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, 3) determine the de- drug use as a chronic, but treatable disorder. The TC substance abuse programs (SAPs) gree to which the provider conforms to the The focus of the treatment provider is on in the California state prison system provide therapeutic community model of treatment, treating the person for his/her substance between 6 and 24 months of treatment at the and 4) collect descriptive data on SAP par- abuse problem with the goal of reducing the end of inmates’ prison terms. Combined, ticipants. The process evaluations use data drug use and improving the mental and these programs cover all levels of security clas- drawn from program documents; observa- physical health of the person (Prendergast & sification (Minimum to Maximum) and male tions of programming activities; interviews Burdon, 2001). Furthermore, the reality of the and female inmates. With few exceptions, with program administrators, treatment and relationship between these two systems is that participation in these programs is mandatory corrections staff, and OSAP personnel; peri- the treatment system operates within the cor- for inmates who have a documented history odic focus groups with treatment staff, cus- rectional system, with the latter typically serv- of substance use or abuse (based on a review tody staff, and inmates assigned to each ing in the role of contractor. As such, the of inmate files) and who do not meet estab- program; and standardized program assess- correctional system can be viewed as a lished exclusionary criteria for entrance into ment instruments. Client-level information “superordinate” system within which the a TC SAP (e.g., documented in-prison gang is derived from the records of the in-prison “subordinate” treatment system operates. affiliations, being housed in a Security Hous- treatment providers and from an intake as- This organizational reality, combined with ing Unit within the previous 12 months for sessment instrument administered by the pro- the conflicting philosophies of the two sys- assault or weapons possession, Immigration viders at the time clients enter the TC SAPs.3 tems, places constraints on what treatment and Naturalization Service holds). Also, most providers are able to accomplish in their at- of the TC SAPs are not fully separated from Implementation and tempt to provide effective substance abuse the general inmate populations of the insti- Operational Issues treatment services to inmate populations. tutions within which they are located.1 Out- The process evaluations have revealed a num- Most important, the goals and philosophies side of their designated housing unit and the ber of macro-level issues that are relevant to of the subordinate treatment system do not 20 hours per week of programming activities the implementation and ongoing operations have as much influence as those of the in which they are required to participate, TC of prison-based TC substance abuse treat- superordinate correctional system. Because of SAP inmates remain integrated with the gen- ment programs in general; that is, these is- this, effective and open communication and eral population inmates of the facility in sues are not unique to California. The first collaboration between the two become criti- which they are located. three issues (collaboration and communica- cal. Both systems need to be committed to December 2002 IMPLEMENTATION AND OPERATIONAL ISSUES 5 developing and maintaining an inter-organi- likely to require changes or additions to exist- working in a prison environment is often a zational “culture of disclosure” (Prendergast ing policies, procedures, and possibly even leg- far more stressful experience than they may & Burdon, 2001). That is, they need to de- islative penal code. Most important, however, expect. More often than not, new counselors velop a common set of goals and they need to and given the paramilitary nature of correctional will have little or no experience working with share system-, program-, and client-level in- systems, change must be initiated at the top of prisoners or in a prison setting, and many may formation in an atmosphere of openness and the organizational hierarchy and directed down- not even be familiar with the TC model of mutual understanding and trust. However, it ward to line staff. Thus, the commitment and treatment. Indeed, because of the shortage of is ultimately incumbent upon the larger con- continued support of correctional manage- experienced staff for prison programs, it is not trolling superordinate system (i.e., the cor- ment at both the departmental