urban institute nonprofit social and economic policy research

Voices from the Field

Practitioners Identify Key Issues in Corrections-Based Drug Treatment

Read complete document: PDF


PrintPrint this page
Document date: January 01, 2003
Released online: January 01, 2003

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

This report is available in its entirety in the Portable Document Format (PDF).


Contents

EXECUTIVE SUMMARY

1. INTRODUCTION

2. DRUG SCREENING AND ASSESSMENT
Instruments

3. TREATMENT MATCHING AND PLANNING
Treatment Matching
Treatment Planning

4. TREATMENT PROGRAMMING
Definitional Issues
Cognitive-Behavioral Treatment Approaches
Diversity of Programs and Implementation
Maintaining a Drug-Free Environment
Voluntary and Mandatory Treatment
Meeting the Need for Drug Treatment
Selection of Specific Treatment Programs

5. TREATMENT GOALS AND EXPECTATIONS

6. GENERATING AND SUSTAINING SUPPORT FOR TREATMENT
Social and Political Support
Funding
Research and Education as Key Ingredients to Generating Support

7. TRANSITIONAL SERVICES
Assisting with Reentry
Lack of Coordinated Services and Information Exchange
Addressing Multiple Needs
Funding and Coordinating Aftercare Services
Promising Transitional Ideas and Practice

8. RESEARCH WISH LIST
Research That Is Accessible
Focused Research
Systems-Focused Monitoring and Research

9. REFERENCES

APPENDIX: INTERVIEW SCHEDULE


EXECUTIVE SUMMARY

According to some estimates, only 61 percent of state correctional facilities provide substance abuse treatment. Despite a significant infusion of federal funds to support residential substance abuse treatment in prisons, the percentage of state prisoners participating in such programs declined from 25 percent in 1991 to 10 percent in 1997. The policy shortfall is clear: Inmates with substance abuse problems may not be receiving the treatment that would reduce their drug problems and criminal behavior.

Why they are not getting treatment remains largely unknown. One possibility is simply a lack of political or correctional interest in providing drug treatment. But an equally plausible explanation is a lack of sufficient funding. In addition, there may be conflicting expectations, systems constraints, and philosophies. These and other possible explanations suggest that there are yet-to-be-specified roles that federal agencies might play to assist the integration of treatment into corrections.

This report emerged from a collaboration between the Urban Institute and the National Institute on Drug Abuse (NIDA), the goal of which was to help identify and address the unique circumstances of the criminal justice environment and the challenges posed by the integration of treatment services and a public health orientation into this environment.

To help achieve this goal, the study, funded by NIDA, included three components: (1) a literature review covering a range of issues pertaining to correctional drug treatment; (2) interviews with practitioners, such as directors of state correctional agencies or programming divisions; and (3) a meeting of researchers and practitioners to discuss issues raised from the literature review and interviews. Both the interviews and the meeting were designed to help bridge the gap between researchers and correctional practitioners and to identify key issues and solutions for which practitioners have unique insight.

This report presents results from the interview stage of the study, the main findings of which are summarized below. Twenty interviews were conducted with practitioners such as directors of state correctional systems and treatment programming, as well as drug treatment providers and consultants. In all, 13 states were represented. The 13 states were not selected randomly but rather were selected to capture perspectives from different regions and states of different sizes.

Each interview was conducted by telephone and involved a series of questions about a range of issues pertaining to drug treatment in prisons:

  • Drug Screening and Assessment
  • Treatment Matching and Planning
  • Treatment Programming
  • Treatment Goals and Expectations
  • Generating and Sustaining Support for Treatment
  • Transitional Services
  • A Research Wish List

The questions focused on the type of treatment provided, how treatment programming decisions are made, and the types of practical research needs practitioners would like to see addressed. The full set of questions that guided the interview process is provided in the appendix.

PRACTITIONER PERSPECTIVES ON KEY ISSUES

Drug Screening and Assessment

Instruments

  • Across the 13 state correctional systems in this study, practitioners and researchers reported considerable variation in the instruments used, the quality of the instruments used, and the quality of the screening and assessment process.
  • Respondents reported that the screening process typically is cursory, even though it provides the basis for the sorting and classification of offenders. In some systems, the initial drug screening process consists of a recommendation from the judge or sentencing court that the offender be placed in treatment.
  • For a simple screening process, most interviewees in our sample reported using the Texas Christian University Drug Screen (TCUDS), which is touted as being more "realistic" and producing fewer false positives than other screens, as well as the Simple Screening Instrument (SSI). The Michigan Alcoholism Screening Test (MAST) was also mentioned. Other states chose to create their own instrument by modifying existing instruments and then validating their new instrument.
  • Assessment instruments used by the state correctional systems we examined include the Level of Supervision Inventory-Revised (LSI-R), Addiction Severity Index (ASI), Adult Substance Use Survey (ASUS), and Substance Use History Matrix (SUHM).

