Abstract
The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. Methods: A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. Results: At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. Conclusions: With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed.
Highlights
Designed to be implemented in a psychiatric setting, the concept of the Therapeutic Community (TC) has evolved to be applied to drug rehabilitation [1]
For those individuals with a primary alcohol problem, 77% of this subsample (n = 30) were considered severely alcohol dependent. Baseline wellbeing in this cohort was markedly low, with only 7.2% of residents scoring within the range of normative Australian individual scores (50.4 to 100, across 30 studies, n = 59,536; [45]), and with a substantially lower group mean Personal Wellbeing Index (PWI) score than found in other substance misuse cohorts
While some researchers have suggested that significant results can only be achieved within a TC following a minimum Length of stay (LOS) of 90 days (e.g., [22]), our results indicate that reductions in substance use can be found in residents who stayed for under 90 days, but these improvements are only half of what is achieved compared to those staying longer than 9 months
Summary
Designed to be implemented in a psychiatric setting, the concept of the Therapeutic Community (TC) has evolved to be applied to drug rehabilitation [1]. The TC approach is a highly structured and primarily self-governed community, which distinguishes it from other types of residential rehabilitation, with clear expectations, consequences, roles, and schedules, in which residents progress through a hierarchy of increasing responsibilities. These structures help residents integrate into social networks, increase social skills, enhance accountability to the group, and instil self-reliance [3]. This study sought to determine substance use and biopsychosocial outcomes at 3 months and 9 months following TC treatment across two sites. This study sought to determine the role of length of stay in clinical outcomes
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