According to Field (1998) obstacles to continuity of offender treatment are:

Reach-in programs - Community supervision staff, treatment program staff, or both, begin services before the offender leaves prison. Oregon prison therapeutic community and pre-release day treatment programs have used a number of strategies to build on this continuity model including program design, interagency agreements, and funding that follows the inmate/offender. (Finigan, 1996)

Third party continuity - an agency separate from corrections or treatment takes primary responsibility for ensuring service continuity. Third party continuity programs are best represented by TASC programs. Treatment Alternatives to Street Crimes (TASC) serve as a bridge between the separate systems of criminal justice and substance abuse treatment. (Weinman, 1992)

Mixed continuity models - the three models above can be combined into various combination models. The Amity program at the Donovan facility in California began as a prison therapeutic community, then developed its own follow-up therapeutic community for prison program graduates (Wexler, 1996)

The Stay'n Out study shows that in-prison therapeutic community outcomes peak between nine and twelve months in hard-core offender-addict inmates participants followed by at least six months in community-based treatment. (Wexler,et al, 1988)

Key-Crest views the time spent in an aftercare facility or halfway facility as more important. As little as six months may be spent in prison TC, but 12-18 months should be spent in aftercare. (Inciardi et al. 1997).

Some research (Wexler et al. 1988) does show that prosocial outcomes begin to diminish when men and women are held in programs longer than twelve months and not released. Stay'n Out dealt with this problem by creating a cadre of "post-graduate" residents who participate as training staff in week-long training sessions with guest-trainees. (Lipton, 1998)

Inmates in the correctional treatment system often need to be encouraged to participate in programs. Simply offering treatment programs to them is unlikely to obtain and sustain a sufficient level of cooperation and participation. Incentives are needed - reductions in time served, eligibility for less secure placement, safety, comfort and status rewards.(Lipton, 1998)

Success in programs rarely occurs when treatment is imposed. The program is enhanced when offenders are involved in developing their recovery program. Forcing or compelling unwilling offenders to participate in programs should be avoided, it breeds resentment, resistance and minimal change or faked change indicating apparent compliance.(Lipton, 1998)

About 60% of successful program graduates admit that they entered a treatment program while in prison for other than therapeutic reasons. (Wexler, 1988)

Programs recruit by making entry better than non-entry, and leaving worst than staying. This is done by creating an environment that is physically safer, cleaner, and more secure psychologically than the alternative GP. (Lipton, 1998)

If mandated inmates are given a clear understanding of the treatment conditions and consequences for failure, making them clearly aware that the system is prepared to enforce and has a record of actively enforcing the conditions, retention is enhanced. (Lipton, 1998)

The third stage of a TC, reentry, consists of two phases: early (13-18 months and late (18-24 months). In prison these two phases are spent partly in prison but mainly in the community-based TC. Residents in early reentry continue to live in the institution, but may hold jobs or attend school while still being expected to participate in the facility's daily activities. Late reentry involves successful separation from the institution to a community-based program. Two excellent examples of reentry facilities for prison-based TC treatment are Serendipity House associated with Stay'n Out in New York and Vista in San Diego associated with Amity at Donovan program. The Crest reentry facility variant in Delaware is a work-release program for program graduates from the Key program.(De Leon, 1995)

Among rewards, studies indicate that time incentives appear to be the most motivating, followed by eligibility for less secure placement, personal safety considerations, comfort and status rewards. Negative sanctions include loss of good time, loss of pay, transfer to a more secure custody, lesser housing (less privacy, less comfort), and worse job assignments with distinctively stigmatizing uniforms for failing to meet contingency contracts.

For drug addicts, dwelling on drugs, drug using behaviors and drug transactions experiences, and discussing paraphernalia tends to foster craving. Also, these topics allow inmates opportunities to re-experience positive drug-related events publicly, and this generates anticipation about continuing drug use upon return to the community, and encourages the acquisition of contraband drugs in the institution.(Lipton, 1997)

In prisons where TCs are in place such as Stay'n Out in New York, Amity Donovan in Cal. and the New Outlook in Alabama ex-offenders/ex-addicts serve as powerful role models. They demonstrate the realistic possibility for successful recovery. They speak the language and understand the feelings and concerns of drug abusing clients.

