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 .