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RSAT Forum > Monthly Discussion > February 2018: Drug treatment in prisons. View modes: 
JCosta - 2/2/2018 4:29:58 PM
   
February 2018: Drug treatment in prisons.
Question: Our state wants to expand drug treatment in our prisons. We currently have a RSAT program in one of our facilities. As required, it is a six-month program and offers a modified therapeutic community treatment program. With non-federal funding, would it be better to provide shorter programs that can reach more individuals in need? Do other treatment modalities work as well as therapeutic communities for drug treatment in prisons?

Answer:
Program Length
There is limited sophisticated research available to answer your question. Currently, there are no correctional drug treatment programs in the National Institute of Justice (NIJ) Crime Solutions registry that are not at least 180 days in length. One program was initially established as a 90-day program, but the Department abandoned it when research revealed it was significantly less effective than the same Department’s 180 day and one-year treatment program in two of its other prisons.1 The program cited is based on a therapeutic treatment model that amerces participants in a therapeutic milieu even when not involved in the formal sessions.

There is a consensus in the research literature that “longer is better” in terms of correctional treatment duration. The National Institute of Drug Abuse (NIDA), based on its extensive review of both TC and other drug treatment programs, concludes, for example: Length of time in treatment was found to be important for TCs, as well as for other modalities. Participating for at least 3 months was associated with better outcomes at 1 year—a finding that is consistent with other research showing the importance of treatment duration.2 Substance use disorder treatment program less than 90 days has specifically been found to be ineffective “to realize long-term benefits.”3 Other researchers have concluded simply: “Lower relapse rates were usually associated with longer treatment exposure.4 Of course, participation in subsequent treatment or aftercare after release remains essential.”5

Treatment Modality
A 2012 study synthesized results from 74 evaluations of incarceration-based drug treatment programs using meta-analysis. Incarceration-based drug treatment programs fell into four distinct types: therapeutic communities (TCs), group counseling, boot camps specifically for drug offenders, and narcotic maintenance programs.6 The programs were evaluated in terms of both post-release recidivism and drug use. The study found: Our results consistently found support for the effectiveness of TC programs on both outcome measures, and this finding was robust to variations in method, sample, and program features. We also found support for the effectiveness of group counseling programs in reducing offending, but these programs’ effects on drug use were negligible. The effect of narcotic maintenance programs was also mixed with reductions in drug use but not offending. Boot camps had no substantive effect on either outcome measure (30).

The researchers stated: “(T)he most consistent evidence of treatment effectiveness came from evaluations of TC programs. These programs consistently showed modest reductions in post-release recidivism and drug use. The finding of reductions in recidivism was robust to methodological variation. In fact, even among the most rigorous evaluations, participation in TC programs was consistently related to reductions in re-offending.” Researchers found: “TCs were effective in reducing recidivism in several different types of samples (e.g., female only samples, male only samples, and adult samples), which suggests that TCs can be applied to wide-range of offenders.”

Specifically reviewing what the analysis revealed about non-TC prison treatment programs, the researchers concluded: The evidence regarding counseling programs indicated that these programs were effective in reducing re-offending but not drug use. Counseling programs appeared to be most effective in reducing re-offending when targeted towards adult offenders and single gender samples. The evidence also indicated that counseling programs that were strictly voluntary appeared to be more effective in reducing re-offending than other counseling programs. (30)

The researchers made the following recommendation for policy-makers. “Policymakers seeking effective interventions for incarcerated substance abusers are most likely to find success with programs that intensively focus on the multiple problems of substance abusers, such as TC programs. Policymakers should expect smaller treatment benefits from less intensive treatment programs. (30)”

It is a widely agreed research-based principle that positive programming in community corrections should make up from 40 to 70% of high risk offender’s time for 3 to 9 months to be effective.7 TC programs meet that standard for incarcerated populations.

The only analysis that found that “outpatient (non-TC) treatment for adults during incarceration has approximately the same effect as inpatient or intensive outpatient treatment,” was conducted by the Washington State Institute of Public Policy in 2012. It looked at studies of TCs as well as other non-TC treatment programs, inpatient or intensive outpatient, or non-intensive outpatient. The report, unfortunately, did not include the programs’ durations, although it appears most may have been six to 18 months in duration.8

Medicated Assisted Treatment
On the other hand, a growing number of jails are finding that they can educate, medically examine, prescribe, and initiate opioid medication for individuals with opioid use disorders in as little as two weeks. Medication assisted treatment (MAT) has been found to improve the effectiveness of all drug treatment programs. Further, many of those who enter prison have already been involved in prior abstinence-only treatment before and relapsed. The key to these initiatives is to then connect the individuals with appropriate treatment and access to continued medication after release.

