In the United States, therapeutic communities are used in the rehabilitation of drug addicts in and out of prison. These communities involve a type of group therapy that focuses more on the person a whole and not so much the offense they committed or their drug abuse. They use a “community of peers” and role models rather than professional clinicians. They focus on lifestyle changes and tend to be more holistic (Lipton 1998, pp. 106-109). By getting inmates to participate in these programs, the prisoners can break their addiction to drugs. By freeing themselves from this addiction they can change their lives. These therapeutic communities can teach them some self-control and ways that they can direct their energies into more productive things, such as sports, religion, or work. Seven out of every ten men and eight out of every ten women in the criminal justice system used drugs with some regularity prior to entering the criminal justice system (Lipton 1998, pp. 106-109). With that many people in prisons that are using drugs and the connection between drug use and crime, then if there was any success at all it seems like it would be a step in the right direction. Many of these offenders will not seek any type of reform when they are in the community. They feel that they do not have the time to commit to go through a program of rehabilitation. It makes sense, then, that they should receive treatment while in prison because one thing they have plenty of is time. In 1979, around four percent of the prison population, or about 10,000, were receiving treatment through the 160 programs that were available throughout the country (National Institute on Drug Abuse 1981). Forty-nine of these programs were based on the therapeutic community model, which served around 4,200 prisoners. In 1989, the percentage of prisoners that participated in these programs grew to about eleven percent (Chaiken 1989). Some incomplete surveys state today that over half the states provide some form of treatment to their prisoners and about twenty percent of identified drug-using offenders are using these programs (Frohling 1989).
The public started realizing that drug abuse and crime were on the rise and that something had to be done about it. This led to more federal money being put into treatment programs in prisons (Beckett 1994, pp. 425-447). The States were assisted through two Federal Government initiatives, projects REFORM and RECOVERY. REFORM began in 1987, and laid the groundwork for the development of effective prison-based treatment for incarcerated drug abusers. Presentations were made at professional conferences to national groups and policy makers and to local correctional officials. At these presentations the principles of effective correctional change and the efficacy of prison-based treatment were discussed. New models were formed that allowed treatment that began in prison to continue after prisoners were released into the community. Many drug abuse treatment system components were established due to Project REFORM that include: 39 assessment and referral programs implemented and 33 expanded or improved; 36 drug education programs implemented and 82 expanded or improved; 44 drug resource centers established and 37 expanded or improved; 20 in-prison 12-step programs implemented and 62 expanded or improved; 11 urine monitoring systems expanded; 74 prerelease counseling and/or referral programs implemented and 54 expanded or improved; 39 post release treatment programs with parole and 10 improved; and 77 isolated-unit treatment programs started. In 1991, the new Center for Substance Abuse Treatment established Project RECOVERY. This program provided technical assistance and training services to start out prison drug treatment programs. Most of the states that participated in REFORM were involved with RECOVERY, as well as a few new states.
In most therapeutic communities, recovered drug users are placed in a therapeutic environment, isolated from the general prison population. This is due to the fact that if they live with the general population, it is much harder to break away from old habits. The primary clinical staff is usually made up of former substance abusers that at one time were rehabilitated in therapeutic communities. The perspective of the treatment is that the problem is with the whole person and not the drug. The addiction is a symptom and not the core of the disorder. The primary goal is to change patterns of behavior, thinking, and feeling that predispose drug use (Inciardi et al. 1997, pp. 261-278). This returns to the general theory of crime and the argument that it is the opportunity that creates the problem. If you take away the opportunity to commit crimes by changing one’s behavior and thinking then the opportunity will not arise for the person to commit these crimes that were readily available in the past. The most effective form of therapeutic community intervention involves three stages: incarceration, work release, and parole or other form of supervision (Inciardi et al. 1997, pp.261-278). The primary stage needs to consist of a prison-based therapeutic community.
