July 2006

Grant Results
National Program

Substance Abuse Policy Research Program

SUMMARY

From December 2000 through November 2004, Kathryn E. McCollister, Ph.D., and researchers from the University of Miami compared the costs of in-prison and aftercare substance abuse treatment services for criminal offenders with the savings resulting from fewer days of reincarceration to determine whether such programs are cost effective.

McCollister also worked with colleagues at the University of California at Los Angeles and National Development and Research Institutes.

The project was part of the Robert Wood Johnson Foundation’s (RWJF) national Substance Abuse Policy Research Program (SAPRP) (for more information see Grant Results).

Key Findings
Researchers reported the following findings in a chapter of the book Treatment of Drug Offenders: Policies and Issues and in articles published in Law & Policy, Justice Quarterly and Journal of Quantitative Criminology. See the Bibliography.

* Substance abuse treatment services delivered in criminal justice settings are less expensive than treatment provided in standard, community-based residential settings.
* Participation by criminal offenders in programs that combine in-prison and aftercare substance abuse treatment reduced days of reincarceration and resulted, in most cases, in cost savings.
* Aftercare programs are critical to the success of treatment programs for offenders.

For detailed findings see Findings.

Funding
RWJF supported the project with a grant of $189,133.

See Grant Detail & Contact Information
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THE PROBLEM

More than 80 percent of state and 70 percent of federal inmates reported drug use, not including alcohol, according to a 1999 report by the federal Bureau of Justice Statistics.

While public recognition of the need for substance abuse treatment in correctional institutions has grown, often such programs are poorly implemented and not adequate for addressing the host of problems experienced by substance abusing inmates.

The U.S. Office of National Drug Control Policy estimated that while some form of treatment was available in 90 percent of the correctional facilities examined, only 10 to 20 percent of inmates used these programs.

According to researchers at the University of Miami, a number of studies concluded that providing substance abuse treatment to offenders only while they are incarcerated is not effective in rehabilitating them. These studies showed that offenders receiving in-prison treatment without formal aftercare (continuing treatment after they leave prison) had recidivism and drug relapse rates similar to offenders who did not receive any treatment.

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THE PROJECT

McCollister and colleagues at the University of Miami, the University of California at Los Angeles and National Development and Research Institutes (a New York-based research and educational organization) examined the costs and savings associated with in-prison and aftercare substance abuse treatment.

Two in-prison therapeutic communities and their affiliated aftercare programs served as the study sites. Therapeutic communities are separate settings within prisons where inmates live, work and receive treatment services. The therapeutic process involves using the activities and interactions among residents to create socially positive lifestyles. The study sites were:

* Amity in-prison therapeutic community and Vista aftercare treatment program in California. Researchers analyzed data at one and five years post-release.
* CREST Outreach Center work release therapeutic community and aftercare program for criminal offenders in Delaware. CREST work release included substance abuse treatment services. Researchers analyzed data at 18 months post-release.

See the Appendix for details on study samples and the costs of incarceration used for comparison.

Researchers presented findings at six meetings (including three annual meetings of the American Public Health Association) and at a teleconference organized by RWJF and the Office of State Legislatures entitled Substance Abuse Treatment and Corrections: Prison-Based Treatment and Aftercare. See the Bibliography for details.

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FINDINGS

Researchers reported the following findings in a chapter of the book Treatment of Drug Offenders: Policies and Issues and in articles published in Law & Policy, Justice Quarterly and Journal of Quantitative Criminology (see the Bibliography for details):

