at least one week was spent in each tc , evaluating infrastructure , policies and procedures , treatment and rehabilitation programs , and staff competencies .
many tools were used in the evaluations , including questionnaires for residents and treatment teams ; interviews with directors , treatment teams and residents ; observations of tc approaches and activities ; and reviews of documents and residents files.18 at the end of each tc visit , using these observations and tools , a short version of the seeq was completed .
the internal review board of the college of medicine , al imam muhammad ibn saud islamic university , riyadh , kingdom of saudi arabia ethically approved the design and execution of this study .
the survey instrument consisted of the seeq , which is the most well studied and validated questionnaire to investigate the essential elements of tc .
melnick & de leon developed the seeq constructs ( dimensions , domains , and items ) based on a theoretical framework of the tc treatment model.22,23 a national panel of 11 tc directors and one research expert conducted a modified delphi process of the questionnaire and made further modifications and amendments after an extensive review.3,20 the final questionnaire contained 135 likert - type items arranged in 6 broad dimensions highlighting the different components of tc treatment , and 27 domains reflecting the core philosophy and essential components.3,18,20 respondent evaluated every item with the accompanying scale : 0=objectionable ; 1=very little importance ; 2=some importance ; 3=moderate importance ; 4=fairly important ; 5=extremely important .
for this study , the short version of the seeq was used , which amended the original seeq by condensing and consolidating different items per domain into one statement ( table 1).18,20 the original
seeq demonstrates high overall reliability , with a cronbach s alpha value of 0.97 . the short version of the seeq exhibited cronbach s alpha values of 0.81 and 0.85 in 2 independent samples,3,20 suggesting that it has an acceptable reliability .
survey of essential elements questionnaire ( short version ) domain scores utilized at tcs in kingdom of saudi arabia . data were collected and stored in microsoft excel 2010 , then coded and imported into statistical package for social sciences , version 20.0 ( ibm inc , chicago , illinois , usa ) for analysis . mean and standard deviation were calculated for each domain for all tcs and for all dimensions of each tc .
one - way analysis of variance ( anova ) was used to determine whether there were any differences in scoring among the tcs .
the confidence interval was set at 95% , where a corresponding p - value<0.05 was used to identify statistical significance .
as part of a national study to evaluate addiction tcs in the kingdom of saudi arabia , the author visited all saudi addiction tcs ( in saudi arabia , there are only 5 tcs ) in september , october and november of 2014 .
at least one week was spent in each tc , evaluating infrastructure , policies and procedures , treatment and rehabilitation programs , and staff competencies .
many tools were used in the evaluations , including questionnaires for residents and treatment teams ; interviews with directors , treatment teams and residents ; observations of tc approaches and activities ; and reviews of documents and residents files.18 at the end of each tc visit , using these observations and tools , a short version of the seeq was completed .
the internal review board of the college of medicine , al imam muhammad ibn saud islamic university , riyadh , kingdom of saudi arabia ethically approved the design and execution of this study .
the survey instrument consisted of the seeq , which is the most well studied and validated questionnaire to investigate the essential elements of tc .
melnick & de leon developed the seeq constructs ( dimensions , domains , and items ) based on a theoretical framework of the tc treatment model.22,23 a national panel of 11 tc directors and one research expert conducted a modified delphi process of the questionnaire and made further modifications and amendments after an extensive review.3,20 the final questionnaire contained 135 likert - type items arranged in 6 broad dimensions highlighting the different components of tc treatment , and 27 domains reflecting the core philosophy and essential components.3,18,20 respondent evaluated every item with the accompanying scale : 0=objectionable ; 1=very little importance ; 2=some importance ; 3=moderate importance ; 4=fairly important ; 5=extremely important .
for this study , the short version of the seeq was used , which amended the original seeq by condensing and consolidating different items per domain into one statement ( table 1).18,20 the original
seeq demonstrates high overall reliability , with a cronbach s alpha value of 0.97 . the short version of the seeq exhibited cronbach s alpha values of 0.81 and 0.85 in 2 independent samples,3,20 suggesting that it has an acceptable reliability .
survey of essential elements questionnaire ( short version ) domain scores utilized at tcs in kingdom of saudi arabia .
