Treatment process in the therapeutic community: Associations with retention and outcomes among adolescent residential clients

This study examined associations of a new multidimensional measure of therapeutic community (TC) treatment process, the Dimensions of Change Instrument (DCI), with treatment retention (n = 397) and posttreatment outcomes (n = 207) among adolescent residential clients. Adolescents who increased during the first 30 days in treatment on three of the eight DCI factors (Positive Self-Attitude and Commitment to Abstinence; Problem Recognition; Social Network) were more likely to stay in treatment for 90 days or more. Although change in DCI factor scores was not directly predictive of posttreatment outcomes, staying in treatment for 90 days or more increased the likelihood of attending 12-step meetings and having a 12-step sponsor after leaving treatment. Several demographic and pretreatment characteristics also predicted retention, posttreatment outcomes, or both. Much remains to be learned about how the TC treatment process produces positive outcomes for adolescents; however, results from this study highlight components of the treatment process that may be particularly important for practitioners to consider and monitor in their clients.