Applied research in substance abuse treatment

Substance Abuse

There is a significant correlation between drug addiction and the tendency to commit crime. The United States Bureau of Prisons (BOP) in 1989 developed a comprehensive substance abuse treatment program in an attempt to alter both the criminal and substance abuse behaviors of inmates (Substance Abuse Treatment). The BOP reports that 50 institutions that are governed by the bureau have drug abuse treatment programs. All of the inmates that are part of the program are housed together in a separate section of the corrections facility (Substance Abuse Treatment). This program is designed to provide inmates with intensive treatment. In addition to adult corrections facilities the need for substance abuse treatment is also a reality for juvenile corrections facilities. According to the Substance Abuse and Mental Health Services Administration 37% of the juvenile corrections facilities in America have on site substance abuse treatment.

The research indicates that those treatment programs in which there are high rates of retention and significant lengths of stay (longer than 90 days) are the most effective. The research also seems to indicate aftercare plays a crucial role in ensuring that relapse does not occur.

Introduction

Corrections facilities throughout the world are confronted with the reality of substance abuse problems amongst inmates. Substance abuse is present in both adult and juvenile corrections facilities. As a result, substance abuse treatment is a necessary part of the rehabilitation process as many inmates will eventually leave the corrections facilities and be reintroduced into society. This applied research paper will discuss substance abuse treatment in adult and juvenile corrections facilities.

Purpose

The purpose of this discussion is to determine which treatment programs are most effective in treating inmates with substance abuse problems. The discussion will focus on the treatment programs that are available to both adult and juvenile offenders. The investigation will also focus on why these treatment programs are needed and the efficacy of these programs.

Problem

There is a significant correlation between drug addiction and the tendency to commit crime. For this reason, corrections facilities have to be extremely mindful when attempting to rehabilitate inmates. Facilities have to consider the role that substance abuse and addiction plays in the actions of inmates and the impact of those actions once these individuals are released.

Review of Literature

According to the United States Bureau of Prisons (BOP) in 1989 a comprehensive substance abuse treatment program was developed in an attempt to alter both the criminal and substance abuse behaviors of inmates (Substance Abuse Treatment). The strategy proposed involved drug abuse education and a strong community transition program (Substance Abuse Treatment). The BOP further explains that under certain circumstances substance abuse treatment is mandatory for inmates under certain circumstance (Substance Abuse Treatment). For instance, inmates must participate in such treatment if 1) There is proof in the pre-sentence investigation report that the use of illegal substances contributed to the commission of their crime (Substance Abuse Treatment).

2) They violated supervised release or parole conditions associated with placement in a halfway house or conditions of home confinement based as a result of drug or alcohol use (Substance Abuse Treatment).

3) The sentencing judge suggested that the offender participate in a drug treatment program while in a corrections facility (Substance Abuse Treatment).

The author further explains that as it relates to the drug abuse education course, inmates are given information concerning the social, physical, and psychological affects associated with of abusing drugs and alcohol (Substance Abuse Treatment). Those inmates who are recognized as having an additional need for treatment are encouraged to partake in non-residential or residential substance abuse treatment (Substance Abuse Treatment).

The BOP also reports that 50 institutions that are governed by the bureau have drug abuse treatment programs. All of the inmates that are part of the program are housed together in a separate section of the corrections facility (Substance Abuse Treatment). This program is designed to provide inmates with intensive treatment that takes place five days a week and last half a day. During the rest of the day inmates spend time working on skills training, education and the additional inmate training available at the facility (Substance Abuse Treatment). Once inmates have completed the program they are provided with aftercare services when they are placed back into the general population (Substance Abuse Treatment). There are also residential re-entry centers that are designed to maximize the inmates' ability to carry-over skills; this ensures that they will have an effective transition from the program provided by the corrections facility into the community (Substance Abuse Treatment).

In addition to the mandatory reasons for prisoners to participate in substance abuse treatment programs, in 1994 the Violent Crime Control Act also offered an incentive for inmates who volunteer to participate in the residential drug abuse program (Substance Abuse Treatment). Under this Act non-violent inmates who were diagnosed with a substance use disorder were eligible for up to a year off their sentence (Substance Abuse Treatment). This reduction in sentence time was determined by the Director of the BOP (Substance Abuse Treatment).

The article also reports that the Bureau and National Institute on Drug Abuse funded an analysis of the residential drug treatment program developed by the Bureau (Substance Abuse Treatment). Findings of the research assert that RDAP participants were considerably less likely to be re-offend and less likely to relapse than those that did not participate in the program (Substance Abuse Treatment). The studies also found that the Bureau's RDAPs change the lives of inmates once they are released from custody and return to their communities (Substance Abuse Treatment).

