UCLA Integrated Substance Abuse Programs Amity In-Prison Therapeutic Community: Five-Year Outcomes Association of Criminal Justice Research (CA) Sacramento, California March 17, 2005

UCLA Integrated Substance Abuse Programs Prendergast, Michael; Hall, Elizabeth; Wexler, Harry; Melnick, Gerald; & Cao, Yan. (2004). Amity prison-based therapeutic community: Five-year outcomes. Prison Journal, 84(1), McCollister, Kathryn; French, Michael; Prendergast, Michael; Hall, Elizabeth; & Sacks, Stan. (2004). Long-term cost effectiveness of addiction treatment for criminal offenders. Justice Quarterly, 21(3), Funding from the National Institute on Drug Abuse and the Robert Wood Johnson Foundation

UCLA Integrated Substance Abuse Programs Aims To assess long-term post-treatment outcomes of a prison-based TC program To determine differential outcomes within selected subgroups To examine factors that contribute to the long-term recovery of those who did not participate in treatment

UCLA Integrated Substance Abuse Programs Aims To conduct secondary analyses of data previously collected To conduct a cost analysis of the prison TC program and the TC continuing care program

UCLA Integrated Substance Abuse Programs Subjects 715 inmates enrolled in or on a waiting list for a prison-based therapeutic community drug treatment program ( ) Randomly assigned to treatment or comparison group Housed in a Level 3 prison in San Diego Those completing treatment were eligible for TC aftercare at Amity Vista upon release

UCLA Integrated Substance Abuse Programs Subjects Male White 37.8%, Hispanic 30.1%, African American 22.4% Average age at follow up: 38 years (range, 26 to 72) Low educational attainment Primarily users of methamphetamine, heroin, and cocaine Violent: 75% had committed assault, kidnapping, rape, or murder Mean arrests (lifetime) at baseline: 27 Mean incarcerations (lifetime) at baseline: 17 Mean years in prison (lifetime) at baseline: 6

UCLA Integrated Substance Abuse Programs Methods Five-year follow-up interviews : 576 completed (80% of original sample) Face-to-face Many interviews were conducted in jails and prisons Modified NDRI follow-up instrument and DARC’s Natural History instrument Urine samples (31% of completed sample) Hair samples (19% of completed sample)

UCLA Integrated Substance Abuse Programs Methods: Follow-up Status

UCLA Integrated Substance Abuse Programs Findings at Years 1, 2, and 3 Calculated from Lowe, Wexler, & Peters (1998), Wexler, De Leon, Kressel, & Peters (1999) Wexler Melnick, Lowe, & Peters (1999).

UCLA Integrated Substance Abuse Programs Outcomes for Intent-to-Treat Sample Variable (% Yes)Control (n=235) Treatment (n=341) p Reincarcerated within 5 years Used drugs heavily in past year Held a job in past year (Chi-square)

UCLA Integrated Substance Abuse Programs Outcomes for Treatment Subgroups Variable (% Yes)Prison TC Drop (n=77) Prison TC Completer (n=159) Vista Drop (n=26) Vista Completer (n=79 ) p Reincarcerated within 5 years <0.001 Used drugs heavily in past year Held a job in past year <0.001 (Chi-square)

UCLA Integrated Substance Abuse Programs Days to 1st Incarceration

UCLA Integrated Substance Abuse Programs Cost Effectiveness Study Condition Treatment CostDays Incarcerated During Follow-up Control (N=235) $1, Prison TC Only (N=236) $3, Prison TC + Vista (N=105) $15, All Amity Participants (N=341) $7,041544

UCLA Integrated Substance Abuse Programs Cost Effectiveness Cost-Effectiveness Comparison Incremental Treatment Cost Incremental Days Incarcerated Incremental Cost Effectiveness Ratio Ctrl vs. Prison TC Only$1, N/A Ctrl vs. Prison TC + Vista $12,780287$45 Ctrl vs. All Amity Participants $5,31181$65 Prison TC Only vs. Prison TC + Vista $11,969291$41

UCLA Integrated Substance Abuse Programs Summary After five years, reincarceration was high, but Amity participants were significantly less likely to have been returned to prison than comparison subjects. No difference between treatment and comparison groups in drug use and employment. Among treatment subgroups, those who completed Vista TC aftercare performed significantly better on reincarceration and employment measures, but not drug use. Prison treatment plus community treatment is a cost-effective policy for reducing reincarceration.

UCLA Integrated Substance Abuse Programs Thank You Questions? ISAP website: uclaisap.org