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Therapeutic communities (during incarceration) for individuals with substance use disorders

Adult Criminal Justice
Benefit-cost methods last updated December 2024.  Literature review updated July 2024.
Prison-based therapeutic communities (TC) for substance use disorders are an intensive form of substance abuse treatment provided to individuals with substance use disorders. Participation in therapeutic community programs may be voluntary, or individuals can be referred or assigned to TC treatment based on intake assessments of SUD history and treatment need. Although TC participants remain within correctional facilities, they live in a 24/7 therapeutic milieu apart from the general prison population. Therapeutic communities use a hierarchical social learning model, wherein participants earn increased social and personal responsibility as they progress through stages of treatment. Treatment involves a highly structured therapeutic environment, peer support, and peer accountability intended to teach participants prosocial norms and behaviors; participants engage in both individual and group-based activities. Many TC programs in correctional settings are followed by an aftercare component, which may include community-based residential treatment or other service modalities.

This analysis includes participants of prison TC programs who also participated in post-release aftercare (61% of all TC participants) and excludes evaluations of programs targeting persons with co-occurring mental health and substance use disorders. Participants remained in TC programs for an average of 9.8 months (range: 5 to 16.5 months) with treatment on weekdays for 4-8 hours per day and live-in staff. Crime outcomes were measured between 1 and 5 years (average 3.2 years) post-release.
 
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 $3,692 Benefits minus costs $10,429
Participants ($54) Benefit to cost ratio $9.56
Others $7,116 Chance the program will produce
Indirect $893 benefits greater than the costs 89%
Total benefits $11,647
Net program cost ($1,218)
Benefits minus cost $10,429

^^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.
 34 14 7730 -0.133 0.053 35 -0.133 0.053 43 -0.133 0.013
Employment^^
Any employment, including part-time work.
34 1 341 0.063 0.103 37 n/a n/a n/a 0.063 0.543
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.
 34 2 896 0.010 0.057 37 0.000 0.187 40 0.010 0.866
Technical violations^^
Violations of the conditions of an individual’s terms of probation, parole, or supervision.
 34 2 800 -0.072 0.071 35 n/a n/a n/a -0.072 0.312
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 $3,763 $0 $7,168 $1,881 $12,812
Illicit drug use disorder Labor market earnings associated with illicit drug abuse or dependence ($15) ($35) $0 $0 ($49)
Health care associated with illicit drug abuse or dependence ($51) ($8) ($52) ($26) ($137)
Mortality associated with illicit drugs ($5) ($12) $0 ($354) ($370)
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($609) ($609)
Totals $3,692 ($54) $7,116 $893 $11,647
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,218 2023 Present value of net program costs (in 2023 dollars) ($1,218)
Comparison costs $0 2023 Cost range (+ or -) 10%
The per-participant cost estimate for in-prison TC treatment was provided by the Washington State Department of Corrections (DOC). The estimate is based on delivering a full-time program (five days per week, eight hours per day) at a rate of $51 per hour (salary and benefits) for DOC Program Specialist staff delivering this program. It assumes an average group size of 87 individuals.
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

Clark, V.A. (2024). Less is more: The effect of a short-term substance use disorder treatment program on recidivism. Corrections, 9(1), 91-108.

DiMeglio, M. (2024). Evaluating the effectiveness of substance abuse treatment within the Illinois prison system and its effect on recidivism. Master's thesis, Loyola University Chicago.

Duwe, G. (2010). Prison-based chemical dependency treatment in Minnesota: An outcome evaluation. Journal of Experimental Criminology, 6(1), 57-81.

Jensen, E., & Kane, S. (2012). The effects of therapeutic community on recidivism up to four years after release from prison: A multisite study. Criminal Justice and Behavior, 39(8).

Klebe, K.J., & O'Keefe, M. (2004). Outcome evaluation of the Crossroads to Freedom House and Peer I therapeutic communities (Document No. 208126). Washington, DC: National Institute of Justice.

Mosher, C., Phillips, D. (2001). Program evaluation of the Pine Lodge pre-release residential therapeutic community for women offenders in Washington State, final report (Document No. 196670). Pullman: Washington State University, Social and Economic Sciences Research Center.

Miller, J.M., & Miller, H.V. (2011). Considering the effectiveness of drug treatment behind bars: Findings from the South Carolina RSAT evaluation. Justice Quarterly, 28(1), 70-86.

Prendergast, M.L., Hall, E.A., Wexler, H.K., Melnick, G., & Cao, Y. (2004). Amity prison-based therapeutic community: 5-year outcomes. The Prison Journal, 84(1), 36-60.

Welsh, W.N., & Zajac, G. (2013). A multisite evaluation of prison-based drug treatment: Four-year follow-up results. The Prison Journal, 93(3), 251-271.

Wexler, H.K., Falkin, G.P., Lipton, D.S., & Rosenblum, A.B. (1990). Outcome evaluation of a prison therapeutic community for substance abuse treatment. Criminal Justice and Behavior, 17(1), 71-92.

Zhang, S.X., Roberts, R.E.L., & McCollister, K.E. (2011). Therapeutic community in a California prison: Treatment outcomes after 5 years. Crime Delinquency OnlineFirst.