ArticlePDF Available

Three-Year Outcomes of Therapeutic Community Treatment for Drug-Involved Offenders in Delaware: From Prison to Work Release to Aftercare



Delaware researchers have argued for a continuum of primary (in prison), secondary (work release), and tertiary (aftercare) therapeutic community (TC) treatment for drug-involved offenders. Previous work has demonstrated significant reductions in relapse and recidivism for offenders who received primary and secondary TC treatment 1 year after leaving work release. However, much of the effect declines significantly when the time at risk moves to 3 years after release. Further analyses reveal that program effects remain significant when the model takes into account not simply exposure to the TC program, but, more importantly, program participation, program completion, and aftercare. Clients who complete secondary treatment do better than those with no treatment or program dropouts, and those who receive aftercare do even better in remaining drug- and arrest-free.
1. Subject Area: Criminal Justice Client
Three Year Outcomes of Therapeutic Community Treatment for Drug Involved Offenders in Delaware: From Prison to
Work Release to Aftercare.
Author/s Individualized or Group
Subjects Info Randomized Controlled
Generalizable to Iowa?
Martin, Butzin, Saum,
Both individual and group
interventions were
involved in the study
Relapse and
N=about 200
68% Af. American
28% Caucasian
Mean Age: 29
No. Iowa TC’s are residential
only and the results support
a continuum through work
release and aftercare in the
Martin, S. S., Butzin, C. A., Saum, C. A., & Inciardi, J. A. (1999). Three year outcomes of therapeutic community treatment for drug involved offenders in
delaware: from prison to work release to aftercare. The Prison Journal, 79
(3), 294-320.
Delaware provides a continuum of primary (prison), secondary (work release) and tertiary (aftercare) Therapeutic Community
treatment. Earlier studies reflected reductions in relapse and recidivism for prisoners receiving primary and secondary TC treatment, but declined when the time
at risk moved to 36 months. Program effects remained constant when more recent analyses went beyond exposure to TC and examined program participation, as
well as completion and aftercare. “Clients who complete secondary treatment during work release have better outcomes than “no treatment” or dropouts and
those who complete tertiary treatment aftercare have even better outcomes for staying drug free and arrest-free.”
Revision of comparative grouping in this three year study looked at three more realistic distinctions of engagement in the TC continuum in relationship to the no
treatment comparison group; treatment dropouts, completers without aftercare, and completers with aftercare. Study dropouts were as likely to be arrested on a
new charge as the comparison group (no treatment). Those who complete do much better, and those who complete with aftercare are least likely to have a new
arrest. One in three with aftercare have a new arrest opposed to two of three in the comparison and dropout groups.
Program dropouts were “more than three times as likely to be drug-free than the comparison group, the program completers without aftercare were five times
more likely to be drug-free, and those who completed the program with aftercare were seven times more likely to be drug-free. It appears that the length of time
in transitional and aftercare TC treatment is a significant and an incremental protective factor against likelihood of relapse.” As more subjects enter the tertiary
follow-up stage, more information will be available to examine all stages in the continuum equally. Results are still preliminary.
2. Subject Area: Criminal Justice Client
Effectiveness of Drug Treatment Courts: Evidence from a Randomized Trial.
Author/s Individualized or Group
Subjects Info Randomized Controlled
Generalizable to Iowa?
Gottfredson, Najaka and
Not clear from article. Recidivism. N=about 235
74% male
89.2% African
American heroin
Yes. Randomized to
treatment and non-
treatment groups.
Iowa’s Drug Court system is
different than the study
Gottfredson, D. C., Najaka Stacy S., & Kearly, B. (2003). Effectiveness of drug treatment courts: evidence from a randomized trial . Criminology and Public
Policy, 2(2), 171-196.
This study randomly assigned 235 offenders to either drug treatment court or treatment as usual. Drug Treatment Court subjects who
participated in treatment were less likely to recidivate than the control or untreated drug court subjects. Because jail stays were used as a sanction for relapsing
subjects, it was not surprising that both the number of days in treatment and the number treatment episodes were substantially higher for drug court cases.
Almost one third of the subjects terminated unsatisfactorily (not complying with treatment requirements, or chose to the do the time in a lighter sentence than to
do the effort required of treatment). Drug court subjects were less likely than control subjects to be re-arrested. Drug Court participants were far less likely to be
re-arrested for a drug offense.
