438836

12438836Bahr et al.The Prison Journal

© 2012 SAGE Publications

Reprints and permission:

TPJ92210.1177/00328855

sagepub.com/journalsPermissions.nav

The Prison Journal

What Works in 92(2) 155­–174

© 2012 SAGE Publications
Reprints and permission:
Substance Abuse sagepub.com/journalsPermissions.nav
DOI: 10.1177/0032885512438836
Treatment Programs http://tpj.sagepub.com

for Offenders?

Stephen J. Bahr1, Amber L. Masters2, and

Bryan M.Taylor3

Abstract
The purpose of this article is to review current empirical research on the
effectiveness of drug treatment programs, particularly those for prisoners,
parolees, and probationers. The authors reviewed empirical research pub-
lished after the year 2000 that they classified as Level 3 or higher on the
Maryland Scale. Participants in cognitive-behavioral therapy (CBT), thera-
peutic communities, and drug courts had lower rates of drug use and crime
than comparable individuals who did not receive treatment. Several differ-
ent types of pharmacological treatments were associated with a reduced
frequency of drug use. Those who received contingency management tend-
ed to use drugs less frequently, particularly if they also received cognitive-
behavioral therapy. Finally, researchers reported that drug use and crime
were lower among individuals whose treatment was followed by an after-
care program. Effective treatment programs tend to (a) focus on high-risk
offenders, (b) provide strong inducements to receive treatment, (c) include
several different types of interventions simultaneously, (d) provide intensive
treatment, and (e) include an aftercare component.

1
Professor of Sociology, Brigham Young University, Provo, UT, USA
2
Undergraduate student, Department of Sociology, Brigham Young University, Provo, UT, USA
3
Graduate student, Master of Public Policy, Brigham Young University, Provo, UT, USA

Corresponding Author:
Stephen J. Bahr, Professor of Sociology, 2031 JFSB, Brigham Young University, Provo, UT 84602,
USA
Email: stephen_bahr@byu.edu
156 The Prison Journal 92(2)

Keywords
substance abuse, treatment, effectiveness, prisoners

One of the major social problems in the United States is the prevalence of
substance abuse. Eight percent of Americans aged 12 and older used an illicit
drug during the past month—9% of youths aged 12 to 17 and 20% of those
aged 18 to 25 (Substance Abuse and Mental Health Services Administration,
2009). Among prison inmates in the United States, 73% used drugs regularly
prior to their incarceration (Petersilia, 2005). At the time inmates commit-
ted their latest offense, 50% were under the influence of alcohol or drugs
(Karberg & James, 2005). From 1975 to 2000, there was a 400% increase in
the U.S. incarceration rate, and this was due primarily to a rapid growth in
incarceration for drug offenses (Blumstein & Beck, 2005).
About 95% of all inmates were released to reintegrate into communities
(Petersilia, 2005). During 2008, more than 713,000 inmates were released
from prison or an average of almost 2,000 per day (Sabol & Couture, 2008).
This is more than 4 times the number released 25 years ago. Large numbers
of those released from prison were rearrested and returned to prison, often
because of their inability to refrain from substance abuse (Blumstein & Beck,
2005).
In the past decade, there have been a number of assessments of “what
works” in existing crime prevention, correctional, and reentry programs
(MacKenzie, 2000; Seiter & Kadela, 2003; Sherman, Farrington, Welsh, &
MacKenzie, 2002; Wormwith et al., 2007). However, there has not been a
recent review of the effectiveness of drug treatment programs for offenders.
The purpose of this article is to review and synthesize the current empirical
research on the effectiveness of drug treatment programs, particularly those
used to treat offenders.

Selection Bias
It has been observed in numerous research studies that those who receive
drug treatment tend to have lower rates of drug use than individuals who do
not receive treatment. However, in many of the studies, selection bias may
account for the differences. For example, researchers often compare those
who completed a drug treatment program with a control group. It is difficult
to know whether the lower drug use of the treatment group is due to the treat-
ment or to pretreatment characteristics such as motivation, previous criminal
history, or the extent of drug dependence. Researchers have confirmed that
Bahr et al. 157

those who drop out of treatment programs tend to have more serious criminal
histories and fewer ties to society than those who complete programs
(Huebner & Cobbina, 2007). In this review, we pay particular attention to
how researchers controlled for selection bias.

Method
In this article we review peer-reviewed journal empirical research published
since 2000 that we classified as Level 3 or higher on the Maryland Scale
(Sherman et al., 2002). We searched social and behavioral science databases
using the terms “drug abuse,” “drug use,” “substance use,” or “drug addic-
tion” paired with “treatment,” “treatment outcomes,” or “treatment effective-
ness.” In addition, we examined the bibliographies of the articles we
identified. Finally, for the years 2005 to 2009, we examined the table of
contents of journals that published articles on drug use, abuse, dependence,
and treatment.

Effectiveness of Drug Treatment Programs

The consensus from previous evaluations is that drug treatment programs
can be modestly effective for some people (Adrian, 2001; Dutra et al., 2008;
Hepburn, 2005; Hubbard, Simpson, & Woody, 2009). We turn now to a
review of the research on several commonly used types of treatment pro-
grams administered to criminal offenders.

Cognitive-Behavioral Therapy
Cognitive-behavioral therapy (CBT) assumes that clients have maladaptive
thinking patterns that need to be changed. CBT focuses on restructuring
attitudes and thoughts and on developing interpersonal skills (Milkman &
Wanberg, 2007). Clients are actively involved in activities and usually have
homework assignments to reinforce and develop skills (Lowenkamp,
Hubbard, Makarios, & Latessa, 2009).
We located seven empirical evaluations of CBT drug programs since the
year 2000 that were at least Level 3 on the Maryland Scale. Two of the stud-
ies were evaluations of intensive prison residential programs that lasted at
least 6 months. The first examined 760 persons from 20 prisons who received
CBT. During 6 months following release, those who received CBT were less
likely to use drugs or be rearrested than comparison group participants
(Pelissier et al., 2001).
158 The Prison Journal 92(2)

The second program was the Forever Free program, a CBT substance
abuse treatment program for women prisoners. One year after release, the
101 women who received treatment had significantly less drug use and fewer
arrests than the 79 women in the comparison group (Hall, Prendergast,
Wellisch, Patten, & Cao, 2004).
We located five studies that evaluated CBT as a short-term treatment
method for substance dependence. These were programs that lasted from 8 to
16 weeks, with tracking from 6 months to a year following treatment comple-
tion. All reported that CBT programs were effective in helping participants
reduce drug use during follow-up periods of 6 months to a year (Budney,
Moore, Rocha, & Higgins, 2006; Carroll et al., 2006; Easton et al., 2007;
Kadden, Litt, Kebela-Cormier, & Petry, 2007; Rawson et al., 2006). In addi-
tion, two recent meta-analyses confirmed that CBT is an effective treatment
for substance dependence (Dutra et al., 2008; Magill & Ray, 2009).

