Building Capacity for Substance Use Disorder Treatment

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Building Capacity for Substance Use Disorder Treatment in Prisons

Nearly 60% of state prisoners nationally meet criteria for a substance use disorder – in stark contrast to just 9% of the general U.S. population. However, nationally, only 11% of prisoners identified as needing substance use disorder treatment receive treatment during incarceration.

To bridge this gap and expand treatment capacity, we are comparing the long-term effectiveness of three different substance use disorder treatment models in prisons across the state of Florida. Our goal is to identify ways to build capacity for prisons to dramatically increase the reach of substance use disorder treatment, ideally providing services to every incarcerated person who needs them.  

Most contemporary approaches for in-prison substance use disorder treatment include outpatient treatment, intensive inpatient treatment, and Therapeutic Communities. Outpatient and intensive inpatient treatment functions similarly in prisons as they do in the community. However, Therapeutic Communities are ‘treatment environments,’ where incarcerated individuals with substance use disorders live together in an organized and structured manner. Recovery from substance use disorders guides all daily activities and individuals are provided with counseling, encounter groups, positive peer pressure, role modeling, accountability, and a system of incentives and sanctions to catalyze recovery. There is evidence to suggest that Therapeutic Communities have a greater impact than either outpatient or inpatient services, however, based on the intensity and cost of services, very few individuals receive this treatment. And, outpatient and inpatient treatment approaches are still cost-intensive.

In collaboration with the Florida Department of Corrections, we are examining whether an Interactive Journaling approach -- which allows for more self-directed work with the assistance of a counselor – can reduce costs, but maintain the effectiveness of other program approaches. If Interactive Journaling maintains or enhances program impacts, then there it is likely departments of corrections could meet the treatment needs of a much greater number of incarcerated individuals.  

Our study examines the effectiveness of the different substance abuse treatment models using a large sample of more than 3,600 men and women identified as having a high need for substance use disorder treatment in Florida state prisons.  

We will examine the feasibility of providing different substance abuse treatment approaches to incarcerated individuals as well as their perceived satisfaction with the intervention they received. We will also follow individuals as they release from incarceration and return home to explore how each of the three substance use disorder treatment models influences their success in the community.