Jail-Based Substance User Treatment: An Analysis of Retention

Abstract

Many jail inmates have a history of substance use and “abuse”; few, however, receive comprehensive treatment for substance use disorders while in jail. The authors offer a longitudinal reanalysis of data from five jail-based substance user treatment programs. Survival analysis was used to identify client characteristics associated with length of time in treatment. Survival curves for the five programs were compared, indicating which ones retained inmates the longest. Results from a model stratified by jail site revealed that inmates over 25 years of age and those already sentenced had significantly longer treatment stays. The Substance Abuse Intervention Division (SAID) program, a modified therapeutic community in a New York jail, and the Deciding, Educating, Understanding, Counseling, and Evaluation (DEUCE) program, a curriculum-based intervention, had the longest survival curves and were, therefore, most effective at retaining inmates in treatment.

• Substance user treatment
• Jail
• Prison
• Retention
• Survival analysis

Resumen

Muchos de los reclusos tienen historia de consumo y abuso de sustancias; sin embargo, pocos reciben tratamiento integral contra el abuso de las mismas, mientras están en la cárcel. Los autores ofrecen un nuevo análisis longitudinal con datos de cinco programas contra el abuso de sustancias, que se llevan a cabo con participantes que están en la cárcel. Se utilizó el análisis de supervivencia para identificar las características de los participantes asociadas con la duración del tratamiento. Se compararon las curvas de supervivencia de los cinco programas y se indicó cuáles lograron retener a los presos en el programa por más tiempo. Los resultados de un modelo estratificado por la ubicación de la prisión, revelaron que los presos mayores de 25 años de edad y aquellos que ya estaban cumpliendo una sentencia, permanecen en el tratamiento un periodo de tiempo considerablemente mayor. Las curvas de supervivencia de mayor duración fueron obtenidas del programa de la División de Intervención contra el Abuso de Sustancias (Substance Abuse Intervention Division o ‘SAID’), una comunidad terapéutica modificada en una cárcel de Nueva York, y del programa Decidir, Educar, Entender, Aconsejar y Evaluar (Deciding, Educating, Understanding, Counseling, and Evaluation o ‘DEUCE’), un programa de intervención que utiliza un curriculum; por lo que fueron las más eficaces en conservar a los presos en el tratamiento.

Résumé

Nombre de détenus en prison ont des antécédents d'usage et d'abus de substances toxiques. Ils bénéficient toutefois rarement d'un traitement complet contre l'abus de drogues lors de leur séjour en prison. Les auteurs proposent une nouvelle analyse des données collectées dans le cadre de cinq programmes de traitement contre l'abus de substances psychotropes menés en milieu carcéral. Une analyse de la survie a été effectuée afin d'identifier les caractéristiques des clients en association avec la durée du traitement. Les courbes de survie des cinq programmes ont été comparées, ce qui a permis de mettre en évidence ceux pour lesquels la participation des détenus a été la plus longue. Les résultats obtenus à partir d'un modèle stratifié par prison ont montré que les détenus de plus de 25 ans et ceux qui avaient déjà été condamnés continuaient de suivre le traitement pendant des périodes nettement plus longues. Le programme de la division d'intervention américaine contre l'abus de substances toxiques (≪Substance Abuse Intervention Division≫, SAID), une communauté thérapeutique modifiée dans une prison new-yorkaise, ainsi que le programme de décision, de formation, de compréhension et de conseil baptisé DEUCE (≪Deciding, Educating, Understanding, Counseling, and Evaluation≫), action reposant sur la formation, ont présenté les courbes de survie les plus longues, et donc la meilleure efficacité en matière de maintien des détenus en traitement.

Additional information

Notes on contributors

Christopher P. Krebs

Christopher P. Krebs, Ph.D., earned his B.A. in Sociology from Emory University and his M.S. and Ph.D. in Criminology from Florida State University. He is currently an Associate Research Social Scientist at the Research Triangle Institute (RTI), a nonprofit research organization located in North Carolina. He has several years of research experience in the areas of juvenile justice and delinquency, corrections, drug policy, substance abuse and treatment, intraprison HIV transmission, criminal justice systems, program evaluation, and the disproportionate sentencing of minority offenders. Dr. Krebs employs both quantitative and qualitative methods and has extensive experience writing proposals, designing studies, developing survey instruments, analyzing data, and reporting findings. He has published and presented numerous research articles on a wide variety of topics.

Thomas Brady

Thomas Brady, Ph.D., is a Service Fellow at the Office of Applied Studies at the Substance Abuse Mental Health Services Administration (SAMHSA). In addition to his interest in factors affecting the utilization of substance abuse treatment, his other research interests are in maternal child health and dual disorders. He received his Ph.D. (December, 2001) in Public Health Sciences from the University of Illinois School of Public Health in Chicago. He is a native of Philadelphia, Pennsylvania.

Glen Laird

Glen Laird, Ph.D., received his Ph.D. in statistics from Florida State University in June of 2000, where he also served as a statistical consultant for various faculty, students, and staff at Florida State University who needed help with the planning, analysis, interpretation, or editing of research projects. Since joining RTI in June of 2000, Dr. Laird has been involved in numerous studies involving sample design and data analysis. Dr. Laird has had training in a wide variety of statistical topics, especially survival analysis, which was the focus of his dissertation. He is also proficient in several computer software packages including SAS, S-PLUS, SPSS, and FORTRAN.