Incarceration in a correctional facility can provide an opportunity that might not otherwise be available to provide individuals with effective substance abuse treatment. Incarceration can facilitate temporary prevention of access to drugs and alcohol, and therefore may provide a means to detoxification. But individuals with chemical dependencies are unlikely to remain sober unless they are also engaged in treatment that anticipates the challenges that they will face upon release to the community. Treatment in a correctional facility should seek to accomplish a variety of goals: motivating the individual to change; developing the prisoner's ability to recognize his or her own patterns of behavior and identify alternative patterns; and engaging the person in the development of a transition plan that includes a focus on developing pro-social ties in the community.

There are a variety of options for corrections-based substance abuse treatment, although they do not all provide the same results. Research shows that treatment programs that are most effective for people involved in the criminal justice system employ a therapeutic emphasis on helping the person to change his or her behavior, include multiple levels of care, and use the leverage of the criminal justice program to retain him or her in treatment. In addition, the length of time an individual is in treatment is related to treatment success and reduced recidivism rates-the longer the treatment lasts, the better the outcome is likely to be.

Corrections administrators should consider establishing therapeutic communities (TCs), which have been shown to be particularly effective in treating people in prison or jail with chemical dependencies. TCs are highly structured units of residential treatment where participants live (usually) for a year or longer. TCs offer the advantage of comprehensive, integrated treatment, ease of transfer to similar community-based programs, and the involvement of community- and faith-based services.

Standards for TCs in Correctional Settings

The Office of National Drug Control Policy (ONDCP) offers a detailed listing of performance standards for TCs that fall under 11 domains. The following principles for TCs are excerpted from the ONDCP's list of guiding standards for all corrections-based TCs:

Programs have solid grounding in the existing professional literature that describes the TC theory and treatment model.
Program participants identify with the TC and feel a sense of belonging to change their patterns of criminality and substance use.
Administrative and management staff interfacing with the contracting agency fully understand the TC and function synergistically.
Staff functions in a manner consistent with the philosophy and practice of the TC.
Environment supports participants' primary identification with the TC culture in contrast with the prison culture.
Program components structured to address the common socialization and psychological needs of program participants.
The process of change in the TC unfolds as an interaction between the individual and the community.
Protocol prescribes three major program stages: induction, primary treatment, and re-entry.
Participants and staff are responsible for psychological and physical safety of the community.
Primary problem area of program participants, including mental health, must be assessed.
Community-based aftercare must continue for at least six months after release.

Executive Office of the President, Office of National Drug Control Policy, Therapeutic Communities in Correctional Settings: The Prison Based TC Standards Development Project, Final Report of Phase II (Washington, DC: 1999), available from World Wide Web.

Example: KEY/CREST Program, Delaware Department of Corrections

The KEY/CREST program is a three-stage TC. The first stage (KEY) is a prison-based treatment phase. The second stage involves participation in a work-release program (CREST) during the last six months of the incarceration period so that community-based employment is secured at the time of release. The third stage is an aftercare period that entails an additional six months of treatment after release. During this last stage, participants must remain drug-free, comply with frequent drug testing, attend weekly group and individual sessions, and serve as role models/mentors for clients participating in the work-release stage of the TC.

Example: Amity In-Prison Therapeutic Community, Amity Foundation and the California Department of Corrections

The Amity Foundation operates several TCs in California, including one located within the Richard J. Donovan Correctional Facility in San Diego. The San Diego program, which houses about 200 individuals, is divided into three phases and features an optional aftercare program following release. The treatment phase may last up to two years, depending on whether an individual engages in an additional year of aftercare.

Therapeutic communities that are housed within a corrections system are sometimes referred to as "modified" TCs because they have an increased professional staff and less client control over clinical issues. Modified TCs are most often isolated from the rest of the inmate population to develop a sense of community among TC participants.

Example: Turning Point, ASAP Treatment Services Inc. (OR)

Turning Point is a substance abuse treatment program located in the Columbia Correctional Institution in Portland, Oregon. The program includes a 50-bed program for women and a 50-bed program for men. Turning Point emphasizes alcohol and drug education and treatment, improving family-related difficulties, independent living skills training, linkage to aftercare services, and modifying criminal thinking and living. To be eligible for this program, an inmate must have only 7 to 15 months remaining before his or her anticipated release from prison.

Although therapeutic communities are widely recommended as the most effective treatment modality for people in prison or jail with substance abuse problems, some jurisdictions do not possess the infrastructure required to implement this form of treatment. There are other substance abuse interventions that are more economical to implement in corrections systems and that can prepare participants for a more comprehensive treatment program following release.

When the period in which treatment can be administered in the correctional facility is relatively short, corrections administrators should consider implementing programming that addresses motivation or readiness to change. These programs can foster attitudinal "treatment readiness," which researchers have shown correlates with continued engagement in treatment in the community, even when no legal pressures are imposed to mandate compliance. (See Policy Statement 14, Behaviors and Attitudes, for more on treatment-readiness steps.) Connection to treatment after release is critical to the effectiveness of such treatment-readiness programs, which are typically made available in the last 60–90 days prior to release. (See Policy Statement 20, Planning Continuity of Care, for further discussion of making the link between prison- and community-based treatment.)

Educational programming is another increasingly popular component of substance abuse treatment in correctional facilities. It can be employed as a means to make people in prison or jail aware of the risks and consequences associated with substance use and to encourage behavioral change. Other types of programming designed to decrease substance abuse among this population include vocational training, case management, release planning, and group counseling. Group counseling is a favored approach as it enables prisoners to share their problems and identify with peers, and it provides a vehicle for change. This type of programming is relatively economical and can be provided by trained institutional staff.

Self-help or peer support groups are an additional substance abuse intervention that can be implemented with relatively few resources. Research supporting the efficacy of self-help groups (such as Narcotics Anonymous or Alcoholics Anonymous) is inconsistent, despite their widespread implementation in prisons and jails. However, self-help programs can provide a support network to increase motivation and may be a useful adjunct to more comprehensive programs.

Many prisoners with chemical dependencies have multiple risk factors or needs that must be considered in the development of effective treatment plans. For instance, substance abuse is particularly prevalent among prisoners with serious mental illness. (See Policy Statement 10, Mental Health Care, for more on co-occurring mental health and substance abuse disorders.) Other risk factors, such as a history of violence or physical health problems, should also play a role in determining the correct modality and prioritization of substance abuse treatment. (See Policy Statement 9, Development of the Programming Plan, for more on prioritization of programming for individual prisoners.)