T

he therapeutic community

(TC) for the treatment of

drug abuse and addiction

has existed for about 40 years. 

In general, TCs are drug-free 

residential settings that use a

hierarchical model with treatment stages that reflect increased

levels of personal and social

responsibility. Peer influence,

mediated through a variety of

group processes, is used to help

individuals learn and assimilate

social norms and develop more

effective social skills.

TCs differ from other treatment

approaches principally in their

use of the community, comprising

treatment staff and those in recovery, as key agents of change.

This approach is often referred

to as “community as method.” TC

members interact in structured and

unstructured ways to influence

attitudes, perceptions, and behaviors associated with drug use.

Many individuals admitted to

TCs have a history of social 

functioning, education/vocational

skills, and positive community

and family ties that

have been eroded

by their substance

abuse. For them,

recovery involves

rehabilitation—

relearning or 

re-establishing

healthy functioning, skills, and 

values as well as

from the director

Each year, therapeutic communities (TCs) serve tens of thousands

of people with varying degrees of

drug problems, many of whom 

also have complex social and 

psychological problems. Research

supported by the National Institute

on Drug Abuse (NIDA) has helped

document the important role TCs

serve in treating individuals with

drug-related problems.

Further research is being conducted on the treatment processes

in TCs to better understand how

TCs work. Links between treatment

elements, experiences, and outcomes

need to be further studied to fully

appreciate and enhance the contributions of TCs. NIDA’s research

program is currently focused on

expanding our knowledge of the TC

treatment process and improving

our understanding of organizational and management strategies

to deliver more effective and 

efficient treatment services.

This Research Report is one 

of several aimed at providing 

information on approaches and

modalities used to prevent and

treat drug abuse. Based on over 

30 years of scientific inquiry and

observation, this report addresses

some of the most frequently asked

questions about TCs. Federal and

other national resources are listed

at the end of the report. 

It is hoped that this Research

Report will help establish a common

framework and understanding

about TCs for health care providers,

researchers, policymakers, and

individuals and their families in

need of treatment for drug-related

problems.

Glen R. Hanson, Ph.D., D.D.S.

Acting Director

National Institute on Drug Abuse

U.S. Department of Health and Human Services • National Institutes of Health

ResearchReport NATIONAL INSTITUTE ON DRUG ABUSE

SERIES

THERAPEUTIC

COMMUNITY

What is a therapeutic community?
regaining physical and emotional

health. Other TC residents have

never acquired functional lifestyles. For these people, the TC

is usually their first exposure to

orderly living. Recovery for them

involves habilitation—learning

for the first time the behavioral

skills, attitudes, and values 

associated with socialized living. 

In addition to the importance

of the community as a primary

agent of change, a second 

fundamental TC principle is 

“self-help.” Self-help implies 

that the individuals in treatment

are the main contributors to the

change process. “Mutual selfhelp” means that individuals also

assume partial responsibility for

the recovery of their peers—an

important aspect of an individual’s

own treatment. 

How beneficial

are therapeutic

communities in

treating drug

addiction? 

F

or three decades, NIDA 

has conducted several large 

studies to advance scientific

knowledge of the outcomes of

drug abuse treatment as typically

delivered in the United States.

These studies collected baseline

data from over 65,000 individuals

admitted to publicly funded 

treatment agencies. They included

a sample of TC programs and

other types of programs (i.e.,

methadone maintenance, outpatient drug-free, short-term

inpatient, and detoxification 

programs). Data were collected

at admission, during treatment,

and in a series of followups that

focused on outcomes that

occurred 12 months and longer

after treatment. 

These studies found that

participation in a TC was associated with several positive outcomes. For example, the Drug

Abuse Treatment Outcome Study

(DATOS), the most recent longterm study of drug treatment 

outcomes, showed that those 

who successfully completed treatment in a TC had lower levels of

cocaine, heroin, and alcohol use;

criminal behavior; unemployment;

and indicators of depression than

they had before treatment.

Who receives

treatment in a

therapeutic 

community? 

