Editors Note: This article was adapted from a series of articles that ran in the Journal of Substance Abuse Treatment (JSAT), in accordance with a partnership agreement between Counselor Magazine and JSAT to bridge the gap between research and clinical practice in the addiction treatment field.

In an effort to improve the delivery of drug treatment services, researchers have been working to identify the organizational characteristics of substance abuse treatment programs. Most of that research has been in treatment programs that are located in community settings. Although drug treatment is increasingly being provided in correctional settings, such as prisons, jails and community correctional agencies for parolees and probationers, to date, little is known about the provision of drug treatment services within these settings.

There is much evidence to suggest the re-entry process has a significant impact on successful outcomes for parolees, therefore, it is even more vital to examine substance abuse treatment programs in correctional facilities. The community-based aftercare program to which the offender-client is linked can build on the services made available to the client in the institutional setting — depending on what, if any, services have been received. Services in the correctional institution, as well as the orientation to treatment, may complement or differ from services and the orientation to treatment found in the community, and may thereby support or impede the successful transition of offenders from prison to the community. 

A recent national study identifies the organizational characteristics of drug abuse treatment providers and the types of treatment services provided to offenders in both correctional and community-based settings. From 2004 to 2005, the National Criminal Justice Drug Abuse Treatment Studies (CJ-DATS), a research initiative sponsored by the National Institute on Drug Abuse (NIDA), conducted a comprehensive survey of state and regional administrators, treatment program directors and treatment staff as part of the National Criminal Justice Treatment Practices Survey (NCJTPS).  This article provides a brief summary of the survey objectives and methods; major findings on the types of treatment services provided within correctional settings; and differences in organizational characteristics of community- and correctional-based treatment providers (Taxman, F.S., Young, D.W. & Fletcher, B.W., 2007).

The objectives of the multi-level survey were: to describe current drug treatment practices, policies and delivery systems for offenders who are on probation or parole supervision, in jails, in prisons, or in youth institutions; to examine agency structures, resources and other organizational factors that may affect services delivery; and to assess coordination and integration across criminal justice agencies and between corrections and treatment systems. Researchers surveyed individuals at different levels within the corrections and treatment systems, including: state-level executives administering correctional services; administrators of institutional corrections facilities, community corrections offices and community-based treatment programs; and staff in selected correctional and community drug treatment facilities (Taxman, F.S., Young, D.W. & Fletcher, B.W., 2007). 

Correctional-based substance abuse treatment

The survey of adult facilities covered 98 prisons (74 general prisons and 24 special drug treatment facilities administered by state correctional systems); 57 jails, of which 74 percent are locally operated facilities, with the remaining 26 percent being state operated (either a regional jail or a regional facility); and 134 community correctional agencies. Substance abuse education and awareness is the most prevalent form of service provided across these settings, being offered in 74 percent of prisons, 61 percent of jails and 53 percent of community correctional agencies. The other most frequently provided treatment services in prisons are group substance abuse counseling (55 percent of prisons offer this service for up to four hours per week, and close to half offer it for five to 25 hours per week) and relapse prevention groups (45 percent). Similarly, 60 percent of jails surveyed provide group substance abuse counseling for up to four hours per week, and about one-half provide relapse prevention groups. About one-half of the community correctional agencies surveyed provide group substance abuse counseling for up to four hours per week, and about one-third provide relapse prevention groups. Segregated therapeutic community (TC) programs (i.e., programs that are removed from the general prison population) are offered in about one-fifth of prisons and in about one-quarter of jails. (Tables One, Two and Three show the percentages for treatment services provided in prisons, jails and community correctional agencies, respectively.)

Not surprisingly, specialized drug treatment prisons tend to offer more services to offenders, as compared with generic prisons. Although case management services were provided universally in specialized prison facilities, it was provided in fewer than 10 percent of generic prisons; in about 23 percent of jails; and in less than 10 percent of community correctional agencies. Of additional significance, access to drug treatment services of any kind is limited within correctional settings. Less than one-quarter of the offenders in prisons and jails, and less than 10 percent of those in community correctional agencies, have participated in treatment services through correctional agencies due to limited space and capacity (Taxman, F.S., et. al., 2007). 

Comparing correctional- and community-based treatment

To better understand the continuities (or lack thereof) between correctional and community treatment settings, we examined differences across these two types of settings using data from treatment program administrators. In particular, we examined the types of services provided and the organizational characteristics associated with three different therapeutic orientations that are commonly used within substance abuse treatment: therapeutic community (TC), cognitive behavioral therapy (CBT) and 12-Step (Taxman, F.S., Perdoni, M.L. & Harrison, L.D., 2007).

Organizational characteristics of community versus correctional programs. Over one-half of the sample of 217 treatment programs was located in the community (56 percent); the remainder in correctional settings (44 percent). (Table Four shows the variables on which the two types of programs were compared.) Nearly one-half (48 percent) of the correctional programs were inpatient, compared with 10 percent of the community programs. Correctional programs were more likely to provide specialized services for different types of client populations and had an average higher program capacity. Overall, the majority of all programs had some kind of accreditation, although the proportion was higher among the community programs. 

With regard to administrator and staff characteristics, nearly three-quarters of community program directors had a Master’s degree or higher, compared to about one-half of correctional program directors. Similarly, a greater proportion of the staff in the community programs (79 percent) had specialized training in substance abuse treatment, compared with staff in the correctional programs (55 percent), although the proportion of staff with college degrees was approximately the same across the two types of programs.

As might be expected from their organizational settings, correctional and community programs differed in the degree to which they interacted and had formal arrangements with providers in other service systems. Community programs tended to be more integrated with the judiciary, whereas correctional programs were more integrated with community corrections. Community and correctional programs differed in terms of “treatment climate” in ways that reflect their different organizational context. Community programs scored higher on a measure of staff influence on treatment improvement and on the importance placed on substance abuse treatment relative to other types of services. 

