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Practice Profile

Incarceration-based Therapeutic Communities for Adults

Evidence Ratings for Outcomes:

Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types

Practice Description

Practice Goals/Target Population
Incarceration-based therapeutic communities (TCs) are separate residential drug treatment programs in prisons or jails for treating substance-abusing and addicted offenders. The defining feature of TCs is the emphasis on participation by all members of the program in the overall goal of reducing substance use and recidivism.
 
Practice Theory
The TC theory proposes that recovery from substance abuse involves rehabilitation to learn healthy behaviors and habilitation to integrate those healthy behaviors into a routine (NIDA 2015). TCs differ from other models of treatment by their focus on recovery, overall lifestyle changes, and the use of the “community” as the key instrument for that change (De Leon and Wexler 2009; NIDA 2015; Welsh 2007; Vanderplasschen et al. 2012). The community includes inmate peers and facility staff. TCs use a stepping-stone model in which participants progress through several levels of treatment. As they progress through each treatment level, their level of responsibility also increases. TCs are implemented in a residential setting to help inmates adjust to the idea of a community working together toward a common goal (Welsh 2007). Treatment includes aftercare and reentry services as a means of providing continued support and relapse prevention after leaving the community (NIDA 2015)
 
Practice Components
Residents of TCs progress through treatment in three stages 1) induction and early treatment, 2) primary treatment, and 3) reentry. The first stage provides the resident with an introduction to the TC rules and procedures, staff, and community members. During this stage, residents begin TC model treatment and are integrated into the community. The second stage is the main treatment phase, which focuses on changing attitudes and behavior related to substance use as well as addressing other needs. Common treatment approaches include cognitive behavioral therapy and motivational interviewing. Other treatment services provide assistance with social, familial, medical, and mental health needs. The third stage prepares the residents for their transition from the program and includes aftercare services. During this final stage, resident discharge planning provides referrals for reentry services available in the community once the participants are released (NIDA 2002; 2015).
 
Specific treatment interventions vary by facility, but there are several common components of TCs. Residents of TCs are housed separately from other inmates in order to establish and maintain a drug-free, rehabilitative, prosocial environment. Residents must follow strict community rules and norms, reinforced with set rewards or punishments, as a way to facilitate self-control and responsibility. Routines are established to teach goal planning and accountability. Residents must participate in TC-related roles, as assigned, based on a hierarchy of increasing responsibilities and privileges. Residents must also participate in TC-related activities such as community meetings, individual and group counseling, games, and role playing (NIDA 2002; 2015). These roles include chores and jobs for maintaining the community and its daily operations. All activities, aside from individual counseling, occur in group formats (CSAT 1999). In addition to their assigned community-related work, residents typically participate in 4 to 5 hours of treatment a week (NIDA 2015).

Meta-Analysis Outcomes

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Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Mitchell, Wilson, and MacKenzie (2012) synthesized results from 30 studies that examined the effectiveness of incarceration-based therapeutic communities for adults on recidivism post-release. The results indicated that treatment group offenders were significantly less likely to recidivate than comparison group offenders after release (odds ratio = 1.38 for the treatment group). This means that if the comparison group has an assumed recidivism rate of 35 percent, treatment group offenders have a 28 percent recidivism rate. Drake (2012) analyzed 18 effect sizes on the effectiveness of incarceration-based therapeutic communities for adults on recidivism. The results indicated that treatment group offenders were significantly less likely to recidivate than comparison group offenders (effect size = –0.12).
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11980 - 2011300
Meta-Analysis 21990 - 2011180

Meta-Analysis 1
Mitchell, Wilson, and MacKenzie (2012) synthesized results from 74 independent effect sizes on the effectiveness of incarceration-based drug treatment programs on recidivism and drug use post-release. For inclusion in the analysis, studies had to have been conducted between 1980 and 2011, assessed the effectiveness of prison- or jail-based drug treatment programs, specifically targeted substance users, used a random or quasi-experimental design with a no-treatment or minimal-treatment comparison group, and measured recidivism or drug use post-release.
 
