The EMCDDA has recently published a report on therapeutic communities (TCs) in Europe.1 TCs are represented in most European countries but of the majority of the 1,200 TCs identified in the study were reported from Italy.  Typically, TCs have a small number of residents (between 15 and 25) and length of treatment ranges from 6 to 12 months. In response to changing needs many TCs in Europe have adapted, offering shorter programmes often tailored for a specific group, e.g. prison-based TCs.  However, across Europe many TCs have been negatively affected by funding reductions (with the exception of France).  

The study reviewed the available literature from both Europe and North America. While there are limitations due to the methodologies, in general European studies have reported positive findings, often linked to retention in, and completion of, treatment.  The American studies reported widely varying levels of retention in TC treatment, and in general the results from that region showed that TCs are overall less effective in relation to retention in treatment than other types of interventions.  Both European and North American studies of individuals who had participated in prison-based TCs showed lower levels of recidivism. The authors of the EMCDDA report conclude that the evidence base for TCs needs to be improved, with, for example, more robust research methodologies such as randomised controlled trials. The authors also suggest studying outcomes for those TCs who include residents who are also on opiate substitution treatment. 

Another focus of the report is service standards and quality assurance related to the implementation of evidence-based guidelines. Complying with set standards is acknowledged as challenging for TCs, given the complex and changing TC environment.  However, several countries have developed their own general guidelines and three international instruments are also available. The authors believe that TCs are open to this process but recommended that knowledge and best practice be shared between countries to assist those countries with fewer resources.  This would also help to reduce the amount of heterogeneity between TC programmes in different countries.  The authors conclude that this quality process is vital in determining the future of TC programmes in Europe.

1 Vanderplasschen W, Vandevelde S, Broekaert E (2014) Therapeutic communities for treating addictions in Europe: Evidence, current practices and future challenges. Lisbon: European Monitoring Centre for Drugs and Drug Addiction. www.drugsandalcohol.ie/21770