Prison-based Substance Abuse Treatment Research Articles

Drug Addiction and Incarceration: A Call for Research and Transparency Among Prison-Based Substance Abuse Treatment Programs.

As drug-related offense and illicit drug overdose rates continue to grow in the United States, criminologists have begun to pay more attention to factors influencing illicit drug use as well as effective methods of promoting drug abstinence in treatment programs across the nation. Although much scholarly attention is given to community-based substance abuse treatment programs, a considerably smaller focus of research is devoted to substance abuse treatment programs that are prison-based. Moreover, some of the most effective methods of treating inmates who are addicted to an illicit drug (such as Cognitive Behavioral Therapy, Therapeutic Community, etc.), although praised for their initiative and theoretical effectiveness, are often demonstrated via individualized empirical study that the expected advantages of such programmatic forms of treatment fail to emerge. The present study explores what scholars have discovered regarding the effectiveness of prison-based substance abuse treatment programs, how such findings appear to contradict one another, and why state prison systems should be more transparent regarding their in-house drug treatment programs in their publicly accessible reports that are formulated into cumulative reports on each states' Bureau of Corrections websites.

The Treatment Group and Recidivism: A Multilevel Analysis of Prison-Based Substance Abuse Treatment

This study contributes to the substance abuse treatment literature by examining recidivism across treatment groups, the level of aggregation between the individual and the program. The sample consisted of 618 drug-involved offenders who participated in 12 different treatment groups within a single prison. Reincarceration significantly varied across groups, controlling for time at risk and treatment modality. This between-unit variation was explained by individual level treatment response measures and control variables. Results demonstrated that treatment effectiveness is impacted by the group in which the individual participates. These findings have substantial implications for correctional treatment theory, research, and policy.

Social support and one-year outcomes for women participating in prison-based substance abuse treatment programming

In recent decades, the number of women under criminal justice supervision has increased considerably, many of whom are serving time for drug offenses. Furthermore, women in prison are more likely than their non-institutionalized counterparts to suffer from a substance abuse disorder. While there is a growing body of research concerning women offenders’ drug abuse and treatment needs, few studies have examined the substance abuse treatment outcomes of women in the criminal justice system. Using data from Outcome Evaluation of the Forever Free Substance Abuse Treatment Program, this study compared women’s self-reported drug use twelve months after participation in high-intensity (n = 101) and low-intensity (n = 81) prison-based substance abuse treatment programming (N = 182). Women who perceived high levels of emotional social support were less likely to report substance use at 12-month follow-up. Furthermore, perceptions of emotional social support and treatment intensity interacted in their association with relapse, such that the protective effect of social support was strongest for women who participated in high-intensity programming. The results of the analyses highlight the importance of perceived social support for women with substance abuse disorders who are transitioning from prison-based substance abuse treatment programming to the community.

An historical review of racial bias in prison-based substance abuse treatment design

ABSTRACTThis study leverages critical race and legal epidemiological frameworks to illustrate the race-based historical evolution of U.S. rehabilitation paradigms directed at imprisoned heroin and opioid users. What began as a racist early-20th-century federal antinarcotic trafficking effort has since assumed a state-based treatment agenda whose programmatic operations are largely based in correctional settings disproportionately reserved for poor substance abusers of color. Even in contemporary carceral facilities, where incarcerated populations are teeming with White addicts, in the aggregate, White drug abusers have been protected from the depraved, incorrigible, and inherently pathological drug-using caricature assigned to their non-White counterparts. This historical examination demonstrates how links between broader drug policy and prison-based drug treatment support a legally codified White supremacist narrative that erodes health and wellbeing for program participants of color, and the communities to which they inevitably return.