The findings indicate that the Baltimore City Drug Treatment Court (BCDTC) is reducing criminal offending in a population of drug-addicted chronic offenders.
During the two-year follow-up, 66.2% of the drug court subjects and 81.3% of the control subjects were re-arrested and the number of new arrests was 30%
lower for the treatment than for the control subjects. This study provided the strongest test to date of the impact of the BCDTC.
This study does not differentiate between in-program recidivism and post-program recidivism, an important distinction, because post-program behaviors are
likely to be very different from behaviors during drug court supervision.
3. Subject Area: Criminal Justice Client
Three-Year Reincarceration Outcomes for Amity In-Prison Therapeutic Community and Aftercare in California
Author/s Individualized or Group
Subjects Info Randomized Controlled
Generalizable to Iowa?
Wexler, Melnich, Lowe,
and Peters
Both interventions are
used for In-prison TC and
aftercare TC in the
Return to
custody and
days until
return to
N=478 Males
35% African Am.
25% Hispanic
37% Caucasian
Yes. Intent to treat design
with random assignment.
No. Iowa only has
residential TC programs.
Wexler, H. K., Melnich, G., Lowe, L., & Peters, J. (199). Three-year reincarceration outcomes for amity in-prison therapeutic community and aftercare in
california. The Prison Journal, 79
(3), 321-336.
There was no significant effect for treatment in the intent to treat analysis. This study examined thirty-six month recidivism outcomes
for a prison therapeutic community that included aftercare TC treatment. Outcomes for 478 felons replicated earlier 12 and 24 month studies showing the best
outcomes for prisoners who completed both the in-prison TC treatment and the aftercare TC program. At three-years, 27% of those who completed both in-
prison and aftercare returned to incarceration versus 75% of the other groups studied. There was also a positive relationship between the amount of time spent in
treatment and the “return to custody days” timeframe. “There is strong association between completing both the in-prison and community aftercare treatment
programs and the return-to-custody outcome at three years post-parole. Approximately three-fourths of the control group, the program dropouts and prison
treatment completers were returned to custody, whereas, only 27% of community aftercare program completers were returned to custody. Comparison across the
12-, 24- and 36-month follow up periods demonstrate consistent positive outcomes associated with the completion of the aftercare program.” Results are
Policy implications: Treatment while incarcerated with no aftercare in the community works against the findings for long-term success against recidivism.
4. Subject Area: Criminal Justice Client
Three-Year Reincarceration Outcomes for In-Prison Therapeutic Community Treatment in Texas
Author/s Type of Programming
Subjects Info Randomized Controlled
Generalizable to Iowa?
Knight, Simpson, and
Both interventions are
used for In-prison TC and
aftercare TC in the
rates for
high risk
offenders and
high risk drug
N=394 nonviolent
169 who completed
ITC and aftercare
122 who completed
the ITC but not
No. No. Iowa only has in-prison
TC programs.
Knight, K., Simpson, D. D., & Hiller, M. L. (1999). Three-year reincarceration outcomes for in-prison therapeutic community treatment in texas. The Prison
Journal, 79(3), 337-351.
Forty-one percent (41%) of the entire sample was returned to custody within three years of leaving prison. In-Prison Therapeutic
Community (ITC) treated and untreated offenders were not significantly different (41% vs. 42%). However, when aftercare participation was considered, only
one fourth (25%) of the aftercare completers were returned to
custody, less than the rate for the comparison group. The ITC treatment group had a larger number of high severity subjects, but the greatest effect of treatment
on outcome was realized for the high-severity offenders who completed both the ITC and aftercare treatment.
The aftercare completer group results showed that 6% were reincarcerated for a new offense, significantly less that the rate of 22% for aftercare dropouts and
19% for the comparison group. Again, the greatest effect of treatment on outcome was realized for the high severity offenders who completed both the ITC and
aftercare treatment. Their three year reincarceration rate was 26%, versus 66% for the aftercare dropouts and 54% for the comparisons.
Policy implications: Offender treatment services should be matched with offender risk, and a mandated community aftercare treatment should be in place.
