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Program Profile: Modified Therapeutic Community for Offenders with Mental Illness and Chemical Abuse (MICA) Disorders

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 14, 2011

Program Summary

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.

Program Description

Program Goals

Modified Therapeutic Communities (MTCs) focus on offenders with mental illness and chemical abuse (MICA) disorders. They adapt existing models of therapeutic community (TC) programs for substance users for the growing population of offenders who present co-occurring disorders—that is, individuals with one or more mental health disorders combined with one or more disorders pertaining to alcohol or substance use.

 

Key to the treatment of MICA patients in MTCs is the community method of treatment and the use of peer self-help. The program is adapted for offenders with mental health disorders by making it more flexible, more personalized, and less intensive. This adaptation is accomplished by acknowledging achievements and special developmental needs; increasing rewards, orientation, and instruction; and diminishing sanctions and confrontation within the treatment program. Individual treatment plans set out the goals, objectives, and targets within the requirements for each stage. Rewards grant the patient greater freedoms and responsibilities.

 

Target Population

MTC is adapted for a specific offender population that presents co-occurring disorders. MICA offenders are an increasing cohort within correctional institutions, and MTCs aim to offer better results in reduction of substance use and recidivism than traditional forms of treatment.

 

Program Components

Like traditional TCs, the MTC program involves developing and fostering a community of both offenders and staff, in which members are encouraged to help themselves and others while using the community as part of the treatment. Program participants are all housed together in prison, separate from the general inmate population.

 

The traditional TC formula is modified to make it more accessible and appropriate to MICA offenders who present greater developmental issues. Key elements of the program include group therapy, individual therapy, monitoring of mental health, and medication management. These elements are linked to recovery stages in four phases:

 

·         Phase 1: Admission and Orientation

·         Phase 2: Primary Treatment

·         Phase 3: Live-in Reentry

·         Phase 4: Live-out Reentry

 

Upon release from custody, members can choose to continue treatment in the community for up to six months in an MTC Aftercare program. The TC–oriented aftercare program is a 20-bed program located at Independence House, which is a community corrections facility. MICA offenders occupy five apartments (20 beds) in the facility, while the other 10 apartments are for non–MICA offenders. The program helps inmates continue the treatment that began while in prison, including examination and alteration of criminal thinking and behavior, mastering community living and integrating with society, gaining employment, and fostering connections with a larger recovery community. Program activities are directed by trained staff seven days a week, from 8 a.m. to 8 p.m. Program residents attend program activities three to five hours each day for three to seven days per week during the six-month term. Activities revolve around basic skills (such as meal preparation and banking), medication and symptom management, and emotional and behavioral coping.

 

Services available to residents include mental health counseling, medication, and psychiatric services, which are provided by a local mental health center. As residents progress through program stages and demonstrate greater responsibility, they gradually assume greater independence. Supervision still remains high during this transitional period, as offenders meet twice a week with their community corrections officers.

 

Key Personnel

The MTC program requires that all participants be considered members and have strong involvement and input into the community in order to feel involved and responsible. Staff members act as role models and steer the community members toward gaining greater control over their lives, their disorders, and their opportunities upon reentry. MTC requires the involvement of treatment specialists, therapists and psychiatric services, group managers, program directors, and correctional security personnel.

 

Program Theory

MTCs aim to treat offenders with co-occurring disorders more effectively than traditional methods by including a community treatment element in their recovery. The objective is to treat the underlying substance abuse issues, which are related to continued criminal activity. By addressing the addiction problems of offenders while dealing with mental health disorders at the same time, MTCs aim to prevent future drug use and offending and reduce recidivism. The program benefits the offender by controlling their substance use and providing treatment for mental health disorders, the public by reducing future offending, and the criminal justice (and health care) system by reducing the number of the offender’s future interactions.

Evaluation Outcomes

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Study 1

Substance Use

Sullivan and colleagues (2007) found that there were significantly better outcomes for all substance use variables (any substance, any illegal drug, and alcohol to intoxication) for the modified therapeutic community (MTC) participants compared to the control group. After 12 months, 69 percent of MTC participants had not used any substance, compared to 44 percent for the control group; 75 percent of MTC participants had not used an illegal drug, compared to 56 percent of control group; and 81 percent of MTC participants had not used alcohol to intoxication, compared to 61 percent of the control group.

 

The survival analysis also indicated that those in the MTC group began using substances later than the control group (3.7 months, versus 2.6 months). The MTC group also had a greater reduction in the severity of drug use as well as in the frequency of alcohol consumption compared to the control group.

