Addiction treatment for prisoners during the pivotal time when they are returning to the community has a strikingly persistent benefit and may create a 'turning point' that helps them stay off drugs and out of trouble, NIDA researchers have concluded after tracking the progress of more than a thousand released offenders. The investigators found that prisoners who participated in drug abuse treatment during a work-release program were three times as likely as untreated peers to remain drug-free up to 5 years. Treatment during work release delayed relapse and resulted in more drug-free time during the followup period. Attendance at continuing weekly group sessions following completion of work-release treatment further enhanced outcomes up to 3 years.
Dr. Clifford Butzin, a co-investigator of the study led by Dr. James Inciardi, at the University of Delaware compared the effectiveness of therapy given in different stages of incarceration, release, and reintegration into the wider community. Their project was part of the State's efforts to offer criminal justice-related treatment programs in three stages—during prison, work release, and parole. In 1990, Delaware established a work-release treatment program to ease the prison-to-community transition with funds from a NIDA treatment demonstration grant. The program utilizes the same therapeutic community model that is the format for Delaware's in-prison treatment. In the mid-1990s, the State added a continuing care component designed to help offenders who have completed work release adapt to living in the community with criminal justice supervision.
The research team analyzed the outcomes of 1,122 drug-involved offenders who participated in work release between 1991 and 1998 and in any followup. The participants' (80 percent male, 72 percent African-American) risk profiles included characteristics typically associated with relapse to drug abuse and crime: extensive criminal histories, low rates of marriage, and substantial unemployment before prison (see chart below). The investigators assigned each participant to either standard work-release (WR-S) or the work-release therapeutic community (WR-TC). Because WR-TC slots were limited, priority for them was given to participants who had graduated from the in-prison therapeutic community or whose sentence required treatment as a condition for release.
The participants assigned to the WR-S program served the last 6 months of their sentences working for pay in the community and spent their nonworking hours in a secured residence, but received no formal intervention focused on drugs. Participants in the WR-TC intervention served the last 6 months of their sentences in a secured TC—a "family setting"—in which peers in recovery help participants develop a sense of accountability for their behavior and change negative patterns that lead to drug abuse. They concentrated on treatment goals, performed assigned duties in the residence, and attended group and individual counseling sessions during the first 3 months of the program. They also participated in mock interviews and seminars on job seeking, started looking for work and housing, opened bank accounts, and developed household budgets. During the subsequent 3 months, they worked in the community and continued therapy during nonworking hours. WR-S participants received no additional services.
Benefits of Work-Release Treatment
After completing work release and returning to the community, WR-TC participants continued treatment for at least 6 months. They attended weekly group sessions at the TC, visited a counselor once a month, and were encouraged to spend at least 1 day a month at the facility.
The investigators interviewed participants at work-release initiation and completion and at 18-, 42-, and 60-month followup points, confirming abstinence reports with urinalysis. The results showed that WR-TC participants who relapsed took twice as long to do so as WR-S participants (28.8 months versus 13.2 months, on average). After leaving prison, WR-TC participants had higher abstinence rates than WR-S participants (32 percent versus 10 percent). Employment rates were also higher with WR-TC (55 percent) than without (45 percent).
To further analyze the relationships between the levels of treatment and outcomes, the investigators subdivided the two groups into four: those in WR-S; those who participated in WR-TC but failed to complete it; those who completed WR-TC but did not participate in aftercare; and treatment graduates with aftercare. At each followup, each increase in level of care was associated with a higher percentage of time spent drug-free, for most of the followup period (see chart).
Participants in the WR-TC program typically had abused drugs once a day before incarceration, whereas those in WR-S had abused drugs several times a week. Because of their severe drug problems, more WR-TC participants (32 percent) than WR-S participants (5 percent) had received in-prison treatment. However, the researchers determined that treatment during work release was much more effective than in-prison treatment, contributing the bulk of the advantage attained by the WR-TC group. Treatment during work release halved the likelihood of relapsing, whereas other factors—including treatment before or during prison—did not have a significant impact. "Although addiction treatment episodes have a cumulative effect, several studies have shown that the benefits of treatment during prison seem to fade over time compared with therapy during the prison-to-community transition," says Dr. Butzin.
Among 690 participants who completed all followup interviews, treatment during work release also reduced arrest rates over the 5-year period. Rearrest was common in all groups, however, with 77 percent of WR-S participants, 58 percent of WR-TC treatment graduates who did not receive aftercare, and 52 percent of those who also received aftercare facing new charges at some point.
Supportive Environment is Key
"It makes sense that a therapeutic community—a stable residence with a drug-free culture and supportive peers—helps people who are looking for a job and a place to live after prison. Continuing care for prisoners with drug problems during the transition back to the community is essential for sustained recovery and other public health benefits, including reduced spread of HIV/AIDS and hepatitis C," says Dr. Thomas Hilton of NIDA's Division of Epidemiology, Services and Prevention Research.
Work Release Participant Characteristics
Most participants in the Delaware work-release program demonstrated a long history of criminal activity, chronic drug abuse, and characteristics associated with high rates of relapse and recidivism.
| Characteristic | Percentage |
|---|---|
| Ever married | 29 |
| Unemployed prior to incarceration | 58 |
| Treatment prior to incarceration | 72 |
| Incarcerated for drug-related crime* | 33 |
| Characteristic | Average Number |
| Arrests prior to incarceration | 9 |
| Prior incarcerations | 4 |
* Does not include crimes committed to obtain money for drugs.
Although the prison-to-community transition is critical and may set the pattern for post-release behaviors, research is needed on the best ways to coordinate social and health interventions with criminal justice supervision. Recognizing the importance of science-based knowledge on the effective components of treatment for this population, NIDA established the Criminal Justice-Drug Abuse Treatment Studies (CJ-DATS) research network with Federal partners in justice and public health. CJ-DATS investigators around the United States, including the team in Delaware, are testing interventions and studying approaches for coordinating services for offenders reentering the community.
Source
- Butzin, C.A., et al. Treatment during transition from prison to community and subsequent illicit drug use. Journal of Substance Abuse Treatment 28(4):351-358, 2005. [Abstract]