The Prison Journal
“Recidivism Following Mandated Residential Substance Abuse Treatment for Felony Probationers,”
by Matthew L. Hiller, Kevin Knight, and D. Dwayne Simpson (Volume 86, Number
2, June, 2006).
Reviewed By Sam Torres
Hiller, Knight, and Simpson acknowledge at the outset the link between substance abuse and crime and note that treatment programs have become an important component
of community-based corrections. This study examines findings from a “modified” therapeutic community (TC) that serves substance-abusing probationers in a large metropolitan area, subsequently determined to be the Dallas County Judicial Treatment Center (DCJTC). For those not inclined to read the complete article, the abstract summarizes
the major findings that treatment dropouts were more likely to be rearrested for a serious felony within two years of leaving
the TC program than were those who completed treatment and graduated. Those who completed the program also did better on re-arrest rates than an untreated comparison
group. Furthermore, a significantly smaller proportion of graduates were rearrested
during the second year after successful completion compared to the drop-outs or control group.
Hiller et al. provide a very brief literature review and present data from recent Bureau of Justice Statistics (BJS) reports on adult offenders. At the end of 2004 almost 7 million adults were under some form of correctional control, including more than 2 million offenders incarcerated in prisons and jails, and almost 5 million under probation and parole supervision. That many of these offenders possess extensive criminal histories and exhibit multiple social and psychological problems, including substance abuse, has long been established in the empirical literature. The article also presents some of the literature that has found that rehabilitation-oriented programs can help address these social and psychological problems and thus contribute to reducing the incidence of drug use and crime. However, more specifically, the most intensive approach of the TC has been found in multiple studies to reduce drug use and criminal activity, and five large-scale prison-based TCs showed they were associated with reduced recidivism rates and enhanced parole outcomes. Recent evaluations of prison-based programs like KEY, CREST, and AMITY have found similar favorable reductions in recidivism rates upon release. That is, collectively, the studies show that TCs followed by aftercare reduce criminality and drug use for up to three years following release from prison.
Despite these favorable evaluations of community and prison-based TC intervention strategies, most offenders with substance abuse problems continue to return to the community untreated and thus to their continued pattern of drug use and criminality. Hiller et al. accurately report that, simply put, there are not enough treatment slots to meet the demand and it is unlikely that the demand for treatment can be met within prison-based settings. In fact it appears that, as the prison population has increased, the number of treatment slots has decreased.
The study included a sample of 429 probationers admitted to the DCJTC program in 1998, with the participants divided into treatment graduates (n = 290), treatment dropouts (n = 116), and a third group (n = 23) that included probationers who were discharged for medical problems or who were transferred to another county due to outstanding warrants. Lastly, a comparison group (n = 100) who were similar in gender, ethnicity, and age was included. Overall, 70 percent of the sample was male, 10 percent Hispanic, and average age was noted to be 32.2 years; however, the three study groups differed in gender and average age, with the dropouts more likely to be male and graduates more likely to be older (italics added). Criminal record checks were conducted for all of the study participants for two years following discharge or the grant of probation.
As noted, this article presented the findings of research designed to examine the effectiveness of a TC for reducing recidivism in a group of probationers in Dallas County, Texas. The rates of recidivism for each group (TC graduates, dropouts, and control group) were compared for one and two years following treatment. Hiller et al. found that the TC had a limited impact on subsequent recidivism after the first year following completion of treatment. However, analysis demonstrated that the dropouts were more likely to have been arrested for a serious felony within two years of leaving the treatment program. Of greater significance is the finding that after an initial one-year arrest rate of 17 percent, a substantially smaller number of graduates (4 percent) were arrested during the second year when contrasted with the dropout (10 percent) or control groups (23 percent). In short, the benefits of the TC emerged after the second year following graduation, appearing to insulate the graduate group from being arrested for a serious felony.
The findings of this study appear consistent with the favorable results for TCs, both community and prison-based programs that have found a reduction in recidivism when paired with aftercare treatment. In this study, however, the reductions in recidivism were not observed during the first year after treatment but instead emerged during the second year, when recidivism rates went from 17 percent the first year to 4 percent during the 2nd year.
The limitations of this study were significant. For example, the authors acknowledge that offenders who participate in a TC often receive a greater level of supervision following treatment and thus are more likely to have violations detected. Hence, it is probable that violations in the treatment group were more likely to be detected than those in the control group, thus skewing the favorable results downward. Furthermore, treatment graduates were “significantly” older on average than dropouts and control group participants. As offenders and abusers get older they begin to “age-out” of criminality and substance abuse and generally are more responsive to intervention strategies, while the younger control group would be expected to be more resistant to “getting clean.” In addition, it was not known if the probationers in the control group might have received drug treatment services while they were on probation. Invariably, judges tend to order offenders with substance-abuse problems to participate in a program of drug testing and outpatient treatment at the direction of the probation officer. Rather than comparing a TC group with a non-treatment group, these researchers may well have been comparing TC (inpatient) with outpatient treatment. Thus, the control (no treatment group) may not have been a non-treatment group at all. Finally, Hiller et al. provide no description of the various intervention strategies utilized by the DCJTC participants. Remarkable differences exist in the strategies used by residential drug treatment programs. Some utilize professional treatment agents like MSWs, psychologists, psychiatrists, and other university-trained personnel, while others rely completely on a 12-step program, utilizing paraprofessional recovering addicts. Others utilize a combination of the two approaches.
This study is yet one more of many studies that have examined the most intensive drug treatment approach and found it to be generally effective in reducing recidivism when compared to a do-nothing approach. Most states have yet to jump on the TC bandwagon in lieu of a prison commitment for non-violent, low-risk felons. The TC provides a degree of incapacitation, since it does remove the offender from the community, although the TC is an open setting in contrast to the closed setting of imprisonment. The TC is highly cost-effective, costing approximately 30 percent to 40 percent of imprisonment or less. Furthermore, imprisonment places the substance abuser in a criminogenic environment where he or she will most likely continue using drugs, receive no treatment or intervention, and be released to the community with the same or worse problems. Despite a consistent body of literature demonstrating that TCs are effective in treating substance abuse and reducing recidivism, one cannot expect that our legislators will wake up and see the light any time soon.