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G De Leon - One of the best experts on this subject based on the ideXlab platform.
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the Therapeutic Community a unique social psychological approach to the treatment of addictions and related disorders
Frontiers in Psychiatry, 2020Co-Authors: G De Leon, Humanfriedrich UnterrainerAbstract:The evolution of the contemporary Therapeutic Community (TC) for addictions over the past 50 years may be characterized as a movement from the marginal to the mainstream of substance abuse treatment and human services. TCs currently serve a wide array of clients and their diverse problems; through advances in research in treatment outcomes, the composition of staff has been reshaped, the duration of residential treatment has been reduced, the treatment goals have been reset and, to a considerable extent, the approach of therapy itself has been modified. An overview of the TC as a distinct social-psychological method for treating addiction and related disorders is provided by this paper. Included in this is a focus on the multifaceted psychological wounds that consistently show a strong association with addiction and thereby require initiating a recovery process characterized by life-style and identity changes.
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building the Community endogenous network formation homophily and prosocial sorting among Therapeutic Community residents
Drug and Alcohol Dependence, 2020Co-Authors: Keith Warren, G De Leon, Nathan J Doogan, Benjamin W Campbell, Skyler J Cranmer, Mackenzie Weiler, Fiona DohertyAbstract:Abstract Background Researchers have begun to consider the ways in which social networks influence Therapeutic Community (TC) treatment outcomes. However, there are few studies of the way in which the social networks of TC residents develop over the course of treatment. Methodology We used a Temporal Exponential Random Graph Model (TERGM) to analyze changes in social networks totaling 320,387 peer affirmations exchanged between residents in three correctional TCs, one of which serves men and two of which serve both men and women. The networks were analyzed within weekly and monthly time-frames. Results Within a weekly time-frame residents tended to close triads. Residents who were not previously connected tended not to affirm the same peers. Residents showed homophily by entry cohort. Other results were inconsistent across TC units. Within a monthly time-frame participants showed homophily by graduation status. They showed the same patterns of triadic closure when connected, tendency not to affirm the same peers when not connected and homophily by cohort entry time as in a weekly time frame. Conclusions TCs leverage three human tendencies to bring about change. The first is the tendency of cooperators to work together, in this case in seeking graduation. The second is the tendency of people to build clusters. The third is homophily, in this case by cohort entry time. Consistent with TC clinical theory, residents spread affirmations to a variety of peers when they have no previous connection. This suggests that residents balance network clustering with a concern for the Community as a whole.
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evaluating peer influence processes in a prison based Therapeutic Community a dynamic network approach
Drug and Alcohol Dependence, 2019Co-Authors: Derek A Kreager, David R Schaefer, Kimberly M Davidson, Gary Zajac, Dana L Haynie, G De LeonAbstract:Abstract Background The Therapeutic Community (TC) is a common treatment modality for incarcerated individuals with substance use disorders. TCs rely on peer group processes to promote lasting behavioral and identity change, yet prior research has not adequately tested the peer influence mechanisms underlying the theoretical model. This study applied dynamic network analysis to estimate peer influence processes central to TC philosophy. Methods A stochastic actor-oriented model (SAOM) was applied to ten months of social network data collected from prisoner surveys within a TC unit (N = 62) in a medium-security Pennsylvania prison. Respondents (N = 177, 84% of unit) completed at least one prison survey and provided network and Community role model nominations. Results Although residents’ levels of treatment engagement were significantly correlated with their nominated peers, estimates of peer influence for treatment engagement were non-significant in longitudinal network models. Nor were estimates of peer influence significantly greater for peers perceived as Community role models. Rather, inmates connected with peers who were of similar treatment engagement as themselves (i.e., a peer selection process), and the latter primarily resulted from racial homophily in the TC social network. Conclusions Inconsistent with the desired treatment model, treatment engagement diffusion was not evident in the sampled TC. Results suggested that highly-engaged residents clustered together at the center of the TC’s social structure but had little impact on less-engaged and peripheral inmates. The relatively short (i.e., four-month) program length and moderate-to-low treatment fidelity likely contributed to the lack of peer influence processes.
