The Effectiveness of Treatment for Drug Abusers Under Criminal Justice Supervision.

Series: NIJ Research Report
Published: November 1995
52 pages
113,285 bytes

U.S. Department of Justice
Office of Justice Programs

National Institute of Justice
Jeremy Travis, Director

Christy Visher, Ph.D.
Program Manager

Authored by
Douglas S. Lipton, Ph.D., is a Senior Research
Fellow with the National Development and Research
Institutes in New York.

This paper is an adaptation of the presentation Dr.
Lipton made on July 11, 1995, at "What To Do About
Crime," the annual conference on research and
evaluation, sponsored by the National Institute of
Justice, the Bureau of Justice Assistance, and the
Office of Juvenile Justice and Delinquency
Prevention and held in Washington, D.C.

Opinions or points of view expressed in this
document are those of the author and do not
necessarily reflect the official position of the
U.S. Department of Justice.
NCJ 157642

Contents

Abstract
The Relationship Between Drugs and Crime
Current Availability of Treatment
Evolution of Prison-Based Treatment 
Jail Treatment Programs
The Federal Prison System Program
Drug Treatment in State Correctional Facilities
The TASC Program
Conclusion--A Sound Investment
Notes
References

Abstract

The proportion of people in the criminal justice
system who are substance abusers is very high and
has grown larger in recent years. Rehabilitation
and treatment offered to prison inmates has had a
checkered history in this country, however. This
paper interweaves a number of themes related to
these facts: the relationship of drugs to crime,
the current overcrowded situation in correctional
facilities, and state-of-the-art treatment
approaches used with substance-abusing offenders
who are in custody. The paper presents the findings
of studies that have demonstrated that in-custody
treatment, particularly the therapeutic community
(TC) model, can be effective in preventing rearrest
and in other outcomes. Moreover, with this
approach, successful outcomes are positively
related to the amount of time spent in treatment.
Several successful projects--notably Stay'n Out,
Cornerstone, Amity Prison TC, Key-Crest, KEEP, and
TASC--are highlighted. The CDATE project, a 25-year
update of the author's study of the effectiveness
of correctional treatment, is also described. 

The Relationship Between Drugs and Crime

A large number of people who abuse drugs come into
contact with the criminal justice system when they
are sent to jail or to other correctional
facilities. In fact, the criminal justice system is
flooded with substance abusers. The need for
expanding drug abuse treatment for this group of
people was recognized in the Crime Act of 1994,
which for the first time provided substantial
resources for Federal and State jurisdictions.
Although drafting the Act required reconciling many
disparate points of view, all parties agreed on the
larger goal of crime reduction. Whether treating
offenders is a worthwhile path to this end is in
question, at least in the minds of some members of
Congress, among others. This perspective is
understandable, because treating offenders for
substance abuse has had a checkered history in this
country. 

This paper argues that the time in which drug-using
offenders are in custody presents a unique
opportunity to provide them with treatment.
Presented here are descriptions of several programs
in operation throughout the country. The emphasis
is on programs modeled on the therapeutic community
(TC) approach. For most of the programs presented,
evaluative research has been conducted or is under
way. Where the research findings are available,
they indicate great promise in reducing drug use
and offender arrest rates. 

Even before examining what lies behind the
checkered history of treating offenders in this
country, it is useful to understand why treatment
is necessary for people under criminal justice
supervision. Data from the Drug Use Forecasting
program (DUF), which has been testing arrestees for
the use of illicit drugs since 1987,1 indicate that
the proportion of substance abusers has never
fallen below 60 percent and has been as high as 85
percent (Wish and O'Neil, 1989; National Institute
of Justice, 1994). Among people who are
incarcerated, the proportion of drug-using
offenders is even higher (GAO, 1991; Prendergast,
1992). In many instances, these men and women are
typically users of many drugs--taking them in
combination with each other and with alcohol. At
least 45 percent of arrestees charged with violent
crimes or income-generating crimes (such as
robbery, burglary, and theft) in 1988 tested
positive for use of one or more drugs (NIJ Reports,
1989). If they are chronic users, as one study has
suggested (Johnson, 1986), their drug use pervades
their lifestyle and preoccupies their day-to-day
activities. 

Most drug-using offenders have avoided treatment
while active in the community, although some have
experienced detoxification several times. According
to one report (Lipton, 1989), more than 70 percent
of active street addicts in New York City have
never been in treatment nor intend to enter
treatment for their addiction. The data are almost
identical for Delaware's offender population
(Peyton, 1994:9). 

The Recent Increase in Drug-Abusing Offenders

Since the second half of the 1980's, there has been
a marked growth in prison and jail populations,
continuing a trend that began in the mid-1970's.
The proportion of drug users in the incarcerated
population grew over that time--by the end of the
1980's about one-third of those sent to State
prisons had been convicted of drug offenses--the
highest proportion in the country's history
(Reuter, 1992). 

With the advent of crack use in the mid-1980's, the
already strong relationship between drugs and crime
heightened. Cocaine use doubled in most cities and
tripled in some, while the use of other drugs
(notably heroin and PCP) declined or remained
stable (Wish and O'Neil, 1989). Data from Miami
(Inciardi, 1993) and observational and anecdotal
reports from several cities in the Northeast (New
York, Philadelphia, Baltimore, and Newark) indicate
an increase and a leveling at high levels in heroin
availability, purity, and use.2 Data from DAWN3
support these observations. 

Crack-accelerated violence in the streets--
particularly increasing numbers of apparently
random acts of violence, gang activity, and
shootings of innocent bystanders--has angered the
public; consequently, citizen pressure on the
police and the courts for action has increased.
Levels of crack use have now been reported to be
increasing in rural and suburban as well as urban
areas. As a result, the number of inmates in State
prisons who have histories of crack use has been
increasing as well (Fagan et al., 1990).

Drug Use and Serious Crime 

Overall, the U.S. prison population has grown about
60 percent in the past decade, an increase fueled
largely by the influx of substance-abusing
offenders. They are responsible for a relatively
large amount of crime. Among them the most
predatory--the heroin-using "violent predators"--
committed 15 times more robberies, 20 times more
burglaries, and 10 times more thefts than offenders
who do not use drugs (Chaiken, 1986). Studies
conducted among heroin users in Baltimore (Ball et
al., 1983) and New York (Johnson, 1986)
demonstrated that active drug use accelerates the
users' crime rate by a factor of four to six and
that the crimes committed while people are on drugs
are at least as violent, or more so, than those
committed by people who do not use drugs. Initial
impressions from studies of crack-related crime
indicate that the rate is as high or higher than
heroin-related crime, and is certainly more
violent.

Data vary from study to study, but it would appear
that drug-using felons are also a primary source of
failure on parole; that is, they constitute a
disproportionate share of repeat offenders. Sixty
to 75 percent of untreated parolees who have
histories of heroin and/or cocaine use are reported
to return to using these drugs within 3 months
after release and to become reinvolved in criminal
activity (Wexler et al., 1988). The "revolving
door" analogy epitomizes the situation with
offenders who use hard drugs. 

Crime and severe drug abuse. The extensive research
on the relationship between drug abuse and crime
provides convincing evidence that a relatively few
substance abusers who have a severe drug problem
are responsible for an extraordinary proportion of
crime (Gropper, 1985; based on the work of Johnson
et al., 1985; Ball et al., 1983; and Inciardi,
1979). Because of the seriousness of their crimes
and their criminal records, many of these
drug-abusing offenders are incarcerated. Without
treatment, a high proportion will relapse into drug
use after release from custody and return to crime.
These behaviors are part of a lifestyle that is
both highly destructive and resistant to change
(Walters, 1992). About one-quarter of the drug
users in prison were previously in treatment
(Prendergast, 1992). 

Current Availability of Treatment 

Because a large proportion of drug users in this
country are processed through some part of the
criminal justice system during their
substance-abusing careers, it makes a great deal of
sense to consider the system as a location for
treatment. Most inmates have not been treated in
the community and, when asked, indicate they have
no particular interest in entering treatment
(Lipton, 1989). Thus, their entry into the criminal
justice system presents a major opportunity to
bring to bear the most recent advances in drug
abuse treatment for this otherwise elusive
population. A logical, cost-effective, and
convenient point of intervention is the time they
are in custody. 

How Many Receive Treatment?

In 1979, there were 160 prison treatment programs
serving about 10,000 inmates--4 percent of the
Nation's prison population (NIDA, 1981). Of that
number, 49 programs (32 percent) were based on the
TC model and served about 4,200 participants (or 42
percent of all participants). Almost 10 years
later, the percentage of prison inmates in drug
treatment programs had risen to an estimated 11
percent (Chaiken, 1989). 

Although the increase has been sizable (from 10,500
inmates in 1979 to 51,500 in 1987), the majority of
inmates with substance abuse problems still do not
receive treatment while in prison. According to one
recent estimate (Prendergast, 1992), on the basis
of data from the DUF sites, the number of
drug-using arrestees who are probably in need of
treatment exceeds 2 million (980,000 need treatment
for cocaine use, 280,000 for opiates, 27,000 for
amphetamines, and 780,000 for injection drug use).

There is still no consensus about the percentage of
offenders being treated for drug use. However,
recent (though incomplete) surveys reveal that more
than half the States offer either assessment
procedures, education programs, counseling, other
programs, or some combination (Frohling, 1989; GAO,
1991). An optimistic assessment is that about 20
percent of identified drug-using offenders are
served by these programs (Frohling, 1989; GAO,
1991).