T

Cs treat people with a range

of substance abuse problems. Those treated often

have other severe problems,

2NIDA RESEARCH REPORT SERIES

Pre- and posttreatment self-reported changes among those in long-term residential TCs

*p<.01 for changes pre- and posttreatment.

Pretreatment measures are for the 12 months before admission. Posttreatment measures are for the 12 months after treatment.

Source: Hubbard et al., Psychology of Addictive Behaviors, 11:261-278, 1997.

100

80

60

40 

20

0 Cocaine Heroin Heavy Illegal No full-time Suicidal

(weekly)* (weekly)* alcohol* activity* work* ideation*

Percent of TC patients (N=676)

66%

22% 17%

40%

19%

41%

16%

88%

77%

24%

13%

6%

Pre

Post
such as multiple drug addictions,

involvement with the criminal

justice system, lack of positive

social support, and mental 

health problems (e.g., depression,

anxiety, posttraumatic stress disorder, and antisocial and other

personality disorders).

For example, in DATOS, which

tracked 2,345 admissions to residential TC treatment between

1991 and 1993, two-thirds of

admissions had a criminal justice

status (e.g., on probation, on

parole, or pending trial) at

admission, and about a third 

had been referred to treatment

from the criminal justice system.

Nearly a third of admissions

were women, and nearly half

were African American. Sixty

percent had prior drug abuse

treatment experience.

What is the typical

length of treatment

in a therapeutic

community?

I

n general, individuals progress

through drug addiction treatment at varying speeds, so

there is no predetermined length

of treatment. Those who complete treatment achieve the best

outcomes, but even those who

drop out may receive some benefit.

Good outcomes from TC 

treatment are strongly related to

treatment duration, which likely

reflects benefits derived from the

underlying treatment process.

Still, treatment duration is a 

convenient, robust predictor of

good outcomes. Individuals who

complete at least 90 days of

treatment in a TC have significantly better outcomes on average than those who stay for

shorter periods.

Traditionally, stays in TCs have

varied from 18 to 24 months.

Recently, however, funding

restrictions have forced many TCs

to significantly reduce stays to 12

months or less and/or develop

alternatives to the traditional 

residential model (see “How else

can TCs be modified?”).

For individuals with many serious problems (e.g., multiple drug

addictions, criminal involvement,

mental health disorders, and low

employment), research again

suggests that outcomes were 

better for those who received 

TC treatment for 90 days or

more. In a DATOS study, treatment outcomes were compared

for cocaine addicts with six or

seven categories of problems

and who remained in treatment

at least 90 days. In the year 

following treatment, only 15 percent of those with over 90 days

in TC treatment had returned to

weekly cocaine use, compared 

to 29 percent of those who received over 90 days of outpatient

drug-free treatment and 38 percent of those receiving over 3

weeks of inpatient treatment. 

The relationship between

retention and good treatment

outcomes identified in DATOS

has been replicated in many

studies. However, many TCs

have a high dropout rate,

although about one-third of

dropouts seek readmission. A

significant research effort is

NIDA RESEARCH REPORT SERIES3

1-year outcomes for shorter and longer stays in TC treatment

< 90 days

90+ days

Cocaine

(any use)*

UA+

(any drug)*

Alcohol

(daily use)*

Any jail*

0 20 40 60

Percent of TC patients (N=342)

*p<.01 for all four measures.

Cocaine use, alcohol use, and being jailed are self-report measures for the 12 months after 

treatment. UA+ indicates a positive urinalysis test at the followup interview.

Source: Simpson et al., Psychology of Addictive Behaviors, 11:264-307, 1997.

55%

28%

53%

19%

15%

9%

54%

24%
underway to better understand

and improve TC treatment 

retention by examining external

factors, program services and

processes, and attributes of 

individuals in treatment.

External factors related to

retention include level of association with family or friends

who use drugs or are involved 

in crime, and legal pressures to

enroll in treatment. Inducements—

sanctions or enticements by the

family, employment requirements,

or criminal justice system pressure—can improve treatment

entry and retention and may

increase the individual’s internal

motivation to change with the

help of treatment.

