The Current Importance of Therapeutic Communities

Outside the United States, the therapeutic community (TC) model is widely embraced, with currently 65 countries offering treatments and over 3,000 TC models incorporated into community settings across the world. Since its global expansion beginning in the 1980s, the “modern TC” has evolved to adapt to the unique needs and structures of the setting, such as prisons, women’s treatment centers, and shelters. In this sense, such institutions carry therapeutic principles and concepts, which are often complemented with other treatment modalities. As TCs expanded in number, they’ve adapted to fit the needs of particular settings and populations

Within the treatment frame at TCs, individuals are encouraged to explore forms of gratification that might be found in sharing life with others – a necessary drive force of life that medications alone cannot fix. In addition to meaningful peer relationships, individuals are held accountable for their role in sustaining the social fabrics within their community. At San Patrignano, one of the most renowned TCs located in Central Italy, residents are engaged in craftsmanship and employment opportunities that foster self-efficacy and belongingness amongst their peers. TCs aim to integrate structural frameworks to facilitate the generation of self-mastery, such as involvement in work or education. As an example, residents who work in the food and agricultural sectors take active roles in sustaining the basic sustenance of others. Being able to offer the fruits of one’s hard work offers a unique layer of human connection that further strengthens social cohesion.

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Some of the key points in the addiction recovery process are connectedness, hope, identity, meaning, and empowerment. Two important predictors of well-being in recovery include social contagion (i.e. the time spent with other people in recovery) and meaning (i.e. the meaningfulness of activities spent within social time). The main goal out of supporting these individuals, who are often marginalized due to stigma, is to improve access to social engagement in meaningful ways. There is the belief that attaining deeper social and community capital enables scaffolding to build the personal skills and resources essential for long-term recovery, which is the central element guiding therapeutic communities.

Growing Pains

It is not without saying that TCs have experienced considerable growing pains over the thirty years, and some of this history has been highlighted in popular media in recent months. TCs around the world have carried a treatment plan that was at times suboptimal. This approach was marked by punishment to reinforce ideal behavior, which was not aligned with the standards of care employed today.

Furthermore, TCs often believed that medications for mental health and substance use issues were harmful to the individual in recovery and viewed them more as a “crutch” than a necessary facilitator for healthy recovery. However, such issues have been addressed by increased receptivity to mediation-assisted treatments.

Current Importance

The current importance of therapeutic communities isn’t something to be under-looked. There is sufficient evidence to support invoking multiple modalities to treat a substance use disorder, rather than a reliance on stand-alone treatment (Pedros Ruiz, 2011). Incorporating aspects of TCs, such as peer support and vocational responsibility, is a promising future direction for substance use disorder treatments.

Source: San Patrignano

For individuals involved in the criminal justice system, research supports that therapeutic community principles lead to improved outcomes once they re-enter their community, such as lower rates of re-incarceration and improved social functioning. This is even the case for individuals who have not participated in a prison that holds a TC structure, yet enter into the continuity of care that integrates TC principles once they re-enter society (Sacks, 2012).

Many therapeutic communities also offer admission to the residential community as an alternative to prison. The TC often advocates for the individual and takes steps necessary to ensure that the residents are supported in their petitions that are required to avoid imprisonment. As an example, in the case of San Pa, if there are criminal cases pending for the individual, the community enlists a network of nearly 3,000 lawyers who practice throughout Italy and collaborate with SanPa’s legal office at a negotiated price. Residents are provided consultations, management of their cases, and filing of applications absolutely free of charge.

Integration of a multimodal approach might be necessary to meet the comprehensive needs of individuals with severe substance use disorders. For those subpopulations of individuals with substance use disorder who are deemed unresponsive to treatment attempts, it is thought they might uniquely benefit from the TC model.