Effectiveness of Therapeutic Communities - A Comparison of Prison
Effectiveness of Therapeutic Communities - A Comparison of Prison
Effectiveness of Therapeutic Communities - A Comparison of Prison
Fall 2011
Recommended Citation
Roybal, Nicole R., "Effectiveness of therapeutic Communities: a Comparison of Prison-Based and Community-Based therapeutic
Communities" (2011). All Regis University Theses. 481.
https://epublications.regis.edu/theses/481
This Thesis - Open Access is brought to you for free and open access by ePublications at Regis University. It has been accepted for inclusion in All Regis
University Theses by an authorized administrator of ePublications at Regis University. For more information, please contact epublications@regis.edu.
Regis University
College for Professional Studies Graduate Programs
Final Project/Thesis
Disclaimer
Use of the materials available in the Regis University Thesis Collection
(“Collection”) is limited and restricted to those users who agree to comply with
the following terms of use. Regis University reserves the right to deny access to
the Collection to any person who violates these terms of use or who seeks to or
does alter, avoid or supersede the functional conditions, restrictions and
limitations of the Collection.
The site may be used only for lawful purposes. The user is solely responsible for
knowing and adhering to any and all applicable laws, rules, and regulations
relating or pertaining to use of the Collection.
All content in this Collection is owned by and subject to the exclusive control of
Regis University and the authors of the materials. It is available only for research
purposes and may not be used in violation of copyright laws or for unlawful
purposes. The materials may not be downloaded in whole or in part without
permission of the copyright holder or as otherwise authorized in the “fair use”
standards of the U.S. copyright laws and regulations.
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES
by
Nicole R. Roybal
REGIS UNIVERSITY
October, 2011
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 11
by
Nicole R. Roybal
October, 2011
APPROVED:
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 1
Abstract
This study was conducted to determine whether therapeutic communities can be used as a
restorative justice policy to lower recidivism rates. Particularly, it investigated the effectiveness
of two Colorado Residential Substance Abuse Treatment Therapeutic Communities (RSAT TC)
as treatment to reduce recidivism for male inmates with substance abuse addiction. The first, the
(ACC TC), is a prison-based program. The second, Peer I Therapeutic Community (Peer I), is a
community-based program. The object of this study was to examine these two Colorado
therapeutic communities and whether or not they should be mandated as a recidivism reduction
initiative for a more cost- effective crime control strategy. This study incorporates the social
learning theory and differential learning association theory as concepts for a therapeutic
TABLE OF CONTENTS
1. Introduction............ ... ... ......... ... ... ... ... ..... . ... ............ ... 2
3. Methodology ................................................................. 17
Research Design. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18
Sample .............................................................. 19
Measurement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 19
4. Results ............................................................................ 20
6. References ........................................................................ 27
7. Appendices
Despite the fact that the United States makes up only five percent ofthe world's
Center on Addiction and Substance Abuse, 2010). There is a critical need for new and additional
crime control strategies, other than incarceration. It is essential to find a suitable way to reduce
overcrowding of prisons, lower costs in the court system and corrections, and reduce recidivism
rates by providing help for offenders in order to avoid future offenses. Many times inmates with
substance abuse addictions do not have the critical cognitive, emotional, and life skills needed to
successfully reintegrate back into society. Requiring inmates with addictions to complete a
therapeutic community treatment program as part of the prison sentence may help solve many of
these issues. Evaluative research and second source data were used to identify which ofthe two
different therapeutic communities have the most positive intervention on individual behavior
after completion.
Statement of Problem
The commonality of substance abuse among criminals is extremely high. Often, crimes
are committed while individuals are under the influence of drugs or alcohol. Many times crimes
are committed out of the need to fund their drug or alcohol dependence. The cost of drug and
alcohol abuse is not only costly and detrimental to the offender, but also to tax payers and
communities. Relapse of offenders often become a cycle, overcrowding prisons and the court
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 3
system. The therapeutic community (TC) model could potentially be a positive option in turning
Therapeutic communities have been in existence in the United States correctional system
since the late 1960's. TCs view substance abuse as a disorder of the whole person, which
requires long-term residential treatment to foster changes in lifestyle and identity. TCs differ
from other treatment approaches primarily in their use of the community, comprising treatment
staff and those in recovery, as key agents of change. This approach is often referred to as
Overview of Problem
According to the National Center on Addiction and Substance Abuse (2010), sixty-five
percent of all United States inmates meet medical criteria for substance abuse addiction.