With regard to treatment processes, correctional programs had longer planned treatment duration, with nearly three-quarters providing treatment for over 90 days, compared with one-half of the community programs. In addition, a greater proportion of the correctional programs indicated that they used a written treatment protocol or curriculum.

Types of services provided by community vs. correctional programs. Overall, there was little difference between correctional- and community-based programs in the number of wraparound services provided, with community programs providing slightly more services, on average (4.8 vs. 4.3 out of a total possible of 11).  However, when the individual types of services were examined, there were significant differences in several areas. Community-based programs were more likely to provide family therapy/counseling (69.8 percent vs. 39.3 percent) and child care services (9.2 percent vs. 0), whereas correctional-based programs were more likely to provide legal services (13.5 percent vs. 5 percent) and medical services (44.9 percent vs. 19.3 percent). 

Program characteristics associated with different types of therapeutic orientations. Programs that had a greater adherence to TC orientation were more likely to: be located in prison settings (rather than in the community); be a specialized drug abuse treatment facility; have a larger program capacity; and score higher on a measure of the importance of community treatment for offenders.

Programs that had a greater adherence to a CBT orientation scored higher on measures of staff influence on treatment improvement and the perceived importance of community treatment for offenders, and were more likely to endorse the use of a written protocol or curriculum.

Programs that had a greater adherence to 12-Step orientation were more likely to have staff who had received specialized training in drug abuse treatment. They also were somewhat more likely to be located in inpatient settings, and to report a greater degree of staff influence on treatment improvement, and were somewhat less likely to be accredited.
Implications of National Survey for Policy and Clinical Practice

Overall, the study showed that correctional and community drug abuse treatment programs for offenders diverge in several areas of treatment approach and service delivery. These findings have implications for developing effective transitions between correctional- and community-based treatment, particularly since research has shown that post-release treatment in the community significantly reduces the likelihood of recidivism, compared with in-prison treatment only. Differences in treatment approaches and therapeutic orientations between correctional- and community-based treatment may result in discontinuity during the community re-entry phase. This is most evident in the differing emphases placed on the principles of TC-based treatment across the two types of settings. Whether continuity of approach is related to better post-release outcomes is an area for further research. The greater provision of wraparound services within community-based programs may reflect the need to equip offenders with a broader range of services as they prepare to re-enter the community, including: housing, vocational and family-related resources. 

In sum, the findings from this national survey provide a foundation for understanding the types of supportive services and treatment approaches available in both correctional- and community-based treatment programs that serve drug-abusing offenders. At present, there is increasing emphasis on the use of evidence-based treatment approaches within programs that treat offenders, as well as pressure to demonstrate the effectiveness of both in-prison and community-based treatment. In response to these imperatives, providers to offender populations may be expected to adopt a wider array of treatment practices as well as to meet specific performance objectives. Future research is needed to better understand how organizational characteristics are associated with the ability of programs to respond to these changes in the drug abuse treatment system, and how they impact treatment provided to offenders; their re-entry process following release from prison; and their associated outcomes.

Acknowledgement

The CJ-DATS was funded under a cooperative agreement from the U.S. Department of Health and Human Services, National Institutes of Health (NIH)/NIDA. The authors gratefully acknowledge the collaborative contributions by federal staff from NIDA, members of the coordinating center (Virginia Commonwealth University/University of Maryland at College Park, Bureau of Governmental Research), and the nine research center grantees of the NIH/NIDA CJ-DATS Cooperative (Brown University, Lifespan Hospital; Connecticut Department of Mental Health and Addiction Services; National Development and Research Institutes, Center for the Integration of Research and Practice; Texas Christian University, Institute of Behavioral Research; University of Delaware, Center for Drug and Alcohol Studies; University of Kentucky, Center on Drug and Alcohol Research; University of California at Los Angeles, Integrated Substance Abuse Programs; and University of Miami, Center for Treatment Research on Adolescent Drug Abuse).

Christine E. Grella, PhD, is a research psychologist at the Integrated Substance Abuse Programs (ISAP) at UCLA. Her research focuses on the intersection of multiple service delivery systems, including substance abuse treatment, mental health, child welfare, health services, HIV services and criminal justice, as well as the relationship of service delivery to treatment outcomes.

Faye S Taxman, PhD is a Professor in the Administration of Justice Program at George Mason University and the PI for the Coordinating Center for the NIDA funded Criminal Justice National Drug Treatment Studies (CJ-DATS), where she directs a national survey of practices in correctional settings and is involved in several experimental studies. She also is a published author and a Fellow of the Academy of Experimental Criminology and a member of the Correctional Services Accreditation Panel (CSAP) of England.

References

Grella, C.E. et. al. (2007). Organizational Characteristics of Drug Abuse Treatment Programs for Offenders: The state of the state. Journal of Substance Abuse Treatment. Vol. 32, No.3.
Taxman, Faye S., Young, Douglas W. & Fletcher, Bennett W. (2007). The National Criminal Justice Treatment Practices Survey: An overview of the special issue. Journal of Substance Abuse Treatment. Vol. 32, No. 3.
Taxman, F.S. et. al. (2007). The National Criminal Justice Treatment Practices Survey: Multilevel survey methods and procedures. Journal of Substance Abuse Treatment. Vol. 32, No. 3.
Taxman, F.S., Perdoni, M.L. & Harrison, L.D. (2007). Drug Treatment Services for Adult Offenders: The state of the state. Journal of Substance Abuse Treatment. Vol. 32, No. 3

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