Evidence Rating: Promising | One study
Date:
This program provides intensive treatment in a dedicated housing unit to male incarcerated persons with substance abuse problems during the last 9 to 12 months of their prison terms. The program is rated Promising. Participants had statistically significant lower reincarceration rates at the 24-month and 5-year follow-up periods, compared with the control group. There were no significant differences between the groups in reincarceration rates at the 36-month follow up or in drug use at the 5-year follow up.
A Promising rating implies that implementing the program may result in the intended outcome(s).
This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.
Program Goals/Target Population
The Amity In-Prison Therapeutic Community (TC) provides intensive treatment to male incarcerated persons with substance abuse problems. Participants volunteer for the program; all participants must reside in the dedicated housing unit during the last 9 to 12 months of their prison term. The Amity TC is located in a 200-man housing unit at the R.J. Donovan Correctional Facility, a medium-security prison in San Diego, Calif. Program residents are provided with a variety of treatment services to help prepare them for reentry into the community following release from prison.
Program Components
The Amity TC treatment program uses a three-phase treatment process. The first phase (lasting 2 to 3 months) includes orientation, clinical assessment of incarcerated persons’ needs and problem areas, and planning of interventions and treatment goals. Most program residents are assigned to prison industry jobs and given limited responsibility for the maintenance of the TC.
During the second phase of treatment (lasting 5 to 6 months), residents can earn positions of increased responsibility through hard work and by showing greater involvement in the program. Residents also participate in encounter groups and counseling sessions that focus on self-discipline, self-worth, self-awareness, respect for authority, and acceptance of guidance for problem areas. During the reentry phase, which lasts 1 to 3 months, residents prepare for their return to the community by working with program and parole staff to strengthen their planning and decision-making skills.
The Amity TC program has a number of components that are not generally found in other community or prison TCs. For instance, the program uses a formal curriculum to complement informally mediated teaching sessions. The curriculum, which includes workbooks, teacher’s guides, and videotapes, focuses on topics such as “Basic Assumptions of a Teaching and Therapeutic Community” and “Understanding Violence Both Inside and Outside of Yourself.” The program also uses psychodrama groups that allow participants to reenact roles or situations that remain unresolved. Amity staff use video playback as a therapeutic tool to raise self-awareness and develop realistic self-perception. Participants can see themselves and make appropriate judgment as if they were watching the actions of another person.
Amity TC graduates are offered the opportunity to participate in a community-based, residential aftercare TC treatment program for up to 1 year. The community TC, called Vista, can accommodate up to 40 residents at a time. Vista residents must work to maintain the facility while they continue the program curriculum they began in prison. They are encouraged to participate in self-help groups (such as Narcotics Anonymous) and other community services as needed.
The aftercare program follows a continuity-of-care model by building on the foundation of the in-prison TC curriculum and individualizing services for each resident so that participants can build on the progress they made while in the prison treatment phase. Vista also provides services for the wives and children of residents, as well as a drop-in center for Amity TC graduates, which offers counseling and evening groups to encourage recovery and provide peer support.
Key Personnel
An integral part of the program is the presence of “lifer mentors.” Lifer mentors are highly committed, recovering substance abusers who have criminal histories. They are carefully selected, specially trained, and supervised by senior program staff. These mentors serve as role models for participants because they have demonstrated great commitment and positive personal changes despite their criminal histories and substance abusing past. They support and ensure the Amity TC culture and environment by remaining available to counsel them 24 hours a day. They also work with incarcerated persons prior to release to help them develop a plan for life outside of prison.
Study 1
Reincarceration
Wexler and colleagues (1999a) found that, at 24 months after release, the treatment group that participated in the Amity In-Prison Therapeutic Community (TC) program had a lower reincarceration rate (43.3 percent), compared with the no-treatment control group (67.1 percent). This difference was statistically significant.
Study 2
Reincarceration
Wexler and colleagues (1999b) found that, at 36 months after release, there was no statistically significant difference in reincarceration rates between the Amity TC treatment group and the control group.
