Are therapeutic communities therapeutic for women ? Michele

This paper addresses the growing phenomena of therapeutic community (TC) treatment approaches for women in correctional settings. Although rapidly increasing in number across the country, there is very little empirical research to support the effectiveness of TC treatment for women. Therefore, the literature on the efficacy and effectiveness of TC treatment for women is reviewed in relation to the literature on women's treatment issues. The literature review highlights the gaps where TC treatment ignores or exacerbates issues that are common to addicted women, or uses methods that may be contradictory to women's recovery. Introduction In the past ten years, there has been an explosion of new therapeutic community (TC) programs in prisons across the United States. By 2001, nearly every state in the country had at least one TC program in a prison within its borders, or was planning to start one, and 31 states had a TC program for women [1]. Like other types of substance abuse or criminal thinking programs/approaches used in prisons, TCs have been put in place in women's correctional settings without regard to whether they are the best approach for women. Under the guise of gender-neutrality, programming developed for and tested on men has too often been uncritically applied to women. This paper will review the theory and research supporting the use of TCs in relation to the literature on gender-specific issues in substance abuse treatment. The core philosophy, principles, and tools of a TC will be examined given what we know about women's development and treatment needs. Research on the female offender The growing body of research on the differences between male and female substance-involved offenders strongly suggests the need for gender-specific services. This research has identified different antecedents and consequences to abuse, different patterns of drug use, different barriers to treatment, and different relapse triggers. In addition, the types of crime and motives for criminal activity differ by gender. Some of the major differences are summarized below. A much fuller account of this literature can be found in a comprehensive report commissioned by the National Institute of Corrections [2]. Physical and sexual abuse histories According to Bureau of Justice Statistics data, 40% of incarcerated women compared to only 9% of incarcerated men report a lifetime history of abuse. These figures are based on prison intake records that may underestimate abuse experiences. Other studies report much higher figures for women. For example, some studies have found rates of childhood abuse as high as 70–80% [3-5]. There is a considerable literature that links early trauma and abuse histories to adult substance abuse as women learn to self-medicate the emotional distress created by abuse [6]. In fact, childhood abuse experiences are the primary pathway to substance abuse and incarceration for women. Even when women and men report similar rates of trauma Published: 12 January 2006 Substance Abuse Treatment, Prevention, and Policy 2006, 1:3 doi:10.1186/1747-597X-1-3 Received: 21 November 2005 Accepted: 12 January 2006 This article is available from: http://www.substanceabusepolicy.com/content/1/1/3 © 2006 Eliason; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.