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THERAPEUTIC COMMUNITY
A therapeutic community (TC) is a drug-free residential program that provides a highly structured, prosocial environment for the treatment of drug abuse and addiction. It differs from other treatment approaches by using the community as the key agent of change. Treatment staff and recovering clientele interact in both structured and unstructured ways to influence attitudes, perceptions, and behaviors associated with drug use. In addition, TC uses a staged, hierarchical model in which treatment stages are related to increased levels of individual and social responsibility. The sense of a strong, structured hierarchical environment-in which all participants and staff have specific tasks, responsibilities, and rights-is crucial to the success of most TC programs (Mello et al., 1997).
Meta-analyses of TC programs in the general population have consistently supported the efficacy of TC treatment protocols for substance abusers, especially when treatment has been continued over long periods of time (Garrett, 1985; Andrews et al., 1990; Lipsey, 1991). However, TC programs for incarcerated youth face special challenges. Many TC programs in both adult and youth jails have not been properly implemented because of failure to garner adequate institutional support from correctional facility administrators (Castellano & and Beck, 1991). To avoid disputes over disciplinary authority and funding, TC programs in correctional facilities must make sure that their procedures and activities do not conflict with the general schedule and routine of the larger institution (Cowles and Dorman, 2001). Providing adequate aftercare and involving participants' families is also critical in treating juvenile offenders, since research indicates that juvenile substance abusers are most likely to experience relapse within the first 6 months after treatment and reentry (DeLeon, 2000; Sealock et al., 1997).
Recent studies have demonstrated that properly implemented TC programs for juvenile offenders can have a significant impact on both the substance abuse and recidivism rates of incarcerated youth. A recent analysis of Maryland's CREST program indicates that the program significantly increases participants' likelihood of remaining drug free (Mello, 1997). Two analyses of Arizona's Amity TC program (which features an intensive aftercare component) have also found a marked decrease in both substance abuse and rearrest rates for up to 24 months after leaving prison (Mullen et al., 1991; Wexler, 1999). Subjects in the Wexler study had a rearrest rate of 26.9 percent versus a rate of 40.9 percent for nontreatment offenders. Results such as these suggest that TC programs, while challenging to implement in many correctional settings, are nevertheless worth further investigation and refinement.
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