Christine A. Saum

Three-Year Outcomes of Therapeutic Community Treatment for Drug-Involved Offenders in Delaware: From Prison to Work Release to Aftercare

Delaware researchers have argued for a continuum of primary (in prison), secondary (work release), and tertiary (aftercare) therapeutic community (TC) treatment for drug-involved offenders. Previous work has demonstrated significant reductions in relapse and recidivism for offenders who received primary and secondary TC treatment 1 year after leaving work release. However, much of the effect declines significantly when the time at risk moves to 3 years after release. Further analyses reveal that program effects remain significant when the model takes into account not simply exposure to the TC program, but, more importantly, program participation, program completion, and aftercare. Clients who complete secondary treatment do better than those with no treatment or program dropouts, and those who receive aftercare do even better in remaining drug- and arrest-free.

Sex in Prison: Exploring the Myths and Realities

Prison narratives, mass media, and conclusions drawn from institutional research have fostered a perception of widespread “homosexual rape” in male penitentiaries. However, studies of sexual contact in prison have shown inmate involvement to vary greatly. To explore the nature and frequency of sexual contact between male inmates in a Delaware prison, the authors administered a survey of sexual behavior. Respondents were questioned extensively about sexual activities that they engaged in, directly observed, and heard about “through the grapevine” prior to their entry into a prison treatment program. Findings indicate that (a) although sexual contact is not wide-spread, it nevertheless occurs; (b) the preponderance of the activity is consensual rather than rape; and (c) inmates themselves perceive the myth of pervasive sex in prison, contradicting their own realities.

FACTORS ASSOCIATED WITH COMPLETION OF A DRUG TREATMENT COURT DIVERSION PROGRAM

Factors related to successful completion of a first offender diversion program were examined from initial data of a longitudinal study of drug treatment court outcomes in Delaware. The strongest predictors of success were factors associated with social stakeholder values, especially those involving employment. Other factors associated with program completion included race, education, and frequency of drug use. While the overall success of drug treatment courts continues to be documented, these data suggest success varies with individual characteristics. The continuing study will explore whether these characteristics are also related to subsequent outcomes, especially drug use relapse and criminal recidivism, over a 24-month post-treatment period.

Mental health, gender, and drug court completion

Drug-involved offenders report high rates of mental health problems that can negatively impact criminal justice outcomes. Yet, relatively little attention has been given to the mental health issues of drug court offenders. Therefore, this study examined 449 participants in a Delaware drug court and investigated relationships between mental health, gender, and program completion. Bivariate results indicated that gender was related to both mental health status and completion status. Multivariate findings revealed that two indicators of mental health, depression and being prescribed drugs for a psychological or emotional problem, were significant predictors of drug court completion. Policy implications include assessing the mental health status of all drug court participants at program entry so that services can be provided which aim to improve offender health and increase the likelihood of successful program outcomes. Drug courts must better meet the needs of participants with co-occurring disorders if they are to remain an effective and viable criminal justice intervention.

Violent Offenders in Drug Court

Drug courts are slowly beginning to expand their admission criteria to include more chronic and serious offenders since traditional probation and incarceration have failed to prevent drug use and crime. Drug courts have moved from providing diversion programs for first-time offenders charged with drug possession to developing tracks for more complex clients. Many of these new drug court participants have extensive criminal histories, including histories of violent crime. Drug court decision-makers thus confront the difficulty of balancing the needs of treatment versus corrections by attempting to target offenders whose criminal histories suggest that their candidacy in a drug court would not pose a risk to public safety. To date, little is known about whether drug courts are appropriate for offenders with lengthy criminal histories that often include violence. The research presented here explores correlates of drug court graduation for seriously crime-involved offenders, most of whom have a history of violence.

