Factors that may contribute to recovery certainly are longer length of stay in the TC (retention) and participation in subsequent aftercare, since both variables have been consistently identified as predictors of improved substance use outcomes [23, 26]. Surprisingly, treatment completion was not found to be a predictor of abstinence, but it was associated with reduced recidivism rates in several studies of prison TCs [33, 36]. Treatment in TCs for addictions takes time, usually around 6 to 12 months, which heightens the possibility that residents leave prematurely [27]. Retention in (longer term) TCs is typically lower than in shorter term programs [42, 51, 55], but in general TC residents who stayed longer in treatment had significantly better outcomes than persons who dropped out early.
This has led to concerns with enhancing retention through the involvement of the family and social network and the use of senior staff [63] and with promoting initial engagement through motivational interviewing, contingency management, and induction interventions [64�C66]. An alternative promising way of looking at retention may be to see it as the sum of treatment episodes in different services and the accumulation of associated treatment experiences instead of defining retention as a single uninterrupted stay in one treatment program [67]. Reentry in the community appears to be a critical point after TC treatment, if not prepared adequately (e.g., by providing aftercare) or if drug users go back to their old neighborhoods [68].
Some type of continuing support is warranted after TC treatment not only to prevent relapse, but also to link with employment/training and to engage in community-based activities. Moreover, treatment discharge should be dealt with in a flexible and individualized way, since some persons will need to be further supported or to reenter the community if they are doing Cilengitide poorly. The recovery movement starts from a longitudinal approach to addiction and other mental health problems [69], but few controlled studies have assessed TC outcomes beyond a two-year follow-up period. Available studies suggest that��despite a fading effect of TC treatment over time��recidivism rates continued to be significantly better than these of controls in three studies of prison TCs [28, 33, 37], while findings regarding substance use outcomes indicated fewer between group differences. The three-year follow-up outcomes of the Delaware prison study showed a 94% relapse rate among the usual care group (traditional work release) compared with a 77% relapse rate in the prison aftercare TC group [29].