The US therapeutic community 2017

Citation

Mullen, R. and Arbiter, N. (2017), "The US therapeutic community 2017", Therapeutic Communities: The International Journal of Therapeutic Communities, Vol. 38 No. 4, pp. 206-206. https://doi.org/10.1108/TC-10-2017-0031

Therapeutic communities (TCs) came to prominence in the USA in the heroin crisis of the 1960s – widely recognized and widely replicated as the most effective intervention. Today, as the USA experiences its worst opioid epidemic, TCs are scarcely mentioned. Instead, driven by medical and pharmaceutical interests, medically assisted treatment and short-term clinical interventions are the policies being promoted by the federal government. Several of the large TCs that were the leaders in the field have either closed or turned away from the TC modality. The national trade organization formed by TCs 40 years ago recently removed “therapeutic community” from its name. In the interest of continued funding and mainstream legitimacy, many NGOs that formerly identified themselves as TCs have become more oriented toward conventional medical and clinical interventions, abandoning the “essential elements” that were crucial to the achievement of positive outcomes.

In “The Arc of The TC” (www.youtube.com/watch?v=dDE61cCgXE8), Dr DeLeon details both early vitality and recent decline of US TCs. DeLeon has noted that research has not focused on the “collateral benefits” of the TC: family reconciliation, employment, public safety, reduction of recidivism, high-risk behaviors, communicable diseases, and dependence on public benefits – converting tax takers into tax payers.

However, there are “bright spots:” some governmental entities and NGOs continue to implement TC methodology, “community as method” and whole person education. Particularly in criminal justice, TCs are recognized as being effective not only in addressing drug abuse, but other criminal behaviors including violence, and in reducing recidivism. Where length of stay has been shortened there has been compensation by providing transition to affordable housing and extended supportive services. Today, TCs have gender responsive services for women, men, and LGBTQ. Family services have been extended and expanded. Evaluations continue to provide more evidence of TC effectiveness. Populations heretofore not well-represented in TCs are now present in larger numbers, for example: Asians and Native Americans, and men and women who have served decades of long incarcerations. TCs are a revolution of inclusion in which a healing community nurtures people to become bigger than what wounded them, to leave things better than they found them, to strive to belong to something larger than themselves that contributes to the greater good. The best TC practitioners continue to grow, reflect, and integrate their experience. 2018 marks the 60th anniversary of the formation of the TC in the USA. Hopefully, as a field, we collectively can follow the advice we have given to our newest members.