REFORM and RECOVERY--Federal Catalysts for State
Action

Some 22 States were aided in their efforts to begin
or expand comprehensive, statewide drug treatment
through Project REFORM (funded by the Bureau of
Justice Assistance of the U.S. Department of
Justice) and Project RECOVERY (now funded by the
Center for Substance Abuse Treatment, U.S.
Department of Health and Human Services).4 

As a result of Project REFORM, the following drug
abuse treatment system components were established:

o 39 assessment and referral programs implemented
and 33 expanded or improved.

o 36 drug education programs implemented and 82
expanded or improved.

o 44 drug resource centers established and 27
expanded or improved.

o 20 in-prison 12-step programs implemented and 62
expanded or improved.

o 11 urine monitoring programs expanded and 4
expanded or improved.

o 74 prerelease counseling and/or referral programs
implemented and 54 expanded or improved.

o 39 postrelease treatment programs with parole or
work release implemented and 10 expanded or
improved.

o 77 isolated-unit ("milieu") treatment programs
initiated and/or improved (16 brief [less than 6
weeks] programs, 19 short-term [6-12 weeks]
programs, 34 intermediate [5-9 months] programs,
and 8 long-term [9-15 months] treatment programs). 

The Impact of REFORM 

Project REFORM laid the groundwork for the
development of effective prison-based treatment for
incarcerated drug abusers. It also had indirect
effects on the correctional systems of the
participating States (and those of other,
nonparticipating systems)--effects not easily
assessed but nonetheless real. Presentations were
made at professional conferences to national groups
and policymakers and to local correctional
officials (e.g., wardens, prison administrators)
concerning REFORM, the principles of effective
correctional change, and the efficacy of
prison-based treatment. Information was presented
on the day-to-day benefits of involving inmates in
treatment: decreases in drug use, violence, and
other antisocial behaviors during incarceration. It
is likely that these presentations increased the
receptivity of local and State correctional
officials to imple-menting drug and alcohol abuse
treatment programs in their facilities. 

Perhaps most important was the catalytic effect of
REFORM on the correctional community in general.
Since the mid-1970's, the field of State
corrections had shifted ideologically toward "just
deserts," with rehabilitation as a function and
purpose of corrections diminishing markedly. The
combined effect of workshops, consultants' visits,
the attendance of nonparticipating States at the
workshops, testimony and written presentations by
REFORM's national coordinators and correctional
leadership before Congressional committees and
State hearings, as well as at major meetings of
various national organizations generated interest
within the correctional community. Other States,
and even other countries, began seeking information
about how to organize and initiate drug abuse
treatment programming for their correctional
inmates.

Correctional officials have made clear that the
comprehensive plans developed as a result of
Project REFORM were useful and that the process
helped State officials assess problems related to
the provision of drug and alcohol abuse services
within their correctional system. The plans also
helped them develop appropriate short- and
long-range strategies for service enhancement. 

New service delivery models were created that
enhanced continuity of treatment so that
programming begun in a given institution could
continue after participants were released into the
community. These models included ways of developing
contracts with community programs to provide
counseling and treatment planning assistance to
offenders who were approaching their release date
and providing residential and out-patient treatment
after discharge and/or parole to the community. 

RECOVERY Follows

The focus shifted in 1991 to the new Center for
Substance Abuse Treatment (formerly known as the
Office for Treatment Improvement), which
established Project RECOVERY. RECOVERY provided
technical assistance and training services to pilot
prison drug treatment programs and continued the
work begun by REFORM. Most of the States that
originally participated in REFORM became involved
in RECOVERY, and an additional seven States that
had completed comprehensive correctional treatment
plans were added (Infra, p. 19).5 

Federal Assistance

The States were assisted in their efforts to begin
or expand comprehensive programs through two
Federal Government initiatives, projects REFORM and
RECOVERY. Begun in 1987, Project REFORM laid the
groundwork for the development of prison-based
treatment for incarcerated drug abusers and,
perhaps most important, had a catalytic effect on
the correctional community in general, promoting
corrections officials to shift in their thinking
toward rehabilitation, a concept that had been in
abeyance for some time. Project RECOVERY, launched
in 1991, followed REFORM in providing technical
assistance and training to pilot programs. 

Rising Prison Population Drives the Need

Last year the Nation's prison population passed the
1 million mark, and the total number of adults in
the criminal justice system now approaches 5
million (BJS, 1994). This is the largest number
ever under the control of criminal justice
authorities. The prison population alone increased
two and one-half times between 1980 and 1993. The
vast majority (more than 80 percent) are
recidivists, and about three in four previously
used drugs. The number of prisoners in the custody
of State correctional authorities for drug offenses
increased ninefold (from 19,000 to 172,300) between
1980 and 1992 (Beck and Gilliard [BJS], 1995). 

Many of these prisoners have severe substance abuse
problems. Indeed, about one-third of the inmates
previously used a major drug (heroin, methadone,
cocaine, LSD, and PCP) on a regular basis and more
than half reported using drugs during the month
before the crime for which they were incarcerated.
Slightly more than half say they were under the
influence of alcohol or drugs at the time of the
offense for which they were incarcerated. 
Some of these inmates are predatory criminals with
severe substance abuse problems; they are
responsible for an extraordinary amount of crime
and are involved in a variety of violent crimes,
property offenses, and drug deals. These facts make
it clear that in order to improve the quality of
life and ensure public safety, it is imperative to
find ways to prevent their relapse into drug use
and to significantly reduce recidivism. 

Other Priorities May Take Precedence

It is evident, however, that senior State-level
correctional executives have another overriding
concern: ensuring adequate space to house inmates.
Their budgets reflect that priority: additional
prison space takes priority over rehabilitation
programs. It is also clear that some correctional
officials are in conflict as to where to treat
offenders; that is, they need to determine whether
resources should be allocated to community-based or
prison-based programs. 

Some prison administrators believe that
prison-based treatment programs make it more
difficult to manage inmate housing. Problems occur
when a facility is overcrowded and, in an attempt
to separate program residents from general
population inmates, a separate housing unit has
been dedicated to a treatment program. This
sometimes leads to filling unused treatment space
with inappropriate inmates. 

Legislators, as well as correctional authorities,
are often skeptical about the effectiveness of
correctional treatment and reluctant to spend tax
dollars on efforts that net no votes and are
likely, in their minds, to produce little change in
behavior.

Despite these objections, correctional authorities
evidently recognize that one major benefit of
prison-based drug treatment programs is enhanced
security in the institution. Drug use and drug
dealing (rampant in some prisons) decline with the
introduction of drug treatment programs and random
urinalysis (Vigdal and Stadler, 1989). Infractions
of prison rules as well as violence and threats of
violence also decline, as does the threat of prison
riots. Also, the pernicious influence of gangs
within correctional facilities diminishes as
effective programming increases. For these reasons,
correctional authorities have assigned drug
treatment a higher priority during the past decade.
As a result, between 1979 and 1990 the percentage
of inmates receiving some form of treatment more
than tripled (Lipton et al., 1992).

Public Support

Many policymakers, especially legislators, oppose
funding for prison-based drug treatment programs
because they believe that the public wants
offenders punished and that treatment programs
coddle criminals. Although it is true that
Americans want criminals punished and that public
support for rehabilitation has declined
substantially since the late 1960's, there is
evidence that "support for rehabilitation remains
surprisingly strong" (Cullen and Gendreau, 1988). 

An example from the State of Michigan illustrates
this support. A survey conducted there revealed
that 12 percent of policymakers in Michigan assumed
that citizens favored prison rehabilitation. In
fact, fully 66 percent of the public believed
rehabilitation should be a primary goal of prisons
(cited in Cullen and Gendreau, 1988). This is not
an isolated finding; several other nationwide and
State surveys reveal that the public continues to
support prison rehabilitation. According to another
study, citizens want "assurances of safety much
more than they want assurances of punishment," and
they "want prisons to promote rehabilitation as a
long-term means of controlling crime" (Public
Agenda Foundation, 1987: 5; cited in Cullen and
Gendreau, 1988). Surveys completed in the summer of
1995 continue to indicate support on the part of
the public for prison rehabilitation (H. Kleber,
personal conversation, 1995).

Evolution of Prison-Based Treatment 

Treatment for incarcerated Federal offenders
formally began with the opening of two U.S. Public
Health Service hospitals, one in Lexington,
Kentucky, in 1935 and one in Fort Worth, Texas, in
1938. The need for these facilities was first
recognized by the then-Director of the Federal
Bureau of Prisons, who urged Congress to establish
"Narcotic Farms" in these locations. These
facilities evolved from farms to hospitals to
clinical research centers, were transferred from
the U.S. Public Health Service, and are now part of
the Federal prison system. 

Drug abuse treatment in prisons has been influenced
by the development of therapeutic communities,
which in their prison manifestation often place
recovered drug users in a therapeutic environment
isolated from the general prison population. Before
1980, relatively few evaluative research studies of
therapeutic communities in prison settings had been
conducted. Recently published findings regarding
New York's Stay'n Out program (Wexler, Lipton, and
Falkin, 1989, 1990), Oregon's Cornerstone Program
(Field, 1984, 1989), Delaware's Key-Crest programs
(Inciardi, 1995), and California's Amity Prison TC
program (Wexler, 1995), and unpublished preliminary
findings of a study of the New Vision program in
Kyle, Texas (Simpson and Knight, 1995),
substantiate the significant accomplishments of
correctional-based therapeutic communities with
incarcerated drug-abusing felons.

The "Nothing Works" Era 

As noted above, however, prison drug abuse
treatment, along with treatment for non-drug
abusers, is currently limited, and over the past 20
years the field of corrections is noteworthy for
its failure to pursue rehabilitative goals. I am
responsible, in part, for this situation. The
cynical notion that "nothing works" emerged from a
summary (Martinson, 1974) of a study I conducted in
collaboration with two colleagues and published in
1975 (Lipton, Martinson, and Wilks, 1975). 

The summary appeared at a time when the national
media and the social climate were ripe for a shift
away from the so-called "rehabilitative era."
Liberals and conservatives alike felt that, as
James Q. Wilson put it at the time, ". . .belief in
rehabilitation requires not merely optimistic but
heroic assumptions about the nature of man" (1975:
192).