Community-based aftercare should be an integral part of correctional treatment. Failure to do so undermines the ITC work accomplished during the in-prison
5. Subject Area: Criminal Justice Client
Meta-Analytic Review of the Effectiveness of Corrections-Based Treatments for Drug Abuse
Author/s Type of Programming
Subjects Info Randomized Controlled
Generalizable to Iowa?
Pearson and Lipton Examining TC, boot camp
and drug-focused group
rates for high
risk offenders
and high risk
drug users.
Multiple studies
examined with a
variety of adult
Some juvenile
analysis is reported
as well.
No. Meta analysis of
multiple projects.
May generalize in
relationship to how to serve
high risk offenders as they
leave treatment and
Pearson, F. S., & Lipton, D. S. (1999). A meta-analytic review of the effectiveness of corrections-based treatments for drug abuse. The Prison Journal, 79
This meta-analysis reviewed corrections-based treatment research work completed from 1968-1996. The research included
examination of evidence for effectiveness in reducing recidivism. “Results support the effectiveness of therapeutic community programs that include a full
continuing care component, especially for higher risk subjects. Hypothesis testing did not support the effectiveness of bootcamps or drug-focused group
counseling but too few studies to draw from may be the main reason.”
The article provided a fair description of methodology for such analyses, and was helpful in summarizing work to date, and made recommendations for future
research. Although the interventions studied were based on too few studies to draw strong conclusions, cognitive behavioral therapy, 12-step program,
methadone maintenance treatment and substance abuse education also show promise for offender populations.
Policy implications: There is a need for more research regarding jail programming, because jails have distinctive programming needs from those of prisons
(clients with shorter duration of stay and the presence of un-sentenced prisoners in the facility). Specific treatment models and curricula need to be trialed with
controls for quality assurance and fidelity to the model included.
6. Subject Area: Criminal Justice Client
Integrating Substance Abuse Treatment and Criminal Justice Supervision
Author/s Individualized or Group
Subjects Info Randomized Controlled
Generalizable to Iowa?
Marlowe, Douglas B
N/A Examines need
for community-
based treatment
and ongoing
criminal justice
N=478 Males
35% African Am.
25% Hispanic
37% Caucasian
No. Yes. Community-based
work may benefit.
Iowa’s drug court activity
does not follow the
paradigm assessed here.
Marlowe, D. B. (2003). Integrating substance abuse treatment and criminal justice supervision. Science and Practice Perspectives, 2
, 4-14.
Marlowe provided a complete and efficient way of looking at the needs of community-based corrections as it works to develop the
necessary integration of substance abuse treatment and ongoing criminal justice supervision.
Programs that represented the public health-public safety integration strategy and have demonstrated effectiveness share a core set of attributes:
o They provide treatment in the community.
o They offer the opportunity for clients to avoid incarceration or a criminal record.
o Clients are closely supervised to ensure compliance.
o The consequences for noncompliance are certain and immediate.
Drug courts and work-release therapeutic communities are showing promise with regard to retention in treatment and better outcomes (lower arrest rates) for
long-term shifts at 2 years and 36 months. About 100 quasi-experimental evaluations have shown that drug court clients achieve greater reductions in criminal
recidivism, drug use, and unemployment than did standard probation or intensive probation offenders.
In 2002 the General Accounting Office (GAO), concluded there was insufficient data to gauge the effectiveness of federally funded drug court programs and
called for proposals which could help produce the research needed to accurately evaluate drug court impact on recidivism, drug use, employment and social
functioning. Inherent biases in the TC work release research (comparisons of voluntary clients vs. those who did not volunteer) reinforced the call for more
research. It was also suggested that continuing care be part of the treatment package and not simply a case management referral to someplace else after
completion. There are indications that those who receive continuing therapeutic care after they return to the community have improved outcomes.
This article also suggested that integrated models which include SA treatment and criminal justice supervision work best for high risk clients.
7. Subject Area: Criminal Justice Client
Research on Drug Courts: A Critical Review
Author/s Individualized or Group
Subjects Info Randomized Controlled
Generalizable to Iowa?
Belenko, Steven
Columbia University
National Center on
Addiction and Substance
N/A Retention and
A review of 30
pertaining to 24
drug courts across
the nation.
No. Iowa’s drug court activity
does not follow the drug
court model assessed here.
Belenko, S. (1998). Research on drug courts: a critical review. National Drug Court Institute Review, 1
(1), 10-55.
