Therapeutic Communities: Evolutionary Arc and the Opioid Epidemic

  • George De Leon


The complexity of the present epidemic underscores the need for strategies that address the diversity of people, problems, and social psychological issues associated with drug abuse and the risk of overdose death. Modern TCs emerged during an earlier epidemic of heroin abuse in the 1960s. Its early success spurred a rapid diffusion of the approach to serve a diversity of substance abusers in various settings. This chapter briefly traces the 50-year evolutionary arc of the North American TC, its accomplishments, the challenges of adapting the approach to various populations and settings, and its unique role in the current epidemic.


Opioid use disorder Medically assisted treatment Therapeutic communities Mutual self-help Community as method Recovery perspective 


  1. 1.
    Beckwith M, Best D, Dingle G, Perryman C, Lubman D. Predictors of flexibility in social identity among people entering a Therapeutic Community for substance abuse. Alcohol Treat Q. 2015;33(1):93–104.CrossRefGoogle Scholar
  2. 2.
    Coletti S, Schinka J, Hughes P, Hamilton N, Renard C, Sicilian D, Urman C, Neri R. PAR village for chemically dependent women philosophy and program elements. J Subst Abus Treat. 1995;12(4):289–96.CrossRefGoogle Scholar
  3. 3.
    De Leon G. Aftercare in Therapeutic Communities. Int J Addict. 1990–1991;25(9A&10A):1225–37.PubMedGoogle Scholar
  4. 4.
    De Leon G, editor. Community as method: Therapeutic Communities for special populations and special settings. Westport: Greenwood; 1997.Google Scholar
  5. 5.
    De Leon G. The Therapeutic Community; theory, model and method. New York: Springer Publishing; 2000.CrossRefGoogle Scholar
  6. 6.
    De Leon G. Integrating maintenance and different therapeutic programming. In: Waal H, Haga E, editors. Maintenance treatment of heroin addiction: evidence at the crossroads. Oslo: J.W. CappelenAkademiskForlag; 2003. p. 296–314.Google Scholar
  7. 7.
    De Leon G. Is the Therapeutic Community an evidence based treatment? What the evidence says. Int J Therap Commun. 2010;31(2):104–75.Google Scholar
  8. 8.
    De Leon G. “The Gold Standard” and related considerations for a maturing science of substance abuse treatment. Therapeutic Communities; a case in point. Subst Use Misuse. 2015;50(8-9):1106–9.PubMedCrossRefGoogle Scholar
  9. 9.
    De Leon G. In: Ackerman G, Shuker R, editors. Therapeutic Communities for substance abusers in correctional settings: Springer Publications; In Press.Google Scholar
  10. 10.
    De Leon G, Jones HE, Stitzer M. Medication free treatment of opioid dependence. In: Strain EC, Stitzer ML, editors. The treatment of opioid dependence. Baltimore: Johns Hopkins University Press; 2005. p. 323–45.Google Scholar
  11. 11.
    De Leon G, Melnick G, Cleland C. Client matching: a severity-treatment intensity paradigm. J Addict Dis. 2008;27:99–113.PubMedCrossRefGoogle Scholar
  12. 12.
    De Leon G, Staines GL, Perlis TE, Sacks S, McKendrick K, Hilton R, Brady R. Therapeutic Community methods in methadone maintenance (passages):an open clinical trial. Drug Alcohol Depend. 1995;37(1995):45–57.PubMedCrossRefGoogle Scholar
  13. 13.
    Dye M, Ducharme L, Johnson J, Knudsen H, Roman P. Modified Therapeutic Communities and adherence to traditional elements. J Psychoactive Drugs. 2009;41(3):275–83.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Hiller ML, Saum CA. Substance abuse treatment in prison: the Therapeutic Community. In: Church WT, Springer D, editors. Serving the stigmatized: working within the incarcerated environment. New York: Oxford University Press; 2018.Google Scholar
  15. 15.
    Jainchill N. Therapeutic Communities for adolescents; the same and not the same. In: Community as method: Therapeutic Communities for special populations and special settings. Westport: Greenwood; 1997.Google Scholar
  16. 16.
    Kreager DA, Bouchard M, De Leon G, Schaeffer DR, Soyer M, Young JT, Zajac G. A life course and networks approach to prison Therapeutic Communities. In: Social networks in the life course. Cham: Springer; 2018. p. 433–51.CrossRefGoogle Scholar
  17. 17.
    Lewis B, Ross R. Retention in Therapeutic Communities: challenges for the nineties HIV: advances in research and applications. NIDA Research Monograph Series no. 144 1994, 232-25899=116; 1994.Google Scholar
  18. 18.
    Martin S, Butzin CA, Saum CA, Inciardi JA. Three year outcomes of Therapeutic Community treatment for drug involved offenders in Delaware. Prison J. 1999;79(3):291–320.CrossRefGoogle Scholar
  19. 19.
    McCusker J, Sorensen J. HIV and Therapeutic Communities in Therapeutic Community: advances in research and applications. NIDA Research Monograph Series no. 144; 1994, pp. 232–258.Google Scholar
  20. 20.
    National Institute On Drug Abuse Research Report Series; Therapeutic Community. What is a Therapeutic Community?. Rockville: National Institute on Drug Abuse; 2002, 2015.Google Scholar
  21. 21.
    Sacks S, Banks S, McKendrick K, Sacks J. Modified Therapeutic Community for co-occurring disorders: a summary of four studies. J Subst Abus Treat. 2008;34(1):112–22.CrossRefGoogle Scholar
  22. 22.
    Simpson DD, Curry SJ, editors. Drug abuse treatment outcome studies (DATOS). Psychol Addict Behav. 1997;11(special issue 4):211–337.Google Scholar
  23. 23.
    The Therapeutic Community. Proceedings of Therapeutic Communities of America planning conference, Jan. 29–30, 1976. DHEW Publication No.(ADM) 77-464.Google Scholar
  24. 24.
    Tims F, De Leon G, Jainchill N, editors. 1994 Advances in research and applications. NIDA Research Monograph Series no. 144, 1994.Google Scholar
  25. 25.
    Vanderplasschen W, Colbert K, Autrique M, Rapp RC, Peace S, Broekaert E, Vandevelde S. Therapeutic Communities for addictions: a review of their effectiveness from a recovery-oriented perspective. Sci World J. 2013;2013:1–22.Google Scholar
  26. 26.
    Warren KL, Doogan N, De Leon G, Phillips GS, Moody J, Hodge A. Short-run prosocial behavior in response to receiving corrections and affirmations in three Therapeutic Communities. J Offender Rehabil. 2013;52(4):270–86.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Wexler HK, Prendergast ML. Therapeutic Communities in United States’ prisons: effectiveness and challenges. Ther Communities. 2010;31:157–75.Google Scholar
  28. 28.
    Winick C, Evans J. A Therapeutic Community Program for mothers and their children. In: De Leon G, editor. Community as method: Therapeutic Communities for special populations and special settings. Westport: Greenwood; 1997.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • George De Leon
    • 1
  1. 1.Department of PsychiatryNew York University School of MedicineNew YorkUSA

Personalised recommendations