As I suggested later (Lipton, 1994), the
anti-rehabilitation backlash grew out of the
scientific corroboration that opponents of
rehabilitation were able to match with their deeply
held beliefs regarding punishment, "just deserts,"
and general deterrence. They found that
corroboration in the summary, which proved to be
highly influential. "With few and isolated
exceptions," the article concluded, "rehabilitative
efforts that have been reported so far have no
appreciable effect on recidivism" (1974: 25). 

The phrase "nothing works" became a watchword and
entered the corrections vocabulary; it was treated
as fact. The belief that "nothing works" still
enjoys widespread acceptance and is one of the main
reasons drug treatment programs are given low
priority despite high recidivism rates, especially
among drug-abusing offenders. 

The summary article was a more widely read
popularization of a scholarly assessment of the
outcomes of 30 years of rehabilitation efforts for
criminal offenders--a project I directed and in
which Robert Martinson, who wrote the summary,
participated. The basic conclusion of our study The
Effectiveness of Correctional Treatment was that
"the field of corrections has not as yet found
satisfactory ways to reduce recidivism by
significant amounts" (Lipton et al., 1975: 627).
Other authors who reviewed evaluation studies of
rehabilitation programs came to essentially the
same conclusion (Kirby, 1954; Bailey, 1966; Logan,
1972). 

However, few people who espoused the view that
nothing works questioned the validity of the
research on which it was based or understood the
problems inherent in the design of most treatment
programs and in the methodologies used to evaluate
them. They also did not recognize the difference
between the pessimistic viewpoint of the summary
article and the more guarded conclusion, arrived at
by my colleagues and me, which left open the
possibility that rehabilitation could work.

The Shift Toward Rehabilitation

So influential were research findings in the policy
debate about sentencing reform and rehabilitation
that they became the subject of a scholarly
assessment by the National Academy of Sciences. In
a report on the rehabilitation of criminal
offenders, the Academy tempered the assessment that
nothing works. It stated that "we do not now know
of any program or method of rehabilitation that
could be guaranteed to reduce the criminal activity
of released offenders" (Sechrest et al., 1979: 3).
It raised the question of whether some programs
might work for certain types of offenders. 

Since that time, a growing body of evaluation
studies has come under careful scrutiny, and
several authors have concluded that certain
rehabilitation programs effectively reduce
recidivism (Andrews et al., 1990; Gendreau and
Ross, 1979, 1983-84, 1987; Greenwood and Zimring,
1985; Izzo and Ross, 1990; Lipsey, 1989, 1991;
Lipton, 1992, 1994; Palmer, 1975; Wexler and
Lipton, 1988, 1990; Van Voorhis, 1987). Some,
however, are still pessimistic (Lab and Whitehead,
1988; Rosenbaum, 1988; Whitehead and Lab, 1989). 

Ironically, a few years after publication of the
summary "nothing works" article, the author revised
his conclusion on the basis of further review of
the research. His review revealed that "some
treatment programs do have an appreciable effect on
recidivism" (Martinson, 1979: 244). Two other
scholars have since offered a trenchant critique,
stating their belief that "the doctrine of nothing
works is best seen as a socially constructed
reality [rather than] an established scientific
truth" (Cullen and Gendreau, 1989). 

Persistence of the Anti-Rehabilitation Position

The critique notwithstanding, the generalized
belief that nothing works has been a major factor
in the reluctance of many policymakers to support
prison-based drug treatment. 

Policymakers who espouse this view usually believe
that the public wants offenders punished and that
supporting treatment would be a show of leniency.
This belief is buttressed by the argument that
incarceration is the most--perhaps the only--
effective means of controlling crime. Imprisonment,
it is asserted, will keep criminals off the streets
(the incapacitation argument) and prevent them from
recidivating (the individual deterrence argument),
whereas others will refrain from committing crime
out of fear of the consequences (the general
deterrence argument). 

Because longer and more certain sentences have led
to increases in prison populations, because
significantly more public attention has been paid
to the "drug problem," and because court orders
have limited overcrowding, more prisons have been
built and cells added in the years since the
publication of The Effectiveness of Correctional
Treatment than ever before, and there are no vacant
cells (Reuter, 1992). As noted above, the
proportion of drug users in the incarcerated
population increased in that period, so that by
1988 about one-third of those sent to State prisons
had been convicted of drug offenses--the highest
proportion in history (Reuter, 1992). No new
treatment programs were established, and existing
treatment and rehabilitation programs were
terminated (Murray, 1992). In jails, treatment for
drug abusers is even more limited than in prison
(although this is to be expected given the brief
length of stay) (Peters and May, 1992).

The current reemphasis on providing drug abuse
treatment in prisons and jails appears to be
anchored in the need to do something about the
large numbers of drug abusers who are incarcerated.
The reemphasis is also driven by recent research
findings that reveal the effectiveness of drug
abuse treatment (Hubbard, Marsden, Rachel,
Cavanaugh, and Ginzburg, 1989; and Gerstein and
Harwood, 1992). 

Varying Perspectives on Effectiveness of Treatment

Effectiveness is related specifically to the length
of time an individual remains in treatment,
regardless of the type of treatment provided.
However, it should be kept in mind that once a
person is addicted, the condition is chronic and
the substance abuser is prone to relapse. These two
aspects of drug abuse often make the effectiveness
of drug abuse treatment difficult for many to
understand. Viewed from a health perspective,
treatment should be followed by a "cure," with no
further drug abuse. 

Viewed from the perspective of the legislator and
the lay public, the outcome of treatment should be
reduced recidivism (that is, a reduced tendency to
return to criminal behavior), together with
elimination of or substantial reduction of drug
abuse. In the field of corrections, the health
goals and the criminal justice goals are compatible
but are not frequently implemented coherently. This
often gives rise to tension, though as an
unintended consequence. 

Legislators and the public also appear to suspect
that drug abuse treatment is futile despite
research findings, which have consistently
indicated it is effective (Hubbard, Marsden,
Rachel, Cavanaugh, and Ginzburg, 1989), especially
when combined with criminal justice sanctions
(Leukefeld and Tims, 1986). This suspicion
underlies some of the reluctance to establish
treatment programs. When pressed, correctional
administrators indicate they want these programs,
although not as much in the hope of producing
salutary change as to keep inmates actively
involved during their incarceration.

Experiences related to treating drug abusers in
prisons and jails are drawn largely from this
country. Unfortunately, these experiences are
closely related to the rapid expansion of drug use
in the major urban areas of this country and the
associated crime, most recently crime related to
crack cocaine. These "epidemics" strain the
resources of both correctional facilities and
community treatment settings. They have, however,
given rise to the current recognition of the
expanding drug abuse problem and thus opened for
criminal justice practitioners a window of
opportunity to establish drug abuse treatment
interventions that are documented with research
data and supported by practice. 

In fact, criminal justice practitioners are
recognizing the important control function that
drug abuse treatment can exert in an institution.
This function becomes in some cases a major purpose
of the program and in others an "extra bonus." The
importance of the control function becomes evident
when we recognize that today all but eight States
are under court order for prison overcrowding and
that the more than 100 percent growth rate in the
prison population during the past 10 years is very
much the result of the huge influx of drug
offenders. 

Jail Treatment Programs

A survey conducted in 1992 revealed that only 28
percent of the Nation's jails offer drug abuse
treatment, and only 19 percent fund drug treatment
programs.6 Of the drug treatment programs, 12
percent were isolated from the general jail
population. The survey also revealed detailed
information about the types of prisoners served,
staffing, and program size. It indicated that the
average jail drug treatment program focused on
whites (who constitute 66 percent of program
participants), and the average age of the
participants was 26. The average number of inmates
served in a program was 42, and the staff size was
3. More than 80 percent of the programs operated
with volunteer staff. 

The researchers calculated that only 6.7 percent of
the people in the Nation's jails are enrolled in
drug treatment and concluded that the need for
treatment was acute. They felt the need can be met
by developing links with community drug abuse
treatment programs. The latest figures indicate
that the U.S. jail population count is about
500,000, of whom about 102,000 are in substance
abuse treatment or education programs (imputed,
Beck and Gilliard, 1995). 

Types of Treatment Models for Correctional Settings

Treatment for drug abusers in correctional settings
is expressed in five ways: 

o No specialized services (the most typical).

o Drug education and/or drug abuse counseling.

o Residential units dedicated to drug abuse
treatment.

o Client-initiated and/or maintained services
(self-help groups).

o Specialized services for drug abusers that are
not directly targeted at the drug problems.
Additionally, three treatment models that serve as
alternatives to incarceration have been identified:

o Probation, with a mix of counseling, support, and
surveillance (the most typical). 

o Surveillance, components of which include house
arrest, electronic monitoring, and urinalysis.

o Diversion, which is represented by the TASC
(Treatment Alternatives to Street Crime) program. 

These typical treatments, whether for people who
are incarcerated or people under community
supervision, can take many forms, can be on a large
or small scale, and can take place in a variety of
settings (Brown, 1992).

The Federal Prison System Program

In the Federal Bureau of Prisons (BOP), providing
treatment to drug abusers has been spotty and slow
in coming, although nearly 61 percent of its 88,000
inmates were incarcerated for drug-related crime
(Hawk, 1995). (When examining this high percentage,
it is important to keep in mind that, according to
a 1993 analysis, 21 percent of the inmates were
"low-level" drug law violators; that is, they had
no current or prior convictions for violence, no
record of sophisticated criminal activity, and no
prior commitment of offenses.) 

In about the past 10 years, the number of inmates
in Federal prison has risen from 35,800 to almost
99,000. This increase has been fueled by several
factors, not the least of which is the growing
number of drug offenders (their proportion has
risen from 30 percent in 1984 to more than 60
percent at present). In 10 years the average length
of stay of drug offenders has also increased, from
less than 2 years to more than 5. 