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the Therapeutic Community for addictions an evolving knowledge base
Journal of Drug Issues, 2009Co-Authors: G De Leon, Harry K WexlerAbstract:The Therapeutic Community (TC) has become an established treatment approach serving thousands of substance abusers in Community, institutional, and other settings. This article 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. The TC knowledge base has contributed to the revival of a rehabilitation philosophy in correctional policy, which is described in the second section. The reflections of the authors who have collaborated for about 40 years are provided at the end of the paper.
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benefit cost analysis of a modified Therapeutic Community for mentally ill chemical abusers
Evaluation and Program Planning, 2002Co-Authors: Michael T French, Stanley Sacks, Kathryn E Mccollister, Karen Mckendrick, G De LeonAbstract:Abstract This paper estimates and compares the economic benefits and costs of modified Therapeutic Community (modified TC) treatment for homeless mentally ill chemical abusers (MICAs) relative to a ‘treatment-as-usual’ (TAU) comparison group. Data from the period 12 months pre-admission to the modified TC were compared to data from 12 months post-admission across three outcome categories: employment, criminal activity, and utilization of health care services. The economic cost of the average modified TC treatment episode was $20,361. The economic benefit generated by the average modified TC client was $305,273. The incremental economic benefit per modified TC client (relative to TAU) was $273,698, resulting in a net benefit per modified TC client of $253,337 and a benefit–cost ratio of 13:1. Adjusting for extreme outlier observations, the incremental economic benefit estimate was $105,618, net benefit was $85,257, and the benefit–cost ratio was 5.2. These results quantify the potential economic and social advantages of the modified TC approach and highlight the policy implications of modified TC programs for homeless MICAs. This study is the first comprehensive economic evaluation of TC treatment for homeless MICAs; future research can draw from the economic analysis methods outlined here to apply to larger samples, longer follow-up periods, and other treatment settings.
James A Inciardi - One of the best experts on this subject based on the ideXlab platform.
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five year outcomes of Therapeutic Community treatment of drug involved offenders after release from prison
Crime & Delinquency, 2004Co-Authors: James A Inciardi, Steven S Martin, Clifford A ButzinAbstract:With growing numbers of drug-involved offenders, substance abuse treatment has become a critical part of corrections. A multistage Therapeutic Community implemented in the Delaware correctional system has as its centerpiece a residential treatment program during work release—the transition between prison and Community. An evaluation of this program followed 690 individuals. At 5 years, those who participated in the program were significantly more likely to be drug and arrest free. Furthermore, treatment graduates with or without aftercare had significantly greater probabilities of remaining both arrest free and drug free than did ano treatment comparison group in regular work release. Dropouts also were significantly more likely to be drug free, although not significantly less likely to have a new arrest than those without treatment. These data show that the implementation of such programs could bring about significant reductions in both drug use and drug-related crime.
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three year outcomes of Therapeutic Community treatment for drug involved offenders in delaware from prison to work release to aftercare
The Prison Journal, 1999Co-Authors: Steven S Martin, Clifford A Butzin, Christine A Saum, James A InciardiAbstract:Delaware researchers have argued for a continuum of primary (in prison), secondary (work release), and tertiary (aftercare) Therapeutic Community (TC) treatment for drug-involved offenders. Previous work has demonstrated significant reductions in relapse and recidivism for offenders who received primary and secondary TC treatment 1 year after leaving work release. However, much of the effect declines significantly when the time at risk moves to 3 years after release. Further analyses reveal that program effects remain significant when the model takes into account not simply exposure to the TC program, but, more importantly, program participation, program completion, and aftercare. Clients who complete secondary treatment do better than those with no treatment or program dropouts, and those who receive aftercare do even better in remaining drug- and arrest-free.
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an effective model of prison based treatment for drug involved offenders
Journal of Drug Issues, 1997Co-Authors: James A Inciardi, Clifford A Butzin, Steven S Martin, Robert M Hooper, Lana D HarrisonAbstract:A multistage Therapeutic Community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the client's changing correctional status—incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based Therapeutic Community only, (2) a work release Therapeutic Community followed by aftercare, and (3) the prison-based Therapeutic Community followed by the work release Therapeutic Community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for othe...
