skip to main content
Washington State Institute for Public Policy
Back Button

Outpatient treatment (during incarceration) for individuals with substance use disorder

Adult Criminal Justice
Benefit-cost methods last updated December 2024.  Literature review updated August 2024.
This analysis includes evaluations of intensive and non-intensive outpatient substance abuse treatment programs delivered during incarceration to individuals with a substance use disorder. Individuals in the included studies were largely incarcerated in the general population in either a jail or prison setting; in one case, participants were in a treatment-focused correctional facility. Treatment types include individual and group cognitive behavioral therapy, psychoeducation, or a combination of approaches. On average, programs were designed to deliver 86 hours of treatment (range 24 to 125 hours) over approximately ten weeks (range four to 16 weeks).

This analysis excludes evaluations of prison-based therapeutic communities.
 
ALL
BENEFIT-COST
META-ANALYSIS
CITATIONS
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2023).  The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $2,791 Benefits minus costs $9,115
Participants $0 Benefit to cost ratio $32.00
Others $5,370 Chance the program will produce
Indirect $1,248 benefits greater than the costs 96%
Total benefits $9,409
Net program cost ($294)
Benefits minus cost $9,115

^^WSIPP does not include this outcome when conducting benefit-cost analysis for this program.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the program impacts measured in the research literature (for example, impacts on crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information on how we estimate effect sizes.

The effect size may be adjusted from the unadjusted effect size estimated in the meta-analysis. Historically, WSIPP adjusted effect sizes to some programs based on the methodological characteristics of the study. For programs reviewed in 2024 or later, we do not make additional adjustments, and we use the unadjusted effect size whenever we run a benefit-cost analysis.

Research shows the magnitude of effects may change over time. For those effect sizes, we estimate outcome-based adjustments, which we apply between the first time ES is estimated and the second time ES is estimated. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Treatment age No. of effect sizes Treatment N Effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Crime
Any criminal conviction according to court records, sometimes measured through charges, arrests, incarceration, or self-report.
 31 7 1390 -0.135 0.071 32 -0.135 0.071 40 -0.135 0.059
Technical violations^^
Violations of the conditions of an individual’s terms of probation, parole, or supervision.
 31 1 260 -0.175 0.107 31 n/a n/a n/a -0.175 0.100
Illicit drug use disorder^^
Clinical diagnosis of illicit drug use disorder or symptoms measured on a validated scale. When possible, we exclude cannabis/marijuana use disorder from this outcome.
 31 1 30 -0.514 0.529 31 0.000 0.187 34 -0.514 0.332
Anxiety disorder^^
Clinical diagnosis of an anxiety disorder (e.g., general anxiety, panic, social anxiety, obsessive compulsive disorder) or symptoms measured on a validated scale.
 31 1 37 -0.115 0.431 31 -0.060 0.528 33 -0.115 0.789
Major depressive disorder^^
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 31 1 37 -0.732 0.395 31 -0.381 0.484 33 -0.732 0.064
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Crime Criminal justice system $2,791 $0 $5,370 $1,395 $9,556
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($147) ($147)
Totals $2,791 $0 $5,370 $1,248 $9,409
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $294 2023 Present value of net program costs (in 2023 dollars) ($294)
Comparison costs $0 2023 Cost range (+ or -) 30%
The per-participant cost estimate is based on delivering an 86-hour program at a rate of $51 per hour (salary and benefits) for Washington State Department of Corrections (DOC) staff (Program Specialist 4) delivering this program. It assumes a typical group size of 15 participants. DOC provided hourly rate and typical group size; the number of program hours is based on the weighted average of treatment dosage for the studies included in the analysis.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

Bahr, S.J., Harris, P.E., Strobell, J.H., & Taylor, B.M. (2013). An evaluation of a short-term drug treatment for jail inmates. International Journal of Offender Therapy and Comparative Criminology, 57(10), 1275-96.

Daley, M., Love, C.T., Shepard, D.S., Petersen, C.B., White, K.L., & Hall, F.B. (2004). Cost-effectiveness of Connecticut's in-prison substance abuse treatment. Journal of Offender Rehabilitation, 39(3), 69-92.

Dugan J.R. and Everett, R.S. (1998). An experimental test of chemical dependency therapy for jail inmates. International Journal of Offender Therapy and Comparative Criminology, 42(4), 360-368.

Hughey, R., & Klemke, L.W. (1996). Evaluation of a jail-based substance abuse treatment program. Federal Probation, 60(4), 40-45.

Koegl, C.J. (2019). A short and long-term evaluation of a substance abuse program for incarcerated men. Journal of Offender Rehabilitation, 58(4), 281-304.

Lanza, P.V., García, P.F., Lamelas, F.R., & González-Menéndez, A. (2014). Acceptance and commitment therapy versus cognitive behavioral therapy in the treatment of substance use disorder with incarcerated women. Journal of Clinical Psychology, 70(7), 644-657.

Porporino, F.J., Robinson, D., Millson, B., & Weekes, J.R. (2002). An outcome evaluation of prison-based treatment programming for substance users. Substance Use & Misuse, 37(8-10), 1047-1077.