Contingency Management
A commonly used treatment for drug dependence is contingency manage-
ment (CM) in which various types of rewards are given to reinforce positive
behavior. A reward is given if a client receives a negative urine sample,
attends treatment, or fulfills other obligations. A reward can be almost any-
thing, but common rewards are vouchers, prizes, and medication.
We identified 12 recent studies at Level 3 or higher on the Maryland Scale
that evaluated the effectiveness of drug treatments using CM. All 12 reported
that clients who received vouchers or other rewards were more likely to be
abstinent than clients who did not receive vouchers. CM was effective in
treating a variety of drugs, including marijuana (Budney et al., 2006; Carroll
et al., 2006; Kadden et al., 2007), methamphetamines (Rawson et al., 2006;
Roll et al., 2006), cocaine (Budney et al., 2006; Epstein et al., 2009; Groβ,
Marsch, Badger, & Bickel, 2006; Higgins et al., 2006; Olmstead & Petry,
2009; Petry & Martin, 2002; Petry et al., 2005; Prendergast, Podus, Finney,
Greenwell, & Roll, 2006), and opiates (Epstein et al., 2009; Groβ et al., 2006;
Higgins et al., 2006; Olmstead & Petry, 2009; Petry & Martin, 2002; Petry
et al., 2005; Prendergast et al., 2006). However, a limitation of CM is that
when the rewards are discontinued the rates of abstinence tend to decrease
(Hall, Prendergast, Roll, & Wards, 2009; Prendergast et al., 2006).
When researchers compared the effectiveness of CBT and CM, the two
methods were similar in overall effectiveness (Rawson et al., 2006). Together
CM and CBT were more effective than either was alone (Budney et al., 2006;
Carroll et al., 2006; Dutra et al., 2008; Kadden et al., 2007).
Bahr et al. 159

Therapeutic Communities
A therapeutic community is a highly structured residence program where
clients are organized into groups and leaders are chosen from within the
group. The purpose is to give governance and accountability to the clients
themselves. Because of the responsibility of the clients for each other, peer
pressure within the group helps constrain individuals and encourage compli-
ance with rules (De Leon, 2000). Individuals in therapeutic communities
receive a variety of treatment modalities, including cognitive therapy, indi-
vidual counseling, group counseling, and 12-step programs.
The therapeutic community is a widely used treatment modality both
within and outside correctional facilities. In reviews of research, Sherman
et al. (2002) and Seiter and Kadela (2003) identified three major research
projects that evaluated therapeutic community programs in prison: (1) Wexler
and his colleagues evaluated therapeutic communities in California (Wexler,
De Leon, Thomas, Kressell, & Peters, 1999; Wexler, Falkin, & Lipton, 1990;
Wexler, Melnick, Lowe, & Peters, 1999); (2) Inciardi, Martin, and their col-
leagues evaluated the Key-Crest therapeutic community in Delaware
(Inciardi, Martin, Butzin, Hooper, & Harrison, 1997; Martin, Butzin, &
Inciardi, 1995; Martin, Butzin, Saum, & Inciardi, 1999); (3) Knight and col-
leagues assessed a therapeutic community in Texas (Hiller, Knight, &
Simpson, 1999; Knight, Simpson, & Hiller, 1999) In all three projects, indi-
viduals who were involved in prison therapeutic communities were more
likely to remain drug and arrest free than comparable individuals who were
not treated in a therapeutic community.
From 2000 to 2009, we discovered eight additional studies on therapeutic
communities that met our criteria. Those studies replicated previous findings
and extended our knowledge in several ways.
First, 5 years after completion, those who participated in the Delaware
program were less likely to have used drugs or have a new arrest. Participants
who dropped out of the program were more likely to remain drug free than a
comparison group. Those who participated in aftercare had less recidivism
and higher levels of employment than individuals who did not receive after-
care (Inciardi, Martin, & Butzin, 2004).
Second, the 5-year evaluation of the California therapeutic community
produced similar results, although the treatment effect diminished for those
who did not receive aftercare (Prendergast, Hall, Wexler, Melnick, & Cao,
2004). Among high-risk individuals, those who participated in the therapeu-
tic community had lower recidivism than individuals who were not treated.
However, among low-risk individuals there was no difference between the
treated and untreated individuals (Wexler, Melnick, & Cao, 2004).
160 The Prison Journal 92(2)

Third, two new evaluations of therapeutic communities were completed.

Two years after release, those who participated in five prison therapeutic
communities in Pennsylvania had lower rearrest and reincarceration rates
than a no-treatment group (Welsh, 2007). A study of 1,193 federal prisoners
revealed that prisoners in therapeutic communities had lower rates of drug
relapse and recidivism than two untreated groups (Rhodes et al., 2001). The
cumulative evidence is that therapeutic communities can be effective in
reducing the risk of drug relapse and rearrest, particularly among high-risk
individuals and when followed by aftercare programs.

