Gerald Melnick

Three-Year Reincarceration Outcomes for Amity In-Prison Therapeutic Community and Aftercare in California

The study assessed 36-month recidivism outcomes for a prison therapeutic community (TC) program with aftercare using an intent-to-treat design with random assignment. Outcomes for 478 felons at 36 months replicated findings of an earlier report on 12- and 24-month outcomes, showing the best outcomes for those who completed both in-prison and aftercare TC programs. At 36 months, 27% of the prison TC plus aftercare completers recidivated, versus 75% for other groups. In addition, a significant positive relationship was found between the amount of time spent in treatment and the time until return for the parolees who recidivated. However, the reduced recidivism rates for in-prison treatment found only at 12 and 24 months was not maintained at 36 months.

Circumstances, Motivation, Readiness, and Suitability (The CMRS Scales): Predicting Retention in Therapeutic Community Treatment

Based upon clinical considerations, scales were developed measuring client perceptions across four interrelated domains: circumstances (external pressures), motivation (intrinsic pressures), readiness, and suitability (CMRS) for residential TC treatment. This paper, the first in a series, reports findings on the reliability of the CMRS and its validity as a predictor of retention in TC treatment in three cohorts of consecutive admissions to a long-term residential TC. The main findings show that: (a) discriminant and factor analyses confirm the face validity of the original four rationale scales; (b) scores distribute into four groups, with most clients in the moderately low to moderately high range; (c) two cross-validation studies confirm the internal consistency of the scales, and a linear relationship between the separate and total CMRS scores and short-term retention in all three cohorts and long-term retention in two cohorts. The present psychometric study provides impressive findings on the reliability and validity of the CMRS scales as predictors of retention in long-term TCs. Although still considered experimental, awaiting replicational studies and firm conclusions concerning generalizability, the CMRS holds considerable promise for research, theory, and practice.

Amity Prison-Based Therapeutic Community: 5-Year Outcomes

Few studies have examined outcomes of prison-based treatment programs over a 5-year observation period. The present analysis was based on a sample of 715 prisoners randomly assigned either to the Amity therapeutic community program or to a notreatment group. At 5-years postrelease, 90% of the original participants were located and 81% were interviewed. The main findings were based on a conservative intent-to-treat approach. On measures of recidivism, the Amity treatment group had significantly lower rates of reincarceration than the control group, but in multivariate analysis of time to first reincarceration, this main treatment effect disappeared and other factors (age and postrelease treatment) became significant predictors of delayed time to reincarceration. As in previous reports on this cohort, those who attended aftercare had lower levels of reincarceration, longer time to reincarceration, and higher levels of employment.

Motivation and Readiness for Therapeutic Community Treatment among Cocaine and Other Drug Abusers

There is currently little empirical research on the effect of motivation and readiness on the treatment of different groups of substance abusers. In the present study, the CMRS scales are used to assess motivation and readiness for treatment of a large sample of primary alcohol, marijuana, heroin, cocaine, and crack cocaine abusers admitted to a long-term residential therapeutic community. Findings show few significant differences in overall retention or initial motivation and readiness. Initial motivation and readiness scores persist as significant predictors of short-term retention in treatment across most groups. Findings support the TC perspective that the substance abuse problem is the person, not the drug of choice, and are consistent with prior research emphasizing the importance of dynamic rather than fixed variables as determinants of retention.

Is the Therapeutic Community Culturally Relevant? Findings on Race/Ethnic Differences in Retention in Treatment

The therapeutic community (TC) views cultural diversity as an essential ingredient in its treatment approach. However, based on clinical observation and some research, questions persist concerning the relevance of TC programming for numerical race/ethnic minorities. This article briefly reviews pertinent research and presents findings from recent studies on race/ethnic differences in readiness and suitability for, and retention in, TC treatment. A framework is outlined for the empirical study of cultural relevance issues in TCs.