This article reviewed various types of evaluations of drug courts. Most examined data related to client retention in treatment, drug use,
and re-arrest rates.
The majority of the research info focused on the timeframe that clients are participating in drug court, rather than the long-term results post-drug court.
Evaluations varied considerably in method, quality and scope but consistent promise can be addressed:
o Drug courts are improving retention and engagement for felony offenders with longer criminal histories and substance abuse that has not be treated.
o Drug courts provide more comprehensive supervision than other forms of community monitoring.
o Criminal behavior and drug use are decreased while clients are participating, and lower after graduation from treatment, but few studies are available so
sample data is minimal.
o Drug courts are successful in creating a judiciary, corrections, and substance abuse treatment team to better manage and treat the various needs of
o More post-program research is needed. More outcomes need to be measured (education, employment, social connections, coping skills, etc...).
o More research needs to be experimental, with comparison groups that match size and characteristics of the study group.
o The individual dynamics of drug courts (judge involvement, graduated sanctions, length of time in treatment) need to be studied to understand how
these factors work to improve retention.
o Because drug courts are new and going through many changes, study needs to be devoted to how the changes over time impact the results.
8. Subject Area: Criminal Justice Client
Effective Strategies for Intervening with Drug Abusing Offenders
Author/s Individualized or Group
Subjects Info Randomized Controlled
Generalizable to Iowa?
Marlowe, Douglas B N/A Retention and
A review effective
strategies for
working with
substance abusing
No. Iowa’s drug court and TC
activity does not follow the
specific models assessed
here, but there are
recommended intervention
strategies that may be
Marlowe, D. B. (2002). Effective strategies for intervening with drug abusing offenders. Villanova Law Review, 47
(4), 989-1025.
This article provided a solid review of the history of strategic attempts to intervene with substance using offenders. It included a
snapshot of all pertinent researchers active in criminal justice research for substance using clients. In general, drug courts and TC’s with a continuum of care that
includes aftercare, have the potential to combine the successes of criminal justice systems monitoring and substance abuse treatment.
A brief history of “sobering” efforts included:
o Prison: Approximately one-half of drug abusers recidivate within eighteen months of release if they have not received treatment.
o Treatment in Prison: in-prison treatment efforts have a small impact on recidivism and little or no effect on relapse. Those with mimimal effect are
exemplary programs (most in Canada) where structured behavioral or cognitive-behavioral treatment that focuses on antisocial attitudes, impulsivity,
sensation-seeking and negative peer group associations.
o In-prison TC’s were found to have slight impact on recidivism, depending on the quality of the programming. A full re-entry continuum of care must
accompany the residential TC to have any impact for clients.
o There is potential promise for in-prison methadone maintenance, twelve-step programs, and cognitive-behavioral interventions, but the few studies
available do not allow for definitive conclusion.
o Civil committal works to assist retention for long-term residential (up to a year), followed by long-term aftercare.
o Most studies examined were flawed in design, using biased comparison samples. Studies also failed to perform “intent to treat” analyses for the original
sample and thus excluded dropouts and terminated clients.
o Residential treatment gains did not transition to re-entry and community life without a continuum of aftercare support that is more than a referral to a
twelve-step meeting or a referral to a counseling office.
o Providing the chance to avoid a criminal record and/or incarceration is a meaningful reward for offenders engaged in positive behavior change.
o Random urinalysis and contingency management rewards can improve engagement and retention in therapeutic interventions.
9. Subject Area: Criminal Justice Clients
Article Title: Helping Women Recover: Creating Gender-Specific Treatment for Substance-Abusing Women and Girls in
Community Correctional Settings.
Author/s Individualized or Group
Subjects Info Randomized Controlled
Generalizable to Iowa?
Covington Both modalities are
N/A N/A No. Yes.
Covington, S. (2000). Helping women recover: creating gender-specific treatment for substance-abusing women and girls in community correctional settings. M.
McMahon (ED), Assessment to Assistance: Programs for Women in Community Corrections
(pp. 171-233). Latham, MD.