Examining Treatment Climate Across Prison-Based Substance Abuse Treatment Groups

ABSTRACTBackground: With notable exceptions, few studies have looked critically at the role and effects of factors other than individual or programmatic differences that contribute to the climate within substance abuse treatment programs. De Leon's work on the therapeutic community, however, indicates that factors beyond the individual and program can contribute to the overall functioning of similarly situated communities. Objectives: In this study, we introduce and examine the concept of the “treatment group,” the level of aggregation between the individual who participates in treatment and the organization that provides it. The treatment group refers to the social context and dynamics that operate among treatment participants, and we sought to study differences in treatment climate across 12 prison-based treatment groups within a single prison. Methods: Using data from 604 participants who were assigned at random to one of the 12 groups, we analyzed differences on seven treatment climate indicators from one month and six months into the program across the treatment groups. Results: No differences were found among the treatment groups at after one month; however, after 6 months, significant differences emerged across the groups on three treatment climate variables: program structure, counselor rapport, and counselor competence. Conclusions/Importance: This study is among the first of its kind to conceptualize and examine treatment climate across otherwise similar groups and find that differences emerge on several indicators of climate. As such, we argue that the treatment group may be important to consider in both the delivery and evaluation of substance abuse treatment.

Staying safe in the community: adaptation of WaySafe to help probationers make better decisions about their health risks

Transition from incarceration to the community is a critical time for offenders, especially those with substance abuse problems. Many succumb to temptation to return to drug use and possibly risky needle sharing, and engaging in risky sex activities. This critical time period entails substantial health risks for the offender as well as significant risks to public health. Well-established and consistent use of HIV/HBV/HCV risk reduction prevention programs with continuity of care do not exist in most criminal justice treatment systems because of lack of policy development and integration between institution and community-based corrections, health, and social service agencies. Interventions targeting re-entry are crucial because of the likelihood for risk behaviors to increase upon return to the community. Approaches for community correction populations are needed that have the capability of addressing motivational, social, and cognitive deficits. This presentation discusses an approach to translating ideas from the prison-based WaySafe curriculum into community settings for probationers who have recently completed residential, intensive outpatient, or prison-based substance abuse treatment. The adapted intervention, StaySafe, will be based on evidence-based cognitive principles, including TCU Mapping Enhanced Counseling techniques designed to improve decision-making skills regarding health risk behaviors during the critical first 6 months under community supervision. It is being designed to be self-administered by participating probationers during downtime, either prior to or following meetings with their probation officers. An important goal in the adaptation and testing of StaySafe is to have a sustainable, evidence-based product for probation departments that can be administered with minimal staff training and time that is engaging and easy to use by probationers, requires minimal maintenance, and is free to probation departments (other than the cost of the touch-screen computers). In this presentation, we describe the StaySafe intervention and the adaptation process from a prison-based group curriculum to a community corrections-based individualized approach. The adaptation process borrows ideas from the ADAPT-ITT framework [1]. We will describe initial results from focus groups and interviews with probationers and probation officers on problems and successes in probation, logistical issues with delivering interventions in probation settings, and results of a “theater” test of elements of StaySafe to gauge participant reactions.

Gender as a Moderator in Predicting Re-Arrest Among Treated Drug-Involved Offenders

The primary aim of the current study is to explore gender differences on the relationships of pre-treatment risk factors and psychosocial functioning with time to re-arrest following termination from prison. The sample consisted of 384 males and 313 females who were admitted to four prison-based substance abuse treatment programs. Results showed that female inmates experienced a longer time to re-arrest than male inmates. Higher self-reported ratings of decision making confidence and peer support were associated with a lower likelihood of re-arrest for males. Males with higher self-esteem ratings were more likely to be re-arrested than males who reported lower self-esteem. Females with more self-reported criminal involvement had a higher rate of re-arrest than did those with less criminal involvement. In contrast to males, females with relatively high self-reported self-esteem had a lower rate of re-arrest than their counterparts who reported low self-esteem. Clinical implications include the importance of enhancing decision-making confidence and peer support for males and self-esteem for females.

Creating Lasting Family Connections

There is increasing evidence of the effectiveness of continued care after reentry for those who have participated in prison-based substance abuse treatment. This article presents results from analyses of program and comparison group data from two community-based programs that implemented a culturally adapted version of the Creating Lasting Family Connections (CLFC) curriculum. Both programs sought to strengthen individuals (and their families) recently reentering the community after incarceration. Results suggested that the first program had effects on increasing HIV knowledge and spirituality, while reducing intentions to binge drink and recidivism. The second program similarly showed effects on recidivism, and participants also showed an increase in nine separate relationship skills. The policy implications of the results are discussed.

Benefits and costs of substance abuse treatment programs for state prison inmates: results from a lifetime simulation model.

