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Program Profile: Pennsylvania Department of Corrections (PADOC) Therapeutic Community

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on October 17, 2014

Program Summary

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.

Program Description

Program Goals
The Pennsylvania Department of Corrections (PADOC) offers therapeutic community (TC) drug treatment programs to inmates serving time in prisons throughout Pennsylvania. Therapeutic communities (TCs) are prison-based residential drug treatment programs that provide a highly structured, prosocial environment to treat substance abuse and addiction. The overall goal of the TC is to reduce offenders’ risk of drug relapse and recidivism once they return to the community.

Program Theory
TCs provide treatment to each person on an individual level through the use of a community of one’s peers. They differ from other models of treatment by their use of the ‘community’ as the key instrument of change (Welsh 2007; Vanderplasschen et al. 2012; De Leon and Wexler 2009). TCs use a stepping stone model in which participants progress through several levels of treatment. As the participant progresses through each treatment level, his or her level of responsibility also increases. The treatment program places heavy emphasis on community norms, with reinforcement delivered though a set of rewards and sanctions that are intended to help in the development of self-control and responsibility. 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).

Target Population
Inmates in the PADOC prisons are eligible to participate if they receive a score of 3 or greater on the TCU Drug Screen 2 instrument (a score of 3 or higher indicates a serious drug-related problem).

Program Components
Inmates who participate in the TC program at a PADOC prison go through three treatment phases. The first phase (orientation) takes place during the initial 1 to 3 months and covers the orientation process. During this phase, participants learn about the philosophy of TC treatment, receive a diagnosis and more information about their diagnosis, and go through an assimilation process.

The second phase (primary treatment) takes place over months 3 through 7. This is when the primary treatment begins. Participants begin to take on additional responsibilities and involvement in the program, which includes providing support in the day-to-day operations of the program as well teaching new members who are starting the program. The second phase uses a combination of peer interactions, group therapy, and individual therapy to help inmates learn behavioral management, positive social and confrontation skills, recovery tools, identifying relapse triggers, accepting guidance, trust and relationship issues, critical thinking, self-awareness and regulation, and how to effectively participate in the inmate house structure (inmate committees, early house meetings, etc.).

The final phase (reentry) lasts 1 to 3 months. During reentry, inmates work with a treatment specialist to create an individual relapse prevention plan, work on strengthening their relapse prevention plan, and build their planning and decision-making skills. Program counselors provide information to the inmates on 12-step programs such as Alcoholic Anonymous or Narcotics Anonymous and their availability in the community and provide encouragement to the inmates to partake in these services. However, no mandatory community aftercare is provided to TC graduates.

Key Personnel
The program is run and operated through the Pennsylvania Department of Corrections. The program is supervised by trained treatment specialists and counselors from outside of the prison, with additional support provided by the inmates during their second phase of treatment.

Evaluation Outcomes

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Study 1
Although Welsh and Zajac (2013) found a small significant effect of participating in the Pennsylvania Department of Corrections (PADOC) therapeutic communities (TCs) on reincarceration, there was no significant effect on rearrests or drug relapse. The preponderance of evidence suggests the TC treatment program had limited to no effects on participants.

There was a statistically significant difference between the TC group and the comparison group for reincarceration rates, where inmates who had participated in the TC program were reincarcerated less often than the control group (59 percent for the TC group versus 50 percent for the comparison group). However, the effect size was small (d=0.2).

When looking at rates of rearrest, there were no statistically significant differences between the TC group and the comparison group.

Drug Relapse
There also were no statistically significant differences between the groups for rates of drug relapse.
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Evaluation Methodology

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Study 1
Welsh and Zajac (2013) used a quasi-experimental design to examine the effectiveness of therapeutic communities (TCs) operated by the Pennsylvania Department of Corrections (PADOC). Pretreatment data was collected, such as demographics and criminal history, as well as postrelease data for inmates who had been admitted to a drug treatment program in five all-male prisons from Jan. 1 through Nov. 30, 2000. Each of the five participating prisons had a well-established TC–based treatment program. Through the use of qualitative analysis (such as structured observations and inspection of treatment files), the researchers were able to establish TC compliance and consistency across all five prisons. Two of the prisons were maximum security, two were medium security, and one was a minimum/medium security.