This article provided a comprehensive summary of the needs of female offenders and the difficulties women face regarding their
opportunities to receive substance abuse treatment. Poverty, motherhood, abuse trauma, and coping with drugs as a pathway to crime and
imprisonment. Women are most at risk for substance use disorders if they: began substance abuse at an early age; have parents who abuse alcohol
or drugs; are victims of incest, sexual abuse and/or physical violence; have weak family and school relationships; have a poor self-concept
(particularly body image); have easy access to substances; and/or have difficulty coping with stress related to relationships. The material provided a
comprehensive plan for curriculum modules to address the needs of the “whole person”, recommendations for administrative planning and ideas for
future research. The referenced bibliography is excellent.
... Die geringe Rate an Therapieweisungen für unbehandelte Gefangene ist also auch im Licht gesetzlicher Vorgaben zu betrachten. Dieser Zusammenhang erscheint einerseits kontraintuitiv, da verschiedene Studien bei mehrstufigen Programmen bessere Effekte gezeigt haben als bei einzelnen Interventionen (Martin et al. 1999;Ndrecka 2014). Andererseits ist zu vermuten, dass sich viele Gefangene nach zwei Jahren Sozialtherapie bereits intensiv mit ihrer Tat und eigenen Risikofaktoren auseinandergesetzt haben, sodass eine Nachfolgebehandlung angesichts der niedrigen Rückfallraten im Sinne eines Deckeneffekts keine zusätzliche Varianz aufklärt. ...
... waren. AuchMartin et al. (1999) konnten zeigen, dass ein mehrteiliges Programm mit intraund extramuraler Betreuung einzelnen Bestandteilen hinsichtlich der Rückfallprävention überlegen war. Für den deutschsprachigen Raum gibt es bis dato noch keine vergleichbaren Untersuchungen. ...
Full-text available
Zusammenfassung Die ambulante Behandlung entlassener Sexualstraftäter hat in den letzten Jahren zunehmend an Bedeutung gewonnen. Insbesondere seit der Reform der Führungsaufsicht 2006 wurde das Nachsorgeangebot für Haftentlassene sukzessive ausgebaut. Ein Großteil der nachbehandelten Sexualstraftäter wird über Bewährungsauflagen oder Weisungen der Führungsaufsicht an eine Nachsorgeeinrichtung angebunden, bislang gibt es aber kaum Informationen darüber, wie häufig Therapieauflagen erteilt werden, an welche Faktoren sie geknüpft sind und wie wirksam sie sind. Die vorliegende Studie untersucht daher an einer Stichprobe entlassener Sexualstraftäter ( n = 1.537), welche individuellen, haftbezogenen und entlassungsbezogenen Faktoren die Wahrscheinlichkeit einer Therapieweisung beeinflussen. Zudem wird analysiert, ob eine Therapieweisung unter Kontrolle anderer relevanter Faktoren eine rückfallpräventive Wirkung aufweist. Als Datenbasis diente ein umfassender Erhebungsbogen, der bei Haftentlassung von den Fachdiensten ausgefüllt wurde. Unsere Ergebnisse zeigen, dass 77 % aller Sexualstraftäter eine Therapieauflage erhielten, dabei war der Anteil seit 2004 signifikant angestiegen. Jüngere Straftäter, Täter mit ausschließlich kindlichen Opfern, mit niedrigerem Static-99-Wert und einer Behandlung in Haft erhielten häufiger eine Therapieauflage. Für in der Haft unbehandelte Sexualstraftäter war eine Therapieauflage mit signifikant weniger Rückfall assoziiert, bei Straftätern mit Einzel- und Gruppentherapie galt dies nur für Rückfälle mit einem Gewaltdelikt. Für Entlassene aus der Sozialtherapie war eine Therapieauflage kein signifikanter Prädiktor. Implikationen für die Nachsorge von Sexualstraftätern und weitere Forschungsansätze werden diskutiert.
... Because many DTC programs are approximately twelve to eighteen months in length, measuring outcomes after two years allows adequate time to elapse for most participants to have completed or been discharged from the program. After three to five years, recidivism rates for persons charged with drug-related crimes are likely to reach a plateau (Gossop et al., 2005;Inciardi et al., 2004;Martin et al., 1999). This means that most participants who will recidivate are likely to have done so by that time. ...
... As was mentioned earlier, if it is feasible, recidivism should be tracked for at least three years post-entry and ideally up to five years post-entry. Research suggests most new offenses for drug and alcohol-involved persons occur within three to five years after treatment (Gossop et al., 2005;Inciardi et al., 2004;Martin et al., 1999). Therefore, following participants for three to five years should ensure that most recidivism events are accounted for in the evaluation results. ...