However, only eleven percent receives any treatment. Of the 2.3 million inmates crowding our
nation's prisons and jails, 1.5 million meet the DSM-V medical criteria for substance abuse or
addiction, and another 458,000, while not meeting the strict DSM-V criteria, had histories of
substance abuse; were under the influence of alcohol or other drugs at the time of their crime;
committed their offense to get money to buy drugs; were incarcerated for an alcohol or drug law
Purpose of Project
The purpose of this study was to determine whether therapeutic communities could be
used as a restorative justice policy to lower recidivism rates and to investigate the effectiveness
of two Colorado Residential Substance Abuse Treatment Therapeutic Communities (RSAT TC)
RQ 1: What are the recidivism rates of male inmates with substance abuse additions after
RQ2: Would recidivism rates decrease if more therapeutic communities were mandated
In addition, this study examined restorative justice as the solution to substance abuse and
addiction. It attempted to incorporate the Social Learning Theory and Differential Association
Theory as an explanation for addiction, as well as the possibility that socialleaming could be
Limitations
Limitations that occur when using secondary data is the fact that we are not receiving the
information directly, but analyzing what others have already studied. Secondary data can be a
limitation in some ways. It cannot be determined if the researcher held a bias. Not having
actually conducted the research, it cannot be assured that the results are accurate. None the less,
Delimitations
In order to get past these limitations, the author used multiple sources of secondary data.
This way, the different sources were able to be cross checked as confirmation of one another.
Secondary data is less expensive and much less time consuming when collecting data, as
opposed to primary data. Using several different secondary sources can also be more accurate.
However, before using secondary data there is need to evaluate both the data itself and its source.
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 5
Definitions
Therapeutic Community: TCs are drug-free residential settings that use a hierarchical
model with treatment stages that reflect increased levels of personal and social responsibility.
Peer influence, mediated through a variety of group processes, is used to help individuals learn
and assimilate social norms and develop more effective social skills (National Institute of Drug
Recidivism: Return to inmate status in Colorado for either new criminal activity or
Substance Abuse: The use of a substance that modifies mood or behavior in a manner
Restorative Justice: A method of dealing with convicted criminals in which they are
urged to accept responsibility for their offences through meeting victims, making amends to
Social Learning Theory: A concept that the impulse to behave aggressively is subject to
the influence of learning, socialization, and experience. Social learning theorists believe
Differential Association Theory: A theory that criminal and deviant behavior is learned
through close and frequent association with criminal or deviant behavior patterns, norms, and
DSM-V: Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual
of Mental Disorders, 5th. Edition. Better known as the DSM-V, the manual is published by the
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 6
American Psychiatric Association and covers all mental health disorders for both children and
Literature Review
The following literature review consists of scholarly, peer reviewed articles concerning
therapeutic communities (TCs), substance abuse, and recidivism. This research is relevant to
identify the relationship between substance abuse and recidivism, and to determine whether
therapeutic communities could be used as a restorative justice policy to lower recidivism rates.
There is widespread recognition today that the successful re-entry of prisoners into society is a
critical public safety issue. Successful re-entry reduces recidivism, victimization, enhances
public safety and saves public resources. According to Colorado Department of Corrections
(2011), recidivism refers to the proportion of offenders who commit a subsequent crime
following contact with the justice system. High rates of recidivism are a primary reason why
Colorado's prison population and correctional costs are rising. Breaking this cycle of repeat
Therapeutic communities are an option for inmates with substance abuse addictions being
released into the community. TCs view substance abuse as a disorder of the whole person,
which requires long-term residential treatment to foster changes in lifestyle and identity.
Numerous studies that describe the social and psychological characteristics of admissions to TC
programs support this perspective. In addition to their substance abuse and social deviancy, drug
abusers who enter TCs reveal a considerable degree of psychological disability, which is further
abuse treatment by their comprehensive range of interventions provided within a single setting
and an emphasis on the community itself as primary therapist. Peer influence, mediated through
a variety of group processes, is used to help individuals learn and assimilate social norms and
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 8
develop more effective social skills (National Institute on Drug Abuse [NIDA], 2002). Many
individuals admitted to TCs have a history of social functioning, education or vocational skills,
and positive community and family ties that have been destroyed by their substance abuse
healthy functioning, skills, and values as well as regaining physical and emotional health. Other
TC residents have never acquired functional life-styles. For these people, the TC is usually their
first exposure to orderly living. Recovery for them involves habilitation, or learning for the first
time the behavioral skills, attitudes, and values associated with socialized living (NIDA, 2002).
