title: 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.
authors: Department of Orthopedagogics, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium. wouter.vanderplasschen@ugent.be
authors: Wouter
authors: W
authors: Vanderplasschen
authors: Kathy
authors: K
authors: Colpaert
authors: Mieke
authors: M
authors: Autrique
authors: Richard Charles
authors: RC
authors: Rapp
authors: Steve
authors: S
authors: Pearce
authors: Eric
authors: E
authors: Broekaert
authors: Stijn
authors: S
authors: Vandevelde
mesh_terms: D016739:Behavior, Addictive / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012008:Recurrence; D019966:Substance-Related Disorders / Q000628:therapy; D013808:Therapeutic Community
references: Am J Public Health. 1997 Oct;87(10):1637-44
references: 9357345
references: Subst Use Misuse. 2008;43(12-13):2001-20
references: 19016176
references: Addiction. 2005 Apr;100(4):447-58
references: 15784059
references: Psychol Addict Behav. 2004 Sep;18(3):257-68
references: 15482081
references: Drug Alcohol Rev. 2004 Dec;23(4):471-81
references: 15763752
references: J Subst Abuse Treat. 2010 Jan;38(1):51-9
references: 19631490
references: Int J Nurs Stud. 2011 Oct;48(10):1244-57
references: 21481390
references: J Psychoactive Drugs. 1995 Jan-Mar;27(1):109-16
references: 7602434
references: Addiction. 2006 Dec;101(12):1677-8
references: 17156161
references: Arch Gen Psychiatry. 1984 Feb;41(2):185-91
references: 6365016
references: Am J Drug Alcohol Abuse. 1981;8(2):185-201
references: 7331975
references: Addiction. 2002 Mar;97(3):249-52
references: 11964098
references: Addiction. 2003 Mar;98(3):291-303
references: 12603229
references: J Subst Abuse Treat. 1999 Dec;17(4):339-47
references: 10587936
references: Subst Use Misuse. 2011;46(8):1023-31
references: 21235341
references: Drug Alcohol Depend. 2008 Aug 1;96(3):271-80
references: 18486361
references: Cochrane Database Syst Rev. 2006 Jan 25;(1):CD005338
references: 16437526
references: J Subst Abuse Treat. 2001 Jan;20(1):15-23
references: 11239724
references: J Subst Abuse Treat. 1996 Jul-Aug;13(4):349-58
references: 9076653
references: J Psychoactive Drugs. 2011 Apr-Jun;43(2):99-107
references: 21858956
references: Psychiatr Q. 2010 Sep;81(3):227-38
references: 20361355
references: Am J Public Health. 1995 Oct;85(10):1426-9
references: 7573630
references: Eur Addict Res. 2012;18(1):1-11
references: 21997500
references: Psychiatr Serv. 1998 Jan;49(1):68-76
references: 9444683
references: Behav Sci Law. 2004;22(4):477-501
references: 15282836
references: J Consult Clin Psychol. 1998 Apr;66(2):280-9
references: 9583331
references: J Subst Abuse Treat. 1998 Nov-Dec;15(6):595-7
references: 9845873
references: Am J Drug Alcohol Abuse. 2000 Aug;26(3):461-80
references: 10976669
references: Am J Drug Alcohol Abuse. 2007;33(6):823-32
references: 17994478
references: Psychiatr Serv. 1999 Dec;50(12):1577-83
references: 10577876
references: Eval Health Prof. 1999 Mar;22(1):60-85
references: 10350964
references: Drug Alcohol Depend. 2002 Jun 1;67(1):53-72
references: 12062779
references: Eur Addict Res. 2006;12(1):1-11
references: 16352897
references: Eur Addict Res. 2005;11(1):1-9; discussion 10-4
references: 15608466
references: Psychiatr Rehabil J. 2007 Summer;31(1):32-7
references: 17694713
references: J Nerv Ment Dis. 1996 Aug;184(8):482-9
references: 8752077
references: Psychiatr Q. 2004 Fall;75(3):279-94
references: 15335230
references: J Consult Clin Psychol. 1999 Jun;67(3):428-34
references: 10369064
references: JAMA. 2000 Oct 4;284(13):1689-95
references: 11015800
references: Arch Gen Psychiatry. 1997 Jan;54(1):71-80
references: 9006403
references: Arch Gen Psychiatry. 1980 Feb;37(2):179-93
references: 7352849
references: J Subst Abuse Treat. 2012 Apr;42(3):247-59
references: 21943810
references: J Subst Abuse Treat. 2010 Mar;38(2):97-107
references: 20015605