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Prison-Based Therapeutic Community Substance Abuse Programs—Implementation and Operational Issues

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Prison-Based Therapeutic Community Substance Abuse Programs—Implementation and Operational Issues December 2002 IMPLEMENTATION AND OPERATIONAL ISSUES 3 Prison-Based Therapeutic Community Substance Abuse Programs—Implementation and Operational Issues William M. Burdon, Ph.D., David Farabee, Ph.D., Michael L. Prendergast, Ph.D., Nena P. Messina, Ph.D., Jerome Cartier, M.A. University of California, Los Angeles, Integrated Substance Abuse Programs SINCE THE 1980s, attempts to break the policy was the evaluation of the “Stay’n Out” mained in, treatment and those who did not. cycle of drug use and crime have included prison TC in New York (Wexler, Falkin, However, a recent evaluation of treatment providing treatment to substance-abusing Lipton, & Rosenblum, 1992), which found programs within the Federal Bureau of Pris- offenders at various stages of the criminal jus- that the TC was more effective than no treat- ons found that inmates who had completed tice system, including in prison. Although a ment or other types of less intensive treatment treatment in one of the federal prison pro- variety of approaches to treating substance- in reducing recidivism, and that longer time grams were significantly less likely to relapse abusing inmates have been developed, the in TC treatment was associated with lower to drug use or experience new arrests in the therapeutic community (TC) is the treatment recidivism rates after release to parole. The six months following release than were in- modality that has received the most attention positive findings from this evaluation became mates in a comparison group, even after con- from researchers and policy makers. the foundation for federal and state initiatives trolling for individual- and system-level Therapeutic communities in prisons have to support the expansion of prison-based TCs selection factors (Pelissier et al., 2000). several distinctive characteristics: 1) they during the 1990s. The California Initiative present an alternative concept of inmates that The Stay’n Out evaluation did not examine is usually much more positive than prevailing the impact of aftercare on outcomes by program California has more individuals under cor- beliefs; 2) their activities embody positive val- graduates following release to parole, but more rectional supervision (i.e., prison and parole) ues, help to promote positive social relation- recent evaluations have assessed the provision than any other state (Bureau of Justice Statis- ships, and start a process of socialization that of aftercare in connection with other prison- tics, 2001a,b). As of September 30, 2001, there encourages a more responsible and productive based TCs. These studies have provided consis- were 161,497 inmates in California’s 33 pris- way of life; 3) their staff, some of whom are tent evidence that adding aftercare to ons (California Department of Corrections recovering addicts and former inmates, pro- prison-based TC treatment for graduates pa- [CDC], 2001a). Of these, 45,219 (28 percent) vide positive role models; and 4) they provide roled into the community significantly improves were incarcerated for an offense involving transition from institutional to community clients’ behavior while under parole supervision drugs, at an annual cost of approximately $1.2 existence, with treatment occurring just prior (Field, 1984, 1989; Knight, Simpson, & Hiller, billion (CDC, 2001b). Another 21 percent to release and with continuity of care in the 1999; Martin, Butzin, Saum, & Inciardi, 1999; were incarcerated for a property offense, community (Pan, Scarpitti, Inciardi, & Prendergast, Wellisch, & Wong, 1996; Wexler, which in many cases was related to drug use Lockwood, 1993). Because prison environ- Blackmore, & Lipton, 1991; Wexler, De Leon, (Lowe, 1995). As of September 30, 2001, there ments stress security and custody, the designs Kressel, & Peters, 1999; Wexler, Melnick, Lowe, were 119,636 individuals on parole in Cali- of prison-based TCs are modified versions of & Peters, 1999) and thus increases the likelihood fornia. Of these, 38 percent had been incar- the community-based TC model. However, of positive outcomes (i.e., reduced recidivism cerated for a drug offense and 26 percent had the goals of prison-based TCs remain the same and relapse to drug use). been incarcerated for a property offense as community-based TCs, and they are gener- It should be noted that most of these stud- (CDC, 2001a). Furthermore, according to ally designed to operate in much the same way ies did not employ a true experimental de- CDC (2000), 67 percent of the individuals (Inciardi, 1996; Wexler & Love, 1994). sign in which study-eligible inmates were entering the state’s prison system in 1999 were Evaluations of prison-based