level (e.g., de- unusual for the minimum requirements for rectional system) to ensure the presence of partment director, deputy directors) and entry-level counselors in prison-based treat- an environment within which this level of institutional level (e.g., wardens, deputy war- ment programs to omit requirements that communication and collaboration can occur. dens, associate wardens) are required for treat- they be certified to provide substance abuse To the extent that this does not occur, the ment programs to exist and operate effectively treatment in a criminal justice setting, or even ability of treatment providers to operate within the prison environment. have any previous experience as a substance prison-based TC SAPs as intended and to cre- To this end, departmental and institu- abuse treatment counselor. In most cases, these ate a culture that is conducive to therapeutic tional management can facilitate the success- requisites are obtained after the counselors change is negatively impacted. ful implementation of treatment programs by have been hired and have begun working with Supportive organizational culture. Devel- issuing regular written and verbal statements client populations, generally through orga- oping and sustaining an environment that of support for them. Also, efforts should be nized training and certification courses that facilitates and supports effective communi- made to incorporate policies and procedures they are required to attend within a prescribed cation and collaboration among treatment into existing departmental operations manu- period of time. In addition, most (if not all) and correctional staff is difficult at best. Most als and (if necessary) penal code that facili- new counselors are subjected to long periods departments of corrections are, by nature, tate the ongoing operation of these programs, at the beginning of their employment (usually highly bureaucratic organizations that require while ensuring the continued safety and se- the first 2–3 months) during which they are personnel to operate in accordance with writ- curity of staff (custody and treatment) and “tested” by the inmates and struggle to estab- ten policy and procedure manuals and/or leg- inmates. Over time, such efforts may result lish their personal boundaries of interaction. islative code. This fact, combined with the in a shift in the organizational culture to one Also, unlike previous experiences that they may underlying philosophies and objectives of characterized by strong support for the pres- have had in substance abuse treatment settings, correctional systems, supports and reinforces ence of substance abuse programs. Without their counseling methods and interpersonal a well-developed and firmly entrenched or- this commitment and support from correc- interactions (both formal and informal) with ganizational culture that emphasizes safety, tional management and the resulting change inmates may be severely restricted and closely security, and strict conformance to estab- in organizational culture, treatment programs watched by both their supervisors and custody lished policies and procedures. For the most will not be able, and should not be expected, staff to ensure that they do not become over- part, such an organizational culture does not to operate at their full potential. familiar with the inmates. facilitate or support the presence of a system, Sufficient resources. As important as open In short, many individuals who come to such as a substance abuse treatment program, communication and collaboration and the ex- work in prison-based treatment programs are that has different philosophies and objectives. istence of a supportive organizational culture unprepared for the realities of working with Yet, in order for substance abuse treatment are to the existence and effectiveness of prison- inmates in a prison environment. In addition, programs to operate with any degree of ef- based treatment programs, the continued low pay, combined with a highly stressful fectiveness, there must be some degree of availability of sufficient resources (primarily working environment, quickly diminish meaningful integration of the criminal justice financial resources) properly directed at these whatever altruistic motivations most coun- and treatment systems. For this to occur, the services is essential to ensuring treatment ef- selors had when they were hired. Many of organizational culture must be altered in a fectiveness. Indeed, most discussions of the them may fail to develop appropriate bound- way that facilitates the work of treatment pro- elements of an integrated