Process

  • Respondents stated that in many state correctional systems the screening and assessment process is, in the words of one interviewee, "in dire need of help."
  • Within and across state correctional systems, there is reported to be considerable variation in when screening and assessments are conducted, how and by whom they are conducted, the instruments and quality of assessment, and the use to which the results are put.
  • Typically, full drug assessments do not take place until inmates enter an assigned, structured program, according to respondents.
  • Some, not all, interviewees reported that within the state correctional system, security concerns ultimately override consideration of assessment recommendations. Further, although programs generally are not meant to be mutually exclusive, treatment is generally secondary to other types of programming. In many prisons, the decision to provide drug treatment is an "either/or" one — the offender either receives treatment or is sent to another program or receives nothing at all.
  • Most respondents emphasized that the major problem they face with screening and assessment has less to do with selecting an instrument and more to do with the overall screening and assessment process. Two major problems they reported include the lack of transfer of information and the lack of standardized policies for transferring information (e.g., among counties, correctional treatment providers, and parole boards).
  • Many respondents reported that their correctional systems lack a centralized, comprehensive, functional, cross-system database. The better systems link data from several sources and across different database systems (e.g., within different parts of the correctional system, between corrections and the courts, between prisons and post-release supervisory agencies), track behavioral and program outcomes over time and across different facilities and programs, and can be easily used to guide placement decisions.

Treatment Matching and Planning

Treatment Matching

  • The use of theoretically and empirically guided placement criteria is in the formative stages for some correctional systems.
  • Respondents reported that many state correctional systems would like to build consistent criteria into their assessments, particularly criteria for treatment matching and level of care, but many systems cannot afford rigorous implementation of treatment matching.

Drug Treatment Planning

  • Respondents emphasized that treatment planning is a central part of drug treatment services, though treatment is often secondary to security considerations.
  • Most correctional systems reportedly lack database automation, vary greatly in their processing and treatment orientation, and frequently lack basic information, such as case files or medications, because of poor communication between different departments or divisions.

Treatment Programming

Definitional Issues

  • The term "treatment" is widely used throughout jails and state and federal prisons, yet a concise, agreed-upon definition of treatment is rare. The definitional issues concerned many respondents in trying to describe their drug treatment services and to interpret others' services.
  • Most respondents did not consider Alcoholics Anonymous or Narcotics Anonymous (AA/NA) and education-type services alone to constitute drug treatment. When asked about the treatment provided in their systems, respondents generally stated that they provided some kind of residential treatment, therapeutic community, or intensive outpatient treatment, and viewed these collectively as "drug treatment."
  • Respondents emphasized holistic philosophies about drug treatment, but the range of services varied tremendously, as did the level and types of services at different stages in the criminal justice system. Because there are so many variations of similar programs, program directors and correctional administrators wanted to know more about the quality of programs and what factors were most relevant for effectively treating offenders with drug problems.

Cognitive-Behavioral Treatment Approaches

  • The cognitive-behavioral approach, regardless of setting, was the dominant approach reported by correctional agency representatives and direct service providers.
  • Some agencies have attempted to standardize their alcohol and drug treatment philosophy to reflect cognitive-behavioral orientations. In agencies where there is an entrenched commitment to specific treatment modalities or philosophies, this process has been difficult but not insurmountable.
  • Most of the programs reported by our respondents addressed at least some "dynamic"/"criminogenic" needs, particularly risk and resiliency, procriminal attitudes, and deficits in educational, vocational, and employment skills.

Diversity of Programs and Implementation

  • A wide range of drug treatment programs is provided by the prisons in our sample; many do not directly address drug problems yet are viewed as indirectly helping to address such problems. Programs include educational and vocational programs, AA/NA, life skills programs, therapeutic communities, substance abuse facilities for probationers, faith-based residential centers, and separate facilities for offenders with co-occurring disorders.
  • Implementation of particular treatment programs, such as therapeutic communities, can vary considerably across correctional systems, according to respondents.
  • Few prisons monitor or carefully assess the quality of program implementation, and respondents said they want guidance on what aspects of implementation are most important. They also want more assistance with program design.
  • Some respondents felt that much more attention should be given to providing substance abuse treatment in jails, where many offenders have drug problems that may go unidentified and that contribute to subsequent criminal activity.

Maintaining a Drug-Free Environment

  • Prison administrators emphasized that a broader reason for maintaining a drug-free environment is that the prevalence of drugs within a facility can undermine correctional agency operations, not just treatment.
  • Prison officials reported employing several strategies to create a drug-free environment. These elements include random urine testing; the use of canines; electronic drug interdiction for staff and visitors; machines in the mail room that can identify drug paraphernalia; random searches of staff; use of sanctions (e.g., loss of visiting privileges) for misconduct relating to drug distribution or use; and ensuring that gang members are separated from each other to discourage drug access and distribution.

