Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Butzin, C. A., Martin, S. S., & Inciardi, J. A. Treatment during transition from prison to community and subsequent illicit drug use. Journal of Substance Abuse Treatment, 28(4), 351-358.
Inciardi, J. A., Martin, S. S., & Butzin, C. A.. Five-year outcomes of therapeutic community treatment of drug-involved offenders after release from prison. Crime and Delinquency, 50(1), 88-107.
Martin, S. S., O'Connell, D. J., Paternoster, R., & Bachman, R. D. The long and winding road to desistance from crime for drug-involved offenders: The long-term influences of TC treatment or re-arrest. Journal of Drug Issues, 41(2), 179-196.
Supplementary Materials Criminal Justice Committee of Therapeutic Communities of America. Therapeutic communities in correctional settings: The Prison Based TC Standards Development project. Final report of phase II. Washington, DC: Executive Office of the President, Office of National Drug Control Policy.
Inciardi, J. A. Final report: Grant no. 5R37 DA6124-15. Ongoing studies of treatment for high risk drug abusers.
Inciardi, J. A., & Lockwood, D. When worlds collide: Establishing CREST Outreach Center. In B. W. Fletcher, J. A. Inciardi, & A. M. Horton (Eds.), Drug abuse treatment: The implementation of innovative approaches (pp. 63-78). Westport, CT: Greenwood Press.
Lockwood, D., Inciardi, J. A., & Surratt, H. L. CREST Outreach Center: A model for blending treatment and corrections. In F. M. Tims, J. A. Inciardi, B. W. Fletcher, & A. M. Horton Jr. (Eds.), The effectiveness of innovative approaches in the treatment of drug abuse (pp. 70-82). Westport, CT: Greenwood Press.
Martin, S. S., Butzin, C. A., Saum, C. A., & Inciardi, J. A. Three-year outcomes of therapeutic community treatment for drug-involved offenders in Delaware: From prison to work release to aftercare. Prison Journal, 79(3), 294-320.
Outcomes
| Outcome 1: Rearrests |
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Description of Measures
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Rearrests were measured by participants' self-report of rearrests and by official arrest records. At each follow-up assessment, participants responded "yes" or "no" to a question asking whether they had been rearrested. Each participant's self-report was cross-checked against arrest records from the Delaware Statistical Analysis Center (SAC) and the Interstate Compact Offender Tracking System (ICOTS), which can be used to track arrests in other States and territories. If a participant reported no rearrests, but the SAC or ICOTS had a record of a rearrest, then the measure was coded as a rearrest. If a respondent reported a rearrest, but there was no official rearrest record in the SAC or ICOTS, the measure was still coded as a rearrest.
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Key Findings
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In a quasi-experimental field trial, incarcerated offenders who had drug-involved arrests and a history of chronic substance abuse and who were eligible for a work release program (as determined by criminal history and correctional counselor interviews) during the 6 months before prison release were assigned to the intervention or control group. Participants in the intervention group received CTC for Substance Abusers, and those in the control group participated in the standard work release program for the full 6 months before prison release (i.e., working or going to school in the community on weekdays and returning to the in-prison dormitory at night and on weekends). Some participants in the intervention group also received treatment in a prior, in-prison therapeutic community and/or received aftercare treatment programming in a therapeutic community environment following prison release. Assessments occurred at prison release, which coincided with the completion of the 6-month intervention or the standard work release program (i.e., 6 months after study entry), and at 1-, 3-, and 4.5-year follow-ups (i.e., 18, 42, and 60 months after study entry, respectively). Findings included the following:
- From prison release to the 3-year follow-up, participants in the intervention group were less likely than those in the control group to be rearrested (p = .003). This group difference was associated with a small effect size (odds ratio = 1.71).
- From prison release to the 4.5-year follow-up, participants in the intervention group were less likely than those in the control group to be rearrested (p = .017). This group difference was associated with a small effect size (odds ratio = 1.61).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.4
(0.0-4.0 scale)
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| Outcome 2: Abstinence from illicit drug use |
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Description of Measures
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Abstinence from illicit drug use was assessed through the following:
- Self-report of drug use. Participants were asked whether they had used any illicit drugs since the previous assessment, and if so, they were asked to recall when that illicit drug use had first occurred and to report the frequency of that use on a scale ranging from 0 (no use) to 6 (used more than once a day).