Drug Courts
A drug court is a specialized program that is designed to use the power of the
court to encourage individuals to receive treatment and decrease drug use.
Specific procedures vary across drug courts although most combine drug
treatment with judicial monitoring, drug testing, and intensive supervision
(Carey & Finigan, 2006; Giacomazzi & Bell, 2007; Sanford & Arrigo, 2005;
Wiseman, 2005).
Typically, individuals who participate in a drug court are required to plead
guilty to their charges, but the charges are held in abeyance as long as they
comply with the requirements of the court. All participants are required to
take a urinalysis test regularly and attend all components of their treatment
plans. If they comply with treatment requirements and successfully graduate
from drug court, their charges are dropped and expunged from their record. If
they do not, the judge may sentence them to jail or prison since they previ-
ously pled guilty (Cooper, 2003; Jensen & Mosher, 2005-2006; Turner et al.,
2002).
A review of 27 drug court evaluations conducted from 1993 to 2002
revealed that drug courts can be effective in helping offenders reduce their
criminal activity (MacKenzie, 2006). We identified 14 evaluations of drug
courts from 2000 to 2009 that we judged to be at least Level 3 on the Maryland
Scale. Ten were new studies that were not available when MacKenzie con-
ducted her review.
In a series of evaluations of the Baltimore City Drug Treatment Court,
participants tended to have less drug use and crime than nonparticipants
(Banks & Gottfredson, 2003, 2004; Gottfredson & Exum, 2002; Gottfredson,
Kearly, Najaka, & Rocha, 2005; Gottfredson, Najaka, & Kearly, 2003).
Particularly important was the fact that they randomized participants into
treatment and control groups and followed them for 3 years (Gottfredson
et al., 2005). Evaluations of drug courts in eight other states (Florida, Idaho,
Bahr et al. 161

Missouri, Nebraska, Nevada, Ohio, Oregon, and Pennsylvania) and Australia

provided additional evidence of the effectiveness of drug courts (Brewster,
2001; Goldkamp, White, & Robinson, 2001; Listwan, Sundt, Holsinger, &
Latessa, 2003; Shaffer, Hartman, & Listwan, 2009; Spohn, Piper, Martin, &
Frenzel, 2001; Truitt et al., 2003; Weatherburn, Jones, Snowball, & Hua,
2008). However, in two studies in Las Vegas and California there were no
differences between those who did and did not participate in a drug court
(Miethe, Lu, & Reese, 2000; Wolfe, Guydish, & Termondt, 2002).
Overall, the evidence indicates that if implemented well, drug courts can
be effective in helping offenders reduce drug use and crime. The success of
drug courts appears to be due to the combination of judicial oversight, intense
supervision, drug testing, and rehabilitative services (Fischer, Geiger, &
Hughes, 2007; Giacomazzi & Bell, 2007; Jensen & Mosher, 2005-2006).

Pharmacological Treatment
During the past two decades, there have been significant developments in the
pharmacological treatment of drug and alcohol abuse. First, a drug has been
used as a substitute for a more harmful drug. These are classified as agonists
because they induce a full or partial pharmacological response. An example
of this type of treatment is methadone, which is used to treat heroin addic-
tion. Second, medications are used to counteract the effects of another drug.
These are termed antagonists and may reduce cravings (O’Brien, 1997). In
this section, we review evidence relevant to the effectiveness of several phar-
macological treatments for drug dependence.
Topiramate. Although originally used in the treatment of epileptic seizures,
topiramate has been evaluated as a possible treatment of alcohol dependence
because it tends to decrease the release of dopamine in the midbrain after
alcohol intake (Johnson et al., 2007). In a comparison of topiramate and a
placebo, those on topiramate had fewer drinks per day, fewer heavy drinking
days, and more days abstinent (Baltieri, Daro, Ribeiro, & de Andrade, 2008;
Johnson et al., 2003, 2007). Those taking topiramate also showed an increase
in safe drinking periods compared to those on a placebo (Ma, Ait-Daoud, &
Johnson, 2006).
Buprenorphine. In January of 2003, buprenorphine became available for
the treatment of opiate dependence (Colameco, Armando, & Trotz, 2005). In
a 28-day outpatient treatment with either buprenorphine or clonidine, those
receiving buprenorphine had significantly higher retention in treatment and
higher percentages of opiate abstinence (Marsch et al., 2005). In a compari-
son of 126 heroin dependent patients receiving detoxification and drug
162 The Prison Journal 92(2)

counseling, those treated with buprenorphine had a longer time to first heroin
use and more abstinent days than those using a placebo (Schottenfeld, Cha-
warski, & Mazlan, 2008). Another study examined the impact of psycho-
therapy and buprenorphine treatment on outpatients dependent on both
cocaine and heroin. Those who received both psychotherapy and buprenor-
phine had lower rates of drug use (Montoya et al., 2005).
Groβ et al. evaluated three randomly assigned treatment groups. The first
group received standard treatment including buprenorphine, regardless of
their urinalysis results. The second group not only received standard treat-
ment and buprenorphine but also earned vouchers for each negative urine
sample on an escalating schedule. The third group received half of their pre-
scribed buprenorphine dose if they attended the clinic and the other half if
their urinalysis was negative. Those in the medication contingent (third)
group had more weeks of continuous abstinence from opiates and cocaine
than those in the voucher group (Groβ et al., 2006).
Naltrexone. Naltrexone is an opioid antagonist that has been used to treat
individuals dependent on opioids or cocaine. The research on naltrexone has
been mixed. A study of naltrexone and alcohol dependence revealed that nal-
trexone-treated participants tended to have lower relapse rates, consume
fewer drinks, and have slower progression to drinking (Anton, Drobes, Voro-
nin, Durazo-Avizu, & Moak, 2004; Guardia et al., 2002; Morley et al., 2006).
However, other research indicates that naltrexone was not as effective as
topiramate or buprenorphine in helping individuals reduce their dependence
(Baltieri et al., 2008; Schottenfeld et al., 2008).
Methadone. Methadone maintenance is a specific type of pharmacological
treatment in which heroin dependence is replaced with methadone depen-
dence. The objective is to control the dosage and enable the addicts to live
relatively normal lives. Although there have been a number of studies of
methadone maintenance, we located only two which were Level 3 or higher
on the Maryland Scale. The first randomly assigned 197 prison inmates to
one of three conditions: (1) counseling only, (2) counseling plus methadone
maintenance at release, and (3) counseling and methadone maintenance in
prison. A follow-up 90 days after release revealed that the counseling + meth-
adone group had more frequent attendance at drug treatment, less heroin use,
and less reincarceration than the counseling-only group (Kinlock, Gordon,
Schwartz, & O’Grady, 2008). The second study tested a combination of
methadone maintenance and CM on heroin and cocaine use (Epstein et al.,
2009). Using two different levels of methadone administration, they found
that the higher dose increased heroin abstinence but not cocaine abstinence.
CM tended to reduce the use of both heroin and cocaine and a higher-value
Bahr et al. 163

incentive and a higher dose of methadone resulted in greater abstinence

(Epstein et al., 2009).
In summary, the evidence indicates that drugs can be effective supple-
ments in treating alcohol and drug dependence, particularly topiramate and
buprenorphine. Pharmacological treatments appear to be particularly useful
when paired with therapy or CM.