which clients are responsible to both themselves and one another. There are group consequences
for individual behavior and positive peer pressure and confrontation as central principles of
treatment programming. This type of treatment is based on the principles of Albert Bandura's
Social Learning Theory. These principles are important in this study because peer-to-peer
intervention can influence a client in either a positive or negative way. The concept of the
The Social Learning Theory suggests that people learn from one another, through
observation, imitation, and modeling. This model places emphasis on personal responsibility,
accountability, and recovery. This type of intensive peer-based approach assists clients in
developing pro-social values and the skills necessary to reintegrate into the community. It may
be possible that Albert Bandura's Social Learning Theory & Edwin Sutherland's Differential
Association Theory could also be used in restorative justice for a complete change in the
Observational learning.
The first key factor in the Social Learning Theory is observational learning.
Observational learning is to learn through live, observational, and symbolic models. This is also
known as imitation or modeling. This type of learning occurs when individuals observe and
Intrinsic reinforcement.
The second aspect in this theory is intrinsic reinforcement. This is considered a form of
internal reward, such as pride, satisfaction, and a sense of accomplishment. The emphasis on
internal thoughts and cognitions helps connect learning theories to cognitive developmental
theories. Environmental experiences are an additional influence of the Social Learning Theory.
Modeling process.
Lastly, the modeling process is a factor in the Social Learning Theory. This component
stresses the importance of modeling appropriate behaviors. This is critical in the recovery of
addicts. Modeling proper behaviors of staff and peers is what forms positive results in the
therapeutic community. However, the modeling process could also be used in a negative
manner. For example, prisoners who are released into society with no therapeutic treatment may
go back to their old ways if there is no change in their social circle. In this study, modeling of
negative influences applies more to the individuals who did not receive any treatment, and went
back to their old ways once released into society. This would fall under the Differential
Association Theory, as an explanation of why some inmates succeed and other do not.
theory was developed by Edwin Sutherland, proposing that through interaction with others,
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 10
individuals learn the values, attitudes, techniques, and motives for criminal behavior. After
inmates are released back into society, this may be one reason that they often tum to what they
knew best and what was comfortable to them. By acknowledging this and mandating
rehabilitation through a therapeutic community for a period of time after their release, we may be
According to DeLeon & Wexler (2009), the evolution of therapeutic community (TC)
research can be framed in terms of two broad eras. First, the early period which was roughly
1970-1989, and the more recent period, 1990-present. The emphasis of research has shifted over
these time periods, reflecting the social and political context as well as scientific issues. The
therapeutic community (TC) has become an established treatment approach serving thousands of
substance abusers in community, institutional, and other settings. The rationale for TC-based
treatment in prisons is that most inmates have long histories of drug use and dependence that
require high-intensity treatment that attempts to restructure attitudes and thinking. Unlike
shorter, less intensive treatment programs, the TC approach is based on the view that drug abuse
is a multi-dimensional disorder of the whole person. The therapeutic goal of the TC is a global
activities, and the development of employment skills and pro-social attitudes and values (De
A study conducted by De Leon & Wexler (2009) summarizes the research that
contributed to the acceptance and growth of TCs and laid the groundwork for the establishment
of TCs for substance abusers in correctional settings. Dr. George De Leon is an internationally
recognized expert in the treatment of substance abuse and is acknowledged as the leading
authority on treatment and research in therapeutic communities. Dr. Harry Wexler has achieved
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 11
a national reputation over the last forty years, in the areas of substance abuse policy, treatment,
and research. His research has been influential in efforts to expand prison drug treatment.
admissions 1 to 12 years after their treatment in TCs. These studies document that long-term
residential TCs are effective in reducing drug abuse and antisocial behavior. They have
determined that the extent of improvement is directly related to retention in treatment. They
have found that the longer clients remain in treatment, the greater the improvement at follow-up
(De Leon & Wexler, 2009). According to De Leon & Wexler (2009), the length of stay in
treatment is the largest and most consistent variable of positive post-treatment outcomes. The
dropout rate is highest in the first 30 days of treatment and characteristically declines thereafter.
