Is there a European approach to drug-free therapeutic communities? A narrative review

Background Since early 1960s, the American Therapeutic Communities (TC) movement has strongly influenced the addiction treatment field. However, in Europe the knowledge base of TCs is still fragmented. Objectives There is the need to describe differences and similarities between American and European TCs, in terms of approaches, roles and positions for organizational, treatment and preventive policies issues in substance abuse. Methods An electronic literature search was conducted (1966-2010) using the Medline, Psych Info and CINAHL databases. Results Social and ideological characteristics supporting TCs significantly influence the relative weight given to different therapeutic contents such as behaviourism, milieu therapy, social learning, professional team role, networking and evidence based assessment of outcomes. Across Europe, different trends in different countries coexist. Conclusions Although the American TC movement undoubtedly influenced treatment of addiction throughout Europe, an original European model has emerged in terms of theoretical models, treatment implementation strategies and staff training. An ongoing cross-cultural comparison between different settings would allow a better understanding of the strengths and weaknesses of rehabilitation programmes in TCs.