In the TC, the level of treatment

engagement and participation is

related to retention and outcomes.

Treatment factors associated 

with increased retention include 

having a good relationship with

one’s counselor, being satisfied

with the treatment, and attending

education classes. One study

tested a strategy to enhance

motivation by increasing new

residents’ exposure to experienced staff, in contrast to the

more traditional approach of

largely relying on junior staff as

role models. The senior staff provided seminars for new residents

based on their own experiences

with retention-related topics. This

strategy appeared to increase the

30-day retention rate and was

particularly effective for those

whose pretreatment motivation

was the weakest.

Important attributes linked to

treatment retention include selfesteem, attitudes and beliefs

about oneself and one’s future,

and readiness and motivation 

for treatment. Retention can be

improved through interventions

to address these areas. One

approach focuses on teaching

cognitive strategies to improve

self-esteem, develop “road maps”

for positive personal change,

improve understanding of how

to benefit from drug abuse treatment, and develop appropriate

expectations for treatment and

recovery. This approach was particularly effective for individuals

with lower educational levels.

What are the 

fundamental 

components of

therapeutic 

communities?

Research spanning more

than 30 years has identified

key concepts, beliefs, 

clinical and educational practices,

and program components common to most TC programs. These

elements reflect the two principles

that drive TC operations: the

community as change agent and

the efficacy of self-help.

Typically, TCs are residential

facilities separate from other programs and located away from the

drug-related environment. As a

participant in the community, the

resident in treatment is expected

to adhere to strict and explicit

behavioral norms. These norms

are reinforced with specific 

contingencies (rewards and 

punishments) directed toward

developing self-control and

responsibility. The resident will

progress through a hierarchy of

increasingly important roles, with

greater privileges and responsibilities. Other aspects of the TC’s

“community as method” therapeutic approach focus on changing negative patterns of thinking

and behavior through individual

and group therapy, group sessions

with peers, community-based

learning, confrontation, games,

and role-playing.

TC members are expected to

become role models who actively

reflect the values and teachings

of the community. Ordered 

routine activities are intended 

to counter the characteristically

disordered lives of these residents

and teach them how to plan, 

set, and achieve goals and be

accountable.

Ultimately, participation in a

TC is designed to help people

appropriately and constructively

identify, express, and manage

their feelings. The concepts of

“right living” (learning personal

and social responsibility and

ethics) and “acting as if”

(behaving as the person should

be rather than has been) are

integrated into the TC groups,

meetings, and seminars. These

activities are intended to heighten

awareness of specific attitudes 

or behaviors and their impact 

on oneself and the social 

environment. 

How are 

therapeutic 

communities

structured?

T

Cs are physically and programatically designed to

emphasize the experience of

4NIDA RESEARCH REPORT SERIES
community within the residence.

Newcomers are immersed in the

community and must fully participate in it. It is expected that in

doing so, their identification 

with and ties to their previous

drug-using life will lessen and

they will learn and assimilate new

prosocial attitudes, behaviors,

and responsibilities.

Although the residential 

capacity of TCs can vary widely, a

typical program in a communitybased setting accommodates 40 

to 80 people. TCs are located in

various settings, often determined

by need, funding sources, and

community tolerance. Some, 

for example, are situated on the

grounds of former camps and

ranches or in suburban houses.

Others have been established 

in jails, prisons, and shelters.

Larger agencies may support 

several facilities in different 

settings to meet various clinical

and administrative needs. 

In DATOS, there was an average of one counselor reported

for every 11 residents in treatment. About two-thirds of the

counseling staff had themselves

successfully completed drug

abuse treatment programs.

Increasingly, TCs rely on degreed

staff (e.g., social workers, nurses,

and psychologists) for some

aspects of treatment.

How is treatment

provided in a

therapeutic 

community?

T

C treatment can be divided

into three major stages. 

Stage 1. Induction 

and early treatment typically 

occurs during the first 30 days 

to assimilate the individual into

the TC. The new resident learns

TC policies and procedures;

establishes trust with staff and

other residents; initiates an assisted

personal assessment of self, 

circumstances, and needs; begins

to understand the nature of

addiction; and should begin to

commit to the recovery process.