system of care ad- aries of interaction with SAP participants, grams, while ensuring the continued safety dress the issue of resources (Field, 1998; “burn-out” within a short period, and end up and security of the inmates, staff, and public. Greenley, 1992; Rose, Zweben, & Stoffel, 1999; being terminated or resigning. While it is not realistic to expect that treat- Taxman, 1998). While departments of correc- The difficulty treatment providers have in ment programs operating within a correc- tions understandably want to control costs, recruiting and (more important) retaining tional environment should be exempt from commitment of insufficient financial re- experienced counseling staff negatively im- departmental and institutional policies and sources, especially in the form of funds for sala- pacts almost every aspect of a treatment procedures, it is also not realistic to expect ries, will likely prevent the recruitment and program’s operations. Most important, fre- treatment programs, especially those that are retention of experienced and qualified treat- quent staff turnover prevents inmates from designed as TC treatment programs, to oper- ment staff, resulting in persistent staff turnover. developing therapeutic bonds with counse- ate effectively in a prison environment that is Paying treatment staff salaries that are lors and becoming engaged in the treatment not designed for and does not support the competitive with the local markets from process. Sufficient resources in the form of existence and operation of such programs. which they are recruited may not suffice. Even higher pay scales that reflect the uniqueness Altering an organizational culture requires for individuals who have previous experience of working in a correctional environment, time. In a correctional environment, it is also as substance abuse treatment counselors, higher prerequisites for newly hired treatment 6 FEDERAL PROBATION Volume 66 Number 3

staff (e.g., previous experience working with The use of a scientifically valid and reliable Incentives and rewards in treatment. By inmate populations, certification to provide method of screening inmates for substance their nature, correctional environments en- counseling services in a correctional environ- abuse problems and assessing their specific force compliance with institutional rules and ment), and adequate administrative support needs will aid in ensuring that each inmate is codes of conduct through negative reinforce- for counseling staff are among the keys to referred to the proper modality and intensity ment—the contingent delivery of punish- minimizing staff turnover. The presence of a of treatment. This will further enhance the ment to individuals who violate these rules stable and experienced treatment staff who are effectiveness of existing programs by not and codes of conduct. Seldom, if ever, do in- properly supported administratively will, in populating them with inmates who do not mates receive positive reinforcement for en- turn, result in a more stable and consistent have serious substance abuse problems or gaging in pro-social behaviors (i.e., complying treatment curriculum, which will further en- who are not amenable to treatment. with institutional rules and codes of conduct). gage clients in the treatment process. Treatment curriculum. “Community as Similarly, the TC model specifies disciplin- Screening, assessment, and referral. Thera- method” refers to that portion of TC philoso- ary actions that should be taken in response peutic community treatment is the most in- phy that calls for a full immersion of the client to TC rule violations (De Leon, 2000), but says tensive form of substance abuse treatment into a community environment and culture little about rewarding specific acts of positive available. It is also the most costly to deliver. that is designed to change the “whole person.” behavior (e.g., punctuality, participation, In addition, not all substance-abusing offend- In correctional environments where treatment timely completion of tasks). Rather, rein- ers are alike in terms of their characteristics or programs are not fully segregated from the forcement for positive behavior takes the needs. As these characteristics and needs vary, general inmate population, inmates participat- form of moving the client to more advanced so too do individuals’ needs for specific types ing in the treatment curricula remain exposed stages of the TC program and conferring on of substance abuse treatment. Simply put, not to the prison subculture and its negative social him/her additional privileges. As such, this all