July 2006

Grant Results

National Program

Substance Abuse Policy Research Program

SUMMARY

From December 2000 through November 2004, Kathryn E. McCollister, Ph.D., and researchers from the University of Miami compared the costs of in-prison and aftercare substance abuse treatment services for criminal offenders with the savings resulting from fewer days of reincarceration to determine whether such programs are cost effective.

McCollister also worked with colleagues at the University of California at Los Angeles and National Development and Research Institutes.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national Substance Abuse Policy Research Program (SAPRP) (for more information see Grant Results).

Key Findings
Researchers reported the following findings in a chapter of the book Treatment of Drug Offenders: Policies and Issues and in articles published in Law & Policy, Justice Quarterly and Journal of Quantitative Criminology. See the Bibliography.

  • Substance abuse treatment services delivered in criminal justice settings are less expensive than treatment provided in standard, community-based residential settings.
  • Participation by criminal offenders in programs that combine in-prison and aftercare substance abuse treatment reduced days of reincarceration and resulted, in most cases, in cost savings.
  • Aftercare programs are critical to the success of treatment programs for offenders.

For detailed findings see Findings.

Funding
RWJF supported the project with a grant of $189,133.

 See Grant Detail & Contact Information
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THE PROBLEM

More than 80 percent of state and 70 percent of federal inmates reported drug use, not including alcohol, according to a 1999 report by the federal Bureau of Justice Statistics.

While public recognition of the need for substance abuse treatment in correctional institutions has grown, often such programs are poorly implemented and not adequate for addressing the host of problems experienced by substance abusing inmates.

The U.S. Office of National Drug Control Policy estimated that while some form of treatment was available in 90 percent of the correctional facilities examined, only 10 to 20 percent of inmates used these programs.

According to researchers at the University of Miami, a number of studies concluded that providing substance abuse treatment to offenders only while they are incarcerated is not effective in rehabilitating them. These studies showed that offenders receiving in-prison treatment without formal aftercare (continuing treatment after they leave prison) had recidivism and drug relapse rates similar to offenders who did not receive any treatment.

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THE PROJECT

McCollister and colleagues at the University of Miami, the University of California at Los Angeles and National Development and Research Institutes (a New York-based research and educational organization) examined the costs and savings associated with in-prison and aftercare substance abuse treatment.

Two in-prison therapeutic communities and their affiliated aftercare programs served as the study sites. Therapeutic communities are separate settings within prisons where inmates live, work and receive treatment services. The therapeutic process involves using the activities and interactions among residents to create socially positive lifestyles. The study sites were:

  • Amity in-prison therapeutic community and Vista aftercare treatment program in California. Researchers analyzed data at one and five years post-release.
  • CREST Outreach Center work release therapeutic community and aftercare program for criminal offenders in Delaware. CREST work release included substance abuse treatment services. Researchers analyzed data at 18 months post-release.

See the Appendix for details on study samples and the costs of incarceration used for comparison.

Researchers presented findings at six meetings (including three annual meetings of the American Public Health Association) and at a teleconference organized by RWJF and the Office of State Legislatures entitled Substance Abuse Treatment and Corrections: Prison-Based Treatment and Aftercare. See the Bibliography for details.

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FINDINGS

Researchers reported the following findings in a chapter of the book Treatment of Drug Offenders: Policies and Issues and in articles published in Law & Policy, Justice Quarterly and Journal of Quantitative Criminology (see the Bibliography for details):