Stage 2. Primary treatment

often uses a structured model of

progression through increasing

levels of prosocial attitudes,

behaviors, and responsibilities.

The TC may use interventions to

change the individual’s attitudes,

perceptions, and behaviors related

to drug use and to address the

social, educational, vocational,

familial, and psychological needs

of the individual. 

NIDA RESEARCH REPORT SERIES5

What is daily life like in a therapeutic community?

T

he TC day is varied but regimented. A typical TC day

begins at 7 a.m. and ends at 11 p.m. and includes 

morning and evening house meetings, job assignments,

groups, seminars, scheduled personal time, recreation, 

and individual counseling. As employment is considered 

an important element of successful participation in society,

work is a distinctive component of the TC model.

In the TC, all activities and interpersonal and social interactions are considered important opportunities to facilitate

individual change. These methods can be organized by 

their primary purpose, as follows:

■ Clinical groups (e.g., encounter groups and retreats)

use a variety of therapeutic approaches to address 

significant life problems.

■ Community meetings (e.g., morning, daily house, 

and general meetings and seminars) review the goals, 

procedures, and functioning of the TC.

■ Vocational and educational activities occur in 

group sessions and provide work, communication, and 

interpersonal skills training.

■ Community and clinical management activities

(e.g., privileges, disciplinary sanctions, security, and 

surveillance) maintain the physical and psychological 

safety of the environment and ensure that resident life 

is orderly and productive.
Stage 3. Re-entry is intended

to facilitate the individual’s 

separation from the TC and 

successful transition to the larger

society. A TC graduate leaves the

program drug-free and employed

or in school. Postresidential 

aftercare services may include

individual and family counseling

and vocational and educational

guidance. Self-help groups such

as Alcoholics Anonymous and

Narcotics Anonymous are often

incorporated into TC treatment,

and TC residents are encouraged

to participate in such groups

after treatment.

Can therapeutic

communities treat

populations with

special needs?

Research shows that those

with special or complex

needs can be treated in

TCs. For example, individuals

with co-occurring mental illness

and substance abuse may be

treated in TC-oriented programs

based in shelters, community 

residences, day treatment 

clinics, partial hospitalization 

settings, or on hospital wards.

Community-based TC programs

provide effective treatment for

clients with criminal involvement,

but successful TC programs 

for drug-involved offenders 

have also been established in

correctional settings. Other 

special populations with substance abuse problems that 

may benefit from TC-oriented

programs include adolescents,

women and their children,

persons with HIV/AIDS, and

homeless people.

Specialized treatment strategies

and services are often incorporated as part of the TC for these

populations. Support may include

child care services for mothers;

programs aimed at normalizing

the developmental process for

adolescents; access to mental

health and social services for

individuals with co-occurring

mental illness and substance

abuse; attention to changing

criminal thinking and behavior

for the criminal offender; and

links to medical and social services for those with HIV/AIDS.

Individualized treatment, including lengths of stay tailored to the

person’s needs, is especially

important due to the complexity

of possible problems. In addition,

TC clinical and management

activities may need to be modified

in terms of disciplinary sanctions,

peer interactions, and degree of

confrontation in groups.

Women 

Women who enter drug abuse

treatment often have many serious problems. Many suffer from

low self-esteem, depression, or

other mental health disorders;

are in abusive relationships; have

little access to medical, mental

health, and social services; lack

marketable job skills; and have

child custody concerns.

Both women-only programs

and mixed-gender programs can

be helpful in treating the drug

problems of women. As might

be expected, women-only programs and programs that serve

higher percentages of women

usually provide more services

that women need. The evidence

suggests that these services 

can contribute to significantly

longer lengths of stay in treatment, which is related to better

treatment outcomes.

Newer TC approaches for

treating women with drug addictions often focus on issues related

to family and children. Some

6NIDA RESEARCH REPORT SERIES

Therapeutic communities often 

incorporate specialized 

strategies and services to treat those

with special or complex needs.
model programs have found 

that allowing a woman’s children

to live with her in the TC can

improve her mental health and

lengthen retention. Although 

evidence tends to support the

benefits of specialized services

for women, more research is

needed to determine the optimal

structure of TC treatment in

meeting women’s needs.