The probability of remaining in or completing treatment increases with actual time in treatment.
Studies show no reliable sociodemographic characteristics that predict dropout, although severe
criminality and severe psychopathology are correlated with lower retention. Dynamic factors,
such as motivation and readiness, are modest but consistent predictors of retention in treatment
(De Leon & Wexler, 2009). With the dropout rate being highest in the first 30 days of treatment,
this study examined the recidivism rates of those who have completed a minimum of 30 days of
retention in treatment.
Since the late 1980s, the thinking behind corrections in the U.S, has undergone a major
re-orientation in philosophy, a shift away from the almost exclusive focus on security, control,
and punishment of the 1970s and early 1980s to a focus that includes programming for
rehabilitation and treatment (De Leon & Wexler, 2009). According to De Leon & Wexler
(2009), two studies helped lay the foundation for the revival of rehabilitation for prisoners with
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 12
drug problems: the positive treatment outcomes of the Cornerstone TC program in Oregon and
the Stay'n Out TC substance abuse treatment program in New York. Over the decade that
followed, favorable results from other prison treatment outcome studies consolidated the position
that effective prison substance abuse treatment, particularly when followed by treatment in the
community, was an important strategy to promote public safety and public health.
therapeutic communities in particular and drug treatment in general has developed primarily
from field effectiveness studies rather than controlled efficacy research. Advancing the
evolution of a science that is relevant to substance abuse treatment will require a continued
reciprocity between practice in the field and research. With the general acceptance of
correctional rehabilitation, there may be some limits of what can be done in institutions primarily
De Leon (2000), suggested that therapeutic communities may have been positively
perceived by outsiders without sufficient information. With the evolution of TCs, whether
community based or prison based, he suggests that they have become quite removed from the
original roots of the TC model. TCs are evolving rapidly which may cause an inconsistency with
the original modality. He advises that TCs go back to their roots and cautiously evolve, adapt,
and change. Many times, paraprofessionals in charge of directing a TC have completed the
program themselves and have learned primarily through personal experience and apprenticeship.
This can be problematic because it broadens the treatment and weakens the structure of the
program. Knowledge gained exclusively from the experience of personal recovery can remain
static and unresponsive to individual differences. TCs are made up of very unique individuals
with different backgrounds. De Leon (2000 recommends that an explicit theoretical framework
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 13
be established to define, conceptualize, and illustrate the basics of TCs. This information would
by corrections departments at some point. The fact that each therapeutic community is made up
of many individual differences, may affect the results of this study. Because TCs are a fairly
new concept, and they are evolving quickly, there may be an inconsistency between the modality
Crossroad to Freedom TC
Correctional Center (ACC). This therapeutic community was established to treat chronic
substance abusing inmates who present a serious recidivism risk to public safety (O'keefe &
Kleebe, 2002). It is the first TC in the nation to be accredited by the American Correctional
This treatment program is considered a level 4d, with a 9-12 month duration. According
to the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition [DSM-IV], a level4d
treatment program is residential in nature and is designed for individuals with extensive criminal
histories, antisocial behavior, limited social support, and multiple unsuccessful treatment
attempts. Level 4d programs use the "community as a method" treatment model, which views
substance abuse as a disorder of the whole person. This model focuses on a complete change in
the offender's thinking, lifestyle and identity. This TC operates from a cognitive- behavioral
offenders deep-rooted in an addictive, criminal lifestyle. The program places high demands and
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 14
expectations on community members, modeling the rules within society. Responsibility for
actions within the community is stressed to residents (Engleman & Weber, 2011).
A study conducted by O'Keefe, Klebe, Roebken, & Fisher in 2004 aimed to establish the
effectiveness of two of Colorado's TCs by examining different factors in three distinct studies.
The two programs evaluated in these studies were the substance abuse TC at the Arrowhead
Correctional Center (ACC) and the Peer I TC. The first of the three studies focused primarily on
evaluation of the two programs and the treatment participants. The next study further explored
and evaluated the delivery of treatment services. This revealed a successful treatment program.
Nonetheless, a significant problem with retention rates was discovered. The researchers found
that the median length of stay was 74.5 days in this twelve month program. Approximately one
third left either treatment programs within the first month. This study found that the two
programs differed greatly in terms of operations. It was discovered that the TC at Arrowhead
Correctional Center was less intense, which was to be expected because it was a prison- based
treatment model. Conversely, Peer I strictly followed the TC model (O'Keef et aI., 2004).
