Substance Abuse Treatment in Adult and Juvenile Corrections

Introduction

Corrections facilities throughout the world are confronted with the reality of substance abuse problems among 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, since many inmates will eventually leave corrections facilities and be reintroduced into society. This applied research paper discusses substance abuse treatment in adult and juvenile corrections facilities.

The purpose of this discussion is to determine which treatment programs are most effective in treating inmates with substance abuse problems. The discussion focuses on the treatment programs available to both adult and juvenile offenders, as well as why these programs are needed and how efficacious they are.

There is a significant correlation between drug addiction and the tendency to commit crime. For this reason, corrections facilities must be extremely mindful when attempting to rehabilitate inmates. Facilities have to consider the role that substance abuse and addiction play 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), a comprehensive substance abuse treatment program was developed in 1989 in an attempt to alter both the criminal and substance abuse behaviors of inmates. The strategy proposed involved drug abuse education and a strong community transition program. The BOP further explains that under certain circumstances substance abuse treatment is mandatory for inmates. 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.

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

3) The sentencing judge recommended that the offender participate in a drug treatment program while in a corrections facility.

As it relates to the drug abuse education course, inmates are given information concerning the social, physical, and psychological effects associated with abusing drugs and alcohol. Those inmates recognized as having an additional need for treatment are encouraged to participate in non-residential or residential substance abuse treatment.

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

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

The BOP also reports that the Bureau and the National Institute on Drug Abuse funded an analysis of the residential drug treatment program. Findings assert that Residential Drug Abuse Program (RDAP) participants were considerably less likely to re-offend and less likely to relapse than those who did not participate in the program. 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.

Lemieux (2002) asserts that among inmates in state prisons with a substance abuse issue, about one-third are enrolled in a drug treatment program. The author also reports that this is a relatively recent phenomenon in corrections, one that developed in part due to research concerning crack cocaine addiction and its effects on prisoners once they reenter society.

Lemieux (2002) further explains that substance abuse treatment within the prison system has grown substantially since the 1980s. Several programs are now available to inmates, including drug education, group counseling, fellowship support groups, assessment, and therapeutic communities. 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 necessary for a drug-free lifestyle. Frankel (1989) believed that the therapeutic community serves as a substitute family for its members, providing a supportive and caring environment that facilitates client acceptance, understanding, and change (Lemieux, 2002).

Lemieux (2002) also explains that the length of time an inmate undergoes treatment has a significant impact on treatment outcome. For this reason, some corrections facilities offer aftercare and view it as a necessary component of treatment for ensuring that inmates maintain sobriety. A prime example of the success of such a program can be found in Amity Prison's therapeutic community and aftercare program in California, which is believed to have been instrumental in decreasing recidivism by more than 50% among offenders who had been released for two years (Lemieux, 2002).

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

Juvenile Correction Facilities

In addition to adult corrections facilities, the need for substance abuse treatment is also a reality in juvenile corrections facilities. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 37% of the juvenile corrections facilities in America have on-site substance abuse treatment. Nearly 20,000 juveniles are receiving substance abuse treatment at these facilities. Of the facilities that offer substance abuse treatment, nearly 90% provide individual or group counseling, and 72% also provide 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 detoxification and self-help program 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 reported that they carried out some form of drug testing in the previous year. In addition, 25% of facilities conducted random tests and 52% conducted tests based on reasonable suspicion. There were also facilities that conducted both random tests and tests based on reasonable suspicion (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002).

Of the facilities that responded to the survey, 17% tested residents at the time of admission, and 8% tested juveniles upon release. The survey also found that drug testing was more likely to occur in correction facilities that offered substance abuse treatment — 75% of facilities offering 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. Washington State had the highest proportion of juvenile corrections facilities offering on-site substance abuse treatment: 31 of the 49 juvenile correctional facilities — approximately 63% — provided substance abuse treatment. Approximately 80 to 90% of juvenile facilities in Washington offered needs assessment, drug testing, and education (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002). At the other end of the spectrum, Mississippi was least likely to offer substance abuse treatment in juvenile facilities; only two of the 15 juvenile facilities in Mississippi provided such treatment. However, 36% of Mississippi facilities offered drug testing, 60% offered needs assessment services, and 82% offered education programs (Drug and Alcohol Treatment in Juvenile Correctional Facilities, 2002).

Despite the significant gap in the number of juvenile corrections facilities offering on-site substance abuse treatment, the number of juveniles entering drug treatment programs has increased. According to Chan et al. (2003), juvenile drug treatment admissions increased by approximately 46% over the five years beginning in 1993, largely as a result of referrals from the juvenile justice system.