substance-abusing offenders are in need of and environmental forces, which may weaken type of reinforcement “tends to be intermit- TC treatment. This clearly demonstrates the or negate whatever benefits they receive dur- tent and, in contrast to sanctions, less specific, need for a scientifically valid and reliable ing programming activities. This is especially not immediately experienced, and based on method of identifying substance-abusing of- true in the case of mandated treatment pro- a subjective evaluation of a client’s progress fenders, assessing their specific treatment grams, where problem recognition and moti- in treatment” (Burdon, Roll, Prendergast, & needs, and matching them to an appropriate vation for change among many treatment Rawson, 2001, p. 78). modality and intensity of treatment. participants may be lacking, at least initially. Where participation in prison-based TC Given the bureaucratic nature of correc- In addition, SAP participants, most of whom treatment programs is mandated for inmates tional systems and their philosophical foun- have become indoctrinated into the prison meeting established criteria, the emphasis on dations of punishment and incarceration, subculture, with its taboos on self-disclosure punishments and disincentives in the treat- entrenched organizational cultures, and pres- and sharing of personal information, have dif- ment process acts to compound the resent- sures to conform to existing policies and pro- ficulty discussing personal issues in group set- ment and resistance that inmates feel and cedures, many correctional systems may opt tings, which is a basic component of most TC exhibit as a result of being coerced into treat- instead to identify and assign inmates to treat- treatment curricula. ment. Incentives and rewards would likely ment programs based on reviews of inmates’ To counteract the negative influence that alleviate much of this resentment and resis- criminal files by department personnel for any exposure to the prison subculture has on par- tance and may even increase motivation to history of drug use or drug-related criminal ticipants in treatment, it is important that participate in treatment. However, at some activity. Indeed, in correctional systems char- treatment curricula be structured, rigorous, institutions, the ability of treatment provid- acterized by a less than supportive organiza- and void of repetitiveness. In addition, the ers to develop and implement incentive or tional culture, decisions to place inmates into early phases of treatment are important be- reward systems may be limited by departmen- treatment programs may be based less on cause of their potential effect on a client’s tal and institutional policies and procedures whether they have a substance abuse prob- motivation for change and willingness to en- that forbid the granting of special privileges, lem than on other factors relating to such gage in the treatment process. In community- rewards, or other incentives to specific groups things as institutional management and se- based treatment, increasing the number of of inmates (e.g., those participating in a treat- curity concerns. When this occurs, inmates individual counseling sessions during the first ment program). In sum, the ability of treat- who could or should be placed into these pro- month of treatment has been shown to sig- ment providers to implement effective grams (i.e., those with substance abuse dis- nificantly improve client retention (De Leon, systems of incentives and rewards in the treat- orders) may be excluded, whereas inmates 1993). Clearly, given the higher proportions ment process may be restricted due to the who may not be amenable to or appropriate of involuntary clients in correctional treat- priority that the penal philosophy takes over for treatment programs may be included (e.g., ment programs, the initial phase of treatment the treatment philosophy within the context those who have severe mental illness or are should emphasize problem recognition and of a prison-based treatment program. dangerous sex offenders). This, in turn, di- willingness to change before introducing the Coercion alone is rarely sufficient to pro- rectly impacts the treatment providers’ abil- tools to do so. Also, one-on-one counseling mote engagement in treatment. Overcoming ity to provide efficient and effective treatment in the early phases of the treatment may serve inmates’ resentment over having been man- services to those who are most in need of as a useful tool for gradually introducing in- dated into treatment and their resulting resis- them. Also, inmates with