Voluntary and Mandatory Treatment

  • Many respondents believe that coerced treatment can be effective, a view supported by recent research.
  • "Coerced treatment" is prevalent in most correctional systems in our sample, but treatment is not generally mandatory per se. However, some states employ mandatory treatment in prison or upon release.
  • Some respondents hold the belief that for treatment to be effective, offenders must be voluntary and ready for treatment.

Meeting the Need for Drug Treatment

  • "I don't think anybody has a handle on demand for services." This view was echoed by several respondents, who emphasized that definitional ambiguity, particularly about the distinction between drug abuse and drug addiction, underlies much research and policy.
  • Practitioners warn that using a broad definition of substance abuse problem to allocate treatment beds can help justify funding for drug treatment. However, some also emphasized that it can dramatically overstate the actual extent of need.
  • Some respondents suggested that treatment need and supply should be described with respect to specific stages of the criminal justice system as well as to specific stages of an inmate's term of incarceration.

Selection of Specific Treatment Programs

  • Respondents in the 13 states in the study reported that the Department of Corrections ultimately makes the decision about the type of treatment programming offered in the system. However, the process of making the decision involves input from a variety of key policy staff.
  • According to respondents, some states have created committees consisting of representatives from a range of agencies and backgrounds, while others rely on informal consultation.
  • Some correctional agencies rely on single-state agencies, which are responsible for licensing and accrediting all treatment programs, both within and outside of correctional settings. Some respondents report that the involvement of single-state agencies greatly improves correctional drug treatment.

Treatment Goals and Expectations

  • Treatment providers and system administrators were asked if recidivism is the "gold standard" for evaluating drug treatment. Respondents stated that recidivism is not the only expected goal, but it is the one in which most legislators and the public are interested. Recidivism is most widely accepted by state legislators, the group that ultimately influences programming via funding.
  • Many respondents stressed that recidivism, especially as reflected by reincarceration rates, is misleading. They emphasized that it is more appropriate to talk about incremental, less visible expectations and outcomes related to treatment, such as better management of inmates, reduced medical needs, improved self-esteem, increased compliance with after-care, greater employability, increased likelihood of family reunification, and either reduced drug use or relapse to less serious drug use.
  • Many correctional practitioners focused on goals and outcomes that could be met while an offender is in prison, as opposed to outcomes, such as recidivism, that frequently cannot be directly controlled. Examples including maintaining sobriety while in prison, compliance in treatment, completion of treatment, and an understanding of addiction and its consequences.

Generating and Sustaining Support for Treatment

  • Although many studies cite funding and space limitations as key factors limiting drug treatment, correctional practitioners emphasized additional, underlying factors. Correctional practitioners' responses suggest a model in which the key components to funding drug treatment include social and political support, funding from diverse sources, and implementation of effective drug treatment. Once drug treatment is provided, there is a need to demonstrate benefits and educate policymakers about these benefits.
  • Some respondents noted that interest in drug treatment emerged as the result of crises precipitated by lawsuits. In such instances, cases had been filed arguing that offenders' needs had been neglected to the point of criminal or civil liability, leading eventually to significant changes in treatment capacity. As one respondent said, "If [there is a] crisis, you get the political attention [needed to support treatment]."
  • Most respondents emphasized that whatever the initial motivation to provide treatment, the failure to actively obtain ongoing social and political support for treatment can result in dwindling funding to the point where treatment programs are closed.
  • Although legislatures may fund treatment after being convinced by studies demonstrating the effectiveness of some programs, respondents noted that legislatures frequently then want evidence that the specific programs they fund also are effective. However, the research capacity of many state correctional systems was reported to be quite low.
  • Respondents emphasized that some legislators view addiction as a moral deficit and thus are less inclined to fund treatment. One respondent reported that if arguments for drug treatment are grounded in terms of accountability and substance abuse treatment, treatment has a broader appeal. Another stated: "To address the concerns [of those who do not believe in treatment], I emphasize that drug treatment promotes public safety."
  • The majority of states reported that legislative support for treatment had declined, but they also indicated that there are many strategies for generating support. Some states build treatment into their formulas for all budget requests involving construction of new facilities. Others actively lobby legislators for funding or propose specific legislation.