According to O'Keef, Klebe, Robeken & Fisher (2004), the findings of this study
indicated that while the program did treat the target population, with severe recidivism risk and
substance abuse needs, the program also routinely violated its own admission criteria. There
appeared to be a high number of clients not assessed as having a need for this modality, who had
a limited time before release, a disciplinary infraction prior to admission, or acute psychiatric
needs. Consequently, these factors may have skewed the success rates. This information relates
to the current study because of the fact that in the study conducted by O'Keef, Klebe, Robeken &
Fisher (2004), there appeared to be a large number of clients not assessed and admitted correctly.
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 15
The clients may not have had strong need for therapy, which could have inaccurately increased
dropout rates.
Another element to consider is the fact that this study found a strong therapeutic
environment within the prison- based TC at Arrowhead. The prison- based program faced
distinct challenges because of its integration within the general prison population. Generally,
separation from the general population is the key to any successful prison- based TC. From this
study, it appeared that treatment groups were last in priority in the prison- based therapeutic
community. Logically, one would believe that substance abuse treatment would take priority,
next to security, because the need for treatment is the driving force in placement in the program.
Contrary to the TC model, the prison- based TC was much less intense than the community-
It was discovered that most clients were expelled from treatment. The average length of
stay was less than four months in this long- term program. This may suggest that the program's
current clients may need to motivate new clients in order to preserve a positive peer culture with
Peer 1 TC
Peer I is a 126-bed Therapeutic Community (TC) located on the Fort Logan Campus in
Denver, Colorado. It offers long-term, intensive treatment for men who meet the criteria for
substance dependence. The primary goal of Peer I is to facilitate individual change and positive
growth by residing in a community of concerned peers working together to help themselves and
Peer 1 is a community- based TC, licensed by the Colorado Alcohol and Drug Abuse
Community Corrections center. Clients are referred from the criminal justice system, a direct
judicial sentence, or from a variety of non-criminal justice agencies. Peer I clients typically stay
modification, contingency management approaches and cognitive strategies to help shape pro-
social attitudes, behaviors and enhanced coping skills. Daily activities include in-house job
assignments, individual and group sessions, family meetings and educational seminars about
Research completed by O'Keefe, Klebe, Roebken, & Fisher in 2004 indicated that Peer I
was found to be a therapeutically sound program. As a whole, Peer I was able to carry out
unique TC components that are often impossible with prison- based programs. The study
determined that Peer I was a very effective program, however it is rare that offenders transition
from the prison- based TC to the community- based TC, as a continuing care component. It
would be ideal if prisoners admitted into the prison- based TC eventually transitioned to a
community- based TC for additional therapy, before being released back into the community.
O'Keefe, Klebe, Roebken, & Fisher (2004) determined that the prison- based TC needs to
within the prison- based TC. There are issues that can only be addressed through this
collaboration, such as separation from the general population and better accommodation for
group therapy.
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 17
Restorative Justice
By going back to the roots of the TC model, it may be possible to incorporate restorative
justice as a means to reduce recidivism rates. Restorative justice is the process of repairing what has
been already occurred and the offender taking full responsibility for their behavior. The restorative
justice model includes teaching the offender to understand how their behavior resulted from a choice
that could have been made differently and taking action to repair the harm where possible. The critical
factor in restorative justice is for the offender to make changes necessary to avoid such behavior in the
future. This is where therapeutic communities can be significant in rehabilitating substance abusers
and reducing recidivism in those who complete the program. The two specific therapeutic
communities that were examined for effectiveness in this study are Peer I and the Crossroad to
Freedom house at Arrowhead Correctional Center. The ultimate goal of a therapeutic community,
whether it be prison- based or community- based, is to reintegrate inmates with substance addiction
into society. Through therapeutic communities, they may learn to become law abiding, tax paying
citizens.
This is why it is crucial that recidivism rates of inmates with substance addictions are studied.
It is important to determine the most effective way to restore justice. By revealing which type of
therapeutic community has the lowest recidivism rates after completion, it could be possible to
mandate therapy before inmates with addictions are released into the community.
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 18
Methodology
This study encompassed evaluative, quantitative research for the purpose of determining
the impact of two different Colorado therapeutic communities as a means to reduce recidivism.
