This examination of the development of therapeutic communities and their availability in Europe contains an overview of their effectiveness as measured by evaluation research, as well as the guidelines that govern them, with attention to their implications for management and training.
A "therapeutic community" (TC) is defined as "a drug-free environment in which people with addictive and other problems live together in an organized and structured way in order to promote change and make it possible for them to lead a drug-free life in the outside society." The use of TCs for the treatment of addictions was one of the first treatment approaches developed to address the emerging heroin problem in many European countries during the 1960s. During the 1990s, TCs in many European countries evolved from long-term generic treatment programs to shorter term modified programs. Currently, approximately 1,200 facilities are using TC-type interventions across Europe, with two-thirds of them conducted in Italy. Based on a review of 16 randomized controlled studies of TCs in North America and 14 observational studies conducted in Europe, there is evidence for the effectiveness of TCs in reducing substance abuse and criminal activity. Specifically, individuals who participated in TCs while in prison had lower reincarceration rates 1 year after release compared with prisoners who received no treatment or were assigned to alternative services. The development and implementation of evidence-based clinical guidelines and service standards play an important role in ensuring quality services as well as ongoing improvement in TC processes. For the future, it is likely that cost containment will continue to reduce the length of TC treatment and increase the role of volunteer staff while reducing the number of professional staff. Extensive tables and figures, 150 references, and appended details on evaluation research studies
European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
Cais do Sodré, Lisbon 1249-289, Portugal
Best Practice/State-of-the-Art Review