- Self-report of living situation and associated drug use. Participants were asked to recall where they were living at the time of the previous assessment and to report the frequency of illicit drug use while living there on a scale ranging from 0 (no use) to 6 (used more than once a day). The process was repeated for the next residence until the complete period between follow-up assessments was described by type of residence and frequency of any associated illicit drug use.
- Urinalysis. Participants were asked to provide a urine sample at each follow-up assessment. The urine sample was tested for the presence of opiates, marijuana, cocaine, barbiturates, phencyclidine, and amphetamines.
If none of the measures indicated illicit drug use, the participant was classified as being abstinent through the last available assessment date.
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Key Findings
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In a quasi-experimental field trial, incarcerated offenders who had drug-involved arrests and a history of chronic substance abuse and who were eligible for a work release program (as determined by criminal history and correctional counselor interviews) during the 6 months before prison release were assigned to the intervention or control group. Participants in the intervention group received CTC for Substance Abusers, and those in the control group participated in the standard work release program for the full 6 months before prison release (i.e., working or going to school in the community on weekdays and returning to the in-prison dormitory at night and on weekends). Some participants in the intervention group also received treatment in a prior, in-prison therapeutic community and/or received aftercare treatment programming in a therapeutic community environment following prison release. Assessments occurred at study entry; at prison release, which coincided with the completion of the 6-month intervention or the standard work release program (i.e., 6 months after study entry); and at 1-, 3-, and 4.5-year follow-ups (i.e., 18, 42, and 60 months after study entry, respectively). Findings included the following:
- From prison release to the 3-year follow-up, participants in the intervention group were more than 4 times as likely as those in the control group to be abstinent from illicit drug use (p < .001). This group difference was associated with a medium effect size (odds ratio = 4.49).
- From prison release to the 4.5-year follow-up, participants in the intervention group were more than 3.5 times as likely as those in the control group to be abstinent from illicit drug use (p < .001). This group difference was associated with a medium effect size (odds ratio = 3.54).
- Also from prison release to the 4.5-year follow-up, participants in the intervention group had a larger proportion of time abstinent from illicit drug use than those in the control group (p < .0001). This group difference was concentrated in the first 3 years following prison release; that is, participants in the intervention group had a larger proportion of time abstinent from illicit drug use than those in the control group from prison release to the 1-year follow-up (p < .001) and from the 1- to 3-year follow-up (p < .001). From the 3- to 4.5-year follow-up, the difference in proportion of time abstinent from illicit drug use was not significantly different between groups.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.3
(0.0-4.0 scale)
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| Outcome 3: Illicit drug use relapse |
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Description of Measures
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Illicit drug use relapse was assessed through the following:
- Self-report of drug use. Participants were asked whether they had used any illicit drugs since the previous assessment, and if so, they were asked to recall when that illicit drug use had first occurred and to report the frequency of that use on a scale ranging from 0 (no use) to 6 (used more than once a day).
- Self-report of living situation and associated drug use. Participants were asked to recall where they were living at the time of the previous assessment and to report the frequency of illicit drug use while living there on a scale ranging from 0 (no use) to 6 (used more than once a day). The process was repeated for the next residence until the complete period between follow-up assessments was described by type of residence and frequency of any associated illicit drug use.
- Urinalysis. Participants were asked to provide a urine sample at each follow-up assessment. The urine sample was tested for the presence of opiates, marijuana, cocaine, barbiturates, phencyclidine, and amphetamines.
If any of the measures indicated illicit drug use, the time to initial illicit drug use relapse was determined by the first occurring indicator of drug use. If illicit drug use was reported as first occurring during the residential period, the initial date of that period was used as the time to illicit drug use relapse.