minimal substance mate participants to and engaging them in the tance to participating in treatment requires that abuse involvement may be referred to inten- TC treatment process, which relies more on programs and institutions not only remove sive TC treatment, which they may not need. group dynamics and community. disincentives, but also incorporate incentives, December 2002 IMPLEMENTATION AND OPERATIONAL ISSUES 7 when possible, that would serve as meaning- Summary Services Branch, California Department of ful inducements to participating in the treat- Since prison-based TCs first appeared in the Corrections. ment process. Gendreau, in his 1996 review of 1980s, numerous evaluations have been con- California Department of Corrections. (2001a). effective correctional programs, recommended ducted at both the state and federal levels that CDC facts–Third quarter 2001. Sacramento, CA: that positive reinforcers outnumber punish- have provided empirical support for the ef- Offender Information Services Branch, Califor- ers by at least 4 to 1. Possible incentives for fectiveness of these programs in reducing re- nia Department of Corrections. treatment participation could include such cidivism and relapse to drug use, especially California Department of Corrections. (2001b). things as improved living quarters and en- when combined with continuity of care in the CDC facts–Fourth quarter 2001. Sacramento, hanced vocational or employment opportuni- community following release to parole. Other CA: Offender Information Services Branch, ties, or, where allowed, early release. studies have focused on the so-called “black California Department of Corrections. Coerced treatment. Much of the growth in box” of treatment (i.e., the treatment process) California Department of Corrections. (2001c). criminal justice treatment (both in Califor- in an effort to identify relevant factors that Office of substance abuse programs: Weekly in- nia and nationally) is based on the widely ac- predict success among participants in TC prison population report–November 6, 2001. Sac- cepted dictum that involuntary substance treatment programs (e.g., Simpson, 2001; ramento, CA: Office of Substance Abuse Programs, California Department of Correc- abuse clients tend to do as well as, or better Simpson & Knight; 2001). However, few have tions. than, voluntary clients (Farabee, Prendergast, focused on the system- and treatment-level & Anglin, 1998; Leukefeld & Tims, 1988; process issues relating to the implementation De Leon, G. (1993). What psychologists can learn from addiction treatment research. Journal of Simpson & Friend, 1988). However, these and ongoing operations of TCs in correctional Addictive Behaviors, 7, 103-109. studies were based on community-based environments and how these issues impact treatment samples. As mentioned above, co- the ability of treatment providers to effectively De Leon, G. (2000). The therapeutic community: Theory, model, and method. New York: Springer erced participation in prison-based treatment provide treatment services to inmate popu- Publishing Company. programs breeds a high degree of resentment lations. and resistance among many of the inmates It is also important to note that most (if Farabee, D., Prendergast, M. L., & Anglin, M. D. (1998). The effectiveness of coerced treatment forced into these programs. Some inmates not all) of the issues discussed in this paper for drug-abusing offenders. Federal Probation, desire to change their behavior and welcome have application beyond prison-based TCs 62(1), 3-10. the opportunity to participate. Other inmates and should be considered in any initiative that Farabee, D., Prendergast, M. L., Cartier, J., Wexler, may, over time, develop a desire to remain and seeks to implement or expand substance H., Knight, K., & Anglin, M. D. (1999). Barri- participate. However, a substantial portion of abuse treatment in correctional settings. In ers to implementing effective correctional treat- the inmates coerced into treatment remain addition, although these issues may appear ment programs. Prison Journal, 79(2), 150-162. resentful, refuse to participate, and, in many to address different aspects of treatment pro- Field, G. (1984). The cornerstone program: A client cases, actively disrupt the programs and the gram operations, they are not mutually ex- outcome study. Federal Probation, 48, 50-55. existing community culture. Furthermore, clusive. Indeed, to maximize the operational Field, G. (1989). A study of the effects of intensive despite their continued disruptive behavior effectiveness of substance abuse treatment treatment on reducing the criminal recidivism and the negative impact that it has on pro- programs in correctional environments, they of addicted offenders. Federal Probation, 53(10), viders’ ability to deliver effective program- should be considered in their entirety. 