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a (Simpson, Wexler, & Inciardi, 1999). Many factors other than need for treatment (e.g., security concerns, inmate work schedules, mental health or medical problems, minimum length of sentence remaining, inmate refisal to participate, biases in the referral process) may innuence program placement decisions in prison (Farabee et al., 1999; Fletcher and Tims, 1992; ONDCP, 1996, 1999; Pearson and Lipton, 1999). In the Delaware study (Martin et al., 999), only a partial randomized design was used. Random assignment was used only for one cohort of inmates who were randomly assigned to work release (CREST) or not. No random assignment was used to assign subjects to an experimental treatment (KEY, the TC program) or control group. No pre-service assessment of need for drug treatment guided the creation of comparison groups: “The instruments include much of the Addiction Severity Index (ASI) and MDA’s Risk Behavior Assessment (RBA). It is important to note that these instruments were administered by the researchers after client selection and not as part of the client selection process” (Martin et al., 1999:300). Further, analyses of outcomes (drug relapse, rearrest) relied heavily upon inmate self-reports (Inciardi et al., 1997). Arrestees’ self-reports underestimate drug use detected by urinalysis by magnitudes of 40 to 60 percent (Taylor et al., 2001), while problems with self-report measures of criminal behavior are well known (e.g., Cantor and Lynch, 2000; Thornberry and Krohn, 2000). In the Amity, California prison study (Wexler et al., 1999), researchers used randomization to assign inmates who volunteered for treatment to either TC or a wait-listed, “intent-to-treat” comparison group. Volunteers were deemed eligible if they met admission criteria of having a drug problem (no information on the severity of drug problem or the means of a assessment was reported), and having at least 9 to 14 months remaining in their sentence prior to parole eligibility. Inmates remained in the TC-eligible pool until they had less than 9 months to 34 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.
9 serve, then they were removed fiom the pool and designated as members of the “no-treatment” control group. In reality, inmates in the “no-treatment” comparison group may have received some unknown mix of drug education, self-help, or outpatient services: “The control group did not receive any formal substance abuse treatment during their prison stay, although limited drug education and 12-step groups were available” (p. 325). Numerous questions remain about the effectiveness of prison-based substance abuse treatment programs. For example: How is quality of program implementation related to treatment outcomes? Studies of prison-based TC in Texas (Martin, Butzin, and Inciardi, 1995), California (Wexler and Williams, 1986) and Delaware (Inciardc Martin, Lockwood, Hooper, and Wald, 1992) found numerous implementation problems, including inadequate numbers of trained and experienced counseling staff and lack of standardized screening, assessment, and selection processes (see also Farabee et al., 1999; Linhorst et al., 2001). Variations in TC implementation across different sites may significantly influence treatment outcomes such as recidivism. Relationships between inmate characteristics, treatment process and outcomes are not yet well understood (Pearson and Lipton, 1999). For example, how are drug and alcohol needs assessments conducted, and how do needs assessments influence treatment process and outcomes? Are inmates with different levels and types of need matched with appropriate treatment (Andrews et al, 1990)? To what degree does appropriate assessment and program placement moderate treatment effects? What kinds of inmates are best suited for TC’s? Finally, what magnitude of treatment effect is to be expected fiom TC if appropriate extraneous influences are controlled for in analyses (Pearson and Lipton, 1999)? So far, results of a prison-based TC have been based upon research conducted mainly in four states (Delaware, Texas, New York, and California), and it is unclear to what extent observed treatment effects 35 This document is a research report submitted to the U.S. Department of Justice. This report has not been published by the Department. Opinions or points of view expressed are those of the author(s) and do not necessarily reflect the official position or policies of the U.S. Department of Justice.
