Response: Pathways to Recovery and Reintegration

Abstract

Harry K Wexler: When I started out, there was very little treatment for offenders. Prisons were seen as warehouses, and “nothing works” was the prevailing belief. Then research started to demonstrate reductions in recidivism with therapeutic communities (TCs). Policymakers and legislators became very interested. TC became the dominant model throughout prisons. It is still prominent throughout the United States, especially in the California prison and parole system. However, there is now much diversity in these programs and curricula, with elements of cognitive-behavioral therapy (CBT), criminal thinking therapy, and Twelve Steps. Flo Stein: As Dr. Prendergast (2009) writes, a number of therapeutic models have now been shown to be effective for offenders and parolees. In North Carolina, the State Department of Corrections provides CBT training for custody personnel who use it in the prison system. Part of the model’s appeal is that CBT learning can be reinforced by community treatment providers and extended each time an offender re-enters the criminal justice system. The offender doesn’t have to start over each time. Deanne Benos: In Illinois, we’ve been working on a program called Operation Spot-light that uses CBT to address criminogenic factors among high-risk parolees. When parolees violate parole rules, have difficulty complying with the community treatment program, or show a high level of risk of returning to prison, we use a graduated sanctions process that includes sending them to Spotlight Re-Entry Centers. The centers—there are seven of them spread across the State—provide services, including individual counseling sessions, to parolees seeking assistance upon release from prison as well as to high-risk offenders. They have contributed to an 18 percent drop in new offense incarcerations between 2004 and 2007, resulting in the lowest annual rate on this measure in State history. In addition, the centers have helped reduce parole technical offense violations by nearly 40 percent from 2006 to 2008. Stein: We’re implementing a large-scale contingency management (CM) program in North Carolina. Some of our legislators went to a National Conference of State Legislatures meeting where CM was presented. They came back very enthusiastic and passed legislation that requires each of our programs to use up to 1 percent of its money for rewards and other incentives. Wexler: That’s quite an experiment. How’s it working? Stein: We’re in our first year, so time will tell. I think some are using the model well, and others are still learning. I do think CM is an important strategy: Rewarding appropriate behaviors, such as showing up on time for treatment, participating in the group effectively, and things like that, can improve client motivation. Wexler: The CM concept makes sense: Using positive rewards and counterpunches is simply Learning Theory 101. The National Development and Research Institute participated in a CM project that obtained positive results as part of NIDA’s Criminal Justice–Drug Abuse Treatment Studies (CJ-DATS) project. However, CM’s effect is limited in the offender population. As with any specialized intervention that does not treat the “whole” person, CM needs to be delivered in conjunction with other services. Although it certainly has a place in treatment of these patients, overreliance on it would be a mistake. Pharmacotherapy, which Dr. Prendergast mentions only briefly, holds a lot of promise but has been ignored and unfairly criticized. Several studies have identified high death rates among releasees who are addicted to opioids. Members of this population are good candidates for methadone and buprenorphine. We should explore ways to identify these individuals pre-release and to begin pharmacotherapy before they are paroled. With careful vetting and explicit guidelines, we can avoid a lot of the criticism and resistance to pharmacotherapy.