Matthew L. Hiller

Three-Year Reincarceration Outcomes for In-Prison Therapeutic Community Treatment in Texas

Longer term in-prison therapeutic community (ITC) outcome studies are needed, along with more attention on who benefits most from these programs. This study examined reincarceration records for 394 nonviolent offenders during the 3 years following prison. Those who completed both ITC and aftercare were the least likely to be reincarcerated (25%), compared to 64% of the aftercare dropouts and 42% of the untreated comparison groups. Furthermore, high-severity aftercare completers were reincarcerated only half as often as those in the aftercare dropout and comparison groups (26% vs. 66% and 52%). The findings support the effectiveness of intensive treatment when it is integrated with aftercare, and the benefits are most apparent for offenders with more serious crime and drug-related problems.

Motivation as a Predictor of Therapeutic Engagement in Mandated Residential Substance Abuse Treatment

Studies of community-based substance abuse treatment indicate that motivation for treatment is critical for retaining clients in the program and for their becoming therapeutically engaged in the recovery process. Relatively little work, however, has examined the effect of motivation on therapeutic engagement in criminal justice settings. Baseline and during-treatment data were collected prospectively from 419 probationers remanded to a 6-month modified therapeutic community. Findings showed that desire for help and treatment readiness were associated with indicators of therapeutic engagement even after statistically controlling for additional factors that could have confounded these relationships. Targeted readiness and induction interventions are therefore recommended for offenders with low motivation who are remanded to treatment in correctional settings.

Gender differences at admission and follow-up in a sample of methadone maintenance clients

Although one-third of clients enrolled in methadone treatment in the United States are female, few studies have looked at gender differences at admission and follow-up. Using interview data from 435 clients (31% female) collected at admission and approximately 1 year after discharge, females were found to have more dysfunctional families of origin and greater prior and current psychological and medical problems. Both genders improved following treatment, as evidenced by reduced illicit drug, tobacco, and alcohol use, criminal involvement, and HIV/AIDS-risky behaviors. Females were more likely to seek further help for both drug misuse and psychological problems subsequent to discharge.

Legal Pressure and Treatment Retention in a National Sample of Long-Term Residential Programs:

This study examined the association between legal pressure and treatment retention in a national sample of 2,605 clients admitted to 18 long-term residential facilities that participated in the Drug Abuse Treatment Outcome Study (DATOS). Hierarchical linear models were used to assess the relationship of background factors and legal pressure with treatment participation for 90 days or longer. Two thirds of the sample entered residential treatment with moderate to high pressure from legal authorities, and they were significantly more likely than the low-pressure clients to stay 90 days or more. Moreover, the difference in retention between moderate-to-high-and low-pressure clients was even greater in programs with proportionally larger caseloads under legal surveillance. The criminal justice system (CJS) can influence treatment participation and retention, and it appears essential for the CJS and treatment programs to maintain an open and constructive relationship to maximize their potential combined impact.

Risk Factors That Predict Dropout from Corrections-Based Treatment for Drug Abuse:

Early dropout or failure to engage in drug abuse treatment is a common problem in correctional settings. This study presents findings from 339 felony probationers mandated to a 6-month modified therapeutic community in lieu of imprisonment. Early dropout was related to cocaine dependence, having a history of psychiatric treatment, being unemployed before adjudication to treatment, and to higher levels of depression, anxiety, and hostility. Dropout rates also were higher for probationers with deviant peer networks and lower ratings of self-efficacy. However, multivariate analyses showed that scoring high on a criminality risk index was the strongest predictor of leaving treatment early and appears to represent a good composite risk measure. These findings can help identify who needs residential treatment, and who is at greatest risk for not completing it.

Legal Pressure, Treatment Readiness, and Engagement in Long-Term Residential Programs

Abstract Clients are less likely to drop out of residential drug treatment programs prematurely when they are either internally motivated (i.e., having a high level of treatment readiness) or externally pressured by the legal system to enter, participate, and remain in treatment. However, little is known about the combined impact these factors have on treatment engagement and retention. This study focused on a national sample of 2,194 clients admitted to 18 long-term residential facilities. Although there was no significant interaction effect, findings indicated that clients with higher levels of treatment readiness at intake stayed in treatment at least 90 days, regardless of legal pressure. Likewise, those under legal pressure (defined by legal status and supervisory pressures) remained in treatment longer, regardless of treatment readiness. However, motivational readiness for treatment accounted for the greatest improvements in retention and, unlike legal pressure, was related to indicators of therapeutic engagement.

Drug treatment process indicators for probationers and prediction of recidivism

Research has shown that substance abuse treatment is associated with reduced criminal activity as well as reduced drug use. An increasingly important aspect of treatment evaluation, however, is understanding more about the therapeutic process involved. Based on a sample of 279 probationers assigned to residential treatment for drug use problems, the purpose of this study is to examine several elements of treatment process and how they influence recidivism. Rearrest rate during a 2-year follow-up study period was 36%, and survival analysis showed it was directly related to poorer during-treatment ratings by probationers of self-esteem, counselor competence, and peer support from others in the treatment program. These were better predictor measures than background and demographic characteristics generally used in other studies, suggesting the role of therapeutic engagement in the recovery process.

Peer, family, and motivational influences on drug treatment process and recidivism for probationers.

Treatment efforts appear to be effective in reducing crime among drug using individuals, but components of the treatment process associated with client improvement need to be identified. Furthermore, these elements of treatment may play an intermediate role in the connection between client background characteristics and later criminal activity. The current study examines a structural equation model including client perceptions of their drug related problems, peer deviance, and family dysfunction as influences upon the formation of therapeutic relationships during treatment and rearrests following treatment. Results showed therapeutic relationships were positively associated with recognition of drug related problems and negatively related to rearrest. Peer deviance also was positively related to rearrest.

A Cost-Effectiveness Analysis of In-Prison Therapeutic Community Treatment and Risk Classification

Policy makers need scientifically based information to help them to determine which correctional treatment alternatives are effective and economically viable. Three-year outcome data from 394 parolees (291 treated, 103 untreated comparison) were examined to determine the relative cost-effectiveness of prison-based treatment and aftercare, controlling for risk of recidivism. Findings showed that intensive services were cost-effective only when the entire treatment continuum was completed, and that the largest economic impact was evident among high-risk cases. Therefore, assignments to correctional treatment should consider an offenders problem severity level, and every effort should be made to engage them in aftercare upon release from prison.

PREDICTING RECIDIVISM FOR RELEASED STATE PRISON OFFENDERS: Examining the Influence of Individual and Neighborhood Characteristics and Spatial Contagion on the Likelihood of Reincarceration

We examined the influence of individual and neighborhood characteristics and spatial contagion in predicting reincarceration on a sample of 5,354 released Pennsylvania state prisoners. Independent variables included demographic characteristics, offense type, drug involvement, various neighborhood variables (e.g., concentrated disadvantage, residential mobility), and spatial contagion (i.e., proximity to others who become reincarcerated). Using geographic information systems (GIS) and logistic regression modeling, our results showed that the likelihood of reincarceration was increased with male gender, drug involvement, offense type, and living in areas with high rates of recidivism. Older offenders and those convicted of violent or drug offenses were less likely to be reincarcerated. For violent offenders, drug involvement, age, and spatial contagion were particular risk factors for reincarceration. None of the neighborhood environment variables were associated with increased risk of reincarceration. Reentry programs need to particularly address substance abuse issues of ex-offenders as well as take into consideration their residential locations.