It includes second source data that was re-analyzed for the purpose of this study. According to
Babbie (2010), secondary analysis is valuable when data collected and processed by one
appropriate in the process of determining whether a social intervention has produced the
Research Design
This study encompassed evaluative, quantitative research for the purpose of determining
the impact of two different Colorado therapeutic communities as a means to reduce recidivism.
It includes second source data that was re-analyzed for the purpose of this study. According to
Babbie (2010), secondary analysis is valuable when data collected and processed by one
appropriate in the process of determining whether a social intervention has produced the
Using these methods, the research attempted to answer the following research questions:
RQl: What are the recidivism rates of male inmates with substance abuse additions after PEER
Correctional Center (ACC TC)? RQ2: Would recidivism rates decrease if more therapeutic
communities were mandated for male inmates with substance abuse addiction? The variables
IV 2: PEER 1 TC
Sample
Second source data was collected to complete this research. It consists of peer reviewed
journal articles, Colorado Department of Corrections annual reports, PEER 1 annual reports,
Arrowhead Correctional Center reports, statistics and data files. Focusing on recidivism rates for
male inmates with substance addictions who have completed PEER 1 and inmates who have
completed the Crossroad to Freedom TC, the author will evaluate recidivism rates for each
program.
Measurement
An analysis was used in this particular study to give insight to the overall effectiveness
based on recidivism rates after completion of Arrowhead Correctional Center TC, a prison based
program and Peer I TC, a community based program. Recidivism rates after completion of both
of these programs were analyzed and compared to determine which program is more effective.
Because of the high number of drop out rates, this study examined clients who have completed at
Results
In Colorado, as of June 2011, there were 20,512 male inmates being held in prisons
across the state. There were a total of 176,212 crimes committed in Colorado (Colorado
Bureau ofInvestigation, 2010). For those released on mandatory parole in Colorado, sixty-five
percent will return to prison within three years (Colorado Coalition of Criminal Justice Reform,
2010). It is well documented that alcohol and drugs are significant factors in all types of crime,
not just alcohol and drug law violations. According to Przybylski (2009), approximately 8 out of 10
inmates are in need of substance abuse treatment. This data clearly indicates that there needs to
be an intervention in attempt to restore justice and end the cycle of relapse among offenders.
Colorado, 63.7 percent of the inmates released from the Colorado Department of Corrections in
2002 were rearrested within 3 years. Various studies have shown that substance abuse treatment
for inmates provide a greater return on investment to taxpayers than incarceration. Addressing
substance abuse and addiction is essential to decreasing government costs associated with state
corrections. If substance addiction amongst inmates is left untreated, there is sure to be a higher
rate of failure on probation and parole, which in turn will lead to higher rates of recidivism.
Recidivism rates shown in the graph below clearly indicate that TCs coupled with
aftercare treatment show the greatest degree of positive outcomes. Figure 1 is based on
recidivism rates for inmates who either had no treatment, completed a minimum of thirty days in
thirty days of continuous treatment from prison-based to community-based. The recidivism rates
of these inmates after one year of being released into the community show that 45% of those
who had no treatment were rearrested. Of the inmates who had treatment at both prison-based
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 21
and community-based TCs continuously, there were only 8% who were rearrested after one year.
Inmates who progress from a prison based TC to a community TC, are the least likely to be
rearrested and/or relapse. It has also been found that clients who participate in aftercare have the
45.00%
37.00% 35.00%
8.00%
Substance abuse and addiction inflict substantial costs on state budgets and a heavy
burden on taxpayers. Przybylski (2008) stated that in the last twenty years, Colorado's General
Fund appropriation has grown from $76 million in 1988 to $636 million in 2008. According to
Rios & Greene (2009) in 2007, Colorado spent 8.8 percent of its total general fund expenditures
on corrections. Currently, Colorado Department of Corrections (2010) states that the annual cost
for incarcerating one inmate is $29,825 and the daily cost per inmate is $81.71. The prison
system cannot currently accommodate the projected inmate growth. It is critical to public safety
that changes are made in order to curb the cycle of recidivism. There is potential for significant
financial savings to victims and taxpayers. A study by the National Center for Alcohol and
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 22
Substance Abuse (2010) found that Colorado currently has the lowest per capita spending on
substance abuse prevention, treatment, and research out of the 46 reporting states.