Lemieux (2002) asserts that among those inmates in state prisons with a substance abuse issue about one third of these individuals are enrolled in a drug treatment program. The author also reports that this is a recent phenomenon as it relates to corrections facilities that provide prisoners with such treatment programs. The author asserts that the inclusion of such programs has developed in part to the research concerning Crack cocaine addiction and its effects on prisoners once they reenter society.

The author also explains that substance abuse treatment within the prison system has grown substantially since the 1980's. There are several programs that are now available to inmates including drug education, group counseling, fellowship support groups, assessment, therapeutic communities and fellowship support groups (Lemieux 2002). The author further explains that both Long-term and large-scale evaluations of therapeutic community programs have consistently demonstrated positive client outcomes and considerable cost savings (Lipton, Falkin, & Wexler, 1992; Peters, Kearns, Murrin, Dolente, & May, 1993). According to Nielsen and Scarpitti (1997), the sense of community and strict behavioral guidelines are the two most influential elements of therapeutic community treatment. Therapeutic communities use the community of peers to teach, model, and reinforce the values and behaviors that are necessary for a drug-free lifestyle. Frankel (1989) believed that the therapeutic community serves as a substitute family for its members. The community provides a supportive and caring environment that facilitates client acceptance, understanding, and change (Lemieux 2002)."

The author also explains that the length of time that an inmate undergoes treatment has a significant impact on the outcome of the treatment.

For this reason some corrections facilities offer aftercare and view as a necessary aspect of treatment as it relates to ensuring that inmates maintain sobriety (Lemieux 2002). A prime example of the success of such a program can be found in Amity prison's therapeutic community and aftercare program in California. This program is believed to be instrumental in decreasing recidivism by more than 50% among offenders who had been released for 2 years (Lemieux 2002).

In addition, a Delaware-based program found that offenders who had undergone multistage therapeutic community treatment had lower rates of relapse and recidivism than those who only participated in a prison-based therapeutic community programs (Lemieux 2002).

Juvenile Correction Facilities

In addition to adult corrections facilities the need for substance abuse treatment is also a reality for juvenile corrections facilities. According to the Substance Abuse and Mental Health Services Administration 37% of the juvenile corrections facilities in America have on site substance abuse treatment.

In addition nearly 20,000 juveniles are receiving substance abuse treatment at these facilities. At the facilities that offer substance abuse treatment, nearly 90% supplied individual counseling or group counseling, and 72% also provided family counseling (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). As it relates to services other than substance abuse treatment, juvenile corrections facilities were more likely to carry out needs assessment, awareness and education programs, and drug testing than to provide inmates with detoxification and self-help programs services (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002).

In a survey conducted by the Drug and Alcohol Services Information System (DASIS), 59% of respondents asserted that they carried out some sort of drug testing in the previous year (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). In addition 25% of the facilities asserted that they conducted random tests and 52% of respondents reported that they conducted tests based on reasonable suspicion (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). There were also facilities that conducted both random tests and tests based on reasonable suspicion (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002).

In addition, of the facilities that responded to the survey 17% tested residents at the time that they were admitted to the facility, and 8% of the facilities tested the juveniles when they were released (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). The survey also found that drug testing was more likely to occur in correction facilities that offered substance abuse treatment (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). In addition, 75% of the facilities that offered substance abuse treatment conducted drug testing during the previous year, and 38% tested juveniles on a random basis (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002).

The report also explains that treatment in juvenile corrections facilities differs greatly from state to state. The report explains that Washington State had the highest proportion of juvenile corrections facilities offering on-site substance abuse treatment. In fact 31 of the 49 juvenile correctional facilities or 63% of the facilities provide substance abuse treatment in the state of Washington (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). As it relates to additional services, approximately 80 to 90% of the juvenile facilities in the state of Washington offered needs assessment, drug testing, and education (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). At the other end of the spectrum the state of Mississippi was least likely to offer substance abuse treatment in juvenile facilities (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). In fact only two of the 15 juvenile facilities in Mississippi offer substance abuse treatment. Although 36% of the facilities in Mississippi do offer drug testing and 60% of the facilities offer needs assessment services and another 82% off education programs to juveniles (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002).

Indeed, there is a significant gap in the number of juvenile corrections facilities that offer substance abuse treatment on-site; however there is an increase in the number of juveniles that are entering drug treatment programs. According to Chan et al. (2003) juvenile drug treatment admissions increased by approximately 46% throughout the five years that began in 1993. The authors report that this increase in admissions came as a result of referrals from the juvenile justice system (Chan et al. 2003).