The majority of the studies included in the overall analysis were published after 1999 (60 percent) and were conducted in the United States (88 percent). Thirty studies reported on the effects of incarceration-based therapeutic communities for adults on recidivism post-release. Of the included studies, 6 percent used an experimental design, 31 percent used a rigorous quasi-experimental design, 43 percent used a standard quasi-experiment design, and 20 percent used a weak quasi-experimental design. Offenders in the treatment group were residents of therapeutic communities while incarcerated; offenders in the comparison group received no treatment or treatment-as-usual while incarcerated.
 
Odds-ratio effect sizes were calculated and analyzed using the random-effects inverse-variance weight method.

Meta-Analysis 2
Drake (2012) analyzed 55 studies on the effectiveness of chemical dependency treatment on reducing crime and substance use in juvenile and criminal justice systems. For inclusion in the analysis, studies had to assess the effectiveness of a therapeutic community, intensive outpatient, or outpatient chemical dependency treatment program in either the adult criminal or juvenile justice system, use a random or rigorous quasi-experimental design with a control or comparison group, provide sufficient information to calculate an effect size, and report on measures of recidivism. Studies were excluded if their treatment groups consisted of program completers only.
 
The analysis included 45 studies with adults and 10 studies with juveniles. Eighteen effect sizes were synthesized on the effectiveness of incarceration-based therapeutic communities for adults in the criminal justice system. The average age of program participants was 30. No information was reported on the gender and race/ethnicity of program participants. Offenders in the treatment group were residents of therapeutic communities while incarcerated or under community supervision; offenders in the comparison group received no treatment or treatment-as-usual.
 
The analysis reported results using mean-difference effect sizes. The mean-difference effect sizes of studies with small samples were adjusted using the Hedges’ g correction factor. A random-effects model was used to calculate the weighted average effect size.
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Cost

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After conducting a cost–benefit analysis on studies on the effectiveness of chemical dependency treatment programs in the criminal justice system, Drake (2012) found that for every $1 spent, adult therapeutic communities produced a benefit of $2.59, or a 23 percent return on investment. Adult therapeutic communities also produced an average savings of $11,075 in recidivism-related costs, when crime was avoided. The analysis was based on 2011 treatment costs.
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Other Information

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Mitchell, Wilson, and MacKenzie (2012) conducted a moderator analysis of treatment characteristics of the therapeutic communities. Treatment characteristics included mandatory aftercare, location of intervention (jail or prison), length of treatment program maturity, nature of participation (voluntary or at least partially mandatory), and average number of participants. The results showed that programs with voluntary participation in therapeutic communities had significantly larger effect sizes than programs in which participation was partially mandatory. No significant effects were detected for the other treatment characteristics.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Mitchell, Ojmarrh, David B. Wilson, and Doris L. MacKenzie. 2012. "The Effectiveness of Incarceration-Based Drug Treatment on Criminal Behavior: A Systematic Review." Campbell Systematic Reviews 18.
http://www.campbellcollaboration.org/lib/project/20/

Meta-Analysis 2
Drake, Elizabeth. 2012. Chemical Dependency Treatment for Offenders: A Review of the Evidence and Benefit-Cost Findings. Olympia, Wash.: Washington State Institute for Public Policy.
http://www.wsipp.wa.gov/ReportFile/1112/Wsipp_Chemical-Dependency-Treatment-for-Offenders-A-Review-of-the-Evidence-and-Benefit-Cost-Findings_Full-Report.pdf
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Additional References

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These sources were used in the development of the practice profile:

Center for Substance Abuse Treatment (CSAT). 1999. "Therapeutic Communities." Treatment of Adolescents with Substance Use Disorders: Treatment Improvement Protocol (TIP) Series No. 32. Rockville, Md.: Substance Abuse and Mental Health Services Administration.
http://adaiclearinghouse.org/downloads/TIP-32-Treatment-of-Adolescents-with-Substance-Use-Disorders-62.pdf

De Leon, George, and Harry K. Wexler. 2009. "The Therapeutic Community for Addictions: An Evolving Knowledge Base." Journal of Drug Issues 39:167–78.

Holloway, Katy R., Trevor H. Bennett, and David P. Farrington. 2006. "The Effectiveness of Drug Treatment Programs in Reducing Criminal Behavior: A Meta-Analysis." Psicothema 18(3):620–29.