Boot Camps
Boot camps were designed as a military-type regimen to rehabilitate offend-
ers through strict discipline and swift punishment for rule infractions. They
emphasize vigorous physical activity, manual labor, and discipline. The goal
is to help offenders learn respect for authority and develop skills that will
enable them to desist from crime.
Research has been consistent in showing that boot camps do not reduce
recidivism among juvenile or adult offenders (Wilson & MacKenzie, 2005).
We identified 7 studies from 2000 to 2009 that evaluated the effectiveness of
boot camps. Similar to previous research, no differences were found between
boot camp participants and control groups (Bottcher & Ezell, 2005;
Stinchcomb & Terry, 2001). However, in one study boot camp participants
with a previous record had lower recidivism than controls (Kempinen &
Kurlychek, 2003). In three other studies, boot camp arrestees were less likely
to be convicted (Steiner & Giacomazzi, 2007), less likely to be recommitted
(Wells, Minor, Angel, & Stearman, 2006), or if reincarcerated, spent less time
in prison (Duwe & Kerschner, 2008). These findings suggest that arrestees
who have been to boot camps may commit less serious offenses than arrest-
ees who have not been to boot camps. Finally, boot camp participants who
received a 90-day aftercare were significantly less likely to be rearrested 2
years after completion—22% for the aftercare group compared to 33%
among those who did not receive aftercare (Kurlychek & Kempinen, 2006).
In summary, the evidence indicates that boot camps might reduce recidivism
among high-risk participants or if the boot camp is followed by aftercare.

Twelve-Step Programs
Twelve-step programs are among the oldest and most well-known drug and
alcohol treatment programs. The first 12-step program began in the mid-
1930s, and the programs have grown to become one of the most widely used
drug treatment approaches (Alcholics Anonymous World Services, 1957,
1976). It is estimated that 3% of Americans will attend some type of 12-step
164 The Prison Journal 92(2)

program during their lives (Fiorentine, 1999). Examples of 12-step programs

are Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and Cocaine
Anonymous (CA). In addition, 12-step principles have been used as part of
many other treatment programs.
Twelve-step programs assume that substance dependence is a life-long
disease that can be managed but not cured. The program is based on 12 steps
of recovery that individuals strive to attain while regularly reporting their
progress and struggles. Key components of 12-step programs are (a) recog-
nizing that you will always be an addict, (b) weekly or biweekly meetings
with a nonprofessional support group of individuals with similar problems,
(c) recognizing and relying on a higher power, (d) performing service to
others, and (e) group and individual counseling sessions (Foundation, 1987;
Schneider, 2006).
Although 12-step programs are widely used, there has been relatively little
systematic research evaluating their effectiveness. Selection bias is a major
limitation, as only about half of AA participants make it past 3 months
(Fiorentine, 1999). Similar to other substance abuse programs, dropouts tend
to have higher rates of relapse and criminal recidivism (Schneider, 2006).
We discovered only five recent studies that met Level 3 on the Maryland
Scale. Fiorentine (1999) found that those who participated in a 12-step pro-
gram were more likely to be abstinent from both alcohol and other drugs. On
the other hand, Zanis et al. observed that 12-step participation did not reduce
recidivism. Parolees treated in a 12-step program were not less likely than
untreated parolees to be reconvicted of a new offense within 24 months of
release (Zanis et al., 2003). In a comparison of (a) 12-step + CM, (b) CBT, or
(c) CBT + CM, 12-step participants had higher levels of marijuana use than
those receiving the other treatments (Carroll et al., 2006). In a study of AA as
a supplement to alcohol couples in behavioral therapy, there was no addi-
tional benefit to combining AA attendance with behavioral therapy (McCrady,
Epstein, & Hirsch, 1999). Finally, a comparison of CBT, motivational
enhancement therapy, and Twelve Step Facilitation (TSF) on drinks per day
and the number of days abstinent over 3 years revealed no difference among
the three treatments (Babor & Del Boca, 2003). Overall, the evidence sug-
gests that 12-step programs are not as effective as other treatments in reduc-
ing drug use and recidivism.

Summary, Discussion, and Conclusion

In summary, there is evidence that drug courts, therapeutic communities,
cognitive-behavioral treatment, CM, and pharmacological treatment can be
Bahr et al. 165

effective in helping individuals decrease their drug use and desist from
criminal activity. Effective treatment programs tend to (a) focus on high-risk
offenders, (b) provide strong inducements to receive treatment, (c) include
several different types of interventions simultaneously, (d) provide intensive
treatment, and (e) include an aftercare component.
Research demonstrated that aftercare increased the impact of both thera-
peutic communities and boot camps. The findings on boot camps were par-
ticularly surprising given the fact that previous research had found that boot
camps were not effective.
Another important issue is whether or not mandated treatment is effective.
The clients of drug courts often are coerced in that they must accept treatment
in the drug court or face prison time. Since retention is important for drug
treatment success, strong inducements to continue treatment would appear to
be important. Recent research confirms that legally mandating treatment
tends to lower dropout rates and reduce illicit drug use and criminal offending
(Kelly, Finney, & Moos, 2005; McSweeney, Stevens, Hunt, & Turnbill, 2007;
Perron & Bright, 2008; Young & Belenko, 2002).
A final issue is whether individuals can desist from drug abuse without
treatment. Although spontaneous remission is not uncommon, the evidence
indicates that treatment can be an effective tool in helping many individuals
reduce their drug use (Price, Risk, & Spitznagel, 2001).
Several existing theories of change are useful in interpreting and applying
these results. Social learning and social control theories are consistent with
much of the research we reviewed (Agnew, 2005; Gottfredson & Hirschi,
1990; Hirschi, 1969). The findings illustrate that learning and reinforcement
are useful change tools along with attempts to develop appropriate bonds to
individuals and groups that do not abuse drugs.
Another useful theoretical perspective is to view drug addiction as a
chronic brain disease. From this perspective drug abuse may produce changes
in the structure and functioning of the brain that are long lasting and difficult
to modify. These changes may decrease the ability of people to control their
drug use (Leshner, 1997; Powledge, 1999).
Viewing drug abuse as a brain disease has a number of implications for
treatment. First, if individuals have a disease that they no longer control, then
they need treatment rather than criminal sanctions. Second, the focus may
need to shift from curing the disease to managing it. Chronic diseases are not
cured after initial treatment but require long-term management and ongoing
treatment. Third, treatments may need to include pharmacological as well as
behavioral methods. The pharmacological research demonstrates the useful-
ness of this perspective and that drug therapies can be an effective supple-
ment to other types of treatment.
166 The Prison Journal 92(2)

After reviewing the empirical research, we recommend the following.

