Evaluations of the Therapeutic Community in Addiction Treatment

The idea of a “therapeutic community” for the treatment of substance use disorders goes a long way back. It includes famous places such as The Betty Ford Clinic and similar private rehabilitation facilities that help people with the means to afford treatment to detox amongst others who also struggle to get straight.
There are also infamous “therapeutic communities” (TC) where drug offenders are sentenced to spend time in a prison or prison-like inpatient facilities until their sentences are completed.
The use of therapeutic communities to treat substance use disorders is in the news suddenly thanks to Robert F. Kennedy, Jr., former presidential candidate and nominee for Director of Health and Human Services (HHS). Kennedy, a self-admitted former heroin addict, credits therapeutic communities, including Alcoholics Anonymous, for helping straighten out his life. In a Latino Town Hall on YouTube, Kennedy said:
I’m going to create these wellness farms where they can go and get off of illegal drugs, off of opiates, but also legal drugs.
Alec Schemmel at Fox News took a long look at Kennedy’s idea of “wellness farms,” which he said “relies heavily on peer-to-peer support and behavioral solutions for addiction, as compared to medication-based treatment strategies like methadone or buprenorphine therapy.”
Let’s take a look, then, at some of the research on the effectiveness of therapeutic communities in the treatment of substance use disorders.
First up is a study from South Korea published in the Journal of Addictions Nursing involving 38 men being treated for alcohol use disorder (AUD) as outpatients. A “therapeutic community program was conducted daily for 12 weeks.” 19 patients participated in the program and 19 did not.
The average age of the TC group was 52.84 years and for the control group 52.21 years — nearly identical. They had been drinking alcohol on average for 30 years. The TC program used was modeled after the DAYTOP inpatient program at a drug treatment facility in New York. The outpatient version in South Korea ran for eight hours a day, every day, for 12 weeks, and included:
[A] morning meeting, an encounter group, a seminar, an Alcoholics Anonymous (AA) meeting, art therapy, a static group, one-on-one counseling, and a department activity.
Patients also had a “sobriety test” at the start of each day. The study does not mention whether patients were simultaneously receiving medication. The presumption is that they were, since the control group that was not part of the TC was being treated and tested daily through a hospital.
I will add at this point that it is difficult to imagine Americans attending a 12-week, 7-days-a-week, 8-hours-a-day program for substance use disorder, with or without compensation. And what government would pay for 12 weeks of daily professional care, plus medications, plus some sort of living stipend due to three months without working? Bringing recovering addicts together for eight hours a day every day is a recipe for disaster, as it was for the DAYTOP program in New York State, which “closed amidst sexual and child abuse concerns.”
This study found that the TC program increased scores on the Resilience Scale developed by Wagnild and Young, and the Client Assessment Scale (CAS), described as:
The CAS measures clinical progress in TC with developmental dimension, socialization dimension, psychological dimension, and community member dimension… High scores indicate a more effective recovery process.
On the Resilience Scale (RS), those in the daily TC program showed a statistically significant increase of 14 points compared with the control group, which had two points of improvement. The authors note:
In addition, the mean acceptance of self and life score, which is a subscale of RS, of the experimental groups increased more than the control group after 12 weeks, to a statistically significant extent.
On the combined CAS scores, the control group improved by 2.88 points and the TC group improved by seven points, “a significant improvement.” The authors also note:
[P]sychological and community member dimension scores of the experimental groups statistically significantly increased more than the control group after 12 weeks.
A study employing a similar method of therapeutic community in Ghana with inpatients at a psychiatric hospital being treated for substance use disorders found that:
[P]articipants mainly expressed positive experiences in the programme, including experiencing a sense of belongingness, enhanced self-esteem/self-worth, and most importantly, developing hope of a life free of addiction.
Where are the statistics? Where are the 12-week follow-ups? Do any improvements hold over time? We will continue to look for solid evidence that therapeutic communities or “wellness farms” have a better track record at treating substance use disorders than medication plus a mental health app.
Written by Steve O’Keefe. First published February 3, 2025.
Sources:
“RFK Jr.’s plan to combat addiction: ‘wellness farms’,” Fox News, January 26, 2025.
“Recovering America — A Film About Healing Our Addiction Crisis,” Robert F. Kennedy, Jr., June 15, 2024.
“Effectiveness of Therapeutic Community Program on Resilience and Change in Lifestyle in People With Alcohol Use Disorder,” Journal of Addictions Nursing, October 12, 2022.
“Experiences of residents in a therapeutic community model of substance use disorder treatment in a mental hospital in Ghana,” BMC Psychiatry, October 18, 2024.
Image Copyright: dotshock.