Applying the national statistics of 65 percent of all United States inmates meeting the
medical criteria for substance abuse addiction, to Colorado adult male parole population, the
following graph shows the benefit of the two studied therapeutic communities in reducing
recidivism.
8000
6000
4000
2313
2000
500
o
Male Inmates Meet Medical Recidivism Recidivism With Potential
Released Annually Criteria for Without Prison- Based and Prevented Crimes
Substance Treatment (1 Yr) Community-
Addiction Based Treatment
(1 Yr)
Based on these statistics, there is a potential savings of $68 million, annually, that would
have been spent on incarceration. This money could be reallocated to therapeutic community
Figure 3: Benefit to Taxpayers and Crime Victims Per Dollar Spent on Programs
Non-prison TC
Job Counseling
Prison TC
According to the National Center on Addiction and Substance Abuse (2010), over a third
of all federal, state, and local inmates are violent crime offenders. This includes murder, forcible
rape, robbery, and aggravated assault. Seventy-eight percent of these inmates were substance
involved, meaning they were under the influence of drugs or alcohol at the time of the crime,
they committed the crime to get money to buy drugs, or they had a history of alcohol treatment, a
history of regular drug use, or had a substance disorder. Twenty-nine percent of federal, state,
and local inmates were incarcerated for alcohol or drug law violations and were considered
substance involved. Nineteen percent of the inmate population were incarcerated for property
crimes. Property crimes consist of burglary, larceny- theft, car theft, and arson. Of these
Policy makers, practitioners and scholars alike are beginning to focus attention on the
challenges presented by the record number prison inmates returning to communities. Many
criminal offenders have a limited education, poor employment skills, substance abuse problems
and other deficits that are well known risk factors for a return to crime. Without treatment and
assistance during the transition to community life, many offenders are likely to fail and return to
pnson.
With no treatment, inmates typically return to their former lives with a high probability of
re-offending and continued drug and alcohol use. There is a need to develop new strategies to
deal with the increasing rate of prison growth. Research consistently shows that longer duration
of treatment is associated with positive recidivism outcomes. Future studies must also look at
motivation and readiness in order to increase retention. Even the best treatment programs will
Based on the results of this study and the literature review incorporated in this analysis, it
is determined that therapeutic communities decrease recidivism rates. The best case scenario is
if the offender has consecutively completed both, a prison-based TC and a community-based TC.
It is concluded that the longer the duration of treatment, the more successful the outcome of
reducing recidivism. Researchers have found that in order to increase the likelihood of success
after treatment, clients should remain in treatment for at least ninety days before the benefits of
treatment can have an impact. This way, the client receives more time to develop stronger
control mechanisms, before being introduced back into the community where there will be
unavoidable adversity (Zavaras, 2011). The results of this study prove this statement to be
offenders were capable of using self-control methods after they were released into the
community.
Zavaras (2011), suggested that extensive supervision or aftercare is the best way to
prevent recidivism after completion of either a community- based or a prison- based therapeutic
community treatment program. This works to help reduce relapse and sustain a positive path to
recovery. Longer time spent in a TC or supervision after successful completion may allow
inmates more opportunity to distance themselves psychologically from their former destructive
acquaintances, which may help reduce recidivism. As anticipated, the Differential Association
Theory did explain why many offenders who do not receive treatment end up returning to prison.
Once they are released, without a therapeutic community, they go back to the crowd they were
used to associating with. Through that interaction, they generally end up acquiring the attitudes,
techniques, and motives to return to the life of crime. On the contrary, the Social Leaming
Theory was an explanation to the positive results of therapeutic communities. Given a long
enough duration, clients learned from each other appropriate behavior through observation,
These studies document that long-term residential TCs are effective in reducing drug
abuse and antisocial behavior. Empirical research has determined that the extent of improvement
is directly related to retention in treatment. Why not mandate both programs consecutively,
before releasing offenders into the community? Based on the review of literature, appropriate
matching of client needs to programs, retention, length of stay, and continued aftercare are the
determine which factors may relate to motivation and readiness of treatment, which affect
Substance Abuse (2010), the monetary benefits of treatment far outweighed the costs in terms of
The question for further research may be to ask what characteristics predict dropout and
how can we keep substance abusers accountable after they complete the therapy? There appears
understood that there has been a revival of rehabilitation for prisoners with drug problems, now
there is a need to determine how to make restorative justice and therapeutic communities a
References
Addiction Research and Treatment Services [ARTS]. (2009). Annual Report [Data file].
http://allpsych.com/disorders/dsm.html
Babbie, Earl R. 2010. The Practice of5,'ocial Research (lih ed.). Belmont, CA: Wadsworth
Publishing.