First, the use of therapeutic communities should be expanded for prisoners
and others in residential settings. Second, the use of drug courts should be
expanded for offenders on probation and in the community. Given the costs
of incarceration and recidivism, the expense of expanding therapeutic com-
munities and drug courts would be offset by reductions in incarceration,
crime, and substance dependence. Within therapeutic communities and drug
courts, cognitive behavioral, CM, and pharmacological treatments should be
made readily available.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The authors disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This research was supported by the
Department of Sociology and the College of Family, Home and Social Sciences of
Brigham Young University.

References
Adrian, M. (2001). Do treatments and other interventions work? Some critical issues.
Substance Use & Misuse, 36(13), 1759-1780.
Agnew, R. (2005). Why do criminal offend? A general theory of crime and delin-
quency. Los Angeles, CA: Roxbury.
Alcholics Anonymous World Services, I. (1976). Alcoholics Anonymous: The story
of how many thousands of men and women have recovered from alcoholism (3rd
ed.). New York, NY: Author.
Alcoholics Anonymous World Services, I. (1957). Alcoholics Anonymous comes of
age: A brief history of A.A. New York, NY: Author.
Anton, R. F., Drobes, D. J., Voronin, K., Durazo-Avizu, R., & Moak, D. (2004). Naltrex-
one effects on alcohol concumption in a clinical laboratory paradigm: Temporal
effects of drinking. Psychopharmacology, 173, 32-40.
Babor, T. F., & Del Boca, F. K. (Eds.). (2003). Treatment matching in alcoholism.
Cambridge, UK: Cambridge University Press.
Baltieri, D. A., Daro, F. R., Ribeiro, P. L., & de Andrade, A. G. (2008). Comparing
topmiramate with naltrexone in the treatment of alcohol dependence. Addiction,
103, 2035-2044.
Banks, D., & Gottfredson, D. C. (2003). The effects of drug treatment and supervi-
sion on time to rearrest among drug treatment court participants. Journal of Drug
Issues, 33(2), 385-412.
Bahr et al. 167

Banks, D., & Gottfredson, D. C. (2004). Participation in drug treatment court and time
to rearrest. Justice Quarterly, 21(3), 638-658.
Blumstein, A., & Beck, A. J. (2005). Reentry as a transient state between liberty
and recommitment. In J. Travis & C. Visher (Ed.), Prison reentry and crime in
America (pp. 50-79). New York, NY: Cambridge University Press.
Bottcher, J., & Ezell, M. E. (2005). Examining the effectiveness of boot camps:
A randomized experiment with a long-term follow up. Journal of Researach in
Crime and Delinquency, 42(3), 309-332.
Brewster, M. P. (2001). An evaluation of the Chester County (PA) drug court program.
Journal of Drug Issues, 31(1), 177-206.
Budney, A. J., Moore, B. A., Rocha, H. L., & Higgins, S. T. (2006). Clinical trial of
abstinence-based vouchers and cognitive-behavioral therapy for cannabis depen-
dence. Journal of consulting and Clinical Psychology, 74(2), 307-316.
Carey, S. M., & Finigan, M. W. (2006). Drug courts: The second decade (NCJ211081).
Washington, DC: National Institute of Justice, Office of Justice Programs, U.S.
Department of Justice.
Carroll, K. M., Easton, C. J., Nich, C., Hunkele, K. A., Neavins, T. M., Sinha, R., . . .
Rounsaville, B. J. (2006). The use of contingency management and motivational/
skills-building therapy to treat young adults with marijuana dependence. Journal
of Consulting and Clinical Psychology, 74, 955-966.
Colameco, S., Armando, J., & Trotz, C. (2005). Opiate dependence treatment with
buprenorphine: One year’s experience in a family practice residency setting.
Journal of Addictive Diseases, 24(2), 25-32.
Cooper, C. S. (2003). Drug courts: Current issues and future perspectives. Substance
Use & Misuse, 38(11), 1671-1711.
De Leon, G. (2000). The therpeutic community: Theor, model, and method. New
York, NY: Springer.
Dutra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., & Otto, M.
W. (2008). A meta-analytic review of psychosocial interventions for substance use
disorders. American Journal of Psychiatry, 165, 179-187.
Duwe, G., & Kerschner, D. (2008). Removing a nail from the boot camp coffin: An
outcome evaluation of Minnesota’s Challenge Incarceration Program. Crime &
Delinquency, 54(4), 614-643.
Easton, C. J., Mandel, D. L., Hunkele, K. A., Nich, C., Rounsaville, B. J., & Car-
roll, K. M. (2007). A cognitive behavioral therapy for alcohol-dependent domestic
violence affenders: An integrated substance abuse-domestic violence treatment
approach. American Journal on Addictions, 16, 24-31.
Epstein, D. H., Schmittner, J., Umbricht, A., Schroeder, J., R., Moolchan, E. T., &
Preston, K. L. (2009). Promoting abstinence from cocaine and heroin with a meth-
oadone dose increase and a novel contingency. Drug and Alcohol Dependence,
101, 92-100.
168 The Prison Journal 92(2)

