Therapeutic Communities: History, Effectiveness and Prospects

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50 Years After Its First Appearance, the TC Has Evolved Into a Successful Treatment Model

Seven out of every 10 men and eight out of every 10 women in the criminal justice system are drug users - persons who used illicit drugs with some regularity prior to entering the criminal justice system. The Federal Drug Use Forecasting system data show that the use of all drugs except cocaine has increased since 1989, and cocaine remains at the same level. Accordingly, the 1990s have seen major increases in arrests of drug users, followed by pressure for funds to expand correctional capacity to treat those inmates with serious drug problems. Interestingly, with this increase has come increased public support for programs aimed at treating drug users and curbing drug-related crime. There is a genuine public and government concern that without treatment, most drug-involved offenders will resume their criminal activities and drug use after release and inevitably will return to criminal justice system custody.

The 1994 Crime Bill included, for the first time, a substantial sum provided for treatment of inmates in state and local correctional systems. The Residential Substance Abuse Treatment for State Prisoners Formula Grant Program (abbreviated RSAT) legislation created an opportunity for states to apply for funds to establish residential substance abuse programs beginning in 1996. In conjunction with this legislation, Congress has authorized spending $270 million for the first five years of the program, the largest sum ever for the development and enhancement of substance abuse treatment programs in state and local correctional facilities.

Largely because of research showing that prison-based therapeutic community programs can significantly reduce recidivism and drug relapse, RSAT legislation encourages the development of this residential treatment model, in addition to other viable treatment approaches, including cognitive skills training, behavioral programming, vocational methods and even 12-step programming.

Therapeutic Communities

Historically, the term "therapeutic community" (TC) has been used for several different forms of treatment - sanctuaries, residential group homes and even special schools - and for several different conditions, including mental illness, drug abuse and alcoholism. For example, the British TC emerged primarily as a process for treating military veterans as they returned from WWII with serious neurotic conditions from their experiences in combat and as prisoners of war. The term was coined when Thomas Main pioneered a therapeutic model combining community therapy with ongoing psychoanalytic psychotherapy in 1946. This was a modification of therapeutic work developed about the same time by Maxwell Jones and several others. By 1954, TC ideas were influencing wards in British psychiatric hospitals.

At about the same time, the use of tranquilizers began to emerge as …