Reflecting drug use patterns and criminal justice policies throughout the 1990s and 2000s, prisons hold a disproportionate number of society's drug abusers. Approximately 50% of state prisoners meet the criteria for a diagnosis of drug abuse or dependence, but only 10% receive medically based drug treatment. Because of the link between substance abuse and crime, treating substance abusing and dependent state prisoners while incarcerated has the potential to yield substantial economic benefits. In this paper, we simulate the lifetime costs and benefits of improving prison-based substance abuse treatment and post-release aftercare for a cohort of state prisoners. Our model captures the dynamics of substance abuse as a chronic disease; estimates the benefits of substance abuse treatment over individuals' lifetimes; and tracks the costs of crime and criminal justice costs related to policing, adjudication, and incarceration. We estimate net societal benefits and cost savings to the criminal justice system of the current treatment system and five policy scenarios. We find that four of the five policy scenarios provide positive net societal benefits and cost savings to the criminal justice system relative to the current treatment system. Our study demonstrates the societal gains to improving the drug treatment system for state prisoners.

Motivation for Treatment Among Women Offenders in Prison-Based Treatment and Longitudinal Outcomes Among Those Who Participate in Community Aftercare

Participation in aftercare may reduce risk of recidivism among women offenders with substance use problems following their release to the community. This study examines motivation to participate in aftercare among women offenders and whether their participation in both in-custody and aftercare treatment reduces their risk of recidivism. Surveys were conducted with women (N = 1,158) in prison-based substance abuse treatment programs. Return-to-prison was examined among participants in community-based aftercare (N = 1,182) over 12 months following treatment discharge. Higher treatment motivation was associated with child welfare involvement, prior treatment, and use of “harder” drugs; ethnic minority women had lower treatment motivation compared with White women. Participants who completed the aftercare program, or who had longer treatment duration, and those who had participated in an in-prison program prior to parole had reduced risk of recidivism. Study findings suggest the value of community aftercare for women offenders, particularly when combined with prior in-prison treatment.

Analysis of the Stages of Change Model of Drug and Alcohol Treatment Readiness Among Prisoners

A classification and regression tree (CART) analysis was applied to data for 237 male participants (M = 31.93 years, SD = 7.64) in a prison-based substance abuse treatment program to study the integrity of the Stages of Change model of treatment readiness. Using the Stages of Change Questionnaire (STOCQ), participants were assigned to Contemplation (102), Action (118), or Maintenance (17) groups. A CART analysis then examined differences in the overall group profiles on the basis of scores on the Psychological Inventory of Criminal Thinking, the Situational Confidence Questionnaire, and the Carlson Psychological Survey. The assumption of discrete stages of change was not supported. Alternative models are suggested: one based on states of change and one on personality characteristics. A focus on equal attention to both cognitive and behavioral aspects of substance abuse treatment readiness is suggested.

A randomized experimental study of gender-responsive substance abuse treatment for women in prison

This experimental pilot study compared postrelease outcomes for 115 women who participated in prison-based substance abuse treatment. Women were randomized to a gender-responsive treatment (GRT) program using manualized curricula (Helping Women Recover and Beyond Trauma) or a standard prison-based therapeutic community. Data were collected from the participants at prison program entry and 6 and 12 months after release. Bivariate and multivariate analyses were conducted. Results indicate that both groups improved in psychological well-being; however, GRT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer (2.6 vs. 1.8 months, p < .05), and were less likely to have been reincarcerated within 12 months after parole (31% vs. 45%, respectively; a 67% reduction in odds for the experimental group, p < .05). Findings show the beneficial effects of treatment components oriented toward women's needs and support the integration of GRT in prison programs for women.

Diagnostic profiles of offenders in substance abuse treatment programs

This study examined the association of Axis I and Axis II disorders among offenders who were in prison-based substance abuse treatment in a national multi-site study. Participants (N = 280) received a psychosocial assessment and a structured diagnostic interview in two separate sessions. Logistic regression models examined the association between lifetime mood and anxiety disorders with two personality disorders, and the relationship of Axis I and Axis II disorders (alone and in combination) to pre-treatment psychosocial functioning. Over two-thirds of the sample met criteria for at least one mental disorder. Borderline personality disorder was strongly associated with having a lifetime mood disorder (odds ratio = 7.5) or lifetime anxiety disorder (odds ratio = 8.7). Individuals with only an Axis II disorder, or who had both Axis I and Axis II disorders, had more severe problems in psychosocial functioning than those without any disorder. Clinical treatment approaches need to address this heterogeneity in diagnostic profiles, symptom severity, and psychosocial functioning.