Fiorentine, R. (1999). After drug treatment: Are 12-step programs effective in main-
taining abstinence? American Journal of Drug and Alcohol Abuse, 25(1), 93-116.
Fischer, M., Geiger, B., & Hughes, M. E. (2007). Femal recidivists speak about their
experience in drug court while engaging in appreciative inquiry. International
Journal of Offender Therapy and Comparative Criminology, 51(6), 703-722.
Foundation, H. (1987). The twelve steps of Alcoholics Anonymous. New York, NY:
Harper/Hazelden.
Giacomazzi, A. L., & Bell, V. (2007). Drug court program monitoring: Lessons
learned about program implementation and research methodology. Criminal Justice
Policy Review, 18(3), 294-312.
Goldkamp, J. S., White, M. D., & Robinson, J. B. (2001). Do drug courts work?
Getting inside the drug court black box. Journal of Drug Issues, 31(1), 27-72.
Gottfredson, D. C., & Exum, M. L. Y. (2002). The Baltimore City drug treatment
court: One-year results from a randomized study. Journal of Researach in Crime
and Delinquency, 39(3), 337-356.
Gottfredson, M. R., & Hirschi, T. (1990). A general theory of crime. Stanford, CA:
Stanford University Press.
Gottfredson, D. C., Kearly, B. W., Najaka, S. S., & Rocha, C. M. (2005). The Bal-
timore City drug treatment court: 3-year self-report outcome study. Evaluation
Review, 29(1), 42-64.
Gottfredson, D. C., Najaka, S. S., & Kearly, B. (2003). Effectiveness of drug treat-
ment courts: Evidence from a randomized trial. Criminology and Public Policy,
2(2), 171-196.
Groβ, A., Marsch, L. A., Badger, G. J., & Bickel, W. K. (2006). A comparison between
low-magnitude voucher and buprenorphine medication contingencies in promot-
ing abstinence from opiods and cocaine. Experimental and clinical psychophar-
macology, 14, 148-156.
Guardia, J., Caso, C., Arias, F., Gual, A., Jordi, S., Ramirez, M., . . . Casa, M. (2002).
A double-blind, placebo-controlled study of naltrexone in the treatment of alco-
hol-dependence disorder: Results from a multicenter clinical trial. Alcoholism:
Clinical and Experimental Research, 26(9), 1381-1387.
Hall, E. A., Prendergast, M. L., Roll, J. M., & Wards, U. (2009). Reinforcing absti-
nence and treatment participation among offenders in a drug diversion program:
Are vouchers effective? Criminal Justice and Behavior, 36(9), 935-953.
Hall, E. A., Prendergast, M. L., Wellisch, J., Patten, M., & Cao, Y. (2004). Treating
drug-abusing women prisoners: An outcomes evaluation of the Forever Free
program. The Prison Journal, 84(1), 81-105.
Hepburn, J. R. (2005). Recidivism among drug offenders following exposure to treat-
ment. Criminal Justice Policy Review, 16(2), 237-259.
Higgins, S. T., Heil, S. H., Dantona, R., Donham, R., Matthews, M., & Badger, G. J.
(2006). Effects of varying the monetary value of coucher-based incentives on
Bahr et al. 169

abstinence achieved during and following treatment among cocaine-dependent

outpatients. Addiction, 102, 271-281.
Hiller, M. L., Knight, K., & Simpson, D. D. (1999). Prison-based substance abuse
treatment, residential aftercare and recidvisim. Addiction, 94(6), 833-842.
Hirschi, T. (1969). Causes of delinquency. Berkeley: University of California Press.
Hubbard, R., Simpson, D. D., & Woody, G. (2009). Treatment research: Accomplish-
ments and challenges. Journal of Drug Issues, 39, 153-166.
Huebner, B. M., & Cobbina, J. (2007). The effect of drug use, drug treatment par-
ticipation, and treatment completion on probationer recidivism. Journal of Drug
Issues, 37(3), 619-641.
Inciardi, J. A., Martin, S. S., & Butzin, C. A. (2004). Five-year outcomes of thera-
peutic community treatment of drug-involved offenders after release from prison.
Crime & Delinquency, 50, 88-107.
Inciardi, J. A., Martin, S. S., Butzin, C. A., Hooper, R. M., & Harrison, L. D. (1997).
An effective model of prison-based treatment for drug involved offenders. Jour-
nal of Drug Issues, 27, 261-278.
Jensen, E. L., & Mosher, C. (2005-2006). Adult drug courts: Emergence, growth,
outcome evaluations, and the need for a continuum of care. Idaho Law Review,
42, 443-470.
Johnson, B. A., Ait-Daoud, N., Bowden, C. L., DiClemente, C. C., Roache, J. D.,
Lawson, K., . . . Ma, J. Z. (2003). Oral topirmate for treatment of alcohol depen-
dence: A randomized controlled trial. Lancet, 361, 1677-1685.
Johnson, B. A., Rosenthal, N., Capece, J. A., Wiegand, F., Mao, L., Beyers, K., . . .
Swift, R. M. (2007). Topiramate for treating alcohol dependence: A randomized
controlled trial. Journal of American Medical Association, 298(14), 1641-1651.
Kadden, R. M., Litt, M. D., Kebela-Cormier, E., & Petry, N. M. (2007). Abstinence
rates following behavioral treatments for marijuana dependence. Addictive Behav-
iors, 32(6), 1220-1236.
Karberg, J. C., & James, D. J. (2005). Substance dependence, abuse, and treatment of
jail inmates, 2002 (Bureau of Justice Statistics Special Report No. NCJ 209588).
Washington, DC: Bureau of Justice Statistics.
Kelly, J. F., Finney, J. W., & Moos, R. (2005). Substance use disorder patients who
are mandated to treatment: Characteristics, treatment process, and 1- and 5-year
outcomes. Journal of Substance Abuse Treatment, 28, 213-223.
Kempinen, C. A., & Kurlychek, M. C. (2003). An outcome evaluation of Pennsylva-
nia’s boot camp: Does rehabilitative programming within a disciplinary setting
reduce recidvism? Crime & Delinquency, 49(4), 581-602.
Kinlock, T. W., Gordon, M. S., Schwartz, R. P., & O’Grady, K. E. (2008). A study
of methadone maintenance for male prisoners: 3-month postrelease outcomes.
Criminal Justice and Behavior, 35(1), 34-47.
170 The Prison Journal 92(2)

