Incarceration-based drug treatment

America's continuing "war on drugs" has flooded the criminal justice system with substance abusers (Lipton, 1995; 1998). A 1997 Bureau of Justice Statistics survey of incarcerated offenders found that 57% of state inmates and 45% of federal inmates reported drug use in the month prior to their offense. These rates are increases of 14% and 40%, respectively, over 1991 levels (Mumola, 1999). During the same period drug use among the general U.S. population was declining or holding steady (SAMHSA, 1998). Moreover, many of these drug using offenders are serious substance abusers, not casual users. Peters and his colleagues (1998), for example, reported that 56% of a sample of Texas inmates were diagnosed as having a substance abuse or dependence disorder during the 30 days prior to their incarceration. Similarly, a survey of jail inmates in Ohio found that 51% were currently drug dependent (Lo and Stephens, 2000). In all, a large body of accumulated evidence points to the substantial treatment need for a considerable proportion of offenders under criminal justice supervision (Belenko et al., 1998; Lo and Stephens, 2000). In fact, it is estimated that about 40% of all Americans who clearly need drug treatment are under the supervision of the criminal justice system (Gerstein and Harwood, 1990:7). Without effective substance abuse treatment, a high-proportion of these incarcerated offenders will resume their patterns of illicit drug use, and in all likelihood their patterns of criminal offending, once released from prison. As such, the period of time when an offender is incarcerated represents a crucial opportunity to prevent crime by intervening in this cycle of drug abuse and crime. Several aspects of correctional facilities (i.e., prisons, jails) make incarceration-based substance abuse treatment attractive. Perhaps most importantly, these facilities have the capacity to mobilize considerable coercive force to encourage substance abusing offenders to engage in treatment; many of whom otherwise would not do so. Additionally, the reduced availability of illicit substances facilitates detoxification and the isolated environments of many of these programs allow participants to focus on their substance abuse problems, in an environment typically more safe and clean than the environment in the general population. While the potential of incarceration-based drug treatment programs is clear, their effectiveness is much less so. Many evaluations of these programs have been conducted; however, methodological shortcomings prevalent in this body of research make it difficult to determine whether the observed effects are actually due to the program, or to methodological flaws in the evaluation. This chapter reviews this body of research utilizing meta-analytic techniques in an attempt to determine whether participation in these programs is associated with reduced drug use and other criminal behavior. More specifically, this systematic review focuses on addressing the following research questions: Are incarceration-based drug treatment programs effective in reducing recidivism and drug use? Approximately how effective are these programs? Is the estimated magnitude of a program?s effect associated with attributes of the research method, research sample, or intervention? Are there particular types of drug treatment that are especially effective or ineffective?