Page 1 and 2: The author(s) shown below used Fede
Page 3 and 4: Table of Contents Executive Summary
Page 5 and 6: EXECUTIVE SUMMARY Evaluation of Pri
Page 7 and 8: e the same five institutions were c
Page 9 and 10: 0 0 Treatment staff showed a high l
Page 11 and 12: Policy Issues and Recommendations R
Page 13 and 14: 1. Overview In fro duction Like oth
Page 15 and 16: a years old. Offenders were serving
Page 17 and 18: integrated into the other activitie
Page 19 and 20: e repeatedly incarcerated, but untr
Page 21 and 22: 0 According to a recent report by t
Page 23 and 24: e and Camacho, 1997), and the Feder
Page 25 and 26: 8% lower reincarceration rate compa
Page 27 and 28: e reincarcerated, compared to only
Page 29 and 30: e of less violence and greater drug
Page 31 and 32: included those clients who graduate
Page 33 and 34: e conjunction with the National Ins
Page 35: @ drug use than untreated women (35
Page 39 and 40: programming per week (mean = 30 hr/
Page 41 and 42: participation in treatment) and pos
Page 43 and 44: 1990; Bonta, 1996; Jones, 1996). Th
Page 45 and 46: Admission and Classification. 1 I I
Page 47 and 48: e or both’*. TC clients were aske
Page 49 and 50: e Post-release indicators focused u
Page 51 and 52: a Independent Variables One excelle
Page 53 and 54: state prison system. The test-retes
Page 55 and 56: e high correlation with the Beck De
Page 57 and 58: The social conformity scale has dis
Page 59 and 60: e (Simpson, 1997). Items assess the
Page 61 and 62: @ Sample Characteristics For each i
Page 63 and 64: ~~ 0 inmates participated in AOD pr
Page 65 and 66: ~ ~~ a Table 5 Treatment Exposure:
Page 67 and 68: Inmates in the four program types d
Page 69 and 70: dichotomous outcomes such as reinca
Page 71 and 72: We also observed statkg ratios (inm
Page 73 and 74: e until they are mandated to go, so
Page 75 and 76: a Table 8 Inmate Characteristics bv
Page 77 and 78: more counselors and that the progra
Page 79 and 80: Waymart. Inmates attend a morning m
Page 81 and 82: current TC inmates (REST and CRC fo
Page 83 and 84: ~ ~~~~ e However, a number of inmat
Page 85 and 86: e Counselor ratings of client attri
Page 87 and 88:
@ process across the five programs,
Page 89 and 90:
Table 10 Mean CRC Scores: Time 1, T
Page 91 and 92:
Table 12 Mean CRC Scores: Paired Sa
Page 93 and 94:
Table 14 ChanPes in Ratings of Trea
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DOC custody for a parole violation,
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0 Table 15 Number and Type of Relea
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Because few inmates had been releas
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0 Table 16 Reincarceration SamDle C
Page 103 and 104:
0 Table 18 Lopistic Repression of R
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Table 19 Survival Analvsis: Life Ta
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Rearrests Rearrest analyses were ba
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Table20 ~~~ Rearrest Sample Charact
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Table 22 LoPistic Repression of Rea
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Table 23 Survival Analvsis: Life Ta
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e Drug Relapse and Other Parole Dat
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successfill discharges only), the e
Page 119 and 120:
treatment, psychological hctioning)
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Table 25 Logistic Repression of Dru
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i Comparison Group TC Group Note. E
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c 0 E 40% icr E Cresson Graterford
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Hazard Function V C comparison grou
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For each of the three dependent var
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V. CONCLUSIONS AND RECOMMENDATIONS
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Employment may help prevent drug re
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group did get some treatment help
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Recommendations: 2. Correctional ad
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an inmate gets closer to hisher min
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Findings suggested that certain inm
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e Finding: TC programs varied littl
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an evaluation study can be linked w
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and Ryder, 2001; Travis and Petersi
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References Andrews, Donald A. (1995
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Derogatis, L.R., H. Yevzeroff, and
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Hiller, Matthew L.; Knight, Kevin,
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the Physician Leadership on Nationa
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Palmer, Ted. (1995) "Programmatic a
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Simpson, D. Dwayne (1994) TCUPTA Fo
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U.S. Department of Justice (1998) S
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Criminal Justice. U.S. GPO. No. 198
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Appendix I. Overview of DOC Databas
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INMATE RECORDS SYSTEM This database
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Inmate (Program Participant) Interv
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' Appendix 3. Subject Consent Form
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Confidentiali@/Anonymitv I understa
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DRUG SCREEN PLEASE COMPLETE ALL INF
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@ Appendix 5. TCU Resident Evaluati
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EVALUATION OF SELF AND TIiEATMENT (
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EVALUATION OF SELF AND TREATMENT (C
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EVALUATION OF SELF AND TREATMENT (C
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Appendix 6. TCU Counselor Rating of
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COUNSELOR RATING OF CLIENT (CONTINU
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@ INDIVIDUAL PROGRAM REPORTS: DOC-T
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pattern, chemical abuse and health
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~ on the inmate with respect to pre
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1. Presence of AOD problem that has
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@ and consists of suggestions on ho
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0 tasks, the inmate must receive a
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StaffDemographics (fidl time AOD st
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@ provided describing drug and alco
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The Inmate Handbook also lists reas
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Examples of Phase I1 problem areas
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counselor and through institutional
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9. What are the criteria for succes
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and then listing an alternative ass
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Finally, in Phase IV the inmate is
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INDIVIDUAL PROGRAM REPORTS: DOC-TEM
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Specific Program Content and Struct
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Name of Staff Member: Job Title: Hi
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