A Few Sobering Reminders About Correctional Treatment

Substance Abuse Treatment with Correctional Clients: Practical Implications for Institutional and Community Settings

Barbara Sims, PhD (ed.); The Haworth Press, Binghamton, N.Y., (800) 429-6784; 2005; ISBN: 0-7890-2127-7; softcover; 257 pages

For those addiction professionals who might have come to believe that the treatment field has ideal tools for reaching the addicted offender, Substance Abuse Treatment with Correctional Clients frequently serves as something of a reality check. While by no means does it set out to present a pessimistic view of treatment in the justice system, the book offers plenty of reminders of the many obstacles to working successfully in these settings.

The analysis begins with a basic overview of the prevalence of substance-using behavior among offenders, but quickly moves to a discussion of this population's prospects for treatment success once in the justice system's control. A chapter on predictors of success and failure in correctional programs emphasizes how factors such as past history of mental health problems, negative self-concept, and inadequate postrelease planning can impede good outcomes for the correctional client.

The book's chapters on institutional treatment, focusing on use of the therapeutic community (TC) model, offer perhaps the best evidence that the reality doesn't always match the hype in the national discussion of treatment in the justice system. One study cited in this section of the book looks at reasons why nearly one-third of the first 800 admissions in the Arkansas Department of Correction's TC program had to be removed from treatment—a percentage well in excess of treatment dropout rates in federal prison treatment programs. The study found that factors such as living alone prior to incarceration were strongly linked to having problems adjusting to the group dynamic that is so critical to the TC's operation.

A separate study that involved site visits to the Arkansas program in 1999 and 2001 uncovered several problems through observations and interviews with inmates. Factors such as establishing an inmate hierarchy in which some inmates were allowed to have a measure of control over others caused tension. One inmate said, “One thing I don't understand is placing one convict over another convict. It is a bunch of criminals picking at each other and we're being taught by [inmates who have committed serious crimes]. I can't look past that.” Other inmates faced long wait times for admission into the program, despite the fact that several open slots existed.

The study led to several recommended changes in the Arkansas program, including modifying the influence of the community hierarchy, increasing staffing levels, and improving rule application consistency.

While some may believe that the TC suits the correctional setting perfectly, researchers at Boise State University who looked at a program at the South Idaho Correctional Institution make a compelling point here about an inherent conflict that must be addressed. They state that “the operation of the therapeutic community requires trust, yet the operation of a prison and the security concerns that prevail with inmate populations necessarily require distrust. Such different perspectives may never be completely reconcilable.”

Still, it is important to emphasize that in the discussion of TCs and a subsequent review of drug court programs, the book does not convey a message of hopelessness. In fact, the various chapter authors all seem to see these innovative strategies as necessary alternatives to a punishment-focused approach to addicted offenders. However, the book's emphasis on actual observation of these programs at work gives professionals invaluable information on how they can go beyond the rhetoric about justice system strategies, and deliver services that are research-based and standardized for the offender population.