In short, these programs do not really constitute prison drug treatment in the general sense, but offer conditions to improve the success of treatment that can be provided upon release. In addition, the provision of medication before release can be life-saving, given the extraordinary risk of overdose deaths of recently released individuals with substance use disorders.9 While treatment in these jails may be available to limited numbers due to the number of treatment beds available, the MAT can be offered to many more struggling with addiction.



Endnotes

1 Program Profile, Minnesota Prison-based Chemical Dependence Treatment, https://www.crimesolutions.gov/ProgramDetails.aspx?ID=150, downloaded December 28, 2017.

2 NIH National Institute on drug abuse, research report series, Therapeutic Communities. https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/are-therapeutic-communities-effective

3 De Leon G. Is the therapeutic community an evidence-based treatment? What the evidence says. 2010;31:104 – 128; Vanderplasschen, W. et. al., Therapeutic Communities for Addictions: A Review of Their Effectiveness from a Recovery-Oriented Perspective, The Scientific World Journal, (2013), Article ID 427817, 22 pages, http://dx.doi.org/10.1155/2013/427817

4 G. De Leon, S. Sacks, G. Staines, and K. McKendrick, “Modified therapeutic community for homeless mentally ill chemical abusers: treatment outcomes,” American Journal of Drug and Alcohol Abuse, vol. 26, no. 3, pp. 461–480, 2000; A. L. Nielsen, F. R. Scarpitti, and J. A. Inciardi, “Integrating the therapeutic community and work release for drug-involved offenders: the CREST program,” Journal of Substance Abuse Treatment, vol. 13, no. 4, pp. 349–358, 1996; R. N. Bale, V. P. Zarcone, W. W. Van Stone, J. M. Kuldau, T. M. J. Engelsing, and R. M. Elashoff, “Three therapeutic communities. A prospective controlled study of narcotic addiction treatment: process and two-year follow-up results,” Archives of General Psychiatry, vol. 41, no. 2, pp. 185–191, 1984; R. H. Coombs, “Back on the streets: therapeutic communities' impact upon drug users,” American Journal of Drug and Alcohol Abuse, vol. 8, no. 2, pp. 185–201, 1981; J. Mccusker, A. Stoddard, R. Frost, and M. Zorn, “Planned versus actual duration of drug abuse treatment: reconciling observational and experimental evidence,” Journal of Nervous and Mental Disease, vol. 184, no. 8, pp. 482–489, 1996.

5 S. S. Martin, C. A. Butzin, and J. A. Inciardi, “Assessment of a multistage therapeutic community for drug-involved offenders,” Journal of Psychoactive Drugs, vol. 27, no. 1, pp. 109–116, 1995: H. K. Wexler, G. De Leon, G. Thomas, D. Kressel, and J. Peters, “The amity prison TC evaluation: reincarceration outcomes,” Criminal Justice and Behavior, vol. 26, no. 2, pp. 147–167, 1999.

6 Mitchell O, Wilson D, MacKenzie DL. The Effectiveness of Incarceration-Based Drug Treatment on Criminal Behavior: A Systematic Review. Campbell Systematic Reviews 2012:18, DOI: 10.4073/csr.2012.18

7 Crime & Justice Institute & National Institute of Corrections (2010). Implementing Evidence-Based Practices in Community Corrections: The Principles of Effective Intervention, Revised, 4; Palmer, T. (1995). Programmatic and non-programmatic aspects of successful intervention: New directions for research. Crime & Delinquency, 41(1): 100-131; Gendreau, P. and C. Goggin (1997). Correctional Treatment: Accomplishments and Realities. Correctional Counseling and Rehabilitation, P. V. Voorhis, M. Braswell and D. Lester. Cincinnati, Anderson; Gendreau, P. and C. Goggin. (1995). Principles of effective correctional programming with offenders. Center for Criminal Justice Studies and Department of Psychology, University of New Brunswick, New Brunswick; Steadman, H., S. Morris, et al. (1995). The Diversion of Mentally Ill Persons from Jails to Community-Based Services:A Profile of Programs. American Journal of Public Health 85 (12): 1630-1635.

8 Washington Institute for Public Policy (December 2012). Chemical Dependency Treatment for offenders: A Review of the Evidence and Benefit-Cost Findings. http://www.wsipp.wa.gov/ReportFile/1112/Wsipp_Chemical-Dependency-Treatment-for-Offenders-A-Review-of-the-Evidence-and-Benefit-Cost-Findings_Full-Report.pdf

9 Binswanger, I. et al (2013). Mortality After Prison Release: Opioid Overdose and Other Causes of Death, Risk Factors, and Time Trends From 1999 to 2009, Annals of Internal Medicine, 159 (9), 592-600.

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