Clifford A. Butzin

An Effective Model of Prison-Based Treatment for Drug-Involved Offenders

A multistage therapeutic community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the clients changing correctional status—incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based therapeutic community only, (2) a work release therapeutic community followed by aftercare, and (3) the prison-based therapeutic community followed by the work release therapeutic community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for other risk factors. The results support the effectiveness of a multistage therapeutic community model for drug-involved offenders, and the importance of a work release transitional therapeutic community as a component of this model.

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.

Five-Year Outcomes of Therapeutic Community Treatment of Drug-Involved Offenders after Release from Prison

With growing numbers of drug-involved offenders, substance abuse treatment has become a critical part of corrections. A multistage therapeutic community implemented in the Delaware correctional system has as its centerpiece a residential treatment program during work release—the transition between prison and community. An evaluation of this program followed 690 individuals. At 5 years, those who participated in the program were significantly more likely to be drug and arrest free. Furthermore, treatment graduates with or without aftercare had significantly greater probabilities of remaining both arrest free and drug free than did ano treatment comparison group in regular work release. Dropouts also were significantly more likely to be drug free, although not significantly less likely to have a new arrest than those without treatment. These data show that the implementation of such programs could bring about significant reductions in both drug use and drug-related crime.

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.

Evaluating component effects of a prison-based treatment continuum.

A continuum of correctional-based therapeutic community (TC) treatment programs for drug-involved offenders has been functioning for several years in Delaware. Previous evaluations have shown the efficacy of the full continuum for up to three years posttreatment, though there has been some question of the benefits of treatment within prison. The particular focus here is on the relative impact of the within-prison, transitional, and aftercare treatment components upon criminal recidivism and relapse to illicit drug use. The relative benefit of participation in each component is supported, over and above the effects of differences in demographics and histories of criminal behavior and illicit substance use. However, the residential transitional program effects are generally larger and more long lasting. Additionally, the two outcomes appear differentially sensitive to the degree of completion of the continuum.

Post-Release Substance Abuse Treatment for Criminal Offenders: A Cost-Effectiveness Analysis

This study conducted a cost-effectiveness analysis of Delawares CREST Outreach Center, a work release therapeutic community (TC) and aftercare program for criminal offenders. Treatment effectiveness was assessed using the number of days reincarcerated during an 18-month, post-release follow-up period. The 6-month CREST program cost

Acute hemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goat model

1937 for the average participant, and led to ∼30 fewer days incarcerated (29% less) than the average participant in a standard work release program. This implies that the CREST program reduced incarceration for criminal offenders at an average cost of

Comparing clinician-applied loads for routine difficult and shoulder dystocia deliveries

65 per day. The additional investment of

Use of Health Care Services in a Sample of Drug-Involved Offenders A Comparison With National Norms

935 per client to provide aftercare services led to 49 fewer days incarcerated (43% less) than CREST work release-only participants. This suggests that by adding an aftercare component to the CREST work release program, a day of incarceration is avoided at an average cost of

Integrating HIV-Prevention Strategies in a Therapeutic Community Work-Release Program for Criminal Offenders

19 per day. These findings have implications for future investments in post-release substance abuse treatment for criminal offenders. However, the results must be interpreted with caution given potential selection bias in the groups that participated in the CREST work release and aftercare programs. Selection bias and the policy implications of this research are noted and discussed.