Therapeutic communities (TCs) are highly structured
programs in which patients stay at a residence, typically
for 6 to 12 months. Patients in TCs include those
with relatively long histories of drug dependence, involvement
in serious criminal activities, and seriously impaired social
functioning. The focus of the TC is on the resocialization
of the patient to a drug-free, crime-free lifestyle.
Short-term residential programs, often referred
to as chemical dependency units, are often based on the
"Minnesota Model" of treatment for alcoholism.
These programs involve a 3- to 6-week inpatient treatment
phase followed by extended outpatient therapy or participation
in 12-step self-help groups, such as Narcotics Anonymous
or Cocaine Anonymous. Chemical dependency programs
for drug abuse arose in the private sector in the mid-1980s
with insured alcohol/cocaine abusers as their primary patients.
Today, as private provider benefits decline, more programs
are extending their services to publicly funded patients.
Drug treatment programs in prisons can succeed
in preventing patients' return to criminal behavior, particularly
if they are linked to community-based programs that continue
treatment when the client leaves prison. Some of
the more successful programs have reduced the rearrest rate
by one-fourth to one-half. For example, the "Delaware
Model," an ongoing study of comprehensive treatment
of drug- addicted prison inmates, shows that prison-based
treatment including a therapeutic community setting, a work
release therapeutic community, and community-based aftercare
reduces the probability of rearrest by 57 percent and reduces
the likelihood of returning to drug use by 37 percent.
Drug abuse has a great economic impact on society-an estimated
$67 billion per year. This figure includes costs related
to crime, medical care, drug abuse treatment, social welfare
programs, and time lost from work. Treatment of drug abuse
can reduce those costs. Studies have shown that from $4
to $7 are saved for every dollar spent on treatment. It
costs approximately $3,600 per month to leave a drug abuser
untreated in the community, and incarceration costs approximately
$3,300 per month. In contrast, methadone maintenance therapy
costs about $290 per month.
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