Study 3
Reincarceration
Prendergast and colleagues (2004) found that, at 5 years after release, the Amity TC treatment group had a lower reincarceration rate (75.7 percent), compared with the control group (83.4 percent). This difference was statistically significant.
Hard Drug Use
At 5 years after release, there was no statistically significant difference in hard drug use between the Amity TC treatment group and the control group.
Study 1
Wexler, De Leon, and colleagues (1999a) conducted a randomized controlled trial to evaluate the Amity In-Prison Therapeutic Community (TC). Volunteers were recruited from the general population of a medium-security prison in San Diego, Calif. The California Department of Corrections (DOC) and Amity staff reviewed incarcerated persons' records to identify eligible incarcerated persons. Incarcerated persons were eligible to participate in the program if they met the admission criteria of having a drug problem and being 9 to 14 months from parole. Incarcerated persons who were convicted of arson or sexual crimes involving minors were excluded. The remaining eligible incarcerated persons in the volunteer pool were randomly assigned to the treatment condition as bed space became available. Incarcerated persons who were not randomly selected to participate became members of the no-treatment control group. The control group did not receive formal substance abuse treatment while in prison, although limited drug education and 12-step groups were available.
The study sample included 715 males, of which 425 were in the treatment group, and 290 were in the no-treatment control group. The treatment group had an average age of 31.2 years and was 39.5 percent white, 28.4 percent Hispanic, 23 percent African American, and 9.2 percent was other. The control group had an average age of 30.5 years and was 35.3 percent white, 32.5 percent Hispanic, 21.6 percent African American, and 10.6 percent was other. The only statistically significant difference between the treatment and control groups at baseline was in educational level; the control group had a slightly greater number of participants who had continued their education beyond the high school level.
The outcome of interest was reincarceration, which was measured as a return to prison for either a parole violation or for a new arrest. The study looked at the 12- and 24-month periods following participants’ release from prison (the CrimeSolutions review of the study focused on the outcomes at the 24-month follow up). Follow up was conducted on all study participants for at least 12 months following their release from prison, and 263 study participants were observed for the 24-month follow-up period. Reincarceration data were obtained from the California DOC’s computerized Offender Based Information System (OBIS). Intent-to-treat analyses were conducted using bivariate analyses (chi square).
Subgroup analyses looked at reincarceration rates separately for the four treatment subgroups using multivariate analyses. The treatment group was divided into four subgroups: 1) incarcerated persons who entered the in-prison TC program, but who left early for disciplinary or personal reasons (prison TC dropouts); 2) incarcerated persons who completed the in-prison TC, but who did not choose to participate in the aftercare TC available in the community (prison TC treatment completers); 3) incarcerated persons who completed the in-prison TC and volunteered to attend the aftercare TC, but who dropped out in less than 3 months (aftercare TC treatment dropouts); and 4) incarcerated persons who completed the prison and Vista aftercare TC programs (aftercare TC completers).
Study 2
Wexler, Melnick, and colleagues (1999b) conducted a 36-month follow-up assessment using study participants from the original sample in Study 1 (Wexler et al. 1999a). Of the original sample of 715 study participants, this study included 478 participants (289 members in the treatment group and 189 members in the control group).
The average age of the treatment group members was 30.85 years, and they were 31 percent African American, 28 percent white, 27 percent Hispanic, and 4 percent was other. The average age of the control group members was 30.48 years, and they were 36 percent African American, 35 percent white, 22 percent Hispanic, and 7 percent was other. The only statistically significant difference between the treatment and control groups at baseline was age and race/ethnicity, which were statistically significant predictors for reincarceration but not controlled for in the analysis.
The outcome of interest was reincarceration within 3 years following release from prison. Reincarceration included a return to prison for either a parole violation or for a new arrest. Return-to-prison data were collected from the DOC’s OBIS. Intent-to-treat analyses was conducted using bivariate analyses (chi-square).