TC programs randomly assigned to either a treatment or a parole violators; 55.5 percent of these were that have been conducted in several states and non-treatment condition. Therefore, it is pos- returned to custody for a drug-related offense. within the federal prison system have pro- sible that some of the presumed effects of In response to the large number of pris- vided empirical support for the development these programs may have been the result of oners and parolees with substance abuse of these programs throughout the nation. An self-selection bias, that is, systematic differ- problems, and in an attempt to reduce recidi- early study that had a substantial impact on ences between inmates who opted for, and re- vism rates, the California legislature has ap- 4 FEDERAL PROBATION Volume 66 Number 3 propriated approximately $94 million toward Inmates who successfully parole from tion, supportive organizational culture, suf- the expansion of prison-based substance these prison-based TC SAPs have the option ficient resources) represent system-related abuse programs based on the TC model of of participating in up to six months of con- issues, while the remaining four issues treatment. As a result, since 1997, the num- tinued treatment in the community. Unlike (screening, assessment, and referral; treat- ber of prison-based TC beds within the Cali- prison-based treatment, participation in af- ment curriculum, incentives and rewards; and fornia state prison system has increased from tercare is voluntary, and failure to enter com- coerced treatment) represent treatment-re- 500 in 3 programs at 3 prisons to 7,650 in 32 munity-based treatment in accordance with lated issues. Many, if not most, states that programs at 17 institutions. Additional ex- the established aftercare plan does not con- establish or expand TC substance abuse treat- pansions are planned to further increase these stitute a parole violation.2 ment for inmates face the same, or similar, numbers to approximately 38 programs pro- As part of the ongoing expansion of these issues (Farabee et al., 1999; Harrison & Mar- viding substance abuse treatment to approxi- prison-based TC SAPs, UCLA Integrated tin, 2000; Moore & Mears, 2001). Thus, these mately 9,000 inmates at 19 institutions (CDC, Substance Abuse Programs (ISAP) is con- issues will be discussed in terms of their im- 2001c). The initiative is operated by CDC’s ducting process evaluations of 17 of these pro- portance as key elements in developing and Office of Substance Abuse Programs (OSAP). grams (located in 10 institutions and totaling sustaining effective TC substance abuse treat- The treatment is provided by contracted treat- approximately 4,900 beds). ISAP (previously ment programs in correctional environments. ment providers with experience in TC treat- known as the Drug Abuse Research Center Collaboration and communication. Any ment for correctional populations. [DARC]) has an extensive background in cor- initiative that is aimed at implementing and/ The selection of the TC as the model of rections-based treatment research, including or expanding substance abuse treatment in a treatment for these programs was based some of the earliest studies done on prison- correctional environment represents an effort largely on the positive results that emerged based treatment of drug-involved offenders to bring together two systems (i.e., corrections from the evaluation studies (cited above) of (Anglin, 1988; McGlothlin, Anglin, & Wil- and treatment) that have conflicting core prison-based TCs in other parts of the coun- son, 1977; Hall, Baldwin, & Prendergast, 2001; philosophies regarding substance use and try and, more specifically, the results of an Hser, Anglin, & Powers, 1993; Hser, abuse. Correctional systems view drug use as evaluation of the Amity TC in San Diego, Hoffman, Grella, & Anglin, 2001; Prender- a crime. As such, their goals are based on phi- California (Wexler, 1996). Also, as a result gast, Hall, Wellisch, & Baldwin, 1999). The losophies of punishment and incarceration. of those evaluation findings, the California main purpose of these process evaluations is The focus of a correctional system is on the initiative includes a major aftercare compo- to 1) document the goals and objectives of crime that was committed and the sanctions nent for graduates from the prison-based TC CDC’s drug treatment programs and any ad- to punish the offender and deter him/her programs that provides funding for up to six ditional goals and objectives of each provider, from engaging in subsequent criminal activ- months of continued treatment (residential 2) assess the degree to which the providers ity. Treatment is secondary. On the other or outpatient services) in the community fol- are able to implement these goals and objec- hand, substance abuse treatment systems view lowing release to parole. tives in their programs,
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