Recent Increase in Treatment Programs 

Ten years ago, drug abuse programming of all kinds
served less than 4,200 inmates. Now, mainly as a
result of the initiatives of the current BOP
Director, Kathleen M. Hawk, programming has
increased markedly. Now, the 30 percent of
prisoners with moderate to severe drug use problems
are treated in 34 residential therapeutic
communities, and those with less severe problems
are treated in nonresidential programs providing
individual counseling and group therapy, special
seminars, and aftercare. It is also important to
note that the BOP now provides for continuity of
treatment (transitional treatment and relapse
prevention) when inmates are released either to
supervision or to a halfway house. 

The BOP's Comprehensive Approach

The Bureau has developed a comprehensive drug abuse
treatment strategy, which includes a multitiered
approach as well as a comprehensive evaluation. The
approach includes one level of drug education,
three treatment levels, and one level of
transitional services. The elements are as follows:

o Mandatory drug education programs for inmates
with a substance abuse history.

o Individual, group, and self-help drug abuse
counseling services, available on an outpatient
basis to volunteers.

o Comprehensive residential drug treatment units,
five of which began operating in fall 1990.

o Three pilot drug abuse treatment programs with a
research emphasis, which became operational early
in 1991.

o Transitional services for community reentry after
release from comprehensive and pilot residential
programs. 

The BOP Program Under Study

The BOP's drug abuse treatment program was the
subject of an evaluative study, whose preliminary
results are soon to be released (Pellissier and
McCarthy, 1992). The study focus was residential
treatment and several sites were examined. Inmates
were divided into four groups for study purposes.
One group was randomly assigned to a high-intensity
pilot program; another, a comparison group,
received no further in-prison treatment; still
another comparison group received
moderate-intensity residential treatment; and the
final group was a nonvolunteer comparison group. 

The study measured inmates' socio-demographic
characteristics; such cognitive attributes as
psychological impairment, motivation, and cognition
regarding substance abuse; treatment structure and
process; and the post-release environment. The
researchers examined the effect of the study on
such short-term outcomes as prisoner "adjustment"
(including rule infractions, urine that tested
positive for drugs, and participation in
institutional programs) and perceptions of drug
use. The long-term outcomes the researchers
examined included inmates' drug use and criminal
activities, recidivism, social and occupational
functioning, and mental/physical health. 

Drug Treatment in State Correctional Facilities

New York's Stay'n Out Program

In enacting its "Omnibus Prison Bill" in 1989, the
New York legislature adopted a coordinated approach
to treatment. The new law provided $1 billion (from
both tax levy and Federal block grant funds) for an
approach emphasizing treatment. A 750-bed alcohol
and substance abuse treatment facility and seven
200-bed substance abuse annexes are the core of the
expansion. These Comprehensive Alcohol and
Substance Abuse Treatment (CASAT) facilities use
outside contractors to provide drug treatment to
inmates who are within 2 years of parole
eligibility, and they will guarantee participating
inmates a place in their noncorrectional treatment
facilities upon release. The bill also provides
$500,000 to train as many as an additional 300
counselors who will serve as part of intensified
drug treatment programs. 

The Stay'n Out model. The model on which New York's
program is based is the Stay'n Out program. Stay'n
Out is a therapeutic community program that was
established in New York in 1977 by a group of
recovered addicts who were also ex-offenders
(Wexler, Lipton et al., 1992). The program was
evaluated in a study of about 2,000 program
participants, begun in 1984.7 The researchers
reported that this prison-based therapeutic
community treatment, which was provided by an
outside contractor, New York Therapeutic
Communities, Inc. (staffed by the group of
ex-addict ex-offenders and using a modified Phoenix
House model), reduced recidivism (rearrest) for
both males and females. 

The "time-in-program" hypothesis. The rationale for
establishing the "Stay'n Out" prison TC was the
findings of research on TC's based in the
community. An important finding was that successful
outcomes (measured in terms of reduced crime and
substance use and increased employment) were
related to the amount of time spent in treatment
(DeLeon et al., 1979; Simpson, 1979, 1980). In
fact, residents who were sent to the program by the
courts had a higher success rate than did
volunteers. However, the community TC's produced
excessively high dropout rates, which limited their
effectiveness to the relatively few clients who
remained at least 3 months in the program (DeLeon,
1979). 

One of the justifications for establishing the
Stay'n Out program was to test the efficacy of the
"time-in-program" variable in an environment--
prison--where residents were likely to stay far
longer than 3 months. It was expected that inmates
would find the isolated program unit (which
shielded them from the general prison population)
considerably more desirable than regular prison
units. Thus, the major objectives of the evaluation
were to evaluate the effectiveness of prison-based
TC treatment and assess the "time-in-program"
hypothesis.
Inmates in the Stay'n Out group were studied along
with two types of comparison groups: inmates who
volunteered for the TC program but who for various
administrative reasons never participated (the
"no-treatment controls") and inmates similar to
those in Stay'n Out but who participated in other
types of prison-based drug use treatment programs
(counseling and milieu therapy) elsewhere in the
prison system (Wexler, Falkin, and Lipton, 1990).
(In analyzing the effects of the program over time,
the treatment comparison groups help control for
self-selection factors.)

Parole results. One measure analyzed by the
evaluation was success or failure on parole. The
information about parole was obtained from the
records of 1,626 male and 398 female inmates in the
State prisons. The treatment groups included all
program clients who left the program through
February 1984. The male and female no-treatment
comparison groups comprised inmates who had
volunteered for the therapeutic community program,
were placed on waiting lists, but never entered the
program because they could not meet the time
eligibility criteria or for other administrative
reasons. In other words, they were not dropouts.

The 435 members of the Stay'n Out male TC treatment
group and the 247 members of the Stay'n Out female
TC group were compared to no-treatment control
groups and other-treatment groups. The male TC
treatment group was compared to 159 members of
no-treatment control groups that consisted of
inmates who were on a waiting list for the program.
These controls met all the criteria for admission
except parole time eligibility and therefore
completed their prison term without treatment. 

The male TC group was also compared to a 576-member
milieu treatment group, which was a residential
treatment program offering less intensive treatment
than the TC. (In the milieu treatment group, time
was less structured than in the TC, there was no
hierarchy of jobs or social roles, counselors were
not ex-addicts or ex-offenders but were trained
correctional officers, good conduct in the program
was not rewarded with greater responsibility, and
interaction with community TC's was less
extensive.) Additionally, the male TC group was
compared to a 261-member group that received
individual and group counseling once a week. 

The female TC group was compared to a 38-member
control group that received no treatment and a
113-member group that received counseling. These
female groups were similar to their male
counterparts; that is, the control groups met the
basic criteria for admission but did not receive
treatment, and the alternative treatment group
received only counseling services.

In background characteristics, the samples were
comparable except that the male milieu group had a
significantly higher mean age and criminal history
score (a weighted average of prior criminal
arrests, convictions, and sentences) and spent more
time in prison than the other male groups. Certain
statistical analyses were performed to control for
the possible confounding effects of these
differences on treatment outcomes. 

The samples of inmates were selected from those
released from prison between 1977 and 1984. The
followup period, which ended in 1986, therefore
ranged from 2 years to 9 years, depending on the
year of release. 

The groups were compared on several recidivism
measures: the percentage arrested, the mean number
of months until arrest, the percentage successfully
discharged from parole, and the percentage not
reincarcerated. In looking at arrests, the
researchers found that at 27 percent, the rate for
male TC treatment group was significantly lower
than for all the other male groups. The arrest rate
for the male TC group was significantly lower than
for the male group in milieu therapy (35 percent),
the male group that received counseling (40
percent), and the male group that received no
treatment. (See table 2.) The male counseling
group's arrest rate did not differ from that of the
male group that received no treatment. Thus, the
data provided support for the study hypotheses,
with the TC treatment group showing the best
results, followed by the group receiving milieu
therapy treatment, the group receiving counseling,
and, lastly, the group receiving no treatment
(Wexler, Falkin, and Lipton, 1990).

Most impressive, however, were the time-in-program
effects. There is a strong positive relationship
between number of months in the program and the
percentage of people positively (that is,
successfully) discharged from parole for the male
TC group who were in treatment for up to 12 months.
The percentage of male TC positive parole
discharges increased from 49 percent for those in
treatment less than 3 months to 58 percent for
those in treatment 3 to 6 months, to 62 percent for
those in treatment for 6 to 9 months, to a peak of
77 percent for those in TC 9 to 12 months. (See
table 3.) The percentage then decreased to 57
percent for those in the program more than 12
months (Wexler, Falkin, and Lipton, 1990). Another
significant finding was that the members of the
male TC treatment group who subsequently failed on
parole stayed drug- and crime-free for
significantly longer periods than the comparison
groups.

Similar arrest results were found among the
females, with the TC group having a significantly
lower arrest rate than that for the combined
counseling and no-treatment groups. (See table 2.)
Comparisons reveal that at 17.8 percent, the female
TC's arrest rate was significantly lower than that
of the counseling group, whose arrest rate was 33
percent. But the differences between the
no-treatment group and the counseling and TC groups
were not statistically significant. In fact, the
no-treatment group had a lower recidivism rate than
the counseling group (Wexler, Falkin and Lipton,
1990). Thus, the findings for female inmates
indicate that the TC was effective in reducing
recidivism rates, but counseling showed no such
effect. 

With respect to parole, the time-in-program data
for females are similar to those for males: an
increase in positive parole outcomes, from 79
percent for those in treatment less than 3 months
to a peak of 92 percent for those spending 9 to 12
months in treatment. 

The robust central conclusion of the Stay'n Out
evaluation is that hard-core drug abusers who
remain in the prison-based therapeutic community
longer are considerably more likely to succeed than
those who leave earlier, and that 9 to 12 months
appears to be the optimal duration for the
treatment. As time in therapeutic community
treatment increases, recidivism declines
significantly. The Stay'n Out evaluation, like
other therapeutic community evaluative research,
consistently found statistically significant and
salient effects of time-in-program on treatment
outcomes. 