Adolescents

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.

Posttreatment 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.

Individuals with 

co-occurring mental 

health disorders

Individuals with co-occurring

mental health and substance

abuse disorders are among the

most difficult to treat. Such individuals often have serious and

complex impairments in multiple

areas, in addition to drug abuse

and mental illness. TCs can be

adapted to treat individuals with

mental disorders, including, in

NIDA RESEARCH REPORT SERIES7
some cases, the use of psychotropic medications to treat

serious mental illness. A recent

study compared a TC for people

who were homeless, mentally ill,

and substance abusers to a community residence based on a traditional mental health treatment

model. In the mental health

model, individuals were housed

within a less restrictive alternative to the psychiatric hospital by

coupling a high level of personal

freedom with counseling, skills

training, and monitoring of medication compliance. The TC provided integrated mental health

and drug abuse treatment in a

highly structured, hierarchical

environment that stressed mutual

self-help and treatment community participation. Those in the

TC showed more improvement

on all measures of psychopathology than those in the community

residence. In addition, the TC

program retained the most

impaired individuals longer than

did the community residence.

The investigators concluded that

the increased structure provided

by the TC may be a better option

for this population than the less

restrictive community residence

model.

Another study that tested modifications to the TC to accommodate homeless drug abusers

with co-occurring mental health

problems included greater flexibility in program requirements,

reduced duration of activities 

and level of confrontation, and

greater responsiveness to individual needs. A second set of modifications, for a low-intensity 

TC, allowed residents greater

freedom to leave the facility during the early stages of treatment,

offered services in day treatment

settings outside the residence,

decreased the level of peer

responsibility, and increased the

amount of direct staff assistance.

The modified TCs were compared to “treatment as usual,”

which consisted of a heterogeneous mix of alternatives often

encountered after discharge from

shelters or psychiatric facilities.

Analyses comparing the outcomes of modified TC treatment

to the usual options found that

drug use was reduced in both

groups, although participation in

the modified TCs led to significantly greater improvements for

criminal activity and indicators 

of depression. 

Populations involved in

the criminal justice system

As drug abuse and crime are

often linked, many drug-abusing

or addicted individuals also are

involved with the criminal justice

system. Some of the most extensive research studies on TCs

have been conducted on treatment for populations involved 

in the criminal justice system.

These studies have found benefits for prison-based TC treatment

in preparing inmates to return to

the community and for creating 

a safer, better managed prison

environment. Drug-involved

offenders have the best outcomes when they participate in

community-based TC treatment

while transitioning from incarceration to re-entry to the 

community.

One such study followed drugabusing and addicted inmates in

the Delaware Correctional

System to determine the effectiveness of a continuum of care

on relapse to drug use and

recidivism to criminal activity.

The continuum of care began in

prison with a State-funded TC

program called The Key. Inmates

transitioned back into the community through a work-release

program that allowed them to

work in the community but

required their return to a secure

facility overnight. Some inmates

were randomly assigned to usual

work release, and some were

assigned to Crest, a TC workrelease program. In the third

stage of treatment, some who

had completed the Crest workrelease TC and were living in 

the community continued in 

an aftercare program, which 

provided continued monitoring

by TC counselors, outpatient

counseling, group therapy, and

family sessions.

One year after scheduled 

completion of work release, 

significantly higher percentages

of inmates who had participated

in Crest or in both Key and Crest

were drug-free and arrest-free

than those assigned to usual

work release. Further, outcomes

for those who participated in

both Key and Crest were better

than for all three other groups.

At 3 years after work release,

Crest treatment graduates and

especially those who continued

with aftercare had significantly

8NIDA RESEARCH REPORT SERIES
better outcomes than those who

dropped out in terms of avoiding

both relapse to drug use and rearrest. This study also highlights

the value of continuing treatment

of offenders during their transition back into the community.