Violent and disruptive behavior among drug‐involved prisoners: Relationship with psychiatric symptoms

This study examines the relationship between psychiatric symptoms and violent/disruptive behavior among 192 inmates who participated in prison-based substance abuse treatment. Participants came from two sites able to provide narrative reports of disciplinary actions in the Criminal Justice Drug Abuse Treatment Studies' Co-Occurring Disorders Screening Instrument study. In multivariate logistic models, a lifetime history of thought insertion/control ideation (OR, 11.6; 95% CI, 1.8-75.2), antisocial personality disorder (OR, 3.3; 95% CI, 1.2-8.9), and disciplinary action related to possession of controlled substances or contraband (OR, 4.9; 95% CI, 1.9-12.3) were associated with increased risk for violent or disruptive behavior while in prison, whereas lifetime phobic symptoms (OR, 0.2; 95% CI, 0.1-0.54) and high school graduation (OR, 0.4; 95% CI, 0.2-1.0) were associated with a decreased risk of violence and disruptive behavior in general. We conclude that, among inmates in substance abuse treatment, symptoms that increase risk for violence or disruptive behavior include thought control/insertion ideation and disciplinary infractions related to controlled substances, contraband, or failure to participate in assigned programs, as well a history of antisocial personality disorder.

Treatment Needs and Completion of Community-Based Aftercare Among Substance-Abusing Women Offenders

Women offenders with substance abuse problems typically have many treatment needs on reentry to the community from prison. This paper explores the correlates of treatment needs among a sample of women offenders with substance-abuse problems (n = 1,404), and the relationship between their treatment needs and other background characteristics with completion of community-based treatment after parole. Treatment needs were assessed at admission into prison-based substance abuse treatment; participants were admitted into community-based treatment upon parole. Descriptive statistics and multiple regression were used to examine their treatment needs; logistic regression analysis was used to determine the factors related to completion of the aftercare program. Analysis of variance was used to examine ethnic differences in treatment needs. Greater treatment needs were associated with unstable housing before incarceration, a history of sexual or physical abuse, mental health problems, alcohol or drug dependence, and first arrest at age <19; lower treatment needs were associated with having been mandated to prison-based treatment (versus volunteering). Mental health problems and earlier age at first arrest predicted treatment noncompletion. Drug dependence was associated with higher treatment needs and a greater likelihood of treatment completion, whereas African American and Hispanic ethnicity were both associated with lower treatment needs (compared with Whites) and a lower likelihood of treatment completion. Interventions are needed to engage substance-abusing women offenders in community treatment after parole to address their treatment needs, improve their retention in treatment, and reduce the likelihood of recidivism.

Differences in motivation, coping style, and self-efficacy among incarcerated male and female drug users

This study compared sex differences in theoretically relevant cognitive–behavioral treatment concepts in a sample of 1,189 male and 300 female offenders participating in a prison-based substance abuse treatment program. Multivariate analysis of variance was used to examine the differences between men and women in the areas of motivation, self-efficacy, and coping styles. The results show that the women reported a greater recognition of having a substance use problem, less self-efficacy to remain abstinent in high-risk situations, and greater reliance on the coping strategies of seeking support, accepting responsibility, and escaping as compared with the men. The recognition of potential sex differences in the context of a theoretically driven treatment for substance users is discussed.