51-56. ming, efforts to remove these disruptive References Field, G. (1998). From the institution to the com- inmates from the programs in a timely fash- munity. Corrections Today, 60(6), 94-97, 113. ion often prove elusive due to correctional de- Anglin, M. D. (1988). The efficacy of civil com- Gendreau, P. (1996). The principles of effective partment policies and procedures governing mitment in treating narcotic addiction. In C. G. Leukefeld & F. M. Tims (Eds.), Compulsory intervention with offenders. In A. T. Harland the movement and classification of inmates (Ed.), Choosing correctional options that work in the prison environment. treatment of drug abuse: Research and clinical practice (NIDA Research Monograph 86, pp. (pp.117-130). Thousand Oaks, CA: SAGE. One possible strategy to overcome this re- 8-34). Rockville, MD: National Institute on Greenley, J. R. (1992). Neglected organizational sentment and resistance and to expedite the Drug Abuse. and management issues in mental health sys- development of a TC culture would be to Burdon, W. M., Roll, J. M., Prendergast, M. L., & tems development. Community Mental Health limit admissions during a program’s first Rawson, R. (2001). Drug courts and contin- Journal, 28(5), 371-384. year or so to a relatively small number of gency management. Journal of Drug Issues, Hall, E. A., Baldwin, D. M., & Prendergast, M. L. inmates who volunteer for treatment. Once 31(1), 73-90. (2001). Women on parole: Barriers to success a treatment milieu is established, issues such Bureau of Justice Statistics. (2001a). Prisoners in after substance abuse treatment. Human Or- as program size and the presence of invol- 2000 (NCJ 188207). Washington, DC: Bureau ganization, 60(3), 225-233. untary inmates may prove more tractable. of Justice Statistics, U.S. Department of Justice. Harrison, L. D., & Martin, S. S. (2000). Residential Also, motivation for treatment should be a Bureau of Justice Statistics. (2001b). Probation and substance abuse treatment for state prisoners for- consideration for prison-based treatment parole in the United States, 2000 – Press release mula grant: Compendium of program implemen- referral and admission. Ideally, the majority (NCJ 188208) Washington, DC: Bureau of Jus- tation and accomplishments. Final report. of clients referred to prison-based programs tice Statistics, U. S. Department of Justice. Newark, DE: Center for Drug and Alcohol (particularly new programs) should be in- Studies, University of Delaware. California Department of Corrections. (2000). mates with at least a modicum of desire to California prisoners and parolees–2000 prelimi- Hser, Y., Anglin, M. D., & Powers, K. I. (1993). A change their behavior through the assistance nary. Sacramento, CA: Offender Information 24-year follow-up of California narcotics addicts. of a treatment program. Archives of General Psychiatry, 50(7), 577-584. 8 FEDERAL PROBATION Volume 66 Number 3

Hser, Y. I., Hoffman, V., Grella, C. E., & Anglin, M. Pelissier, B., Rhodes, W., Saylor, W., Gaes, G., Wexler, H. K. (1996, November). The Amity prison D. (2001). A 33-year follow-up of narcotics ad- Camp, S., Vanyur, S. D., & Wallace, S. (2000). TC evaluation: Inmate profiles and dicts. Archives of General Psychiatry, 58, 503-508. TRIAD drug treatment evaluation project: Final reincarceration outcomes. Presented tot the Cali- Inciardi, J. A. (1996). The therapeutic community: report of three-year outcomes. Washington, DC: fornia Department of Corrections, Youth and An effective model for corrections-based drug Federal Bureau of Prisons. Adult Correctional Agency, Sacramento, CA. abuse treatment. In K. Early (Ed.), Drug treat- Prendergast, M. L., & Burdon, W. M. (2001). Inte- Wexler, H. K., Blackmore, J., & Lipton, D. S. ment behind bars: Prison based strategies for grated systems of care for substance abusing (1991). Project REFORM: Developing a drug change. Westport, CT: Praeger Publishers. offenders. In C. Leukefeld, F. Tims & D. Farabee abuse treatment strategy for corrections. Jour- Knight, K., Simpson, D. D., & Hiller, M. L. (1999). (Eds.), Treatment of drug offenders: Policies and nal of Drug Issues, 21(2), 469-490. Three-year reincarceration outcomes for in- issues. New York: Springer. Wexler, H. K., De Leon, G., Kressel, D., & Peters, prison therapeutic community treatment in