Is the therapeutic community an evidence-based treatment? What the evidence says
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Is the therapeutic community an evidence-based treatment? What the evidence says.

De Leon G.
Therapeutic Communities: 2010, 31(2), p. 104–128.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr De Leon at

By means of this review of prominent North American trials and meta-analyses, a leading researcher in to therapeutic communities tries to settle the issue of whether these effectively and cost-effectively treat addiction, so research can move on to how to make them more effective.

Summary Despite decades of therapeutic community outcome research, critics have questioned whether these are an evidence-based treatment for addictions. Given the relative lack of randomised, double-blind control trials, it is asserted that effectiveness has not been 'proven'. Such assertions have serious implications for the acceptance and future development of the therapeutic community. The purpose of this paper is to foster consensus among researchers, policy makers, providers and the public as to the research evidence for the effectiveness of the therapeutic community. Main findings and conclusions are summarised from multiple sources of outcome research in North America, including multi-programme field effectiveness studies, single programme controlled studies, meta-analytic statistical surveys, and cost-benefit studies. The weight of the research evidence from all sources is compelling in supporting the hypothesis that the therapeutic community is an effective and cost-effective treatment for certain subgroups of substance abusers. However, full acceptance of the therapeutic community as a bona fide evidence-based approach will require a generation of studies that include randomised controlled trials as well as other quantitative and qualitative research designs.

Last revised 05 January 2011

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