Drug treatment for juveniles in the criminal justice system differs somewhat from the same treatment programs for adults (Chan et al., 2003). With respect to adolescents, courts often recommend residential treatment programs in lieu of incarcerating or detaining the juvenile — usually only in the case of non-violent offenders. Although there is a significant reliance on these residential facilities, very little research has been conducted on the effectiveness of such programs (Chan et al., 2003).

However, 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 typically planned as a 9- to 12-month placement. Because treatment attrition limits the likely effectiveness of these services, researchers have examined the client and program characteristics associated with program retention among adolescent probationers referred to residential rehabilitation by the Juvenile Court (Chan et al., 2003).

Program retention is critical, as it has been found to be a key factor in ensuring that treatment is effective. There is a positive correlation between long-term outcomes and retention rates for both adults and adolescents. In their analysis, Hser et al. (2001) assessed the correlation between post-treatment outcomes and program retention for adolescents in the Drug Abuse Treatment Outcomes Project, across a range of program types including short-term inpatient, residential, and outpatient drug-free programs. The study found that longer stays in treatment — 90 days or more — were correlated with lower levels of substance abuse and lower rates of arrest in the year following treatment.

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

Although each of these studies reports a correlation between treatment retention and treatment outcomes, none clearly establishes whether the correlation results from the treatment itself or from the characteristics of the client (Chan et al., 2003). It is possible that early dropout and poor outcome status are both products of weak treatment motivation on the part of the client.

Whatever the case, there must be a clearer understanding of the factors that contribute to improvements in retention rates in drug and alcohol abuse treatment (Chan et al., 2003). Research conducted with adults has found that factors associated with retention are positively correlated with treatment length and pretreatment client characteristics, including motivation for treatment. Although treatment programs have very little control over pretreatment client characteristics, other research has examined factors that influence retention independently of client characteristics and which may be within 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. Another study suggested that abstinence and program participation during the first two weeks of treatment for methadone addiction were strong indicators of retention and drug use outcomes at 6 and 9 months post-treatment (Chan et al., 2003). Research 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).

Relatively few studies of adolescents examine factors associated with treatment program retention, and those that do focus solely on pretreatment characteristics. Bastien and Adelman compared treatment retention among youths who were and 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 reported 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.

Conclusion and Recommendations

The research indicates that those treatment programs with high rates of retention and significant lengths of stay — longer than 90 days — are the most effective. The research also indicates that aftercare plays a crucial role in ensuring that relapse does not occur. While the research is limited concerning the effectiveness of drug treatment programs for incarcerated juveniles, many researchers have assumed that if such research were conducted, the findings would be consistent with those involving adults.

As far as recommendations are concerned, future research must address the impact of substance abuse treatment programs within juvenile corrections facilities. A major point of interest would be investigating whether treatment among juvenile offenders reduces the likelihood that they become adult offenders. It is also recommended that more state corrections facilities for both adults and juveniles adopt treatment programs that have been proven effective. Doing so has the potential to greatly reduce recidivism rates and improve the lives of offenders.

References

Chan, K. S., Morral, A. R., & Orlando, M. (2003). Retention of court-referred youths in residential treatment programs: Client characteristics and treatment process effects. American Journal of Drug and Alcohol Abuse, 29(2), 337+.

De Leon, G., Melnick, G., Kressel, D., & Jainchill, N. (1994). Circumstances, motivation, readiness, and suitability (the CMRS scales): Predicting retention in therapeutic community treatment. American Journal of Drug and Alcohol Abuse, 20(4), 495–515.

Drug and alcohol treatment in juvenile correctional facilities. (2002). http://www.oas.samhsa.gov/2k2/YouthJusticeTX/YouthJusticeTX.htm

Hser, Y. I., Grella, C. E., Hubbard, R. L., Hsieh, S. C., Fletcher, B. W., Brown, B. S., & Anglin, M. D. (2001). An evaluation of drug treatments for adolescents in 4 U.S. cities. Archives of General Psychiatry, 58(7), 689–695.

Latimer, W. W., Newcomb, M., Winters, K. C., & Stinchfield, R. D. (2000). Adolescent substance abuse treatment outcome: The role of substance abuse problem severity, psychosocial, and treatment factors. Journal of Consulting and Clinical Psychology, 68(4), 684–696.

Lemieux, C. M. (2002). Social support among offenders with substance abuse problems: Overlooked and underused. Journal of Addictions & Offender Counseling, 23(1), 41.

Substance abuse treatment. Federal Bureau of Prisons.

Winters, K. C., Stinchfield, R. D., Opland, E., Weller, C., & Latimer, W. W. (2000). The effectiveness of the Minnesota Model approach in the treatment of adolescent drug abusers. Addiction, 95(4), 601–612.