Program Profile: Minnesota Prison-based Chemical Dependency Treatment

This is a prison-based chemical dependency treatment for incarcerated persons who abuse chemicals or are chemically dependent. The main goal is to reduce their recidivism rates once they reenter the community. The program is rated Promising. Those who received treatment showed statistically significant lower rates of rearrest, reconviction, and reincarceration, compared with the control group at the follow-up period.

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Minnesota Department of Corrections (MNDOC) provides prison-based chemical dependency (CD) treatment for those who abuse chemicals or are chemically dependent. The primary goal of in-prison treatment programs is to reduce the recidivism rates of those with CD issues once they reenter the community.

Targeted Population/Eligibility

CD treatment offered by the MNDOC is available in seven of the 11 State facilities that house females and males. They undergo a brief 20- to 40-minute CD assessment shortly after they’re admitted to prison in Minnesota. On average, about 85 percent of newly admitted prisoners are directed to get CD treatment based on the assessment that shows they abuse chemicals or are chemically dependent. The licensed assessors, who determine the CD diagnoses of prisoners, use Diagnostic and Statistical Manual of Mental Disorders (or DSM–IV) criteria for substance abuse. The criteria for abuse include experiencing problems at work or school, having financial problems, having legal problems, and engaging in dangerous behavior while intoxicated. The criteria for dependence include increased tolerance, withdrawal symptoms, inability to cut down or quit, and a lot of time spent acquiring, using, or recovering from use.

Although the vast majority of newly admitted prisoners are directed to enter CD treatment, not all of them will have the opportunity to participate in prison-based treatment. This is because the number of treatment-directed offenders (more than 3,000 annually) is greater than the number of treatment slots available (about 1,800 annually). Incarcerated persons are instead prioritized to receive treatment based on their needs and recidivism risk. The amount of time remaining to serve in prison is also another important factor considered when determining who receives treatment.

Program Components

The prison-based CD treatment is based on the therapeutic community model. Incarcerated persons in treatment are housed separately from the rest of the prison population. There are typically 15–25 hours of treatment programming per week, and the programs maintain a staff-to-inmate ratio of 1:15. The treatment programs also emphasize to incarcerated persons that it is their personal responsibility to identify and acknowledge their criminal and addictive thinking and behavior. CD programming includes educational materials that provide information on the signs and symptoms of CD, as well as the dangers and effects that drug use can have on the body and on family and relationships.

The MNDOC initially offered short- (90 days), medium- (180 days), and long-term (365 days) CD treatment programming. The short-term programming was discontinued in 2006, however, after evidence seemed to suggest that the short-term treatment programs weren’t as effective as the programs that were longer in duration. The medium- and long-term programs primarily focus on the relationship between substance abuse issues and criminal behavior. As they progress through the program, they are expected to increase their level of active participation in services. The programs include education, individual counseling, and group counseling components.

Study

Duwe (2010) used a retrospective quasi-experimental design to examine the effectiveness of prison-based chemical dependency (CD) treatment provided by the Minnesota Department of Corrections (MNDOC) to reduce recidivism among those who abuse chemicals or are chemically dependent. The study compared recidivism outcomes between treated people and a matched comparison group of untreated people.

The main outcome of interest was recidivism, which was defined as rearrest, felony reconviction, or reincarceration for a new sentence. Recidivism data was collected through Dec. 31, 2008. The follow-up periods ranged from 36–48 months. Data on arrests and convictions was collected from the Minnesota Bureau of Criminal Apprehension. Data on reincarceration was collected from the Correctional Operations Management System maintained by the MNDOC.

Study participants included 3,499 people who were directed to enter CD treatment when they were admitted to prison after 2001. All of the participants were released during 2005. Of these 3,499 people, 1,164 participated in CD treatment, and the remaining 2,335 were not offered treatment, primarily due to a lack of available space in treatment (35 were removed from this sample because they refused treatment). The study used the propensity score matching (PSM) method to control for selection bias and match treated people to nontreated people. PSM involves finding a predicted probability of selection (or a propensity score) that is estimated by a logistic regression model in which selection into the CD treatment is the dependent variable and the predictor variables included 17 control variables that could have had an impact on the selection process (such as sex, race, and prior felony conviction).

The PSM procedure resulted in matching 926 people in the treatment group with 926 people in the non-treatment group. The matched treatment group was 90 percent male and 43.5 percent minority, with an average age of 33.44 years at release from prison. The matched untreated group was 88.5 percent male and 45 percent minority, with an average age of 33.3 years at release. Due to the PSM process, there were no significant differences between the two groups.

The study also looked at the effects of treatment by comparing completers and dropouts in the treated group, and the effects of program duration by separating out treated people who participated short- (90 days), medium- (180 days), and long-term (365 days) programming. Separate PSM were estimated for each of the five measures of treatment: 1) treatment completers (n= 843); 2) treatment dropouts (n=321); 3) short-term program participants (n=671); 4) medium-term program participants (n=393); and 5) long-term program participants (n=100). Untreated people were matched with treated people for each of the five treatment measures.

Survival analysis models were used to analyze the outcome results because they use time-dependent data, which was important to help determine not only whether people recidivated but also when they recidivated. The study also used the Cox regression model, which included both “time” and “status” variables in estimating the impact of treatment on recidivism. The “time” variable measures the amount of time from the date of release until the date of the first rearrest, reconviction, or reincarceration. For those who did not recidivate, the date of Dec. 31, 2008, was used. The “status” variable measured whether people reoffended during the period they were at risk to recidivate. The time people spent in prison as a result of violating supervised release was subtracted from their at-risk period, but only if it preceded a rearrest, reconviction, and reincarceration for a new offense or if the person did not recidivate prior to Jan. 1, 2009.

Subgroup Analysis

Duwe (2010) found that dropping out of treatment (either quitting or being terminated from the program) did not have a statistically significant effect on any measure of the recidivism (i.e., rearrest, reconviction, or reincarceration); however, there was a significant effect based on treatment completion. Completing treatment reduced the likelihood of rearrest by 22 percent, reconviction by 20 percent, and incarceration by 27 percent. Additionally, both short- (90 days) and medium-term (180 days) programs had statistically significant effects on all three recidivism measures, whereas long-term (365 days) programs did not have a significant effect. Compared with matched nontreated people, the hazard ratio for treated people in the short-term programs was 18 percent lower for rearrest and reconviction, and 24 percent lower for reincarceration. The hazard ratio for treated people in the medium-term programs was 32 percent lower for rearrest, 28 percent lower for reconviction, and 30 percent lower for reincarceration, compared with the matched nontreated group.

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Incarceration-based Therapeutic Communities for Adults

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

Rehabilitation Programs for Adults Convicted of a Crime

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

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?