Changing the behavior of substance abusers: Factors influencing the effectiveness of therapeutic communities

In this paper we explicate the treatment process leading to the success of therapeutic communities (TCs) in rehabilitating clients through a case study of CREST, a combined TC and work release program for substance abusers with criminal histories. We develop a comprehensive framework for understanding how and why TCs provide effective treatment to substance- abusing clients. Using data derived from a process analysis of CREST, and substantiated by the literature on TCs, the model considers both structural and programmatic elements and individual level factors. Our framework is unique in that it attempts to show the dynamic processes ongoing among various elements in the setting to produce global changes in clients that are important for living drug free.