Social Network Conceptualization and Operationalization of Hierarchy Within Therapeutic Communities

TL;DR

This paper introduces a new conceptual framework and measurement method for understanding hierarchy within Therapeutic Communities, enhancing research on peer influence and social structure in substance use disorder treatment.

Contribution

It provides the first clear conceptualization and operationalization of hierarchy in TCs, using social network analysis to enable rigorous study of peer roles.

Findings

New social network-based measurement of hierarchy

Framework enables analysis of peer influence dynamics

Facilitates future research on treatment community structure

Abstract

In the United States, the Therapeutic Community (TC) treatment model for substance use disorder recovery relies heavily upon the assumption that peers serve as mentors, affirming behavior consistent with the norms of the treatment model and correcting behavior contrary to those norms. Despite being foundational to the TC model, little work has been done to clearly conceptualize and operationalize this hierarchy. In this manuscript, we fill that gap in the literature, presenting a novel conceptualization of hierarchy within the TC context, complete with a complementary measurement drawing from the field of social network analysis. With this new framework for understanding and studying hierarchy within TCs, we can ask and rigorously answer a new set of questions previously unexamined.