Dual diagnosis patients in the modified therapeutic community: does a criminal history hinder adjustment to treatment?

The efficacy of the drug-free therapeutic community (TC) in treating patients with chemical dependence and in rehabilitating persons with criminal histories has been extensively studied and is well established since the late 1960's. More recently, this format has been modified in order to treat individuals suffering from both addictive disorders and chronic, severe mental illness. In an indigent inner-city population, this latter group includes many patients who also have significant histories of criminal behavior. To date, there have been no systematic attempts to assess the impact of a history of criminality on the course of treatment of these patients, as they might be thought less adaptable to the milieu of a TC. In the current study, data from a sample of homeless male MICA patients were analyzed to determine if those patients with a history of criminal convictions were as likely as non-criminal patients to adjust effectively to the social milieu of a modified drug-free therapeutic community. Of 183 sequential admissions studied, 76 had never been convicted of a crime, 46 had 1 conviction, and 61 had 2 or more. No differences were observed between the groups with respect to length of stay, social adjustment on admission, and change in social adjustment during the first two months of treatment. These findings suggest that a history of criminal conduct does not compromise a dually diagnosed patient's likelihood of engaging in the social contract necessary for successful treatment in a TC.