Subgroup analyses looked at reincarceration rates separately for the three subgroups using multivariate analyses. The treatment group consisted of three subgroups: 1) prison TC dropouts, 2) prison TC treatment completers, and 3) aftercare TC completers (aftercare TC treatment dropouts were not examined).
Study 3
Prendergast and colleagues (2004) conducted a 5-year follow-up assessment using study participants from the original sample in Study 1 (Wexler et al. 1999a). For those study participants who could be located, interviews were conducted in the community, in jails and prisons, and out of state. Of the original sample of 715 study participants, 81 percent were interviewed for the follow-up study, 5 percent were confirmed to have died, 3 percent refused to participate, 2 percent had been deported, and 10 percent could not be located. The final sample consisted of 576 participants, including 341 treatment group members and 235 control group members. There were no statistically significant differences between the study participants who were interviewed and the study participants who could not be interviewed, except for race. There were fewer white participants in the group that was interviewed, compared with the group of study participants that was not interviewed.
The outcomes of interest were reincarceration and heavy drug use. Reincarceration was defined as a return to prison in the 5 years since release. Heavy drug use was defined as self-report of having used drugs (excluding alcohol and marijuana) several times per week in the 12 months before the interview. To supplement the self-reported information on criminal justice system involvement, arrest records were also obtained from the California Department of Justice’s Automated Criminal History System (ACHS). Incarceration and parole records were also collected from the California DOC’s OBIS. Reincarceration data were censored at 1,825 days (5 years).
Intent-to-treat analyses were conducted using bivariate analyses (chi square). Subgroup analyses looked at reincarceration rates separately for the four subgroups of the treatment group using multivariate analyses: 1) prison TC dropouts; 2) prison TC treatment completers; 3) aftercare TC treatment dropouts; and 4) aftercare TC completers.
According to estimates from DATCAP, the Amity TC program cost $8.57 per day per participant and the Vista aftercare program cost $16.26 per day per participant. The results from the CEA found that the intent-to-treatment group cost an average of $4,122 and had 36 percent less incarceration time (51.48 fewer incarceration days) than the average control group member, which translates into a cost of $80 per avoided incarceration day. Incarcerated persons who just completed the Amity TC (but no aftercare program) cost an average of $2,708, and generated 17 percent less incarceration time (23.9 fewer incarceration days) than the average control group member, which translates into a cost of $133 per avoided incarceration day, the highest cost savings of any other group. Finally, for incarcerated persons who completed both Amity TC and the Vista aftercare program, the average cost of treatment was $4,277, and led to 84 fewer incarceration days compared to the average control group member. According to the results, with the in-prison TC program already in place, the cost of avoiding an additional incarceration day through the aftercare component was $51.
Therefore, the CEA found that for about $80 per day per person, the California Department of Corrections could reduce reincarceration rates for substance abusers. This translates to an additional investment of about $20 per day over the daily cost of housing an incarcerated person (McCollister et al. 2003).
Subgroup Analysis
Wexler and colleagues (1999a) and Prendergast and colleagues (2004) divided the Amity Therapeutic Community (TC) treatment group into four subgroups. Wexler and colleagues (1999b) categorized the treatment groups similarly; however, they excluded the aftercare treatment dropout subgroup (see Evaluation Methodology for subgroup details).
Wexler and colleagues (1999a) found that the no-treatment control group had a reincarceration rate of 67.1 percent; the aftercare TC completers had the lowest reincarceration rate (14.0 percent); prison TC completers had a 48.8 reincarceration rate; prison TC dropouts had a 57.5 reincarceration rate; and aftercare TC dropouts had a 60.0 percent reincarceration rate at 24 months after release. The overall comparison between the four groups was statistically significant, but pairwise comparisons were not conducted. The statistical significance was clearly driven by the difference between the aftercare TC completers, compared to the control group in reincarceration rates. However, due to the type of analysis conducted by the study authors, it was not clear if there was any statistically significant differences in the reincarceration rates between the control group and the prison TC completers, prison TC dropouts, and the after TC dropouts.