Relationships and HIV Risk Among Incarcerated Women

HIV risk is a public health concern, particularly for women prisoners who are reentering the community. This article describes findings from focus groups conducted as part of the National Institute on Drug Abuse—funded Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement to inform the development of a gender-specific HIV intervention for women. Focus group findings indicate that a womans HIV risk behavior is influenced by relationships: (a) drug and alcohol use are common in relationships, (b) sex is used as a strategy to manipulate partners, (c) trust is often derived from a perceived long-term commitment, (d) perceived safety is influenced by specific partner characteristics, (e) HIV and other sexually transmitted infections were not viewed as potential consequences of risky behavior, (f) feelings of low self-esteem and self-worth become normalized in problem relationships, and (g) women fear rejection if they ask their partners to use protection. Recommendations for developing a relationship-focused HIV intervention for women prisoners at community reentry are discussed.

Gender Differences in Treatment Engagement Among a Sample of Incarcerated Substance Abusers

This article examines gender differences in treatment engagement, psychosocial variables, and criminal thinking among a sample of male and female substance abusers (N = 2,774) enrolled in 20 prison-based treatment programs in five different states as part of the National Institute on Drug Abuse—funded Criminal Justice Drug Abuse Treatment Studies cooperative agreement. Results indicate that inmates in female treatment programs report more psychosocial dysfunction, less criminal thinking, and higher engagement than in male facilities, and there is a more negative relationship between psychosocial variables and treatment engagement (compared to male programs). Only one subscale of criminal thinking had a significant gender interaction, with males having a significantly stronger relationship between cold-heartedness and low treatment engagement. Implications for treatment interventions with a gender-specific focus are discussed.

The Impact of Drug Use and Crime Involvement on Health Problems Among Female Drug Offenders

Health problems comprise some of the most important concerns about female offenders today. In comparison to others, they suffer more frequent and serious chronic disease, acute illness, and injuries. Although many have argued that these higher rates can be explained by poverty, inaccessible medical care, and poor nutrition, few have studied the impact of the severity of criminal and substance abuse involvement on the same. Consequently, the authors ask if these factors help explain the likelihood of leading health problems of female cocaine-abusing offenders. Bivariate logistic regression analyses on women (n = 848) from Dade County, Florida, show important effects of criminal and substance abuse involvement on chronic disease and illness, sexually transmitted diseases and HIV/AIDS, and mental illness. However, after controlling for demographic variables with multivariate logistic models, their predictive power decreases substantially. The findings lend insights to both theoretical models explaining health problems and to policy recommendations for female offenders and inmates.

Social Functioning, Treatment Dropout, and Recidivism of Probationers Mandated to a Modified Therapeutic Community

Few studies have examined the impact of corrections-based drug abuse treatment programs on changes in social functioning. The current study, therefore, examines social functioning (i.e., hostility, risk taking, and social conformity) among 406 probationers in a modified therapeutic community. Data are collected prospectively and include intake, during treatment, and posttreatment information. Findings show that social functioning changes modestly during the first 90 days of treatment. Specifically, risk taking decreases with time, social conformity increases, and unexpectedly, hostility increases across time in treatment. Hostility is the only social functioning factor that predicts treatment dropout. Findings show there are no associations between social functioning indicators and recidivism both 1 and 2 years after treatment. However, recidivism within 1 year of treatment release is associated with criminal history, and recidivism within 2 years is associated with age.

Substance Abuse Treatment Options: A Federal Initiative

Pervasive drug enforcement efforts and new federal sentencing guidelines have led to an increase in substance abusers entering the federal prisons. Although the Federal Bureau of Prisons (BOP) has been committed to providing substance abuse treatment since the 1960s, a comprehensive expansion of its programs was necessary so that quality services could be provided for the growing drug-offender population. This article describes the BOPs six-part drug treatment strategy, which includes screening, education, residential treatment, nonresidential treatment, transitional treatment, and evaluation. The programs entail a biopsychosocial model and a multiphasic approach to comply with the BOPs goal of preparing inmates for a successful reentry into the community, free from criminal and substance-abusing behaviors.