Practice Goals/Target Population
Incarceration-based therapeutic communities (TCs) are separate residential drug treatment programs in prisons or jails for treating substance-abusing and addicted individuals. The defining feature of TCs is the emphasis on participation by all members of the program in the overall goal of reducing substance use and recidivism.
Practice Theory
The TC theory proposes that recovery from substance abuse involves rehabilitation to learn healthy behaviors and habilitation to integrate those healthy behaviors into a routine (NIDA 2015). TCs differ from other models of treatment by their focus on recovery, overall lifestyle changes, and the use of the “community” as the key instrument for that change (De Leon and Wexler 2009; NIDA 2015; Welsh 2007; Vanderplasschen et al. 2012). The community includes inmate peers and facility staff. TCs use a stepping-stone model in which participants progress through several levels of treatment. As they progress through each treatment level, their level of responsibility also increases. TCs are implemented in a residential setting to help inmates adjust to the idea of a community working together toward a common goal (Welsh 2007). Treatment includes aftercare and reentry services as a means of providing continued support and relapse prevention after leaving the community (NIDA 2015).
Practice Components
Residents of TCs progress through treatment in three stages 1) induction and early treatment, 2) primary treatment, and 3) reentry. The first stage provides the resident with an introduction to the TC rules and procedures, staff, and community members. During this stage, residents begin TC model treatment and are integrated into the community. The second stage is the main treatment phase, which focuses on changing attitudes and behavior related to substance use as well as addressing other needs. Common treatment approaches include cognitive behavioral therapy and motivational interviewing. Other treatment services provide assistance with social, familial, medical, and mental health needs. The third stage prepares the residents for their transition from the program and includes aftercare services. During this final stage, resident discharge planning provides referrals for reentry services available in the community once the participants are released (NIDA 2002; 2015).
Specific treatment interventions vary by facility, but there are several common components of TCs. Residents of TCs are housed separately from other inmates in order to establish and maintain a drug-free, rehabilitative, prosocial environment. Residents must follow strict community rules and norms, reinforced with set rewards or punishments, as a way to facilitate self-control and responsibility. Routines are established to teach goal planning and accountability. Residents must participate in TC-related roles, as assigned, based on a hierarchy of increasing responsibilities and privileges. Residents must also participate in TC-related activities such as community meetings, individual and group counseling, games, and role playing (NIDA 2002; 2015). These roles include chores and jobs for maintaining the community and its daily operations. All activities, aside from individual counseling, occur in group formats (CSAT 1999). In addition to their assigned community-related work, residents typically participate in 4 to 5 hours of treatment a week (NIDA 2015).