Moreover, the fact that male and female Stay'n Out
clients do better on parole if they remain in the
program 9 to 12 months rather than terminating
earlier (or later) appears to be borne out in other
studies as well and that similar lengths of time
spent in the comparison modalities do not produce
equally positive effects. This pattern was found to
be consistent for the other outcome variables other
than recidivism as well. It leads confidently to
the conclusion that Stay'n Out is more effective
than no treatment and alternative treatments and is
especially effective when clients remain in
treatment for an optimal period--9 to 12 months. 

For those who failed on parole (that is, were
rearrested), spending more time in therapeutic
community treatment also tended to produce positive
outcomes. When the researchers compared mean time
until arrest for the two periods until program
termination, they found that clients who received
treatment for a shorter time were arrested much
sooner than those who stayed in the program 9 to 12
months.

New York City's KEEP

The Key Extended Entry Program (KEEP) is a unique
criminal justice-based treatment program using
methadone maintenance (Magura, Rosenbaum, and
Joseph, 1992). The program was established in 1987
on Rikers Island in New York City to provide
methadone maintenance to heroin addicts charged
with misdemeanors and referral to community
methadone programs with dedicated treatment slots.
KEEP was also designed to provide methadone
maintenance to prisoners already in MMTPs
(methadone maintenance treatment programs) to
ensure some program continuity (that is, in the
pharmacologic component). 

A long-term followup study of 225 program
participants and controls revealed that KEEP
participants were daily heroin and cocaine users,
more than half of the injectors (54 percent)
reported sharing needles or works in the previous 6
months, and property crimes were their most
frequent arrest charge. For those not in methadone
treatment when released to community treatment, the
attrition rate (rate of return to substance abuse)
was high--60 percent for men and 67 percent for
women. For those who were already methadone
patients when they were incarcerated, the attrition
rate was much lower (Magura et al., 1992). 

Florida's Four-Tiered Approach

The Florida Department of Corrections, more than
half of whose inmates admit to a serious substance
abuse problem, has established a four-tiered
approach as part of its comprehensive statewide
strategy (Bell, Mitchell, Williams, Benvino, and
Darabi, 1992). The program starts with an
assessment of the severity of substance abuse and a
recommendation for a treatment level. The four
tiers of the program are as follows: 

o Tier I--a 40-hour program focused on providing
educational drug abuse information for inmates
identified as having a less-than-severe substance
abuse history, who deny having a problem, and whose
sentences are brief. 

o Tier II--an intensive, 8-week residential
modified therapeutic community program for inmates
diagnosed with a severe drug problem. 

o Tier III--residential therapeutic community
treatment, provided for 9 to 12 months in the
community through contract services, to inmates who
meet work release requirements. The number of beds
available is 54.

o Tier IV--10 weeks of community counseling focused
on relapse prevention and supportive therapy for
inmates assigned to Community Correctional Centers.

Now under way is an evaluative study of the program
process, focused on program "integrity," and an
outcome evaluation aimed at assessing changes in
inmate knowledge, attitudes, and behaviors. 

New Jersey--Wharton Tract Narcotics Treatment
Program

Among the drug treatment programs the State of New
Jersey has established for its prison inmates, the
Wharton Tract Narcotics Treatment program, in
operation since 1970, is particularly notable. (See
description in Platt et al., 1980.) A satellite
unit of the Youth Reception and Correction Center
in Yardville, New Jersey, the program housed 45
youthful offenders (over 19 years of age) in a
former State forestry camp situated in Wharton
State Forest. Offenders were admitted if they met
the following criteria: had 8 to 12 months of
incarceration remaining in their sentence, had been
dependent on heroin more than 6 months but less
than 5 years, exhibited no extreme psychopathology,
had no recent escapes, and had no serious pending
offense. 

The program was based on the therapeutic community
model and included "Guided Group Interaction"
(GGI), which holds that development of a group
enhances the recovery of its members through a
process of interaction. Also included was the
technique of "Interpersonal Problem-Solving Group
Therapy." This involved development of
problem-solving skills (e.g., identification of a
problem and the feelings associated with it,
acquiring information, searching for possible
solutions, and assessing consequences) through a
series of group exercises. The program also offered
couples therapy, family counseling, individual
counseling, and recreational activities. 

Residents completed the program in three phases: a
30-day evaluation period, intensive therapy
(lasting at least 60 days), and a transition phase
of several months to ease residents back into the
community.

An evaluative study revealed that program graduates
did better in avoiding recommitment after parole
and remaining arrest-free. A group of 160 program
graduates was compared with a group of 148 control
subjects who had met all the criteria for admission
but did not enter treatment (Platt et al., 1980).
There were no significant differences between the
background characteristics of the two groups. 

A 2-year followup revealed that the rate at which
the control group was recommitted was significantly
higher following parole than the rate of the group
that graduated from the program (30 percent and 18
percent, respectively).8 What is more, the proportion
of graduates who remained arrest-free was
significantly higher than in the control group (51
percent and 34 percent, respectively).

The Texas Initiative 

The "Texas Initiative" in correctional substance
abuse treatment started by then-Governor Ann
Richards was enormous and complex. For 4 years the
planned initiative was developing into the most
ambitious and aggressive prison-based drug and
alcohol treatment system ever established in the
country. Since then, however, program development
has halted, although prison construction proceeds
apace. 

The State's prison population is now approaching
120,000, with 80 to 90 percent said to have serious
alcohol and drug abuse problems. Provision of
treatment for substance abusers, however, is
regressing, having been cut in half--from 1,600
beds to 800. It should be noted that this apparent
shift was not merely a product of a new political
orientation but a reasoned and prudent response to
an impassioned but too hasty approach to the
problems of drug offenders in the Texas system.

Provisions of the law. The landmark law that
launched the Texas Initiative was enacted in 1991
and provided the statutory foundation for
developing a comprehensive treatment system for
substance-abusing offenders. Though now vastly
scaled back, it still represents the largest such
effort ever attempted in this country. The
legislation established the following three
criminal justice substance abuse initiatives: 

o Treatment Alternatives to Incarceration Program
(TAIP). Under TAIP, offenders in the six largest
counties in Texas were to be screened and assessed
for chemical dependency problems and referred for
appropriate community-based chemical dependency
treatment. Funding for treatment for those referred
by the screening and referral system was also
augmented by the legislation. The Senate version of
the law required full implementation of the program
in the six counties by the end of fiscal year 1992.
The year after the law was passed, the legislature
recommended expanding the TAIP program to the next
seven most populous counties.

o Substance Abuse Felony Punishment (SAFP) System.
In this program, offenders convicted of nonviolent
felonies who had crime-related substance abuse
problems could, as a condition of probation or
parole, receive 6 to 12 months of long-term
substance abuse treatment in SAFP facilities.
Clients who completed primary treatment in SAFP
facilities were then assimilated back into the
community through a 15-month continuum of care that
incorporated a support system of decreasing
intensity and structure. The primary components of
the continuum of care in the community consisted of
Transition Treatment Centers (TTC) that were to
provide residential and nonresidential supportive
services; a transition team whose membership
included a TTC representative, representatives of
probation or parole, the client and the client's
spouse or other partner; and peer support and peer
networking groups. 

As originally enacted, the legislation authorized
the acquisition and construction of 12,000 secure
treatment beds for the SAFP program and a
sufficient number of community residential program
beds and nonresidential client slots. All were to
be fully implemented by the end of fiscal year
1995, and an amendment authorized an additional
7,000 beds by the same time. The remaining 5,000
treatment beds were to be operational by the end of
fiscal year 1996.

o In-Prison Therapeutic Community (ITC) Treatment
System. In this program, prison-incarcerated
offenders were to receive long-term (6 to 12
months), intensive chemical dependency treatment
and habilitation before their return to the
community. Clients who completed primary treatment
in ITC facilities were to re-enter the community
with the assistance of the same continuum of care
received by the SAFP clients (noted above). In
1992, 600 beds were established, with another 500
added by the end of the next fiscal year. 
The ITC system was to be fully operational--with
2,000 treatment beds--by the end of fiscal year
1995.

When the entire system was fully operational in
1996, there were to have been 28 ITC and SAFP
facilities throughout Texas. The size of each
facility ranged from 200 to 1,000 beds and was to
serve a stable, maximum population of 14,000 (2,000
ITC and 12,000 SAFP clients). Clients were to
progress through therapeutic community treatment
cycles averaging 9 months. 

On the basis of these numbers, Texas corrections
officials projected that between 18,000 and 20,000
clients would be released from these in-custody
treatment facilities and return to communities
annually. This required approximately 4,000 new
residential program beds and 17,000 new
nonresidential program slots in the community.

Growth problems. Unfortunately, because of the
unprecedented numbers of clients progressing
through the system (a situation likely to continue
for the foreseeable future), the Texas Initiative
faces serious problems, which were created by its
size and the push for rapid implementation (Fabelo,
1995). Among these problems are:

o An insufficiently experienced and trained staff.

o Too few quality post-release treatment programs
to maintain continuity of care.

o A nonexistent selection/diagnostic process or one
not adequate enough to ensure that offenders
selected for the programs would be the ones likely
to benefit from them.

o Management of the financial and accountability
infrastructure that was inadequate for the expanded
effort.

o Unrealistic expectations on the part of
correctional officials for program success. 

o An unrealistic anticipation of low attrition.
(The State auditor reported an attrition rate of 58
percent and believes that correctional officials
may have misled the legislature on this point.) 

Evaluation findings. A 1-year followup study of
1,000 inmates referred to the in-prison treatment
units showed favorable results (Fabelo, 1995). Only
7.2 percent of those who completed 3 or more months
of treatment had been reincarcerated, in contrast
to 18.5 percent of those who had received no
treatment. There was a 42-percent dropout rate,
although it is comparable to that of other modified
prison-based TC programs. 

