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Therapeutic communities (TCs) are a common form of long-term residential treatment for substance use disorders that emerged in the late 1950s out of the self-help recovery movement.

TCs have a recovery orientation, focusing on the whole person and overall lifestyle changes, not simply abstinence from drug use. This orientation acknowledges the chronic, relapsing nature of substance use disorders. Recovery is seen as a gradual, ongoing process of cognitive change through clinical interventions, and it is expected that it will take time for program participants to advance through the stages of treatment, setting personal objectives along the way.

TCs encourage participants to examine their personal behavior to help them become more pro-social and to engage in “right living”— considered to be based on honesty, taking responsibility, hard work, and willingness to learn. As program participants progress through the stages of recovery, they assume greater personal and social responsibilities in the community. The goal is for a TC participant to leave the program not only drug-free but also employed or in school or training.

Following the concept of “community as method,” TCs use active participation in group living and activities to drive individual change and the attainment of therapeutic goals. With an emphasis on social learning and mutual self-help, individual participants take on some of the responsibility for their peers’ recovery. This aid to others is seen as an important part of changing oneself.

The recovery orientation recognizes that people will need options for ongoing support once they complete residential treatment to help them avoid relapsing. Relapse prevention is a part of many treatment programs, aiming to increase awareness and build coping skills both to reduce the likelihood or frequency of relapse and its severity if and when it does occur. As they move toward completion of a TC program, participants are aided in connecting with formal aftercare and self-help groups in the community.

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