Knight, K., Simpson, D. D., & Hiller, M. (1999). Three-year reincarceration outcomes
for in-prison therapeutic community treatment in Texas. The Prison Journal,
79(3), 337-351.
Kurlychek, M., & Kempinen, C. (2006). Beyond boot camp: The impact of aftercare
on offender reentry. Criminology & Public Policy, 5, 363-388.
Leshner, A. I. (1997). Addiction is a brain disease, and it matters. Science, 278, 45-47.
Listwan, S. J., Sundt, J. L., Holsinger, A. M., & Latessa, E. J. (2003). The effect
of drug court programming on recidivism: The Cincinnati experience. Crime &
Delinquency, 49(3), 389-411.
Lowenkamp, C., Hubbard, D., Makarios, M. D., & Latessa, E. J. (2009). A quasi-
experimental evaluation of Thinking for a Change: A “real word” application.
Criminal Justice and Behavior, 36(2), 137-146.
Ma, J. Z., Ait-Daoud, N., & Johnson, B. A. (2006). Topiramate reduces the harm
of exessive drinking: Implications for public health and primary care. Addiction,
101, 1561-1568.
MacKenzie, D. L. (2000). Evidence-based corrections: Identifying what works. Crime
& Delinquency, 46, 457-471.
Magill, M., & Ray, L. A. (2009). Cognitive-behavioral treatment with adult alcohol
and illicit drug users: A meta-analysis of randomized controlled trials. Journal of
Studies on Alcohol and Drugs, 70, 516-527.
Marsch, L. A., Bickel, W. K., Badger, G. J., Stothart, M. E., Quesnel, K. J., Stanger,
C., & Brooklyn, J. (2005). Comparison of pharmacological treatments for opiod-
dependent adolescents. Archives of General Psychiatry, 62, 1157-1164.
Martin, S. S., Butzin, C. A., & Inciardi, J. A. (1995). Assessment of a multi-stage
therapeutic community for drug-involved offenders. Journal of Psychoactive
Drugs, 27, 109-116.
Martin, S. S., Butzin, C. A., Saum, C., & Inciardi, J. A. (1999). Three-year outcomes
of therapeutic community treatment for drug-involved offenders in Delaware:
From prison to work release to aftercare. The Prison Journal, 79(3), 294-320.
McCrady, B. S., Epstein, E. E., & Hirsch, L. S. (1999). Maintaining change after
conjoint behavioral alcohol treatment for men: Outcomes at 6 months. Addiction,
94(9), 1381-1396.
McSweeney, T., Stevens, A., Hunt, N., & Turnbill, P. J. (2007). Twisting arms or a
helping hand? Assessing the impact of “coerced” and comparable “voluntary”
drug treatment options. British Journal of Criminology, 47, 470-490.
Miethe, T. D., Lu, H., & Reese, E. (2000). Reintegrative shaming and recidivism risks
in drug court: Explanations for some unexpected findings. Crime & Delinquency,
46(4), 522-541.
Milkman, H., & Wanberg, K. (2007). Cognitive-behavioral treatment: A review and
discussion for correctional professionals (021657). Washington, DC: National
Institute of Corrections.
Bahr et al. 171

Montoya, I. D., Schroeder, J., R., Preston, K. L., Covi, L., Umbricht, A., Contoreggi,
C., . . . Gorelick, D. A. (2005). Influence of psychotherapy attendance on buprenor-
phine treatment outcome. Journal of Substance Abuse Treatment, 28, 247-254.
Morley, K. C., Teesson, M., Reid, S. C., Sannibale, C., Thomson, C., Phung, N., . . .
Haber, P. S. (2006). Naltrexone versus acamprosate in the treatment of alcohol
dependence: A multi-centre, randomized, double-blind, placebo-controlled trial.
Addiction, 101, 1451-1462.
O’Brien, C. P. (1997). A range of research-based pharmacotherapies for addiction.
Science, 278(5335), 66-70.
Olmstead, T. A., & Petry, N. M. (2009). The cost effectiveness of prize-based and
voucher-based contingency management in a population of cocaine- or opiod-
dependent outpatients. Drug and Alcohol Dependence, 102, 108-115.
Pelissier, B., Wallace, S., O’Neil, J. A., Gaes, G. G., Camp, S., Rhodes, W., & Saylor,
W. (2001). Federal prison residential drug treatment reduces substance use
and arrests after release. American Journal of Drug and Alcohol Abuse, 27(2),
315-337.
Perron, B. E., & Bright, C. L. (2008). The influence of legal coercion on dropout
from substance abuse treatment: Results from a national survey. Drug and Alco-
hol Dependence, 92, 123-131.
Petersilia, J. (2005). From cell to society: Who is returning home? In J. Travis & C.
Visher (Eds.), Prison reentry and crime in America (pp. 15-49). New York, NY:
Cambridge University Press.
Petry, N. M., & Martin, B. (2002). Low-cost contingency management for treating
cocaine- and opioid-abusing methadone patients. Journal of Consulting and Clin-
ical Psychology, 70(2), 398-405.
Petry, N. M., Peirce, J. M., Stitzer, M. L., Blaine, J., Roll, J. M., Cohen, A., . . . Li,
R. (2005). Effect of prize-based incentives on outcomes in stimulant abusers in
outpatient psychosocial treatment programs. Archives of General Psychiatry, 62,
1148-1156.
Powledge, T. M. (1999). Addiction and the brain. Bioscience, 49, 513-519.
Prendergast, M. L., Hall, E. A., Wexler, H. K., Melnick, G., & Cao, Y. (2004). Amity
prison-based therapeutic community: 5-year outcomes. The Prison Journal,
84(1), 36-60.
Prendergast, M. L., Podus, D., Finney, J., Greenwell, L., & Roll, J. (2006). Con-
tingency management for treatment of substance use disorders: A met-analysis.
Addiction, 101, 1546-1560.
Price, R. K., Risk, N. K., & Spitznagel, E. L. (2001). Remission from drug abuse over
a 25-year periods: Patterns of remission and treatment use. American Journal of
Public Health, 91(7), 1107-1113.
172 The Prison Journal 92(2)

