The therapeutic community (TC) is a culture of change. All of the activities, social roles, interpersonal interactions, and community teachings focus upon the theme of individual change. The perceptions that are considered to be essential to recovery are interrelated, although they can be organized into classes to clarify their contribution to the process. Perceptions related to treatment reflect the individual’s motivation, readiness, and suitability to engage in the process of change in the TC. Self-control is indicated when individuals perceive the problem as internal rather than external, as one of regulating their impulses. Perceptions of self-management of patterns of behaviors, attitudes, and feelings depend upon previously learned control of specific behaviors in various situations. Assessing and affirming individual progress is a central activity in the TC. Staff evaluations formally assess the levels of self-change, while peers and staff assess them informally.

Work is one of the most distinctive components of the therapeutic community (TC) treatment model. Indeed, the telling mark of the TC social environment is the vibrancy of its work activities. Work in the TC is a fundamental activity used to mediate socialization, self-help recovery, and right living. This chapter describes how work mediates essential educational, therapeutic, and community goals. For disadvantaged, antisocial, or nonhabilitated substance abusers, many of whom have few work skills, social identity and self-esteem are first acquired through participation in the work structure of the TC. Work in the TC addresses characteristics of the person and the disorder. These characteristics can be classified into related categories: personal habits, work habits, work relations, self-management, and work value. Job functions are utilized in three main ways: for skills training and education, for therapeutic change, and to enhance the peer community.

Privileges and sanctions constitute an interrelated system of community and clinical management through behavioral training. The management of the community is the responsibility of peers and staff. This chapter details the formal system of community privileges and sanctions prescribed by staff and the informal system of verbal affirmations and correctives implemented primarily by peers. Privileges are used to promote individual socialization and personal growth. It confirms the resident’s overall personal autonomy and ability for self-management. Money is a major problem in the lives of substance abusers. However, money difficulties also reflect social and psychological problems among substance abusers in therapeutic communities (TCs). Sanctions may be grouped into verbal correctives and disciplinary actions. Sanctions promote community awareness and peer self-management and maintain social order through addressing individual and collective infractions. Sexuality is approached differently from the other rule-governed behaviors in the TC.

In the therapeutic community (TC), surveillance means supervision and management of the orderliness and safety of the physical environment, as well as the health and conduct of the social environment. This chapter describes the main facility-wide surveillance activities of the general inspections (GI), the house run, and urine testing, actions implemented in the management of the community. The GI is a useful community and clinical management activity. The house run is the main system of surveillance in the TC. In terms of management goals, house runs permit early detection of potentially larger problems such as those related to fire, sanitation, and security. However, its fundamental clinical purpose is to assess the status of individuals in terms of self-care, self-management, and their relationship to the community. The main urine test procedures used by most TCs are unannounced random urine screens and incident-related testing procedures.