Effectiveness of a therapeutic community for substance use: stage completion and time in treatment as predictors of outcome

The optimal time and stage in treatment for improving psychological and substance-related outcomes in an Australian Therapeutic Community (TC) was investigated in the present study. The sample consisted of 96 adults who were receiving treatment for problematic substance use as part of the Odyssey House NSW residential program. Most participants were presented with polysubstance use and at least one psychiatric diagnosis. Psychological distress, quality of life and substance dependence were assessed at pre-treatment and as the resident progressed through the TC treatment stages. Earlier treatment stages were significantly associated with improvement in psychological distress, quality of life and substance dependence. Improvements in the three outcome measures were also significantly related to time in treatment (days), with the most notable gains occurring after three or 12 months. The Odyssey House NSW residential program is efficacious in improving psychological distress, quality of life and substance dependence, with optimal changes occurring during the earlier stages of treatment and after 3 or 12 months. These improvements may be attributable to the program, individual factors, or retention biases. Future research should standardise the TC model, explore confounding variables and address high attrition rates. <b>What is already known about this topic:</b>The prevalence of substance use disorders is increasing over time.Residential rehabilitation is an established treatment approach for substance use disorders.It is unclear whether duration in treatment, or progression through stages of treatment, is the better predictor of treatment outcome. The prevalence of substance use disorders is increasing over time. Residential rehabilitation is an established treatment approach for substance use disorders. It is unclear whether duration in treatment, or progression through stages of treatment, is the better predictor of treatment outcome. <b>What this topic adds:</b>Among the individuals seeking residential treatment for substance abuse, amphetamine-type stimulants (e.g. “ice”) was the most common substance of concern.The optimal changes in treatment outcomes occurred within the first two treatment stages or within the first 3 months after entry to the program.Treatment gains were achieved irrespective of demographic differences between individuals participating in the program. Among the individuals seeking residential treatment for substance abuse, amphetamine-type stimulants (e.g. “ice”) was the most common substance of concern. The optimal changes in treatment outcomes occurred within the first two treatment stages or within the first 3 months after entry to the program. Treatment gains were achieved irrespective of demographic differences between individuals participating in the program.