Mitchell, Ojmarrh, David B. Wilson, and Doris L. MacKenzie. 2006. "The Effectiveness of Incarceration-Based Drug Treatment on Criminal Behavior." Campbell Systematic Reviews 11.

Vanderplasschen, Wouter, Kathy Colpaert, Mieke Autrique, Richard Charles Rapp, Steve Pearce, Eric Broekaert, and Stijn Vandevelde. 2013. "Therapeutic Communities for Addictions: A Review of Their Effectiveness From a Recovery-Oriented Perspective." The Scientific World Journal. doi:10.1155/2013/427817

National Institute on Drug Abuse (NIDA). 2002. Therapeutic Community. Research Report Series. Bethesda, MD: National Institute on Drug Abuse.

National Institute on Drug Abuse (NIDA). 2015. Therapeutic Community. Research Report Series. Bethesda, MD: National Institute on Drug Abuse.
https://www.drugabuse.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities

Welsh, Wayne N. 2007. "A Multisite Evaluation of Prison-Based Therapeutic Community Drug Treatment." Criminal Justice and Behavior 34(11):1481–98.
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Forever Free Promising - One study
The first comprehensive, in-prison, residential substance abuse treatment program designed for incarcerated women. The program is rated Promising. The intervention group reported fewer arrests during parole, less drug use and were employed more at follow-up than the comparison group.

Amity In-Prison Therapeutic Community Promising - One study
Provides intensive treatment to male inmates with substance abuse problems during the last 9 to 12 months of their prison term. The volunteer participants must reside in a dedicated program housing unit during treatment. The program is rated Promising. Overall, participants had lower levels of reincarceration rates compared to the control groups.

Delaware KEY/Crest Substance Abuse Programs Promising - One study
A prison-based therapeutic community for offenders with a history of substance abuse and a residential work release center that allows offenders to continue their treatment as they transition to the community. The program is rated Promising. Program completers and aftercare recipients were less likely to be arrested or use drugs. Also, the treatment group did better at follow-up in remaining arrest and drug-free.

Modified Therapeutic Community for Offenders with Mental Illness and Chemical Abuse (MICA) Disorders Promising - One study
An adaptation of the therapeutic community models for use with offenders who have both drug abuse problems and mental health disorders. This modified version uses a more flexible, more personalized, and less intense program that targets reductions in substance use and recidivism. The program is rated Promising. Participants in the treatment group were less likely to abuse substances; and if they did start, it was later than the control group.

Minnesota Prison-based Chemical Dependency Treatment Promising - One study
Prison-based treatment for offenders who are chemically abusive or dependent. The program is rated Promising. Offenders who received treatment had significantly lower rates of reoffending. Completing treatment reduced the hazard for rearrest by 22 percent, for reconviction by 20 percent, and for incarceration by 27 percent. Increased treatment time was also found to have some impact on recidivism.

InnerChange Freedom Initiative (Minnesota) Promising - One study
A voluntary, faith-based prisoner reentry program that attempts to prepare inmates for reintegration into the community, employment, family, and other significant relationships through educational, values-based programming. The program is rated Promising. Participants were rearrested, reconvicted, and reincarcerated less than the comparison group. There was no statistically significant impact on revocations for a technical violation between the groups.

Pennsylvania Department of Corrections (PADOC) Therapeutic Community No Effects - One study
A prison-based drug treatment program based on the principles of therapeutic communities with the overall goal of reducing offenders’ risk of drug relapse and recidivism once they return to the community. The program is rated No Effects. The program did not significantly impact participants’ rates of rearrests or drug relapse, and only had a small effect on reincarceration rates.
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Practice Snapshot

Age: 18+

Gender: Both

Targeted Population: Alcohol and Other Drug (AOD) Offenders, Prisoners

Settings: Correctional

Practice Type: Aftercare/Reentry, Alcohol and Drug Prevention, Alcohol and Drug Therapy/Treatment, Cognitive Behavioral Treatment, Group Therapy, Individual Therapy, Motivational Interviewing, Residential Treatment Center, Therapeutic Communities

Unit of Analysis: Persons