Although one-third of clients enrolled in methadone treatment in the United States are female, few studies have looked at gender differences at admission and follow-up. Using interview data from 435 clients (31% female) collected at admission and approximately 1 year after discharge, females were found to have more dysfunctional families of origin and greater prior and current psychological and medical problems. Both genders improved following treatment, as evidenced by reduced illicit drug, tobacco, and alcohol use, criminal involvement, and HIV/AIDS-risky behaviors. Females were more likely to seek further help for both drug misuse and psychological problems subsequent to discharge.

Stays of 3 months or longer in drug abuse treatment generally predict better follow-up outcomes. In a national sample of community-based programs that participated in the Drug Abuse Treatment Outcome Study, median lengths of stay were 3 months for clients in long-term residential and outpatient drug-free treatments and 1 year for clients in outpatient methadone treatment. However, individual programs within each of these modalities differed widely in how long they kept their clients in treatment as well as their service delivery. Programs treating individuals with heavier cocaine and alcohol use and more psychological dysfunction usually had shorter retention rates. Nonetheless, even after statistically controlling for these client differences, some programs were more effective than others in engaging and retaining clients.National outcome studies have helped establish that treatment in community settings can be effective, thereby supporting federal drug abuse strategies and treatment funding policies in the

Longer term in-prison therapeutic community (ITC) outcome studies are needed, along with more attention on who benefits most from these programs. This study examined reincarceration records for 394 nonviolent offenders during the 3 years following prison. Those who completed both ITC and aftercare were the least likely to be reincarcerated (25%), compared to 64% of the aftercare dropouts and 42% of the untreated comparison groups. Furthermore, high-severity aftercare completers were reincarcerated only half as often as those in the aftercare dropout and comparison groups (26% vs. 66% and 52%). The findings support the effectiveness of intensive treatment when it is integrated with aftercare, and the benefits are most apparent for offenders with more serious crime and drug-related problems.

Studies of community-based substance abuse treatment indicate that motivation for treatment is critical for retaining clients in the program and for their becoming therapeutically engaged in the recovery process. Relatively little work, however, has examined the effect of motivation on therapeutic engagement in criminal justice settings. Baseline and during-treatment data were collected prospectively from 419 probationers remanded to a 6-month modified therapeutic community. Findings showed that desire for help and treatment readiness were associated with indicators of therapeutic engagement even after statistically controlling for additional factors that could have confounded these relationships. Targeted readiness and induction interventions are therefore recommended for offenders with low motivation who are remanded to treatment in correctional settings. M otivation predicts both retention and engagement in community-based treatment for substance abuse (De Leon

Corrections-based treatment policy should emphasize a continuum of care model (from institution to community) with high quality programs and services.

The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health. Unfortunately, a low proportion of those who could benefit from treatment actually receive it while involved in the CJS. This article presents a review of recent research on the effectiveness of major substance abuse treatment interventions used at different possible linkage points during criminal justice case processing, including diversion, jail, prison, and community supervision. This is followed by a discussion of key research and practice issues, including low rates of treatment access and under-utilization of medication-assisted treatment. Concluding comments discuss principles of effective treatment for offenders and identify key gaps in research and practice that need to be addressed to improve and expand provision of effective treatment for offenders.

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This study examined the association between legal pressure and treatment retention in a national sample of 2,605 clients admitted to 18 long-term residential facilities that participated in the Drug Abuse Treatment Outcome Study (DATOS). Hierarchical linear models were used to assess the relationship of background factors and legal pressure with treatment participation for 90 days or longer. Two thirds of the sample entered residential treatment with moderate to high pressure from legal authorities, and they were significantly more likely than the low-pressure clients to stay 90 days or more. Moreover, the difference in retention between moderate-to-high-and low-pressure clients was even greater in programs with proportionally larger caseloads under legal surveillance. The criminal justice system (CJS) can influence treatment participation and retention, and it appears essential for the CJS and treatment programs to maintain an open and constructive relationship to maximize their potential combined impact.