Drug treatment for juveniles in the criminal justice system is somewhat different from these same treatment programs for adults (Chan et al. 2003). The authors explains that as it relates to adolescents, courts often suggest residential treatment programs in lieu of incarcerating or detaining the juvenile; this is usually only the case with non-violent juveniles (Chan et al. 2003). The article explains that although there is a dependence on these residential facilities, very little research has been conducted concerning the effectiveness of such programs (Chan et al. 2003).

However the article does assert that there is considerable evidence that retention in these programs may be quite low, with up to 35% of admissions dropping out of treatment within the first 30 days of what is usually planned as a 9- to 12-month placement. Because treatment attrition limits the likely effectiveness of these services, in this report we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles (Chan et al. 2003)."

Indeed program retention is critical as it has been found to be a critical part of ensuring that treatment is effective. The authors explain that there is a positive correlation between long-term outcomes and retention rates four both adults and adolescents. In their analysis Hser et al. (2001) assessed the correlation between after treatment outcomes and program retention for adolescents in the Drug Abuse Treatment Outcomes Project. This assessment was conducted across a range of program types that were inclusive of short-term inpatient, residential, and outpatient drug-free (Hser et al. 2001). The study found that longer stays in treatment (90 days or more) could be correlated with lower levels of substance abuse in addition to lower rates of arrest in the year following treatment.

In addition other studies have found that length of stay and treatment completion are correlated with reduced substance abuse problem severity and increased abstinence rates in a sample of adolescent outpatient and residential treatment program participants (Latimer, 2000; Winters et al., 2000). Also studies involving adolescent residential treatment programs have found this same correlation (De Leon et al., 1994). In addition a recent study of the adolescent substance abuse treatment found that treatment completion was consistently related to positive treatment outcomes across treatment modalities (Chan et al. 2003).

Although each of these studies report a correlation between treatment retention and treatment outcomes, none of them are clear concerning whether this correlation is a result of the treatment effect or the characteristics of the client (Chan et al. 2003). It is possible that early drop-out along with poor outcome status are a result of weak treatment motivation as it relates to the client (Chan et al. 2003).

Whatever the case there must be a clearer understanding of the factors that contribute to improvements in retention rates and it relates to drug and alcohol abuse treatment (Chan et al. 2003). Knowing this information may assist in improving treatment services for juveniles. Research that has been conducted with adults and has found that factors associated with retention are positively correlated with treatment length and pretreatment client characteristics including motivation for treatment (Chan et al. 2003).

The authors further explains that although treatment programs have very little control over pretreatment client characteristics, other research has paid careful attention to factors that influence retention independently of any client characteristics and which may be under the control of treatment programs (Chan et al. 2003). One such study reported that motivation and early involvement in the program were indicators of length of stay among adult patients (Chan et al. 2003). In addition another study suggested that abstinence and program participation during the first 2 weeks of treatment for methadone addiction were strong indicators of retention and drug use outcomes 6 and 9 months after treatment (Chan et al. 2003). In addition involving adult patients in the national DATOS found that pretreatment factors such as depression, problem severity and motivation, along with treatment process components such as therapeutic involvement and session attributes) were indicators of treatment retention (Chan et al. 2003).

The authors also explain that Relatively few studies of adolescents examine factors associated with treatment program retention, and those that have focus solely on pretreatment characteristics. Bastien and Adelman (19) compared treatment retention among youths who either were or were not court-referred to a residential treatment program and found that patients' perception of choice of placement was more important than source of referral in predicting retention. In contrast, Pompi and Resnick report that court pressure can strongly enhance adolescent retention in therapeutic communities (Chan et al. 2003)."

The authors further conclude that personal and situational pretreatment characteristics can be correlated with adolescents' length of stay in substance abuse treatment (Chan et al. 2003). However, the impact of treatment program process effects on retention has not been thoroughly studied as it relates to juveniles (Chan et al. 2003).

Discussion of Relevant Issues

The issue of substance abuse treatment in adult and juvenile corrections facilities is critical in ensuring that once offenders re-enter society they will not suffer relapse and recidivism. These treatment programs offer adults and juveniles the opportunity to confront their problems with substance abuse in a controlled environment. In addition, many of these treatment programs provide aftercare for offenders to prevent relapse once they leave the facility.

The correlation between substance abuse and the likelihood of being incarcerated is undeniable. For this reason the research seems to indicate that among adult corrections facilities there has been a concerted effort to ensure that inmates receive some sort of treatment for substance use while they are incarcerated. The need for such treatment is so evident that the Bureau of Prison actually created a program for the very purpose of treating substance abuse within the prison system. Although adult corrections facilities have been offering these programs for some time, it appears that juvenile corrections facilities have been slower in adopting such programs.