That the intended 14,000 beds will probably not get
much beyond 5,300 (New York Times, 1995) is not a
tragedy, but an appropriate retrenchment, and at
$188 million for the next 2 years, the program is
not only the largest in the country but also the
most expensive. However, some promising programming
may be discontinued, notably a branch of Stay'n
Out, the Lone Star Stay'n Out, opened in Amarillo
in 1994. 

New vision. The flagship program, the first TC in a
private prison, is the 520-bed New Vision Chemical
Dependency Treatment Facility, which opened in
Kyle, near Austin, in 1992. The program, operated
by Wackenhut (a private contractor), is likely to
continue. An evaluation being conducted by Texas
Christian University's Dwayne Simpson (Simpson and
Knight, 1995) is revealing favorable results for
the program. 

Of the 343 inmates referred to New Vision during
the second half of 1993, fully 80 percent
successfully completed the program (of the others,
14 percent were expelled and the others left for
medical or other reasons). The progress of
graduates was compared with that of a matched
sample from the general prison population who also
met all treatment eligibility requirements but did
not have enough time left to serve to be able to
participate. 

Data are available from half the scheduled 6-month
followups. They revealed that 6 months after
leaving prison, parolees who received TC treatment
were less likely to be arrested than those who did
not receive treatment (15 percent and 20 percent,
respectively) and less likely to have used cocaine
or crack (7 percent and 26 percent, respectively). 

The 61 percent who completed a 3-month residential
care program after leaving prison did better on
several outcomes--committing crime, being employed,
and being arrested--than did parolees who did not
complete the aftercare program. (See table 4.)
Although the findings are not complete, they
clearly support the importance of maintaining
structured aftercare following prison TC treatment.

Wisconsin

Wisconsin's tradition of providing a systemwide
approach to treating drug-abusing offenders dates
back to 1975, when an alcohol treatment unit was
established and was shown to be effective (Vigdal
and Stadler, 1992; Vigdal, Stadler, Goodrick, and
Sutton, 1980). 

Program components. The State's current program
includes the following components: 

o Alternative to revocation, with 10 percent of the
treatment spaces held for offenders who are being
revoked and for whom no community treatment is
available.

o Three special treatment programs, one for alcohol
and two for other drugs.

o A 9- to 12-month residential TC for chronic
heroin and cocaine addicts.

o Intensive supervision combined with drug testing,
implemented by five teams of two officers each
(with a 40-client caseload for each team).

o An intermediate sanction-day treatment program in
which care is coordinated with correctional
treatment facilities. 

Diagnostic procedures--used to match the treatment
with the offender--are also part of Wisconsin's
program. The procedures cover alcohol dependence,
involvement with other drugs, psychiatric
impairment, and psychopathic tendencies. 

California--Amity Prison TC

Intake data from California's State correctional
facilities indicate that the number of drug
offenders grew from just under 4,000 in 1984 to
almost 20,000 in 1988; and in 1988 drug offense
commitments constituted, for the first time, the
largest category of felony commitments. Reacting to
the growing need to ameliorate this situation, the
California Department of Corrections (CDC) decided
to participate in a research project that would
examine the effectiveness of a modified TC for drug
abusers. The result was the Amity Prison TC
program, begun in 1989 and located at the R.J.
Donovan Correctional Facility near San Diego.9

The program and its components. R.J. Donovan is a
medium-security facility housing approximately
4,000 men in five self-contained living areas. All
aspects of daily living--housing, sustenance,
education, and work--are accommodated within these
areas. One 200-man housing unit in one of these
areas is designated for the Amity Prison TC
program. The men who live in this housing unit
participate in daily TC programming, which is
conducted largely by Amity, Inc. staff who work out
of two trailers located near the housing unit.

Almost all inmates selected for the project are
recruited through the reception center at the R.J.
Donovan facility. Participants must meet several
criteria for eligibility: They must have a history
of drug abuse, demonstrate evidence of
institutional participation (or absence of evidence
of both in-prison assaults or weapon possession
within the past 5 years and sex-related offenses in
prison within the past 10 years), have no history
of child molestation or mental illness, and be
within 9 to 15 months of release on parole. 

The program is modeled on New York's Stay'n Out;
that is, it is a TC modified to fit a correctional
setting. Program participants are housed in a
residential unit separate from other inmates,
although they eat in a common dining room and
participate in activities with other inmates who
live in the same yard. 

Program phases. Treatment lasts about 12 months,
during which participants move through three
distinct phases of treatment. The first phase
consists of orientation, diagnosis, and an
assimilation process. Lasting 2 to 3 months, this
phase involves clinical observation and assessment
of residents' needs and problem areas. In this
phase, prison TC procedures are learned, and there
are encounter groups, seminars, and similar group
activities. Residents are assigned prison industry
jobs and are also given limited responsibility for
maintenance of the TC. 

During the second phase of treatment, which lasts 5
to 6 months, residents are given opportunities to
take on positions of increased responsibility
through involvement in the program and emotional
"work." More seasoned residents are expected to
share their insights by teaching the newer members
of the community and by assisting in the day-to-day
operation of the facility. In this phase, encounter
groups and counseling sessions deepen in content
and focus on self-discipline, self-worth,
self-awareness, respect for authority, and
acceptance of guidance for problem areas. Seminars
take on a more intellectual approach. Debate is
encouraged as a means to enhance self-expression
and to increase self-confidence. 

During the third phase, community reentry, which
lasts 1 to 3 months, inmates strengthen their
skills in planning and decisionmaking and design
their individual exit plans under the guidance of
correctional, treatment, and parole staff. 

The entire course of treatment is viewed as a
developmental growth process in which the resident
becomes an increasingly responsible member of the
community. An important and unique program
component is a core group of residents who are paid
prison wages for holding key positions in the TC.
These positions are earned by residents who have
shown progress in the program and who have won the
respect of the community through their hard
emotional work. 

Aftercare offered. Upon release from prison,
graduates of the Amity Prison Project are offered
the opportunity to continue in residential TC
treatment for up to 1 year in a community facility
also operated by Amity. The community TC can
accommodate up to 40 residents. All residents share
responsibility for the security, maintenance, and
emotional health of the TC. The TC welcomes the
wives, children, and parents of residents and
offers special services to meet their needs as both
clients and supporters in the recovery process. 
The curriculum of the community TC builds upon what
is offered in the prison and is individualized for
each resident, depending on the level of progress
achieved in the Prison TC treatment program. Prison
TC residents who choose not to continue treatment
in the community facility are encouraged to
maintain strong ties to the house by joining weekly
family groups, attending special functions
sponsored by Amity, and by telephoning residents or
Amity staff to update the house on their current
situation and plans. 

All graduates of the Amity Prison TC program and
community TC's are encouraged to participate in
treatment activities sponsored by other human
service providers in the community (e.g.,
Alcoholics Anonymous and Narcotics Anonymous). 

The prison TC program is staffed largely by veteran
treatment counselors who have relocated from the
Amity program in Tucson, Arizona. Many program
staff are role models, because they have histories
of substance abuse and criminal offending and are
graduates of community TC's. The Amity Program in
Tucson and Continuance TC in Vista, California,
provide ongoing staff training. 

Amity evaluated. The prospective study of
California's Amity Prison TC is based on an
experimental design in which 720 male inmates are
chosen randomly. Extensive followup is part of the
study. A wide variety of background information and
psychological data about program participants are
collected at various points during the study: at
admission, after 6 and 12 months while in the
program, 12 months following release from prison,
and 12 months following aftercare. The report of
the evaluation (Wexler, 1995) was based on the
first set of criminal record data obtained from the
Centers for Disease Control and Prevention (CDC)
and reflects findings after 6 months of program
participation. 

The data reveal information about the record of
retention in the program and about recidivism
(rearrest and reincarceration). Both retention and
recidivism information is available for the first
189 participants who were paroled from the Donovan
Prison; for 290 participants who were parolees,
only information about reincarceration (after 1
year) was obtained. 

Information on program retention and recidivism was
obtained for four groups: clients who completed the
prison TC program, clients who completed the prison
TC plus the aftercare program, program dropouts,
and a control group consisting of randomly selected
inmates. There were no significant background
differences among the group members: the proportion
of whites, Hispanics, and blacks was similar in all
four groups; the average age in all groups was 30
(and ranged from the early 20's to over 60); more
than half had completed high school or received a
GED certificate; and reading proficiency was at the
seventh grade level. Sexual relations were for the
most part limited to heterosexual partners. 

For all four groups, various forms of stimulant
drugs (other than alcohol and including cocaine,
crack, and methamphetamine) were the most widely
used category of substances. They were used by 95
percent of the inmates. The preferred drugs were
heroin and methamphetamine. More than half the
group members (53 percent) reported ever using
heroin, and this proportion was lower than the
proportion who used any stimulant. Sixty percent of
the inmates were IDU's (intravenous drug users),
and nearly two-thirds of them shared needles with
other drug users. 

The study population consisted of hard-core felons;
that is, they had extensive criminal histories,
with an average of 321 offenses committed in their
lifetime. More than 70 percent had committed a
violent crime (assault, kidnapping, manslaughter,
rape, or murder). Fifteen percent said they had
committed murder and 3 percent reported having
committed rape. Many have long criminal histories:
half the study participants had been declared
delinquent by a juvenile court, and the average
inmate had spent more than half of his adult life
in prison, with prison/jail terms averaging 19
years. 

The psychological status scores were in the normal
range and were significantly lower than in the
psychiatric outpatient population. As expected,
because the inmates were asked primarily about
their criminal behavior, a very high proportion (52
percent) were diagnosed as having antisocial
personalities. The unexpected finding that one out
of five inmates evidenced intense phobic symptoms
will be explored in later analyses.

