Therapeutic communities (TCs) for addictions are drug-free environments in which people with addictive problems live together in an organized and structured way to promote change toward recovery and reinsertion in society. Despite a long research tradition in TCs, the evidence base for the effectiveness of TCs is limited according to available reviews. Since most of these studies applied a selective focus, we made a comprehensive systematic review of all controlled studies that compared the effectiveness of TCs for addictions with that of a control condition. The focus of this paper is on recovery, including attention for various life domains and a longitudinal scope. We searched the following databases: ISI Web of Knowledge (WoS), PubMed, and DrugScope. Our search strategy revealed 997 hits. Eventually, 30 publications were selected for this paper, which were based on 16 original studies. Two out of three studies showed significantly better substance use and legal outcomes among TC participants, and five studies found superior employment and psychological functioning. Length of stay in treatment and participation in subsequent aftercare were consistent predictors of recovery status. We conclude that TCs can promote change regarding various outcome categories. Since recovering addicts often cycle between abstinence and relapse, a continuing care approach is advisable, including assessment of multiple and subjective outcome indicators.

Empirically informed, evidence-driven research is necessary to understand how TCs work and how TC practice can be improved. This understanding may offer lessons for the improvement of psychosocial aspects of psychiatric care more generally.

DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.

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Background Borderline personality disorder (BPD) is a serious mental disorder characterized by marked interpersonal disturbances, including difficulties trusting others and volatile impressions of others’ moral character, often resulting in premature relationship termination. We tested a hypothesis that moral character inference is disrupted in BPD and sensitive to democratic therapeutic community (DTC) treatment. Methods Participants with BPD ( n = 43; 20 untreated and 23 DTC-treated) and control participants without BPD ( n = 106) completed a moral inference task where they predicted the decisions of 2 agents with distinct moral preferences: the “bad” agent was more willing than the “good” agent to harm others for money. Periodically, participants rated their subjective impressions of the agent’s moral character and the certainty of those impressions. We fit a hierarchical Bayesian learning model to participants’ trialwise predictions to describe how beliefs about the morality of the agents were updated by new information. Results The computational mechanisms of moral inference differed for patients with untreated BPD relative to matched control participants and patients with DTC-treated BPD. In patients with BPD, beliefs about harmful agents were more certain and less amenable to updating relative to both control participants and participants who were treated with DTC. Conclusions The findings suggest that DTC may help the maintenance of social relationships in BPD by increasing patients’ openness to learning about adverse interaction partners. The results provide mechanistic insights into social deficits in BPD and demonstrate the potential for combining objective behavioral paradigms with computational modeling as a tool for assessing BPD pathology and treatment outcomes.