Transcript Amity in-prison therapeutic community: Five

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), 36-60.
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), 659-679.
Funding from the National Institute on Drug Abuse and the Robert Wood
Johnson Foundation
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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
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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
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Subjects
• 715 inmates enrolled in or on a waiting list for a prison-based
therapeutic community drug treatment program (1993-1995)
• 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
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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
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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)
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Methods: Follow-up Status
Refusal
3.1%
Deported
1.7%
Dead
5.3%
Not located
9.6%
Completed
80.3%
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Calculated from Lowe,
Wexler, & Peters (1998),
Wexler, De Leon,
Kressel, & Peters (1999)
Wexler Melnick, Lowe, &
Peters (1999).
100
80
60
40
36-months
24-months
12-months
20
DESIGN GROUPS
Aftercare
Completers
Aftercare
Dropouts
Prison TC
Completers
Prison TC
Dropouts
Treatment
Exposed
0
Comparison
PERCENTAGE REINCARCERATED
Findings at Years 1, 2, and 3
TREATMENT-EXPOSED GROUPS
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Outcomes for Intent-to-Treat Sample
Variable (% Yes)
Control
(n=235)
Treatment
(n=341)
p
Reincarcerated within 5 years
83.4
75.7
0.02
Used drugs heavily in past year
22.6
24.9
0.51
Held a job in past year
52.3
54.8
0.55
(Chi-square)
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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
87.0
86.2
80.8
41.8
<0.001
Used drugs heavily
in past year
24.7
27.7
19.2
21.5
0.66
Held a job in past
year
40.3
56.0
38.5
72.2
<0.001
(Chi-square)
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Days to 1st Incarceration
1.0
.8
.6
Treatment Status
.4
Af tercare Complete
Af tercare Drop
.2
Prison Complete
Prison Drop
0.0
Control
0
200
400
600
Days to 1st incarceration
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800
1000
Cost Effectiveness
Study Condition
Treatment Cost
Days Incarcerated
During Follow-up
Control
(N=235)
$1,731
626
Prison TC Only
(N=236)
$3,356
634
$15,325
343
$7,041
544
Prison TC + Vista
(N=105)
All Amity Participants
(N=341)
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Cost Effectiveness
Cost-Effectiveness
Comparison
Incremental
Treatment Cost
Incremental Days
Incarcerated
Incremental Cost
Effectiveness
Ratio
Ctrl vs. Prison TC Only
$1,626
-8.26
N/A
Ctrl vs. Prison TC +
Vista
$12,780
287
$45
Ctrl vs. All Amity
Participants
$5,311
81
$65
Prison TC Only vs.
Prison TC + Vista
$11,969
291
$41
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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.
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Thank You
Questions?
ISAP website: uclaisap.org
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