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integrating the Therapeutic Community and work release for drug involved offenders the crest program
Journal of Substance Abuse Treatment, 1996Co-Authors: Amie L Nielsen, Frank R Scarpitti, James A InciardiAbstract:As the nation's first Therapeutic Community (TC) and work release center for drug involved offenders, CREST combines the basic elements of both modalities into an effective agent for behavioral change. This article explores the ways in which these elements are integrated and applied, and the outcome of such treatment as determined by subsequent substance abuse and criminal activity. Clients entering the program from prison progress through several phases of counseling, group interaction, confrontation, and education before they enter the work release phase, where they gain realistic experience and can implement what they learned in the TC concerning living drug free. Follow-up data collected at 6 and 18 months after entry into the program indicate that CREST clients have significantly lower relapse and recidivism rates than a comparable comparison group. CREST has similar effects on relapse and recidivism across sexes, racial/ethnic groups, and different age categories, although length of time in treatment and whether clients graduated do impact outcome variables.
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assessment of a multistage Therapeutic Community for drug involved offenders
Journal of Psychoactive Drugs, 1995Co-Authors: Steven S Martin, Clifford A Butzin, James A InciardiAbstract:A multistage Therapeutic Community (TC) treatment program has been instituted in the Delaware correctional system. Components in place long enough to provide follow-up data consist of a TC in prison and a "transitional" TC outside the prison for parolees. Baseline data at release from prison, and outcome data six months after release were analyzed for 457 respondents. A group who had participated in neither of the TCs was compared to groups who had participated in the TC in prison only, the transitional TC only, or both TCs. The latter two groups had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for other risk factors. There was also a reduction for the prison TC group, although more modest and statistically significant only when adjusted for baseline differences. Outcome benefits of the TC participation were also found for behaviors affecting the risk of HIV infection. The results support the efficacy of a multistage TC program and the importance of the transitional TC as a component.
Karen Mckendrick - One of the best experts on this subject based on the ideXlab platform.
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a randomized clinical trial of a Therapeutic Community treatment for female inmates outcomes at 6 and 12 months after prison release
Journal of Addictive Diseases, 2012Co-Authors: Joann Y Sacks, Karen Mckendrick, Zachary HamiltonAbstract:This random assignment study compared female offenders (n = 468) with substance use disorders in a prison Therapeutic Community program with those in a cognitive-behavioral intervention. The study demonstrates that all women benefitted from gender-sensitive prison treatment, but the Therapeutic Community was more effective in reducing drug use, criminal activity, and exposure to trauma and increasing mental health functioning and time until reincarceration during the year after prison. In addition, the ability to sustain and even improve behavior change after the women leave prison highlights the importance of providing accessible Community-based continuity of mental health and substance abuse services during reentry.
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randomized trial of a reentry modified Therapeutic Community for offenders with co occurring disorders crime outcomes
Journal of Substance Abuse Treatment, 2012Co-Authors: Stanley Sacks, Joann Y Sacks, Karen Mckendrick, Michael Chaple, Charles M ClelandAbstract:This article describes a randomized study to determine the effectiveness of a reentry modified Therapeutic Community (RMTC) for offenders with co-occurring substance use and mental disorders (co-occurring disorders or COD). Men with COD, approved for Community corrections placement postrelease, were recruited from nine Colorado prisons and stratified according to the type of treatment received while incarcerated (i.e., a prison modified Therapeutic Community [MTC] program or standard care). When released, each offender was randomly assigned either to the experimental RMTC (E-RMTC) condition (n = 71) or to the control parole supervision and case management (PSCM) condition (n = 56). An intent-to-treat analysis 12 months postprison release showed that the E-RMTC participants were significantly less likely to be reincarcerated (19% vs. 38%), with the greatest reduction in recidivism found for participants who received MTC treatment in both settings. These findings support the RMTC as a stand-alone intervention and provide initial evidence for integrated MTC programs in prison and in aftercare for offenders with COD.