Pro-social values should be taught in an environment that is separate from the normal prison population. This should be an on-going and evolving process that lasts at least twelve months, with the ability to stay longer if it is deemed necessary. The prisoners need to grasp the concept of the addiction cycle and interact with other recovering addicts. The second stage should include a transitional work release program. This is a form of partial incarceration in which inmates that are approaching release dates can work for pay in the free community, but they must spend their non-working hours in either the institution or a work release facility (Inciardi et al. 1997, pp. 261-278). The only problem here is that during their stay at this facility, they are reintroduced to groups and behaviors that put them there in the first place. If it is possible, these recovering addicts should stay together and live in a separate environment than the general population. Once the inmate is released into the free community, he or she will remain under the supervision of a parole officer or some other type of supervisory program. Treatment should continue through either outpatient counseling or group therapy.
In addition, they should also be encouraged to return to the work release therapeutic community for refresher sessions, attend weekly groups, call their counselors on a regular basis and spend one day a month at the facility (Inciardi et al. 1997, pp. 261-278). Since the early 1990’s, the Delaware correctional system has been operating this three-stage model. It is based around three therapeutic communities: the KEY, a prison-based therapeutic community for men; WCI Village, a prison-based therapeutic community for women; and CREST Outreach Center, a residential work release center for men and women. According to Inciardi et al. (1997, pp.261-278), the continuing of therapeutic community treatment and sufficient length of follow up time, a consistent pattern of reduction of drug use and recidivism exists. Their study shows the effectiveness of the program extending beyond the in-prison program. New York’s model for rehabilitation is called the Stay’n Out Program. This is a therapeutic community program that was established in 1977 by a group of recovered addicts (Wexler et al. 1992, pp. 156-175). The program was evaluated in 1984 and it was reported that the program reduced recidivism for both males and females. Also, from this study, the “time-in-program” hypothesis was formed. This came from the finding that successful outcomes were directly related to the amount of time that was spent in treatment.
Another study, by Toumbourou et al. (1998, pp. 1051-1064), tested the time-in-program hypothesis. In this study, they found a linear relationship between reduced recidivism rates and time spent in the program as well as the level of treatment attained. This study found that it was the attainment of level progress rather than time in the treatment that was most important. The studies done on New York’s Stay’n Out program and Delaware’s Key-Crest program are some of the first large-scale evidence that prison-based therapeutic communities actually produce a significant reduction in recidivism rates and show a consistency over time. The programs of the past did work, but before most of the programs were privately funded, and when the funds ran out in seven or eight years, so did the programs. Now with the government backing these types of programs, they should continue to show a decrease in recidivism. It is much more cost effective to treat these inmates. A program like Stay’n Out cost about $3,000 to $4,000 more than the standard correctional costs per inmate per year (Lipton 1998, pp. 106-109). In a program in Texas, it was figured that with the money spent on 672 offenders that entered the program, 74 recidivists would have to be prevented from returning to break even. It was estimated that 376 recidivists would be kept from returning using the therapeutic community program (Eisenberg and Fabelo 1996, pp. 296-318). The savings produced in crime-related and drug use-associated costs pay for the cost of treatment in about two to three years. The main question that arises when dealing with this subject is whether or not people change. According to Gottfredson and Hirschi, the person does not change, only the opportunity changes. By separating themselves from people that commit crimes and commonly do drugs, they are actually avoiding the opportunity to commit these crimes. They do not put themselves in the situation that would allow their low self-control to take over. Starting relationships with people who exhibit self-control and ending relationships with those who do not is a major factor in the frequency of committing crimes. Addiction treatment is very important to this country’s war on drugs.
While these abusers are incarcerated it provides us with an excellent opportunity to give them treatment. The will not seek treatment on their own. Without treatment, the chances of them continuing on with their past behavior are very high. But with the treatment programs we have today, things might be looking up. The studies done on the various programs, such as New York’s Stay’n Out and Delaware’s Key-Crest program, prove that there are cost effective ways available to treat these prisoners. Not only are they cost effective, but they are also proven to reduce recidivism rates significantly.
These findings are very consistent throughout all of the research, there are not opposing views. I believe that we can effectively treat these prisoners while they are incarcerated and they can be released into society and be productive, not destructive. Nothing else has worked to this point, we owe it to them, and more importantly, we owe it to ourselves.
We can again feel safe on the streets after dark, and we do not have to spend so much of our money to do it. Bibliography
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