Advancing substance use disorder treatment in correctional facilities
The basis for substance use programs in Mass. DOC facilities is a combination of the Therapeutic Community model and Cognitive Behavioral Therapy
By Earl Warren
Spectrum Health Systems’ Correctional Division was launched within the Massachusetts Department of Correction (MADOC) in October 1993. Since that time, much has changed in the way we treat both criminal justice and substance use disorders. For that reason, Spectrum and MADOC have continued to assess and improve the way programming is provided to incarcerated individuals.
The evolving treatment continuum
Today, the basis for Spectrum’s substance use programs in MADOC facilities is a combination of two things: the Therapeutic Community (TC) model, and Cognitive Behavioral Therapy (CBT).
The TC model acknowledges the chronic nature of addiction and advances the idea that lapses are opportunities to learn and improve. Through a recovery orientation like a modified TC model, justice-involved individuals are encouraged to focus more on overall lifestyle change rather than simply focusing on abstinence from substance use.
CBT also helps individuals address more than just the symptoms of their substance use disorder. In CBT sessions, individuals can take a more critical look at the events that led to their incarceration, while receiving training in emotional regulation and assistance in developing healthy coping strategies.
Research shows that the TC model is the best modality for prison populations with assessed substance use program needs. But because TCs are built around the chronic disease model of addiction, the success of a TC program hinges on the aftercare individuals receive upon their release. This is why Spectrum’s services in MADOC facilities extend beyond programming for assessed substance use programming needs and provides resources after the individual’s release.
Spectrum’s Recidivism Reduction services are designed to address specific criminogenic needs, using curricula like Violence Reduction and Criminal Thinking programs. Spectrum has designed a separate and distinct program for females that is gender-responsive and trauma-informed. All these components work in tandem to treat both criminal behavior and substance use disorder.
Pushing to reduce recidivism
Ultimately, the goal of this programming approach is to help justice-involved individuals find the resources and the motivation they need to prevent any chance of future incarceration. By looking at the Spectrum program’s effect on recidivism rates, promising results have been found. In February 2019, MADOC released a one-year recidivism study concerning releases of male individuals who had or had not attended a Correctional Recovery Academy (CRA) to address assessed substance use programming, a High School Equivalency Credential (HSE) for education needs, or both.
The research showed that individuals with an assessed substance use program need who completed CRA while incarcerated had a 12.5% recidivism rate. This can be compared to a 20.7% recidivism rate for individuals with a substance use need who did not complete the CRA. Additionally, individuals with an educational need that attended an HSA program had a recidivism rate of just 9.7% in comparison to 16.3% for those with an unaddressed education need. Individuals with an assessed substance use program need and an educational need had significantly lower recidivism rates if both program needs were met. The recidivism rate was 6.5% for individuals with both substance use and educational need who completed the CRA program and achieved an HSE, compared to a rate of 23.7% for individuals who did not meet both need areas.
Importance of aftercare
Addiction is a disease – but it is not untreatable. By ensuring an individual’s continued participation in their recovery work beyond their release, real progress can be made at reducing cycles of incarceration.
When offenders are released back into the community employed, reunited with their families, and attending programming to address the underlying cause of their incarceration, it does more than just lower recidivism. It lowers crime and reduces the number of resources expended on the criminal justice system. Individuals contribute to the overall health of their community by paying taxes and having a job.
To serve this crucial need, Spectrum maintains peer recovery centers that provide resources for continued engagement in recovery. Here, individuals can receive assistance and resources for education, housing, employment, social gatherings, and other events and opportunities to keep them engaged in long-term recovery. All these resources combine to benefit not only the individual being released from incarceration but the public as well. When we provide treatment for the individual, the whole community recovers.
About the author
Earl Warren is vice president of Correctional Services at Spectrum Health Systems. In this role, Warren is responsible for executive oversight of Spectrum’s national Corrections Division. Warren joined Spectrum in 1998 and holds a master's degree in Business Administration.