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prison Therapeutic Community treatment for female offenders profiles and preliminary findings for mental health and other variables crime substance use and hiv risk
Journal of Offender Rehabilitation, 2008Co-Authors: Joann Y Sacks, Stanley Sacks, Karen Mckendrick, Zachary Hamilton, Steven M Banks, Marlies Schoeneberger, Joseph Stommel, Joanie ShoemakerAbstract:ABSTRACT This random assignment study compared women in a prison Therapeutic Community (TC) program with those in a cognitive-behavioral intervention. Over two thirds of study subjects received a lifetime diagnosis of severe mental disorder, nearly one-half received a diagnosis of PTSD, and virtually all reported exposure to trauma. Preliminary analysis (n = 314) found significantly better six-month post-prison outcomes for the TC group on measures of mental health, criminal behavior and HIV-risk behavior. These findings suggest the short-term effectiveness of prison TC treatment for female offenders with substance use disorders, and underscore the importance of adapting treatment to address mental health.
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modified Therapeutic Community for co occurring disorders a summary of four studies
Journal of Substance Abuse Treatment, 2008Co-Authors: Stanley Sacks, Karen Mckendrick, Steven M Banks, Joann Y SacksAbstract:This article summarizes results from four research studies (n = 902) that examined the effectiveness of the modified Therapeutic Community (MTC) for clients with co-occurring disorders (most with severe mental disorders). Significantly better outcomes for MTC were found across four experimental versus control comparisons on 23.1% (12 of 52) of primary outcome measures of substance use, mental health, crime, HIV risk, employment, and housing. Study limitations included the potential for selection bias, limited measurement of program fidelity, and insufficient examination of the relationship between treatment dose and outcome. Future research should emphasize clinical trial replications, multiple outcome domains, and further development of continuing care models. Given the need for research-based approaches, the MTC warrants consideration when program and policy planners are designing programs for co-occurring disorders.
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modified Therapeutic Community treatment for offenders with mica disorders substance use outcomes
American Journal of Drug and Alcohol Abuse, 2007Co-Authors: Christopher J Sullivan, Stanley Sacks, Karen Mckendrick, Steven M BanksAbstract:Correctional systems nationwide have increasingly turned to Therapeutic Community (TC) programs for the treatment of addiction in prisons. TC treatment, with modifications, has shown considerable promise in treating offenders who have co-occurring mental and substance use disorders, a group that has a mounting prevalence in prison populations. This article reports data from a study that randomly assigned male inmates with mental illness and chemical abuse (MICA) disorders (n = 139) to either a Modified TC (MTC) or a comparison group. Analyses revealed that the MTC group had significantly greater declines in alcohol and drug use at 12-months post-prison release. Additional analysis related positive substance use outcomes to reduced contact with the justice system and self-reported criminal activity. Implications for treatment and policy are discussed.
Clifford A Butzin - One of the best experts on this subject based on the ideXlab platform.
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five year outcomes of Therapeutic Community treatment of drug involved offenders after release from prison
Crime & Delinquency, 2004Co-Authors: James A Inciardi, Steven S Martin, Clifford A ButzinAbstract:With growing numbers of drug-involved offenders, substance abuse treatment has become a critical part of corrections. A multistage Therapeutic Community implemented in the Delaware correctional system has as its centerpiece a residential treatment program during work release—the transition between prison and Community. An evaluation of this program followed 690 individuals. At 5 years, those who participated in the program were significantly more likely to be drug and arrest free. Furthermore, treatment graduates with or without aftercare had significantly greater probabilities of remaining both arrest free and drug free than did ano treatment comparison group in regular work release. Dropouts also were significantly more likely to be drug free, although not significantly less likely to have a new arrest than those without treatment. These data show that the implementation of such programs could bring about significant reductions in both drug use and drug-related crime.