Prendergast, M. L., Hall, E., Wellisch, J., & Baldwin, J. (1999). The amity prison TC evaluation: Texas. Prison Journal, 79(3), 337-351. D. (1999). A process evaluation of the Forever Reincarceration outcomes. Criminal Justice and Leukefeld, C. G., & Tims, F. M. (1988). Compulsory Free Substance Abuse Treatment Program—(Fi- Behavior, 26(2), 147-167. treatment of drug abuse: Research and clinical nal Report, Grant 97-RT-VX-K003, submitted Wexler, H. K., Falkin, G. P., Lipton, D. S., & practice (NIDA Research Monograph 86, De- to the National Institute of Justice). Los Ange- Rosenblum, A. B. (1992). Outcome evaluation partment of Health and Human Services Publi- les: UCLA Drug Abuse Research Center. of a prison therapeutic community for substance cation No. ADM 89-1578, pp. 236-249). Prendergast, M. L., Wellisch, J., & Wong, M. abuse treatment. In C. G. Leukefeld & F. M. Tims Washington, DC: U.S. Government Printing (1996). Residential treatment for women pa- (Eds.), Drug Abuse Treatment in Prisons and Jails Office. rolees following prison drug treatment: Treat- (NIDA Research Monograph 118, Department Lowe, L. (1995). A profile of the young adult offender ment experiences, needs and services, of Health and Human Services Pub No. [ADM] in California prisons as of December 31, 1994 outcomes. Prison Journal, 76(3), 253-274. 92-1884, pp.156-175) Rockville, MD: National (Prepared for the Substance Abuse Research Rose, S. J., Zweben, A., & Stoffel, V. (1999). Inter- Institute on Drug Abuse. Consortium, Spring 1995). Sacramento: Office faces between substance abuse treatment and Wexler, H., & Love, C. (1994). Therapeutic com- of Substance Abuse Programs, California De- other health and social systems. In B. S. McCrady munities in prison. In F. Tims, G. De Leon & partment of Corrections. & E. B. Epstein (Eds.), Addictions: A Compre- N. Jainchill (Eds.), Therapeutic community: Martin, S. S., Butzin, C. A., Saum, C. A., & Inciardi, hensive Guidebook. New York: Oxford UP. Advances in Research and Application (NIDA J. A. (1999). Three-year outcomes of therapeu- Simpson, D. D. (2001). Modeling treatment pro- Research Monograph Series 144, pp. 181-208). tic community treatment for drug-involved of- cess and outcomes. Addiction, 96(2), 207-211. Rockville, MD: National Institute on Drug Abuse. fenders in Delaware: From prison to work release Simpson, D. D., & Friend, H. J. (1988). Legal sta- to aftercare. Prison Journal, 79(3), 294-320. tus and long-term outcomes for addicts in the Wexler, H. K., Melnick, G., Lowe, L., & Peters, J. McGlothlin, W. H., Anglin, M. D., & Wilson, B. DARP follow-up project. In C. G. Leukefeld & (1999). Three-year reincarceration outcomes D. (1977). An evaluation of the California civil F. M. Tims (Eds.), Compulsory treatment of drug for Amity in-prison therapeutic community addicts program. (NIDA Services Research abuse: Research and clinical practice (NIDA Re- and aftercare in California. Prison Journal, Monograph Series, Department of Health and search Monograph 86, Department of Health 79(3), 312-336. Human Services Publication No. ADM 78- and Human Services number (ADM)89-1578, 558). Rockville, MD: National Institute on pp. 81-98). Washington DC: U.S. Government Endnotes Drug Abuse. Printing Office. 1 Two programs located at the Substance Abuse Moore, G. E., & Mears, D. P. (2001). Strong science Simpson, D. D., & Knight, K. (2001). The TCU Treatment Facility (SATF) in Corcoran exist within for strong practice: Linking research to drug treat- model of treatment process and outcomes in completely separate prison facilities that are de- ment in the criminal justice system. Views of prac- correctional settings. Offender Substance Abuse voted to substance abuse treatment. titioners. Washington DC: The Urban Institute. Report, 1(4), 51-53, 58. 2 The exception to this are “civil addicts,” inmates Pan, H., Scarpitti, F. R., Inciardi, J. A., & Lockwood, Taxman, F. S. (1998). Reducing recidivism through classified as drug-dependent by the sentencing D. (1993). Some considerations on therapeu- a seamless system of care: Components of effec- court. Participation in aftercare is mandatory for tic communities in corrections. In J. A. Inciardi tive treatment, supervision, and transition ser- civil addicts who parole from prison. (Ed.), Drug treatment and criminal justice (pp. vices in the community. (Prepared for Office of 3 30-43). Newbury Park, CA: SAGE. National Drug Control Policy Treatment and Outcome evaluations are being conducted at 5 Criminal Justice System Conference). SAPs. Findings will be reported as they become Greenbelt, MD, University of Maryland, Col- available. lege Park.