Transitional Services

  • Every respondent stressed the importance of transitional services to the overall success of treatment and reentry. But this issue reportedly has been neglected during the past decade, with much more attention given to what occurs inside prisons.
  • Long-standing, documented obstacles to the continuity of treatment include system segmentation, lack of coordination, lack of structured incentives and sanctions, and lack of services in the community. These issues were mentioned by our respondents as well. The problem cited most often was the lack of systems integration.
  • Several respondents talked about the variety of "stressors" present when an inmate returns to the community. These stressors include financial, personal, and medical stress in addition to substance abuse treatment needs. Because of the wide range of needs, providing effective treatment can be a particular challenge.
  • Several states reported problems with state funding for aftercare. One state respondent reported their state had undertaken an ambitious pilot program that showed promise but then lost funding before it could become institutionalized.
  • According to some respondents, the sheer magnitude of resources for reentry can be overwhelming and thus difficult to efficiently or effectively access, especially in the absence of a centralized basis for coordinating these services.
  • Not all correctional systems/agencies reported difficulties with transitional services. Several respondents reported that their state correctional system had adequate transitional services. Some, for example, stated that treatment services were continual and uninterrupted, from prison to placement in a short-term residential treatment program to treatment on an out-patient basis for three to nine months. One state reported using aftercare contracts, in which all therapeutic communities run by contractors are required to include provisions for aftercare in their contract. Another state has included legislation to update and change the correctional philosophy toward treatment and reintegration.

Research Wish List

Research That Is Accessible

  • Many respondents reported that there was little information available that was easily accessed and understood. What they, as correctional practitioners, wanted were succinct reports that stated the core findings and policy implications directly.

Focused Research

  • Respondents also spoke about the need for "practical" research. By this, they generally meant research on such issues as "how to fund programs" and "how to form and enhance partnerships with other agencies."
  • Respondents spoke about the need for focused research in under-developed areas, such as the needs of black males and Hispanics, women with children, offenders with co-occurring disorders, etc. Respondents felt such research was needed to determine appropriate types of treatment. For example, are there specific factors that differentially influence the recovery of specific groups?
  • Respondents wanted to know more about program implementation, including specific information about such issues as staff qualifications, the types of staff who work better in certain types of treatment programs, and the best types of training approaches.
  • Many respondents reported that they would like to see research that focuses on the "soft outcomes," such as tracking quality of life, education, employment, and treatment patterns. Recidivism was not viewed as the only relevant outcome.

Systems-Level Monitoring and Research

  • Several respondents, particularly correctional administrators, reported that they would like to see more statewide, global, systems-level research. They noted that it is relatively easy to find documentation or studies of specific programs or modalities, but, as administrators, they would like to know how their system is doing as a whole.
  • Respondents wanted research to focus on all agencies involved with a transition back to the community to pinpoint exactly what went wrong and where.
  • Respondents felt that research was needed on resolving continuing tensions regarding "treatment" versus "correctional" orientations to determine the best way to resolve this problem.

ACKNOWLEDGMENTS

The authors gratefully acknowledge the funding for this project, Strong Science for Strong Practice, provided by the National Institute on Drug Abuse (NIDA), Contract #N01DA-1-1104. The NIDA staff provided considerable support throughout all stages of this project. Special thanks are extended to Alan Leshner, Jack Stein, Pete Delany, Bennett Fletcher, and Jane Smither Holland. Glen Fischer of the Management Assistance Corporation assisted with the ongoing contractual issues in managing the project and helped ensure the success of the meeting of practitioners and researchers. Special thanks is given for the support provided by many Urban Institute staff, including Adele Harrell, Dionne Davis, Ruth White, John Hunsaker, and Dave Williams. Finally, we extend our appreciation and thanks to the many criminal justice practitioners and researchers who provided assistance with and/or participated in various stages of this project.

This report is one of an Urban Institute four-part series on drug treatment in the criminal justice system:

Drug Treatment in the Criminal Justice System: The Current State of Knowledge
by Daniel P. Mears, Laura Winterfield, John Hunsaker, Gretchen E. Moore, and Ruth M. White

Voices from the Field: Practitioners Identify Key Issues in Corrections-Based Drug Treatment
by Gretchen E. Moore and Daniel P. Mears

A Meeting of the Minds: Researchers and Practitioners Discuss Key Issues in Corrections-Based Drug Treatment
by Gretchen E. Moore and Daniel P. Mears

Improving the Link Between Research and Drug Treatment in Correctional Settings - Summary Report
by Daniel P. Mears, Gretchen E. Moore, Jeremy Travis, and Laura Winterfield


Topics/Tags: | Crime/Justice


Usage and reprints: Most publications may be downloaded free of charge from the web site and may be used and copies made for research, academic, policy or other non-commercial purposes. Proper attribution is required. Posting UI research papers on other websites is permitted subject to prior approval from the Urban Institute—contact [email protected].

If you are unable to access or print the PDF document please contact us or call the Publications Office at (202) 261-5687.

Disclaimer: The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders. Copyright of the written materials contained within the Urban Institute website is owned or controlled by the Urban Institute.

Email this Page