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three year outcomes of Therapeutic Community treatment for drug involved offenders in delaware from prison to work release to aftercare
The Prison Journal, 1999Co-Authors: Steven S Martin, Clifford A Butzin, Christine A Saum, James A InciardiAbstract:Delaware researchers have argued for a continuum of primary (in prison), secondary (work release), and tertiary (aftercare) Therapeutic Community (TC) treatment for drug-involved offenders. Previous work has demonstrated significant reductions in relapse and recidivism for offenders who received primary and secondary TC treatment 1 year after leaving work release. However, much of the effect declines significantly when the time at risk moves to 3 years after release. Further analyses reveal that program effects remain significant when the model takes into account not simply exposure to the TC program, but, more importantly, program participation, program completion, and aftercare. Clients who complete secondary treatment do better than those with no treatment or program dropouts, and those who receive aftercare do even better in remaining drug- and arrest-free.
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an effective model of prison based treatment for drug involved offenders
Journal of Drug Issues, 1997Co-Authors: James A Inciardi, Clifford A Butzin, Steven S Martin, Robert M Hooper, Lana D HarrisonAbstract:A multistage Therapeutic Community treatment system has been instituted in the Delaware correctional system, and its effectiveness has captured the attention of the National Institutes of Health, the Department of Justice, members of Congress, and the White House. Treatment occurs in a three-stage system, with each phase corresponding to the client's changing correctional status—incarceration, work release, and parole. In this paper, 18 month follow-up data are analyzed for those who received treatment in: (1) a prison-based Therapeutic Community only, (2) a work release Therapeutic Community followed by aftercare, and (3) the prison-based Therapeutic Community followed by the work release Therapeutic Community and aftercare. These groups are compared with a no-treatment group. Those receiving treatment in the two-stage (work release and aftercare) and three-stage (prison, work release, and aftercare) models had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for othe...
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assessment of a multistage Therapeutic Community for drug involved offenders
Journal of Psychoactive Drugs, 1995Co-Authors: Steven S Martin, Clifford A Butzin, James A InciardiAbstract:A multistage Therapeutic Community (TC) treatment program has been instituted in the Delaware correctional system. Components in place long enough to provide follow-up data consist of a TC in prison and a "transitional" TC outside the prison for parolees. Baseline data at release from prison, and outcome data six months after release were analyzed for 457 respondents. A group who had participated in neither of the TCs was compared to groups who had participated in the TC in prison only, the transitional TC only, or both TCs. The latter two groups had significantly lower rates of drug relapse and criminal recidivism, even when adjusted for other risk factors. There was also a reduction for the prison TC group, although more modest and statistically significant only when adjusted for baseline differences. Outcome benefits of the TC participation were also found for behaviors affecting the risk of HIV infection. The results support the efficacy of a multistage TC program and the importance of the transitional TC as a component.
Harry K Wexler - One of the best experts on this subject based on the ideXlab platform.
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the Therapeutic Community for addictions an evolving knowledge base
Journal of Drug Issues, 2009Co-Authors: G De Leon, Harry K WexlerAbstract:The Therapeutic Community (TC) has become an established treatment approach serving thousands of substance abusers in Community, institutional, and other settings. This article 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. The TC knowledge base has contributed to the revival of a rehabilitation philosophy in correctional policy, which is described in the second section. The reflections of the authors who have collaborated for about 40 years are provided at the end of the paper.
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amity prison based Therapeutic Community 5 year outcomes
The Prison Journal, 2004Co-Authors: Michael Prendergast, Harry K Wexler, Gerald Melnick, Elizabeth A H Hall, Yan CaoAbstract:Few studies have examined outcomes of prison-based treatment programs over a 5-year observation period. The present analysis was based on a sample of 715 prisoners randomly assigned either to the A...
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three year reincarceration outcomes for amity in prison Therapeutic Community and aftercare in california
The Prison Journal, 1999Co-Authors: Harry K Wexler, Gerald Melnick, Lois Lowe, Jean PetersAbstract:The study assessed 36-month recidivism outcomes for a prison Therapeutic Community (TC) program with aftercare using an intent-to-treat design with random assignment. Outcomes for 478 felons at 36 ...
