TROSA Program Model: Modified Therapeutic Community

Modified Therapeutic Community

TROSA is a modified therapeutic community (TC), providing evidence-based services through a comprehensive multi-year residential treatment program. 

TROSA is considered a modified therapeutic community because of our increased emphasis on orientation and instruction; professional and clinical staff; on-site services for primary care and mental health needs; our ability to help individuals with co-occurring mental health disorders; the use of some medications; and post-program continuing care services for graduates.

Thanks to partnerships with our medical community, TROSA has on-site primary care services and coordinates specialty care with area providers.

Our trauma-informed staff and clinical counseling team enhance our evidence-based peer-driven program, providing therapies to address trauma. 

TROSA also offers post-program care, so that program graduates are supported through the critical first year of living independently while in recovery. TROSA’s Continuing Care department advises and assists graduates and residents approaching graduation with special services including transitional housing and job transportation.

TROSA has received national, regional, and community awards highlighting the expertise of our staff, the effectiveness of our evidence-based clinical practices, and the civic engagement of our residents and staff.

This article incorporates definitions and citations from the National Institute on Drug Abuse (NIDA)’s website.

Effective Programs With A Recovery Orientation

TCs are effective programs that have a recovery orientation, focusing on the whole person and overall lifestyle changes; not simply abstinence from drug use. (Vanderplasschen et al., 2013; De Leon, 2012). 

In TCs, recovery is seen as a gradual, ongoing process of cognitive change. TCs are traditionally longer-term in length so that participants have the time, space, and opportunities to grow and change, setting personal goals along the way. At TROSA, residents set goals which are incorporated into individualized treatment plans. TROSA residents progress through program stages while receiving feedback from staff and peers. 

A recovery orientation model like TROSA’s is different from an acute-care model. Acute care models focus on interrupting drug use and helping the patient attain abstinence during treatment episodes rather than overall lifestyle change (Vanderplasschen et al., 2013; De Leon, 2000; Sacks et al., 2008b; Perfas & Spross, 2007; De Leon, 2012).

Recovery is a lifelong process. The National Institute on Drug Abuse ( shares that the rate of relapse is between 40-60%. Most residential treatment programs are shorter-term in duration. TROSA’s cost-free multi-year program is unique, giving individuals the time to make lasting changes. TROSA conducts surveys of our program graduates. Consistently, more than 90% of TROSA graduates are in recovery, are employed, and have no new criminal convictions one year after graduating our program.

Community as Method

The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies “Community” as one of four major dimensions of recovery. SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation.

Following the concept of “community as method,” TCs use active participation in group living and activities to drive individual change and the attainment of therapeutic goals (Dye et al., 2009; Dye et al., 2012; Vanderplasschen et al., 2013; Vanderplasschen et al., 2014; Bunt et al., 2008).  Each element or activity of TROSA’s program has therapeutic and/or educational value that also reinforces community connection.

With therapeutic communities’ emphasis on social learning and mutual self-help, individual participants take on some of the responsibility for their peers’ recovery. This aid to others is seen as an important part of changing oneself (De Leon, 2000; De Leon, 2015; Sacks et al., 2012a). 

At TROSA, our program participants (residents) identify, model, and reinforce positive behaviors that lead to a better life. This includes learning to take responsibility for oneself and others, and learning to care about others. Peers also observe and identify negative behaviors that may be unhelpful in one’s recovery, and residents can rely on the community to help with accountability so that changes can be made towards a better life. 

TROSA’s community-driven model also gives residents the opportunity to organize and participate in special events and activities, both on- and off-campus. These serve as important team-building opportunities and help show our residents that they can have fun in recovery. Recent outings have included sports events, professional theatrical and dance productions, museums, arcades, and nature walks.

This important social learning is augmented by TROSA’s on-site clinical counselors and trauma-informed staff to help address our residents’ mental health needs.

Leading Better, Healthier Lives that Benefit Their Communities

As program participants progress through the stages of recovery, they assume greater personal and social responsibilities in the community, taking on leadership roles and serving as mentors to others. 

The goal is for our residents to leave TROSA’s program not only drug-free but also equipped to lead better, healthier lives that can also benefit the greater community. 

To learn more about TROSA’s program, visit our Program Services page. You can also learn more about TROSA by reading the stories and experiences of TROSA program graduates

TROSA senior residents and staff at 2023 Duke Gardens outing

Citations referenced from NIDA’s research report:

  • Bunt GC, Muehlbach B, Moed CO. The Therapeutic Community: international perspective. Subst. Abuse. 2008; 29:81-87.
  • De Leon G. The Therapeutic Community: Theory, Model, and Method. New York, NY: Springer Publishing Company; 2000.
  • De Leon G. Therapeutic communities: today and tomorrow. Presentation to Drugs and Society Seminar, Columbia University, May 2012.
  • De Leon G. Therapeutic Communities. In: Galanter M, Kleber HD, Brady KT, eds. The American Psychiatric Textbook of Substance Abuse Treatment. 5th ed. Washington, DC: American Psychiatric Publishing Inc.; 2015:511-530.
  • Dye MH, Ducharme LJ, Johnson JA, Knudsen HK, Roman PM. Modified therapeutic communities and adherence to traditional elements. J Psychoactive Drugs. 2009;41:275-283.
  • Dye MH, Roman PM, Knudsen HK, Johnson JA. The availability of integrated care in a national sample of therapeutic communities. J Behav. Health Serv Res. 2012;39:1-27.
  • Perfas FB, Spross S. Why the concept-based therapeutic community can no longer be called drug-free. J Psychoactive Drugs. 2007;39:69-79.
  • Sacks JY, McKendrick K, Hamilton Z. A randomized clinical trial of a therapeutic community treatment for female inmates: outcomes at 6 and 12 months after prison release. J Addic. Dis. 2012;31:258-269.
  • Sacks S, Banks S, McKendrick K, Sacks JY. Modified therapeutic community for co-occurring disorders: a summary of four studies. J Subst. Abuse Treat. 2008;34:112-122.
  • Sacks S, Chaple M, Sacks JY, McKendrick K, Cleland CM. Randomized trial of a reentry modified therapeutic community for offenders with co-occurring disorders: crime outcomes. J Subst. Abuse Treat. 2012;42:247-59.
  • Sacks S, McKendrick K, Sacks JY, Banks S, Harle M. Enhanced outpatient treatment for co-occurring disorders: main outcomes. J Subst. Abuse Treat. 2008;34:48-60.
  • Vanderplasschen W, Colpaert K, Autriquem M, et al. Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. Scientific World Journal. 2013;2013:427817.
  • Vanderplasschen W, Vandevelde S, Broekaert E. Therapeutic communities for treating addictions in Europe: evidence, current practices and future challenges. European Monitoring Centre for Drugs and Drug Addiction. 2014.