Retention and recidivism. After 6 months, findings
regarding retention in the program revealed that of
the prison TC admissions, one-third were still
enrolled and in good standing, half had completed
the program, and the balance (17 percent) had been
dropped because of serious infractions of prison
policy or had left of their own volition.
Approximately one in five graduates of the prison
TC volunteered to participate in Amity's Vista
community TC. 

The findings regarding recidivism revealed that
participants who went through both the program and
the community-based TC had the lowest
reincarceration rate of any group. Among
participants who completed the program but did not
go on to the community TC, the percent
reincarcerated was higher. Moreover, half the
program drop-outs were reincarcerated, as were 63
percent of the control group subjects. (See table
5.) (These reincarceration results were
statistically significant, as were the arrest
results [not shown].) 

It should be noted that inmates who completed
treatment and program dropouts were at risk (i.e.,
had been released from prison) for a slightly
shorter period--12 months--than the control group--
15 months. These findings about recidivism outcomes
are similar to those of the New York Stay'n Out
prison program and compare favorably with national
outcome evaluations of other community-based TC's. 

Oregon's Cornerstone Program

The Cornerstone Program, located on the grounds of
the Oregon State Hospital, is a 32-bed TC for
correctional inmates that began in 1975 (Field,
1992). Somewhat like Stay'n Out, it is modeled on
the TC concept but has a higher proportion of
professional staff and trained correction officers
than the New York program. The Stay'n Out staff
consists largely of recovered addict ex-offenders. 

Studies of recidivism and criminal activity. Two
evaluation studies of Cornerstone examined several
treatment outcomes, including recidivism (Field
1984, 1989). In the first study, a 3-year followup,
the researcher looked at two outcome measures: not
returning to prison and not being convicted of a
crime. Program graduates were found to have had a
significantly higher success rate on both outcomes
than did each of the other groups (dropouts and
parolees). Three years after release, 71 percent of
the graduates were not reincarcerated, whereas only
26 percent of the dropouts avoided reincarceration.
Similarly, whereas slightly more than half the
program graduates were not convicted of any crime
(including minor offenses), this was true for less
than 15 percent of the dropouts. 

Program graduates also did significantly better
than the other comparison group: the sample of
Oregon parolees. Among parolees, 63 percent were
not reincarcerated and only 36 percent were not
convicted of any crime. The differences actually
understate the effect of the treatment because the
program graduates had significantly more severe
criminal histories and substance abuse problems
than the others.

The second study produced similar results, although
it used a different research design. This time,
three-fourths of the graduates were not
reincarcerated compared with the other groups, of
which 37 percent were not reincarcerated. The
findings for the dropouts are even more dramatic.
Only 8 percent of the clients who dropped out after
less than two months in the program were not
arrested during the 3-year followup, only 11
percent of them were not convicted, and only 15
percent were not reincarcerated. These findings are
consistent with the those for the Stay'n Out
program, which demonstrated that increased time in
the program is associated with more positive
treatment outcomes.

The arrest rate, the conviction rate, and the
incarceration rate for the group of program
graduates was lower than for each of the comparison
groups. Furthermore, as the length of time in
treatment increased, recidivism rates declined.
Perhaps the most interesting findings pertain to
the comparisons between the pretreatment and
posttreatment intervals. Whereas the recidivism
rates during both pretreatment intervals were about
the same for each of the groups, recidivism rates
during the posttreatment period were considerably
lower among the program graduates. In addition, the
decline in recidivism rates between the
pretreatment and posttreatment periods was greatest
for the program graduates (Field, 1989).

Cornerstone a model. Having shown evidence of
positive outcomes in two evaluations, Cornerstone
is now a model for three additional therapeutic
communities, which also partially serve drug abuse
offenders who are sex offenders, mentally ill, and
mentally or socially retarded. Other programs in
Oregon include:


o Two additional residential treatment programs.

o Correctional institutional group counseling
through contracts with community treatment
professionals.

o Several cooperative agreements for community
treatment.

o A pilot program with subsidy funds for releasees
who are high risks.

o A demonstration project to examine coordinated
community services.

o The use of Alcoholics Anonymous and Narcotics
Anonymous groups.

o Alcohol and drug education classes for alcoholics
and addicts.

o Institutional information centers to assist
inmate recovery.

In addition, all inmates are subject to random
urine testing. 

Followup study. The research on Cornerstone also
indicated that the clients demonstrated enhanced
self-esteem, reduced psychiatric symptoms,
increased knowledge in critical treatment areas,
reduced criminal activity, and reduced criminal
recidivism. These manifestations were a function of
the treatment program (Field, 1984). 

The researcher followed up 220 people admitted to
the program from 1983 to 1985, separating them into
four groups--program graduates, nongraduates who
completed at least 6 months of the program,
nongraduates who completed 2 to 5 months, and
nongraduates who left before 60 days. He found
criminal activity continues to decrease for
Cornerstone participants, but addicted offenders
who receive little or no treatment show accelerated
criminal activity. He also found that as the amount
of time in treatment increases, criminal activity
decreases. Finally, the followup study indicated
that the number of arrests, convictions, and
incarceration are about equally accurate as
measures of success/failure.

Delaware's Key-Crest Program

The Key-Crest program is a three-stage treatment
model program operating within the correctional
system of the State of Delaware. Only the first two
stages are operating. The program is built around
two TC's: the "Key," a prison-based TC for men and
the "Crest," a residential work release center for
both men and women. 

Three-stage program. The concept of the Key, the
primary stage of treatment, is modeled on the
Stay'n Out program and is a 12-month intensive
residential TC based in the institution. In the
institution there is time for comprehensive
treatment, because time and isolation are resources
used for working on problems, and the competing
demands of the street, work, friends, and family
are absent. 

The Key-Crest program is distinctive because of its
secondary stage of treatment--a "transitional TC,"
which is a TC work release program. In this stage,
inmates who are nearing their release date are
allowed to hold paying jobs in the outside
community while spending their nonworking time in a
"family setting" similar to a traditional TC. The
third stage (aftercare) is for released inmates,
now parolees, who have completed the first two
stages and are living in the outside community
under parole or other supervision. Intervention at
this stage involves outpatient group and individual
counseling and the opportunity to return to the
work release TC for refresher/reinforcement
sessions, to attend weekly groups, and to spend one
day a month at the work release TC.

Stage 1 and 2 studied. A study of drug-involved
offenders who experienced the first two stages
(prison-based TC followed by work release TC)
revealed surprisingly positive results. The
characteristics of the study group were as follows:
81 percent were men, 72 percent were African
American, 82 percent previously had drug treatment,
the average (mean) age was 29.6 years, the age at
first arrest was 17, and the number of previous
incarcerations was two.

The design of the evaluation study contrasted
participants in the Key alone, participants in
Crest alone, and participants in the combined
Key-Crest program with inmates who received no
treatment other than HIV prevention education.
After controlling for other factors (such as number
of days in treatment, time since discharge, and
number of times previously incarcerated), the
researcher found highly positive results as
measured by percentage drug-free and arrest-free
after 6 months. 

Essentially, program participants did much better
at staying drug-free than did the comparison group
(which received HIV-education only). The group that
fared best after 6 months were those in the Key and
the Crest combined. Those in the Crest work release
did better than those in the Key alone, and all
three of these treatment groups did better than the
comparison group. When the researchers examined the
proportions who remained arrest-free, they found
similar results (Lockwood, Inciardi, and Surratt,
1995; Martin, Butzin, and Inciardi 1995; Inciardi,
1995). (See table 6.)

After 18 months the percentages who remained
drug-free declined somewhat (Inciardi, 1995). (See
table 6.) The results suggest the pattern of
improvement with increasing exposure to the TC
continuum is maintained since the 6-month point,
even after controlling for a number of potential
covariates. Participants in Crest and Key-Crest are
significantly more likely to be drug-free than the
comparison group, although the Key group was not
significantly different from the comparison group
(Inciardi, 1995).

Time-in-program. The pattern of improvement with
increasing exposure may also be seen in the data on
arrests after 18 months. (See table 6.) They
confirm the relative improvement generated by the
work release TC, rather than an in-prison TC only,
but continue to indicate the strongest and most
consistent pattern of success comes from the group
that receives the full continuum of TC treatment.
This was evident in the results of the Amity Prison
TC and Stay'n Out studies.

Controlling for gender, race, age, prison history,
treatment history, and previous drug use.
Exposure to TC at Key-Crest produced other benefits
that can be seen in some additional 18-month
outcome data. These include significant reductions
in the use of injection drugs, in the amount of
income from crime in the previous year, and in
fewer returns to prison for new sentences among
those who attended Crest compared to those who did
not. The robust findings through two stages of
research are that length of time in treatment and
the degree of involvement in treatment are
important for success and that even controlling for
these influences, participation in the prison TC in
combination with the work release TC treatment
continuum significantly improves outcome (Inciardi,
1995).
 
The TASC Program

There are many drug-using offenders who could
benefit from being diverted from incarceration and
who would not, under appropriate levels of
supervision, present a serious risk to the
community. A successful vehicle for accomplishing
this is the Treatment Alternatives to Street Crime
(TASC) program, which, working together with
parole, can successfully and systematically
intervene. 

TASC Components

TASC provides case management for drug-abusing
defendants and offenders, serving as a bridge
between criminal justice agencies (courts and
probation) and treatment providers. Currently there
are more than 180 TASC projects in 27 States and 2
territories. They provide screening, assessment,
treatment planning, monitoring, urinalysis, and
court liaison functions (Personal Communication,
Kenneth W. Robertson, Executive Director, National
Consortium of TASC Programs, 1993).

The concept of TASC emerged from research showing
treatment is more effective in settings in which
legal sanctions and close supervision provide
incentives for clients to conform with treatment
program protocols and objectives. Longer duration
of treatment is consistently associated with better
treatment outcome, and clients under legal coercion
generally stay in treatment longer than those who
are not. 

