Practice Profile: Incarceration-based Therapeutic Communities for Adults

Evidence Rating for Outcomes

Crime & Delinquency | Multiple crime/offense types

Date: This profile was posted on December 07, 2015

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.

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 individuals. 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 Snapshot
	Literature Coverage Dates	Number of Studies	Number of Study Participants
Meta Analysis 1	1980-2011	30	0
Meta Analysis 2	1980-2011	18	0

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. Participants in the treatment group were residents of therapeutic communities while incarcerated; those 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. Participants in the treatment group were residents of therapeutic communities while incarcerated or under community supervision; those 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.

Date Created: July 17, 2024

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Practice Snapshot

Age: 18+

Gender: Male, Female

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

Setting (Delivery): Correctional

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

Unit of Analysis: Persons

Practice Profile: Incarceration-based Therapeutic Communities for Adults

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Practice Summary

Practice Description

Practice Goals/Target Population

Practice Theory

Practice Components

Meta-Analysis Outcomes

Meta-Analysis Methodology

Cost

Other Information

Evidence-Base (Meta-Analyses Reviewed)

Additional References

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