  • Substance abuse treatment services delivered in criminal justice settings are less expensive than treatment provided in standard, community-based residential settings:
    • In-prison treatment programs (including the Amity program in California) cost between $37 and $68 per offender per week.
    • Vista aftercare services in California cost $181 per offender per week.
    • A modified therapeutic community for mentally ill substance abusers in New York had a weekly cost of $554 (according to a previous study by McCollister and colleagues). (Treatment of Drug Offenders: Policies and Issues)
  • Participation by criminal offenders in programs that combine in-prison and aftercare substance abuse treatment reduced days of reincarceration and, in most cases, resulted in cost savings. Participation in aftercare treatment was particularly important in reducing days of reincarceration:
    • In California at one year (daily cost of incarceration = $59):
      • The cost per average participant in the California substance abuse treatment program was $4,112, and the average participant had 51 fewer days of reincarceration than those in the control group, resulting in a cost per avoided incarceration day of $81.
      • Participants who attended the Vista aftercare program had 84 fewer days of incarceration than those who only attended in-prison treatment. Since the incremental cost of the aftercare treatment over in-prison treatment was $4,277, each additional avoided incarceration day cost $51.
      • In comparison to people in the control group, participants who attended both in-prison and aftercare treatment programs had 108 fewer incarceration days at a cost of $65 per day. (Law & Policy)
    • In California at five years (daily cost of incarceration = $72):
      • The average cost for all participants of the California substance abuse treatment program was $5,311 over the cost for those in the control group (many of whom attended other programs). The average participant had 81 fewer days of incarceration over five years, at a cost of $65 per avoided day of incarceration.
      • Participants who attended the Vista aftercare program had 291 fewer days of incarceration over five years than those who only attended in-prison treatment. Since the five-year incremental cost of the aftercare treatment over in-prison treatment was $11,969, each additional avoided incarceration day cost $41.
      • In comparison to people in the control group, participants who attended both in-prison and aftercare treatment programs had 283 fewer incarceration days over five years at a cost of $48 per day. (Justice Quarterly)
    • In Delaware at 18 months (daily cost of incarceration = $57):
      • The average cost for the CREST program was $1,937 and the average participant had 30 fewer days of incarceration than those in the comparison group, with a cost per avoided day of incarceration of $65.
      • Participants who attended the aftercare portion of the program had 49 fewer days of incarceration than those who attended only CREST work release. Since the incremental cost of the aftercare treatment over work release alone was $935, each additional avoided incarceration day cost $19.
      • In contrast to people in the comparison group, the participants who attended both CREST work release and aftercare programs had 62 fewer incarceration days over 18 months at a cost of $41 per day. (Journal of Quantitative Criminology)

Limitations

The principal investigator noted the following limitations of the study:

  • Aftercare services are voluntary in both the California and the Delaware programs, and people could not be randomly assigned to a group to receive aftercare services or not receive them. It is possible that offenders who chose to pursue aftercare treatment had different characteristics — that would have influenced the likelihood of their reincarceration — from offenders who chose not to attend aftercare.
  • The only measure of cost-effectiveness was days of reincarceration. This ignores significant other savings that are likely to be realized from substance abuse treatment, particularly in reductions in health care and welfare costs and increases in earnings.
  • This analysis was based on 18 months of follow-up on one program in Delaware and five years of follow-up on one program in California. While the findings are useful for the Delaware and California Departments of Corrections, it is not clear that they would apply to other correctional systems.
  • Although comparison and control group members were assumed to have no treatment after release, in fact many reported that they did receive limited treatment services. These experiences could have had an effect on reincarceration.

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CONCLUSIONS

The principal investigator offered the following conclusion from the study:

  • If corrections officials have to choose between treatment only or treatment plus aftercare, it would be substantially more cost effective to choose the combination of treatment plus aftercare.

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LESSONS LEARNED

  1. Establish back-up plans for collecting data, to avoid project delays. In this project, researchers encountered delays in receiving the five-year follow-up data from prisons in California. They changed strategies and secured 18-month follow-up data from the CREST program in Delaware. (Project Director)
  2. Anticipate and plan for challenges in presenting results of economic studies to multidisciplinary audiences. Researchers adapted study findings and analyses to make them useful to corrections officials in California and Delaware. (Project Director)
  3. Use the resources available from RWJF to disseminate research results. The communications director of RWJF's Substance Abuse Policy Research Program was of great help in publicizing the results of the analyses, including the organization of a teleconference with the Office of State Legislatures and addiction and criminal justice experts. (Project Director)

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AFTER THE GRANT

In June 2004, the principal investigator received a grant from the National Institute on Drug Abuse to continue developing methods for conducting economic evaluations of substance abuse treatment in criminal justice settings.

