Modified Therapeutic Communities (MTCs) focus on offenders with mental illness and chemical abuse (MICA) disorders. They adapt existing models of therapeutic community (TC) programs for substance users for the growing population of offenders who present co-occurring disorders—that is, individuals with one or more mental health disorders combined with one or more disorders pertaining to alcohol or substance use.
Key to the treatment of MICA patients in MTCs is the community method of treatment and the use of peer self-help. The program is adapted for offenders with mental health disorders by making it more flexible, more personalized, and less intensive. This adaptation is accomplished by acknowledging achievements and special developmental needs; increasing rewards, orientation, and instruction; and diminishing sanctions and confrontation within the treatment program. Individual treatment plans set out the goals, objectives, and targets within the requirements for each stage. Rewards grant the patient greater freedoms and responsibilities.
MTC is adapted for a specific offender population that presents co-occurring disorders. MICA offenders are an increasing cohort within correctional institutions, and MTCs aim to offer better results in reduction of substance use and recidivism than traditional forms of treatment.
Like traditional TCs, the MTC program involves developing and fostering a community of both offenders and staff, in which members are encouraged to help themselves and others while using the community as part of the treatment. Program participants are all housed together in prison, separate from the general inmate population.
The traditional TC formula is modified to make it more accessible and appropriate to MICA offenders who present greater developmental issues. Key elements of the program include group therapy, individual therapy, monitoring of mental health, and medication management. These elements are linked to recovery stages in four phases:
· Phase 1: Admission and Orientation
· Phase 2: Primary Treatment
· Phase 3: Live-in Reentry
· Phase 4: Live-out Reentry
Upon release from custody, members can choose to continue treatment in the community for up to six months in an MTC Aftercare program. The TC–oriented aftercare program is a 20-bed program located at Independence House, which is a community corrections facility. MICA offenders occupy five apartments (20 beds) in the facility, while the other 10 apartments are for non–MICA offenders. The program helps inmates continue the treatment that began while in prison, including examination and alteration of criminal thinking and behavior, mastering community living and integrating with society, gaining employment, and fostering connections with a larger recovery community. Program activities are directed by trained staff seven days a week, from 8 a.m. to 8 p.m. Program residents attend program activities three to five hours each day for three to seven days per week during the six-month term. Activities revolve around basic skills (such as meal preparation and banking), medication and symptom management, and emotional and behavioral coping.
Services available to residents include mental health counseling, medication, and psychiatric services, which are provided by a local mental health center. As residents progress through program stages and demonstrate greater responsibility, they gradually assume greater independence. Supervision still remains high during this transitional period, as offenders meet twice a week with their community corrections officers.
The MTC program requires that all participants be considered members and have strong involvement and input into the community in order to feel involved and responsible. Staff members act as role models and steer the community members toward gaining greater control over their lives, their disorders, and their opportunities upon reentry. MTC requires the involvement of treatment specialists, therapists and psychiatric services, group managers, program directors, and correctional security personnel.
MTCs aim to treat offenders with co-occurring disorders more effectively than traditional methods by including a community treatment element in their recovery. The objective is to treat the underlying substance abuse issues, which are related to continued criminal activity. By addressing the addiction problems of offenders while dealing with mental health disorders at the same time, MTCs aim to prevent future drug use and offending and reduce recidivism. The program benefits the offender by controlling their substance use and providing treatment for mental health disorders, the public by reducing future offending, and the criminal justice (and health care) system by reducing the number of the offender’s future interactions.
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Sullivan and colleagues (2007) found that there were significantly better outcomes for all substance use variables (any substance, any illegal drug, and alcohol to intoxication) for the modified therapeutic community (MTC) participants compared to the control group. After 12 months, 69 percent of MTC participants had not used any substance, compared to 44 percent for the control group; 75 percent of MTC participants had not used an illegal drug, compared to 56 percent of control group; and 81 percent of MTC participants had not used alcohol to intoxication, compared to 61 percent of the control group.
The survival analysis also indicated that those in the MTC group began using substances later than the control group (3.7 months, versus 2.6 months). The MTC group also had a greater reduction in the severity of drug use as well as in the frequency of alcohol consumption compared to the control group.