At the 36-month follow up, Wexler and colleagues (1999b) found that the control group had a reincarceration rate of 75.0 percent; 27.0 percent of aftercare TC completers had a 27.0 percent reincarceration rate; prison TC dropouts had an 82.0 percent reincarceration rate; and prison TC completers had a 79.0 reincarceration rate. The overall comparison between the four groups was statistically significant, but pairwise comparisons were not conducted. This statistical significance was clearly driven by the difference between the aftercare TC completers, compared to the control group, in re
These sources were used in the development of the program profile:
Study 1
Wexler, Harry K., George De Leon, George Thomas, David Kressel, and Jean Peters. 1999a. “The Amity Prison TC Evaluation: Reincarceration Outcomes.” Criminal Justice and Behavior 26(2):147–67.
Study 2
Wexler, Harry K., Gerald Melnick, Lois Lowe, and Jean Peters. 1999b. “Three-Year Reincarceration Outcomes for Amity In-Prison Therapeutic Community and Aftercare in California.” The Prison Journal 79(3):321–36.
Study 3
Prendergast, Michael L., Elizabeth A. Hall, Harry K. Wexler, Gerald Melnick, and Yan Cao. 2004. “Amity Prison-Based Therapeutic Community: 5-Year Outcomes.” The Prison Journal 84(1):36–60.
These sources were used in the development of the program profile:
De Leon, George, Gerald Melnick, George Thomas, David Kressel, and Harry K. Wexler. 2000. “Motivation for Treatment in a Prison-Based Therapeutic Community.” American Journal of Drug and Alcohol Abuse 26(1):33–46.
McCollister, Kathryn E., Michael T. French, Michael Prendergast, Harry Wexler, Stan Sacks, and Elizabeth Hall. 2003. “Is In-Prison Treatment Enough? A Cost-Effectiveness Treatment and Aftercare Services for Substance-Abuse Offenders.” Law & Policy 25(1):63–82.
Prendergast, Michael L., Elizabeth A. Hall, and Harry K. Wexler. 2003. “Multiple Measures of Outcome in Assessing a Prison-Based Drug Treatment Program.” In Nathaniel J. Pallone (ed.). Treating Substance Abusers in Correctional Contexts: New Understandings, New Modalities. Philadelphia, Pa.: The Haworth Press, Inc., 65–94.
Wexler, Harry K., Gerald Melnick, and Yan Cao. 2004. “Risk and Prison Substance Abuse Treatment Outcomes: A Replication and Challenge.” The Prison Journal 84(1):106–20.
Following are CrimeSolutions-rated programs that are related to this practice:
This practice uses a comprehensive, residential drug treatment program model for treating substance-abusing and addicted inmates to foster changes in attitudes, perceptions, and behaviors related to substance use. The practice is rated Promising in reducing recidivism rates after release for participants in therapeutic communities.
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types |
This practice involves correctional programs that focus on the transition of individuals from prison into the community. Reentry programs involve treatment or services that have been initiated while the individual is in custody and a follow-up component after the individual is released. The practice is rated Promising for reducing recidivism.
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types |
This practice includes programs that are designed to reduce recidivism among adults by improving their behaviors, skills, mental health, social functioning, and access to education and employment. They may become participants in rehabilitation programs during multiple points in their involvement with the criminal justice system. This practice is rated Promising for reducing recidivism among adults who have been convicted of an offense.
Evidence Ratings for Outcomes
Crime & Delinquency - Multiple crime/offense types |
Age: 18+
Gender: Male
Race/Ethnicity: White, Black, Hispanic, Other
Geography: Suburban Urban
Setting (Delivery): Other Community Setting, Correctional
Program Type: Alcohol and Drug Therapy/Treatment, Aftercare/Reentry, Group Therapy, Individual Therapy, Residential Treatment Center, Therapeutic Communities
Targeted Population: Alcohol and Other Drug (AOD) Offenders, Prisoners
Current Program Status: Active
480 Alta Road
RJ Donovan Correctional Facility
R.J. Donovan Correctional Facility
San Diego, CA 92179
United States