data were collected and stored in microsoft excel 2010 , then coded and imported into statistical package for social sciences , version 20.0 ( ibm inc , chicago , illinois , usa ) for analysis . mean and standard deviation were calculated for each domain for all tcs and for all dimensions of each tc .
one - way analysis of variance ( anova ) was used to determine whether there were any differences in scoring among the tcs .
the confidence interval was set at 95% , where a corresponding p - value<0.05 was used to identify statistical significance .
the average total score of saudi addiction tcs on the short version of the seeq was 3.7 of 5 ( table 1 ) . on the individual dimensions , the tcs scored 4.2 on the tc perspective 4.15 , on the agency treatment approach and structure 3.72 , on community as therapeutic agent 4.40 , on educational and work activities 2.60 , on formal therapeutic elements 3.50 and 4.30 on process ( table 2 ) .
there were no statistically significant differences between the tcs in the dimension scores ( table 2 ) .
academic and/or vocational training is available  ( 2.4 ) ,  life skills training is available  ( 2.2 ) ,  treatment approach is centered on member participation  ( 2.8 ) , and  family members are included as part of therapy  ( 2.8 ) .
mean survey of essential elements questionnaire ( short version ) dimension scores among tcs in the kingdom of saudi arabia .
no statistical significant value at 0.05 , standard deviations are shown in parentheses , tc - therapeutic communities
addiction tcs in the kingdom of saudi arabia scored fairly highly on the seeq questionnaire , which reflects a good implementation of the tc essential elements .
this scoring is not far from american and european tcs scores.3,19,20 however , the saudi tcs were rated by an independent addiction tc expert who stayed at and observed each tc for one week , rather than a tc director , which may add more validity to the scores and reduce conflicts of interest .
this achievement is shared by all saudi addiction tcs , which may reflect the strict standards and policies held by the related licensing authority .
the dammam addiction tc was the first and only tc in saudi arabia for more than 9 years , serving as a role model for the development of other addiction tcs , which may provide another explanation for the high scoring and lack of variability between the saudi tcs .
they scored between 3.3 and 4.3 out of 5 in all dimensions except educational and work activities , which had an average score of 2.8 .
the low scoring in this dimension was observed in all tcs , which may reflect a lesser focus on academic , vocational and life skills training .
saudi tcs scored even 3 or more in all domains of other dimensions except in 2 ; however , each of these scores was limited to a single tc . in conclusion
however , the essential components of this model tested by seeq may need special adaptation to the social culture and values .
vocational ; life - skills training , and work activities are essential elements of tcs and represent major elements in rehabilitation programs to which saudi tcs aspire .
low scoring in this dimension warrants further studies to analyze the situation , investigating for the causes and suggesting solutions . although the existence of the essential elements in the saudi tcs may point indirectly to treatment efficacy through good quality program implementation , other elements of tcs like infrastructure , treatment team competencies , resident and family satisfaction , and quality of services have to be evaluated to properly gauge saudi tc efficacy .
a longitudinal outcome - based effectiveness study would be the best measure of saudi addiction tc efficacy .
 objective : to investigate whether saudi therapeutic communities ( tcs ) implement essential elements of tcs.methods:this is a cross sectional study where the author visited all of the saudi addiction tcs between september and december 2014 . 
 at least one week was spent in each tc , attending many therapeutic activities , reviewing patient files and program documents , and interviewing directors , treating teams and residents . at the end of each visit , a short version of the survey of essential elements questionnaire ( seeq ) 
 was conducted , which is a reliable tool to evaluate the essential elements of tcs.results:in 2014 , there were only 5 tcs in saudi arabia . 
 all of them were traditional tcs for adult male residents . 
 the average total score was 3.72 out of 5 on the seeq . regarding the 6 dimensions of the seeq , the tcs scored 4.15 on the tc perspective , 3.72 on the agency treatment approach and structure , 4.40 on community as therapeutic agent , 2.60 on educational and work activities , 3.50 on formal therapeutic elements , and 4.3 on process 
 . 
 there were no significant differences in dimensions scores among the 5 saudi tcs.conclusion:in general , all of the saudi tcs scored fairly high on the seeq , which may reflect a sufficient implementation of the tc as a therapeutic model . 
 educational and work activities lagged behind the other dimensions and should be improved and re - evaluated . 
Methods
Sample and data collection
Instrument
Data analysis
Results
Discussion