Participants included all inmates who had been admitted to the prison TC program, while the comparison group consisted of inmates who were eligible for TC program participation but who did not participate in the TC. Eligibility to participate in TC is based on the TCU Drug Screen 2 instrument, with scores of 3 or greater considered treatment eligible. Because of the shortage of space at each TC site, the PADOC placed many TC–eligible offenders in less-intensive forms of treatment. This resulted in TC inmates having 15 times the exposure to treatment that non-TC group participants had. The final sample included 555 TC inmates (36 percent) and 998 comparison inmates (64 percent).

All study participants were male. Average age was 34.5 years. The mean time remaining until the inmate’s release was 3 months. The racial background of participants were 53 percent African American, 37 percent white, 9 percent Hispanic, and 1 percent unaccounted for (including Asian or Pacific Islander). Data showed that participants had moderate ranges of offense severity and drug dependence. Sixty-nine percent of subjects had been out of prison at least 4 years at the time pretest data was collected.

Prior substance use was measured with the TCU Drug Screen 2 (TCUDS) questionnaire. The scores on TCUDS range from 0 to 9, with values greater than 3 indicating serious (relatively severe) drug-related problems. The outcomes that were measured included reincarceration, rearrest, and drug relapse on a 0–1 scale (0=no, 1=yes). Employment status postrelease was calculated using information from the Pennsylvania Board of Probation and Parole and a 1- to 3-point scale (1=employed full or part time, 2=unemployed but able to work, 3=unemployed and unable to work). Reincarceration data and rates were collected from the PADOC, while data on rearrest and dates were provided by the Pennsylvania Commission on Crime and Delinquency. Drug-testing data was acquired though automated urinalyses conducted by the Pennsylvania Board of Probation and Parole.

The study used logistic regression analyses to predict reincarceration, rearrest, and drug relapse. Other known predictors of recidivism—such as offender age, criminal history, postrelease employment, and substance abuse—were controlled for during analyses. Follow-up was conducted for 4 years postrelease from prison.
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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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

Study 1
Welsh, Wayne N., and Gary Zajac. 2013. “A Multisite Evaluation of Prison-Based Drug Treatment: 4-Year Follow-Up Results. “Prison Journal 93:251–71.
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Additional References

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

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

Vanderplasschen, Wouter, Kathy Colpaert, Mieke Autrique, Richard Charles Rapp, Steve Pearce, Eric Broekaert, and Stijn Vandevelde. 2012. “Therapeutic Communities for Addictions: A Review of Their Effectiveness From a Recovery-Oriented Perspective.” Scientific World journal article ID 427817.

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

Welsh, Wayne N. 2009. A Multi-Site Evaluation of Prison-Based Drug Treatment: A Research Partnership Between the Pennsylvania Department of Corrections and Temple University. Philadelphia, PA.: Temple University, Department of Criminal Justice.

Welsh, Wayne N., Patrick McGrain, Nicole Salamatin, and Gary Zajac. 2007. “Effects if Prison Drug Treatment on Inmate Misconduct: A Repeated Measures Analysis.” Criminal Justice and Behavior 34(5):600–615.

Welsh, Wayne N., Gary Zajac, and Kristofer Bret Bucklen. 2013. “For Whom Does Prison-Based Drug Treatment Work? Results from a Randomized Experiment.” Journal of Experimental Criminology, published online September 26, 2013.
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Related Practices

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Following are practices that are related to this program:

Incarceration-based Therapeutic Communities for Adults
This practice uses a comprehensive, residential drug treatment program model for treating substance-abusing and addicted inmates to foster changes in attitudes, perceptions, and behaviors related to substance use. The practice is rated Promising in reducing recidivism rates after release for participants in therapeutic communities.

Evidence Ratings for Outcomes:
Promising - More than one Meta-Analysis Crime & Delinquency - Multiple crime/offense types
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Program Snapshot

Age: 18+

Gender: Male

Race/Ethnicity: Black, Asian/Pacific Islander, Hispanic, White

Setting (Delivery): Correctional

Program Type: Alcohol and Drug Therapy/Treatment, Conflict Resolution/Interpersonal Skills, Group Therapy, Individual Therapy, Therapeutic Communities

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

Current Program Status: Active