Rawson, R. A., McCann, M. J., Flammino, F., Shoptaw, S., Miotto, K., Reiber, C.,
& Ling, W. (2006). A comparison of contingency management and cognitive-
behavioral approaches for stimulant-dependent individuals. Addiction, 101,
267-274.
Rhodes, W., Pelissier, B., Gaes, G., Saylor, W., Camp, S., & Wallace, S. (2001). Alter-
native solutions to the problem of selection bias in an analysis of federal residen-
tial drug treatment programs. Evaluation Review, 25(3), 331-369.
Roll, J. M., Petry, N. M., Stitzer, M. L., Brecht, M. L., Peirce, J. M., McCann, M. J., . .
. Kellogg, S. (2006). Contingency management efficacious for methamphetamine
users. American Journal of Psychiatry, 163, 1993-1999.
Sabol, W. J., & Couture, H. (2008). Prison inmates at midyear 2007 (NCJ 221944).
Washington, DC: Bureau of Justice Statistucs.
Sanford, J. S., & Arrigo, B. A. (2005). Lifting the cover on drug courts: Evlauation
findings and policy concerns. Intrnational Journal of Offender Therapy and com-
parative Criminology, 49(3), 239-259.
Schneider, S. V. (2006). Trauma and 12-step recovery. Journal of Chemical Depen-
dency Treatment, 8(2), 163-186.
Schottenfeld, R. S., Chawarski, M. C., & Mazlan, M. (2008). Maintenance treatment
with buprenorphine and naltrexone for heroin dependence in Malaysia: A ran-
domised, double-blind, placebo-controlled trial. Lancet, 371, 2192-2200.
Seiter, R. P., & Kadela, K. R. (2003). Prisoner reentry: What works, what does not,
and what is promising. Crime & Delinquency, 49, 360-388.
Shaffer, D. K., Hartman, J. L., & Listwan, S. J. (2009). Drug abusing women in the
community: The impact of drug court involvement on recidivism. Journal of
Drug Issues, 39(4), 803-828.
Sherman, L. W., Farrington, D. P., Welsh, B. C., & MacKenzie, D. L. (Eds.). (2002).
Evidence-based crime prevention. London: Routledge.
Spohn, C., Piper, R. K., Martin, T., & Frenzel, E. D. (2001). Drug courts and recidi-
vism: The results of an evaluation using two comparison groups and multiple
indicators of recidivism. Journal of Drug Issues, 31(1), 149-176.
Steiner, B., & Giacomazzi, A. L. (2007). Juvenile waiver, boot camp, and recidivism
in a Northwestern state. The Prison Journal, 87(2), 227-240.
Stinchcomb, J. B., & Terry, W. C., III. (2001). Predicting the likelihood of rearrest
among shock incarceration graduates: Moving beyond anothere nail in the boot
camp coffin. Crime & Delinquency, 42(2), 221-242.
Substance Abuse and Mental Health Services Administration. (2009). Results from
the 2008 National Survey on Drug Use and Health: National findings (NSDUH
Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD: Author.
Truitt, L., Rhodes, W. M., Hoffmann, N. G., Seeherman, A. M., Jalbert, S. K., Kane,
M., . . . Finn, P. (2003). Evaluating treatment drug courts in Kansas City,
Bahr et al. 173

Missouri and Pensacola, Florida: Final reports for phase 1 and phase II (198477).
Washington, DC: National Criminal Justice Reference Service, Office of Justice
Programs, U.S. Department of Justice.
Turner, S., Longshore, D., Wenzel, S., Deschenes, E., Greenwood, P., Fain, T., . . .
McBride, D. (2002). A decade of drug treatment court research. Substance Use &
Misuse, 37(12), 1489-1527.
Weatherburn, D., Jones, C., Snowball, L., & Hua, J. (2008). The NSW drug court: A
re-evaluation of its effectiveness (Number 121). Sydney, Australia: NSW Bureau
of Crime Statistics and Research.
Wells, J. B., Minor, K. I., Angel, E., & Stearman, K. D. (2006). A quasi-experimental
evaluation of a shock incarceration and aftercare program for juvenile offenders.
Youth Violence and Juvenile Justice, 4(3), 219-233.
Welsh, W. N. (2007). A multisite evaluation of prison-based therapeutic community
drug treatment. Criminal Justice & Behavior, 34(11), 1481-1498.
Wexler, H. K., De Leon, G., Thomas, G., Kressell, D., & Peters, J. (1999). The Amity
Prison TC evaluation: Reincarceration outcomes. Criminal Justice and Behavior,
26(2), 147-167.
Wexler, H. K., Falkin, G. P., & Lipton, D. S. (1990). Outcome evaluation of a prison
therapeutic community for substance abuse treatment. Criminal Justice &
Behavior, 17(1), 71-92.
Wexler, H. K., Melnick, G., & Cao, Y. (2004). Risk and prison substance abuse treat-
ment outcomes: A replication and challenge. The Prison Journal, 84, 106-120.
Wexler, H. K., Melnick, G., Lowe, L., & Peters, J. (1999). Three-year reincarceration
outcomes for Amity in-prison therapeutic community and aftercare in California.
The Prison Journal, 17(3), 321-336.
Wilson, D. B., & MacKenzie, D. L. (2005). Boot camps. In B. C. Welsh & D. P.
Farrington (Eds.), Preventing crime: What works for children, offenders, victims,
and places (pp. 73-86). Belmont, CA: Wadsworth.
Wiseman, C. (2005). Drug courts: Framing policy to ensure success. International
Journal of Offender Therapy and Comparative Criminology, 49(3), 235-238.
Wolfe, E., Guydish, J., & Termondt, J. (2002). A drug court outcome evaluation
comparing arrests in a two year follow-up period. Journal of Drug Issues, 32(4),
1155-1172.
Wormwith, J. S., Althouse, R., Simpson, M., Reitzel, L. R., Fagan, T. J., & Morgan,
R. D. (2007). The rehabilitation and reintegration of offenders: The current land-
scape and some future directions for correctional psychology. Criminal Justice &
Behavior, 34, 879-892.
Young, D., & Belenko, S. (2002). Program retention and perceived coercion in three
models of mandatory drug treatment. Journal of Drug Issues, 32(1), 297-328.
174 The Prison Journal 92(2)

Zanis, D. A., Mulvaney, F., Coviello, D., Alterman, A. I., Savtiz, B., & Thompson, W.
(2003). The effectiveness of early parole to substance abuse treatment facilities on
24-month criminal recidivism. Journal of Drug Issues, 33(1), 223-236.

Bios
Stephen J. Bahr is professor of sociology at Brigham Young University. He previ-
ously taught at the University of Texas at Austin. Recent publications have focused
on prisoner reentry, desistance from crime, and adolescent drinking and drug use.

Amber L. Masters recently received her BS degree in sociology from Brigham

Young University. She has been a research assistant on projects related to drug abuse
and juvenile delinquency, and the evaluation of a reentry program to help adults and
juveniles.

Bryan M. Taylor is a graduate student in the Masters in Public Policy program at

Brigham Young University. He received his BS degree in sociology and has been
involved in research on drug abuse, prisoner reentry, divorce, and pretrial services.