... However, the impact on CTC-only on rearrest maintains its statistical significance. In a Cohen's D interpretation, CTC as a standalone -2 -1.5 -1 -0.5 0 0.5 1 1.5 2 Zhang et al., 2011Inciardi et al., 2004Welsh, 2007Jenson et al., 2012Wexler et al., 1999Knight et al., 1999Martin et al.,1999 Van Overall Effect Size (Fixed) ...
... CTC + Aftercare Impact on Recidivism Incardi et al., 2004Zhang et al., 2011Martin et al., 1999Knight et al., 1999Wexler et al., 1999Staton-Tindall et al., 2009Hiller et al., 1999 Overall Effect Size (Fixed) Overall Effect Size (Random) ...
At any given time, 60% to 85% of prisoners across the United States are struggling with substance addiction and dependence. Upon release, about two-thirds of former prisoners will reoffend and return to prison. Due to the high rate of substance use and abuse in prisons, drug treatment, specifically Correctional Therapeutic Communities (CTCs) can potentially help with reintegration. The community justice framework can explain the utilization of substance abuse treatment in prison. This framework calls for correctional facilities to create community partnerships to facilitate the reintegration of inmates into society upon release. CTCs are in-prison programs that utilize segregated housing, a structured environment, mentorship, and a progression of phases to treat substance use and abuse. In many cases, CTCs are followed by aftercare treatment or services to assist with reintegration. The purpose of this study is to determine what relationship CTCs have on recidivism, with or without aftercare treatment, via meta-analysis. Findings indicate that those participating in CTCs without aftercare are 39% less likely to recidivate compared to those not in a CTC. Those participating in CTCs with aftercare treatment are 56% less likely to recidivate compared to those not in a CTC or aftercare. Differences in magnitude between CTCs with aftercare and without are not statistically significant. These findings suggest that CTCs, with or without aftercare, have a small to
... Für manche Gefangenengruppen stellt das Gefängnis wiederum einen gewissen Schutzraum dar, zum Beispiel für Alkohol-oder Drogenabhängige (Lösel, 2020). Kombinationen aus intramuraler Behandlung und anschließender ambulanter Nachsorge erzielten außerdem bessere Effekte als eine ausschließlich intramurale oder ambulante Intervention (Hiller et al., 1999;Martin et al., 1999;Ndrecka, 2014). ...
Full-text available
Die vorliegende Dissertation bietet wissenschaftlich begründete Implikationen zur Ausgestaltung von Kriminalprävention und Kriminaltherapie. Sie umfasst insgesamt acht Einzelpublikationen aus drei Projekten zur Evaluation der Kriminaltherapie in Bayern. Die Publikationen betrachten und analysieren verschiedene Faktoren, die sich auf die Wirksamkeit kriminaltherapeutischer Maß-nahmen sowie deren Evaluation auswirken können. Darunter fallen Merkmale des Kontexts (zum Beispiel stationär vs. ambulant, Rahmenbedingungen der Institution), Merkmale des Programms (z.B. Programmintensität), Merkmale der Zielgruppe (z.B. Rückfallrisiko, Art der Delinquenz, Motivation, Behandlungsabbruch) und Merkmale des Evaluationsdesigns (z.B. verwendete Wirkungsmaße, Art des Stichprobenvergleichs). Im Fokus steht dabei die Frage, wie sich die jeweiligen Merkmale auf die Effektivität der Interventionen auswirken, inwieweit sie miteinander interagieren und welche Rückschlüsse daraus auf weitere Forschungsvorhaben gezogen werden können.
... Historically, corrections-based treatment has primarily focused on treating substance use, sex offenses, and reducing recidivism to increase public safety. The associated research over time altered the recommended treatment procedures from confrontational therapeutic community groups Martin et al., 1999) to cognitive behavioral learning techniques (McHugh et al., 2010) and currently to the focus of intensive treatment for those at the highest risk of recidivism (i.e., the risk-need-responsivity model; Bonta & Andrews, 2016;Wooditch et al., 2014). Yet, many debilitating predictive factors, such as the impact of lifelong trauma, are missing from the analytical models of treatment outcomes studies, impeding the availability of specialized treatment programs designed to address such factors. ...
