiatry movement, these early TCs favored an abstinence-based approach to recovery under the belief that use of drugs in any form was a threat to sobriety and recovery 24 25. Throughout the 1960 and 1970s, modifications of the original programs flourished throughout the United States. These were termed modified TCs (MTCs) and aimed to adapt to the norms and culture they were housed in, as well as to the growing complexities of SUD presentations and interindividual differences in patient populations 26. Given the diversity in populations that SUDs affect, it was sensible to make adjustments in order to meet the unique needs of each individual as they present for treatment. This included those with severe drug abuse who carried co-occurring social disorders, had children, were homeless, or involved in criminality 26. MTCs supported the notion that initiation of recovery meant acknowledging the individual’s unique circumstances, perceived needs and objectives, and how they experience their own personal journey.
Today, there are over 3,000 TCs or MTCs implemented in rehabilitation structures across the world 17. The most prevalent are within the correctional settings, including prisons and jails, with the overall goal of reducing recidivism and substance use through a prosocial environment 27. There are also many others tailored to the needs of their specific patient population, including pregnant women with SUDs 28, undomiciled individuals with co-occurring disorders of substance abuse and mental illness 29, and adolescents 30.
Though challenged with research demonstrating the considerable efficacy of MATs and psychiatric medications for SUDs, the historical roots of abstinence are still widely entrenched throughout TCs 25 31. Increasingly, however, MTCs are adopting comprehensive care systems for their patients, including primary medical care and psychotherapy, as well as MATs and psychiatric medications 17 2.
- 23. Main, T. F. (1946). The hospital as a therapeutic institution. Bulletin of the Menninger Clinic, 10(3), 66.
- 24. Clark, C. D. (2017). The recovery revolution: The battle over addiction treatment in the United States. Columbia University Press.
- 25. a. b. Sorensen, J. L., Andrews, S., Delucchi, K. L., Greenberg, B., Guydish, J., Masson, C. L., & Shopshire, M. (2009). Methadone patients in the therapeutic community: A test of equivalency. Drug and alcohol dependence, 100(1-2), 100-106.
- 26. a. b. De Leon, G., & Rosenthal, M. (1979). Therapeutic Communities. In: DuPont R, Goldsstein A, O’Donnell PJ, editors. Handbook on drug abuse; p. 39- 48.
- 17. a. b. De Leon, G. (2015). "The Gold Standard" and related considerations for a maturing science of substance abuse treatment. Therapeutic Communities; a case in point. Substance Use & Misuse, 50(8-9), 1106-1109.
- 27. Welsh, W. N. (2007). A multisite evaluation of prison-based therapeutic community drug treatment. Criminal Justice and Behavior, 34(11), 1481-1498.
- 28. De Leon, G., & Jainchill, N. (1991). Residential therapeutic communities for female substance abusers. Bulletin of the New York Academy of Medicine, 67(3), 277.
- 29. Skinner, D. C. (2005). A modified therapeutic community for homeless persons with co-occurring disorders of substance abuse and mental illness in a shelter: An outcome study. Substance use & misuse, 40(4), 483-497.
- 30. Winters, K. C., & Winters, K. C. (1999). Treatment of adolescents with substance use disorders. US Department of Health and Human Services, Public Health Service, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treat
- 31. Greenberg, B., Hall, D. H., & Sorensen, J. L. (2007). Methadone maintenance therapy in residential therapeutic community settings: challenges and promise. Journal of psychoactive drugs, 39(3), 203-210.
- 2. Smith D. E. (2012). The medicalization of therapeutic communities in the era of health care reform. Journal of psychoactive drugs, 44(2), 93–95.