Practice Goals/Target Population
Incarceration-based therapeutic communities (TCs) are separate, residential drug-treatment programs in detention facilities for treating substance-abusing and addicted individuals . These TCs address adolescent substance abuse and mental health issues, promote healthy development, and provide continued academic instruction. The defining feature of the TC model is its emphasis on participation by all members of the program in the overall goal of reducing substance use and recidivism after release.
Practice Theory
TC theory proposes that recovery from substance abuse involves rehabilitation to learn healthy behaviors and habilitation to integrate those healthy behaviors into a routine (National Institute of Drug Abuse [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 peers and facility staff. TCs use a stepping stone model, in which participants move through several levels of treatment. As participant 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
In the traditional TC model, residents progress through the following three stages of treatment: 1) induction and early treatment, 2) primary treatment, and 3) reentry. The first stage provides residents 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 and focuses on changing attitudes and behavior related to substance use as well as on 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 residents receive discharge planning with referrals to services available in the community after release (NIDA 2002, 2015).
The juvenile TC model uses a developmentally appropriate comprehensive approach to a) address substance abuse and mental health issues, and b) promote healthy development. The model uses cognitive restructuring to change attitudes supporting unhealthy behaviors and replace them with prosocial behaviors to support responsibility and recovery. The juvenile model also includes elements of life-skills training to support social development. Other treatment approaches include motivational enhancement, trauma-informed care, art therapy, yoga, and meditation (NIDA 2015). Therapy in juvenile TCs also incorporates participation from parents, family members, and other supportive adults. Following release from incarceration, juveniles are referred to community resources for continuing family therapy and other needs (Center for Substance Abuse and Treatment [CSAT] 1999).
In the traditional TC model, residents of the TC 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).
TCs for juveniles follow the traditional TC model, which includes stages of treatment, daily routines, a system for rewards and punishments, and services for social and mental health needs (NIDA 2015). Common work responsibilities include cleaning the common areas, making dinner, and washing dishes. Juvenile TCs place more emphasis on education and schoolwork rather than on traditional work responsibilities. Juvenile residents receive at least 5 hours of educational instruction a day and additional scheduled study time (CSAT 1999).
