Therapeutic community (TC) studies are reviewed to assess the effects of legal referral on treatment retention and outcome. The main findings reveal little evidence for differential outcomes between legally referred and non-legally referred clients in TCs, although legal referrals to TCs remain longer in treatment than do “voluntary” clients. Thus, there is an indirect relationship between legal referral and outcome which is mediated through retention in treatment. Issues are discussed which have confounded interpretation of research on the efficacy of compulsory treatment, e.g., definitions, client perception of pressure, implementation of legal referral procedures and the complexity of the recovery process itself. It is hypothesized that legal pressure can have a limited but potent role in the recovery process for appropriately identified substance abusers.
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