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GRANT DETAILS & CONTACT INFORMATION

Project

Costs and Benefits of Prison-Based Treatment Plus Aftercare for Drug-Abusing Offenders

Grantee

University of Miami Health Services Research Center (Miami,  FL)

  • Amount: $ 189,133
    Dates: December 2000 to November 2004
    ID#:  041070

Contact

Kathryn E. McCollister, Ph.D.
(305) 243-3749
KmcColli@miami.edu

Web Site

http://www.saprp.org/grant_publications.cfm?AppID=267

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APPENDICES


Appendix 1

Methodology: Study Samples and Comparison Costs of Incarceration

Study Samples
California

For the Amity and Vista programs in California, researchers analyzed treatment costs and days of reincarceration over one and five years for 531 criminal offenders released between 1993 and 1995. Inmates who volunteered for the Amity program were randomly assigned to either in-prison treatment or the control group. Those who completed the in-prison treatment could then volunteer for the Vista aftercare program. Treatment participation for the 531 offenders was as follows:

  • Participation in Amity in-prison treatment program only (225).
  • Participation in both Amity in-prison treatment and the Vista aftercare program (110).
  • No participation in treatment — the control group (196).

Delaware
Researchers analyzed treatment costs and days of reincarceration over 18 months for 836 Delaware offenders released in 1997. Eligible inmates were randomly assigned to either the CREST work release program or to standard work release. Those completing CREST work release could then volunteer for aftercare services. Treatment participation was the following:

  • Participation in CREST work release only (378).
  • Participation in CREST work release, followed by aftercare services (209).
  • Participation in work release only, without treatment — the comparison group (249).

Costs of Incarceration Used for Comparison

  • California one-year analysis: The 1997–1998 cost of incarceration was $59 per day, according to the California Department of Corrections.
  • California five-year analysis: The 2000 cost of incarceration was $72, as adjusted from 1996–1997 data from the California State Auditor.
  • Delaware 18-month analysis: The daily cost of incarceration is $57, according to project researchers.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Book Chapters

McCollister KE and French MT. "The Economic Cost of Substance Abuse Treatment in Criminal Justice Settings." In Treatment of Drug Offenders: Policies and Issues, Leukefeld CG, Tims F and Farabee D (eds.). New York: Springer Publishing Company, 2002.

Articles

McCollister KE, French MT, Inciardi JA, Butzin CA, Martin SS and Hooper RM. "A Cost-Effectiveness Analysis of Post-Release Substance Abuse Treatment for Criminal Offenders." Journal of Quantitative Criminology, 19(4): 389–407, 2003.

McCollister KE, French MT, Prendergast M, Hall E and Sacks S. "Long-Term Cost-Effectiveness of Addiction Treatment for Criminal Offenders: Evaluating Treatment History and Reincarceration Five Years Post-Parole." Justice Quarterly, 21(3): 659–679, 2004.

McCollister KE, French MT, Prendergast M, Wexler H, Sacks S and Hall E. "Is In-Prison Treatment Enough? A Cost-Effectiveness Analysis of Prison-Based Treatment and Aftercare Services for Substance Abusing Offenders." Law and Policy, 25(1): 62–83, 2003.

Presentations and Testimony

Kathryn E. McCollister, "Prison-Based Substance Abuse Treatment and Aftercare: A Cost-Effectiveness Analysis," at the Annual Meeting of the American Public Health Association, October 24, 2001, Atlanta. Abstract available online.

Kathryn E. McCollister, "Post-Release Substance Abuse Treatment for Criminal Offenders: A Cost-Effectiveness Analysis," at the Annual Meeting of the American Public Health Association, November 12, 2002, Philadelphia. Abstract available online.

Kathryn E. McCollister, "Long-Term Cost-Effectiveness of Addiction Treatment for Criminal Offenders: Evaluating Treatment History and Reincarceration Five Years Post-Parole," at the Annual Meeting of the American Public Health Association, November 9, 2004, Washington. Abstract available online.

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Report prepared by: Mary Nakashian
Reviewed by: Mary B. Geisz
Reviewed by: Molly McKaughan
Program Officer: Victor A. Capoccia
Program Officer: Michelle A. Larkin

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