Organizational factors and collaboration and integration activities in criminal justice and drug abuse treatment agencies

Despite strong interest in improving collaborations between correctional and substance abuse treatment organizations, there is a lack of empirical data describing the existing practices. The current study used a national survey of correctional administrators to examine organizational factors related to cross-agency collaboration and integration activities between corrections and substance abuse treatment organizations. Using a measure of collaboration that scaled cross-agency activities from less structured, informal networking and coordination to more structured and formalized levels of cooperation and collaboration, we found that different correctional settings (e.g., community corrections, jails, prisons) differed significantly in terms of their collaborative activities with substance abuse treatment agencies. We also found that the organizational characteristics that were associated with different levels of collaboration and integration differed across the correctional settings. Further research is needed to better understand how and why correctional agencies decide to formalize collaborative arrangements with treatment agencies and whether these efforts lead to more favorable outcomes.

Client Perceptions Of Prison-Based Therapeutic Community Drug Treatment Programs:

This study is part of an ongoing effort to evaluate the growing number of prison-based substance abuse treatment programs from the perspective of the clients. The study tested whether 1,059 participants from 13 prison-based substance abuse treatment programs could be grouped according to elevated, moderate, or low perceptions of the treatment environment (i.e., their perception of the use of therapeutic community, cognitive-behavioral therapy, and 12-step treatment activities) and according to their perceptions of the program climate (i.e., a positive sense of community). It also tested whether those who observed higher levels of these treatment components had a higher evaluation of their treatment and of their rapport with counselors and, overall, higher levels of treatment satisfaction. Despite being coerced into treatment, the majority of participants were positive about their treatment experience.

Violent offenses associated with co-occurring substance use and mental health problems: Evidence from CJDATS

The present study examines the relationship between substance use, mental health problems, and violence in a sample of offenders released from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,349) in a federally funded cooperative, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self-reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. For most offenders with substance use problems, the quantity of alcohol consumed and the frequency of drug use were associated with a greater probability of self-reported violence. Mental health problems were not indicative of increases in violent behavior, with the exception of antisocial personality problems, which were associated with violence. The paper emphasizes the importance of providing substance abuse treatment in relation to violent behavior among offenders with mental health problems being discharged to the community.

CJDATS CO-OCCURRING DISORDERS SCREENING INSTRUMENT (CODSI) FOR MENTAL DISORDERS (MD): A Validation Study.

Three standardized screening instruments—the Global Appraisal of Individual Needs Short Screener, the Mini-International Neuropsychiatric Interview—Modified, and the Mental Health Screening Form (MHSF)—were compared to two shorter instruments, the 6-item Co-Occurring Disorders Screening Instrument for Mental Disorders (CODSI-MD) and the 3-item CODSI for Severe Mental Disorders (CODSI-SMD) for use with offenders in prison substance abuse treatment programs. Results showed that the CODSI screening instruments were comparable to the longer instruments in overall accuracy and that all of the instruments performed reasonably well. The CODSI instruments showed sufficient value to justify their use in prison substance abuse treatment programs and to warrant validation testing in other criminal justice populations and settings.

Therapeutic Communities: Diversity in Treatment Elements

This study addresses the need to describe the diversity of therapeutic community (TC) programs. The Survey of Essential Elements Questionnaire (SEEQ) was used to develop a typology of TC programs based on 19 programs that identified themselves as traditional or modified TCs in the Drug Abuse Treatment Outcome Studies (DATOS). These traditional and modified TCs differed in adherence to the elements of TC treatment, on operational characteristics, and in client mix. Differences in treatment philosophy and approach included the emphasis on self- reliance, and the use of work as a therapeutic agent for traditional TCs. There were also trends for traditional TC programs to utilize community-as-method, provide educational and vocational training, and include family members as part of therapy. Modified programs showed a greater tendency to rely on counselors. Implications of the findings for program quality, health care policy, and research are discussed.