Moreover, abstinence and treatment completion were the sole outcome measures in this study. Finally, the meta-analysis by Lees and colleagues [27] can be regarded as outdated, till as it does not include any published study since 1999. Since sound scientific evidence is needed to inform service users, treatment providers, and policy makers about TCs’ potential to promote recovery, the aim of this paper is to review the effectiveness of TCs for addictions, based on a comprehensive systematic review of available randomized and nonrandomized controlled studies. The paper is limited to studies with a controlled design, as these are robust study designs that generate a high level of evidence. Also, nonrandomized studies were included, since the number of randomized studies was very small (n = 5) and true randomization was compromised in several studies.

Given the focus on recovery, a range of outcome measures��apart from abstinence��will be evaluated and a long-term outcome perspective will be applied, including an assessment of the influence of aftercare or continuing support. 2. MethodsThis narrative review focuses on controlled studies (randomized trials as well as quasi-experimental designs) of therapeutic communities for addictions. We opted for a narrative review instead of a meta-analysis, given the heterogeneity of the study methodologies and the variety in data reporting. Studies were eligible if they met the following inclusion criteria.

Intervention: therapeutic communities for the treatment of drug addiction that are long-term hierarchically structured (residential) educational environments, where former drug users live together and work towards recovery, and which are based on self-help and mutual help principles [12, 21].Target population: adults addicted to illegal drugs (mostly heroin, cocaine, or amphetamines), often in combination with an addiction to other (legal) substances (e.g., alcohol, prescription drugs). Studies including Batimastat persons with comorbid psychiatric disorders were eligible, if all study participants had a drug addiction.Outcome measures: at least one of the following (nonexhaustive) list of outcome measures was reported: substance use (illicit drug use, alcohol use), length of stay in treatment (retention, treatment completion/drop-out), employment status, criminal involvement, health and well being, family relations, quality of life, treatment status, mortality, and so forth. Objective (describing the actual situation) and subjective (indicating individuals’ personal perspective) indicators were considered, as well as self-report measures, biological markers, and administrative data.