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Key Findings
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In a quasi-experimental field trial, incarcerated offenders who had drug-involved arrests and a history of chronic substance abuse and who were eligible for a work release program (as determined by criminal history and correctional counselor interviews) during the 6 months before prison release were assigned to the intervention or control group. Participants in the intervention group received CTC for Substance Abusers, and those in the control group participated in the standard work release program for the full 6 months before prison release (i.e., working or going to school in the community on weekdays and returning to the in-prison dormitory at night and on weekends). Some participants in the intervention group also received treatment in a prior, in-prison therapeutic community and/or received aftercare treatment programming in a therapeutic community environment following prison release. Assessments occurred at study entry; at prison release, which coincided with the completion of the 6-month intervention or the standard work release program (i.e., 6 months after study entry); and at 1-, 3-, and 4.5-year follow-ups (i.e., 18, 42, and 60 months after study entry, respectively). From prison release through the 4.5-year follow-up, the time to illicit drug use relapse was longer for participants in the intervention group than for those in the control group (28.8 vs. 13.2 months; p < .001).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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2.6
(0.0-4.0 scale)
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| Outcome 4: Employment |
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Description of Measures
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Employment was measured by self-report. Participants were asked whether they were employed at least 30 hours each week since prison release.
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Key Findings
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In a quasi-experimental field trial, incarcerated offenders who had drug-involved arrests and a history of chronic substance abuse and who were eligible for a work release program (as determined by criminal history and correctional counselor interviews) during the 6 months before prison release were assigned to the intervention or control group. Participants in the intervention group received CTC for Substance Abusers, and those in the control group participated in the standard work release program for the full 6 months before prison release (i.e., working or going to school in the community on weekdays and returning to the in-prison dormitory at night and on weekends). Some participants in the intervention group also received treatment in a prior, in-prison therapeutic community and/or received aftercare treatment programming in a therapeutic community environment following prison release. Assessments occurred at prison release, which coincided with the completion of the 6-month intervention or the standard work release program (i.e., 6 months after study entry), and at 1-, 3-, and 4.5-year follow-ups (i.e., 18, 42, and 60 months after study entry, respectively). During the follow-up period, the percentage of participants who obtained employment since prison release was higher for the intervention group than the control group (54.6% vs. 45.4%; p < .01).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Quasi-experimental
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Quality of Research Rating
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1.7
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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26-55 (Adult)
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79.9% Male
20.1% Female
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73.1% Black or African American
26.9% Race/ethnicity unspecified
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Rearrests
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3.0
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3.0
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2.8
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0.5
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1.8
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3.4
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2.4
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2: Abstinence from illicit drug use
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3.1
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2.5
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2.8
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0.5
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1.8
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3.4
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2.3
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3: Illicit drug use relapse
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3.1
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2.5
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2.8
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1.9
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1.8
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3.5
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2.6
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4: Employment
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0.0
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0.0
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2.8
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1.9
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1.8
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3.5
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1.7
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Study Strengths Self-reported rearrests were cross-checked against State and interstate arrest databases, staff who retrieved database records were blind to study condition assignments, and mismatches between self-reported rearrests and database records were coded conservatively as rearrests, increasing both the reliability and validity of the outcome measure. The self-reported illicit drug use items came from known interview instruments, and self-reported illicit drug use was confirmed by urinalysis at each assessment point, increasing the validity of the outcome measure in the study population. Staff were trained to deliver the intervention using a written protocol for treatment delivery, and the structured nature of correctional facilities adds to the strength of intervention fidelity. The study design benefited from a long, longitudinal follow-up period after prison release, and covariate predictors were tested to rule out some of the potential confounding variables. Statistic modeling of the data was appropriate and included sophisticated analyses such as survival analyses for two of the four outcomes to address successive waves of participants entering into a longitudinal field study and right censoring of the data (i.e., withdrawal of participants before the outcome is observed).
Study Weaknesses There is no documentation of reliability or validity for the self-report employment measure, and there was no attempt to corroborate self-reported employment with an objective, independent measure of employment, such as a reference check. There was no information on the percentages of intervention group sessions and residential meetings that were rated for fidelity. Missing data were substantial (up to 31%) across the study's follow-up period, and investigators did not model the missing data or compare remaining participants and those lost to attrition on measures at study entry, despite the strong likelihood that the data were not missing at random. Across the follow-up period, there was a moderate amount of missing data handled simply by casewise deletion, despite the possibility that these data were not missing at random. Potential confounds, which make clear interpretations of the outcomes difficult, include the following: nonrandom assignment; lack of an attention control to account for nonspecific treatment elements, such as participant expectations, social desirability, and secondary gain; 3-month differential in access to the outside community between the two study conditions; and the fact that some of the offenders in the intervention group participated in a prior, in-prison therapeutic community and/or participated in an aftercare therapeutic community following prison release.
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