Another study conducted in

the R.J. Donovan Correctional

Facility in San Diego, California,

investigated the effect of the TC

on criminal recidivism for inmates

with drug problems. This study

compared rates of re-incarceration

and time until re-incarceration

for those randomly assigned to a

prison-based TC (the Amity program) to rates for a no-treatment

control group. After prison, some

who completed the Amity program chose to enter Vista, a

community-based TC aftercare

program designed to complement and continue the prison

program’s curriculum. Those

who benefited most were the

individuals who continued and

completed treatment in Vista.

Similar outcomes were found

at 3 years after release from

prison. Only 27 percent of those

completing Vista treatment had

been returned to custody, compared to 75 percent of the notreatment controls. Among those

who were re-incarcerated, the

amount of exposure to treatment

was significantly related to the

number of days until return to

custody, with greater treatment

exposure related to a longer time

until re-incarceration.

NIDA RESEARCH REPORT SERIES9

*p<.05 from no treatment.

Percentages show any use of drugs (either self-reported or detected by urinalysis) and any arrests

in the year after work release. Note that prisoners were allowed to access treatment on their own,

and some of those in the no treatment condition did receive services that were not part of the Key

or Crest programs. Total number of patients was 448.

Source: Martin et al., The Prison Journal 79:294-320, 1999.

100

80

60

40 

20

0 No Tmt Key Crest Key-Crest

Percent of patients

16%

46%

22%

31%

57%

47%

77%

43%

Drug-free Arrest-free

Delaware Correctional System participants in prison 

TC (Key) and work release TC (Crest)

Drug-free and arrest-free 1 year after work release

No treatment 

controls

Prison TC dropouts

Prison TC completers

Prison TC completers

aftercare dropouts

Prison TC completers

aftercare completers

0 10 20 30 40 50

Percent of participants

Bars show the percentage of individuals re-incarcerated in the year following release from prison.

Total number of participants was 715. 

Source: Wexler et al., Criminal Justice and Behavior, 26:147-167, 1999.

50%

45%

40%

39%

8%

R.J. Donovan Correctional Facility participants in prison 

TC (Amity) and community-based TC aftercare (Vista)

Re-incarceration rates 12 months after prison release

*

* *

*
Persons living with

HIV/AIDS 

Several studies have shown that

the TC can be effective in caring

for HIV-infected substance

abusers and in modifying risk

behavior to reduce HIV transmission. In the late 1980s, when

AIDS was considered a terminal

illness, several approaches to

modifying the TC were developed to provide a comprehensive, multilayered therapeutic

milieu addressing the multiple

problems of individuals with

HIV/AIDS.

One such model in New York

merged modified TC principles

with nursing home standards of

medical and psychiatric care to

improve physical and psychological health. This model has

evolved in step with advances 

in treatment for AIDS. Another

modified TC model in San

Francisco was designed to

engage HIV-infected persons in

treatment, retain them, and link

them to appropriate medical,

psychiatric, and other social 

services. The modifications to

this TC included providing these

individuals with accelerated entry

into the program, a more comprehensive assessment, a higher

ratio of professional mental

health and medical staff, and

greater attention to staff issues

such as stress, grief, and burnout.

Several studies have found 

that TC treatment reduces HIV

risk by reducing injection drug

use. Length of treatment, an

important predictor of drug use

outcomes, may also be important

in reducing some HIV risk

behaviors. In a study conducted

in San Francisco, reductions in

injection drug use and risky 

sexual practices were found 

for both a traditional TC and 

a modified day-treatment TC. 

The longer the person was in

treatment, the less likely he 

or she was to engage in risky

behaviors.

How else can 

therapeutic 

communities be

modified?

More recently, research

efforts have sought 

to determine how to

modify TCs to accommodate 

the realities and constraints of a

managed care health environment. Major adaptations being

tested include the impact of

shorter lengths of stay and the

use of a day treatment model. 

Shorter lengths of stay

Originally, the TC was envisioned

as an alternative community that

had no specific length of stay. 

As the TC developed into a

mainstream treatment modality

and external pressures emerged

to manage treatment resources

more efficiently, the expected

length of treatment became

shorter—first to around 24 months

and now to around 12 months. 