Colorado Bureau oflnvestigation. (2010). Crime in Colorado: Annual Report [Data file].
Colorado Coalition of Criminal Justice Reform. (2010). 2010 Colorado Quick Facts [Data file].
Colorado Department of Corrections. (2010). Cost per day [Data file]. Retrieved from
http://www.doc.state.co.us/sites/default/files/opalFY%202009
10%20Cost%20Per%20Day%20Final_O.pdf
http://www.doc.state.co.us/crossroad-freedom-tc-arrowhead-correctional-facility
Colorado Department of Corrections. (2011). Monthly population and capacity report [Data
http://www.doc.state.co.us/sites/default/fiies/opalMnthyPop Aug.pdf
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 28
De Leon, G., & Wexler, H. (2009). The therapeutic community for addictions: Anevolving
De Leon, G. (2009). The therapeutic community: Theory, model, and method. New York, NY:
Dictionary.com. (2011). Definition of differential association theory [Data file]. Retrieved from
http://dictionary.reference.comlbrowse/differential+association
Division of Criminal Justice. (2009). Brief research summary for CCJJ sentencing discussion:
Evidence based practices to reduce crime by known offenders. Office of Research and Statistics
Engleman, L. & Weber, K. R. (2011). Overview ofsubstance abuse treatment services: Fiscal
research-unit
Nalitz, M. (2011, June 3). New era in prison reform? Part 2 of 3. Retrieved from
http://www.examiner.com/prison-policy-in-denver/new-era-prison-reforrn-part-2-of
3?fb comment=33925846
National Center on Addiction and Substance Abuse. (2010). Behind bars II: Substance abuse
National Institute on Drug Abuse. (2002). Therapeutic communities [Data file]. The
http://www.nida.nih.gov/ResearchReports/Therapeutic/Therapeutic2.html
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 29
O'Keef, M. L. & Klebe, K. J. (2002). Process evaluation of the Crossroad to Freedom House and
https://www.ncjrs.gov/pdffilesl/nij/grants/192290.pdf
http://www.doc.state.co.us/alcohol-and-drug-research-unit
http://dcj.state.co.us/ors/pdf/docs/ww08 022808.pdf
Przybylski, R. (2009). Correctional and sentencing reform for drug offenders: Research
findings on selected key issues. Colorado Criminal Justice Reform Coalition. Retrieved
ders.pdf
Rios, N. & Greene, J. (2009). Reducing recidivism: A review of effective state initiatives. Justice
The Free Dictionary. (2011). Medical dictionary [Data file]. Retrieved from http://medical
dictionary.thefreedictionary.comldrug+abuse
The Free Dictionary. (2011). Legal dictionary [Data file]. Retrieved from http://legal
dictionary.thefreedictionary.com/restorative+justice
University of Colorado School of Medicine. (2011). Peer 1 overview [Data file]. Retrieved from
http://www.ucdenver.edu/academics/colleges/medicalschoolldepartments/psychi
y/PatientCare/ARTSClinicaliARTSTreatment/Pages/PeerIOverview.aspx
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 30
RAFTRevised 2.pdf
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 31
Appendix A
One Year Recidivism Rates (Return to prison or re-arrest for new crime)
45.00%
37.00% 35.00%
8.00%
Retrieved from
2.pdf
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 32
Appendix B
This figure represents the potential reduction in recidivism, as it applies to Colorado, based on
8000
6000
4000
2313
2000
sao
a
Male Inmates Meet Medical Recidivism Recidivism With Potential
Released Annually Criteria for Without Prison- Based and Prevented Crimes
Substance Treatment (1 Yr) Community-
Addiction Based Treatment
(1 Yr)
EFFECTIVENESS OF THERAPEUTIC COMMUNITIES 33
Appendix C
Figure 3: Benefit to Taxpayers and Crime Victims Per Dollar Spent on Programs
This figure represents a cost- benefit analysis for taxpayers and crime victims per dollar spent on
different programs.
Non-prison TC
Job Counseling
Adapted from Division of Criminal Justice. (2009). Brief research summary for CCJJ sentencing
discussion: Evidence based practices to reduce crime by known offenders. Office of Research and
df