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What's the Difference Between an Alcohol Rehab and a Therapeutic Community for Drug or Alcohol Addiction Treatment?

Where Should You Go?

When people with substance abuse problems consider a residential facility for the treatment of an addiction, they are faced with a choice between two very distinct models of treatment. An alcohol rehab facility will generally offer shorter periods of very intensive professional therapy and enforced sobriety, and a therapeutic community will offer a very long period of structured living and therapeutic involvement in an orderly community based model of recovery. An alcohol rehab program may finish in as little as 28 days, and rarely exceeds three months, but therapeutic community treatment offers long term care, generally from 12 months to 2 years.

Why Such a Difference in the Length of Involvement?

The two types of residential drug treatment have slightly different goals, and as such require different lengths of involved participation to achieve their aims.

An alcohol rehab facility is exclusively designed to help people overcome a physical or psychological addiction to drugs or alcohol, but does not offer much in the way of general living skills training or support. A therapeutic community also exists to help people overcome an addiction, but also recognizes that many of the people suffering from a dependency to drugs or alcohol lack basic socialization and life skills, and that without first learning (or re learning) these necessary skills they are at great risk for a relapse back to abuse.

Because the therapeutic community attempts a far more ambitious program of personal change and growth, by necessity, the programming needs to be far longer lasting.

How Does the Therapeutic Programming Differ Between Rehab and Therapeutic Community?

The types of professionally run therapies offered do not differ much between the two models of residential treatment. Both will offer 12 steps meetings for recovery, individual sessions with a psychologist or addictions professional, peer support group programming, and cognitive behavioral education and training.

Intensity of Therapies

Although the two types of facilities will offer the same types of programming, the intensity of therapeutic programming does differ. An alcohol rehab facility aims only to teach the needed life skills and strategies to end drug or alcohol seeking behaviors, and as such the brief period of residency is therapeutically intense. Residents will participate in differing therapies and education classes exclusively, and will not be required to do anything during the period of recovery other than focus on self healing.

A therapeutic community will offer the same types of therapies, but with a lesser intensity.

Firstly, because residents are expected to maintain participation for as long as two years, there is not the pressing need to teach all needed skills within a shorter duration of residency; and more importantly, the basic philosophical model of treatment has recovery and therapy occurring more out of participation and interaction in the community than through top down addictions programming.

Working While in Treatment

An essential part of a therapeutic community is a full participation in work responsibilities and in the running of the community. Through a regimented and hierarchical participation in the running of the community, residents gradually learn how to better live in society as they also learn the strategies needed to stay drug or alcohol free.

Through rigid and orderly participation in a very structured community, patients learn how to follow rules and observe norms of behavior, how to work for, with and eventually supervise other members of the community; and how to socialize in appropriate and constructive ways with others in the community. The essential goal of the therapeutic community is not only drug or alcohol avoidance, but a complete re socialization of appropriate behaviors required to participate constructively and soberly in society.

Which Type of Program is Right for You?

Although drug or alcohol addiction and the behaviors of abuse can impact on familial and professional relationships, those people who have managed to stay relatively involved in society and the community likely do not require the more intensive treatment as offered at a therapeutic community.

  • Some patients have either never appropriately learned how to participate in society, or have been abusing drugs or alcohol for so long that they need to intensively relearn these social skills; and for these people, a therapeutic community is likely the better option.
  • Patients with an existing social support network (family, non abusing friends) often benefit more from a brief participation in a rehab.
  • Patients with severe mental conditions co occurring with addiction often benefit from the slower and more comprehensive style of recovery and socialization as offered at a long term therapeutic community, and likewise, people with severe histories of addiction, and multiple failed attempts at standard drug rehab, may also benefit more from a therapeutic community.
  • Many of the residents in a therapeutic community are mandated to participate through judicial involvement.

Residents benefiting most from a participation in a therapeutic community tend to have more severe, longer and more antisocial histories of addiction, more criminality and less family or peer support. They also tend to have greater rates of dual diagnosis addictions.

Which Type of Treatment Works Better?

The recovery rates do not differ substantially. The people most often seeking out treatment at a therapeutic community generally have more intense and longer histories of abuse and addiction, and require a much longer and more intensive period of residency; and although they spend far longer in therapeutic recovery, because of the difficulty in treating severe addictions, they do not show greatly better recovery rates as a result.

What is most important is that addicts get treatment in a facility most appropriate and suited to their history of abuse and addiction. Patients who maintain some family or peer support, who can still function in society, and who do not suffer from a severe dual diagnosis; are much better treated at a conventional alcohol rehab facility.

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Page last updated Jun 28, 2012

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