Full-text available
This pilot study examined a peer-facilitated trauma-focused intervention among 624 incarcerated men (Exploring Trauma). Pre- and postintervention data were collected on trauma-related mental health symptoms, aggression, and anger. The results demonstrated statistically significant improvement in trauma-related symptoms relative to pretreatment functioning and demonstrated support for the feasibility of peer-facilitation. Effect sizes were small to moderate, with the largest impact on current traumatic distress, depression, and anxiety (Cohen’s d = .54, .48, .46, respectively). The mixed-effects regression results showed the impact of adverse childhood experiences (ACEs) on outcomes was strong and cumulative (i.e., greater exposure to ACEs increased the likelihood of participant program gain on mental health and aggression symptoms, ranging from .15 to .77). The findings showed that trauma can be safely addressed in corrections and provide promising support for peer-facilitation with training and oversight. Rigorous studies are needed on the impact of trauma-informed services and models of program delivery.
... Given the type of interventions, it was impossible that the participants did not know to which group they belonged, which is inevitable in the psychosocial field. The studies by Martin, Butzin, Saum and Inciardi (1999), Rus-Makovec and Čebašek-Travnik (2008), and Thurstin, Alfano and Nerviano (1987) showed a higher level of risk of bias. These three studies ...
Rationale The reconceptualization of substance use disorders (SUD) as a chronic phenomenon calls for a paradigm shift in service provision, particularly by way of long-term treatment and support. Studies that have evaluated the efficacy of long-term treatment models seem to indicate that they are an improvement on more standard short-term treatments, even though these studies do not take the durations into consideration. Objective Measure the efficacy of SUD treatments and support lasting 18 months or more regarding their ability to decrease substance use as compared to shorter treatments. Methods A meta-analysis based on a systematic literature review was conducted. Eight databases were consulted for peer-reviewed studies. Certain variables were coded as moderators: intervention length, participant characteristics, and treatment characteristics. Results The main results suggest that the people who received a planned long-term treatment or support had a 23.9 % greater chance of abstaining or consuming moderately than did people who received a shorter standard treatment (OR = 1.347 [CI 95 % = 1.087–1.668], p < .006, adjusted OR = 1.460 [CI 95 % = 1.145–1.861]). None of the moderation analyses revealed any variation in the efficacy of the long-term treatments and support. Conclusions The reconceptualization of the SUD as a chronic disorder among people with this problem leads us to reconsider both the length of the services provided and the paradigms underlying their organization.
Therapeutic communities are not geared to address all of the attributes of all offenders and their criminality. Rather, they tend to address the problems of substance abusers and their related criminal behavior. In this chapter, we discuss the attributes of therapeutic communities and the research on them. We explore strengthening therapeutic communities through both process and outcome evaluations, which allow the stakeholders to assess their relative worth and weaknesses. We then distill from the research best practices for the operation of therapeutic communities. The chapter concludes with a review of where we have been and where we might go in the evolution of therapeutic communities.
Full-text available
Addressing societal blocks for securing employment after incarceration
Full-text available
Careful reading of the literature on the psychology of criminal conduct and of prior reviews of studies of treatment effects suggests that neither criminal sanctioning without provision of rehabilitative service nor servicing without reference to clinical principles of rehabilitation will succeed in reducing recidivism. What works, in our view, is the delivery of appropriate correctional service, and appropriate service reflects three psychological principles: (1) delivery of service to higher risk cases, (2) targeting of criminogenic needs, and (3) use of styles and modes of treatment (e.g., cognitive and behavioral) that are matched with client need and learning styles. These principles were applied to studies of juvenile and adult correctional treatment, which yielded 154 phi coefficients that summarized the magnitude and direction of the impact of treatment on recidivism. The effect of appropriate correctional service (mean phi = .30) was significantly (p
Full-text available
There has been renewed interest in residential drug abuse treatment research since the late 198Os. Earlier research employed control group designs. This article argues that for today's treatment research, the applicability of control groups created by either matched groups or by random sampling is limited. Four difficulties with control group designs are (1) client differences make assembling matched treatment and control groups untenable, (2) implementing random designs is practically impossible in field research, (3) there are ethical, political, and legal dilemmas in with holding treatment from a control group, and (4) randomly selected client populations will behave differently from the more realistic treatment circumstance involving client populations who are selected based on need and motivation. A more applicable perspective for drug abuse treatment research than the control group design needs to recognize that the client influences the treatmenta as well as that the treatment influences the client. Also, it must be understood that most clients view residential treatment as only one aspect of their life. Most importantly, individual differences must be taken into account when predicting outcome. A perspective that incorporates these concepts can use client history or baseline as its no-treatment comparative condition, and make use of multivariate analyses to help account for many other influences on outcome.