There is a distinct role for trained officers who serve as co-therapists and important advantages accrue. Their partnerships demonstrate that some authority figures are trustworthy and genuinely interested in their welfare.(Lipton, 1998)

The clinical optimum is to continue treatment in a halfway house or work release facility. Good examples - NYs Stay'n Out with Serendipity House; DE's Key with Crest work release; CA's Amity at Donovan with Vista. Successful programming involves initiating reentry planning with parole/probation staff at least three months before a program participant is released. The TC staff contract with the parolee as part of this planned reentry and provide escorted referral to a private community-based treatment program or to a halfway house where the process of prosocial change continues.(Lipton, 1998)

Lipton (1998) advocates that if a resident is found to have a positive urine test, he or she should be sent back to the lowest entry level of the program and targeted for more frequent urinalysis. If a resident fails a second time he or she may be expelled from the TC depending on how the rules for expulsion are established. TC staff should hold an exit interview to assist with this transition back to the GP and to extend another chance to the inmate in the future after a cooling off period is completed.

Anglin et al (1998) found no clear pattern in 11 separate studies of outcomes of therapeutic communities as to whether mandatory placement of abusing offenders reduces positive outcomes as opposed to purely voluntary programs.

In 1997 the state of California opened Corcoran, a 528-bed treatment unit in a brand new correctional institution. When inmates there complete six months of treatment they will move to a statewide "managed care" network, with a full continuum of services, from intensive residential treatment to outpatient counseling. (State of Maryland, Cabinet Council on Criminal and Juvenile Justice Strategic Planning Workshop, University of Maryland, Dec. 8-9, 1997.

Peters, R. H. (1993) Relapse prevention approaches in the criminal justice system. In: Gorski, T. T.; Kelley, J. M.; Havens, L.; and Peters, R. H. Relapse prevention and the substance abusing criminal offender. Technical Assistance Publication (TAP) Series, Number 8 DHHS Pub. N (SMA) 95-3071. Center for Substance Abuse Treatment, Rockville, MD

Field, G. and Karecki, M. (1992). Outcome study of the parole transition release project. Oregon Department of Corrections.

Weinman, B. A. (1992). Coordinated Approach for Drug-Abusin Offenders: TASC and Parole. In: NIDA Research Monograph, 118; 232-245

Wexler, H.; Falkin, G. and Lipton, D. (1988). A model prison rehabilitation program. An evaluation of the Stay’N Out therapeutic community. A final report to the National Institute of Drug Abuse by Narcotic and Drug Research, Inc.

De Leon, G. (1995) Therapeutic communities for addictions: A theoretical framework. International Journal of the Addictions. Inciardi, J. A. (1996). A corrections-based continuum of effective abuse treatment. National Institute of Justice, Washington, D.C.

Wexler H. (1996). The Amity prison T C evaluation: Inmate profiles and reincarceration outcomes. Presentation for the California Department of Corrections.

Field, Gary, Ph.D. (1998). Continuity of Offender Treatment: Institution to the Community, Prepared at the Request of the Office of National Drug Control Policy.

Finnigan, M. (1997) Evaluation of three Oregon pre-release day treatment substance abuse programs for inmates. Center for Substance Abuse Treatment, Washington, D.C.

Lipton, Douglas S., Ph. D., (1998) Principles of Correctional Therapeutic Community Treatment Programming for Drug Abusers, National Development and Research Institutes, Inc., New York, NY.

Anglin, M. Douglas; Prendergast, Michael; Farabee, David: The Effectiveness of Coerced Treatment for Drug-Abusing Offenders, UCLA Drug Abuse Research Center, Office of National Drug Control Policy's Conference of Scholars and Policy Makers, Washington, DC, March 23-25, 1998.

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