* Substance abuse treatment services delivered in criminal justice settings are less expensive than treatment provided in standard, community-based residential settings:
o In-prison treatment programs (including the Amity program in California) cost between $37 and $68 per offender per week.
o Vista aftercare services in California cost $181 per offender per week.
o A modified therapeutic community for mentally ill substance abusers in New York had a weekly cost of $554 (according to a previous study by McCollister and colleagues). (Treatment of Drug Offenders: Policies and Issues)
* Participation by criminal offenders in programs that combine in-prison and aftercare substance abuse treatment reduced days of reincarceration and, in most cases, resulted in cost savings. Participation in aftercare treatment was particularly important in reducing days of reincarceration:
o In California at one year (daily cost of incarceration = $59):
+ The cost per average participant in the California substance abuse treatment program was $4,112, and the average participant had 51 fewer days of reincarceration than those in the control group, resulting in a cost per avoided incarceration day of $81.
+ Participants who attended the Vista aftercare program had 84 fewer days of incarceration than those who only attended in-prison treatment. Since the incremental cost of the aftercare treatment over in-prison treatment was $4,277, each additional avoided incarceration day cost $51.
+ In comparison to people in the control group, participants who attended both in-prison and aftercare treatment programs had 108 fewer incarceration days at a cost of $65 per day. (Law & Policy)
o In California at five years (daily cost of incarceration = $72):
+ The average cost for all participants of the California substance abuse treatment program was $5,311 over the cost for those in the control group (many of whom attended other programs). The average participant had 81 fewer days of incarceration over five years, at a cost of $65 per avoided day of incarceration.
+ Participants who attended the Vista aftercare program had 291 fewer days of incarceration over five years than those who only attended in-prison treatment. Since the five-year incremental cost of the aftercare treatment over in-prison treatment was $11,969, each additional avoided incarceration day cost $41.
+ In comparison to people in the control group, participants who attended both in-prison and aftercare treatment programs had 283 fewer incarceration days over five years at a cost of $48 per day. (Justice Quarterly)
o In Delaware at 18 months (daily cost of incarceration = $57):
+ The average cost for the CREST program was $1,937 and the average participant had 30 fewer days of incarceration than those in the comparison group, with a cost per avoided day of incarceration of $65.
+ Participants who attended the aftercare portion of the program had 49 fewer days of incarceration than those who attended only CREST work release. Since the incremental cost of the aftercare treatment over work release alone was $935, each additional avoided incarceration day cost $19.
+ In contrast to people in the comparison group, the participants who attended both CREST work release and aftercare programs had 62 fewer incarceration days over 18 months at a cost of $41 per day. (Journal of Quantitative Criminology)

More at: http://www.rwjf.org/reports/grr/041070.htm

Alcohol and Drug Abuse Hurts Everyone in the Family

Dependence on alcohol and drugs is our most serious national public health problem. It is prevalent among rich and poor, in all regions of the country, and all ethnic and social groups.

Millions of Americans misuse or are dependent on alcohol or drugs. Most of them have families who suffer the consequences, often serious, of living with this illness. If there is alcohol or drug dependence in your family, remember you are not alone.

Most individuals who abuse alcohol or drugs have jobs and are productive members of society creating a false hope in the family that “it’s not that bad.”

The problem is that addiction tends to worsen over time, hurting both the addicted person and all the family members. It is especially damaging to young children and adolescents.

People with this illness really may believe that they drink normally or that “everyone” takes drugs. These false beliefs are called denial; this denial is a part of the illness.
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It Doesn’t Have to be That Way
Drug or alcohol dependence disorders are medical conditions that can be effectively treated. Millions of Americans and their families are in healthy recovery from this disease.

If someone close to you misuses alcohol or drugs, the first step is to be honest about the problem and to seek help for yourself, your family, and your loved one.

Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Stopping the alcohol or drug use is the first step to recovery, and most people need help to stop. Often a person with alcohol or drug dependence will need treatment provided by professionals just as with other diseases. Your doctor may be able to guide you.

best families “What is Substance Abuse Treatment? A Booklet for Families” – was written especially for family members and is available through SAMHSA’s National Helpline 1-800-662-HELP.
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Family Intervention Can Start the Healing
Getting a loved one to agree to accept help, and finding support services for all family members are the first steps toward healing for the addicted person and the entire family.

When an addicted person is reluctant to seek help, sometimes family members, friends, and associates come together out of concern and love, to confront the problem drinker. They strongly urge the person to enter treatment and list the serious consequences of not doing so, such as family breakup or job loss.

This is called “intervention.” When carefully prepared and done with the guidance of a competent, trained specialist, the family, friends and associates are usually able to convince their loved one – in a firm and loving manner – that the only choice is to accept help and begin the road to recovery.

People with alcohol or drug dependence problems can and do recover. Intervention is often the first step.
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Children Need Help Too! best families
Children in families experiencing alcohol or drug abuse need attention, guidance and support. They may be growing up in homes in which the problems are either denied or covered up.

These children need to have their experiences validated. They also need safe, reliable adults in whom to confide and who will support them, reassure them, and provide them with appropriate help for their age. They need to have fun and just be kids.

Families with alcohol and drug problems usually have high levels of stress and confusion. High stress family environments are a risk factor for early and dangerous substance use, as well as mental and physical health problems.

It is important to talk honestly with children about what is happening in the family and to help them express their concerns and feelings. Children need to trust the adults in their lives and to believe that they will support them.

Children living with alcohol or drug abuse in the family can benefit from participating in educational support groups in their school student assistance programs. Those age 11 and older can join Alateen groups, which meet in community settings and provide healthy connections with others coping with similar issues. Being associated with the activities of a faith community can also help.