NUMBER 679• 9 FEBRUARY • THERAPEUTIC COMMUNITIES
Can therapeutic communities treat populations with special needs?
The closely supervised residential TC environment provides benefits for troubled youth. A study on adolescent drug treatment outcomes showed that adolescents treated in TC programs were more likely than those in outpatient drug-free programs to have prior drug abuse treatment experience, more severe problems, and a criminal justice history. Despite being more difficult to treat, however, adolescents in these programs had significantly improved outcomes in drug use, psychological adjustment, school performance, and criminal activities.
Another study compared the outcomes for adolescents referred through probation to TC treatment to outcomes for those referred to group homes with no specialized drug treatment services. The group homes were the same size and offered the same length of stay as the TC setting. The study found robust reductions in drug use, criminal behavior, and measures of psychological dysfunction at 3 months for all placements. However, after that period, those in the TC sustained or increased their improvements in problematic behaviors, while those in the group homes did not.
Several studies have examined longer term effects for adolescents participating in TCs. For example, one study followed adolescents treated in six TCs. One year after treatment, these adolescents showed significant declines in alcohol, marijuana, and other illicit drug use, as well as reductions in criminal activity and other deviant behavior. Although the planned length of stay varied among the six participating TCs, completing treatment was significantly related to better outcomes. Reductions in drug use were also strongly related to having good relationships with counselors and to avoiding deviant peers after treatment. Post treatment criminal activity was higher for those who associated with deviant peers.
It is often necessary to modify some of the traditional components of the TC to accommodate adolescent developmental differences and to facilitate their maturation. The modifications may include less hierarchy and confrontation and greater priority to education than work. For example, many TCs for adolescents have an onsite school. In addition, such programs offer a range of family services that require family participation. After formal treatment is completed, continuing care is often arranged.
NATIONAL INSTITUTE ON DRUG ABUSE