Full-text available
This article is drawn from an ongoing evaluation of the effectiveness of the Amity prison therapeutic community (TC) and aftercare program for substance abusers located in San Diego, California. Data collection consisted of face-to-face interviews and reviews of criminal justice records on a sample of 715 male inmates. Ss were randomly assigned to the prison TC intent-to-treat group and no-treatment control group from a waiting list of inmates who had volunteered for substance abuse treatment in the Amity program. Reductions in reincarceration rates of more than 40% at 12 mo and more than 50% at 24 mo after release from prison were found for the group that completed prison TC plus aftercare. These improvements remained significant after controlling for client characteristics that have been identified as predictors of recidivism. The findings support the efficacy of prison TC plus aftercare in reducing reincarceration rates among inmates treated for substance abuse. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this paper we explicate the treatment process leading to the success of therapeutic communities (TCs) in rehabilitating clients through a case study of CREST, a combined TC and work release program for substance abusers with criminal histories. We develop a comprehensive framework for understanding how and why TCs provide effective treatment to substance- abusing clients. Using data derived from a process analysis of CREST, and substantiated by the literature on TCs, the model considers both structural and programmatic elements and individual level factors. Our framework is unique in that it attempts to show the dynamic processes ongoing among various elements in the setting to produce global changes in clients that are important for living drug free.
This paper reports the participant observation of a Brazilian psychologist and a Brazilian psychiatrist during a 1-month period in two therapeutic communities (TCs) for drug-using offenders. A description of the activities undertaken by the prisoners who are serving their sentences at the Multi-Purpose Criminal Justice Facility in Wilmington, Del., is complemented with a theoretical understanding of the process. Clinical and developmental psychological approaches are used to explain the functioning of TCs when applied to a correctional environment. The theory of scripts and the use of metacommunication as a therapeutic tool are used in the explanation of these therapeutic procedures.
A multistage therapeutic community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the client's changing correctional status-incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based therapeutic community only, (2) a work release therapeutic community followed by aftercare, and (3) the prison-based therapeutic community followed by the work release therapeutic community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for other risk factors. The results support the effectiveness of a multistage therapeutic community model for drug-involved offenders, and the importance era work release transitional therapeutic community as a component of this model.
This article reviews the recent literature on health services use by drug abusers. A revised Andersen-Newman model is posited as a theoretical orientation for health service initiatives focused on drug abuse. The model highlights specific predisposing factors, historical health factors, current illness factors, and enabling/mediating factors associated with drug abuse. The limited number of cost-effectiveness studies have demonstrated that publicly funded drug treatment can produce savings by reducing selected health care costs and decreasing crime. However, short-term costs related to drug abuse can be greater to realize than long-term savings. The criminal justice system can serve as a point of contact and provides a concentrated reservoir of drug users. However, drug-abusing offenders are more likely to present a variety of health problems including hepatitis, tuberculosis, and HIV/AIDS. From a managed care and health services use perspective, drug abuse treatment in the criminal justice system should minimize long-term health care- and crime-related costs.
Arrest rates for the year preceding admission to and the year following discharge from the Gateway Houses program were determined for three groups of former residents: Group 1, early dropouts; Group 2, late dropouts; and Group 3, persons who completed treatment. Data were obtained from police records. Results showed that arrest rates for the groups were comparable prior to admission but significantly different following discharge. Group 1 showed no change in arrest rates from the year prior to admission to the year following discharge, Group 2 showed an 81% reduction in arrest rates, and Group 3 showed a 97% reduction in arrest rates. It is argued that change in criminal behavior occurred as a function of treatment.
Prison-based drug treatment programs in the United States have been in existence for over 20 years. However, it is only in the last few years that they have been available on a large scale. The effects of these programs on recidivism rates tend to be mixed. Given the relatively modest costs, prison administrators may feel the costs are justified even when marginal results are obtained.