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Evaluation Methodology

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Study 1

Sullivan, McKendrick, Sacks, and Banks’ 2007 study aimed to determine what the substance use outcomes were for offenders with mental illness and chemical abuse (MICA) disorders who received treatment in the modified therapeutic community (MTC) program operated by the Colorado Department of Corrections (DOC) in the San Carlos Correctional Facility. Male MICA inmates were randomly assigned to the treatment or control group after initial consent to participate, baseline interview, and admission into treatment. The treatment group received MTC while the control group was given traditional mental health treatment and the 72-hour cognitive behavioral therapy for substance abuse and relapse prevention. Treatment participants lived in the MTC while in prison for 12 months, and were offered the option of MTC Aftercare for 6 months after release. The duration of treatment for the control group varied. In many instances, control group participants and treatment group participants who did not elect aftercare pursued other treatment or aftercare, although details of this follow-on treatment were unavailable.

 

The sample consisted of subjects for whom 12-month postprison release data were available. The original sample of 185 participants was reduced to 139, with retrieval rates of 75 percent overall (12 months post release). Seventy-five subjects received the MTC treatment, and 64 subjects in the control group received the customary psychiatric and substance abuse treatments provided by the Colorado DOC. Of the 75 members of the treatment group, 32 received MTC treatment in prison only, while 43 continued treatment in the MTC Aftercare program. The sample was all male, and 49 percent white, 30 percent African American, and 16.5 percent Hispanic, with an average age of 34.3 years.

 

Data for the study was obtained from standardized self-report instruments, which were administered by trained interviewers and from the records of the Colorado DOC. Data were measured at three points: at baseline (admission into the program), at  6 months after release from prison, and at 12 months post release. The outcome measures of interest were any substance use, any illegal drug use, and alcohol use to intoxication. Other measures included severity of use and time to relapse.

 

Differences between the groups were examined with logistic and ordinary least squares (or OLS) regression in intent-to-treat analyses. The multivariate analysis controlled for age at baseline, age at first illegal activity, months spent in prison, employment, stable housing, suicide attempts, and living with a relative (other than parents) while growing up. A survival analysis was conducted to measure the differential treatment effects for time to relapse.

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Cost

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Sacks and colleagues (2004) identified the per diem cost of a Modified Therapeutic Community (MTC) for inmates with mental illness and chemical abuse (MICA) disorder in Colorado’s San Carlos Correctional Facility at $155.56 per inmate. This includes the cost of incarceration ($148.19) and MTC treatment ($7.37). The total costs of MICA services were lower than the cost of delivering the same services in the general prison population.
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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
Sullivan, Christopher J., Karen McKendrick, Stanley Sacks, and Steven Banks. 2007. “Modified Therapeutic Community Treatment for Offenders with MICA Disorders: Substance Use Outcomes.” The American Journal of Drug and Alcohol Abuse 33:823–32.
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Additional References

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

McKendrick, Karen, Christopher Sullivan, Steven Banks, and Stanley Sacks. 2006. “Modified Therapeutic Community Treatment for Offenders with MICA Disorder: Antisocial Personality Disorder and Treatment Outcomes.” Journal of Offender Rehabilitation 44(2/3):133–59.

Sacks, Stanley, JoAnn Y. Sacks, and Joe Stommel. 2003. “Modified Therapeutic Community Program for Inmates with Mental Illness and Chemical Abuse Disorders.” Corrections Today 65(6):90–99.

Sacks, Stanley, JoAnn Y. Sacks, Karen McKendrick, Steven Banks, and Joseph Stommel. 2004. “Modified TC for MICA Offenders: Crime Outcomes.” Behavioural Sciences and the Law 22:477–501. (This study was reviewed but did not meet the CrimeSolutions.gov criteria for inclusion in the overall program rating.)

Sullivan, Christopher J., Stanley Sacks, Karen McKendrick, Steven Banks, JoAnn Y. Sacks, and Joseph Stommel. 2007. “Modified Therapeutic Community Treatment for Offenders With Co-Occurring Disorders: Mental Health Outcomes.” Mental Health Issues in the Criminal Justice System 45(1):227–47.

Van Stelle, Kit R. and D. Paul Moberg. 2004. “Outcome Data for MICA Clients After Participation in an Institutional Therapeutic Community.” Journal of Offender Rehabilitation 39(1):37–62.
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Related Practices

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Following are CrimeSolutions.gov-rated 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



Adult Reentry Programs
This practice involves correctional programs that focus on the transition of individuals from prison into the community. Reentry programs involve treatment or services that have been initiated while the individual is in custody and a follow-up component after the individual is released. The practice is rated Promising for reducing recidivism.

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

Age: 18+

Gender: Male

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Rural, Suburban, Urban

Setting (Delivery): Correctional, Other Community Setting

Program Type: Alcohol and Drug Therapy/Treatment, Aftercare/Reentry, Individual Therapy, Therapeutic Communities

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

Current Program Status: Active

Listed by Other Directories: National Reentry Resource Center, National Registry of Evidence-based Programs and Practices