Case management, through TASC, incorporates
support, staff training, data collection, client
identification based on eligibility criteria,
assessment and referral, urinalysis, and monitoring
(Weinman, 1992). TASC clients remain in treatment 6
to 7 weeks longer than other criminal justice
clients, whether referred to residential or
outpatient programs. 

TASC and Prison Crowding

If TASC or TASC-like programs were available in
more cities, many more people, particularly young
people, could be diverted to treatment.
Unfortunately, with recent upward trends in
drug-related crimes, the demand for treatment
programs is far greater than the treatment system
can provide. Thus, not only must there be more
programs for offenders who are incarcerated but a
great deal more for those on probation or in other
community supervision statuses. Several studies
indicate that TASC has been successful in reducing
prison crowding and facilitating treatment through
the TASC and parole partnership. Only now, however,
is a formal research evaluation taking place.10

CDATE--a Retrospective Overview of Evaluative
Research 

The therapeutic community is not the only modality
that has shown positive outcomes among drug-abusing
offenders. The National Development and Research
Institutes, Inc. in New York is assembling the
results of 25 years of correctional evaluation
research in a project called CDATE: Correctional
Drug Abuse Treatment Effectiveness. CDATE is a
comprehensive, detailed review of the evaluation
research that has been conducted on rehabilitation
programs for offenders in general. Special
attention is being given to drug treatment offered
to offenders in all levels of criminal justice
custody. The project, which began in 1994 and will
be completed in 1996, was funded by the National
Institute on Drug Abuse.

Research Goals

The research consists of assembling, annotating,
and analyzing all studies conducted since 1968;
that is, since the studies reported in 1975 in The
Effectiveness of Correctional Treatment: A Survey
of Treatment Evaluation Studies. Goals of the
current study include the following: 

o Seek all credible evaluation studies of treatment
of offenders, drug abusing and non-drug abusing
alike.

o Examine and assemble these studies in a way that
can best inform policy and practice.

o Assess the effectiveness of the most advanced
correctional treatment. 
More specific aims include the following: 

o Develop a comprehensive information data base of
correctional treatment evaluation studies from all
countries completed between 1968 and 1994.

o Categorize and systematically annotate all these
studies, noting participation by and outcomes for
offenders with drug abuse histories.

o Critically evaluate the study methodologies.

o Assess the effect of the various treatments on
several outcome measures, particularly drug abuse
and recidivism.

o Describe the policy implications of the results
for correctional treatment programming, training,
staffing, program implementation, programmatic
evaluation, and future research.

o Describe each modality of treatment for offenders
in detail in terms of size, variety, clientele,
goals, staff, setting, relative isolation, use of
incentives, duration, frequency, intensity,
priority, completeness of implementation,
relationship to drug abuse, continuity of
treatment, outcome, and many other factors.

o Describe and analyze each outcome criterion (for
example, relapse to drug use, recidivism) in terms
of variety, relative precision, and utility for
evaluations of correctional treatment for non-drug
abusing offenders as well as drug abusers.

o Perform a meta-analysis to compare the effect of
each treatment on each of the outcomes; compare the
size of the effects for different population
subsets (for example, gender, age, and race
groupings), and assess the degree to which a
variety of independent variables (e.g., treatment
methods, program characteristics, client
characteristics, research methodologies) affect
evaluation findings. 

o Widely disseminate findings on "what works" to
practitioners, policymakers, and legislators in
correctional treatment for non-drug abusers as well
as drug abusers. 

o Deposit the entire collection of articles,
documents, and other materials and annotations in a
publicly accessible library and, depending on
availability of funding, make the entire data set
available on CD-ROM. 

Also being compiled, translated, and added to the
analysis are the contributions of the correctional
evaluation research work of scientists in other
countries over the past 25 years--chiefly from
Canada, Great Britain, Australia, Netherlands,
Germany, Norway, Denmark, and Sweden. These
contributions will be incorporated into this
compendium of the literature of correctional
rehabilitation and into the meta-analysis. 

Conclusion--A Sound Investment

Addiction treatment is a critical component of the
Nation's war on drugs, and the incarceration of
people found guilty of various crimes who are also
chronic substance abusers presents a propitious
opportunity for treatment. It is propitious because
these people would be unlikely to seek treatment on
their own. Without treatment they are extremely
likely to continue their drug use and criminality
after release, and we now appear to have
cost-effective technologies to effectively treat
them while they are in custody and thus alter their
life styles. Moreover, it appears that the
technologies may be sufficiently strong to treat
violent offenders as well.

Evidence Based on Sound Research

The studies of New York's Stay'n Out program,
Oregon's Cornerstone program, California's Amity
Prison TC program, and Delaware's Key-Crest
program, described here, are the first large-scale
research evaluations to provide solid evidence that
prison-based TC treatment can produce significant
reductions in recidivism rates among chronic
drug-abusing felons and to show consistency of such
results over time. 

This is not to say that prison-based TC's have not
been successful before but that formal research
evaluations have not been undertaken before these.
In fact TC's have been used since the early 1950's
in many Federal and State prisons, and most lasted
about 7 to 9 years, usually until budget priorities
changed. It is worth noting that the success of
this type of holistic treatment is probably due to
the fact that it deals with many of the inmates'
social and psychological problems, which prevent
them from returning to acceptable social
functioning. It deals with the myriad problems
associated with the lifestyle of addiction as well
as the drug use--and is therefore more likely to be
successful in the long run than treatment programs
that focus mainly on drug abuse. 

The Benefits Are Worth the Costs 

The cost-effectiveness of the treatment supports
its implementation even more. Programs like Stay'n
Out cost about $3,000 to $4,000 more than the
standard correctional costs per inmate per year.
(Programs like Cornerstone, with more professional
staff and one-fourth the caseload per staff member,
cost a little over twice as much for the same time
period.) The savings produced in crime-related and
drug use-associated costs, however, pay for the
cost of the treatment in about 2 to 3 years. 

It is an inescapable conclusion that treatment
lowers crime and health costs as well as the
associated social and criminal justice costs.
Moreover, the higher the investment in
rehabilitating the most severe offender-addicts,
the greater the probable effect. The most serious
chronic heroin and cocaine users (about 3 percent
to 10 percent of all offenders, depending on
jurisdiction) are each responsible for a high
volume of predatory crime (Gropper, 1985 based on
the work of Johnson et al., 1985; Ball et al.,
1983; and Inciardi, 1979). Substantial reductions
in the high-volume criminality of this group has an
immediate effect on the quality of our lives.
Without intervention, this group will return to
crime and drug use 9 times out of 10 after release,
and most will be back in custody within 3 years.
With appropriate intervention provided for a
sufficient duration, more than three out of four
will succeed; that is, reenter the community and
subsequently lead a socially acceptable life. 

This highly predatory group of criminals is
amenable to long-term (9- to 12-month) TC treatment
while incarcerated (or in a combined program begun
in the institution and continued in the community)
and is unlikely to benefit significantly from
treatment lasting less than 6 months. 

Cause for Optimism

It is important to note the consistency of the
findings irrespective of locale and populations--
unusual in correctional evaluation research.
Moreover, the findings are relevant for more than
drug offenders, because a great many of the
successful graduates of these programs had
histories of violent crime. This has important
implications for the use of this modality for
offenders because very few programs using other
methods have been as successful. 

I am genuinely optimistic about our ability to
effectively treat people normally deemed by
conventional wisdom to be "very high risk" (that
is, chronic heroin and cocaine users with extensive
predatory criminal histories). Careful evaluations
of interventions in several States with diverse
populations show remarkably consistent levels of
success. There appears to be mounting evidence that
high-rate addict-felons who each commit 40 to 60
robberies a year, 70 to 100 burglaries a year, and
many violent offenses, as well as conduct more than
4,000 drug transactions a year, can be effectively
and cost-efficiently helped. We have reliable
evidence from studies of diverse areas that has
demonstrated a substantial reduction in recidivism
after treatment--a reduction of sufficient size to
yield a tangible improvement in our quality of
life.

Notes

1. The Drug Use Forecasting program (DUF),
administered by the National Institute of Justice,
tests booked arrestees for a variety of drugs in
selected major metropolitan areas.

2. Reported in various articles in the New York
Times, January 1992, April 1993, May 1994, and
March 1995, as well as in the Philadelphia
Inquirer, Newark Star Ledger, and Baltimore Sun. 

3. The Drug Abuse Warning Network, administered by
the U.S. Department of Health and Human Services. 

4. Along with my colleague Harry Wexler, I was
involved in helping the States with these
initiatives. The States that had Project REFORM
programs were Alabama, Connecticut, Delaware,
Florida, Hawaii, New Jersey, Oregon, Washington,
California,  New York, and New Mexico. 

5. The States were Colorado, Georgia, Michigan,
North Carolina, North Dakota, Pennsylvania, and
Virginia. Texas and Ohio also participated in
RECOVERY activities. It was Texas' participation
with RECOVERY staff that facilitated and infused
the Texas Initiative. 

6. The information is from a survey conducted by
the American Jail Association to examine the scope
of drug abuse treatment services in jails
throughout the country. A little over half (57
percent) of the 1,737 jails responded (Peters and
May, 1992).

7. The evaluation was conducted by National
Development and Research Institutes, Inc., with
funding from the National Institute on Drug Abuse. 

8. The difference was statistically significant at
the p<.05 level; that is, the probability is less
than 1 in 20 it could have happened by chance. 

9. The program is operated by Amity, Inc., with
funding by the California Department of
Corrections. The program evaluation is under the
direction of Harry Wexler and is funded by the
National Institute on Drug Abuse as part of the
Center on Therapeutic Community Research, directed
by George De Leon for National Development and
Research Institutes, Inc. 

10. The study is directed by James Inciardi and
Duane McBride, among others.

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