Culture and community in the therapeutic community: implications for the treatment of recovering substance misusers.

This paper critically discusses the conceptualization and structure of the therapeutic community employed for the treatment of substance misuse in America. The predominant American model, the concept-house model, is criticized on the grounds that the therapeutic milieu of these treatment agencies is contaminated by their subordinance to the influences of the larger American society. These influences include: the predominance of the medical model, the agency as an agent of service delivery, capitalism and inequity, implicit views of human nature, and stratification of social structure. The thesis of this paper is that treatment personnel in therapeutic communities must develop increased sensitivity to the larger cultural factors which influence the construction of the therapeutic community. It is argued that problems within the American culture play a significant role in the etiology of substance misuse. Therefore, treatment personnel must be careful to avoid constructing therapeutic communities which too closely mirror the larger culture. This cultural influence in therapeutic communities functions to maintain long-term substance misuse problems within the individual and the nation.