Perception of Helpfulness Among Participants in a Prison-Based Residential Substance Abuse Treatment Program

The purpose of the current study was to determine the extent to which an early prison release incentive impacted inmates’ perceptions of substance abuse treatment helpfulness, overall satisfaction and focus on treatment issues. Three groups of inmates participating in their first, third or sixth month of residential drug abuse treatment were surveyed. Overall, findings indicated that the early release incentive served to encourage inmates’ engagement in drug treatment and did not appear to distract inmates from perceiving their treatment as helpful or to hinder their pursuit of various treatment topics and skills. Statistically significant differences in what the inmates expected to learn or acquire, overall satisfaction and perceived helpfulness were found between those inmates who were provisionally eligible for the early release incentive versus those who were not. Emphasizing the importance of treatment engagement, an examination of qualitative data also revealed that those who had been in the program longer had higher rates of perceived helpfulness and suggests that at the six-month point in treatment inmates begin to experience and integrate their treatment gains.

The Effects of PTSD on Treatment Adherence, Drug Relapse, and Criminal Recidivism in a Sample of Incarcerated Men and Women

Objective/Method: Given the relationship between post-traumatic stress disorder (PTSD) and substance use disorders (SUD), and the prevalence of SUD among offenders, the inattention to trauma before, during, and after incarceration is troubling. This exploratory study compared those with and without co-occurring PTSD among men (n = 139) and women (n = 60) involved in prison-based substance abuse treatment. Results: More than one half the sample met criteria for lifetime PTSD with women experiencing a greater number of events and men experiencing more recent events. Women with PTSD were significantly more likely to relapse than women without. Men with PTSD were more likely to enter community aftercare treatment and recidivate than those without. Conclusion: The findings suggest that trauma-related disorders, among those with SUD, affect postincarceration outcomes. Therefore, from a practice and policy perspective, interventions addressing this co-occurring disorder should be available to men and women within the criminal justice system.

Cost-Effectiveness of Connecticut's In-Prison Substance Abuse Treatment

Over the past two decades, the criminal justice population in the US has grown by over 200%, most of this due to an increase in drug-involved offenders. Although there is good evidence that prison-based substance abuse treatment programs can be effective in reducing rearrest, few cost-effectiveness studies have been conducted. Using data from the Connecticut Department of Correction and the Connecticut Department of Mental Health and Addiction Services (DMHAS), we compared the cost-effectiveness of four tiers (levels) of substance abuse treatment programs for a sample of 831 offenders who were released during FY1996-FY1997. Effectiveness, measured by reductions in the likelihood of rearrest within six months, one year and 18 months post-release, was compared for inmates who had received treatment while incarcerated (n = 358) and those who had not (n = 473). At all intervals, offenders who attended any of the higher tier programs (two, three and four) had significantly lower rates of rearrest when compared to offenders who attended Tier One only or who had attended no tier programs, even after controlling for background characteristics that may have differentiated the two groups. The benefits to the State of Connecticut correctional system alone, measured in terms of the costs of avoided re-incarcerations, were from 1.8 to 5.7 times the cost of implementing the programs, ranging from $20,098 (Tier Four) to $37,605 (Tier Two). Since society receives a favorable return on its investment in prison-based treatment programs, we should find ways to ensure that more drug-involved inmates receive treatment.

Outcome Data for MICA Clients After Participation in an Institutional Therapeutic Community

The current study assessed the effectiveness of a prison-based substance abuse treatment therapeutic community (TC) providing treatment to male inmates dually diagnosed with both substance abuse and mental health disorders. The findings show a short-term impact of the program on arrest after release, with program participants significantly less likely than comparison group offenders to be arrested or returned to prison within three months of release. Logistic regression analyses confirmed that program participants are more likely than the comparison group to be medication compliant, abstinent from substances, and more stable at three months after release. The analyses suggest that participation in the program increases the likelihood of medication compliance after release. The mediational model resulting from this study suggests that treatment participation directly impacts medication compliance. Medication compliance impacts substance use, and these two factors then combine to improve mental health stability. For this population, mental health stability leads to positive outcomes in the community. Medication compliance not only improves mental health stability, but also leads to a reduction or elimination of mental illness symptoms that decreases the need to self-medicate with substances. For these men, medication compliance is the pivotal factor in reducing recidivism after release. These outcome evaluation results indicate that program participation has a significant positive impact on the lives of participants after release. The primary outcome findings suggest that programs treating dually diagnosed offenders should continue to emphasize the importance of medication compliance. Medication compliance should be stressed not only during residential TC services, but during the provision of aftercare and outreach services as well. The current findings demonstrate the effectiveness of the treatment model for dually diagnosed offenders.