One study compared two 

TCs differing in the length of 

residential stay. The planned

treatment duration was 12

months in each program, but

one was designed as a 9-month

residential/3-month outpatient

program and the other was a 

6-month residential/6-month 

outpatient phase. No statistically

significant differences in outcomes were found between these

treatment designs, except that

the program with the 9-month

residential phase produced

better employment outcomes.

However, successful outcomes

depended more on completing

both phases of the programs than

on the length of the residential

phase. 

The day treatment TC 

The day treatment TC is less

intensive than residential TC

treatment but more intensive

than the typical outpatient drug

treatment program. Day treatment TCs employ a community

approach and the principles of

mutual self-help. They can be

helpful in preparing a person for

entry into a residential program

or may serve as a “step down”

modality after the residential

phase is complete. Day treatment

TCs can also provide comprehensive, self-contained treatment

for those who may not need 

residential care. 

In a study comparing a day

treatment TC with a traditional

residential TC, the day treatment

TC produced outcomes comparable to the traditional TC,

including reduction in alcohol

and drug use and improvement

in many problem areas. Possibly

10NIDA RESEARCH REPORT SERIES
NIDA RESEARCH REPORT SERIES11

because of poorer retention

rates, the day treatment program

was not as successful as the 

traditional TC with those who

had severe social and psychiatric

problems. The traditional 

residential TC also had better

outcomes for employment, an

area heavily emphasized in 

most residential TC program.

However, for those with less

severe mental health and social

functioning problems, the day

treatment TC may be more 

cost-effective.

Resources

NIDA

General Inquiries: NIDA Public Information Office, 301-443-1124 

Inquiries about NIDA’s treatment research activities: 

■ Division of Treatment Research and Development, 301-443-6173

■ Division of Epidemiology, Services, and Prevention Research, 

301-443-4060.

www.drugabuse.gov

Center for Substance Abuse Treatment (CSAT)

CSAT, a part of the Substance Abuse and Mental Health Services

Administration, supports treatment services through block grants, 

disseminates findings to the field, and promotes their adoption. CSAT 

also operates the National Treatment Referral Hotline (1-800-662-HELP).

CSAT publications are available through the National Clearinghouse on 

Alcohol and Drug Information (1-800-729-6686). www.samhsa.gov/csat

National Clearinghouse on Alcohol and Drug Information

(NCADI)

NIDA educational resources on drug addiction treatment and publications

from other Federal agencies are available from this source. Staff 

provides assistance in English and Spanish and has TDD capability; 

call 1-800-729-6686. www.health.org

National Institute of Justice (NIJ)

NIJ supports research, evaluation, and demonstration programs on 

drug abuse in the contexts of crime and the criminal justice system. 

For information and publications, contact the National Criminal Justice

Reference Service at 1-800-851-3420 or 301-519-5500.

www.ojp.usdoj.gov/nij

Therapeutic Communities of America (TCA)

TCA is an association of member organizations that advocate for 

and promote understanding of TCs. TCA increases knowledge of the 

TC philosophy and methodology; develops and promulgates standards 

of quality for TC programs and practitioners; provides members with 

information, networking, and forums to promote the TC methodology; 

and creates a supportive atmosphere for members in their individual efforts

and national representation. For more information, call 202-296-3503.

www.tcanet.org

Access NIDA 

information on the

Internet

• What’s new on the NIDA Web site

• Information on drugs of abuse

• Publications and communications

(including NIDA NOTES)

• Calendar of events

• Links to NIDA organizational units

• Funding information 

(including program announcements 

and deadlines)

• International activities

• Links to related Web sites 

(access to Web sites of many other

organizations in the field)

NIDA Web Sites

www.drugabuse.gov

www.marijuana-info.org

www.steroidabuse.org

www.clubdrugs.org

NCADI

Web Site: www.health.org

Phone No.: 1-800-729-6686
12NIDA RESEARCH REPORT SERIES

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NIH Publication Number 02-4877

Printed August 2002

Feel free to reprint this publication.