• John Gramling MSCP masters candidate
  • Donald Arthur Johnson


Therapeutic Community; Hierarchy; Social Support; Motivation; Psychological Distress Symptoms; Self-Esteem


A prominent drug and alcohol rehabilitation method worldwide is the Therapeutic Community (TC), which employs a hierarchal system to promote member addicts to leadership positions.  All addicts begin the TC program at the bottom of this hierarchy and move up the ladder throughout their stay. Some eventually become work leaders and mentors for the newer members of the addict community. However, with shorter rehabilitation durations, member addicts often finish the program without having experienced the top tiers of the hierarchy.


Although research is abundant regarding relapse of TC community members, there is little on the self-esteem of these patients resulting from poor social support, the presence of psychological distress symptoms, poor motivation, and poor hierarchy positions.  The current study attempted to examine why some addicts were leaving the program with low self-esteem, hypothesizing that perceived social support, achievement motivation, and psychological distress symptoms all play a role. This relationship is moderated by the patients’ position in the social hierarchy.


Findings suggest that perceived social support and psychological distress symptoms (specifically depression and hostility) significantly affected patient self-esteem upon exiting the community. Still, social hierarchy did not play a role in moderating this relationship, nor was it a significant predictor of self-esteem.  Further research could benefit from a longitudinal study that monitors self-esteem at multiple patient rehabilitation intervals. 


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