Smith L A, Gates S, Foxcroft D
Oxford Brookes University, School of Health and Social Care, Jack Straws Lane, Marston, Oxford, UK, OX3 0FL.
Cochrane Database Syst Rev. 2006 Jan 25(1):CD005338. doi: 10.1002/14651858.CD005338.pub2.
Therapeutic communities (TCs) are a popular treatment for the rehabilitation of drug users in the USA and Europe.
To determine the effectiveness of TC versus other treatments for substance dependents, and to investigate whether effectiveness is modified by client or treatment characteristics.
We searched: Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005); MEDLINE, EMBASE, Psycinfo, CINAHL, SIGLE from their inception to March 2004. Reference lists of studies were scanned.
Randomised controlled trials comparing TC with other treatments, no treatment or another TC.
Two authors independently inspected abstracts, the methodological quality was assessed using Drug and Alcohol CRG checklist. When possible, data were summarised using relative risks and differences in means, otherwise results are presented as reported by authors.
Seven studies were included. Differences between studies precluded any pooling of data, results are summarised for each trial individually: TC versus community residence: no significant differences for treatment completion; Residential versus day TC: attrition (first two weeks), and abstinence rates at six months significantly lower in the residential treatment group; Standard TC versus enhanced abbreviated TC: number of employed higher in standard TC RR 0.78 (95% CI 0.63, 0.96). Three months versus six months programme within modified TC, and six months versus 12 months programme within standard TC: completion rate higher in the three months programme and retention rate (40 days) significantly greater with the 12 months than 6 months programme. Two trials evaluated TCs within a prison setting: one reported significantly fewer re incarcerated 12 months after release from prison in the TC group compared with no treatment, RR 0.68 (95% CI 057, 0.81). In the other, people treated in prison with TC compared with Mental Health Treatment Programmes showed significantly fewer re incarcerations RR 0.28 (95% CI 0.13, 0.63), criminal activity 0.69 (95% CI 0.52, 0.93) and alcohol and drug offences 0.62 (95% CI 0.43, 0.90) 12 months after release from prison.
AUTHORS' CONCLUSIONS: There is little evidence that TCs offer significant benefits in comparison with other residential treatment, or that one type of TC is better than another. Prison TC may be better than prison on it's own or Mental Health Treatment Programmes to prevent re-offending post-release for in-mates. However, methodological limitations of the studies may have introduced bias and firm conclusions cannot be drawn due to limitations of the existing evidence.
治疗社区（TCs）在美国和欧洲是一种治疗吸毒者康复的常用方法。
确定治疗社区与其他治疗方法相比对药物依赖者的有效性，并调查有效性是否因服务对象或治疗特征而有所不同。
我们检索了：Cochrane对照试验中心注册库（《Cochrane图书馆》2005年第2期）；MEDLINE、EMBASE、Psycinfo、CINAHL、SIGLE，检索时间从各数据库建库至2004年3月。对纳入研究的参考文献列表进行了筛查。
比较治疗社区与其他治疗方法、无治疗或另一个治疗社区的随机对照试验。
两位作者独立审查摘要，使用药物与酒精CRG清单评估方法学质量。如有可能，使用相对风险和均值差异汇总数据，否则按作者报告呈现结果。
纳入了7项研究。研究间的差异使得无法合并任何数据，每项试验的结果单独汇总如下：治疗社区与社区居住：治疗完成率无显著差异；住院治疗社区与日间治疗社区：住院治疗组在前两周的退出率和6个月时的戒断率显著较低；标准治疗社区与强化简化治疗社区：标准治疗社区就业人数较多，相对风险为0.78（95%可信区间0.63，0.96）。改良治疗社区内3个月与6个月项目，以及标准治疗社区内6个月与12个月项目：3个月项目的完成率较高，12个月项目的留存率（40天）显著高于6个月项目。两项试验评估了监狱环境中的治疗社区：一项报告称，与未接受治疗相比，治疗社区组在出狱12个月后再次入狱的人数显著减少，相对风险为0.68（95%可信区间0.57，0.81）。另一项试验表明，与心理健康治疗项目相比，在监狱中接受治疗社区治疗的人在出狱12个月后再次入狱的人数显著减少，相对风险为0.28（95%可信区间0.13，0.63），犯罪活动相对风险为0.69（95%可信区间0.52，0.93），酒精和毒品犯罪相对风险为0.62（95%可信区间0.43，0.90）。
几乎没有证据表明治疗社区与其他住院治疗相比能带来显著益处，也没有证据表明一种治疗社区比另一种更好。监狱治疗社区可能比单独的监狱或心理健康治疗项目更能预防囚犯出狱后再次犯罪。然而，研究的方法学局限性可能引入了偏倚，由于现有证据的局限性，无法得出确凿结论。
